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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
3440613
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777662
MR00389011
00
04/28/2021
04/28/2021
04/29/2021
56151081350
TRUETRACK GLUCOSE TEST STRIPS
STRIP
50
100
50
50.00000
Replenished
1001850290
3054303927
False
3447154
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777662
MR00389011
00
04/28/2021
04/28/2021
04/29/2021
56151081350
TRUETRACK GLUCOSE TEST STRIPS
STRIP
50
100
50
50.00000
Replenished
1001850290
3054303927
False
4266476
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777662
MR00389011
01
08/13/2021
08/13/2021
08/14/2021
56151081350
TRUETRACK GLUCOSE TEST STRIPS
STRIP
50
100
50
50.00000
Replenished
1001903802
3064589181
False
4272188
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777662
MR00389011
01
08/13/2021
08/13/2021
08/14/2021
56151081350
TRUETRACK GLUCOSE TEST STRIPS
STRIP
50
100
50
50.00000
Replenished
1001903802
3064589181
False
4968726
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786255
MR00389011
00
11/16/2021
11/16/2021
11/17/2021
56151081350
TRUETRACK GLUCOSE TEST STRIPS
STRIP
50
100
50
50.00000
Replenished
1001960301
3074163361
False
4974705
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786255
MR00389011
00
11/16/2021
11/16/2021
11/17/2021
56151081350
TRUETRACK GLUCOSE TEST STRIPS
STRIP
50
100
50
50.00000
Replenished
1001960301
3074163361