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Customer number: 21322 <br />Store number: 16639 <br />Batch number: 147 <br />Account number: 008-030510 <br />Name: DEUEL VOCATIONAL <br />INSTITUTION <br />e. trrrrr <br />4 <br />Credits passed through: 21322 <br />Customer reference number: GRX21322147 <br />Service Date: 08/02/2006 <br />®rint Date: <br />9/20/2006 <br />Phone: <br />(916) 928-0641 <br />Wholesaler: <br />AMERISOURCEBERGEN-008 <br />Address: <br />1325 WEST STRIKER AVENUE <br />1.000 <br />SACRAMENTO, CA 95834 <br />Returnable Report <br />ABBOTT PHARM (Direct) <br />Drug Name i Quantity Size',,- Strength, NDCN Cfaii', price <br />1 I <br />DEPAKOTE i 1.0001 100.001 125 MG I 00074621213 R 56.38 <br />Total: 1.000156.38 <br />ACTAVIS <br />N <br />NDC Siren N <br />Drug Nam <br />CARBIDOPA AND LEVODOPA 1.000 <br />100.00 25MG 00228254010 R 40.45 <br />CARBIDOPA AND LEVODOPA 7.000 100.00 25MG 00228254010 R 4045 <br />r- I I 1 80-90 <br />AKORN <br />. Drug Name <br />Quatity <br />SIZ" <br />Strengt" <br />pr co <br />Price',-"- <br />CROMOLYN SODIUM OPTHALMIC SOLUTION <br />1.000 <br />1.00 <br />4 % <br />17478029111 <br />R <br />22.79 <br />CROMOLYN SODIUM OPTHALMIC SOLUTION <br />1.000 <br />1.00 <br />4% <br />17478029111 <br />R <br />22.79 <br />SODIUM CHLORIDE <br />1.000 <br />1.00 <br />5% <br />17478062312 <br />1% <br />9.43 <br />SODIUM CHLORIDE <br />1.000 <br />1.00 <br />5% <br />17478062312 <br />R <br />9.43 <br />GENTAK <br />1.000 <br />1.00 <br />3MG/GM <br />1747828435 <br />R <br />6.25 <br />Total: <br />5.000 <br />1.00 <br />10% <br />24208031705 <br />R <br />70.69 <br />ALCON <br />Drug Narne,,' antlty,,- <br />Size <br />tf�engt ... .... .. <br />.. <br />lea J, <br />pr co <br />TRAVATAN 1.000 <br />1.00 <br />0.004% <br />65026634 <br />R <br />99.50 <br />TRAVATAN 1.000 <br />1.00 <br />0.004% <br />65026634 <br />R <br />99.50 <br />VEXOL 1.000 <br />1.00 <br />1% <br />00065062707 <br />R <br />27.40 <br />VEXOL 1.000 <br />1.00 <br />1% <br />00065062707 <br />R <br />27.40 <br />Total: 4.000 <br />1% <br />24208075006 <br />R <br />2.16 <br />253.80 <br />NIVIERICAN PHARM. INC. (Direct) <br />Cluantit�?] Size- 'e ]�L, Strsngth.:��.-j Ptic <br />Drug.Nprrie; <br />FLUPHENAZINE DEEANOATE 1 1,0001 25.001 25MG 633230272051 R 1 55.44 <br />Total: 1 1.0001 1 1 1 55.441 <br />ASTELLAS PHARIVIA INC. <br />PROGRAF <br />ASTRA/ZENECA <br />'w <br />NamePrlca <br />XYLOCAINE HCL 0.200 1 <br />1 5.00 001860115121 R 2.42 <br />SEROQUEL 10 <br />0.060 0.001 25MG 1 003100275391 Rq9.47 <br />Total; 1 2.0001 1 1 1 11.89 <br />BARR <br />FLUDROCORTISONE ACETA <br />BAUSCH LOMB PHARM. <br />.Drug Name, <br />Quantity', <br />.,,Slze - <br />Strength <br />,Price..,, <br />LEVOBUNOLOL HCl <br />1.000 <br />1.00 <br />0 <br />24208050505 <br />R <br />4.65 <br />LEVOBUNOLOL HCL <br />1.000 <br />1.00 <br />0 <br />24208050505 <br />R <br />4.65 <br />FLURATE <br />1.000 <br />1.00 <br />30MCG <br />24208073205 <br />R <br />6.56 <br />ATROPINE SULFATE <br />1.000 <br />1.00 <br />1% <br />24208075006 <br />R <br />2.16 <br />SULFACETAMIDE SODIUM W/PREDNISOLONE <br />1.000 <br />1.00 <br />10% <br />24208031705 <br />R <br />12.03 <br />SULFACETAMIDE SODIUM WIPREDNISOLONE <br />1.000 <br />1.00 <br />10% <br />24208031705 <br />R <br />12.03 <br />SULFACETAMIDE SODIUM WIPREDNISOLONE <br />1.000 <br />1.00 <br />10% <br />24208031705 <br />R <br />12.03 <br />DIPIVEFRIN HCL <br />1.000 <br />1.00 <br />0 <br />24208054005 <br />R <br />2.90 <br />DIPIVEFRIN HCL <br />1.000 <br />1.00 <br />0 <br />24208054005 <br />R <br />2.90 <br />DIPIVEFRIN HCL <br />1,000 <br />1.00 <br />0 <br />24208054005 <br />R <br />2.90 <br />FLUOROMETHOLONE <br />2.000 <br />1.00 <br />0.1% <br />24208028815 <br />R <br />17.90 <br />FLUOROMETHOLONE <br />1.000 <br />1.00 <br />0.1% <br />24208028815. <br />R <br />Total: <br />13.000 <br />I <br />I COUMADIN <br />NY Division: 100 Colin Drive, <br />Holbrook, NY 11741, Phone: <br />I <br />.15 <br />i 66 <br />BIOGEN INC. <br />CATAPRES-TTS <br />12.00 <br />Drug Name <br />Quantity.' <br />Size <br />Strength <br />NDCNO-l',', <br />class <br />Price <br />AVONEX <br />1.000 <br />4.00 <br />30MCG <br />5962700205 <br />R <br />11"�` <br />1169.75 <br />Total: <br />1.000 <br />1,169.75 <br />BOEHRINGER <br />Drug Name <br />Size <br />Strength <br />NDCNO <br />Class <br />Price <br />1.000 <br />005970031121 <br />R <br />1 71 <br />1166.71 q <br />Total: 1.000 1 <br />1 <br />BRISTOL/SQUIBB/NOVO (Direct) <br />I I 1 :1 1 <br />Drug Name <br />:Size <br />Strength <br />I COUMADIN <br />NY Division: 100 Colin Drive, <br />Holbrook, NY 11741, Phone: <br />1 0.5301 1-00.06-�- <br />1-800-473-2138; Midwest Division: 100 Teduke <br />Page 2 of 16 <br />7.5 MG 1 000560173701 R 1 54.031 <br />Court, St Charles, MO 63301, Phone: 1-800-729-3279 <br />CATAPRES-TTS <br />12.00 <br />0.1 MG <br />