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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
3026236
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780284
MR00037445
00
03/02/2021
03/02/2021
03/03/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
60
100.00000
Replenished
1001839075
3052306186
False
3276696
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780284
MR00037445
01
04/07/2021
04/07/2021
04/08/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
20
33.33300
Replenished
1001864958
3056990723
False
3269398
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780284
MR00037445
01
04/07/2021
04/07/2021
04/08/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
40
66.66700
Replenished
1001839075
3052306186
False
3494431
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780284
MR00037445
02
05/06/2021
05/06/2021
05/07/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
60
100.00000
Replenished
1001864958
3056990723
False
3638926
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780284
MR00037445
03
05/26/2021
05/26/2021
05/27/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
20
33.33300
Replenished
1001864958
3056990723
False
3643986
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780284
MR00037445
03
05/26/2021
05/26/2021
05/27/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
40
66.66700
Replenished
1001882607
3060033992
False
3886026
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782927
MR00037445
00
06/28/2021
06/28/2021
06/29/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
60
100.00000
Replenished
1001882607
3060033992
False
4184277
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783689
MR00037445
00
08/02/2021
08/02/2021
08/03/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
60
100.00000
Replenished
1001917809
3066693686
False
4436437
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783689
MR00037445
01
09/02/2021
09/02/2021
09/03/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
20
33.33300
Replenished
1001956102
3073301294
False
4430603
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783689
MR00037445
01
09/02/2021
09/02/2021
09/03/2021
68001017800
GLIMEPIRIDE 2 MG TABLET
2 MG
TABLET
100
60
40
66.66700
Replenished
1001917809
3066693686