FPV Practice Exam 2-06
24215899
3/22/20XX
Richard Hanson
Samuel Bernstein
Take 1 tablet by mouth once daily.
Atenolol 100 mg Tablet
90
1
3/21/20XX
Teva
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00378-0757-93
Quantity: 90
Days Supply: 90
AWP Cost/Unit: $1.22
Total Drug Cost: $109.80
Dispensing Fee: $2.00
Total Billed: $111.80
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00378-0757-93
Quantity: 90
Days Supply: 90
AWP Cost/Unit: $1.22
Total Drug Cost: $109.80
Dispensing Fee: $2.00
Total Billed: $111.80
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 24215899
Dispensing Date: 3/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 3/22/20XX
Initials: RPh
Drug Manu: Mylan
Rx Documentation
Dispensing Date: 3/22/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 3/22/20XX
Initials: RPh
Drug Manu: Mylan