Prescription Receipt

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HealthCare Pharmacy Store #RX-2045 Community Prescription Center 1250 Main Street Chicago, IL 60605 United States Phone: (312) 555-7821

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Your Health Is Our Priority Thank You For Choosing HealthCare Pharmacy

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Customer

John Doe

Receipt #

RX-582741

Phone

(555) 123-4567

Pharmacist

Daniel Smith

Prescription Type

Refill

Rx Number

78451296

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Date: 6/11/2026 Time: 6:45:40 PM

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Amoxicillin 500mg (30 Capsules)

$18.99

Ibuprofen 200mg (100 Tablets)

$9.49

Vitamin D3 Supplement

$12.99

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Subtotal$41.47

Tax$0.95

Total

$42.42

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Payment MethodCredit Card (VISA)

Card Last 41234

Entry MethodChip

Authorization Code582913

StatusAPPROVED

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1234567890

Please retain this receipt for insurance records Refills can be requested online or by phone Thank you for choosing HealthCare Pharmacy!

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