Remote Filling Verification - Click on 2 Different Errors
8735412
7/6/20XX
Julia Bontrager
George Platz
Take one tablet by mouth three times daily until all taken.
Augmentin 250 mg Chewable Tablet
30
1
7/5/20XX
Beecham
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00029-6074-47
Quantity: 30
Days Supply: 10
AWP Cost/Unit: $5.43
Total Drug Cost: $162.90
Dispensing Fee: $2.00
Total Billed: $164.90
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00029-6074-47
Quantity: 30
Days Supply: 10
AWP Cost/Unit: $5.43
Total Drug Cost: $162.90
Dispensing Fee: $2.00
Total Billed: $164.90
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 8735421
Dispensing Date: 7/6/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 7/6/20XX
Initials: RPh
Drug Manu: Beecham
Rx Documentation
Dispensing Date: 7/6/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 7/6/20XX
Initials: RPh
Drug Manu: Beecham
