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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	8682312		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794754	MR00074500	02	02/21/2023	02/21/2023	02/25/2023	62332003031	ROPINIROLE HCL 0.25 MG TABLET	0.25 MG	TABLET	100	60	60	100.00000	Replenished		1002199438	3129427833
False	9059607		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794754	MR00074500	03	04/06/2023	04/06/2023	04/07/2023	62332003031	ROPINIROLE HCL 0.25 MG TABLET	0.25 MG	TABLET	100	60	20	33.33300	Replenished	06/05/2023	1002226246	3135522746
False	9051451		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794754	MR00074500	03	04/06/2023	04/06/2023	04/07/2023	62332003031	ROPINIROLE HCL 0.25 MG TABLET	0.25 MG	TABLET	100	60	40	66.66700	Replenished		1002199438	3129427833
False	9276480		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794754	MR00074500	04	05/01/2023	05/01/2023	05/04/2023	62332003031	ROPINIROLE HCL 0.25 MG TABLET	0.25 MG	TABLET	100	60	60	100.00000	Replenished	06/05/2023	1002226246	3135522746
False	9544226		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794754	MR00074500	05	05/31/2023	05/31/2023	06/01/2023	62332003031	ROPINIROLE HCL 0.25 MG TABLET	0.25 MG	TABLET	100	60	20	33.33300	Replenished	06/05/2023	1002226246	3135522746
False	9558095		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794754	MR00074500	05	05/31/2023	05/31/2023	06/01/2023	62332003031	ROPINIROLE HCL 0.25 MG TABLET	0.25 MG	TABLET	100	60	40	66.66700	Replenished	07/06/2023	1002240234	3138951860
False	9848986		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794754	MR00074500	06	07/03/2023	07/03/2023	07/04/2023	62332003031	ROPINIROLE HCL 0.25 MG TABLET	0.25 MG	TABLET	100	60	60	100.00000	Replenished	07/06/2023	1002240234	3138951860