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) 66758020501KLOR-CON SPRINKLE ER 10 MEQ CP10 MEQCAPSULE SA10001000.00000Suspended 1001137481
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001011707LEVETIRACETAM 500 MG TABLET500 MGTABLET1200600.00000Suspended 1001602316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001011707LEVETIRACETAM 500 MG TABLET500 MGTABLET12001200.00000Suspended 1001602316
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) 68462012601GABAPENTIN 600 MG TABLET600 MGTABLET1000200.00000Suspended 1001326094
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68462072029DROSPIRENONE-EE 3-0.02 MG TAB0.02-3(28)TABLET840840.00000Suspended 1001704140
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) 69097096607NABUMETONE 750 MG TABLET750 MGTABLET1000600.00000Suspended 1001805758
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 70010077001METHOCARBAMOL 750 MG TABLET750 MGTABLET1000220.00000Suspended 1001800027
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 86227070035SURE COMFORT 3/10 ML SYRINGE30 GX5/16"DISP SYRIN10001000.00000Suspended 1001186033