Remote Filling Verification - Click on 2 Different Errors
6548721
8/11/20XX
Alice Saylor
George Platz
Take one tablet by mouth 30 minutes after breakfast and
supper.
Gemfibrozil 600 mg Tablet
60
6
8/9/20XX
Mylan
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00378-0517-91
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $1.08
Total Drug Cost: $64.80
Dispensing Fee: $2.00
Total Billed: $66.80
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00378-0517-91
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $1.08
Total Drug Cost: $64.80
Dispensing Fee: $2.00
Total Billed: $66.80
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 6548721
Dispensing Date: 8/11/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 8/11/20XX
Initials: RPh
Drug Manu: Mylan
Rx Documentation
Dispensing Date: 8/11/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 8/11/20XX
Initials: RPh
Drug Manu: Mylan
