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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	8279737		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789625	MR00041824	03	01/10/2023	01/10/2023	01/11/2023	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	90	40	44.44400	Replenished		1002162186	3119565263
False	8289207		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789625	MR00041824	03	01/10/2023	01/10/2023	01/11/2023	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	90	50	55.55600	Replenished		1002168256	3121399107
False	8240992		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792408	MR00389118	02	01/05/2023	01/05/2023	01/06/2023	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	60	60	100.00000	Replenished		1002161832	3119403854
False	9276545		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793518	MR00005078	01	04/27/2023	04/27/2023	05/04/2023	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	90	10	11.11100	Replenished	05/08/2023	1002213418	3132524753
False	9295629		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793518	MR00005078	01	04/27/2023	04/27/2023	05/04/2023	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	90	40	44.44400	Replenished	05/08/2023	1002213418	3132524753
False	9295630		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793518	MR00005078	01	04/27/2023	04/27/2023	05/04/2023	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	90	40	44.44500	Replenished	05/26/2023	1002223394	3134652724
False	8111343		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794001	MR00395196	01	12/20/2022	12/20/2022	12/21/2022	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	30	30	100.00000	Replenished		1002154521	3117768446
False	8367486		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794001	MR00395196	02	01/20/2023	01/20/2023	01/21/2023	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	30	30	100.00000	Replenished		1002168256	3121399107
False	8065936		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794212	MR00128572	01	12/14/2022	12/14/2022	12/15/2022	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	30	30	100.00000	Replenished		1002154521	3117768446
False	8156738		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794328	MR00027244	01	12/27/2022	12/27/2022	12/28/2022	55111046601	METOPROLOL SUCC ER 25 MG TAB	25 MG	TAB.SR 24H	100	30	30	100.00000	Replenished		1002156662	3118689060