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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 000000781176 420030004/23/202104/23/202104/24/202100093005101CARVEDILOL 3.125 MG TABLET3.125 MGTABLET1001808044.44400Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781176 420030004/23/202104/23/202104/24/202100093005101CARVEDILOL 3.125 MG TABLET3.125 MGTABLET10018010055.55600Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782754 MR000166040006/21/202106/21/202106/22/202100093005101CARVEDILOL 3.125 MG TABLET3.125 MGTABLET1001802011.11100Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782754 MR000166040006/21/202106/21/202106/22/202100093005101CARVEDILOL 3.125 MG TABLET3.125 MGTABLET10018010055.55600Replenished 1001877828 3059333148