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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	9691884		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	07	06/15/2023	06/15/2023	06/16/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	60	66.66700	Replenished	08/22/2023	1002247993	3140061854
False	9949658		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	08	07/14/2023	07/14/2023	07/16/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	40	44.44400	Replenished	08/22/2023	1002247993	3140061854
False	9953484		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	08	07/14/2023	07/14/2023	07/16/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	50	55.55600	Replenished	08/18/2023	1002260285	3143898442
False	10171629		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	09	08/16/2023	08/16/2023	08/17/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	50	55.55600	Replenished	08/18/2023	1002260285	3143898442
False	9420460		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	06	05/18/2023	05/18/2023	05/19/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	70	77.77800	Replenished	06/19/2023	1002234814	3137091283
False	9686033		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	07	06/15/2023	06/15/2023	06/16/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	30	33.33300	Replenished	06/19/2023	1002234814	3137091283
False	9413497		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	06	05/18/2023	05/18/2023	05/19/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	20	22.22200	Replenished	05/22/2023	1002221811	3134071093
False	9295675		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797734	MR00157951	00	05/03/2023	05/03/2023	05/04/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	80	88.88900	Replenished	05/22/2023	1002221811	3134071093
False	9166408		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793575	MR00117446	05	04/19/2023	04/19/2023	04/20/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	90	100.00000	Replenished	05/08/2023	1002213418	3132524753
False	9276559		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797734	MR00157951	00	05/03/2023	05/03/2023	05/04/2023	68001041200	GABAPENTIN 800 MG TABLET	800 MG	TABLET	100	90	10	11.11100	Replenished	05/08/2023	1002213418	3132524753