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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
2934128
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011187
MR00092991
00
02/02/2021
02/02/2021
02/03/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
50
41.66700
Replenished
1001806279
False
2934129
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011187
MR00092991
00
02/02/2021
02/02/2021
02/03/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
70
58.33300
Replenished
1001811232
987509357
False
2951915
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011252
MR00389170
00
02/10/2021
02/10/2021
02/11/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
105
30
28.57100
Replenished
1001811232
987509357
False
2951916
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011252
MR00389170
00
02/10/2021
02/10/2021
02/11/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
105
35
33.33400
Replenished
1001812276
987651856
False
2934127
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011252
MR00389170
00
02/10/2021
02/10/2021
02/11/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
105
40
38.09500
Replenished
1001811232
987509357
False
2934126
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011258
MR00072992
00
02/12/2021
02/12/2021
02/13/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
60
60
100.00000
Replenished
1001811232
987509357
False
2961662
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011266
MR00208636
00
02/17/2021
02/17/2021
02/18/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
90
25
27.77800
Replenished
1001814818
987756776
False
2958373
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011266
MR00208636
00
02/17/2021
02/17/2021
02/18/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
90
65
72.22200
Replenished
1001812276
987651856
False
2971483
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011275
MR00062075
00
02/19/2021
02/19/2021
02/20/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
45
37.50000
Replenished
1001839075
3052306185
False
2967682
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011275
MR00062075
00
02/19/2021
02/19/2021
02/20/2021
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
75
62.50000
Replenished
1001814818
987756776