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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 000000781948 MR003890110201/12/202201/12/202201/13/202229300019219LOSARTAN-HCTZ 100-25 MG TAB100MG-25MGTABLET909090100.00000Replenished 1001989205 3080047510
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785301 MR003401660201/31/202202/04/202202/05/202229300019219LOSARTAN-HCTZ 100-25 MG TAB100MG-25MGTABLET903030100.00000Replenished 1002046961 3092154961
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785301 MR003401660303/02/202203/02/202203/03/202229300019219LOSARTAN-HCTZ 100-25 MG TAB100MG-25MGTABLET903030100.00000Replenished 1002046961 3092154961
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785301 MR003401660404/02/202204/02/202204/03/202229300019219LOSARTAN-HCTZ 100-25 MG TAB100MG-25MGTABLET903030100.00000Replenished 1002046961 3092154961