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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	9728662		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735368		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735369		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735370		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735371		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735372		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735373		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735374		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735375		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514
False	9735376		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000004012742	MR00298017	00	06/20/2023	06/20/2023	06/21/2023	00143965901	TESTOSTERONE CYP 200 MG/ML	200 MG/ML	VIAL	1	10	1	10.00000	Replenished	06/22/2023	1002235956	3137532514