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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
9803683
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012756
MR00092991
00
06/28/2023
06/28/2023
06/29/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
135
89
65.92600
Replenished
08/18/2023
1002260285
3143898441
False
9595277
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012726
MR00313919
00
06/06/2023
06/06/2023
06/07/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
20
20
100.00000
Replenished
06/12/2023
1002232577
3136303177
False
9569324
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012721
MR00062075
00
06/01/2023
06/01/2023
06/03/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
31
25.83400
Replenished
06/12/2023
1002232577
3136303177
False
9562791
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012721
MR00062075
00
06/01/2023
06/01/2023
06/03/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
34
28.33300
Replenished
06/05/2023
1002226579
3135522747
False
9569323
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012721
MR00062075
00
06/01/2023
06/01/2023
06/03/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
55
45.83300
Replenished
06/05/2023
1002226579
3135522747
False
9544218
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012712
MR00072992
00
05/30/2023
05/30/2023
06/01/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
84
8
9.52400
Replenished
06/05/2023
1002226246
3135522745
False
9558083
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012712
MR00072992
00
05/30/2023
05/30/2023
06/01/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
84
10
11.90500
Replenished
06/05/2023
1002226246
3135522745
False
9558084
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012712
MR00072992
00
05/30/2023
05/30/2023
06/01/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
84
66
78.57100
Replenished
06/05/2023
1002226579
3135522747
False
9544271
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012711
MR00076060
00
05/30/2023
05/30/2023
06/01/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
90
90
100.00000
Replenished
06/05/2023
1002226246
3135522745
False
9470454
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012702
MR00108692
00
05/24/2023
05/24/2023
05/25/2023
00228202910
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
30
30
100.00000
Replenished
05/30/2023
1002224253
3134809499