Remote Filling Verification - Click on 2 Different Errors
6779541
2/15/20XX
Evelyn Johnson
Carolyn Abman
Take one tablet by mouth twice a day as needed for anxiety.
Alprazolam 1 mg Tablet
90
6
2/13/20XX
Greenstone
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 59762-3721-03
Quantity: 90
Days Supply: 30
AWP Cost/Unit: $0.96
Total Drug Cost: $86.40
Dispensing Fee: $2.00
Total Billed: $88.40
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 59762-3721-03
Quantity: 90
Days Supply: 30
AWP Cost/Unit: $0.96
Total Drug Cost: $86.40
Dispensing Fee: $2.00
Total Billed: $88.40
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 6779541
Dispensing Date: 2/15/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/15/20XX
Initials: RPh
Drug Manu: Greenstone
Rx Documentation
Dispensing Date: 2/15/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/15/20XX
Initials: RPh
Drug Manu: Greenstone
