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Health Center:
Memorial Hospital
Pharmacy:
Trapp Pharmacy (#1)
Capture Date :
To:
Fetching results...
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
7890382
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793539
MR00097732
00
11/14/2022
11/14/2022
11/24/2022
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
1002142535
3114755271
False
8097460
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793539
MR00097732
01
12/17/2022
12/17/2022
12/19/2022
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
1002151208
3116741985
False
8345432
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793539
MR00097732
02
01/17/2023
01/17/2023
01/19/2023
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
1002169832
3121860284
False
8581300
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793539
MR00097732
03
02/13/2023
02/13/2023
02/15/2023
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
1002178976
3123538684
False
8867495
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793539
MR00097732
04
03/16/2023
03/16/2023
03/19/2023
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
1002193454
3127106974
False
9129103
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793539
MR00097732
05
04/13/2023
04/13/2023
04/15/2023
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
04/17/2023
1002208015
3130203110
False
9397962
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793539
MR00097732
06
05/09/2023
05/09/2023
05/18/2023
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
05/19/2023
1002221549
3133876132
False
9772079
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798602
MR00097732
00
06/15/2023
06/15/2023
06/25/2023
00169477212
OZEMPIC 2 MG/DOSE (8 MG/3 ML)
2MG/0.75ML
PEN INJCTR
3
3
3
100.00000
Replenished
06/26/2023
1002237426
3137855548