Remote Filling Verification - Click on Error(s)
6072202
12/14/20XX
William P. Jones
Cynthia McDonald
Take 1 or 2 tablets by mouth every 6 hours as needed for pain.
Hydrocodone/APAP 5 mg/325 mg Tablet
20
0
12/13/20XX
Camber
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 3
Pharmacy DAW Code: 0
Drug NDC: 31722-0996-01
Quantity: 20
Days Supply: 3
AWP Cost/Unit: $0.69
Total Drug Cost: $16.56
Dispensing Fee: $2.00
Total Billed: $18.56
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 3
Pharmacy DAW Code: 0
Drug NDC: 31722-0996-01
Quantity: 20
Days Supply: 3
AWP Cost/Unit: $0.69
Total Drug Cost: $16.56
Dispensing Fee: $2.00
Total Billed: $18.56
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 6072202
Dispensing Date: 12/14/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/14/20XX
Initials: RPh
Drug Manu: Camber
Rx Documentation
Dispensing Date: 12/14/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/14/20XX
Initials: RPh
Drug Manu: Camber
