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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	3540436		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776451	MR00283017	02	05/12/2021	05/12/2021	05/13/2021	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1001860456	3056066373
False	6848114		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000787465	MR00148300	02	07/09/2022	07/09/2022	07/11/2022	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002078117	3098957440
False	6324098		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790237	MR00218418	00	05/16/2022	05/16/2022	05/17/2022	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002052652	3093325138
False	6855179		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791454	MR00034656	00	07/11/2022	07/11/2022	07/12/2022	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002080842	3099576536
False	8314800		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791454	MR00034656	02	01/14/2023	01/14/2023	01/15/2023	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002164074	3119751775
False	6884061		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791528	MR00205174	00	07/14/2022	07/14/2022	07/15/2022	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002080842	3099576536
False	7562645		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792235	MR00205174	00	10/13/2022	10/13/2022	10/14/2022	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002122389	3109361369
False	8328079		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792235	MR00205174	01	01/16/2023	01/16/2023	01/17/2023	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002165418	3120576240
False	9135210		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792235	MR00205174	02	04/15/2023	04/15/2023	04/16/2023	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished	04/17/2023	1002208238	3130238295
False	8102606		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794862	MR00072992	00	12/19/2022	12/19/2022	12/20/2022	68001033400	LISINOPRIL 10 MG TABLET	10 MG	TABLET	100	90	90	100.00000	Replenished		1002151463	3116913607