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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 000000787945 MR002897470209/15/202209/15/202209/16/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA1001808044.44400Replenished 1002108257 3106376963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787945 MR002897470209/15/202209/15/202209/16/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA10018010055.55600Replenished 1002108257 3106376963