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Customer number: 21322nt Date: 2/16/2007
<br />Store number: 16639 one: (916) 928-0641
<br />Batch number: 153 a ttrrtl Wholesaler: AMERISOURCEBERGEN-008
<br />Account number: 008-030510 Address: 1325 WEST STRIKER AVENUE
<br />A
<br />Name: DEUEL VOCATIONAL SACRAMENTO, CA 95834
<br />INSTITUTION
<br />Credits passed through: 21322
<br />Customer reference number: GRX21322153
<br />Service Date: 01/22/2007
<br />Returnable Report
<br />McA! Wr
<br />g'
<br />quantity,
<br />'C
<br />a
<br />AR�CEPT 6024590 R
<br />147.38AR CEI o 6024630 R 73.76
<br />Total: 1 2.0001 1221.14
<br />AS
<br />Nain -,I-Quantity1'11,1,1�1*1611-,
<br />Drug >,Strangt4 I
<br />5/250M('�" 307681 R I JU.61
<br />iCARBIDOPA AND UNUL)UHA .001 2
<br />Total: 1.000 I I 1 1 30.87
<br />FALCON
<br />7
<br />Qsantlity,"
<br />Size
<br />Strength
<br />NDCNO,
<br />Cla8W,",
<br />Price:. ,;-,.
<br />...........
<br />BETAXOLOL HCl
<br />1.000
<br />1.00
<br />0.5%
<br />61314024503
<br />R
<br />32.58
<br />BETAXOLOL HCl
<br />1.000
<br />1.00
<br />0,5%
<br />61314024503
<br />R
<br />32.58
<br />BETAXOLOL HCI
<br />1.000
<br />1.00
<br />0.5%
<br />61314024503
<br />R
<br />32.58
<br />BETAXOLOL HCI
<br />1.000
<br />-000
<br />1. 00
<br />0.5%
<br />'61314024503
<br />R
<br />32.58
<br />CIPROFLOXACIN HCL
<br />1.000
<br />1.00
<br />0.3%
<br />61314065625
<br />R
<br />13.35
<br />Total:
<br />5.000
<br />143.67
<br />to
<br />Size Strength
<br />S CIO
<br />ND a
<br />TOLNAFTATE 1 00� 1% 0011680009101 1 1.55 -b5
<br />TOLNAFTATE 1.000 1.00 1 % 00 68000910 1.55
<br />Total: 2.000 3.101
<br />GLAXO WELLCOME
<br />rug a
<br />Quantity'
<br />Size,'
<br />,-Strength
<br />NDCN0`,',-,
<br />Cla8W,",
<br />Price:. ,;-,.
<br />...........
<br />PAXIL CR
<br />0.833
<br />30.00
<br />37.5 MG
<br />00029320813
<br />R
<br />71.08
<br />ATOVAGUONE (ORAL PERPACK)
<br />1.000
<br />42.00
<br />75015ML
<br />00173054700
<br />R
<br />618.11
<br />ATOVAGLIONE (ORAL PERPACK)
<br />1.000
<br />42.00
<br />75015ML
<br />00173054700
<br />R
<br />618.11
<br />BENZA
<br />BENZA
<br />0.250
<br />1.000
<br />112.00
<br />112.00
<br />200MG
<br />200MG
<br />00007550040
<br />00007550040
<br />R
<br />R
<br />36.86
<br />147.44
<br />Total:
<br />5.000
<br />1.00
<br />50 MG
<br />00409302401
<br />R
<br />1,491.60
<br />= HDI
<br />C
<br />D N9
<br />02129255050
<br />Total:
<br />HOSPIRA WORLDWIDE (Direct)
<br />12.161
<br />12.16
<br />drug Name,
<br />Quantity'
<br />Size,'
<br />,-Strength
<br />NDCNO.-1`
<br />Cla8W,",
<br />Price:. ,;-,.
<br />...........
<br />NITROPRESS
<br />1.000
<br />1.00
<br />50 MG
<br />00409302401
<br />R
<br />7.35
<br />NITROPRESS
<br />1.000
<br />1.00
<br />50 MG
<br />00409302401
<br />R
<br />7.35
<br />NITROPRESS
<br />1.000
<br />1.00
<br />50 MG
<br />00409302401
<br />R
<br />7.35
<br />NITROPRESS
<br />1.000
<br />1.00
<br />50 MG
<br />00409302401
<br />R
<br />7.35
<br />NITROPRESS
<br />1.000
<br />1.00
<br />50 MG
<br />00409302401
<br />R
<br />7.35
<br />Total:
<br />5,000
<br />36.75
<br />I . M . . 11-1.1 - K. . I I
<br />Drug Name
<br />Quantity'
<br />Size,'
<br />,-Strength
<br />NDCNO.-1`
<br />Cla8W,",
<br />Price:. ,;-,.
<br />...........
<br />RISPERDAL
<br />1.000
<br />1.00
<br />1 MG
<br />504580305�3
<br />R
<br />118.67
<br />HALDOL DECANOATE
<br />0,200
<br />5.00
<br />100 MG/M
<br />00045025414
<br />R
<br />74.17
<br />NIZORAL
<br />1.000
<br />1.00
<br />2%
<br />50458022304
<br />R
<br />24.70
<br />DITROPAN
<br />1.000
<br />100.00
<br />10 MG
<br />17314850101
<br />R
<br />278.91
<br />DITROPAN
<br />1.000
<br />100.00
<br />10 MG
<br />17314850101
<br />R
<br />278,91
<br />Total:
<br />5.000
<br />775.36
<br />LILLY
<br />DrugNama
<br />Quantity,
<br />" 1'� Size Strength
<br />NDCNO, 'I
<br />j1;Z:1:P1REXA
<br />0.6611
<br />60.00 2.5 MG 000024112601,
<br />R Zut.lu
<br />Total:
<br />I
<br />1 1.0001
<br />207.10
<br />MAJOR (Direct)
<br />Drug Naine..�, Quantity,
<br />Size'
<br />Strength
<br />NDCNO, 'I
<br />class
<br />CARBAMIDE 1 .000
<br />E PERoAE DL- L L"--- - - ----- Total: 1.000
<br />I
<br />1.15
<br />MERCK & CO. INC.
<br />Drug Name Quantity_] Size Strength NDCNO Class yPrice
<br />ITRUSOPT 1.000 1 1.001 2% 1 00006351936 R 51.46
<br />Total:'. l 1.0001 1 51.46
<br />MYLAN (Direct)
<br />Size
<br />Name , - , I � , ., strength'
<br />Quantity NDCNO
<br />IBUTEROL SULFATE1.000 100.001 4 MG 0037805/201j R I
<br />T( Ii 1.000 i I
<br />NY Division: 100 Colin Drive, Holbrook, NY 11741, Phone: 1-800-473-2138; Midwest Division: 100 Teduke Court, St Charles, MO 63301, Phone: 1-800-729-3279
<br />Page 3 of 11
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