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Find your prescription claim details and mail order payment
details here. Simply select from the tabs
below.
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| 2005 Prescription claims |
|
| Summary
for patient: Chris Johnson |
| Date filled |
Rx
number
Drug information |
You paid |
Prescription filled
at: |
| 08/12/05 |
123456789
Prozac Tabs10mg |
$3.00 |
FAMILYMEDS PHARMACY #831 |
| 07/16/05 |
123456789
Prozac Tabs10mg |
$3.00 |
CVS PHARMACY #5045 |
| 08/12/05 |
123456789
Atenolol Tabs25mg |
$0.00 |
FAMILYMEDS PHARMACY #831 |
| 08/16/05 |
123456789
Prozac Tabs10mg |
$3.00 |
CVS PHARMACY #5045 |
| 09/01/05 |
123456789
Diabinese Tabs100mg |
$0.00 |
CVS PHARMACY #5045 |
| 09/03/05 |
123456789
Zyrtec Tabs10mg |
$0.00 |
CVS PHARMACY #5045 |
| 09/19/05 |
123456789
Nasonex |
$5.00 |
PRICE CHOPPER PHCY #175 |
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Subtotal: |
$14.00 |
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Household Total for 2005: |
$14.00 |
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| *This amount does not
include any rebates that your insurer or employer
may receive. |
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| Everyday Specials |
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