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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	10005470		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799318	MR00319594	00	07/24/2023	07/24/2023	07/25/2023	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished	08/22/2023	1002250380	3141162968
False	9397886		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795335	MR00319594	02	05/17/2023	05/17/2023	05/18/2023	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished	05/19/2023	1002221549	3133876130
False	9375330		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796812	MR00171522	01	05/11/2023	05/11/2023	05/16/2023	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	100	50	50.00000	Replenished	05/18/2023	1002221191	3133750053
False	9391924		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796812	MR00171522	01	05/11/2023	05/11/2023	05/16/2023	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	100	50	50.00000	Replenished	05/18/2023	1002221191	3133750053
False	6094268		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789559	MR00319594	00	04/14/2022	04/14/2022	04/15/2022	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished		1002036295	3089902768
False	6324072		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790242	MR00319594	00	05/16/2022	05/16/2022	05/17/2022	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished		1002052652	3093325137
False	6840628		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790242	MR00319594	01	07/08/2022	07/08/2022	07/09/2022	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished		1002077877	3098828685
False	7278615		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790242	MR00319594	02	09/06/2022	09/06/2022	09/09/2022	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished		1002102296	3105614641
False	7667194		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790242	MR00319594	03	10/27/2022	10/27/2022	10/28/2022	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished		1002126984	3110896802
False	8066008		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790242	MR00319594	04	12/13/2022	12/13/2022	12/15/2022	65702071110	ACCU-CHEK GUIDE TEST STRIP		STRIP	50	50	50	100.00000	Replenished		1002150356	3116568457