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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
7890398
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794454
MR00356943
00
11/23/2022
11/23/2022
11/24/2022
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
6
2
33.33300
Replenished
1002163795
3119751774
False
8493331
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
3
10.00000
Replenished
1002181581
3124681384
False
8423286
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795734
MR00018239
00
01/26/2023
01/26/2023
01/27/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
20
3
15.00000
Replenished
1002170585
3122206860
False
8663272
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
3
10.00000
Replenished
1002185583
3125815325
False
8771328
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
3
10.00000
Replenished
1002194250
3127552216
False
8901516
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
3
10.00000
Replenished
1002199093
3129254774
False
9047109
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
3
10.00000
Replenished
05/04/2023
1002212865
3132056302
False
9217210
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
3
10.00000
Replenished
05/08/2023
1002213772
3132524754
False
9306857
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797685
MR00043501
00
05/05/2023
05/05/2023
05/06/2023
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
30
3
10.00000
Replenished
05/26/2023
1002223394
3134652724
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