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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
7495108
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793341
MR00182534
00
10/05/2022
10/06/2022
10/07/2022
45802005535
TRIAMCINOLONE 0.1% OINTMENT
0.1 %
OINT.(GM)
15
15
15
100.00000
Replenished
1002119084
3108617904
False
7528309
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793471
MR00250558
00
10/11/2022
10/11/2022
10/12/2022
45802005535
TRIAMCINOLONE 0.1% OINTMENT
0.1 %
OINT.(GM)
15
30
15
50.00000
Replenished
1002120414
3109055000
False
7536757
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793471
MR00250558
00
10/11/2022
10/11/2022
10/12/2022
45802005535
TRIAMCINOLONE 0.1% OINTMENT
0.1 %
OINT.(GM)
15
30
15
50.00000
Replenished
1002120414
3109055000