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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	2999026		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	06	02/25/2021	02/25/2021	02/26/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001817241	988063131
False	3003843		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	06	02/25/2021	02/25/2021	02/26/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001817241	988063131
False	3207050		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	07	03/30/2021	03/30/2021	03/31/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001835056	3051528184
False	3212001		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	07	03/30/2021	03/30/2021	03/31/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001835056	3051528184
False	3527658		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	08	05/11/2021	05/11/2021	05/12/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001857662	3055508681
False	3536988		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	08	05/11/2021	05/11/2021	05/12/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001857662	3055508681
False	3813452		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	09	06/22/2021	06/22/2021	06/23/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001878574	3059465018
False	3820749		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774681	MR00074500	09	06/22/2021	06/22/2021	06/23/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001878574	3059465018
False	4184281		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783743	MR00074500	00	08/02/2021	08/02/2021	08/03/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001899045	3063437222
False	4187529		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783743	MR00074500	00	08/02/2021	08/02/2021	08/03/2021	00032121201	CREON DR 12,000 UNIT CAPSULE	12K-38K-60	CAPSULE DR	100	200	100	50.00000	Replenished		1001899045	3063437222