Purchased as a set at a chiropractic clinic. I am also selling the mattress, mattress pad, and sheet set. The mattress and other items are new and unused, but this pillow has been used a few times. The box was set up by the doctor and given to me at the time of purchase, so I don't have the box. Although I've used it a few times, I have washed and ironed the cover, and disinfected the pillow itself. I have cleaned it as best I can, but please refrain from purchasing if you are overly concerned about cleanliness. Suyayaka ¥19,250 Shipping costs will be covered by me. #Suyayaka #Pillow #Nihon Chokuhan (Japan Direct Sales) #Chiropractic