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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
2951962
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779685
MR00152715
00
02/05/2021
02/05/2021
02/06/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
5
16.66700
Replenished
1001819785
3048855808
False
2933923
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779685
MR00152715
00
02/05/2021
02/05/2021
02/06/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
10
33.33300
Replenished
1001811232
987509358
False
2933922
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779685
MR00152715
00
02/05/2021
02/05/2021
02/06/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
15
50.00000
Replenished
1001807887
False
2933921
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779799
MR00361721
00
02/10/2021
02/10/2021
02/11/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
90
100.00000
Replenished
1001811232
987509358
False
2976632
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780077
MR00165004
00
02/22/2021
02/22/2021
02/23/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
90
100.00000
Replenished
1001819785
3048855808
False
3059570
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780382
MR00035389
00
03/08/2021
03/08/2021
03/09/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
15
16.66700
Replenished
1001824882
3049647435
False
3056729
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780382
MR00035389
00
03/08/2021
03/08/2021
03/09/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
75
83.33300
Replenished
1001823796
3049396293
False
3075289
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780432
MR00248486
00
03/10/2021
03/10/2021
03/11/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
120
35
29.16700
Replenished
1001826768
3050065356
False
3071217
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780432
MR00248486
00
03/10/2021
03/10/2021
03/11/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
120
85
70.83300
Replenished
1001824882
3049647435
False
3116497
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780546
MR00361721
00
03/15/2021
03/15/2021
03/16/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
25
27.77800
Replenished
1001827193
3050193216