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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	10241880		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794668	MR00296590	04	08/25/2023	08/25/2023	08/26/2023	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	08/28/2023	1002263052	3144881029
False	10218115		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793453	MR00035389	01	08/22/2023	08/22/2023	08/23/2023	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	08/28/2023	1002263052	3144881029
False	10052111		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794668	MR00296590	03	07/31/2023	07/31/2023	08/01/2023	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	08/28/2023	1002263052	3144881029
False	9888307		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794668	MR00296590	02	07/07/2023	07/07/2023	07/08/2023	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	08/28/2023	1002263052	3144881029
False	9276542		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794668	MR00296590	01	05/04/2023	05/04/2023	05/05/2023	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	05/08/2023	1002213418	3132524753
False	9148370		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797369	MR00295595	00	04/17/2023	04/17/2023	04/18/2023	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	05/08/2023	1002213418	3132524753
False	8156726		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795066	MR00295595	00	12/27/2022	12/27/2022	12/28/2022	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	05/08/2023	1002213418	3132524753
False	7528318		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791052	MR00234113	01	10/11/2022	10/11/2022	10/12/2022	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished		1002120414	3109055000
False	7528335		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793453	MR00035389	00	10/11/2022	10/11/2022	10/12/2022	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished	05/08/2023	1002213418	3132524753
False	7522518		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793430	MR00296590	00	10/10/2022	10/10/2022	10/11/2022	68462063945	NITROGLYCERIN 0.4 MG TABLET SL	0.4 MG	TAB SUBL	100	25	25	100.00000	Replenished		1002120414	3109055000