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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
3440633
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000773883
MR00389371
03
04/28/2021
04/28/2021
04/28/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
90
30
33.33300
Replenished
1001850290
3054303929
False
3447149
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000773883
MR00389371
03
04/28/2021
04/28/2021
04/28/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
90
30
33.33300
Replenished
1001850290
3054303929
False
3447150
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000773883
MR00389371
03
04/28/2021
04/28/2021
04/28/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
90
30
33.33400
Replenished
1001850290
3054303929
False
2948695
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777952
MR00055148
03
02/15/2021
02/15/2021
02/16/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001811232
987509358
False
6110297
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787686
MR00055148
03
04/16/2022
04/16/2022
04/17/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002036889
3089903742
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
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
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
3964690
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781366
MR00055148
02
06/14/2021
06/14/2021
07/02/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001884798
3060456967
False
5878807
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787686
MR00055148
02
03/17/2022
03/17/2022
03/18/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002020474
3086983191