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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 000000785427 MR003395610010/11/202110/11/202110/11/202100173086910ANORO ELLIPTA 62.5-25 MCG INH62.5-25MCGDISK W/DEV606060100.00000Replenished 1001939012 3070433439
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785427 MR003395610111/16/202111/16/202111/16/202100173086910ANORO ELLIPTA 62.5-25 MCG INH62.5-25MCGDISK W/DEV606060100.00000Replenished 1001960301 3074163363