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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	7841807		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788476	MR00326153	03	11/17/2022	11/17/2022	11/18/2022	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	180	100	55.55600	Replenished		1002137601	3113250051
False	8587380		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796109	MR00326153	00	02/14/2023	02/14/2023	02/15/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	180	100	55.55600	Replenished		1002178976	3123538684
False	9397874		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798008	MR00326153	00	05/17/2023	05/17/2023	05/18/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	180	100	55.55600	Replenished	05/19/2023	1002221549	3133876132
False	8395379		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795665	MR00082070	00	01/24/2023	01/24/2023	01/25/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	90	90	100.00000	Replenished		1002167601	3121067798
False	7848141		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788476	MR00326153	03	11/17/2022	11/17/2022	11/18/2022	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	180	80	44.44400	Replenished		1002138927	3113726126
False	7517879		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789871	MR00082070	02	10/08/2022	10/08/2022	10/09/2022	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	90	80	88.88900	Replenished		1002124663	3110135018
False	8581289		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796109	MR00326153	00	02/14/2023	02/14/2023	02/15/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	180	80	44.44400	Replenished		1002178976	3123538684
False	9406108		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798008	MR00326153	00	05/17/2023	05/17/2023	05/18/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	180	70	38.88900	Replenished	05/19/2023	1002221549	3133876132
False	7458156		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000786520	MR00389011	10	10/01/2022	10/01/2022	10/02/2022	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	60	100.00000	Replenished		1002119666	3108617906
False	7725640		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000786520	MR00389011	11	11/04/2022	11/04/2022	11/06/2022	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	60	100.00000	Replenished		1002129142	3111671677