Accumulator - View By Claim

Export to Excel

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) 68462012601GABAPENTIN 600 MG TABLET600 MGTABLET1000200.00000Suspended 1001326094
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011701FUROSEMIDE 40 MG TABLET40 MGTABLET1000280.00000Suspended08/29/2023 1002263052 3144881029
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011701FUROSEMIDE 40 MG TABLET40 MGTABLET10001000.00000Suspended08/29/2023 1002263052 3144881029
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011601FUROSEMIDE 20 MG TABLET20 MGTABLET1000140.00000Suspended08/29/2023 1002260285 3143898442
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011601FUROSEMIDE 20 MG TABLET20 MGTABLET1000280.00000Suspended08/29/2023 1002263052 3144881029
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011601FUROSEMIDE 20 MG TABLET20 MGTABLET10001000.00000Suspended08/29/2023 1002260285 3143898442
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 99073070914FREESTYLE FREEDOM LITE METERKIT1010.00000Suspended 1000589531
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 61442012101FAMOTIDINE 20 MG TABLET20 MGTABLET100020.00000Suspended 1001340999
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001025704DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR300300.00000Suspended 1001591028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001041404DULOXETINE HCL DR 30 MG CAP30 MGCAPSULE DR300300.00000Suspended08/11/2023 1002254446 3143082008