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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
2933618
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
60432062116
VALPROIC ACID 250 MG/5 ML SOLN
250 MG/5ML
SOLUTION
473
0
473
0.00000
Suspended
1000934136
True
2933546
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
68001011707
LEVETIRACETAM 500 MG TABLET
500 MG
TABLET
120
0
60
0.00000
Suspended
1001602316
True
2933544
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
68001011707
LEVETIRACETAM 500 MG TABLET
500 MG
TABLET
120
0
120
0.00000
Suspended
1001602316
True
2934041
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00054485925
TRIAZOLAM 0.25 MG TABLET
0.25 MG
TABLET
100
0
10
0.00000
Suspended
1001744025
True
2933642
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00228277911
PROPRANOLOL ER 80 MG CAPSULE
80 MG
CAP.SA 24H
100
0
40
0.00000
Suspended
1001335840
True
2933640
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00228277911
PROPRANOLOL ER 80 MG CAPSULE
80 MG
CAP.SA 24H
100
0
100
0.00000
Suspended
1001335840
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
2933633
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00378025701
HALOPERIDOL 1 MG TABLET
1 MG
TABLET
100
0
70
0.00000
Suspended
1000925060
True
2933632
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00378207301
LISINOPRIL 5 MG TABLET
5 MG
TABLET
100
0
20
0.00000
Suspended
1001290521
True
2934319
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00527128201
DICYCLOMINE 20 MG TABLET
20 MG
TABLET
100
0
35
0.00000
Suspended
1001794902