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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
7255804
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792651
MR00389116
00
09/02/2022
09/02/2022
09/03/2022
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
64
4
6.25000
Replenished
1002100333
3104971542
False
7260634
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792651
MR00389116
00
09/02/2022
09/02/2022
09/03/2022
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
64
60
93.75000
Replenished
1002102488
3105614645
False
8156704
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795094
MR00358244
00
12/27/2022
12/27/2022
12/28/2022
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
1002178117
3123055057
False
9115872
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797248
MR00358244
00
04/11/2023
04/11/2023
04/13/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9686047
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797248
MR00358244
01
06/15/2023
06/15/2023
06/16/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
5677968
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788382
MR00340493
00
02/17/2022
02/17/2022
02/18/2022
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
20
7
35.00000
Replenished
1002076632
3098638591
False
5672705
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788382
MR00340493
00
02/17/2022
02/17/2022
02/18/2022
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
20
13
65.00000
Replenished
1002008101
3084006370
False
8728077
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796457
MR00315442
00
03/02/2023
03/02/2023
03/03/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
1002194250
3127552216
False
9035379
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797098
MR00315442
00
04/04/2023
04/04/2023
04/05/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
1001773574
False
8566687
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796020
MR00311967
00
02/09/2023
02/09/2023
02/11/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
2
9.52400
Replenished
1002194250
3127552216