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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
3638906
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779473
MR00018670
04
05/26/2021
05/26/2021
05/27/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001864958
3056990723
False
3898799
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779473
MR00018670
05
06/29/2021
06/29/2021
06/30/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
10
33.33300
Replenished
1001889250
3061354275
False
3892186
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779473
MR00018670
05
06/29/2021
06/29/2021
06/30/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
20
66.66700
Replenished
1001883113
3060162693
False
4133430
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779473
MR00018670
06
07/27/2021
07/27/2021
07/28/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001900472
3063887831
False
6377261
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790423
MR00018670
00
05/23/2022
05/23/2022
05/24/2022
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1002058743
3094409887
False
6646543
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790423
MR00018670
01
06/21/2022
06/21/2022
06/22/2022
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1002073350
3097384163
False
6957775
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790423
MR00018670
02
07/25/2022
07/25/2022
07/26/2022
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1002083390
3100621822
False
7187635
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790423
MR00018670
03
08/24/2022
08/24/2022
08/25/2022
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
10
33.33300
Replenished
1002076632
3098638591
False
7172315
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790423
MR00018670
03
08/24/2022
08/24/2022
08/25/2022
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
20
66.66700
Replenished
1002096808
3104187393
False
7383687
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790423
MR00018670
04
09/21/2022
09/21/2022
09/22/2022
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1002118447
3108304458