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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 000000785069 MR000182390009/27/202109/27/202109/28/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET90903033.33300Replenished 1001959026 3073746996
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785069 MR000182390009/27/202109/27/202109/28/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET90906066.66700Replenished 1001928804 3069023028