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R receipts here. Do not staple! If you have additional receipts, tape them on a separate piece of paper. Tape receipt for prescription 1 here. Tape receipt for prescription 2 here. Receipts must contain the following information: Date prescription filled Name and address of pharmacy Doctor name or ID number NDC number (drug number) Name of drug and strength Quantity and days supply Prescription number (Rx number) DAW (Dispense As Written) Amount paid Rec.

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