Remote Filling Verification - Click on 2 Different Errors
14434564
8/4/20XX
John R. Morgan
Carolyn Abman
Take one tablet by mouth every morning with breakfast.
Azathioprine 50 mg Tablet
60
6
8/4/20XX
Roxane
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00054-4084-25
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $1.31
Total Drug Cost: $78.60
Dispensing Fee: $2.00
Total Billed: $80.60
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00054-4084-25
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $1.31
Total Drug Cost: $78.60
Dispensing Fee: $2.00
Total Billed: $80.60
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 14434564
Dispensing Date: 8/4/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 8/4/20XX
Initials: RPh
Drug Manu: Purepac
Rx Documentation
Dispensing Date: 8/4/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 8/4/20XX
Initials: RPh
Drug Manu: Purepac
