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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	2934164		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775156	MR00044366	02	01/29/2021	01/29/2021	01/30/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	90	6	6.66700	Replenished		1001814818	987756777
False	2934163		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775156	MR00044366	02	01/29/2021	01/29/2021	01/30/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	90	84	93.33300	Replenished		1001803996
False	2934162		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000777641	MR00164691	00	02/12/2021	02/12/2021	02/13/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	90	90	100.00000	Replenished		1001811232	987509358
False	2934161		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779863	MR00155501	00	02/12/2021	02/12/2021	02/13/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	90	90	100.00000	Replenished		1001811232	987509358
False	2948708		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779906	MR00293789	00	02/15/2021	02/15/2021	02/16/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	15	15	100.00000	Replenished		1001814818	987756777
False	2963018		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780009	MR00386472	00	02/18/2021	02/18/2021	02/19/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	30	30	100.00000	Replenished		1001814818	987756777
False	2971485		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778742	MR00389484	01	02/19/2021	02/19/2021	02/20/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	60	21	35.00000	Replenished		1001819785	3048855808
False	2967707		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778742	MR00389484	01	02/19/2021	02/19/2021	02/20/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	60	39	65.00000	Replenished		1001814818	987756777
False	2976608		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780076	MR00165004	00	02/22/2021	02/22/2021	02/23/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	45	45	100.00000	Replenished		1001819785	3048855808
False	3031635		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780283	MR00037445	00	03/02/2021	03/02/2021	03/03/2021	60505257909	ATORVASTATIN 20 MG TABLET	20 MG	TABLET	90	30	6	20.00000	Replenished		1001823796	3049396293