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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 000000784916 MR001128430009/20/202109/20/202109/21/202168001025404FLUCONAZOLE 200 MG TABLET200 MGTABLET301010100.00000Replenished 1001989515 3080235784
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786858 MR002290390012/13/202112/13/202112/14/202168001025404FLUCONAZOLE 200 MG TABLET200 MGTABLET301010100.00000Replenished 1001989515 3080235784
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787623 MR002484860001/13/202201/13/202201/14/202268001025404FLUCONAZOLE 200 MG TABLET200 MGTABLET301010100.00000Replenished 1001989515 3080235784
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778601 MR002792250012/16/202012/16/202012/18/202068001025404FLUCONAZOLE 200 MG TABLET200 MGTABLET3010880.00000Replenished 1001780016