Details
- Category
- Vendor
- Shields Pharmacy
- Amount
- 124.00
- Date
- 10/21/2024
- Processed
- Feb 25, 2026 2:46 PM EST
- Original File
- Scan_02252026_144523_000011.pdf
Summary
This document is a payment invoice from Shields Pharmacy dated 10/21/2024. It details a transaction for a methylcobalamin injection (5mL vial) with a total charge of $124.00, which includes $109.00 for the medication, $10.00 for FedEx Ground shipping, and $5.00 for an injection kit. The transaction has been approved, and the total change/credit is $0.00. The invoice is for a compounded prescription, which cannot be returned.
Notes
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OCR Text
Shields Pharmacy
2196 Main Street Suite A
Dunedin, FL 34698
727-648-2680
Bill to:
SOPHIA JONGSMA
00
Dunedin, FL 33704
(727) 225-2475
Ordering Physician: USMAN, ANJUM
Sale Status:
This transaction has been approved.
PAYMENT
10/21/2024
Tx/Invoice #: 69502020
Purchase Order #:
Practice Phone: (630) 995-4242
Ship to:
SOPHIA JONGSMA
00
Dunedin, FL 34698
(727) 225-2475
Master Order: 58772251
Order
Date
Description
Item
Count
Price/
Item
Discount/
Item
Amount
10/21/24
RX 60219773 (Order #58772251) METHYLCOBALAMIN INJECTION 10MG/ML (5ML VIAL) (Qty: 1
VIAL) (Formula ID: 12063) (Fill ID: 5206597)
1
$ 109.00
$ 109.00
Fedex Ground
$ 10.00
3 Injection Kit
1
$ 5.00
$ 5.00
TOTAL CHARGES
$ 124.00
MasterCard 2208 - TX Ref. Number: 80688772812
($ 124.00)
TOTAL CREDITS
$ 124.00
TOTAL CHANGE/CREDIT
$ 0.00
Please Note: Compounded prescriptions are made specially for you and cannot be returned.
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