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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	9996079		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799273	MR00145513	00	07/21/2023	07/21/2023	07/22/2023	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	30	30	100.00000	Replenished	08/22/2023	1002249643	3140846559
False	7625775		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793695	MR00210929	00	10/21/2022	10/21/2022	10/22/2022	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	90	60	66.66700	Replenished		1002130385	3112283351
False	8332410		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793695	MR00210929	01	01/16/2023	01/16/2023	01/17/2023	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	90	30	33.33300	Replenished	04/21/2023	1002209232	3130801353
False	8328072		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793695	MR00210929	01	01/16/2023	01/16/2023	01/17/2023	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	90	60	66.66700	Replenished		1002164575	3120074504
False	9166405		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793695	MR00210929	02	04/19/2023	04/19/2023	04/20/2023	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	90	30	33.33300	Replenished	04/21/2023	1002209232	3130801353
False	9170877		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793695	MR00210929	02	04/19/2023	04/19/2023	04/20/2023	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	90	60	66.66700	Replenished	08/22/2023	1002249643	3140846559
False	6343464		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790317	MR00145513	00	05/18/2022	05/18/2022	05/19/2022	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	30	30	100.00000	Replenished		1002075533	3098184651
False	6749344		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790317	MR00145513	01	06/29/2022	06/29/2022	07/01/2022	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	30	30	100.00000	Replenished		1002075533	3098184651
False	7773189		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790317	MR00145513	04	11/09/2022	11/09/2022	11/10/2022	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	30	30	100.00000	Replenished		1002130385	3112283351
False	8187349		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790317	MR00145513	05	12/30/2022	12/30/2022	01/01/2023	68382009716	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	90	30	30	100.00000	Replenished		1002164575	3120074504