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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
2934188
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777784
MR00158620
01
02/01/2021
02/01/2021
02/02/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
90
60
66.66700
Replenished
1001811232
987509358
False
3456013
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777784
MR00158620
02
04/30/2021
04/30/2021
05/01/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
90
60
66.66700
Replenished
1001850989
3054468652
False
2934187
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777784
MR00158620
01
02/01/2021
02/01/2021
02/02/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
90
30
33.33300
Replenished
1001805758
False
3462852
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777784
MR00158620
02
04/30/2021
04/30/2021
05/01/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
90
30
33.33300
Replenished
1001871163
3057980095
False
2934186
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779681
MR00315442
00
02/05/2021
02/05/2021
02/06/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001811232
987509358
False
3048351
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779681
MR00315442
01
03/05/2021
03/05/2021
03/06/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001836706
3051817902
False
3476620
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779681
MR00315442
03
05/04/2021
05/04/2021
05/05/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001871163
3057980095
False
3885990
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779681
MR00315442
05
06/28/2021
06/28/2021
06/29/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001899045
3063437222
False
4396241
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779681
MR00315442
07
08/28/2021
08/28/2021
08/29/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001963534
3074872858
False
4606602
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779681
MR00315442
08
09/27/2021
09/27/2021
09/28/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001963534
3074872858