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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	10180327		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794836	MR00108206	03	08/17/2023	08/17/2023	08/18/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	90	90	100.00000	Replenished	08/21/2023	1002260563	3144082982
False	10158161		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799710	MR00073260	00	08/14/2023	08/14/2023	08/15/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	180	70	38.88800	Replenished	08/21/2023	1002260563	3144082982
False	10185470		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799777	MR00205174	00	08/17/2023	08/17/2023	08/18/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	60	10	16.66700	Replenished	08/21/2023	1002260563	3144082982
False	10180317		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799777	MR00205174	00	08/17/2023	08/17/2023	08/18/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	60	30	50.00000	Replenished	08/21/2023	1002260563	3144082982
False	9956813		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798370	MR00064924	01	07/15/2023	07/15/2023	07/16/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	90	30	33.33300	Replenished	08/16/2023	1002259761	3143593678
False	10052113		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798928	MR00195463	01	07/31/2023	07/31/2023	08/01/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	30	30	100.00000	Replenished	08/16/2023	1002259761	3143593678
False	10028402		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799401	MR00317585	00	07/27/2023	07/27/2023	07/28/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	30	30	100.00000	Replenished	08/16/2023	1002259761	3143593678
False	10154867		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799710	MR00073260	00	08/14/2023	08/14/2023	08/15/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	180	10	5.55600	Replenished	08/16/2023	1002259761	3143593678
False	10158160		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799710	MR00073260	00	08/14/2023	08/14/2023	08/15/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	180	100	55.55600	Replenished	08/16/2023	1002259761	3143593678
False	9953481		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793580	MR00117446	09	07/14/2023	07/14/2023	07/16/2023	65162010110	GABAPENTIN 100 MG CAPSULE	100 MG	CAPSULE	100	90	40	44.44400	Replenished	08/22/2023	1002248167	3140221892