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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 000000784034 MR003244150008/14/202108/14/202108/15/202172647033104METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK212121100.00000Replenished 1001904108 3064589184
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784045 MR001741360008/16/202108/16/202108/17/202172647033104METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK212121100.00000Replenished 1001904997 3064847322