2 ROUTE/STOP 715 / 045

Card i na I HealthUNIVERSITY OF CALIFORNIACOWELL STUDENT HLTI-{ SRVS PHCY930 ORCHARD RDDAVIS, CA 95616

ITEM NUMBER

2

CARDINAL HEALTH3238 DWIGHT RD.ELK GROVE, CA 95758

DEA RW-0236009 FED ID 31-1470544SH UNIVERSITY OF CALIFORNIA

COWELL STUDENT HLTH SRVS PHCY930 ORCHARD RD

T DAVIS, CA 956160

DESCRIPTION

10 TOTAL PIECES SHIPPED

PAGE 1 OF

.lIIW[.IYi[ ORIGINAL INVOICE COPY 115488 I 2/12/15 1 1948326

P E 3622AU4999100 12687965 3SHCSGO287

I 2/11/15 I 00175

fln IRETAIL I UNIT

(800) 678-7889

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3533239 66685-1001-01TOTE# 3

3947660 00173-0719-20TOTE# 3

4765475 67877-0295-05TOTE# 3

3437100

4965422

2 EA AMOX/POT CLAV 875-125MG 100 100TB

3 3 EA FLOVENT HFA 11OMCG 12GM DCTR 1IN

1 1 EA IBUPROFEN 600MG 500 CPLT 500TB

see message00378-1803-01 2TOTE# 3

53746-0515-01 2TOTE# 3

(s) : 1212 EA LEVOTHYROXINE 5OMCG 100

2 EA SPIRONOLACTONE 100MG 100

EXTENSION

7 7 14 CT

10 PIECES SHIPPED

S U M M A R YTotal RX

NET AMOUNT

INVOICE SHIP DATE: 2/12/2015

For SDS Visit: http://www.mycardinalsdspd.com

PLEASE REMIT YOUR PAYMENTS TO FOLLOWING ADDRESS:CARDINAL HEALTH 411, INCC/C BANK OF AMERICAP0 BOX 742946LOS ANGELES, CA 90074-2946

essages

100TB

100TB

777.90

777 . 90

FEB 12 [(

, I,IIIIII!IIf IIIIIIIIIII II715 / 045

38.57

178.71 53613CT

26.63 2663CT

28.44 5688CT

40 56 8112CT

SUBTOT 77790

LAST INVOICE COPY

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Customer 5 a o.,.,,.. r purcrrasing to, wn use and will not redistribute prescription phermaceutcalsinto the secondary market. The prices shown on this invoice are net of discounts provided at the time of purchase. Some of the productslisted on this invoice may be subject to additional discounts or rebates. Please refer to your contract for any specificadditional discounts or rebates that may apply to these purchases. You may have art obligation pursuant to42 USC §1 320a-7b to report discounts and rebates to Medicare, Medicaid or other governmental health care programs.

Effective January 1, 2015, DSCSA Transaction Data for qualified prescription drugs can be accessed viayour usual orderinci olatform. such as Order Exoress or Med eCommercte. or at rtardinalhealth rrnmItrw

2 ROUTE/STOP 715 / 045

‘CardinalHealthUNIVERSITY OF CALIFORNIA

COWELL STUDENT HLTH SRVS P1-ICY930 ORCHARD RD

DAVIS, CA 95616

ITEM NUMBERNDC/UPC I I

121 This product is

edication guide

29 .htm

CARDINAL HEALTH3238 DWIGHT RD.ELK GROVE, CA 95758

DEA RW-0236009 FED ID 31-1470544

UNIVERSITY OF CALIFORNIACOWELL STUDENT HLTH SRVS PHCY930 ORCHARD RDDAVIS, CA 95616

IS n Ca esignationIE On

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PAGE 2 OF

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2/25/15DUE DATE

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I1I[iJai ORIGINAL INVOICE COPY 115488 I 2/12/15 1948326•;1*I[.I.iI1II]iE 3622AU4999l00 2687965 3SHCSGO287‘]ml.];l.]i;I’

I 2/11/1J 00175

FDESCRIPTION SIZE

__________________________ ___________

M II ‘RETAIL I UNITPRICE I PRICE

required by the FDA to be dispensed with a medication guide. To obtain a mfor this product, please visit http://www.fda.gov/Drugs/DrugSafety/ucm0857

77790

The prices shown on this invoice are net ot cltscounts provided at the time of purchase. Some of the productslisted on this invoice may be subject to addtional discounts or rebates. Please refer to your contract for any specificadditional discounts or rebates that may apply to these purchases. You may have an obligation pursuant to42 USC §1 320a-7b to report discounts and rebatot; to Medicare, Medicaid or other governmental health care programs.

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Effective January 1, 2015, DSCSA Transaction Data for qualified prescription drugs can be accessed viayour usual orderinci platform. such as Order Exoress or Med eCommerce nr sit rsirrlinsilhpsilfh rtmItre

‘CardinalHealthBI UNIVERSITY OF CALIFORNIAL COWELL STUDENT HLTH SRVS PHCYL 930 ORCHARD RDT DAVIS, CA 95616

NDC/UPC

CARDINAL HEALTH3238 DWIGHT RD.ELK GROVE, CA 95758

DEA RW-0236009 FED ID 31-1470544SH UNIVERSITY OF CALIFORNIACOWELL STUDENT HLTH SRVS PHCY930 ORCHARD RD

T DAVIS, CA 956160

DESCRIPTION

3163219 00173-0696-00TOTE# 1

see message(s) 1214134219 10370-0101-03 12 12 EA BUPROPION XL 150MG 30

TOTE# 2see message(s):. 121

2837235 00025-1525-31 1. 1 A CELEBREX 200MG 100TOTE# 1

see message(s) : 1213441839 51672-1303-02 1 1 EA ECONAZOLE NITRATE 1% 30GM

(800) 678-7889

ITEM NUMBER

PAGE 1 OF 3 ROUTE/STOP 715 / 045

P

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DVIIii’[e ORIGINAL INVOICE COPY 115488 2 12 15 1947371•:lcI[. ‘

IE 3622AU4999100I2686956 3S1-{CSGU287‘1 :1 P1

I 2/11/15 I 09593

3 EA ADVAIR DISKUS 250-5OMCG 60

RETAIL I UNITPRICE I PRICE

1IN 276.18 82854CT

3OTB 21.56 25872CT

TOTE# 13620416 58406-0435-04 1

TOTE# 4see message

3947660 00173-0719-20 3TOTE# 1

3947686 00173-0720-20 4TOTE# 1

1757152 00555-0071-02 2TOTE# 1

4985032 00603-1880-16 1TOTE# 1

2902351 63481-0687-06 1TOTE# 2

3592102 62037-0571-01 2TOTE# 1

5041884 51293-0802-01 1TOTE# 1

1148246 21200-0035-52 6TOTE# 5

4169272 68382-0138-14 6TOTE# 2

100CP 719.12

1CR 132.29

1 CT ENBREL 5OMG/ML 4X0.98ML PF 4SY j 2728.82

(s): 1213 EA FLOVENT HFA 11OMCG 12GM DCTR 1IN 178.71

4 EA FLOVENT HFA 22OMCG 12GM DCTR uN 277.59

2 EA ISONIAZID 300MG 100 100TB 11.97+

1 EA LIDOCAINE 5% 30 3OAP 207.02

1 CT LIDODERM 5% 30 3OAP 243.47

2 EA METFORMIN ER 500MG 100 100TB 7.98

1 EA PHENAZOPYRIDINE HCL 200MG 100 100TB 236.14

6 EASCOTCH RX LABEL 1.5N BULK #800 1TP 8.56 7.85

6 EA TOPIRAMATE 25MG 60 6OTB 1.54

__________________________________________________

I

__________________ ______________

715 / 045 --

The paces shown on this invoice are nc-tot discc•uats provided at the time of Some of the productsstod on this invoice may be subject to ad. noeai .1:,counts or rebates. Plea ‘ refer to your contract for any specificadditcnal discounts or rebates that may apply to thcs purchases. You may an obligaton pursuant to42 USC §1320a-7b to report discounsanoroeatos to Medicare. Medicaid orcder aovc•mmontal health care programs.Effective January 1, 2015, DSCSA Transaction Data for qualified prescription drugs can be accessed viayour usual orderina Dlatform. such as Order ExDress or Med eCommerce. or at cardinaIheIth.tnmItrare

71912

1322 9CT

272882

53 613 CT

11103 6 CT

23 94 CT

2 0 7 02 CT

24347

15 96 CT

23 6 14 CT

4710SN’I

924 CT

No’e Codes:1 TaxableC Generic SuiSF

see message(s) : 121

CT Cc:a• Omit Codes:SN Specia Nd Dropahip Not smoked / Druçj Recat -

O’ Piicr 2 DC Out 5 Mfr Disc 8 New tern/stock unavail. S.C Sovrce Contret 3 MIt Out 6 DC Disc 9 Restricted turn

Customer se fina dispenser purcitasing (or own use and mu not edistribute prascription pflemracautcaissecondatymartiet.

3 ROUTE/STOP 715 / 045

LL

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CardinalHealthUNIVERSITY OF CALIFORNIACOWELL STUDENT HLTH SRVS PHCY930 ORCHARD RDDAVIS, CA 95616

57iPC:q

2

CARDINAL HEALTH3238 DWIGHT RD.ELK GROVE, CA 95758

DEA RW-0236009 FED ID 31-1470544SH UNIVERSITY OF CALIFORNIAI COWELL STUDENT HLTH SRVS P1-ICY930 ORCHARD RD

T DAVIS, CA 956160

53 PIECES SHIPPED

53 TOTAL PIECES SHIPPEDTOTAL OF TAXES

TotalTotalTotalSales

RXOtherRetailTax

PAGE 2 OFDV

IeiI1[.IJi ORIGINAL INVOICE COPY 115488 I 2/12/15 1947371

E 3622AU4999100 2686956 3SHCSGO287.]11.];l.];1’YlI

I 2/11/15 09593

I RETAIL UNIT. PRICE PRICE

90T8 70.26

7340.8647.1051.364.00

7391 . 96

For SDS Visit: http://www.mycardinalsdspd.com

(800) 678-7889

ITEM NUMBER

P

4305223 00378-4276-77TOTE# 2

4524823 60505-3779-03TOTE# 2

3739232

DESCRIPTION

see message(s) : 12100173-0682-20 3 3 EAVENTOLIN HFA 9OMCG 18GM W/DCTRTOTE# 2

2 EA VALACYCLOVIR HCL 1GM 90

4 4 EA VENLAFAXINE ER 75MG 3OUU 3OCP

uN

EXTENSION

14 0 52 CT

S U M M A R Y

INVOICE SHIP DATE: 2/12/2015

NET ANOUNT

6.20 2480CT

41.93 12579CT

SUBTOT 738796

400

LAST INVOICE COPY

PLEASE REMIT YOUR PAYMENTS TO FOLLOWING ADDRESS:CARDINAL HEALTH 411, INCC/C BANK OF A1’IERICAP0 BOX 742946LOS ANGELES, CA 90074-2946

essages

mu Co&.s CT C,Ir.trIOl OinitCodes:1 aw be SN St sc Ni C Dropsbip 4 Not stocked / Dm9 RecallC C ant ic Sub O’ Prii Sri m 2 DC Out 5 Mfr DiSC 8 NCW tern/stock unavail.SF & rid CS F icc Cnn tot Thu 6 DC Disc 9 Restricted item

Customer .s a at dispafisce purchasing for own use ano wit not reeistribute prescription phamiaceuticaisntc the secondaty market.

fluEuhu lure

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I II II715 / 045

The prices shown on this invoice are net of discounts provided at the time of purchase. Some of the pioductslisted on this invoice may be subject to riscounts or rebates. Please refer to your contract for any specificadditional discounts or robates that to trese purchases. You may have an obligation pursuant to42 usc §1 320a-7b to report disco . to Medicare. Medicaid or other governmental health care programs.Effective January 1, 2015, DSCSA Transaction Data for qualified prescription drugs can be accessed viayour usual orderina olatform. such as Order Exoress or Med eCnmmerrp nr mr,1ineIheIfh rnIfr,’

(800) 678-7889 PAGE 3 OF 3 ROUTE/STOP 715 / 045

CardinalHealthUNIVERSITY OF CALIFORNIACOWELL STU]DENT HIJTI-I SRVS PHCY930 ORCHARD RDDAVIS, CA 95616

ITEM NUMBER NDC/UPC I I121 This product is

edication guide29. htm

CARDINAL HEALTH3238 DWIGHT RD.ELK GROVE, CA 95758

DEA RW-0236009 FED ID 31-1470544

UNIVERSITY OF CALIFORNIACOWELL STUDENT HLTH SRVS PHCY930 ORCHARD RDDAVIS, CA 95616

DESCRIPTION I

LL

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_______ _________

ORIGINAL INVOICE COPY 115488 2/1215 I 1947371•1*I[ill [‘IIIE 3622AU4999100I2686956 3SHCSGO287

2/11/15 I 09593

I RETAIL I UNITPRICE I PRICE •II1ii[.]•

required by the FDA to be dispensed with a medication guide. To obtain a mfor this product, please visit http://www.fda.gov/Drugs/DrugSafety/ucm0857

2/25/15 739196DUE DATE

The prices shown on this invoice are net of discounts provided at the time of purchase. Some of the productslisted on this invoice may be subject to additional discounts or rebates. Please refer to your contract for any specificadditional discounts or rebates that may apply to these purchases. You may have an obligatton pursuant to42 usc §1320a-7b to report discounts and rebates to Medicare. Medicaid or other governmental health care programs.

Customer is a tinai spenser pU(CCaing for ov use an wf I not reOistribute prescription pharniaceuiaIs,nto the secondary market.

S ; ,,.unit $Sic atc

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Effective January 1, 2015, DSCSA Transaction Data for qualified prescription drugs can be accessed viayour usual orderina platform, such as Order Exoress or Med eCommerce. or at cardinlhpslth rrnmItrsr’u

Ext Costs are respected Costs multiplied by Qty Received.

STUDENT HEALTH SERVICESPHARMACY530-752-2338

QtyGEN3 AWP ACQ Received Ext. AWP Ext. Acq000 340.48 276.42 3 PKG(s) 1.02144 829.26000 921.55 719.12 1 PKG(s) 92155 719.120.00 3093 16.47 1 PKG(s) 30 93 16.470.00 221.68 178.86 6 PKG(s) 1330.08 1.073 160.00 359.32 277.59 4 PKG(s) 143728 1110.360.00 25.63 11.98 2 PKG(s) 51 26 23 960 00 280 81 207.02 1 PKG(s) 280 81 207.020.00 79.50 7.98 2 PKG(s) 159.00 15 96000 399.99 236 34 1 PKG(s) 399.99 236.340.00 47.76 21.57 12 PKG(s) 573.12 258.84000 153.29 1.54 6 PKG(s) 919.74 9.240.00 1,137.78 70.32 2 PKG(s) 2,275.56 140.64000 148.08 6 20 4 PKG(s) 592 32 24 80000 5428 41.93 3 PKG(s) 162.84 125790.00 490 00 38.60 2 PKG(s) 980.00 77 200 00 257 65 26.66 1 PKG(s) 257 65 26 660.00 49 60 28.46 2 PKG(s) 99.20 56 920.00 14245 40.60 2 PKG(s) 284 90 81.200.00 3,294.98 2,731.15 1 PKG(s) 3,294.98 2,731.15

Totals: $15,072.65 $7,764.09

Historical Drug ShipmentShowing All Records

Ref: 3SHCSGO287 Description:Purchase Qty

Drug NDC Qty On Hand GENI GEN2ADVAIR 250150 60S DISK 00173069600 1 EA 4 EA 0.00 0.00CeIeBREX 200MG CAP 00025152531 100 EA 42 EA 0.00 0.00ECONAZOLE NITRATE 1% 30GM CREA 51672130302 1 EA -55 EA 0.00 0.00FLOVENT HFA DC IIOMCG AERO 00173071920 1 EA -35 EA 0.00 0.00FLOVENT HFA DC 220 MCG AERO 00173072020 1 EA 11 EA 0.00 0.00ISONIAZID BARR LABS 300MG TAB 00555007102 100 EA 3697 EA 0.00 000LIDOCAINE 5% PATC 00603188016 1 EA 0 EA 0.00 0 00metFORMIN ER 500MG TABL 62037057101 100 EA -34 EA 0.00 000PHENAZOPYRIDINE 200MG TAB 51293080201 100 EA 197 EA 0.00 000buPROPion XL 150MG TABL 10370010103 30 EA 61 EA 0 00 0.00TOPIRAMATE 25MG TABL 68382013814 60 EA 26 EA 0.00 0.00valACYclovir 1GM TABL 00378427677 90 EA 115 EA 0.00 000VENLAFAXINE 75MG ER CAP 60505377903 30 EA 300 EA 0 00 0 00VENTOLIN HFA 18 GM INH 00173068220 1 EA 5 EA 0.00 0 00AMOXICILLINICLAV 87511 25MG TABL 66685100101 100 EA -296 EA 0.00 0.00IBUPROFEN 600MG TAB 67877029505 500 EA 637 EA 0.00 0.00LEVOTHYROXIN 5OMCG TAB 00378180301 100 EA 363 EA 0 00 0.00SPIRONOLACT 100MG TAB 53746051501 100 EA 600 EA 0.00 0.00ENBREL REG 5OMG/ML INJE 58406043504 1 EA 5 EA 0.00 0.00

19 Shipments Listed

ProPharm 8.5.2.136 02/12/2015 1151 am Page 1 of 1