Pharmaceutical Fee Schedule Calculator
Simple Pharmacy
Simple Physician
Compound Pharmacy
Compound Physician
Simple Pharmaceutical Fee Schedule Calculator
For Physician Dispensed Prescriptions
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NBC number repackaged:
Underlying Product NDC Number:
Non-Legend(OTC):
*Documented Paid Cost:
*Usual and Customary Price:
*Date of Service:
*Total Metric Decimal Units Dispensed:
NPI Number:
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