Geri Script

GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143

10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB HOUSE CHARGES 100 W MAGNOLIA AVE MAYWOOD, NJ 07607

10/01/09 CHARGE R3679934 10135-0115-01 ONCE DAILY MULTIVITAMIN TABLET 600 22.26 OTC 10/01/09 CHARGE R3679935 00002-8031-01 GLUCAGON EMERGENCY KIT 1MG 3 418.97 RX 10/01/09 CHARGE R3681336 00555-0720-51 ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) 2 30.74 RX 10/01/09 CHARGE R3681337 00555-0720-51 ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) 1 15.37 RX 10/01/09 CHARGE R3681338 00555-0720-51 ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) 1 15.37 RX 10/02/09 CHARGE R3681457 22170-0215-16 CEPACOL SUGAR-FREE LOZENGE 96 20.02 OTC 10/02/09 CHARGE R3681456 00182-0287-01 DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) 600 18.73 OTC 10/02/09 CHARGE R3681459 00182-1093-10 SENNA-GEN 8.6MG TABLET 400 6.93 OTC 10/02/09 CHARGE R3681460 00904-7591-60 FERROUS SULFATE 325MG TABLET 600 10.11 OTC 10/02/09 CHARGE R3681461 74312-0077-10 GLUCOSAMINE 500MG CAPSULE 240 30.22 OTC 10/03/09 CHARGE R3682275 00113-0915-55 OMEPRAZOLE OTC 20MG TABLET DR 168 68.81 OTC 10/03/09 CHARGE R3682276 00182-1039-01 IBUPROFEN 200MG TABLET 400 13.17 OTC 10/05/09 CHARGE R3683215 00799-0001-04 CALMOSEPTINE OINTMENT 4520 238.34 OTC 10/05/09 CHARGE R3682838 53807-0401-16 MILK OF MAGNESIA 400MG/5ML ORAL SUSP 1419 6.74 OTC 10/06/09 CHARGE R3686070 00185-0144-05 AMIODARONE HCL 200MG TABLET 6 4.43 RX 10/06/09 CHARGE R3685172 59741-0306-12 BISACODYL SUPP 10MG SUPP.RECT (RP:DULCOLAX) 24 4.06 OTC 10/07/09 CHARGE R3686761 00182-0287-01 DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) 600 18.73 OTC 10/07/09 CHARGE R3686807 10135-0144-01 ACETAMINOPHEN X-S 500MG CAPLET 600 5.49 OTC 10/07/09 CHARGE R3686823 00904-7591-60 FERROUS SULFATE 325MG TABLET 600 10.11 OTC


10/31/09 Invoice# PH61821


10/07/09 CHARGE R3686824 10135-0115-01 ONCE DAILY MULTIVITAMIN TABLET 300 3.18 OTC 10/07/09 CHARGE R3686828 00182-1039-01 IBUPROFEN 200MG TABLET 300 9.88 OTC 10/07/09 CHARGE R3687705 00182-1061-07 ASPIRIN EC 81MG TABLET EC 480 8.77 OTC 10/07/09 CHARGE R3687709 50383-0786-08 GOLDEN AGE LIQUID (RP:CERTAGEN) 480 6.88 OTC 10/07/09 CHARGE R3687710 00121-0544-16 DOCUSATE SODIUM 100MG/10ML LIQUID (RP:COLACE) 1440 28.79 OTC 10/07/09 CHARGE R3687711 53807-0401-16 MILK OF MAGNESIA 400MG/5ML ORAL SUSP 1419 6.74 OTC 10/07/09 CHARGE R3687712 00904-5452-09 SENNA 8.8MG/5ML SYRUP 720 37.10 OTC 10/07/09 CHARGE R3687758 66424-0092-01 CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET 200 4.66 OTC 10/08/09 CHARGE R3688091 00002-8031-01 GLUCAGON EMERGENCY KIT 1MG 3 402.20 RX 10/12/09 CHARGE R3690481 00799-0001-04 CALMOSEPTINE OINTMENT 1130 59.59 OTC 10/12/09 CHARGE R3691602 00113-0915-55 OMEPRAZOLE OTC 20MG TABLET DR 252 103.21 OTC 10/12/09 CHARGE R3691605 00904-7591-60 FERROUS SULFATE 325MG TABLET 600 10.11 OTC 10/12/09 CHARGE R3692545 00536-3222-01 ACETAMINOPHEN 325MG TABLET 400 11.55 OTC 10/12/09 CHARGE R3692546 32131-0824-06 MULTIVITAMIN W/MINERALS TABLET 120 5.49 OTC 10/15/09 CHARGE R3698403 59390-0040-46 ACETAMINOPHEN 160MG/5ML ELIXIR 1892 12.93 OTC 10/15/09 CHARGE R3698408 00113-0915-55 OMEPRAZOLE OTC 20MG TABLET DR 336 137.61 OTC 10/15/09 CHARGE R3698665 00904-7927-60 BISACODYL 5MG TABLET EC 200 8.11 OTC 10/19/09 CHARGE R3700824 00182-0287-01 DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) 600 18.73 OTC 10/20/09 CHARGE R3702508 66424-0092-01 CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET 600 13.98 OTC


10/31/09 Invoice# PH61821


10/21/09 CHARGE R3704325 00799-0001-04 CALMOSEPTINE OINTMENT 1130 59.59 OTC 10/21/09 CHARGE R3704209 00536-3222-01 ACETAMINOPHEN 325MG TABLET 600 17.33 OTC 10/21/09 CHARGE R3704326 00182-1093-10 SENNA-GEN 8.6MG TABLET 600 10.39 OTC 10/21/09 CHARGE R3704327 00904-7927-60 BISACODYL 5MG TABLET EC 600 24.34 OTC 10/21/09 CHARGE R3704329 66424-0092-01 CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET 600 13.98 OTC 10/22/09 CHARGE R3706001 00799-0001-04 CALMOSEPTINE OINTMENT 1130 59.59 OTC 10/23/09 CHARGE R3708116 00781-2144-01 AMPICILLIN TRIHYDRATE 250MG CAPSULE 4 2.88 RX 10/23/09 CHARGE R3708127 60505-2616-06 CLARITHROMYCIN 250MG TABLET (RP:BIAXIN) 10 23.73 RX 10/23/09 CHARGE R3708160 55111-0126-05 CIPROFLOXACIN 250MG TABLET (RP:CIPRO) 1 2.88 RX 10/23/09 CHARGE R3708161 00054-4728-31 PREDNISONE 5MG TABLET 8 2.88 RX 10/23/09 CHARGE R3708163 66593-3126-02 VANCOCIN HCL 250MG CAPSULE 6 292.93 RX 10/23/09 CHARGE R3708183 51672-4030-03 WARFARIN SODIUM 3MG TABLET (RP:COUMADIN) 1 2.88 RX 10/23/09 CHARGE R3708186 51672-4032-03 WARFARIN SODIUM 5MG TABLET (RP:COUMADIN) 1 2.88 RX 10/23/09 CHARGE R3708147 00093-0311-05 LOPERAMIDE 2MG CAPSULE (RP:IMODIUM) 3 2.88 RX 10/25/09 CHARGE R3709276 00182-0287-01 DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) 400 12.49 OTC 10/26/09 CHARGE R3709364 54838-0001-80 FERROUS SULFATE 220MG/5ML ELIXIR 1416 14.20 OTC 10/26/09 CHARGE R3709368 10135-0115-01 ONCE DAILY MULTIVITAMIN TABLET 600 6.35 OTC 10/26/09 CHARGE R3709370 32131-0824-06 MULTIVITAMIN W/MINERALS TABLET 240 10.97 OTC 10/26/09 CHARGE R3709371 00182-1039-01 IBUPROFEN 200MG TABLET 200 6.59 OTC


10/31/09 Invoice# PH61821


10/26/09 CHARGE R3709372 10135-0144-01 ACETAMINOPHEN X-S 500MG CAPLET 400 3.66 OTC 10/26/09 CHARGE R3709373 00536-3222-01 ACETAMINOPHEN 325MG TABLET 600 17.33 OTC 10/26/09 CHARGE R3709374 00182-0287-01 DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) 600 18.73 OTC 10/26/09 CHARGE R3709549 59741-0306-12 BISACODYL SUPP 10MG SUPP.RECT (RP:DULCOLAX) 24 4.06 OTC 10/26/09 CHARGE R3709550 00168-0011-31 BACITRACIN ZINC 500U/1GM OINTMENT 60 3.66 OTC 10/27/09 CHARGE R3711303 00113-0915-55 OMEPRAZOLE OTC 20MG TABLET DR 126 51.60 OTC 10/27/09 CHARGE R3712610 50383-0786-08 GOLDEN AGE LIQUID (RP:CERTAGEN) 720 10.31 OTC 10/31/09 CHARGE R3717486 22170-0215-16 CEPACOL SUGAR-FREE LOZENGE 32 6.67 OTC

HOUSE OTC 1312.87 0.00 RECAP RX 1221.02

2533.89


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ALDERS, CLYDE 100 W MAGNOLIA AVE RESIDENT# : 368 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/02/09 RETURN R3642618 60505-0234-01 GOLDFARB TORSEMIDE 20MG TABLET (RP:DEMADEX) -30 -15.75 RX 09/02/09 RETURN R3627206 74312-0871-90 GOLDFARB ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) -14 -0.58 OTC 09/02/09 RETURN R3627207 00185-0223-05 GOLDFARB CILOSTAZOL 100MG TABLET (RP:PLETAL) -14 -7.67 RX 09/02/09 RETURN R3627210 00093-7223-98 GOLDFARB FOSINOPRIL 20MG TABLET (RP:MONOPRIL) -14 -8.37 RX 09/02/09 RETURN R3627201 62175-0128-37 GOLDFARB ISOSORBIDE MONONITRATE ER 30MG TABLET SA -14 -13.38 RX (RP:IMDUR) 09/02/09 RETURN R3627205 00245-0058-15 GOLDFARB KLOR-CON M 20 20MEQ TABLET SA (RP:K-DUR (1500MG)) -14 -6.49 RX 09/02/09 RETURN R3627202 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) -29 -4.35 RX 09/02/09 RETURN R3627209 00071-0157-23 GOLDFARB LIPITOR 40MG TABLET -15 -47.24 RX 09/02/09 RETURN R3627208 00071-0155-23 GOLDFARB LIPITOR 10MG TABLET -15 -33.12 RX 09/02/09 RETURN R3627204 58177-0368-04 GOLDFARB METOPROLOL SUCCINATE ER 100MG TAB.SR 24H -14 -19.94 RX (RP:TOPROL XL) 09/02/09 RETURN R3627199 66582-0414-54 GOLDFARB ZETIA 10MG TABLET -15 -39.93 RX 09/10/09 RETURN R3617203 00093-0233-56 GOLDFARB ONDANSETRON 4MG TABLET (RP:ZOFRAN) -12 -13.20 RX

PATIENT RX -209.44 0.00 RECAP OTC -0.58

-210.02


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ALIMI, GANI 100 W MAGNOLIA AVE RESIDENT# : 364 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3627125 51079-0007-56 GOLDFARB OMEPRAZOLE (B) 20MG CAPSULE DR -9 -35.81 RX 09/10/09 RETURN R3627196 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET -3 -0.22 RX 09/10/09 RETURN R3627194 00228-2898-03 GOLDFARB GLIPIZIDE ER 2.5MG TABLET SA (RP:GLUCOTROL XL) -6 -1.61 RX 09/10/09 RETURN R3642617 31722-0213-05 GOLDFARB SERTRALINE HCL 50MG TABLET (RP:ZOLOFT) -7 -0.90 RX 09/10/09 RETURN R3627198 00182-1576-26 GOLDFARB OYST-CAL 500MG TABLET (RP:OYSTER SHELL CALCIUM) -38 -1.55 OTC 09/10/09 RETURN R3627196 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET -13 -0.94 RX 09/10/09 RETURN R3627195 62175-0128-37 GOLDFARB ISOSORBIDE MONONITRATE ER 30MG TABLET SA -9 -8.60 RX (RP:IMDUR) 09/10/09 RETURN R3627193 00591-0844-01 GOLDFARB GLIPIZIDE ER 5MG TABLET SA (RP:GLUCOTROL XL) -6 -1.61 RX 09/17/09 RETURN R3627197 00169-0082-81 GOLDFARB PRANDIN 1MG TABLET -15 -22.00 RX 09/17/09 RETURN R3627197 00169-0082-81 GOLDFARB PRANDIN 1MG TABLET -10 -14.67 RX


-87.91


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ANDERSON, BERYL 100 W MAGNOLIA AVE RESIDENT# : 342 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3633905 00172-4364-60 TANK LABETALOL 100MG TABLET -15 -3.24 RX 09/17/09 RETURN R3633904 16252-0571-01 TANK RAMIPRIL 2.5MG CAPSULE (RP:ALTACE) -15 -7.32 RX 09/17/09 RETURN R3645013 00172-4364-60 TANK LABETALOL 100MG TABLET -3 -0.65 RX 09/17/09 RETURN R3648796 00143-9898-05 TANK CEPHALEXIN 250MG CAPSULE (RP:KEFLEX) -9 -1.66 RX 09/17/09 RETURN R3648800 63736-0105-06 TANK BACID CAPLET -3 -1.54 OTC 09/17/09 RETURN R3652378 00185-0122-01 TANK NITROFURANTOIN MONOHYDRATE 100MG CAPSULE -3 -4.04 RX (RP:MACROBID)


-18.45


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ANTENUCCI, CARMELA 100 W MAGNOLIA AVE RESIDENT# : 409 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/07/09 CHARGE R3688057 00555-0720-51 PAGANO ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) 2 30.74 RX 10/07/09 CHARGE R3688059 31722-0238-10 PAGANO AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 5 2.88 RX 10/07/09 CHARGE R3688061 16729-0006-17 PAGANO SIMVASTATIN 40MG TABLET (RP:ZOCOR) 5 2.88 RX 10/07/09 CHARGE R3688068 00406-0512-05 PAGANO OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX 10/07/09 CHARGE R3688058 63481-0687-06 PAGANO LIDODERM 5% PATCH 15 75.81 RX 10/07/09 CHARGE R3688060 00007-3230-11 PAGANO ARIXTRA 2.5MG/0.5ML DISP SYRIN 5 397.58 RX 10/07/09 CHARGE R3688064 00574-0412-02 PAGANO POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) 255 12.90 RX 10/07/09 CHARGE R3688065 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 5 13.50 RX 10/07/09 CHARGE R3688067 00071-1012-68 PAGANO LYRICA 25MG CAPSULE 15 26.50 RX 10/07/09 CHARGE R3688069 67767-0123-18 PAGANO FENTANYL 100MCG/HR PATCH 5 212.11 RX 10/07/09 CHARGE R3688070 00378-9119-98 PAGANO FENTANYL 12MCG/HR PATCH 5 47.44 RX 10/12/09 CHARGE R3688259 31722-0238-10 PAGANO AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/12/09 CHARGE R3688260 16729-0006-17 PAGANO SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX 10/12/09 CHARGE R3688261 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 15 40.50 RX 10/20/09 CHARGE R3702022 00555-0720-51 PAGANO ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) 2 30.74 RX 10/21/09 CHARGE R3703328 67767-0123-18 PAGANO FENTANYL 100MCG/HR PATCH 5 212.11 RX 10/21/09 CHARGE R3703494 00378-9119-98 PAGANO FENTANYL 12MCG/HR PATCH 5 47.44 RX 10/21/09 CHARGE R3706101 00071-1012-68 PAGANO LYRICA 25MG CAPSULE 15 26.50 RX 10/26/09 CHARGE R3693951 31722-0238-10 PAGANO AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ANTENUCCI, CARMELA 100 W MAGNOLIA AVE RESIDENT# : 409 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3693952 16729-0006-17 PAGANO SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX 10/26/09 CHARGE R3693953 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 15 40.50 RX 10/28/09 CHARGE R3714866 00713-0135-12 PAGANO PROCHLORPERAZINE 25MG SUPP.RECT (RP:COMPAZINE) 12 30.58 RX 10/29/09 CHARGE R3716305 00007-3230-11 PAGANO ARIXTRA 2.5MG/0.5ML DISP SYRIN 5 397.58 RX

PATIENT RX 1668.75 0.00 RECAP

1668.75


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BART, ANNA 100 W MAGNOLIA AVE RESIDENT# : 392 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3649121 42043-0141-05 GOLDFARB CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) -1 -0.36 RX 10/02/09 CHARGE R3681730 51672-4032-03 GOLDFARB WARFARIN SODIUM 5MG TABLET 3 2.88 RX


2.52


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BAZEWICZ, MARY 100 W MAGNOLIA AVE RESIDENT# : 7 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/14/09 CHARGE R3694810 54162-0500-02 TESTA HYDROPHOR OINTMENT 100 3.84 OTC

PATIENT OTC 3.84 0.00 RECAP

3.84


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BEHNKE, FRED 100 W MAGNOLIA AVE RESIDENT# : 416 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

10/01/09 CHARGE R3681360 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET 162 11.66 RX 10/01/09 CHARGE R3681365 55111-0172-90 GOLDFARB FINASTERIDE 5MG TABLET (RP:PROSCAR) 27 46.71 RX 10/01/09 CHARGE R3681367 16252-0528-90 GOLDFARB PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) 27 9.61 RX 10/01/09 CHARGE R3681371 00185-0144-05 GOLDFARB AMIODARONE HCL 200MG TABLET (RP:CORDARONE) 27 19.93 RX 10/01/09 CHARGE R3681372 16252-0097-22 GOLDFARB ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/01/09 CHARGE R3681373 00143-1248-10 GOLDFARB FOLIC ACID 1MG TABLET 27 2.88 RX 10/01/09 CHARGE R3681376 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 14 2.88 RX 10/01/09 CHARGE R3681377 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 14 3.56 RX 10/01/09 CHARGE R3681379 00527-1324-10 GOLDFARB DIGOXIN 0.125MG TABLET 27 5.75 RX 10/01/09 CHARGE R3681381 00024-4200-10 GOLDFARB UROXATRAL 10MG TABLET SA 1 3.62 RX 10/02/09 CHARGE R3681724 00024-4200-10 GOLDFARB UROXATRAL 10MG TABLET SA 26 64.72 RX 10/13/09 CHARGE R3694230 51079-0072-56 GOLDFARB FUROSEMIDE (B) 20MG TABLET 26 2.88 RX 10/14/09 CHARGE R3696051 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA (RP:K-DUR (750MG)) 12 3.05 RX 10/16/09 CHARGE R3699992 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 10 2.88 RX 10/16/09 CHARGE R3699990 58177-0368-04 GOLDFARB METOPROLOL SUCCINATE ER 100MG TAB.SR 24H 10 9.31 RX (RP:TOPROL XL) 10/16/09 CHARGE R3699993 00074-3079-90 GOLDFARB NIASPAN 750MG TABLET SA 20 46.94 RX 10/18/09 CHARGE R3700612 16252-0097-22 GOLDFARB ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX


253.64


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BELLARDITA, ANN 100 W MAGNOLIA AVE RESIDENT# : 83 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

09/18/09 CHARGE R3708126 17714-0020-01 TESTA DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL) 1 2.88 OTC 10/05/09 CHARGE R3683160 63736-0105-06 WIENER BACID CAPLET 20 7.72 OTC


10.60


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BELLAVIA, LUCY 100 W MAGNOLIA AVE RESIDENT# : 232 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICAID

10/06/09 CHARGE R3686013 17478-0060-12 RENNER AKWA TEARS (ARTIFICIAL TEARS) DROPS 15 2.88 OTC 10/12/09 CHARGE R3676474 00574-0508-01 RENNER FERROUS GLUCONATE 324MG TABLET 15 2.88 OTC 10/26/09 CHARGE R3693881 00574-0508-01 RENNER FERROUS GLUCONATE 324MG TABLET 15 2.88 OTC


8.64


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BIZZARO, EMANUEL 100 W MAGNOLIA AVE RESIDENT# : 434 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/29/09 CHARGE R3715269 00024-4200-10 TANK UROXATRAL 10MG TABLET SA 11 27.38 RX 10/29/09 CHARGE R3715271 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/29/09 CHARGE R3715272 00173-0696-00 TANK ADVAIR DISKUS 250MCG/50MCG INHALER 60 157.07 RX 10/29/09 CHARGE R3715274 63824-0008-50 TANK MUCINEX 600MG TABLET SA 22 12.49 OTC 10/29/09 CHARGE R3715275 00597-0075-41 TANK SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER 30 137.45 RX 10/29/09 CHARGE R3716176 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX

PATIENT RX 566.82 0.00 RECAP OTC 12.49

579.31


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BONANNO, FLORENCE 100 W MAGNOLIA AVE RESIDENT# : 14 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/09/09 CHARGE R3689834 00521-2750-00 RENNER VASELINE LIP THERAPY (10GM) LOTION 1 2.88 OTC


2.88


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BONANNO, LUCILLE 100 W MAGNOLIA AVE RESIDENT# : 407 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/05/09 CHARGE R3683392 00591-3433-30 GOLDFARB IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 90 45.17 RX SOLUTION (RP:DUONEB 3 ML VIAL) 10/09/09 CHARGE R3689831 00186-1989-04 GOLDFARB PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. 30 2.88 RX 10/12/09 CHARGE R3676583 00603-3856-32 GOLDFARB HCTZ 25MG TABLET 15 2.88 RX 10/12/09 CHARGE R3676584 00378-1805-01 GOLDFARB LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) 15 4.37 RX 10/12/09 CHARGE R3676585 65726-0235-10 GOLDFARB DYNACIRC CR 5MG TABLET SA 15 8.92 RX 10/19/09 CHARGE R3700554 00085-1401-01 GOLDFARB FORADIL AEROLIZER 12MCG INHALER 60 110.34 RX


174.56


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BOODAGHIAN, MARY 100 W MAGNOLIA AVE RESIDENT# : 406 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/06/09 CHARGE R3686256 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA 6 2.88 RX 10/06/09 CHARGE R3686318 00338-0049-04 TANK SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. 1000 4.79 IV 10/07/09 CHARGE R3687704 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/07/09 CHARGE R3688486 00338-0049-04 TANK SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. 1000 4.79 IV 10/10/09 CHARGE R3690882 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 4 2.88 OTC 10/12/09 CHARGE R3676544 59762-5019-01 TANK QUINAPRIL 5MG TABLET 15 3.75 RX 10/12/09 CHARGE R3676546 00781-2074-01 TANK TRIAMTERENE/HCTZ 37.5-25MG CAPSULE (RP:DYAZIDE ) 15 4.77 RX 10/12/09 CHARGE R3676547 57664-0397-58 TANK METFORMIN 500MG TABLET 30 2.88 RX 10/12/09 CHARGE R3676549 00378-1800-01 TANK LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) 7.5 2.88 RX 10/12/09 CHARGE R3676550 00378-1807-10 TANK LEVOTHYROXINE SODIUM 88MCG TABLET 15 4.44 RX 10/12/09 CHARGE R3688258 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA 15 6.95 RX 10/12/09 CHARGE R3676545 00008-0607-01 TANK PANTOPRAZOLE 40MG TABLET DR 15 40.50 RX 10/12/09 CHARGE R3691455 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 30 2.88 OTC 10/13/09 CHARGE R3693306 00378-0028-01 TANK NADOLOL 20MG TABLET 26 12.09 RX 10/13/09 CHARGE R3693322 00781-1123-01 TANK TRIAMTERENE/HCTZ 37.5/25 TABLET (RP:MAXZIDE-25) 6.5 2.88 RX 10/14/09 CHARGE R3695920 00169-7501-11 TANK NOVOLOG 100U/1ML INSULIN 10 76.45 RX 10/16/09 CHARGE R3697959 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX

PATIENT RX 633.05 OTC 5.76 0.00 RECAP IV 9.58

648.39


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BOSNYAK, DOROTHY 100 W MAGNOLIA AVE RESIDENT# : 29 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

09/28/09 CHARGE R3659641 58468-0021-01 SILVERMAN RENAGEL (SEVELAMER HCL) 800MG TABLET 9 23.02 RX 09/28/09 CREDIT R3659641 58468-0021-01 SILVERMAN RENAGEL (SEVELAMER HCL) 800MG TABLET 90 -239.77 RX 09/28/09 CHARGE R3659952 00378-1805-01 SILVERMAN LEVOTHYROXINE SODIUM 75MCG TABLET 3 2.88 RX 09/28/09 CREDIT R3659952 00378-1805-01 SILVERMAN LEVOTHYROXINE SODIUM 75MCG TABLET 30 -8.73 RX 09/28/09 CHARGE R3659953 00456-2010-01 SILVERMAN LEXAPRO 10MG TABLET 3 9.72 RX 09/28/09 CREDIT R3659953 00456-2010-01 SILVERMAN LEXAPRO 10MG TABLET 30 -101.21 RX 09/28/09 CHARGE R3659954 63304-0579-10 SILVERMAN METOPROLOL TARTRATE 25MG TABLET 6 2.88 RX 09/28/09 CREDIT R3659954 63304-0579-10 SILVERMAN METOPROLOL TARTRATE 25MG TABLET 60 -4.32 RX 09/28/09 CHARGE R3659956 00008-0841-81 SILVERMAN PROTONIX 40MG TABLET DR 6 28.76 RX 09/28/09 CREDIT R3659956 00008-0841-81 SILVERMAN PROTONIX 40MG TABLET DR 60 -299.56 RX 09/28/09 CHARGE R3659957 16729-0005-17 SILVERMAN SIMVASTATIN 20MG TABLET (RP:ZOCOR) 3 2.88 RX 09/28/09 CREDIT R3659957 16729-0005-17 SILVERMAN SIMVASTATIN 20MG TABLET (RP:ZOCOR) 30 -6.30 RX

PATIENT RX -589.75 0.00 RECAP

-589.75


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BOSNYAK, DOROTHY 100 W MAGNOLIA AVE RESIDENT# : 29 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/13/09 CHARGE R3693374 51672-1275-02 SILVERMAN CLOTRIMAZOLE 1% CREAM (RP:LOTRIMIN AF) 30 11.91 OTC 10/26/09 CHARGE R3693670 54391-0002-01 SILVERMAN NEPHRO-VITE TABLET 30 6.41 OTC


18.32


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BOSTICCO, JOSEPH 100 W MAGNOLIA AVE RESIDENT# : 399 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/26/09 CHARGE R3682981 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) 1 2.88 RX 10/02/09 CHARGE R3678127 51672-4028-03 TANK WARFARIN SODIUM 2MG TABLET 3 2.88 RX


5.76


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BURDICK, ANN 100 W MAGNOLIA AVE RESIDENT# : 429 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/20/09 CHARGE R3704049 53746-0101-05 TANK GABAPENTIN 100MG CAPSULE (RP:NEURONTIN) 6 2.88 RX 10/20/09 CHARGE R3704059 55111-0158-10 TANK OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) 12 47.75 RX 10/20/09 CHARGE R3704063 00603-1378-59 TANK LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/20/09 CHARGE R3704064 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX (RP:PROVENTIL ) 10/20/09 CHARGE R3704070 42043-0141-05 TANK CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) 4 2.88 RX 10/20/09 CHARGE R3704086 65162-0627-50 TANK TRAMADOL 50MG TABLET 30 2.88 RX 10/20/09 CHARGE R3704052 00456-2010-01 TANK LEXAPRO 10MG TABLET 6 13.36 RX 10/20/09 CHARGE R3704060 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/20/09 CHARGE R3704067 51660-0526-28 TANK LORATADINE 10MG TABLET (RP:CLARITIN) 15 2.88 OTC 10/20/09 CHARGE R3704068 00065-0266-25 TANK TRAVATAN 0.004% DROPS 2.5 58.41 RX 10/20/09 CHARGE R3704074 00064-5010-15 TANK SANTYL OINTMENT 30 85.21 RX 10/20/09 CHARGE R3704078 49884-0404-01 TANK METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) 3 2.88 RX 10/23/09 CHARGE R3708290 63736-0105-06 TANK BACID CAPLET 28 10.81 OTC 10/23/09 CHARGE R3708432 68180-0512-02 TANK LISINOPRIL 2.5MG TABLET 3 2.88 RX 10/24/09 CHARGE R3707204 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/24/09 CHARGE R3707210 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/26/09 CHARGE R3706226 53746-0101-05 TANK GABAPENTIN 100MG CAPSULE (RP:NEURONTIN) 15 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB BURDICK, ANN 100 W MAGNOLIA AVE RESIDENT# : 429 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3706228 55111-0158-10 TANK OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) 30 119.37 RX 10/26/09 CHARGE R3709506 68180-0512-02 TANK LISINOPRIL 2.5MG TABLET 15 2.88 RX 10/26/09 CHARGE R3706227 00456-2010-01 TANK LEXAPRO 10MG TABLET 15 33.40 RX 10/26/09 CHARGE R3706229 49884-0404-01 TANK METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) 7.5 5.43 RX 10/27/09 CHARGE R3712552 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 13 2.88 RX 10/29/09 CHARGE R3716254 00186-1989-04 TANK PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. 60 5.56 RX 10/29/09 CHARGE R3716315 00054-4728-31 TANK PREDNISONE 5MG TABLET 9 2.88 RX 10/30/09 CHARGE R3717129 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 10 2.88 RX


692.09


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CALANDRIELLO, ROSE 100 W MAGNOLIA AVE RESIDENT# : 361 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/02/09 CHARGE R3682128 00143-2260-01 SILVERMAN ISOSORBIDE MONONITRATE ER 60MG TABLET SA 10 6.00 RX (RP:IMDUR) 10/02/09 CHARGE R3682131 16729-0006-17 SILVERMAN SIMVASTATIN 40MG TABLET (RP:ZOCOR) 10 2.88 RX 10/02/09 CHARGE R3682132 00378-1803-01 SILVERMAN LEVOTHYROXINE SODIUM 50MCG TABLET 10 2.88 RX 10/02/09 CHARGE R3682136 31722-0521-10 SILVERMAN HYDRALAZINE 50MG TABLET 30 12.60 RX 10/02/09 CHARGE R3682137 00168-0080-31 SILVERMAN HYDROCORTISONE 2.5% CREAM 30 4.95 RX 10/02/09 CHARGE R3682133 17714-0019-01 SILVERMAN SIMETHICONE 80MG TAB CHEW 45 2.88 OTC 10/02/09 CHARGE R3682148 64253-0111-35 SILVERMAN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 10 2.88 RX SYRIN 10/02/09 CHARGE R3682149 64253-0333-35 SILVERMAN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 10 2.88 IV SYRIN 10/02/09 CHARGE R3682129 49884-0405-01 SILVERMAN METOPROLOL SUCCINATE ER 50MG TAB.SR 24H 10 7.25 RX 10/02/09 CHARGE R3682130 00149-0752-15 SILVERMAN ASACOL DELAYED RELEASE 400MG TABLET 60 76.27 RX 10/02/09 CHARGE R3682134 00078-0360-34 SILVERMAN DIOVAN 320MG TABLET 10 23.79 RX 10/02/09 CHARGE R3682138 00409-6533-01 SILVERMAN C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION 100 27.26 RX 10/02/09 CHARGE R3682139 17478-0711-30 SILVERMAN LIDOCAINE HCL 2% JELLY 30 11.46 RX 10/02/09 CHARGE R3682142 00169-7501-11 SILVERMAN NOVOLOG 100U/1ML INSULIN 10 76.45 RX 10/06/09 CHARGE R3686389 61314-0656-05 SILVERMAN CIPROFLOXACIN HCL OPHTH. 0.3% DROPS (RP:CILOXAN 5 37.85 RX OPHTHALMIC)


10/31/09 Invoice# PH61821


10/12/09 CHARGE R3683337 00143-2260-01 SILVERMAN ISOSORBIDE MONONITRATE ER 60MG TABLET SA 15 9.00 RX (RP:IMDUR) 10/12/09 CHARGE R3683340 16729-0006-17 SILVERMAN SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX 10/12/09 CHARGE R3683341 00378-1803-01 SILVERMAN LEVOTHYROXINE SODIUM 50MCG TABLET 15 3.95 RX 10/12/09 CHARGE R3683343 31722-0521-10 SILVERMAN HYDRALAZINE 50MG TABLET 45 18.90 RX 10/12/09 CHARGE R3683338 49884-0405-01 SILVERMAN METOPROLOL SUCCINATE ER 50MG TAB.SR 24H 15 10.87 RX 10/12/09 CHARGE R3683339 00149-0752-15 SILVERMAN ASACOL DELAYED RELEASE 400MG TABLET 90 114.41 RX 10/12/09 CHARGE R3683342 00078-0360-34 SILVERMAN DIOVAN 320MG TABLET 15 35.69 RX 10/13/09 CHARGE R3693212 00409-6533-01 SILVERMAN C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION 100 27.26 RX 10/19/09 CHARGE R3708132 00378-5110-01 SILVERMAN PROCHLORPERAZINE 10MG TABLET (RP:COMPAZINE) 1 2.88 RX 10/23/09 CHARGE R3708651 16729-0006-17 SILVERMAN SIMVASTATIN 40MG TABLET 3 2.88 RX 10/23/09 CHARGE R3708654 00143-2260-01 SILVERMAN ISOSORBIDE MONONITRATE ER 60MG TABLET SA 3 2.88 RX (RP:IMDUR) 10/23/09 CHARGE R3708655 00378-1803-01 SILVERMAN LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) 3 2.88 RX 10/23/09 CHARGE R3708657 31722-0521-10 SILVERMAN HYDRALAZINE 50MG TABLET 9 3.78 RX 10/23/09 CHARGE R3708682 62037-0640-01 SILVERMAN OMEPRAZOLE 40MG CAPSULE DR 3 5.20 RX 10/23/09 CHARGE R3708683 00168-0080-31 SILVERMAN HYDROCORTISONE 2.5% CREAM 30 4.95 RX 10/23/09 CHARGE R3708650 00149-0752-15 SILVERMAN ASACOL DELAYED RELEASE 400MG TABLET 18 22.88 RX 10/23/09 CHARGE R3708652 00078-0359-34 SILVERMAN DIOVAN 160MG TABLET 3 5.64 RX


10/31/09 Invoice# PH61821


10/23/09 CHARGE R3708658 17478-0711-30 SILVERMAN LIDOCAINE HCL 2% JELLY 30 11.46 RX 10/23/09 CHARGE R3708661 17714-0019-01 SILVERMAN SIMETHICONE 80MG TAB CHEW 100 2.88 OTC 10/23/09 CHARGE R3708662 00088-2220-33 SILVERMAN LANTUS 100U/1ML VIAL-INSUL 10 70.92 RX 10/23/09 CHARGE R3708663 00169-7501-11 SILVERMAN NOVOLOG 100U/1ML INSULIN 10 76.45 RX 10/23/09 CHARGE R3708681 00409-6533-01 SILVERMAN C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION 100 27.26 RX

PATIENT RX 756.50 IV 2.88 0.00 RECAP OTC 5.76

765.14


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CARUSO, JOSEPH 100 W MAGNOLIA AVE RESIDENT# : 427 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/15/09 CHARGE R3698602 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 11 2.88 RX 10/15/09 CHARGE R3698603 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 11 2.88 RX 10/15/09 CHARGE R3698604 55111-0119-10 TANK FAMOTIDINE 20MG TABLET (RP:PEPCID) 11 2.88 RX 10/15/09 CHARGE R3698605 42043-0141-05 TANK CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) 6 2.88 RX 10/15/09 CHARGE R3698607 63736-0105-06 TANK BACID CAPLET 4 2.88 OTC 10/15/09 CHARGE R3698608 51672-4030-03 TANK WARFARIN SODIUM 3MG TABLET 7 4.09 RX 10/15/09 CHARGE R3708182 51672-4030-03 TANK WARFARIN SODIUM 3MG TABLET (RP:COUMADIN) 1 2.88 RX 10/19/09 CHARGE R3702262 51672-4028-03 TANK WARFARIN SODIUM 2MG TABLET 2 2.88 RX 10/19/09 CHARGE R3702263 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA 14 6.48 RX 10/19/09 CHARGE R3702265 00603-1378-59 TANK LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/19/09 CHARGE R3702267 65580-0643-71 TANK METOLAZONE 2.5MG TABLET (RP:ZAROXOLYN) 2 2.88 RX 10/22/09 CHARGE R3707878 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET 3 2.88 RX 10/23/09 CHARGE R3708593 00781-1966-10 TANK FUROSEMIDE 40MG TABLET 6 2.88 RX 10/26/09 CHARGE R3701187 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3701188 55111-0119-10 TANK FAMOTIDINE 20MG TABLET (RP:PEPCID) 15 2.88 RX 10/26/09 CHARGE R3706247 00781-1966-10 TANK FUROSEMIDE 40MG TABLET 30 2.88 RX 10/26/09 CHARGE R3711179 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA (RP:K-DUR (1500MG)) 45 20.84 RX 10/29/09 CHARGE R3716243 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET 4 2.88 RX 10/29/09 CHARGE R3716717 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) 1 2.88 RX


95.69


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CASTILLO, GLORIA 100 W MAGNOLIA AVE RESIDENT# : 423 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3692964 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/12/09 CHARGE R3692967 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 30 4.50 RX 10/12/09 CHARGE R3692968 00245-0058-15 GOLDFARB KLOR-CON M 20 20MEQ TABLET SA 30 13.89 RX 10/12/09 CHARGE R3692972 07431-2011-40 GOLDFARB VITAMIN D 400IU TABLET 15 2.88 OTC 10/12/09 CHARGE R3692973 00536-3551-01 GOLDFARB VITAMIN B12 500MCG TABLET 15 2.88 OTC 10/12/09 CHARGE R3692974 74312-0871-90 GOLDFARB ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) 15 2.88 OTC 10/12/09 CHARGE R3692975 00182-1576-26 GOLDFARB OYST-CAL 500MG TABLET (RP:OS-CAL 500) 15 2.88 OTC 10/12/09 CHARGE R3693010 60505-2633-01 GOLDFARB CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 15 2.88 OTC 10/12/09 CHARGE R3692963 00006-0117-54 GOLDFARB SINGULAIR 10MG TABLET 15 45.11 RX 10/12/09 CHARGE R3692965 00228-2578-50 GOLDFARB DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) 15 20.09 RX 10/12/09 CHARGE R3692969 49884-0404-01 GOLDFARB METOPROLOL SUCCINATE ER 25MG TABLET 15 10.87 RX 10/12/09 CHARGE R3692970 00149-0478-01 GOLDFARB ACTONEL 150MG TABLET 1 81.64 RX 10/12/09 CHARGE R3692976 00075-1506-16 GOLDFARB NASACORT AQ NASAL 55MCG SPRAY 16.5 73.93 RX 10/12/09 CHARGE R3692977 00037-0241-30 GOLDFARB ASTELIN NASAL 137MCG SPRAY 30 76.56 RX 10/13/09 CHARGE R3694134 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 13 2.88 RX 10/26/09 CHARGE R3693918 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3693920 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 30 4.50 RX 10/26/09 CHARGE R3693921 00245-0058-15 GOLDFARB KLOR-CON M 20 20MEQ TABLET SA 30 13.89 RX 10/26/09 CHARGE R3701172 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 15 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CASTILLO, GLORIA 100 W MAGNOLIA AVE RESIDENT# : 423 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3693917 00006-0117-54 GOLDFARB SINGULAIR 10MG TABLET 15 45.11 RX 10/26/09 CHARGE R3693919 00228-2578-50 GOLDFARB DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) 15 20.09 RX 10/26/09 CHARGE R3693922 49884-0404-01 GOLDFARB METOPROLOL SUCCINATE ER 25MG TABLET 15 10.87 RX 10/26/09 CHARGE R3693923 07431-2011-40 GOLDFARB VITAMIN D 400IU TABLET 15 2.88 OTC 10/26/09 CHARGE R3693924 00536-3551-01 GOLDFARB VITAMIN B12 500MCG TABLET 15 2.88 OTC 10/26/09 CHARGE R3693925 74312-0871-90 GOLDFARB ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) 15 2.88 OTC 10/26/09 CHARGE R3693926 00182-1576-26 GOLDFARB OYST-CAL 500MG TABLET (RP:OS-CAL 500) 15 2.88 OTC 10/26/09 CHARGE R3693927 60505-2633-01 GOLDFARB CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 15 2.88 OTC


461.91


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CHIARAMONTE, ANTONINA 100 W MAGNOLIA AVE RESIDENT# : 28 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/15/09 CHARGE R3698065 00023-0667-04 PAGANO REFRESH PM OPHTH OINT 3.5 10.44 OTC


10.44


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CHINNI, MARIE 100 W MAGNOLIA AVE RESIDENT# : 242 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/05/09 CHARGE R3684688 51672-4032-03 GOLDFARB WARFARIN SODIUM 5MG TABLET 2 2.88 RX 10/05/09 CHARGE R3684689 51672-4031-03 GOLDFARB WARFARIN SODIUM 4MG TABLET 2 2.88 RX 10/08/09 CHARGE R3689698 51672-4031-03 GOLDFARB WARFARIN SODIUM 4MG TABLET 4 2.88 RX 10/12/09 CHARGE R3676441 00143-1248-10 GOLDFARB FOLIC ACID 1MG TABLET 15 2.88 RX 10/12/09 CHARGE R3676442 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3676443 00172-3758-60 GOLDFARB LISINOPRIL 5MG TABLET 15 2.88 RX 10/12/09 CHARGE R3676446 00245-0058-15 GOLDFARB KLOR-CON M 20 20MEQ TABLET SA 15 6.95 RX 10/12/09 CHARGE R3676447 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/12/09 CHARGE R3676444 49884-0405-01 GOLDFARB METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL 30 21.73 RX XL) 10/12/09 CHARGE R3676445 00456-3210-60 GOLDFARB NAMENDA 10MG TABLET 15 34.22 RX 10/13/09 CHARGE R3694153 51672-4032-03 GOLDFARB WARFARIN SODIUM 5MG TABLET 4 2.88 RX 10/13/09 CHARGE R3694154 51672-4031-03 GOLDFARB WARFARIN SODIUM 4MG TABLET 3 2.88 RX 10/26/09 CHARGE R3693846 00143-1248-10 GOLDFARB FOLIC ACID 1MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693847 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/26/09 CHARGE R3693848 00172-3758-60 GOLDFARB LISINOPRIL 5MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693851 00245-0058-15 GOLDFARB KLOR-CON M 20 20MEQ TABLET SA 15 6.95 RX 10/26/09 CHARGE R3693852 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CHINNI, MARIE 100 W MAGNOLIA AVE RESIDENT# : 242 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3693849 49884-0405-01 GOLDFARB METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL 30 21.73 RX XL) 10/26/09 CHARGE R3693850 00456-3210-60 GOLDFARB NAMENDA 10MG TABLET 15 34.22 RX 10/27/09 CHARGE R3712871 51672-4031-03 GOLDFARB WARFARIN SODIUM 4MG TABLET 1 2.88 RX 10/27/09 CHARGE R3712872 51672-4032-03 GOLDFARB WARFARIN SODIUM 5MG TABLET 2 2.88 RX


169.54


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CIANCIABELLA, ANTONINA 100 W MAGNOLIA AVE RESIDENT# : 419 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/07/09 CHARGE R3687968 31722-0239-10 GOLDFARB AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 5 2.88 RX 10/07/09 CHARGE R3687973 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 5 2.88 RX 10/07/09 CHARGE R3687974 00603-1378-59 GOLDFARB LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/07/09 CHARGE R3687976 00172-3758-60 GOLDFARB LISINOPRIL 5MG TABLET 5 2.88 RX 10/07/09 CHARGE R3687984 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 5 2.88 RX 10/07/09 CHARGE R3687988 00228-2888-50 GOLDFARB ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) 15 2.88 RX 10/07/09 CHARGE R3687990 00378-0155-05 GOLDFARB PROPOXYPHENE/NAPS/APAP 100-650MG TABLET 22.5 4.05 RX (RP:DARVOCET-N 100) 10/07/09 CHARGE R3687979 00075-0624-30 GOLDFARB LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/11/09 CHARGE R3691104 60505-2633-01 GOLDFARB CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 1 2.88 OTC 10/12/09 CHARGE R3688276 31722-0239-10 GOLDFARB AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 15 2.88 RX 10/12/09 CHARGE R3688277 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3688278 00172-3758-60 GOLDFARB LISINOPRIL 5MG TABLET 15 2.88 RX 10/12/09 CHARGE R3688279 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/12/09 CHARGE R3691471 60505-2633-01 GOLDFARB CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 15 2.88 OTC 10/14/09 CHARGE R3696367 00378-0155-05 GOLDFARB PROPOXYPHENE/NAPS/APAP 100-650MG TABLET 22.5 4.05 RX (RP:DARVOCET-N 100) 10/16/09 CHARGE R3698783 00378-0155-05 GOLDFARB PROPOXYPHENE/NAPS/APAP 100-650MG TABLET 22.5 4.05 RX (RP:DARVOCET-N 100)


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CIANCIABELLA, ANTONINA 100 W MAGNOLIA AVE RESIDENT# : 419 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/23/09 CHARGE R3708288 23558-0016-70 GOLDFARB SALINE NASAL 0.65% SPRAY 45 5.81 OTC 10/24/09 CHARGE R3708845 23558-0016-70 GOLDFARB SALINE NASAL 0.65% SPRAY 45 5.81 OTC 10/26/09 CHARGE R3694025 31722-0239-10 GOLDFARB AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3694026 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/26/09 CHARGE R3694027 00172-3758-60 GOLDFARB LISINOPRIL 5MG TABLET 15 2.88 RX 10/26/09 CHARGE R3694028 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3694029 60505-2633-01 GOLDFARB CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 15 2.88 OTC 10/27/09 CHARGE R3712894 00409-1952-32 GOLDFARB TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP 10 9.28 RX SYRIN (RP:TIGAN INJECTION) 10/27/09 CHARGE R3720199 00409-1952-32 GOLDFARB TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP 2 2.88 RX SYRIN 10/29/09 CHARGE R3716498 00075-0624-30 GOLDFARB LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/30/09 CHARGE R3716825 51672-1289-02 GOLDFARB NYSTATIN 100MU/1GM CREAM 30 2.97 RX


460.81


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CIRINCION, JOSEPH 100 W MAGNOLIA AVE RESIDENT# : 383 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/01/09 RETURN R3636923 63736-0105-06 TANK BACID CAPLET -4 -2.06 OTC 09/02/09 RETURN R3636934 00406-2023-10 TANK ATENOLOL 50MG TABLET -2 -0.10 RX 09/02/09 RETURN R3636933 68180-0488-09 TANK PRAVASTATIN 80MG TABLET (RP:PRAVACHOL) -2 -1.15 RX 09/02/09 RETURN R3638504 31722-0239-10 TANK AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) -4 -0.71 RX 09/02/09 RETURN R3641561 00456-2005-01 TANK LEXAPRO 5MG TABLET -2 -4.26 RX 09/02/09 RETURN R3641559 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE -1 -1.00 RX 09/10/09 RETURN R3641816 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA -4 -1.85 RX 09/10/09 RETURN R3639270 50111-0334-02 TANK METRONIDAZOLE 500MG TABLET (RP:FLAGYL) -13 -2.83 RX 09/10/09 RETURN R3636927 00172-3759-60 TANK LISINOPRIL 10MG TABLET -6 -0.41 RX 09/10/09 RETURN R3636928 00172-3760-60 TANK LISINOPRIL 20MG TABLET (RP:ZESTRIL ) -5 -0.40 RX 09/10/09 RETURN R3636929 62175-0128-37 TANK ISOSORBIDE MONONITRATE ER 30MG TABLET SA -2 -1.91 RX (RP:IMDUR) 09/10/09 RETURN R3636930 31722-0238-10 TANK AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) -6 -0.77 RX 09/10/09 RETURN R3636931 55111-0181-04 TANK LEVETIRACETAM 250MG TABLET (RP:KEPPRA) -4 -1.72 RX

PATIENT OTC -2.06 0.00 RECAP RX -17.11

-19.17


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB COLLING, EDITH 100 W MAGNOLIA AVE RESIDENT# : 233 MAYWOOD, NJ 07607 STATION : SUB STATUS : PRIVATE

10/27/09 CHARGE R3712891 24208-0324-05 SCERBO TIMOLOL MALEATE OPHTH 0.5% DROPS 5 4.50 RX 10/27/09 CHARGE R3712895 00172-3759-60 SCERBO LISINOPRIL 10MG TABLET 13 2.88 RX 10/27/09 CHARGE R3712896 00310-0278-10 SCERBO SEROQUEL 50MG TABLET 26 86.10 RX 10/27/09 CHARGE R3712897 00143-2260-01 SCERBO ISOSORBIDE MONONITRATE ER 60MG TABLET SA 13 7.80 RX 10/27/09 CHARGE R3712898 00781-1966-10 SCERBO FUROSEMIDE 40MG TABLET 13 2.88 RX 10/27/09 CHARGE R3712900 00406-2030-05 SCERBO METFORMIN 1000MG TABLET 26 4.32 RX


108.48


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CORPI, THERESA 100 W MAGNOLIA AVE RESIDENT# : 396 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/03/09 CHARGE R3682587 67253-0900-11 SILVERMAN ALPRAZOLAM 0.25MG TABLET 30 2.88 RX 10/04/09 CHARGE R3682674 62856-0500-10 SILVERMAN FRAGMIN 5000IU/0.2ML DISP SYRIN 2 240.21 RX 10/05/09 CHARGE R3682924 00406-0512-05 SILVERMAN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX


250.11


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB COSTELLO, ELAINE 100 W MAGNOLIA AVE RESIDENT# : 325 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/20/09 CHARGE R3704153 00603-2116-21 TANK ALLOPURINOL 300MG TABLET 6 2.88 RX 10/20/09 CHARGE R3704154 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) 6 2.88 RX 10/20/09 CHARGE R3704157 00093-7254-01 TANK GLIMEPIRIDE 1MG TABLET (RP:AMARYL) 6 2.88 RX 10/20/09 CHARGE R3704159 55111-0158-10 TANK OMEPRAZOLE 20MG CAPSULE DR 12 47.75 RX 10/20/09 CHARGE R3704161 00378-0523-01 TANK BISOPROLOL FUMARATE 5MG TABLET (RP:ZEBETA) 6 6.41 RX 10/20/09 CHARGE R3704162 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 12 2.88 RX 10/20/09 CHARGE R3704164 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/20/09 CHARGE R3704165 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/20/09 CHARGE R3704155 00006-0117-54 TANK SINGULAIR 10MG TABLET 6 18.05 RX 10/20/09 CHARGE R3704158 60505-0829-01 TANK FLUTICASONE PROPIONATE NASAL SPRAY 50MCG 16 58.62 RX (RP:FLONASE NASAL) 10/20/09 CHARGE R3704160 00186-0370-20 TANK SYMBICORT 160-4.5MCG HFA AER AD 10.2 148.98 RX 10/21/09 CHARGE R3704605 67877-0124-85 TANK SILVER SULFADIAZINE 1% CREAM (RP:SILVADENE) 85 5.36 RX 10/21/09 CHARGE R3705769 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/25/09 CHARGE R3709324 00169-1833-11 TANK NOVOLIN R 100U/1ML VIAL-INSUL 10 33.87 RX 10/26/09 CHARGE R3706218 00603-2116-21 TANK ALLOPURINOL 300MG TABLET 15 2.88 RX 10/26/09 CHARGE R3706219 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB COSTELLO, ELAINE 100 W MAGNOLIA AVE RESIDENT# : 325 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3706221 00093-7254-01 TANK GLIMEPIRIDE 1MG TABLET (RP:AMARYL) 15 2.88 RX 10/26/09 CHARGE R3706222 55111-0158-10 TANK OMEPRAZOLE 20MG CAPSULE DR 30 119.37 RX 10/26/09 CHARGE R3706223 00378-0523-01 TANK BISOPROLOL FUMARATE 5MG TABLET (RP:ZEBETA) 15 16.04 RX 10/26/09 CHARGE R3706224 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 30 2.88 RX 10/26/09 CHARGE R3706220 00006-0117-54 TANK SINGULAIR 10MG TABLET 15 45.11 RX 10/28/09 CHARGE R3713005 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN


566.16


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB CUTTITTA, VICTOR 100 W MAGNOLIA AVE RESIDENT# : 367 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3639026 00172-3759-60 TANK LISINOPRIL 10MG TABLET (RP:ZESTRIL) -10 -0.68 RX 09/10/09 RETURN R3639025 49884-0405-01 TANK METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL -12 -8.34 RX XL) 09/10/09 RETURN R3648262 00310-0275-34 TANK SEROQUEL 25MG TABLET -2 -4.03 RX 09/17/09 RETURN R3639029 74312-0811-50 TANK COD LIVER OIL CAPSULE -10 -0.23 OTC 09/17/09 RETURN R3639028 31604-0012-74 TANK FOLIC ACID 400MCG TABLET -10 -0.13 OTC 09/17/09 RETURN R3638808 37000-0024-04 TANK METAMUCIL SMOOTH S-F PACKET -15 -5.35 OTC 09/17/09 RETURN R3642658 55111-0119-10 TANK FAMOTIDINE 20MG TABLET (RP:PEPCID) -10 -1.50 RX 09/17/09 RETURN R3639027 00555-0997-02 TANK FLUDROCORTISONE ACETATE 0.1MG TABLET (RP:FLORINEF -10 -5.23 RX ACETATE) 09/17/09 RETURN R3639023 60505-0170-09 TANK PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) -11 -3.92 RX 09/17/09 RETURN R3639024 31722-0237-10 TANK AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) -12 -1.55 RX


-30.96


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DEFRANCESCO, ANGELO 100 W MAGNOLIA AVE RESIDENT# : 343 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3639227 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP -4 -10.03 RX SYRIN 10/04/09 CHARGE R3682716 00781-2067-01 TANK MYCOPHENOLATE MOFETIL 250MG CAPSULE (RP:CELLCEPT) 16 8.46 RX 10/04/09 CHARGE R3682734 00378-0208-10 TANK FUROSEMIDE 20MG TABLET 2 2.88 RX 10/04/09 CHARGE R3682739 13668-0009-05 TANK CITALOPRAM 10MG TABLET (RP:CELEXA) 8 2.88 RX 10/04/09 CHARGE R3682740 00591-0409-01 TANK LISINOPRIL 40MG TABLET 8 2.88 RX 10/04/09 CHARGE R3682742 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 32 2.88 RX 10/04/09 CHARGE R3682744 00054-4728-31 TANK PREDNISONE 5MG TABLET 8 2.88 RX 10/04/09 CHARGE R3682746 55111-0158-10 TANK OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) 16 63.66 RX 10/04/09 CHARGE R3682747 00406-0512-05 TANK OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX 10/04/09 CHARGE R3682720 54391-0002-01 TANK NEPHRO-VITE TABLET 8 2.88 OTC 10/04/09 CHARGE R3682726 30768-0006-01 TANK VITAMIN B COMPLEX TABLET 8 2.88 OTC 10/04/09 CHARGE R3682736 79649-9031-06 TANK GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE 8 2.88 OTC 10/04/09 CHARGE R3682718 63481-0687-06 TANK LIDODERM 5% PATCH 30 151.63 RX 10/04/09 CHARGE R3682723 00169-1833-11 TANK NOVOLIN R 100U/1ML VIAL-INSUL 10 33.87 RX 10/04/09 CHARGE R3682730 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE 1 2.88 RX 10/04/09 CHARGE R3682733 00574-0508-01 TANK FERROUS GLUCONATE 324MG TABLET 16 2.88 OTC 10/04/09 CHARGE R3682741 62175-0261-55 TANK NIFEDIPINE XL 60MG TABLET SA (RP:PROCARDIA XL) 8 11.97 RX 10/04/09 CHARGE R3682743 54092-0252-90 TANK FOSRENOL 500MG TAB CHEW 90 429.36 RX


10/31/09 Invoice# PH61821


10/04/09 CHARGE R3682745 60505-0133-00 TANK CYCLOSPORINE 25MG CAPSULE 60 64.38 RX 10/06/09 CHARGE R3685154 58468-0021-01 TANK RENAGEL (SEVELAMER HCL) 800MG TABLET 18 31.65 RX 10/08/09 CHARGE R3689451 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/12/09 CHARGE R3683278 00378-0208-10 TANK FUROSEMIDE 20MG TABLET 4 2.88 RX 10/12/09 CHARGE R3683321 00781-2067-01 TANK MYCOPHENOLATE MOFETIL 250MG CAPSULE (RP:CELLCEPT) 30 15.87 RX 10/12/09 CHARGE R3683326 13668-0009-05 TANK CITALOPRAM 10MG TABLET (RP:CELEXA) 15 2.88 RX 10/12/09 CHARGE R3683327 00591-0409-01 TANK LISINOPRIL 40MG TABLET 15 2.88 RX 10/12/09 CHARGE R3683329 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 60 4.32 RX 10/12/09 CHARGE R3683330 00054-4728-31 TANK PREDNISONE 5MG TABLET 15 2.88 RX 10/12/09 CHARGE R3683331 55111-0158-10 TANK OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) 30 119.37 RX 10/12/09 CHARGE R3683322 54391-0002-01 TANK NEPHRO-VITE TABLET 15 3.20 OTC 10/12/09 CHARGE R3683324 00574-0508-01 TANK FERROUS GLUCONATE 324MG TABLET 30 2.88 OTC 10/12/09 CHARGE R3683325 79649-9031-06 TANK GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE 15 5.41 OTC 10/12/09 CHARGE R3683323 30768-0006-01 TANK VITAMIN B COMPLEX TABLET 15 2.88 OTC 10/12/09 CHARGE R3683328 62175-0261-55 TANK NIFEDIPINE XL 60MG TABLET SA (RP:PROCARDIA XL) 15 22.44 RX 10/12/09 CHARGE R3688267 58468-0021-01 TANK RENAGEL (SEVELAMER HCL) 800MG TABLET 45 79.12 RX 10/13/09 CHARGE R3693378 00406-0512-05 TANK OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX 10/13/09 CHARGE R3694146 00406-0552-01 TANK OXYCODONE HCL IR 5MG TABLET 15 3.60 RX


10/31/09 Invoice# PH61821


10/13/09 CHARGE R3694145 59011-0100-10 TANK OXYCONTIN 10MG TABLET SA 15 21.00 RX 10/14/09 CHARGE R3696170 00378-0032-10 TANK METOPROLOL TARTRATE 50MG TABLET 24 2.88 RX 10/14/09 CHARGE R3694806 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/19/09 CHARGE R3703963 00409-1952-32 TANK TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP 2 2.88 RX SYRIN 10/21/09 CHARGE R3704435 59011-0100-10 TANK OXYCONTIN 10MG TABLET SA 15 21.00 RX 10/23/09 CHARGE R3708352 00406-0552-01 TANK OXYCODONE HCL IR 5MG TABLET 15 3.60 RX 10/23/09 CHARGE R3708339 54092-0252-90 TANK FOSRENOL 500MG TAB CHEW 90 429.36 RX


1606.34


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DELVECCHIO, MARIE 100 W MAGNOLIA AVE RESIDENT# : 432 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/23/09 CHARGE R3708627 00228-2888-50 GOLDFARB ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) 15 2.88 RX 10/23/09 CHARGE R3708632 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 3 2.88 RX 10/23/09 CHARGE R3708634 00378-1805-01 GOLDFARB LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) 3 2.88 RX 10/23/09 CHARGE R3708638 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 3 2.88 RX 10/23/09 CHARGE R3708639 31722-0239-10 GOLDFARB AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 3 2.88 RX 10/23/09 CHARGE R3708629 58177-0368-04 GOLDFARB METOPROLOL SUCCINATE ER 100MG TAB.SR 24H 3 2.88 RX (RP:TOPROL XL) 10/23/09 CHARGE R3708630 50383-0232-10 GOLDFARB DORZOLAMIDE HCL 2% DROPS (RP:TRUSOPT) 10 45.93 RX 10/23/09 CHARGE R3708631 61314-0144-05 GOLDFARB BRIMONIDINE TARTRATE 0.15% DROPS (RP:ALPHAGAN P) 5 47.21 RX 10/23/09 CHARGE R3708633 60505-0823-06 GOLDFARB CALCITONIN-SALMON NASAL 200 U/DOSE SPRAY/PUMP 3.7 81.50 RX 10/24/09 CHARGE R3709087 00228-2076-50 GOLDFARB TEMAZEPAM 15MG CAPSULE 15 2.88 RX 10/26/09 CHARGE R3709517 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 15 2.88 RX 10/26/09 CHARGE R3709518 00378-1805-01 GOLDFARB LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) 15 4.37 RX 10/26/09 CHARGE R3709519 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3709520 31722-0239-10 GOLDFARB AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3709516 58177-0368-04 GOLDFARB METOPROLOL SUCCINATE ER 100MG TAB.SR 24H 15 13.96 RX (RP:TOPROL XL) 10/27/09 CHARGE R3712570 00378-0345-05 GOLDFARB DIAZEPAM 5MG TABLET (RP:VALIUM) 15 2.88 RX


224.65


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DERBYSHIRE, NANCY 100 W MAGNOLIA AVE RESIDENT# : 36 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

10/31/09 CHARGE R3717396 60505-2633-01 TESTA CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 30 3.61 OTC 10/31/09 CHARGE R3717393 16252-0528-90 TESTA PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) 30 10.68 RX 10/31/09 CHARGE R3717394 63653-1171-05 TESTA PLAVIX 75MG TABLET 30 118.82 RX 10/31/09 CHARGE R3717395 00781-5224-01 TESTA CARVEDILOL 25MG TABLET (RP:COREG) 60 8.58 RX 10/31/09 CHARGE R3717397 55111-0119-10 TESTA FAMOTIDINE 20MG TABLET (RP:PEPCID) 60 9.00 RX 10/31/09 CHARGE R3717398 00088-2220-33 TESTA LANTUS 100U/1ML VIAL-INSUL 10 70.92 RX 10/31/09 CHARGE R3717400 00904-5496-46 TESTA NITROGLYCERIN 0.4MG/HR PATCH TD24 30 38.09 RX 10/31/09 CHARGE R3717404 31722-0213-05 TESTA SERTRALINE HCL 50MG TABLET (RP:ZOLOFT) 30 3.84 RX 10/31/09 CHARGE R3717405 65162-0627-50 TESTA TRAMADOL 50MG TABLET 60 5.40 RX 10/31/09 CHARGE R3717406 00075-0620-40 TESTA LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/31/09 CHARGE R3717407 49502-0685-26 TESTA IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/31/09 CHARGE R3717408 49884-0775-86 TESTA CLONIDINE PATCH-2 0.2MG PATCH (RP:CATAPRES-TTS-2) 4 133.37 RX 10/31/09 CHARGE R3717410 58468-0020-01 TESTA RENAGEL (SEVELAMER HCL) 400MG TABLET 90 79.12 RX 10/31/09 CHARGE R3717413 00169-7501-11 TESTA NOVOLOG 100U/1ML INSULIN 10 76.45 RX 10/31/09 CHARGE R3717419 16252-0097-22 TESTA ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX (RP:PROVENTIL ) 10/31/09 CHARGE R3717422 31722-0239-10 TESTA AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 30 5.34 RX 10/31/09 CHARGE R3717423 64679-0924-03 TESTA ENALAPRIL MALEATE 5MG TABLET (RP:VASOTEC) 30 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DERBYSHIRE, NANCY 100 W MAGNOLIA AVE RESIDENT# : 36 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

10/31/09 CHARGE R3717424 31722-0520-10 TESTA HYDRALAZINE 25MG TABLET (RP:APRESOLINE) 90 29.52 RX 10/31/09 CHARGE R3717425 00378-0208-10 TESTA FUROSEMIDE 20MG TABLET (RP:LASIX) 60 3.36 RX 10/31/09 CHARGE R3717426 00781-1966-10 TESTA FUROSEMIDE 40MG TABLET 60 3.60 RX

PATIENT OTC 3.61 0.00 RECAP RX 850.64

854.25


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DESIMONE, GLADYS 100 W MAGNOLIA AVE RESIDENT# : 80 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/01/09 CHARGE R3681253 00064-4022-16 TESTA CERAVE MOISTURIZING CREAM 453 21.33 RX 10/06/09 CHARGE R3686054 17478-0060-12 TESTA AKWA TEARS (ARTIFICIAL TEARS) DROPS (RP:ARTIFICIAL 15 2.88 OTC TEARS) 10/15/09 CHARGE R3698027 00062-0205-02 TESTA BIAFINE EMULSION 45 21.81 RX 10/22/09 CHARGE R3707867 17478-0060-12 TESTA AKWA TEARS (ARTIFICIAL TEARS) DROPS (RP:ARTIFICIAL 15 2.88 OTC TEARS) 10/26/09 CHARGE R3709483 32131-0804-86 TESTA OPTI-MULTI CAPLET (RP:OCUVITE) 30 2.88 OTC


51.78


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DESMOND, MARY 100 W MAGNOLIA AVE RESIDENT# : 84 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/24/09 CHARGE R3709127 66825-0002-01 SHERMAN FLORASTOR 250MG CAPSULE 30 34.06 OTC


34.06


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DIGIORGIO, FRANK 100 W MAGNOLIA AVE RESIDENT# : 366 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3650613 00143-1201-01 SILVERMAN COLCHICINE 0.6MG TABLET -14 -2.40 RX 09/17/09 RETURN R3650612 60505-2606-01 SILVERMAN CARVEDILOL 3.125MG TABLET (RP:COREG) -29 -4.15 RX 09/17/09 RETURN R3650611 00378-0045-01 SILVERMAN DILTIAZEM 60MG TABLET -14 -1.56 RX 10/02/09 CHARGE R3681797 51672-4032-03 SILVERMAN WARFARIN SODIUM 5MG TABLET 2 2.88 RX 10/05/09 CHARGE R3683359 51672-4033-01 SILVERMAN WARFARIN SODIUM 6MG TABLET 2 2.88 RX 10/05/09 CHARGE R3683361 51672-4027-03 SILVERMAN WARFARIN SODIUM 1MG TABLET 2 2.88 RX 10/06/09 CHARGE R3686047 51672-4027-03 SILVERMAN WARFARIN SODIUM 1MG TABLET 3 2.88 RX 10/06/09 CHARGE R3686048 51672-4033-01 SILVERMAN WARFARIN SODIUM 6MG TABLET 3 2.88 RX 10/07/09 CHARGE R3687661 00574-2021-08 SILVERMAN LAC LOTION 12% LOTION 225 25.16 RX 10/09/09 CHARGE R3690104 51672-4033-01 SILVERMAN WARFARIN SODIUM 6MG TABLET 14 11.70 RX 10/09/09 CHARGE R3690105 51672-4027-03 SILVERMAN WARFARIN SODIUM 1MG TABLET 14 7.56 RX 10/12/09 CHARGE R3683300 00378-0023-05 SILVERMAN DILTIAZEM 30MG TABLET 45 4.59 RX 10/12/09 CHARGE R3683301 00093-0051-01 SILVERMAN CARVEDILOL 3.125MG TABLET (RP:COREG) 15 2.88 RX 10/12/09 CHARGE R3683302 00781-1966-10 SILVERMAN FUROSEMIDE 40MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3683299 00143-1201-01 SILVERMAN COLCHICINE 0.6MG TABLET 15 2.88 RX 10/13/09 CHARGE R3694250 51672-4032-03 SILVERMAN WARFARIN SODIUM 5MG TABLET 1 2.88 RX 10/14/09 CHARGE R3696323 51672-4032-03 SILVERMAN WARFARIN SODIUM 5MG TABLET 2 2.88 RX


69.70


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DIPIERRO, MARIE 100 W MAGNOLIA AVE RESIDENT# : 355 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3649656 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET -10 -0.72 RX 09/10/09 RETURN R3649647 00185-0144-05 TANK AMIODARONE HCL 200MG TABLET -13 -21.95 RX 09/10/09 RETURN R3649639 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA -5 -2.31 RX 09/10/09 RETURN R3649676 00781-1599-05 TANK SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) -5 -1.50 RX 09/10/09 RETURN R3649646 63736-0105-06 TANK BACID CAPLET -19 -9.78 OTC 09/10/09 RETURN R3649645 00093-0657-01 TANK CALCITRIOL 0.25MCG CAPSULE -5 -3.99 RX 09/10/09 RETURN R3649675 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) -5 -1.28 RX 09/10/09 RETURN R3649646 63736-0105-06 TANK BACID CAPLET -43 -22.12 OTC 09/10/09 RETURN R3649644 00378-0433-01 TANK BUPROPION HCL 75MG TABLET -5 -2.38 RX 09/10/09 RETURN R3649643 57664-0434-88 TANK ALLOPURINOL 100MG TABLET -4 -0.32 RX 09/10/09 RETURN R3649653 00310-0271-10 TANK SEROQUEL 100MG TABLET -5 -17.29 RX 09/10/09 RETURN R3649649 00093-2131-01 TANK NITROFURANTOIN MACROCRYSTAL 100MG CAPSULE -2 -2.45 RX 09/10/09 RETURN R3649650 00143-1482-01 TANK PRIMIDONE 50MG TABLET -3 -0.98 RX 09/10/09 RETURN R3649667 00781-1446-05 TANK FUROSEMIDE 80MG TABLET -16 -1.66 RX 09/10/09 RETURN R3649652 00054-4728-31 TANK PREDNISONE 5MG TABLET -4 -0.08 RX 09/17/09 RETURN R3649673 51991-0203-11 TANK FERREX 150 150MG CAPSULE (RP:NIFEREX-150) -8 -1.45 OTC 09/17/09 RETURN R3649654 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN -3 -177.21 RX


-267.47


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DISCAFANI, FLORENTYN 100 W MAGNOLIA AVE RESIDENT# : 384 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/15/09 CHARGE R3698593 00115-4222-01 GOLDFARB MIDODRINE 5MG TABLET 22 40.44 RX 10/15/09 CHARGE R3698599 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 11 2.88 RX 10/15/09 CHARGE R3698601 16252-0097-22 GOLDFARB ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 72 8.28 RX 10/15/09 CHARGE R3698592 00093-3171-01 GOLDFARB CLINDAMYCIN 150MG CAPSULE 9 7.37 RX 10/15/09 CHARGE R3698597 00173-0696-00 GOLDFARB ADVAIR DISKUS 250MCG/50MCG INHALER 60 157.07 RX 10/15/09 CHARGE R3698638 54092-0252-90 GOLDFARB FOSRENOL 500MG TAB CHEW 90 429.36 RX 10/26/09 CHARGE R3701197 00115-4222-01 GOLDFARB MIDODRINE 5MG TABLET 30 55.14 RX 10/26/09 CHARGE R3701198 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX


703.42


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB DUPIRAK, ANNE 100 W MAGNOLIA AVE RESIDENT# : 32 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

07/06/09 CHARGE R3561794 30768-0006-01 PAGANO VITAMIN B COMPLEX TABLET 30 2.88 OTC 07/06/09 CHARGE R3577211 37000-0024-04 PAGANO METAMUCIL SMOOTH S-F PACKET 30 11.07 OTC 07/25/09 CHARGE R3599570 37000-0024-04 PAGANO METAMUCIL SMOOTH S-F PACKET 30 11.07 OTC 08/03/09 CHARGE R3594245 30768-0006-01 PAGANO VITAMIN B COMPLEX TABLET 30 2.88 OTC 08/10/09 CHARGE R3617538 37000-0024-04 PAGANO METAMUCIL SMOOTH S-F PACKET 30 11.07 OTC 08/31/09 CHARGE R3627511 30768-0006-01 PAGANO VITAMIN B COMPLEX TABLET 30 2.88 OTC 08/31/09 CHARGE R3642845 37000-0024-04 PAGANO METAMUCIL SMOOTH S-F PACKET 30 11.07 OTC 09/15/09 CHARGE R3660459 37000-0024-04 PAGANO METAMUCIL SMOOTH S-F PACKET 30 11.07 OTC 09/24/09 CHARGE R3672182 00501-3793-10 PAGANO POLYSPORIN POWDER 10 14.47 OTC 09/28/09 CHARGE R3659856 30768-0006-01 PAGANO VITAMIN B COMPLEX TABLET 30 2.88 OTC 10/01/09 CHARGE R3680167 37000-0024-04 PAGANO METAMUCIL SMOOTH S-F PACKET 30 11.07 OTC 10/18/09 CHARGE R3700664 37000-0024-04 PAGANO METAMUCIL SMOOTH S-F PACKET 30 11.07 OTC 10/26/09 CHARGE R3693577 30768-0006-01 PAGANO VITAMIN B COMPLEX TABLET 30 2.88 OTC


106.36


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ENGEL, EMILY 100 W MAGNOLIA AVE RESIDENT# : 68 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/26/09 CHARGE R3693498 74312-0077-10 WIENER GLUCOSAMINE 500MG CAPSULE 30 3.77 OTC 10/26/09 CHARGE R3693502 64980-0147-03 WIENER RISAQUAD 230MG CAPSULE (RP:FLORA-Q) 30 18.18 OTC


21.95


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB FAY, EILEEN 100 W MAGNOLIA AVE RESIDENT# : 391 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3649114 00536-4409-10 TANK PYRIDOXINE (VIT B6) 100MG TABLET (RP:PYRIDOXINE -4 -0.10 OTC (VIT B6)) 09/10/09 RETURN R3649108 00006-0952-54 TANK COZAAR 50MG TABLET -4 -6.59 RX 09/10/09 RETURN R3649112 31722-0237-10 TANK AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) -4 -0.52 RX 09/10/09 RETURN R3649109 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) -5 -1.28 RX 09/10/09 RETURN R3649110 00378-1809-01 TANK LEVOTHYROXINE SODIUM 100MCG TABLET -4 -1.20 RX


-9.69


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB FAY, THOMAS 100 W MAGNOLIA AVE RESIDENT# : 386 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/02/09 RETURN R3642332 00054-4728-31 TANK PREDNISONE 5MG TABLET -1 -0.02 RX 09/02/09 RETURN R3642325 00378-9102-93 TANK NITROGLYCERIN 0.1MG1H PATCH TD24 -15 -15.64 RX 09/17/09 RETURN R3642640 00310-0275-34 TANK SEROQUEL 25MG TABLET -7 -14.11 RX 09/17/09 RETURN R3642951 63736-0105-06 TANK BACID CAPLET -5 -2.57 OTC 09/17/09 RETURN R3642639 31722-0239-10 TANK AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) -7 -1.25 RX 09/17/09 RETURN R3648104 00456-2010-01 TANK LEXAPRO 10MG TABLET -5 -11.13 RX


-44.72


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB FLOOD, ROSE 100 W MAGNOLIA AVE RESIDENT# : 282 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

09/26/09 CREDIT R3674310 54391-0002-01 TANK NEPHRO-VITE TABLET 2 -2.88 OTC 09/26/09 CREDIT R3674314 32131-0804-86 TANK OPTI-MULTI CAPLET (RP:OCUVITE) 2 -2.88 OTC 09/26/09 CREDIT R3674317 00169-7501-11 TANK NOVOLOG 100U/1ML INSULIN 10 -115.84 RX 09/26/09 CREDIT R3674320 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 1 -2.88 RX 09/26/09 CREDIT R3674322 00378-1817-01 TANK LEVOTHYROXINE SODIUM 175MCG TABLET (RP:SYNTHROID) 2 -2.88 RX 09/26/09 CREDIT R3674323 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) 2 -2.88 RX 09/26/09 CREDIT R3674325 00169-0081-81 TANK PRANDIN 0.5MG TABLET 2 -4.45 RX 09/26/09 CREDIT R3674327 00169-0084-81 TANK PRANDIN 2MG TABLET 4 -8.89 RX 09/26/09 CREDIT R3674329 00006-0112-54 TANK JANUVIA 50MG TABLET 2 -14.29 RX 09/27/09 CREDIT R3674520 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 1 -2.88 RX 09/27/09 CREDIT R3674521 00169-0082-81 TANK PRANDIN 1MG TABLET 2 -4.45 RX 09/27/09 CREDIT R3674531 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 -8.63 RX 09/27/09 CREDIT R3674533 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 -6.75 RX (RP:ATROVENT INH U-D) 09/28/09 CREDIT R3674667 54391-0002-01 TANK NEPHRO-VITE TABLET 30 -6.20 OTC 09/28/09 CREDIT R3674668 32131-0804-86 TANK OPTI-MULTI CAPLET (RP:OCUVITE) 30 -2.88 OTC 09/28/09 CREDIT R3674669 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 30 -2.88 RX 09/28/09 CREDIT R3674670 00169-0082-81 TANK PRANDIN 1MG TABLET 60 -133.35 RX 09/28/09 CREDIT R3674916 59676-0310-01 TANK PROCRIT 10MU/1ML VIAL 4 -722.00 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB FLOOD, ROSE 100 W MAGNOLIA AVE RESIDENT# : 282 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

09/28/09 CREDIT R3675737 00006-0112-54 TANK JANUVIA 50MG TABLET 30 -214.36 RX 09/28/09 CREDIT R3675738 00169-0081-81 TANK PRANDIN 0.5MG TABLET 30 -66.68 RX 09/28/09 CREDIT R3675740 00378-1817-01 TANK LEVOTHYROXINE SODIUM 175MCG TABLET (RP:SYNTHROID) 30 -12.84 RX 09/28/09 CREDIT R3675741 63653-1171-05 TANK PLAVIX 75MG TABLET 30 -180.03 RX 09/28/09 CREDIT R3675742 60505-0065-01 TANK OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) 60 -238.74 RX 09/28/09 CREDIT R3675743 00456-3210-60 TANK NAMENDA 10MG TABLET 30 -93.90 RX 09/28/09 CREDIT R3675744 00456-2020-01 TANK LEXAPRO 20MG TABLET 30 -105.61 RX 09/28/09 CREDIT R3675746 00527-1324-10 TANK DIGOXIN 0.125MG TABLET 30 -6.39 RX 09/28/09 CREDIT R3675747 60505-2608-01 TANK CARVEDILOL 12.5MG TABLET (RP:COREG) 60 -8.58 RX 09/28/09 CREDIT R3675928 16729-0004-17 TANK SIMVASTATIN 10MG TABLET (RP:ZOCOR) 30 -5.25 RX


-1980.27


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GALLAGHER, RICHARD 100 W MAGNOLIA AVE RESIDENT# : 387 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3652172 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET -6 -22.85 RX 10/01/09 CHARGE R3680390 00781-1446-05 GOLDFARB FUROSEMIDE 80MG TABLET (RP:LASIX) 22 2.88 RX 10/02/09 CHARGE R3681686 00536-4534-08 GOLDFARB SIMETHICONE 125MG TAB CHEW 60 3.45 OTC 10/03/09 CHARGE R3682571 51991-0467-01 GOLDFARB CYCLOBENZAPRINE HCL 5MG TABLET 27 6.70 RX 10/03/09 CHARGE R3682572 60505-0113-08 GOLDFARB GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) 9 2.88 RX 10/05/09 CHARGE R3684684 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 14 2.88 RX 10/08/09 CHARGE R3687745 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 12 3.05 RX 10/10/09 CHARGE R3690870 63481-0687-06 GOLDFARB LIDODERM 5% PATCH 30 151.63 RX 10/12/09 CHARGE R3676599 00185-0144-05 GOLDFARB AMIODARONE HCL 200MG TABLET 15 11.07 RX 10/12/09 CHARGE R3676600 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET 30 2.88 RX 10/12/09 CHARGE R3676601 60505-0141-01 GOLDFARB GLIPIZIDE 5MG TABLET (RP:GLIPIZIDE) 7.5 2.88 RX 10/12/09 CHARGE R3676603 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/12/09 CHARGE R3683312 00054-0018-29 GOLDFARB PREDNISONE 20MG TABLET 15 2.88 RX 10/12/09 CHARGE R3683314 51991-0467-01 GOLDFARB CYCLOBENZAPRINE HCL 5MG TABLET 45 11.16 RX 10/12/09 CHARGE R3683315 60505-0113-08 GOLDFARB GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) 15 2.88 RX 10/12/09 CHARGE R3691463 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3691464 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 15 3.81 RX 10/12/09 CHARGE R3676602 00597-0058-01 GOLDFARB FLOMAX 0.4MG CAPSULE SA 15 44.34 RX 10/12/09 CHARGE R3676604 00074-6123-90 GOLDFARB TRICOR 145MG TABLET 15 44.71 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GALLAGHER, RICHARD 100 W MAGNOLIA AVE RESIDENT# : 387 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3676606 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 15 59.41 RX 10/19/09 CHARGE R3701359 00603-1378-59 GOLDFARB LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/20/09 CHARGE R3703800 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 12 2.88 RX 10/22/09 CHARGE R3707089 00143-1473-10 GOLDFARB PREDNISONE 10MG TABLET 4 2.88 RX 10/26/09 CHARGE R3693980 00185-0144-05 GOLDFARB AMIODARONE HCL 200MG TABLET 15 11.07 RX 10/26/09 CHARGE R3693982 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET 30 2.88 RX 10/26/09 CHARGE R3693983 00591-0460-05 GOLDFARB GLIPIZIDE 5MG TABLET 7.5 2.88 RX 10/26/09 CHARGE R3693985 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3693989 51991-0467-01 GOLDFARB CYCLOBENZAPRINE HCL 5MG TABLET 45 11.16 RX 10/26/09 CHARGE R3693990 53746-0102-05 GOLDFARB GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) 15 2.88 RX 10/26/09 CHARGE R3693992 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 15 3.81 RX 10/26/09 CHARGE R3706244 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 30 2.88 RX 10/26/09 CHARGE R3709523 00143-1473-10 GOLDFARB PREDNISONE 10MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693984 00597-0058-01 GOLDFARB FLOMAX 0.4MG CAPSULE SA 15 44.34 RX 10/26/09 CHARGE R3693986 00074-6123-90 GOLDFARB TRICOR 145MG TABLET 15 44.71 RX 10/26/09 CHARGE R3693987 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 15 59.41 RX


560.75


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GANGEMI, WINIFRED 100 W MAGNOLIA AVE RESIDENT# : 382 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3649867 00310-0275-34 GOLDFARB SEROQUEL 25MG TABLET -14 -28.22 RX 09/17/09 RETURN R3639018 57664-0397-58 GOLDFARB METFORMIN 500MG TABLET (RP:GLUCOPHAGE) -12 -0.90 RX 09/17/09 RETURN R3639019 74312-0813-80 GOLDFARB VITAMIN B12 1000MCG TABLET -6 -0.27 OTC 09/17/09 RETURN R3642657 00310-0275-34 GOLDFARB SEROQUEL 25MG TABLET -12 -24.18 RX


-53.57


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GAROFOLA, CHARLES 100 W MAGNOLIA AVE RESIDENT# : 433 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/28/09 CHARGE R3714939 00597-0075-41 PAGANO SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER 30 137.45 RX 10/28/09 CHARGE R3714940 00536-5895-88 PAGANO NICOTINE 14MG/24HR PATCH TD24 (RP:NICODERM CQ) 14 20.62 OTC 10/28/09 CHARGE R3714942 00378-1140-01 PAGANO BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) 36 2.88 RX 10/28/09 CHARGE R3714943 63304-0579-10 PAGANO METOPROLOL TARTRATE 25MG TABLET 24 2.88 RX 10/28/09 CHARGE R3714944 00228-2578-50 PAGANO DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) 12 16.07 RX 10/28/09 CHARGE R3714945 00087-2772-32 PAGANO AVAPRO 150MG TABLET 12 20.65 RX 10/28/09 CHARGE R3714947 00781-1966-10 PAGANO FUROSEMIDE 40MG TABLET (RP:LASIX) 12 2.88 RX 10/28/09 CHARGE R3714948 63824-0008-50 PAGANO MUCINEX 600MG TABLET SA 24 13.61 OTC 10/28/09 CHARGE R3714951 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 1 2.88 RX 10/28/09 CHARGE R3714954 00054-0018-29 PAGANO PREDNISONE 20MG TABLET 12 2.88 RX 10/28/09 CHARGE R3714955 00169-0084-81 PAGANO PRANDIN 2MG TABLET 24 35.21 RX 10/28/09 CHARGE R3714956 00075-0620-40 PAGANO LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/28/09 CHARGE R3714957 00186-1989-04 PAGANO PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. 60 5.56 RX 10/28/09 CHARGE R3714958 00591-3433-30 PAGANO IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 9 4.52 RX SOLUTION (RP:DUONEB 3 ML VIAL) 10/28/09 CHARGE R3714961 00169-3687-12 PAGANO LEVEMIR 100U/1ML VIAL-INSUL 10 70.94 RX 10/28/09 CHARGE R3714962 00185-0144-05 PAGANO AMIODARONE HCL 200MG TABLET 12 8.86 RX 10/28/09 CHARGE R3714981 50111-0459-01 PAGANO THEOPHYLLINE ER 300MG TAB.SR 12H (RP:THEO-DUR) 12 3.16 RX 10/29/09 CHARGE R3715237 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 11 29.70 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GAROFOLA, CHARLES 100 W MAGNOLIA AVE RESIDENT# : 433 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/29/09 CHARGE R3715239 00591-3433-30 PAGANO IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 90 45.17 RX SOLUTION (RP:DUONEB 3 ML VIAL) 10/29/09 CHARGE R3716275 00591-0658-05 PAGANO BUSPIRONE HCL 10MG TABLET (RP:BUSPAR) 22 2.88 RX


665.09


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GASNICK, MARJORIE 100 W MAGNOLIA AVE RESIDENT# : 76 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/26/09 CHARGE R3693448 51660-0526-28 TESTA LORATADINE 10MG TABLET 30 2.88 OTC 10/26/09 CHARGE R3693450 32131-0804-86 TESTA OPTI-MULTI CAPLET (RP:OCUVITE) 30 2.88 OTC


5.76


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GATES, RUTH 100 W MAGNOLIA AVE RESIDENT# : 405 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/05/09 CHARGE R3685137 00378-1650-01 TANK NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE 2 2.88 RX (RP:MACRODANTIN) 10/05/09 CHARGE R3684798 00185-0122-01 TANK NITROFURANTOIN MONOHYDRATE 100MG CAPSULE 14 19.61 RX (RP:MACROBID) 10/07/09 CHARGE R3687703 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/08/09 CHARGE R3688376 00406-0552-01 TANK OXYCODONE HCL IR 5MG TABLET 7 2.88 RX 10/08/09 CHARGE R3704648 58177-0324-04 TANK NITROQUICK SL 0.4MG TAB SUBL 100 5.75 RX 10/13/09 CHARGE R3693074 55111-0119-10 TANK FAMOTIDINE 20MG TABLET 28 4.20 RX 10/13/09 CHARGE R3693077 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) 14 3.58 RX 10/13/09 CHARGE R3693079 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 14 2.88 RX 10/13/09 CHARGE R3693083 00172-3758-60 TANK LISINOPRIL 5MG TABLET 14 2.88 RX 10/13/09 CHARGE R3693130 00378-1803-01 TANK LEVOTHYROXINE SODIUM 50MCG TABLET 14 3.68 RX 10/13/09 CHARGE R3694283 00406-0552-01 TANK OXYCODONE HCL IR 5MG TABLET 7 2.88 RX 10/13/09 CHARGE R3693076 00143-1201-01 TANK COLCHICINE 0.6MG TABLET 14 2.88 RX 10/13/09 CHARGE R3693084 62175-0128-37 TANK ISOSORBIDE MONONITRATE ER 30MG TABLET SA 14 4.77 RX (RP:IMDUR) 10/13/09 CHARGE R3693085 63653-1171-05 TANK PLAVIX 75MG TABLET 14 55.45 RX 10/14/09 CHARGE R3696009 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/19/09 CHARGE R3701349 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET 14 2.88 OTC


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GATES, RUTH 100 W MAGNOLIA AVE RESIDENT# : 405 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/23/09 CHARGE R3707620 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/26/09 CHARGE R3693892 55111-0119-10 TANK FAMOTIDINE 20MG TABLET 30 4.50 RX 10/26/09 CHARGE R3693894 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX 10/26/09 CHARGE R3693895 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693896 00172-3758-60 TANK LISINOPRIL 5MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693906 00378-1803-01 TANK LEVOTHYROXINE SODIUM 50MCG TABLET 15 3.95 RX 10/26/09 CHARGE R3709587 00406-0552-01 TANK OXYCODONE HCL IR 5MG TABLET 7 2.88 RX 10/26/09 CHARGE R3693893 00143-1201-01 TANK COLCHICINE 0.6MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693897 62175-0128-37 TANK ISOSORBIDE MONONITRATE ER 30MG TABLET SA 15 5.12 RX (RP:IMDUR) 10/26/09 CHARGE R3693898 63653-1171-05 TANK PLAVIX 75MG TABLET 15 59.41 RX 10/26/09 CHARGE R3706225 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET 30 2.88 OTC 10/29/09 CHARGE R3716288 00406-0512-05 TANK OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX


747.16


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GRECO, PETER 100 W MAGNOLIA AVE RESIDENT# : 428 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/15/09 CHARGE R3698611 16729-0006-17 GOLDFARB SIMVASTATIN 40MG TABLET (RP:ZOCOR) 11 2.88 RX 10/15/09 CHARGE R3698614 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 11 2.88 RX 10/15/09 CHARGE R3698617 00378-0032-10 GOLDFARB METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) 22 2.88 RX 10/15/09 CHARGE R3698619 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 22 3.30 RX 10/15/09 CHARGE R3698623 00536-3985-01 GOLDFARB MECLIZINE HCL 12.5MG TABLET (RP:ANTIVERT) 30 2.88 OTC 10/15/09 CHARGE R3698612 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 11 43.57 RX 10/15/09 CHARGE R3698622 00065-0266-25 GOLDFARB TRAVATAN 0.004% DROPS 2.5 58.41 RX 10/15/09 CHARGE R3698625 58177-0324-18 GOLDFARB NITROQUICK (25'S) 0.4MG TAB SUBL (RP:NITROSTAT 25 2.88 RX 4X25'S) 10/15/09 CHARGE R3698627 00169-7501-11 GOLDFARB NOVOLOG 100U/1ML INSULIN 10 76.45 RX 10/16/09 CHARGE R3699302 00258-3678-01 GOLDFARB BENZONATATE 200MG CAPSULE (RP:TESSALON PERLE) 21 5.17 RX 10/21/09 CHARGE R3706102 00574-2121-28 GOLDFARB AMMONIUM LACTATE 2X140GM 12% CREAM (RP:LAC-HYDRIN) 280 25.28 RX 10/26/09 CHARGE R3701189 16729-0006-17 GOLDFARB SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX 10/26/09 CHARGE R3701191 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/26/09 CHARGE R3701192 00378-0032-10 GOLDFARB METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) 30 2.88 RX 10/26/09 CHARGE R3701193 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 30 4.50 RX 10/26/09 CHARGE R3701190 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 15 59.41 RX


300.09


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB GUADAGNINO, ANTHONY 100 W MAGNOLIA AVE RESIDENT# : 395 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3653655 00007-3230-11 SCERBO ARIXTRA 2.5MG/0.5ML DISP SYRIN -4 -318.06 RX 09/17/09 RETURN R3653780 00054-0018-29 SCERBO PREDNISONE 20MG TABLET -21 -1.68 RX


-319.74


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB HEIDER, EVA 100 W MAGNOLIA AVE RESIDENT# : 40 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/26/09 CHARGE R3693726 51991-0203-11 PAGANO FERREX 150 150MG CAPSULE (RP:NIFEREX-150) 90 17.02 OTC


17.02


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB HOEPKER, ANN 100 W MAGNOLIA AVE RESIDENT# : 414 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/06/09 CHARGE R3686120 00406-2023-10 GOLDFARB ATENOLOL 50MG TABLET 6 2.88 RX 10/12/09 CHARGE R3688257 00406-2023-10 GOLDFARB ATENOLOL 50MG TABLET 15 2.88 RX


5.76


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB HOFFMAN, MARION 100 W MAGNOLIA AVE RESIDENT# : 315 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3649873 00075-0620-40 SILVERMAN LOVENOX 40MG/0.4ML DISP SYRIN -2 -118.14 RX


-118.14


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB HOMBERGER, IDA 100 W MAGNOLIA AVE RESIDENT# : 426 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/15/09 CHARGE R3698566 63736-0105-06 TANK BACID CAPLET 22 8.50 OTC 10/15/09 CHARGE R3698568 58177-0267-04 TANK DOXAZOSIN MESYLATE 2MG TABLET (RP:CARDURA) 11 6.51 RX 10/15/09 CHARGE R3698569 64679-0968-01 TANK BETHANECHOL CHLORIDE 50MG TABLET (RP:BETHANECOL) 33 64.58 RX 10/15/09 CHARGE R3698582 63481-0687-06 TANK LIDODERM 5% PATCH 30 151.63 RX 10/16/09 CHARGE R3699830 49884-0404-01 TANK METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) 5 3.62 RX 10/16/09 CHARGE R3699838 59676-0320-04 TANK PROCRIT 20MU/1ML VIAL 1 238.26 RX 10/19/09 CHARGE R3702271 00603-1378-59 TANK LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/20/09 CHARGE R3704150 00009-5190-01 TANK DETROL LA 2MG CAPSULE SA 12 37.83 RX 10/23/09 CHARGE R3707627 59676-0320-04 TANK PROCRIT 20MU/1ML VIAL 1 238.26 RX 10/25/09 CHARGE R3698583 00065-0266-25 TANK TRAVATAN 0.004% DROPS 2.5 58.41 RX 10/26/09 CHARGE R3701194 63736-0105-06 TANK BACID CAPLET 30 11.59 OTC 10/26/09 CHARGE R3701196 49884-0404-01 TANK METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) 7.5 5.43 RX 10/26/09 CHARGE R3706248 00009-5190-01 TANK DETROL LA 2MG CAPSULE SA 30 94.58 RX 10/29/09 CHARGE R3716551 00527-1324-10 TANK DIGOXIN 0.125MG TABLET 11 2.88 RX 10/31/09 CHARGE R3717855 59676-0320-04 TANK PROCRIT 20MU/1ML VIAL 1 238.26 RX


1181.15


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB HUGHES, MARY 100 W MAGNOLIA AVE RESIDENT# : 400 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/01/09 CHARGE R3680023 00406-0512-05 RENNER OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 15 3.51 RX 10/03/09 CHARGE R3682586 59676-0340-01 RENNER PROCRIT 40MU/1ML VIAL 1 476.52 RX 10/05/09 CHARGE R3683288 00406-0512-05 RENNER OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 15 3.51 RX 10/05/09 CHARGE R3682922 00075-0624-30 RENNER LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/09/09 CHARGE R3689833 59011-0100-10 RENNER OXYCONTIN 10MG TABLET SA 15 21.00 RX 10/09/09 CHARGE R3690028 59676-0340-01 RENNER PROCRIT 40MU/1ML VIAL 1 476.52 RX 10/12/09 CHARGE R3676646 60505-0093-00 RENNER DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) 4 2.88 RX 10/12/09 CHARGE R3676647 00378-0208-10 RENNER FUROSEMIDE 20MG TABLET (RP:LASIX) 4 2.88 RX 10/12/09 CHARGE R3676648 00245-0058-15 RENNER KLOR-CON M 20 20MEQ TABLET SA 4 2.88 RX 10/12/09 CHARGE R3676649 00378-0023-05 RENNER DILTIAZEM 30MG TABLET 12 2.88 RX 10/13/09 CHARGE R3694170 00075-0624-30 RENNER LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/14/09 CHARGE R3695921 00406-0512-05 RENNER OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 15 3.51 RX


1350.57


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB HUGHES, MARY 100 W MAGNOLIA AVE RESIDENT# : 400 MAYWOOD, NJ 07607 STATION : SUB STATUS : PRIVATE

10/16/09 CHARGE R3699960 63481-0687-06 RENNER LIDODERM 5% PATCH 30 151.63 RX 10/16/09 CHARGE R3699963 59011-0100-10 RENNER OXYCONTIN 10MG TABLET SA 15 21.00 RX 10/16/09 CHARGE R3676649 00378-0023-05 RENNER DILTIAZEM 30MG TABLET 33 3.37 RX 10/16/09 CHARGE R3676648 00245-0058-15 RENNER KLOR-CON M 20 20MEQ TABLET SA 11 5.09 RX 10/16/09 CHARGE R3676647 00378-0208-10 RENNER FUROSEMIDE 20MG TABLET (RP:LASIX) 11 0.62 RX 10/16/09 CHARGE R3676646 60505-0093-00 RENNER DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) 11 6.51 RX 10/19/09 CHARGE R3700842 00075-0624-30 RENNER LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/19/09 CHARGE R3700845 59676-0340-01 RENNER PROCRIT 40MU/1ML VIAL 1 476.52 RX 10/26/09 CHARGE R3694043 60505-0093-00 RENNER DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) 15 8.88 RX 10/26/09 CHARGE R3694044 00378-0208-10 RENNER FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/26/09 CHARGE R3694045 00245-0058-15 RENNER KLOR-CON M 20 20MEQ TABLET SA 15 6.95 RX 10/26/09 CHARGE R3694046 00378-0023-05 RENNER DILTIAZEM 30MG TABLET 45 4.59 RX 10/26/09 CHARGE R3709082 59676-0340-01 RENNER PROCRIT 40MU/1ML VIAL 1 476.52 RX 10/28/09 CHARGE R3713006 00075-0624-30 RENNER LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/29/09 CHARGE R3716210 00025-1525-51 RENNER CELEBREX 200MG CAPSULE 11 31.91 RX 10/30/09 CHARGE R3717117 00406-0512-05 RENNER OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX


1557.97


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB INGOGLIA, ROSE 100 W MAGNOLIA AVE RESIDENT# : 357 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/04/09 RETURN R3627766 00093-8344-10 TANK GLYBURIDE 5MG TABLET -21 -5.94 RX 09/10/09 RETURN R3609007 49884-0035-10 TANK MECLIZINE HCL 25MG TABLET -30 -7.95 RX 09/10/09 RETURN R3627760 00185-0144-05 TANK AMIODARONE HCL 200MG TABLET -10 -16.88 RX 09/10/09 RETURN R3633907 00456-2005-01 TANK LEXAPRO 5MG TABLET -10 -21.29 RX 09/10/09 RETURN R3627761 00078-0423-15 TANK DIOVAN 40MG TABLET -12 -17.56 RX 09/10/09 RETURN R3627763 00781-1599-05 TANK SPIRONOLACTONE 25MG TABLET -10 -3.00 RX 09/10/09 RETURN R3627762 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET -23 -1.66 RX 09/10/09 RETURN R3645703 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE -3 -3.01 RX 09/10/09 RETURN R3649045 51672-4030-03 TANK WARFARIN SODIUM 3MG TABLET -13 -7.60 RX 09/10/09 RETURN R3627767 00378-1805-01 TANK LEVOTHYROXINE SODIUM 75MCG TABLET -3 -0.87 RX 09/17/09 RETURN R3627765 57664-0397-58 TANK METFORMIN 500MG TABLET -22 -1.65 RX


-87.41


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB KING, EDYTHE 100 W MAGNOLIA AVE RESIDENT# : 179 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/14/09 CHARGE R3696387 00378-1813-01 TANK LEVOTHYROXINE SODIUM 125MCG TABLET (RP:SYNTHROID) 12 4.20 RX 10/14/09 CHARGE R3696391 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 12 2.88 RX 10/14/09 CHARGE R3696393 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 12 2.88 RX 10/14/09 CHARGE R3696399 67253-0900-11 TANK ALPRAZOLAM 0.25MG TABLET (RP:XANAX) 30 2.88 RX 10/14/09 CHARGE R3696394 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 24 2.88 OTC 10/14/09 CHARGE R3696389 63653-1171-05 TANK PLAVIX 75MG TABLET 12 47.53 RX 10/14/09 CHARGE R3696390 00008-0833-22 TANK EFFEXOR XR 75MG CAP.SR 24H 12 39.24 RX 10/14/09 CHARGE R3696392 49884-0405-01 TANK METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL 12 8.70 RX XL) 10/14/09 CHARGE R3696397 63481-0687-06 TANK LIDODERM 5% PATCH 15 75.81 RX 10/19/09 CHARGE R3701433 31722-0237-10 TANK AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) 7 2.88 RX 10/19/09 CHARGE R3701436 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/22/09 CHARGE R3707685 00008-0837-21 TANK EFFEXOR XR 37.5MG CAP.SR 24H 4 3.89 RX 10/23/09 CHARGE R3708342 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 10 27.23 RX SYRIN 10/26/09 CHARGE R3701178 00378-1813-01 TANK LEVOTHYROXINE SODIUM 125MCG TABLET (RP:SYNTHROID) 15 5.25 RX 10/26/09 CHARGE R3701181 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3701183 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 15 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB KING, EDYTHE 100 W MAGNOLIA AVE RESIDENT# : 179 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3706242 31722-0237-10 TANK AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3701179 63653-1171-05 TANK PLAVIX 75MG TABLET 15 59.41 RX 10/26/09 CHARGE R3701182 49884-0405-01 TANK METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL 15 10.87 RX XL) 10/26/09 CHARGE R3701184 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 30 2.88 OTC 10/26/09 CHARGE R3709521 00008-0837-21 TANK EFFEXOR XR 37.5MG CAP.SR 24H 15 14.59 RX 10/26/09 CHARGE R3709522 00008-0833-22 TANK EFFEXOR XR 75MG CAP.SR 24H 15 49.05 RX


385.57


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LANGOL, MARIE 100 W MAGNOLIA AVE RESIDENT# : 39 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/10/09 CHARGE R3690479 58768-0103-30 TESTA EYESCRUB LID CLEANSER PAD (RP:OCUSOFT LID SCRUB) 30 13.10 OTC 10/13/09 CHARGE R3693107 17478-0060-12 TESTA AKWA TEARS (ARTIFICIAL TEARS) DROPS 15 2.88 OTC


15.98


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LANOTTE, FRANK 100 W MAGNOLIA AVE RESIDENT# : 25 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/09/09 CHARGE R3690278 58768-0103-30 TESTA EYESCRUB LID CLEANSER PAD (RP:OCUSOFT LID SCRUB) 30 13.10 OTC


13.10


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LATTANZIO, LOUIS 100 W MAGNOLIA AVE RESIDENT# : 18 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/13/09 CHARGE R3694287 63736-0105-06 TESTA BACID CAPLET 20 7.72 OTC 10/16/09 CHARGE R3698682 00023-9205-15 TESTA REFRESH LIQUIGEL 1% DROPS 15 9.78 OTC


17.50


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LAZARUS, BERNICE 100 W MAGNOLIA AVE RESIDENT# : 35 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

10/13/09 CHARGE R3694410 31722-0239-10 GOLDFARB AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 13 2.88 RX 10/13/09 CHARGE R3694412 00245-0041-11 GOLDFARB KLOR-CON 10 (YELLOW) 10MEQ TABLET SA 13 3.30 RX 10/13/09 CHARGE R3694413 00603-1378-59 GOLDFARB LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/13/09 CHARGE R3694414 00603-4975-21 GOLDFARB OXYBUTYNIN 5MG TABLET (RP:DITROPAN) 39 6.44 RX 10/13/09 CHARGE R3694417 16252-0528-90 GOLDFARB PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) 13 4.63 RX 10/13/09 CHARGE R3694422 55111-0158-10 GOLDFARB OMEPRAZOLE 20MG CAPSULE DR 13 51.73 RX 10/13/09 CHARGE R3694424 16252-0097-22 GOLDFARB ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/13/09 CHARGE R3694428 51672-4032-03 GOLDFARB WARFARIN SODIUM 5MG TABLET 1 2.88 RX 10/13/09 CHARGE R3694586 00378-1803-01 GOLDFARB LEVOTHYROXINE SODIUM 50MCG TABLET 13 3.42 RX 10/13/09 CHARGE R3694416 00182-1576-26 GOLDFARB OYST-CAL 500MG TABLET (RP:OS-CAL 500) 13 2.88 OTC 10/13/09 CHARGE R3694427 63736-0105-06 GOLDFARB BACID CAPLET 14 5.41 OTC 10/13/09 CHARGE R3694411 00078-0360-34 GOLDFARB DIOVAN 320MG TABLET 13 30.93 RX 10/13/09 CHARGE R3694418 00023-9163-30 GOLDFARB RESTASIS 0.05% DROPERETTE 30 89.02 RX 10/13/09 CHARGE R3694420 66582-0414-54 GOLDFARB ZETIA 10MG TABLET 13 34.60 RX 10/13/09 CHARGE R3694426 63304-0582-01 GOLDFARB CEFADROXIL 500MG CAPSULE (RP:DURICEF) 14 39.92 RX 10/13/09 CHARGE R3694431 00064-5010-15 GOLDFARB SANTYL OINTMENT 30 85.21 RX 10/15/09 CHARGE R3697915 51672-4032-03 GOLDFARB WARFARIN SODIUM 5MG TABLET 2 2.88 RX 10/15/09 CHARGE R3697923 00075-0621-60 GOLDFARB LOVENOX 60MG/0.6ML DISP SYRIN 6 354.82 RX 10/16/09 CHARGE R3699013 00406-0512-05 GOLDFARB OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LAZARUS, BERNICE 100 W MAGNOLIA AVE RESIDENT# : 35 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

10/16/09 CHARGE R3699595 51672-4032-03 GOLDFARB WARFARIN SODIUM 5MG TABLET 7 4.13 RX 10/16/09 CHARGE R3699315 60505-0379-00 GOLDFARB CICLOPIROX 8% SOLUTION (RP:PENLAC) 6.6 117.18 RX 10/19/09 CHARGE R3702190 51672-4031-03 GOLDFARB WARFARIN SODIUM 4MG TABLET (RP:COUMADIN) 7 4.10 RX 10/19/09 CHARGE R3700797 00064-5010-15 GOLDFARB SANTYL OINTMENT 60 170.42 RX 10/22/09 CHARGE R3707404 00409-1952-32 GOLDFARB TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP 10 9.28 RX SYRIN 10/26/09 CHARGE R3701144 31722-0239-10 GOLDFARB AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 30 5.34 RX 10/26/09 CHARGE R3701146 00245-0041-11 GOLDFARB KLOR-CON 10 (YELLOW) 10MEQ TABLET SA 30 7.62 RX 10/26/09 CHARGE R3701147 00603-4975-21 GOLDFARB OXYBUTYNIN 5MG TABLET (RP:DITROPAN) 90 14.85 RX 10/26/09 CHARGE R3701149 16252-0528-90 GOLDFARB PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) 30 10.68 RX 10/26/09 CHARGE R3701151 55111-0158-10 GOLDFARB OMEPRAZOLE 20MG CAPSULE DR 30 119.37 RX 10/26/09 CHARGE R3701152 00378-1803-01 GOLDFARB LEVOTHYROXINE SODIUM 50MCG TABLET 30 7.89 RX 10/26/09 CHARGE R3710933 51672-4028-03 GOLDFARB WARFARIN SODIUM 2MG TABLET 2 2.88 RX 10/26/09 CHARGE R3701145 00078-0360-34 GOLDFARB DIOVAN 320MG TABLET 30 71.38 RX 10/26/09 CHARGE R3701148 00182-1576-26 GOLDFARB OYST-CAL 500MG TABLET (RP:OS-CAL 500) 30 2.88 OTC 10/26/09 CHARGE R3701150 66582-0414-54 GOLDFARB ZETIA 10MG TABLET 30 79.86 RX 10/28/09 CHARGE R3714788 51672-4028-03 GOLDFARB WARFARIN SODIUM 2MG TABLET 2 2.88 RX 10/30/09 CHARGE R3717244 51672-4030-03 GOLDFARB WARFARIN SODIUM 3MG TABLET 1.5 2.88 RX


1391.03


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LAZARUS, BERNICE 100 W MAGNOLIA AVE RESIDENT# : 35 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/01/09 CHARGE R3681046 63736-0105-06 GOLDFARB BACID CAPLET 20 10.63 OTC 10/07/09 CHARGE R3687657 17714-0020-01 GOLDFARB DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL) 30 2.88 OTC


13.51


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LEWICKA, MARY 100 W MAGNOLIA AVE RESIDENT# : 394 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3657049 51672-4031-03 TANK WARFARIN SODIUM 4MG TABLET -2 -1.17 RX 09/17/09 RETURN R3653576 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET (RP:COUMADIN) -3 -1.77 RX


-2.94


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LEWIS, LYNN 100 W MAGNOLIA AVE RESIDENT# : 354 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3627746 00310-0275-34 GOLDFARB SEROQUEL 25MG TABLET -12 -24.18 RX 09/10/09 RETURN R3627749 00002-3240-30 GOLDFARB CYMBALTA 30MG CAPSULE EC -9 -29.68 RX 09/10/09 RETURN R3627748 60505-2606-01 GOLDFARB CARVEDILOL 3.125MG TABLET (RP:COREG) -27 -3.86 RX 09/10/09 RETURN R3627747 00597-0058-01 GOLDFARB FLOMAX 0.4MG CAPSULE SA -11 -29.83 RX


-87.55


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LINDSAY, ELIZABETH 100 W MAGNOLIA AVE RESIDENT# : 379 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

10/01/09 CHARGE R3681231 63653-1171-05 TANK PLAVIX 75MG TABLET 11 45.55 RX 10/01/09 CHARGE R3681233 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 11 2.88 OTC 10/01/09 CHARGE R3681235 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 185.27 RX 10/01/09 CHARGE R3681242 00093-0051-01 TANK CARVEDILOL 3.125MG TABLET (RP:COREG) 22 3.15 RX 10/01/09 CHARGE R3681243 00115-4222-01 TANK MIDODRINE 5MG TABLET 33 60.65 RX 10/01/09 CHARGE R3681244 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE 2 2.88 RX 10/01/09 CHARGE R3681385 00172-3758-60 TANK LISINOPRIL 5MG TABLET 11 2.88 RX 10/10/09 CHARGE R3690879 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 4 2.88 OTC 10/12/09 CHARGE R3683292 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 3 2.88 OTC 10/12/09 CHARGE R3683293 00093-0051-01 TANK CARVEDILOL 3.125MG TABLET (RP:COREG) 6 2.88 RX 10/12/09 CHARGE R3683294 00172-3758-60 TANK LISINOPRIL 5MG TABLET 3 2.88 RX 10/12/09 CHARGE R3691454 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 6 2.88 OTC 10/12/09 CHARGE R3683291 63653-1171-05 TANK PLAVIX 75MG TABLET 3 11.88 RX


329.54


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LINQUITO, PHILOMENA 100 W MAGNOLIA AVE RESIDENT# : 69 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/06/09 CHARGE R3686063 17478-0060-12 TESTA AKWA TEARS (ARTIFICIAL TEARS) DROPS 15 2.88 OTC 10/26/09 CHARGE R3693488 00182-4141-26 TESTA CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 30 2.88 OTC


5.76


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LODICO, JOANNE 100 W MAGNOLIA AVE RESIDENT# : 270 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

10/24/09 CHARGE R3709116 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 2 2.88 RX 10/24/09 CHARGE R3709120 63736-0105-06 GOLDFARB BACID CAPLET 2 2.88 OTC 10/24/09 CHARGE R3709126 00228-2666-50 GOLDFARB GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) 6 2.88 RX 10/24/09 CHARGE R3709129 62175-0128-37 GOLDFARB ISOSORBIDE MONONITRATE ER 30MG TABLET SA 2 2.88 RX (RP:IMDUR) 10/24/09 CHARGE R3709131 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 2 2.88 RX 10/24/09 CHARGE R3709138 00093-7128-01 GOLDFARB TORSEMIDE 10MG TABLET 2 2.88 RX 10/24/09 CHARGE R3709151 00406-0512-05 GOLDFARB OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX 10/24/09 CHARGE R3709095 00169-7501-11 GOLDFARB NOVOLOG 100U/1ML INSULIN 10 76.45 RX 10/24/09 CHARGE R3709096 64764-0301-15 GOLDFARB ACTOS 30MG TABLET 2 11.12 RX 10/24/09 CHARGE R3709117 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/24/09 CHARGE R3709121 00781-6054-70 GOLDFARB DORZOLAMIDE HCL/TIMOLOL MALEATE 2%-0.5% DROPS 10 84.21 RX (RP:COSOPT OPHTH) 10/24/09 CHARGE R3709124 00006-0960-54 GOLDFARB COZAAR 100MG TABLET 2 4.49 RX 10/24/09 CHARGE R3709128 00228-2900-50 GOLDFARB GLIPIZIDE ER 10MG TABLET SA (RP:GLUCOTROL XL) 4 2.88 RX 10/24/09 CHARGE R3709134 00013-8303-04 GOLDFARB XALATAN 0.005% DROPS 2.5 56.84 RX 10/24/09 CHARGE R3709148 59011-0100-10 GOLDFARB OXYCONTIN 10MG TABLET SA 30 42.00 RX 10/24/09 CHARGE R3709171 00071-1013-68 GOLDFARB LYRICA 50MG CAPSULE 90 159.03 RX 10/26/09 CHARGE R3709473 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 30 3.87 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LODICO, JOANNE 100 W MAGNOLIA AVE RESIDENT# : 270 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

10/26/09 CHARGE R3709474 63736-0105-06 GOLDFARB BACID CAPLET 30 11.59 OTC 10/26/09 CHARGE R3709476 00228-2666-50 GOLDFARB GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) 90 11.16 RX 10/26/09 CHARGE R3709479 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 30 6.30 RX 10/26/09 CHARGE R3709480 00093-7128-01 GOLDFARB TORSEMIDE 10MG TABLET 30 14.40 RX 10/26/09 CHARGE R3710924 00603-1378-59 GOLDFARB LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/26/09 CHARGE R3709472 64764-0301-15 GOLDFARB ACTOS 30MG TABLET 30 166.90 RX 10/26/09 CHARGE R3709475 00006-0960-54 GOLDFARB COZAAR 100MG TABLET 30 67.33 RX 10/26/09 CHARGE R3709477 00228-2900-50 GOLDFARB GLIPIZIDE ER 10MG TABLET SA (RP:GLUCOTROL XL) 60 33.25 RX 10/26/09 CHARGE R3709478 62175-0128-37 GOLDFARB ISOSORBIDE MONONITRATE ER 30MG TABLET SA 30 10.22 RX (RP:IMDUR) 10/28/09 CHARGE R3714980 00168-0258-46 GOLDFARB CLOTRIMAZOLE/BETAMETHASONE DIPROP CREAM 45 37.04 RX (RP:LOTRISONE) 10/29/09 CHARGE R3716143 00406-0512-05 GOLDFARB OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX 10/31/09 CHARGE R3717766 00071-1013-68 GOLDFARB LYRICA 50MG CAPSULE 30 53.01 RX


1140.51


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LOMBARDI, ROSE 100 W MAGNOLIA AVE RESIDENT# : 54 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/05/09 CHARGE R3683304 00182-6151-40 TESTA VITAMIN LIQUID 480 7.25 OTC 10/14/09 CHARGE R3696403 63736-0105-06 TESTA BACID CAPLET 20 7.72 OTC


14.97


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LUTZ, RUTH 100 W MAGNOLIA AVE RESIDENT# : 412 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/06/09 CHARGE R3686154 00406-0552-01 TANK OXYCODONE HCL IR 5MG TABLET 15 3.60 RX 10/07/09 CHARGE R3686419 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/09/09 CHARGE R3690506 31722-0238-10 TANK AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 3 2.88 RX 10/09/09 CHARGE R3690508 00555-0720-51 TANK ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) 2 30.74 RX 10/09/09 CHARGE R3690496 00075-0621-60 TANK LOVENOX 60MG/0.6ML DISP SYRIN 6 354.82 RX 10/09/09 CHARGE R3690505 63481-0687-06 TANK LIDODERM 5% PATCH 15 75.81 RX 10/10/09 CHARGE R3690872 00172-3759-60 TANK LISINOPRIL 10MG TABLET 2 2.88 RX 10/11/09 CHARGE R3691098 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET 2 2.88 RX 10/12/09 CHARGE R3691451 31722-0238-10 TANK AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/12/09 CHARGE R3691452 00172-3759-60 TANK LISINOPRIL 10MG TABLET 15 2.88 RX 10/15/09 CHARGE R3698133 51672-4030-03 TANK WARFARIN SODIUM 3MG TABLET 3.5 2.88 RX 10/16/09 CHARGE R3699348 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 20 2.88 RX 10/19/09 CHARGE R3702251 51672-4028-03 TANK WARFARIN SODIUM 2MG TABLET 3 2.88 RX 10/19/09 CHARGE R3702252 00172-3760-60 TANK LISINOPRIL 20MG TABLET 7 2.88 RX 10/20/09 CHARGE R3703961 51672-4029-03 TANK WARFARIN SODIUM 2.5MG TABLET 7 4.07 RX 10/20/09 CHARGE R3704275 51672-4029-03 TANK WARFARIN SODIUM 2.5MG TABLET (RP:COUMADIN) 1 2.88 RX 10/20/09 CHARGE R3704105 00169-1833-11 TANK NOVOLIN R 100U/1ML VIAL-INSUL 10 33.87 RX 10/22/09 CHARGE R3706135 00555-0720-51 TANK ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) 2 30.74 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LUTZ, RUTH 100 W MAGNOLIA AVE RESIDENT# : 412 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/23/09 CHARGE R3708178 51672-4029-03 TANK WARFARIN SODIUM 2.5MG TABLET (RP:COUMADIN) 4 2.88 RX 10/23/09 CHARGE R3708592 63481-0687-06 TANK LIDODERM 5% PATCH 15 75.81 RX 10/26/09 CHARGE R3701171 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 30 2.88 RX 10/26/09 CHARGE R3706217 00172-3760-60 TANK LISINOPRIL 20MG TABLET 15 2.88 RX 10/30/09 CHARGE R3716992 51672-4029-03 TANK WARFARIN SODIUM 2.5MG TABLET 7 4.07 RX 10/30/09 CHARGE R3717045 55111-0126-05 TANK CIPROFLOXACIN 250MG TABLET (RP:CIPRO) 10 3.75 RX 10/30/09 CHARGE R3717050 63736-0105-06 TANK BACID CAPLET 14 5.41 OTC


673.74


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LYNCH, MARION 100 W MAGNOLIA AVE RESIDENT# : 435 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/30/09 CHARGE R3717377 00186-5040-54 GOLDFARB NEXIUM 40MG CAPSULE SA 10 42.57 RX 10/30/09 CHARGE R3717378 31722-0237-10 GOLDFARB AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) 10 2.88 RX 10/30/09 CHARGE R3717379 31722-0214-05 GOLDFARB SERTRALINE HCL 100MG TABLET (RP:ZOLOFT ) 20 2.88 RX 10/30/09 CHARGE R3717380 58177-0268-04 GOLDFARB DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) 10 6.21 RX 10/30/09 CHARGE R3717381 00486-1125-01 GOLDFARB K-PHOS NEUTRAL 250MG TABLET 12 2.88 RX 10/31/09 CHARGE R3717751 00029-1527-25 GOLDFARB BACTROBAN 2% CREAM 30 59.49 RX


116.91


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB LYONS, JOHN 100 W MAGNOLIA AVE RESIDENT# : 375 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3633789 00008-0607-01 TANK PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) -24 -64.81 RX 09/10/09 RETURN R3633786 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) -12 -2.52 RX 09/17/09 RETURN R3633788 00093-2210-05 TANK SUCRALFATE 1GM TABLET (RP:CARAFATE) -20 -7.38 RX 09/17/09 RETURN R3633788 00093-2210-05 TANK SUCRALFATE 1GM TABLET (RP:CARAFATE) -30 -11.07 RX


-85.78


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MAHER, MARGARET 100 W MAGNOLIA AVE RESIDENT# : 411 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3676539 00378-0208-10 GOLD FUROSEMIDE 20MG TABLET (RP:LASIX) 8 2.88 RX 10/12/09 CHARGE R3676540 00527-1324-10 GOLD DIGOXIN 0.125MG TABLET 15 3.20 RX 10/12/09 CHARGE R3676541 63304-0579-10 GOLD METOPROLOL TARTRATE 25MG TABLET 15 2.88 RX 10/12/09 CHARGE R3676542 60505-0065-01 GOLD OMEPRAZOLE 20MG CAPSULE DR (RP:OMEPRAZOLE) 30 119.37 RX 10/12/09 CHARGE R3676543 16729-0005-17 GOLD SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/12/09 CHARGE R3691834 00054-0018-29 GOLD PREDNISONE 20MG TABLET 10 2.88 RX 10/12/09 CHARGE R3691833 60505-2633-01 GOLD CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 15 2.88 OTC 10/15/09 CHARGE R3696914 55111-0119-10 GOLD FAMOTIDINE 20MG TABLET (RP:PEPCID) 22 3.30 RX 10/16/09 CHARGE R3699469 63736-0105-06 GOLD BACID CAPLET 14 5.41 OTC 10/16/09 CHARGE R3699473 55111-0126-05 GOLD CIPROFLOXACIN 250MG TABLET 14 5.25 RX 10/19/09 CHARGE R3702242 00168-0162-46 GOLD CLOBETASOL PROPIONATE 0.05% OINTMENT 45 8.73 RX 10/26/09 CHARGE R3693940 00378-0208-10 GOLD FUROSEMIDE 20MG TABLET (RP:LASIX) 8 2.88 RX 10/26/09 CHARGE R3693941 00527-1324-10 GOLD DIGOXIN 0.125MG TABLET 15 3.20 RX 10/26/09 CHARGE R3693942 63304-0579-10 GOLD METOPROLOL TARTRATE 25MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693944 16729-0005-17 GOLD SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3701174 55111-0119-10 GOLD FAMOTIDINE 20MG TABLET (RP:PEPCID) 30 4.50 RX 10/26/09 CHARGE R3693945 60505-2633-01 GOLD CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) 15 2.88 OTC


179.42


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MALATINO, CARMELA 100 W MAGNOLIA AVE RESIDENT# : 360 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

09/10/09 RETURN R3643590 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) -9 -1.16 RX 09/10/09 RETURN R3643597 00006-0747-54 GOLDFARB HYZAAR 100MG-25MG TABLET -8 -19.85 RX 09/17/09 RETURN R3627771 00002-3240-30 GOLDFARB CYMBALTA 30MG CAPSULE EC -1 -3.30 RX 09/17/09 RETURN R3627770 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET -1 -3.81 RX 09/17/09 RETURN R3627769 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) -2 -0.30 RX 09/17/09 RETURN R3627769 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) -2 -0.30 RX 09/17/09 RETURN R3627768 16729-0006-17 GOLDFARB SIMVASTATIN 40MG TABLET (RP:ZOCOR) -3 -0.77 RX 09/17/09 RETURN R3652148 31722-0237-10 GOLDFARB AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) -6 -0.77 RX 09/17/09 RETURN R3643594 00228-2128-50 GOLDFARB CLONIDINE 0.2MG TABLET -25 -3.53 RX 09/17/09 RETURN R3643594 00228-2128-50 GOLDFARB CLONIDINE 0.2MG TABLET -15 -2.12 RX 10/26/09 CHARGE R3711222 16729-0006-17 GOLDFARB SIMVASTATIN 40MG TABLET (RP:ZOCOR) 30 7.68 RX 10/26/09 CHARGE R3711226 00904-3232-92 GOLDFARB CALCIUM CARBONATE 600MG TABLET 30 2.88 OTC 10/26/09 CHARGE R3711228 00115-4222-01 GOLDFARB MIDODRINE 5MG TABLET (RP:PRO-AMATINE) 60 110.28 RX 10/26/09 CHARGE R3711230 55111-0127-05 GOLDFARB CIPROFLOXACIN 500MG TABLET 10 4.50 RX 10/26/09 CHARGE R3711232 00093-0051-01 GOLDFARB CARVEDILOL 3.125MG TABLET (RP:COREG) 60 8.58 RX 10/26/09 CHARGE R3711233 00574-2008-30 GOLDFARB NYSTATIN 100000U/1GM POWDER 30 52.44 RX 10/26/09 CHARGE R3711223 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 30 118.82 RX 10/26/09 CHARGE R3711225 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/26/09 CHARGE R3711227 00078-0359-34 GOLDFARB DIOVAN 160MG TABLET 30 56.42 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MALATINO, CARMELA 100 W MAGNOLIA AVE RESIDENT# : 360 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

10/26/09 CHARGE R3711229 00002-3237-30 GOLDFARB CYMBALTA 60MG CAPSULE EC 30 98.92 RX 10/28/09 CHARGE R3714585 00002-3240-30 GOLDFARB CYMBALTA 30MG CAPSULE EC 5 16.49 RX 10/28/09 CHARGE R3714592 00456-2005-01 GOLDFARB LEXAPRO 5MG TABLET 5 10.65 RX 10/29/09 CHARGE R3716303 00228-2888-50 GOLDFARB ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) 30 2.88 RX


690.92


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MANZETTI, JEAN 100 W MAGNOLIA AVE RESIDENT# : 420 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/07/09 CHARGE R3688042 00378-1140-01 GOLDFARB BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) 5 2.88 RX 10/07/09 CHARGE R3688047 00603-1378-59 GOLDFARB LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/07/09 CHARGE R3688048 00378-1803-01 GOLDFARB LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) 5 2.88 RX 10/07/09 CHARGE R3688052 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 5 2.88 RX 10/07/09 CHARGE R3688053 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 5 2.88 RX 10/07/09 CHARGE R3688054 50111-0433-01 GOLDFARB TRAZODONE 50MG TABLET 5 2.88 RX 10/07/09 CHARGE R3688056 00406-0512-05 GOLDFARB OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX 10/07/09 CHARGE R3688071 00781-1599-05 GOLDFARB SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) 5 2.88 RX 10/07/09 CHARGE R3688236 00378-1650-01 GOLDFARB NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE 2 2.88 RX (RP:MACRODANTIN) 10/07/09 CHARGE R3688045 64455-0799-42 GOLDFARB CARDIZEM CD 360MG CAPSULE SA 5 26.04 RX 10/07/09 CHARGE R3688046 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/07/09 CHARGE R3688049 00006-0951-54 GOLDFARB COZAAR 25MG TABLET 5 6.43 RX 10/07/09 CHARGE R3688050 60258-0173-06 GOLDFARB MAG-SR 64MG TABLET SA 60 5.49 OTC 10/07/09 CHARGE R3688051 00185-0122-01 GOLDFARB NITROFURANTOIN MONOHYDRATE 100MG CAPSULE 14 19.61 RX (RP:MACROBID) 10/11/09 CHARGE R3691159 63736-0105-06 GOLDFARB BACID CAPLET 6 2.88 OTC 10/12/09 CHARGE R3688268 00378-1140-01 GOLDFARB BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) 15 2.88 RX 10/12/09 CHARGE R3688270 00378-1803-01 GOLDFARB LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) 15 3.95 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MANZETTI, JEAN 100 W MAGNOLIA AVE RESIDENT# : 420 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3688272 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 15 3.81 RX 10/12/09 CHARGE R3688273 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/12/09 CHARGE R3688274 50111-0433-01 GOLDFARB TRAZODONE 50MG TABLET 15 2.88 RX 10/12/09 CHARGE R3688275 00781-1599-05 GOLDFARB SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) 15 4.50 RX 10/12/09 CHARGE R3688269 64455-0799-42 GOLDFARB CARDIZEM CD 360MG CAPSULE SA 15 78.11 RX 10/12/09 CHARGE R3688271 00006-0951-54 GOLDFARB COZAAR 25MG TABLET 15 19.28 RX 10/13/09 CHARGE R3694127 00228-2888-50 GOLDFARB ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) 15 2.88 RX 10/16/09 CHARGE R3699387 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/23/09 CHARGE R3708354 00406-0512-05 GOLDFARB OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 30 7.02 RX 10/26/09 CHARGE R3694005 00378-1140-01 GOLDFARB BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) 15 2.88 RX 10/26/09 CHARGE R3694007 00378-1803-01 GOLDFARB LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) 15 3.95 RX 10/26/09 CHARGE R3694009 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 15 3.81 RX 10/26/09 CHARGE R3694010 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3694011 50111-0433-01 GOLDFARB TRAZODONE 50MG TABLET 15 2.88 RX 10/26/09 CHARGE R3694012 00781-1599-05 GOLDFARB SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) 15 4.50 RX 10/26/09 CHARGE R3694006 64455-0799-42 GOLDFARB CARDIZEM CD 360MG CAPSULE SA 15 78.11 RX 10/26/09 CHARGE R3694008 00006-0951-54 GOLDFARB COZAAR 25MG TABLET 15 19.28 RX


828.04


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MARION, ANNE 100 W MAGNOLIA AVE RESIDENT# : 424 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3693000 74312-0871-90 PAGANO ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) 1 2.88 OTC 10/12/09 CHARGE R3693004 32131-0804-86 PAGANO OPTI-MULTI CAPLET (RP:OCUVITE) 1 2.88 OTC 10/12/09 CHARGE R3693005 00781-1228-10 PAGANO METOPROLOL TARTRATE 100MG TABLET 2 2.88 RX 10/12/09 CHARGE R3693007 31722-0239-10 PAGANO AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 1 2.88 RX 10/12/09 CHARGE R3693008 58177-0268-04 PAGANO DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) 1 2.88 RX 10/12/09 CHARGE R3693002 62856-0245-90 PAGANO ARICEPT 5MG TABLET 1 5.14 RX 10/12/09 CHARGE R3693003 00173-0696-00 PAGANO ADVAIR DISKUS 250MCG/50MCG INHALER 60 157.07 RX 10/12/09 CHARGE R3693006 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 1 2.88 RX 10/13/09 CHARGE R3693094 58177-0268-04 PAGANO DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) 14 8.69 RX 10/13/09 CHARGE R3693097 00781-1228-10 PAGANO METOPROLOL TARTRATE 100MG TABLET 28 2.88 RX 10/13/09 CHARGE R3693099 31722-0239-10 PAGANO AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 14 2.88 RX 10/13/09 CHARGE R3693092 74312-0871-90 PAGANO ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) 14 2.88 OTC 10/13/09 CHARGE R3693096 32131-0804-86 PAGANO OPTI-MULTI CAPLET (RP:OCUVITE) 14 2.88 OTC 10/13/09 CHARGE R3693095 62856-0245-90 PAGANO ARICEPT 5MG TABLET 14 71.88 RX 10/13/09 CHARGE R3693098 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 14 37.81 RX 10/26/09 CHARGE R3693900 58177-0268-04 PAGANO DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) 15 9.32 RX 10/26/09 CHARGE R3693903 00781-1228-10 PAGANO METOPROLOL TARTRATE 100MG TABLET 30 2.88 RX 10/26/09 CHARGE R3693905 31722-0239-10 PAGANO AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3693899 74312-0871-90 PAGANO ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) 15 2.88 OTC


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MARION, ANNE 100 W MAGNOLIA AVE RESIDENT# : 424 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3693901 62856-0245-90 PAGANO ARICEPT 5MG TABLET 15 77.01 RX 10/26/09 CHARGE R3693902 32131-0804-86 PAGANO OPTI-MULTI CAPLET (RP:OCUVITE) 15 2.88 OTC 10/26/09 CHARGE R3693904 00008-0607-01 PAGANO PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) 15 40.50 RX 10/29/09 CHARGE R3716296 00078-0359-34 PAGANO DIOVAN 160MG TABLET 11 20.69 RX


468.43


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MATTHEWS, CELIA 100 W MAGNOLIA AVE RESIDENT# : 22 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/26/09 CHARGE R3693634 51660-0526-28 TESTA LORATADINE 10MG TABLET (RP:CLARITIN) 30 2.88 OTC


2.88


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MILLINGTON, HENRIETTA 100 W MAGNOLIA AVE RESIDENT# : 418 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/04/09 CHARGE R3682980 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) 1 2.88 RX 10/05/09 CHARGE R3682894 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 7 2.88 RX 10/05/09 CHARGE R3682895 00406-2023-10 TANK ATENOLOL 50MG TABLET 7 2.88 RX 10/05/09 CHARGE R3682896 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 7 2.88 RX 10/05/09 CHARGE R3682900 00228-2888-50 TANK ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) 15 2.88 RX 10/05/09 CHARGE R3682901 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/05/09 CHARGE R3682902 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/05/09 CHARGE R3682903 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET 1 2.88 RX 10/05/09 CHARGE R3682904 00406-0512-05 TANK OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 15 3.51 RX 10/05/09 CHARGE R3685014 00406-0552-01 TANK OXYCODONE HCL IR 5MG TABLET 15 3.60 RX 10/05/09 CHARGE R3682897 00228-2578-50 TANK DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) 7 9.38 RX 10/06/09 CHARGE R3686297 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET 7 3.78 RX 10/09/09 CHARGE R3690246 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 3 2.88 OTC 10/09/09 CHARGE R3690250 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 6 2.88 OTC 10/09/09 CHARGE R3690247 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE 2 2.88 RX 10/12/09 CHARGE R3683308 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3683309 00406-2023-10 TANK ATENOLOL 50MG TABLET 15 2.88 RX 10/12/09 CHARGE R3683310 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX


10/31/09 Invoice# PH61821


10/12/09 CHARGE R3691461 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 15 2.88 OTC 10/12/09 CHARGE R3683311 00228-2578-50 TANK DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) 15 20.09 RX 10/12/09 CHARGE R3691462 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 30 2.88 OTC 10/14/09 CHARGE R3696011 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/14/09 CHARGE R3696012 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/14/09 CHARGE R3696180 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET 2 2.88 RX 10/14/09 CHARGE R3696184 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN 0.8 47.26 RX 10/16/09 CHARGE R3699610 51672-4029-03 TANK WARFARIN SODIUM 2.5MG TABLET 3 2.88 RX 10/19/09 CHARGE R3702258 51672-4029-03 TANK WARFARIN SODIUM 2.5MG TABLET 3 2.88 RX 10/19/09 CHARGE R3702259 00172-3758-60 TANK LISINOPRIL 5MG TABLET 7 2.88 RX 10/22/09 CHARGE R3707491 51672-4029-03 TANK WARFARIN SODIUM 2.5MG TABLET 5 2.91 RX 10/26/09 CHARGE R3693974 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/26/09 CHARGE R3693975 00406-2023-10 TANK ATENOLOL 50MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693976 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3706243 00172-3758-60 TANK LISINOPRIL 5MG TABLET 15 2.88 RX 10/26/09 CHARGE R3709610 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/26/09 CHARGE R3693977 00228-2578-50 TANK DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) 15 20.09 RX 10/26/09 CHARGE R3693978 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 15 2.88 OTC


10/31/09 Invoice# PH61821


10/26/09 CHARGE R3693979 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 30 2.88 OTC 10/26/09 CHARGE R3711183 17714-0019-01 TANK SIMETHICONE 80MG TAB CHEW 100 2.88 OTC 10/26/09 CHARGE R3711212 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN 0.8 47.26 RX 10/27/09 CHARGE R3712783 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET 1 2.88 RX 10/27/09 CHARGE R3712794 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/30/09 CHARGE R3717012 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET 14 8.26 RX


458.19


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MORAVICK, THERESA 100 W MAGNOLIA AVE RESIDENT# : 221 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/22/09 CHARGE R3707672 00185-0144-05 TANK AMIODARONE HCL 200MG TABLET 2 2.88 RX 10/22/09 CHARGE R3707674 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 4 2.88 OTC 10/22/09 CHARGE R3707679 57664-0397-58 TANK METFORMIN 500MG TABLET 8 2.88 RX 10/22/09 CHARGE R3707681 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 4 2.88 RX 10/22/09 CHARGE R3707684 65862-0143-01 TANK CARVEDILOL 6.25MG TABLET (RP:COREG) 8 2.88 RX 10/22/09 CHARGE R3707666 00310-0275-34 TANK SEROQUEL 25MG TABLET 2 4.03 RX 10/22/09 CHARGE R3707670 00169-1833-11 TANK NOVOLIN R 100U/1ML VIAL-INSUL 10 33.87 RX 10/22/09 CHARGE R3707689 60258-0006-01 TANK PHOS-NAK PACKET 30 8.00 OTC 10/22/09 CHARGE R3707889 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/26/09 CHARGE R3709510 00185-0144-05 TANK AMIODARONE HCL 200MG TABLET 8 5.90 RX 10/26/09 CHARGE R3709511 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 15 2.88 OTC 10/26/09 CHARGE R3709512 57664-0397-58 TANK METFORMIN 500MG TABLET 30 2.88 RX 10/26/09 CHARGE R3709513 16729-0005-17 TANK SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3709514 65862-0143-01 TANK CARVEDILOL 6.25MG TABLET (RP:COREG) 30 4.29 RX 10/26/09 CHARGE R3709509 00310-0275-34 TANK SEROQUEL 25MG TABLET 7.5 15.12 RX 10/30/09 CHARGE R3717126 00378-1800-01 TANK LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) 5 2.88 RX


274.64


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB MUTTEL, JOHN 100 W MAGNOLIA AVE RESIDENT# : 390 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3676449 00378-0181-01 TESTA ALLOPURINOL 300MG TABLET (RP:ALLOPURINOL) 15 2.88 RX 10/12/09 CHARGE R3676450 16729-0006-17 TESTA SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX 10/12/09 CHARGE R3676451 00378-1815-01 TESTA LEVOTHYROXINE SODIUM 150MCG TABLET 15 5.40 RX 10/12/09 CHARGE R3676453 00527-1325-10 TESTA DIGOXIN 0.25MG TABLET 15 3.20 RX 10/12/09 CHARGE R3676448 00597-0058-01 TESTA FLOMAX 0.4MG CAPSULE SA 15 44.34 RX 10/12/09 CHARGE R3676452 64764-0541-30 TESTA PREVACID 15MG CAPSULE DR 15 64.95 RX


124.61


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB NAPOLITANO, CONNIE 100 W MAGNOLIA AVE RESIDENT# : 79 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/08/09 CHARGE R3684668 00023-4554-30 RENNER CELLUVISC OPHTH 1% DROPS 30 13.25 OTC 10/19/09 CHARGE R3700818 00023-4554-30 RENNER CELLUVISC OPHTH 1% DROPS 30 13.25 OTC


26.50


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB NICCOLI, MARIE 100 W MAGNOLIA AVE RESIDENT# : 67 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/06/09 CHARGE R3686065 00023-0667-04 TESTA REFRESH PM OPHTH OINT 3.5 10.44 OTC 10/07/09 CHARGE R3687730 00023-9205-15 TESTA REFRESH LIQUIGEL 1% DROPS 15 9.78 OTC


20.22


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PANNY, ANNIE 100 W MAGNOLIA AVE RESIDENT# : 372 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3644253 00172-3760-60 SHERMAN LISINOPRIL 20MG TABLET -25 -2.00 RX 09/17/09 RETURN R3650591 00536-3985-01 SHERMAN MECLIZINE HCL 12.5MG TABLET -25 -1.50 OTC 09/17/09 RETURN R3644252 16729-0005-17 SHERMAN SIMVASTATIN 20MG TABLET (RP:ZOCOR) -13 -2.73 RX


-6.23


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PETRASEK, GLORIA 100 W MAGNOLIA AVE RESIDENT# : 329 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/02/09 RETURN R3627807 00172-3758-60 TANK LISINOPRIL 5MG TABLET -15 -0.72 RX 09/10/09 RETURN R3642654 00555-0607-02 TANK MEGESTROL ACETATE 40MG TABLET (RP:MEGACE) -16 -10.82 RX 09/10/09 RETURN R3642654 00555-0607-02 TANK MEGESTROL ACETATE 40MG TABLET (RP:MEGACE) -30 -20.28 RX 09/10/09 RETURN R3627809 63213-1523-10 TANK VITAMIN C 250MG TABLET -15 -0.25 OTC 09/10/09 RETURN R3627812 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET -30 -2.16 RX 09/10/09 RETURN R3627809 63213-1523-10 TANK VITAMIN C 250MG TABLET -20 -0.33 OTC 09/17/09 RETURN R3627811 63736-0105-06 TANK BACID CAPLET -24 -12.35 OTC 09/17/09 RETURN R3627810 79649-9031-06 TANK GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE -30 -10.46 OTC 09/17/09 RETURN R3627810 79649-9031-06 TANK GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE -20 -6.98 OTC 09/17/09 RETURN R3627805 59366-2819-02 TANK DEMECLOCYCLINE 150MG TABLET (RP:DECLOMYCIN) -11 -104.45 RX 09/17/09 RETURN R3627808 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET -18 -0.71 OTC 09/17/09 RETURN R3627808 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET -30 -1.19 OTC 09/17/09 RETURN R3600500 63481-0687-06 TANK LIDODERM 5% PATCH -30 -151.63 RX 09/17/09 RETURN R3627812 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET -7 -0.50 RX 09/17/09 RETURN R3645012 68180-0512-02 TANK LISINOPRIL 2.5MG TABLET -11 -0.41 RX


-323.24


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PETRULLO, KAY 100 W MAGNOLIA AVE RESIDENT# : 403 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/01/09 CHARGE R3679903 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 4 247.02 RX 10/05/09 CHARGE R3683270 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 7 2.88 RX 10/05/09 CHARGE R3683272 60505-0093-00 GOLDFARB DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) 7 4.14 RX 10/07/09 CHARGE R3688072 45802-0112-22 GOLDFARB MUPIROCIN 2% OINTMENT (RP:BACTROBAN) 22 41.45 RX 10/12/09 CHARGE R3676624 00406-2023-10 GOLDFARB ATENOLOL 50MG TABLET 15 2.88 RX 10/12/09 CHARGE R3676627 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 15 2.88 RX 10/12/09 CHARGE R3676628 00378-1803-01 GOLDFARB LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) 15 3.95 RX 10/12/09 CHARGE R3676629 00591-0409-01 GOLDFARB LISINOPRIL 40MG TABLET 15 2.88 RX 10/12/09 CHARGE R3688254 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/12/09 CHARGE R3688255 60505-0093-00 GOLDFARB DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) 15 8.88 RX 10/12/09 CHARGE R3676625 00025-1525-51 GOLDFARB CELEBREX 200MG CAPSULE 15 43.52 RX 10/12/09 CHARGE R3676630 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 15 59.41 RX 10/22/09 CHARGE R3706150 65162-0627-50 GOLDFARB TRAMADOL 50MG TABLET (RP:ULTRAM) 30 2.88 RX 10/22/09 CHARGE R3706153 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/24/09 CHARGE R3708924 00378-1805-01 GOLDFARB LEVOTHYROXINE SODIUM 75MCG TABLET 2 2.88 RX 10/26/09 CHARGE R3693867 00406-2023-10 GOLDFARB ATENOLOL 50MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693869 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 15 2.88 RX 10/26/09 CHARGE R3693871 00591-0409-01 GOLDFARB LISINOPRIL 40MG TABLET 15 2.88 RX 10/26/09 CHARGE R3693873 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PETRULLO, KAY 100 W MAGNOLIA AVE RESIDENT# : 403 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3693874 60505-0093-00 GOLDFARB DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) 15 8.88 RX 10/26/09 CHARGE R3709498 00378-1805-01 GOLDFARB LEVOTHYROXINE SODIUM 75MCG TABLET 15 4.37 RX 10/26/09 CHARGE R3693868 00025-1525-51 GOLDFARB CELEBREX 200MG CAPSULE 15 43.52 RX 10/26/09 CHARGE R3693872 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 15 59.41 RX


792.52


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PIETROWITZ, EDWARD 100 W MAGNOLIA AVE RESIDENT# : 422 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3691311 00378-1800-01 GOLDFARB LEVOTHYROXINE SODIUM 25MCG TABLET 15 3.48 RX 10/12/09 CHARGE R3691320 59366-2819-02 GOLDFARB DEMECLOCYCLINE 150MG TABLET (RP:DECLOMYCIN) 4 37.98 RX 10/12/09 CHARGE R3691640 24208-0324-05 GOLDFARB TIMOLOL MALEATE OPHTH 0.5% DROPS 5 4.50 RX 10/12/09 CHARGE R3692592 68180-0512-02 GOLDFARB LISINOPRIL 2.5MG TABLET 15 2.88 RX 10/12/09 CHARGE R3691308 00597-0058-01 GOLDFARB FLOMAX 0.4MG CAPSULE SA 15 44.34 RX 10/12/09 CHARGE R3691310 00456-3210-60 GOLDFARB NAMENDA 10MG TABLET 30 68.43 RX 10/12/09 CHARGE R3691315 00013-8303-04 GOLDFARB XALATAN 0.005% DROPS 2.5 56.84 RX 10/12/09 CHARGE R3692552 62856-0246-90 GOLDFARB ARICEPT 10MG TABLET 15 77.01 RX 10/21/09 CHARGE R3705830 00258-3678-01 GOLDFARB BENZONATATE 200MG CAPSULE (RP:TESSALON PERLE) 21 5.17 RX 10/26/09 CHARGE R3694049 00378-1800-01 GOLDFARB LEVOTHYROXINE SODIUM 25MCG TABLET 15 3.48 RX 10/26/09 CHARGE R3694051 68180-0512-02 GOLDFARB LISINOPRIL 2.5MG TABLET 15 2.88 RX 10/26/09 CHARGE R3694047 00597-0058-01 GOLDFARB FLOMAX 0.4MG CAPSULE SA 15 44.34 RX 10/26/09 CHARGE R3694048 00456-3210-60 GOLDFARB NAMENDA 10MG TABLET 30 68.43 RX 10/26/09 CHARGE R3694050 62856-0246-90 GOLDFARB ARICEPT 10MG TABLET 15 77.01 RX 10/28/09 CHARGE R3713918 00378-1803-01 GOLDFARB LEVOTHYROXINE SODIUM 50MCG TABLET 12 3.16 RX 10/31/09 CHARGE R3717728 59366-2819-02 GOLDFARB DEMECLOCYCLINE 150MG TABLET 18 170.91 RX


670.84


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PRUZINSKY, MARIE 100 W MAGNOLIA AVE RESIDENT# : 90 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/07/09 CHARGE R3687732 00023-0667-04 SCERBO REFRESH PM OPHTH OINT 3.5 10.44 OTC 10/09/09 CHARGE R3689533 00023-0798-15 SCERBO REFRESH TEARS OPHTH DROPS 15 9.78 OTC


20.22


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PUGLISI, VINCENT 100 W MAGNOLIA AVE RESIDENT# : 294 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/21/09 CHARGE R3705966 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) 5 2.88 RX 10/21/09 CHARGE R3705975 00378-6173-01 TANK METOLAZONE 5MG TABLET (RP:ZAROXOLYN) 5 5.34 RX 10/21/09 CHARGE R3705976 00245-0057-10 TANK KLOR-CON M 10 10MEQ TABLET SA 10 2.88 RX 10/21/09 CHARGE R3705977 00781-5224-01 TANK CARVEDILOL 25MG TABLET (RP:COREG) 10 2.88 RX 10/21/09 CHARGE R3705979 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 10 2.88 RX 10/21/09 CHARGE R3705965 00169-0081-81 TANK PRANDIN 0.5MG TABLET 10 14.67 RX 10/21/09 CHARGE R3705968 00173-0697-00 TANK ADVAIR DISKUS 500MCG/50MCG INHALER 60 206.59 RX 10/21/09 CHARGE R3705969 00006-0951-54 TANK COZAAR 25MG TABLET 5 6.43 RX 10/21/09 CHARGE R3705970 00781-6054-70 TANK DORZOLAMIDE HCL/TIMOLOL MALEATE 2%-0.5% DROPS 10 84.21 RX (RP:COSOPT OPHTH) 10/21/09 CHARGE R3705972 00228-2588-50 TANK DILTIAZEM CD 120MG CAP.SR 24H (RP:CARDIZEM CD) 5 3.92 RX 10/21/09 CHARGE R3705973 00173-0712-04 TANK AVODART 0.5MG CAPSULE 5 13.31 RX 10/21/09 CHARGE R3705974 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE 2 2.88 RX 10/21/09 CHARGE R3705980 00169-1833-11 TANK NOVOLIN R 100U/1ML VIAL-INSUL 10 33.87 RX 10/22/09 CHARGE R3707816 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET 2 2.88 RX 10/22/09 CHARGE R3707817 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA 1 2.88 RX 10/22/09 CHARGE R3707818 00245-0057-10 TANK KLOR-CON M 10 10MEQ TABLET SA 1 2.88 RX 10/23/09 CHARGE R3707932 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET 1 2.88 RX 10/23/09 CHARGE R3708490 00378-0023-05 TANK DILTIAZEM 30MG TABLET 9 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PUGLISI, VINCENT 100 W MAGNOLIA AVE RESIDENT# : 294 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/23/09 CHARGE R3708535 57664-0434-88 TANK ALLOPURINOL 100MG TABLET 3 2.88 RX 10/24/09 CHARGE R3709073 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET 5 2.95 RX 10/26/09 CHARGE R3706234 16729-0006-17 TANK SIMVASTATIN 40MG TABLET (RP:ZOCOR) 15 3.84 RX 10/26/09 CHARGE R3706238 00378-6173-01 TANK METOLAZONE 5MG TABLET (RP:ZAROXOLYN) 15 16.02 RX 10/26/09 CHARGE R3706239 00245-0057-10 TANK KLOR-CON M 10 10MEQ TABLET SA 30 7.62 RX 10/26/09 CHARGE R3706240 00781-5224-01 TANK CARVEDILOL 25MG TABLET (RP:COREG) 30 4.29 RX 10/26/09 CHARGE R3706241 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 30 2.88 RX 10/26/09 CHARGE R3709507 00378-0023-05 TANK DILTIAZEM 30MG TABLET 45 4.59 RX 10/26/09 CHARGE R3709508 57664-0434-88 TANK ALLOPURINOL 100MG TABLET 15 2.88 RX 10/26/09 CHARGE R3706233 00169-0081-81 TANK PRANDIN 0.5MG TABLET 30 44.01 RX 10/26/09 CHARGE R3706235 00006-0951-54 TANK COZAAR 25MG TABLET 15 19.28 RX 10/26/09 CHARGE R3706237 00173-0712-04 TANK AVODART 0.5MG CAPSULE 15 39.92 RX 10/26/09 CHARGE R3711193 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET 30 2.88 OTC 10/29/09 CHARGE R3716381 51672-4032-03 TANK WARFARIN SODIUM 5MG TABLET 7 4.13 RX


555.31


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PUZZO, MARY 100 W MAGNOLIA AVE RESIDENT# : 85 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/12/09 CHARGE R3691479 00182-6135-77 PAGANO NASAL 0.65% SPRAY (RP:OCEAN NASAL) 45 2.88 OTC 10/26/09 CHARGE R3693540 00486-1125-01 PAGANO K-PHOS NEUTRAL 250MG TABLET 90 14.23 RX 10/26/09 CHARGE R3693543 00904-5062-60 PAGANO CALCIUM CITRATE 200MG TABLET 60 2.88 OTC


19.99


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB PYRYT, THERESA 100 W MAGNOLIA AVE RESIDENT# : 66 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/06/09 CHARGE R3686060 00023-0798-15 SILVERMAN REFRESH TEARS OPHTH DROPS 15 9.78 OTC


9.78


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB REO, ANTOINETTE 100 W MAGNOLIA AVE RESIDENT# : 73 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/26/09 CHARGE R3693468 30768-0006-01 PAGANO VITAMIN B COMPLEX TABLET 30 2.88 OTC


2.88


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB REVILLA, MARIA 100 W MAGNOLIA AVE RESIDENT# : 381 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3642638 00527-1325-10 TANK DIGOXIN 0.25MG TABLET -4 -0.85 RX 09/17/09 RETURN R3642638 00527-1325-10 TANK DIGOXIN 0.25MG TABLET -7 -1.49 RX


-2.34


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB RIEDEL, LAURA 100 W MAGNOLIA AVE RESIDENT# : 371 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/02/09 RETURN R3639880 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN -4 -236.28 RX


-236.28


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ROMA, MILDRED 100 W MAGNOLIA AVE RESIDENT# : 300 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/26/09 CHARGE R3693748 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 60 2.88 OTC


2.88


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ROMANO, MARY 100 W MAGNOLIA AVE RESIDENT# : 15 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/10/09 CHARGE R3690637 00299-3923-04 KIM CETAPHIL GENTLE CLEANS BAR 1 4.34 OTC 10/20/09 CHARGE R3702704 17478-0060-12 KIM AKWA TEARS (ARTIFICIAL TEARS) DROPS 15 2.88 OTC


7.22


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ROSS, PAUL 100 W MAGNOLIA AVE RESIDENT# : 425 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/14/09 CHARGE R3696417 00781-1599-05 TANK SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) 24 7.20 RX 10/14/09 CHARGE R3696418 31722-0521-10 TANK HYDRALAZINE 50MG TABLET 36 15.12 RX 10/14/09 CHARGE R3696420 00378-1800-01 TANK LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) 12 2.88 RX 10/14/09 CHARGE R3696423 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 12 2.88 RX 10/14/09 CHARGE R3696424 00781-5224-01 TANK CARVEDILOL 25MG TABLET (RP:COREG) 24 3.43 RX 10/14/09 CHARGE R3696426 16729-0006-17 TANK SIMVASTATIN 40MG TABLET 12 3.07 RX 10/14/09 CHARGE R3696427 31722-0520-10 TANK HYDRALAZINE 25MG TABLET 36 11.81 RX 10/14/09 CHARGE R3696419 00574-0412-02 TANK POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) 255 12.90 RX 10/14/09 CHARGE R3696422 00258-3613-01 TANK ISOSORBIDE DINITRATE ER 40MG TABLET SA 36 20.93 RX 10/15/09 CHARGE R3696421 59676-0340-01 TANK PROCRIT 40MU/1ML VIAL 1 476.52 RX 10/15/09 CHARGE R3698038 99389-0191-31 TANK MOISTURIZING LOTION 473 4.48 OTC 10/19/09 CHARGE R3701300 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/21/09 CHARGE R3706103 00168-0162-46 TANK CLOBETASOL PROPIONATE 0.05% OINTMENT (RP:TEMOVATE) 45 8.73 RX 10/24/09 CHARGE R3709047 59676-0340-01 TANK PROCRIT 40MU/1ML VIAL 1 476.52 RX 10/26/09 CHARGE R3701199 00781-1599-05 TANK SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) 30 9.00 RX 10/26/09 CHARGE R3701200 31722-0521-10 TANK HYDRALAZINE 50MG TABLET 45 18.90 RX 10/26/09 CHARGE R3701201 00378-1800-01 TANK LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) 15 3.48 RX 10/26/09 CHARGE R3701203 00781-1966-10 TANK FUROSEMIDE 40MG TABLET (RP:LASIX) 15 2.88 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ROSS, PAUL 100 W MAGNOLIA AVE RESIDENT# : 425 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3701204 00781-5224-01 TANK CARVEDILOL 25MG TABLET (RP:COREG) 30 4.29 RX 10/26/09 CHARGE R3701205 16729-0006-17 TANK SIMVASTATIN 40MG TABLET 15 3.84 RX 10/26/09 CHARGE R3701206 31722-0520-10 TANK HYDRALAZINE 25MG TABLET 45 14.76 RX 10/26/09 CHARGE R3701202 00258-3613-01 TANK ISOSORBIDE DINITRATE ER 40MG TABLET SA 45 26.16 RX 10/28/09 CHARGE R3713192 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/29/09 CHARGE R3716292 00143-9898-05 TANK CEPHALEXIN 250MG CAPSULE (RP:KEFLEX) 14 2.88 RX 10/29/09 CHARGE R3716295 63736-0105-06 TANK BACID CAPLET 20 7.72 OTC 10/30/09 CHARGE R3717035 55111-0126-05 TANK CIPROFLOXACIN 250MG TABLET (RP:CIPRO) 10 3.75 RX


1171.35


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB RUSSO, RALPH 100 W MAGNOLIA AVE RESIDENT# : 228 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/28/09 CHARGE R3686162 00338-0017-38 TANK DEXTROSE 5% (100ML BAG) IV SOLN. 200 16.12 IV

PATIENT IV 16.12 0.00 RECAP

16.12


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SACCO, MARIO 100 W MAGNOLIA AVE RESIDENT# : 421 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/09/09 CHARGE R3690284 00378-1811-01 TANK LEVOTHYROXINE SODIUM 112MCG TABLET 3 2.88 RX 10/09/09 CHARGE R3690286 16729-0007-17 TANK SIMVASTATIN 80MG TABLET (RP:ZOCOR) 3 2.88 RX 10/09/09 CHARGE R3690287 00536-3550-01 TANK VITAMIN B12 250MCG TABLET 6 2.88 OTC 10/09/09 CHARGE R3690290 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET 3 2.88 OTC 10/09/09 CHARGE R3690295 30768-0156-05 TANK VITAMIN D (D-3) 1000IU TABLET 3 2.88 OTC 10/09/09 CHARGE R3690319 00406-0512-05 TANK OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) 15 3.51 RX 10/12/09 CHARGE R3691456 00378-1811-01 TANK LEVOTHYROXINE SODIUM 112MCG TABLET 15 5.16 RX 10/12/09 CHARGE R3691457 16729-0007-17 TANK SIMVASTATIN 80MG TABLET (RP:ZOCOR) 15 3.84 RX 10/12/09 CHARGE R3691458 00536-3550-01 TANK VITAMIN B12 250MCG TABLET 30 2.88 OTC 10/12/09 CHARGE R3691459 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET 15 2.88 OTC 10/12/09 CHARGE R3691460 30768-0156-05 TANK VITAMIN D (D-3) 1000IU TABLET 15 2.88 OTC 10/13/09 CHARGE R3693384 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/15/09 CHARGE R3696840 00574-0412-02 TANK POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) 255 12.90 RX 10/15/09 CHARGE R3696863 00002-3235-60 TANK CYMBALTA 20MG CAPSULE EC 11 32.35 RX 10/20/09 CHARGE R3703814 00378-1813-01 TANK LEVOTHYROXINE SODIUM 125MCG TABLET 6 2.88 RX 10/20/09 CHARGE R3703821 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 6 2.88 OTC 10/20/09 CHARGE R3703819 00517-0031-25 TANK CYANOCOBALAMIN 1000MCG/1ML VIAL 4 3.30 RX 10/26/09 CHARGE R3693955 16729-0007-17 TANK SIMVASTATIN 80MG TABLET (RP:ZOCOR) 15 3.84 RX 10/26/09 CHARGE R3706230 00378-1813-01 TANK LEVOTHYROXINE SODIUM 125MCG TABLET 15 5.25 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SACCO, MARIO 100 W MAGNOLIA AVE RESIDENT# : 421 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3706232 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 15 2.88 OTC 10/26/09 CHARGE R3693957 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET 15 2.88 OTC 10/26/09 CHARGE R3693958 30768-0156-05 TANK VITAMIN D (D-3) 1000IU TABLET 15 2.88 OTC 10/26/09 CHARGE R3701173 00002-3235-60 TANK CYMBALTA 20MG CAPSULE EC 15 44.11 RX


328.94


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SALZANO, RUTH 100 W MAGNOLIA AVE RESIDENT# : 209 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

09/28/09 CHARGE R3666422 00172-4096-80 TANK BACLOFEN 10MG TABLET 12 2.88 RX 09/28/09 CREDIT R3666422 00172-4096-80 TANK BACLOFEN 10MG TABLET 90 -4.77 RX 09/28/09 CHARGE R3666423 16729-0005-17 TANK SIMVASTATIN 20MG TABLET 4 2.88 RX 09/28/09 CREDIT R3666423 16729-0005-17 TANK SIMVASTATIN 20MG TABLET 30 -6.30 RX 09/28/09 CHARGE R3666424 00378-1120-01 TANK VERAPAMIL HCL ER 120MG TABLET SA 4 2.88 RX 09/28/09 CREDIT R3666424 00378-1120-01 TANK VERAPAMIL HCL ER 120MG TABLET SA 30 -21.25 RX 09/28/09 CHARGE R3671864 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 12 2.88 RX 09/28/09 CREDIT R3671864 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 90 -6.48 RX 09/28/09 CHARGE R3671865 16252-0571-01 TANK RAMIPRIL 2.5MG CAPSULE 4 2.88 RX 09/28/09 CREDIT R3671865 16252-0571-01 TANK RAMIPRIL 2.5MG CAPSULE 30 -14.64 RX 09/28/09 CHARGE R3676062 51672-4031-03 TANK WARFARIN SODIUM 4MG TABLET 4 2.88 RX 09/28/09 CREDIT R3676062 51672-4031-03 TANK WARFARIN SODIUM 4MG TABLET 8 -4.69 RX


-40.85


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SANANDRES, GRACE 100 W MAGNOLIA AVE RESIDENT# : 358 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

09/02/09 RETURN R3610642 55111-0532-01 TANK DIVALPROEX SODIUM SPRINKLES 125MG CAPSULE -11 -6.51 RX (RP:DEPAKOTE SPRINKLES)


-6.51


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SANGIORGIO, VINCENZA 100 W MAGNOLIA AVE RESIDENT# : 430 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

10/21/09 CHARGE R3706057 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/21/09 CHARGE R3706058 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/21/09 CHARGE R3706060 00172-3759-60 TANK LISINOPRIL 10MG TABLET 5 2.88 RX 10/21/09 CHARGE R3706061 00378-0032-10 TANK METOPROLOL TARTRATE 50MG TABLET 10 2.88 RX 10/21/09 CHARGE R3706063 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 5 2.88 RX 10/21/09 CHARGE R3706064 00169-1833-11 TANK NOVOLIN R 100U/1ML VIAL-INSUL 10 33.87 RX 10/22/09 CHARGE R3707102 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/22/09 CHARGE R3707717 00071-0155-23 TANK LIPITOR 10MG TABLET 4 8.83 RX 10/26/09 CHARGE R3706210 00172-3759-60 TANK LISINOPRIL 10MG TABLET 30 2.88 RX 10/26/09 CHARGE R3706211 00378-0032-10 TANK METOPROLOL TARTRATE 50MG TABLET 60 3.00 RX 10/26/09 CHARGE R3706212 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 30 2.88 RX 10/26/09 CHARGE R3709471 00071-0155-23 TANK LIPITOR 10MG TABLET 30 66.23 RX 10/26/09 CHARGE R3711188 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 60 2.88 OTC 10/26/09 CHARGE R3711194 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE 1 2.88 RX 10/28/09 CHARGE R3713190 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/28/09 CHARGE R3714901 51672-1275-02 TANK CLOTRIMAZOLE 1% CREAM 30 11.91 OTC


186.60


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SANTORO, MICHAEL 100 W MAGNOLIA AVE RESIDENT# : 408 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/05/09 CHARGE R3683568 00338-3552-48 GOLDFARB VANCOMYCIN 1 GM 200 MLS 4 112.28 IV 10/05/09 CHARGE S821873 GOLDFARB IV ADMIN.SET NON-FILTER 4 0.00 IVSPL 10/05/09 CHARGE S821872 GOLDFARB CENTRAL DRESSING CHANGE KIT 1 0.00 IVSPL 10/05/09 CHARGE S824348 GOLDFARB INJECTION SITE NEEDLELESS VALVE 1 0.00 IVSPL 10/05/09 CHARGE R3683571 64253-0333-35 GOLDFARB HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 4 2.88 IV SYRIN 10/05/09 CHARGE R3683572 64253-0111-35 GOLDFARB SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 10 2.88 RX SYRIN 10/06/09 CHARGE R3686250 55513-0478-10 GOLDFARB EPOGEN 20MU/1ML VIAL 1 206.17 RX 10/09/09 CHARGE R3690464 00064-5010-15 GOLDFARB SANTYL OINTMENT 30 85.21 RX 10/12/09 CHARGE R3676526 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET 15 2.88 RX 10/12/09 CHARGE R3676527 00172-4365-60 GOLDFARB LABETALOL 200MG TABLET 15 5.37 RX 10/12/09 CHARGE R3676528 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 15 2.88 RX 10/12/09 CHARGE R3683295 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3688256 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 30 7.62 RX 10/12/09 CHARGE R3692823 00338-3552-48 GOLDFARB VANCOMYCIN 1 GM 200 MLS 4 112.28 IV 10/12/09 CHARGE S821873 GOLDFARB IV ADMIN.SET NON-FILTER 4 0.00 IVSPL 10/12/09 CHARGE S821872 GOLDFARB CENTRAL DRESSING CHANGE KIT 1 0.00 IVSPL 10/12/09 CHARGE S824348 GOLDFARB INJECTION SITE NEEDLELESS VALVE 1 0.00 IVSPL


10/31/09 Invoice# PH61821


10/12/09 CHARGE R3692829 64253-0333-35 GOLDFARB HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 4 2.88 IV SYRIN 10/12/09 CHARGE R3692832 64253-0111-35 GOLDFARB SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 8 2.88 RX SYRIN 10/13/09 CHARGE R3694169 55513-0478-10 GOLDFARB EPOGEN 20MU/1ML VIAL 1 206.17 RX 10/19/09 CHARGE R3702027 00338-3552-48 GOLDFARB VANCOMYCIN 1 GM 200 MLS 4 112.28 IV 10/19/09 CHARGE S824348 GOLDFARB INJECTION SITE NEEDLELESS VALVE 1 0.00 IVSPL 10/19/09 CHARGE S821873 GOLDFARB IV ADMIN.SET NON-FILTER 4 0.00 IVSPL 10/19/09 CHARGE S821872 GOLDFARB CENTRAL DRESSING CHANGE KIT 1 0.00 IVSPL 10/19/09 CHARGE R3702028 64253-0111-35 GOLDFARB SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 8 2.88 RX SYRIN 10/19/09 CHARGE R3702029 64253-0333-35 GOLDFARB HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 4 2.88 IV SYRIN 10/20/09 CHARGE R3702066 55513-0478-10 GOLDFARB EPOGEN 20MU/1ML VIAL 1 206.17 RX 10/23/09 CHARGE R3708591 00013-8303-04 GOLDFARB XALATAN 0.005% DROPS 2.5 56.84 RX 10/26/09 CHARGE R3693913 00172-4365-60 GOLDFARB LABETALOL 200MG TABLET 15 5.37 RX 10/26/09 CHARGE R3693914 55111-0119-10 GOLDFARB FAMOTIDINE 20MG TABLET (RP:PEPCID) 15 2.88 RX 10/26/09 CHARGE R3709504 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 8 2.88 RX 10/26/09 CHARGE R3709505 00245-0057-10 GOLDFARB KLOR-CON M 10 10MEQ TABLET SA 8 2.88 RX


10/31/09 Invoice# PH61821


10/26/09 CHARGE R3709858 00338-3552-48 GOLDFARB VANCOMYCIN 1 GM 200 MLS 4 112.28 IV 10/26/09 CHARGE S824348 GOLDFARB INJECTION SITE NEEDLELESS VALVE 1 0.00 IVSPL 10/26/09 CHARGE S821873 GOLDFARB IV ADMIN.SET NON-FILTER 4 0.00 IVSPL 10/26/09 CHARGE S821872 GOLDFARB CENTRAL DRESSING CHANGE KIT 1 0.00 IVSPL 10/26/09 CHARGE R3709861 64253-0333-35 GOLDFARB HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 4 2.88 IV SYRIN 10/26/09 CHARGE R3709862 64253-0111-35 GOLDFARB SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 8 2.88 RX SYRIN 10/26/09 CHARGE R3709061 55513-0478-10 GOLDFARB EPOGEN 20MU/1ML VIAL 1 206.17 RX 10/31/09 CHARGE M832506 GOLDFARB OCT 2009 IV SUPPLY PER DIEM 1 98.00 IVSPL

PATIENT IV 460.64 RX 1013.89 0.00 RECAP IVSPLY 98.00

1572.53


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SANTUCCI, ANTHONY 100 W MAGNOLIA AVE RESIDENT# : 410 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/05/09 CHARGE R3683441 63736-0105-06 GOLDFARB BACID CAPLET 14 5.41 OTC 10/05/09 CHARGE R3683448 00045-1525-50 GOLDFARB LEVAQUIN 500MG TABLET 7 70.70 RX 10/12/09 CHARGE R3676533 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3676534 00378-1800-01 GOLDFARB LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) 15 3.48 RX 10/12/09 CHARGE R3676535 00245-0058-15 GOLDFARB KLOR-CON M 20 20MEQ TABLET SA 15 6.95 RX 10/12/09 CHARGE R3676536 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/12/09 CHARGE R3676537 00172-3760-60 GOLDFARB LISINOPRIL 20MG TABLET (RP:ZESTRIL ) 30 2.88 RX 10/12/09 CHARGE R3676538 00378-2268-01 GOLDFARB TERAZOSIN 5MG CAPSULE 15 2.88 RX 10/12/09 CHARGE R3683298 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/19/09 CHARGE R3702174 63481-0687-06 GOLDFARB LIDODERM 5% PATCH 30 151.63 RX 10/22/09 CHARGE R3707123 00075-0624-30 GOLDFARB LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/26/09 CHARGE R3693930 00378-1800-01 GOLDFARB LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) 15 3.48 RX 10/26/09 CHARGE R3693931 00245-0058-15 GOLDFARB KLOR-CON M 20 20MEQ TABLET SA 15 6.95 RX 10/26/09 CHARGE R3693932 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET (RP:ZOCOR) 15 3.15 RX 10/26/09 CHARGE R3693933 00172-3760-60 GOLDFARB LISINOPRIL 20MG TABLET (RP:ZESTRIL ) 30 2.88 RX 10/26/09 CHARGE R3693934 00378-2268-01 GOLDFARB TERAZOSIN 5MG CAPSULE 15 2.88 RX 10/26/09 CHARGE R3693935 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3706231 00378-0208-10 GOLDFARB FUROSEMIDE 20MG TABLET 30 2.88 RX


455.18


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SCALERA, SOPHIE 100 W MAGNOLIA AVE RESIDENT# : 417 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/02/09 CHARGE R3682118 00378-1807-10 GOLDFARB LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID) 10 2.96 RX 10/02/09 CHARGE R3682119 00185-0144-05 GOLDFARB AMIODARONE HCL 200MG TABLET 10 7.38 RX 10/02/09 CHARGE R3682125 65162-0627-50 GOLDFARB TRAMADOL 50MG TABLET (RP:ULTRAM) 15 2.88 RX 10/02/09 CHARGE R3682126 00603-1378-59 GOLDFARB LACTULOSE 10GM/15ML SOLUTION 946 20.81 RX 10/02/09 CHARGE R3682121 00182-4141-26 GOLDFARB CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 10 2.88 OTC 10/02/09 CHARGE R3682123 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 2 118.15 RX 10/05/09 CHARGE R3683378 65162-0627-50 GOLDFARB TRAMADOL 50MG TABLET (RP:ULTRAM) 15 2.88 RX 10/05/09 CHARGE R3684747 51660-0526-28 GOLDFARB LORATADINE 10MG TABLET (RP:CLARITIN) 7 2.88 OTC 10/05/09 CHARGE R3684746 00310-0751-90 GOLDFARB CRESTOR 10MG TABLET 7 20.71 RX 10/05/09 CHARGE R3684752 00025-1525-51 GOLDFARB CELEBREX 200MG CAPSULE 14 40.62 RX 10/12/09 CHARGE R3683305 00378-1807-10 GOLDFARB LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID) 15 4.44 RX 10/12/09 CHARGE R3683306 00185-0144-05 GOLDFARB AMIODARONE HCL 200MG TABLET 15 11.07 RX 10/12/09 CHARGE R3691610 65162-0627-50 GOLDFARB TRAMADOL 50MG TABLET (RP:ULTRAM) 30 2.88 RX 10/12/09 CHARGE R3683307 00182-4141-26 GOLDFARB CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 15 2.88 OTC 10/12/09 CHARGE R3688262 00310-0751-90 GOLDFARB CRESTOR 10MG TABLET 15 44.38 RX 10/12/09 CHARGE R3688263 51660-0526-28 GOLDFARB LORATADINE 10MG TABLET (RP:CLARITIN) 15 2.88 OTC 10/12/09 CHARGE R3688264 00025-1525-51 GOLDFARB CELEBREX 200MG CAPSULE 30 87.03 RX 10/15/09 CHARGE R3696918 31722-0237-10 GOLDFARB AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) 11 2.88 RX 10/26/09 CHARGE R3693965 00378-1807-10 GOLDFARB LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID) 15 4.44 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SCALERA, SOPHIE 100 W MAGNOLIA AVE RESIDENT# : 417 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/26/09 CHARGE R3693966 00185-0144-05 GOLDFARB AMIODARONE HCL 200MG TABLET 15 11.07 RX 10/26/09 CHARGE R3701177 31722-0237-10 GOLDFARB AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) 15 2.88 RX 10/26/09 CHARGE R3693967 00182-4141-26 GOLDFARB CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 15 2.88 OTC 10/26/09 CHARGE R3693968 00310-0751-90 GOLDFARB CRESTOR 10MG TABLET 15 44.38 RX 10/26/09 CHARGE R3693969 51660-0526-28 GOLDFARB LORATADINE 10MG TABLET (RP:CLARITIN) 15 2.88 OTC 10/26/09 CHARGE R3693970 00025-1525-51 GOLDFARB CELEBREX 200MG CAPSULE 30 87.03 RX 10/29/09 CHARGE R3716306 65162-0627-50 GOLDFARB TRAMADOL 50MG TABLET (RP:ULTRAM) 30 2.88 RX


539.03


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SCARPULLA, GIUSEPINA 100 W MAGNOLIA AVE RESIDENT# : 41 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

09/17/09 CHARGE R3708121 17714-0020-01 RENNER DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL) 1 2.88 OTC 10/15/09 CHARGE R3698400 00054-3117-63 RENNER CALCIUM CARBONATE (ELEM.CALCIUM 500MG/5ML) 500 15.98 OTC 1250MG/5ML ORAL SUSP 10/27/09 CHARGE R3712869 63736-0105-06 RENNER BACID CAPLET 28 10.81 OTC


29.67


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SCHNEPEL, ANNA 100 W MAGNOLIA AVE RESIDENT# : 431 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/22/09 CHARGE R3706282 63736-0105-06 GOLDFARB BACID CAPLET 16 6.17 OTC 10/22/09 CHARGE R3706284 00781-2822-01 GOLDFARB FLUOXETINE 20MG CAPSULE (RP:PROZAC) 4 2.88 RX 10/22/09 CHARGE R3706286 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET 8 2.88 RX 10/22/09 CHARGE R3706292 42043-0141-05 GOLDFARB CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) 30 10.92 RX 10/22/09 CHARGE R3706299 00228-2888-50 GOLDFARB ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) 15 2.88 RX 10/22/09 CHARGE R3706288 00006-0951-54 GOLDFARB COZAAR 25MG TABLET 4 5.14 RX 10/25/09 CHARGE R3709327 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 1 3.96 RX 10/26/09 CHARGE R3709499 63736-0105-06 GOLDFARB BACID CAPLET 60 23.17 OTC 10/26/09 CHARGE R3709500 00781-2822-01 GOLDFARB FLUOXETINE 20MG CAPSULE (RP:PROZAC) 15 2.88 RX 10/26/09 CHARGE R3709501 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET 30 2.88 RX 10/26/09 CHARGE R3709502 00006-0951-54 GOLDFARB COZAAR 25MG TABLET 15 19.28 RX 10/26/09 CHARGE R3709503 63653-1171-05 GOLDFARB PLAVIX 75MG TABLET 15 59.41 RX 10/29/09 CHARGE R3716554 67253-0900-11 GOLDFARB ALPRAZOLAM 0.25MG TABLET (RP:XANAX) 30 2.88 RX 10/29/09 CHARGE R3716555 00406-0357-05 GOLDFARB HYDROCODONE/APAP 5MG/500MG TABLET (RP:VICODIN) 30 14.28 RX


159.61


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SCIMECA, VIOLA 100 W MAGNOLIA AVE RESIDENT# : 89 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

09/28/09 CHARGE R3671858 31722-0238-10 RENNER AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 8 2.88 RX 09/28/09 CREDIT R3671858 31722-0238-10 RENNER AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 30 -3.87 RX 09/28/09 CHARGE R3671859 00781-1599-05 RENNER SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) 8 2.88 RX 09/28/09 CREDIT R3671859 00781-1599-05 RENNER SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) 30 -9.00 RX 09/28/09 CHARGE R3671860 00186-5040-54 RENNER NEXIUM 40MG CAPSULE SA 8 49.54 RX 09/28/09 CREDIT R3671860 00186-5040-54 RENNER NEXIUM 40MG CAPSULE SA 30 -193.50 RX 09/28/09 CHARGE R3671861 57664-0458-88 RENNER METHIMAZOLE 5MG TABLET (RP:TAPAZOLE) 8 3.37 RX 09/28/09 CREDIT R3671861 57664-0458-88 RENNER METHIMAZOLE 5MG TABLET (RP:TAPAZOLE) 30 -12.63 RX


-160.33


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SETTANI, THERESA 100 W MAGNOLIA AVE RESIDENT# : 71 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/06/09 CHARGE R3649223 00023-0667-04 WIENER REFRESH PM OPHTH OINT 3.5 10.44 OTC 10/10/09 CHARGE R3690698 00023-0667-04 WIENER REFRESH PM OPHTH OINT 3.5 10.44 OTC


20.88


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SHAYNE, BETTY 100 W MAGNOLIA AVE RESIDENT# : 413 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

09/28/09 CHARGE R3686111 00338-0049-04 SILVERMAN SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. 2000 19.72 IV 10/01/09 CHARGE R3679973 00006-3843-71 SILVERMAN INVANZ INJ 1 GM 110 MLS (SODIUM CHLORIDE 0.9% 2 148.98 IV MINI-BAG PLUS (100ML BAG)) 10/01/09 CHARGE S822714 SILVERMAN IV ADMIN.SET NON-FILTER 2 0.00 IVSPL 10/01/09 CHARGE R3679974 64253-0111-35 SILVERMAN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 4 2.88 RX SYRIN 10/01/09 CHARGE R3679978 64253-0333-35 SILVERMAN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 2 2.88 IV SYRIN 10/01/09 CHARGE R3681093 00378-0208-10 SILVERMAN FUROSEMIDE 20MG TABLET (RP:LASIX) 81 4.54 RX 10/05/09 CHARGE R3683557 00006-3843-71 SILVERMAN INVANZ INJ 1 GM 110 MLS (SODIUM CHLORIDE 0.9% 7 501.20 IV MINI-BAG PLUS (100ML BAG)) 10/05/09 CHARGE S822714 SILVERMAN IV ADMIN.SET NON-FILTER 7 0.00 IVSPL 10/05/09 CHARGE S822713 SILVERMAN CENTRAL DRESSING CHANGE KIT 1 0.00 IVSPL 10/05/09 CHARGE S822712 SILVERMAN INJECTION SITE NEEDLELESS VALVE 1 0.00 IVSPL 10/05/09 CHARGE R3683554 64253-0333-35 SILVERMAN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 7 2.88 IV SYRIN 10/05/09 CHARGE R3683556 64253-0111-35 SILVERMAN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 14 2.88 RX SYRIN 10/05/09 CHARGE R3684662 00064-5010-15 SILVERMAN SANTYL OINTMENT 30 85.21 RX


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SHAYNE, BETTY 100 W MAGNOLIA AVE RESIDENT# : 413 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICARE

10/06/09 CHARGE M832505 SILVERMAN OCT 2009 IV SUPPLY PER DIEM 1 31.50 IVSPL

PATIENT IV 675.66 RX 95.51 0.00 RECAP IVSPLY 31.50

802.67


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SIEGLEN, CAROL 100 W MAGNOLIA AVE RESIDENT# : 377 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/24/09 CHARGE R3708169 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) 3 2.88 RX 09/29/09 CHARGE R3682995 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) 1 2.88 RX 10/01/09 CHARGE R3681074 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET 8 4.32 RX 10/12/09 CHARGE R3676430 00527-1324-10 TANK DIGOXIN 0.125MG TABLET 6 2.88 RX 10/12/09 CHARGE R3676637 13668-0009-05 TANK CITALOPRAM 10MG TABLET (RP:CELEXA) 15 2.88 RX 10/12/09 CHARGE R3688280 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3688281 00245-0057-10 TANK KLOR-CON M 10 10MEQ TABLET SA 15 3.81 RX 10/12/09 CHARGE R3692980 51672-4027-03 TANK WARFARIN SODIUM 1MG TABLET 3 2.88 RX 10/12/09 CHARGE R3692981 51672-4030-03 TANK WARFARIN SODIUM 3MG TABLET 4 2.88 RX 10/12/09 CHARGE R3676635 00006-0951-54 TANK COZAAR 25MG TABLET 15 19.28 RX 10/12/09 CHARGE R3676636 49884-0404-01 TANK METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) 15 10.87 RX


58.44


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SIEGLEN, EVELYN 100 W MAGNOLIA AVE RESIDENT# : 415 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/01/09 CHARGE R3680354 64679-0714-04 TANK ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) 7.5 2.88 RX 10/02/09 CHARGE R3681857 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA 20 9.26 RX 10/05/09 CHARGE R3684820 50111-0990-01 TANK VITAMIN D 50000IU CAPSULE 2 2.88 RX 10/09/09 CHARGE R3689531 00075-0620-40 TANK LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/10/09 CHARGE R3690890 00574-0412-02 TANK POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) 255 12.90 RX 10/12/09 CHARGE R3683332 63304-0579-10 TANK METOPROLOL TARTRATE 25MG TABLET 45 3.24 RX 10/12/09 CHARGE R3683333 16252-0505-90 TANK SIMVASTATIN 5MG TABLET (RP:ZOCOR) 15 2.88 RX 10/12/09 CHARGE R3683335 55111-0158-10 TANK OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) 15 59.69 RX 10/12/09 CHARGE R3683336 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA 30 13.89 RX 10/12/09 CHARGE R3683334 07431-2011-40 TANK VITAMIN D 400IU TABLET 15 2.88 OTC 10/13/09 CHARGE R3694119 00245-0057-10 TANK KLOR-CON M 10 10MEQ TABLET SA (RP:K-DUR (750MG)) 13 3.30 RX


350.09


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SKLENAR, FLORENCE 100 W MAGNOLIA AVE RESIDENT# : 2 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/26/09 CHARGE R3693547 54900-0001-22 KIM VITAMIN E 400IU SOFTGEL 30 2.88 OTC 10/26/09 CHARGE R3693548 00182-4141-26 KIM CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 60 2.88 OTC


5.76


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SMITH, CHARLES 100 W MAGNOLIA AVE RESIDENT# : 347 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/10/09 RETURN R3636494 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET -11 -0.66 RX 09/10/09 RETURN R3636493 00228-2672-11 GOLDFARB SPIRONOLACTONE 50MG TABLET (RP:ALDACTONE) -12 -6.46 RX 09/10/09 RETURN R3605686 00378-1903-01 GOLDFARB MIDODRINE 10MG TABLET -13 -40.74 RX 09/10/09 RETURN R3624741 63304-0579-10 GOLDFARB METOPROLOL TARTRATE 25MG TABLET -0.5 -0.04 RX 09/10/09 RETURN R3624736 65649-0301-03 GOLDFARB XIFAXAN 200MG TABLET -5 -18.86 RX 09/17/09 RETURN R3625567 00228-2672-11 GOLDFARB SPIRONOLACTONE 50MG TABLET (RP:ALDACTONE) -3 -1.62 RX 09/17/09 RETURN R3627736 63736-0105-06 GOLDFARB BACID CAPLET -28 -14.41 OTC 09/17/09 RETURN R3625566 63736-0105-06 GOLDFARB BACID CAPLET -22 -11.32 OTC 09/17/09 RETURN R3627736 63736-0105-06 GOLDFARB BACID CAPLET -30 -15.44 OTC


-109.55


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SPADARO, ANNA 100 W MAGNOLIA AVE RESIDENT# : 55 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICARE

10/26/09 CHARGE R3711245 00781-2128-01 TESTA RAMIPRIL 5MG CAPSULE 30 15.36 RX 10/26/09 CHARGE R3711246 00143-2260-01 TESTA ISOSORBIDE MONONITRATE ER 60MG TABLET SA 30 18.00 RX (RP:IMDUR) 10/26/09 CHARGE R3711247 49884-0405-01 TESTA METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL 30 21.73 RX XL) 10/26/09 CHARGE R3711249 00409-6533-01 TESTA C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION 210 57.25 RX


112.34


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SPADARO, ANNA 100 W MAGNOLIA AVE RESIDENT# : 55 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/02/09 CHARGE R3681741 63736-0105-06 TESTA BACID CAPLET 10 3.86 OTC 10/06/09 CHARGE R3686227 63736-0105-06 TESTA BACID CAPLET 14 5.41 OTC


9.27


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SPIEGEL, PHILIP 100 W MAGNOLIA AVE RESIDENT# : 393 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/05/09 CHARGE S817031 GOLDFARB IV ADMIN.SET NON-FILTER 3 0.00 IVSPL 10/05/09 CHARGE S817030 GOLDFARB CENTRAL DRESSING CHANGE KIT 1 0.00 IVSPL 10/05/09 CHARGE S817029 GOLDFARB INJECTION SITE NEEDLELESS VALVE 1 0.00 IVSPL 10/05/09 CHARGE R3684947 64253-0111-35 GOLDFARB SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP 14 2.88 RX SYRIN 10/05/09 CHARGE R3684948 64253-0333-35 GOLDFARB HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP 7 2.88 IV SYRIN 10/05/09 CHARGE R3684950 00409-6533-01 GOLDFARB VANCOMYCIN HCL 1.5 GM 280 MLS (SODIUM CHLORIDE 3 65.82 IV 0.9% (250ML BAG) ) 10/06/09 CHARGE R3686152 00045-1525-50 GOLDFARB LEVAQUIN 500MG TABLET 7 70.70 RX 10/09/09 CHARGE R3689832 00781-6141-16 GOLDFARB LEVETIRACETAM 100MG/1ML SOLUTION (RP:KEPPRA) 473 165.08 RX 10/12/09 CHARGE R3676659 51079-0007-56 GOLDFARB OMEPRAZOLE (B) 20MG CAPSULE DR 30 119.37 RX 10/12/09 CHARGE R3676662 55111-0532-01 GOLDFARB DIVALPROEX SODIUM SPRINKLES 125MG CAPSULE 270 221.67 RX 10/12/09 CHARGE R3676663 49884-0545-04 GOLDFARB RANITIDINE 300MG TABLET (RP:ZANTAC) 15 3.05 RX 10/12/09 CHARGE R3676664 16729-0005-17 GOLDFARB SIMVASTATIN 20MG TABLET 15 3.15 RX 10/12/09 CHARGE R3676660 63736-0105-06 GOLDFARB BACID CAPLET 15 5.80 OTC 10/12/09 CHARGE R3676661 00597-0058-01 GOLDFARB FLOMAX 0.4MG CAPSULE SA 15 44.34 RX 10/13/09 CHARGE M832504 GOLDFARB OCT 2009 IV SUPPLY PER DIEM 1 10.50 IVSPL

PATIENT IVSPLY 10.50 IV 68.70 0.00 RECAP RX 630.24 OTC 5.80

715.24


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SPITALNIAK, SR MARY (THERESA) 100 W MAGNOLIA AVE RESIDENT# : 388 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3646861 50111-0334-02 TANK METRONIDAZOLE 500MG TABLET (RP:FLAGYL) -1 -0.22 RX


-0.22


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SPRAGUER, JENNIE 100 W MAGNOLIA AVE RESIDENT# : 58 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/26/09 CHARGE R3693799 00904-3232-92 TESTA CALCIUM CARBONATE 600MG TABLET (RP:CALTRATE-600) 60 2.88 OTC 10/26/09 CHARGE R3693802 00486-1125-01 TESTA K-PHOS NEUTRAL 250MG TABLET 30 4.74 RX


7.62


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB SUAREZ, JOAN 100 W MAGNOLIA AVE RESIDENT# : 335 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/28/09 CHARGE R3714963 16714-0061-05 TESTA METOCLOPRAMIDE 5MG TABLET (RP:REGLAN) 36 6.62 RX 10/28/09 CHARGE R3714964 00378-1803-01 TESTA LEVOTHYROXINE SODIUM 50MCG TABLET 12 3.16 RX 10/28/09 CHARGE R3714965 00054-3542-58 TESTA MEGESTROL ACETATE 40MG/1ML ORAL SUSP 240 98.97 RX 10/28/09 CHARGE R3714966 00143-1473-10 TESTA PREDNISONE 10MG TABLET 12 2.88 RX 10/28/09 CHARGE R3714967 00527-1325-10 TESTA DIGOXIN 0.25MG TABLET 12 2.88 RX 10/28/09 CHARGE R3714968 00173-0697-00 TESTA ADVAIR DISKUS 500MCG/50MCG INHALER 60 206.59 RX 10/28/09 CHARGE R3714969 16252-0097-22 TESTA ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX (RP:PROVENTIL ) 10/28/09 CHARGE R3714970 00008-0833-22 TESTA EFFEXOR XR 75MG CAP.SR 24H 12 39.24 RX 10/28/09 CHARGE R3714971 00536-3442-38 TESTA CEROVITE ADVANCED FORMULA 27-0.4MG TABLET 12 2.88 OTC (RP:CENTRUM) 10/28/09 CHARGE R3714972 00245-0057-10 TESTA KLOR-CON M 10 10MEQ TABLET SA 12 3.05 RX 10/28/09 CHARGE R3714975 00182-4141-26 TESTA CALCARB/VIT D 600/400 TABLET 12 2.88 OTC 10/28/09 CHARGE R3714976 00006-0117-54 TESTA SINGULAIR 10MG TABLET 12 36.09 RX 10/28/09 CHARGE R3714977 00597-0075-41 TESTA SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER 30 137.45 RX 10/28/09 CHARGE R3714978 60505-0829-01 TESTA FLUTICASONE PROPIONATE NASAL SPRAY 50MCG 16 58.62 RX (RP:FLONASE NASAL) 10/28/09 CHARGE R3714979 67253-0900-11 TESTA ALPRAZOLAM 0.25MG TABLET (RP:XANAX) 30 2.88 RX


612.82


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB TOBIN, DOROTHY 100 W MAGNOLIA AVE RESIDENT# : 402 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/01/09 CHARGE R3681088 59762-5016-01 GOLDFARB FLUCONAZOLE 100MG TABLET (RP:DIFLUCAN) 2 2.88 RX 10/02/09 CHARGE R3681411 16252-0097-22 GOLDFARB ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX (RP:PROVENTIL ) 10/02/09 CHARGE R3681412 49502-0685-26 GOLDFARB IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/02/09 CHARGE R3681655 00093-7254-01 GOLDFARB GLIMEPIRIDE 1MG TABLET (RP:AMARYL) 10 2.88 RX 10/05/09 CHARGE R3683423 59762-5016-01 GOLDFARB FLUCONAZOLE 100MG TABLET (RP:DIFLUCAN) 5 4.42 RX 10/05/09 CHARGE R3683431 00075-0620-40 GOLDFARB LOVENOX 40MG/0.4ML DISP SYRIN 4 236.29 RX 10/10/09 CHARGE R3690597 49502-0685-26 GOLDFARB IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/10/09 CHARGE R3690598 16252-0097-22 GOLDFARB ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX (RP:PROVENTIL ) 10/12/09 CHARGE R3676456 00378-0032-10 GOLDFARB METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) 30 2.88 RX 10/12/09 CHARGE R3676458 31722-0238-10 GOLDFARB AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) 15 2.88 RX 10/12/09 CHARGE R3676459 00172-3760-60 GOLDFARB LISINOPRIL 20MG TABLET (RP:ZESTRIL ) 15 2.88 RX 10/12/09 CHARGE R3676460 60505-0065-01 GOLDFARB OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) 30 119.37 RX 10/12/09 CHARGE R3676461 00781-1966-10 GOLDFARB FUROSEMIDE 40MG TABLET (RP:LASIX) 15 2.88 RX 10/12/09 CHARGE R3683289 00093-7254-01 GOLDFARB GLIMEPIRIDE 1MG TABLET (RP:AMARYL) 15 2.88 RX 10/12/09 CHARGE R3676455 00182-4141-26 GOLDFARB CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) 15 2.88 OTC


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB TOBIN, DOROTHY 100 W MAGNOLIA AVE RESIDENT# : 402 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/12/09 CHARGE R3676454 00456-3210-60 GOLDFARB NAMENDA 10MG TABLET 15 34.22 RX 10/16/09 CHARGE R3699554 16252-0097-22 GOLDFARB ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX (RP:PROVENTIL ) 10/16/09 CHARGE R3699116 50111-0990-01 GOLDFARB VITAMIN D 50000IU CAPSULE 2 2.88 RX


459.61


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB TRENTACOSTE, MARY 100 W MAGNOLIA AVE RESIDENT# : 74 MAYWOOD, NJ 07607 STATION : 2 STATUS : MEDICAID

10/07/09 CHARGE R3687819 63736-0105-06 TESTA BACID CAPLET 20 7.72 OTC 10/26/09 CHARGE R3693458 00182-1576-26 TESTA OYST-CAL 500MG TABLET (RP:OS-CAL 500) 30 2.88 OTC


10.60


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB VERLINGO, FREDERICK 100 W MAGNOLIA AVE RESIDENT# : 404 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/02/09 CHARGE R3681479 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/05/09 CHARGE R3682839 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX (RP:ATROVENT INH U-D) 10/05/09 CHARGE R3683391 59676-0320-04 TANK PROCRIT 20MU/1ML VIAL 1 238.26 RX 10/06/09 CHARGE R3686296 59676-0320-04 TANK PROCRIT 20MU/1ML VIAL 2 476.52 RX 10/12/09 CHARGE R3676577 00143-1248-10 TANK FOLIC ACID 1MG TABLET 15 2.88 RX 10/12/09 CHARGE R3676578 57664-0397-58 TANK METFORMIN 500MG TABLET 30 2.88 RX 10/12/09 CHARGE R3676579 00527-1116-10 TANK SODIUM CHLORIDE 1GM TABLET 15 2.88 OTC 10/12/09 CHARGE R3676580 00378-1903-01 TANK MIDODRINE 10MG TABLET 45 141.03 RX 10/12/09 CHARGE R3676576 00597-0058-01 TANK FLOMAX 0.4MG CAPSULE SA 30 88.69 RX 10/13/09 CHARGE R3693285 00075-0624-30 TANK LOVENOX 30MG/0.3ML DISP SYRIN 3 177.24 RX 10/14/09 CHARGE R3695919 00169-1833-11 TANK NOVOLIN R 100U/1ML VIAL-INSUL 10 33.87 RX 10/19/09 CHARGE R3701353 59676-0320-04 TANK PROCRIT 20MU/1ML VIAL 2 476.52 RX


1656.15


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB VERRIEST, JANET 100 W MAGNOLIA AVE RESIDENT# : 362 MAYWOOD, NJ 07607 STATION : SUB STATUS : HMO PATIENTS

09/17/09 RETURN R3636487 17714-0019-01 GOLDFARB SIMETHICONE 80MG TAB CHEW (RP:GAS-X) -5 -0.14 OTC

PATIENT OTC -0.14 0.00 RECAP

-0.14


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB VITA, ANGELA 100 W MAGNOLIA AVE RESIDENT# : 30 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/26/09 CHARGE R3693675 00182-4141-26 TANK CALCARB/VIT D 600/400 TABLET 60 2.88 OTC 10/30/09 CHARGE S831868 17191-0051-04 TANK ADAPTA-CAP 28MM/SIZE K (PHENYTOIN) EACH 1 2.88 OTC


5.76


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB VRANA, MURIEL 100 W MAGNOLIA AVE RESIDENT# : 365 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

10/09/09 CHARGE R3690264 00378-1805-01 TANK LEVOTHYROXINE SODIUM 75MCG TABLET 3 2.88 RX 10/09/09 CHARGE R3690266 57664-0434-88 TANK ALLOPURINOL 100MG TABLET 2 2.88 RX 10/09/09 CHARGE R3690267 00904-5062-60 TANK CALCIUM CITRATE 200MG TABLET 3 2.88 OTC 10/09/09 CHARGE R3690268 65580-0643-71 TANK METOLAZONE 2.5MG TABLET 3 2.88 RX 10/09/09 CHARGE R3690273 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/09/09 CHARGE R3690274 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX 10/09/09 CHARGE R3690276 60505-2607-01 TANK CARVEDILOL 6.25MG TABLET (RP:COREG) 6 2.88 RX 10/09/09 CHARGE R3690280 65162-0627-50 TANK TRAMADOL 50MG TABLET 15 2.88 RX 10/09/09 CHARGE R3690393 00378-0208-10 TANK FUROSEMIDE 20MG TABLET 3 2.88 RX 10/09/09 CHARGE R3690282 11523-7162-01 TANK CLARITIN D 12 HOUR 5MG/120MG TABLET SA 30 43.09 OTC 10/09/09 CHARGE R3690270 00006-0951-54 TANK COZAAR 25MG TABLET 3 3.86 RX 10/09/09 CHARGE R3690281 00065-8533-02 TANK CIPRODEX 0.3% DROPS SUSP 7.5 79.78 RX 10/09/09 CHARGE R3690310 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/09/09 CHARGE R3690391 49884-0035-10 TANK MECLIZINE HCL 25MG TABLET 7.5 2.88 RX 10/10/09 CHARGE R3690893 00168-0006-80 TANK TRIAMCINOLONE ACETONIDE 0.1% OINTMENT 80 4.00 RX 10/11/09 CHARGE R3691106 60505-2608-01 TANK CARVEDILOL 12.5MG TABLET (RP:COREG) 2 2.88 RX 10/12/09 CHARGE R3691447 57664-0434-88 TANK ALLOPURINOL 100MG TABLET 6 2.88 RX 10/12/09 CHARGE R3691465 00378-1805-01 TANK LEVOTHYROXINE SODIUM 75MCG TABLET 15 4.37 RX


10/31/09 Invoice# PH61821


10/12/09 CHARGE R3691467 65580-0643-71 TANK METOLAZONE 2.5MG TABLET 15 13.37 RX 10/12/09 CHARGE R3691469 00378-0208-10 TANK FUROSEMIDE 20MG TABLET 15 2.88 RX 10/12/09 CHARGE R3691470 60505-2608-01 TANK CARVEDILOL 12.5MG TABLET (RP:COREG) 30 4.29 RX 10/12/09 CHARGE R3691466 00904-5062-60 TANK CALCIUM CITRATE 200MG TABLET 15 2.88 OTC 10/12/09 CHARGE R3691468 00006-0951-54 TANK COZAAR 25MG TABLET 15 19.28 RX 10/14/09 CHARGE R3696165 00072-5760-04 TANK LAC-HYDRIN 5 5% LOTION 120 8.36 OTC 10/15/09 CHARGE R3698197 00409-1316-25 TANK HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP 5 13.61 RX SYRIN 10/16/09 CHARGE R3698626 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX 10/16/09 CHARGE R3698628 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/20/09 CHARGE R3704107 00245-0058-15 TANK KLOR-CON M 20 20MEQ TABLET SA 1 2.88 RX 10/21/09 CHARGE R3704323 65580-0643-71 TANK METOLAZONE 2.5MG TABLET 5 4.46 RX 10/23/09 CHARGE R3708239 00338-0049-04 TANK SODIUM CHLORIDE 0.9% (1000ML BAG) 1000 MLS 4 27.88 IV 10/23/09 CHARGE S830267 TANK IV SOLUTION SET W/ REGULATOR 4 0.00 IVSPL 10/26/09 CHARGE R3693841 57664-0434-88 TANK ALLOPURINOL 100MG TABLET 6 2.88 RX 10/26/09 CHARGE R3694019 00378-1805-01 TANK LEVOTHYROXINE SODIUM 75MCG TABLET 15 4.37 RX 10/26/09 CHARGE R3694024 60505-2608-01 TANK CARVEDILOL 12.5MG TABLET (RP:COREG) 30 4.29 RX 10/26/09 CHARGE R3709524 00378-0208-10 TANK FUROSEMIDE 20MG TABLET (RP:LASIX) 15 2.88 RX 10/26/09 CHARGE R3709592 49502-0685-26 TANK IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION 62.5 6.75 RX


10/31/09 Invoice# PH61821


10/26/09 CHARGE R3709611 16252-0097-22 TANK ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION 75 8.63 RX 10/26/09 CHARGE R3694020 00904-5062-60 TANK CALCIUM CITRATE 200MG TABLET 15 2.88 OTC 10/26/09 CHARGE R3694022 00006-0951-54 TANK COZAAR 25MG TABLET 15 19.28 RX 10/31/09 CHARGE M832503 TANK OCT 2009 IV SUPPLY PER DIEM 1 10.50 IVSPL

PATIENT RX 272.15 IV 27.88 0.00 RECAP OTC 60.09 IVSPLY 10.50

370.62


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB WYMAN, DOROTHY 100 W MAGNOLIA AVE RESIDENT# : 312 MAYWOOD, NJ 07607 STATION : 3 STATUS : MEDICAID

10/08/09 CHARGE R3689585 62261-0112-01 TANK CARBAMIDE PEROXIDE OTIC 6.5% DROPS (RP:DEBROX 15 2.88 OTC OTIC) 10/26/09 CHARGE R3693759 74312-0813-80 TANK VITAMIN B12 1000MCG TABLET 30 2.88 OTC 10/28/09 CHARGE R3714535 63736-0105-06 TANK BACID CAPLET 10 3.86 OTC


9.62


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ZAKRZEWSKI, CORA 100 W MAGNOLIA AVE RESIDENT# : 385 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3650030 51672-4030-03 TANK WARFARIN SODIUM 3MG TABLET -8 -4.67 RX 09/17/09 RETURN R3657063 51672-4028-03 TANK WARFARIN SODIUM 2MG TABLET -14 -7.90 RX 09/17/09 RETURN R3642636 00781-2272-01 TANK AMLODIPINE/BENAZEPRIL 5-10MG CAPSULE (RP:LOTREL) -3 -5.36 RX 09/17/09 RETURN R3642634 00591-0347-01 TANK HYDROCHLOROTHIAZIDE 12.5MG CAPSULE -3 -0.36 RX 09/17/09 RETURN R3642633 00310-0751-90 TANK CRESTOR 10MG TABLET -5 -14.79 RX 09/17/09 RETURN R3642637 62175-0118-43 TANK OMEPRAZOLE 20MG CAPSULE DR -6 -23.87 RX


-56.95


10/31/09 Invoice# PH61821

MAYWOOD CTR FOR HEALTH & REHAB ZVYURNIE, ANGELINA 100 W MAGNOLIA AVE RESIDENT# : 373 MAYWOOD, NJ 07607 STATION : SUB STATUS : MEDICARE

09/17/09 RETURN R3658285 50111-0333-01 ARNOUK METRONIDAZOLE 250MG TABLET (RP:FLAGYL) -24 -2.04 RX


-2.04


10/31/09 Invoice# PH61821

MAYWOOD CENTER FOR HEALTH & REHABILITATION MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE CUSTOMER# 24M MAYWOOD, NJ 07607

10/13/09 CASH CK# 00015 THANK YOU FOR YOUR PAYMENT.... - JUNE 2009 PYMT -42418.39 10/26/09 CASH CK# 00163 THANK YOU FOR YOUR PAYMENT.... -39604.32 10/31/09 PH NEW CHARGES 33537.21

0-30 31-60 61-90 91-120 121+ 0.00 32866.85 41412.93 32446.24 0.00 0.00

155211.52 33537.21 0.00 188748.73 82022.71 106726.02

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