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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
7910158
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794429
MR00340768
00
11/23/2022
11/26/2022
11/27/2022
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
30
30
100.00000
Replenished
1002139940
3113875440
False
8475159
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794429
MR00340768
02
02/01/2023
02/01/2023
02/02/2023
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
30
30
100.00000
Replenished
1002170239
3122206378
False
9065576
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797184
MR00116621
00
04/07/2023
04/07/2023
04/08/2023
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
15
15
100.00000
Replenished
05/08/2023
1002213418
3132524753
False
9276491
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797184
MR00116621
01
05/01/2023
05/01/2023
05/04/2023
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
15
15
100.00000
Replenished
05/08/2023
1002213418
3132524753
False
9562796
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798331
MR00116621
00
06/02/2023
06/02/2023
06/03/2023
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
15
15
100.00000
Replenished
06/15/2023
1002234244
3136767437
False
9661711
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798505
MR00116621
00
06/13/2023
06/13/2023
06/14/2023
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
30
15
50.00000
Replenished
06/15/2023
1002234244
3136767437
False
9669249
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798505
MR00116621
00
06/13/2023
06/13/2023
06/14/2023
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
30
15
50.00000
Replenished
08/14/2023
1002254688
3143269122
False
10118255
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799674
MR00116621
00
08/10/2023
08/10/2023
08/11/2023
16729032110
OLMESARTAN MEDOXOMIL 20 MG TAB
20 MG
TABLET
30
30
15
50.00000
Replenished
08/14/2023
1002254688
3143269122