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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
2934186
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779681
MR00315442
00
02/05/2021
02/05/2021
02/06/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001811232
987509358
False
2948693
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779895
490
00
02/15/2021
02/15/2021
02/16/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
10
33.33300
Replenished
1001811232
987509358
False
2951895
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779895
490
00
02/15/2021
02/15/2021
02/16/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
20
66.66700
Replenished
1001836706
3051817902
False
3151642
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780673
490
00
03/22/2021
03/22/2021
03/23/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001836706
3051817902
False
3390996
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781325
490
00
04/20/2021
04/20/2021
04/21/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001850989
3054468652
False
3622339
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782132
490
00
05/24/2021
05/24/2021
05/25/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001871163
3057980095
False
3775718
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782620
490
00
06/16/2021
06/16/2021
06/17/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
30
30
100.00000
Replenished
1001899045
3063437222
False
4859406
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785889
MR00148300
00
11/01/2021
11/01/2021
11/02/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
15
15
100.00000
Replenished
1001963534
3074872858
False
5022802
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000786431
MR00108206
00
11/23/2021
11/23/2021
11/24/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
15
15
100.00000
Replenished
1001963534
3074872858
False
2934187
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777784
MR00158620
01
02/01/2021
02/01/2021
02/02/2021
00527293237
PREDNISONE 5 MG TABLET
5 MG
TABLET
100
90
30
33.33300
Replenished
1001805758