Back

Accumulator - View By Claim

Export to Excel

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 000000787806 MR001520150001/20/202201/20/202201/21/202200173071820FLOVENT HFA 44 MCG INHALER44 MCGAER W/ADAP10.610.610.6100.00000Replenished 1001992840 3080996426
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797474 MR001520150004/21/202304/21/202304/22/202300173071820FLOVENT HFA 44 MCG INHALER44 MCGAER W/ADAP10.610.610.6100.00000Replenished04/24/2023 1002209778 3130976966
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787806 MR001520150110/20/202210/20/202210/21/202200173071820FLOVENT HFA 44 MCG INHALER44 MCGAER W/ADAP10.610.610.6100.00000Replenished 1002124047 3110135014
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787806 MR001520150212/30/202212/30/202201/01/202300173071820FLOVENT HFA 44 MCG INHALER44 MCGAER W/ADAP10.610.610.6100.00000Replenished 1002161109 3118886769