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Accumulator - View By Claim

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Health Center:
Pharmacy:
Capture Date :
To:


Health
Center
Pharmacy
ShipTo
Claim
Type
RX
Number
Member ID
Fill
Fill Date
Adjud
Date
Captured
Date
NDC
Drug
Name
Strength
Form
Pkg
Size
QTY
Disp
Curr
QTY
% of
Claim
Status
Status
Date
Order
Wholesaler
Invoice
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779271 MR002899720001/18/202101/18/202101/19/202113668009290PRAMIPEXOLE 0.25 MG TABLET0.25 MGTABLET906060100.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780012 MR002899720002/18/202102/18/202102/19/202113668009290PRAMIPEXOLE 0.25 MG TABLET0.25 MGTABLET90603050.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780012 MR002899720002/18/202102/18/202102/19/202113668009290PRAMIPEXOLE 0.25 MG TABLET0.25 MGTABLET90603050.00000Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780564 MR002899720003/15/202103/15/202103/16/202113668009290PRAMIPEXOLE 0.25 MG TABLET0.25 MGTABLET906060100.00000Replenished 1001826768 3050065356