Remote Filling Verification - Click on 2 Different Errors
7620781
9/12/20XX
Don Q. Wright
George Platz
Take one tablet by mouth two times daily.
Lopressor 50 mg Tablet
100
1
9/2/20XX
Geigy
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00028-0035-01
Quantity: 100
Days Supply: 50
AWP Cost/Unit: $1.31
Total Drug Cost: $131.00
Dispensing Fee: $2.00
Total Billed: $133.00
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00028-0035-01
Quantity: 100
Days Supply: 50
AWP Cost/Unit: $1.31
Total Drug Cost: $131.00
Dispensing Fee: $2.00
Total Billed: $133.00
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 7620871
Dispensing Date: 9/12/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/12/20XX
Initials: RPh
Drug Manu: Geigy
Rx Documentation
Dispensing Date: 9/12/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/12/20XX
Initials: RPh
Drug Manu: Geigy
