Remote Filling Verification - Click on 2 Different Errors
1998206
3/9/20XX
Kyle O. Bruno
Cynthia McDonald
Take one tablet by mouth daily.
Allopurinol 100 mg Tablet
100
PRN
3/5/20XX
Schein
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00364-0633-01
Quantity: 100
Days Supply: 100
AWP Cost/Unit: $0.44
Total Drug Cost: $4.40
Dispensing Fee: $2.00
Total Billed: $6.40
Payer Code: CASH
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00364-0633-01
Quantity: 100
Days Supply: 100
AWP Cost/Unit: $0.44
Total Drug Cost: $4.40
Dispensing Fee: $2.00
Total Billed: $6.40
Payer Code: CASH
Pharmacy Software System
Rx Documentation
Rx Number: 1998206
Dispensing Date: 3/5/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 3/9/20XX
Initials: RPh
Drug Manu: Schein
Rx Documentation
Dispensing Date: 3/5/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 3/9/20XX
Initials: RPh
Drug Manu: Schein
