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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
9138956
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791454
MR00034656
03
04/15/2023
04/15/2023
04/16/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
1
1.11100
Replenished
04/21/2023
1002209232
3130801353
False
9490167
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793404
MR00151354
07
05/25/2023
05/25/2023
05/26/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
1
1.66700
Replenished
06/28/2023
1002238348
3138156842
False
8737573
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795959
MR00308211
01
03/02/2023
03/02/2023
03/03/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
1
3.33300
Replenished
1002193992
3127402543
False
9187786
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795959
MR00308211
02
04/21/2023
04/21/2023
04/22/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
1
3.33400
Replenished
05/08/2023
1002213772
3132524754
False
9301108
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000793404
MR00151354
06
05/05/2023
05/05/2023
05/06/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
9
15.00000
Replenished
05/08/2023
1002213772
3132524754
False
8885360
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796791
MR00150399
00
03/20/2023
03/20/2023
03/21/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
9
30.00000
Replenished
1002193992
3127402543
False
9166402
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797414
MR00037851
00
04/19/2023
04/19/2023
04/20/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
9
10.00000
Replenished
04/21/2023
1002209232
3130801353
False
9787443
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798772
MR00368660
00
06/26/2023
06/26/2023
06/27/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
9
30.00000
Replenished
06/28/2023
1002238348
3138156842
False
3863418
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776361
MR00151354
08
06/24/2021
06/24/2021
06/25/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
10
16.66700
Replenished
1001880371
3059776595
False
3638940
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778886
MR00119852
05
05/26/2021
05/26/2021
05/27/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
10
33.33300
Replenished
1001864958
3056990723