Prescription Receipt generator

Bare-bones pharmacy visit. One drug and a fee, and the whole thing costs less than a decent lunch in Bergen County. Most prescription receipts look exactly like this, whether the patient picks up a ten-day course of antibiotics or a ninety-day statin refill. SummitCare Pharmacy at 1190 Ridgewood Ave, Paramus, NJ 07652 is the pharmacy on this one.
Amoxicillin 500mg for twenty-one capsules runs $18.75. Dispensing and counseling fee at $6.00. Comes to $24.75 total. No tax, because prescriptions are exempt in New Jersey. Dr. Alan Hughes is the prescriber on file. Laura Bennett is the patient. Prescription RX-774219. The name is editable. The drug name is not locked in either.
Edit the prescriber or the pharmacy to make a receipt for a completely different pickup. A blood pressure pill or an inhaler, the fields do not care.