FPV Practice Exam 2-08
84816216
3/17/20XX
Elmer Johnson
George Platz
Take 1 tablet by mouth 2 times a day.
Allopurinol 100 mg Tablet
60
2
3/17/20XX
Mylan
1 Year
RPh
Pharmacy Software System
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00378-0181-01
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $0.59
Total Drug Cost: $35.40
Dispensing Fee: $2.00
Total Billed: $37.40
Payer Code: 3-PARTY
Insurance Information
Rx Origin Code: 1
Pharmacy DAW Code: 0
Drug NDC: 00378-0181-01
Quantity: 60
Days Supply: 30
AWP Cost/Unit: $0.59
Total Drug Cost: $35.40
Dispensing Fee: $2.00
Total Billed: $37.40
Payer Code: 3-PARTY
Pharmacy Software System
Rx Documentation
Rx Number: 84816216
Dispensing Date: 3/17/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 3/17/20XX
Initials: RPh
Drug Manu: Allopurinol
Rx Documentation
Dispensing Date: 3/17/20XX
Fill Type: New
Fill Number: 1
Last Fill Date: 3/17/20XX
Initials: RPh
Drug Manu: Allopurinol