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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
6133337
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787065
MR00210929
02
04/20/2022
04/20/2022
04/21/2022
68382000116
PAROXETINE HCL 40 MG TABLET
40 MG
TABLET
90
60
30
50.00000
Replenished
1002039367
3090544681
False
6140506
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787065
MR00210929
02
04/20/2022
04/20/2022
04/21/2022
68382000116
PAROXETINE HCL 40 MG TABLET
40 MG
TABLET
90
60
30
50.00000
Replenished
1002053268
3093648508
False
5867367
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788900
MR00388862
00
03/14/2022
03/14/2022
03/16/2022
68382000116
PAROXETINE HCL 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1002039367
3090544681
False
6102434
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788900
MR00388862
01
04/14/2022
04/14/2022
04/16/2022
68382000116
PAROXETINE HCL 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1002039367
3090544681
False
6312679
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788900
MR00388862
02
05/14/2022
05/14/2022
05/15/2022
68382000116
PAROXETINE HCL 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1002053268
3093648508
False
6343443
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790318
MR00145513
00
05/18/2022
05/18/2022
05/19/2022
68382000116
PAROXETINE HCL 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1002053268
3093648508