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Health Center:
Pharmacy:
Capture Date :
To:


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
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783369 MR001622560007/15/202107/15/202107/15/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601803016.66700Replenished 1001890275 3061781565
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783369 MR001622560007/15/202107/15/202107/15/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601803016.66700Replenished 1001898379 3063180504
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783369 MR001622560007/15/202107/15/202107/15/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601806033.33300Replenished 1001890275 3061781565
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783369 MR001622560007/15/202107/15/202107/15/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601806033.33300Replenished 1001890275 3061781565
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785664 MR001622560010/20/202110/20/202110/20/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601803016.66700Replenished 1001946281 3071423777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785664 MR001622560010/20/202110/20/202110/20/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601803016.66700Replenished 1001950376 3072152538
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785664 MR001622560010/20/202110/20/202110/20/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601806033.33300Replenished 1001946281 3071423777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785664 MR001622560010/20/202110/20/202110/20/202100003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601806033.33300Replenished 1001946281 3071423777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000787963 MR001622560001/28/202201/28/202201/28/202200003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601803016.66700Replenished 1001996178 3081761727
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000787963 MR001622560001/28/202201/28/202201/28/202200003089321ELIQUIS 2.5 MG TABLET2.5 MGTABLET601803016.66700Replenished 1002011074 3084743907