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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
9081874
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000791084
MR00024743
10
04/10/2023
04/10/2023
04/11/2023
68001036700
POTASSIUM CL ER 10 MEQ TABLET
10 MEQ
TAB PRT SR
100
60
60
100.00000
Replenished
04/12/2023
1002200467
3129734792
False
9059614
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795248
MR00162256
01
04/06/2023
04/06/2023
04/07/2023
68001036700
POTASSIUM CL ER 10 MEQ TABLET
10 MEQ
TAB PRT SR
100
90
40
44.44400
Replenished
04/12/2023
1002200467
3129734792
False
9051480
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795248
MR00162256
01
04/06/2023
04/06/2023
04/07/2023
68001036700
POTASSIUM CL ER 10 MEQ TABLET
10 MEQ
TAB PRT SR
100
90
50
55.55600
Replenished
1002199438
3129427833
False
8978058
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795578
MR00313919
02
03/29/2023
03/29/2023
03/30/2023
68001036700
POTASSIUM CL ER 10 MEQ TABLET
10 MEQ
TAB PRT SR
100
30
30
100.00000
Replenished
1002199438
3129427833
False
8890576
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796772
MR00170923
00
03/20/2023
03/20/2023
03/21/2023
68001036700
POTASSIUM CL ER 10 MEQ TABLET
10 MEQ
TAB PRT SR
100
120
20
16.66700
Replenished
1002199438
3129427833
False
8885332
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796772
MR00170923
00
03/20/2023
03/20/2023
03/21/2023
68001036700
POTASSIUM CL ER 10 MEQ TABLET
10 MEQ
TAB PRT SR
100
120
100
83.33300
Replenished
1002193992
3127402543