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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
3120297
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780592
MR00018670
00
03/16/2021
03/16/2021
03/17/2021
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001827193
3050193216
False
3136397
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780627
MR00095217
00
03/18/2021
03/18/2021
03/19/2021
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001828853
3050481048
False
6312677
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790217
MR00038013
00
05/13/2022
05/13/2022
05/15/2022
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002051762
3093034357
False
6749368
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791203
MR00038013
00
06/30/2022
06/30/2022
07/01/2022
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002075533
3098184651
False
6782442
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791250
MR00025513
00
07/01/2022
07/01/2022
07/02/2022
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002075849
3098184654
False
7023233
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791920
MR00051059
00
08/02/2022
08/02/2022
08/03/2022
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002086833
3101665733
False
7100662
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792153
MR00051165
00
08/12/2022
08/12/2022
08/13/2022
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002093757
3102657638
False
7286299
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792750
MR00145031
00
09/07/2022
09/07/2022
09/10/2022
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002102488
3105614645
False
8250858
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795316
MR00074500
00
01/06/2023
01/06/2023
01/07/2023
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002161109
3118886769
False
8367469
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795599
MR00170923
00
01/20/2023
01/20/2023
01/21/2023
21922000909
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002165771
3120576242