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Patient Name - Dallesandro, Baxter Prescription:>> Day Supply: > Last Action Date/Time: > Last Approved Doctor: > No. of Refill: > Pharmacy: > Pharmacy Address: > Qty.: > Sig: > Status: > Drug: > Denial Reason: > Denial Reason Code: > Discount Link: > Discount Message: > Discount Price: > Qty: 30>> Sig: Apply 1/2 inch ribbon topically to eyelid(s) Instill 1 topical ophthalmic drop BID>> Days Supply: 30>> No. of Refill: 2>> Provider: Ellis, Priscilla>> Pharmacy: Bannockburn Pharmacy for staging>> Drug: LESCOL XL 80 MG TABLET

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