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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	6102440		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789578	MR00038013	00	04/15/2022	04/15/2022	04/16/2022	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished		1002036633	3089903741
False	8581302		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796115	MR00178696	00	02/14/2023	02/14/2023	02/15/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished		1002178976	3123538684
False	10180325		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796115	MR00178696	01	08/17/2023	08/17/2023	08/18/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished	08/21/2023	1002260563	3144082982
False	8835697		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796693	MR00289747	00	03/14/2023	03/14/2023	03/15/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished		1002192444	3126767439
False	9004093		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797072	MR00158471	00	04/03/2023	04/03/2023	04/04/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished		1002198481	3129060211
False	9035383		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797141	MR00289747	00	04/05/2023	04/05/2023	04/06/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished		1002199093	3129254774
False	9375379		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797946	MR00171522	00	05/15/2023	05/15/2023	05/16/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished	05/18/2023	1002221191	3133750055
False	9470466		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798175	MR00178696	00	05/24/2023	05/24/2023	05/25/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished	05/26/2023	1002223394	3134652724
False	9933529		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799101	MR00413229	00	07/12/2023	07/12/2023	07/13/2023	00713067831	NYSTATIN 100,000 UNIT/GM CREAM	100000/G	CREAM(GM)	30	30	30	100.00000	Replenished	08/22/2023	1002247471	3140061852