View By Claim

Back

Accumulator - View By Claim

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
False	8893520		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796813	MR00171522	00	03/21/2023	03/21/2023	03/22/2023	65702073110	ACCU-CHEK GUIDE ME GLUCOSE MTR		EACH	1	1	1	100.00000	Replenished		1002194250	3127552215