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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
4810475
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781217
MR00060045
04
10/25/2021
10/25/2021
10/26/2021
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
120
20
16.66700
Replenished
1002045985
3091824990
False
4806784
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781217
MR00060045
04
10/25/2021
10/25/2021
10/26/2021
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
120
100
83.33300
Replenished
1001948371
3071858707
False
5117252
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786733
MR00279225
00
12/06/2021
12/06/2021
12/07/2021
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
30
30
100.00000
Replenished
1002045985
3091824990
False
6232303
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789972
MR00167942
00
05/02/2022
05/02/2022
05/03/2022
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
90
40
44.44400
Replenished
1002067998
3096617326
False
6224726
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000789972
MR00167942
00
05/02/2022
05/02/2022
05/03/2022
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
90
50
55.55600
Replenished
1002045985
3091824990
False
6558714
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790928
MR00167942
00
06/16/2022
06/16/2022
06/17/2022
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
90
30
33.33300
Replenished
1002087130
3101872451
False
6553632
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790928
MR00167942
00
06/16/2022
06/16/2022
06/17/2022
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
90
60
66.66700
Replenished
1002067998
3096617326
False
6976649
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791808
MR00388814
00
07/27/2022
07/27/2022
07/28/2022
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
30
30
100.00000
Replenished
1002087130
3101872451
False
7033806
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791964
MR00167942
00
08/03/2022
08/03/2022
08/04/2022
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
180
40
22.22200
Replenished
1002087130
3101872451
False
7041203
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791964
MR00167942
00
08/03/2022
08/03/2022
08/04/2022
67877032101
IBUPROFEN 800 MG TABLET
800 MG
TABLET
100
180
40
22.22200
Replenished
1002129142
3111671677