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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
9803667
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798853
MR00283017
00
06/28/2023
06/28/2023
06/29/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
49
54.44400
Replenished
06/30/2023
1002238934
3138442989
False
9787443
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798772
MR00368660
00
06/26/2023
06/26/2023
06/27/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
9
30.00000
Replenished
06/28/2023
1002238348
3138156842
False
9790075
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798772
MR00368660
00
06/26/2023
06/26/2023
06/27/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
21
70.00000
Replenished
06/30/2023
1002238934
3138442989
False
9760657
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798766
MR00233748
00
06/23/2023
06/23/2023
06/24/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9728639
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798670
MR00287658
00
06/20/2023
06/20/2023
06/21/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9482447
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798184
MR00018670
00
05/25/2023
05/25/2023
05/26/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9793587
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798184
MR00018670
01
06/27/2023
06/27/2023
06/28/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/30/2023
1002238934
3138442989
False
9451141
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798091
MR00233748
00
05/22/2023
05/22/2023
05/23/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
05/30/2023
1002224253
3134810060
False
9375349
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797910
MR00368660
00
05/12/2023
05/12/2023
05/16/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
05/24/2023
1002222847
3134351839
False
9209515
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797543
MR00233748
00
04/25/2023
04/25/2023
04/26/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
05/08/2023
1002213772
3132524754