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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)Cash 340B 000000783090 MR003285980007/06/202107/06/202107/06/202162559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA1002004020.00000Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783090 MR003285980007/06/202107/06/202107/06/202162559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA1002006030.00000Replenished 1001892297 3062473633
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783090 MR003285980007/06/202107/06/202107/06/202162559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA10020010050.00000Replenished 1001885854 3060825455