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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 000000794105 MR003248850301/30/202301/30/202302/01/202329300042101AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100301033.33300Replenished 1002169597 3121860283
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794105 MR003248850301/30/202301/30/202302/01/202329300042101AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100302066.66700Replenished04/21/2023 1002209232 3130801353