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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	3166423		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780737	2240145	00	03/24/2021	03/24/2021	03/25/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001831820	3050993427
False	3171392		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780737	2240145	00	03/24/2021	03/24/2021	03/25/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001831820	3050993427
False	3171393		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780737	2240145	00	03/24/2021	03/24/2021	03/25/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33400	Replenished		1001831820	3050993427
False	3892203		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782965	2240145	00	06/29/2021	06/29/2021	06/30/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001883113	3060162693
False	3898794		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782965	2240145	00	06/29/2021	06/29/2021	06/30/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001883113	3060162693
False	3898795		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782965	2240145	00	06/29/2021	06/29/2021	06/30/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33400	Replenished		1001883113	3060162693
False	3020636		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780231	2241340	00	03/01/2021	03/01/2021	03/02/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001819373	988099025
False	3024380		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780231	2241340	00	03/01/2021	03/01/2021	03/02/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001819373	988099025
False	3024381		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780231	2241340	00	03/01/2021	03/01/2021	03/02/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33400	Replenished		1001819373	988099025
False	3688165		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782400	2241340	00	06/03/2021	06/03/2021	06/04/2021	65862020330	LOSARTAN POTASSIUM 100 MG TAB	100 MG	TABLET	30	90	30	33.33300	Replenished		1001868899	3057728019