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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 000000792037 MR003344950008/08/202208/08/202208/09/202268001018000QUETIAPINE FUMARATE 50 MG TAB50 MGTABLET1009090100.00000Replenished 1002182751 3124681385
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795324 MR003344950001/06/202301/06/202301/07/202368001018000QUETIAPINE FUMARATE 50 MG TAB50 MGTABLET100301033.33300Replenished 1002182751 3124681385