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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	10010791		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797598	MR00179628	03	07/25/2023	07/25/2023	07/26/2023	43547036209	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	90	30	30	100.00000	Replenished	08/21/2023	1002260563	3144082982
False	10201299		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799196	MR00319594	01	08/19/2023	08/19/2023	08/20/2023	43547036209	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	90	30	30	100.00000	Replenished	08/28/2023	1002263052	3144881029
False	10185468		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799787	MR00182714	00	08/17/2023	08/17/2023	08/18/2023	43547036209	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	90	90	30	33.33300	Replenished	08/28/2023	1002263052	3144881029
False	10180314		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799787	MR00182714	00	08/17/2023	08/17/2023	08/18/2023	43547036209	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	90	90	60	66.66700	Replenished	08/21/2023	1002260563	3144082982
False	10241887		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799963	MR00179628	00	08/24/2023	08/24/2023	08/26/2023	43547036209	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	90	30	30	100.00000	Replenished	08/28/2023	1002263052	3144881029