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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
2934577
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778196
MR00214201
00
12/01/2020
12/01/2020
12/03/2020
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
48
24
50.00000
Replenished
1001773574
False
8901518
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796825
MR00064924
00
03/21/2023
03/21/2023
03/22/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
90
34
37.77800
Replenished
1001773574
False
8951415
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796965
MR00127901
00
03/28/2023
03/28/2023
03/29/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
1001773574
False
9035379
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797098
MR00315442
00
04/04/2023
04/04/2023
04/05/2023
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
21
21
100.00000
Replenished
1001773574
False
2934578
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778196
MR00214201
00
12/01/2020
12/01/2020
12/03/2020
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
48
24
50.00000
Replenished
1001916855
3066262939
False
3426488
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781472
MR00218313
00
04/26/2021
04/26/2021
04/27/2021
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
4
4
100.00000
Replenished
1001916855
3066262939
False
3886003
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782944
MR00064924
00
06/28/2021
06/28/2021
06/29/2021
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001916855
3066262939
False
4120929
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782944
MR00064924
01
07/24/2021
07/24/2021
07/25/2021
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001916855
3066262939
False
4404243
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784421
MR00064924
00
08/30/2021
08/30/2021
08/31/2021
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
12
40.00000
Replenished
1001916855
3066262939
False
4408594
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784421
MR00064924
00
08/30/2021
08/30/2021
08/31/2021
59746017306
PREDNISONE 10 MG TABLET
10 MG
TABLET
100
30
18
60.00000
Replenished
1001963534
3074872858