Remote Filling Verification - Click on 2 Different Errors
83640012
11/26/20XX
Billy Hanson
Sandra Jones
Instill five drops in the right ear two times daily for 10
days.
Ofloxacin 0.3% Otic Solution
5 ml
0
11/25/20XX
Apotex Corp.
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 60505-0363-01
Quantity: 5 ml
Days Supply: 25
AWP Cost/Unit: $14.85
Total Drug Cost: $74.25
Dispensing Fee: $2.00
Total Billed: $76.25
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 60505-0363-01
Quantity: 5 ml
Days Supply: 25
AWP Cost/Unit: $14.85
Total Drug Cost: $74.25
Dispensing Fee: $2.00
Total Billed: $76.25
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 83640012
Dispensing Date: 11/26/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 11/26/20XX
Initials: RPh
Drug Manu: Apotex Corp.
Rx Documentation
Dispensing Date: 11/26/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 11/26/20XX
Initials: RPh
Drug Manu: Apotex Corp.
