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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
8090674
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794878
MR00319594
00
12/16/2022
12/16/2022
12/17/2022
65702015610
ACCU-CHEK SOFTCLIX LANCETS
EACH
100
100
100
100.00000
Replenished
1002150980
3116568651
False
8279747
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795370
MR00319594
00
01/10/2023
01/10/2023
01/11/2023
65702015610
ACCU-CHEK SOFTCLIX LANCETS
EACH
100
100
100
100.00000
Replenished
1002162186
3119565262
False
8925046
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796898
MR00171522
00
03/23/2023
03/23/2023
03/24/2023
65702015610
ACCU-CHEK SOFTCLIX LANCETS
EACH
100
100
100
100.00000
Replenished
1002195085
3127879944