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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
7960377
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794582
MR00248486
00
12/01/2022
12/01/2022
12/03/2022
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
30
100.00000
Replenished
1002196370
3128329091
False
8231158
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795264
MR00248486
00
01/04/2023
01/04/2023
01/05/2023
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
30
100.00000
Replenished
1002196370
3128329091
False
8703722
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796377
MR00248486
00
02/27/2023
02/27/2023
03/01/2023
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
30
100.00000
Replenished
1002196370
3128329091
False
8951423
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796976
MR00248486
00
03/28/2023
03/28/2023
03/29/2023
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
10
33.33300
Replenished
1002196370
3128329091
False
8959542
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796976
MR00248486
00
03/28/2023
03/28/2023
03/29/2023
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
20
66.66700
Replenished
06/29/2023
1002238604
3138299994
False
9276459
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797630
MR00248486
00
04/27/2023
04/27/2023
05/04/2023
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
30
100.00000
Replenished
06/29/2023
1002238604
3138299994
False
9470448
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797630
MR00248486
01
05/23/2023
05/23/2023
05/24/2023
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
30
100.00000
Replenished
06/29/2023
1002238604
3138299994
False
9793595
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797630
MR00248486
02
06/27/2023
06/27/2023
06/28/2023
60505132001
MIDODRINE HCL 2.5 MG TABLET
2.5 MG
TABLET
100
30
20
66.66700
Replenished
06/29/2023
1002238604
3138299994