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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 000000786060 MR003895090011/05/202111/05/202111/06/202100574402435ERYTHROMYCIN 0.5% EYE OINTMENT5 MG/GRAMOINT.(GM)3.53.53.5100.00000Replenished 1001953128 3073037530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796638 MR003888140003/10/202303/10/202303/11/202300574402435ERYTHROMYCIN 0.5% EYE OINTMENT5 MG/GRAMOINT.(GM)3.53.53.5100.00000Replenished 1002187584 3126302342