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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 000000793125 MR000649240112/19/202212/19/202212/20/202243547036009LOSARTAN POTASSIUM 25 MG TAB25 MGTABLET909090100.00000Replenished 1002151463 3116913607
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795252 MR002010450001/04/202301/04/202301/05/202343547036009LOSARTAN POTASSIUM 25 MG TAB25 MGTABLET909090100.00000Replenished 1002168592 3121399810
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795252 MR002010450207/05/202307/05/202307/06/202343547036009LOSARTAN POTASSIUM 25 MG TAB25 MGTABLET909090100.00000Replenished08/22/2023 1002240777 3139104980