Pharmacy Receipt Generator
Create a drugstore receipt for over-the-counter medicine, health and personal care items. Useful for HSA/FSA reimbursement records and medical expense tracking.
Common uses for a pharmacy receipt
- HSA / FSA reimbursement documentation
- Medical expense tax records
- Replace faded pharmacy receipts
- Healthcare app design mockups
PHARMACY RECEIPT
WellCare Pharmacy
910 Health Plaza Drive
Denver, CO 80202
(303) 555-0155
06/14/2026 09:31 · Receipt #280853
| Item | Qty | Price | Total |
|---|---|---|---|
| Ibuprofen 200mg 100ct | 1 | $8.99 | $8.99 |
| Vitamin D3 2000IU | 1 | $12.49 | $12.49 |
| Adhesive Bandages 40ct | 1 | $4.79 | $4.79 |
Your health, our priority.
280853
What a pharmacy receipt may show of your card
Federal law limits this, and the limit is specific. 15 U.S.C. § 1681c(g) (opens in a new tab) bars any business that accepts cards from printing more than the last five digits of the card number, or the expiry date at all, on the receipt handed to the cardholder at the point of sale. Most merchants print four digits rather than five, which is inside the rule.
It is why a genuine pharmacy receipt shows something like "VISA ****4821" and never the full number. A recreated receipt should follow the same convention — our builder takes only the last four digits for that reason. The rule governs the printed customer copy, so it is one of the few receipt details that is a legal requirement rather than a merchant's house style.
Pharmacy receipt FAQ
Can I use this receipt for HSA or FSA reimbursement?
A recreated receipt can support an HSA/FSA claim when the original is lost, but administrators usually also require proof of payment such as a card statement. Include the pharmacy name, date, item names and amounts, and check your plan administrator's documentation rules.
Sources & references
The rules cited on this page, with what each one is cited for. They describe how pharmacy receipts are treated — they are not advice about your own situation.
- 15 U.S.C. § 1681c(g) — Truncation of credit card and debit card numbers (opens in a new tab)
U.S. Code (Cornell Legal Information Institute) · US
The FACTA truncation rule: an electronically printed receipt may show no more than the last 5 digits of the card number, and must not show the expiration date.
Sources last checked August 19, 2026. We re-verify every link monthly and update the dates above. Citing these rules is not legal or tax advice — see our editorial policy.
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