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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
2958374
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775876
MR00177844
05
02/17/2021
02/17/2021
02/18/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
30
30
100.00000
Replenished
1001822785
3049139689
False
3110966
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775876
MR00177844
06
03/15/2021
03/15/2021
03/16/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
30
30
100.00000
Replenished
1001830087
3050733659
False
2934207
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778350
MR00389371
00
12/07/2020
12/07/2020
12/08/2020
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
40
44.44400
Replenished
1001777031
False
2934208
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778350
MR00389371
00
12/07/2020
12/07/2020
12/08/2020
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
50
55.55600
Replenished
1001822785
3049139689
False
3048355
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778350
MR00389371
01
03/05/2021
03/05/2021
03/06/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
20
22.22200
Replenished
1001822785
3049139689
False
3052152
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778350
MR00389371
01
03/05/2021
03/05/2021
03/06/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
70
77.77800
Replenished
1001825961
3049810904
False
3080843
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780524
MR00051318
00
03/12/2021
03/12/2021
03/13/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
60
30
50.00000
Replenished
1001825961
3049810904
False
3087800
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780524
MR00051318
00
03/12/2021
03/12/2021
03/13/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
60
30
50.00000
Replenished
1001830087
3050733659
False
3151643
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780678
MR00107755
00
03/22/2021
03/22/2021
03/23/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
40
44.44400
Replenished
1001830087
3050733659
False
3157464
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780678
MR00107755
00
03/22/2021
03/22/2021
03/23/2021
00378021801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
50
55.55600
Replenished
1001841063
3052473905