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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	9972273		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795679	MR00097587	02	07/19/2023	07/19/2023	07/20/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	10	11.11100	Replenished	08/22/2023	1002248829	3140665212
False	9977674		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795679	MR00097587	02	07/19/2023	07/19/2023	07/20/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	80	88.88900	Replenished	08/22/2023	1002251223	3141466060
False	9793583		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798187	MR00018670	01	06/27/2023	06/27/2023	06/28/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	90	100.00000	Replenished	08/22/2023	1002248829	3140665212
False	10019920		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798187	MR00018670	02	07/26/2023	07/26/2023	07/27/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	20	22.22200	Replenished	08/22/2023	1002251223	3141466060
False	9217217		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790420	MR00018670	11	04/25/2023	04/25/2023	04/26/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	10	11.11100	Replenished	05/30/2023	1002224253	3134810060
False	9482437		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798187	MR00018670	00	05/25/2023	05/25/2023	05/26/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	90	100.00000	Replenished	05/30/2023	1002224253	3134810060
False	9209542		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790420	MR00018670	11	04/25/2023	04/25/2023	04/26/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	80	88.88900	Replenished	05/02/2023	1002210717	3131427601
False	9163758		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795679	MR00097587	01	04/18/2023	04/18/2023	04/19/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	20	22.22200	Replenished	05/02/2023	1002210717	3131427601
False	9157499		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795679	MR00097587	01	04/18/2023	04/18/2023	04/19/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	70	77.77800	Replenished	04/19/2023	1001804274
False	2934412		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776643	MR00097587	04	01/30/2021	01/30/2021	01/31/2021	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	30	10	33.33300	Replenished		1001857662	3055508681