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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) 55513071001PROLIA 60 MG/ML SYRINGE60 MG/MLDISP SYRIN1010.00000Suspended 1001483941
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 99073070914FREESTYLE FREEDOM LITE METERKIT1010.00000Suspended 1000589531
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00002149580MOUNJARO 5 MG/0.5 ML PEN5 MG/0.5MLPEN INJCTR2020.00000Suspended07/06/2023 1002240468 3138951861
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) 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) 00409677802LORAZEPAM 2 MG/ML VIAL2 MG/MLVIAL100100.00000Suspended 1001067246
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) 68462079917NYSTATIN-TRIAMCINOLONE OINTM100000-0.1OINT.(GM)150150.00000Suspended 1001926498 3068455122
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00002446430CIALIS 20 MG TABLET20 MGTABLET30010.00000Suspended 1000541010