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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
2934340
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779619
MR00283017
00
02/02/2021
02/02/2021
02/03/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
180
45
25.00000
Replenished
1001806279
False
2934342
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779619
MR00283017
00
02/02/2021
02/02/2021
02/03/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
180
100
55.55600
Replenished
1001806279
False
9051455
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795507
MR00289747
03
04/06/2023
04/06/2023
04/07/2023
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001806279
False
8984129
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795579
MR00313919
02
03/29/2023
03/29/2023
03/30/2023
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
12
40.00000
Replenished
1001806279
False
9081886
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797209
MR00279837
00
04/10/2023
04/10/2023
04/11/2023
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
13
43.33300
Replenished
04/11/2023
1001806279
False
2934338
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777338
MR00195463
03
02/05/2021
02/05/2021
02/06/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001811232
987509358
False
2934336
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777502
MR00101113
01
02/10/2021
02/10/2021
02/11/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
180
70
38.88900
Replenished
1001811232
987509358
False
2951967
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777502
MR00101113
01
02/10/2021
02/10/2021
02/11/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
180
100
55.55600
Replenished
1001811232
987509358
False
2934337
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778496
MR00097732
02
02/09/2021
02/09/2021
02/10/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001811232
987509358
False
2934335
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779144
MR00281435
01
02/11/2021
02/11/2021
02/12/2021
69315011601
FUROSEMIDE 20 MG TABLET
20 MG
TABLET
100
30
30
100.00000
Replenished
1001811232
987509358