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Get WA F245-010-000 2014-2024

Vider. Time required to combine the ingredients in the prescription. List in minutes. Check the appropriate box. Total charge for the filled prescription. The fee for services provided by the pharmacist. Fee for compounding time. Total charge for filled prescription (drug cost + professional fee + applicable tax). Compound Itemization Each column must be completed per line item. Enter the NDC; name; strength; quantity (number of units supplied); drug cost/unit; and the total drug cost for each .

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