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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 000000780641 MR000443660003/19/202103/19/202103/20/202168382013914TOPIRAMATE 50 MG TABLET50 MGTABLET60756080.00000Replenished 1001829373 3050481049
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797054 MR000443660004/03/202304/03/202304/04/202368382013914TOPIRAMATE 50 MG TABLET50 MGTABLET606060100.00000Replenished 1002198481 3129060211