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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 000000792163 MR002108810008/12/202208/12/202208/13/202267877074957FOSFOMYCIN 3 GM SACHET3 GPACKET111100.00000Replenished 1002093757 3102657638
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792371 MR002108810008/23/202208/23/202208/25/202267877074957FOSFOMYCIN 3 GM SACHET3 GPACKET111100.00000Replenished 1002096808 3104187393
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792752 MR002108810009/07/202209/07/202209/10/202267877074957FOSFOMYCIN 3 GM SACHET3 GPACKET111100.00000Replenished 1002102488 3105614645