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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) 69315011601FUROSEMIDE 20 MG TABLET20 MGTABLET1000280.00000Suspended08/29/2023 1002263052 3144881029
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011701FUROSEMIDE 40 MG TABLET40 MGTABLET1000280.00000Suspended08/29/2023 1002263052 3144881029
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011701FUROSEMIDE 40 MG TABLET40 MGTABLET10001000.00000Suspended08/29/2023 1002263052 3144881029
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) 69315011601FUROSEMIDE 20 MG TABLET20 MGTABLET1000140.00000Suspended08/29/2023 1002260285 3143898442
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69315011601FUROSEMIDE 20 MG TABLET20 MGTABLET10001000.00000Suspended08/29/2023 1002260285 3143898442
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA1000800.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 62559029101POTASSIUM CITRATE ER 10 MEQ TB10 MEQTABLET SA10001000.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001041404DULOXETINE HCL DR 30 MG CAP30 MGCAPSULE DR300300.00000Suspended08/11/2023 1002254446 3143082008
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00002149580MOUNJARO 5 MG/0.5 ML PEN5 MG/0.5MLPEN INJCTR2020.00000Suspended07/06/2023 1002240468 3138951861