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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	7769416		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787805	MR00152015	03	11/08/2022	11/08/2022	11/09/2022	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	30	33.33300	Replenished		1002164831	3120236936
False	7761439		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787805	MR00152015	03	11/08/2022	11/08/2022	11/09/2022	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	60	66.66700	Replenished		1002130060	3112131940
False	3260699		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779479	MR00177844	02	04/05/2021	04/05/2021	04/07/2021	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	30	30	100.00000	Replenished		1001851763	3054766187
False	4231907		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779577	MR00277177	02	08/09/2021	08/09/2021	08/10/2021	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	30	33.33300	Replenished		1001951777	3072578295
False	4228209		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779577	MR00277177	02	08/09/2021	08/09/2021	08/10/2021	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	60	66.66700	Replenished		1001902393	3064140711
False	6961809		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787805	MR00152015	02	07/25/2022	07/25/2022	07/26/2022	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	30	33.33300	Replenished		1002086492	3101518230
False	6957823		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787805	MR00152015	02	07/25/2022	07/25/2022	07/26/2022	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	60	66.66700	Replenished		1002083390	3100621822
False	3056738		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779479	MR00177844	01	03/08/2021	03/08/2021	03/09/2021	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	30	30	100.00000	Replenished		1001851763	3054766187
False	3476612		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779577	MR00277177	01	05/04/2021	05/04/2021	05/05/2021	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	90	100.00000	Replenished		1001852121	3054859692
False	5511408		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000785919	MR00277177	01	01/26/2022	01/26/2022	01/27/2022	00093720198	PRAVASTATIN SODIUM 20 MG TAB	20 MG	TABLET	90	90	30	33.33300	Replenished		1002037486	3090307729