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Price Quote / Order

New / Refill / Transfer

 

Quote

Member ID ________________ or fill out followings.

Your Name Last name_____________ First Name ____________

Company Name ____________________________________________

Address __________________________________________________

City _____________ State ________ Country ___ ZipCode______

Telephone (       )        -

Fax(      )        -

E-Mail Address ________________________

(Medicine)

Name ______________________ Strength_________Size_____Quantity_____

Name ______________________ Strength_________Size_____Quantity_____

Name ______________________ Strength_________Size_____Quantity_____

Name ______________________ Strength_________Size_____Quantity_____

Generics___ Brand___


Equipment

Name ____________________________________

Model No._________________________________

Company_________________________________

Quantity______________      Size______________

Used for _____________________

Special Direction __________________________________________________
__________________________________________________
__________________________________________________

Customized packaging: Child-proof caps,Non-child-proof caps,Blister(30dy)
Payment method
Credit card/Cashiers check/check/cash-pickup
* Shipping Charge up to $50 : $4.00
           over $50.00  $6.00(up to 5 Ibs.)
    Out of city :case by case
Overnite + $10.50, Second day+$3.50 ,Regular(6-7 days);same
* submit ___ or Cancel ___  or Correct ___
* Home __


Please e-mail, fax or call.
Ronstin@aol.com

Fax (213)277-8089
Tel.(213)277-8080


MediCal/Madicare Coverage

u9.gif (564 bytes) Cane, Quad-Cane(Arthirtis)
u9.gif (564 bytes) Crutches,Walker   (Arthritis)
u9.gif (564 bytes) Commode(Bedside portable toilet)
u9.gif (564 bytes) Bath Bench (MediCal)
u9.gif (564 bytes) Raised Toilet Seat(MediCal)
u9.gif (564 bytes) Bathtub Grab Bars(MediCal)
u9.gif (564 bytes) Transfer Bench (MediCal)
u9.gif (564 bytes) Seat Lift Chair (MediCare)
u9.gif (564 bytes) Vacuum Erection Device(MediCare)
u9.gif (564 bytes) Blood Glucose Monitor (Insulin)
u9.gif (564 bytes) Hospital Bed
u9.gif (564 bytes) Pressure Pad,Alternating w/pump
u9.gif (564 bytes) Electric Heating Pads
u9.gif (564 bytes) Wheelchairs(Manual/Motorized)
u9.gif (564 bytes) Nebulizer(Asthma)
u9.gif (564 bytes) Oxygen Concentrators, Tank
u9.gif (564 bytes) Breast Pump Kit
u9.gif (564 bytes) TENS(Transcutaneous electrical nerve stimulator)
u9.gif (564 bytes) Infusion Pumps
u9.gif (564 bytes) IV Pole
u9.gif (564 bytes) Enteral Nutrition, Parentaral Nutrition

 
* If you have a question about your insurance coverage of medicine, medical
supplies or equipment, please contact our technician by telephone, fax or E-mail.
Ronstin@aol.com
Fax (213)277-8089
Tel.(213)277-8080



Olive Pharmacy

 

If you have any comments or question regarding this Web page, click below to e-mail.
supersam@pacbell.net