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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 000000792544 MR003614600008/30/202208/30/202209/01/202200054032656FLUTICASONE-SALMETEROL 100-50100-50 MCGDISK W/DEV606060100.00000Replenished 1002099459 3104747366
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792544 MR003614600110/26/202210/26/202210/27/202200054032656FLUTICASONE-SALMETEROL 100-50100-50 MCGDISK W/DEV606060100.00000Replenished 1002126238 3110721551
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794911 MR003614600012/19/202212/19/202212/20/202200054032656FLUTICASONE-SALMETEROL 100-50100-50 MCGDISK W/DEV606060100.00000Replenished 1002151463 3116913607