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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	3414258		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781439	MR00034656	00	04/23/2021	04/23/2021	04/24/2021	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1001848263	3053810032
False	3696931		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781954	MR00389011	00	06/04/2021	06/04/2021	06/05/2021	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1001869532	3057728430
False	5569576		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788104	MR00357576	00	02/04/2022	02/04/2022	02/05/2022	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1002001191	3082500308
False	5700449		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788474	MR00271790	00	02/22/2022	02/22/2022	02/23/2022	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1002010073	3084421077
False	5926940		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789097	MR00016604	00	03/22/2022	03/22/2022	03/23/2022	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1002024556	3087532248
False	6094270		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789562	MR00319594	00	04/14/2022	04/14/2022	04/15/2022	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1002036295	3089902768
False	6782486		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791231	MR00389011	00	06/30/2022	06/30/2022	07/01/2022	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1002075849	3098184652
False	7841819		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794258	MR00402958	00	11/17/2022	11/17/2022	11/18/2022	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1002110752	3107139680
False	8218039		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795207	MR00389011	00	01/03/2023	01/03/2023	01/04/2023	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1002156662	3118688759
False	4738385		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781954	MR00389011	01	10/14/2021	10/14/2021	10/15/2021	08470046501	UNILET COMFORTOUCH LANCET		EACH	100	100	100	100.00000	Replenished		1001940281	3070884324