Sample prescription drug receipt image
Sample prescription drug receipt image
  1. Name and address of pharmacist or supplier 
  2. Name of patient 
  3. Prescription drug number and name of drug 
  4. Prescribing doctor 
  5. Individual charge for each prescription 
  6. Date of service 

If you submit a pharmacy ledger, make sure the pharmacist's signature, provider number and the date are on each page. We can’t accept a cash register tape.