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U
<br />Customer number: 21322
<br />Store number: 16639
<br />Batch number: 147
<br />Account number: 008-030510
<br />Name: DEUEL VOCATIONAL
<br />INSTITUTION
<br />rtsrra
<br />re C
<br />Credits passed through: 21322
<br />Customer reference number: GRX21322147
<br />Service Date: 08/0212006
<br />Returnable Report
<br />BRISTOL/SQUIBB/NOVO (Direct)
<br />leint Date: 9/20/2006
<br />Phone: (916) 928-0641
<br />Wholesaler: AMERISOURCEBERGEN-008
<br />Address: 1325 WEST STRIKER AVENUE
<br />SACRAMENTO, CA 95834
<br />Drug-Nana
<br />Quantity, me
<br />Strength NDCNO,
<br />Class f
<br />"Class;
<br />Price,
<br />COUMADIN
<br />0.930 100.00
<br />7.5 MG
<br />00056017375
<br />Total:
<br />91.17
<br />COUMADIN
<br />3.000 l0000
<br />7.5 MG
<br />00056017375
<br />R
<br />294.09
<br />COUMADIN
<br />0.280 100.00
<br />7.5 MG
<br />00056017375
<br />R
<br />27.45
<br />COUMADIN
<br />1.000 100.00
<br />-
<br />2.5 MG
<br />-
<br />00056017675
<br />R
<br />73.39
<br />Total:
<br />7.000
<br />00168016346
<br />R
<br />26.60
<br />540.13
<br />DFY
<br />Drug,. arni
<br />Quantity, ]� Size
<br />Strength NDCNO,
<br />Class f
<br />Price'
<br />EPI-PEN1
<br />EPI -PEN
<br />0001 1.001
<br />1.000 1.00
<br />0.3 MG 1 49502050001
<br />0.3 MG 49502050001
<br />R
<br />R
<br />47.13
<br />47.13
<br />Total:
<br />1 2.0001
<br />1
<br />1.50
<br />94.26
<br />F11A1 INC
<br />Drug Name
<br />�IEI�T�
<br />Size` Strength�:, ,NDCNO class
<br />i
<br />za'�
<br />AR 11 1 0.2501
<br />62B560245901
<br />9'U.Ou IF, SMG R
<br />1 97.55
<br />Total: 1 1.0001
<br />1 1
<br />1 97.55
<br />FAI CON
<br />• i0 Name, 4,�
<br />NPP JC lass
<br />za'�
<br />CIPROFLOXACIN HCL 1.0001
<br />13140656251 R 1
<br />13.35
<br />Total: 1.0001
<br />1 1
<br />13.35
<br />11
<br />FOREST PHARM.
<br />77
<br />P
<br />JCELEXA 1 1.0001 100.00 ji 20 MG 004564020631 R 250.94
<br />1 Total: 1 1.0001 1I 1 1 250.941
<br />FOUGERA
<br />r it W
<br />ant1ty,,,,
<br />za'�
<br />strongth,":,•,,_
<br />5.00 SG
<br />Class
<br />• rice
<br />HYDROCORTISONE
<br />1.000
<br />1.00
<br />1%
<br />00168001531
<br />R
<br />1.50
<br />CLOBETASOL PROPIONATE
<br />1.000
<br />1.00
<br />.05%
<br />00168016246
<br />R
<br />26.60
<br />CLOBETASOL PROPIONATE
<br />1.000
<br />1.00
<br />.05 %
<br />00168016346
<br />R
<br />26.60
<br />CLOBETASOL PROPIONATE
<br />1.000
<br />1.00
<br />.05 %
<br />00168016346
<br />R
<br />26.60
<br />BACITRACIN
<br />1.000
<br />1.00
<br />500 U/GM
<br />00168002638
<br />R
<br />2,04
<br />Total:
<br />5.000
<br />20 MCGIM
<br />58160085716
<br />R
<br />394.70
<br />$3.34
<br />r it W
<br />kXO WELLCOME
<br />rug*anaw
<br />HAVRIX
<br />Quantity
<br />za'�
<br />strongth,":,•,,_
<br />5.00 SG
<br />Class
<br />• rice
<br />PR , OMETHEGA , N
<br />1.000
<br />12.00
<br />25 MG
<br />00713052612
<br />R
<br />32.96
<br />PROCHLORPERAZINE
<br />1.000
<br />12.00
<br />25MG
<br />00713013512
<br />R
<br />26.06
<br />PROCHLORPERAZINE
<br />1.000
<br />12.00
<br />25MG
<br />00713013512
<br />R
<br />26.06
<br />Total:
<br />3.000
<br />1440 EL
<br />58160083546
<br />R
<br />216.94
<br />85.08
<br />kXO WELLCOME
<br />rug*anaw
<br />HAVRIX
<br />Quantity,
<br />size
<br />trength,-
<br />5.00 SG
<br />082130090 29.52
<br />00064100 051 R 1 40.85
<br />001
<br />Price
<br />0.800
<br />5.00
<br />1440 EL
<br />58160083546
<br />R
<br />216.94
<br />HAVRIX
<br />0.600
<br />5.00
<br />1440 EL
<br />58160083546
<br />R
<br />162.70
<br />HAVRIX
<br />1.000
<br />5.00
<br />1440 EL
<br />58160083546
<br />R
<br />271.17
<br />HAVRIX
<br />0.800
<br />5.00
<br />1440 EL
<br />58160083546
<br />R
<br />216.94
<br />HAVRIX
<br />1.000
<br />5.00
<br />1440 EL
<br />58160083546
<br />R
<br />271.17
<br />ENGERIX-6
<br />0,320
<br />25.00
<br />20 MCGIM
<br />58160085716
<br />R
<br />394.70
<br />ENGERIX-13
<br />1.000
<br />1.00
<br />20MCG/ML
<br />58160085701
<br />R
<br />50.63
<br />IMITREX
<br />0,800
<br />5.00
<br />12 MG/ML
<br />00173044902
<br />R
<br />222.46
<br />WELLBUTRIN XL
<br />0.300
<br />30.00
<br />300 MG
<br />173073101
<br />R
<br />34.88
<br />PAXIL CR
<br />2.300,
<br />30.00
<br />37.5 MG
<br />00029320813
<br />R
<br />186.92
<br />Total:
<br />1 12.0001
<br />10.000
<br />1
<br />-
<br />i
<br />2,028.51
<br />HEALTHPOINT
<br />19 Name' .Quantity,,'
<br />h
<br />NDCNO Class Price -
<br />1
<br />10DOFLEX 1.000
<br />ACCUZYME
<br />5.00 SG
<br />082130090 29.52
<br />00064100 051 R 1 40.85
<br />001
<br />Total: 1 2,0001
<br />1
<br />1 1 70.37
<br />JANSSFNIC)RTHO/MCNEIL
<br />Orup Name
<br />Quantity
<br />Size
<br />Strength
<br />NDCNO
<br />Class
<br />-Price
<br />LEVAQUIN
<br />0.200
<br />50.00
<br />250MG
<br />00045152050
<br />R
<br />85.73
<br />RISPERDAL
<br />0.833
<br />60.00
<br />1
<br />50458030006
<br />R
<br />168,69
<br />RISPERDAL
<br />0.667
<br />60.00
<br />2 M
<br />50458032006
<br />R
<br />223.60
<br />RISPERDAL
<br />0.500
<br />500.00
<br />2 M
<br />50458032050
<br />R
<br />1396.78
<br />HALDOL DECANOATE
<br />0.400
<br />10.00
<br />50 MG/ML
<br />00045025301
<br />R
<br />155.64
<br />HALDOL DECANOATE
<br />1,000
<br />10.00
<br />50 MG/ML
<br />00045025301
<br />R
<br />389.10
<br />HALDOL DECANOATE
<br />0,800
<br />10.00
<br />50 MG/ML
<br />00045025301
<br />R
<br />311.28
<br />HALDOL DECANOATE
<br />0.200
<br />10.00
<br />50 MG/ML
<br />00045025301
<br />R
<br />77.82
<br />HALDOL DECANOATE
<br />1.000
<br />10,00
<br />50 MG/ML
<br />00045025301
<br />R
<br />389.10
<br />SPORANOX PULSE PAK
<br />1.000
<br />28.00
<br />100 MG
<br />50458029028
<br />R
<br />231.55
<br />1 Total:
<br />10.000
<br />i
<br />i 3,429.:2_91
<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 16
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