Remote Filling Verification - Click on 2 Different Errors
87354098
11/22/20XX
David Bontrager
Arnold Grear
Take one-half teaspoonful (2.5 mL) by mouth daily.
Lanoxin 0.05 mg/mL Oral Elixir
60 mL
1
11/22/20XX
BW
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00081-0264-81
Quantity: 60 mL
Days Supply: 24
AWP Cost/Unit: $1.09
Total Drug Cost: $65.40
Dispensing Fee: $2.00
Total Billed: $67.40
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00081-0264-81
Quantity: 60 mL
Days Supply: 24
AWP Cost/Unit: $1.09
Total Drug Cost: $65.40
Dispensing Fee: $2.00
Total Billed: $67.40
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 87354098
Dispensing Date: 11/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 11/22/20XX
Initials: RPh
Drug Manu: BW
Rx Documentation
Dispensing Date: 11/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 11/22/20XX
Initials: RPh
Drug Manu: BW
