Rx #: 158421
Dispensing Date: 11/3/20XX
Patient: Hilda R. Morgan
Doctor: George Platz
DEA: AP7323013
NDC: 53746-0102-01
RPh Initials: TCW
Drug: Gabapentin 300 mg Capsule
Manufacturer: Amneal
DAW Code: 0
SIG: T,1,CAP,PO,TID
Fill Type: Refill
Fill Number: 11
Last Fill Date: 10/5/20XX
Refills Remaining: 1
Quantity: 100
Day Supply: 30
Drug Unit Cost: $1.34
Dispensing Fee: $1.75
Total Cost: $135.75
