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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 000000775876 MR001778440401/14/202101/14/202101/15/202168382002201ATENOLOL 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775876 MR001778440704/19/202104/19/202104/20/202168382002201ATENOLOL 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779104 MR000513180001/11/202101/11/202101/12/202168382002201ATENOLOL 25 MG TABLET25 MGTABLET100604066.66700Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779104 MR000513180001/11/202101/11/202101/12/202168382002201ATENOLOL 25 MG TABLET25 MGTABLET100602033.33300Replenished 1001794902