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) 55111034101AMLODIPINE-BENAZEPRIL 10-20 MG10 MG-20MGCAPSULE1000700.00000Suspended 1000882343
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00781615757AMOXICILLIN 400 MG/5 ML SUSP400 MG/5MLSUSP RECON750750.00000Suspended 1002169921 3122017060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00378117591BUSPIRONE HCL 30 MG TABLET30 MGTABLET600600.00000Suspended 1002068507 3096751040
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00456141030BYSTOLIC 10 MG TABLET10 MGTABLET300300.00000Suspended 1001986783 3079460980
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET1000200.00000Suspended 1001287036
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET10001000.00000Suspended 1001287036
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET10001000.00000Suspended 1001308866
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET10001000.00000Suspended 1001316498
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 16571065710CEVIMELINE HCL 30 MG CAPSULE30 MGCAPSULE10001000.00000Suspended 1001965736 3075594883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00069046903CHANTIX 1 MG CONT MONTH BOX1 MGTABLET560560.00000Suspended 1001597272