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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
4147191
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777474
MR00174136
03
07/28/2021
07/28/2021
07/29/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
90
5
5.55600
Replenished
1001897770
3062993331
False
4153946
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777474
MR00174136
03
07/28/2021
07/28/2021
07/29/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
90
85
94.44400
Replenished
1001906178
3065115185
False
2934324
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777814
MR00030549
03
02/11/2021
02/11/2021
02/12/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
30
30
100.00000
Replenished
1001830991
3050869519
False
3608358
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779871
MR00298017
03
05/21/2021
05/21/2021
05/22/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
15
15
100.00000
Replenished
1001880371
3059776595
False
4640899
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782804
MR00298017
03
10/01/2021
10/01/2021
10/02/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
15
15
100.00000
Replenished
1001951777
3072578295
False
2934327
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772286
MR00256137
02
01/15/2021
01/15/2021
01/16/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
90
5
5.55600
Replenished
1001835626
3051655272
False
2934326
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772286
MR00256137
02
01/15/2021
01/15/2021
01/16/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
90
85
94.44400
Replenished
1001797497
False
3462851
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777474
MR00174136
02
04/30/2021
04/30/2021
05/01/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
90
10
11.11100
Replenished
1001860966
3056169530
False
3456004
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777474
MR00174136
02
04/30/2021
04/30/2021
05/01/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
90
80
88.88900
Replenished
1001850989
3054468652
False
3378841
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779871
MR00298017
02
04/19/2021
04/19/2021
04/20/2021
00378023101
ATENOLOL 50 MG TABLET
50 MG
TABLET
100
15
15
100.00000
Replenished
1001850989
3054468652