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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) 00193731150CONTOUR NEXT TEST STRIPSTRIP500500.00000Suspended 1002010073 3084421077
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 53885024450ONETOUCH ULTRA TEST STRIPSTRIP500500.00000Suspended 1002138927 3113726124
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 53885024450ONETOUCH ULTRA TEST STRIPSTRIP500500.00000Suspended 1002138927 3113726124
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 99073070914FREESTYLE FREEDOM LITE METERKIT1010.00000Suspended 1000589531
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) 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) 00069046903CHANTIX 1 MG CONT MONTH BOX1 MGTABLET560560.00000Suspended 1001597272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00378025701HALOPERIDOL 1 MG TABLET1 MGTABLET1000200.00000Suspended 1000902944
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00378025701HALOPERIDOL 1 MG TABLET1 MGTABLET1000700.00000Suspended 1000925060