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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
10158159
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012644
MR00073260
03
08/14/2023
08/14/2023
08/15/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
30
17
56.66700
Replenished
08/28/2023
1002263052
3144881028
False
10241886
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012756
MR00092991
02
08/24/2023
08/24/2023
08/26/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
135
83
61.48100
Replenished
08/28/2023
1002263052
3144881028
False
10154868
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012644
MR00073260
03
08/14/2023
08/14/2023
08/15/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
30
13
43.33300
Replenished
08/16/2023
1002259761
3143593677
False
10100404
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012767
MR00192351
01
08/07/2023
08/07/2023
08/08/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
30
30
100.00000
Replenished
08/16/2023
1002259761
3143593677
False
10062940
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012801
MR00072992
00
08/01/2023
08/01/2023
08/02/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
84
57
67.85700
Replenished
08/16/2023
1002259761
3143593677
False
10054471
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012799
MR00062075
00
07/31/2023
07/31/2023
08/01/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
73
60.83300
Replenished
08/22/2023
1002252535
3142130207
False
10056546
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012801
MR00072992
00
08/01/2023
08/01/2023
08/02/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
84
27
32.14300
Replenished
08/22/2023
1002252535
3142130207
False
10041572
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012756
MR00092991
01
07/28/2023
07/28/2023
07/29/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
135
53
39.25900
Replenished
08/22/2023
1002252361
3141976737
False
10052105
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012799
MR00062075
00
07/31/2023
07/31/2023
08/01/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
47
39.16700
Replenished
08/22/2023
1002252361
3141976737
False
9969297
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012644
MR00073260
02
07/18/2023
07/18/2023
07/19/2023
59762372001
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
30
18
60.00000
Replenished
08/22/2023
1002251766
3141657238