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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
2967716
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780015
MR00389243
00
02/19/2021
02/19/2021
02/20/2021
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
50
50
100.00000
Replenished
1001896238
3062733235
False
4128169
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783569
MR00389243
00
07/26/2021
07/26/2021
07/27/2021
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
50
40
80.00000
Replenished
1001896238
3062733235
False
6440300
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788085
MR00189875
01
06/01/2022
06/01/2022
06/02/2022
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002086833
3101665733
False
6782497
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788085
MR00189875
02
07/01/2022
07/01/2022
07/02/2022
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002086833
3101665733
False
7023243
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791936
MR00189875
00
08/02/2022
08/02/2022
08/03/2022
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002086833
3101665733
False
7236452
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792578
MR00189875
00
08/31/2022
08/31/2022
09/01/2022
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002129142
3111671677
False
7432943
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793127
MR00189875
00
09/27/2022
09/27/2022
09/28/2022
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002129142
3111671677
False
7725642
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793940
MR00189875
00
11/02/2022
11/02/2022
11/05/2022
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002129142
3111671677
False
7942636
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794577
MR00189875
00
11/30/2022
11/30/2022
12/01/2022
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002178117
3123055057
False
8250852
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795320
MR00189875
00
01/06/2023
01/06/2023
01/07/2023
68001036305
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
30
30
100.00000
Replenished
1002178117
3123055057