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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
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
4257905
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782189
MR00117446
00
08/12/2021
08/12/2021
08/13/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001903497
3064589180
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
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
False
4079789
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783419
MR00051059
00
07/19/2021
07/19/2021
07/20/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001891373
3062039555
False
4228193
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783552
MR00038013
00
07/26/2021
08/09/2021
08/10/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001896238
3062733235
False
4237841
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783929
MR00038013
00
08/10/2021
08/10/2021
08/11/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001902816
3064329315
False
4968718
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783930
MR00038013
00
11/16/2021
11/16/2021
11/17/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001960301
3074163363
False
4458906
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784568
MR00051059
00
09/07/2021
09/07/2021
09/08/2021
45802016000
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001919113
3067013098