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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	2934233		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000771663	MR00279837	10	02/10/2021	02/10/2021	02/11/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	60	30	50.00000	Replenished		1001811232	987509358
False	2951940		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000771663	MR00279837	10	02/10/2021	02/10/2021	02/11/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	60	30	50.00000	Replenished		1001811232	987509358
False	3026216		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773343	MR00386717	03	03/02/2021	03/02/2021	03/03/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	40	44.44400	Replenished		1001819785	3048855808
False	3031638		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773343	MR00386717	03	03/02/2021	03/02/2021	03/03/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	50	55.55600	Replenished		1001822785	3049139689
False	2999022		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773630	MR00117914	03	02/25/2021	02/25/2021	02/26/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	40	44.44400	Replenished		1001817241	988063131
False	3003852		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773630	MR00117914	03	02/25/2021	02/25/2021	02/26/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	90	50	55.55600	Replenished		1001819785	3048855808
False	2958379		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773811	MR00177844	09	02/17/2021	02/17/2021	02/18/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	30	100.00000	Replenished		1001814818	987756777
False	3188846		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773811	MR00177844	10	03/26/2021	03/26/2021	03/28/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	30	100.00000	Replenished		1001835056	3051528184
False	3426498		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773811	MR00177844	11	04/26/2021	04/26/2021	04/27/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	10	33.33300	Replenished		1001849254	3054056168
False	3431014		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000773811	MR00177844	11	04/26/2021	04/26/2021	04/27/2021	67877019890	AMLODIPINE BESYLATE 5 MG TAB	5 MG	TABLET	90	30	20	66.66700	Replenished		1001850290	3054303929