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    Cvs Mail Service Caremarj I Invoice/Receipt

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    hbryant587
    This document is an invoice from CVS Mail Service summarizing a prescription order for Julia Bryant. It shows she received a 28 day supply of Erythrocin tablets and a 12 day supply of Ibuprofen tablets with no co-pay. The total for the order was $3.84 which was paid in full by Discover card. No additional balance is due.

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    Cvs Mail Service Caremarj I Invoice/Receipt

    Uploaded by

    hbryant587
    186 views1 page
    This document is an invoice from CVS Mail Service summarizing a prescription order for Julia Bryant. It shows she received a 28 day supply of Erythrocin tablets and a 12 day supply of Ibuprofen tablets with no co-pay. The total for the order was $3.84 which was paid in full by Discover card. No additional balance is due.

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    Cvs Mail Service Caremarj<i Invoice/Receipt

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    This document is an invoice from CVS Mail Service summarizing a prescription order for Julia Bryant. It shows she received a 28 day supply of Erythrocin tablets and a 12 day supply of Ibuprofen tablets with no co-pay. The total for the order was $3.84 which was paid in full by Discover card. No additional balance is due.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    186 views1 page

    Cvs Mail Service Caremarj I Invoice/Receipt

    Uploaded by

    hbryant587
    This document is an invoice from CVS Mail Service summarizing a prescription order for Julia Bryant. It shows she received a 28 day supply of Erythrocin tablets and a 12 day supply of Ibuprofen tablets with no co-pay. The total for the order was $3.84 which was paid in full by Discover card. No additional balance is due.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    000001921053161007

    CVS MAIL SERVICE


    CAREMARJ<I INVOICE/RECEIPT
    Balance Due Upon Receipt
    $0.00

    033000448

    JULIA BRYANT
    587 PICKERINGTON HILLS DRIVE
    PICKERINGTON, OH 43147

    Please return the top portion of this form with your payment.
    See reverse side for payment or refund options.

    Retain 'the ~b~6iiom 'portion dffhi'sfdfm 'for'ydur


    Summary
    records. for Order:
    CAREMARJC 000001921053161 Date: 04/24/2009 Days
    Benefit Co-Pay Supply Drug Name / NDC Provider
    N a m e / R f# Quantity Paid Amount
    JULIA BRYANT 28 EA 7 Erythrocin TAB 250MG NDC 00074634620 $3.23*
    Rx# 934983933 $0.00
    JULIA BRYANT Ibuprofen TAB 800MG NDC 53746046605
    Rx# 934984012 12 EA 3 $0.00 $0.61*

    * FSA/HRA eligible health care expenses. Retain Invoice/Receipt for your records.

    Shipping Charge Total $0.00


    for this Order $0.00 $3.84
    Previous Account Balance $0.00
    Payment Received with this Order by DISCOVER CARD $3.84
    Balance Due Upon Receipt $0.00
    A Balance Due may not reflect payments recently mailed separate from this order.

    Thank you for your participation. Please remember that you can order refills online at the web address on your id card.
    If you have any questions, you can contact Customer Care at 1-800-378-8851 Page 1

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