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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
8065972
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791374
MR00319594
05
12/13/2022
12/13/2022
12/15/2022
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
30
100.00000
Replenished
1002192761
3126917243
False
8269085
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795337
MR00319594
00
01/09/2023
01/09/2023
01/10/2023
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
30
100.00000
Replenished
1002192761
3126917243
False
8552420
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795337
MR00319594
01
02/10/2023
02/10/2023
02/11/2023
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
30
100.00000
Replenished
1002192761
3126917243
False
8847889
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795337
MR00319594
02
03/15/2023
03/15/2023
03/16/2023
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
10
33.33300
Replenished
1002192761
3126917243
False
8850764
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795337
MR00319594
02
03/15/2023
03/15/2023
03/16/2023
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
20
66.66700
Replenished
06/19/2023
1002234814
3137091283
False
9115832
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797289
MR00319594
00
04/13/2023
04/13/2023
04/14/2023
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
30
100.00000
Replenished
06/19/2023
1002234814
3137091283
False
9397871
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797289
MR00319594
01
05/17/2023
05/17/2023
05/18/2023
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
30
100.00000
Replenished
06/19/2023
1002234814
3137091283
False
9686048
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797289
MR00319594
02
06/15/2023
06/15/2023
06/16/2023
75834029301
METOPROLOL SUCC ER 200 MG TAB
200 MG
TAB.SR 24H
100
30
20
66.66700
Replenished
06/19/2023
1002234814
3137091283