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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 000000795950 MR002239180208/07/202308/07/202308/08/202372516003101METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H1009090100.00000Replenished08/24/2023 1002262221 3144548022
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798170 MR001542460308/22/202308/22/202308/23/202372516003101METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H100301033.33300Replenished08/24/2023 1002262221 3144548022