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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	3625918		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778545	MR00348850	05	05/24/2021	05/24/2021	05/25/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	5	16.66700	Replenished		1001866451	3057164798
False	2934236		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779405	MR00398102	00	01/25/2021	01/25/2021	01/26/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	5	5.55600	Replenished		1001811232	987509358
False	3694152		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780342	MR00177615	01	06/03/2021	06/03/2021	06/04/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	5	5.55600	Replenished		1001869532	3057728431
False	3788673		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780663	MR00279837	03	06/17/2021	06/17/2021	06/18/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	60	5	8.33300	Replenished		1001882607	3060033992
False	4305061		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780663	MR00279837	05	08/17/2021	08/17/2021	08/18/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	60	5	8.33300	Replenished		1001906487	3065291855
False	3962169		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781545	MR00101113	02	07/01/2021	07/01/2021	07/02/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	5	16.66700	Replenished		1001885854	3060825455
False	4187546		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781545	MR00101113	03	08/02/2021	08/02/2021	08/03/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	5	16.66700	Replenished		1001902816	3064329315
False	4245940		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781810	MR00398102	01	08/10/2021	08/10/2021	08/11/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	5	16.66700	Replenished		1001904997	3064847322
False	3660505		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782263	MR00067064	00	05/28/2021	05/28/2021	05/29/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	5	5.55600	Replenished		1001867724	3057523425
False	3675650		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782308	MR00180356	00	06/01/2021	06/01/2021	06/02/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	5	5.55600	Replenished		1001868899	3057728019