Back

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) 13668000801ZOLPIDEM TARTRATE 10 MG TABLET10 MGTABLET1000100.00000Suspended 1001800608
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505253006ZIPRASIDONE HCL 60 MG CAPSULE60 MGCAPSULE600600.00000Suspended 1001326094
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505252906ZIPRASIDONE HCL 40 MG CAPSULE40 MGCAPSULE600600.00000Suspended 1001024027
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60432062116VALPROIC ACID 250 MG/5 ML SOLN250 MG/5MLSOLUTION47304730.00000Suspended 1000934136
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00002223680TRULICITY 3 MG/0.5 ML PEN3 MG/0.5MLPEN INJCTR2020.00000Suspended 1002168499 3121399108
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00054485925TRIAZOLAM 0.25 MG TABLET0.25 MGTABLET1000100.00000Suspended 1001744025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 45802004935TRIAMCINOLONE 0.5% OINTMENT0.5 %OINT.(GM)150150.00000Suspended 1002073350 3097384163
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 31722064430TADALAFIL 5 MG TABLET5 MGTABLET300300.00000Suspended 1001735909
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 86227070035SURE COMFORT 3/10 ML SYRINGE30 GX5/16"DISP SYRIN10001000.00000Suspended 1001186033
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 59746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1000450.00000Suspended 1001782104