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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
3485909
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777309
MR00074834
06
04/16/2021
04/16/2021
05/06/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001864958
3056990723
False
3549252
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777309
MR00074834
07
05/13/2021
05/13/2021
05/14/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001863343
3056588488
False
3746036
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777309
MR00074834
08
06/11/2021
06/11/2021
06/12/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001879330
3059650533
False
4040660
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777309
MR00074834
09
07/13/2021
07/13/2021
07/14/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001892297
3062473633
False
4266487
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777309
MR00074834
10
08/13/2021
08/13/2021
08/14/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001906178
3065115185
False
4505289
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777309
MR00074834
11
09/13/2021
09/13/2021
09/14/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001927749
3068767552
False
2976618
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777646
MR00087628
01
02/22/2021
02/22/2021
02/23/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
90
30
33.33300
Replenished
1001816056
987916714
False
2978589
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777646
MR00087628
01
02/22/2021
02/22/2021
02/23/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
90
60
66.66700
Replenished
1001818667
988063364
False
2967692
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778846
MR00043501
01
01/28/2021
01/28/2021
02/20/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001814818
987756777
False
2972724
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778846
MR00043501
02
02/20/2021
02/20/2021
02/21/2021
68180047902
SIMVASTATIN 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1001816056
987916714