Cpe-71-67-128-96.woh.res.rr.com

Prescription claims (Jan 01, 2007 - Dec 31, 2007)
The claims below include only those prescriptions that have been processed to date.
2007 Prescription claims
Patient: Ingrid Richmond
Plan paid
Rx Number: 0393037
Date of service: 01/03/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 01/08/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0428295
Date of service: 01/11/07
Drug information: Doxycycline Hycl Caps 50mg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 01/30/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0393037
Date of service: 01/30/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 03/02/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0393037
Date of service: 03/02/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 03/28/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 04/06/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Patient: Ingrid Richmond
Plan paid
Rx Number: 0448160
Date of service: 04/28/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0453612
Date of service: 05/01/07
Drug information: Vexol Drops 5ml 1%
Filled at: CVS PHARMACY #4401
Rx Number: 0401272
Date of service: 05/05/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 05/29/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 05/29/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0453612
Date of service: 06/13/07
Drug information: Vexol Drops 5ml 1%
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 06/24/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 06/30/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 07/22/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 07/31/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 08/21/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 08/26/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Patient: Ingrid Richmond
Plan paid
Rx Number: 0448160
Date of service: 09/18/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 09/20/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 10/18/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 10/28/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0484871
Date of service: 11/13/07
Drug information: Propoxyphene Napsylate/apap Tabs 100/650
Filled at: CVS PHARMACY #4401
Rx Number: 0484872
Date of service: 11/13/07
Drug information: Amoxicillin Caps 500mg
Filled at: CVS PHARMACY #4401
Rx Number: 0457958
Date of service: 11/28/07
Drug information: Low-ogestrel Tabs 28's
Filled at: CVS PHARMACY #4401
Rx Number: 0448160
Date of service: 12/10/07
Drug information: Unithroid Tabs 100mcg
Filled at: CVS PHARMACY #4401
Subtotal:
Patient: Mark Richmond
Plan paid
Rx Number: 062470363407
Date of service: 02/14/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 070452567307
Date of service: 02/15/07
Drug information: Fluticasone Prop Nasal Spray 50mcg
Filled at: MEDCO HEALTH WILLINGBORO
Patient: Mark Richmond
Plan paid
Rx Number: 063422857607
Date of service: 02/17/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 063422857707
Date of service: 02/17/07
Drug information: Zyrtec Tabs 10mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 062470363407
Date of service: 05/21/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH LAS VEGAS
Rx Number: 0458296
Date of service: 05/30/07
Drug information: Lisinopril Tabs 10mg
Filled at: CVS PHARMACY #4401
Rx Number: 0460834
Date of service: 06/14/07
Drug information: Diltiazem Xt(cartia Xt)cap 180mg
Filled at: CVS PHARMACY #4401
Rx Number: 0460834
Date of service: 07/02/07
Drug information: Diltiazem Xt(cartia Xt)cap 180mg
Filled at: CVS PHARMACY #4401
Rx Number: 063422857607
Date of service: 07/05/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 0460834
Date of service: 07/23/07
Drug information: Diltiazem Xt(cartia Xt)cap 180mg
Filled at: CVS PHARMACY #4401
Rx Number: 072072032407
Date of service: 07/26/07
Drug information: Diltiazem Xt(cartia Xt)cap 240mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 0469191
Date of service: 08/07/07
Drug information: Sonata Caps 10mg
Filled at: CVS PHARMACY #4401
Rx Number: 070452567307
Date of service: 09/06/07
Drug information: Fluticasone Prop Nasal Spray 50mcg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 072493590907
Date of service: 09/07/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH LAS VEGAS
Patient: Mark Richmond
Plan paid
Rx Number: 0475201
Date of service: 09/14/07
Drug information: Triamcinolone Cream 15gm 0.1%
Filled at: CVS PHARMACY #4401
Rx Number: 0476338
Date of service: 09/21/07
Drug information: Micardis Tabs 40mg
Filled at: CVS PHARMACY #4401
Rx Number: 063422857607
Date of service: 10/14/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 072950402807
Date of service: 10/22/07
Drug information: Micardis Tabs 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 072493590907
Date of service: 11/13/07
Drug information: Lipitor Tabs 10mg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 0475201
Date of service: 12/09/07
Drug information: Triamcinolone Cream 15gm 0.1%
Filled at: CVS PHARMACY #4401
Rx Number: 070452567307
Date of service: 12/20/07
Drug information: Fluticasone Prop Nasal Spray 50mcg
Filled at: MEDCO HEALTH WILLINGBORO
Rx Number: 073543322207
Date of service: 12/21/07
Drug information: Nexium Caps 40mg
Filled at: MEDCO HEALTH LAS VEGAS
Rx Number: 072950402807
Date of service: 12/28/07
Drug information: Micardis Tabs 40mg
Filled at: MEDCO HEALTH WILLINGBORO
Subtotal:
$2588.14
Household Total for 2007:
$2815.38

Source: ftp://cpe-71-67-128-96.woh.res.rr.com/My%20Passport/Mark_Personal/Aloha-HP/Memeo/Aloha-HP/C_/Users/Public/Documents/Medical%20Data/2007%20Medical%20Claims.pdf