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stoiiasr *ON-RETURNABLES MANIST <br />Cust. #: 15152 a an rteed <br />Store #: 5793 et.rns <br />0C #: 145 <br />t. #: 805663 <br />Cu :r: DEUEL VOCATIONAL INSTITUTION <br />Address 23500 KASSON ROAD <br />P.O. BOX 400 - PHARMACY DEPT. <br />TRACY, CA 95376 <br />Contact ESPERANZA <br />Dea # AV3309831 <br />DEVOS LTD., DBA GUARANTEED RETURNS <br />100 Colin Drive <br />Holbrook, NY 11741-4306 <br />(DEA#: RD0188311 EPA#: NY0000997692 ) <br />Page: 230 <br />Print Date : Sep 8, 2004 <br />Phone: (209) 835-4141 <br />Credits passed through: 15152 Wholesaler: MCKESSON-26 <br />Cust Ref #/Debit#: GRX15152145 Address: 3775 SEAPORT BLVD. <br />Service Date: 08/23/04 182-W. SACRAMENTO, CA 94403 <br />Total Items: 27 <br />REASON CODE KEY: <br />20 VENDOR DOES NOT ACCEPT PRESCRIPTIONS <br />11 NOT ELIGIBLE FOR CREDIT <br />06 WHSLR RTN. NO CHARGE <br />01 OUTDATED PAST VENDOR POLICY <br />02 VENDOR ACCEPTS FULL PACKAGES ONLY <br />14 PREPACKS NOT ELIGIBLE FOR RETURN <br />QUANTITY <br />DEA <br />REASON <br />VENDOR <br />F I P <br />SIZE <br />STRENGTH <br />DRUG NAME <br />NDCNO <br />CLASS <br />EXPIRES <br />PRICE <br />CODE <br />ABBOTT <br />HOSP <br />.600 <br />10.00 <br />5MG/ML <br />DIAZEPAM INJECTION USP <br />74127332 <br />4 <br />12.16 <br />20 <br />ABBOTT <br />HOSP <br />.200 <br />10.00 <br />2MG/ML <br />LORAZEPAM INJ <br />74198511 <br />4 <br />4.40 <br />20 <br />ABBOTT <br />HOSP <br />1.000 <br />10.00 <br />2MG/ML <br />LORAZEPAM INJ <br />74198511 <br />4 <br />10/03 <br />22.00 <br />01 <br />ABBOTT <br />HOSP <br />.500 <br />10.00 <br />5MG/ML <br />DIAZEPAM INJECTION, USP <br />74321032 <br />4 <br />7.45 <br />11 <br />ABBOTT <br />HOSP <br />.400 <br />10.00 <br />2 MG/ML <br />LORAZEPAM <br />74677802 <br />4 <br />11/03 <br />2.06 <br />01 <br />APOTEX <br />CORP <br />.330 <br />100.00 <br />0.5 MG <br />CLONAZEPAM <br />60505006601 <br />4 <br />6.07 <br />11 <br />BARR <br />.180 <br />100.00 <br />25 MG <br />CHLORDIAZEPDXIDE HCL <br />555015902 <br />4 <br />1.19 <br />02 <br />BAXTER <br />HEALTHCARE <br />.500 <br />10.00 <br />5MG/ML <br />DIAZEPAM INJECTION,USP <br />1001900567 <br />4 <br />.25 <br />06 <br />LILLY <br />1.050 <br />100.00 <br />100 MG <br />DARVON-N <br />2035333 <br />4 <br />83.70 <br />20 <br />TEVA PHARM. <br />.030 <br />100.00 <br />1 MG <br />CLONAZEPAM <br />93083301 <br />4 <br />2.06 <br />02 <br />TEVA PHARM. <br />.530 <br />100.00 <br />2 MG <br />CLONAZEPAM <br />93083401 <br />4 <br />50.20 <br />02 <br />UDL <br />.100 <br />100.00 <br />5 MG <br />DIAZEPAM <br />51079028520 <br />4 <br />.67 <br />11 <br />UDL <br />.040 <br />100.00 <br />5 MG <br />DIAZEPAM <br />51079028520 <br />4 <br />.27 <br />11 <br />UDL <br />.100 <br />100.00 <br />2 MG <br />DIAZEPAM <br />51079028420 <br />4 <br />11/02 <br />.64 <br />01 <br />UDL <br />.200 <br />100.00 <br />2 MG <br />DIAZEPAM <br />51079028420 <br />4 <br />1.28 <br />02 <br />UDL <br />.240 <br />100.00 <br />1 MG <br />CLONAZEPAM TABLETS, USP <br />5107988221 <br />4 <br />5.35 <br />02 <br />UDL <br />.700 <br />100.00 <br />2MG <br />CLONAZEPAM <br />5107988320 <br />4 <br />18.76 <br />14 <br />UDL <br />.350 <br />100.00 <br />1MG <br />CLONAZEPAM <br />5107986220 <br />4 <br />7.66 <br />02 <br />UDL <br />.200 <br />100.00 <br />1MG <br />CLONAZEPAM <br />5107988220 <br />4 <br />4.38 <br />02 <br />UDL <br />.700 <br />100.00 <br />1 MG <br />LORAZEPAM <br />51079038620 <br />4 <br />07/99 <br />35.71 <br />01 <br />UDL <br />.110 <br />100.00 <br />2 MG <br />LORAZEPAM <br />51079038720 <br />4 <br />05/99 <br />8.27 <br />01 <br />.400 <br />100.00 <br />2MG <br />CLONAZEPAM <br />5107988320 <br />4 <br />08/99 <br />10.72 <br />01 <br />.200 <br />100.00 <br />2 MG <br />LORAZEPAM <br />51079038720 <br />4 <br />05/99 <br />15.03 <br />01 <br />UD <br />.210 <br />100.00 <br />2.5 MG -0 <br />DIPHENOXYLATE HCL W/ATROPINE <br />51079006720 <br />5 <br />05/99 <br />8.60 <br />01 <br />UDL <br />.200 <br />100.00 <br />2.5 MG -0 <br />DIPHENOXYLATE HCL W/ATROPINE <br />51079006720 <br />5 <br />05/99 <br />8.19 <br />01 <br />UDL <br />.200 <br />100.00 <br />2.5 MG -0 <br />DIPHENOXYLATE HCL W/ATROPINE <br />51079006720 <br />5 <br />05/99 <br />8.19 <br />01 <br />325.26 <br />Total Items: 27 <br />REASON CODE KEY: <br />20 VENDOR DOES NOT ACCEPT PRESCRIPTIONS <br />11 NOT ELIGIBLE FOR CREDIT <br />06 WHSLR RTN. NO CHARGE <br />01 OUTDATED PAST VENDOR POLICY <br />02 VENDOR ACCEPTS FULL PACKAGES ONLY <br />14 PREPACKS NOT ELIGIBLE FOR RETURN <br />