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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 000000780696 MR003466920003/22/202103/22/202103/23/202117478071310OFLOXACIN 0.3% EYE DROPS0.3 %DROPS555100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781263 MR003119670004/16/202104/16/202104/17/202117478071310OFLOXACIN 0.3% EYE DROPS0.3 %DROPS555100.00000Replenished 1001844500 3053146134
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784773 MR003691350009/14/202109/14/202109/15/202117478071310OFLOXACIN 0.3% EYE DROPS0.3 %DROPS555100.00000Replenished 1001923412 3067730838
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786968 MR001613760012/16/202112/16/202112/17/202117478071310OFLOXACIN 0.3% EYE DROPS0.3 %DROPS555100.00000Replenished 1001975100 3077386380