HARBORVIEW PHARMACY
2000 Van Ness Ave, San Francisco, CA 94109
(415) 555-0140 · NPI 1447722910
Rx #RX-2288104
Fill Date07/26/2026
PatientPriya A. Deshmukh
DOB01/22/1993
Patient Phone(415) 555-0162
AMOXICILLIN 500MG CAP
Qty30
SigTAKE 1 CAP PO TID X 10D
PrescriberTran, Melissa NP
DEA#MT4127839
Refills0
InsurancePacificCare PPO
Member IDPCP-994210583
Copay$12.00
Plan Paid$38.40
Counsel offered and declined. Generic substitution permitted.
Keep this receipt for your HSA/FSA records.