Remote Filling Verification - Click on 2 Different Errors
6412206
7/30/20XX
Laurie Elder
Harold Green
Take one tablet by mouth twice daily.
Clonazepam 0.5 mg Tablet
60
3
7/23/20XX
Teva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00093-0832-01
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $0.75
Total Drug Cost: $45.00
Dispensing Fee: $2.00
Total Billed: $47.00
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00093-0832-01
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $0.75
Total Drug Cost: $45.00
Dispensing Fee: $2.00
Total Billed: $47.00
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 6412206
Dispensing Date: 7/23/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 7/30/20XX
Initials: RPh
Drug Manu: Teva
Rx Documentation
Dispensing Date: 7/23/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 7/30/20XX
Initials: RPh
Drug Manu: Teva
