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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 000000790510 MR001249950204/21/202304/21/202304/22/202300574029201AMILORIDE HCL 5 MG TABLET5 MGTABLET100902022.22200Replenished04/24/2023 1002209778 3130976966
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790510 MR001249950112/14/202212/14/202212/15/202200574029201AMILORIDE HCL 5 MG TABLET5 MGTABLET100901011.11100Replenished 1002150356 3116568459
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790510 MR001249950112/14/202212/14/202212/15/202200574029201AMILORIDE HCL 5 MG TABLET5 MGTABLET100908088.88900Replenished04/24/2023 1002209778 3130976966
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790510 MR001249950008/18/202208/18/202208/19/202200574029201AMILORIDE HCL 5 MG TABLET5 MGTABLET1009090100.00000Replenished 1002150356 3116568459