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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	9603238		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798396	MR00032603	00	06/06/2023	06/06/2023	06/07/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	90	4	4.44400	Replenished	08/22/2023	1002252535	3142130208
False	9724312		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798663	MR00387542	00	06/19/2023	06/19/2023	06/20/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	30	30	100.00000	Replenished	08/22/2023	1002252535	3142130208
False	9825572		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798914	MR00145513	00	06/30/2023	06/30/2023	07/01/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	30	30	100.00000	Replenished	08/22/2023	1002252535	3142130208
False	10056556		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798914	MR00145513	01	08/01/2023	08/01/2023	08/02/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	30	26	86.66700	Replenished	08/22/2023	1002252535	3142130208
False	9595283		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797625	MR00313919	01	06/06/2023	06/06/2023	06/07/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	30	30	100.00000	Replenished	06/08/2023	1002227496	3135977002
False	9295615		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797632	MR00071187	00	04/27/2023	04/27/2023	05/04/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	90	4	4.44400	Replenished	06/08/2023	1002227496	3135977002
False	9276603		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797641	MR00098575	00	04/28/2023	04/28/2023	05/04/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	30	30	100.00000	Replenished	06/08/2023	1002227496	3135977002
False	9295616		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797679	MR00012058	00	05/02/2023	05/02/2023	05/04/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	90	30	33.33300	Replenished	06/08/2023	1002227496	3135977002
False	9595281		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798396	MR00032603	00	06/06/2023	06/06/2023	06/07/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	90	26	28.88900	Replenished	06/08/2023	1002227496	3135977002
False	9603237		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798396	MR00032603	00	06/06/2023	06/06/2023	06/07/2023	16729044315	BUPROPION HCL XL 150 MG TABLET	150 MG	TAB.SR 24H	90	90	60	66.66700	Replenished	06/08/2023	1002227496	3135977002