Free Pharmacy Receipt Generator
Create and customize this pharmacy receipt template with our free online receipt maker. A pharmacy receipt with prescription and refill references, itemized medications, insurance discount, copay breakdown, card payment, and pharmacist instructions.
Customize this receipt
GREENFIELD COMMUNITY PHARMACY 325 MONROE STREET MADISON, WI 53711 (608) 555-0168
09/16/2026 09:20
Rx #: RX-614829
Refills left: 2
| 1 AMOXICILLIN 500MG / 30 CAPS | $18.50 |
| 1 LISINOPRIL 10MG / 90 TABS | $22.00 |
| 1 INSURANCE COPAY DISCOUNT | $-10.50 |
Pharmacist: Nina Alvarez, RPh License: RP-284195
Take as directed with food. Refill by: 12/16/2026 Questions? Call (608) 555-0168.
Related receipt templates
Show more templates →
2187 EAST COLONIAL DRIVE ORLANDO, FL 32803 407.555.0186
REG#02 TRN#6341 CSHR#0000048 STR#4187
| 1 B460 NL CLP DUO EACH | 6.79 |
3816 5472 1098 7643 22 Returns with receipt, subject to CVS Return Policy, thru 09/10/2026
AUGUST 11, 2026
4:36PM
GET YOUR CVS EXTRACARE CARD
We would love to hear your feedback on your recent experience with us. This survey will take only 1 minute to complete
CVS Pharmacy Receipt
(312) 555 - 0184 MANAGER ALEX MORGAN 151 N STATE ST CHICAGO IL 60601 ST# 04628 OP# 003817 TE# 14 TR# 05829
PRODUCT SERIAL # WG72P9K4QZ
| 1 NEUTROGENA CLEANSING WIPES | $10.49 |
8/11/2026, 3:54:21 PM
# ITEMS SOLD 1 TC# 6318 2740 9581 4263 7704
Walgreens Receipt
845 MARKET STREET SAN FRANCISCO, CA 94103 (415) 555-0136
Date: 08/11/2026 3:42 PM
| 1 RARE BEAUTY BLUSH | $25.00 |
| 1 GLOW RECIPE SERUM | $35.00 |
| 1 SEPHORA LIP OIL | $16.00 |
| 1 FACE MASK SET | $12.00 |
Sephora Receipt
HARBOR & GRAIN FURNITURE 930 DESIGN DISTRICT DRIVE COLUMBUS, OH 43215 (614) 555-0194 SALES@HARBORANDGRAIN.EXAMPLE
09/16/2026 03:10 PM
CASHIER: LANE 2
ORDER #: FUR-62841
DELIVERY: 09/22/2026
NOTE: CURBSIDE
| 1 LINEN SOFA - SAND | $849.00 |
| 1 SOLID OAK COFFEE TABLE | $329.00 |
| 1 DELIVERY FEE | $75.00 |
PLEASE INSPECT ITEMS UPON DELIVERY. REPORT DAMAGE WITHIN 48 HOURS.
Assembly instructions included. Thank you for furnishing your home with us!
Furniture
Amazon.com 2021 7th Avenue Seattle, WA 98121 1-888-280-4331
08/11/2026, 4:42:09 PM
Order Number
Sold By
#114-7264931-5082176
Amazon.com Services LLC
| 1 Anker Nano USB-C Charger 30W | $16.99 |
| 2 Amazon Basics AAA Batteries (36-Pack) | $14.49 |
| 1 Fire TV Stick HD | $34.99 |
| 1 Echo Pop Smart Speaker | $39.99 |
Thanks for shopping with us! Track your order at amazon.com/orders