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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
10171643
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798439
MR00152715
02
08/16/2023
08/16/2023
08/17/2023
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
30
100.00000
Replenished
08/21/2023
1002260563
3144082982
False
10168701
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799729
MR00368660
00
08/15/2023
08/15/2023
08/16/2023
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
60
34
56.66700
Replenished
08/21/2023
1002260563
3144082982
False
10180323
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799788
MR00025513
00
08/17/2023
08/17/2023
08/18/2023
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
36
40.00000
Replenished
08/21/2023
1002260563
3144082982
False
10154854
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799278
MR00093265
01
08/14/2023
08/14/2023
08/15/2023
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
14
14
100.00000
Replenished
08/17/2023
1002259987
3143744568
False
10154866
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799707
MR00122156
00
08/14/2023
08/14/2023
08/15/2023
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
60
60
100.00000
Replenished
08/17/2023
1002259987
3143744568
False
10162453
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799729
MR00368660
00
08/15/2023
08/15/2023
08/16/2023
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
60
26
43.33300
Replenished
08/17/2023
1002259987
3143744568
False
6259222
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788080
MR00124995
03
05/06/2022
05/06/2022
05/07/2022
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
30
100.00000
Replenished
1002087704
3101872455
False
6241703
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790019
MR00035389
00
05/04/2022
05/04/2022
05/05/2022
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
25
27.77800
Replenished
1002087704
3101872455
False
6283295
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790124
MR00152715
00
05/10/2022
05/10/2022
05/11/2022
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
30
100.00000
Replenished
1002087704
3101872455
False
7051522
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790712
MR00124995
02
08/06/2022
08/06/2022
08/07/2022
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
30
15
50.00000
Replenished
1002087704
3101872455