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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	7079331		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	11	08/10/2022	08/10/2022	08/11/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished		1002114625	3108158138
False	6855208		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	10	07/11/2022	07/11/2022	07/12/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	10	33.33300	Replenished		1002078923	3099104399
False	6859338		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	10	07/11/2022	07/11/2022	07/12/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	20	66.66700	Replenished		1002114625	3108158138
False	6505405		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	09	06/08/2022	06/08/2022	06/10/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished		1002078923	3099104399
False	6293950		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	08	05/11/2022	05/11/2022	05/12/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished		1002078923	3099104399
False	6036083		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	07	04/07/2022	04/07/2022	04/08/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished		1002078923	3099104399
False	5837531		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	06	03/10/2022	03/10/2022	03/11/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished		1002018450	3086242545
False	9544243		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794623	MR00195463	06	05/30/2023	05/30/2023	06/01/2023	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished	06/05/2023	1002226246	3135522746
False	5605436		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784781	MR00195463	05	02/09/2022	02/09/2022	02/10/2022	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished		1002018450	3086242545
False	9276472		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794623	MR00195463	05	05/01/2023	05/01/2023	05/04/2023	51672403901	ENALAPRIL MALEATE 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished	06/05/2023	1002226246	3135522746