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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 000000799203 MR000852540108/15/202308/15/202308/16/202331722071390PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR90603050.00000Replenished08/17/2023 1002259987 3143744568
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799586 MR000729920008/08/202308/08/202308/09/202331722071390PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR903030100.00000Replenished08/17/2023 1002259987 3143744568
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799726 MR002564910008/15/202308/15/202308/16/202331722071390PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR903030100.00000Replenished08/17/2023 1002259987 3143744568