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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 000000795234 MR001265220001/04/202301/04/202301/05/202372578010092LEVOFLOXACIN 750 MG TABLET750 MGTABLET2077100.00000Replenished 1002163051 3119751772
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795405 MR001265220001/11/202301/11/202301/12/202372578010092LEVOFLOXACIN 750 MG TABLET750 MGTABLET20141392.85700Replenished 1002163051 3119751772