FPV Practice Exam 1-01
9262975
2/8/20XX
Coleen Bontrager
Samuel Bernstein
Take 1 tablet by mouth once daily.
Fluoxetine 20 mg Tablets
30
2
2/6/20XX
Cadila Healthcare
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 54458-0989-10
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $2.77
Total Drug Cost: $83.10
Dispensing Fee: $2.00
Total Billed: $85.10
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 54458-0989-10
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $2.77
Total Drug Cost: $83.10
Dispensing Fee: $2.00
Total Billed: $85.10
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 9262975
Dispensing Date: 2/8/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/8/20XX
Initials: RPh
Drug Manu: Cadila Healthcare
Rx Documentation
Dispensing Date: 2/8/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/8/20XX
Initials: RPh
Drug Manu: Cadila Healthcare