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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	2963037		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775608	MR00112843	02	02/18/2021	02/18/2021	02/19/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	40	44.44400	Replenished		1001814475	987756775
False	2966260		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775608	MR00112843	02	02/18/2021	02/18/2021	02/19/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	50	55.55600	Replenished		1001823796	3049396293
False	2934198		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777647	MR00087628	01	02/01/2021	02/01/2021	02/02/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	10	11.11100	Replenished		1001811232	987509358
False	2934197		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777647	MR00087628	01	02/01/2021	02/01/2021	02/02/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	20	22.22200	Replenished		1001805758
False	2951949		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777647	MR00087628	01	02/01/2021	02/01/2021	02/02/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	60	66.66700	Replenished		1001814475	987756775
False	3462869		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777647	MR00087628	02	04/29/2021	04/29/2021	04/30/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	10	11.11100	Replenished		1001861596	3056318148
False	3455998		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777647	MR00087628	02	04/29/2021	04/29/2021	04/30/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	80	88.88900	Replenished		1001850989	3054468652
False	3212008		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778716	MR00195504	01	03/30/2021	03/30/2021	03/31/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	30	33.33300	Replenished		1001838628	3052278967
False	3207032		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778716	MR00195504	01	03/30/2021	03/30/2021	03/31/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	60	66.66700	Replenished		1001835056	3051528184
False	2934196		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779844	MR00177615	00	02/11/2021	02/11/2021	02/12/2021	68001035800	METOPROLOL SUCC ER 100 MG TAB	100 MG	TAB.SR 24H	100	90	90	100.00000	Replenished		1001811232	987509358