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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	4050042		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781016	MR00053037	03	07/14/2021	07/14/2021	07/15/2021	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	30	30	100.00000	Replenished		1001939012	3070433439
False	8647140		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794338	MR00201045	03	02/22/2023	02/22/2023	02/23/2023	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	30	30	100.00000	Replenished	04/17/2023	1002207066	3130202878
False	8412369		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794338	MR00201045	02	01/25/2023	01/25/2023	01/26/2023	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	30	11	36.66700	Replenished	04/17/2023	1002207066	3130202878
False	8405282		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794338	MR00201045	02	01/25/2023	01/25/2023	01/26/2023	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	30	19	63.33300	Replenished		1002167937	3121218016
False	9562801		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796842	MR00201045	02	06/01/2023	06/01/2023	06/03/2023	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	30	9	30.00000	Replenished	06/26/2023	1002237206	3137855547
False	5988464		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787042	MR00201045	01	03/31/2022	03/31/2022	04/01/2022	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	90	15	16.66700	Replenished		1002108257	3106376963
False	5984552		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787042	MR00201045	01	03/31/2022	03/31/2022	04/01/2022	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	90	75	83.33300	Replenished		1002027827	3088434371
False	7442561		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792307	MR00014380	01	09/28/2022	09/28/2022	09/29/2022	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	24	24	100.00000	Replenished		1002126238	3110721551
False	8156732		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794338	MR00201045	01	12/27/2022	12/27/2022	12/28/2022	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	30	30	100.00000	Replenished		1002167937	3121218016
False	9115835		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794507	MR00014380	01	04/13/2023	04/13/2023	04/14/2023	42806008801	ESTRADIOL 1 MG TABLET	1 MG	TABLET	100	90	29	32.22200	Replenished	04/17/2023	1002207066	3130202878