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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
2933697
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777478
MR00174136
01
01/22/2021
01/22/2021
01/23/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
10
11.11100
Replenished
1001800608
False
2933698
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777478
MR00174136
01
01/22/2021
01/22/2021
01/23/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
80
88.88900
Replenished
1001814475
987756775
False
2963049
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779986
MR00162256
00
02/18/2021
02/18/2021
02/19/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
20
22.22200
Replenished
1001814475
987756775
False
2966262
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779986
MR00162256
00
02/18/2021
02/18/2021
02/19/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
70
77.77800
Replenished
1001850989
3054468652
False
3285615
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781117
MR00218313
00
04/09/2021
04/09/2021
04/10/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
4
4
100.00000
Replenished
1001850989
3054468652
False
3455987
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777478
MR00174136
02
04/30/2021
04/30/2021
05/01/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
26
28.88900
Replenished
1001850989
3054468652
False
3462875
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000777478
MR00174136
02
04/30/2021
04/30/2021
05/01/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
64
71.11100
Replenished
1001860456
3056066373
False
3540428
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781860
MR00195463
00
05/12/2021
05/12/2021
05/13/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
30
30
100.00000
Replenished
1001860456
3056066373
False
3577394
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781973
MR00162256
00
05/17/2021
05/17/2021
05/18/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
6
6.66700
Replenished
1001860456
3056066373
False
3580474
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781973
MR00162256
00
05/17/2021
05/17/2021
05/18/2021
69315011701
FUROSEMIDE 40 MG TABLET
40 MG
TABLET
100
90
84
93.33300
Replenished
1001874950
3058793435