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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
3540436
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776451
MR00283017
02
05/12/2021
05/12/2021
05/13/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
90
100.00000
Replenished
1001860456
3056066373
False
3577390
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781978
MR00218418
00
05/17/2021
05/17/2021
05/18/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
10
11.11100
Replenished
1001860456
3056066373
False
3608361
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776361
MR00151354
07
05/21/2021
05/21/2021
05/22/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
20
33.33300
Replenished
1001862702
3056474257
False
3580470
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781978
MR00218418
00
05/17/2021
05/17/2021
05/18/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
80
88.88900
Replenished
1001862702
3056474257
False
3615194
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775867
MR00287658
08
05/22/2021
05/22/2021
05/23/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001863873
3056827847
False
3613141
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776361
MR00151354
07
05/21/2021
05/21/2021
05/22/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
40
66.66700
Replenished
1001863873
3056827847
False
3622352
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782165
MR00072992
00
05/24/2021
05/24/2021
05/25/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
30
33.33300
Replenished
1001863873
3056827847
False
3638940
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778886
MR00119852
05
05/26/2021
05/26/2021
05/27/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
10
33.33300
Replenished
1001864958
3056990723
False
3638906
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779473
MR00018670
04
05/26/2021
05/26/2021
05/27/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001864958
3056990723
False
3625920
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782165
MR00072992
00
05/24/2021
05/24/2021
05/25/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
60
66.66700
Replenished
1001864958
3056990723