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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 000000797288 MR003195940004/13/202304/13/202304/14/202350742025090DILTIAZEM 24H ER(CD) 240 MG CP240 MGCAP.SR 24H903030100.00000Replenished08/22/2023 1002245176 3139279941
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797288 MR003195940105/17/202305/17/202305/18/202350742025090DILTIAZEM 24H ER(CD) 240 MG CP240 MGCAP.SR 24H903030100.00000Replenished08/22/2023 1002245176 3139279941
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797288 MR003195940206/15/202306/15/202306/16/202350742025090DILTIAZEM 24H ER(CD) 240 MG CP240 MGCAP.SR 24H903030100.00000Replenished08/22/2023 1002245176 3139279941