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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	7100632		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792165	MR00331064	00	08/12/2022	08/12/2022	08/13/2022	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	30	30	100.00000	Replenished		1002109429	3106829729
False	7317820		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792165	MR00331064	01	09/12/2022	09/12/2022	09/13/2022	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	30	30	100.00000	Replenished		1002109429	3106829729
False	7573169		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792165	MR00331064	02	10/15/2022	10/15/2022	10/16/2022	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	30	30	100.00000	Replenished		1002160851	3118886767
False	7372710		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792982	MR00188111	00	09/20/2022	09/20/2022	09/21/2022	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	90	40	44.44400	Replenished		1002109429	3106829729
False	7378991		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792982	MR00188111	00	09/20/2022	09/20/2022	09/21/2022	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	90	50	55.55600	Replenished		1002122389	3109361369
False	7569709		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793535	MR00192351	00	10/13/2022	10/13/2022	10/14/2022	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	90	40	44.44400	Replenished		1002160851	3118886767
False	7562618		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793535	MR00192351	00	10/13/2022	10/13/2022	10/14/2022	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	90	50	55.55600	Replenished		1002122389	3109361369
False	8240975		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795275	MR00192351	00	01/05/2023	01/05/2023	01/06/2023	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	90	30	33.33300	Replenished		1002160851	3118886767
False	8247387		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795275	MR00192351	00	01/05/2023	01/05/2023	01/06/2023	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	90	60	66.66700	Replenished		1002187584	3126302342
False	9133518		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795275	MR00192351	01	04/14/2023	04/14/2023	04/15/2023	72578009001	TRIAMTERENE-HCTZ 37.5-25 MG CP	37.5-25 MG	CAPSULE	100	90	40	44.44400	Replenished	06/12/2023	1002232577	3136303178