FPV Practice Exam 2-04
3437076
1/22/20XX
Margaret Morgan
Carolyn Abman
Take 1 tablet by mouth 2 times a day for 10 days.
Cefuroxime Axetil 250 mg Tablet
20
0
1/20/20XX
Lupin
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 68180-0302-20
Quantity: 20
Days Supply: 10
AWP Cost/Unit: $4.40
Total Drug Cost: $88.00
Dispensing Fee: $2.00
Total Billed: $90.00
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 68180-0302-20
Quantity: 20
Days Supply: 10
AWP Cost/Unit: $4.40
Total Drug Cost: $88.00
Dispensing Fee: $2.00
Total Billed: $90.00
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 3437076
Dispensing Date: 1/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 1/22/20XX
Initials: RPh
Drug Manu: Lupin
Rx Documentation
Dispensing Date: 1/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 1/22/20XX
Initials: RPh
Drug Manu: Lupin