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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	3933469		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782989	MR00192351	00	06/30/2021	06/30/2021	07/01/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	10	11.11100	Replenished		1001883742	3060343039
False	4368318		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784300	MR00112843	00	08/25/2021	08/25/2021	08/26/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	10	11.11100	Replenished		1001925175	3068316933
False	4305062		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779844	MR00177615	02	08/17/2021	08/17/2021	08/18/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	20	22.22200	Replenished		1001917157	3066422605
False	4147197		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783639	MR00087628	00	07/28/2021	07/28/2021	07/29/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	20	22.22200	Replenished		1001897770	3062993331
False	4199204		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783802	MR00154246	00	08/04/2021	08/04/2021	08/05/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	60	30	50.00000	Replenished		1001899595	3063713218
False	4204864		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783802	MR00154246	00	08/04/2021	08/04/2021	08/05/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	60	30	50.00000	Replenished		1001905867	3064981467
False	4556848		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784908	MR00025513	00	09/20/2021	09/20/2021	09/21/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	30	33.33300	Replenished		1001925175	3068316933
False	4606566		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778716	MR00195504	03	09/27/2021	09/27/2021	09/28/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	40	44.44400	Replenished		1001935630	3069588900
False	4458941		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784575	MR00154246	00	09/07/2021	09/07/2021	09/08/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	60	60	100.00000	Replenished		1001925175	3068316933
False	4560518		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784908	MR00025513	00	09/20/2021	09/20/2021	09/21/2021	68001047000	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	60	66.66700	Replenished		1001935630	3069588900