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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 000000792233 MR002051740009/09/202209/09/202209/10/202257664023288NITROFURANTOIN MCR 50 MG CAP50 MGCAPSULE1003030100.00000Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792233 MR002051740110/10/202210/10/202210/11/202257664023288NITROFURANTOIN MCR 50 MG CAP50 MGCAPSULE1003030100.00000Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792233 MR002051740211/09/202211/09/202211/10/202257664023288NITROFURANTOIN MCR 50 MG CAP50 MGCAPSULE1003030100.00000Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792233 MR002051740312/09/202212/09/202212/10/202257664023288NITROFURANTOIN MCR 50 MG CAP50 MGCAPSULE100301033.33300Replenished 1002155556 3118088750