Remote Filling Verification - Click on Error(s)
1245783
9/8/20XX
William Williams
Carolyn Abman
Take 1 teaspoonful (5 mL) by mouth every 4 to 6 hours as needed for cough.
Promethazine with Codeine 6.25 mg/10 mg/5 mL Suspension
240 mL
1
9/5/20XX
MGP
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 4
Pharmacy DAW Code: 0
Drug NDC: 60432-0606-16
Quantity: 240 mL
Days Supply: 8
AWP Cost/Unit: $0.13
Total Drug Cost: $31.20
Dispensing Fee: $2.00
Total Billed: $33.20
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 4
Pharmacy DAW Code: 0
Drug NDC: 60432-0606-16
Quantity: 240 mL
Days Supply: 8
AWP Cost/Unit: $0.13
Total Drug Cost: $31.20
Dispensing Fee: $2.00
Total Billed: $33.20
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 1245783
Dispensing Date: 9/8/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/8/20XX
Initials: RPh
Drug Manu: MGP
Rx Documentation
Dispensing Date: 9/8/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/8/20XX
Initials: RPh
Drug Manu: MGP
