Remote Filling Verification - Click on 2 Different Errors
6501231
5/25/20XX
Evelyn Johnson
James T. Warren
Take one tablet by mouth daily.
Aricept 10 mg ODT
90
3
5/25/20XX
Eisai-Pfizer
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 62856-0246-30
Quantity: 90
Days Supply: 90
AWP Cost/Unit: $12.11
Total Drug Cost: $1089.90
Dispensing Fee: $2.00
Total Billed: $1091.90
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 62856-0246-30
Quantity: 90
Days Supply: 90
AWP Cost/Unit: $12.11
Total Drug Cost: $1089.90
Dispensing Fee: $2.00
Total Billed: $1091.90
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 6501231
Dispensing Date: 5/25/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 5/25/20XX
Initials: RPh
Drug Manu:
Rx Documentation
Dispensing Date: 5/25/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 5/25/20XX
Initials: RPh
Drug Manu:
