1-800-686-RPHS

1-918-584-0774 (Office)

1-918-583-RPHS (FAX)

Please submit a SEPARATE time sheet for each location worked!

Enter RPHS, Inc. Contractor Name Here

Enter Pharmacist License # Here

Enter Pharmacy Name Here

Enter RPHS, Inc. Contractor # Here

Enter Location Here

Enter Social Security #

Enter Period From:                   

Period Ending:           

UNTIL

MON

TUES

WED

THUR

FRI

SAT

SUN

WEEK ENDING

IN

OUT

WEEK ENDING

IN

OUT

WEEK ENDING

IN

OUT

TOTALS

SUM TOTAL HOURS

SUM TOTAL MILEAGE

DATE

R.Ph. SIGNATURE

SUMMARY

DATE

PHARMACY SIGNATURE

Welcome to     RPHS, INC. | Pharmacy Links | Company History | On-Line Weekly Time Sheet | Independent Contractor (R.Ph.)
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