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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	5363251		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787511	MR00092991	00	01/07/2022	01/07/2022	01/08/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	60	100.00000	Replenished		1001999272	3082324547
False	5555066		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	00	02/02/2022	02/02/2022	02/03/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	20	33.33300	Replenished		1002031903	3089169382
False	5550166		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	00	02/02/2022	02/02/2022	02/03/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	40	66.66700	Replenished		1001999272	3082324547
False	5811449		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	01	03/07/2022	03/07/2022	03/08/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	60	100.00000	Replenished		1002031903	3089169382
False	6036052		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	02	04/06/2022	04/06/2022	04/07/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	20	33.33300	Replenished		1002031903	3089169382
False	6042072		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	02	04/06/2022	04/06/2022	04/07/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	40	66.66700	Replenished		1002050928	3092714512
False	6283315		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	03	05/10/2022	05/10/2022	05/11/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	60	100.00000	Replenished		1002050928	3092714512
False	6487319		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	04	06/07/2022	06/07/2022	06/08/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	60	100.00000	Replenished		1002079621	3099252329
False	6871628		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	05	07/12/2022	07/12/2022	07/13/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	20	33.33300	Replenished		1002102488	3105614645
False	6863260		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788045	MR00092991	05	07/12/2022	07/12/2022	07/13/2022	00054001025	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	60	40	66.66700	Replenished		1002079621	3099252329