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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) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA1000800.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA10001000.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 66758020501KLOR-CON SPRINKLE ER 10 MEQ CP10 MEQCAPSULE SA1000100.00000Suspended 1001102120
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 66758020501KLOR-CON SPRINKLE ER 10 MEQ CP10 MEQCAPSULE SA10001000.00000Suspended 1001137481
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001011707LEVETIRACETAM 500 MG TABLET500 MGTABLET1200600.00000Suspended 1001602316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001011707LEVETIRACETAM 500 MG TABLET500 MGTABLET12001200.00000Suspended 1001602316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001025704DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR300300.00000Suspended 1001591028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001041100GABAPENTIN 600 MG TABLET600 MGTABLET1000600.00000Suspended08/29/2023 1002261840 3144399971
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001041404DULOXETINE HCL DR 30 MG CAP30 MGCAPSULE DR300300.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68462012601GABAPENTIN 600 MG TABLET600 MGTABLET1000200.00000Suspended 1001326094