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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
True
2933643
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00169183411
NOVOLIN N 100 UNIT/ML VIAL
100/ML
VIAL
10
0
10
0.00000
Suspended
1000367846
True
2933644
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00169183411
NOVOLIN N 100 UNIT/ML VIAL
100/ML
VIAL
10
0
10
0.00000
Suspended
1000367846
True
2933617
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
60505001506
DILT XR 180 MG CAPSULE
180 MG
CAPSULE CR
100
0
20
0.00000
Suspended
1000503562
True
2933655
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00002446430
CIALIS 20 MG TABLET
20 MG
TABLET
30
0
1
0.00000
Suspended
1000541010
True
2933653
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00002446430
CIALIS 20 MG TABLET
20 MG
TABLET
30
0
30
0.00000
Suspended
1000541010
True
2933598
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
62037083201
METOPROLOL SUCC ER 100 MG TAB
100 MG
TAB.SR 24H
100
0
10
0.00000
Suspended
1000583727
True
2933604
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
99073070914
FREESTYLE FREEDOM LITE METER
KIT
1
0
1
0.00000
Suspended
1000589531
True
2933600
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
55111034101
AMLODIPINE-BENAZEPRIL 10-20 MG
10 MG-20MG
CAPSULE
100
0
70
0.00000
Suspended
1000882343
True
2933636
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00378025701
HALOPERIDOL 1 MG TABLET
1 MG
TABLET
100
0
20
0.00000
Suspended
1000902944
True
2933557
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
60505313001
QUETIAPINE FUMARATE 25 MG TAB
25 MG
TABLET
100
0
30
0.00000
Suspended
1000905285