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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 000000791336 MR000182050204/14/202304/14/202304/15/202331722070630FAMCICLOVIR 125 MG TABLET125 MGTABLET301010100.00000Replenished04/17/2023 1002208015 3130203110
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791336 MR000182050109/07/202209/07/202209/10/202231722070630FAMCICLOVIR 125 MG TABLET125 MGTABLET301010100.00000Replenished04/17/2023 1002208015 3130203110
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791336 MR000182050007/06/202207/06/202207/07/202231722070630FAMCICLOVIR 125 MG TABLET125 MGTABLET301010100.00000Replenished04/17/2023 1002208015 3130203110