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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) 00169183411NOVOLIN N 100 UNIT/ML VIAL100/MLVIAL100100.00000Suspended 1000367846
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00169183411NOVOLIN N 100 UNIT/ML VIAL100/MLVIAL100100.00000Suspended 1000367846
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00409677802LORAZEPAM 2 MG/ML VIAL2 MG/MLVIAL100100.00000Suspended 1001067246
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA1000800.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA10001000.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00002446430CIALIS 20 MG TABLET20 MGTABLET30010.00000Suspended 1000541010
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00002446430CIALIS 20 MG TABLET20 MGTABLET300300.00000Suspended 1000541010
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00054485925TRIAZOLAM 0.25 MG TABLET0.25 MGTABLET1000100.00000Suspended 1001744025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00069046903CHANTIX 1 MG CONT MONTH BOX1 MGTABLET560560.00000Suspended 1001597272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00093720656MIRTAZAPINE 15 MG TABLET15 MGTABLET300300.00000Suspended 1001180414