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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
3026230
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000780290
MR00361721
00
03/02/2021
03/02/2021
03/02/2021
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
30
100.00000
Replenished
1001819785
3048855808
False
3734542
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782547
MR00154246
00
06/09/2021
06/09/2021
06/10/2021
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
60
30
50.00000
Replenished
1001872170
3058237732
False
9880167
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798995
MR00043501
00
07/06/2023
07/06/2023
07/07/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
60
30
50.00000
Replenished
08/22/2023
1002244869
3139279459
False
10085753
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799531
MR00043501
00
08/04/2023
08/04/2023
08/05/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
60
30
50.00000
Replenished
08/22/2023
1002253366
3142468423
False
8485415
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795022
MR00043501
03
02/03/2023
02/03/2023
02/04/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
1002170585
3122206860
False
8657240
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796292
MR00043501
00
02/23/2023
02/23/2023
02/24/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
1002181581
3124681384
False
8765238
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796292
MR00043501
01
03/06/2023
03/06/2023
03/07/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
1002185583
3125815325
False
8893516
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796292
MR00043501
02
03/21/2023
03/21/2023
03/22/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
1002194250
3127552216
False
9035399
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796292
MR00043501
03
04/04/2023
04/04/2023
04/05/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
1002199093
3129254774
False
9209523
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797510
MR00043501
00
04/24/2023
04/24/2023
04/25/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
05/04/2023
1002212865
3132056302