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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) 00228277911PROPRANOLOL ER 80 MG CAPSULE80 MGCAP.SA 24H1000400.00000Suspended 1001335840
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00228277911PROPRANOLOL ER 80 MG CAPSULE80 MGCAP.SA 24H10001000.00000Suspended 1001335840
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 10370083011DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H300300.00000Suspended 1001645408
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) 55111034101AMLODIPINE-BENAZEPRIL 10-20 MG10 MG-20MGCAPSULE1000700.00000Suspended 1000882343
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505252906ZIPRASIDONE HCL 40 MG CAPSULE40 MGCAPSULE600600.00000Suspended 1001024027
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505253006ZIPRASIDONE HCL 60 MG CAPSULE60 MGCAPSULE600600.00000Suspended 1001326094
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505001506DILT XR 180 MG CAPSULE180 MGCAPSULE CR1000200.00000Suspended 1000503562
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