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) 27241012403SILDENAFIL 20 MG TABLET20 MGTABLET900200.00000Suspended 1001711128
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 31722064430TADALAFIL 5 MG TABLET5 MGTABLET300300.00000Suspended 1001735909
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 43547027503DONEPEZIL HCL 5 MG TABLET5 MGTABLET300300.00000Suspended 1001001730
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 43547027503DONEPEZIL HCL 5 MG TABLET5 MGTABLET300300.00000Suspended 1001205652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 43547039910CYCLOBENZAPRINE 5 MG TABLET5 MGTABLET1000290.00000Suspended 1002076632 3098638591
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) 49884015676VARENICLINE 1 MG TABLET1 MGTABLET560560.00000Returned Suspended 1002068256 3096617328
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 50111033401METRONIDAZOLE 500 MG TABLET500 MGTABLET1000240.00000Suspended 1001079172
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