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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
3309174
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781194
MR00264752
00
04/13/2021
04/13/2021
04/14/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001842802
3052853627
False
3378845
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780627
MR00095217
02
04/19/2021
04/19/2021
04/20/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001845547
3053392934
False
3426516
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781486
MR00038013
00
04/26/2021
04/26/2021
04/27/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001849254
3054056168
False
3582764
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780627
MR00095217
03
05/18/2021
05/18/2021
05/19/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001860966
3056169530
False
3655414
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781486
MR00038013
01
05/28/2021
05/28/2021
05/29/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001866451
3057164798
False
3729028
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781486
MR00038013
02
06/09/2021
06/09/2021
06/10/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001872170
3058237732
False
3753317
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780453
MR00170923
01
06/12/2021
06/12/2021
06/13/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001873690
3058440009
False
3766745
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782681
MR00206514
00
06/15/2021
06/15/2021
06/16/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001874950
3058793435
False
4228232
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781486
MR00038013
03
07/02/2021
08/09/2021
08/10/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001888398
3061086532
False
4034034
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783278
MR00082070
00
07/12/2021
07/12/2021
07/13/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001889250
3061354275