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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
2934067
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772245
MR00184897
03
12/09/2020
12/09/2020
12/10/2020
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
15
16.66700
Replenished
1001857662
3055508681
False
2934066
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772245
MR00184897
03
12/09/2020
12/09/2020
12/10/2020
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
75
83.33300
Replenished
1001777031
False
2934065
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777341
2245997
02
12/28/2020
12/28/2020
12/29/2020
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
15
15
100.00000
Replenished
1001857662
3055508681
False
2934064
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777683
MR00005078
01
02/10/2021
02/10/2021
02/11/2021
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
90
100.00000
Replenished
1001811232
987509358
False
3536992
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781827
MR00005078
00
05/11/2021
05/11/2021
05/12/2021
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
30
33.33300
Replenished
1001903802
3064589183
False
3527649
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781827
MR00005078
00
05/11/2021
05/11/2021
05/12/2021
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
60
66.66700
Replenished
1001857662
3055508681
False
4272198
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784016
MR00005078
00
08/13/2021
08/13/2021
08/14/2021
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
30
33.33300
Replenished
1001952427
3072856896
False
4266477
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784016
MR00005078
00
08/13/2021
08/13/2021
08/14/2021
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
60
66.66700
Replenished
1001903802
3064589183
False
4879777
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786009
MR00005078
00
11/03/2021
11/03/2021
11/04/2021
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
30
33.33300
Replenished
1001993278
3080996427
False
4874977
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786009
MR00005078
00
11/03/2021
11/03/2021
11/04/2021
68180046509
SIMVASTATIN 80 MG TABLET
80 MG
TABLET
90
90
60
66.66700
Replenished
1001952427
3072856896