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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	3993651		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778664	MR00018205	02	07/06/2021	07/06/2021	07/07/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	90	5	5.55600	Replenished		1001906780	3065449437
False	2951962		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779685	MR00152715	00	02/05/2021	02/05/2021	02/06/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	30	5	16.66700	Replenished		1001819785	3048855808
False	3026221		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779685	MR00152715	01	03/02/2021	03/02/2021	03/03/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	30	5	16.66700	Replenished		1001819785	3048855808
False	3304912		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779685	MR00152715	02	04/12/2021	04/12/2021	04/13/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	30	5	16.66700	Replenished		1001845547	3053392934
False	3431016		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781483	MR00035389	00	04/26/2021	04/26/2021	04/27/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	90	5	5.55600	Replenished		1001863873	3056827847
False	3993650		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778664	MR00018205	02	07/06/2021	07/06/2021	07/07/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	90	10	11.11100	Replenished		1001906780	3065449437
False	2933923		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779685	MR00152715	00	02/05/2021	02/05/2021	02/06/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	30	10	33.33300	Replenished		1001811232	987509358
False	3398551		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781301	MR00248486	00	04/19/2021	04/20/2021	04/21/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	120	10	8.33300	Replenished		1001846719	3053644954
False	10154854		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799278	MR00093265	01	08/14/2023	08/14/2023	08/15/2023	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	14	14	100.00000	Replenished	08/17/2023	1002259987	3143744568
False	3126211		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778392	MR00369135	01	03/16/2021	03/16/2021	03/17/2021	68382080501	TRAZODONE 50 MG TABLET	50 MG	TABLET	100	90	15	16.66700	Replenished		1001832780	3051158401