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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
4585054
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778387
MR00288026
03
09/16/2021
09/23/2021
09/24/2021
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33300
Replenished
1001927749
3068767552
False
4590029
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778387
MR00288026
03
09/16/2021
09/23/2021
09/24/2021
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33300
Replenished
1001927749
3068767552
False
4590030
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778387
MR00288026
03
09/16/2021
09/23/2021
09/24/2021
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33400
Replenished
1001927749
3068767552
False
6194861
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787577
MR00288026
01
04/28/2022
04/28/2022
04/29/2022
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33300
Replenished
1002043831
3091402520
False
6200871
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787577
MR00288026
01
04/28/2022
04/28/2022
04/29/2022
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33300
Replenished
1002043831
3091402520
False
6200872
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787577
MR00288026
01
04/28/2022
04/28/2022
04/29/2022
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33400
Replenished
1002043831
3091402520
False
6884046
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791531
MR00288026
00
07/14/2022
07/14/2022
07/15/2022
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33300
Replenished
1002080842
3099576536
False
6890273
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791531
MR00288026
00
07/14/2022
07/14/2022
07/15/2022
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33300
Replenished
1002080842
3099576536
False
6890274
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791531
MR00288026
00
07/14/2022
07/14/2022
07/15/2022
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33400
Replenished
1002080842
3099576536
False
7528327
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791531
MR00288026
01
10/11/2022
10/11/2022
10/12/2022
43547034206
RISPERIDONE 2 MG TABLET
2 MG
TABLET
60
180
60
33.33300
Replenished
1002120414
3109055000