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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
10010777
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799329
MR00244665
00
07/25/2023
07/25/2023
07/26/2023
43547036103
LOSARTAN POTASSIUM 50 MG TAB
50 MG
TABLET
30
90
30
33.33300
Replenished
08/22/2023
1002250897
3141314504
False
10016879
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799329
MR00244665
00
07/25/2023
07/25/2023
07/26/2023
43547036103
LOSARTAN POTASSIUM 50 MG TAB
50 MG
TABLET
30
90
30
33.33300
Replenished
08/22/2023
1002250897
3141314504
False
10016880
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799329
MR00244665
00
07/25/2023
07/25/2023
07/26/2023
43547036103
LOSARTAN POTASSIUM 50 MG TAB
50 MG
TABLET
30
90
30
33.33400
Replenished
08/22/2023
1002250897
3141314504