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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) 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) 68001041100GABAPENTIN 600 MG TABLET600 MGTABLET1000600.00000Suspended08/29/2023 1002261840 3144399971
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68462012601GABAPENTIN 600 MG TABLET600 MGTABLET1000200.00000Suspended 1001326094
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) 60505253006ZIPRASIDONE HCL 60 MG CAPSULE60 MGCAPSULE600600.00000Suspended 1001326094
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241000500.00000Suspended 1001753044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001025704DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR300300.00000Suspended 1001591028