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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
4050042
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781016
MR00053037
03
07/14/2021
07/14/2021
07/15/2021
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
30
100.00000
Replenished
1001939012
3070433439
False
4248754
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783987
MR00053037
00
08/11/2021
08/11/2021
08/12/2021
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
30
100.00000
Replenished
1001939012
3070433439
False
4487844
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784690
MR00053037
00
09/10/2021
09/10/2021
09/11/2021
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
30
100.00000
Replenished
1001939012
3070433439
False
4710538
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785417
MR00053037
00
10/11/2021
10/11/2021
10/12/2021
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
10
33.33300
Replenished
1001939012
3070433439
False
4714225
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785417
MR00053037
00
10/11/2021
10/11/2021
10/12/2021
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
20
66.66700
Replenished
1001976721
3077692823
False
5231568
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787042
MR00201045
00
12/20/2021
12/20/2021
12/21/2021
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
90
10
11.11100
Replenished
1002027827
3088434371
False
5227869
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787042
MR00201045
00
12/20/2021
12/20/2021
12/21/2021
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
90
80
88.88900
Replenished
1001976721
3077692823
False
5988464
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787042
MR00201045
01
03/31/2022
03/31/2022
04/01/2022
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
90
15
16.66700
Replenished
1002108257
3106376963
False
5984552
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787042
MR00201045
01
03/31/2022
03/31/2022
04/01/2022
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
90
75
83.33300
Replenished
1002027827
3088434371
False
5700447
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788470
MR00317585
00
02/22/2022
02/22/2022
02/23/2022
42806008801
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
15
15
100.00000
Replenished
1002027827
3088434371