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Created By/On: Devel# 11/26/2015 | 5:23:47 AM

Maintained By/On: Jayden Smith 02/12/2018 | 5:06:479 AM

Name: Maria Rodriguez
DOB: 10/07/1976
Patient Type: Compliance Packaging , Care Facility Patient

Other Meds

Intake - OTC Drugs

OTC Drug Name	Generic Name	Active
A+D Prevent	Diaper Rash Products - Ointment*
Abacavir Sulfate	Abacavir Sulfate Tab 300 MG (Base Equiv)
Amlodipine Besy-Benazepril HCL	Amlodipine Besylate-Benazepril HCL Cap 5-40 MG

Intake - Other Drugs These Drugs are not linked to Clinical Data and will not be included in any Conflict Scans

Other Drug Name	Active

Search Criteria

Product Name

NDC

GPI

Product Name Product Name	NDC NDC	MFG. MFG.	GPI GPI	PKG Size PKG Size	Unit Cost Unit Cost	AWP AWP	Status Status	QTY Available QTY Available	Route Route
Abacavir Sulfate Tablet 300 MG	54569-6351-00	AsmedSolut	4785123421	28.823	3.75	2.50	Active	59	Oral
Abilify Tablet	59148-0007-13	BMS-PC	4784251231	66.666	5.50	1.45	Active	99	Oral
Disprin Aero Breath Act 2	21321-2312-31	VK Pharma	4784512321	22.000	2.90	1.20	Active	21	Oral
Digoxin Tablet 125 MCG	59148-2312-31	Sandoz	4784215123	90.000	3.60	2.10	Active	19	Oral
Macrobid Capsule 100 MG	54569-3544-31	Almatica	5184212347	22.000	6.80	3.25	Active	7	Oral

Search Criteria

Date of Birth

Enter last name, first name

MRN

Phone

Address

City

State

ZIP

Name Name	Date of Birth Date of Birth	Address Address	City City	State State	ZIP ZIP	Phone Phone	CF CF	Status Status
Annie Wiedman	10/07/1978	88 Center Rd	Bedford	OH	44146	715-361-4850		Active
Maria Rodriguez	12/03/1976	2349 Spinnaker Lane	Joliet	LA	60432	724-376-4350		Active
Scott Adams	08/19/1979	1919 County Line Road	Tampa	FL	33634	727-729-9038		Active
Smith James	04/11/1978	1566 Elm Drive	Cambridge	NY	12816	532-247-7219		Active
Teresa Andresen	11/28/1987	1227 Perine Street	Alexandria	VA	22304	703-823-4297		Active