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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 000000792565 MR003021040008/31/202208/31/202209/01/202200093417773CEPHALEXIN 250 MG/5 ML SUSP250 MG/5MLSUSP RECON10030010033.33300Replenished 1002099737 3104970859
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792565 MR003021040008/31/202208/31/202209/01/202200093417773CEPHALEXIN 250 MG/5 ML SUSP250 MG/5MLSUSP RECON10030010033.33300Replenished 1002099737 3104970859
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792565 MR003021040008/31/202208/31/202209/01/202200093417773CEPHALEXIN 250 MG/5 ML SUSP250 MG/5MLSUSP RECON10030010033.33400Replenished 1002099737 3104970859
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793572 MR002995140010/17/202210/17/202210/18/202200093417773CEPHALEXIN 250 MG/5 ML SUSP250 MG/5MLSUSP RECON10020010050.00000Replenished 1002123446 3109811595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793572 MR002995140010/17/202210/17/202210/18/202200093417773CEPHALEXIN 250 MG/5 ML SUSP250 MG/5MLSUSP RECON10020010050.00000Replenished 1002123446 3109811595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794570 MR004052150011/30/202211/30/202212/01/202200093417773CEPHALEXIN 250 MG/5 ML SUSP250 MG/5MLSUSP RECON10030010033.33300Replenished 1002165771 3120576242