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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	2967681		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000772315	BS9YX6AB5BJS	09	02/19/2021	02/19/2021	02/20/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	30	30	100.00000	Replenished		1001814818	987756777
False	2958381		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000772414	MR00200984	03	02/17/2021	02/17/2021	02/18/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001812276	987651857
False	2961668		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000772414	MR00200984	03	02/17/2021	02/17/2021	02/18/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001812276	987651857
False	2961669		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000772414	MR00200984	03	02/17/2021	02/17/2021	02/18/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33400	Replenished		1001812276	987651857
False	3041641		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000772971	MR00041417	04	03/04/2021	03/04/2021	03/05/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	30	30	100.00000	Replenished		1001822140	3049139687
False	3247512		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774923	MR00122156	03	04/02/2021	04/02/2021	04/03/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001836706	3051817902
False	3251960		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774923	MR00122156	03	04/02/2021	04/02/2021	04/03/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001836706	3051817902
False	3251962		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774923	MR00122156	03	04/02/2021	04/02/2021	04/03/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33400	Replenished		1001836706	3051817902
False	2976602		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775950	MR00119370	02	02/22/2021	02/22/2021	02/23/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001816056	987916714
False	2978584		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775950	MR00119370	02	02/22/2021	02/22/2021	02/23/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001816056	987916714