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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
3734546
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778427
MR00264032
02
06/09/2021
06/09/2021
06/10/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
30
33.33300
Replenished
1001872664
3058406459
False
3729036
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778427
MR00264032
02
06/09/2021
06/09/2021
06/10/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
60
66.66700
Replenished
1001872170
3058237732
False
3753318
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780286
MR00152715
03
06/12/2021
06/12/2021
06/13/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1001874393
3058663336
False
3678001
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781697
MR00340166
01
06/02/2021
06/02/2021
06/03/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1001872170
3058237732
False
3742734
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782582
MR00390554
00
06/10/2021
06/10/2021
06/11/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
30
33.33300
Replenished
1001874393
3058663336
False
3737015
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782582
MR00390554
00
06/10/2021
06/10/2021
06/11/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
60
66.66700
Replenished
1001872664
3058406459
False
3760394
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782626
MR00333515
00
06/14/2021
06/14/2021
06/15/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
90
100.00000
Replenished
1001874393
3058663336
False
3760361
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782648
MR00195504
00
06/14/2021
06/14/2021
06/15/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
30
33.33300
Replenished
1001874393
3058663336
False
3764189
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782648
MR00195504
00
06/14/2021
06/14/2021
06/15/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
60
66.66700
Replenished
1001970299
3076236282
False
5125973
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785300
MR00340166
02
12/07/2021
12/07/2021
12/08/2021
16729000615
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1001970299
3076236282