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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
False	5485423		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787894	MR00017195	00	01/25/2022	01/25/2022	01/26/2022	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	14	14	100.00000	Replenished		1002008101	3084006370
False	9152105		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797363	MR00018670	00	04/17/2023	04/17/2023	04/18/2023	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	28	6	21.42900	Replenished	05/19/2023	1002221549	3133876132
False	9148377		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797363	MR00018670	00	04/17/2023	04/17/2023	04/18/2023	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	28	22	78.57100	Replenished	04/19/2023	1002208692	3130511160
False	7116264		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792173	MR00030919	00	08/15/2022	08/15/2022	08/16/2022	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	21	21	100.00000	Replenished		1002096808	3104187393
False	8395397		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795654	MR00037445	00	01/24/2023	01/24/2023	01/25/2023	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	21	21	100.00000	Replenished		1002194556	3127701430
False	9397864		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798002	MR00037851	00	05/17/2023	05/17/2023	05/18/2023	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	15	8	53.33300	Replenished	05/19/2023	1002221549	3133876132
False	6957763		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791703	MR00039596	00	07/25/2022	07/25/2022	07/26/2022	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	15	15	100.00000	Replenished		1002087483	3101872453
False	5819934		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788795	MR00043501	00	03/08/2022	03/08/2022	03/09/2022	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	21	21	100.00000	Replenished		1002045985	3091824990
False	5227911		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787047	MR00074373	00	12/20/2021	12/20/2021	12/21/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	28	28	100.00000	Replenished		1002008101	3084006370
False	4540389		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784893	MR00098575	00	09/17/2021	09/17/2021	09/18/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	40	40	100.00000	Replenished		1001944297	3070884327