Remote Filling Verification - Click on Error(s)
9052538
12/13/20XX
Richard T. Hanson
Carolyn Abman
Take 1 tablet by mouth 3 times per day as needed for anxiety.
Alprazolam 0.5 mg Tablet
30
3
12/9/20XX
Actavis
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 2
Pharmacy DAW Code: 0
Drug NDC: 00228-2029-10
Quantity: 30
Days Supply: 10
AWP Cost/Unit: $0.95
Total Drug Cost: $28.50
Dispensing Fee: $2.00
Total Billed: $30.50
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 2
Pharmacy DAW Code: 0
Drug NDC: 00228-2029-10
Quantity: 30
Days Supply: 10
AWP Cost/Unit: $0.95
Total Drug Cost: $28.50
Dispensing Fee: $2.00
Total Billed: $30.50
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 9052538
Dispensing Date: 12/13/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/13/20XX
Initials: RPh
Drug Manu: Actavis
Rx Documentation
Dispensing Date: 12/13/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/13/20XX
Initials: RPh
Drug Manu: Actavis
