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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	2951921		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773661	MR00050302	02	02/09/2021	02/09/2021	02/10/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	90	30	33.33300	Replenished		1001814818	987756777
False	2934150		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773661	MR00050302	02	02/09/2021	02/09/2021	02/10/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	90	60	66.66700	Replenished		1001811232	987509358
False	2979702		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774132	MR00279358	03	02/23/2021	02/23/2021	02/24/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	90	90	100.00000	Replenished		1001816393	987952822
False	2967694		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775708	MR00159159	06	02/19/2021	02/19/2021	02/20/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	30	30	100.00000	Replenished		1001814818	987756777
False	3188839		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775708	MR00159159	07	03/26/2021	03/26/2021	03/28/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	30	30	100.00000	Replenished		1001833661	3051191521
False	3433636		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775708	MR00159159	08	04/27/2021	04/27/2021	04/28/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	30	30	100.00000	Replenished		1001849752	3054181639
False	3655404		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775708	MR00159159	09	05/28/2021	05/28/2021	05/29/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	30	30	100.00000	Replenished		1001866451	3057164798
False	3933466		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775708	MR00159159	10	06/30/2021	06/30/2021	07/01/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	30	30	100.00000	Replenished		1001883742	3060343039
False	3188849		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776165	MR00117914	02	03/26/2021	03/26/2021	03/28/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	90	90	100.00000	Replenished		1001833661	3051191521
False	2934151		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776819	MR00316314	02	02/01/2021	02/01/2021	02/02/2021	60505267109	ATORVASTATIN 80 MG TABLET	80 MG	TABLET	90	30	30	100.00000	Replenished		1001814818	987756777