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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
3892180
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782950
10990
00
06/29/2021
06/29/2021
06/30/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
14
46.66700
Replenished
1001883113
3060162693
False
3898803
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782950
10990
00
06/29/2021
06/29/2021
06/30/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
16
53.33300
Replenished
1001885854
3060825455
False
4512153
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784809
1882
00
09/14/2021
09/14/2021
09/15/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001924089
3068049380
False
4764933
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785592
1882
00
10/18/2021
10/18/2021
10/19/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
13
43.33300
Replenished
1001951777
3072578295
False
4761359
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785592
1882
00
10/18/2021
10/18/2021
10/19/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
17
56.66700
Replenished
1001945251
3071148263
False
3558494
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781945
2240145
00
05/14/2021
05/14/2021
05/15/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
7
7
100.00000
Replenished
1001873947
3058526323
False
4113013
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783537
2240145
00
07/23/2021
07/23/2021
07/24/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
7
7
100.00000
Replenished
1001899897
3063887299
False
2934339
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779621
BBG9FRG6YEC4
00
02/04/2021
02/04/2021
02/06/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001811232
987509358
False
3056709
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779621
BBG9FRG6YEC4
01
03/08/2021
03/08/2021
03/09/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001824202
3049524740
False
3301284
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779621
BBG9FRG6YEC4
02
04/12/2021
04/12/2021
04/13/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
11
36.66700
Replenished
1001842172
3052723058