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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
2934123
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772144
MR00218418
03
02/09/2021
02/09/2021
02/10/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
10
11.11100
Replenished
1001811232
987509358
False
2951954
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772144
MR00218418
03
02/09/2021
02/09/2021
02/10/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
80
88.88900
Replenished
1001811232
987509358
False
3006964
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775867
MR00287658
05
02/27/2021
02/27/2021
02/28/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001823796
3049396293
False
3247526
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775867
MR00287658
06
04/02/2021
04/02/2021
04/03/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001836706
3051817902
False
3426499
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775867
MR00287658
07
04/26/2021
04/26/2021
04/27/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001850989
3054468652
False
4147218
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775867
MR00287658
10
07/28/2021
07/28/2021
07/29/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001899296
3063578940
False
2963028
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776361
MR00151354
04
02/18/2021
02/18/2021
02/19/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
60
100.00000
Replenished
1001818667
988063364
False
3145667
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776361
MR00151354
05
03/20/2021
03/20/2021
03/21/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
30
50.00000
Replenished
1001829639
3050481250
False
3149080
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776361
MR00151354
05
03/20/2021
03/20/2021
03/21/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
30
50.00000
Replenished
1001836706
3051817902
False
3378814
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000776361
MR00151354
06
04/19/2021
04/19/2021
04/20/2021
68180098001
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
60
60
100.00000
Replenished
1001846719
3053644954