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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	10065702		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799499	MR00234113	00	08/02/2023	08/02/2023	08/03/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	90	20	22.22200	Replenished	08/22/2023	1002252826	3142288891
False	9174094		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797457	MR00055737	00	04/20/2023	04/20/2023	04/21/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	30	50.00000	Replenished	04/24/2023	1002209494	3130976965
False	9179302		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797457	MR00055737	00	04/20/2023	04/20/2023	04/21/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	30	50.00000	Replenished	05/08/2023	1002213418	3132524753
False	9470484		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797457	MR00055737	01	05/23/2023	05/23/2023	05/24/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	60	100.00000	Replenished	06/05/2023	1002226579	3135522748
False	9787457		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797457	MR00055737	02	06/26/2023	06/26/2023	06/27/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	30	50.00000	Replenished	06/28/2023	1002238348	3138156842
False	9790064		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797457	MR00055737	02	06/26/2023	06/26/2023	06/27/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	30	50.00000	Replenished	07/03/2023	1002239529	3138618794
False	9972260		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797457	MR00055737	03	07/19/2023	07/19/2023	07/20/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	60	100.00000	Replenished	08/22/2023	1002252826	3142288891
False	9004077		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797058	MR00234113	00	04/03/2023	04/03/2023	04/04/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	90	20	22.22200	Replenished		1001797497
False	9025071		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797058	MR00234113	00	04/03/2023	04/03/2023	04/04/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	90	70	77.77800	Replenished	04/24/2023	1002209494	3130976965
False	9295641		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797058	MR00234113	01	05/02/2023	05/02/2023	05/04/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	90	20	22.22200	Replenished	06/05/2023	1002226579	3135522748