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marcus-aurelius-1975-06-17.xml
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marcus-aurelius-1975-06-17.xml
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<Message xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" StructuresVersion="20170715" ECLVersion="20170715" DatatypesVersion="20170715" TransactionDomain="SCRIPT" TransactionVersion="20170715" TransportVersion="20170715">
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<MessageID>MESAGE1234567890</MessageID>
<RelatesToMessageID>MESAGE1234567890</RelatesToMessageID>
<SentTime>2021-06-30T16:35:00+00:00</SentTime>
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<BusinessName>Pax Pharmacy, INC.</BusinessName>
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<BusinessName>Pax Pharmacy, INC.</BusinessName>
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<PostalCode>98000</PostalCode>
</Address>
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<LastFillDate>
<Date>2024-02-23</Date>
</LastFillDate>
<Substitutions>0</Substitutions>
<Note>04</Note>
<RefillsRemaining>0</RefillsRemaining>
<Pharmacy>
<Identification>
<NCPDPID>0</NCPDPID>
<DEANumber>XX0000000</DEANumber>
<NPI>0</NPI>
<MutuallyDefined>XX0000000</MutuallyDefined>
</Identification>
<BusinessName>Nerva Pharmacy</BusinessName>
<Address>
<AddressLine1>1 SomeHWY S</AddressLine1>
<City>Seattle</City>
<StateProvince>WA</StateProvince>
<PostalCode>98000</PostalCode>
</Address>
<CommunicationNumbers>
<PrimaryTelephone>
<Number>2061009000</Number>
</PrimaryTelephone>
</CommunicationNumbers>
</Pharmacy>
<Prescriber>
<NonVeterinarian>
<Identification>
<DEANumber>XX0000000</DEANumber>
<NPI>0</NPI>
<MutuallyDefined>XX0000000</MutuallyDefined>
</Identification>
<Name>
<LastName>Calvilla</LastName>
<FirstName>Domita</FirstName>
</Name>
<Address>
<AddressLine1>1 Old ST</AddressLine1>
<City>Seattle</City>
<StateProvince>WA</StateProvince>
<PostalCode>98000</PostalCode>
</Address>
</NonVeterinarian>
</Prescriber>
<HistorySource>
<Source>
<Reference>
<DEANumber>XX0000000</DEANumber>
</Reference>
<SourceQualifier>P2</SourceQualifier>
</Source>
<SourceReference>0869436</SourceReference>
<FillNumber>00</FillNumber>
</HistorySource>
</MedicationDispensed>
<MedicationDispensed>
<DrugDescription>OxyCONTIN 30 MG Extended Release Oral Tablet</DrugDescription>
<DrugCoded>
<ProductCode>
<Code>59011043020</Code>
<Qualifier>ND</Qualifier>
</ProductCode>
</DrugCoded>
<Quantity>
<Value>30</Value>
<CodeListQualifier>87</CodeListQualifier>
<QuantityUnitOfMeasure>
<Code>Unspecified</Code>
</QuantityUnitOfMeasure>
</Quantity>
<DaysSupply>30</DaysSupply>
<WrittenDate>
<Date>2024-02-23</Date>
</WrittenDate>
<LastFillDate>
<Date>2024-02-23</Date>
</LastFillDate>
<Substitutions>0</Substitutions>
<Note>04</Note>
<RefillsRemaining>0</RefillsRemaining>
<Pharmacy>
<Identification>
<NCPDPID>0</NCPDPID>
<DEANumber>XX0000000</DEANumber>
<NPI>0</NPI>
<MutuallyDefined>XX0000000</MutuallyDefined>
</Identification>
<BusinessName>Nerva Pharmacy</BusinessName>
<Address>
<AddressLine1>1 SomeHWY S</AddressLine1>
<City>Seattle</City>
<StateProvince>WA</StateProvince>
<PostalCode>98000</PostalCode>
</Address>
<CommunicationNumbers>
<PrimaryTelephone>
<Number>2061009000</Number>
</PrimaryTelephone>
</CommunicationNumbers>
</Pharmacy>
<Prescriber>
<NonVeterinarian>
<Identification>
<DEANumber>XX0000000</DEANumber>
<NPI>0</NPI>
<MutuallyDefined>XX0000000</MutuallyDefined>
</Identification>
<Name>
<LastName>Calvilla</LastName>
<FirstName>Domita</FirstName>
</Name>
<Address>
<AddressLine1>1 Old ST</AddressLine1>
<City>Seattle</City>
<StateProvince>WA</StateProvince>
<PostalCode>98000</PostalCode>
</Address>
</NonVeterinarian>
</Prescriber>
<HistorySource>
<Source>
<Reference>
<DEANumber>XX0000000</DEANumber>
</Reference>
<SourceQualifier>P2</SourceQualifier>
</Source>
<SourceReference>0869436</SourceReference>
<FillNumber>00</FillNumber>
</HistorySource>
</MedicationDispensed>
<MedicationDispensed>
<DrugDescription>fentanyl 0.1 MG Buccal Tablet</DrugDescription>
<DrugCoded>
<ProductCode>
<Code>51862063401</Code>
<Qualifier>ND</Qualifier>
</ProductCode>
</DrugCoded>
<Quantity>
<Value>10</Value>
<CodeListQualifier>87</CodeListQualifier>
<QuantityUnitOfMeasure>
<Code>Unspecified</Code>
</QuantityUnitOfMeasure>
</Quantity>
<DaysSupply>10</DaysSupply>
<WrittenDate>
<Date>2024-03-02</Date>
</WrittenDate>
<LastFillDate>
<Date>2024-03-02</Date>
</LastFillDate>
<Substitutions>0</Substitutions>
<Note>04</Note>
<RefillsRemaining>0</RefillsRemaining>
<Pharmacy>
<Identification>
<NCPDPID>0</NCPDPID>
<DEANumber>XX0000000</DEANumber>
<NPI>0</NPI>
<MutuallyDefined>XX0000000</MutuallyDefined>
</Identification>
<BusinessName>Nerva Pharmacy</BusinessName>
<Address>
<AddressLine1>1 SomeHWY S</AddressLine1>
<City>Seattle</City>
<StateProvince>WA</StateProvince>
<PostalCode>98000</PostalCode>
</Address>
<CommunicationNumbers>
<PrimaryTelephone>
<Number>2061009000</Number>
</PrimaryTelephone>
</CommunicationNumbers>
</Pharmacy>
<Prescriber>
<NonVeterinarian>
<Identification>
<DEANumber>XX0000000</DEANumber>
<NPI>0</NPI>
<MutuallyDefined>XX0000000</MutuallyDefined>
</Identification>
<Name>
<LastName>Calvilla</LastName>
<FirstName>Domita</FirstName>
</Name>
<Address>
<AddressLine1>1 Old ST</AddressLine1>
<City>Seattle</City>
<StateProvince>WA</StateProvince>
<PostalCode>98000</PostalCode>
</Address>
</NonVeterinarian>
</Prescriber>
<HistorySource>
<Source>
<Reference>
<DEANumber>XX0000000</DEANumber>
</Reference>
<SourceQualifier>P2</SourceQualifier>
</Source>
<SourceReference>0869436</SourceReference>
<FillNumber>00</FillNumber>
</HistorySource>
</MedicationDispensed>
<RequestedDates>
<StartDate>
<Date>2018-01-01</Date>
</StartDate>
<EndDate>
<Date>2021-06-30</Date>
</EndDate>
</RequestedDates>
</RxHistoryResponse>
</Body>
</Message>