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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	6526560		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	00	06/10/2022	06/13/2022	06/14/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33300	Replenished		1002067085	3096284899
False	6533447		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	00	06/10/2022	06/13/2022	06/14/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33300	Replenished		1002067085	3096284899
False	6533448		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	00	06/10/2022	06/13/2022	06/14/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33400	Replenished		1002067085	3096284899
False	7338531		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	01	09/15/2022	09/15/2022	09/16/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33300	Replenished		1002108257	3106376963
False	7340768		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	01	09/15/2022	09/15/2022	09/16/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33300	Replenished		1002108257	3106376963
False	7340769		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	01	09/15/2022	09/15/2022	09/16/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33400	Replenished		1002108257	3106376963
False	8090681		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	02	12/17/2022	12/17/2022	12/18/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33300	Replenished		1002150980	3116568653
False	8095407		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	02	12/17/2022	12/17/2022	12/18/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33300	Replenished		1002150980	3116568653
False	8095408		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790819	MR00389011	02	12/17/2022	12/17/2022	12/18/2022	33342005507	PIOGLITAZONE HCL 30 MG TABLET	30 MG	TABLET	30	90	30	33.33400	Replenished		1002150980	3116568653