Remote Filling Verification - Click on Error(s)
7641855
8/16/20XX
Elizabeth R. Bruno
Sherman F. Fleer, DDS
Take 1 tablet by mouth every 4 hours as needed for pain.
Codeine/APAP 30 mg/300 mg Tablet
24
0
8/15/20XX
Amneal
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 2
Pharmacy DAW Code: 0
Drug NDC: 65162-0033-10
Quantity: 24
Days Supply: 4
AWP Cost/Unit: $0.80
Total Drug Cost: $19.20
Dispensing Fee: $2.00
Total Billed: $21.20
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 2
Pharmacy DAW Code: 0
Drug NDC: 65162-0033-10
Quantity: 24
Days Supply: 4
AWP Cost/Unit: $0.80
Total Drug Cost: $19.20
Dispensing Fee: $2.00
Total Billed: $21.20
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 7641855
Dispensing Date: 8/16/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 8/16/20XX
Initials: RPh
Drug Manu: Amneal
Rx Documentation
Dispensing Date: 8/16/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 8/16/20XX
Initials: RPh
Drug Manu: Amneal
