Remote Filling Verification - Click on 2 Different Errors
7540122
9/29/20XX
Harold Elder
Samuel Bernstein
Take one tablet by mouth every 8 hours as needed for anxiety.
Diazepam 2 mg Tablet
45
0
9/29/20XX
Purepac
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00228-2051-50
Quantity: 45
Days Supply: 15
AWP Cost/Unit: $0.10
Total Drug Cost: $4.50
Dispensing Fee: $2.00
Total Billed: $6.50
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00228-2051-50
Quantity: 45
Days Supply: 15
AWP Cost/Unit: $0.10
Total Drug Cost: $4.50
Dispensing Fee: $2.00
Total Billed: $6.50
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 7540122
Dispensing Date: 9/29/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/29/20XX
Initials: RPh
Drug Manu: Purepac
Rx Documentation
Dispensing Date: 9/29/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/29/20XX
Initials: RPh
Drug Manu: Purepac
