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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
9760670
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798767
MR00389371
00
06/23/2023
06/23/2023
06/24/2023
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
66
36.66700
Replenished
06/26/2023
1002237206
3137855547
False
9765759
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798767
MR00389371
00
06/23/2023
06/23/2023
06/24/2023
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
100
55.55600
Replenished
06/26/2023
1002237206
3137855547
False
8933733
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794896
MR00389371
01
03/24/2023
03/24/2023
03/25/2023
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
34
18.88800
Replenished
06/26/2023
1002237206
3137855547
False
8925041
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794896
MR00389371
01
03/24/2023
03/24/2023
03/25/2023
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
46
25.55600
Replenished
1002195085
3127879945
False
8933732
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794896
MR00389371
01
03/24/2023
03/24/2023
03/25/2023
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
100
55.55600
Replenished
1002195085
3127879945
False
8102596
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794896
MR00389371
00
12/19/2022
12/19/2022
12/20/2022
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
26
14.44400
Replenished
1002151463
3116913607
False
8108098
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794896
MR00389371
00
12/19/2022
12/19/2022
12/20/2022
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
54
30.00000
Replenished
1002195085
3127879945
False
8108097
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794896
MR00389371
00
12/19/2022
12/19/2022
12/20/2022
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
100
55.55600
Replenished
1002151463
3116913607
False
7391520
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787105
MR00389371
03
09/22/2022
09/22/2022
09/23/2022
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
6
3.33300
Replenished
1002110013
3107139019
False
7396466
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787105
MR00389371
03
09/22/2022
09/22/2022
09/23/2022
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
74
41.11100
Replenished
1002151463
3116913607