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M
<br />In
<br />Customer number: 21322
<br />Store number: 16639
<br />Batch number: 147
<br />Account number: 008-030510
<br />Name: DEUEL VOCATIONAL
<br />INSTITUTION
<br />HOSPIRA WORLDWIDE (Direct)
<br />Credits passed through: 21322
<br />Customer reference number: GRX21322147
<br />Service Date: 08/02/2006
<br />Non -Returnable Report
<br />int Date: 9/20/2006
<br />Phone: (916) 928-0641
<br />Wholesaler: AMERISOURCEBERGEN-008
<br />Address: 1325 WEST STRIKER AVENUE
<br />SACRAMENTO, CA 95834
<br />ui,&TESTOINII
<br />Drug Natne
<br />".Quantity.:
<br />'Size ,
<br />I
<br />�4 re I
<br />"', '"q
<br />Ntcwo,� ,
<br />Class
<br />Price,
<br />RC90V
<br />Lot'Nurnbsr,
<br />ExplraDato�
<br />EPINEPHRINE HCL
<br />0.040
<br />25.00
<br />1:1,000
<br />00074724101
<br />R
<br />0.44
<br />01
<br />073203A
<br />07/05
<br />EPINEPHRINE HCL
<br />0.120
<br />25.00
<br />1:1,000
<br />00074724101
<br />R
<br />1.32
<br />01
<br />1MG
<br />10/05
<br />EPINEPHRINE HCL
<br />0.040
<br />25.00
<br />1:1,000
<br />00074724101
<br />R
<br />0.44
<br />01
<br />104603A
<br />10/05
<br />EPINEPHRINE HCL
<br />0,040
<br />25.00
<br />1:1,000
<br />00074724101
<br />R
<br />0.44
<br />01
<br />104603A
<br />10/05
<br />LIDOCANE
<br />0,100
<br />10.00
<br />100MG
<br />00074132305
<br />R
<br />1.67
<br />01
<br />10504EV
<br />10/05
<br />LIDOCANE
<br />0.100
<br />10.00
<br />100MG
<br />00074132305
<br />R
<br />1.67
<br />01
<br />09195EV
<br />09/05
<br />LIDOCANE
<br />0.200
<br />10.00
<br />100MG
<br />00074132305
<br />R
<br />334
<br />01
<br />09195
<br />09/05
<br />PROCAINAMIDE HCL
<br />0.040
<br />25.00
<br />100 MG/M
<br />00074190201
<br />R
<br />2.17
<br />02
<br />18351EV
<br />00002803101
<br />PROCAINAMIDE HCL
<br />0.040
<br />25.00
<br />100 MG/M
<br />00074190201
<br />R
<br />2.17
<br />02
<br />18351EV
<br />1-01
<br />PROCAINAMIDE HCL
<br />0.160
<br />25.00
<br />100 MG/M
<br />00074190201
<br />R
<br />8.68
<br />02
<br />GN4719
<br />Tota
<br />HEPARIN LOCK FLUSH
<br />0.140
<br />100.00
<br />100 UIML
<br />00074115270
<br />R
<br />1.54
<br />01
<br />P8819
<br />03/06
<br />ISUPREL
<br />0.600
<br />10.00
<br />.2MGIML
<br />00074141005
<br />R
<br />23.70
<br />01
<br />141003A
<br />02/06
<br />DEXTROSE
<br />0.080
<br />25.00
<br />50%
<br />00074664802
<br />R
<br />1.82
<br />01
<br />583383
<br />04102
<br />DOPAMINE HCL
<br />0.080
<br />50.00
<br />400 MG
<br />00074910420.
<br />R
<br />1.40
<br />02
<br />Total:
<br />46.000I
<br />i
<br />I
<br />1
<br />1 299.311
<br />1
<br />ui,&TESTOINII
<br />Drug Natne
<br />".Quantity.:
<br />'Size ,
<br />I
<br />�4 re I
<br />"', '"q
<br />Ntcwo,� ,
<br />N CN
<br />Classl
<br />�
<br />':,, :,Lot Number-' :�j -1
<br />'Expire Date
<br />SODIUM BICARBONATE
<br />0.100
<br />10.00
<br />0.893ME0
<br />0054:33022000
<br />1 R
<br />2.00
<br />01
<br />R
<br />03/06
<br />SODIUM BICARBONATE
<br />0.800
<br />10.00
<br />0.893ME0
<br />.. 4 3300R
<br />00546330200
<br />R
<br />16.00
<br />01
<br />1MG
<br />03106
<br />EPINEPHRINE
<br />0.520
<br />25.00
<br />0.1 MG/M
<br />00548101600
<br />R
<br />25.35
<br />01
<br />1.000
<br />03106
<br />EPINEPHRINE
<br />0.440
<br />25.00
<br />0.1 MG/M
<br />00548101600
<br />R
<br />21.45
<br />01
<br />GLUCAGON EMERGANCY KIT
<br />03/06
<br />Total,
<br />4.000
<br />1MG
<br />00002803101
<br />R
<br />73.55
<br />64.80
<br />02
<br />8RX86S
<br />LABORATORIES
<br />0
<br />Er4 " am Classl RC de Lot'NOMber ExplreDato
<br />ACETAMINOPHENgN 0 size I
<br />1 0.3331 ", 240.001P " , 500MG 01181914396 , , 1 1 2.471 06 1 34 1 5961
<br />Total: 1 1.0001 1 1 1 1 2.471 1 1 1
<br />,Y (Direct)
<br />MAJOR (Direct)
<br />Size Strength ,'_j
<br />Quentit
<br />S!
<br />Ntcwo,� ,
<br />N CN
<br />Classl
<br />�
<br />Lot'Noinkisr,"," ��_
<br />rExpilie'tYate'
<br />^
<br />Lot,,Nurnbar-
<br />Expire Date"
<br />GLUCAGON EMERGANCY KIT
<br />4 MG
<br />1.000
<br />1.00
<br />1MG
<br />00002803101
<br />R
<br />73.55
<br />21
<br />0.400
<br />8RX50S
<br />100MG
<br />GLUCAGON EMERGANCY KIT
<br />R
<br />1.000
<br />1.00
<br />1MG
<br />00002803101
<br />R
<br />73.55
<br />21
<br />200 MG
<br />8RX51S
<br />R
<br />GLUCAGON EMERGANCY KIT
<br />02
<br />1.000
<br />1.00
<br />1MG
<br />00002803101
<br />R
<br />73.55
<br />21
<br />R
<br />8RX51S
<br />02
<br />GLUCAGON EMERGANCY KIT
<br />1.000
<br />1.00
<br />1MG
<br />00002803101
<br />R
<br />73.55
<br />21
<br />02
<br />8RX86S
<br />GLUCAGON EMERGANCY KIT
<br />0.050
<br />8.000
<br />1.00
<br />1MG
<br />00002803101
<br />R
<br />588.40
<br />21
<br />8RX86S
<br />0.900
<br />GLUCAGON EMERGANCY KIT
<br />400 MG
<br />6.000
<br />1.00
<br />1MG
<br />00002803101
<br />R
<br />441.30
<br />21
<br />0.480
<br />100.00
<br />500 MG
<br />GLUCAGON EMERGANCY KIT
<br />R
<br />6.000
<br />1.00
<br />1MG
<br />00002803101
<br />R
<br />441.30
<br />21
<br />250 MG
<br />00904145361
<br />R
<br />GLUCAGON EMERGANCY KIT
<br />02
<br />1�2
<br />1-01
<br />1MG
<br />0.100
<br />R
<br />73.55,
<br />21
<br />R
<br />1.00
<br />02
<br />GN4719
<br />Tota
<br />01
<br />0.180
<br />100.00,
<br />750 MG
<br />00904229561
<br />1838.751
<br />4.31,
<br />02
<br />P8819
<br />MAJOR (Direct)
<br />MALLINCKRODT, INC.
<br />Drug Name Quantity
<br />Size Strength ,'_j
<br />NDCNOI � , ,,
<br />t
<br />Ntcwo,� ,
<br />Expire' Date I
<br />FLUOXETINE HCL
<br />HYDROCODONE BITRATE AND ACETA.
<br />�
<br />Lot'Noinkisr,"," ��_
<br />rExpilie'tYate'
<br />DOXAZOSIN MESYLATE
<br />0.200
<br />100.00
<br />4 MG
<br />904552460
<br />R
<br />1.53
<br />02
<br />GM7112
<br />TRAZODONE HCL
<br />0.400
<br />500.00
<br />100MG
<br />00904522040
<br />R
<br />12.68
<br />02
<br />THEO-TIME
<br />0.700
<br />100.00
<br />200 MG
<br />00904161161
<br />R
<br />13.34
<br />02
<br />P8800
<br />THEO-TIME
<br />0.500
<br />100.00
<br />300 MG
<br />00904161261
<br />R
<br />12.25
<br />02
<br />P8801
<br />GLIPIZIDE
<br />0.750
<br />1000.00
<br />5 M
<br />00904792480
<br />R
<br />22.31
<br />02
<br />M840
<br />PENTOXIFYLLINE
<br />0.050
<br />500.00
<br />400 MG
<br />00904544840
<br />R
<br />2.45
<br />02
<br />GM7143
<br />CIMETIDINE
<br />0.900
<br />500.00
<br />400 MG
<br />00904544640
<br />R
<br />24.92
<br />02
<br />M834
<br />NAPROXEN
<br />0.480
<br />100.00
<br />500 MG
<br />904553761
<br />R
<br />6.90
<br />02
<br />P9149
<br />METRONIDAZOLE
<br />0.540
<br />100.00
<br />250 MG
<br />00904145361
<br />R
<br />5.55
<br />02
<br />P9108
<br />DOXAZOSIN MESYLATE
<br />0.100
<br />100.00
<br />2MG
<br />904552360
<br />R
<br />1.00
<br />02
<br />GN4719
<br />POTASSIUM CHLORIDE
<br />0.180
<br />100.00,
<br />750 MG
<br />00904229561
<br />R
<br />4.31,
<br />02
<br />P8819
<br />Total:
<br />1
<br />1
<br />i
<br />i107.24i
<br />I
<br />MALLINCKRODT, INC.
<br />Drug Name Quantity
<br />Size Strength ,'_j
<br />NDCNOI � , ,,
<br />I Class I Price I RCode
<br />LotNumber °.
<br />Expire' Date I
<br />FLUOXETINE HCL
<br />HYDROCODONE BITRATE AND ACETA.
<br />�
<br />004060661051
<br />004060357011
<br />R 1 94.98 02
<br />3
<br />Total: 2.0001
<br />T
<br />1 1 8.751
<br />i
<br />I 1 95.64
<br />MARLEX PHARM
<br />Drug Nam&''..'. Quantity,
<br />Quantlty,
<br />NDCNO
<br />lClalss I Price
<br />I RCodej Lot Number ,., Expire Date
<br />ASPIRIN 0.7501
<br />ASPIRIN 1.000
<br />1000.001
<br />1000.00
<br />925MG 10195015010
<br />325MG 10135015010
<br />3.751
<br />5.00
<br />06 101820
<br />06 1 01 820
<br />Total: 2.0001
<br />1
<br />1 1 8.751
<br />1
<br />MCKESSON PACKAGING
<br />Drug Naint
<br />Quantlty,
<br />ND ' CNO, - _I Class Price Number __,�,
<br />ACYCLOVIR TABI.
<br />ACYCLOVIR TAB
<br />00.00 400MG 6373931515� R 1.40 020017730
<br />00.00 400MG 6373931 5 5 R 1 .40 02 0017730
<br />�ExplreDaj
<br />Total:
<br />2.0001
<br />2.80
<br />01 MGI PH ARMA
<br />NY Division: 100 Colin Drive, Holbrook, NY 11741, Phone: 1-800-473-2138; Midwest Division: 100 Teduke Court, St Charles, MID 63301, Phone: 1-800r729-3279
<br />Page 11 of 16
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