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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
9397852
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
03
05/09/2023
05/09/2023
05/18/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
05/19/2023
1002221549
3133876132
False
9406141
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
03
05/09/2023
05/09/2023
05/18/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
05/19/2023
1002221549
3133876132
False
9087353
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
02
04/10/2023
04/10/2023
04/12/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
04/13/2023
1002200708
3129881445
False
9095080
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
02
04/10/2023
04/10/2023
04/12/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
04/13/2023
1002200708
3129881445
False
8784335
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
01
03/07/2023
03/07/2023
03/09/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
1002192444
3126767439
False
8793076
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
01
03/07/2023
03/07/2023
03/09/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
1002192444
3126767439
False
8590182
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
00
02/06/2023
02/06/2023
02/16/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
1002179310
3123694460
False
8595882
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795936
MR00148300
00
02/06/2023
02/06/2023
02/16/2023
69097032187
BUDESONIDE 1 MG/2 ML INH SUSP
1 MG/2 ML
AMPUL-NEB.
60
120
60
50.00000
Replenished
1002179310
3123694460