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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 000000798508 MR001166210006/12/202306/12/202306/13/202368001025204FLUCONAZOLE 100 MG TABLET100 MGTABLET30211676.19000Replenished06/14/2023 1002233505 3136619883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797251 MR003582440106/03/202306/07/202306/08/202368001025204FLUCONAZOLE 100 MG TABLET100 MGTABLET301414100.00000Replenished06/14/2023 1002233505 3136619883