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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
3519952
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781774
MR00376673
00
05/10/2021
05/10/2021
05/11/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
10
11.11100
Replenished
1001856282
3055381317
False
8412380
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795701
MR00376673
00
01/25/2023
01/25/2023
01/26/2023
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
10
11.11100
Replenished
05/18/2023
1002221191
3133750055
False
4207171
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783822
MR00376673
00
08/05/2021
08/05/2021
08/06/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
20
22.22200
Replenished
1001899897
3063887299
False
7738886
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793936
MR00376673
00
11/02/2022
11/02/2022
11/05/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
20
22.22200
Replenished
1002167937
3121218016
False
4917837
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786128
MR00376673
00
11/09/2021
11/09/2021
11/10/2021
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
30
33.33300
Replenished
1001956560
3073437016
False
7097522
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792128
MR00376673
00
08/11/2022
08/11/2022
08/12/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
30
33.33300
Replenished
1002129142
3111671677
False
5605441
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788180
MR00376673
00
02/08/2022
02/08/2022
02/09/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
40
44.44400
Replenished
1002004060
3083116802
False
6299048
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790151
MR00376673
00
05/11/2022
05/11/2022
05/12/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
40
44.44400
Replenished
1002093542
3102645765
False
5611735
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788180
MR00376673
00
02/08/2022
02/08/2022
02/09/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
50
55.55600
Replenished
1002051193
3092898029
False
6293946
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790151
MR00376673
00
05/11/2022
05/11/2022
05/12/2022
68180046801
LOVASTATIN 20 MG TABLET
20 MG
TABLET
100
90
50
55.55600
Replenished
1002051193
3092898029