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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
6148773
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789705
MR00250558
00
04/21/2022
04/21/2022
04/22/2022
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
30
30
100.00000
Replenished
1002077877
3098828686
False
6846132
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789705
MR00250558
01
07/08/2022
07/08/2022
07/09/2022
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
30
5
16.66700
Replenished
1002167937
3121218016
False
6840641
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789705
MR00250558
01
07/08/2022
07/08/2022
07/09/2022
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
30
25
83.33300
Replenished
1002077877
3098828686
False
6235972
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789846
MR00250558
00
05/04/2022
05/04/2022
05/05/2022
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
45
45
100.00000
Replenished
1002077877
3098828686
False
8405255
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789846
MR00250558
01
01/25/2023
01/25/2023
01/26/2023
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
45
5
11.11100
Replenished
1002167937
3121218016
False
8412368
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789846
MR00250558
01
01/25/2023
01/25/2023
01/26/2023
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
45
40
88.88900
Replenished
1002196370
3128329091
False
7079340
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791161
MR00250558
00
08/10/2022
08/10/2022
08/11/2022
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
45
45
100.00000
Replenished
1002167937
3121218016
False
7750790
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791161
MR00250558
01
11/07/2022
11/07/2022
11/08/2022
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
45
45
100.00000
Replenished
1002167937
3121218016
False
8951428
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796961
MR00195463
00
03/28/2023
03/28/2023
03/29/2023
00832054211
BUMETANIDE 2 MG TABLET
2 MG
TABLET
100
60
60
100.00000
Replenished
1002196370
3128329091