example@example.com

Please Select CVS Costco RiteAid Walgreens Walmart Vons Other - Please add Pharmacy Name to Address below

Street name only is okay.

	Medication Name	Dosage (mg, inj)	Frequency (Ex: 1 per day)
1
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	Doctor Name	Type	Medical Group	Location (Street/Area)
1		PCP Specialist	Scripps Mercy UCSD Sharp Kaiser Other
2		PCP Specialist	Scripps Mercy UCSD Sharp Kaiser Other
3		PCP Specialist	Scripps Mercy UCSD Sharp Kaiser Other
4		PCP Specialist	Scripps Mercy UCSD Sharp Kaiser Other