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			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	10261531		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799916	MR00198270	00	08/26/2023	08/26/2023	08/28/2023	00002150680	MOUNJARO 2.5 MG/0.5 ML PEN	2.5 MG/0.5	PEN INJCTR	2	2	2	100.00000	Replenished	08/29/2023	1002263471	3145042172