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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	2933881		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776630	MR00229039	02	01/15/2021	01/15/2021	01/16/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	90	70	77.77800	Replenished		1001797497
False	8933736		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796888	MR00055737	00	03/23/2023	03/23/2023	03/24/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	10	16.66700	Replenished		1001797497
False	9004077		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797058	MR00234113	00	04/03/2023	04/03/2023	04/04/2023	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	90	20	22.22200	Replenished		1001797497
False	2933880		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776603	MR00055737	04	01/19/2021	01/19/2021	01/20/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	60	100.00000	Replenished		1001814475	987756775
False	2963031		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776603	MR00055737	05	02/18/2021	02/18/2021	02/19/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	20	33.33300	Replenished		1001814475	987756775
False	2933882		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776630	MR00229039	02	01/15/2021	01/15/2021	01/16/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	90	20	22.22200	Replenished		1001814475	987756775
False	2966254		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776603	MR00055737	05	02/18/2021	02/18/2021	02/19/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	60	40	66.66700	Replenished		1001819373	988099025
False	3020631		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780234	MR00234113	00	03/01/2021	03/01/2021	03/02/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	270	60	22.22200	Replenished		1001819373	988099025
False	3024364		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780234	MR00234113	00	03/01/2021	03/01/2021	03/02/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	270	100	37.03700	Replenished		1001819373	988099025
False	3024365		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780234	MR00234113	00	03/01/2021	03/01/2021	03/02/2021	62332003231	ROPINIROLE HCL 1 MG TABLET	1 MG	TABLET	100	270	100	37.03700	Replenished		1001819373	988099025