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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
2933742
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779572
490
00
02/01/2021
02/01/2021
02/02/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
60
30
50.00000
Replenished
1001805758
False
2933743
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779572
490
00
02/01/2021
02/01/2021
02/02/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
60
30
50.00000
Replenished
1001834470
3051403572
False
3056720
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780367
490
00
03/08/2021
03/08/2021
03/09/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
60
60
100.00000
Replenished
1001834470
3051403572
False
3197308
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780834
MR00134157
00
03/29/2021
03/29/2021
03/30/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
90
10
11.11100
Replenished
1001834470
3051403572
False
3203486
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780834
MR00134157
00
03/29/2021
03/29/2021
03/30/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
90
80
88.88900
Replenished
1001836706
3051817902
False
3247520
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780965
MR00174245
00
04/02/2021
04/02/2021
04/03/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
90
20
22.22200
Replenished
1001836706
3051817902
False
3251959
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780965
MR00174245
00
04/02/2021
04/02/2021
04/03/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
90
70
77.77800
Replenished
1001838628
3052278967
False
3260704
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781022
490
00
04/05/2021
04/05/2021
04/07/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
60
30
50.00000
Replenished
1001838628
3052278967
False
3266024
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781022
490
00
04/05/2021
04/05/2021
04/07/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
60
30
50.00000
Replenished
1001867724
3057523425
False
3470721
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781622
490
00
05/03/2021
05/03/2021
05/04/2021
65162036110
FOLIC ACID 1 MG TABLET
1 MG
TABLET
100
60
60
100.00000
Replenished
1001867724
3057523425