|
Customer number: 21322
<br />Store number: 16639
<br />Batch number: 147
<br />Account number: 008-030510
<br />Name: DEUEL VOCATIONAL
<br />INSTITUTION
<br />JOM - REGRANEX
<br />U4r411 'I
<br />Credits passed through: 21322
<br />Customer reference number: GRX21322147
<br />Service Date: 08/02/2006
<br />Returnable Report
<br />GInt Date:
<br />9/20/2006
<br />Phone:
<br />(916) 928-0641
<br />Wholesaler:
<br />AMERISOURCEBERGEN-008
<br />Address:
<br />1325 WEST STRIKER AVENUE
<br />488.16
<br />SACRAMENTO, CA 95834
<br />'G'EL
<br />tran NOCNO,
<br />�
<br />Rl=G-`RAN'i X 1.00
<br />1.001 0.01 % 000450810151 R
<br />48816
<br />Total: 1 ..
<br />Tot O�
<br />ZYPREXA ZYDIS
<br />488.16
<br />LILLY (Direct)
<br />�,Dr�g Name
<br />,�;Quar tity,'
<br />'.� .Size , ;
<br />Strength; -
<br />-NPCNO'„ff-',"""
<br />loss,
<br />C
<br />Price
<br />ZYPREXA ZYDIS
<br />0.800
<br />30,00
<br />5 M
<br />00002445385
<br />R
<br />170.16
<br />HUMALOG
<br />2.000
<br />1.00
<br />-00
<br />1 00 U/ML
<br />00002751001R
<br />R
<br />133.92
<br />HUMALOG
<br />2.000
<br />1.00
<br />100 UIML
<br />00002751001
<br />R
<br />133.92
<br />ZYPREXA INTRAMUSCULAR
<br />1.000
<br />1.00
<br />10MG
<br />2759701
<br />R
<br />19.50
<br />ZYPREXA
<br />0.250
<br />60.00
<br />10MG
<br />00002411760
<br />R
<br />138.00
<br />VANCOCIN HCL
<br />1.000
<br />20.00
<br />250 MG
<br />00002312642
<br />R
<br />368.86
<br />Total:
<br />8.000
<br />964.36
<br />MAJOR (Direct)
<br />'Drbg Natmo,,§
<br />V,Quantity N DCN,
<br />CIMETIDINE 1.0001 500.001 400 MG 00904544640 R 27.69
<br />DOXAZOSIN MESYLATE 1.000 100.00 4 M 904552460 R 7.65
<br />Total: 1 2.0001 1 35.34
<br />MCKESSON PACKAGING
<br />MERCK & CO. INC.
<br />"'
<br />�_NDCN0Class
<br />COGENTIN 0.400 5.001 2MG/2ML 1 63275011 R 1 15.291
<br />Total: 1.000 15.291
<br />MERCK (VACCINES)
<br />'Dreg Name, m
<br />,�;Quar tity,'
<br />'.� .Size , ;
<br />Strength; -
<br />'NDCNO,
<br />Class
<br />Price
<br />PNEUMOVAX 23
<br />1.000
<br />1.00
<br />0
<br />00006473900
<br />R
<br />107.77
<br />PNEUMOVAX 23
<br />4.000
<br />1.00
<br />0
<br />00006473900
<br />R
<br />431.08
<br />PNEUMOVAX23
<br />2.000
<br />1.00
<br />0
<br />00006473900
<br />R
<br />215.54
<br />PNEUMOVAX 23
<br />1.000
<br />1.00
<br />0
<br />00006473900
<br />R
<br />107.77
<br />Total:
<br />8.000
<br />100.00
<br />12.5 MG
<br />00378300701
<br />R
<br />862.16,
<br />MISSION
<br />Drug N 'I
<br />ty
<br />Slay,
<br />'m
<br />UROC -K 1 1.0001 100.001 10 MEQ 001780610011 R 1 32.17
<br />1 Total: 1 1.0001 1 1 1 32.17
<br />MYLAN
<br />2.17
<br />MYLAN (Direct)
<br />Name
<br />,�;Quar tity,'
<br />'.� .Size , ;
<br />>- 'I," Strength,
<br />'NDCNO,
<br />Class
<br />Price
<br />THIOTHIXENE
<br />1.000
<br />100.00
<br />2 MG
<br />00378200201
<br />R
<br />12.54
<br />THIOTHIXENE
<br />1.000
<br />100.00
<br />10 MG
<br />00378501001
<br />R
<br />26.81
<br />THIOTHIXENE
<br />1,000
<br />100.00
<br />10 MG
<br />00378501001
<br />R
<br />26.81
<br />CAPTOPRIL
<br />1.000
<br />100.00
<br />12.5 MG
<br />00378300701
<br />R
<br />29.15
<br />CAPTOPRIL
<br />1.000
<br />100.00
<br />12.5 MG
<br />00378300701
<br />R
<br />29.15
<br />CAPTOPRIL
<br />1.000
<br />100.00
<br />12.5 MG
<br />00378300701
<br />R
<br />29.15
<br />Total:
<br />6.000
<br />153.61
<br />NOVARTIS PHARM. (Direct)
<br />Name?. ::'%; ,,, ., s ,.. ','
<br />,�;Quar tity,'
<br />'.� .Size , ;
<br />>- 'I," Strength,
<br />'NDCNO,
<br />Class
<br />Price
<br />FAMVIR
<br />0,500
<br />30.00
<br />500MG
<br />00078036815
<br />R
<br />112.10
<br />FAMVIR
<br />0.333
<br />30.00
<br />500MG
<br />00078036815
<br />R
<br />74.66
<br />DIOVAN HCT
<br />1.000
<br />90.00
<br />80/12.5
<br />78031434
<br />R
<br />146.73
<br />010VAN
<br />0.333
<br />90.00
<br />160MG
<br />78035934
<br />R
<br />48.85
<br />Total:
<br />4.000
<br />382.34
<br />PADDOCK
<br />.e Drug
<br />Quantity),,,
<br />Size_ j-
<br />�f-,,,Strength
<br />5, �'
<br />NDCNQ
<br />Class .,.,Price.
<br />ACTIDOSE-AQUA
<br />1.000
<br />1.00
<br />25 GM
<br />00574012174
<br />9.59-
<br />ACTIDOSE-AQUA
<br />1.000
<br />1.00
<br />25 GM
<br />0057401 21 74
<br />9.59
<br />ACTIDOSE-AQUA
<br />1.000
<br />1.00
<br />25 GM
<br />00574012174�
<br />9.59
<br />3.000
<br />28.77
<br />PARPHARM
<br />:Drug Name Quantity I Vzo
<br />I Strength
<br />NDCNO,'� class
<br />DOXEPIN HCL 1.000 100.00
<br />150 MG
<br />49864022201 R 23.75
<br />Total: 1 1.0001
<br />23.75
<br />PFIZER
<br />g Name NOCNO Class 1<",,,„""""Prlc4�,,,,,,",�I
<br />ICELEBREX 1 1.0001 100,001 100 MG 1 000251520341 R 1 159.48
<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 4 of 16
<br />Ll
<br />
|