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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
2933879
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779466
MR00086036
00
01/26/2021
01/26/2021
01/27/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
30
100.00000
Replenished
1001849752
3054181639
False
2988201
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779466
MR00086036
01
02/24/2021
02/24/2021
02/25/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
30
100.00000
Replenished
1001849752
3054181639
False
3166391
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779466
MR00086036
02
03/24/2021
03/24/2021
03/25/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
30
100.00000
Replenished
1001849752
3054181639
False
3433678
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779466
MR00086036
03
04/27/2021
04/27/2021
04/28/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
10
33.33300
Replenished
1001849752
3054181639
False
3438514
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779466
MR00086036
03
04/27/2021
04/27/2021
04/28/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
20
66.66700
Replenished
1001902816
3064329315
False
3577391
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781626
MR00086036
00
05/17/2021
05/17/2021
05/18/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
30
100.00000
Replenished
1001902816
3064329315
False
3988913
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783097
MR00086036
00
07/06/2021
07/06/2021
07/07/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
30
100.00000
Replenished
1001902816
3064329315
False
4245924
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783950
MR00086036
00
08/10/2021
08/10/2021
08/11/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
10
33.33300
Replenished
1001973568
3076863124
False
4237817
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783950
MR00086036
00
08/10/2021
08/10/2021
08/11/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
20
66.66700
Replenished
1001902816
3064329315
False
4505255
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784704
MR00086036
00
09/13/2021
09/13/2021
09/14/2021
00046110081
PREMARIN 0.3 MG TABLET
0.3 MG
TABLET
100
30
30
100.00000
Replenished
1001973568
3076863124