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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 000000781301 MR002484860004/19/202104/20/202104/21/202168382080501TRAZODONE 50 MG TABLET50 MGTABLET100120108.33300Replenished 1001846719 3053644954
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781301 MR002484860004/19/202104/20/202104/21/202168382080501TRAZODONE 50 MG TABLET50 MGTABLET1001201512.50000Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781301 MR002484860004/19/202104/20/202104/21/202168382080501TRAZODONE 50 MG TABLET50 MGTABLET1001209579.16700Replenished 1001845547 3053392934