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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
2933826
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775745
MR00289972
00
11/14/2020
11/14/2020
11/15/2020
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
360
40
11.11100
Replenished
1001765042
False
2933828
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775745
MR00289972
00
11/14/2020
11/14/2020
11/15/2020
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
360
100
27.77700
Replenished
1001765042
False
2933829
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775745
MR00289972
00
11/14/2020
11/14/2020
11/15/2020
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
360
100
27.77800
Replenished
1001765042
False
2933830
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775745
MR00289972
00
11/14/2020
11/14/2020
11/15/2020
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
360
100
27.77800
Replenished
1001765042
False
7068454
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792016
MR00117446
00
08/09/2022
08/09/2022
08/10/2022
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
90
90
100.00000
Replenished
1002102296
3105614642
False
7278661
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792706
MR00117446
00
09/06/2022
09/06/2022
09/09/2022
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
90
10
11.11100
Replenished
1002102296
3105614642
False
7282278
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792706
MR00117446
00
09/06/2022
09/06/2022
09/09/2022
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
90
80
88.88900
Replenished
1002114625
3108158138
False
7470763
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792706
MR00117446
01
10/03/2022
10/03/2022
10/04/2022
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
90
20
22.22200
Replenished
1002114625
3108158138
False
7474289
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792706
MR00117446
01
10/03/2022
10/03/2022
10/04/2022
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
90
70
77.77800
Replenished
1002128232
3111347420
False
7700830
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793575
MR00117446
00
11/01/2022
11/01/2022
11/02/2022
68001041200
GABAPENTIN 800 MG TABLET
800 MG
TABLET
100
90
30
33.33300
Replenished
1002128232
3111347420