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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
10187855
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799806
MR00209146
00
08/18/2023
08/18/2023
08/19/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
08/21/2023
1002260861
3144082983
False
10085754
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
3
5.00000
Replenished
08/21/2023
1002260861
3144082983
False
10080804
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
27
45.00000
Replenished
08/22/2023
1002253366
3142468423
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
9880168
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
3
5.00000
Replenished
08/22/2023
1002253366
3142468423
False
9873270
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
27
45.00000
Replenished
08/22/2023
1002244869
3139279459
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
9758100
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798726
MR00043501
00
06/22/2023
06/22/2023
06/23/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
3
10.00000
Replenished
08/22/2023
1002244869
3139279459
False
9752351
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798726
MR00043501
00
06/22/2023
06/22/2023
06/23/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
27
90.00000
Replenished
06/26/2023
1002236912
3137855546
False
9475896
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798154
MR00043501
00
05/24/2023
05/24/2023
05/25/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
3
10.00000
Replenished
06/08/2023
1002227496
3135977002