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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
5117255
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781195
MR00264752
02
12/06/2021
12/06/2021
12/07/2021
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
90
40
44.44400
Replenished
1001969736
3076071583
False
5123568
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781195
MR00264752
02
12/06/2021
12/06/2021
12/07/2021
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
90
50
55.55600
Replenished
1002043399
3091212807
False
5715612
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781195
MR00264752
03
02/23/2022
02/23/2022
02/24/2022
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
90
10
11.11100
Replenished
1002015325
3085493191
False
5709534
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781195
MR00264752
03
02/23/2022
02/23/2022
02/24/2022
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
90
80
88.88900
Replenished
1002010793
3084577185
False
4716838
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781407
MR00074834
00
10/12/2021
10/12/2021
10/13/2021
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
30
30
100.00000
Replenished
1001946740
3071601882
False
4962642
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781407
MR00074834
01
11/15/2021
11/15/2021
11/16/2021
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
30
10
33.33300
Replenished
1001959681
3074009069
False
4966274
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781407
MR00074834
01
11/15/2021
11/15/2021
11/16/2021
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
30
20
66.66700
Replenished
1001963244
3074735172
False
5160760
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781407
MR00074834
02
12/10/2021
12/10/2021
12/11/2021
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
30
10
33.33300
Replenished
1002043399
3091212807
False
5155225
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781407
MR00074834
02
12/10/2021
12/10/2021
12/11/2021
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
30
20
66.66700
Replenished
1002043399
3091212807
False
5386168
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781407
MR00074834
03
01/11/2022
01/11/2022
01/12/2022
68001048600
LISINOPRIL 40 MG TABLET
40 MG
TABLET
100
30
30
100.00000
Replenished
1001996178
3081761727