Remote Filling Verification - Click on 2 Different Errors
6578921
6/6/20XX
Rose Bontrager
Royal T. Shumway
Take 0.5 mL by mouth every twelve hours until all taken.
Biaxin 250 mg/5 mL Oral Suspension
15 mL
0
6/5/20XX
Abbott
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00074-3188-13
Quantity: 15 mL
Days Supply: 10
AWP Cost/Unit: $1.33
Total Drug Cost: $19.95
Dispensing Fee: $2.00
Total Billed: $21.95
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00074-3188-13
Quantity: 15 mL
Days Supply: 10
AWP Cost/Unit: $1.33
Total Drug Cost: $19.95
Dispensing Fee: $2.00
Total Billed: $21.95
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 6578921
Dispensing Date: 6/6/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 6/6/20XX
Initials: RPh
Drug Manu: Abbott
Rx Documentation
Dispensing Date: 6/6/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 6/6/20XX
Initials: RPh
Drug Manu: Abbott
