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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
4378222
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784283
MR00094363
00
08/24/2021
08/26/2021
08/27/2021
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001911378
3066004376
False
4383050
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784283
MR00094363
00
08/24/2021
08/26/2021
08/27/2021
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001911378
3066004376
False
4563451
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784954
MR00094363
00
09/21/2021
09/21/2021
09/22/2021
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001926498
3068455122
False
4568589
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784954
MR00094363
00
09/21/2021
09/21/2021
09/22/2021
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001926498
3068455122
False
5015913
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784954
MR00094363
01
11/22/2021
11/22/2021
11/23/2021
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001963244
3074735172
False
5020120
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784954
MR00094363
01
11/22/2021
11/22/2021
11/23/2021
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001963244
3074735172
False
5433830
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784954
MR00094363
02
01/18/2022
01/18/2022
01/19/2022
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001990723
3080663331
False
5439883
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784954
MR00094363
02
01/18/2022
01/18/2022
01/19/2022
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
60
30
50.00000
Replenished
1001990723
3080663331
False
6393174
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790442
MR00094363
00
05/24/2022
05/24/2022
05/25/2022
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
180
30
16.66500
Replenished
1002058117
3094226560
False
6387480
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790442
MR00094363
00
05/24/2022
05/24/2022
05/25/2022
67877048330
TELMISARTAN 40 MG TABLET
40 MG
TABLET
30
180
30
16.66700
Replenished
1002058117
3094226560