FPV Practice Exam 2-07
94065511
5/14/20XX
Julie Bontrager
Harold Green
Take 1 tablet by mouth 3 times per day.
Biaxin 250 mg Tablet
20
0
5/14/20XX
Abbott
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00074-3368-60
Quantity: 20
Days Supply: 10
AWP Cost/Unit: $8.07
Total Drug Cost: $80.70
Dispensing Fee: $2.00
Total Billed: $82.70
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 1
Drug NDC: 00074-3368-60
Quantity: 20
Days Supply: 10
AWP Cost/Unit: $8.07
Total Drug Cost: $80.70
Dispensing Fee: $2.00
Total Billed: $82.70
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 90465511
Dispensing Date: 5/14/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 5/14/20XX
Initials: RPh
Drug Manu: Abbott
Rx Documentation
Dispensing Date: 5/14/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 5/14/20XX
Initials: RPh
Drug Manu: Abbott