Remote Filling Verification - Click on 2 Different Errors
5879633
4/20/20XX
Robert Roberts
Norman Keyes
Take one tablet by mouth at bedtime as needed for sleep.
Triazolam 0.25 mg Tablet
14
1
4/20/20XX
Geneva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00054-4859-29
Quantity: 14
Days Supply: 14
AWP Cost/Unit: $0.63
Total Drug Cost: $8.82
Dispensing Fee: $2.00
Total Billed: $10.82
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00054-4859-29
Quantity: 14
Days Supply: 14
AWP Cost/Unit: $0.63
Total Drug Cost: $8.82
Dispensing Fee: $2.00
Total Billed: $10.82
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 5879633
Dispensing Date: 4/20/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 4/20/20XX
Initials: RPh
Drug Manu: Geneva
Rx Documentation
Dispensing Date: 4/20/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 4/20/20XX
Initials: RPh
Drug Manu: Geneva
