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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
8250855
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
04
01/06/2023
01/06/2023
01/07/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
30
100.00000
Replenished
1002199797
3129427834
False
8552504
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
05
02/06/2023
02/06/2023
02/11/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
30
100.00000
Replenished
1002199797
3129427834
False
8807355
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
06
03/09/2023
03/09/2023
03/10/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
30
100.00000
Replenished
1002199797
3129427834
False
9065578
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
07
04/07/2023
04/07/2023
04/08/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
10
33.33300
Replenished
1002199797
3129427834
False
9071438
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
07
04/07/2023
04/07/2023
04/08/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
20
66.66700
Replenished
08/22/2023
1002244869
3139279459
False
9397896
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
08
05/08/2023
05/08/2023
05/17/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
30
100.00000
Replenished
08/22/2023
1002244869
3139279459
False
9621071
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
09
06/08/2023
06/08/2023
06/09/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
30
100.00000
Replenished
08/22/2023
1002244869
3139279459
False
9873256
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792233
MR00205174
10
07/06/2023
07/06/2023
07/07/2023
68001038500
NITROFURANTOIN MCR 50 MG CAP
50 MG
CAPSULE
100
30
20
66.66700
Replenished
08/22/2023
1002244869
3139279459