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BRISTOL/SQUIBB/ NOVO <br />G TAB MS 1 0.1671 30.001 2 MG 591480006131 R 1 191.64 <br />Totals: I I I I I 1 591.64 <br />r- <br />-1 <br />MG TAB 90'S 0.2781 90.001 10 MG 1 62856246901 R 5294.56.5d6 <br />,Cwr 1Totals: i t294.56 <br />jurl <br />th-, <br />PROCRTT .000 UNITS/ML SDV IML 0.1671 6.001 101000 59676310001 R I 5106.23 <br />,3 <br />Totals: 11 !t106.23 <br />LILLY <br />DNettleClass PI'IOE, <br />Q — - 11 "DMft <br />SYMBYAX 3MG/25MG CAP 30'S 0.3331 30.001 3MG125MG 23230301 R 598.00 <br />Totals: 11 1 1 591L00 <br />NOVO-NORDISK <br />NOVOLIN N 1000NIML VL 10ML <br />NOVOLIN N 1000NIML VL 10ML <br />Cycle Number. 45778-75 <br />Account Number. 157483 <br />1.00 <br />1.01 0 <br />X <br />Printed Date: 8/29/2013 <br />aler., AMERISOURCEBERGEN <br />Wholesaler. <br />Name: KPNC-STOCKTON HP MAIN MOB 168 <br />4 <br />Whole8073031 <br />10 <br />0.800 100.001 25 MG 1 591078301 <br />GUARARTEEOREOiTURNS <br />111.. <br />5219.80 <br />Service Date: 8/1/2013 <br />Returnable Report <br />Total Estimated of Returnable Products <br />BRISTOL/SQUIBB/ NOVO <br />G TAB MS 1 0.1671 30.001 2 MG 591480006131 R 1 191.64 <br />Totals: I I I I I 1 591.64 <br />r- <br />-1 <br />MG TAB 90'S 0.2781 90.001 10 MG 1 62856246901 R 5294.56.5d6 <br />,Cwr 1Totals: i t294.56 <br />jurl <br />th-, <br />PROCRTT .000 UNITS/ML SDV IML 0.1671 6.001 101000 59676310001 R I 5106.23 <br />,3 <br />Totals: 11 !t106.23 <br />LILLY <br />DNettleClass PI'IOE, <br />Q — - 11 "DMft <br />SYMBYAX 3MG/25MG CAP 30'S 0.3331 30.001 3MG125MG 23230301 R 598.00 <br />Totals: 11 1 1 591L00 <br />NOVO-NORDISK <br />SANDOZ SERVICES INC. <br />.u. Drug Iartie <br />AMOXICILLIN 400 MG 5ML SUS 100 ML <br />SERONO, <br />1.0w 1.001 400MG/5 7816157461 R 1 11.55 <br />Totals: I I I I 51.55 <br />ante <br />OVIDREL 250MG/0.5ML FOR IN] 1.0001 1.001 25010.5M 44087115011 R 1100.72 <br />Totals: I i I I I 5100.72 <br />WATSON PHARMA. INC. <br />NOVOLIN N 1000NIML VL 10ML <br />NOVOLIN N 1000NIML VL 10ML <br />8.000 <br />2.000 <br />1.00 <br />1.01 0 <br />1000/ML <br />00 / L <br />UM <br />1000/ML <br />169183411 <br />16910411 <br />R <br />R <br />5175.84 <br />$43.96 <br />Totals. <br />10 <br />0.800 100.001 25 MG 1 591078301 <br />1 <br />111.. <br />5219.80 <br />SANDOZ SERVICES INC. <br />.u. Drug Iartie <br />AMOXICILLIN 400 MG 5ML SUS 100 ML <br />SERONO, <br />1.0w 1.001 400MG/5 7816157461 R 1 11.55 <br />Totals: I I I I 51.55 <br />ante <br />OVIDREL 250MG/0.5ML FOR IN] 1.0001 1.001 25010.5M 44087115011 R 1100.72 <br />Totals: I i I I I 5100.72 <br />WATSON PHARMA. INC. <br />DIETHYLPROPION 25 MG TAB 100'S <br />0.800 100.001 25 MG 1 591078301 <br />4 <br />111.. <br />Totals: 1 <br />911." <br />Total Estimated of Returnable Products <br />$96976 <br />Credits to be Issued Direct from Vendors <br />$0.00 <br />Service Fee <br />$57.22 <br />Estimated Credit Issued by Wholesaler <br />$912.54 <br />Total Items: <br />18 <br />NY Division: 100 Colin Drive Holbrook, NY 11741, Phone: 1-800-473-2138 <br />Page 2 of 4 <br />