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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
7401218
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012366
MR00279358
00
09/23/2022
09/23/2022
09/24/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002110752
3107139681
False
7406779
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012366
MR00279358
00
09/23/2022
09/23/2022
09/24/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002110752
3107139681
False
7202350
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012332
MR00279358
00
08/26/2022
08/26/2022
08/27/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002098027
3104187396
False
7206958
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012332
MR00279358
00
08/26/2022
08/26/2022
08/27/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002098027
3104187396
False
6987300
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012286
MR00279358
00
07/28/2022
07/28/2022
07/29/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002085352
3101083316
False
6992872
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012286
MR00279358
00
07/28/2022
07/28/2022
07/29/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002085352
3101083316
False
6727338
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012236
MR00279358
00
06/27/2022
06/27/2022
06/28/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002074778
3097678847
False
6731137
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012236
MR00279358
00
06/27/2022
06/27/2022
06/28/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002074778
3097678847
False
6429565
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012194
MR00279358
00
05/31/2022
05/31/2022
06/01/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002059808
3094872673
False
6437216
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012194
MR00279358
00
05/31/2022
05/31/2022
06/01/2022
60505252603
MODAFINIL 100 MG TABLET
100 MG
TABLET
30
60
30
50.00000
Replenished
1002059808
3094872673