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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
2934334
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778931
MR00018670
00
12/31/2020
12/31/2020
01/01/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
30
100.00000
Replenished
1001830087
3050733659
False
2934333
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
00
01/26/2021
01/26/2021
01/27/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
30
100.00000
Replenished
1001830087
3050733659
False
2988211
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
01
02/24/2021
02/24/2021
02/25/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
30
100.00000
Replenished
1001830087
3050733659
False
3151653
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
02
03/22/2021
03/22/2021
03/23/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
10
33.33300
Replenished
1001830087
3050733659
False
3157463
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
02
03/22/2021
03/22/2021
03/23/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
20
66.66700
Replenished
1001883113
3060162693
False
3426475
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
03
04/26/2021
04/26/2021
04/27/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
30
100.00000
Replenished
1001883113
3060162693
False
3638937
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
04
05/26/2021
05/26/2021
05/27/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
30
100.00000
Replenished
1001883113
3060162693
False
3898787
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
05
06/29/2021
06/29/2021
06/30/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
10
33.33300
Replenished
1001928804
3069023028
False
3892187
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
05
06/29/2021
06/29/2021
06/30/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
20
66.66700
Replenished
1001883113
3060162693
False
4133433
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779474
MR00018670
06
07/27/2021
07/27/2021
07/28/2021
00143124101
DIGOXIN 250 MCG TABLET
250 MCG
TABLET
100
30
30
100.00000
Replenished
1001928804
3069023028