Remote Filling Verification - Click on 2 Different Errors
1459087
2/6/20XX
Elmer Johnson
Harold L. Green
Take one tablet by mouth four times daily.
Coumadin 2.5 mg Tablet
30
3
2/3/20XX
DuPont
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00056-0173-70
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $2.38
Total Drug Cost: $71.40
Dispensing Fee: $2.00
Total Billed: $73.40
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00056-0173-70
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $2.38
Total Drug Cost: $71.40
Dispensing Fee: $2.00
Total Billed: $73.40
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 1459087
Dispensing Date: 2/6/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/6/20XX
Initials: RPh
Drug Manu: DuPont
Rx Documentation
Dispensing Date: 2/6/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/6/20XX
Initials: RPh
Drug Manu: DuPont
