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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) 00456141030BYSTOLIC 10 MG TABLET10 MGTABLET300300.00000Suspended 1001986783 3079460980
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00527128201DICYCLOMINE 20 MG TABLET20 MGTABLET1000350.00000Suspended 1001794902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00597015330JARDIANCE 25 MG TABLET25 MGTABLET300300.00000Suspended 1001890605 3061781567
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00781572001POTASSIUM CL ER 20 MEQ TABLET20 MEQTAB PRT SR1000310.00000Suspended 1001363678
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00781615757AMOXICILLIN 400 MG/5 ML SUSP400 MG/5MLSUSP RECON750750.00000Suspended 1002169921 3122017060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 10370083011DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H300300.00000Suspended 1001645408
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 13107003234MIRTAZAPINE 45 MG TABLET45 MGTABLET300300.00000Suspended 1002068507 3096751040
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 13668000801ZOLPIDEM TARTRATE 10 MG TABLET10 MGTABLET1000100.00000Suspended 1001800608
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 13668001101CITALOPRAM HBR 40 MG TABLET40 MGTABLET1000400.00000Suspended 1001790379
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 16571065710CEVIMELINE HCL 30 MG CAPSULE30 MGCAPSULE10001000.00000Suspended 1001965736 3075594883