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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 000000794246 MR000732600112/22/202201/02/202301/03/202359762121103DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1002156127 3118340660
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794909 MR002484860012/19/202212/20/202212/21/202259762121103DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1002151726 3117074799