Remote Filling Verification - Click on 2 Different Errors
87639057
12/4/20XX
Beth Bruno
George Platz
Take one tablet by mouth daily as directed.
Levaquin 500 mg Tablet
10
0
12/4/20XX
Ortho-McNeil
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00045-1525-50
Quantity: 10
Days Supply: 10
AWP Cost/Unit: $14.69
Total Drug Cost: $146.90
Dispensing Fee: $2.00
Total Billed: $148.90
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00045-1525-50
Quantity: 10
Days Supply: 10
AWP Cost/Unit: $14.69
Total Drug Cost: $146.90
Dispensing Fee: $2.00
Total Billed: $148.90
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 87639057
Dispensing Date: 12/4/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/4/20XX
Initials: RPh
Drug Manu: Ortho-McNeil
Rx Documentation
Dispensing Date: 12/4/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 12/4/20XX
Initials: RPh
Drug Manu: Ortho-McNeil
