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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
9391921
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790395
MR00124995
02
05/15/2023
05/15/2023
05/16/2023
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
14
7.77700
Replenished
05/24/2023
1002222847
3134351839
False
9391920
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790395
MR00124995
02
05/15/2023
05/15/2023
05/16/2023
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
66
36.66700
Replenished
05/18/2023
1002221191
3133750055
False
9375331
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790395
MR00124995
02
05/15/2023
05/15/2023
05/16/2023
62332014231
CELECOXIB 200 MG CAPSULE
200 MG
CAPSULE
100
180
100
55.55600
Replenished
05/18/2023
1002221191
3133750055