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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	4320737		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779099	MR00095217	07	08/19/2021	08/19/2021	08/20/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	10	33.33300	Replenished		1001906487	3065291855
False	4086971		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783433	MR00055148	00	07/20/2021	07/20/2021	07/21/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	30	100.00000	Replenished		1001906487	3065291855
False	4228204		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783883	MR00298017	00	08/09/2021	08/09/2021	08/10/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	30	100.00000	Replenished		1001906487	3065291855
False	4313020		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784157	MR00035389	00	08/18/2021	08/18/2021	08/19/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	30	100.00000	Replenished		1001906487	3065291855
False	4326192		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779099	MR00095217	07	08/19/2021	08/19/2021	08/20/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	20	66.66700	Replenished		1001923771	3067867836
False	4522958		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781409	MR00117446	01	09/15/2021	09/15/2021	09/16/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	20	66.66700	Replenished		1001923771	3067867836
False	4505288		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783883	MR00298017	01	09/13/2021	09/13/2021	09/14/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	30	100.00000	Replenished		1001923771	3067867836
False	4512173		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784776	MR00055148	00	09/14/2021	09/14/2021	09/15/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	30	100.00000	Replenished		1001923771	3067867836
False	4531006		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779099	MR00095217	08	09/16/2021	09/16/2021	09/17/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	30	100.00000	Replenished		1001935094	3069471044
False	4528554		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781409	MR00117446	01	09/15/2021	09/15/2021	09/16/2021	29300035001	ALLOPURINOL 300 MG TABLET	300 MG	TABLET	100	30	10	33.33300	Replenished		1001935094	3069471044