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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 000000799709 MR003261530008/14/202308/14/202308/15/202300527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90902730.00000RECTIFIED-COMPLETE02/28/2024
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799709 MR003261530008/14/202308/14/202308/15/202300527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90906370.00000Replenished08/16/2023 1002259761 3143593678