Remote Filling Verification - Click on 2 Different Errors
7600921
6/30/20XX
Robert O. Sykes
Samuel Bernstein
Take one tablet by mouth daily.
Accupril 5 mg Tablet
60
3
6/29/20XX
Parke-Davis
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00071-0527-23
Quantity: 60
Days Supply: 60
AWP Cost/Unit: $2.59
Total Drug Cost: $155.40
Dispensing Fee: $2.00
Total Billed: $157.40
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00071-0527-23
Quantity: 60
Days Supply: 60
AWP Cost/Unit: $2.59
Total Drug Cost: $155.40
Dispensing Fee: $2.00
Total Billed: $157.40
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 7600921
Dispensing Date: 6/30/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 6/30/20XX
Initials: RPh
Drug Manu: Parke-Davis
Rx Documentation
Dispensing Date: 6/30/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 6/30/20XX
Initials: RPh
Drug Manu: Parke-Davis
