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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
3502093
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781770
MR00030324
00
05/07/2021
05/07/2021
05/08/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001855254
3055135221
False
3783970
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781770
MR00030324
01
06/17/2021
06/17/2021
06/18/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001876050
3059092759
False
2948695
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777952
MR00055148
03
02/15/2021
02/15/2021
02/16/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001811232
987509358
False
3151665
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780669
MR00055148
00
03/22/2021
03/22/2021
03/23/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001830087
3050733659
False
3390992
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781366
MR00055148
00
04/21/2021
04/21/2021
04/22/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001846719
3053644954
False
3964690
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781366
MR00055148
02
06/14/2021
06/14/2021
07/02/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001884798
3060456967
False
4086960
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783435
MR00055148
00
07/20/2021
07/20/2021
07/21/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001891615
3062304712
False
4313007
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784137
MR00055148
00
08/18/2021
08/18/2021
08/19/2021
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1001906178
3065115185
False
5901048
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787686
MR00055148
01
02/17/2022
02/17/2022
03/19/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002021108
3086983194
False
5878807
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787686
MR00055148
02
03/17/2022
03/17/2022
03/18/2022
00006027731
JANUVIA 100 MG TABLET
100 MG
TABLET
30
30
30
100.00000
Replenished
1002020474
3086983191