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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) 00008121130PRISTIQ ER 50 MG TABLET50 MGTAB.SR 24H300300.00000Suspended 1000930509
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00781572001POTASSIUM CL ER 20 MEQ TABLET20 MEQTAB PRT SR1000310.00000Suspended 1001363678
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA1000800.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA10001000.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 53885024450ONETOUCH ULTRA TEST STRIPSTRIP500500.00000Suspended 1002138927 3113726124
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 53885024450ONETOUCH ULTRA TEST STRIPSTRIP500500.00000Suspended 1002138927 3113726124
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68462079917NYSTATIN-TRIAMCINOLONE OINTM100000-0.1OINT.(GM)150150.00000Suspended 1001926498 3068455122
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00169183411NOVOLIN N 100 UNIT/ML VIAL100/MLVIAL100100.00000Suspended 1000367846
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00169183411NOVOLIN N 100 UNIT/ML VIAL100/MLVIAL100100.00000Suspended 1000367846
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241000500.00000Suspended 1001753044