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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 000000781047 MR001450310004/07/202104/07/202104/08/202129300018901BISOPROLOL-HCTZ 10-6.25 MG TAB10-6.25 MGTABLET100902022.22200Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781047 MR001450310004/07/202104/07/202104/08/202129300018901BISOPROLOL-HCTZ 10-6.25 MG TAB10-6.25 MGTABLET100907077.77800Replenished 1001845547 3053392934