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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
10100392
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799561
MR00107755
00
08/07/2023
08/07/2023
08/08/2023
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
40
44.44400
Replenished
08/09/2023
1002227296
3135831552
False
9306861
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797787
MR00107755
00
05/05/2023
05/05/2023
05/06/2023
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
60
66.66700
Replenished
06/07/2023
1002227296
3135831552
False
8710925
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794481
MR00389371
01
02/27/2023
02/27/2023
03/01/2023
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
70
77.77800
Replenished
05/08/2023
1002213772
3132524754
False
9301133
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797787
MR00107755
00
05/05/2023
05/05/2023
05/06/2023
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
30
33.33300
Replenished
05/08/2023
1002213772
3132524754
False
8485416
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794026
MR00107755
01
02/02/2023
02/02/2023
02/03/2023
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
10
11.11100
Replenished
1002170585
3122206860
False
8493341
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794026
MR00107755
01
02/02/2023
02/02/2023
02/03/2023
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
80
88.88900
Replenished
1002183817
3125156097
False
7926270
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794481
MR00389371
00
11/28/2022
11/29/2022
11/30/2022
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
90
100.00000
Replenished
1002170585
3122206860
False
8703714
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794481
MR00389371
01
02/27/2023
02/27/2023
03/01/2023
65862016801
ATENOLOL 25 MG TABLET
25 MG
TABLET
100
90
20
22.22200
Replenished
1002183817
3125156097