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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
3126211
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778392
MR00369135
01
03/16/2021
03/16/2021
03/17/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
15
16.66700
Replenished
1001832780
3051158401
False
3120305
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778392
MR00369135
01
03/16/2021
03/16/2021
03/17/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
75
83.33300
Replenished
1001827193
3050193216
False
3820757
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778392
MR00369135
02
06/22/2021
06/22/2021
06/23/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
35
38.88900
Replenished
1001883113
3060162693
False
3813460
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778392
MR00369135
02
06/22/2021
06/22/2021
06/23/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
55
61.11100
Replenished
1001878574
3059465018
False
3260672
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778664
MR00018205
01
04/05/2021
04/05/2021
04/07/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
15
16.66700
Replenished
1001838628
3052278967
False
3266031
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778664
MR00018205
01
04/05/2021
04/05/2021
04/07/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
75
83.33300
Replenished
1001842172
3052723058
False
3993651
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778664
MR00018205
02
07/06/2021
07/06/2021
07/07/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
5
5.55600
Replenished
1001906780
3065449437
False
3993650
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778664
MR00018205
02
07/06/2021
07/06/2021
07/07/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
10
11.11100
Replenished
1001906780
3065449437
False
3988903
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778664
MR00018205
02
07/06/2021
07/06/2021
07/07/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
75
83.33300
Replenished
1001906780
3065449437
False
2951962
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779685
MR00152715
00
02/05/2021
02/05/2021
02/06/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
5
16.66700
Replenished
1001819785
3048855808