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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
4187543
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783696
MR00229039
00
08/02/2021
08/02/2021
08/03/2021
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
1001899045
3063437222
False
5258291
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787149
MR00229039
00
12/23/2021
12/23/2021
12/24/2021
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
1001978209
3078024705
False
9375331
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790395
MR00124995
02
05/15/2023
05/15/2023
05/16/2023
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
05/18/2023
1002221191
3133750055
False
6416991
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790562
MR00229039
00
05/27/2022
05/27/2022
05/28/2022
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
1002058998
3094409889
False
7738861
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793967
MR00229039
00
11/03/2022
11/03/2022
11/05/2022
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
1002129142
3111671677
False
8913114
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796867
MR00229039
00
03/22/2023
03/22/2023
03/23/2023
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
1002194556
3127701430
False
10041575
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799448
MR00229039
00
07/28/2023
07/28/2023
07/29/2023
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
08/22/2023
1002251766
3141657239
False
7673370
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790395
MR00124995
01
10/27/2022
10/27/2022
10/28/2022
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
94
52.22200
Replenished
1002129142
3111671677
False
7667171
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790395
MR00124995
01
10/27/2022
10/27/2022
10/28/2022
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
86
47.77800
Replenished
1002126984
3110896803
False
7430103
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793086
MR00122860
00
09/26/2022
09/26/2022
09/27/2022
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
90
84
93.33300
Replenished
1002113582
3107872087