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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	2933770		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779601	MR00013012	00	02/01/2021	02/01/2021	02/02/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	30	10	33.33300	Replenished		1001805758
False	2933771		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779601	MR00013012	00	02/01/2021	02/01/2021	02/02/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	30	20	66.66700	Replenished		1001858287	3055645573
False	3048348		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780346	MR00013012	00	03/05/2021	03/05/2021	03/06/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	30	30	100.00000	Replenished		1001858287	3055645573
False	3285607		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781109	MR00013012	00	04/09/2021	04/09/2021	04/10/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	30	30	100.00000	Replenished		1001858287	3055645573
False	3546031		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781870	MR00013012	00	05/12/2021	05/12/2021	05/13/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	30	10	33.33300	Replenished		1001872170	3058237732
False	3540434		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781870	MR00013012	00	05/12/2021	05/12/2021	05/13/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	30	20	66.66700	Replenished		1001858287	3055645573
False	5843238		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782539	MR00013012	00	03/11/2022	03/11/2022	03/12/2022	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	30	20	66.66700	Replenished		1002018687	3086273043
False	3729032		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782554	MR00013012	00	06/09/2021	06/09/2021	06/10/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	90	90	100.00000	Replenished		1001872170	3058237732
False	4505296		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782554	MR00013012	01	09/13/2021	09/13/2021	09/14/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	90	90	100.00000	Replenished		1001972080	3076588674
False	5155214		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782554	MR00013012	02	12/10/2021	12/10/2021	12/11/2021	60505009600	DOXAZOSIN MESYLATE 8 MG TAB	8 MG	TABLET	100	90	10	11.11100	Replenished		1001972080	3076588674