Remote Filling Verification - Click on 2 Different Errors
2273691
6/2/20XX
Edward Miller
Carolyn Abman
Take one tablet by mouth every 4 to 6 hours if needed for
pain.
Oxycodone 10 mg IR Tablet
40
0
6/2/XX
Purdue Pharma
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 59011-0100-10
Quantity: 40
Days Supply: 6
AWP Cost/Unit: $2.15
Total Drug Cost: $86.00
Dispensing Fee: $2.00
Total Billed: $88.00
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 59011-0100-10
Quantity: 40
Days Supply: 6
AWP Cost/Unit: $2.15
Total Drug Cost: $86.00
Dispensing Fee: $2.00
Total Billed: $88.00
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 2273691
Dispensing Date: 6/2/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 6/2/20XX
Initials: RPh
Drug Manu: Purdue Pharma
Rx Documentation
Dispensing Date: 6/2/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 6/2/20XX
Initials: RPh
Drug Manu: Purdue Pharma
