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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 000000797556 MR001825340004/25/202304/25/202304/26/202313107008401LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished05/30/2023 1002224253 3134809499
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012709 MR001825340005/25/202305/25/202305/26/202313107008401LORAZEPAM 1 MG TABLET1 MGTABLET100564478.57100Replenished05/30/2023 1002224253 3134809499
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012709 MR001825340005/25/202305/25/202305/26/202313107008401LORAZEPAM 1 MG TABLET1 MGTABLET100561221.42900Replenished08/22/2023 1002249643 3140846558
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012746 MR001825340006/22/202306/22/202306/23/202313107008401LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished08/22/2023 1002249643 3140846558
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012789 MR001825340007/21/202307/21/202307/22/202313107008401LORAZEPAM 1 MG TABLET1 MGTABLET100563257.14300Replenished08/22/2023 1002249643 3140846558