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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
10180318
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799794
MR00194370
00
08/17/2023
08/17/2023
08/18/2023
65862029630
ROSUVASTATIN CALCIUM 40 MG TAB
40 MG
TABLET
30
90
30
33.33300
Replenished
08/21/2023
1002260563
3144082982
False
10185472
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799794
MR00194370
00
08/17/2023
08/17/2023
08/18/2023
65862029630
ROSUVASTATIN CALCIUM 40 MG TAB
40 MG
TABLET
30
90
30
33.33300
Replenished
08/21/2023
1002260563
3144082982
False
10185473
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799794
MR00194370
00
08/17/2023
08/17/2023
08/18/2023
65862029630
ROSUVASTATIN CALCIUM 40 MG TAB
40 MG
TABLET
30
90
30
33.33400
Replenished
08/21/2023
1002260563
3144082982