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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	9035409		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	02	04/05/2023	04/05/2023	04/06/2023	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002199093	3129254774
False	9047105		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	02	04/05/2023	04/05/2023	04/06/2023	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002199093	3129254774
False	8669213		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	01	02/24/2023	02/24/2023	02/25/2023	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002182751	3124681385
False	8676799		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	01	02/24/2023	02/24/2023	02/25/2023	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002182751	3124681385
False	8019453		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	00	12/09/2022	12/09/2022	12/10/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002147857	3115655016
False	8025519		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794755	MR00074500	00	12/09/2022	12/09/2022	12/10/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002147857	3115655016
False	7725616		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789144	MR00074500	06	11/05/2022	11/05/2022	11/06/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002129142	3111671677
False	7738845		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789144	MR00074500	06	11/05/2022	11/05/2022	11/06/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002129142	3111671677
False	7470774		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789144	MR00074500	05	10/03/2022	10/03/2022	10/04/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002114625	3108158138
False	7474272		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789144	MR00074500	05	10/03/2022	10/03/2022	10/04/2022	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1002114625	3108158138