Phamacist(s) aff liated to NASRUL
lffi,lFeanCoutu ANAS
JOSEPH,AMIEL 2066 Claremont 438.622.3182
5107 Sherbrooke Ouest
Montreal, QC H4A1T2
Montreal, QC Printed on , May 29 2024 12 46 r il:cr i i :j
514-483.il850
Pharmmist{s) aff liated to At oXtCtLLlN 500 MG, CAPS
21 PirS Rr 1 33't748-0257 Total Cov. nsured
I Un nsured lnsured Amoufl Daid
DrxHlEU.r-K.-D (2907{q prlce amount amount patent contribution by rsurel
mlOeanEouml Non{efi1lable
" May 29, 2020
DtN 02230244 Deduct b e Ccp ay
JOSEPI-N AMIEL
5'107 Sherbrooke Ouest
1B 67 NiA a
Montreal, QC, H4A1T2 514.483-2850 Totartonavl.3glP
NASRUI", ANAS
2066 Claremont
Additional lnformation
Montreal, QC 438-622-3182
Cost price pald by the pharmac st -,i
(A)101 (B) For the To the Total Professioral RGAI'I ns!red totai
(c)1867 (D)000 medicatron who esaler fees prce cortr bltron
iltillliltililililltilIililt 46251471161 4 275 0.18 293 1574 293 0c0
JOSEPH AMIEL 1331748-0257 May 29, 2020 Non-refillable
5'14-483-2850 Pharmeist(s)afnriatedto LEliJeinCoutid Pms amoxicillin, 500 mg, caps Oty 21
mI?lG [.licrutr Ust
1 capsu e 3 times a day every 8 hours for 7 days
NASRUL, ANAS
2066 Claremont
Montreal. r..)C 438-622-3182
Date of Birth: Mar. 4, 1981
Allergies : No known allergy
lPrinted on . May 29, 2020 12.461