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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)Cash 340B 000000785071 MR000418240010/20/202110/20/202110/20/202150458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001946281 3071423777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240010/20/202110/20/202110/20/202150458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001946281 3071423777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240010/20/202110/20/202110/20/202150458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33400Replenished 1001946281 3071423777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240101/22/202201/22/202201/22/202250458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001993531 3080996429
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240101/22/202201/22/202201/22/202250458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001993531 3080996429
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240101/22/202201/22/202201/22/202250458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33400Replenished 1001993531 3080996429
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240204/21/202204/21/202204/21/202250458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1002039782 3090640341
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240204/21/202204/21/202204/21/202250458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1002039782 3090640341
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785071 MR000418240204/21/202204/21/202204/21/202250458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33400Replenished 1002039782 3090640341
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785736 MR001128430010/25/202110/25/202110/25/202150458014030INVOKANA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001948371 3071858707