Back

Accumulator - View By Claim

Export to Excel

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) 00378025701HALOPERIDOL 1 MG TABLET1 MGTABLET1000700.00000Suspended 1000925060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00008121130PRISTIQ ER 50 MG TABLET50 MGTAB.SR 24H300300.00000Suspended 1000930509
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60432062116VALPROIC ACID 250 MG/5 ML SOLN250 MG/5MLSOLUTION47304730.00000Suspended 1000934136
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505313001QUETIAPINE FUMARATE 25 MG TAB25 MGTABLET10001000.00000Suspended 1000970964
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 43547027503DONEPEZIL HCL 5 MG TABLET5 MGTABLET300300.00000Suspended 1001001730
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505313001QUETIAPINE FUMARATE 25 MG TAB25 MGTABLET10001000.00000Suspended 1001020386
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505252906ZIPRASIDONE HCL 40 MG CAPSULE40 MGCAPSULE600600.00000Suspended 1001024027
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00409677802LORAZEPAM 2 MG/ML VIAL2 MG/MLVIAL100100.00000Suspended 1001067246
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505313001QUETIAPINE FUMARATE 25 MG TAB25 MGTABLET10001000.00000Suspended 1001067246
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 50111033401METRONIDAZOLE 500 MG TABLET500 MGTABLET1000240.00000Suspended 1001079172