Laserfiche WebLink
Customer number: 21322 lent Date: 2/16/2007 <br />Store number: 16639 x+xxrxxf:crr3' one: (916) 928-0641 <br />Batch number: 153 x: farrrn° Wholesaler: AMERISOURCEBERGEN-008 <br />Account number: 008-030510 Address: 1325 WEST STRIKER AVENUE <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 />Non -Returnable Repqrt _ <br />DEY <br />Drug.Nelne.� Quant)ty.,,s,..Siz,,,r,a„Sfrngtit.-,. �NRC11D....:.erode Ls+t,NuittGpC,, Expi[@_ate•; <br />n�.., <br />EPIPEN 2-PAK 1.000 2.00 0.3MG 49502050002 R 90.27 19 DAMAGED <br />Total: 2.000 1 1 135.411 1 <br />FTHFX <br />El <br />Drug'Nome = ' quantity'_ , 2,"Size. Strangth, NDCNO ' "Class "`_ P;rica': '°RCods -' ' , "Lot Number <br />NITROQUICK 0,1001 100.00 0.4MG 58177032418 R 1.27 02 67031 <br />Total: 1.00.1 11.27 <br />FOREST PHARM. <br />quant)fy,: <br />"; Siza" <br />Drug Name <br />LEVOTHROID <br />Class <br />ci •Price " <br />RCoda <br />G&W <br />Expire a . <br />FUROSEMIDE <br />Drug'Name" ". <br />PROMETHEGANf <br />10MG/NL <br />409610202 <br />R <br />GLAXO WELLCOME <br />02 <br />28227DK <br />ENGERIX B <br />FUROSEMIDE <br />0.080 <br />25.00 <br />DrMg- Neme .. <br />quant)fy,: <br />"; Siza" <br />Strength.: <br />NDC,Nq <br />Class <br />ci •Price " <br />RCoda <br />'" LotNytrnbar," ".�.1,; <br />Expire a . <br />FUROSEMIDE <br />0.880 <br />25.00 <br />10MG/NL <br />409610202 <br />R <br />9.46 <br />02 <br />28227DK <br />FUROSEMIDE <br />0.080 <br />25.00 <br />10MG/NL <br />409610202 <br />R <br />0.86 <br />02 <br />28227DK <br />EPINEPHRINE HCL <br />0.200 <br />25.00 <br />1:1,000 <br />00074724101 <br />R <br />2.20 <br />01 <br />192053A <br />07/06 <br />-oINEPHRINE HCL <br />0.040 <br />25.00 <br />1:1,000 <br />00074724101 <br />R <br />0.44 <br />01 <br />181953A <br />06/06 <br />INEPHRINE HCL <br />0.200 <br />25.00 <br />1:1,000 <br />00074724101 <br />R <br />2.20 <br />01 <br />192053A <br />07/06 <br />,INEPHRINE HCL <br />0.120 <br />25.00 <br />1:1,000 <br />00074724101 <br />R <br />1.32 <br />01 <br />181953A <br />06106 <br />'07/06 <br />EPINEPHRINE HCL <br />0.200 <br />25.00 <br />1:1,000 <br />00074724101 <br />R <br />2.20 <br />01 <br />192053A <br />NITROPRESS <br />- 1.000 <br />1.00 <br />50 MG <br />00074302401 <br />R <br />5.95 <br />01 <br />25897Z7 <br />07/06 <br />MAGNESIUM SULFATE. <br />0.100 <br />10.00 <br />500 MG/M <br />00074175410 <br />R <br />3.31 <br />02 <br />23365EV <br />MAGNESIUM SULFATE <br />0.200 <br />_ 10.00 <br />500 MG/M <br />00074175410 <br />R <br />6.62 <br />02 <br />23365EV <br />MAGNESIUM SULFATE <br />0,500 <br />10.00 <br />.500 MG/M <br />00074175410 <br />R <br />16.54 <br />02 <br />23365EV <br />PHENYTOIN SODIUM INJECTION <br />- 0.400 <br />10.00 <br />100MG/2M <br />409184432 <br />R <br />5.14 <br />01 <br />2150OLL <br />09/06 <br />PHENYTOIN SODIUM INJECTION <br />0.500 <br />10.00 <br />100MG/2M <br />409184432 <br />R <br />6.42 <br />01 <br />2150OLL <br />09/06 <br />PHENYTOIN SODIUM INJECTION <br />0.500 <br />10.00 <br />100MG/2M <br />409184432 <br />R <br />6.42 <br />01 <br />2150OLL <br />09/06 <br />PHENYTOIN SODIUM INJECTION <br />0.400 <br />10.00 <br />100MG/2M <br />409184432 <br />R <br />5.14 <br />01 <br />2150OLL <br />09/06 <br />DROPERIDOL <br />0.100 <br />100.00 <br />2.5 MG/M <br />00074118701 <br />R <br />1.09 <br />02 <br />28165DK <br />DOPAMINE HCL <br />0.420 <br />50.00 <br />400 MG <br />00074910420 <br />R <br />7.35 <br />01 <br />17424DK <br />05/06 <br />VANCOMYCIN HCL <br />1.000 <br />10.00 <br />500 MG <br />00074433201 <br />R <br />31.50 <br />21 <br />17786ZT <br />VANCOMYCIN HCL <br />1.000 <br />10.00 <br />500 MG <br />00074433201 <br />R <br />31.50 <br />21 <br />17786Z7 <br />DEXTROSE <br />0.200 <br />10.00 <br />50% <br />00074751716 <br />R <br />5.00 <br />02 <br />23172EV <br />HEPARIN LOCK FLUSH <br />0.010 <br />100.00 <br />100 U/ML <br />00074115270 <br />R <br />0.11 <br />01 <br />21448DK <br />03106 <br />LIDOCAINE HCL <br />0.200 <br />25.00 <br />4% <br />00409428301 <br />R <br />9.25 <br />02 <br />28356DK <br />LIDOCAINE HCL <br />0.200 <br />25.00 <br />4% <br />00409428301 <br />R <br />9.25 <br />02 <br />283560K <br />LIDOCAINE HCL <br />0.200 <br />25.00 <br />4% <br />00409428301 <br />R <br />9.25 <br />02 <br />28356DK <br />LIDOCAINE HCL <br />0.200 <br />25.00 <br />4% <br />00409428301 <br />R <br />9.25 <br />02 <br />28356DK <br />LIDOCAINE HCL <br />0.200 <br />25.00 <br />4% <br />00409428301 <br />R <br />9.25 <br />02 <br />28356DK <br />Total: <br />26.000 <br />197.02 <br />_ <br />:O IAS <br />Drug Name.,:,quantity .. Size strength NDCNO ' :Class 'Price - RCode ✓ : Lot Number„ Expiie;t, ate <br />BENZOIN 1.000 1.00 /NA 00395024792 1.72 06 521626 <br />MAGNESIUM CITRATE ORAL SOLUTION 1.000 1.00 N/A 00395060010 R 0.60 06 81106) <br />Total: 2.000 12.3211 <br />z +ni-fl <br />"Drug Name - quantity Size' Strength NDCNO. Class .. Price ,':RCode LotNumber�: Expire -Dates <br />LISINOPRIL 0.500 100.00 10 MG 904563961 R 7.13 02 P9699 <br />DOXAZOSIN MESYLATE TABLETS 0.760 100.00 2MG 00904552361 R 9.03 02 P9834 <br />Total: 1 2.0001 16.161 1 <br />VENDORS <br />FDrug Name , ,. „ ", " .quantity ,: size Strength NDCNO Class I Price I:RCode Lot Number, Expire Datez <br />MIXED TABS TO BE DESTROYED I 1.000 1000.00 N/A 000000001841 R 1 0.021 21 <br />Total: - 1.0001 0.021 <br />'TOMEL 0.52 <br />0 100.00 <br />Total: 1 000 56.61 <br />MYLAN (Direct) <br />Drug.Name quantity r-Siis .Strength rNDCNO 'Class -Price RCode Lot Number 7 Expire Data:: <br />I LEVOTHYROXINE SODIUM 0.250 0 <br />100.00.075 MG I 0037818U5011 R 3.07 1 12 1 11V!3695 <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 7 of 11 <br />