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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	2933914		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779859	MR00389502	00	02/11/2021	02/11/2021	02/12/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001811232	987509358
False	3166413		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777578	MR00145513	01	03/24/2021	03/24/2021	03/25/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001831820	3050993427
False	3350517		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774985	MR00210929	03	04/15/2021	04/15/2021	04/16/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33300	Replenished		1001843888	3053146133
False	3357321		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774985	MR00210929	03	04/15/2021	04/15/2021	04/16/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33300	Replenished		1001843888	3053146133
False	3357322		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774985	MR00210929	03	04/15/2021	04/15/2021	04/16/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33400	Replenished		1001843888	3053146133
False	3414266		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777578	MR00145513	02	04/23/2021	04/23/2021	04/24/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001848263	3053810034
False	3655422		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777578	MR00145513	03	05/28/2021	05/28/2021	05/29/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001866451	3057164798
False	3956567		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783022	MR00145513	00	07/01/2021	07/01/2021	07/02/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001884259	3060456965
False	4040662		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779859	MR00389502	01	07/13/2021	07/13/2021	07/14/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001889580	3061517655
False	4086975		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783441	MR00210929	00	07/20/2021	07/20/2021	07/21/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33300	Replenished		1001891615	3062304712