Remote Filling Verification - Click on Error(s)
8733024
9/21/20XX
Daniel Day
Norman Keyes
Take 1 tablet by mouth at bedtime as needed for sleep.
Trazodone 150 mg Tablet
15
1
9/19/20XX
Teva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 3
Pharmacy DAW Code: 0
Drug NDC: 50111-0560-01
Quantity: 15
Days Supply: 15
AWP Cost/Unit: $0.65
Total Drug Cost: $9.75
Dispensing Fee: $2.00
Total Billed: $11.75
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 3
Pharmacy DAW Code: 0
Drug NDC: 50111-0560-01
Quantity: 15
Days Supply: 15
AWP Cost/Unit: $0.65
Total Drug Cost: $9.75
Dispensing Fee: $2.00
Total Billed: $11.75
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 8733024
Dispensing Date: 9/21/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/21/20XX
Initials: RPh
Drug Manu: Teva
Rx Documentation
Dispensing Date: 9/21/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/21/20XX
Initials: RPh
Drug Manu: Teva
