Back

Accumulator - View By Claim

Export to Excel

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 000000783602 MR001943700209/29/202109/29/202109/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001929791 3069291945
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783602 MR001943700209/29/202109/29/202109/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90302480.00000Replenished 1001948371 3071858707