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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
2934248
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779661
MR00376673
00
02/04/2021
02/04/2021
02/06/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
90
100.00000
Replenished
1001856282
3055381317
False
3519952
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781774
MR00376673
00
05/10/2021
05/10/2021
05/11/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
10
11.11100
Replenished
1001856282
3055381317
False
3523146
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781774
MR00376673
00
05/10/2021
05/10/2021
05/11/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
80
88.88900
Replenished
1001899897
3063887299
False
4207171
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783822
MR00376673
00
08/05/2021
08/05/2021
08/06/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
20
22.22200
Replenished
1001899897
3063887299
False
4211970
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783822
MR00376673
00
08/05/2021
08/05/2021
08/06/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
70
77.77800
Replenished
1001956560
3073437016
False
4917837
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786128
MR00376673
00
11/09/2021
11/09/2021
11/10/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
30
33.33300
Replenished
1001956560
3073437016
False
4923977
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786128
MR00376673
00
11/09/2021
11/09/2021
11/10/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
60
66.66700
Replenished
1002004060
3083116802
False
5605441
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788180
MR00376673
00
02/08/2022
02/08/2022
02/09/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
40
44.44400
Replenished
1002004060
3083116802
False
5611735
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788180
MR00376673
00
02/08/2022
02/08/2022
02/09/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
50
55.55600
Replenished
1002051193
3092898029
False
6299048
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790151
MR00376673
00
05/11/2022
05/11/2022
05/12/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
40
44.44400
Replenished
1002093542
3102645765