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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
9276578
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795948
MR00055148
03
05/04/2023
05/04/2023
05/05/2023
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
05/08/2023
1002213418
3132524753
False
9115837
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795948
MR00055148
02
04/11/2023
04/11/2023
04/13/2023
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
04/17/2023
1002207066
3130202878
False
8784343
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795948
MR00055148
01
03/08/2023
03/08/2023
03/09/2023
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002186410
3126119732
False
8514200
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795948
MR00055148
00
02/07/2023
02/07/2023
02/08/2023
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002175801
3122701271
False
8231175
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793417
MR00055148
03
01/04/2023
01/04/2023
01/05/2023
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002160525
3118886765
False
8008723
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793417
MR00055148
02
12/08/2022
12/08/2022
12/09/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002147534
3115655014
False
7761433
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793417
MR00055148
01
11/08/2022
11/08/2022
11/09/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002130060
3112131940
False
7522486
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793417
MR00055148
00
10/10/2022
10/10/2022
10/11/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002120077
3108911610
False
7278617
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790640
MR00055148
03
09/06/2022
09/06/2022
09/09/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002102296
3105614642
False
7013557
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790640
MR00055148
02
08/01/2022
08/01/2022
08/02/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002086492
3101518230