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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 000000786614 MR001285720608/04/202208/04/202208/06/202200002143480TRULICITY 1.5 MG/0.5 ML PEN1.5 MG/0.5PEN INJCTR222100.00000Replenished 1002087483 3101872453
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786614 MR001285720911/14/202211/14/202211/15/202200002143480TRULICITY 1.5 MG/0.5 ML PEN1.5 MG/0.5PEN INJCTR222100.00000Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794842 MR001285720012/14/202212/14/202212/15/202200002143480TRULICITY 1.5 MG/0.5 ML PEN1.5 MG/0.5PEN INJCTR222100.00000Replenished 1002150356 3116568459