|
Customer number: 21322
<br />Store number: 16639
<br />Batch number: 147
<br />Account number: 008-030510
<br />Name: DEUEL VOCATIONAL
<br />INSTITUTION
<br />MISC. VENDORS
<br />Credits passed through: 21322
<br />Customer reference number: GRX21322147
<br />Service Date: 08/02/2006
<br />Non -Returnable Report
<br />hint Date:
<br />9/20/2006
<br />Phone:
<br />(916)928-0641
<br />Wholesaler:
<br />AMERISOURCEBERGEN-008
<br />Address:
<br />1325 WEST STRIKER AVENUE
<br />1000.00 N/A
<br />SACRAMENTO, CA 95834
<br />35r Na
<br />,.49 -
<br />(ivan tHy_
<br />Size-=- Str" rSgtlt°;..'NDC�I.
<br />��.
<br />_ Claps ,
<br />:' EPrlce
<br />RCp Lot Gnt6e ._t4 :�xatrD_te;
<br />MIXED TABS TO BE DESTROYED
<br />20.000
<br />1000.00 N/A
<br />00000000184 R
<br />0.37
<br />21 NO LOT #
<br />MIXED TABS TO BE DESTROYED
<br />6.000
<br />7000.00 N/A
<br />00000000184 R
<br />0.11
<br />21
<br />1M0437
<br />Total: 1 26.0001
<br />1
<br />1 1 1
<br />0.481
<br />1
<br />MONARCH PHARM
<br />MYLAN (Direct)
<br />Drug Name,,',, �,
<br />- g
<br />rit18L1tI _
<br />Eft':•-
<br />8i
<br />,e• 'Stt'$rl9th
<br />- ;NDGl!tii„
<br />$
<br />°1„PNca,; -RCode
<br />,RCode
<br />;?a,:Loi-Nurniier
<br />-Expir®,Da(te.
<br />HALOPERIDOL
<br />0.350
<br />100.00
<br />1 MG
<br />00378025701
<br />R
<br />5.08
<br />02
<br />1M0437
<br />HALOPERIDOL
<br />0.080
<br />100.00
<br />1 MG
<br />00378025701
<br />R
<br />1.16
<br />02
<br />1M0437
<br />HALOPERIDOL
<br />0.250
<br />100.00
<br />0.5 MG
<br />00378035101
<br />R
<br />2.56
<br />02
<br />1L4002
<br />HALOPERIDOL
<br />0.250
<br />100.00
<br />0.5 MG
<br />00378035101
<br />R
<br />2.56
<br />02
<br />1L4002
<br />09/05
<br />HALOPERIDOL
<br />0.300
<br />100.00
<br />0.5 MG
<br />00378035101
<br />R
<br />3.07
<br />02
<br />114002
<br />06/05
<br />PRAZOSIN HCl
<br />0.333
<br />100.00
<br />1 MG
<br />00378110101
<br />R
<br />4.39
<br />02
<br />1M1272
<br />NADOLOL
<br />0.100
<br />100.00
<br />40
<br />00378117101
<br />R
<br />4.33
<br />02
<br />3KO533
<br />DOXEPIN HCL
<br />0.800
<br />100.00
<br />50 MG
<br />00378425001
<br />R
<br />18.22
<br />02
<br />3L1771
<br />DITIAZEM
<br />0.800
<br />100.00
<br />120 MG
<br />00378612001
<br />R
<br />40.84
<br />02
<br />IM0260
<br />DITIAZEM
<br />0.550
<br />100.00
<br />120 MG
<br />00378612001
<br />R
<br />28.08
<br />02
<br />1M0339
<br />THIOTHIXENE
<br />0.100
<br />100.00
<br />2 MG
<br />00378200201
<br />R
<br />- 1.25
<br />02
<br />1M1924
<br />THIOTHIXENE
<br />0.750
<br />100.00
<br />10 MG
<br />00378501001
<br />R
<br />2011
<br />02
<br />1L4070
<br />Total:
<br />12.000
<br />i
<br />i
<br />1
<br />131.651
<br />i
<br />PADDOCK
<br />DrugNarrle, ";Quantity
<br />.' Cede, Lot iEtf(rlre Dai4 s
<br />GLUTOSE 15 1.000
<br />GLUTOSE 151.000
<br />1.00 15G 1 00574006915 1 1.02 01 3308912 06/05
<br />3.00 00574006930 5.04 01 3308912 06/05
<br />Total: -1 2.0001
<br />1 1 1 1 6.06
<br />PARPHARM
<br />;;d)Fltg Name
<br />Quatt2lty,
<br />, , ,
<br />? ,Str@ry9th '';;NGCN 1 �„ Cless ,. , Prtca
<br />Class
<br />.,. ,Proe ,.,
<br />,RCode
<br />, Lot Nutn3s�r.,`., s, °,
<br />Exp1we Data°'
<br />BENZTROPINE MESYLATE
<br />0.600
<br />1000.00
<br />2 MG
<br />49884016610
<br />R
<br />11.36
<br />02
<br />042531
<br />DOXEPIN HCL
<br />0.250
<br />100.00
<br />150 MG
<br />49884022201
<br />R
<br />5.94
<br />02
<br />043011
<br />IMIPRAMINE HCL
<br />0.7501
<br />100.00
<br />25 MG
<br />49884005501
<br />R
<br />7.88
<br />02
<br />044099
<br />IMIPRAMINE HCL
<br />0.4501
<br />100.00
<br />50 MG
<br />49884005601
<br />R
<br />5.78
<br />02
<br />043981
<br />09/05
<br />Total:
<br />4.000T_30.96
<br />100.00
<br />65 MG
<br />00603545921
<br />4
<br />0.40
<br />20
<br />PRESCR. BOTTLE
<br />06/05
<br />QUALITEST
<br />Drug Name ., .
<br />Quatt2lty,
<br />, , ,
<br />? ,Str@ry9th '';;NGCN 1 �„ Cless ,. , Prtca
<br />Class
<br />.,. ,Proe ,.,
<br />,RCode
<br />, Lot Nutn3s�r.,`., s, °,
<br />Exp1we Data°'
<br />AMITRIPTYLINE HCL
<br />0.100
<br />100.00
<br />10 MG
<br />00603221221
<br />R
<br />0.52
<br />02
<br />NO LOT #
<br />BELLADONNA ALKALOID W/PHENOBARBITAL
<br />0.500
<br />1000.00
<br />16.2 MG
<br />00603241832
<br />R
<br />9.52
<br />02
<br />S3A035G
<br />CARISOPRODOL
<br />0.350
<br />100.00
<br />350 MG
<br />00603258221
<br />R
<br />6.26
<br />02
<br />S3A035G
<br />PREDNISONE
<br />0.900
<br />1000.00
<br />5 MG
<br />00603533232
<br />R
<br />11.41
<br />01
<br />573948
<br />09/05
<br />PROPDXYPHENE HCL
<br />0.030
<br />100.00
<br />65 MG
<br />00603545921
<br />4
<br />0.40
<br />20
<br />PRESCR. BOTTLE
<br />06/05
<br />MIGQUIN
<br />0.040
<br />100.00
<br />N/A
<br />00603466421
<br />4
<br />0.69
<br />20
<br />PRESCR. BOTTLE
<br />PRIMIDONE
<br />0.850
<br />500.00
<br />50 MG
<br />00603536928
<br />R
<br />57:12
<br />02
<br />5374
<br />PRIMIDONE
<br />0.900
<br />500.00
<br />50 MG
<br />00603536928
<br />R
<br />60.48
<br />02
<br />5374
<br />Total:
<br />8.000
<br />146.40
<br />RICHMOND PHARM.
<br />;.._ `Drug Name ,,,,,,,,,,,,,,,s',,,
<br />Prue ` :RCode Lot;Nlmbet' Ex ire Date!
<br />P
<br />, , ,
<br />? ,Str@ry9th '';;NGCN 1 �„ Cless ,. , Prtca
<br />aCtad
<br />.. .,.; , �4hNutlther, _. ,.'=
<br />Expire Date'
<br />TRIHEXYPHENIDYL HCl
<br />0.333
<br />100.00
<br />SMG 5473855501 R 9.62
<br />02
<br />C0851203A
<br />5 MG/ML
<br />Total:
<br />1.000
<br />3.21
<br />9.62
<br />S3A035G
<br />METOPROLOL TARTRATE
<br />ROCHE/SYNTEX
<br />ROXANE
<br />'F, Dru Narks QuanH " Sixs ;
<br />g- g ty
<br />Prue ` :RCode Lot;Nlmbet' Ex ire Date!
<br />P
<br />MIRTAZAPINE 0.13330.00 15 MG
<br />PREDNISONE 0.100 100.00 10 MG
<br />54467613 R 7.56 01 OS/O5
<br />54001725 R 0.43 04 556586A
<br />_
<br />Total: 2.000
<br />7.991 1
<br />SANDOZ SERVICES INC.
<br />DrugName
<br />Quanttt}.
<br />Size 'r
<br />%;�trangthu;
<br />a- =NDDNb
<br />Class,_.Pr[ce:.r'RGode;;LotNui»6sr
<br />Exptre�atea
<br />METOPROLOL TARTRATE
<br />0.083
<br />12.00
<br />5 MG/ML
<br />00781307075
<br />R
<br />3.21
<br />02
<br />S3A035G
<br />METOPROLOL TARTRATE
<br />0.100
<br />10.00
<br />1 MG/ML
<br />781307095
<br />R
<br />3.22
<br />02
<br />S3A035G
<br />METOPROLOL TARTRATE
<br />0.100
<br />10.00
<br />1 MG/ML
<br />781307095
<br />R
<br />3.22
<br />02
<br />S3A035G
<br />HALOPERIDOL
<br />0.300
<br />100.00
<br />2 MG
<br />00781139301
<br />R
<br />4.33
<br />02
<br />138465
<br />HALOPERIDOL
<br />0.400
<br />100.00
<br />10 MG
<br />00781139701
<br />R
<br />41.92
<br />01
<br />06/05
<br />TRIAMTERENE AND HYDROCHLOROTHIAZIDE
<br />0.900
<br />1000.00
<br />37.5/25
<br />00781207410
<br />R
<br />183.56
<br />02
<br />NO LOT
<br />Total:
<br />6.000
<br />239.46
<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 12 of 16
<br />C
<br />
|