docPharmacy Brand Products Order Form - E
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Pharmacy Brand Products Order Form - E
Pharmacy Brand Products Order Form DrugName ABILIFY 2 MG TAB/ 30 ABILIFY 10 MG TAB / 30 ABILIFY 15 MG TAB / 30 ABILIFY 20 MG TAB / 30 ABILIFY 30 MG TAB / 30 ABILIFY 5MG TAB / 30 ACIPHEX 20MG TAB /30 ACIPHEX 20MG TAB /90 ACTONEL 150 MG TAB/ 1 ACTONEL 35MG TAB/ 4 ACTOPLUS MET 15-500MG / 60 ACTOPLUS MET 15-850MG / 60 ACTOS 15MG TAB /30 ACTOS 15MG TAB /90 ACTOS 30MG TAB /30 ACTOS 30MG TAB /90 ACTOS 45MG TAB /30 ACTOS 45MG TAB /90 ACULAR OPT SOL 10ML ACULAR OPT SOL 5 ML ACULAR LS SOL 5 ML ADVAIR DISKUS 100-50 / 60 ADVAIR DISKUS 250-50 / 60 ADVAIR DISKUS 500-50 / 60 ADVAIR HFA 115 DOS / CNT ADVAIR HFA 230 DOS / CNT ADVAIR HFA 45 DOS / CNT AGGRENOX 200-25MG CAPS/60 ALPHAGAN-P OP SOL 0.15% 10 ML ALPHAGAN-P 0.1% DROPS 10ML ALPHAGAN-P 0.1% DROPS 15ML ALPHAGAN-P 0.1% DROPS 5ML ALPHAGAN-P OP SOL 0.15% 15 ML ALPHAGAN-P OP SOL 0.15% 5 ML ALREX 0.2% EYE DROPS 10ML ALREX 0.2% EYE DROPS 5 ML AMBIEN CR 12.5 MG / 100 AMBIEN CR 6.25 MG / 100 AMBIEN CR PAK 12.5 MG / 30 AMBIEN CR PAK 6.25 MG / 30 NDC 59148000613 59148000813 59148000913 59148001013 59148001113 59148000713 62856024330 62856024390 00149047801 00149047201 64764015560 64764015860 64764015104 064764015105 64764030114 64764030115 64764045124 64764045125 00023218110 00023218105 00023927705 00173069500 00173069600 00173069700 00173071620 00173071720 00173071520 00597000160 00023917710 00023932110 00023932115 00023932105 00023917715 00023917705 24208035310 24208035305 00024552131 00024550131 00024552110 00024550110 Order Qty AMBIEN TAB 10 MG / 100 AMBIEN TAB 5 MG / 100 AMITIZA GEL CAP 24 MCG / 60 AMITIZA GEL CAP 8 MCG / 60 ANTARA 130 MG / CAP 30 ARICEPT 10MG TAB /30 ARICEPT 10MG TAB /90 ARICEPT 5MG TAB /30 ARICEPT 5MG TAB /90 ARIMIDEX 1MG TAB / 30 ARTHROTEC 75MG-200 TAB / 60 ARTHROTEC 50MG-200 TAB/ 60 ASACOL 400MG TAB / 180 ASMANEX 0.24 GM /30 INH ASMANEX 0.24 GM /60 INH ASMANEX TWISTHALR 110 CMG ASTELIN RDY SPR 30 ML ATROVENT HFA 200 AVALIDE 150-12,5 TAB / 30 AVALIDE 150-12,5 TAB / 90 AVALIDE 300 - 25 MG / 30 AVALIDE 300-12.5 MG / 30 AVALIDE 300-12.5 MG / 90 AVANDIA 8MG TAB / 90 AVANDIA 8MG TAB /30 AVANDIA 2MG TAB /60 AVANDIA 4MG TAB /30 AVANDIA 4MG TAB /90 AVAPRO 150MG TAB / 30 AVAPRO 300 MG TAB /30 AVAPRO 300 MG TAB /90 AVAPRO 75 MG TAB / 30 AVAPRO 75 MG TAB / 90 AVELOX TAB 400MG / 30 AVODART 0.5 MG CAP / 30 AVODART 0.5 MG CAP / 90 AZOPT OPT SOL 1% 10ML AZOPT OPT SOL 1% 15ML AZOR 5-20 MG TAB / 30 AZOR 5-40 MG TAB / 30 AZOR 10-40 MG TAB / 30 BARACLUDE 1 MG TAB / 30 BENICAR 20/12.5 TAB / 30 BENICAR 20 MG TAB / 30 BENICAR 40 MG TAB / 30 BENICAR 40 MG TAB / 90 BENICAR 40/12.5 TAB / 30 BENICAR 40/12.5 TAB / 90 BENICAR 40/25 MG TAB / 30 BENICAR 5 MG TAB / 30 BETOPTIC S .25% 10 ML BETOPTIC S .25% 15 ML BONIVA 150MG TAB / 3 BYSTOLIC 5 MG / 30 00024542131 00024540131 64764024060 64764008060 27437011006 62856024630 62856024690 62856024530 62856024590 00310020130 00025142160 00025141160 00149075215 00085134103 00085134102 00085146102 00037024130 00597008717 00087277531 00087277532 00087278831 00087277631 00087277632 00029316059 00029316013 00029315818 00029315913 00029315900 00087277231 00087277331 00087277332 00087277131 00087277132 00085173301 00173071215 00173071204 00065027510 00065027515 65597011030 65507011230 65597011330 00003161212 65597010530 65597010330 65597010430 65597010490 65597010630 65597010690 65597010730 65597010130 00065024610 00065024615 00004018682 00456140530 BYSTOLIC 10 MG / 30 BYSTOLIC 2.5 MG TAB / 30 CASODEX 50 MG TAB / 30 CATAPRES TTS - 1 1 X 4 CATAPRES TTS - 2 1 X 4 CATAPRES TTS - 3 1 X 4 CELEBREX 100MG CAP /100 CELEBREX 200MG CAP /100 CELLCEPT 250 MG CAPS / 100 CELLCEPT 500 MG TAB / 100 CLARINEX 5 MG TAB PAC / 30 CLARINEX 5MG TAB / 100 COMBIVENT** 90-18MCG/INH AER /14.7 COREG CR CAPS 10MG /30 COREG CR CAPS 20MG /30 COREG CR CAPS 40MG /30 COREG CR CAPS 80MG /30 COREG** 12.5MG TAB /100 COREG** 25MG TAB /100 COREG** 3.125MG TAB /100 COREG** 6.25MG TAB /100 COSOPT 10ML COZAAR 25MG TAB / 90 COZAAR 50MG TAB /30 COZAAR 50MG TAB /90 COZAAR** 100MG TAB /30 COZAAR** 100MG TAB /90 CREON 12000 / 100 CREON 24000 / 100 CRESTOR 10MG TAB / 90 CRESTOR 20MG TAB / 90 CRESTOR 40MG TAB / 30 CRESTOR 5MG TAB / 90 CYMBALTA 20MG/60 CYMBALTA 30 MG/30 CYMBALTA 60 MG/30 DETROL LA 2MG CAP /30 DETROL LA 2MG CAP /90 DETROL LA 4MG CAP /90 DETROL LA 4MG CAP /30 DEXILANT 30 MG CAPS / 30 DEXILANT 60 MG CAPS / 30 DIOVAN 160 MG TAB /90 DIOVAN 320 MG TAB /90 DIOVAN 40 MG TAB /30 DIOVAN 80 MG TAB /90 DIOVAN HCT 160-12,5MG TAB /90 DIOVAN HCT 160-25MG TAB /90 DIOVAN HCT 320-12,5MG TAB / 90 DIOVAN HCT 320-25MG TAB / 90 DIOVAN HCT 80-12,5MG TAB /90 DYNACIRC CR 10MG / 30 DYNACIRC CR 5MG / 30 00456141030 00456140230 00310070530 00597003134 00597003234 00597003334 00025152031 00025152531 00004025901 00004026001 00085126404 00085126401 00597001314 00007337013 00007337113 00007337213 00007337313 00007414120 00007414220 00007413920 00007414020 00006362836 00006095154 00006095231 00006095254 00006096031 00006096054 00032121201 00032122401 00310075190 00310075290 00310075430 00310075590 00002323560 00002324030 00002327030 00009519001 00009519002 00009519102 00009519101 64764017130 64764017130 00078035934 00078036034 00078042315 00078035834 00078031534 00078038334 00078047134 00078047234 00078031434 00173078501 00173078401 EFFEXOR XR 150 MG /30 EFFEXOR XR 150 MG /90 EFFEXOR XR 37.5MG /90 EFFEXOR XR 37.5MG /30 EFFEXOR XR 75MG /30 EFFEXOR XR 75MG /90 ELESTAT 0.05 % 5 ML ENABLEX 15 MG TAB /30 ENABLEX 7.5 MG TAB / 30 EVISTA 60 TAB / 30 EVISTA 60MG TAB /100 EXELON PATCH 4.6 MG / 30 EXELON PATCH 9.5 MG / 30 EXELON 1.5 MG / 60 EXELON 3MG CAP /60 EXELON 4.5 MG CAP / 60 EXELON 6MG CAP /60 FEMARA 2.5 MG / 30 FLECTOR PATCH 1.3% / 30 FLOMAX** 0.4MG CAP /100 FLOVENT HFA 110 DOS/CNT FLOVENT HFA 44 DOS/CNT GEODON 20 MG CAP / 60 GEODON 40 MG CAP / 60 GEODON 60 MG CAP / 60 GEODON 80 MG CAP / 60 GLEEVEC 100 MG TAB / 90 GLEEVEC 400 MG TAB / 30 GRIS PEG 250 MG TAB / 100 HYZAAR 100-12.5 MG TAB / 30 HYZAAR 100-12.5 MG TAB / 90 HYZAAR 100-25MG TAB /30 HYZAAR 100-25MG TAB /90 HYZAAR 50-12.5 MG TAB / 90 HYZAAR 50-12.5MG TAB /30 INSPRA 25 MG TAB / 30 INVEGA 3 MG TAB / 30 INVEGA 6 MG TAB / 30 INVEGA 9 MG TAB / 30 INVIRASE CAPS 200 MG / 270 INVIRASE CAPS 500 MG / 120 JANUMET 50-1000 MG TAB / 60 JANUMET 50-500 MG TAB / 60 JANUVIA 100MG TAB / 30 JANUVIA 100MG TAB / 90 JANUVIA 25 MG TAB / 30 JANUVIA 50MG TAB / 30 KEPPRA 500 MG TAB / 120 LEVAQUIN 500MG TAB/50 LEVAQUIN 750MG TAB/50 LEXAPRO** 10MG TAB /100 LEXAPRO** 20MG TAB /100 LEXAPRO** 5MG TAB /100 LIDODERM PATCH 5% / 30 00008083621 00008083622 00008083722 00008083721 00008083321 00008083322 00023920105 00078042015 00078041915 00002416530 00002416502 00078050115 00078050215 00078032344 00078032444 00078032544 00078032644 00078024915 63857011133 00597005801 00173071920 00173071820 00049396060 00049397060 00049398060 00049399060 00078040134 00078043815 00884077304 00006074531 00006074554 00006074731 00006074754 00006071754 00006071731 00025171001 50458055001 50458055101 50458055201 00004024515 00004024451 00006057761 00006057561 00006027731 00006027754 00006022131 00006011231 50474059540 00045152550 50458093020 00456201001 00456202001 00456200501 63481068706 LIPITOR 10MG TAB /90 LIPITOR 20 MG TAB / 90 LIPITOR 40 MG TAB / 90 LIPITOR 80 MG TAB / 90 LOTEMAX SUSP 10 ML LOTEMAX SUSP 15ML LOTEMAX SUSP 5ML LOTREL 5-10 MG / 100 LOVAZA 1GM GELCAP / 120 LOVAZA 1GM GELCAP / 60 LOVENOX 80 MG / 08 ML LUMIGAN 0.03% 2.5 ML LUMIGAN 0.03% 5.0 ML LUMIGAN 0.03% 7.5 ML LUNESTA 1 MG / 30 LUNESTA 2 MG / 100 LUNESTA 3 MG / 100 LUVOX CR 150 MG CAPS / 30 LYRICA CAPS 25 / 90 LYRICA CAPS 50 / 90 LYRICA CAPS 75 / 90 MAXALT 10 MG TAB / 18 MAXALT MLT 10 MG TAB / 18 MICARDIS 40MG TAB / 30 MICARDIS 80MG TAB / 30 MICARDIS HCT 40-12.5 MG / 30 MICARDIS HCT 80- 25 MG / 30 MICARDIS HCT 80-12.5 MG / 30 MIRAPEX 0.25 MG TAB / 90 MIRAPEX 1.5MG TAB / 90 MIRAPEX 0.125 MG / 90 MIRAPEX 0.5 MG TAB / 90 NAFTIN GEL 40 G ???? NAFTIN GEL 60G ?? NAMENDA** 10MG TAB /60 NAMENDA** 5MG TAB /60 NASACORT AQ SPRAY NASONEX SPR SC-FR 50MCG NEVANAC 3 ML NEXIUM 20MG CAP /30 NEXIUM 20MG CAP /90 NEXIUM 40MG CAP /30 NEXIUM 40MG CAP /90 NIASPAN 500MG TAB / 90 NIASPAN 750MG TAB / 90 NITROLINGUAL SPRAY 12G NITROLINGUAL SPRAY 4.9 G ONGLYZA TAB 2.5 MG / 30 ONGLYZA TAB 5 MG / 30 OPTIVAR SOL 6ML OXYTROL 3.9MG PAT /8 PATADAY OP SOL 2.5 ML PATANOL OP SOL 5ML PENTASA 500 MG CAP / 120 00071015523 00071015623 00071015723 00071015823 24208029910 24208029915 24208029905 00078040505 00173078302 00173078301 0075062280 00023918703 00023918705 00023918707 63402019030 63402019110 63402019310 68727060101 00071101268 00071101368 00071101468 00006026718 00006380118 00597004037 00597004137 00597004337 00597004237 00597004437 00597018490 00597019190 0597018390 00597018590 00259477040 00259477060 00456321060 00456320560 00075150616 00085128801 00065000203 00186502031 00186502054 00186504031 00186504054 00074307490 00074307990 59630030020 59630030065 00003421511 00003421511 00037702560 52544092008 00065027225 00065027105 54092019112 PLAVIX 75MG TAB /30 PLAVIX 75MG TAB /90 PRANDIN 0.5 MG TAB / 100 PREMARIN 0.625 MG TAB/ 100 PREMARIN VAG** 0.625MG/GM CRM PROTONIX 40 MG TAB / 90 PROVENTIL HFA 6.7 GM PROVIGIL 200 MG / 100 PULMICORT INH 200 MCG PULMICORT RESPUL .25 QVAR INH 8.7 / 120 ACTUA 40 MCG RANEXA 1000MG / 60 RANEXA 500MG / 60 RELPAX 40 MG / 6 RENAGEL 800 MG TAB / 180 RENVELA 800 MG TAB / 270 RESTASIS OPT EMUL / 30 REVATIO 20 MG TAB / 90 RHINOCORT AQUA 32 MCG 120 DS ROZEREM 8 MG TAB / 30 SANCTURA 20 MG TAB / 60 SANCTURA XR 60 MG / 30 SENSIPAR 30 MG TAB / 30 SENSIPAR 60 MG TAB / 30 SENSIPAR 90 MG TAB / 30 SEREVENT DISKUS 60 MCG SEROQUEL 200MG TAB /100 SEROQUEL 300MG TAB /60 SEROQUEL 400MG TAB /100 SEROQUEL 100MG TAB /100 SEROQUEL 25MG TAB /100 SEROQUEL 50MG TAB /100 SEROQUEL XR 150 MG / 60 SEROQUEL XR 200 / 60 SEROQUEL XR 300 / 60 SEROQUEL XR 400 / 60 SEROQUEL XR 50 MG / 60 SINGULAIR 10MG TAB /30 SINGULAIR 10MG TAB /90 SINGULAIR 4 MG / 30 SINGULAIR 5MG TAB CHEW /30 SKELAXIN 800MG TAB /100 SOLARAZE GEL SONATA 10 MG / 100 SONATA 50 MG / 100 SPIRIVA HANDINHALER /30 STARLIX 120MG TAB /100 SYMBICORT 160 / 4.5 SYMBICORT 80 / 4.5 TACLONEX 60 G TEKTURNA 300 MG TAB / 30 TEKTURNA 150 MG TAB / 30 TEKTURNA TAB 150-12.5 MG/30 TEKTURNA TAB 300-12.5MG/30 63653117106 63653117101 00169008181 00046110281 00046087293 00008084181 00085113201 63459020101 00186091542 00186198804 59310020240 61958100201 61958100101 00049234045 58468002101 58468013001 00023916330 00069419068 00186107008 64764080530 00023351360 00023935030 55513007330 55513007430 55513007530 00173052100 00310027210 00310027460 00310027910 00310027110 00310027510 00310027810 00310028160 00310028260 00310028360 00310028460 00310028060 00006011731 00006011754 00006071131 00006027531 60793013601 10337080301 60793014601 60793014501 00597007541 00078035205 00186037020 00186037220 50222022704 00078048615 00078048515 00078052115 00078052315 TEKTURNA TAB 300-25 MG/30 TOBRADEX SUSP 5 ML TOBRADEX SUSP 10 ML TOBRADEX OP OI 3.5 G TOFRANIL PM 75 MG CAP / 30 TOPROL XL 50 MG / 100 TOPROL XL 100 MG / 100 TOPROL XL 200 MG / 100 TOPROL XL 25 MG/100 TRAVATAN - Z 2.5 ML TRAVATAN - Z 5 ML TRAVATAN OP SOL 2.5 ML TRAVATAN OP SOL 5 ML TREXIMET 85-500 MG / 9 TRICOR 145MG TAB / 90 TRICOR 48 MG TAB / 90 TRILIPIX CAPS 45 MG / 90 TRILIPIX CAPS 135 MG / 90 TRUSOPT 2% 10ML ULORIC 40 MG TAB / 30 ULORIC 80 MG TAB / 30 ULTRAM ER 100 MG TAB / 30 ULTRAM ER 200 MG TAB / 30 ULTRASE MT20 CAPS / 100 UROXATRAL 10MG TAB / 100 VALTREX 1000MG TAB / 30 VALTREX 500MG TAB / 30 VECTICAL OINT 100 GM VERAMYST SPR 27.5 MCG VESICARE 10MG TAB /30 VESICARE 5MG TAB /30 VESICARE 5MG TAB /90 VIGAMOX 0.5% 3ML VOLTAREN GEL 1% 100 G / 3 VOLTAREN OP SOL 5 ML VYTORIN 10-10MG TAB /30 VYTORIN 10-20MG TAB /30 VYTORIN 10-20MG TAB /90 VYTORIN 10-40MG TAB /30 VYTORIN 10-40MG TAB /90 VYTORIN 10-80MG TAB /30 WELCHOL 625 MG TAB / 180 WELLBUTRIN XL 150MG TER /30 WELLBUTRIN XL 300 MG / 30 XELODA 500MG TAB / 120 XENICAL CAPS 120 MG/90 XIBROM 2.5 ML SOL XIBROM 5 ML SOL XOPENEX HFA 15 MG XOPENEX INH SOL 0.63/3ML XOPENEX INH SOL 1.25 / 3 ML ZEGERID 40-1100 CAPS / 30 ZEMPLAR CAPS 1 MCG / 30 ZEMPLAR CAPS 2 MCG / 30 00078052415 00065064705 00065064710 00065064835 00406992303 00186109005 00186109205 00186109405 00186108805 00065026025 00065026005 00065026625 00065026634 00173075000 00074612390 00074612290 00074964290 00074918990 00006351936 64764091830 64764067730 00062065330 00062065530 58914000410 00024420010 00173056504 00173093308 00299201210 00173075300 51248015101 51248015001 51248015003 00065401303 63481068403 00078047861 66582031131 66582031231 66582031254 66582031331 66582031354 66582031531 65597070118 4455073030 4455073130 00004110150 00004025652 67425000412 67425000450 63402051001 63402051224 63402051324 68012010430 00074431730 00074431730 ZETIA 10MG TAB /30 ZETIA 10MG TAB /90 ZOVIRAX OINT 15 GM ZOVIRAX 5% CREAM 2 GM ZOVIRAX 5% CREAM 5 GM ZYLET OPT SUSP 10ML ZYLET OPT SUSP 5ML ZYMAR SOL 0.3% 5ML ZYPREXA 10MG TAB /30 ZYPREXA 15MG TAB / 30 ZYPREXA 2.5MG TAB /30 ZYPREXA 20MG TAB /30 ZYPREXA 5MG TAB /30 ZYPREXA 7.5 MG TAB / 30 ZYPREXA ZYDIS 10MG ODT /30 ZYPREXA ZYDIS 20MG ODT /30 ZYPREXA ZYDIS** 5MG ODT /30 ZYVOX 600 MG TAB / 20 66582041431 66582041454 64455099394 64455099442 64455099445 24208035810 24208035805 00023921805 00002411730 00002441530 00002411230 00002442030 00002411530 00002411630 00002445485 00002445685 00002445385 00009513502 Account Number: _____________________________ Account Name: ________________________________ Ordered By: __________________________________________Direct Phone: ___________________________ Customer Signature: _______________________________________________Date: ______________________ Visit us on the web at www.emedrx.com
15/850 mg
50mg/1.25ml
Sertraline
Thioridazine
Thiothixene
Topiramate
Trazodone
Trihexyphenidyl
Valproic Acid
Venlafaxine
Venlafaxine ER
Ziprasidone HCL
Zolpidem Tartrate
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