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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
9790061
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798783
MR00064924
00
06/26/2023
06/26/2023
06/27/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
90
76
84.44400
Replenished
08/22/2023
1002251223
3141466060
False
10019923
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799378
MR00264032
00
07/26/2023
07/26/2023
07/27/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
40
24
60.00000
Replenished
08/22/2023
1002251223
3141466060
False
9115872
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797248
MR00358244
00
04/11/2023
04/11/2023
04/13/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9686047
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797248
MR00358244
01
06/15/2023
06/15/2023
06/16/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9157479
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797390
MR00195504
00
04/18/2023
04/18/2023
04/19/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
5
5
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9544234
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798256
MR00198781
00
05/30/2023
05/30/2023
06/01/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
06/28/2023
1002238348
3138156842
False
9787467
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798783
MR00064924
00
06/26/2023
06/26/2023
06/27/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
90
14
15.55600
Replenished
06/28/2023
1002238348
3138156842
False
8566687
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796020
MR00311967
00
02/09/2023
02/09/2023
02/11/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
2
9.52400
Replenished
1002194250
3127552216
False
8637243
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796203
MR00210929
00
02/20/2023
02/20/2023
02/21/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
1002194250
3127552216
False
8728077
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796457
MR00315442
00
03/02/2023
03/02/2023
03/03/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
1002194250
3127552216