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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 000000779672 MR002108810002/04/202102/04/202102/06/202167877021520CEFUROXIME AXETIL 250 MG TAB250 MGTABLET20562035.71400Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779672 MR002108810002/04/202102/04/202102/06/202167877021520CEFUROXIME AXETIL 250 MG TAB250 MGTABLET20562035.71500Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784987 MR000309190009/22/202109/22/202109/23/202167877021520CEFUROXIME AXETIL 250 MG TAB250 MGTABLET202020100.00000Replenished 1001927409 3068590036