Remote Filling Verification - Click on 2 Different Errors
327264521
12/11/20XX
Evelyn Johnson
Norman Keyes
Take 1 mL by mouth two times daily.
Haloperidol 2 mg/mL Oral Soluion
15 mL
0
12/1/20XX
Roxane
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00054-3350-41
Quantity: 15 mL
Days Supply: 15
AWP Cost/Unit: $15.93
Total Drug Cost: $238.95
Dispensing Fee: $2.00
Total Billed: $240.95
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00054-3350-41
Quantity: 15 mL
Days Supply: 15
AWP Cost/Unit: $15.93
Total Drug Cost: $238.95
Dispensing Fee: $2.00
Total Billed: $240.95
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 327264521
Dispensing Date: 12/11/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/11/20XX
Initials: RPh
Drug Manu: Roxane
Rx Documentation
Dispensing Date: 12/11/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/11/20XX
Initials: RPh
Drug Manu: Roxane
