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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)Cash 340B 000000773632 MR004061140602/18/202102/18/202102/18/202100074379902HUMIRA 40 MG/0.8 ML SYRINGE40MG/0.8MLSYRINGEKIT24250.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000773632 MR004061140602/18/202102/18/202102/18/202100074379902HUMIRA 40 MG/0.8 ML SYRINGE40MG/0.8MLSYRINGEKIT24250.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780798 MR004061140003/25/202103/25/202103/25/202100074379902HUMIRA 40 MG/0.8 ML SYRINGE40MG/0.8MLSYRINGEKIT24250.00000Replenished 1001832780 3051158401
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780798 MR004061140003/25/202103/25/202103/25/202100074379902HUMIRA 40 MG/0.8 ML SYRINGE40MG/0.8MLSYRINGEKIT24250.00000Replenished 1001832780 3051158401