FPV Practice Exam 1-04
93172981
4/20/20XX
Coleen Bontrager
Carolyn Abman
Take 1 tablet by mouth once daily.
Olanzapine 5 mg Tablet
30
4
3/6/20XX
Teva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00093-5768-56
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $13.22
Total Drug Cost: $396.60
Dispensing Fee: $2.00
Total Billed: $398.60
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00093-5768-56
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $13.22
Total Drug Cost: $396.60
Dispensing Fee: $2.00
Total Billed: $398.60
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 93172981
Dispensing Date: 4/20/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 4/20/20XX
Initials: RPh
Drug Manu: Teva
Rx Documentation
Dispensing Date: 4/20/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 4/20/20XX
Initials: RPh
Drug Manu: Teva