Receipt

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Header

HEALTH PHARMACY

Logo

Store Name

Store Address

City, State, Zip

Store Phone

Divider at Bottom

Date & Time

2026-09-09 06:34:25 PM

Custom message

Thank you for shopping with us!

Items list

2 items

Totals

Tax: 0%

Payment

Payment Method: card

Barcode

CODE128: 7329283703039783

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HEALTH PHARMACY
456 Medical Plaza
Healthtown, USA 67890
(555) 987-6543
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Cheque 12345678
DR. SMITH, JOHN MD
Gasten 1
Tafel 1
09/09/2026
06:34:25 PM
Thank you for shopping with us!
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1   LISINOPRIL 10MG
$12.99
1   METFORMIN 500MG
$8.99
Subtotaal$21.98
Btw$0.00
TOTAAL$21.98
SALDO VERSCHULDIGD$21.98
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Card Number**** **** **** 4922
Card TypeDebit
Card EntryChip
StatusAPPROVED
7329283703039783

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