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) 55111034101AMLODIPINE-BENAZEPRIL 10-20 MG10 MG-20MGCAPSULE1000700.00000Suspended 1000882343
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) 57237010001METOPROLOL TARTRATE 25 MG TAB25 MGTABLET1000500.00000Suspended 1001653069
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 59746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1000450.00000Suspended 1001782104
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) 60505001506DILT XR 180 MG CAPSULE180 MGCAPSULE CR1000200.00000Suspended 1000503562
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET1000200.00000Suspended 1001287036
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET10001000.00000Suspended 1001287036
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET10001000.00000Suspended 1001308866
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505018300CARBAMAZEPINE 200 MG TABLET200 MGTABLET10001000.00000Suspended 1001316498