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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
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
7897038
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
4
66.66700
Replenished
1002161832
3119403854
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
6646550
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791022
MR00170923
00
06/21/2022
06/21/2022
06/22/2022
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
10
10
100.00000
Replenished
1002163795
3119751774
False
3729015
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
24
40.00000
Replenished
1001872170
3058237732
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
3207031
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780896
MR00097732
00
03/30/2021
03/30/2021
03/31/2021
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
6
6
100.00000
Replenished
1001872170
3058237732
False
5837542
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788837
MR00043501
00
03/10/2022
03/10/2022
03/11/2022
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
6
6
100.00000
Replenished
1002163795
3119751774
False
5916748
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789041
MR00043501
00
03/21/2022
03/21/2022
03/22/2022
00591256230
COLCHICINE 0.6 MG TABLET
0.6 MG
TABLET
30
6
6
100.00000
Replenished
1002163795
3119751774