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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
3713987
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781016
MR00053037
02
06/07/2021
06/07/2021
06/08/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
10
33.33300
Replenished
1001871163
3057980095
False
3717322
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781016
MR00053037
02
06/07/2021
06/07/2021
06/08/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
20
66.66700
Replenished
1001879330
3059650533
False
2934399
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777500
MR00397359
01
02/04/2021
02/05/2021
02/06/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
10
33.33300
Replenished
1001850290
3054303929
False
2934398
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777500
MR00397359
01
02/04/2021
02/05/2021
02/06/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
20
66.66700
Replenished
1001807887
False
3059547
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778556
MR00201045
01
03/08/2021
03/08/2021
03/09/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
90
30
33.33300
Replenished
1001871163
3057980095
False
3056728
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000778556
MR00201045
01
03/08/2021
03/08/2021
03/09/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
90
60
66.66700
Replenished
1001850290
3054303929
False
3549241
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781016
MR00053037
01
05/13/2021
05/13/2021
05/14/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
30
100.00000
Replenished
1001871163
3057980095
False
4606559
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782846
MR00201045
01
09/27/2021
09/27/2021
09/28/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
90
90
100.00000
Replenished
1001928804
3069023028
False
3026232
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780273
MR00053037
00
03/02/2021
03/02/2021
03/03/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
30
100.00000
Replenished
1001850290
3054303929
False
3260674
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781016
MR00053037
00
04/05/2021
04/05/2021
04/07/2021
51862033301
ESTRADIOL 1 MG TABLET
1 MG
TABLET
100
30
30
100.00000
Replenished
1001871163
3057980095