FPV Practice Exam 2-01
29919528
2/22/20XX
Georgia Eldon
Samuel Bernstein
Take 1 tablet by mouth once daily for high cholesterol.
Lovastatin 40 mg Tablets
30
2
2/20/20XX
Teva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 54458-0932-10
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $4.92
Total Drug Cost: $147.60
Dispensing Fee: $2.00
Total Billed: $149.60
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 54458-0932-10
Quantity: 30
Days Supply: 30
AWP Cost/Unit: $4.92
Total Drug Cost: $147.60
Dispensing Fee: $2.00
Total Billed: $149.60
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 29919528
Dispensing Date: 2/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/22/20XX
Initials: RPh
Drug Manu: Teva
Rx Documentation
Dispensing Date: 2/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 2/22/20XX
Initials: RPh
Drug Manu: Teva