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gr_whtrn-storlasr WO—d`Ed,lJRNA LES 1°1A IOST <br />Page: 1 <br />,.ernntard <br />151$2 DEVOS LTD., DBA GUARANTEED RETURNS <br />Store #: 5793 100 Colin Drive <br />tch #: 149I461hrook, NY 11741-4306 <br />#: 805663 (AEA.#: RD0188311 EPA#; NY0000997692 ) Print Date : Dot 16, 2004 <br />Phone: (209) 835-4141 <br />Customer: DEUEL VOCATIONAL INSTITUTION <br />Add".** 2,1500 RA92ON ROAD <br />P,0• BOX 400 1AHARMACY DEPT. Creditq parmed through: 153,52 Wholcsalcr: MCKESSON•26 <br />TRACY, CA 95376 Cust Ref #/Debit#; CRX15152149 Addreae: 3775 SEAPORT.BLVD. <br />Contact : ESPERANZA Service Date: 12/16/04 182-W_ SACRAMENTO, CA 94403 <br />Den # AV2209221 <br />QUANTITY DEA REASON <br />VENDOR F I P 817.,E STRENGTH DRUG NAME NDCNO CLASS EXPIRES PRICE CODE <br />--------------------------------==®n=om:a----------- ----- -------- ----- <br />UCP PHARMA/WHITBY 040 100,00 5/500 LORTAB 5047490201 3 2.73, 1.1. <br />ABBOTT HOSP 100 10.00 5 MG/ML DIAZEPAM 74321001 4 5.20 02 <br />ALLSCRIPS 130 100.00 60 MG PHENOBARBITAL 54569093900 4 .66 20 <br />LILLY .200 100.00 65 MG DARVON 2080333 4 11.36 20 <br />'.TEVA PHARM• .090 100.00 1 MG CLONAZEPAM 93083301 4 6.16 20 <br />TEVA PHARM. .440 100.00 0.5 MG CLONAZEPAM 930837.01 4 26,37 20 <br />UDL .190 100,00 2 MG LORAZEPAM 51079038720 4 14.28 02 <br />UDL .200 100.00 2 MG LORAZEPAM 51079036720 4 15.03 02 <br />UDL .140 100.00 2MG CLONAZEPAM 5107988320 4 3.75 02 <br />UDL .200 100.00 1MQ CLONAZEPAM 5107988220 4 4.38 02 <br />UDL 520 100.00 1MG CLONAZEPAM ;1,07988220 4 11.38 02 <br />UDL .31.0 7,00.00 0.5 MG LORAZEPAM 51079047,720 4 14.95 02 <br />WATSON PHARMA. INC.. .1.1.0 100.00 100 MG PHENOBARBITAL 591580201 4 .20 20 <br />WYETH/AYERST/LED£RLF .270 1100.00 2 MG ATIVAN 8006502 4 36.87 2.0 <br />153.30 <br />Total Itr..ms: 14 <br />REASON CODS KEY; <br />11 NOT ELIGIBLE FOR CREDIT 02 VENDOR ACCEPTS FULL PACICAQES ONLY <br />20 VENDOR DOES NOT ACCEPT PRESCRIPTIONS <br />1� <br />u <br />