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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
2972726
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000773469
MR00326153
09
02/20/2021
02/20/2021
02/21/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
60
60
100.00000
Replenished
1001816056
987916714
False
3280661
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000773469
MR00326153
10
04/08/2021
04/08/2021
04/09/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
60
1
1.66700
Replenished
1001839679
3052473904
False
3283755
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000773469
MR00326153
10
04/08/2021
04/08/2021
04/09/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
60
59
98.33300
Replenished
1001842172
3052723058
False
3512415
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000773469
MR00326153
11
05/08/2021
05/08/2021
05/09/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
60
60
100.00000
Replenished
1001856282
3055381317
False
2934338
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777338
MR00195463
03
02/05/2021
02/05/2021
02/06/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001811232
987509358
False
3041655
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777338
MR00195463
04
03/04/2021
03/04/2021
03/05/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001824202
3049524740
False
3260682
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777338
MR00195463
05
04/05/2021
04/05/2021
04/07/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001839679
3052473904
False
2988215
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777408
MR00393085
03
02/24/2021
02/24/2021
02/25/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001824202
3049524740
False
3301302
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777408
MR00393085
04
04/12/2021
04/12/2021
04/13/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001842172
3052723058
False
2951969
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777502
MR00101113
01
02/10/2021
02/10/2021
02/11/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
180
10
5.55500
Replenished
1001811909
987581092