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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 000000777982 MR001082060011/19/202011/19/202011/19/202050458058030XARELTO 10 MG TABLET10 MGTABLET30453066.66700Replenished 1001768253
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000796411 MR001852200003/01/202303/01/202303/01/202350458058030XARELTO 10 MG TABLET10 MGTABLET30903033.33300Replenished 1002184140 3125312648
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000796411 MR001852200003/01/202303/01/202303/01/202350458058030XARELTO 10 MG TABLET10 MGTABLET30903033.33300Replenished 1002184140 3125312648
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000796411 MR001852200003/01/202303/01/202303/01/202350458058030XARELTO 10 MG TABLET10 MGTABLET30903033.33400Replenished 1002184140 3125312648