Remote Filling Verification - Click on 2 Different Errors
871206328
9/12/20XX
Wendy Moore
Carolyn Abman
Take one tablet by mouth three times daily until all taken.
Metronidazole 500 mg Tablet
30
1
9/12/20XX
Teva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00093-0852-05
Quantity: 30
Days Supply: 10
AWP Cost/Unit: $0.69
Total Drug Cost: $20.70
Dispensing Fee: $2.00
Total Billed: $22.70
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00093-0852-05
Quantity: 30
Days Supply: 10
AWP Cost/Unit: $0.69
Total Drug Cost: $20.70
Dispensing Fee: $2.00
Total Billed: $22.70
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 871206328
Dispensing Date: 9/12/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/12/20XX
Initials: RPh
Drug Manu: Teva
Rx Documentation
Dispensing Date: 9/12/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 9/12/20XX
Initials: RPh
Drug Manu: Teva
