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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	4184281		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783743	MR00074500	00	08/02/2021	08/02/2021	08/03/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001899045	3063437222
False	4187529		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783743	MR00074500	00	08/02/2021	08/02/2021	08/03/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001899045	3063437222
False	4505294		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784755	MR00074500	00	09/13/2021	09/13/2021	09/14/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001923041	3067590209
False	4509077		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784755	MR00074500	00	09/13/2021	09/13/2021	09/14/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001923041	3067590209
False	5452743		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787785	MR00074500	00	01/20/2022	01/20/2022	01/21/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001992840	3080996426
False	5457969		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787785	MR00074500	00	01/20/2022	01/20/2022	01/21/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001992840	3080996426
False	5935530		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789144	MR00074500	00	03/24/2022	03/24/2022	03/25/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002025130	3087713920
False	5941211		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789144	MR00074500	00	03/24/2022	03/24/2022	03/25/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002025130	3087713920
False	8019453		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	00	12/09/2022	12/09/2022	12/10/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002147857	3115655016
False	8025519		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	00	12/09/2022	12/09/2022	12/10/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002147857	3115655016