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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	3729019		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782565	MR00157951	00	06/09/2021	06/09/2021	06/10/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	20	20	100.00000	Replenished		1001897770	3062993331
False	3746031		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782606	MR00139617	00	06/11/2021	06/11/2021	06/12/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	14	14	100.00000	Replenished		1001897770	3062993331
False	3996543		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783144	MR00174697	00	07/07/2021	07/07/2021	07/08/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	30	30	100.00000	Replenished		1001897770	3062993331
False	4007211		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783197	MR00165004	00	07/08/2021	07/08/2021	07/09/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	14	14	100.00000	Replenished		1001897770	3062993331
False	4018946		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783200	MR00165004	00	07/09/2021	07/09/2021	07/10/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	7	7	100.00000	Replenished		1001897770	3062993331
False	4153944		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783629	MR00373597	00	07/28/2021	07/28/2021	07/29/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	21	6	28.57100	Replenished		1001944297	3070884327
False	4147216		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783629	MR00373597	00	07/28/2021	07/28/2021	07/29/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	21	15	71.42900	Replenished		1001897770	3062993331
False	4387143		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784338	MR00263582	00	08/27/2021	08/27/2021	08/28/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	21	21	100.00000	Replenished		1001944297	3070884327
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
False	4599549		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000785058	MR00207749	00	09/25/2021	09/25/2021	09/26/2021	00093314701	CEPHALEXIN 500 MG CAPSULE	500 MG	CAPSULE	100	28	28	100.00000	Replenished		1001944297	3070884327