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Prescription Records<br />
Confidential Patient Information<br />
Alanna Craven<br />
83 CLAPP STREET<br />
MILTON, MA 02186<br />
(617) 480-4738<br />
06/09/1986<br />
Female<br />
01/01/2017 to 12/31/2017 Showing All prescriptions, sorted by fill date (most recent)<br />
Fill Date Prescription Prescriber Pharmacist NDC# Ins/Claim Ref# Price<br />
12/28/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:2008774-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
IMG 68462022401 HPHC/<br />
5906421186<br />
$10.00<br />
12/21/2017 Microgestin 1/20 Tabs 21s White<br />
Rx:2051520-10317<br />
Qty:21<br />
12/19/2017 Spironolactone 100mg Tablets<br />
Rx:2050792-10317<br />
Qty:60<br />
SHIN,ALICE DEC 51862000706 HPHC/<br />
5898685708<br />
SOBELL,JEFFREY IMG 00228267311 HPHC/<br />
5895003235<br />
$0.00<br />
$10.00<br />
12/17/2017 Propranolol 10mg Tablets<br />
Rx:1999509-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00115165901 HPHC/<br />
5892647838<br />
$10.00<br />
12/04/2017 Quetiapine 100mg Tablets<br />
Rx:2017655-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5875905896<br />
$6.70<br />
11/30/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:2008774-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
IMG 68462022401 HPHC/<br />
5871997384<br />
$10.00<br />
11/06/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:2008774-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 68462022401 HPHC/<br />
5844707805<br />
$10.00<br />
11/06/2017 Lamotrigine 25mg Tablets<br />
Rx:2041233-10317<br />
Qty:180<br />
GOODALL,SHERY<br />
L<br />
DEC 00093003901 HPHC/<br />
5844312967<br />
$16.20<br />
11/04/2017 Propranolol 10mg Tablets<br />
Rx:1999509-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00115165901 HPHC/<br />
5842782787<br />
$10.00<br />
11/04/2017 Quetiapine 100mg Tablets<br />
Rx:2017655-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
DEC 68180044701 HPHC/<br />
5842782842<br />
$6.70<br />
11/04/2017 Spironolactone 100mg Tablets<br />
Rx:2034844-10317<br />
Qty:60<br />
SOBELL,JEFFREY DEC 00228267311 HPHC/<br />
5842782893<br />
$10.00<br />
10/30/2017 Valacyclovir 500mg Tablets<br />
Rx:2039695-10317<br />
Qty:6<br />
STEWART,PATRIC<br />
IA<br />
IMG 65862044830 HPHC/<br />
5836382201<br />
$3.94<br />
10/09/2017 Propranolol 10mg Tablets<br />
Rx:1999509-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00115165901 HPHC/<br />
5811340279<br />
$10.00<br />
10/09/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:2008774-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 68462022401 HPHC/<br />
5811340372<br />
$10.00<br />
10/09/2017 Quetiapine 100mg Tablets<br />
Rx:2017655-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
DEC 68180044701 HPHC/<br />
5811340209<br />
$6.70<br />
10/09/2017 Spironolactone 100mg Tablets<br />
Rx:2034844-10317<br />
Qty:60<br />
SOBELL,JEFFREY IMG 00228267311 HPHC/<br />
5812052525<br />
$10.00<br />
09/30/2017 Alprazolam 0.5mg Tablets<br />
Rx:2033013-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 00228202996 HPHC/<br />
5802086039<br />
$2.02<br />
09/13/2017 Quetiapine 100mg Tablets<br />
Rx:2017655-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5782273496<br />
$6.70
08/26/2017 Propranolol 10mg Tablets<br />
Rx:1999509-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00115165901 HPHC/<br />
5762293405<br />
$10.00<br />
08/20/2017 Lamotrigine 25mg Tablets<br />
Rx:1990258-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
IMG 00093003901 HPHC/<br />
5754901664<br />
$9.10<br />
08/18/2017 Quetiapine 100mg Tablets<br />
Rx:2017655-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
DEC 68180044701 HPHC/<br />
5753279175<br />
$6.70<br />
08/02/2017 Propranolol 10mg Tablets<br />
Rx:1999509-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
MEF 00115165901 HPHC/<br />
5734721537<br />
$10.00<br />
07/23/2017 Quetiapine 100mg Tablets<br />
Rx:2017655-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5723499434<br />
$6.70<br />
07/17/2017 Spironolactone 100mg Tablets<br />
Rx:2016062-10317<br />
Qty:60<br />
SOBELL,JEFFREY DEC 00228267311 HPHC/<br />
5716971325<br />
$10.00<br />
07/15/2017 Lamotrigine 25mg Tablets<br />
Rx:1990258-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
DEC 00093003901 HPHC/<br />
5715110134<br />
$9.10<br />
07/07/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:2008774-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 68462022401 HPHC/<br />
5706153329<br />
$10.00<br />
06/20/2017 Spironolactone 100mg Tablets<br />
Rx:1984826-10317<br />
Qty:60<br />
SOBELL,JEFFREY IMG 00228267311 HPHC/<br />
5687269021<br />
$10.00<br />
06/20/2017 Lamotrigine 25mg Tablets<br />
Rx:1990258-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
IMG 00093003901 HPHC/<br />
5687269073<br />
$9.10<br />
06/12/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:2008774-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
IMG 68462022401 HPHC/<br />
5678580267<br />
$10.00<br />
06/12/2017 Quetiapine 100mg Tablets<br />
Rx:2008776-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5678579625<br />
$8.73<br />
05/20/2017 Spironolactone 100mg Tablets<br />
Rx:1984826-10317<br />
Qty:60<br />
SOBELL,JEFFREY DEC 00228267311 HPHC/<br />
5653753556<br />
$10.00<br />
05/20/2017 Lamotrigine 25mg Tablets<br />
Rx:1990258-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
DEC 00093003901 HPHC/<br />
5653753579<br />
$9.18<br />
05/10/2017 Quetiapine 100mg Tablets<br />
Rx:1994540-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5642086248<br />
$8.73<br />
05/10/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:1994600-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
IMG 00054002025 HPHC/<br />
5642086320<br />
$10.00<br />
05/01/2017 Propranolol 10mg Tablets<br />
Rx:1999509-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
IMG 00115165901 HPHC/<br />
5630854268<br />
$10.00<br />
04/16/2017 Spironolactone 100mg Tablets<br />
Rx:1984826-10317<br />
Qty:60<br />
SOBELL,JEFFREY IMG 00228267311 HPHC/<br />
5613721836<br />
$10.00<br />
04/16/2017 Lamotrigine 25mg Tablets<br />
Rx:1990258-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
IMG 00093003901 HPHC/<br />
5613721853<br />
$9.18<br />
04/10/2017 Quetiapine 100mg Tablets<br />
Rx:1994540-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
DEC 68180044701 HPHC/<br />
5606577395<br />
$8.73<br />
04/08/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:1994600-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00054002025 HPHC/<br />
5605755923<br />
$10.00<br />
04/04/2017 Propranolol 10mg Tablets<br />
Rx:1976937-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00591555410 HPHC/<br />
5600099791<br />
$10.00
03/20/2017 Alprazolam 0.5mg Tablets<br />
Rx:1977862-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 00228202996 HPHC/<br />
5582107903<br />
$2.10<br />
03/20/2017 Lamotrigine 25mg Tablets<br />
Rx:1990258-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
IMG 00093003901 HPHC/<br />
5582664869<br />
$9.18<br />
03/19/2017 Spironolactone 100mg Tablets<br />
Rx:1984826-10317<br />
Qty:60<br />
SOBELL,JEFFREY IMG 00228267311 HPHC/<br />
5581695478<br />
$10.00<br />
03/15/2017 Quetiapine 100mg Tablets<br />
Rx:1979134-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5577513465<br />
$8.73<br />
03/13/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:1988715-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 68462022401 HPHC/<br />
5574629009<br />
$10.00<br />
03/11/2017 Propranolol 10mg Tablets<br />
Rx:1976937-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00591555410 HPHC/<br />
5573199562<br />
$10.00<br />
02/21/2017 Lamotrigine 25mg Tablets<br />
Rx:1980102-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
DEC 00093003901 HPHC/<br />
5550642955<br />
$9.18<br />
02/21/2017 Spironolactone 100mg Tablets<br />
Rx:1984826-10317<br />
Qty:60<br />
SOBELL,JEFFREY DEC 00228267311 HPHC/<br />
5551323949<br />
$10.00<br />
02/17/2017 Quetiapine 100mg Tablets<br />
Rx:1979134-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5546813729<br />
$8.73<br />
02/08/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:1969102-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 68462022401 HPHC/<br />
5535331013<br />
$10.00<br />
02/08/2017 Propranolol 10mg Tablets<br />
Rx:1976937-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
DEC 00591555410 HPHC/<br />
5535331059<br />
$10.00<br />
01/29/2017 Lamotrigine 25mg Tablets<br />
Rx:1980102-10317<br />
Qty:90<br />
GOODALL,SHERY<br />
L<br />
DEC 00093003901 HPHC/<br />
5523265384<br />
$9.18<br />
01/24/2017 Spironolactone 100mg Tablets<br />
Rx:1978993-10317<br />
Qty:60<br />
01/24/2017 Finacea 15% Foam 50gm<br />
Rx:1979018-10317<br />
Qty:50<br />
SOBELL,JEFFREY IMG 53746051501 HPHC/<br />
5517640294<br />
SOBELL,JEFFREY DEC 50419082901 HPHC/<br />
5516890051<br />
$10.00<br />
$25.00<br />
01/24/2017 Quetiapine 100mg Tablets<br />
Rx:1979134-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5517639637<br />
$8.73<br />
01/18/2017 Alprazolam 0.5mg Tablets<br />
Rx:1977862-10317<br />
Qty:30<br />
GOODALL,SHERY<br />
L<br />
MHL 00228202996 HPHC/<br />
5510046211<br />
$2.10<br />
01/13/2017 Spironolactone 100mg Tablets<br />
Rx:1971717-10317<br />
Qty:60<br />
SOBELL,JEFFREY DEC 53746051501 HPHC/<br />
5504124249<br />
$10.00<br />
01/13/2017 Lamotrigine 25mg Tablets<br />
Rx:1972281-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
AAB 00093003901 HPHC/<br />
5504124336<br />
$6.48<br />
01/13/2017 Propranolol 10mg Tablets<br />
Rx:1976937-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
AAB 00591555410 HPHC/<br />
5504220393<br />
$10.00<br />
01/06/2017 Lithium Carbonate ER 450mg Tablets<br />
Rx:1969102-10317<br />
Qty:60<br />
GOODALL,SHERY<br />
L<br />
IMG 68462022401 HPHC/<br />
5492738587<br />
$10.00<br />
01/06/2017 Quetiapine 100mg Tablets<br />
Rx:1969224-10317<br />
Qty:15<br />
GOODALL,SHERY<br />
L<br />
IMG 68180044701 HPHC/<br />
5492738652<br />
$4.91<br />
Total: $548.53<br />
Generics saved you $0.00<br />
Insurance saved you $6,709.96
Please be aware that certain insurance claim information may not be included in this report. Please speak with a pharmacy staff member if you<br />
have questions regarding payments for your prescriptions.<br />
Thank you for choosing Walgreens.<br />
Walgreens | 877-250-5823 | PO Box 29063 Phoenix,AZ 85038
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