Remote Filling Verification - Click on 2 Different Errors
2541998
11/13/20XX
Alice Sawyer
James Warner
Take one tablet by mouth at bedtime as needed for sleep.
Ambien 10 mg Tablet
20
0
1/25/20XX
Searle
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00025-5421-31
Quantity: 20
Days Supply: 20
AWP Cost/Unit: $9.19
Total Drug Cost: $183.80
Dispensing Fee: $2.00
Total Billed: $185.80
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00025-5421-31
Quantity: 20
Days Supply: 20
AWP Cost/Unit: $9.19
Total Drug Cost: $183.80
Dispensing Fee: $2.00
Total Billed: $185.80
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 2541998
Dispensing Date: 11/13/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 11/13/20XX
Initials: RPh
Drug Manu: Searle
Rx Documentation
Dispensing Date: 11/13/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 11/13/20XX
Initials: RPh
Drug Manu: Searle
