Geri Script
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GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/03/09 10/03/09 10/05/09 10/05/09 10/06/09 10/06/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3679934 R3679935 R3681336 R3681337 R3681338 R3681457 R3681456 R3681459 R3681460 R3681461 R3682275 R3682276 R3683215 R3682838 R3686070 R3685172 R3686761 R3686807 R3686823
10135-0115-01 00002-8031-01 00555-0720-51 00555-0720-51 00555-0720-51 22170-0215-16 00182-0287-01 00182-1093-10 00904-7591-60 74312-0077-10 00113-0915-55 00182-1039-01 00799-0001-04 53807-0401-16 00185-0144-05 59741-0306-12 00182-0287-01 10135-0144-01 00904-7591-60
HOUSE CHARGES
ONCE DAILY MULTIVITAMIN TABLET GLUCAGON EMERGENCY KIT 1MG ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) CEPACOL SUGAR-FREE LOZENGE DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) SENNA-GEN 8.6MG TABLET FERROUS SULFATE 325MG TABLET GLUCOSAMINE 500MG CAPSULE OMEPRAZOLE OTC 20MG TABLET DR IBUPROFEN 200MG TABLET CALMOSEPTINE OINTMENT MILK OF MAGNESIA 400MG/5ML ORAL SUSP AMIODARONE HCL 200MG TABLET BISACODYL SUPP 10MG SUPP.RECT (RP:DULCOLAX) DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) ACETAMINOPHEN X-S 500MG CAPLET FERROUS SULFATE 325MG TABLET
600 3 2 1 1 96 600 400 600 240 168 400 4520 1419 6 24 600 600 600
22.26 418.97 30.74 15.37 15.37 20.02 18.73 6.93 10.11 30.22 68.81 13.17 238.34 6.74 4.43 4.06 18.73 5.49 10.11
OTC RX RX RX RX OTC OTC OTC OTC OTC OTC OTC OTC OTC RX OTC OTC OTC OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/08/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/15/09 10/15/09 10/15/09 10/19/09 10/20/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3686824 R3686828 R3687705 R3687709 R3687710 R3687711 R3687712 R3687758 R3688091 R3690481 R3691602 R3691605 R3692545 R3692546 R3698403 R3698408 R3698665 R3700824 R3702508
10135-0115-01 00182-1039-01 00182-1061-07 50383-0786-08 00121-0544-16 53807-0401-16 00904-5452-09 66424-0092-01 00002-8031-01 00799-0001-04 00113-0915-55 00904-7591-60 00536-3222-01 32131-0824-06 59390-0040-46 00113-0915-55 00904-7927-60 00182-0287-01 66424-0092-01
HOUSE CHARGES
ONCE DAILY MULTIVITAMIN TABLET IBUPROFEN 200MG TABLET ASPIRIN EC 81MG TABLET EC GOLDEN AGE LIQUID (RP:CERTAGEN) DOCUSATE SODIUM 100MG/10ML LIQUID (RP:COLACE) MILK OF MAGNESIA 400MG/5ML ORAL SUSP SENNA 8.8MG/5ML SYRUP CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET GLUCAGON EMERGENCY KIT 1MG CALMOSEPTINE OINTMENT OMEPRAZOLE OTC 20MG TABLET DR FERROUS SULFATE 325MG TABLET ACETAMINOPHEN 325MG TABLET MULTIVITAMIN W/MINERALS TABLET ACETAMINOPHEN 160MG/5ML ELIXIR OMEPRAZOLE OTC 20MG TABLET DR BISACODYL 5MG TABLET EC DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET
300 300 480 480 1440 1419 720 200 3 1130 252 600 400 120 1892 336 200 600 600
3.18 9.88 8.77 6.88 28.79 6.74 37.10 4.66 402.20 59.59 103.21 10.11 11.55 5.49 12.93 137.61 8.11 18.73 13.98
OTC OTC OTC OTC OTC OTC OTC OTC RX OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/22/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/25/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3704325 R3704209 R3704326 R3704327 R3704329 R3706001 R3708116 R3708127 R3708160 R3708161 R3708163 R3708183 R3708186 R3708147 R3709276 R3709364 R3709368 R3709370 R3709371
00799-0001-04 00536-3222-01 00182-1093-10 00904-7927-60 66424-0092-01 00799-0001-04 00781-2144-01 60505-2616-06 55111-0126-05 00054-4728-31 66593-3126-02 51672-4030-03 51672-4032-03 00093-0311-05 00182-0287-01 54838-0001-80 10135-0115-01 32131-0824-06 00182-1039-01
HOUSE CHARGES
CALMOSEPTINE OINTMENT ACETAMINOPHEN 325MG TABLET SENNA-GEN 8.6MG TABLET BISACODYL 5MG TABLET EC CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET CALMOSEPTINE OINTMENT AMPICILLIN TRIHYDRATE 250MG CAPSULE CLARITHROMYCIN 250MG TABLET (RP:BIAXIN) CIPROFLOXACIN 250MG TABLET (RP:CIPRO) PREDNISONE 5MG TABLET VANCOCIN HCL 250MG CAPSULE WARFARIN SODIUM 3MG TABLET (RP:COUMADIN) WARFARIN SODIUM 5MG TABLET (RP:COUMADIN) LOPERAMIDE 2MG CAPSULE (RP:IMODIUM) DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) FERROUS SULFATE 220MG/5ML ELIXIR ONCE DAILY MULTIVITAMIN TABLET MULTIVITAMIN W/MINERALS TABLET IBUPROFEN 200MG TABLET
1130 600 600 600 600 1130 4 10 1 8 6 1 1 3 400 1416 600 240 200
59.59 17.33 10.39 24.34 13.98 59.59 2.88 23.73 2.88 2.88 292.93 2.88 2.88 2.88 12.49 14.20 6.35 10.97 6.59
OTC OTC OTC OTC OTC OTC RX RX RX RX RX RX RX RX OTC OTC OTC OTC OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/27/09 10/27/09 10/31/09
HOUSE RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC RX
R3709372 R3709373 R3709374 R3709549 R3709550 R3711303 R3712610 R3717486
10135-0144-01 00536-3222-01 00182-0287-01 59741-0306-12 00168-0011-31 00113-0915-55 50383-0786-08 22170-0215-16
1312.87 1221.02
HOUSE CHARGES
ACETAMINOPHEN X-S 500MG CAPLET ACETAMINOPHEN 325MG TABLET DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) BISACODYL SUPP 10MG SUPP.RECT (RP:DULCOLAX) BACITRACIN ZINC 500U/1GM OINTMENT OMEPRAZOLE OTC 20MG TABLET DR GOLDEN AGE LIQUID (RP:CERTAGEN) CEPACOL SUGAR-FREE LOZENGE
400 600 600 24 60 126 720 32
3.66 17.33 18.73 4.06 3.66 51.60 10.31 6.67
OTC OTC OTC OTC OTC OTC OTC OTC
0.00 2533.89
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ALDERS, CLYDE RESIDENT# : 368 STATION : SUB STATUS : MEDICARE
09/02/09 09/02/09 09/02/09 09/02/09 09/02/09
RETURN RETURN RETURN RETURN RETURN
R3642618 R3627206 R3627207 R3627210 R3627201
60505-0234-01 74312-0871-90 00185-0223-05 00093-7223-98 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
09/02/09 09/02/09 09/02/09 09/02/09 09/02/09
RETURN RETURN RETURN RETURN RETURN
R3627205 R3627202 R3627209 R3627208 R3627204
00245-0058-15 55111-0119-10 00071-0157-23 00071-0155-23 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
09/02/09 09/10/09
RETURN RETURN
R3627199 R3617203
66582-0414-54 00093-0233-56
GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
-209.44 -0.58
TORSEMIDE 20MG TABLET (RP:DEMADEX) ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) CILOSTAZOL 100MG TABLET (RP:PLETAL) FOSINOPRIL 20MG TABLET (RP:MONOPRIL) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) KLOR-CON M 20 20MEQ TABLET SA (RP:K-DUR (1500MG)) FAMOTIDINE 20MG TABLET (RP:PEPCID) LIPITOR 40MG TABLET LIPITOR 10MG TABLET METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) ZETIA 10MG TABLET ONDANSETRON 4MG TABLET (RP:ZOFRAN)
-30 -14 -14 -14 -14
-15.75 -0.58 -7.67 -8.37 -13.38
RX OTC RX RX RX
-14 -29 -15 -15 -14
-6.49 -4.35 -47.24 -33.12 -19.94
RX RX RX RX RX
-15 -12
-39.93 -13.20
RX RX
0.00 -210.02
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ALIMI, GANI RESIDENT# : 364 STATION : SUB STATUS : MEDICARE
09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09
RETURN RETURN RETURN RETURN RETURN RETURN RETURN
R3627125 R3627196 R3627194 R3642617 R3627198 R3627196 R3627195
51079-0007-56 63304-0579-10 00228-2898-03 31722-0213-05 00182-1576-26 63304-0579-10 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
09/10/09 09/17/09 09/17/09
RETURN RETURN RETURN
R3627193 R3627197 R3627197
00591-0844-01 00169-0082-81 00169-0082-81
GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
-86.36 -1.55
OMEPRAZOLE (B) 20MG CAPSULE DR METOPROLOL TARTRATE 25MG TABLET GLIPIZIDE ER 2.5MG TABLET SA (RP:GLUCOTROL XL) SERTRALINE HCL 50MG TABLET (RP:ZOLOFT) OYST-CAL 500MG TABLET (RP:OYSTER SHELL CALCIUM) METOPROLOL TARTRATE 25MG TABLET ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) GLIPIZIDE ER 5MG TABLET SA (RP:GLUCOTROL XL) PRANDIN 1MG TABLET PRANDIN 1MG TABLET
-9 -3 -6 -7 -38 -13 -9
-35.81 -0.22 -1.61 -0.90 -1.55 -0.94 -8.60
RX RX RX RX OTC RX RX
-6 -15 -10
-1.61 -22.00 -14.67
RX RX RX
0.00 -87.91
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3633905 R3633904 R3645013 R3648796 R3648800 R3652378
00172-4364-60 16252-0571-01 00172-4364-60 00143-9898-05 63736-0105-06 00185-0122-01
-16.91 -1.54
ANDERSON, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK
BERYL : 342 : SUB : MEDICARE
LABETALOL 100MG TABLET RAMIPRIL 2.5MG CAPSULE (RP:ALTACE) LABETALOL 100MG TABLET CEPHALEXIN 250MG CAPSULE (RP:KEFLEX) BACID CAPLET NITROFURANTOIN MONOHYDRATE 100MG CAPSULE (RP:MACROBID)
-15 -15 -3 -9 -3 -3
-3.24 -7.32 -0.65 -1.66 -1.54 -4.04
RX RX RX RX OTC RX
0.00 -18.45
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/12/09 10/12/09 10/12/09 10/20/09 10/21/09 10/21/09 10/21/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3688057 R3688059 R3688061 R3688068 R3688058 R3688060 R3688064 R3688065 R3688067 R3688069 R3688070 R3688259 R3688260 R3688261 R3702022 R3703328 R3703494 R3706101 R3693951
00555-0720-51 31722-0238-10 16729-0006-17 00406-0512-05 63481-0687-06 00007-3230-11 00574-0412-02 00008-0607-01 00071-1012-68 67767-0123-18 00378-9119-98 31722-0238-10 16729-0006-17 00008-0607-01 00555-0720-51 67767-0123-18 00378-9119-98 00071-1012-68 31722-0238-10
ANTENUCCI, CARMELA RESIDENT# : 409 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) SIMVASTATIN 40MG TABLET (RP:ZOCOR) OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LIDODERM 5% PATCH ARIXTRA 2.5MG/0.5ML DISP SYRIN POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) LYRICA 25MG CAPSULE FENTANYL 100MCG/HR PATCH FENTANYL 12MCG/HR PATCH AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) SIMVASTATIN 40MG TABLET (RP:ZOCOR) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) FENTANYL 100MCG/HR PATCH FENTANYL 12MCG/HR PATCH LYRICA 25MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC)
2 5 5 30 15 5 255 5 15 5 5 15 15 15 2 5 5 15 15
30.74 2.88 2.88 7.02 75.81 397.58 12.90 13.50 26.50 212.11 47.44 2.88 3.84 40.50 30.74 212.11 47.44 26.50 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/28/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX
R3693952 R3693953 R3714866 R3716305
16729-0006-17 00008-0607-01 00713-0135-12 00007-3230-11
1668.75
ANTENUCCI, CARMELA RESIDENT# : 409 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO
SIMVASTATIN 40MG TABLET (RP:ZOCOR) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) PROCHLORPERAZINE 25MG SUPP.RECT (RP:COMPAZINE) ARIXTRA 2.5MG/0.5ML DISP SYRIN
15 15 12 5
3.84 40.50 30.58 397.58
RX RX RX RX
0.00 1668.75
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 10/02/09
PATIENT RECAP
RETURN CHARGE
RX
R3649121 R3681730
42043-0141-05 51672-4032-03
2.52
BART, ANNA RESIDENT# : 392 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB
CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) WARFARIN SODIUM 5MG TABLET
-1 3
-0.36 2.88
RX RX
0.00 2.52
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/14/09
PATIENT RECAP
CHARGE
OTC
R3694810
54162-0500-02
3.84
BAZEWICZ, RESIDENT# STATION STATUS
TESTA
HYDROPHOR OINTMENT
MARY : 7 : 3 : MEDICAID
100
3.84
OTC
0.00 3.84
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
BEHNKE, FRED RESIDENT# : 416 STATION : 2 STATUS : MEDICARE
10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/02/09 10/13/09 10/14/09 10/16/09 10/16/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3681360 R3681365 R3681367 R3681371 R3681372 R3681373 R3681376 R3681377 R3681379 R3681381 R3681724 R3694230 R3696051 R3699992 R3699990
63304-0579-10 55111-0172-90 16252-0528-90 00185-0144-05 16252-0097-22 00143-1248-10 00378-0208-10 00245-0057-10 00527-1324-10 00024-4200-10 00024-4200-10 51079-0072-56 00245-0057-10 00781-1966-10 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/16/09 10/18/09
CHARGE CHARGE
R3699993 R3700612
00074-3079-90 16252-0097-22
GOLDFARB GOLDFARB
PATIENT RECAP
RX
253.64
METOPROLOL TARTRATE 25MG TABLET FINASTERIDE 5MG TABLET (RP:PROSCAR) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) AMIODARONE HCL 200MG TABLET (RP:CORDARONE) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION FOLIC ACID 1MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA DIGOXIN 0.125MG TABLET UROXATRAL 10MG TABLET SA UROXATRAL 10MG TABLET SA FUROSEMIDE (B) 20MG TABLET KLOR-CON M 10 10MEQ TABLET SA (RP:K-DUR (750MG)) FUROSEMIDE 40MG TABLET (RP:LASIX) METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) NIASPAN 750MG TABLET SA ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION
162 27 27 27 75 27 14 14 27 1 26 26 12 10 10
11.66 46.71 9.61 19.93 8.63 2.88 2.88 3.56 5.75 3.62 64.72 2.88 3.05 2.88 9.31
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
20 75
46.94 8.63
RX RX
0.00 253.64
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/18/09 10/05/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3708126 R3683160
17714-0020-01 63736-0105-06
10.60
BELLARDITA, RESIDENT# : STATION : STATUS :
TESTA WIENER
ANN 83 2 MEDICAID
DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL) BACID CAPLET
1 20
2.88 7.72
OTC OTC
0.00 10.60
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/12/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE
OTC
R3686013 R3676474 R3693881
17478-0060-12 00574-0508-01 00574-0508-01
8.64
BELLAVIA, RESIDENT# STATION STATUS
RENNER RENNER RENNER
LUCY : 232 : SUB : MEDICAID
AKWA TEARS (ARTIFICIAL TEARS) DROPS FERROUS GLUCONATE 324MG TABLET FERROUS GLUCONATE 324MG TABLET
15 15 15
2.88 2.88 2.88
OTC OTC OTC
0.00 8.64
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/29/09 10/29/09 10/29/09 10/29/09 10/29/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3715269 R3715271 R3715272 R3715274 R3715275 R3716176
00024-4200-10 16252-0097-22 00173-0696-00 63824-0008-50 00597-0075-41 00075-0620-40
566.82 12.49
BIZZARO, EMANUEL RESIDENT# : 434 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK
UROXATRAL 10MG TABLET SA ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION ADVAIR DISKUS 250MCG/50MCG INHALER MUCINEX 600MG TABLET SA SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER LOVENOX 40MG/0.4ML DISP SYRIN
11 75 60 22 30 4
27.38 8.63 157.07 12.49 137.45 236.29
RX RX RX OTC RX RX
0.00 579.31
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/09/09
PATIENT RECAP
CHARGE
OTC
R3689834
00521-2750-00
2.88
BONANNO, FLORENCE RESIDENT# : 14 STATION : 3 STATUS : MEDICAID
RENNER
VASELINE LIP THERAPY (10GM) LOTION
1
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
BONANNO, LUCILLE RESIDENT# : 407 STATION : SUB STATUS : MEDICARE
10/05/09
CHARGE
R3683392
00591-3433-30
GOLDFARB
10/09/09 10/12/09 10/12/09 10/12/09 10/19/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3689831 R3676583 R3676584 R3676585 R3700554
00186-1989-04 00603-3856-32 00378-1805-01 65726-0235-10 00085-1401-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX
174.56
IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 SOLUTION (RP:DUONEB 3 ML VIAL) PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. HCTZ 25MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) DYNACIRC CR 5MG TABLET SA FORADIL AEROLIZER 12MCG INHALER
90
45.17
RX
30 15 15 15 60
2.88 2.88 4.37 8.92 110.34
RX RX RX RX RX
0.00 174.56
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/06/09 10/07/09 10/07/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/13/09 10/14/09 10/16/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX IV
R3686256 R3686318 R3687704 R3688486 R3690882 R3676544 R3676546 R3676547 R3676549 R3676550 R3688258 R3676545 R3691455 R3693306 R3693322 R3695920 R3697959
00245-0058-15 00338-0049-04 00075-0620-40 00338-0049-04 00182-4141-26 59762-5019-01 00781-2074-01 57664-0397-58 00378-1800-01 00378-1807-10 00245-0058-15 00008-0607-01 00182-4141-26 00378-0028-01 00781-1123-01 00169-7501-11 00075-0620-40
633.05 9.58
OTC
BOODAGHIAN, RESIDENT# : STATION : STATUS :
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
MARY 406 SUB MEDICARE
KLOR-CON M 20 20MEQ TABLET SA SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. LOVENOX 40MG/0.4ML DISP SYRIN SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) QUINAPRIL 5MG TABLET TRIAMTERENE/HCTZ 37.5-25MG CAPSULE (RP:DYAZIDE ) METFORMIN 500MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) LEVOTHYROXINE SODIUM 88MCG TABLET KLOR-CON M 20 20MEQ TABLET SA PANTOPRAZOLE 40MG TABLET DR CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) NADOLOL 20MG TABLET TRIAMTERENE/HCTZ 37.5/25 TABLET (RP:MAXZIDE-25) NOVOLOG 100U/1ML INSULIN LOVENOX 40MG/0.4ML DISP SYRIN
5.76
6 1000 4 1000 4 15 15 30 7.5 15 15 15 30 26 6.5 10 4
2.88 4.79 236.29 4.79 2.88 3.75 4.77 2.88 2.88 4.44 6.95 40.50 2.88 12.09 2.88 76.45 236.29
RX IV RX IV OTC RX RX RX RX RX RX RX OTC RX RX RX RX
0.00 648.39
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT
RX
R3659641 R3659641 R3659952 R3659952 R3659953 R3659953 R3659954 R3659954 R3659956 R3659956 R3659957 R3659957
58468-0021-01 58468-0021-01 00378-1805-01 00378-1805-01 00456-2010-01 00456-2010-01 63304-0579-10 63304-0579-10 00008-0841-81 00008-0841-81 16729-0005-17 16729-0005-17
-589.75
BOSNYAK, DOROTHY RESIDENT# : 29 STATION : 3 STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
RENAGEL (SEVELAMER HCL) 800MG TABLET RENAGEL (SEVELAMER HCL) 800MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET LEXAPRO 10MG TABLET LEXAPRO 10MG TABLET METOPROLOL TARTRATE 25MG TABLET METOPROLOL TARTRATE 25MG TABLET PROTONIX 40MG TABLET DR PROTONIX 40MG TABLET DR SIMVASTATIN 20MG TABLET (RP:ZOCOR) SIMVASTATIN 20MG TABLET (RP:ZOCOR)
9 90 3 30 3 30 6 60 6 60 3 30
23.02 -239.77 2.88 -8.73 9.72 -101.21 2.88 -4.32 28.76 -299.56 2.88 -6.30
RX RX RX RX RX RX RX RX RX RX RX RX
0.00 -589.75
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693374 R3693670
51672-1275-02 54391-0002-01
18.32
BOSNYAK, DOROTHY RESIDENT# : 29 STATION : 3 STATUS : MEDICAID
SILVERMAN SILVERMAN
CLOTRIMAZOLE 1% CREAM (RP:LOTRIMIN AF) NEPHRO-VITE TABLET
30 30
11.91 6.41
OTC OTC
0.00 18.32
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/26/09 10/02/09
PATIENT RECAP
CHARGE CHARGE
RX
R3682981 R3678127
51672-4027-03 51672-4028-03
5.76
BOSTICCO, RESIDENT# STATION STATUS
TANK TANK
JOSEPH : 399 : SUB : MEDICARE
WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) WARFARIN SODIUM 2MG TABLET
1 3
2.88 2.88
RX RX
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
BURDICK, ANN RESIDENT# : 429 STATION : SUB STATUS : MEDICARE
10/20/09 10/20/09 10/20/09 10/20/09
CHARGE CHARGE CHARGE CHARGE
R3704049 R3704059 R3704063 R3704064
53746-0101-05 55111-0158-10 00603-1378-59 16252-0097-22
TANK TANK TANK TANK
10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/23/09 10/23/09 10/24/09 10/24/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3704070 R3704086 R3704052 R3704060 R3704067 R3704068 R3704074 R3704078 R3708290 R3708432 R3707204 R3707210
42043-0141-05 65162-0627-50 00456-2010-01 00075-0620-40 51660-0526-28 00065-0266-25 00064-5010-15 49884-0404-01 63736-0105-06 68180-0512-02 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/26/09
CHARGE
R3706226
53746-0101-05
TANK
GABAPENTIN 100MG CAPSULE (RP:NEURONTIN) OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) LACTULOSE 10GM/15ML SOLUTION ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) TRAMADOL 50MG TABLET LEXAPRO 10MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN LORATADINE 10MG TABLET (RP:CLARITIN) TRAVATAN 0.004% DROPS SANTYL OINTMENT METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) BACID CAPLET LISINOPRIL 2.5MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) GABAPENTIN 100MG CAPSULE (RP:NEURONTIN)
6 12 946 75
2.88 47.75 20.81 8.63
4 30 6 4 15 2.5 30 3 28 3 75 62.5
2.88 2.88 13.36 236.29 2.88 58.41 85.21 2.88 10.81 2.88 8.63 6.75
15
2.88
RX RX RX RX RX RX RX RX OTC RX RX RX OTC RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/27/09 10/29/09 10/29/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3706228 R3709506 R3706227 R3706229 R3712552 R3716254 R3716315 R3717129
55111-0158-10 68180-0512-02 00456-2010-01 49884-0404-01 63304-0579-10 00186-1989-04 00054-4728-31 00378-0208-10
678.40 13.69
BURDICK, ANN RESIDENT# : 429 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK
OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) LISINOPRIL 2.5MG TABLET LEXAPRO 10MG TABLET METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) METOPROLOL TARTRATE 25MG TABLET PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. PREDNISONE 5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX)
30 15 15 7.5 13 60 9 10
119.37 2.88 33.40 5.43 2.88 5.56 2.88 2.88
RX RX RX RX RX RX RX RX
0.00 692.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CALANDRIELLO, ROSE RESIDENT# : 361 STATION : SUB STATUS : MEDICARE
10/02/09
CHARGE
R3682128
00143-2260-01
SILVERMAN
10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682131 R3682132 R3682136 R3682137 R3682133 R3682148
16729-0006-17 00378-1803-01 31722-0521-10 00168-0080-31 17714-0019-01 64253-0111-35
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
10/02/09
CHARGE
R3682149
64253-0333-35
SILVERMAN
10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/06/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682129 R3682130 R3682134 R3682138 R3682139 R3682142 R3686389
49884-0405-01 00149-0752-15 00078-0360-34 00409-6533-01 17478-0711-30 00169-7501-11 61314-0656-05
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 50MCG TABLET HYDRALAZINE 50MG TABLET HYDROCORTISONE 2.5% CREAM SIMETHICONE 80MG TAB CHEW SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN METOPROLOL SUCCINATE ER 50MG TAB.SR 24H ASACOL DELAYED RELEASE 400MG TABLET DIOVAN 320MG TABLET C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION LIDOCAINE HCL 2% JELLY NOVOLOG 100U/1ML INSULIN CIPROFLOXACIN HCL OPHTH. 0.3% DROPS (RP:CILOXAN OPHTHALMIC)
10
6.00
RX
10 10 30 30 45 10
2.88 2.88 12.60 4.95 2.88 2.88
10
2.88
IV
10 60 10 100 30 10 5
7.25 76.27 23.79 27.26 11.46 76.45 37.85
RX RX RX RX RX RX RX
RX RX RX RX OTC RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CALANDRIELLO, ROSE RESIDENT# : 361 STATION : SUB STATUS : MEDICARE
10/12/09
CHARGE
R3683337
00143-2260-01
SILVERMAN
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/19/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3683340 R3683341 R3683343 R3683338 R3683339 R3683342 R3693212 R3708132 R3708651 R3708654
16729-0006-17 00378-1803-01 31722-0521-10 49884-0405-01 00149-0752-15 00078-0360-34 00409-6533-01 00378-5110-01 16729-0006-17 00143-2260-01
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708655 R3708657 R3708682 R3708683 R3708650 R3708652
00378-1803-01 31722-0521-10 62037-0640-01 00168-0080-31 00149-0752-15 00078-0359-34
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 50MCG TABLET HYDRALAZINE 50MG TABLET METOPROLOL SUCCINATE ER 50MG TAB.SR 24H ASACOL DELAYED RELEASE 400MG TABLET DIOVAN 320MG TABLET C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION PROCHLORPERAZINE 10MG TABLET (RP:COMPAZINE) SIMVASTATIN 40MG TABLET ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) HYDRALAZINE 50MG TABLET OMEPRAZOLE 40MG CAPSULE DR HYDROCORTISONE 2.5% CREAM ASACOL DELAYED RELEASE 400MG TABLET DIOVAN 160MG TABLET
15
9.00
RX
15 15 45 15 90 15 100 1 3 3
3.84 3.95 18.90 10.87 114.41 35.69 27.26 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX RX
3 9 3 30 18 3
2.88 3.78 5.20 4.95 22.88 5.64
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/23/09 10/23/09 10/23/09 10/23/09 10/23/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3708658 R3708661 R3708662 R3708663 R3708681
17478-0711-30 17714-0019-01 00088-2220-33 00169-7501-11 00409-6533-01
756.50 5.76
IV
CALANDRIELLO, ROSE RESIDENT# : 361 STATION : SUB STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
LIDOCAINE HCL 2% JELLY SIMETHICONE 80MG TAB CHEW LANTUS 100U/1ML VIAL-INSUL NOVOLOG 100U/1ML INSULIN C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION
2.88
30 100 10 10 100
11.46 2.88 70.92 76.45 27.26
RX OTC RX RX RX
0.00 765.14
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/19/09 10/19/09 10/19/09 10/19/09 10/22/09 10/23/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09 10/29/09 PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE RX OTC
R3698602 R3698603 R3698604 R3698605 R3698607 R3698608 R3708182 R3702262 R3702263 R3702265 R3702267 R3707878 R3708593 R3701187 R3701188 R3706247 R3711179 R3716243 R3716717
00781-1966-10 16729-0005-17 55111-0119-10 42043-0141-05 63736-0105-06 51672-4030-03 51672-4030-03 51672-4028-03 00245-0058-15 00603-1378-59 65580-0643-71 51672-4027-03 00781-1966-10 16729-0005-17 55111-0119-10 00781-1966-10 00245-0058-15 51672-4027-03 51672-4027-03 92.81 2.88
CARUSO, JOSEPH RESIDENT# : 427 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
FUROSEMIDE 40MG TABLET (RP:LASIX) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) BACID CAPLET WARFARIN SODIUM 3MG TABLET WARFARIN SODIUM 3MG TABLET (RP:COUMADIN) WARFARIN SODIUM 2MG TABLET KLOR-CON M 20 20MEQ TABLET SA LACTULOSE 10GM/15ML SOLUTION METOLAZONE 2.5MG TABLET (RP:ZAROXOLYN) WARFARIN SODIUM 1MG TABLET FUROSEMIDE 40MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) FUROSEMIDE 40MG TABLET KLOR-CON M 20 20MEQ TABLET SA (RP:K-DUR (1500MG)) WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 1MG TABLET (RP:COUMADIN)
11 11 11 6 4 7 1 2 14 946 2 3 6 15 15 30 45 4 1
2.88 2.88 2.88 2.88 2.88 4.09 2.88 2.88 6.48 20.81 2.88 2.88 2.88 3.15 2.88 2.88 20.84 2.88 2.88
RX RX RX RX OTC RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 95.69
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3692964 R3692967 R3692968 R3692972 R3692973 R3692974 R3692975 R3693010 R3692963 R3692965 R3692969 R3692970 R3692976 R3692977 R3694134 R3693918 R3693920 R3693921 R3701172
16729-0005-17 55111-0119-10 00245-0058-15 07431-2011-40 00536-3551-01 74312-0871-90 00182-1576-26 60505-2633-01 00006-0117-54 00228-2578-50 49884-0404-01 00149-0478-01 00075-1506-16 00037-0241-30 00781-1966-10 16729-0005-17 55111-0119-10 00245-0058-15 00781-1966-10
CASTILLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
GLORIA : 423 : SUB : MEDICARE
SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) KLOR-CON M 20 20MEQ TABLET SA VITAMIN D 400IU TABLET VITAMIN B12 500MCG TABLET ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OYST-CAL 500MG TABLET (RP:OS-CAL 500) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) SINGULAIR 10MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) METOPROLOL SUCCINATE ER 25MG TABLET ACTONEL 150MG TABLET NASACORT AQ NASAL 55MCG SPRAY ASTELIN NASAL 137MCG SPRAY FUROSEMIDE 40MG TABLET (RP:LASIX) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) KLOR-CON M 20 20MEQ TABLET SA FUROSEMIDE 40MG TABLET (RP:LASIX)
15 30 30 15 15 15 15 15 15 15 15 1 16.5 30 13 15 30 30 15
3.15 4.50 13.89 2.88 2.88 2.88 2.88 2.88 45.11 20.09 10.87 81.64 73.93 76.56 2.88 3.15 4.50 13.89 2.88
RX RX RX OTC OTC OTC OTC OTC RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3693917 R3693919 R3693922 R3693923 R3693924 R3693925 R3693926 R3693927
00006-0117-54 00228-2578-50 49884-0404-01 07431-2011-40 00536-3551-01 74312-0871-90 00182-1576-26 60505-2633-01
433.11 28.80
CASTILLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
GLORIA : 423 : SUB : MEDICARE
SINGULAIR 10MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) METOPROLOL SUCCINATE ER 25MG TABLET VITAMIN D 400IU TABLET VITAMIN B12 500MCG TABLET ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OYST-CAL 500MG TABLET (RP:OS-CAL 500) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC)
15 15 15 15 15 15 15 15
45.11 20.09 10.87 2.88 2.88 2.88 2.88 2.88
RX RX RX OTC OTC OTC OTC OTC
0.00 461.91
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09
PATIENT RECAP
CHARGE
OTC
R3698065
00023-0667-04
10.44
CHIARAMONTE, ANTONINA RESIDENT# : 28 STATION : 3 STATUS : MEDICAID
PAGANO
REFRESH PM OPHTH OINT
3.5
10.44
OTC
0.00 10.44
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CHINNI, MARIE RESIDENT# : 242 STATION : SUB STATUS : MEDICARE
10/05/09 10/05/09 10/08/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3684688 R3684689 R3689698 R3676441 R3676442 R3676443 R3676446 R3676447 R3676444
51672-4032-03 51672-4031-03 51672-4031-03 00143-1248-10 00378-0208-10 00172-3758-60 00245-0058-15 16729-0005-17 49884-0405-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/12/09 10/13/09 10/13/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3676445 R3694153 R3694154 R3693846 R3693847 R3693848 R3693851 R3693852
00456-3210-60 51672-4032-03 51672-4031-03 00143-1248-10 00378-0208-10 00172-3758-60 00245-0058-15 16729-0005-17
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 4MG TABLET FOLIC ACID 1MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) NAMENDA 10MG TABLET WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 4MG TABLET FOLIC ACID 1MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR)
2 2 4 15 15 15 15 15 30
2.88 2.88 2.88 2.88 2.88 2.88 6.95 3.15 21.73
RX RX RX RX RX RX RX RX RX
15 4 3 15 15 15 15 15
34.22 2.88 2.88 2.88 2.88 2.88 6.95 3.15
RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CHINNI, MARIE RESIDENT# : 242 STATION : SUB STATUS : MEDICARE
10/26/09
CHARGE
R3693849
49884-0405-01
GOLDFARB
10/26/09 10/27/09 10/27/09
CHARGE CHARGE CHARGE
R3693850 R3712871 R3712872
00456-3210-60 51672-4031-03 51672-4032-03
GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX
169.54
METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) NAMENDA 10MG TABLET WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 5MG TABLET
30
21.73
RX
15 1 2
34.22 2.88 2.88
RX RX RX
0.00 169.54
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CIANCIABELLA, ANTONINA RESIDENT# : 419 STATION : SUB STATUS : MEDICARE
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3687968 R3687973 R3687974 R3687976 R3687984 R3687988 R3687990
31722-0239-10 00378-0208-10 00603-1378-59 00172-3758-60 16729-0005-17 00228-2888-50 00378-0155-05
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/07/09 10/11/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/14/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3687979 R3691104 R3688276 R3688277 R3688278 R3688279 R3691471 R3696367
00075-0624-30 60505-2633-01 31722-0239-10 00378-0208-10 00172-3758-60 16729-0005-17 60505-2633-01 00378-0155-05
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/16/09
CHARGE
R3698783
00378-0155-05
GOLDFARB
AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET (RP:LASIX) LACTULOSE 10GM/15ML SOLUTION LISINOPRIL 5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) PROPOXYPHENE/NAPS/APAP 100-650MG TABLET (RP:DARVOCET-N 100) LOVENOX 30MG/0.3ML DISP SYRIN CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) PROPOXYPHENE/NAPS/APAP 100-650MG TABLET (RP:DARVOCET-N 100) PROPOXYPHENE/NAPS/APAP 100-650MG TABLET (RP:DARVOCET-N 100)
5 5 946 5 5 15 22.5
2.88 2.88 20.81 2.88 2.88 2.88 4.05
3 1 15 15 15 15 15 22.5
177.24 2.88 2.88 2.88 2.88 3.15 2.88 4.05
22.5
4.05
RX RX RX RX RX RX RX RX OTC RX RX RX RX OTC RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CIANCIABELLA, ANTONINA RESIDENT# : 419 STATION : SUB STATUS : MEDICARE
10/23/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/27/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708288 R3708845 R3694025 R3694026 R3694027 R3694028 R3694029 R3712894
23558-0016-70 23558-0016-70 31722-0239-10 00378-0208-10 00172-3758-60 16729-0005-17 60505-2633-01 00409-1952-32
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/27/09
CHARGE
R3720199
00409-1952-32
GOLDFARB
10/29/09 10/30/09
CHARGE CHARGE
R3716498 R3716825
00075-0624-30 51672-1289-02
GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
440.55 20.26
SALINE NASAL 0.65% SPRAY SALINE NASAL 0.65% SPRAY AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN (RP:TIGAN INJECTION) TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN LOVENOX 30MG/0.3ML DISP SYRIN NYSTATIN 100MU/1GM CREAM
45 45 15 15 15 15 15 10
5.81 5.81 2.88 2.88 2.88 3.15 2.88 9.28
OTC OTC RX RX RX RX OTC RX
2
2.88
RX
3 30
177.24 2.97
RX RX
0.00 460.81
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CIRINCION, JOSEPH RESIDENT# : 383 STATION : SUB STATUS : MEDICARE
09/01/09 09/02/09 09/02/09 09/02/09 09/02/09 09/02/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
R3636923 R3636934 R3636933 R3638504 R3641561 R3641559 R3641816 R3639270 R3636927 R3636928 R3636929
63736-0105-06 00406-2023-10 68180-0488-09 31722-0239-10 00456-2005-01 50111-0990-01 00245-0058-15 50111-0334-02 00172-3759-60 00172-3760-60 62175-0128-37
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
09/10/09 09/10/09
RETURN RETURN
R3636930 R3636931
31722-0238-10 55111-0181-04
TANK TANK
PATIENT RECAP
OTC RX
-2.06 -17.11
BACID CAPLET ATENOLOL 50MG TABLET PRAVASTATIN 80MG TABLET (RP:PRAVACHOL) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) LEXAPRO 5MG TABLET VITAMIN D 50000IU CAPSULE KLOR-CON M 20 20MEQ TABLET SA METRONIDAZOLE 500MG TABLET (RP:FLAGYL) LISINOPRIL 10MG TABLET LISINOPRIL 20MG TABLET (RP:ZESTRIL ) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LEVETIRACETAM 250MG TABLET (RP:KEPPRA)
-4 -2 -2 -4 -2 -1 -4 -13 -6 -5 -2
-2.06 -0.10 -1.15 -0.71 -4.26 -1.00 -1.85 -2.83 -0.41 -0.40 -1.91
OTC RX RX RX RX RX RX RX RX RX RX
-6 -4
-0.77 -1.72
RX RX
0.00 -19.17
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/27/09 10/27/09 10/27/09 10/27/09 10/27/09 10/27/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3712891 R3712895 R3712896 R3712897 R3712898 R3712900
24208-0324-05 00172-3759-60 00310-0278-10 00143-2260-01 00781-1966-10 00406-2030-05
108.48
COLLING, EDITH RESIDENT# : 233 STATION : SUB STATUS : PRIVATE
SCERBO SCERBO SCERBO SCERBO SCERBO SCERBO
TIMOLOL MALEATE OPHTH 0.5% DROPS LISINOPRIL 10MG TABLET SEROQUEL 50MG TABLET ISOSORBIDE MONONITRATE ER 60MG TABLET SA FUROSEMIDE 40MG TABLET METFORMIN 1000MG TABLET
5 13 26 13 13 26
4.50 2.88 86.10 7.80 2.88 4.32
RX RX RX RX RX RX
0.00 108.48
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/03/09 10/04/09 10/05/09
PATIENT RECAP
CHARGE CHARGE CHARGE
RX
R3682587 R3682674 R3682924
67253-0900-11 62856-0500-10 00406-0512-05
250.11
CORPI, THERESA RESIDENT# : 396 STATION : SUB STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN
ALPRAZOLAM 0.25MG TABLET FRAGMIN 5000IU/0.2ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
30 2 30
2.88 240.21 7.02
RX RX RX
0.00 250.11
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
COSTELLO, RESIDENT# STATION STATUS
10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3704153 R3704154 R3704157 R3704159 R3704161 R3704162 R3704164 R3704165
00603-2116-21 16729-0006-17 00093-7254-01 55111-0158-10 00378-0523-01 00781-1966-10 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK TANK
10/20/09 10/20/09
CHARGE CHARGE
R3704155 R3704158
00006-0117-54 60505-0829-01
TANK TANK
10/20/09 10/21/09 10/21/09
CHARGE CHARGE CHARGE
R3704160 R3704605 R3705769
00186-0370-20 67877-0124-85 00409-1316-25
TANK TANK TANK
10/25/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3709324 R3706218 R3706219
00169-1833-11 00603-2116-21 16729-0006-17
TANK TANK TANK
ELAINE : 325 : SUB : MEDICARE
ALLOPURINOL 300MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) GLIMEPIRIDE 1MG TABLET (RP:AMARYL) OMEPRAZOLE 20MG CAPSULE DR BISOPROLOL FUMARATE 5MG TABLET (RP:ZEBETA) FUROSEMIDE 40MG TABLET (RP:LASIX) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) SINGULAIR 10MG TABLET FLUTICASONE PROPIONATE NASAL SPRAY 50MCG (RP:FLONASE NASAL) SYMBICORT 160-4.5MCG HFA AER AD SILVER SULFADIAZINE 1% CREAM (RP:SILVADENE) HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN NOVOLIN R 100U/1ML VIAL-INSUL ALLOPURINOL 300MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR)
6 6 6 12 6 12 75 62.5
2.88 2.88 2.88 47.75 6.41 2.88 8.63 6.75
RX RX RX RX RX RX RX RX
6 16
18.05 58.62
RX RX
10.2 85 5
148.98 5.36 13.61
RX RX RX
10 15 15
33.87 2.88 3.84
RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3706221 R3706222 R3706223 R3706224 R3706220 R3713005
00093-7254-01 55111-0158-10 00378-0523-01 00781-1966-10 00006-0117-54 00409-1316-25
566.16
COSTELLO, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK
ELAINE : 325 : SUB : MEDICARE
GLIMEPIRIDE 1MG TABLET (RP:AMARYL) OMEPRAZOLE 20MG CAPSULE DR BISOPROLOL FUMARATE 5MG TABLET (RP:ZEBETA) FUROSEMIDE 40MG TABLET (RP:LASIX) SINGULAIR 10MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN
15 30 15 30 15 5
2.88 119.37 16.04 2.88 45.11 13.61
RX RX RX RX RX RX
0.00 566.16
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CUTTITTA, RESIDENT# STATION STATUS
09/10/09 09/10/09
RETURN RETURN
R3639026 R3639025
00172-3759-60 49884-0405-01
TANK TANK
09/10/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
RETURN RETURN RETURN RETURN RETURN RETURN
R3648262 R3639029 R3639028 R3638808 R3642658 R3639027
00310-0275-34 74312-0811-50 31604-0012-74 37000-0024-04 55111-0119-10 00555-0997-02
TANK TANK TANK TANK TANK TANK
09/17/09 09/17/09
RETURN RETURN
R3639023 R3639024
60505-0170-09 31722-0237-10
TANK TANK
PATIENT RECAP
RX OTC
-25.25 -5.71
VICTOR : 367 : SUB : MEDICARE
LISINOPRIL 10MG TABLET (RP:ZESTRIL) METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) SEROQUEL 25MG TABLET COD LIVER OIL CAPSULE FOLIC ACID 400MCG TABLET METAMUCIL SMOOTH S-F PACKET FAMOTIDINE 20MG TABLET (RP:PEPCID) FLUDROCORTISONE ACETATE 0.1MG TABLET (RP:FLORINEF ACETATE) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC)
-10 -12
-0.68 -8.34
RX RX
-2 -10 -10 -15 -10 -10
-4.03 -0.23 -0.13 -5.35 -1.50 -5.23
RX OTC OTC OTC RX RX
-11 -12
-3.92 -1.55
RX RX
0.00 -30.96
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DEFRANCESCO, ANGELO RESIDENT# : 343 STATION : SUB STATUS : MEDICARE
09/17/09
RETURN
R3639227
00409-1316-25
TANK
10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682716 R3682734 R3682739 R3682740 R3682742 R3682744 R3682746 R3682747 R3682720 R3682726 R3682736 R3682718 R3682723 R3682730 R3682733 R3682741 R3682743
00781-2067-01 00378-0208-10 13668-0009-05 00591-0409-01 63304-0579-10 00054-4728-31 55111-0158-10 00406-0512-05 54391-0002-01 30768-0006-01 79649-9031-06 63481-0687-06 00169-1833-11 50111-0990-01 00574-0508-01 62175-0261-55 54092-0252-90
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN MYCOPHENOLATE MOFETIL 250MG CAPSULE (RP:CELLCEPT) FUROSEMIDE 20MG TABLET CITALOPRAM 10MG TABLET (RP:CELEXA) LISINOPRIL 40MG TABLET METOPROLOL TARTRATE 25MG TABLET PREDNISONE 5MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) NEPHRO-VITE TABLET VITAMIN B COMPLEX TABLET GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE LIDODERM 5% PATCH NOVOLIN R 100U/1ML VIAL-INSUL VITAMIN D 50000IU CAPSULE FERROUS GLUCONATE 324MG TABLET NIFEDIPINE XL 60MG TABLET SA (RP:PROCARDIA XL) FOSRENOL 500MG TAB CHEW
-4
-10.03
RX
16 2 8 8 32 8 16 30 8 8 8 30 10 1 16 8 90
8.46 2.88 2.88 2.88 2.88 2.88 63.66 7.02 2.88 2.88 2.88 151.63 33.87 2.88 2.88 11.97 429.36
RX RX RX RX RX RX RX RX OTC OTC OTC RX RX RX OTC RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DEFRANCESCO, ANGELO RESIDENT# : 343 STATION : SUB STATUS : MEDICARE
10/04/09 10/06/09 10/08/09
CHARGE CHARGE CHARGE
R3682745 R3685154 R3689451
60505-0133-00 58468-0021-01 00409-1316-25
TANK TANK TANK
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/13/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3683278 R3683321 R3683326 R3683327 R3683329 R3683330 R3683331 R3683322 R3683324 R3683325 R3683323 R3683328 R3688267 R3693378 R3694146
00378-0208-10 00781-2067-01 13668-0009-05 00591-0409-01 63304-0579-10 00054-4728-31 55111-0158-10 54391-0002-01 00574-0508-01 79649-9031-06 30768-0006-01 62175-0261-55 58468-0021-01 00406-0512-05 00406-0552-01
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
CYCLOSPORINE 25MG CAPSULE RENAGEL (SEVELAMER HCL) 800MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN FUROSEMIDE 20MG TABLET MYCOPHENOLATE MOFETIL 250MG CAPSULE (RP:CELLCEPT) CITALOPRAM 10MG TABLET (RP:CELEXA) LISINOPRIL 40MG TABLET METOPROLOL TARTRATE 25MG TABLET PREDNISONE 5MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) NEPHRO-VITE TABLET FERROUS GLUCONATE 324MG TABLET GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE VITAMIN B COMPLEX TABLET NIFEDIPINE XL 60MG TABLET SA (RP:PROCARDIA XL) RENAGEL (SEVELAMER HCL) 800MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) OXYCODONE HCL IR 5MG TABLET
60 18 5
64.38 31.65 13.61
4 30 15 15 60 15 30 15 30 15 15 15 45 30 15
2.88 15.87 2.88 2.88 4.32 2.88 119.37 3.20 2.88 5.41 2.88 22.44 79.12 7.02 3.60
RX RX RX RX RX RX RX RX RX RX OTC OTC OTC OTC RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DEFRANCESCO, ANGELO RESIDENT# : 343 STATION : SUB STATUS : MEDICARE
10/13/09 10/14/09 10/14/09
CHARGE CHARGE CHARGE
R3694145 R3696170 R3694806
59011-0100-10 00378-0032-10 00409-1316-25
TANK TANK TANK
10/19/09
CHARGE
R3703963
00409-1952-32
TANK
10/21/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE
R3704435 R3708352 R3708339
59011-0100-10 00406-0552-01 54092-0252-90
TANK TANK TANK
PATIENT RECAP
RX OTC
1580.45 25.89
OXYCONTIN 10MG TABLET SA METOPROLOL TARTRATE 50MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN OXYCONTIN 10MG TABLET SA OXYCODONE HCL IR 5MG TABLET FOSRENOL 500MG TAB CHEW
15 24 5
21.00 2.88 13.61
RX RX RX
2
2.88
RX
15 15 90
21.00 3.60 429.36
RX RX RX
0.00 1606.34
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DELVECCHIO, RESIDENT# : STATION : STATUS :
10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708627 R3708632 R3708634 R3708638 R3708639 R3708629
00228-2888-50 00781-1966-10 00378-1805-01 31722-0238-10 31722-0239-10 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/23/09 10/23/09 10/23/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708630 R3708631 R3708633 R3709087 R3709517 R3709518 R3709519 R3709520 R3709516
50383-0232-10 61314-0144-05 60505-0823-06 00228-2076-50 00781-1966-10 00378-1805-01 31722-0238-10 31722-0239-10 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/27/09
CHARGE
R3712570
00378-0345-05
GOLDFARB
PATIENT RECAP
RX
224.65
MARIE 432 SUB MEDICARE
ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) FUROSEMIDE 40MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) DORZOLAMIDE HCL 2% DROPS (RP:TRUSOPT) BRIMONIDINE TARTRATE 0.15% DROPS (RP:ALPHAGAN P) CALCITONIN-SALMON NASAL 200 U/DOSE SPRAY/PUMP TEMAZEPAM 15MG CAPSULE FUROSEMIDE 40MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) DIAZEPAM 5MG TABLET (RP:VALIUM)
15 3 3 3 3 3
2.88 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX
10 5 3.7 15 15 15 15 15 15
45.93 47.21 81.50 2.88 2.88 4.37 2.88 2.88 13.96
RX RX RX RX RX RX RX RX RX
15
2.88
RX
0.00 224.65
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DERBYSHIRE, RESIDENT# : STATION : STATUS :
10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3717396 R3717393 R3717394 R3717395 R3717397 R3717398 R3717400 R3717404 R3717405 R3717406 R3717407
60505-2633-01 16252-0528-90 63653-1171-05 00781-5224-01 55111-0119-10 00088-2220-33 00904-5496-46 31722-0213-05 65162-0627-50 00075-0620-40 49502-0685-26
TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA
10/31/09 10/31/09 10/31/09 10/31/09
CHARGE CHARGE CHARGE CHARGE
R3717408 R3717410 R3717413 R3717419
49884-0775-86 58468-0020-01 00169-7501-11 16252-0097-22
TESTA TESTA TESTA TESTA
10/31/09 10/31/09
CHARGE CHARGE
R3717422 R3717423
31722-0239-10 64679-0924-03
TESTA TESTA
NANCY 36 3 MEDICARE
CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) PLAVIX 75MG TABLET CARVEDILOL 25MG TABLET (RP:COREG) FAMOTIDINE 20MG TABLET (RP:PEPCID) LANTUS 100U/1ML VIAL-INSUL NITROGLYCERIN 0.4MG/HR PATCH TD24 SERTRALINE HCL 50MG TABLET (RP:ZOLOFT) TRAMADOL 50MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) CLONIDINE PATCH-2 0.2MG PATCH (RP:CATAPRES-TTS-2) RENAGEL (SEVELAMER HCL) 400MG TABLET NOVOLOG 100U/1ML INSULIN ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) ENALAPRIL MALEATE 5MG TABLET (RP:VASOTEC)
30 30 30 60 60 10 30 30 60 4 62.5
3.61 10.68 118.82 8.58 9.00 70.92 38.09 3.84 5.40 236.29 6.75
OTC RX RX RX RX RX RX RX RX RX RX
4 90 10 75
133.37 79.12 76.45 8.63
RX RX RX RX
30 30
5.34 2.88
RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/31/09 10/31/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE
OTC RX
R3717424 R3717425 R3717426
31722-0520-10 00378-0208-10 00781-1966-10
3.61 850.64
DERBYSHIRE, RESIDENT# : STATION : STATUS :
TESTA TESTA TESTA
NANCY 36 3 MEDICARE
HYDRALAZINE 25MG TABLET (RP:APRESOLINE) FUROSEMIDE 20MG TABLET (RP:LASIX) FUROSEMIDE 40MG TABLET
90 60 60
29.52 3.36 3.60
RX RX RX
0.00 854.25
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DESIMONE, RESIDENT# STATION STATUS
10/01/09 10/06/09
CHARGE CHARGE
R3681253 R3686054
00064-4022-16 17478-0060-12
TESTA TESTA
10/15/09 10/22/09
CHARGE CHARGE
R3698027 R3707867
00062-0205-02 17478-0060-12
TESTA TESTA
10/26/09
CHARGE
R3709483
32131-0804-86
TESTA
PATIENT RECAP
RX OTC
43.14 8.64
GLADYS : 80 : 2 : MEDICAID
CERAVE MOISTURIZING CREAM AKWA TEARS (ARTIFICIAL TEARS) DROPS (RP:ARTIFICIAL TEARS) BIAFINE EMULSION AKWA TEARS (ARTIFICIAL TEARS) DROPS (RP:ARTIFICIAL TEARS) OPTI-MULTI CAPLET (RP:OCUVITE)
453 15
21.33 2.88
RX OTC
45 15
21.81 2.88
RX OTC
30
2.88
OTC
0.00 51.78
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/24/09
PATIENT RECAP
CHARGE
OTC
R3709127
66825-0002-01
34.06
DESMOND, MARY RESIDENT# : 84 STATION : 2 STATUS : MEDICAID
SHERMAN
FLORASTOR 250MG CAPSULE
30
34.06
OTC
0.00 34.06
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 10/02/09 10/05/09 10/05/09 10/06/09 10/06/09 10/07/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/14/09
PATIENT RECAP
RETURN RETURN RETURN CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3650613 R3650612 R3650611 R3681797 R3683359 R3683361 R3686047 R3686048 R3687661 R3690104 R3690105 R3683300 R3683301 R3683302 R3683299 R3694250 R3696323
00143-1201-01 60505-2606-01 00378-0045-01 51672-4032-03 51672-4033-01 51672-4027-03 51672-4027-03 51672-4033-01 00574-2021-08 51672-4033-01 51672-4027-03 00378-0023-05 00093-0051-01 00781-1966-10 00143-1201-01 51672-4032-03 51672-4032-03
69.70
DIGIORGIO, FRANK RESIDENT# : 366 STATION : SUB STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
COLCHICINE 0.6MG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) DILTIAZEM 60MG TABLET WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 6MG TABLET WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 6MG TABLET LAC LOTION 12% LOTION WARFARIN SODIUM 6MG TABLET WARFARIN SODIUM 1MG TABLET DILTIAZEM 30MG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) FUROSEMIDE 40MG TABLET (RP:LASIX) COLCHICINE 0.6MG TABLET WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 5MG TABLET
-14 -29 -14 2 2 2 3 3 225 14 14 45 15 15 15 1 2
-2.40 -4.15 -1.56 2.88 2.88 2.88 2.88 2.88 25.16 11.70 7.56 4.59 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 69.70
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3649656 R3649647 R3649639 R3649676 R3649646 R3649645 R3649675 R3649646 R3649644 R3649643 R3649653 R3649649 R3649650 R3649667 R3649652 R3649673 R3649654
63304-0579-10 00185-0144-05 00245-0058-15 00781-1599-05 63736-0105-06 00093-0657-01 16729-0006-17 63736-0105-06 00378-0433-01 57664-0434-88 00310-0271-10 00093-2131-01 00143-1482-01 00781-1446-05 00054-4728-31 51991-0203-11 00075-0624-30
-234.12 -33.35
DIPIERRO, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
MARIE : 355 : SUB : MEDICARE
METOPROLOL TARTRATE 25MG TABLET AMIODARONE HCL 200MG TABLET KLOR-CON M 20 20MEQ TABLET SA SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) BACID CAPLET CALCITRIOL 0.25MCG CAPSULE SIMVASTATIN 40MG TABLET (RP:ZOCOR) BACID CAPLET BUPROPION HCL 75MG TABLET ALLOPURINOL 100MG TABLET SEROQUEL 100MG TABLET NITROFURANTOIN MACROCRYSTAL 100MG CAPSULE PRIMIDONE 50MG TABLET FUROSEMIDE 80MG TABLET PREDNISONE 5MG TABLET FERREX 150 150MG CAPSULE (RP:NIFEREX-150) LOVENOX 30MG/0.3ML DISP SYRIN
-10 -13 -5 -5 -19 -5 -5 -43 -5 -4 -5 -2 -3 -16 -4 -8 -3
-0.72 -21.95 -2.31 -1.50 -9.78 -3.99 -1.28 -22.12 -2.38 -0.32 -17.29 -2.45 -0.98 -1.66 -0.08 -1.45 -177.21
RX RX RX RX OTC RX RX OTC RX RX RX RX RX RX RX OTC RX
0.00 -267.47
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3698593 R3698599 R3698601 R3698592 R3698597 R3698638 R3701197 R3701198
00115-4222-01 00378-0208-10 16252-0097-22 00093-3171-01 00173-0696-00 54092-0252-90 00115-4222-01 00378-0208-10
703.42
DISCAFANI, FLORENTYN RESIDENT# : 384 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
MIDODRINE 5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION CLINDAMYCIN 150MG CAPSULE ADVAIR DISKUS 250MCG/50MCG INHALER FOSRENOL 500MG TAB CHEW MIDODRINE 5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX)
22 11 72 9 60 90 30 15
40.44 2.88 8.28 7.37 157.07 429.36 55.14 2.88
RX RX RX RX RX RX RX RX
0.00 703.42
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
07/06/09 07/06/09 07/25/09 08/03/09 08/10/09 08/31/09 08/31/09 09/15/09 09/24/09 09/28/09 10/01/09 10/18/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC
R3561794 R3577211 R3599570 R3594245 R3617538 R3627511 R3642845 R3660459 R3672182 R3659856 R3680167 R3700664 R3693577
30768-0006-01 37000-0024-04 37000-0024-04 30768-0006-01 37000-0024-04 30768-0006-01 37000-0024-04 37000-0024-04 00501-3793-10 30768-0006-01 37000-0024-04 37000-0024-04 30768-0006-01
106.36
DUPIRAK, ANNE RESIDENT# : 32 STATION : 3 STATUS : MEDICAID
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET METAMUCIL SMOOTH S-F PACKET VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET METAMUCIL SMOOTH S-F PACKET POLYSPORIN POWDER VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET METAMUCIL SMOOTH S-F PACKET VITAMIN B COMPLEX TABLET
30 30 30 30 30 30 30 30 10 30 30 30 30
2.88 11.07 11.07 2.88 11.07 2.88 11.07 11.07 14.47 2.88 11.07 11.07 2.88
OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC
0.00 106.36
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693498 R3693502
74312-0077-10 64980-0147-03
21.95
ENGEL, EMILY RESIDENT# : 68 STATION : 2 STATUS : MEDICAID
WIENER WIENER
GLUCOSAMINE 500MG CAPSULE RISAQUAD 230MG CAPSULE (RP:FLORA-Q)
30 30
3.77 18.18
OTC OTC
0.00 21.95
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
FAY, EILEEN RESIDENT# : 391 STATION : SUB STATUS : MEDICARE
09/10/09
RETURN
R3649114
00536-4409-10
TANK
09/10/09 09/10/09 09/10/09 09/10/09
RETURN RETURN RETURN RETURN
R3649108 R3649112 R3649109 R3649110
00006-0952-54 31722-0237-10 16729-0006-17 00378-1809-01
TANK TANK TANK TANK
PATIENT RECAP
OTC RX
-0.10 -9.59
PYRIDOXINE (VIT B6) 100MG TABLET (RP:PYRIDOXINE (VIT B6)) COZAAR 50MG TABLET AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 100MCG TABLET
-4
-0.10
OTC
-4 -4 -5 -4
-6.59 -0.52 -1.28 -1.20
RX RX RX RX
0.00 -9.69
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09 09/02/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3642332 R3642325 R3642640 R3642951 R3642639 R3648104
00054-4728-31 00378-9102-93 00310-0275-34 63736-0105-06 31722-0239-10 00456-2010-01
-42.15 -2.57
FAY, THOMAS RESIDENT# : 386 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK
PREDNISONE 5MG TABLET NITROGLYCERIN 0.1MG1H PATCH TD24 SEROQUEL 25MG TABLET BACID CAPLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) LEXAPRO 10MG TABLET
-1 -15 -7 -5 -7 -5
-0.02 -15.64 -14.11 -2.57 -1.25 -11.13
RX RX RX OTC RX RX
0.00 -44.72
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
FLOOD, ROSE RESIDENT# : 282 STATION : 3 STATUS : MEDICARE
09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/27/09 09/27/09 09/27/09 09/27/09
CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT
R3674310 R3674314 R3674317 R3674320 R3674322 R3674323 R3674325 R3674327 R3674329 R3674520 R3674521 R3674531 R3674533
54391-0002-01 32131-0804-86 00169-7501-11 00378-0208-10 00378-1817-01 16729-0006-17 00169-0081-81 00169-0084-81 00006-0112-54 00378-0208-10 00169-0082-81 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
CREDIT CREDIT CREDIT CREDIT CREDIT
R3674667 R3674668 R3674669 R3674670 R3674916
54391-0002-01 32131-0804-86 00378-0208-10 00169-0082-81 59676-0310-01
TANK TANK TANK TANK TANK
NEPHRO-VITE TABLET OPTI-MULTI CAPLET (RP:OCUVITE) NOVOLOG 100U/1ML INSULIN FUROSEMIDE 20MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 175MCG TABLET (RP:SYNTHROID) SIMVASTATIN 40MG TABLET (RP:ZOCOR) PRANDIN 0.5MG TABLET PRANDIN 2MG TABLET JANUVIA 50MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) PRANDIN 1MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) NEPHRO-VITE TABLET OPTI-MULTI CAPLET (RP:OCUVITE) FUROSEMIDE 20MG TABLET (RP:LASIX) PRANDIN 1MG TABLET PROCRIT 10MU/1ML VIAL
2 2 10 1 2 2 2 4 2 1 2 75 62.5
-2.88 -2.88 -115.84 -2.88 -2.88 -2.88 -4.45 -8.89 -14.29 -2.88 -4.45 -8.63 -6.75
OTC OTC RX RX RX RX RX RX RX RX RX RX RX
30 30 30 60 4
-6.20 -2.88 -2.88 -133.35 -722.00
OTC OTC RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT
OTC RX
R3675737 R3675738 R3675740 R3675741 R3675742 R3675743 R3675744 R3675746 R3675747 R3675928
00006-0112-54 00169-0081-81 00378-1817-01 63653-1171-05 60505-0065-01 00456-3210-60 00456-2020-01 00527-1324-10 60505-2608-01 16729-0004-17
-14.84 -1965.43
FLOOD, ROSE RESIDENT# : 282 STATION : 3 STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
JANUVIA 50MG TABLET PRANDIN 0.5MG TABLET LEVOTHYROXINE SODIUM 175MCG TABLET (RP:SYNTHROID) PLAVIX 75MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) NAMENDA 10MG TABLET LEXAPRO 20MG TABLET DIGOXIN 0.125MG TABLET CARVEDILOL 12.5MG TABLET (RP:COREG) SIMVASTATIN 10MG TABLET (RP:ZOCOR)
30 30 30 30 60 30 30 30 60 30
-214.36 -66.68 -12.84 -180.03 -238.74 -93.90 -105.61 -6.39 -8.58 -5.25
RX RX RX RX RX RX RX RX RX RX
0.00 -1980.27
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 10/01/09 10/02/09 10/03/09 10/03/09 10/05/09 10/08/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
RETURN CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3652172 R3680390 R3681686 R3682571 R3682572 R3684684 R3687745 R3690870 R3676599 R3676600 R3676601 R3676603 R3683312 R3683314 R3683315 R3691463 R3691464 R3676602 R3676604
63653-1171-05 00781-1446-05 00536-4534-08 51991-0467-01 60505-0113-08 00781-1966-10 00245-0057-10 63481-0687-06 00185-0144-05 63304-0579-10 60505-0141-01 31722-0238-10 00054-0018-29 51991-0467-01 60505-0113-08 00781-1966-10 00245-0057-10 00597-0058-01 00074-6123-90
GALLAGHER, RICHARD RESIDENT# : 387 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PLAVIX 75MG TABLET FUROSEMIDE 80MG TABLET (RP:LASIX) SIMETHICONE 125MG TAB CHEW CYCLOBENZAPRINE HCL 5MG TABLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) FUROSEMIDE 40MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA LIDODERM 5% PATCH AMIODARONE HCL 200MG TABLET METOPROLOL TARTRATE 25MG TABLET GLIPIZIDE 5MG TABLET (RP:GLIPIZIDE) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) PREDNISONE 20MG TABLET CYCLOBENZAPRINE HCL 5MG TABLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) FUROSEMIDE 40MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA FLOMAX 0.4MG CAPSULE SA TRICOR 145MG TABLET
-6 22 60 27 9 14 12 30 15 30 7.5 15 15 45 15 15 15 15 15
-22.85 2.88 3.45 6.70 2.88 2.88 3.05 151.63 11.07 2.88 2.88 2.88 2.88 11.16 2.88 2.88 3.81 44.34 44.71
RX RX OTC RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/19/09 10/20/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3676606 R3701359 R3703800 R3707089 R3693980 R3693982 R3693983 R3693985 R3693989 R3693990 R3693992 R3706244 R3709523 R3693984 R3693986 R3693987
63653-1171-05 00603-1378-59 00781-1966-10 00143-1473-10 00185-0144-05 63304-0579-10 00591-0460-05 31722-0238-10 51991-0467-01 53746-0102-05 00245-0057-10 00781-1966-10 00143-1473-10 00597-0058-01 00074-6123-90 63653-1171-05
557.30 3.45
GALLAGHER, RICHARD RESIDENT# : 387 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PLAVIX 75MG TABLET LACTULOSE 10GM/15ML SOLUTION FUROSEMIDE 40MG TABLET (RP:LASIX) PREDNISONE 10MG TABLET AMIODARONE HCL 200MG TABLET METOPROLOL TARTRATE 25MG TABLET GLIPIZIDE 5MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) CYCLOBENZAPRINE HCL 5MG TABLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) KLOR-CON M 10 10MEQ TABLET SA FUROSEMIDE 40MG TABLET (RP:LASIX) PREDNISONE 10MG TABLET FLOMAX 0.4MG CAPSULE SA TRICOR 145MG TABLET PLAVIX 75MG TABLET
15 946 12 4 15 30 7.5 15 45 15 15 30 15 15 15 15
59.41 20.81 2.88 2.88 11.07 2.88 2.88 2.88 11.16 2.88 3.81 2.88 2.88 44.34 44.71 59.41
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 560.75
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN
RX OTC
R3649867 R3639018 R3639019 R3642657
00310-0275-34 57664-0397-58 74312-0813-80 00310-0275-34
-53.30 -0.27
GANGEMI, WINIFRED RESIDENT# : 382 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SEROQUEL 25MG TABLET METFORMIN 500MG TABLET (RP:GLUCOPHAGE) VITAMIN B12 1000MCG TABLET SEROQUEL 25MG TABLET
-14 -12 -6 -12
-28.22 -0.90 -0.27 -24.18
RX RX OTC RX
0.00 -53.57
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GAROFOLA, RESIDENT# STATION STATUS
10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3714939 R3714940 R3714942 R3714943 R3714944 R3714945 R3714947 R3714948 R3714951 R3714954 R3714955 R3714956 R3714957 R3714958
00597-0075-41 00536-5895-88 00378-1140-01 63304-0579-10 00228-2578-50 00087-2772-32 00781-1966-10 63824-0008-50 00008-0607-01 00054-0018-29 00169-0084-81 00075-0620-40 00186-1989-04 00591-3433-30
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
10/28/09 10/28/09 10/28/09 10/29/09
CHARGE CHARGE CHARGE CHARGE
R3714961 R3714962 R3714981 R3715237
00169-3687-12 00185-0144-05 50111-0459-01 00008-0607-01
PAGANO PAGANO PAGANO PAGANO
CHARLES : 433 : SUB : MEDICARE
SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER NICOTINE 14MG/24HR PATCH TD24 (RP:NICODERM CQ) BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) METOPROLOL TARTRATE 25MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) AVAPRO 150MG TABLET FUROSEMIDE 40MG TABLET (RP:LASIX) MUCINEX 600MG TABLET SA PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) PREDNISONE 20MG TABLET PRANDIN 2MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 SOLUTION (RP:DUONEB 3 ML VIAL) LEVEMIR 100U/1ML VIAL-INSUL AMIODARONE HCL 200MG TABLET THEOPHYLLINE ER 300MG TAB.SR 12H (RP:THEO-DUR) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX)
30 14 36 24 12 12 12 24 1 12 24 4 60 9
137.45 20.62 2.88 2.88 16.07 20.65 2.88 13.61 2.88 2.88 35.21 236.29 5.56 4.52
10 12 12 11
70.94 8.86 3.16 29.70
RX OTC RX RX RX RX RX OTC RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GAROFOLA, RESIDENT# STATION STATUS
10/29/09
CHARGE
R3715239
00591-3433-30
PAGANO
10/29/09
CHARGE
R3716275
00591-0658-05
PAGANO
PATIENT RECAP
RX OTC
630.86 34.23
CHARLES : 433 : SUB : MEDICARE
IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 SOLUTION (RP:DUONEB 3 ML VIAL) BUSPIRONE HCL 10MG TABLET (RP:BUSPAR)
90
45.17
RX
22
2.88
RX
0.00 665.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693448 R3693450
51660-0526-28 32131-0804-86
5.76
GASNICK, MARJORIE RESIDENT# : 76 STATION : 2 STATUS : MEDICAID
TESTA TESTA
LORATADINE 10MG TABLET OPTI-MULTI CAPLET (RP:OCUVITE)
30 30
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GATES, RUTH RESIDENT# : 405 STATION : SUB STATUS : MEDICARE
10/05/09
CHARGE
R3685137
00378-1650-01
TANK
10/05/09
CHARGE
R3684798
00185-0122-01
TANK
10/07/09 10/08/09 10/08/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3687703 R3688376 R3704648 R3693074 R3693077 R3693079 R3693083 R3693130 R3694283 R3693076 R3693084
00075-0624-30 00406-0552-01 58177-0324-04 55111-0119-10 16729-0006-17 63304-0579-10 00172-3758-60 00378-1803-01 00406-0552-01 00143-1201-01 62175-0128-37
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/13/09 10/14/09 10/19/09
CHARGE CHARGE CHARGE
R3693085 R3696009 R3701349
63653-1171-05 00075-0624-30 00182-4141-26
TANK TANK TANK
NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE (RP:MACRODANTIN) NITROFURANTOIN MONOHYDRATE 100MG CAPSULE (RP:MACROBID) LOVENOX 30MG/0.3ML DISP SYRIN OXYCODONE HCL IR 5MG TABLET NITROQUICK SL 0.4MG TAB SUBL FAMOTIDINE 20MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 5MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET OXYCODONE HCL IR 5MG TABLET COLCHICINE 0.6MG TABLET ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) PLAVIX 75MG TABLET LOVENOX 30MG/0.3ML DISP SYRIN CALCARB/VIT D 600/400 TABLET
2
2.88
RX
14
19.61
RX
3 7 100 28 14 14 14 14 7 14 14
177.24 2.88 5.75 4.20 3.58 2.88 2.88 3.68 2.88 2.88 4.77
RX RX RX RX RX RX RX RX RX RX RX
14 3 14
55.45 177.24 2.88
RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GATES, RUTH RESIDENT# : 405 STATION : SUB STATUS : MEDICARE
10/23/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3707620 R3693892 R3693894 R3693895 R3693896 R3693906 R3709587 R3693893 R3693897
00075-0624-30 55111-0119-10 16729-0006-17 63304-0579-10 00172-3758-60 00378-1803-01 00406-0552-01 00143-1201-01 62175-0128-37
TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/26/09 10/26/09 10/29/09
CHARGE CHARGE CHARGE
R3693898 R3706225 R3716288
63653-1171-05 00182-4141-26 00406-0512-05
TANK TANK TANK
PATIENT RECAP
RX OTC
741.40 5.76
LOVENOX 30MG/0.3ML DISP SYRIN FAMOTIDINE 20MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 5MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET OXYCODONE HCL IR 5MG TABLET COLCHICINE 0.6MG TABLET ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) PLAVIX 75MG TABLET CALCARB/VIT D 600/400 TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
3 30 15 15 15 15 7 15 15
177.24 4.50 3.84 2.88 2.88 3.95 2.88 2.88 5.12
15 30 30
59.41 2.88 7.02
RX RX RX RX RX RX RX RX RX RX OTC RX
0.00 747.16
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GRECO, PETER RESIDENT# : 428 STATION : SUB STATUS : MEDICARE
10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3698611 R3698614 R3698617 R3698619 R3698623 R3698612 R3698622 R3698625
16729-0006-17 00378-0208-10 00378-0032-10 55111-0119-10 00536-3985-01 63653-1171-05 00065-0266-25 58177-0324-18
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/15/09 10/16/09 10/21/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3698627 R3699302 R3706102 R3701189 R3701191 R3701192 R3701193 R3701190
00169-7501-11 00258-3678-01 00574-2121-28 16729-0006-17 00378-0208-10 00378-0032-10 55111-0119-10 63653-1171-05
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
297.21 2.88
SIMVASTATIN 40MG TABLET (RP:ZOCOR) FUROSEMIDE 20MG TABLET (RP:LASIX) METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) MECLIZINE HCL 12.5MG TABLET (RP:ANTIVERT) PLAVIX 75MG TABLET TRAVATAN 0.004% DROPS NITROQUICK (25'S) 0.4MG TAB SUBL (RP:NITROSTAT 4X25'S) NOVOLOG 100U/1ML INSULIN BENZONATATE 200MG CAPSULE (RP:TESSALON PERLE) AMMONIUM LACTATE 2X140GM 12% CREAM (RP:LAC-HYDRIN) SIMVASTATIN 40MG TABLET (RP:ZOCOR) FUROSEMIDE 20MG TABLET (RP:LASIX) METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) PLAVIX 75MG TABLET
11 11 22 22 30 11 2.5 25
2.88 2.88 2.88 3.30 2.88 43.57 58.41 2.88
RX RX RX RX OTC RX RX RX
10 21 280 15 15 30 30 15
76.45 5.17 25.28 3.84 2.88 2.88 4.50 59.41
RX RX RX RX RX RX RX RX
0.00 300.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN
RX
R3653655 R3653780
00007-3230-11 00054-0018-29
-319.74
GUADAGNINO, RESIDENT# : STATION : STATUS :
SCERBO SCERBO
ARIXTRA 2.5MG/0.5ML DISP SYRIN PREDNISONE 20MG TABLET
ANTHONY 395 SUB MEDICARE
-4 -21
-318.06 -1.68
RX RX
0.00 -319.74
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693726
51991-0203-11
17.02
HEIDER, EVA RESIDENT# : 40 STATION : 3 STATUS : MEDICAID
PAGANO
FERREX 150 150MG CAPSULE (RP:NIFEREX-150)
90
17.02
OTC
0.00 17.02
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/12/09
PATIENT RECAP
CHARGE CHARGE
RX
R3686120 R3688257
00406-2023-10 00406-2023-10
5.76
HOEPKER, ANN RESIDENT# : 414 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB
ATENOLOL 50MG TABLET ATENOLOL 50MG TABLET
6 15
2.88 2.88
RX RX
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
RX
R3649873
00075-0620-40
-118.14
HOFFMAN, MARION RESIDENT# : 315 STATION : SUB STATUS : MEDICARE
SILVERMAN
LOVENOX 40MG/0.4ML DISP SYRIN
-2
-118.14
RX
0.00 -118.14
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09 10/15/09 10/15/09 10/15/09 10/16/09 10/16/09 10/19/09 10/20/09 10/23/09 10/25/09 10/26/09 10/26/09 10/26/09 10/29/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC RX
R3698566 R3698568 R3698569 R3698582 R3699830 R3699838 R3702271 R3704150 R3707627 R3698583 R3701194 R3701196 R3706248 R3716551 R3717855
63736-0105-06 58177-0267-04 64679-0968-01 63481-0687-06 49884-0404-01 59676-0320-04 00603-1378-59 00009-5190-01 59676-0320-04 00065-0266-25 63736-0105-06 49884-0404-01 00009-5190-01 00527-1324-10 59676-0320-04
20.09 1161.06
HOMBERGER, IDA RESIDENT# : 426 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
BACID CAPLET DOXAZOSIN MESYLATE 2MG TABLET (RP:CARDURA) BETHANECHOL CHLORIDE 50MG TABLET (RP:BETHANECOL) LIDODERM 5% PATCH METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) PROCRIT 20MU/1ML VIAL LACTULOSE 10GM/15ML SOLUTION DETROL LA 2MG CAPSULE SA PROCRIT 20MU/1ML VIAL TRAVATAN 0.004% DROPS BACID CAPLET METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) DETROL LA 2MG CAPSULE SA DIGOXIN 0.125MG TABLET PROCRIT 20MU/1ML VIAL
22 11 33 30 5 1 946 12 1 2.5 30 7.5 30 11 1
8.50 6.51 64.58 151.63 3.62 238.26 20.81 37.83 238.26 58.41 11.59 5.43 94.58 2.88 238.26
OTC RX RX RX RX RX RX RX RX RX OTC RX RX RX RX
0.00 1181.15
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/03/09 10/05/09 10/05/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/14/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3680023 R3682586 R3683288 R3682922 R3689833 R3690028 R3676646 R3676647 R3676648 R3676649 R3694170 R3695921
00406-0512-05 59676-0340-01 00406-0512-05 00075-0624-30 59011-0100-10 59676-0340-01 60505-0093-00 00378-0208-10 00245-0058-15 00378-0023-05 00075-0624-30 00406-0512-05
1350.57
HUGHES, MARY RESIDENT# : 400 STATION : SUB STATUS : MEDICARE
RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER
OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) PROCRIT 40MU/1ML VIAL OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LOVENOX 30MG/0.3ML DISP SYRIN OXYCONTIN 10MG TABLET SA PROCRIT 40MU/1ML VIAL DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 20 20MEQ TABLET SA DILTIAZEM 30MG TABLET LOVENOX 30MG/0.3ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
15 1 15 3 15 1 4 4 4 12 3 15
3.51 476.52 3.51 177.24 21.00 476.52 2.88 2.88 2.88 2.88 177.24 3.51
RX RX RX RX RX RX RX RX RX RX RX RX
0.00 1350.57
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/16/09 10/16/09 10/16/09 10/16/09 10/16/09 10/16/09 10/19/09 10/19/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09 10/29/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3699960 R3699963 R3676649 R3676648 R3676647 R3676646 R3700842 R3700845 R3694043 R3694044 R3694045 R3694046 R3709082 R3713006 R3716210 R3717117
63481-0687-06 59011-0100-10 00378-0023-05 00245-0058-15 00378-0208-10 60505-0093-00 00075-0624-30 59676-0340-01 60505-0093-00 00378-0208-10 00245-0058-15 00378-0023-05 59676-0340-01 00075-0624-30 00025-1525-51 00406-0512-05
1557.97
HUGHES, MARY RESIDENT# : 400 STATION : SUB STATUS : PRIVATE
RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER
LIDODERM 5% PATCH OXYCONTIN 10MG TABLET SA DILTIAZEM 30MG TABLET KLOR-CON M 20 20MEQ TABLET SA FUROSEMIDE 20MG TABLET (RP:LASIX) DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) LOVENOX 30MG/0.3ML DISP SYRIN PROCRIT 40MU/1ML VIAL DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 20 20MEQ TABLET SA DILTIAZEM 30MG TABLET PROCRIT 40MU/1ML VIAL LOVENOX 30MG/0.3ML DISP SYRIN CELEBREX 200MG CAPSULE OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
30 15 33 11 11 11 3 1 15 15 15 45 1 3 11 30
151.63 21.00 3.37 5.09 0.62 6.51 177.24 476.52 8.88 2.88 6.95 4.59 476.52 177.24 31.91 7.02
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 1557.97
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/04/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX
R3627766 R3609007 R3627760 R3633907 R3627761 R3627763 R3627762 R3645703 R3649045 R3627767 R3627765
00093-8344-10 49884-0035-10 00185-0144-05 00456-2005-01 00078-0423-15 00781-1599-05 63304-0579-10 50111-0990-01 51672-4030-03 00378-1805-01 57664-0397-58
-87.41
INGOGLIA, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
GLYBURIDE 5MG TABLET MECLIZINE HCL 25MG TABLET AMIODARONE HCL 200MG TABLET LEXAPRO 5MG TABLET DIOVAN 40MG TABLET SPIRONOLACTONE 25MG TABLET METOPROLOL TARTRATE 25MG TABLET VITAMIN D 50000IU CAPSULE WARFARIN SODIUM 3MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET METFORMIN 500MG TABLET
ROSE : 357 : SUB : MEDICARE
-21 -30 -10 -10 -12 -10 -23 -3 -13 -3 -22
-5.94 -7.95 -16.88 -21.29 -17.56 -3.00 -1.66 -3.01 -7.60 -0.87 -1.65
RX RX RX RX RX RX RX RX RX RX RX
0.00 -87.41
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
KING, EDYTHE RESIDENT# : 179 STATION : SUB STATUS : MEDICARE
10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3696387 R3696391 R3696393 R3696399 R3696394 R3696389 R3696390 R3696392
00378-1813-01 16729-0005-17 00781-1966-10 67253-0900-11 00182-4141-26 63653-1171-05 00008-0833-22 49884-0405-01
TANK TANK TANK TANK TANK TANK TANK TANK
10/14/09 10/19/09 10/19/09
CHARGE CHARGE CHARGE
R3696397 R3701433 R3701436
63481-0687-06 31722-0237-10 00409-1316-25
TANK TANK TANK
10/22/09 10/23/09
CHARGE CHARGE
R3707685 R3708342
00008-0837-21 00409-1316-25
TANK TANK
10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3701178 R3701181 R3701183
00378-1813-01 16729-0005-17 00781-1966-10
TANK TANK TANK
LEVOTHYROXINE SODIUM 125MCG TABLET (RP:SYNTHROID) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FUROSEMIDE 40MG TABLET (RP:LASIX) ALPRAZOLAM 0.25MG TABLET (RP:XANAX) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) PLAVIX 75MG TABLET EFFEXOR XR 75MG CAP.SR 24H METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) LIDODERM 5% PATCH AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN EFFEXOR XR 37.5MG CAP.SR 24H HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN LEVOTHYROXINE SODIUM 125MCG TABLET (RP:SYNTHROID) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FUROSEMIDE 40MG TABLET (RP:LASIX)
12 12 12 30 24 12 12 12
4.20 2.88 2.88 2.88 2.88 47.53 39.24 8.70
RX RX RX RX OTC RX RX RX
15 7 5
75.81 2.88 13.61
RX RX RX
4 10
3.89 27.23
RX RX
15 15 15
5.25 3.15 2.88
RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
KING, EDYTHE RESIDENT# : 179 STATION : SUB STATUS : MEDICARE
10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3706242 R3701179 R3701182
31722-0237-10 63653-1171-05 49884-0405-01
TANK TANK TANK
10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3701184 R3709521 R3709522
00182-4141-26 00008-0837-21 00008-0833-22
TANK TANK TANK
PATIENT RECAP
RX OTC
379.81 5.76
AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) PLAVIX 75MG TABLET METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) EFFEXOR XR 37.5MG CAP.SR 24H EFFEXOR XR 75MG CAP.SR 24H
15 15 15
2.88 59.41 10.87
RX RX RX
30 15 15
2.88 14.59 49.05
OTC RX RX
0.00 385.57
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/10/09 10/13/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3690479 R3693107
58768-0103-30 17478-0060-12
15.98
LANGOL, MARIE RESIDENT# : 39 STATION : 3 STATUS : MEDICAID
TESTA TESTA
EYESCRUB LID CLEANSER PAD (RP:OCUSOFT LID SCRUB) AKWA TEARS (ARTIFICIAL TEARS) DROPS
30 15
13.10 2.88
OTC OTC
0.00 15.98
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/09/09
PATIENT RECAP
CHARGE
OTC
R3690278
58768-0103-30
13.10
LANOTTE, FRANK RESIDENT# : 25 STATION : 3 STATUS : MEDICAID
TESTA
EYESCRUB LID CLEANSER PAD (RP:OCUSOFT LID SCRUB)
30
13.10
OTC
0.00 13.10
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/16/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3694287 R3698682
63736-0105-06 00023-9205-15
17.50
LATTANZIO, LOUIS RESIDENT# : 18 STATION : 3 STATUS : MEDICAID
TESTA TESTA
BACID CAPLET REFRESH LIQUIGEL 1% DROPS
20 15
7.72 9.78
OTC OTC
0.00 17.50
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/15/09 10/15/09 10/16/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3694410 R3694412 R3694413 R3694414 R3694417 R3694422 R3694424 R3694428 R3694586 R3694416 R3694427 R3694411 R3694418 R3694420 R3694426 R3694431 R3697915 R3697923 R3699013
31722-0239-10 00245-0041-11 00603-1378-59 00603-4975-21 16252-0528-90 55111-0158-10 16252-0097-22 51672-4032-03 00378-1803-01 00182-1576-26 63736-0105-06 00078-0360-34 00023-9163-30 66582-0414-54 63304-0582-01 00064-5010-15 51672-4032-03 00075-0621-60 00406-0512-05
LAZARUS, BERNICE RESIDENT# : 35 STATION : 3 STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) KLOR-CON 10 (YELLOW) 10MEQ TABLET SA LACTULOSE 10GM/15ML SOLUTION OXYBUTYNIN 5MG TABLET (RP:DITROPAN) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) OMEPRAZOLE 20MG CAPSULE DR ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION WARFARIN SODIUM 5MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET OYST-CAL 500MG TABLET (RP:OS-CAL 500) BACID CAPLET DIOVAN 320MG TABLET RESTASIS 0.05% DROPERETTE ZETIA 10MG TABLET CEFADROXIL 500MG CAPSULE (RP:DURICEF) SANTYL OINTMENT WARFARIN SODIUM 5MG TABLET LOVENOX 60MG/0.6ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
13 13 946 39 13 13 75 1 13 13 14 13 30 13 14 30 2 6 30
2.88 3.30 20.81 6.44 4.63 51.73 8.63 2.88 3.42 2.88 5.41 30.93 89.02 34.60 39.92 85.21 2.88 354.82 7.02
RX RX RX RX RX RX RX RX RX OTC OTC RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LAZARUS, BERNICE RESIDENT# : 35 STATION : 3 STATUS : MEDICARE
10/16/09 10/16/09 10/19/09 10/19/09 10/22/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3699595 R3699315 R3702190 R3700797 R3707404
51672-4032-03 60505-0379-00 51672-4031-03 00064-5010-15 00409-1952-32
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09 10/30/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3701144 R3701146 R3701147 R3701149 R3701151 R3701152 R3710933 R3701145 R3701148 R3701150 R3714788 R3717244
31722-0239-10 00245-0041-11 00603-4975-21 16252-0528-90 55111-0158-10 00378-1803-01 51672-4028-03 00078-0360-34 00182-1576-26 66582-0414-54 51672-4028-03 51672-4030-03
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
1379.86 11.17
WARFARIN SODIUM 5MG TABLET CICLOPIROX 8% SOLUTION (RP:PENLAC) WARFARIN SODIUM 4MG TABLET (RP:COUMADIN) SANTYL OINTMENT TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) KLOR-CON 10 (YELLOW) 10MEQ TABLET SA OXYBUTYNIN 5MG TABLET (RP:DITROPAN) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) OMEPRAZOLE 20MG CAPSULE DR LEVOTHYROXINE SODIUM 50MCG TABLET WARFARIN SODIUM 2MG TABLET DIOVAN 320MG TABLET OYST-CAL 500MG TABLET (RP:OS-CAL 500) ZETIA 10MG TABLET WARFARIN SODIUM 2MG TABLET WARFARIN SODIUM 3MG TABLET
7 6.6 7 60 10
4.13 117.18 4.10 170.42 9.28
RX RX RX RX RX
30 30 90 30 30 30 2 30 30 30 2 1.5
5.34 7.62 14.85 10.68 119.37 7.89 2.88 71.38 2.88 79.86 2.88 2.88
RX RX RX RX RX RX RX RX OTC RX RX RX
0.00 1391.03
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/07/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3681046 R3687657
63736-0105-06 17714-0020-01
13.51
LAZARUS, BERNICE RESIDENT# : 35 STATION : 3 STATUS : MEDICAID
GOLDFARB GOLDFARB
BACID CAPLET DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL)
20 30
10.63 2.88
OTC OTC
0.00 13.51
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN
RX
R3657049 R3653576
51672-4031-03 51672-4032-03
-2.94
LEWICKA, MARY RESIDENT# : 394 STATION : SUB STATUS : MEDICARE
TANK TANK
WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 5MG TABLET (RP:COUMADIN)
-2 -3
-1.17 -1.77
RX RX
0.00 -2.94
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/10/09 09/10/09
PATIENT RECAP
RETURN RETURN RETURN RETURN
RX
R3627746 R3627749 R3627748 R3627747
00310-0275-34 00002-3240-30 60505-2606-01 00597-0058-01
-87.55
LEWIS, LYNN RESIDENT# : 354 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SEROQUEL 25MG TABLET CYMBALTA 30MG CAPSULE EC CARVEDILOL 3.125MG TABLET (RP:COREG) FLOMAX 0.4MG CAPSULE SA
-12 -9 -27 -11
-24.18 -29.68 -3.86 -29.83
RX RX RX RX
0.00 -87.55
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3681231 R3681233 R3681235 R3681242 R3681243 R3681244 R3681385 R3690879 R3683292 R3683293 R3683294 R3691454 R3683291
63653-1171-05 74312-0813-80 00075-0624-30 00093-0051-01 00115-4222-01 50111-0990-01 00172-3758-60 00182-4141-26 74312-0813-80 00093-0051-01 00172-3758-60 00182-4141-26 63653-1171-05
318.02 11.52
LINDSAY, ELIZABETH RESIDENT# : 379 STATION : 3 STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
PLAVIX 75MG TABLET VITAMIN B12 1000MCG TABLET LOVENOX 30MG/0.3ML DISP SYRIN CARVEDILOL 3.125MG TABLET (RP:COREG) MIDODRINE 5MG TABLET VITAMIN D 50000IU CAPSULE LISINOPRIL 5MG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) VITAMIN B12 1000MCG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) LISINOPRIL 5MG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) PLAVIX 75MG TABLET
11 11 3 22 33 2 11 4 3 6 3 6 3
45.55 2.88 185.27 3.15 60.65 2.88 2.88 2.88 2.88 2.88 2.88 2.88 11.88
RX OTC RX RX RX RX RX OTC OTC RX RX OTC RX
0.00 329.54
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3686063 R3693488
17478-0060-12 00182-4141-26
5.76
LINQUITO, RESIDENT# STATION STATUS
TESTA TESTA
PHILOMENA : 69 : 2 : MEDICAID
AKWA TEARS (ARTIFICIAL TEARS) DROPS CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
15 30
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LODICO, JOANNE RESIDENT# : 270 STATION : 2 STATUS : MEDICARE
10/24/09 10/24/09 10/24/09 10/24/09
CHARGE CHARGE CHARGE CHARGE
R3709116 R3709120 R3709126 R3709129
31722-0238-10 63736-0105-06 00228-2666-50 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/24/09 10/24/09 10/24/09 10/24/09 10/24/09 10/24/09 10/24/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3709131 R3709138 R3709151 R3709095 R3709096 R3709117 R3709121
16729-0005-17 00093-7128-01 00406-0512-05 00169-7501-11 64764-0301-15 00075-0620-40 00781-6054-70
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/24/09 10/24/09 10/24/09 10/24/09 10/24/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3709124 R3709128 R3709134 R3709148 R3709171 R3709473
00006-0960-54 00228-2900-50 00013-8303-04 59011-0100-10 00071-1013-68 31722-0238-10
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) BACID CAPLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) SIMVASTATIN 20MG TABLET (RP:ZOCOR) TORSEMIDE 10MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) NOVOLOG 100U/1ML INSULIN ACTOS 30MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN DORZOLAMIDE HCL/TIMOLOL MALEATE 2%-0.5% DROPS (RP:COSOPT OPHTH) COZAAR 100MG TABLET GLIPIZIDE ER 10MG TABLET SA (RP:GLUCOTROL XL) XALATAN 0.005% DROPS OXYCONTIN 10MG TABLET SA LYRICA 50MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC)
2 2 6 2
2.88 2.88 2.88 2.88
RX OTC RX RX
2 2 30 10 2 4 10
2.88 2.88 7.02 76.45 11.12 236.29 84.21
RX RX RX RX RX RX RX
2 4 2.5 30 90 30
4.49 2.88 56.84 42.00 159.03 3.87
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LODICO, JOANNE RESIDENT# : 270 STATION : 2 STATUS : MEDICARE
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3709474 R3709476 R3709479 R3709480 R3710924 R3709472 R3709475 R3709477 R3709478
63736-0105-06 00228-2666-50 16729-0005-17 00093-7128-01 00603-1378-59 64764-0301-15 00006-0960-54 00228-2900-50 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/28/09
CHARGE
R3714980
00168-0258-46
GOLDFARB
10/29/09 10/31/09
CHARGE CHARGE
R3716143 R3717766
00406-0512-05 00071-1013-68
GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
1126.04 14.47
BACID CAPLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) SIMVASTATIN 20MG TABLET (RP:ZOCOR) TORSEMIDE 10MG TABLET LACTULOSE 10GM/15ML SOLUTION ACTOS 30MG TABLET COZAAR 100MG TABLET GLIPIZIDE ER 10MG TABLET SA (RP:GLUCOTROL XL) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) CLOTRIMAZOLE/BETAMETHASONE DIPROP CREAM (RP:LOTRISONE) OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LYRICA 50MG CAPSULE
30 90 30 30 946 30 30 60 30
11.59 11.16 6.30 14.40 20.81 166.90 67.33 33.25 10.22
OTC RX RX RX RX RX RX RX RX
45
37.04
RX
30 30
7.02 53.01
RX RX
0.00 1140.51
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/05/09 10/14/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3683304 R3696403
00182-6151-40 63736-0105-06
14.97
LOMBARDI, RESIDENT# STATION STATUS
TESTA TESTA
VITAMIN LIQUID BACID CAPLET
ROSE : 54 : 3 : MEDICAID
480 20
7.25 7.72
OTC OTC
0.00 14.97
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LUTZ, RUTH RESIDENT# : 412 STATION : SUB STATUS : MEDICARE
10/06/09 10/07/09
CHARGE CHARGE
R3686154 R3686419
00406-0552-01 00409-1316-25
TANK TANK
10/09/09 10/09/09 10/09/09 10/09/09 10/10/09 10/11/09 10/12/09 10/12/09 10/15/09 10/16/09 10/19/09 10/19/09 10/20/09 10/20/09 10/20/09 10/22/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3690506 R3690508 R3690496 R3690505 R3690872 R3691098 R3691451 R3691452 R3698133 R3699348 R3702251 R3702252 R3703961 R3704275 R3704105 R3706135
31722-0238-10 00555-0720-51 00075-0621-60 63481-0687-06 00172-3759-60 51672-4027-03 31722-0238-10 00172-3759-60 51672-4030-03 63304-0579-10 51672-4028-03 00172-3760-60 51672-4029-03 51672-4029-03 00169-1833-11 00555-0720-51
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
OXYCODONE HCL IR 5MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) LOVENOX 60MG/0.6ML DISP SYRIN LIDODERM 5% PATCH LISINOPRIL 10MG TABLET WARFARIN SODIUM 1MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LISINOPRIL 10MG TABLET WARFARIN SODIUM 3MG TABLET METOPROLOL TARTRATE 25MG TABLET WARFARIN SODIUM 2MG TABLET LISINOPRIL 20MG TABLET WARFARIN SODIUM 2.5MG TABLET WARFARIN SODIUM 2.5MG TABLET (RP:COUMADIN) NOVOLIN R 100U/1ML VIAL-INSUL ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX)
15 5
3.60 13.61
RX RX
3 2 6 15 2 2 15 15 3.5 20 3 7 7 1 10 2
2.88 30.74 354.82 75.81 2.88 2.88 2.88 2.88 2.88 2.88 2.88 2.88 4.07 2.88 33.87 30.74
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/23/09 10/23/09 10/26/09 10/26/09 10/30/09 10/30/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3708178 R3708592 R3701171 R3706217 R3716992 R3717045 R3717050
51672-4029-03 63481-0687-06 63304-0579-10 00172-3760-60 51672-4029-03 55111-0126-05 63736-0105-06
668.33 5.41
LUTZ, RUTH RESIDENT# : 412 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK
WARFARIN SODIUM 2.5MG TABLET (RP:COUMADIN) LIDODERM 5% PATCH METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 20MG TABLET WARFARIN SODIUM 2.5MG TABLET CIPROFLOXACIN 250MG TABLET (RP:CIPRO) BACID CAPLET
4 15 30 15 7 10 14
2.88 75.81 2.88 2.88 4.07 3.75 5.41
RX RX RX RX RX RX OTC
0.00 673.74
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/30/09 10/30/09 10/30/09 10/30/09 10/30/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3717377 R3717378 R3717379 R3717380 R3717381 R3717751
00186-5040-54 31722-0237-10 31722-0214-05 58177-0268-04 00486-1125-01 00029-1527-25
116.91
LYNCH, MARION RESIDENT# : 435 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
NEXIUM 40MG CAPSULE SA AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) SERTRALINE HCL 100MG TABLET (RP:ZOLOFT ) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) K-PHOS NEUTRAL 250MG TABLET BACTROBAN 2% CREAM
10 10 20 10 12 30
42.57 2.88 2.88 6.21 2.88 59.49
RX RX RX RX RX RX
0.00 116.91
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN
RX
R3633789 R3633786 R3633788 R3633788
00008-0607-01 16729-0005-17 00093-2210-05 00093-2210-05
-85.78
LYONS, JOHN RESIDENT# : 375 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK
PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) SIMVASTATIN 20MG TABLET (RP:ZOCOR) SUCRALFATE 1GM TABLET (RP:CARAFATE) SUCRALFATE 1GM TABLET (RP:CARAFATE)
-24 -12 -20 -30
-64.81 -2.52 -7.38 -11.07
RX RX RX RX
0.00 -85.78
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/15/09 10/16/09 10/16/09 10/19/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3676539 R3676540 R3676541 R3676542 R3676543 R3691834 R3691833 R3696914 R3699469 R3699473 R3702242 R3693940 R3693941 R3693942 R3693944 R3701174 R3693945
00378-0208-10 00527-1324-10 63304-0579-10 60505-0065-01 16729-0005-17 00054-0018-29 60505-2633-01 55111-0119-10 63736-0105-06 55111-0126-05 00168-0162-46 00378-0208-10 00527-1324-10 63304-0579-10 16729-0005-17 55111-0119-10 60505-2633-01
168.25 11.17
MAHER, MARGARET RESIDENT# : 411 STATION : SUB STATUS : MEDICARE
GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD
FUROSEMIDE 20MG TABLET (RP:LASIX) DIGOXIN 0.125MG TABLET METOPROLOL TARTRATE 25MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:OMEPRAZOLE) SIMVASTATIN 20MG TABLET (RP:ZOCOR) PREDNISONE 20MG TABLET CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) FAMOTIDINE 20MG TABLET (RP:PEPCID) BACID CAPLET CIPROFLOXACIN 250MG TABLET CLOBETASOL PROPIONATE 0.05% OINTMENT FUROSEMIDE 20MG TABLET (RP:LASIX) DIGOXIN 0.125MG TABLET METOPROLOL TARTRATE 25MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC)
8 15 15 30 15 10 15 22 14 14 45 8 15 15 15 30 15
2.88 3.20 2.88 119.37 3.15 2.88 2.88 3.30 5.41 5.25 8.73 2.88 3.20 2.88 3.15 4.50 2.88
RX RX RX RX RX RX OTC RX OTC RX RX RX RX RX RX RX OTC
0.00 179.42
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3643590 R3643597 R3627771 R3627770 R3627769 R3627769 R3627768 R3652148 R3643594 R3643594 R3711222 R3711226 R3711228 R3711230 R3711232 R3711233 R3711223 R3711225 R3711227
31722-0238-10 00006-0747-54 00002-3240-30 63653-1171-05 55111-0119-10 55111-0119-10 16729-0006-17 31722-0237-10 00228-2128-50 00228-2128-50 16729-0006-17 00904-3232-92 00115-4222-01 55111-0127-05 00093-0051-01 00574-2008-30 63653-1171-05 00075-0620-40 00078-0359-34
MALATINO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
CARMELA : 360 : 2 : MEDICARE
AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) HYZAAR 100MG-25MG TABLET CYMBALTA 30MG CAPSULE EC PLAVIX 75MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) FAMOTIDINE 20MG TABLET (RP:PEPCID) SIMVASTATIN 40MG TABLET (RP:ZOCOR) AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) CLONIDINE 0.2MG TABLET CLONIDINE 0.2MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) CALCIUM CARBONATE 600MG TABLET MIDODRINE 5MG TABLET (RP:PRO-AMATINE) CIPROFLOXACIN 500MG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) NYSTATIN 100000U/1GM POWDER PLAVIX 75MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN DIOVAN 160MG TABLET
-9 -8 -1 -1 -2 -2 -3 -6 -25 -15 30 30 60 10 60 30 30 4 30
-1.16 -19.85 -3.30 -3.81 -0.30 -0.30 -0.77 -0.77 -3.53 -2.12 7.68 2.88 110.28 4.50 8.58 52.44 118.82 236.29 56.42
RX RX RX RX RX RX RX RX RX RX RX OTC RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/28/09 10/28/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX OTC
R3711229 R3714585 R3714592 R3716303
00002-3237-30 00002-3240-30 00456-2005-01 00228-2888-50
688.04 2.88
MALATINO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
CARMELA : 360 : 2 : MEDICARE
CYMBALTA 60MG CAPSULE EC CYMBALTA 30MG CAPSULE EC LEXAPRO 5MG TABLET ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN)
30 5 5 30
98.92 16.49 10.65 2.88
RX RX RX RX
0.00 690.92
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
MANZETTI, RESIDENT# STATION STATUS
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3688042 R3688047 R3688048 R3688052 R3688053 R3688054 R3688056 R3688071 R3688236
00378-1140-01 00603-1378-59 00378-1803-01 00245-0057-10 16729-0005-17 50111-0433-01 00406-0512-05 00781-1599-05 00378-1650-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3688045 R3688046 R3688049 R3688050 R3688051
64455-0799-42 00075-0620-40 00006-0951-54 60258-0173-06 00185-0122-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/11/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE
R3691159 R3688268 R3688270
63736-0105-06 00378-1140-01 00378-1803-01
GOLDFARB GOLDFARB GOLDFARB
JEAN : 420 : SUB : MEDICARE
BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) LACTULOSE 10GM/15ML SOLUTION LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) KLOR-CON M 10 10MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) TRAZODONE 50MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE (RP:MACRODANTIN) CARDIZEM CD 360MG CAPSULE SA LOVENOX 40MG/0.4ML DISP SYRIN COZAAR 25MG TABLET MAG-SR 64MG TABLET SA NITROFURANTOIN MONOHYDRATE 100MG CAPSULE (RP:MACROBID) BACID CAPLET BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID)
5 946 5 5 5 5 30 5 2
2.88 20.81 2.88 2.88 2.88 2.88 7.02 2.88 2.88
RX RX RX RX RX RX RX RX RX
5 4 5 60 14
26.04 236.29 6.43 5.49 19.61
RX RX RX OTC RX
6 15 15
2.88 2.88 3.95
OTC RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/16/09 10/23/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3688272 R3688273 R3688274 R3688275 R3688269 R3688271 R3694127 R3699387 R3708354 R3694005 R3694007 R3694009 R3694010 R3694011 R3694012 R3694006 R3694008
00245-0057-10 16729-0005-17 50111-0433-01 00781-1599-05 64455-0799-42 00006-0951-54 00228-2888-50 00075-0620-40 00406-0512-05 00378-1140-01 00378-1803-01 00245-0057-10 16729-0005-17 50111-0433-01 00781-1599-05 64455-0799-42 00006-0951-54
819.67 8.37
MANZETTI, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
JEAN : 420 : SUB : MEDICARE
KLOR-CON M 10 10MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) TRAZODONE 50MG TABLET SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) CARDIZEM CD 360MG CAPSULE SA COZAAR 25MG TABLET ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) LOVENOX 40MG/0.4ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) KLOR-CON M 10 10MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) TRAZODONE 50MG TABLET SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) CARDIZEM CD 360MG CAPSULE SA COZAAR 25MG TABLET
15 15 15 15 15 15 15 4 30 15 15 15 15 15 15 15 15
3.81 3.15 2.88 4.50 78.11 19.28 2.88 236.29 7.02 2.88 3.95 3.81 3.15 2.88 4.50 78.11 19.28
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 828.04
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3693000 R3693004 R3693005 R3693007 R3693008 R3693002 R3693003 R3693006 R3693094 R3693097 R3693099 R3693092 R3693096 R3693095 R3693098 R3693900 R3693903 R3693905 R3693899
74312-0871-90 32131-0804-86 00781-1228-10 31722-0239-10 58177-0268-04 62856-0245-90 00173-0696-00 00008-0607-01 58177-0268-04 00781-1228-10 31722-0239-10 74312-0871-90 32131-0804-86 62856-0245-90 00008-0607-01 58177-0268-04 00781-1228-10 31722-0239-10 74312-0871-90
MARION, ANNE RESIDENT# : 424 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OPTI-MULTI CAPLET (RP:OCUVITE) METOPROLOL TARTRATE 100MG TABLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) ARICEPT 5MG TABLET ADVAIR DISKUS 250MCG/50MCG INHALER PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) METOPROLOL TARTRATE 100MG TABLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OPTI-MULTI CAPLET (RP:OCUVITE) ARICEPT 5MG TABLET PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) METOPROLOL TARTRATE 100MG TABLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER)
1 1 2 1 1 1 60 1 14 28 14 14 14 14 14 15 30 15 15
2.88 2.88 2.88 2.88 2.88 5.14 157.07 2.88 8.69 2.88 2.88 2.88 2.88 71.88 37.81 9.32 2.88 2.88 2.88
OTC OTC RX RX RX RX RX RX RX RX RX OTC OTC RX RX RX RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
OTC RX
R3693901 R3693902 R3693904 R3716296
62856-0245-90 32131-0804-86 00008-0607-01 00078-0359-34
17.28 451.15
MARION, ANNE RESIDENT# : 424 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO
ARICEPT 5MG TABLET OPTI-MULTI CAPLET (RP:OCUVITE) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) DIOVAN 160MG TABLET
15 15 15 11
77.01 2.88 40.50 20.69
RX OTC RX RX
0.00 468.43
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693634
51660-0526-28
2.88
MATTHEWS, RESIDENT# STATION STATUS
TESTA
CELIA : 22 : 3 : MEDICAID
LORATADINE 10MG TABLET (RP:CLARITIN)
30
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
MILLINGTON, RESIDENT# : STATION : STATUS :
10/04/09 10/05/09 10/05/09 10/05/09 10/05/09 10/05/09 10/05/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682980 R3682894 R3682895 R3682896 R3682900 R3682901 R3682902
51672-4027-03 00378-0208-10 00406-2023-10 16729-0005-17 00228-2888-50 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK
10/05/09 10/05/09 10/05/09 10/05/09 10/06/09 10/09/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682903 R3682904 R3685014 R3682897 R3686297 R3690246 R3690250 R3690247 R3683308 R3683309 R3683310
51672-4027-03 00406-0512-05 00406-0552-01 00228-2578-50 51672-4027-03 74312-0813-80 00182-4141-26 50111-0990-01 00378-0208-10 00406-2023-10 16729-0005-17
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
HENRIETTA 418 SUB MEDICARE
WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) FUROSEMIDE 20MG TABLET (RP:LASIX) ATENOLOL 50MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) WARFARIN SODIUM 1MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) OXYCODONE HCL IR 5MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) WARFARIN SODIUM 1MG TABLET VITAMIN B12 1000MCG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) VITAMIN D 50000IU CAPSULE FUROSEMIDE 20MG TABLET (RP:LASIX) ATENOLOL 50MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR)
1 7 7 7 15 75 62.5
2.88 2.88 2.88 2.88 2.88 8.63 6.75
RX RX RX RX RX RX RX
1 15 15 7 7 3 6 2 15 15 15
2.88 3.51 3.60 9.38 3.78 2.88 2.88 2.88 2.88 2.88 3.15
RX RX RX RX RX OTC OTC RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
MILLINGTON, RESIDENT# : STATION : STATUS :
10/12/09 10/12/09 10/12/09 10/14/09
CHARGE CHARGE CHARGE CHARGE
R3691461 R3683311 R3691462 R3696011
74312-0813-80 00228-2578-50 00182-4141-26 49502-0685-26
TANK TANK TANK TANK
10/14/09 10/14/09 10/14/09 10/16/09 10/19/09 10/19/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3696012 R3696180 R3696184 R3699610 R3702258 R3702259 R3707491 R3693974 R3693975 R3693976 R3706243 R3709610 R3693977 R3693978
16252-0097-22 51672-4032-03 00075-0620-40 51672-4029-03 51672-4029-03 00172-3758-60 51672-4029-03 00378-0208-10 00406-2023-10 16729-0005-17 00172-3758-60 16252-0097-22 00228-2578-50 74312-0813-80
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
HENRIETTA 418 SUB MEDICARE
VITAMIN B12 1000MCG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION WARFARIN SODIUM 5MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN WARFARIN SODIUM 2.5MG TABLET WARFARIN SODIUM 2.5MG TABLET LISINOPRIL 5MG TABLET WARFARIN SODIUM 2.5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) ATENOLOL 50MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) LISINOPRIL 5MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) VITAMIN B12 1000MCG TABLET
15 15 30 62.5
2.88 20.09 2.88 6.75
OTC RX OTC RX
75 2 0.8 3 3 7 5 15 15 15 15 75 15 15
8.63 2.88 47.26 2.88 2.88 2.88 2.91 2.88 2.88 3.15 2.88 8.63 20.09 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/27/09 10/27/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3693979 R3711183 R3711212 R3712783 R3712794 R3717012
00182-4141-26 17714-0019-01 00075-0620-40 51672-4032-03 00075-0624-30 51672-4032-03
438.03 20.16
MILLINGTON, RESIDENT# : STATION : STATUS :
TANK TANK TANK TANK TANK TANK
HENRIETTA 418 SUB MEDICARE
CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) SIMETHICONE 80MG TAB CHEW LOVENOX 40MG/0.4ML DISP SYRIN WARFARIN SODIUM 5MG TABLET LOVENOX 30MG/0.3ML DISP SYRIN WARFARIN SODIUM 5MG TABLET
30 100 0.8 1 3 14
2.88 2.88 47.26 2.88 177.24 8.26
OTC OTC RX RX RX RX
0.00 458.19
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3707672 R3707674 R3707679 R3707681 R3707684 R3707666 R3707670 R3707689 R3707889 R3709510 R3709511 R3709512 R3709513 R3709514 R3709509 R3717126
00185-0144-05 74312-0813-80 57664-0397-58 16729-0005-17 65862-0143-01 00310-0275-34 00169-1833-11 60258-0006-01 00075-0624-30 00185-0144-05 74312-0813-80 57664-0397-58 16729-0005-17 65862-0143-01 00310-0275-34 00378-1800-01
260.88 13.76
MORAVICK, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
THERESA : 221 : SUB : MEDICARE
AMIODARONE HCL 200MG TABLET VITAMIN B12 1000MCG TABLET METFORMIN 500MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CARVEDILOL 6.25MG TABLET (RP:COREG) SEROQUEL 25MG TABLET NOVOLIN R 100U/1ML VIAL-INSUL PHOS-NAK PACKET LOVENOX 30MG/0.3ML DISP SYRIN AMIODARONE HCL 200MG TABLET VITAMIN B12 1000MCG TABLET METFORMIN 500MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CARVEDILOL 6.25MG TABLET (RP:COREG) SEROQUEL 25MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID)
2 4 8 4 8 2 10 30 3 8 15 30 15 30 7.5 5
2.88 2.88 2.88 2.88 2.88 4.03 33.87 8.00 177.24 5.90 2.88 2.88 3.15 4.29 15.12 2.88
RX OTC RX RX RX RX RX OTC RX RX OTC RX RX RX RX RX
0.00 274.64
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3676449 R3676450 R3676451 R3676453 R3676448 R3676452
00378-0181-01 16729-0006-17 00378-1815-01 00527-1325-10 00597-0058-01 64764-0541-30
124.61
MUTTEL, JOHN RESIDENT# : 390 STATION : SUB STATUS : MEDICARE
TESTA TESTA TESTA TESTA TESTA TESTA
ALLOPURINOL 300MG TABLET (RP:ALLOPURINOL) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 150MCG TABLET DIGOXIN 0.25MG TABLET FLOMAX 0.4MG CAPSULE SA PREVACID 15MG CAPSULE DR
15 15 15 15 15 15
2.88 3.84 5.40 3.20 44.34 64.95
RX RX RX RX RX RX
0.00 124.61
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/08/09 10/19/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3684668 R3700818
00023-4554-30 00023-4554-30
26.50
NAPOLITANO, RESIDENT# : STATION : STATUS :
RENNER RENNER
CELLUVISC OPHTH 1% DROPS CELLUVISC OPHTH 1% DROPS
CONNIE 79 2 MEDICAID
30 30
13.25 13.25
OTC OTC
0.00 26.50
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/07/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3686065 R3687730
00023-0667-04 00023-9205-15
20.22
NICCOLI, MARIE RESIDENT# : 67 STATION : 2 STATUS : MEDICAID
TESTA TESTA
REFRESH PM OPHTH OINT REFRESH LIQUIGEL 1% DROPS
3.5 15
10.44 9.78
OTC OTC
0.00 20.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN
RX OTC
R3644253 R3650591 R3644252
00172-3760-60 00536-3985-01 16729-0005-17
-4.73 -1.50
PANNY, ANNIE RESIDENT# : 372 STATION : SUB STATUS : MEDICARE
SHERMAN SHERMAN SHERMAN
LISINOPRIL 20MG TABLET MECLIZINE HCL 12.5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR)
-25 -25 -13
-2.00 -1.50 -2.73
RX OTC RX
0.00 -6.23
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3627807 R3642654 R3642654 R3627809 R3627812 R3627809 R3627811 R3627810 R3627810 R3627805 R3627808 R3627808 R3600500 R3627812 R3645012
00172-3758-60 00555-0607-02 00555-0607-02 63213-1523-10 63304-0579-10 63213-1523-10 63736-0105-06 79649-9031-06 79649-9031-06 59366-2819-02 00182-4141-26 00182-4141-26 63481-0687-06 63304-0579-10 68180-0512-02
-290.97 -32.27
PETRASEK, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
GLORIA : 329 : SUB : MEDICARE
LISINOPRIL 5MG TABLET MEGESTROL ACETATE 40MG TABLET (RP:MEGACE) MEGESTROL ACETATE 40MG TABLET (RP:MEGACE) VITAMIN C 250MG TABLET METOPROLOL TARTRATE 25MG TABLET VITAMIN C 250MG TABLET BACID CAPLET GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE DEMECLOCYCLINE 150MG TABLET (RP:DECLOMYCIN) CALCARB/VIT D 600/400 TABLET CALCARB/VIT D 600/400 TABLET LIDODERM 5% PATCH METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 2.5MG TABLET
-15 -16 -30 -15 -30 -20 -24 -30 -20 -11 -18 -30 -30 -7 -11
-0.72 -10.82 -20.28 -0.25 -2.16 -0.33 -12.35 -10.46 -6.98 -104.45 -0.71 -1.19 -151.63 -0.50 -0.41
RX RX RX OTC RX OTC OTC OTC OTC RX OTC OTC RX RX RX
0.00 -323.24
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/05/09 10/05/09 10/07/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/22/09 10/22/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3679903 R3683270 R3683272 R3688072 R3676624 R3676627 R3676628 R3676629 R3688254 R3688255 R3676625 R3676630 R3706150 R3706153 R3708924 R3693867 R3693869 R3693871 R3693873
00075-0620-40 31722-0238-10 60505-0093-00 45802-0112-22 00406-2023-10 55111-0119-10 00378-1803-01 00591-0409-01 31722-0238-10 60505-0093-00 00025-1525-51 63653-1171-05 65162-0627-50 00075-0620-40 00378-1805-01 00406-2023-10 55111-0119-10 00591-0409-01 31722-0238-10
PETRULLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
KAY : 403 : SUB : MEDICARE
LOVENOX 40MG/0.4ML DISP SYRIN AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) MUPIROCIN 2% OINTMENT (RP:BACTROBAN) ATENOLOL 50MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) LISINOPRIL 40MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) CELEBREX 200MG CAPSULE PLAVIX 75MG TABLET TRAMADOL 50MG TABLET (RP:ULTRAM) LOVENOX 40MG/0.4ML DISP SYRIN LEVOTHYROXINE SODIUM 75MCG TABLET ATENOLOL 50MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) LISINOPRIL 40MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC)
4 7 7 22 15 15 15 15 15 15 15 15 30 4 2 15 15 15 15
247.02 2.88 4.14 41.45 2.88 2.88 3.95 2.88 2.88 8.88 43.52 59.41 2.88 236.29 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX
R3693874 R3709498 R3693868 R3693872
60505-0093-00 00378-1805-01 00025-1525-51 63653-1171-05
792.52
PETRULLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
KAY : 403 : SUB : MEDICARE
DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) LEVOTHYROXINE SODIUM 75MCG TABLET CELEBREX 200MG CAPSULE PLAVIX 75MG TABLET
15 15 15 15
8.88 4.37 43.52 59.41
RX RX RX RX
0.00 792.52
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/21/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3691311 R3691320 R3691640 R3692592 R3691308 R3691310 R3691315 R3692552 R3705830 R3694049 R3694051 R3694047 R3694048 R3694050 R3713918 R3717728
00378-1800-01 59366-2819-02 24208-0324-05 68180-0512-02 00597-0058-01 00456-3210-60 00013-8303-04 62856-0246-90 00258-3678-01 00378-1800-01 68180-0512-02 00597-0058-01 00456-3210-60 62856-0246-90 00378-1803-01 59366-2819-02
670.84
PIETROWITZ, RESIDENT# : STATION : STATUS :
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
EDWARD 422 SUB MEDICARE
LEVOTHYROXINE SODIUM 25MCG TABLET DEMECLOCYCLINE 150MG TABLET (RP:DECLOMYCIN) TIMOLOL MALEATE OPHTH 0.5% DROPS LISINOPRIL 2.5MG TABLET FLOMAX 0.4MG CAPSULE SA NAMENDA 10MG TABLET XALATAN 0.005% DROPS ARICEPT 10MG TABLET BENZONATATE 200MG CAPSULE (RP:TESSALON PERLE) LEVOTHYROXINE SODIUM 25MCG TABLET LISINOPRIL 2.5MG TABLET FLOMAX 0.4MG CAPSULE SA NAMENDA 10MG TABLET ARICEPT 10MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET DEMECLOCYCLINE 150MG TABLET
15 4 5 15 15 30 2.5 15 21 15 15 15 30 15 12 18
3.48 37.98 4.50 2.88 44.34 68.43 56.84 77.01 5.17 3.48 2.88 44.34 68.43 77.01 3.16 170.91
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 670.84
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/09/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3687732 R3689533
00023-0667-04 00023-0798-15
20.22
PRUZINSKY, MARIE RESIDENT# : 90 STATION : 2 STATUS : MEDICAID
SCERBO SCERBO
REFRESH PM OPHTH OINT REFRESH TEARS OPHTH DROPS
3.5 15
10.44 9.78
OTC OTC
0.00 20.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
PUGLISI, VINCENT RESIDENT# : 294 STATION : SUB STATUS : MEDICARE
10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3705966 R3705975 R3705976 R3705977 R3705979 R3705965 R3705968 R3705969 R3705970
16729-0006-17 00378-6173-01 00245-0057-10 00781-5224-01 00781-1966-10 00169-0081-81 00173-0697-00 00006-0951-54 00781-6054-70
TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/21/09 10/21/09 10/21/09 10/21/09 10/22/09 10/22/09 10/22/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3705972 R3705973 R3705974 R3705980 R3707816 R3707817 R3707818 R3707932 R3708490
00228-2588-50 00173-0712-04 50111-0990-01 00169-1833-11 51672-4032-03 00245-0058-15 00245-0057-10 51672-4032-03 00378-0023-05
TANK TANK TANK TANK TANK TANK TANK TANK TANK
SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOLAZONE 5MG TABLET (RP:ZAROXOLYN) KLOR-CON M 10 10MEQ TABLET SA CARVEDILOL 25MG TABLET (RP:COREG) FUROSEMIDE 40MG TABLET (RP:LASIX) PRANDIN 0.5MG TABLET ADVAIR DISKUS 500MCG/50MCG INHALER COZAAR 25MG TABLET DORZOLAMIDE HCL/TIMOLOL MALEATE 2%-0.5% DROPS (RP:COSOPT OPHTH) DILTIAZEM CD 120MG CAP.SR 24H (RP:CARDIZEM CD) AVODART 0.5MG CAPSULE VITAMIN D 50000IU CAPSULE NOVOLIN R 100U/1ML VIAL-INSUL WARFARIN SODIUM 5MG TABLET KLOR-CON M 20 20MEQ TABLET SA KLOR-CON M 10 10MEQ TABLET SA WARFARIN SODIUM 5MG TABLET DILTIAZEM 30MG TABLET
5 5 10 10 10 10 60 5 10
2.88 5.34 2.88 2.88 2.88 14.67 206.59 6.43 84.21
RX RX RX RX RX RX RX RX RX
5 5 2 10 2 1 1 1 9
3.92 13.31 2.88 33.87 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/23/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3708535 R3709073 R3706234 R3706238 R3706239 R3706240 R3706241 R3709507 R3709508 R3706233 R3706235 R3706237 R3711193 R3716381
57664-0434-88 51672-4032-03 16729-0006-17 00378-6173-01 00245-0057-10 00781-5224-01 00781-1966-10 00378-0023-05 57664-0434-88 00169-0081-81 00006-0951-54 00173-0712-04 00182-4141-26 51672-4032-03
552.43 2.88
PUGLISI, VINCENT RESIDENT# : 294 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
ALLOPURINOL 100MG TABLET WARFARIN SODIUM 5MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOLAZONE 5MG TABLET (RP:ZAROXOLYN) KLOR-CON M 10 10MEQ TABLET SA CARVEDILOL 25MG TABLET (RP:COREG) FUROSEMIDE 40MG TABLET (RP:LASIX) DILTIAZEM 30MG TABLET ALLOPURINOL 100MG TABLET PRANDIN 0.5MG TABLET COZAAR 25MG TABLET AVODART 0.5MG CAPSULE CALCARB/VIT D 600/400 TABLET WARFARIN SODIUM 5MG TABLET
3 5 15 15 30 30 30 45 15 30 15 15 30 7
2.88 2.95 3.84 16.02 7.62 4.29 2.88 4.59 2.88 44.01 19.28 39.92 2.88 4.13
RX RX RX RX RX RX RX RX RX RX RX RX OTC RX
0.00 555.31
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE
OTC RX
R3691479 R3693540 R3693543
00182-6135-77 00486-1125-01 00904-5062-60
5.76 14.23
PUZZO, MARY RESIDENT# : 85 STATION : 3 STATUS : MEDICAID
PAGANO PAGANO PAGANO
NASAL 0.65% SPRAY (RP:OCEAN NASAL) K-PHOS NEUTRAL 250MG TABLET CALCIUM CITRATE 200MG TABLET
45 90 60
2.88 14.23 2.88
OTC RX OTC
0.00 19.99
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09
PATIENT RECAP
CHARGE
OTC
R3686060
00023-0798-15
9.78
PYRYT, THERESA RESIDENT# : 66 STATION : 2 STATUS : MEDICAID
SILVERMAN
REFRESH TEARS OPHTH DROPS
15
9.78
OTC
0.00 9.78
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693468
30768-0006-01
2.88
REO, ANTOINETTE RESIDENT# : 73 STATION : 2 STATUS : MEDICAID
PAGANO
VITAMIN B COMPLEX TABLET
30
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN
RX
R3642638 R3642638
00527-1325-10 00527-1325-10
-2.34
REVILLA, MARIA RESIDENT# : 381 STATION : SUB STATUS : MEDICARE
TANK TANK
DIGOXIN 0.25MG TABLET DIGOXIN 0.25MG TABLET
-4 -7
-0.85 -1.49
RX RX
0.00 -2.34
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09
PATIENT RECAP
RETURN
RX
R3639880
00075-0620-40
-236.28
RIEDEL, LAURA RESIDENT# : 371 STATION : SUB STATUS : MEDICARE
TANK
LOVENOX 40MG/0.4ML DISP SYRIN
-4
-236.28
RX
0.00 -236.28
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693748
00182-4141-26
2.88
ROMA, MILDRED RESIDENT# : 300 STATION : 3 STATUS : MEDICAID
TANK
CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
60
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/10/09 10/20/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3690637 R3702704
00299-3923-04 17478-0060-12
7.22
ROMANO, MARY RESIDENT# : 15 STATION : 3 STATUS : MEDICAID
KIM KIM
CETAPHIL GENTLE CLEANS BAR AKWA TEARS (ARTIFICIAL TEARS) DROPS
1 15
4.34 2.88
OTC OTC
0.00 7.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ROSS, PAUL RESIDENT# : 425 STATION : SUB STATUS : MEDICARE
10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/15/09 10/15/09 10/19/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3696417 R3696418 R3696420 R3696423 R3696424 R3696426 R3696427 R3696419 R3696422 R3696421 R3698038 R3701300
00781-1599-05 31722-0521-10 00378-1800-01 00781-1966-10 00781-5224-01 16729-0006-17 31722-0520-10 00574-0412-02 00258-3613-01 59676-0340-01 99389-0191-31 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/21/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3706103 R3709047 R3701199 R3701200 R3701201 R3701203
00168-0162-46 59676-0340-01 00781-1599-05 31722-0521-10 00378-1800-01 00781-1966-10
TANK TANK TANK TANK TANK TANK
SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) HYDRALAZINE 50MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) FUROSEMIDE 40MG TABLET (RP:LASIX) CARVEDILOL 25MG TABLET (RP:COREG) SIMVASTATIN 40MG TABLET HYDRALAZINE 25MG TABLET POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) ISOSORBIDE DINITRATE ER 40MG TABLET SA PROCRIT 40MU/1ML VIAL MOISTURIZING LOTION HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN CLOBETASOL PROPIONATE 0.05% OINTMENT (RP:TEMOVATE) PROCRIT 40MU/1ML VIAL SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) HYDRALAZINE 50MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) FUROSEMIDE 40MG TABLET (RP:LASIX)
24 36 12 12 24 12 36 255 36 1 473 5
7.20 15.12 2.88 2.88 3.43 3.07 11.81 12.90 20.93 476.52 4.48 13.61
RX RX RX RX RX RX RX RX RX RX OTC RX
45 1 30 45 15 15
8.73 476.52 9.00 18.90 3.48 2.88
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ROSS, PAUL RESIDENT# : 425 STATION : SUB STATUS : MEDICARE
10/26/09 10/26/09 10/26/09 10/26/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3701204 R3701205 R3701206 R3701202 R3713192
00781-5224-01 16729-0006-17 31722-0520-10 00258-3613-01 00409-1316-25
TANK TANK TANK TANK TANK
10/29/09 10/29/09 10/30/09
CHARGE CHARGE CHARGE
R3716292 R3716295 R3717035
00143-9898-05 63736-0105-06 55111-0126-05
TANK TANK TANK
PATIENT RECAP
RX OTC
1159.15 12.20
CARVEDILOL 25MG TABLET (RP:COREG) SIMVASTATIN 40MG TABLET HYDRALAZINE 25MG TABLET ISOSORBIDE DINITRATE ER 40MG TABLET SA HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN CEPHALEXIN 250MG CAPSULE (RP:KEFLEX) BACID CAPLET CIPROFLOXACIN 250MG TABLET (RP:CIPRO)
30 15 45 45 5
4.29 3.84 14.76 26.16 13.61
14 20 10
2.88 7.72 3.75
RX RX RX RX RX RX OTC RX
0.00 1171.35
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09
PATIENT RECAP
CHARGE
IV
R3686162
00338-0017-38
16.12
RUSSO, RALPH RESIDENT# : 228 STATION : SUB STATUS : MEDICARE
TANK
DEXTROSE 5% (100ML BAG) IV SOLN.
200
16.12
IV
0.00 16.12
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/15/09 10/15/09 10/20/09 10/20/09 10/20/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3690284 R3690286 R3690287 R3690290 R3690295 R3690319 R3691456 R3691457 R3691458 R3691459 R3691460 R3693384 R3696840 R3696863 R3703814 R3703821 R3703819 R3693955 R3706230
00378-1811-01 16729-0007-17 00536-3550-01 00182-4141-26 30768-0156-05 00406-0512-05 00378-1811-01 16729-0007-17 00536-3550-01 00182-4141-26 30768-0156-05 00075-0624-30 00574-0412-02 00002-3235-60 00378-1813-01 74312-0813-80 00517-0031-25 16729-0007-17 00378-1813-01
SACCO, MARIO RESIDENT# : 421 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
LEVOTHYROXINE SODIUM 112MCG TABLET SIMVASTATIN 80MG TABLET (RP:ZOCOR) VITAMIN B12 250MCG TABLET CALCARB/VIT D 600/400 TABLET VITAMIN D (D-3) 1000IU TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LEVOTHYROXINE SODIUM 112MCG TABLET SIMVASTATIN 80MG TABLET (RP:ZOCOR) VITAMIN B12 250MCG TABLET CALCARB/VIT D 600/400 TABLET VITAMIN D (D-3) 1000IU TABLET LOVENOX 30MG/0.3ML DISP SYRIN POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) CYMBALTA 20MG CAPSULE EC LEVOTHYROXINE SODIUM 125MCG TABLET VITAMIN B12 1000MCG TABLET CYANOCOBALAMIN 1000MCG/1ML VIAL SIMVASTATIN 80MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 125MCG TABLET
3 3 6 3 3 15 15 15 30 15 15 3 255 11 6 6 4 15 15
2.88 2.88 2.88 2.88 2.88 3.51 5.16 3.84 2.88 2.88 2.88 177.24 12.90 32.35 2.88 2.88 3.30 3.84 5.25
RX RX OTC OTC OTC RX RX RX OTC OTC OTC RX RX RX RX OTC RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX OTC
R3706232 R3693957 R3693958 R3701173
74312-0813-80 00182-4141-26 30768-0156-05 00002-3235-60
300.14 28.80
SACCO, MARIO RESIDENT# : 421 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK
VITAMIN B12 1000MCG TABLET CALCARB/VIT D 600/400 TABLET VITAMIN D (D-3) 1000IU TABLET CYMBALTA 20MG CAPSULE EC
15 15 15 15
2.88 2.88 2.88 44.11
OTC OTC OTC RX
0.00 328.94
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT
RX
R3666422 R3666422 R3666423 R3666423 R3666424 R3666424 R3671864 R3671864 R3671865 R3671865 R3676062 R3676062
00172-4096-80 00172-4096-80 16729-0005-17 16729-0005-17 00378-1120-01 00378-1120-01 63304-0579-10 63304-0579-10 16252-0571-01 16252-0571-01 51672-4031-03 51672-4031-03
-40.85
SALZANO, RUTH RESIDENT# : 209 STATION : 3 STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
BACLOFEN 10MG TABLET BACLOFEN 10MG TABLET SIMVASTATIN 20MG TABLET SIMVASTATIN 20MG TABLET VERAPAMIL HCL ER 120MG TABLET SA VERAPAMIL HCL ER 120MG TABLET SA METOPROLOL TARTRATE 25MG TABLET METOPROLOL TARTRATE 25MG TABLET RAMIPRIL 2.5MG CAPSULE RAMIPRIL 2.5MG CAPSULE WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 4MG TABLET
12 90 4 30 4 30 12 90 4 30 4 8
2.88 -4.77 2.88 -6.30 2.88 -21.25 2.88 -6.48 2.88 -14.64 2.88 -4.69
RX RX RX RX RX RX RX RX RX RX RX RX
0.00 -40.85
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09
PATIENT RECAP
RETURN
RX
R3610642
55111-0532-01
-6.51
SANANDRES, GRACE RESIDENT# : 358 STATION : 3 STATUS : MEDICARE
TANK
DIVALPROEX SODIUM SPRINKLES 125MG CAPSULE (RP:DEPAKOTE SPRINKLES)
-11
-6.51
RX
0.00 -6.51
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SANGIORGIO, RESIDENT# : STATION : STATUS :
10/21/09 10/21/09
CHARGE CHARGE
R3706057 R3706058
16252-0097-22 49502-0685-26
TANK TANK
10/21/09 10/21/09 10/21/09 10/21/09 10/22/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3706060 R3706061 R3706063 R3706064 R3707102
00172-3759-60 00378-0032-10 00378-0208-10 00169-1833-11 00409-1316-25
TANK TANK TANK TANK TANK
10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3707717 R3706210 R3706211 R3706212 R3709471 R3711188 R3711194 R3713190
00071-0155-23 00172-3759-60 00378-0032-10 00378-0208-10 00071-0155-23 00182-4141-26 50111-0990-01 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK TANK
10/28/09
CHARGE
R3714901
51672-1275-02
TANK
PATIENT RECAP
RX OTC
171.81 14.79
VINCENZA 430 2 MEDICARE
ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) LISINOPRIL 10MG TABLET METOPROLOL TARTRATE 50MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) NOVOLIN R 100U/1ML VIAL-INSUL HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN LIPITOR 10MG TABLET LISINOPRIL 10MG TABLET METOPROLOL TARTRATE 50MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LIPITOR 10MG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) VITAMIN D 50000IU CAPSULE HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN CLOTRIMAZOLE 1% CREAM
75 62.5
8.63 6.75
RX RX
5 10 5 10 5
2.88 2.88 2.88 33.87 13.61
RX RX RX RX RX
4 30 60 30 30 60 1 5
8.83 2.88 3.00 2.88 66.23 2.88 2.88 13.61
RX RX RX RX RX OTC RX RX
30
11.91
OTC
0.00 186.60
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/05/09 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09
CHARGE CHARGE
R3683568 S821873
CHARGE
00338-3552-48
SANTORO, MICHAEL RESIDENT# : 408 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB
VANCOMYCIN 1 GM 200 MLS IV ADMIN.SET NON-FILTER
4 4
112.28 0.00
IV
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S824348
GOLDFARB
INJECTION SITE NEEDLELESS VALVE
1
0.00
CHARGE
R3683571
64253-0333-35
GOLDFARB
4
2.88
IV
10/05/09
CHARGE
R3683572
64253-0111-35
GOLDFARB
10
2.88
RX
10/06/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 IVSPL 10/12/09 IVSPL 10/12/09 IVSPL
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3686250 R3690464 R3676526 R3676527 R3676528 R3683295 R3688256 R3692823 S821873
55513-0478-10 00064-5010-15 31722-0238-10 00172-4365-60 55111-0119-10 00378-0208-10 00245-0057-10 00338-3552-48
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN EPOGEN 20MU/1ML VIAL SANTYL OINTMENT AMLODIPINE BESYLATE 5MG TABLET LABETALOL 200MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA VANCOMYCIN 1 GM 200 MLS IV ADMIN.SET NON-FILTER
1 30 15 15 15 15 30 4 4
206.17 85.21 2.88 5.37 2.88 2.88 7.62 112.28 0.00
RX RX RX RX RX RX RX IV
CHARGE
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S824348
GOLDFARB
INJECTION SITE NEEDLELESS VALVE
1
0.00
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SANTORO, MICHAEL RESIDENT# : 408 STATION : SUB STATUS : MEDICARE
10/12/09
CHARGE
R3692829
64253-0333-35
GOLDFARB
4
2.88
IV
8
2.88
RX
GOLDFARB GOLDFARB GOLDFARB
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN EPOGEN 20MU/1ML VIAL VANCOMYCIN 1 GM 200 MLS INJECTION SITE NEEDLELESS VALVE
10/12/09
CHARGE
R3692832
64253-0111-35
GOLDFARB
10/13/09 10/19/09 10/19/09 IVSPL 10/19/09 IVSPL 10/19/09 IVSPL 10/19/09
CHARGE CHARGE CHARGE
R3694169 R3702027 S824348
55513-0478-10 00338-3552-48
1 4 1
206.17 112.28 0.00
RX IV
CHARGE
S821873
GOLDFARB
IV ADMIN.SET NON-FILTER
4
0.00
CHARGE
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
R3702028
64253-0111-35
GOLDFARB
8
2.88
RX
10/19/09
CHARGE
R3702029
64253-0333-35
GOLDFARB
4
2.88
IV
10/20/09 10/23/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3702066 R3708591 R3693913 R3693914 R3709504 R3709505
55513-0478-10 00013-8303-04 00172-4365-60 55111-0119-10 00378-0208-10 00245-0057-10
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN EPOGEN 20MU/1ML VIAL XALATAN 0.005% DROPS LABETALOL 200MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA
1 2.5 15 15 8 8
206.17 56.84 5.37 2.88 2.88 2.88
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 IVSPL 10/26/09 IVSPL 10/26/09 IVSPL 10/26/09
CHARGE CHARGE
R3709858 S824348
CHARGE
GOLDFARB GOLDFARB
VANCOMYCIN 1 GM 200 MLS INJECTION SITE NEEDLELESS VALVE
4 1
112.28 0.00
S821873
GOLDFARB
IV ADMIN.SET NON-FILTER
4
0.00
CHARGE
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
R3709861
64253-0333-35
GOLDFARB
4
2.88
IV
10/26/09
CHARGE
R3709862
64253-0111-35
GOLDFARB
8
2.88
RX
10/26/09 10/31/09 IVSPL
CHARGE CHARGE
R3709061 M832506
55513-0478-10
GOLDFARB GOLDFARB
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN EPOGEN 20MU/1ML VIAL OCT 2009 IV SUPPLY PER DIEM
1 1
206.17 98.00
RX
PATIENT RECAP
IV IVSPLY
00338-3552-48
SANTORO, MICHAEL RESIDENT# : 408 STATION : SUB STATUS : MEDICARE
460.64 98.00
RX
1013.89
IV
0.00 1572.53
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/05/09 10/05/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/19/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE OTC RX
R3683441 R3683448 R3676533 R3676534 R3676535 R3676536 R3676537 R3676538 R3683298 R3702174 R3707123 R3693930 R3693931 R3693932 R3693933 R3693934 R3693935 R3706231
63736-0105-06 00045-1525-50 00378-0208-10 00378-1800-01 00245-0058-15 16729-0005-17 00172-3760-60 00378-2268-01 31722-0238-10 63481-0687-06 00075-0624-30 00378-1800-01 00245-0058-15 16729-0005-17 00172-3760-60 00378-2268-01 31722-0238-10 00378-0208-10 5.41 449.77
SANTUCCI, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
ANTHONY : 410 : SUB : MEDICARE
BACID CAPLET LEVAQUIN 500MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) LISINOPRIL 20MG TABLET (RP:ZESTRIL ) TERAZOSIN 5MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LIDODERM 5% PATCH LOVENOX 30MG/0.3ML DISP SYRIN LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) LISINOPRIL 20MG TABLET (RP:ZESTRIL ) TERAZOSIN 5MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET
14 7 15 15 15 15 30 15 15 30 3 15 15 15 30 15 15 30
5.41 70.70 2.88 3.48 6.95 3.15 2.88 2.88 2.88 151.63 177.24 3.48 6.95 3.15 2.88 2.88 2.88 2.88
OTC RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 455.18
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/05/09 10/05/09 10/05/09 10/05/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/15/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682118 R3682119 R3682125 R3682126 R3682121 R3682123 R3683378 R3684747 R3684746 R3684752 R3683305 R3683306 R3691610 R3683307 R3688262 R3688263 R3688264 R3696918 R3693965
00378-1807-10 00185-0144-05 65162-0627-50 00603-1378-59 00182-4141-26 00075-0620-40 65162-0627-50 51660-0526-28 00310-0751-90 00025-1525-51 00378-1807-10 00185-0144-05 65162-0627-50 00182-4141-26 00310-0751-90 51660-0526-28 00025-1525-51 31722-0237-10 00378-1807-10
SCALERA, SOPHIE RESIDENT# : 417 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID) AMIODARONE HCL 200MG TABLET TRAMADOL 50MG TABLET (RP:ULTRAM) LACTULOSE 10GM/15ML SOLUTION CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) LOVENOX 40MG/0.4ML DISP SYRIN TRAMADOL 50MG TABLET (RP:ULTRAM) LORATADINE 10MG TABLET (RP:CLARITIN) CRESTOR 10MG TABLET CELEBREX 200MG CAPSULE LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID) AMIODARONE HCL 200MG TABLET TRAMADOL 50MG TABLET (RP:ULTRAM) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) CRESTOR 10MG TABLET LORATADINE 10MG TABLET (RP:CLARITIN) CELEBREX 200MG CAPSULE AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID)
10 10 15 946 10 2 15 7 7 14 15 15 30 15 15 15 30 11 15
2.96 7.38 2.88 20.81 2.88 118.15 2.88 2.88 20.71 40.62 4.44 11.07 2.88 2.88 44.38 2.88 87.03 2.88 4.44
RX RX RX RX OTC RX RX OTC RX RX RX RX RX OTC RX OTC RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3693966 R3701177 R3693967 R3693968 R3693969 R3693970 R3716306
00185-0144-05 31722-0237-10 00182-4141-26 00310-0751-90 51660-0526-28 00025-1525-51 65162-0627-50
521.75 17.28
SCALERA, SOPHIE RESIDENT# : 417 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
AMIODARONE HCL 200MG TABLET AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) CRESTOR 10MG TABLET LORATADINE 10MG TABLET (RP:CLARITIN) CELEBREX 200MG CAPSULE TRAMADOL 50MG TABLET (RP:ULTRAM)
15 15 15 15 15 30 30
11.07 2.88 2.88 44.38 2.88 87.03 2.88
RX RX OTC RX OTC RX RX
0.00 539.03
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SCARPULLA, GIUSEPINA RESIDENT# : 41 STATION : 3 STATUS : MEDICAID
09/17/09 10/15/09
CHARGE CHARGE
R3708121 R3698400
17714-0020-01 00054-3117-63
RENNER RENNER
10/27/09
CHARGE
R3712869
63736-0105-06
RENNER
PATIENT RECAP
OTC
29.67
DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL) CALCIUM CARBONATE (ELEM.CALCIUM 500MG/5ML) 1250MG/5ML ORAL SUSP BACID CAPLET
1 500
2.88 15.98
OTC OTC
28
10.81
OTC
0.00 29.67
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/25/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC RX
R3706282 R3706284 R3706286 R3706292 R3706299 R3706288 R3709327 R3709499 R3709500 R3709501 R3709502 R3709503 R3716554 R3716555
63736-0105-06 00781-2822-01 63304-0579-10 42043-0141-05 00228-2888-50 00006-0951-54 63653-1171-05 63736-0105-06 00781-2822-01 63304-0579-10 00006-0951-54 63653-1171-05 67253-0900-11 00406-0357-05
29.34 130.27
SCHNEPEL, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
ANNA : 431 : SUB : MEDICARE
BACID CAPLET FLUOXETINE 20MG CAPSULE (RP:PROZAC) METOPROLOL TARTRATE 25MG TABLET CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) COZAAR 25MG TABLET PLAVIX 75MG TABLET BACID CAPLET FLUOXETINE 20MG CAPSULE (RP:PROZAC) METOPROLOL TARTRATE 25MG TABLET COZAAR 25MG TABLET PLAVIX 75MG TABLET ALPRAZOLAM 0.25MG TABLET (RP:XANAX) HYDROCODONE/APAP 5MG/500MG TABLET (RP:VICODIN)
16 4 8 30 15 4 1 60 15 30 15 15 30 30
6.17 2.88 2.88 10.92 2.88 5.14 3.96 23.17 2.88 2.88 19.28 59.41 2.88 14.28
OTC RX RX RX RX RX RX OTC RX RX RX RX RX RX
0.00 159.61
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT
RX
R3671858 R3671858 R3671859 R3671859 R3671860 R3671860 R3671861 R3671861
31722-0238-10 31722-0238-10 00781-1599-05 00781-1599-05 00186-5040-54 00186-5040-54 57664-0458-88 57664-0458-88
-160.33
SCIMECA, VIOLA RESIDENT# : 89 STATION : 2 STATUS : MEDICARE
RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER
AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) NEXIUM 40MG CAPSULE SA NEXIUM 40MG CAPSULE SA METHIMAZOLE 5MG TABLET (RP:TAPAZOLE) METHIMAZOLE 5MG TABLET (RP:TAPAZOLE)
8 30 8 30 8 30 8 30
2.88 -3.87 2.88 -9.00 49.54 -193.50 3.37 -12.63
RX RX RX RX RX RX RX RX
0.00 -160.33
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/10/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3649223 R3690698
00023-0667-04 00023-0667-04
20.88
SETTANI, THERESA RESIDENT# : 71 STATION : 2 STATUS : MEDICAID
WIENER WIENER
REFRESH PM OPHTH OINT REFRESH PM OPHTH OINT
3.5 3.5
10.44 10.44
OTC OTC
0.00 20.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
00338-0049-04 00006-3843-71
SHAYNE, BETTY RESIDENT# : 413 STATION : 2 STATUS : MEDICARE
09/28/09 10/01/09
CHARGE CHARGE
R3686111 R3679973
SILVERMAN SILVERMAN
2000 2
19.72 148.98
10/01/09 IVSPL 10/01/09
CHARGE
S822714
2
0.00
CHARGE
R3679974
64253-0111-35
SILVERMAN
10/01/09
CHARGE
R3679978
64253-0333-35
SILVERMAN
10/01/09 10/05/09
CHARGE CHARGE
R3681093 R3683557
00378-0208-10 00006-3843-71
SILVERMAN SILVERMAN
10/05/09 IVSPL 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09
CHARGE
S822714
SILVERMAN
SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN FUROSEMIDE 20MG TABLET (RP:LASIX) INVANZ INJ 1 GM 110 MLS (SODIUM CHLORIDE 0.9% MINI-BAG PLUS (100ML BAG)) IV ADMIN.SET NON-FILTER
4
2.88
RX
2
2.88
IV
81 7
4.54 501.20
RX IV
7
0.00
CHARGE
S822713
SILVERMAN
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S822712
SILVERMAN
INJECTION SITE NEEDLELESS VALVE
1
0.00
CHARGE
R3683554
64253-0333-35
SILVERMAN
7
2.88
IV
R3683556
64253-0111-35
SILVERMAN
14
2.88
RX
R3684662
00064-5010-15
SILVERMAN
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN SANTYL OINTMENT
10/05/09
CHARGE
10/05/09
CHARGE
30
85.21
RX
SILVERMAN
SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. INVANZ INJ 1 GM 110 MLS (SODIUM CHLORIDE 0.9% MINI-BAG PLUS (100ML BAG)) IV ADMIN.SET NON-FILTER
IV IV
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 IVSPL
PATIENT RECAP
CHARGE
IV IVSPLY
M832505
SHAYNE, BETTY RESIDENT# : 413 STATION : 2 STATUS : MEDICARE
SILVERMAN
675.66 31.50
RX
95.51
OCT 2009 IV SUPPLY PER DIEM
1
31.50
0.00 802.67
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/24/09 09/29/09 10/01/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3708169 R3682995 R3681074 R3676430 R3676637 R3688280 R3688281 R3692980 R3692981 R3676635 R3676636
51672-4027-03 51672-4027-03 51672-4027-03 00527-1324-10 13668-0009-05 00378-0208-10 00245-0057-10 51672-4027-03 51672-4030-03 00006-0951-54 49884-0404-01
58.44
SIEGLEN, CAROL RESIDENT# : 377 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) WARFARIN SODIUM 1MG TABLET DIGOXIN 0.125MG TABLET CITALOPRAM 10MG TABLET (RP:CELEXA) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 3MG TABLET COZAAR 25MG TABLET METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL)
3 1 8 6 15 15 15 3 4 15 15
2.88 2.88 4.32 2.88 2.88 2.88 3.81 2.88 2.88 19.28 10.87
RX RX RX RX RX RX RX RX RX RX RX
0.00 58.44
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/02/09 10/05/09 10/09/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3680354 R3681857 R3684820 R3689531 R3690890 R3683332 R3683333 R3683335 R3683336 R3683334 R3694119
64679-0714-04 00245-0058-15 50111-0990-01 00075-0620-40 00574-0412-02 63304-0579-10 16252-0505-90 55111-0158-10 00245-0058-15 07431-2011-40 00245-0057-10
347.21 2.88
SIEGLEN, EVELYN RESIDENT# : 415 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) KLOR-CON M 20 20MEQ TABLET SA VITAMIN D 50000IU CAPSULE LOVENOX 40MG/0.4ML DISP SYRIN POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) METOPROLOL TARTRATE 25MG TABLET SIMVASTATIN 5MG TABLET (RP:ZOCOR) OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) KLOR-CON M 20 20MEQ TABLET SA VITAMIN D 400IU TABLET KLOR-CON M 10 10MEQ TABLET SA (RP:K-DUR (750MG))
7.5 20 2 4 255 45 15 15 30 15 13
2.88 9.26 2.88 236.29 12.90 3.24 2.88 59.69 13.89 2.88 3.30
RX RX RX RX RX RX RX RX RX OTC RX
0.00 350.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693547 R3693548
54900-0001-22 00182-4141-26
5.76
SKLENAR, FLORENCE RESIDENT# : 2 STATION : 3 STATUS : MEDICAID
KIM KIM
VITAMIN E 400IU SOFTGEL CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
30 60
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3636494 R3636493 R3605686 R3624741 R3624736 R3625567 R3627736 R3625566 R3627736
00781-1966-10 00228-2672-11 00378-1903-01 63304-0579-10 65649-0301-03 00228-2672-11 63736-0105-06 63736-0105-06 63736-0105-06
-68.38 -41.17
SMITH, CHARLES RESIDENT# : 347 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
FUROSEMIDE 40MG TABLET SPIRONOLACTONE 50MG TABLET (RP:ALDACTONE) MIDODRINE 10MG TABLET METOPROLOL TARTRATE 25MG TABLET XIFAXAN 200MG TABLET SPIRONOLACTONE 50MG TABLET (RP:ALDACTONE) BACID CAPLET BACID CAPLET BACID CAPLET
-11 -12 -13 -0.5 -5 -3 -28 -22 -30
-0.66 -6.46 -40.74 -0.04 -18.86 -1.62 -14.41 -11.32 -15.44
RX RX RX RX RX RX OTC OTC OTC
0.00 -109.55
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SPADARO, ANNA RESIDENT# : 55 STATION : 3 STATUS : MEDICARE
10/26/09 10/26/09
CHARGE CHARGE
R3711245 R3711246
00781-2128-01 00143-2260-01
TESTA TESTA
10/26/09
CHARGE
R3711247
49884-0405-01
TESTA
10/26/09
CHARGE
R3711249
00409-6533-01
TESTA
PATIENT RECAP
RX
112.34
RAMIPRIL 5MG CAPSULE ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION
30 30
15.36 18.00
RX RX
30
21.73
RX
210
57.25
RX
0.00 112.34
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/02/09 10/06/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3681741 R3686227
63736-0105-06 63736-0105-06
9.27
SPADARO, ANNA RESIDENT# : 55 STATION : 3 STATUS : MEDICAID
TESTA TESTA
BACID CAPLET BACID CAPLET
10 14
3.86 5.41
OTC OTC
0.00 9.27
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SPIEGEL, PHILIP RESIDENT# : 393 STATION : SUB STATUS : MEDICARE
10/05/09 IVSPL 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09
CHARGE
S817031
GOLDFARB
IV ADMIN.SET NON-FILTER
3
0.00
CHARGE
S817030
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S817029
GOLDFARB
INJECTION SITE NEEDLELESS VALVE
1
0.00
CHARGE
R3684947
64253-0111-35
GOLDFARB
14
2.88
RX
10/05/09
CHARGE
R3684948
64253-0333-35
GOLDFARB
7
2.88
IV
10/05/09
CHARGE
R3684950
00409-6533-01
GOLDFARB
3
65.82
IV
10/06/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 IVSPL
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3686152 R3689832 R3676659 R3676662 R3676663 R3676664 R3676660 R3676661 M832504
00045-1525-50 00781-6141-16 51079-0007-56 55111-0532-01 49884-0545-04 16729-0005-17 63736-0105-06 00597-0058-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN VANCOMYCIN HCL 1.5 GM 280 MLS (SODIUM CHLORIDE 0.9% (250ML BAG) ) LEVAQUIN 500MG TABLET LEVETIRACETAM 100MG/1ML SOLUTION (RP:KEPPRA) OMEPRAZOLE (B) 20MG CAPSULE DR DIVALPROEX SODIUM SPRINKLES 125MG CAPSULE RANITIDINE 300MG TABLET (RP:ZANTAC) SIMVASTATIN 20MG TABLET BACID CAPLET FLOMAX 0.4MG CAPSULE SA OCT 2009 IV SUPPLY PER DIEM
7 473 30 270 15 15 15 15 1
70.70 165.08 119.37 221.67 3.05 3.15 5.80 44.34 10.50
PATIENT RECAP
IVSPLY RX
10.50 630.24
IV OTC
68.70 5.80
RX RX RX RX RX RX OTC RX
0.00 715.24
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
RX
R3646861
50111-0334-02
-0.22
SPITALNIAK, RESIDENT# : STATION : STATUS :
TANK
SR MARY (THERESA) 388 SUB MEDICARE
METRONIDAZOLE 500MG TABLET (RP:FLAGYL)
-1
-0.22
RX
0.00 -0.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC RX
R3693799 R3693802
00904-3232-92 00486-1125-01
2.88 4.74
SPRAGUER, RESIDENT# STATION STATUS
TESTA TESTA
JENNIE : 58 : 3 : MEDICAID
CALCIUM CARBONATE 600MG TABLET (RP:CALTRATE-600) K-PHOS NEUTRAL 250MG TABLET
60 30
2.88 4.74
OTC RX
0.00 7.62
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SUAREZ, JOAN RESIDENT# : 335 STATION : SUB STATUS : MEDICARE
10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3714963 R3714964 R3714965 R3714966 R3714967 R3714968 R3714969
16714-0061-05 00378-1803-01 00054-3542-58 00143-1473-10 00527-1325-10 00173-0697-00 16252-0097-22
TESTA TESTA TESTA TESTA TESTA TESTA TESTA
10/28/09 10/28/09
CHARGE CHARGE
R3714970 R3714971
00008-0833-22 00536-3442-38
TESTA TESTA
10/28/09 10/28/09 10/28/09 10/28/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3714972 R3714975 R3714976 R3714977 R3714978
00245-0057-10 00182-4141-26 00006-0117-54 00597-0075-41 60505-0829-01
TESTA TESTA TESTA TESTA TESTA
10/28/09
CHARGE
R3714979
67253-0900-11
TESTA
PATIENT RECAP
RX OTC
607.06 5.76
METOCLOPRAMIDE 5MG TABLET (RP:REGLAN) LEVOTHYROXINE SODIUM 50MCG TABLET MEGESTROL ACETATE 40MG/1ML ORAL SUSP PREDNISONE 10MG TABLET DIGOXIN 0.25MG TABLET ADVAIR DISKUS 500MCG/50MCG INHALER ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) EFFEXOR XR 75MG CAP.SR 24H CEROVITE ADVANCED FORMULA 27-0.4MG TABLET (RP:CENTRUM) KLOR-CON M 10 10MEQ TABLET SA CALCARB/VIT D 600/400 TABLET SINGULAIR 10MG TABLET SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER FLUTICASONE PROPIONATE NASAL SPRAY 50MCG (RP:FLONASE NASAL) ALPRAZOLAM 0.25MG TABLET (RP:XANAX)
36 12 240 12 12 60 75
6.62 3.16 98.97 2.88 2.88 206.59 8.63
RX RX RX RX RX RX RX
12 12
39.24 2.88
RX OTC
12 12 12 30 16
3.05 2.88 36.09 137.45 58.62
RX OTC RX RX RX
30
2.88
RX
0.00 612.82
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
TOBIN, DOROTHY RESIDENT# : 402 STATION : SUB STATUS : MEDICARE
10/01/09 10/02/09
CHARGE CHARGE
R3681088 R3681411
59762-5016-01 16252-0097-22
GOLDFARB GOLDFARB
10/02/09
CHARGE
R3681412
49502-0685-26
GOLDFARB
10/02/09 10/05/09 10/05/09 10/10/09
CHARGE CHARGE CHARGE CHARGE
R3681655 R3683423 R3683431 R3690597
00093-7254-01 59762-5016-01 00075-0620-40 49502-0685-26
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/10/09
CHARGE
R3690598
16252-0097-22
GOLDFARB
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3676456 R3676458 R3676459 R3676460 R3676461 R3683289 R3676455
00378-0032-10 31722-0238-10 00172-3760-60 60505-0065-01 00781-1966-10 00093-7254-01 00182-4141-26
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
FLUCONAZOLE 100MG TABLET (RP:DIFLUCAN) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) GLIMEPIRIDE 1MG TABLET (RP:AMARYL) FLUCONAZOLE 100MG TABLET (RP:DIFLUCAN) LOVENOX 40MG/0.4ML DISP SYRIN IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LISINOPRIL 20MG TABLET (RP:ZESTRIL ) OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) FUROSEMIDE 40MG TABLET (RP:LASIX) GLIMEPIRIDE 1MG TABLET (RP:AMARYL) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
2 75
2.88 8.63
RX RX
62.5
6.75
RX
10 5 4 62.5
2.88 4.42 236.29 6.75
RX RX RX RX
75
8.63
RX
30 15 15 30 15 15 15
2.88 2.88 2.88 119.37 2.88 2.88 2.88
RX RX RX RX RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
TOBIN, DOROTHY RESIDENT# : 402 STATION : SUB STATUS : MEDICARE
10/12/09 10/16/09
CHARGE CHARGE
R3676454 R3699554
00456-3210-60 16252-0097-22
GOLDFARB GOLDFARB
10/16/09
CHARGE
R3699116
50111-0990-01
GOLDFARB
PATIENT RECAP
RX OTC
456.73 2.88
NAMENDA 10MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) VITAMIN D 50000IU CAPSULE
15 75
34.22 8.63
RX RX
2
2.88
RX
0.00 459.61
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3687819 R3693458
63736-0105-06 00182-1576-26
10.60
TRENTACOSTE, MARY RESIDENT# : 74 STATION : 2 STATUS : MEDICAID
TESTA TESTA
BACID CAPLET OYST-CAL 500MG TABLET (RP:OS-CAL 500)
20 30
7.72 2.88
OTC OTC
0.00 10.60
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
VERLINGO, RESIDENT# STATION STATUS
10/02/09 10/05/09
CHARGE CHARGE
R3681479 R3682839
16252-0097-22 49502-0685-26
TANK TANK
10/05/09 10/06/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/14/09 10/19/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3683391 R3686296 R3676577 R3676578 R3676579 R3676580 R3676576 R3693285 R3695919 R3701353
59676-0320-04 59676-0320-04 00143-1248-10 57664-0397-58 00527-1116-10 00378-1903-01 00597-0058-01 00075-0624-30 00169-1833-11 59676-0320-04
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
PATIENT RECAP
RX OTC
1653.27 2.88
FREDERICK : 404 : SUB : MEDICARE
ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) PROCRIT 20MU/1ML VIAL PROCRIT 20MU/1ML VIAL FOLIC ACID 1MG TABLET METFORMIN 500MG TABLET SODIUM CHLORIDE 1GM TABLET MIDODRINE 10MG TABLET FLOMAX 0.4MG CAPSULE SA LOVENOX 30MG/0.3ML DISP SYRIN NOVOLIN R 100U/1ML VIAL-INSUL PROCRIT 20MU/1ML VIAL
75 62.5
8.63 6.75
1 2 15 30 15 45 30 3 10 2
238.26 476.52 2.88 2.88 2.88 141.03 88.69 177.24 33.87 476.52
RX RX RX RX RX RX OTC RX RX RX RX RX
0.00 1656.15
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
OTC
R3636487
17714-0019-01
-0.14
VERRIEST, RESIDENT# STATION STATUS
GOLDFARB
JANET : 362 : SUB : HMO PATIENTS
SIMETHICONE 80MG TAB CHEW (RP:GAS-X)
-5
-0.14
OTC
0.00 -0.14
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/30/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693675 S831868
00182-4141-26 17191-0051-04
5.76
VITA, ANGELA RESIDENT# : 30 STATION : 3 STATUS : MEDICAID
TANK TANK
CALCARB/VIT D 600/400 TABLET ADAPTA-CAP 28MM/SIZE K (PHENYTOIN) EACH
60 1
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
VRANA, MURIEL RESIDENT# : 365 STATION : SUB STATUS : MEDICARE
10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3690264 R3690266 R3690267 R3690268 R3690273 R3690274 R3690276 R3690280 R3690393 R3690282 R3690270 R3690281 R3690310
00378-1805-01 57664-0434-88 00904-5062-60 65580-0643-71 16252-0097-22 49502-0685-26 60505-2607-01 65162-0627-50 00378-0208-10 11523-7162-01 00006-0951-54 00065-8533-02 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/09/09 10/10/09 10/11/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3690391 R3690893 R3691106 R3691447 R3691465
49884-0035-10 00168-0006-80 60505-2608-01 57664-0434-88 00378-1805-01
TANK TANK TANK TANK TANK
LEVOTHYROXINE SODIUM 75MCG TABLET ALLOPURINOL 100MG TABLET CALCIUM CITRATE 200MG TABLET METOLAZONE 2.5MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION CARVEDILOL 6.25MG TABLET (RP:COREG) TRAMADOL 50MG TABLET FUROSEMIDE 20MG TABLET CLARITIN D 12 HOUR 5MG/120MG TABLET SA COZAAR 25MG TABLET CIPRODEX 0.3% DROPS SUSP HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN MECLIZINE HCL 25MG TABLET TRIAMCINOLONE ACETONIDE 0.1% OINTMENT CARVEDILOL 12.5MG TABLET (RP:COREG) ALLOPURINOL 100MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET
3 2 3 3 75 62.5 6 15 3 30 3 7.5 5
2.88 2.88 2.88 2.88 8.63 6.75 2.88 2.88 2.88 43.09 3.86 79.78 13.61
7.5 80 2 6 15
2.88 4.00 2.88 2.88 4.37
RX RX OTC RX RX RX RX RX RX OTC RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
VRANA, MURIEL RESIDENT# : 365 STATION : SUB STATUS : MEDICARE
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/14/09 10/15/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3691467 R3691469 R3691470 R3691466 R3691468 R3696165 R3698197
65580-0643-71 00378-0208-10 60505-2608-01 00904-5062-60 00006-0951-54 00072-5760-04 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK
15 15 30 15 15 120 5
13.37 2.88 4.29 2.88 19.28 8.36 13.61
RX RX RX OTC RX OTC RX
TANK TANK TANK TANK TANK TANK
METOLAZONE 2.5MG TABLET FUROSEMIDE 20MG TABLET CARVEDILOL 12.5MG TABLET (RP:COREG) CALCIUM CITRATE 200MG TABLET COZAAR 25MG TABLET LAC-HYDRIN 5 5% LOTION HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION KLOR-CON M 20 20MEQ TABLET SA METOLAZONE 2.5MG TABLET SODIUM CHLORIDE 0.9% (1000ML BAG) 1000 MLS IV SOLUTION SET W/ REGULATOR
10/16/09 10/16/09 10/20/09 10/21/09 10/23/09 10/23/09 IVSPL 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3698626 R3698628 R3704107 R3704323 R3708239 S830267
49502-0685-26 16252-0097-22 00245-0058-15 65580-0643-71 00338-0049-04
62.5 75 1 5 4 4
6.75 8.63 2.88 4.46 27.88 0.00
RX RX RX RX IV
CHARGE CHARGE CHARGE CHARGE CHARGE
R3693841 R3694019 R3694024 R3709524 R3709592
57664-0434-88 00378-1805-01 60505-2608-01 00378-0208-10 49502-0685-26
TANK TANK TANK TANK TANK
ALLOPURINOL 100MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET CARVEDILOL 12.5MG TABLET (RP:COREG) FUROSEMIDE 20MG TABLET (RP:LASIX) IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION
6 15 30 15 62.5
2.88 4.37 4.29 2.88 6.75
RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/31/09 IVSPL
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX OTC
R3709611 R3694020 R3694022 M832503
16252-0097-22 00904-5062-60 00006-0951-54
272.15 60.09
IV IVSPLY
VRANA, MURIEL RESIDENT# : 365 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK
ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION CALCIUM CITRATE 200MG TABLET COZAAR 25MG TABLET OCT 2009 IV SUPPLY PER DIEM
27.88 10.50
75 15 15 1
8.63 2.88 19.28 10.50
RX OTC RX
0.00 370.62
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
WYMAN, DOROTHY RESIDENT# : 312 STATION : 3 STATUS : MEDICAID
10/08/09
CHARGE
R3689585
62261-0112-01
TANK
10/26/09 10/28/09
CHARGE CHARGE
R3693759 R3714535
74312-0813-80 63736-0105-06
TANK TANK
PATIENT RECAP
OTC
9.62
CARBAMIDE PEROXIDE OTIC 6.5% DROPS (RP:DEBROX OTIC) VITAMIN B12 1000MCG TABLET BACID CAPLET
15
2.88
OTC
30 10
2.88 3.86
OTC OTC
0.00 9.62
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN
RX
R3650030 R3657063 R3642636 R3642634 R3642633 R3642637
51672-4030-03 51672-4028-03 00781-2272-01 00591-0347-01 00310-0751-90 62175-0118-43
-56.95
ZAKRZEWSKI, RESIDENT# : STATION : STATUS :
TANK TANK TANK TANK TANK TANK
CORA 385 SUB MEDICARE
WARFARIN SODIUM 3MG TABLET WARFARIN SODIUM 2MG TABLET AMLODIPINE/BENAZEPRIL 5-10MG CAPSULE (RP:LOTREL) HYDROCHLOROTHIAZIDE 12.5MG CAPSULE CRESTOR 10MG TABLET OMEPRAZOLE 20MG CAPSULE DR
-8 -14 -3 -3 -5 -6
-4.67 -7.90 -5.36 -0.36 -14.79 -23.87
RX RX RX RX RX RX
0.00 -56.95
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
RX
R3658285
50111-0333-01
-2.04
ZVYURNIE, RESIDENT# STATION STATUS
ARNOUK
ANGELINA : 373 : SUB : MEDICARE
METRONIDAZOLE 250MG TABLET (RP:FLAGYL)
-24
-2.04
RX
0.00 -2.04
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CENTER FOR HEALTH & REHABILITATION 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/26/09 10/31/09
CASH CASH PH
CK# 00015 CK# 00163
MAYWOOD CTR FOR HEALTH & REHAB CUSTOMER# 24M
THANK YOU FOR YOUR PAYMENT.... - JUNE 2009 PYMT THANK YOU FOR YOUR PAYMENT.... NEW CHARGES
0-30 32866.85
31-60 41412.93
61-90 32446.24
91-120 0.00
121+ 0.00
155211.52
33537.21
0.00
188748.73
82022.71
-42418.39 -39604.32 33537.21
0.00
106726.02
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/03/09 10/03/09 10/05/09 10/05/09 10/06/09 10/06/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3679934 R3679935 R3681336 R3681337 R3681338 R3681457 R3681456 R3681459 R3681460 R3681461 R3682275 R3682276 R3683215 R3682838 R3686070 R3685172 R3686761 R3686807 R3686823
10135-0115-01 00002-8031-01 00555-0720-51 00555-0720-51 00555-0720-51 22170-0215-16 00182-0287-01 00182-1093-10 00904-7591-60 74312-0077-10 00113-0915-55 00182-1039-01 00799-0001-04 53807-0401-16 00185-0144-05 59741-0306-12 00182-0287-01 10135-0144-01 00904-7591-60
HOUSE CHARGES
ONCE DAILY MULTIVITAMIN TABLET GLUCAGON EMERGENCY KIT 1MG ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) CEPACOL SUGAR-FREE LOZENGE DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) SENNA-GEN 8.6MG TABLET FERROUS SULFATE 325MG TABLET GLUCOSAMINE 500MG CAPSULE OMEPRAZOLE OTC 20MG TABLET DR IBUPROFEN 200MG TABLET CALMOSEPTINE OINTMENT MILK OF MAGNESIA 400MG/5ML ORAL SUSP AMIODARONE HCL 200MG TABLET BISACODYL SUPP 10MG SUPP.RECT (RP:DULCOLAX) DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) ACETAMINOPHEN X-S 500MG CAPLET FERROUS SULFATE 325MG TABLET
600 3 2 1 1 96 600 400 600 240 168 400 4520 1419 6 24 600 600 600
22.26 418.97 30.74 15.37 15.37 20.02 18.73 6.93 10.11 30.22 68.81 13.17 238.34 6.74 4.43 4.06 18.73 5.49 10.11
OTC RX RX RX RX OTC OTC OTC OTC OTC OTC OTC OTC OTC RX OTC OTC OTC OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/08/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/15/09 10/15/09 10/15/09 10/19/09 10/20/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3686824 R3686828 R3687705 R3687709 R3687710 R3687711 R3687712 R3687758 R3688091 R3690481 R3691602 R3691605 R3692545 R3692546 R3698403 R3698408 R3698665 R3700824 R3702508
10135-0115-01 00182-1039-01 00182-1061-07 50383-0786-08 00121-0544-16 53807-0401-16 00904-5452-09 66424-0092-01 00002-8031-01 00799-0001-04 00113-0915-55 00904-7591-60 00536-3222-01 32131-0824-06 59390-0040-46 00113-0915-55 00904-7927-60 00182-0287-01 66424-0092-01
HOUSE CHARGES
ONCE DAILY MULTIVITAMIN TABLET IBUPROFEN 200MG TABLET ASPIRIN EC 81MG TABLET EC GOLDEN AGE LIQUID (RP:CERTAGEN) DOCUSATE SODIUM 100MG/10ML LIQUID (RP:COLACE) MILK OF MAGNESIA 400MG/5ML ORAL SUSP SENNA 8.8MG/5ML SYRUP CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET GLUCAGON EMERGENCY KIT 1MG CALMOSEPTINE OINTMENT OMEPRAZOLE OTC 20MG TABLET DR FERROUS SULFATE 325MG TABLET ACETAMINOPHEN 325MG TABLET MULTIVITAMIN W/MINERALS TABLET ACETAMINOPHEN 160MG/5ML ELIXIR OMEPRAZOLE OTC 20MG TABLET DR BISACODYL 5MG TABLET EC DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET
300 300 480 480 1440 1419 720 200 3 1130 252 600 400 120 1892 336 200 600 600
3.18 9.88 8.77 6.88 28.79 6.74 37.10 4.66 402.20 59.59 103.21 10.11 11.55 5.49 12.93 137.61 8.11 18.73 13.98
OTC OTC OTC OTC OTC OTC OTC OTC RX OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/22/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/25/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3704325 R3704209 R3704326 R3704327 R3704329 R3706001 R3708116 R3708127 R3708160 R3708161 R3708163 R3708183 R3708186 R3708147 R3709276 R3709364 R3709368 R3709370 R3709371
00799-0001-04 00536-3222-01 00182-1093-10 00904-7927-60 66424-0092-01 00799-0001-04 00781-2144-01 60505-2616-06 55111-0126-05 00054-4728-31 66593-3126-02 51672-4030-03 51672-4032-03 00093-0311-05 00182-0287-01 54838-0001-80 10135-0115-01 32131-0824-06 00182-1039-01
HOUSE CHARGES
CALMOSEPTINE OINTMENT ACETAMINOPHEN 325MG TABLET SENNA-GEN 8.6MG TABLET BISACODYL 5MG TABLET EC CALCIUM (OYST SH) W/VIT D 500MG/200IU TABLET CALMOSEPTINE OINTMENT AMPICILLIN TRIHYDRATE 250MG CAPSULE CLARITHROMYCIN 250MG TABLET (RP:BIAXIN) CIPROFLOXACIN 250MG TABLET (RP:CIPRO) PREDNISONE 5MG TABLET VANCOCIN HCL 250MG CAPSULE WARFARIN SODIUM 3MG TABLET (RP:COUMADIN) WARFARIN SODIUM 5MG TABLET (RP:COUMADIN) LOPERAMIDE 2MG CAPSULE (RP:IMODIUM) DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) FERROUS SULFATE 220MG/5ML ELIXIR ONCE DAILY MULTIVITAMIN TABLET MULTIVITAMIN W/MINERALS TABLET IBUPROFEN 200MG TABLET
1130 600 600 600 600 1130 4 10 1 8 6 1 1 3 400 1416 600 240 200
59.59 17.33 10.39 24.34 13.98 59.59 2.88 23.73 2.88 2.88 292.93 2.88 2.88 2.88 12.49 14.20 6.35 10.97 6.59
OTC OTC OTC OTC OTC OTC RX RX RX RX RX RX RX RX OTC OTC OTC OTC OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/27/09 10/27/09 10/31/09
HOUSE RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC RX
R3709372 R3709373 R3709374 R3709549 R3709550 R3711303 R3712610 R3717486
10135-0144-01 00536-3222-01 00182-0287-01 59741-0306-12 00168-0011-31 00113-0915-55 50383-0786-08 22170-0215-16
1312.87 1221.02
HOUSE CHARGES
ACETAMINOPHEN X-S 500MG CAPLET ACETAMINOPHEN 325MG TABLET DOCUSATE SODIUM 100MG CAPSULE (RP:COLACE) BISACODYL SUPP 10MG SUPP.RECT (RP:DULCOLAX) BACITRACIN ZINC 500U/1GM OINTMENT OMEPRAZOLE OTC 20MG TABLET DR GOLDEN AGE LIQUID (RP:CERTAGEN) CEPACOL SUGAR-FREE LOZENGE
400 600 600 24 60 126 720 32
3.66 17.33 18.73 4.06 3.66 51.60 10.31 6.67
OTC OTC OTC OTC OTC OTC OTC OTC
0.00 2533.89
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ALDERS, CLYDE RESIDENT# : 368 STATION : SUB STATUS : MEDICARE
09/02/09 09/02/09 09/02/09 09/02/09 09/02/09
RETURN RETURN RETURN RETURN RETURN
R3642618 R3627206 R3627207 R3627210 R3627201
60505-0234-01 74312-0871-90 00185-0223-05 00093-7223-98 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
09/02/09 09/02/09 09/02/09 09/02/09 09/02/09
RETURN RETURN RETURN RETURN RETURN
R3627205 R3627202 R3627209 R3627208 R3627204
00245-0058-15 55111-0119-10 00071-0157-23 00071-0155-23 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
09/02/09 09/10/09
RETURN RETURN
R3627199 R3617203
66582-0414-54 00093-0233-56
GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
-209.44 -0.58
TORSEMIDE 20MG TABLET (RP:DEMADEX) ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) CILOSTAZOL 100MG TABLET (RP:PLETAL) FOSINOPRIL 20MG TABLET (RP:MONOPRIL) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) KLOR-CON M 20 20MEQ TABLET SA (RP:K-DUR (1500MG)) FAMOTIDINE 20MG TABLET (RP:PEPCID) LIPITOR 40MG TABLET LIPITOR 10MG TABLET METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) ZETIA 10MG TABLET ONDANSETRON 4MG TABLET (RP:ZOFRAN)
-30 -14 -14 -14 -14
-15.75 -0.58 -7.67 -8.37 -13.38
RX OTC RX RX RX
-14 -29 -15 -15 -14
-6.49 -4.35 -47.24 -33.12 -19.94
RX RX RX RX RX
-15 -12
-39.93 -13.20
RX RX
0.00 -210.02
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ALIMI, GANI RESIDENT# : 364 STATION : SUB STATUS : MEDICARE
09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09
RETURN RETURN RETURN RETURN RETURN RETURN RETURN
R3627125 R3627196 R3627194 R3642617 R3627198 R3627196 R3627195
51079-0007-56 63304-0579-10 00228-2898-03 31722-0213-05 00182-1576-26 63304-0579-10 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
09/10/09 09/17/09 09/17/09
RETURN RETURN RETURN
R3627193 R3627197 R3627197
00591-0844-01 00169-0082-81 00169-0082-81
GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
-86.36 -1.55
OMEPRAZOLE (B) 20MG CAPSULE DR METOPROLOL TARTRATE 25MG TABLET GLIPIZIDE ER 2.5MG TABLET SA (RP:GLUCOTROL XL) SERTRALINE HCL 50MG TABLET (RP:ZOLOFT) OYST-CAL 500MG TABLET (RP:OYSTER SHELL CALCIUM) METOPROLOL TARTRATE 25MG TABLET ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) GLIPIZIDE ER 5MG TABLET SA (RP:GLUCOTROL XL) PRANDIN 1MG TABLET PRANDIN 1MG TABLET
-9 -3 -6 -7 -38 -13 -9
-35.81 -0.22 -1.61 -0.90 -1.55 -0.94 -8.60
RX RX RX RX OTC RX RX
-6 -15 -10
-1.61 -22.00 -14.67
RX RX RX
0.00 -87.91
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3633905 R3633904 R3645013 R3648796 R3648800 R3652378
00172-4364-60 16252-0571-01 00172-4364-60 00143-9898-05 63736-0105-06 00185-0122-01
-16.91 -1.54
ANDERSON, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK
BERYL : 342 : SUB : MEDICARE
LABETALOL 100MG TABLET RAMIPRIL 2.5MG CAPSULE (RP:ALTACE) LABETALOL 100MG TABLET CEPHALEXIN 250MG CAPSULE (RP:KEFLEX) BACID CAPLET NITROFURANTOIN MONOHYDRATE 100MG CAPSULE (RP:MACROBID)
-15 -15 -3 -9 -3 -3
-3.24 -7.32 -0.65 -1.66 -1.54 -4.04
RX RX RX RX OTC RX
0.00 -18.45
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/12/09 10/12/09 10/12/09 10/20/09 10/21/09 10/21/09 10/21/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3688057 R3688059 R3688061 R3688068 R3688058 R3688060 R3688064 R3688065 R3688067 R3688069 R3688070 R3688259 R3688260 R3688261 R3702022 R3703328 R3703494 R3706101 R3693951
00555-0720-51 31722-0238-10 16729-0006-17 00406-0512-05 63481-0687-06 00007-3230-11 00574-0412-02 00008-0607-01 00071-1012-68 67767-0123-18 00378-9119-98 31722-0238-10 16729-0006-17 00008-0607-01 00555-0720-51 67767-0123-18 00378-9119-98 00071-1012-68 31722-0238-10
ANTENUCCI, CARMELA RESIDENT# : 409 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) SIMVASTATIN 40MG TABLET (RP:ZOCOR) OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LIDODERM 5% PATCH ARIXTRA 2.5MG/0.5ML DISP SYRIN POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) LYRICA 25MG CAPSULE FENTANYL 100MCG/HR PATCH FENTANYL 12MCG/HR PATCH AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) SIMVASTATIN 40MG TABLET (RP:ZOCOR) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) FENTANYL 100MCG/HR PATCH FENTANYL 12MCG/HR PATCH LYRICA 25MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC)
2 5 5 30 15 5 255 5 15 5 5 15 15 15 2 5 5 15 15
30.74 2.88 2.88 7.02 75.81 397.58 12.90 13.50 26.50 212.11 47.44 2.88 3.84 40.50 30.74 212.11 47.44 26.50 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/28/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX
R3693952 R3693953 R3714866 R3716305
16729-0006-17 00008-0607-01 00713-0135-12 00007-3230-11
1668.75
ANTENUCCI, CARMELA RESIDENT# : 409 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO
SIMVASTATIN 40MG TABLET (RP:ZOCOR) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) PROCHLORPERAZINE 25MG SUPP.RECT (RP:COMPAZINE) ARIXTRA 2.5MG/0.5ML DISP SYRIN
15 15 12 5
3.84 40.50 30.58 397.58
RX RX RX RX
0.00 1668.75
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 10/02/09
PATIENT RECAP
RETURN CHARGE
RX
R3649121 R3681730
42043-0141-05 51672-4032-03
2.52
BART, ANNA RESIDENT# : 392 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB
CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) WARFARIN SODIUM 5MG TABLET
-1 3
-0.36 2.88
RX RX
0.00 2.52
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/14/09
PATIENT RECAP
CHARGE
OTC
R3694810
54162-0500-02
3.84
BAZEWICZ, RESIDENT# STATION STATUS
TESTA
HYDROPHOR OINTMENT
MARY : 7 : 3 : MEDICAID
100
3.84
OTC
0.00 3.84
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
BEHNKE, FRED RESIDENT# : 416 STATION : 2 STATUS : MEDICARE
10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/02/09 10/13/09 10/14/09 10/16/09 10/16/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3681360 R3681365 R3681367 R3681371 R3681372 R3681373 R3681376 R3681377 R3681379 R3681381 R3681724 R3694230 R3696051 R3699992 R3699990
63304-0579-10 55111-0172-90 16252-0528-90 00185-0144-05 16252-0097-22 00143-1248-10 00378-0208-10 00245-0057-10 00527-1324-10 00024-4200-10 00024-4200-10 51079-0072-56 00245-0057-10 00781-1966-10 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/16/09 10/18/09
CHARGE CHARGE
R3699993 R3700612
00074-3079-90 16252-0097-22
GOLDFARB GOLDFARB
PATIENT RECAP
RX
253.64
METOPROLOL TARTRATE 25MG TABLET FINASTERIDE 5MG TABLET (RP:PROSCAR) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) AMIODARONE HCL 200MG TABLET (RP:CORDARONE) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION FOLIC ACID 1MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA DIGOXIN 0.125MG TABLET UROXATRAL 10MG TABLET SA UROXATRAL 10MG TABLET SA FUROSEMIDE (B) 20MG TABLET KLOR-CON M 10 10MEQ TABLET SA (RP:K-DUR (750MG)) FUROSEMIDE 40MG TABLET (RP:LASIX) METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) NIASPAN 750MG TABLET SA ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION
162 27 27 27 75 27 14 14 27 1 26 26 12 10 10
11.66 46.71 9.61 19.93 8.63 2.88 2.88 3.56 5.75 3.62 64.72 2.88 3.05 2.88 9.31
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
20 75
46.94 8.63
RX RX
0.00 253.64
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/18/09 10/05/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3708126 R3683160
17714-0020-01 63736-0105-06
10.60
BELLARDITA, RESIDENT# : STATION : STATUS :
TESTA WIENER
ANN 83 2 MEDICAID
DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL) BACID CAPLET
1 20
2.88 7.72
OTC OTC
0.00 10.60
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/12/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE
OTC
R3686013 R3676474 R3693881
17478-0060-12 00574-0508-01 00574-0508-01
8.64
BELLAVIA, RESIDENT# STATION STATUS
RENNER RENNER RENNER
LUCY : 232 : SUB : MEDICAID
AKWA TEARS (ARTIFICIAL TEARS) DROPS FERROUS GLUCONATE 324MG TABLET FERROUS GLUCONATE 324MG TABLET
15 15 15
2.88 2.88 2.88
OTC OTC OTC
0.00 8.64
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/29/09 10/29/09 10/29/09 10/29/09 10/29/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3715269 R3715271 R3715272 R3715274 R3715275 R3716176
00024-4200-10 16252-0097-22 00173-0696-00 63824-0008-50 00597-0075-41 00075-0620-40
566.82 12.49
BIZZARO, EMANUEL RESIDENT# : 434 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK
UROXATRAL 10MG TABLET SA ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION ADVAIR DISKUS 250MCG/50MCG INHALER MUCINEX 600MG TABLET SA SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER LOVENOX 40MG/0.4ML DISP SYRIN
11 75 60 22 30 4
27.38 8.63 157.07 12.49 137.45 236.29
RX RX RX OTC RX RX
0.00 579.31
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/09/09
PATIENT RECAP
CHARGE
OTC
R3689834
00521-2750-00
2.88
BONANNO, FLORENCE RESIDENT# : 14 STATION : 3 STATUS : MEDICAID
RENNER
VASELINE LIP THERAPY (10GM) LOTION
1
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
BONANNO, LUCILLE RESIDENT# : 407 STATION : SUB STATUS : MEDICARE
10/05/09
CHARGE
R3683392
00591-3433-30
GOLDFARB
10/09/09 10/12/09 10/12/09 10/12/09 10/19/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3689831 R3676583 R3676584 R3676585 R3700554
00186-1989-04 00603-3856-32 00378-1805-01 65726-0235-10 00085-1401-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX
174.56
IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 SOLUTION (RP:DUONEB 3 ML VIAL) PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. HCTZ 25MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) DYNACIRC CR 5MG TABLET SA FORADIL AEROLIZER 12MCG INHALER
90
45.17
RX
30 15 15 15 60
2.88 2.88 4.37 8.92 110.34
RX RX RX RX RX
0.00 174.56
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/06/09 10/07/09 10/07/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/13/09 10/14/09 10/16/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX IV
R3686256 R3686318 R3687704 R3688486 R3690882 R3676544 R3676546 R3676547 R3676549 R3676550 R3688258 R3676545 R3691455 R3693306 R3693322 R3695920 R3697959
00245-0058-15 00338-0049-04 00075-0620-40 00338-0049-04 00182-4141-26 59762-5019-01 00781-2074-01 57664-0397-58 00378-1800-01 00378-1807-10 00245-0058-15 00008-0607-01 00182-4141-26 00378-0028-01 00781-1123-01 00169-7501-11 00075-0620-40
633.05 9.58
OTC
BOODAGHIAN, RESIDENT# : STATION : STATUS :
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
MARY 406 SUB MEDICARE
KLOR-CON M 20 20MEQ TABLET SA SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. LOVENOX 40MG/0.4ML DISP SYRIN SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) QUINAPRIL 5MG TABLET TRIAMTERENE/HCTZ 37.5-25MG CAPSULE (RP:DYAZIDE ) METFORMIN 500MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) LEVOTHYROXINE SODIUM 88MCG TABLET KLOR-CON M 20 20MEQ TABLET SA PANTOPRAZOLE 40MG TABLET DR CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) NADOLOL 20MG TABLET TRIAMTERENE/HCTZ 37.5/25 TABLET (RP:MAXZIDE-25) NOVOLOG 100U/1ML INSULIN LOVENOX 40MG/0.4ML DISP SYRIN
5.76
6 1000 4 1000 4 15 15 30 7.5 15 15 15 30 26 6.5 10 4
2.88 4.79 236.29 4.79 2.88 3.75 4.77 2.88 2.88 4.44 6.95 40.50 2.88 12.09 2.88 76.45 236.29
RX IV RX IV OTC RX RX RX RX RX RX RX OTC RX RX RX RX
0.00 648.39
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT
RX
R3659641 R3659641 R3659952 R3659952 R3659953 R3659953 R3659954 R3659954 R3659956 R3659956 R3659957 R3659957
58468-0021-01 58468-0021-01 00378-1805-01 00378-1805-01 00456-2010-01 00456-2010-01 63304-0579-10 63304-0579-10 00008-0841-81 00008-0841-81 16729-0005-17 16729-0005-17
-589.75
BOSNYAK, DOROTHY RESIDENT# : 29 STATION : 3 STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
RENAGEL (SEVELAMER HCL) 800MG TABLET RENAGEL (SEVELAMER HCL) 800MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET LEXAPRO 10MG TABLET LEXAPRO 10MG TABLET METOPROLOL TARTRATE 25MG TABLET METOPROLOL TARTRATE 25MG TABLET PROTONIX 40MG TABLET DR PROTONIX 40MG TABLET DR SIMVASTATIN 20MG TABLET (RP:ZOCOR) SIMVASTATIN 20MG TABLET (RP:ZOCOR)
9 90 3 30 3 30 6 60 6 60 3 30
23.02 -239.77 2.88 -8.73 9.72 -101.21 2.88 -4.32 28.76 -299.56 2.88 -6.30
RX RX RX RX RX RX RX RX RX RX RX RX
0.00 -589.75
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693374 R3693670
51672-1275-02 54391-0002-01
18.32
BOSNYAK, DOROTHY RESIDENT# : 29 STATION : 3 STATUS : MEDICAID
SILVERMAN SILVERMAN
CLOTRIMAZOLE 1% CREAM (RP:LOTRIMIN AF) NEPHRO-VITE TABLET
30 30
11.91 6.41
OTC OTC
0.00 18.32
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/26/09 10/02/09
PATIENT RECAP
CHARGE CHARGE
RX
R3682981 R3678127
51672-4027-03 51672-4028-03
5.76
BOSTICCO, RESIDENT# STATION STATUS
TANK TANK
JOSEPH : 399 : SUB : MEDICARE
WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) WARFARIN SODIUM 2MG TABLET
1 3
2.88 2.88
RX RX
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
BURDICK, ANN RESIDENT# : 429 STATION : SUB STATUS : MEDICARE
10/20/09 10/20/09 10/20/09 10/20/09
CHARGE CHARGE CHARGE CHARGE
R3704049 R3704059 R3704063 R3704064
53746-0101-05 55111-0158-10 00603-1378-59 16252-0097-22
TANK TANK TANK TANK
10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/23/09 10/23/09 10/24/09 10/24/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3704070 R3704086 R3704052 R3704060 R3704067 R3704068 R3704074 R3704078 R3708290 R3708432 R3707204 R3707210
42043-0141-05 65162-0627-50 00456-2010-01 00075-0620-40 51660-0526-28 00065-0266-25 00064-5010-15 49884-0404-01 63736-0105-06 68180-0512-02 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/26/09
CHARGE
R3706226
53746-0101-05
TANK
GABAPENTIN 100MG CAPSULE (RP:NEURONTIN) OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) LACTULOSE 10GM/15ML SOLUTION ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) TRAMADOL 50MG TABLET LEXAPRO 10MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN LORATADINE 10MG TABLET (RP:CLARITIN) TRAVATAN 0.004% DROPS SANTYL OINTMENT METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) BACID CAPLET LISINOPRIL 2.5MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) GABAPENTIN 100MG CAPSULE (RP:NEURONTIN)
6 12 946 75
2.88 47.75 20.81 8.63
4 30 6 4 15 2.5 30 3 28 3 75 62.5
2.88 2.88 13.36 236.29 2.88 58.41 85.21 2.88 10.81 2.88 8.63 6.75
15
2.88
RX RX RX RX RX RX RX RX OTC RX RX RX OTC RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/27/09 10/29/09 10/29/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3706228 R3709506 R3706227 R3706229 R3712552 R3716254 R3716315 R3717129
55111-0158-10 68180-0512-02 00456-2010-01 49884-0404-01 63304-0579-10 00186-1989-04 00054-4728-31 00378-0208-10
678.40 13.69
BURDICK, ANN RESIDENT# : 429 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK
OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) LISINOPRIL 2.5MG TABLET LEXAPRO 10MG TABLET METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) METOPROLOL TARTRATE 25MG TABLET PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. PREDNISONE 5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX)
30 15 15 7.5 13 60 9 10
119.37 2.88 33.40 5.43 2.88 5.56 2.88 2.88
RX RX RX RX RX RX RX RX
0.00 692.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CALANDRIELLO, ROSE RESIDENT# : 361 STATION : SUB STATUS : MEDICARE
10/02/09
CHARGE
R3682128
00143-2260-01
SILVERMAN
10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682131 R3682132 R3682136 R3682137 R3682133 R3682148
16729-0006-17 00378-1803-01 31722-0521-10 00168-0080-31 17714-0019-01 64253-0111-35
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
10/02/09
CHARGE
R3682149
64253-0333-35
SILVERMAN
10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/06/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682129 R3682130 R3682134 R3682138 R3682139 R3682142 R3686389
49884-0405-01 00149-0752-15 00078-0360-34 00409-6533-01 17478-0711-30 00169-7501-11 61314-0656-05
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 50MCG TABLET HYDRALAZINE 50MG TABLET HYDROCORTISONE 2.5% CREAM SIMETHICONE 80MG TAB CHEW SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN METOPROLOL SUCCINATE ER 50MG TAB.SR 24H ASACOL DELAYED RELEASE 400MG TABLET DIOVAN 320MG TABLET C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION LIDOCAINE HCL 2% JELLY NOVOLOG 100U/1ML INSULIN CIPROFLOXACIN HCL OPHTH. 0.3% DROPS (RP:CILOXAN OPHTHALMIC)
10
6.00
RX
10 10 30 30 45 10
2.88 2.88 12.60 4.95 2.88 2.88
10
2.88
IV
10 60 10 100 30 10 5
7.25 76.27 23.79 27.26 11.46 76.45 37.85
RX RX RX RX RX RX RX
RX RX RX RX OTC RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CALANDRIELLO, ROSE RESIDENT# : 361 STATION : SUB STATUS : MEDICARE
10/12/09
CHARGE
R3683337
00143-2260-01
SILVERMAN
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/19/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3683340 R3683341 R3683343 R3683338 R3683339 R3683342 R3693212 R3708132 R3708651 R3708654
16729-0006-17 00378-1803-01 31722-0521-10 49884-0405-01 00149-0752-15 00078-0360-34 00409-6533-01 00378-5110-01 16729-0006-17 00143-2260-01
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708655 R3708657 R3708682 R3708683 R3708650 R3708652
00378-1803-01 31722-0521-10 62037-0640-01 00168-0080-31 00149-0752-15 00078-0359-34
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 50MCG TABLET HYDRALAZINE 50MG TABLET METOPROLOL SUCCINATE ER 50MG TAB.SR 24H ASACOL DELAYED RELEASE 400MG TABLET DIOVAN 320MG TABLET C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION PROCHLORPERAZINE 10MG TABLET (RP:COMPAZINE) SIMVASTATIN 40MG TABLET ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) HYDRALAZINE 50MG TABLET OMEPRAZOLE 40MG CAPSULE DR HYDROCORTISONE 2.5% CREAM ASACOL DELAYED RELEASE 400MG TABLET DIOVAN 160MG TABLET
15
9.00
RX
15 15 45 15 90 15 100 1 3 3
3.84 3.95 18.90 10.87 114.41 35.69 27.26 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX RX
3 9 3 30 18 3
2.88 3.78 5.20 4.95 22.88 5.64
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/23/09 10/23/09 10/23/09 10/23/09 10/23/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3708658 R3708661 R3708662 R3708663 R3708681
17478-0711-30 17714-0019-01 00088-2220-33 00169-7501-11 00409-6533-01
756.50 5.76
IV
CALANDRIELLO, ROSE RESIDENT# : 361 STATION : SUB STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
LIDOCAINE HCL 2% JELLY SIMETHICONE 80MG TAB CHEW LANTUS 100U/1ML VIAL-INSUL NOVOLOG 100U/1ML INSULIN C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION
2.88
30 100 10 10 100
11.46 2.88 70.92 76.45 27.26
RX OTC RX RX RX
0.00 765.14
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/19/09 10/19/09 10/19/09 10/19/09 10/22/09 10/23/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09 10/29/09 PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE RX OTC
R3698602 R3698603 R3698604 R3698605 R3698607 R3698608 R3708182 R3702262 R3702263 R3702265 R3702267 R3707878 R3708593 R3701187 R3701188 R3706247 R3711179 R3716243 R3716717
00781-1966-10 16729-0005-17 55111-0119-10 42043-0141-05 63736-0105-06 51672-4030-03 51672-4030-03 51672-4028-03 00245-0058-15 00603-1378-59 65580-0643-71 51672-4027-03 00781-1966-10 16729-0005-17 55111-0119-10 00781-1966-10 00245-0058-15 51672-4027-03 51672-4027-03 92.81 2.88
CARUSO, JOSEPH RESIDENT# : 427 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
FUROSEMIDE 40MG TABLET (RP:LASIX) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) BACID CAPLET WARFARIN SODIUM 3MG TABLET WARFARIN SODIUM 3MG TABLET (RP:COUMADIN) WARFARIN SODIUM 2MG TABLET KLOR-CON M 20 20MEQ TABLET SA LACTULOSE 10GM/15ML SOLUTION METOLAZONE 2.5MG TABLET (RP:ZAROXOLYN) WARFARIN SODIUM 1MG TABLET FUROSEMIDE 40MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) FUROSEMIDE 40MG TABLET KLOR-CON M 20 20MEQ TABLET SA (RP:K-DUR (1500MG)) WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 1MG TABLET (RP:COUMADIN)
11 11 11 6 4 7 1 2 14 946 2 3 6 15 15 30 45 4 1
2.88 2.88 2.88 2.88 2.88 4.09 2.88 2.88 6.48 20.81 2.88 2.88 2.88 3.15 2.88 2.88 20.84 2.88 2.88
RX RX RX RX OTC RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 95.69
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3692964 R3692967 R3692968 R3692972 R3692973 R3692974 R3692975 R3693010 R3692963 R3692965 R3692969 R3692970 R3692976 R3692977 R3694134 R3693918 R3693920 R3693921 R3701172
16729-0005-17 55111-0119-10 00245-0058-15 07431-2011-40 00536-3551-01 74312-0871-90 00182-1576-26 60505-2633-01 00006-0117-54 00228-2578-50 49884-0404-01 00149-0478-01 00075-1506-16 00037-0241-30 00781-1966-10 16729-0005-17 55111-0119-10 00245-0058-15 00781-1966-10
CASTILLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
GLORIA : 423 : SUB : MEDICARE
SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) KLOR-CON M 20 20MEQ TABLET SA VITAMIN D 400IU TABLET VITAMIN B12 500MCG TABLET ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OYST-CAL 500MG TABLET (RP:OS-CAL 500) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) SINGULAIR 10MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) METOPROLOL SUCCINATE ER 25MG TABLET ACTONEL 150MG TABLET NASACORT AQ NASAL 55MCG SPRAY ASTELIN NASAL 137MCG SPRAY FUROSEMIDE 40MG TABLET (RP:LASIX) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) KLOR-CON M 20 20MEQ TABLET SA FUROSEMIDE 40MG TABLET (RP:LASIX)
15 30 30 15 15 15 15 15 15 15 15 1 16.5 30 13 15 30 30 15
3.15 4.50 13.89 2.88 2.88 2.88 2.88 2.88 45.11 20.09 10.87 81.64 73.93 76.56 2.88 3.15 4.50 13.89 2.88
RX RX RX OTC OTC OTC OTC OTC RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3693917 R3693919 R3693922 R3693923 R3693924 R3693925 R3693926 R3693927
00006-0117-54 00228-2578-50 49884-0404-01 07431-2011-40 00536-3551-01 74312-0871-90 00182-1576-26 60505-2633-01
433.11 28.80
CASTILLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
GLORIA : 423 : SUB : MEDICARE
SINGULAIR 10MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) METOPROLOL SUCCINATE ER 25MG TABLET VITAMIN D 400IU TABLET VITAMIN B12 500MCG TABLET ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OYST-CAL 500MG TABLET (RP:OS-CAL 500) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC)
15 15 15 15 15 15 15 15
45.11 20.09 10.87 2.88 2.88 2.88 2.88 2.88
RX RX RX OTC OTC OTC OTC OTC
0.00 461.91
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09
PATIENT RECAP
CHARGE
OTC
R3698065
00023-0667-04
10.44
CHIARAMONTE, ANTONINA RESIDENT# : 28 STATION : 3 STATUS : MEDICAID
PAGANO
REFRESH PM OPHTH OINT
3.5
10.44
OTC
0.00 10.44
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CHINNI, MARIE RESIDENT# : 242 STATION : SUB STATUS : MEDICARE
10/05/09 10/05/09 10/08/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3684688 R3684689 R3689698 R3676441 R3676442 R3676443 R3676446 R3676447 R3676444
51672-4032-03 51672-4031-03 51672-4031-03 00143-1248-10 00378-0208-10 00172-3758-60 00245-0058-15 16729-0005-17 49884-0405-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/12/09 10/13/09 10/13/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3676445 R3694153 R3694154 R3693846 R3693847 R3693848 R3693851 R3693852
00456-3210-60 51672-4032-03 51672-4031-03 00143-1248-10 00378-0208-10 00172-3758-60 00245-0058-15 16729-0005-17
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 4MG TABLET FOLIC ACID 1MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) NAMENDA 10MG TABLET WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 4MG TABLET FOLIC ACID 1MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR)
2 2 4 15 15 15 15 15 30
2.88 2.88 2.88 2.88 2.88 2.88 6.95 3.15 21.73
RX RX RX RX RX RX RX RX RX
15 4 3 15 15 15 15 15
34.22 2.88 2.88 2.88 2.88 2.88 6.95 3.15
RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CHINNI, MARIE RESIDENT# : 242 STATION : SUB STATUS : MEDICARE
10/26/09
CHARGE
R3693849
49884-0405-01
GOLDFARB
10/26/09 10/27/09 10/27/09
CHARGE CHARGE CHARGE
R3693850 R3712871 R3712872
00456-3210-60 51672-4031-03 51672-4032-03
GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX
169.54
METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) NAMENDA 10MG TABLET WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 5MG TABLET
30
21.73
RX
15 1 2
34.22 2.88 2.88
RX RX RX
0.00 169.54
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CIANCIABELLA, ANTONINA RESIDENT# : 419 STATION : SUB STATUS : MEDICARE
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3687968 R3687973 R3687974 R3687976 R3687984 R3687988 R3687990
31722-0239-10 00378-0208-10 00603-1378-59 00172-3758-60 16729-0005-17 00228-2888-50 00378-0155-05
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/07/09 10/11/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/14/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3687979 R3691104 R3688276 R3688277 R3688278 R3688279 R3691471 R3696367
00075-0624-30 60505-2633-01 31722-0239-10 00378-0208-10 00172-3758-60 16729-0005-17 60505-2633-01 00378-0155-05
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/16/09
CHARGE
R3698783
00378-0155-05
GOLDFARB
AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET (RP:LASIX) LACTULOSE 10GM/15ML SOLUTION LISINOPRIL 5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) PROPOXYPHENE/NAPS/APAP 100-650MG TABLET (RP:DARVOCET-N 100) LOVENOX 30MG/0.3ML DISP SYRIN CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) PROPOXYPHENE/NAPS/APAP 100-650MG TABLET (RP:DARVOCET-N 100) PROPOXYPHENE/NAPS/APAP 100-650MG TABLET (RP:DARVOCET-N 100)
5 5 946 5 5 15 22.5
2.88 2.88 20.81 2.88 2.88 2.88 4.05
3 1 15 15 15 15 15 22.5
177.24 2.88 2.88 2.88 2.88 3.15 2.88 4.05
22.5
4.05
RX RX RX RX RX RX RX RX OTC RX RX RX RX OTC RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CIANCIABELLA, ANTONINA RESIDENT# : 419 STATION : SUB STATUS : MEDICARE
10/23/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/27/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708288 R3708845 R3694025 R3694026 R3694027 R3694028 R3694029 R3712894
23558-0016-70 23558-0016-70 31722-0239-10 00378-0208-10 00172-3758-60 16729-0005-17 60505-2633-01 00409-1952-32
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/27/09
CHARGE
R3720199
00409-1952-32
GOLDFARB
10/29/09 10/30/09
CHARGE CHARGE
R3716498 R3716825
00075-0624-30 51672-1289-02
GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
440.55 20.26
SALINE NASAL 0.65% SPRAY SALINE NASAL 0.65% SPRAY AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET (RP:LASIX) LISINOPRIL 5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN (RP:TIGAN INJECTION) TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN LOVENOX 30MG/0.3ML DISP SYRIN NYSTATIN 100MU/1GM CREAM
45 45 15 15 15 15 15 10
5.81 5.81 2.88 2.88 2.88 3.15 2.88 9.28
OTC OTC RX RX RX RX OTC RX
2
2.88
RX
3 30
177.24 2.97
RX RX
0.00 460.81
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CIRINCION, JOSEPH RESIDENT# : 383 STATION : SUB STATUS : MEDICARE
09/01/09 09/02/09 09/02/09 09/02/09 09/02/09 09/02/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
R3636923 R3636934 R3636933 R3638504 R3641561 R3641559 R3641816 R3639270 R3636927 R3636928 R3636929
63736-0105-06 00406-2023-10 68180-0488-09 31722-0239-10 00456-2005-01 50111-0990-01 00245-0058-15 50111-0334-02 00172-3759-60 00172-3760-60 62175-0128-37
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
09/10/09 09/10/09
RETURN RETURN
R3636930 R3636931
31722-0238-10 55111-0181-04
TANK TANK
PATIENT RECAP
OTC RX
-2.06 -17.11
BACID CAPLET ATENOLOL 50MG TABLET PRAVASTATIN 80MG TABLET (RP:PRAVACHOL) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) LEXAPRO 5MG TABLET VITAMIN D 50000IU CAPSULE KLOR-CON M 20 20MEQ TABLET SA METRONIDAZOLE 500MG TABLET (RP:FLAGYL) LISINOPRIL 10MG TABLET LISINOPRIL 20MG TABLET (RP:ZESTRIL ) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LEVETIRACETAM 250MG TABLET (RP:KEPPRA)
-4 -2 -2 -4 -2 -1 -4 -13 -6 -5 -2
-2.06 -0.10 -1.15 -0.71 -4.26 -1.00 -1.85 -2.83 -0.41 -0.40 -1.91
OTC RX RX RX RX RX RX RX RX RX RX
-6 -4
-0.77 -1.72
RX RX
0.00 -19.17
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/27/09 10/27/09 10/27/09 10/27/09 10/27/09 10/27/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3712891 R3712895 R3712896 R3712897 R3712898 R3712900
24208-0324-05 00172-3759-60 00310-0278-10 00143-2260-01 00781-1966-10 00406-2030-05
108.48
COLLING, EDITH RESIDENT# : 233 STATION : SUB STATUS : PRIVATE
SCERBO SCERBO SCERBO SCERBO SCERBO SCERBO
TIMOLOL MALEATE OPHTH 0.5% DROPS LISINOPRIL 10MG TABLET SEROQUEL 50MG TABLET ISOSORBIDE MONONITRATE ER 60MG TABLET SA FUROSEMIDE 40MG TABLET METFORMIN 1000MG TABLET
5 13 26 13 13 26
4.50 2.88 86.10 7.80 2.88 4.32
RX RX RX RX RX RX
0.00 108.48
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/03/09 10/04/09 10/05/09
PATIENT RECAP
CHARGE CHARGE CHARGE
RX
R3682587 R3682674 R3682924
67253-0900-11 62856-0500-10 00406-0512-05
250.11
CORPI, THERESA RESIDENT# : 396 STATION : SUB STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN
ALPRAZOLAM 0.25MG TABLET FRAGMIN 5000IU/0.2ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
30 2 30
2.88 240.21 7.02
RX RX RX
0.00 250.11
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
COSTELLO, RESIDENT# STATION STATUS
10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09 10/20/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3704153 R3704154 R3704157 R3704159 R3704161 R3704162 R3704164 R3704165
00603-2116-21 16729-0006-17 00093-7254-01 55111-0158-10 00378-0523-01 00781-1966-10 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK TANK
10/20/09 10/20/09
CHARGE CHARGE
R3704155 R3704158
00006-0117-54 60505-0829-01
TANK TANK
10/20/09 10/21/09 10/21/09
CHARGE CHARGE CHARGE
R3704160 R3704605 R3705769
00186-0370-20 67877-0124-85 00409-1316-25
TANK TANK TANK
10/25/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3709324 R3706218 R3706219
00169-1833-11 00603-2116-21 16729-0006-17
TANK TANK TANK
ELAINE : 325 : SUB : MEDICARE
ALLOPURINOL 300MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) GLIMEPIRIDE 1MG TABLET (RP:AMARYL) OMEPRAZOLE 20MG CAPSULE DR BISOPROLOL FUMARATE 5MG TABLET (RP:ZEBETA) FUROSEMIDE 40MG TABLET (RP:LASIX) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) SINGULAIR 10MG TABLET FLUTICASONE PROPIONATE NASAL SPRAY 50MCG (RP:FLONASE NASAL) SYMBICORT 160-4.5MCG HFA AER AD SILVER SULFADIAZINE 1% CREAM (RP:SILVADENE) HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN NOVOLIN R 100U/1ML VIAL-INSUL ALLOPURINOL 300MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR)
6 6 6 12 6 12 75 62.5
2.88 2.88 2.88 47.75 6.41 2.88 8.63 6.75
RX RX RX RX RX RX RX RX
6 16
18.05 58.62
RX RX
10.2 85 5
148.98 5.36 13.61
RX RX RX
10 15 15
33.87 2.88 3.84
RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3706221 R3706222 R3706223 R3706224 R3706220 R3713005
00093-7254-01 55111-0158-10 00378-0523-01 00781-1966-10 00006-0117-54 00409-1316-25
566.16
COSTELLO, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK
ELAINE : 325 : SUB : MEDICARE
GLIMEPIRIDE 1MG TABLET (RP:AMARYL) OMEPRAZOLE 20MG CAPSULE DR BISOPROLOL FUMARATE 5MG TABLET (RP:ZEBETA) FUROSEMIDE 40MG TABLET (RP:LASIX) SINGULAIR 10MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN
15 30 15 30 15 5
2.88 119.37 16.04 2.88 45.11 13.61
RX RX RX RX RX RX
0.00 566.16
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
CUTTITTA, RESIDENT# STATION STATUS
09/10/09 09/10/09
RETURN RETURN
R3639026 R3639025
00172-3759-60 49884-0405-01
TANK TANK
09/10/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
RETURN RETURN RETURN RETURN RETURN RETURN
R3648262 R3639029 R3639028 R3638808 R3642658 R3639027
00310-0275-34 74312-0811-50 31604-0012-74 37000-0024-04 55111-0119-10 00555-0997-02
TANK TANK TANK TANK TANK TANK
09/17/09 09/17/09
RETURN RETURN
R3639023 R3639024
60505-0170-09 31722-0237-10
TANK TANK
PATIENT RECAP
RX OTC
-25.25 -5.71
VICTOR : 367 : SUB : MEDICARE
LISINOPRIL 10MG TABLET (RP:ZESTRIL) METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) SEROQUEL 25MG TABLET COD LIVER OIL CAPSULE FOLIC ACID 400MCG TABLET METAMUCIL SMOOTH S-F PACKET FAMOTIDINE 20MG TABLET (RP:PEPCID) FLUDROCORTISONE ACETATE 0.1MG TABLET (RP:FLORINEF ACETATE) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC)
-10 -12
-0.68 -8.34
RX RX
-2 -10 -10 -15 -10 -10
-4.03 -0.23 -0.13 -5.35 -1.50 -5.23
RX OTC OTC OTC RX RX
-11 -12
-3.92 -1.55
RX RX
0.00 -30.96
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DEFRANCESCO, ANGELO RESIDENT# : 343 STATION : SUB STATUS : MEDICARE
09/17/09
RETURN
R3639227
00409-1316-25
TANK
10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09 10/04/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682716 R3682734 R3682739 R3682740 R3682742 R3682744 R3682746 R3682747 R3682720 R3682726 R3682736 R3682718 R3682723 R3682730 R3682733 R3682741 R3682743
00781-2067-01 00378-0208-10 13668-0009-05 00591-0409-01 63304-0579-10 00054-4728-31 55111-0158-10 00406-0512-05 54391-0002-01 30768-0006-01 79649-9031-06 63481-0687-06 00169-1833-11 50111-0990-01 00574-0508-01 62175-0261-55 54092-0252-90
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN MYCOPHENOLATE MOFETIL 250MG CAPSULE (RP:CELLCEPT) FUROSEMIDE 20MG TABLET CITALOPRAM 10MG TABLET (RP:CELEXA) LISINOPRIL 40MG TABLET METOPROLOL TARTRATE 25MG TABLET PREDNISONE 5MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) NEPHRO-VITE TABLET VITAMIN B COMPLEX TABLET GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE LIDODERM 5% PATCH NOVOLIN R 100U/1ML VIAL-INSUL VITAMIN D 50000IU CAPSULE FERROUS GLUCONATE 324MG TABLET NIFEDIPINE XL 60MG TABLET SA (RP:PROCARDIA XL) FOSRENOL 500MG TAB CHEW
-4
-10.03
RX
16 2 8 8 32 8 16 30 8 8 8 30 10 1 16 8 90
8.46 2.88 2.88 2.88 2.88 2.88 63.66 7.02 2.88 2.88 2.88 151.63 33.87 2.88 2.88 11.97 429.36
RX RX RX RX RX RX RX RX OTC OTC OTC RX RX RX OTC RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DEFRANCESCO, ANGELO RESIDENT# : 343 STATION : SUB STATUS : MEDICARE
10/04/09 10/06/09 10/08/09
CHARGE CHARGE CHARGE
R3682745 R3685154 R3689451
60505-0133-00 58468-0021-01 00409-1316-25
TANK TANK TANK
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/13/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3683278 R3683321 R3683326 R3683327 R3683329 R3683330 R3683331 R3683322 R3683324 R3683325 R3683323 R3683328 R3688267 R3693378 R3694146
00378-0208-10 00781-2067-01 13668-0009-05 00591-0409-01 63304-0579-10 00054-4728-31 55111-0158-10 54391-0002-01 00574-0508-01 79649-9031-06 30768-0006-01 62175-0261-55 58468-0021-01 00406-0512-05 00406-0552-01
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
CYCLOSPORINE 25MG CAPSULE RENAGEL (SEVELAMER HCL) 800MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN FUROSEMIDE 20MG TABLET MYCOPHENOLATE MOFETIL 250MG CAPSULE (RP:CELLCEPT) CITALOPRAM 10MG TABLET (RP:CELEXA) LISINOPRIL 40MG TABLET METOPROLOL TARTRATE 25MG TABLET PREDNISONE 5MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) NEPHRO-VITE TABLET FERROUS GLUCONATE 324MG TABLET GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE VITAMIN B COMPLEX TABLET NIFEDIPINE XL 60MG TABLET SA (RP:PROCARDIA XL) RENAGEL (SEVELAMER HCL) 800MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) OXYCODONE HCL IR 5MG TABLET
60 18 5
64.38 31.65 13.61
4 30 15 15 60 15 30 15 30 15 15 15 45 30 15
2.88 15.87 2.88 2.88 4.32 2.88 119.37 3.20 2.88 5.41 2.88 22.44 79.12 7.02 3.60
RX RX RX RX RX RX RX RX RX RX OTC OTC OTC OTC RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DEFRANCESCO, ANGELO RESIDENT# : 343 STATION : SUB STATUS : MEDICARE
10/13/09 10/14/09 10/14/09
CHARGE CHARGE CHARGE
R3694145 R3696170 R3694806
59011-0100-10 00378-0032-10 00409-1316-25
TANK TANK TANK
10/19/09
CHARGE
R3703963
00409-1952-32
TANK
10/21/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE
R3704435 R3708352 R3708339
59011-0100-10 00406-0552-01 54092-0252-90
TANK TANK TANK
PATIENT RECAP
RX OTC
1580.45 25.89
OXYCONTIN 10MG TABLET SA METOPROLOL TARTRATE 50MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN OXYCONTIN 10MG TABLET SA OXYCODONE HCL IR 5MG TABLET FOSRENOL 500MG TAB CHEW
15 24 5
21.00 2.88 13.61
RX RX RX
2
2.88
RX
15 15 90
21.00 3.60 429.36
RX RX RX
0.00 1606.34
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DELVECCHIO, RESIDENT# : STATION : STATUS :
10/23/09 10/23/09 10/23/09 10/23/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708627 R3708632 R3708634 R3708638 R3708639 R3708629
00228-2888-50 00781-1966-10 00378-1805-01 31722-0238-10 31722-0239-10 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/23/09 10/23/09 10/23/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3708630 R3708631 R3708633 R3709087 R3709517 R3709518 R3709519 R3709520 R3709516
50383-0232-10 61314-0144-05 60505-0823-06 00228-2076-50 00781-1966-10 00378-1805-01 31722-0238-10 31722-0239-10 58177-0368-04
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/27/09
CHARGE
R3712570
00378-0345-05
GOLDFARB
PATIENT RECAP
RX
224.65
MARIE 432 SUB MEDICARE
ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) FUROSEMIDE 40MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) DORZOLAMIDE HCL 2% DROPS (RP:TRUSOPT) BRIMONIDINE TARTRATE 0.15% DROPS (RP:ALPHAGAN P) CALCITONIN-SALMON NASAL 200 U/DOSE SPRAY/PUMP TEMAZEPAM 15MG CAPSULE FUROSEMIDE 40MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 75MCG TABLET (RP:SYNTHROID) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) METOPROLOL SUCCINATE ER 100MG TAB.SR 24H (RP:TOPROL XL) DIAZEPAM 5MG TABLET (RP:VALIUM)
15 3 3 3 3 3
2.88 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX
10 5 3.7 15 15 15 15 15 15
45.93 47.21 81.50 2.88 2.88 4.37 2.88 2.88 13.96
RX RX RX RX RX RX RX RX RX
15
2.88
RX
0.00 224.65
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DERBYSHIRE, RESIDENT# : STATION : STATUS :
10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09 10/31/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3717396 R3717393 R3717394 R3717395 R3717397 R3717398 R3717400 R3717404 R3717405 R3717406 R3717407
60505-2633-01 16252-0528-90 63653-1171-05 00781-5224-01 55111-0119-10 00088-2220-33 00904-5496-46 31722-0213-05 65162-0627-50 00075-0620-40 49502-0685-26
TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA TESTA
10/31/09 10/31/09 10/31/09 10/31/09
CHARGE CHARGE CHARGE CHARGE
R3717408 R3717410 R3717413 R3717419
49884-0775-86 58468-0020-01 00169-7501-11 16252-0097-22
TESTA TESTA TESTA TESTA
10/31/09 10/31/09
CHARGE CHARGE
R3717422 R3717423
31722-0239-10 64679-0924-03
TESTA TESTA
NANCY 36 3 MEDICARE
CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) PLAVIX 75MG TABLET CARVEDILOL 25MG TABLET (RP:COREG) FAMOTIDINE 20MG TABLET (RP:PEPCID) LANTUS 100U/1ML VIAL-INSUL NITROGLYCERIN 0.4MG/HR PATCH TD24 SERTRALINE HCL 50MG TABLET (RP:ZOLOFT) TRAMADOL 50MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) CLONIDINE PATCH-2 0.2MG PATCH (RP:CATAPRES-TTS-2) RENAGEL (SEVELAMER HCL) 400MG TABLET NOVOLOG 100U/1ML INSULIN ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) ENALAPRIL MALEATE 5MG TABLET (RP:VASOTEC)
30 30 30 60 60 10 30 30 60 4 62.5
3.61 10.68 118.82 8.58 9.00 70.92 38.09 3.84 5.40 236.29 6.75
OTC RX RX RX RX RX RX RX RX RX RX
4 90 10 75
133.37 79.12 76.45 8.63
RX RX RX RX
30 30
5.34 2.88
RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/31/09 10/31/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE
OTC RX
R3717424 R3717425 R3717426
31722-0520-10 00378-0208-10 00781-1966-10
3.61 850.64
DERBYSHIRE, RESIDENT# : STATION : STATUS :
TESTA TESTA TESTA
NANCY 36 3 MEDICARE
HYDRALAZINE 25MG TABLET (RP:APRESOLINE) FUROSEMIDE 20MG TABLET (RP:LASIX) FUROSEMIDE 40MG TABLET
90 60 60
29.52 3.36 3.60
RX RX RX
0.00 854.25
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
DESIMONE, RESIDENT# STATION STATUS
10/01/09 10/06/09
CHARGE CHARGE
R3681253 R3686054
00064-4022-16 17478-0060-12
TESTA TESTA
10/15/09 10/22/09
CHARGE CHARGE
R3698027 R3707867
00062-0205-02 17478-0060-12
TESTA TESTA
10/26/09
CHARGE
R3709483
32131-0804-86
TESTA
PATIENT RECAP
RX OTC
43.14 8.64
GLADYS : 80 : 2 : MEDICAID
CERAVE MOISTURIZING CREAM AKWA TEARS (ARTIFICIAL TEARS) DROPS (RP:ARTIFICIAL TEARS) BIAFINE EMULSION AKWA TEARS (ARTIFICIAL TEARS) DROPS (RP:ARTIFICIAL TEARS) OPTI-MULTI CAPLET (RP:OCUVITE)
453 15
21.33 2.88
RX OTC
45 15
21.81 2.88
RX OTC
30
2.88
OTC
0.00 51.78
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/24/09
PATIENT RECAP
CHARGE
OTC
R3709127
66825-0002-01
34.06
DESMOND, MARY RESIDENT# : 84 STATION : 2 STATUS : MEDICAID
SHERMAN
FLORASTOR 250MG CAPSULE
30
34.06
OTC
0.00 34.06
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 10/02/09 10/05/09 10/05/09 10/06/09 10/06/09 10/07/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/14/09
PATIENT RECAP
RETURN RETURN RETURN CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3650613 R3650612 R3650611 R3681797 R3683359 R3683361 R3686047 R3686048 R3687661 R3690104 R3690105 R3683300 R3683301 R3683302 R3683299 R3694250 R3696323
00143-1201-01 60505-2606-01 00378-0045-01 51672-4032-03 51672-4033-01 51672-4027-03 51672-4027-03 51672-4033-01 00574-2021-08 51672-4033-01 51672-4027-03 00378-0023-05 00093-0051-01 00781-1966-10 00143-1201-01 51672-4032-03 51672-4032-03
69.70
DIGIORGIO, FRANK RESIDENT# : 366 STATION : SUB STATUS : MEDICARE
SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN SILVERMAN
COLCHICINE 0.6MG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) DILTIAZEM 60MG TABLET WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 6MG TABLET WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 6MG TABLET LAC LOTION 12% LOTION WARFARIN SODIUM 6MG TABLET WARFARIN SODIUM 1MG TABLET DILTIAZEM 30MG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) FUROSEMIDE 40MG TABLET (RP:LASIX) COLCHICINE 0.6MG TABLET WARFARIN SODIUM 5MG TABLET WARFARIN SODIUM 5MG TABLET
-14 -29 -14 2 2 2 3 3 225 14 14 45 15 15 15 1 2
-2.40 -4.15 -1.56 2.88 2.88 2.88 2.88 2.88 25.16 11.70 7.56 4.59 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 69.70
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3649656 R3649647 R3649639 R3649676 R3649646 R3649645 R3649675 R3649646 R3649644 R3649643 R3649653 R3649649 R3649650 R3649667 R3649652 R3649673 R3649654
63304-0579-10 00185-0144-05 00245-0058-15 00781-1599-05 63736-0105-06 00093-0657-01 16729-0006-17 63736-0105-06 00378-0433-01 57664-0434-88 00310-0271-10 00093-2131-01 00143-1482-01 00781-1446-05 00054-4728-31 51991-0203-11 00075-0624-30
-234.12 -33.35
DIPIERRO, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
MARIE : 355 : SUB : MEDICARE
METOPROLOL TARTRATE 25MG TABLET AMIODARONE HCL 200MG TABLET KLOR-CON M 20 20MEQ TABLET SA SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) BACID CAPLET CALCITRIOL 0.25MCG CAPSULE SIMVASTATIN 40MG TABLET (RP:ZOCOR) BACID CAPLET BUPROPION HCL 75MG TABLET ALLOPURINOL 100MG TABLET SEROQUEL 100MG TABLET NITROFURANTOIN MACROCRYSTAL 100MG CAPSULE PRIMIDONE 50MG TABLET FUROSEMIDE 80MG TABLET PREDNISONE 5MG TABLET FERREX 150 150MG CAPSULE (RP:NIFEREX-150) LOVENOX 30MG/0.3ML DISP SYRIN
-10 -13 -5 -5 -19 -5 -5 -43 -5 -4 -5 -2 -3 -16 -4 -8 -3
-0.72 -21.95 -2.31 -1.50 -9.78 -3.99 -1.28 -22.12 -2.38 -0.32 -17.29 -2.45 -0.98 -1.66 -0.08 -1.45 -177.21
RX RX RX RX OTC RX RX OTC RX RX RX RX RX RX RX OTC RX
0.00 -267.47
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3698593 R3698599 R3698601 R3698592 R3698597 R3698638 R3701197 R3701198
00115-4222-01 00378-0208-10 16252-0097-22 00093-3171-01 00173-0696-00 54092-0252-90 00115-4222-01 00378-0208-10
703.42
DISCAFANI, FLORENTYN RESIDENT# : 384 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
MIDODRINE 5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION CLINDAMYCIN 150MG CAPSULE ADVAIR DISKUS 250MCG/50MCG INHALER FOSRENOL 500MG TAB CHEW MIDODRINE 5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX)
22 11 72 9 60 90 30 15
40.44 2.88 8.28 7.37 157.07 429.36 55.14 2.88
RX RX RX RX RX RX RX RX
0.00 703.42
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
07/06/09 07/06/09 07/25/09 08/03/09 08/10/09 08/31/09 08/31/09 09/15/09 09/24/09 09/28/09 10/01/09 10/18/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC
R3561794 R3577211 R3599570 R3594245 R3617538 R3627511 R3642845 R3660459 R3672182 R3659856 R3680167 R3700664 R3693577
30768-0006-01 37000-0024-04 37000-0024-04 30768-0006-01 37000-0024-04 30768-0006-01 37000-0024-04 37000-0024-04 00501-3793-10 30768-0006-01 37000-0024-04 37000-0024-04 30768-0006-01
106.36
DUPIRAK, ANNE RESIDENT# : 32 STATION : 3 STATUS : MEDICAID
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET METAMUCIL SMOOTH S-F PACKET VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET METAMUCIL SMOOTH S-F PACKET POLYSPORIN POWDER VITAMIN B COMPLEX TABLET METAMUCIL SMOOTH S-F PACKET METAMUCIL SMOOTH S-F PACKET VITAMIN B COMPLEX TABLET
30 30 30 30 30 30 30 30 10 30 30 30 30
2.88 11.07 11.07 2.88 11.07 2.88 11.07 11.07 14.47 2.88 11.07 11.07 2.88
OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC OTC
0.00 106.36
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693498 R3693502
74312-0077-10 64980-0147-03
21.95
ENGEL, EMILY RESIDENT# : 68 STATION : 2 STATUS : MEDICAID
WIENER WIENER
GLUCOSAMINE 500MG CAPSULE RISAQUAD 230MG CAPSULE (RP:FLORA-Q)
30 30
3.77 18.18
OTC OTC
0.00 21.95
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
FAY, EILEEN RESIDENT# : 391 STATION : SUB STATUS : MEDICARE
09/10/09
RETURN
R3649114
00536-4409-10
TANK
09/10/09 09/10/09 09/10/09 09/10/09
RETURN RETURN RETURN RETURN
R3649108 R3649112 R3649109 R3649110
00006-0952-54 31722-0237-10 16729-0006-17 00378-1809-01
TANK TANK TANK TANK
PATIENT RECAP
OTC RX
-0.10 -9.59
PYRIDOXINE (VIT B6) 100MG TABLET (RP:PYRIDOXINE (VIT B6)) COZAAR 50MG TABLET AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 100MCG TABLET
-4
-0.10
OTC
-4 -4 -5 -4
-6.59 -0.52 -1.28 -1.20
RX RX RX RX
0.00 -9.69
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09 09/02/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3642332 R3642325 R3642640 R3642951 R3642639 R3648104
00054-4728-31 00378-9102-93 00310-0275-34 63736-0105-06 31722-0239-10 00456-2010-01
-42.15 -2.57
FAY, THOMAS RESIDENT# : 386 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK
PREDNISONE 5MG TABLET NITROGLYCERIN 0.1MG1H PATCH TD24 SEROQUEL 25MG TABLET BACID CAPLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) LEXAPRO 10MG TABLET
-1 -15 -7 -5 -7 -5
-0.02 -15.64 -14.11 -2.57 -1.25 -11.13
RX RX RX OTC RX RX
0.00 -44.72
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
FLOOD, ROSE RESIDENT# : 282 STATION : 3 STATUS : MEDICARE
09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/26/09 09/27/09 09/27/09 09/27/09 09/27/09
CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT
R3674310 R3674314 R3674317 R3674320 R3674322 R3674323 R3674325 R3674327 R3674329 R3674520 R3674521 R3674531 R3674533
54391-0002-01 32131-0804-86 00169-7501-11 00378-0208-10 00378-1817-01 16729-0006-17 00169-0081-81 00169-0084-81 00006-0112-54 00378-0208-10 00169-0082-81 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
CREDIT CREDIT CREDIT CREDIT CREDIT
R3674667 R3674668 R3674669 R3674670 R3674916
54391-0002-01 32131-0804-86 00378-0208-10 00169-0082-81 59676-0310-01
TANK TANK TANK TANK TANK
NEPHRO-VITE TABLET OPTI-MULTI CAPLET (RP:OCUVITE) NOVOLOG 100U/1ML INSULIN FUROSEMIDE 20MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 175MCG TABLET (RP:SYNTHROID) SIMVASTATIN 40MG TABLET (RP:ZOCOR) PRANDIN 0.5MG TABLET PRANDIN 2MG TABLET JANUVIA 50MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) PRANDIN 1MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) NEPHRO-VITE TABLET OPTI-MULTI CAPLET (RP:OCUVITE) FUROSEMIDE 20MG TABLET (RP:LASIX) PRANDIN 1MG TABLET PROCRIT 10MU/1ML VIAL
2 2 10 1 2 2 2 4 2 1 2 75 62.5
-2.88 -2.88 -115.84 -2.88 -2.88 -2.88 -4.45 -8.89 -14.29 -2.88 -4.45 -8.63 -6.75
OTC OTC RX RX RX RX RX RX RX RX RX RX RX
30 30 30 60 4
-6.20 -2.88 -2.88 -133.35 -722.00
OTC OTC RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT CREDIT
OTC RX
R3675737 R3675738 R3675740 R3675741 R3675742 R3675743 R3675744 R3675746 R3675747 R3675928
00006-0112-54 00169-0081-81 00378-1817-01 63653-1171-05 60505-0065-01 00456-3210-60 00456-2020-01 00527-1324-10 60505-2608-01 16729-0004-17
-14.84 -1965.43
FLOOD, ROSE RESIDENT# : 282 STATION : 3 STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
JANUVIA 50MG TABLET PRANDIN 0.5MG TABLET LEVOTHYROXINE SODIUM 175MCG TABLET (RP:SYNTHROID) PLAVIX 75MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) NAMENDA 10MG TABLET LEXAPRO 20MG TABLET DIGOXIN 0.125MG TABLET CARVEDILOL 12.5MG TABLET (RP:COREG) SIMVASTATIN 10MG TABLET (RP:ZOCOR)
30 30 30 30 60 30 30 30 60 30
-214.36 -66.68 -12.84 -180.03 -238.74 -93.90 -105.61 -6.39 -8.58 -5.25
RX RX RX RX RX RX RX RX RX RX
0.00 -1980.27
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 10/01/09 10/02/09 10/03/09 10/03/09 10/05/09 10/08/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
RETURN CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3652172 R3680390 R3681686 R3682571 R3682572 R3684684 R3687745 R3690870 R3676599 R3676600 R3676601 R3676603 R3683312 R3683314 R3683315 R3691463 R3691464 R3676602 R3676604
63653-1171-05 00781-1446-05 00536-4534-08 51991-0467-01 60505-0113-08 00781-1966-10 00245-0057-10 63481-0687-06 00185-0144-05 63304-0579-10 60505-0141-01 31722-0238-10 00054-0018-29 51991-0467-01 60505-0113-08 00781-1966-10 00245-0057-10 00597-0058-01 00074-6123-90
GALLAGHER, RICHARD RESIDENT# : 387 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PLAVIX 75MG TABLET FUROSEMIDE 80MG TABLET (RP:LASIX) SIMETHICONE 125MG TAB CHEW CYCLOBENZAPRINE HCL 5MG TABLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) FUROSEMIDE 40MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA LIDODERM 5% PATCH AMIODARONE HCL 200MG TABLET METOPROLOL TARTRATE 25MG TABLET GLIPIZIDE 5MG TABLET (RP:GLIPIZIDE) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) PREDNISONE 20MG TABLET CYCLOBENZAPRINE HCL 5MG TABLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) FUROSEMIDE 40MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA FLOMAX 0.4MG CAPSULE SA TRICOR 145MG TABLET
-6 22 60 27 9 14 12 30 15 30 7.5 15 15 45 15 15 15 15 15
-22.85 2.88 3.45 6.70 2.88 2.88 3.05 151.63 11.07 2.88 2.88 2.88 2.88 11.16 2.88 2.88 3.81 44.34 44.71
RX RX OTC RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/19/09 10/20/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3676606 R3701359 R3703800 R3707089 R3693980 R3693982 R3693983 R3693985 R3693989 R3693990 R3693992 R3706244 R3709523 R3693984 R3693986 R3693987
63653-1171-05 00603-1378-59 00781-1966-10 00143-1473-10 00185-0144-05 63304-0579-10 00591-0460-05 31722-0238-10 51991-0467-01 53746-0102-05 00245-0057-10 00781-1966-10 00143-1473-10 00597-0058-01 00074-6123-90 63653-1171-05
557.30 3.45
GALLAGHER, RICHARD RESIDENT# : 387 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PLAVIX 75MG TABLET LACTULOSE 10GM/15ML SOLUTION FUROSEMIDE 40MG TABLET (RP:LASIX) PREDNISONE 10MG TABLET AMIODARONE HCL 200MG TABLET METOPROLOL TARTRATE 25MG TABLET GLIPIZIDE 5MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) CYCLOBENZAPRINE HCL 5MG TABLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) KLOR-CON M 10 10MEQ TABLET SA FUROSEMIDE 40MG TABLET (RP:LASIX) PREDNISONE 10MG TABLET FLOMAX 0.4MG CAPSULE SA TRICOR 145MG TABLET PLAVIX 75MG TABLET
15 946 12 4 15 30 7.5 15 45 15 15 30 15 15 15 15
59.41 20.81 2.88 2.88 11.07 2.88 2.88 2.88 11.16 2.88 3.81 2.88 2.88 44.34 44.71 59.41
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 560.75
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN
RX OTC
R3649867 R3639018 R3639019 R3642657
00310-0275-34 57664-0397-58 74312-0813-80 00310-0275-34
-53.30 -0.27
GANGEMI, WINIFRED RESIDENT# : 382 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SEROQUEL 25MG TABLET METFORMIN 500MG TABLET (RP:GLUCOPHAGE) VITAMIN B12 1000MCG TABLET SEROQUEL 25MG TABLET
-14 -12 -6 -12
-28.22 -0.90 -0.27 -24.18
RX RX OTC RX
0.00 -53.57
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GAROFOLA, RESIDENT# STATION STATUS
10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3714939 R3714940 R3714942 R3714943 R3714944 R3714945 R3714947 R3714948 R3714951 R3714954 R3714955 R3714956 R3714957 R3714958
00597-0075-41 00536-5895-88 00378-1140-01 63304-0579-10 00228-2578-50 00087-2772-32 00781-1966-10 63824-0008-50 00008-0607-01 00054-0018-29 00169-0084-81 00075-0620-40 00186-1989-04 00591-3433-30
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
10/28/09 10/28/09 10/28/09 10/29/09
CHARGE CHARGE CHARGE CHARGE
R3714961 R3714962 R3714981 R3715237
00169-3687-12 00185-0144-05 50111-0459-01 00008-0607-01
PAGANO PAGANO PAGANO PAGANO
CHARLES : 433 : SUB : MEDICARE
SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER NICOTINE 14MG/24HR PATCH TD24 (RP:NICODERM CQ) BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) METOPROLOL TARTRATE 25MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) AVAPRO 150MG TABLET FUROSEMIDE 40MG TABLET (RP:LASIX) MUCINEX 600MG TABLET SA PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) PREDNISONE 20MG TABLET PRANDIN 2MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN PULMICORT RESPULES 0.5MG/2ML AMPUL-NEB. IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 SOLUTION (RP:DUONEB 3 ML VIAL) LEVEMIR 100U/1ML VIAL-INSUL AMIODARONE HCL 200MG TABLET THEOPHYLLINE ER 300MG TAB.SR 12H (RP:THEO-DUR) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX)
30 14 36 24 12 12 12 24 1 12 24 4 60 9
137.45 20.62 2.88 2.88 16.07 20.65 2.88 13.61 2.88 2.88 35.21 236.29 5.56 4.52
10 12 12 11
70.94 8.86 3.16 29.70
RX OTC RX RX RX RX RX OTC RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GAROFOLA, RESIDENT# STATION STATUS
10/29/09
CHARGE
R3715239
00591-3433-30
PAGANO
10/29/09
CHARGE
R3716275
00591-0658-05
PAGANO
PATIENT RECAP
RX OTC
630.86 34.23
CHARLES : 433 : SUB : MEDICARE
IPRATROPIUM-ALBUTEROL VIAL 30X3 ML 0.5-2.5/3 SOLUTION (RP:DUONEB 3 ML VIAL) BUSPIRONE HCL 10MG TABLET (RP:BUSPAR)
90
45.17
RX
22
2.88
RX
0.00 665.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693448 R3693450
51660-0526-28 32131-0804-86
5.76
GASNICK, MARJORIE RESIDENT# : 76 STATION : 2 STATUS : MEDICAID
TESTA TESTA
LORATADINE 10MG TABLET OPTI-MULTI CAPLET (RP:OCUVITE)
30 30
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GATES, RUTH RESIDENT# : 405 STATION : SUB STATUS : MEDICARE
10/05/09
CHARGE
R3685137
00378-1650-01
TANK
10/05/09
CHARGE
R3684798
00185-0122-01
TANK
10/07/09 10/08/09 10/08/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3687703 R3688376 R3704648 R3693074 R3693077 R3693079 R3693083 R3693130 R3694283 R3693076 R3693084
00075-0624-30 00406-0552-01 58177-0324-04 55111-0119-10 16729-0006-17 63304-0579-10 00172-3758-60 00378-1803-01 00406-0552-01 00143-1201-01 62175-0128-37
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/13/09 10/14/09 10/19/09
CHARGE CHARGE CHARGE
R3693085 R3696009 R3701349
63653-1171-05 00075-0624-30 00182-4141-26
TANK TANK TANK
NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE (RP:MACRODANTIN) NITROFURANTOIN MONOHYDRATE 100MG CAPSULE (RP:MACROBID) LOVENOX 30MG/0.3ML DISP SYRIN OXYCODONE HCL IR 5MG TABLET NITROQUICK SL 0.4MG TAB SUBL FAMOTIDINE 20MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 5MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET OXYCODONE HCL IR 5MG TABLET COLCHICINE 0.6MG TABLET ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) PLAVIX 75MG TABLET LOVENOX 30MG/0.3ML DISP SYRIN CALCARB/VIT D 600/400 TABLET
2
2.88
RX
14
19.61
RX
3 7 100 28 14 14 14 14 7 14 14
177.24 2.88 5.75 4.20 3.58 2.88 2.88 3.68 2.88 2.88 4.77
RX RX RX RX RX RX RX RX RX RX RX
14 3 14
55.45 177.24 2.88
RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GATES, RUTH RESIDENT# : 405 STATION : SUB STATUS : MEDICARE
10/23/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3707620 R3693892 R3693894 R3693895 R3693896 R3693906 R3709587 R3693893 R3693897
00075-0624-30 55111-0119-10 16729-0006-17 63304-0579-10 00172-3758-60 00378-1803-01 00406-0552-01 00143-1201-01 62175-0128-37
TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/26/09 10/26/09 10/29/09
CHARGE CHARGE CHARGE
R3693898 R3706225 R3716288
63653-1171-05 00182-4141-26 00406-0512-05
TANK TANK TANK
PATIENT RECAP
RX OTC
741.40 5.76
LOVENOX 30MG/0.3ML DISP SYRIN FAMOTIDINE 20MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 5MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET OXYCODONE HCL IR 5MG TABLET COLCHICINE 0.6MG TABLET ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) PLAVIX 75MG TABLET CALCARB/VIT D 600/400 TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
3 30 15 15 15 15 7 15 15
177.24 4.50 3.84 2.88 2.88 3.95 2.88 2.88 5.12
15 30 30
59.41 2.88 7.02
RX RX RX RX RX RX RX RX RX RX OTC RX
0.00 747.16
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
GRECO, PETER RESIDENT# : 428 STATION : SUB STATUS : MEDICARE
10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09 10/15/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3698611 R3698614 R3698617 R3698619 R3698623 R3698612 R3698622 R3698625
16729-0006-17 00378-0208-10 00378-0032-10 55111-0119-10 00536-3985-01 63653-1171-05 00065-0266-25 58177-0324-18
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/15/09 10/16/09 10/21/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3698627 R3699302 R3706102 R3701189 R3701191 R3701192 R3701193 R3701190
00169-7501-11 00258-3678-01 00574-2121-28 16729-0006-17 00378-0208-10 00378-0032-10 55111-0119-10 63653-1171-05
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
297.21 2.88
SIMVASTATIN 40MG TABLET (RP:ZOCOR) FUROSEMIDE 20MG TABLET (RP:LASIX) METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) MECLIZINE HCL 12.5MG TABLET (RP:ANTIVERT) PLAVIX 75MG TABLET TRAVATAN 0.004% DROPS NITROQUICK (25'S) 0.4MG TAB SUBL (RP:NITROSTAT 4X25'S) NOVOLOG 100U/1ML INSULIN BENZONATATE 200MG CAPSULE (RP:TESSALON PERLE) AMMONIUM LACTATE 2X140GM 12% CREAM (RP:LAC-HYDRIN) SIMVASTATIN 40MG TABLET (RP:ZOCOR) FUROSEMIDE 20MG TABLET (RP:LASIX) METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) PLAVIX 75MG TABLET
11 11 22 22 30 11 2.5 25
2.88 2.88 2.88 3.30 2.88 43.57 58.41 2.88
RX RX RX RX OTC RX RX RX
10 21 280 15 15 30 30 15
76.45 5.17 25.28 3.84 2.88 2.88 4.50 59.41
RX RX RX RX RX RX RX RX
0.00 300.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN
RX
R3653655 R3653780
00007-3230-11 00054-0018-29
-319.74
GUADAGNINO, RESIDENT# : STATION : STATUS :
SCERBO SCERBO
ARIXTRA 2.5MG/0.5ML DISP SYRIN PREDNISONE 20MG TABLET
ANTHONY 395 SUB MEDICARE
-4 -21
-318.06 -1.68
RX RX
0.00 -319.74
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693726
51991-0203-11
17.02
HEIDER, EVA RESIDENT# : 40 STATION : 3 STATUS : MEDICAID
PAGANO
FERREX 150 150MG CAPSULE (RP:NIFEREX-150)
90
17.02
OTC
0.00 17.02
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/12/09
PATIENT RECAP
CHARGE CHARGE
RX
R3686120 R3688257
00406-2023-10 00406-2023-10
5.76
HOEPKER, ANN RESIDENT# : 414 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB
ATENOLOL 50MG TABLET ATENOLOL 50MG TABLET
6 15
2.88 2.88
RX RX
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
RX
R3649873
00075-0620-40
-118.14
HOFFMAN, MARION RESIDENT# : 315 STATION : SUB STATUS : MEDICARE
SILVERMAN
LOVENOX 40MG/0.4ML DISP SYRIN
-2
-118.14
RX
0.00 -118.14
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/15/09 10/15/09 10/15/09 10/15/09 10/16/09 10/16/09 10/19/09 10/20/09 10/23/09 10/25/09 10/26/09 10/26/09 10/26/09 10/29/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC RX
R3698566 R3698568 R3698569 R3698582 R3699830 R3699838 R3702271 R3704150 R3707627 R3698583 R3701194 R3701196 R3706248 R3716551 R3717855
63736-0105-06 58177-0267-04 64679-0968-01 63481-0687-06 49884-0404-01 59676-0320-04 00603-1378-59 00009-5190-01 59676-0320-04 00065-0266-25 63736-0105-06 49884-0404-01 00009-5190-01 00527-1324-10 59676-0320-04
20.09 1161.06
HOMBERGER, IDA RESIDENT# : 426 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
BACID CAPLET DOXAZOSIN MESYLATE 2MG TABLET (RP:CARDURA) BETHANECHOL CHLORIDE 50MG TABLET (RP:BETHANECOL) LIDODERM 5% PATCH METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) PROCRIT 20MU/1ML VIAL LACTULOSE 10GM/15ML SOLUTION DETROL LA 2MG CAPSULE SA PROCRIT 20MU/1ML VIAL TRAVATAN 0.004% DROPS BACID CAPLET METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL) DETROL LA 2MG CAPSULE SA DIGOXIN 0.125MG TABLET PROCRIT 20MU/1ML VIAL
22 11 33 30 5 1 946 12 1 2.5 30 7.5 30 11 1
8.50 6.51 64.58 151.63 3.62 238.26 20.81 37.83 238.26 58.41 11.59 5.43 94.58 2.88 238.26
OTC RX RX RX RX RX RX RX RX RX OTC RX RX RX RX
0.00 1181.15
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/03/09 10/05/09 10/05/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/14/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3680023 R3682586 R3683288 R3682922 R3689833 R3690028 R3676646 R3676647 R3676648 R3676649 R3694170 R3695921
00406-0512-05 59676-0340-01 00406-0512-05 00075-0624-30 59011-0100-10 59676-0340-01 60505-0093-00 00378-0208-10 00245-0058-15 00378-0023-05 00075-0624-30 00406-0512-05
1350.57
HUGHES, MARY RESIDENT# : 400 STATION : SUB STATUS : MEDICARE
RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER
OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) PROCRIT 40MU/1ML VIAL OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LOVENOX 30MG/0.3ML DISP SYRIN OXYCONTIN 10MG TABLET SA PROCRIT 40MU/1ML VIAL DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 20 20MEQ TABLET SA DILTIAZEM 30MG TABLET LOVENOX 30MG/0.3ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
15 1 15 3 15 1 4 4 4 12 3 15
3.51 476.52 3.51 177.24 21.00 476.52 2.88 2.88 2.88 2.88 177.24 3.51
RX RX RX RX RX RX RX RX RX RX RX RX
0.00 1350.57
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/16/09 10/16/09 10/16/09 10/16/09 10/16/09 10/16/09 10/19/09 10/19/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09 10/29/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3699960 R3699963 R3676649 R3676648 R3676647 R3676646 R3700842 R3700845 R3694043 R3694044 R3694045 R3694046 R3709082 R3713006 R3716210 R3717117
63481-0687-06 59011-0100-10 00378-0023-05 00245-0058-15 00378-0208-10 60505-0093-00 00075-0624-30 59676-0340-01 60505-0093-00 00378-0208-10 00245-0058-15 00378-0023-05 59676-0340-01 00075-0624-30 00025-1525-51 00406-0512-05
1557.97
HUGHES, MARY RESIDENT# : 400 STATION : SUB STATUS : PRIVATE
RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER
LIDODERM 5% PATCH OXYCONTIN 10MG TABLET SA DILTIAZEM 30MG TABLET KLOR-CON M 20 20MEQ TABLET SA FUROSEMIDE 20MG TABLET (RP:LASIX) DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) LOVENOX 30MG/0.3ML DISP SYRIN PROCRIT 40MU/1ML VIAL DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 20 20MEQ TABLET SA DILTIAZEM 30MG TABLET PROCRIT 40MU/1ML VIAL LOVENOX 30MG/0.3ML DISP SYRIN CELEBREX 200MG CAPSULE OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
30 15 33 11 11 11 3 1 15 15 15 45 1 3 11 30
151.63 21.00 3.37 5.09 0.62 6.51 177.24 476.52 8.88 2.88 6.95 4.59 476.52 177.24 31.91 7.02
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 1557.97
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/04/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX
R3627766 R3609007 R3627760 R3633907 R3627761 R3627763 R3627762 R3645703 R3649045 R3627767 R3627765
00093-8344-10 49884-0035-10 00185-0144-05 00456-2005-01 00078-0423-15 00781-1599-05 63304-0579-10 50111-0990-01 51672-4030-03 00378-1805-01 57664-0397-58
-87.41
INGOGLIA, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
GLYBURIDE 5MG TABLET MECLIZINE HCL 25MG TABLET AMIODARONE HCL 200MG TABLET LEXAPRO 5MG TABLET DIOVAN 40MG TABLET SPIRONOLACTONE 25MG TABLET METOPROLOL TARTRATE 25MG TABLET VITAMIN D 50000IU CAPSULE WARFARIN SODIUM 3MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET METFORMIN 500MG TABLET
ROSE : 357 : SUB : MEDICARE
-21 -30 -10 -10 -12 -10 -23 -3 -13 -3 -22
-5.94 -7.95 -16.88 -21.29 -17.56 -3.00 -1.66 -3.01 -7.60 -0.87 -1.65
RX RX RX RX RX RX RX RX RX RX RX
0.00 -87.41
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
KING, EDYTHE RESIDENT# : 179 STATION : SUB STATUS : MEDICARE
10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3696387 R3696391 R3696393 R3696399 R3696394 R3696389 R3696390 R3696392
00378-1813-01 16729-0005-17 00781-1966-10 67253-0900-11 00182-4141-26 63653-1171-05 00008-0833-22 49884-0405-01
TANK TANK TANK TANK TANK TANK TANK TANK
10/14/09 10/19/09 10/19/09
CHARGE CHARGE CHARGE
R3696397 R3701433 R3701436
63481-0687-06 31722-0237-10 00409-1316-25
TANK TANK TANK
10/22/09 10/23/09
CHARGE CHARGE
R3707685 R3708342
00008-0837-21 00409-1316-25
TANK TANK
10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3701178 R3701181 R3701183
00378-1813-01 16729-0005-17 00781-1966-10
TANK TANK TANK
LEVOTHYROXINE SODIUM 125MCG TABLET (RP:SYNTHROID) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FUROSEMIDE 40MG TABLET (RP:LASIX) ALPRAZOLAM 0.25MG TABLET (RP:XANAX) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) PLAVIX 75MG TABLET EFFEXOR XR 75MG CAP.SR 24H METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) LIDODERM 5% PATCH AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN EFFEXOR XR 37.5MG CAP.SR 24H HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN LEVOTHYROXINE SODIUM 125MCG TABLET (RP:SYNTHROID) SIMVASTATIN 20MG TABLET (RP:ZOCOR) FUROSEMIDE 40MG TABLET (RP:LASIX)
12 12 12 30 24 12 12 12
4.20 2.88 2.88 2.88 2.88 47.53 39.24 8.70
RX RX RX RX OTC RX RX RX
15 7 5
75.81 2.88 13.61
RX RX RX
4 10
3.89 27.23
RX RX
15 15 15
5.25 3.15 2.88
RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
KING, EDYTHE RESIDENT# : 179 STATION : SUB STATUS : MEDICARE
10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3706242 R3701179 R3701182
31722-0237-10 63653-1171-05 49884-0405-01
TANK TANK TANK
10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE
R3701184 R3709521 R3709522
00182-4141-26 00008-0837-21 00008-0833-22
TANK TANK TANK
PATIENT RECAP
RX OTC
379.81 5.76
AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) PLAVIX 75MG TABLET METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) EFFEXOR XR 37.5MG CAP.SR 24H EFFEXOR XR 75MG CAP.SR 24H
15 15 15
2.88 59.41 10.87
RX RX RX
30 15 15
2.88 14.59 49.05
OTC RX RX
0.00 385.57
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/10/09 10/13/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3690479 R3693107
58768-0103-30 17478-0060-12
15.98
LANGOL, MARIE RESIDENT# : 39 STATION : 3 STATUS : MEDICAID
TESTA TESTA
EYESCRUB LID CLEANSER PAD (RP:OCUSOFT LID SCRUB) AKWA TEARS (ARTIFICIAL TEARS) DROPS
30 15
13.10 2.88
OTC OTC
0.00 15.98
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/09/09
PATIENT RECAP
CHARGE
OTC
R3690278
58768-0103-30
13.10
LANOTTE, FRANK RESIDENT# : 25 STATION : 3 STATUS : MEDICAID
TESTA
EYESCRUB LID CLEANSER PAD (RP:OCUSOFT LID SCRUB)
30
13.10
OTC
0.00 13.10
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/16/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3694287 R3698682
63736-0105-06 00023-9205-15
17.50
LATTANZIO, LOUIS RESIDENT# : 18 STATION : 3 STATUS : MEDICAID
TESTA TESTA
BACID CAPLET REFRESH LIQUIGEL 1% DROPS
20 15
7.72 9.78
OTC OTC
0.00 17.50
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/15/09 10/15/09 10/16/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3694410 R3694412 R3694413 R3694414 R3694417 R3694422 R3694424 R3694428 R3694586 R3694416 R3694427 R3694411 R3694418 R3694420 R3694426 R3694431 R3697915 R3697923 R3699013
31722-0239-10 00245-0041-11 00603-1378-59 00603-4975-21 16252-0528-90 55111-0158-10 16252-0097-22 51672-4032-03 00378-1803-01 00182-1576-26 63736-0105-06 00078-0360-34 00023-9163-30 66582-0414-54 63304-0582-01 00064-5010-15 51672-4032-03 00075-0621-60 00406-0512-05
LAZARUS, BERNICE RESIDENT# : 35 STATION : 3 STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) KLOR-CON 10 (YELLOW) 10MEQ TABLET SA LACTULOSE 10GM/15ML SOLUTION OXYBUTYNIN 5MG TABLET (RP:DITROPAN) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) OMEPRAZOLE 20MG CAPSULE DR ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION WARFARIN SODIUM 5MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET OYST-CAL 500MG TABLET (RP:OS-CAL 500) BACID CAPLET DIOVAN 320MG TABLET RESTASIS 0.05% DROPERETTE ZETIA 10MG TABLET CEFADROXIL 500MG CAPSULE (RP:DURICEF) SANTYL OINTMENT WARFARIN SODIUM 5MG TABLET LOVENOX 60MG/0.6ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET)
13 13 946 39 13 13 75 1 13 13 14 13 30 13 14 30 2 6 30
2.88 3.30 20.81 6.44 4.63 51.73 8.63 2.88 3.42 2.88 5.41 30.93 89.02 34.60 39.92 85.21 2.88 354.82 7.02
RX RX RX RX RX RX RX RX RX OTC OTC RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LAZARUS, BERNICE RESIDENT# : 35 STATION : 3 STATUS : MEDICARE
10/16/09 10/16/09 10/19/09 10/19/09 10/22/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3699595 R3699315 R3702190 R3700797 R3707404
51672-4032-03 60505-0379-00 51672-4031-03 00064-5010-15 00409-1952-32
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09 10/30/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3701144 R3701146 R3701147 R3701149 R3701151 R3701152 R3710933 R3701145 R3701148 R3701150 R3714788 R3717244
31722-0239-10 00245-0041-11 00603-4975-21 16252-0528-90 55111-0158-10 00378-1803-01 51672-4028-03 00078-0360-34 00182-1576-26 66582-0414-54 51672-4028-03 51672-4030-03
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
1379.86 11.17
WARFARIN SODIUM 5MG TABLET CICLOPIROX 8% SOLUTION (RP:PENLAC) WARFARIN SODIUM 4MG TABLET (RP:COUMADIN) SANTYL OINTMENT TRIMETHOBENZAMIDE HCL CARPUJECT 100MG/1ML DISP SYRIN AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) KLOR-CON 10 (YELLOW) 10MEQ TABLET SA OXYBUTYNIN 5MG TABLET (RP:DITROPAN) PRAVASTATIN 40MG TABLET (RP:PRAVACHOL) OMEPRAZOLE 20MG CAPSULE DR LEVOTHYROXINE SODIUM 50MCG TABLET WARFARIN SODIUM 2MG TABLET DIOVAN 320MG TABLET OYST-CAL 500MG TABLET (RP:OS-CAL 500) ZETIA 10MG TABLET WARFARIN SODIUM 2MG TABLET WARFARIN SODIUM 3MG TABLET
7 6.6 7 60 10
4.13 117.18 4.10 170.42 9.28
RX RX RX RX RX
30 30 90 30 30 30 2 30 30 30 2 1.5
5.34 7.62 14.85 10.68 119.37 7.89 2.88 71.38 2.88 79.86 2.88 2.88
RX RX RX RX RX RX RX RX OTC RX RX RX
0.00 1391.03
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/07/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3681046 R3687657
63736-0105-06 17714-0020-01
13.51
LAZARUS, BERNICE RESIDENT# : 35 STATION : 3 STATUS : MEDICAID
GOLDFARB GOLDFARB
BACID CAPLET DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL)
20 30
10.63 2.88
OTC OTC
0.00 13.51
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN
RX
R3657049 R3653576
51672-4031-03 51672-4032-03
-2.94
LEWICKA, MARY RESIDENT# : 394 STATION : SUB STATUS : MEDICARE
TANK TANK
WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 5MG TABLET (RP:COUMADIN)
-2 -3
-1.17 -1.77
RX RX
0.00 -2.94
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/10/09 09/10/09
PATIENT RECAP
RETURN RETURN RETURN RETURN
RX
R3627746 R3627749 R3627748 R3627747
00310-0275-34 00002-3240-30 60505-2606-01 00597-0058-01
-87.55
LEWIS, LYNN RESIDENT# : 354 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SEROQUEL 25MG TABLET CYMBALTA 30MG CAPSULE EC CARVEDILOL 3.125MG TABLET (RP:COREG) FLOMAX 0.4MG CAPSULE SA
-12 -9 -27 -11
-24.18 -29.68 -3.86 -29.83
RX RX RX RX
0.00 -87.55
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/01/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3681231 R3681233 R3681235 R3681242 R3681243 R3681244 R3681385 R3690879 R3683292 R3683293 R3683294 R3691454 R3683291
63653-1171-05 74312-0813-80 00075-0624-30 00093-0051-01 00115-4222-01 50111-0990-01 00172-3758-60 00182-4141-26 74312-0813-80 00093-0051-01 00172-3758-60 00182-4141-26 63653-1171-05
318.02 11.52
LINDSAY, ELIZABETH RESIDENT# : 379 STATION : 3 STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
PLAVIX 75MG TABLET VITAMIN B12 1000MCG TABLET LOVENOX 30MG/0.3ML DISP SYRIN CARVEDILOL 3.125MG TABLET (RP:COREG) MIDODRINE 5MG TABLET VITAMIN D 50000IU CAPSULE LISINOPRIL 5MG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) VITAMIN B12 1000MCG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) LISINOPRIL 5MG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) PLAVIX 75MG TABLET
11 11 3 22 33 2 11 4 3 6 3 6 3
45.55 2.88 185.27 3.15 60.65 2.88 2.88 2.88 2.88 2.88 2.88 2.88 11.88
RX OTC RX RX RX RX RX OTC OTC RX RX OTC RX
0.00 329.54
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3686063 R3693488
17478-0060-12 00182-4141-26
5.76
LINQUITO, RESIDENT# STATION STATUS
TESTA TESTA
PHILOMENA : 69 : 2 : MEDICAID
AKWA TEARS (ARTIFICIAL TEARS) DROPS CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
15 30
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LODICO, JOANNE RESIDENT# : 270 STATION : 2 STATUS : MEDICARE
10/24/09 10/24/09 10/24/09 10/24/09
CHARGE CHARGE CHARGE CHARGE
R3709116 R3709120 R3709126 R3709129
31722-0238-10 63736-0105-06 00228-2666-50 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/24/09 10/24/09 10/24/09 10/24/09 10/24/09 10/24/09 10/24/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3709131 R3709138 R3709151 R3709095 R3709096 R3709117 R3709121
16729-0005-17 00093-7128-01 00406-0512-05 00169-7501-11 64764-0301-15 00075-0620-40 00781-6054-70
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/24/09 10/24/09 10/24/09 10/24/09 10/24/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3709124 R3709128 R3709134 R3709148 R3709171 R3709473
00006-0960-54 00228-2900-50 00013-8303-04 59011-0100-10 00071-1013-68 31722-0238-10
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) BACID CAPLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) SIMVASTATIN 20MG TABLET (RP:ZOCOR) TORSEMIDE 10MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) NOVOLOG 100U/1ML INSULIN ACTOS 30MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN DORZOLAMIDE HCL/TIMOLOL MALEATE 2%-0.5% DROPS (RP:COSOPT OPHTH) COZAAR 100MG TABLET GLIPIZIDE ER 10MG TABLET SA (RP:GLUCOTROL XL) XALATAN 0.005% DROPS OXYCONTIN 10MG TABLET SA LYRICA 50MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC)
2 2 6 2
2.88 2.88 2.88 2.88
RX OTC RX RX
2 2 30 10 2 4 10
2.88 2.88 7.02 76.45 11.12 236.29 84.21
RX RX RX RX RX RX RX
2 4 2.5 30 90 30
4.49 2.88 56.84 42.00 159.03 3.87
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LODICO, JOANNE RESIDENT# : 270 STATION : 2 STATUS : MEDICARE
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3709474 R3709476 R3709479 R3709480 R3710924 R3709472 R3709475 R3709477 R3709478
63736-0105-06 00228-2666-50 16729-0005-17 00093-7128-01 00603-1378-59 64764-0301-15 00006-0960-54 00228-2900-50 62175-0128-37
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/28/09
CHARGE
R3714980
00168-0258-46
GOLDFARB
10/29/09 10/31/09
CHARGE CHARGE
R3716143 R3717766
00406-0512-05 00071-1013-68
GOLDFARB GOLDFARB
PATIENT RECAP
RX OTC
1126.04 14.47
BACID CAPLET GABAPENTIN 300MG CAPSULE (RP:NEURONTIN) SIMVASTATIN 20MG TABLET (RP:ZOCOR) TORSEMIDE 10MG TABLET LACTULOSE 10GM/15ML SOLUTION ACTOS 30MG TABLET COZAAR 100MG TABLET GLIPIZIDE ER 10MG TABLET SA (RP:GLUCOTROL XL) ISOSORBIDE MONONITRATE ER 30MG TABLET SA (RP:IMDUR) CLOTRIMAZOLE/BETAMETHASONE DIPROP CREAM (RP:LOTRISONE) OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LYRICA 50MG CAPSULE
30 90 30 30 946 30 30 60 30
11.59 11.16 6.30 14.40 20.81 166.90 67.33 33.25 10.22
OTC RX RX RX RX RX RX RX RX
45
37.04
RX
30 30
7.02 53.01
RX RX
0.00 1140.51
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/05/09 10/14/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3683304 R3696403
00182-6151-40 63736-0105-06
14.97
LOMBARDI, RESIDENT# STATION STATUS
TESTA TESTA
VITAMIN LIQUID BACID CAPLET
ROSE : 54 : 3 : MEDICAID
480 20
7.25 7.72
OTC OTC
0.00 14.97
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
LUTZ, RUTH RESIDENT# : 412 STATION : SUB STATUS : MEDICARE
10/06/09 10/07/09
CHARGE CHARGE
R3686154 R3686419
00406-0552-01 00409-1316-25
TANK TANK
10/09/09 10/09/09 10/09/09 10/09/09 10/10/09 10/11/09 10/12/09 10/12/09 10/15/09 10/16/09 10/19/09 10/19/09 10/20/09 10/20/09 10/20/09 10/22/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3690506 R3690508 R3690496 R3690505 R3690872 R3691098 R3691451 R3691452 R3698133 R3699348 R3702251 R3702252 R3703961 R3704275 R3704105 R3706135
31722-0238-10 00555-0720-51 00075-0621-60 63481-0687-06 00172-3759-60 51672-4027-03 31722-0238-10 00172-3759-60 51672-4030-03 63304-0579-10 51672-4028-03 00172-3760-60 51672-4029-03 51672-4029-03 00169-1833-11 00555-0720-51
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
OXYCODONE HCL IR 5MG TABLET HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX) LOVENOX 60MG/0.6ML DISP SYRIN LIDODERM 5% PATCH LISINOPRIL 10MG TABLET WARFARIN SODIUM 1MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LISINOPRIL 10MG TABLET WARFARIN SODIUM 3MG TABLET METOPROLOL TARTRATE 25MG TABLET WARFARIN SODIUM 2MG TABLET LISINOPRIL 20MG TABLET WARFARIN SODIUM 2.5MG TABLET WARFARIN SODIUM 2.5MG TABLET (RP:COUMADIN) NOVOLIN R 100U/1ML VIAL-INSUL ALENDRONATE SODIUM 70MG TABLET (RP:FOSAMAX)
15 5
3.60 13.61
RX RX
3 2 6 15 2 2 15 15 3.5 20 3 7 7 1 10 2
2.88 30.74 354.82 75.81 2.88 2.88 2.88 2.88 2.88 2.88 2.88 2.88 4.07 2.88 33.87 30.74
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/23/09 10/23/09 10/26/09 10/26/09 10/30/09 10/30/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3708178 R3708592 R3701171 R3706217 R3716992 R3717045 R3717050
51672-4029-03 63481-0687-06 63304-0579-10 00172-3760-60 51672-4029-03 55111-0126-05 63736-0105-06
668.33 5.41
LUTZ, RUTH RESIDENT# : 412 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK
WARFARIN SODIUM 2.5MG TABLET (RP:COUMADIN) LIDODERM 5% PATCH METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 20MG TABLET WARFARIN SODIUM 2.5MG TABLET CIPROFLOXACIN 250MG TABLET (RP:CIPRO) BACID CAPLET
4 15 30 15 7 10 14
2.88 75.81 2.88 2.88 4.07 3.75 5.41
RX RX RX RX RX RX OTC
0.00 673.74
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/30/09 10/30/09 10/30/09 10/30/09 10/30/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3717377 R3717378 R3717379 R3717380 R3717381 R3717751
00186-5040-54 31722-0237-10 31722-0214-05 58177-0268-04 00486-1125-01 00029-1527-25
116.91
LYNCH, MARION RESIDENT# : 435 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
NEXIUM 40MG CAPSULE SA AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) SERTRALINE HCL 100MG TABLET (RP:ZOLOFT ) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) K-PHOS NEUTRAL 250MG TABLET BACTROBAN 2% CREAM
10 10 20 10 12 30
42.57 2.88 2.88 6.21 2.88 59.49
RX RX RX RX RX RX
0.00 116.91
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN
RX
R3633789 R3633786 R3633788 R3633788
00008-0607-01 16729-0005-17 00093-2210-05 00093-2210-05
-85.78
LYONS, JOHN RESIDENT# : 375 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK
PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) SIMVASTATIN 20MG TABLET (RP:ZOCOR) SUCRALFATE 1GM TABLET (RP:CARAFATE) SUCRALFATE 1GM TABLET (RP:CARAFATE)
-24 -12 -20 -30
-64.81 -2.52 -7.38 -11.07
RX RX RX RX
0.00 -85.78
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/15/09 10/16/09 10/16/09 10/19/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3676539 R3676540 R3676541 R3676542 R3676543 R3691834 R3691833 R3696914 R3699469 R3699473 R3702242 R3693940 R3693941 R3693942 R3693944 R3701174 R3693945
00378-0208-10 00527-1324-10 63304-0579-10 60505-0065-01 16729-0005-17 00054-0018-29 60505-2633-01 55111-0119-10 63736-0105-06 55111-0126-05 00168-0162-46 00378-0208-10 00527-1324-10 63304-0579-10 16729-0005-17 55111-0119-10 60505-2633-01
168.25 11.17
MAHER, MARGARET RESIDENT# : 411 STATION : SUB STATUS : MEDICARE
GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD GOLD
FUROSEMIDE 20MG TABLET (RP:LASIX) DIGOXIN 0.125MG TABLET METOPROLOL TARTRATE 25MG TABLET OMEPRAZOLE 20MG CAPSULE DR (RP:OMEPRAZOLE) SIMVASTATIN 20MG TABLET (RP:ZOCOR) PREDNISONE 20MG TABLET CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC) FAMOTIDINE 20MG TABLET (RP:PEPCID) BACID CAPLET CIPROFLOXACIN 250MG TABLET CLOBETASOL PROPIONATE 0.05% OINTMENT FUROSEMIDE 20MG TABLET (RP:LASIX) DIGOXIN 0.125MG TABLET METOPROLOL TARTRATE 25MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) FAMOTIDINE 20MG TABLET (RP:PEPCID) CETIRIZINE HCL 10MG TABLET (RP:ZYRTEC)
8 15 15 30 15 10 15 22 14 14 45 8 15 15 15 30 15
2.88 3.20 2.88 119.37 3.15 2.88 2.88 3.30 5.41 5.25 8.73 2.88 3.20 2.88 3.15 4.50 2.88
RX RX RX RX RX RX OTC RX OTC RX RX RX RX RX RX RX OTC
0.00 179.42
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3643590 R3643597 R3627771 R3627770 R3627769 R3627769 R3627768 R3652148 R3643594 R3643594 R3711222 R3711226 R3711228 R3711230 R3711232 R3711233 R3711223 R3711225 R3711227
31722-0238-10 00006-0747-54 00002-3240-30 63653-1171-05 55111-0119-10 55111-0119-10 16729-0006-17 31722-0237-10 00228-2128-50 00228-2128-50 16729-0006-17 00904-3232-92 00115-4222-01 55111-0127-05 00093-0051-01 00574-2008-30 63653-1171-05 00075-0620-40 00078-0359-34
MALATINO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
CARMELA : 360 : 2 : MEDICARE
AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) HYZAAR 100MG-25MG TABLET CYMBALTA 30MG CAPSULE EC PLAVIX 75MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) FAMOTIDINE 20MG TABLET (RP:PEPCID) SIMVASTATIN 40MG TABLET (RP:ZOCOR) AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) CLONIDINE 0.2MG TABLET CLONIDINE 0.2MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) CALCIUM CARBONATE 600MG TABLET MIDODRINE 5MG TABLET (RP:PRO-AMATINE) CIPROFLOXACIN 500MG TABLET CARVEDILOL 3.125MG TABLET (RP:COREG) NYSTATIN 100000U/1GM POWDER PLAVIX 75MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN DIOVAN 160MG TABLET
-9 -8 -1 -1 -2 -2 -3 -6 -25 -15 30 30 60 10 60 30 30 4 30
-1.16 -19.85 -3.30 -3.81 -0.30 -0.30 -0.77 -0.77 -3.53 -2.12 7.68 2.88 110.28 4.50 8.58 52.44 118.82 236.29 56.42
RX RX RX RX RX RX RX RX RX RX RX OTC RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/28/09 10/28/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX OTC
R3711229 R3714585 R3714592 R3716303
00002-3237-30 00002-3240-30 00456-2005-01 00228-2888-50
688.04 2.88
MALATINO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
CARMELA : 360 : 2 : MEDICARE
CYMBALTA 60MG CAPSULE EC CYMBALTA 30MG CAPSULE EC LEXAPRO 5MG TABLET ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN)
30 5 5 30
98.92 16.49 10.65 2.88
RX RX RX RX
0.00 690.92
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
MANZETTI, RESIDENT# STATION STATUS
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3688042 R3688047 R3688048 R3688052 R3688053 R3688054 R3688056 R3688071 R3688236
00378-1140-01 00603-1378-59 00378-1803-01 00245-0057-10 16729-0005-17 50111-0433-01 00406-0512-05 00781-1599-05 00378-1650-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/07/09 10/07/09 10/07/09 10/07/09 10/07/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3688045 R3688046 R3688049 R3688050 R3688051
64455-0799-42 00075-0620-40 00006-0951-54 60258-0173-06 00185-0122-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/11/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE
R3691159 R3688268 R3688270
63736-0105-06 00378-1140-01 00378-1803-01
GOLDFARB GOLDFARB GOLDFARB
JEAN : 420 : SUB : MEDICARE
BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) LACTULOSE 10GM/15ML SOLUTION LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) KLOR-CON M 10 10MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) TRAZODONE 50MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE (RP:MACRODANTIN) CARDIZEM CD 360MG CAPSULE SA LOVENOX 40MG/0.4ML DISP SYRIN COZAAR 25MG TABLET MAG-SR 64MG TABLET SA NITROFURANTOIN MONOHYDRATE 100MG CAPSULE (RP:MACROBID) BACID CAPLET BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID)
5 946 5 5 5 5 30 5 2
2.88 20.81 2.88 2.88 2.88 2.88 7.02 2.88 2.88
RX RX RX RX RX RX RX RX RX
5 4 5 60 14
26.04 236.29 6.43 5.49 19.61
RX RX RX OTC RX
6 15 15
2.88 2.88 3.95
OTC RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/16/09 10/23/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3688272 R3688273 R3688274 R3688275 R3688269 R3688271 R3694127 R3699387 R3708354 R3694005 R3694007 R3694009 R3694010 R3694011 R3694012 R3694006 R3694008
00245-0057-10 16729-0005-17 50111-0433-01 00781-1599-05 64455-0799-42 00006-0951-54 00228-2888-50 00075-0620-40 00406-0512-05 00378-1140-01 00378-1803-01 00245-0057-10 16729-0005-17 50111-0433-01 00781-1599-05 64455-0799-42 00006-0951-54
819.67 8.37
MANZETTI, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
JEAN : 420 : SUB : MEDICARE
KLOR-CON M 10 10MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) TRAZODONE 50MG TABLET SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) CARDIZEM CD 360MG CAPSULE SA COZAAR 25MG TABLET ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) LOVENOX 40MG/0.4ML DISP SYRIN OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) BUSPIRONE HCL 5MG TABLET (RP:BUSPAR) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) KLOR-CON M 10 10MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) TRAZODONE 50MG TABLET SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) CARDIZEM CD 360MG CAPSULE SA COZAAR 25MG TABLET
15 15 15 15 15 15 15 4 30 15 15 15 15 15 15 15 15
3.81 3.15 2.88 4.50 78.11 19.28 2.88 236.29 7.02 2.88 3.95 3.81 3.15 2.88 4.50 78.11 19.28
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 828.04
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/13/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3693000 R3693004 R3693005 R3693007 R3693008 R3693002 R3693003 R3693006 R3693094 R3693097 R3693099 R3693092 R3693096 R3693095 R3693098 R3693900 R3693903 R3693905 R3693899
74312-0871-90 32131-0804-86 00781-1228-10 31722-0239-10 58177-0268-04 62856-0245-90 00173-0696-00 00008-0607-01 58177-0268-04 00781-1228-10 31722-0239-10 74312-0871-90 32131-0804-86 62856-0245-90 00008-0607-01 58177-0268-04 00781-1228-10 31722-0239-10 74312-0871-90
MARION, ANNE RESIDENT# : 424 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO PAGANO
ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OPTI-MULTI CAPLET (RP:OCUVITE) METOPROLOL TARTRATE 100MG TABLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) ARICEPT 5MG TABLET ADVAIR DISKUS 250MCG/50MCG INHALER PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) METOPROLOL TARTRATE 100MG TABLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER) OPTI-MULTI CAPLET (RP:OCUVITE) ARICEPT 5MG TABLET PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) DOXAZOSIN MESYLATE 4MG TABLET (RP:CARDURA) METOPROLOL TARTRATE 100MG TABLET AMLODIPINE BESYLATE 10MG TABLET (RP:NORVASC) ABC PLUS SENIOR TABLET (RP:CENTRUM SILVER)
1 1 2 1 1 1 60 1 14 28 14 14 14 14 14 15 30 15 15
2.88 2.88 2.88 2.88 2.88 5.14 157.07 2.88 8.69 2.88 2.88 2.88 2.88 71.88 37.81 9.32 2.88 2.88 2.88
OTC OTC RX RX RX RX RX RX RX RX RX OTC OTC RX RX RX RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
OTC RX
R3693901 R3693902 R3693904 R3716296
62856-0245-90 32131-0804-86 00008-0607-01 00078-0359-34
17.28 451.15
MARION, ANNE RESIDENT# : 424 STATION : SUB STATUS : MEDICARE
PAGANO PAGANO PAGANO PAGANO
ARICEPT 5MG TABLET OPTI-MULTI CAPLET (RP:OCUVITE) PANTOPRAZOLE 40MG TABLET DR (RP:PROTONIX) DIOVAN 160MG TABLET
15 15 15 11
77.01 2.88 40.50 20.69
RX OTC RX RX
0.00 468.43
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693634
51660-0526-28
2.88
MATTHEWS, RESIDENT# STATION STATUS
TESTA
CELIA : 22 : 3 : MEDICAID
LORATADINE 10MG TABLET (RP:CLARITIN)
30
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
MILLINGTON, RESIDENT# : STATION : STATUS :
10/04/09 10/05/09 10/05/09 10/05/09 10/05/09 10/05/09 10/05/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682980 R3682894 R3682895 R3682896 R3682900 R3682901 R3682902
51672-4027-03 00378-0208-10 00406-2023-10 16729-0005-17 00228-2888-50 16252-0097-22 49502-0685-26
TANK TANK TANK TANK TANK TANK TANK
10/05/09 10/05/09 10/05/09 10/05/09 10/06/09 10/09/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682903 R3682904 R3685014 R3682897 R3686297 R3690246 R3690250 R3690247 R3683308 R3683309 R3683310
51672-4027-03 00406-0512-05 00406-0552-01 00228-2578-50 51672-4027-03 74312-0813-80 00182-4141-26 50111-0990-01 00378-0208-10 00406-2023-10 16729-0005-17
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
HENRIETTA 418 SUB MEDICARE
WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) FUROSEMIDE 20MG TABLET (RP:LASIX) ATENOLOL 50MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) WARFARIN SODIUM 1MG TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) OXYCODONE HCL IR 5MG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) WARFARIN SODIUM 1MG TABLET VITAMIN B12 1000MCG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) VITAMIN D 50000IU CAPSULE FUROSEMIDE 20MG TABLET (RP:LASIX) ATENOLOL 50MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR)
1 7 7 7 15 75 62.5
2.88 2.88 2.88 2.88 2.88 8.63 6.75
RX RX RX RX RX RX RX
1 15 15 7 7 3 6 2 15 15 15
2.88 3.51 3.60 9.38 3.78 2.88 2.88 2.88 2.88 2.88 3.15
RX RX RX RX RX OTC OTC RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
MILLINGTON, RESIDENT# : STATION : STATUS :
10/12/09 10/12/09 10/12/09 10/14/09
CHARGE CHARGE CHARGE CHARGE
R3691461 R3683311 R3691462 R3696011
74312-0813-80 00228-2578-50 00182-4141-26 49502-0685-26
TANK TANK TANK TANK
10/14/09 10/14/09 10/14/09 10/16/09 10/19/09 10/19/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3696012 R3696180 R3696184 R3699610 R3702258 R3702259 R3707491 R3693974 R3693975 R3693976 R3706243 R3709610 R3693977 R3693978
16252-0097-22 51672-4032-03 00075-0620-40 51672-4029-03 51672-4029-03 00172-3758-60 51672-4029-03 00378-0208-10 00406-2023-10 16729-0005-17 00172-3758-60 16252-0097-22 00228-2578-50 74312-0813-80
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
HENRIETTA 418 SUB MEDICARE
VITAMIN B12 1000MCG TABLET DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION WARFARIN SODIUM 5MG TABLET LOVENOX 40MG/0.4ML DISP SYRIN WARFARIN SODIUM 2.5MG TABLET WARFARIN SODIUM 2.5MG TABLET LISINOPRIL 5MG TABLET WARFARIN SODIUM 2.5MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) ATENOLOL 50MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) LISINOPRIL 5MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION DILTIAZEM CD 240MG CAP.SR 24H (RP:CARDIZEM CD) VITAMIN B12 1000MCG TABLET
15 15 30 62.5
2.88 20.09 2.88 6.75
OTC RX OTC RX
75 2 0.8 3 3 7 5 15 15 15 15 75 15 15
8.63 2.88 47.26 2.88 2.88 2.88 2.91 2.88 2.88 3.15 2.88 8.63 20.09 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/27/09 10/27/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3693979 R3711183 R3711212 R3712783 R3712794 R3717012
00182-4141-26 17714-0019-01 00075-0620-40 51672-4032-03 00075-0624-30 51672-4032-03
438.03 20.16
MILLINGTON, RESIDENT# : STATION : STATUS :
TANK TANK TANK TANK TANK TANK
HENRIETTA 418 SUB MEDICARE
CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) SIMETHICONE 80MG TAB CHEW LOVENOX 40MG/0.4ML DISP SYRIN WARFARIN SODIUM 5MG TABLET LOVENOX 30MG/0.3ML DISP SYRIN WARFARIN SODIUM 5MG TABLET
30 100 0.8 1 3 14
2.88 2.88 47.26 2.88 177.24 8.26
OTC OTC RX RX RX RX
0.00 458.19
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/30/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3707672 R3707674 R3707679 R3707681 R3707684 R3707666 R3707670 R3707689 R3707889 R3709510 R3709511 R3709512 R3709513 R3709514 R3709509 R3717126
00185-0144-05 74312-0813-80 57664-0397-58 16729-0005-17 65862-0143-01 00310-0275-34 00169-1833-11 60258-0006-01 00075-0624-30 00185-0144-05 74312-0813-80 57664-0397-58 16729-0005-17 65862-0143-01 00310-0275-34 00378-1800-01
260.88 13.76
MORAVICK, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
THERESA : 221 : SUB : MEDICARE
AMIODARONE HCL 200MG TABLET VITAMIN B12 1000MCG TABLET METFORMIN 500MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CARVEDILOL 6.25MG TABLET (RP:COREG) SEROQUEL 25MG TABLET NOVOLIN R 100U/1ML VIAL-INSUL PHOS-NAK PACKET LOVENOX 30MG/0.3ML DISP SYRIN AMIODARONE HCL 200MG TABLET VITAMIN B12 1000MCG TABLET METFORMIN 500MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR) CARVEDILOL 6.25MG TABLET (RP:COREG) SEROQUEL 25MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID)
2 4 8 4 8 2 10 30 3 8 15 30 15 30 7.5 5
2.88 2.88 2.88 2.88 2.88 4.03 33.87 8.00 177.24 5.90 2.88 2.88 3.15 4.29 15.12 2.88
RX OTC RX RX RX RX RX OTC RX RX OTC RX RX RX RX RX
0.00 274.64
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3676449 R3676450 R3676451 R3676453 R3676448 R3676452
00378-0181-01 16729-0006-17 00378-1815-01 00527-1325-10 00597-0058-01 64764-0541-30
124.61
MUTTEL, JOHN RESIDENT# : 390 STATION : SUB STATUS : MEDICARE
TESTA TESTA TESTA TESTA TESTA TESTA
ALLOPURINOL 300MG TABLET (RP:ALLOPURINOL) SIMVASTATIN 40MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 150MCG TABLET DIGOXIN 0.25MG TABLET FLOMAX 0.4MG CAPSULE SA PREVACID 15MG CAPSULE DR
15 15 15 15 15 15
2.88 3.84 5.40 3.20 44.34 64.95
RX RX RX RX RX RX
0.00 124.61
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/08/09 10/19/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3684668 R3700818
00023-4554-30 00023-4554-30
26.50
NAPOLITANO, RESIDENT# : STATION : STATUS :
RENNER RENNER
CELLUVISC OPHTH 1% DROPS CELLUVISC OPHTH 1% DROPS
CONNIE 79 2 MEDICAID
30 30
13.25 13.25
OTC OTC
0.00 26.50
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/07/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3686065 R3687730
00023-0667-04 00023-9205-15
20.22
NICCOLI, MARIE RESIDENT# : 67 STATION : 2 STATUS : MEDICAID
TESTA TESTA
REFRESH PM OPHTH OINT REFRESH LIQUIGEL 1% DROPS
3.5 15
10.44 9.78
OTC OTC
0.00 20.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN
RX OTC
R3644253 R3650591 R3644252
00172-3760-60 00536-3985-01 16729-0005-17
-4.73 -1.50
PANNY, ANNIE RESIDENT# : 372 STATION : SUB STATUS : MEDICARE
SHERMAN SHERMAN SHERMAN
LISINOPRIL 20MG TABLET MECLIZINE HCL 12.5MG TABLET SIMVASTATIN 20MG TABLET (RP:ZOCOR)
-25 -25 -13
-2.00 -1.50 -2.73
RX OTC RX
0.00 -6.23
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09 09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3627807 R3642654 R3642654 R3627809 R3627812 R3627809 R3627811 R3627810 R3627810 R3627805 R3627808 R3627808 R3600500 R3627812 R3645012
00172-3758-60 00555-0607-02 00555-0607-02 63213-1523-10 63304-0579-10 63213-1523-10 63736-0105-06 79649-9031-06 79649-9031-06 59366-2819-02 00182-4141-26 00182-4141-26 63481-0687-06 63304-0579-10 68180-0512-02
-290.97 -32.27
PETRASEK, RESIDENT# STATION STATUS
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
GLORIA : 329 : SUB : MEDICARE
LISINOPRIL 5MG TABLET MEGESTROL ACETATE 40MG TABLET (RP:MEGACE) MEGESTROL ACETATE 40MG TABLET (RP:MEGACE) VITAMIN C 250MG TABLET METOPROLOL TARTRATE 25MG TABLET VITAMIN C 250MG TABLET BACID CAPLET GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE GLUCOSAMINE/CHONDROITIN 500MG/400MG CAPSULE DEMECLOCYCLINE 150MG TABLET (RP:DECLOMYCIN) CALCARB/VIT D 600/400 TABLET CALCARB/VIT D 600/400 TABLET LIDODERM 5% PATCH METOPROLOL TARTRATE 25MG TABLET LISINOPRIL 2.5MG TABLET
-15 -16 -30 -15 -30 -20 -24 -30 -20 -11 -18 -30 -30 -7 -11
-0.72 -10.82 -20.28 -0.25 -2.16 -0.33 -12.35 -10.46 -6.98 -104.45 -0.71 -1.19 -151.63 -0.50 -0.41
RX RX RX OTC RX OTC OTC OTC OTC RX OTC OTC RX RX RX
0.00 -323.24
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/05/09 10/05/09 10/07/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/22/09 10/22/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3679903 R3683270 R3683272 R3688072 R3676624 R3676627 R3676628 R3676629 R3688254 R3688255 R3676625 R3676630 R3706150 R3706153 R3708924 R3693867 R3693869 R3693871 R3693873
00075-0620-40 31722-0238-10 60505-0093-00 45802-0112-22 00406-2023-10 55111-0119-10 00378-1803-01 00591-0409-01 31722-0238-10 60505-0093-00 00025-1525-51 63653-1171-05 65162-0627-50 00075-0620-40 00378-1805-01 00406-2023-10 55111-0119-10 00591-0409-01 31722-0238-10
PETRULLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
KAY : 403 : SUB : MEDICARE
LOVENOX 40MG/0.4ML DISP SYRIN AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) MUPIROCIN 2% OINTMENT (RP:BACTROBAN) ATENOLOL 50MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) LEVOTHYROXINE SODIUM 50MCG TABLET (RP:SYNTHROID) LISINOPRIL 40MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) CELEBREX 200MG CAPSULE PLAVIX 75MG TABLET TRAMADOL 50MG TABLET (RP:ULTRAM) LOVENOX 40MG/0.4ML DISP SYRIN LEVOTHYROXINE SODIUM 75MCG TABLET ATENOLOL 50MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) LISINOPRIL 40MG TABLET AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC)
4 7 7 22 15 15 15 15 15 15 15 15 30 4 2 15 15 15 15
247.02 2.88 4.14 41.45 2.88 2.88 3.95 2.88 2.88 8.88 43.52 59.41 2.88 236.29 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX
R3693874 R3709498 R3693868 R3693872
60505-0093-00 00378-1805-01 00025-1525-51 63653-1171-05
792.52
PETRULLO, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
KAY : 403 : SUB : MEDICARE
DOXAZOSIN MESYLATE 1MG TABLET (RP:CARDURA) LEVOTHYROXINE SODIUM 75MCG TABLET CELEBREX 200MG CAPSULE PLAVIX 75MG TABLET
15 15 15 15
8.88 4.37 43.52 59.41
RX RX RX RX
0.00 792.52
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/21/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09 10/31/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3691311 R3691320 R3691640 R3692592 R3691308 R3691310 R3691315 R3692552 R3705830 R3694049 R3694051 R3694047 R3694048 R3694050 R3713918 R3717728
00378-1800-01 59366-2819-02 24208-0324-05 68180-0512-02 00597-0058-01 00456-3210-60 00013-8303-04 62856-0246-90 00258-3678-01 00378-1800-01 68180-0512-02 00597-0058-01 00456-3210-60 62856-0246-90 00378-1803-01 59366-2819-02
670.84
PIETROWITZ, RESIDENT# : STATION : STATUS :
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
EDWARD 422 SUB MEDICARE
LEVOTHYROXINE SODIUM 25MCG TABLET DEMECLOCYCLINE 150MG TABLET (RP:DECLOMYCIN) TIMOLOL MALEATE OPHTH 0.5% DROPS LISINOPRIL 2.5MG TABLET FLOMAX 0.4MG CAPSULE SA NAMENDA 10MG TABLET XALATAN 0.005% DROPS ARICEPT 10MG TABLET BENZONATATE 200MG CAPSULE (RP:TESSALON PERLE) LEVOTHYROXINE SODIUM 25MCG TABLET LISINOPRIL 2.5MG TABLET FLOMAX 0.4MG CAPSULE SA NAMENDA 10MG TABLET ARICEPT 10MG TABLET LEVOTHYROXINE SODIUM 50MCG TABLET DEMECLOCYCLINE 150MG TABLET
15 4 5 15 15 30 2.5 15 21 15 15 15 30 15 12 18
3.48 37.98 4.50 2.88 44.34 68.43 56.84 77.01 5.17 3.48 2.88 44.34 68.43 77.01 3.16 170.91
RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 670.84
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/09/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3687732 R3689533
00023-0667-04 00023-0798-15
20.22
PRUZINSKY, MARIE RESIDENT# : 90 STATION : 2 STATUS : MEDICAID
SCERBO SCERBO
REFRESH PM OPHTH OINT REFRESH TEARS OPHTH DROPS
3.5 15
10.44 9.78
OTC OTC
0.00 20.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
PUGLISI, VINCENT RESIDENT# : 294 STATION : SUB STATUS : MEDICARE
10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09 10/21/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3705966 R3705975 R3705976 R3705977 R3705979 R3705965 R3705968 R3705969 R3705970
16729-0006-17 00378-6173-01 00245-0057-10 00781-5224-01 00781-1966-10 00169-0081-81 00173-0697-00 00006-0951-54 00781-6054-70
TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/21/09 10/21/09 10/21/09 10/21/09 10/22/09 10/22/09 10/22/09 10/23/09 10/23/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3705972 R3705973 R3705974 R3705980 R3707816 R3707817 R3707818 R3707932 R3708490
00228-2588-50 00173-0712-04 50111-0990-01 00169-1833-11 51672-4032-03 00245-0058-15 00245-0057-10 51672-4032-03 00378-0023-05
TANK TANK TANK TANK TANK TANK TANK TANK TANK
SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOLAZONE 5MG TABLET (RP:ZAROXOLYN) KLOR-CON M 10 10MEQ TABLET SA CARVEDILOL 25MG TABLET (RP:COREG) FUROSEMIDE 40MG TABLET (RP:LASIX) PRANDIN 0.5MG TABLET ADVAIR DISKUS 500MCG/50MCG INHALER COZAAR 25MG TABLET DORZOLAMIDE HCL/TIMOLOL MALEATE 2%-0.5% DROPS (RP:COSOPT OPHTH) DILTIAZEM CD 120MG CAP.SR 24H (RP:CARDIZEM CD) AVODART 0.5MG CAPSULE VITAMIN D 50000IU CAPSULE NOVOLIN R 100U/1ML VIAL-INSUL WARFARIN SODIUM 5MG TABLET KLOR-CON M 20 20MEQ TABLET SA KLOR-CON M 10 10MEQ TABLET SA WARFARIN SODIUM 5MG TABLET DILTIAZEM 30MG TABLET
5 5 10 10 10 10 60 5 10
2.88 5.34 2.88 2.88 2.88 14.67 206.59 6.43 84.21
RX RX RX RX RX RX RX RX RX
5 5 2 10 2 1 1 1 9
3.92 13.31 2.88 33.87 2.88 2.88 2.88 2.88 2.88
RX RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/23/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3708535 R3709073 R3706234 R3706238 R3706239 R3706240 R3706241 R3709507 R3709508 R3706233 R3706235 R3706237 R3711193 R3716381
57664-0434-88 51672-4032-03 16729-0006-17 00378-6173-01 00245-0057-10 00781-5224-01 00781-1966-10 00378-0023-05 57664-0434-88 00169-0081-81 00006-0951-54 00173-0712-04 00182-4141-26 51672-4032-03
552.43 2.88
PUGLISI, VINCENT RESIDENT# : 294 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
ALLOPURINOL 100MG TABLET WARFARIN SODIUM 5MG TABLET SIMVASTATIN 40MG TABLET (RP:ZOCOR) METOLAZONE 5MG TABLET (RP:ZAROXOLYN) KLOR-CON M 10 10MEQ TABLET SA CARVEDILOL 25MG TABLET (RP:COREG) FUROSEMIDE 40MG TABLET (RP:LASIX) DILTIAZEM 30MG TABLET ALLOPURINOL 100MG TABLET PRANDIN 0.5MG TABLET COZAAR 25MG TABLET AVODART 0.5MG CAPSULE CALCARB/VIT D 600/400 TABLET WARFARIN SODIUM 5MG TABLET
3 5 15 15 30 30 30 45 15 30 15 15 30 7
2.88 2.95 3.84 16.02 7.62 4.29 2.88 4.59 2.88 44.01 19.28 39.92 2.88 4.13
RX RX RX RX RX RX RX RX RX RX RX RX OTC RX
0.00 555.31
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/12/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE
OTC RX
R3691479 R3693540 R3693543
00182-6135-77 00486-1125-01 00904-5062-60
5.76 14.23
PUZZO, MARY RESIDENT# : 85 STATION : 3 STATUS : MEDICAID
PAGANO PAGANO PAGANO
NASAL 0.65% SPRAY (RP:OCEAN NASAL) K-PHOS NEUTRAL 250MG TABLET CALCIUM CITRATE 200MG TABLET
45 90 60
2.88 14.23 2.88
OTC RX OTC
0.00 19.99
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09
PATIENT RECAP
CHARGE
OTC
R3686060
00023-0798-15
9.78
PYRYT, THERESA RESIDENT# : 66 STATION : 2 STATUS : MEDICAID
SILVERMAN
REFRESH TEARS OPHTH DROPS
15
9.78
OTC
0.00 9.78
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693468
30768-0006-01
2.88
REO, ANTOINETTE RESIDENT# : 73 STATION : 2 STATUS : MEDICAID
PAGANO
VITAMIN B COMPLEX TABLET
30
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN
RX
R3642638 R3642638
00527-1325-10 00527-1325-10
-2.34
REVILLA, MARIA RESIDENT# : 381 STATION : SUB STATUS : MEDICARE
TANK TANK
DIGOXIN 0.25MG TABLET DIGOXIN 0.25MG TABLET
-4 -7
-0.85 -1.49
RX RX
0.00 -2.34
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09
PATIENT RECAP
RETURN
RX
R3639880
00075-0620-40
-236.28
RIEDEL, LAURA RESIDENT# : 371 STATION : SUB STATUS : MEDICARE
TANK
LOVENOX 40MG/0.4ML DISP SYRIN
-4
-236.28
RX
0.00 -236.28
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09
PATIENT RECAP
CHARGE
OTC
R3693748
00182-4141-26
2.88
ROMA, MILDRED RESIDENT# : 300 STATION : 3 STATUS : MEDICAID
TANK
CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
60
2.88
OTC
0.00 2.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/10/09 10/20/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3690637 R3702704
00299-3923-04 17478-0060-12
7.22
ROMANO, MARY RESIDENT# : 15 STATION : 3 STATUS : MEDICAID
KIM KIM
CETAPHIL GENTLE CLEANS BAR AKWA TEARS (ARTIFICIAL TEARS) DROPS
1 15
4.34 2.88
OTC OTC
0.00 7.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ROSS, PAUL RESIDENT# : 425 STATION : SUB STATUS : MEDICARE
10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/14/09 10/15/09 10/15/09 10/19/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3696417 R3696418 R3696420 R3696423 R3696424 R3696426 R3696427 R3696419 R3696422 R3696421 R3698038 R3701300
00781-1599-05 31722-0521-10 00378-1800-01 00781-1966-10 00781-5224-01 16729-0006-17 31722-0520-10 00574-0412-02 00258-3613-01 59676-0340-01 99389-0191-31 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/21/09 10/24/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3706103 R3709047 R3701199 R3701200 R3701201 R3701203
00168-0162-46 59676-0340-01 00781-1599-05 31722-0521-10 00378-1800-01 00781-1966-10
TANK TANK TANK TANK TANK TANK
SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) HYDRALAZINE 50MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) FUROSEMIDE 40MG TABLET (RP:LASIX) CARVEDILOL 25MG TABLET (RP:COREG) SIMVASTATIN 40MG TABLET HYDRALAZINE 25MG TABLET POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) ISOSORBIDE DINITRATE ER 40MG TABLET SA PROCRIT 40MU/1ML VIAL MOISTURIZING LOTION HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN CLOBETASOL PROPIONATE 0.05% OINTMENT (RP:TEMOVATE) PROCRIT 40MU/1ML VIAL SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) HYDRALAZINE 50MG TABLET LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) FUROSEMIDE 40MG TABLET (RP:LASIX)
24 36 12 12 24 12 36 255 36 1 473 5
7.20 15.12 2.88 2.88 3.43 3.07 11.81 12.90 20.93 476.52 4.48 13.61
RX RX RX RX RX RX RX RX RX RX OTC RX
45 1 30 45 15 15
8.73 476.52 9.00 18.90 3.48 2.88
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
ROSS, PAUL RESIDENT# : 425 STATION : SUB STATUS : MEDICARE
10/26/09 10/26/09 10/26/09 10/26/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3701204 R3701205 R3701206 R3701202 R3713192
00781-5224-01 16729-0006-17 31722-0520-10 00258-3613-01 00409-1316-25
TANK TANK TANK TANK TANK
10/29/09 10/29/09 10/30/09
CHARGE CHARGE CHARGE
R3716292 R3716295 R3717035
00143-9898-05 63736-0105-06 55111-0126-05
TANK TANK TANK
PATIENT RECAP
RX OTC
1159.15 12.20
CARVEDILOL 25MG TABLET (RP:COREG) SIMVASTATIN 40MG TABLET HYDRALAZINE 25MG TABLET ISOSORBIDE DINITRATE ER 40MG TABLET SA HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN CEPHALEXIN 250MG CAPSULE (RP:KEFLEX) BACID CAPLET CIPROFLOXACIN 250MG TABLET (RP:CIPRO)
30 15 45 45 5
4.29 3.84 14.76 26.16 13.61
14 20 10
2.88 7.72 3.75
RX RX RX RX RX RX OTC RX
0.00 1171.35
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09
PATIENT RECAP
CHARGE
IV
R3686162
00338-0017-38
16.12
RUSSO, RALPH RESIDENT# : 228 STATION : SUB STATUS : MEDICARE
TANK
DEXTROSE 5% (100ML BAG) IV SOLN.
200
16.12
IV
0.00 16.12
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/15/09 10/15/09 10/20/09 10/20/09 10/20/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3690284 R3690286 R3690287 R3690290 R3690295 R3690319 R3691456 R3691457 R3691458 R3691459 R3691460 R3693384 R3696840 R3696863 R3703814 R3703821 R3703819 R3693955 R3706230
00378-1811-01 16729-0007-17 00536-3550-01 00182-4141-26 30768-0156-05 00406-0512-05 00378-1811-01 16729-0007-17 00536-3550-01 00182-4141-26 30768-0156-05 00075-0624-30 00574-0412-02 00002-3235-60 00378-1813-01 74312-0813-80 00517-0031-25 16729-0007-17 00378-1813-01
SACCO, MARIO RESIDENT# : 421 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
LEVOTHYROXINE SODIUM 112MCG TABLET SIMVASTATIN 80MG TABLET (RP:ZOCOR) VITAMIN B12 250MCG TABLET CALCARB/VIT D 600/400 TABLET VITAMIN D (D-3) 1000IU TABLET OXYCODONE/APAP 5MG/325MG TABLET (RP:PERCOCET) LEVOTHYROXINE SODIUM 112MCG TABLET SIMVASTATIN 80MG TABLET (RP:ZOCOR) VITAMIN B12 250MCG TABLET CALCARB/VIT D 600/400 TABLET VITAMIN D (D-3) 1000IU TABLET LOVENOX 30MG/0.3ML DISP SYRIN POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) CYMBALTA 20MG CAPSULE EC LEVOTHYROXINE SODIUM 125MCG TABLET VITAMIN B12 1000MCG TABLET CYANOCOBALAMIN 1000MCG/1ML VIAL SIMVASTATIN 80MG TABLET (RP:ZOCOR) LEVOTHYROXINE SODIUM 125MCG TABLET
3 3 6 3 3 15 15 15 30 15 15 3 255 11 6 6 4 15 15
2.88 2.88 2.88 2.88 2.88 3.51 5.16 3.84 2.88 2.88 2.88 177.24 12.90 32.35 2.88 2.88 3.30 3.84 5.25
RX RX OTC OTC OTC RX RX RX OTC OTC OTC RX RX RX RX OTC RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX OTC
R3706232 R3693957 R3693958 R3701173
74312-0813-80 00182-4141-26 30768-0156-05 00002-3235-60
300.14 28.80
SACCO, MARIO RESIDENT# : 421 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK
VITAMIN B12 1000MCG TABLET CALCARB/VIT D 600/400 TABLET VITAMIN D (D-3) 1000IU TABLET CYMBALTA 20MG CAPSULE EC
15 15 15 15
2.88 2.88 2.88 44.11
OTC OTC OTC RX
0.00 328.94
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT
RX
R3666422 R3666422 R3666423 R3666423 R3666424 R3666424 R3671864 R3671864 R3671865 R3671865 R3676062 R3676062
00172-4096-80 00172-4096-80 16729-0005-17 16729-0005-17 00378-1120-01 00378-1120-01 63304-0579-10 63304-0579-10 16252-0571-01 16252-0571-01 51672-4031-03 51672-4031-03
-40.85
SALZANO, RUTH RESIDENT# : 209 STATION : 3 STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
BACLOFEN 10MG TABLET BACLOFEN 10MG TABLET SIMVASTATIN 20MG TABLET SIMVASTATIN 20MG TABLET VERAPAMIL HCL ER 120MG TABLET SA VERAPAMIL HCL ER 120MG TABLET SA METOPROLOL TARTRATE 25MG TABLET METOPROLOL TARTRATE 25MG TABLET RAMIPRIL 2.5MG CAPSULE RAMIPRIL 2.5MG CAPSULE WARFARIN SODIUM 4MG TABLET WARFARIN SODIUM 4MG TABLET
12 90 4 30 4 30 12 90 4 30 4 8
2.88 -4.77 2.88 -6.30 2.88 -21.25 2.88 -6.48 2.88 -14.64 2.88 -4.69
RX RX RX RX RX RX RX RX RX RX RX RX
0.00 -40.85
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/02/09
PATIENT RECAP
RETURN
RX
R3610642
55111-0532-01
-6.51
SANANDRES, GRACE RESIDENT# : 358 STATION : 3 STATUS : MEDICARE
TANK
DIVALPROEX SODIUM SPRINKLES 125MG CAPSULE (RP:DEPAKOTE SPRINKLES)
-11
-6.51
RX
0.00 -6.51
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SANGIORGIO, RESIDENT# : STATION : STATUS :
10/21/09 10/21/09
CHARGE CHARGE
R3706057 R3706058
16252-0097-22 49502-0685-26
TANK TANK
10/21/09 10/21/09 10/21/09 10/21/09 10/22/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3706060 R3706061 R3706063 R3706064 R3707102
00172-3759-60 00378-0032-10 00378-0208-10 00169-1833-11 00409-1316-25
TANK TANK TANK TANK TANK
10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3707717 R3706210 R3706211 R3706212 R3709471 R3711188 R3711194 R3713190
00071-0155-23 00172-3759-60 00378-0032-10 00378-0208-10 00071-0155-23 00182-4141-26 50111-0990-01 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK TANK
10/28/09
CHARGE
R3714901
51672-1275-02
TANK
PATIENT RECAP
RX OTC
171.81 14.79
VINCENZA 430 2 MEDICARE
ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) LISINOPRIL 10MG TABLET METOPROLOL TARTRATE 50MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) NOVOLIN R 100U/1ML VIAL-INSUL HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN LIPITOR 10MG TABLET LISINOPRIL 10MG TABLET METOPROLOL TARTRATE 50MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LIPITOR 10MG TABLET CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) VITAMIN D 50000IU CAPSULE HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN CLOTRIMAZOLE 1% CREAM
75 62.5
8.63 6.75
RX RX
5 10 5 10 5
2.88 2.88 2.88 33.87 13.61
RX RX RX RX RX
4 30 60 30 30 60 1 5
8.83 2.88 3.00 2.88 66.23 2.88 2.88 13.61
RX RX RX RX RX OTC RX RX
30
11.91
OTC
0.00 186.60
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/05/09 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09
CHARGE CHARGE
R3683568 S821873
CHARGE
00338-3552-48
SANTORO, MICHAEL RESIDENT# : 408 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB
VANCOMYCIN 1 GM 200 MLS IV ADMIN.SET NON-FILTER
4 4
112.28 0.00
IV
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S824348
GOLDFARB
INJECTION SITE NEEDLELESS VALVE
1
0.00
CHARGE
R3683571
64253-0333-35
GOLDFARB
4
2.88
IV
10/05/09
CHARGE
R3683572
64253-0111-35
GOLDFARB
10
2.88
RX
10/06/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 IVSPL 10/12/09 IVSPL 10/12/09 IVSPL
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3686250 R3690464 R3676526 R3676527 R3676528 R3683295 R3688256 R3692823 S821873
55513-0478-10 00064-5010-15 31722-0238-10 00172-4365-60 55111-0119-10 00378-0208-10 00245-0057-10 00338-3552-48
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN EPOGEN 20MU/1ML VIAL SANTYL OINTMENT AMLODIPINE BESYLATE 5MG TABLET LABETALOL 200MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA VANCOMYCIN 1 GM 200 MLS IV ADMIN.SET NON-FILTER
1 30 15 15 15 15 30 4 4
206.17 85.21 2.88 5.37 2.88 2.88 7.62 112.28 0.00
RX RX RX RX RX RX RX IV
CHARGE
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S824348
GOLDFARB
INJECTION SITE NEEDLELESS VALVE
1
0.00
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SANTORO, MICHAEL RESIDENT# : 408 STATION : SUB STATUS : MEDICARE
10/12/09
CHARGE
R3692829
64253-0333-35
GOLDFARB
4
2.88
IV
8
2.88
RX
GOLDFARB GOLDFARB GOLDFARB
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN EPOGEN 20MU/1ML VIAL VANCOMYCIN 1 GM 200 MLS INJECTION SITE NEEDLELESS VALVE
10/12/09
CHARGE
R3692832
64253-0111-35
GOLDFARB
10/13/09 10/19/09 10/19/09 IVSPL 10/19/09 IVSPL 10/19/09 IVSPL 10/19/09
CHARGE CHARGE CHARGE
R3694169 R3702027 S824348
55513-0478-10 00338-3552-48
1 4 1
206.17 112.28 0.00
RX IV
CHARGE
S821873
GOLDFARB
IV ADMIN.SET NON-FILTER
4
0.00
CHARGE
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
R3702028
64253-0111-35
GOLDFARB
8
2.88
RX
10/19/09
CHARGE
R3702029
64253-0333-35
GOLDFARB
4
2.88
IV
10/20/09 10/23/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3702066 R3708591 R3693913 R3693914 R3709504 R3709505
55513-0478-10 00013-8303-04 00172-4365-60 55111-0119-10 00378-0208-10 00245-0057-10
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN EPOGEN 20MU/1ML VIAL XALATAN 0.005% DROPS LABETALOL 200MG TABLET FAMOTIDINE 20MG TABLET (RP:PEPCID) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA
1 2.5 15 15 8 8
206.17 56.84 5.37 2.88 2.88 2.88
RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 IVSPL 10/26/09 IVSPL 10/26/09 IVSPL 10/26/09
CHARGE CHARGE
R3709858 S824348
CHARGE
GOLDFARB GOLDFARB
VANCOMYCIN 1 GM 200 MLS INJECTION SITE NEEDLELESS VALVE
4 1
112.28 0.00
S821873
GOLDFARB
IV ADMIN.SET NON-FILTER
4
0.00
CHARGE
S821872
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
R3709861
64253-0333-35
GOLDFARB
4
2.88
IV
10/26/09
CHARGE
R3709862
64253-0111-35
GOLDFARB
8
2.88
RX
10/26/09 10/31/09 IVSPL
CHARGE CHARGE
R3709061 M832506
55513-0478-10
GOLDFARB GOLDFARB
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN EPOGEN 20MU/1ML VIAL OCT 2009 IV SUPPLY PER DIEM
1 1
206.17 98.00
RX
PATIENT RECAP
IV IVSPLY
00338-3552-48
SANTORO, MICHAEL RESIDENT# : 408 STATION : SUB STATUS : MEDICARE
460.64 98.00
RX
1013.89
IV
0.00 1572.53
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/05/09 10/05/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/19/09 10/22/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE OTC RX
R3683441 R3683448 R3676533 R3676534 R3676535 R3676536 R3676537 R3676538 R3683298 R3702174 R3707123 R3693930 R3693931 R3693932 R3693933 R3693934 R3693935 R3706231
63736-0105-06 00045-1525-50 00378-0208-10 00378-1800-01 00245-0058-15 16729-0005-17 00172-3760-60 00378-2268-01 31722-0238-10 63481-0687-06 00075-0624-30 00378-1800-01 00245-0058-15 16729-0005-17 00172-3760-60 00378-2268-01 31722-0238-10 00378-0208-10 5.41 449.77
SANTUCCI, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
ANTHONY : 410 : SUB : MEDICARE
BACID CAPLET LEVAQUIN 500MG TABLET FUROSEMIDE 20MG TABLET (RP:LASIX) LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) LISINOPRIL 20MG TABLET (RP:ZESTRIL ) TERAZOSIN 5MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LIDODERM 5% PATCH LOVENOX 30MG/0.3ML DISP SYRIN LEVOTHYROXINE SODIUM 25MCG TABLET (RP:SYNTHROID) KLOR-CON M 20 20MEQ TABLET SA SIMVASTATIN 20MG TABLET (RP:ZOCOR) LISINOPRIL 20MG TABLET (RP:ZESTRIL ) TERAZOSIN 5MG CAPSULE AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) FUROSEMIDE 20MG TABLET
14 7 15 15 15 15 30 15 15 30 3 15 15 15 30 15 15 30
5.41 70.70 2.88 3.48 6.95 3.15 2.88 2.88 2.88 151.63 177.24 3.48 6.95 3.15 2.88 2.88 2.88 2.88
OTC RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX RX
0.00 455.18
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/02/09 10/05/09 10/05/09 10/05/09 10/05/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/15/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3682118 R3682119 R3682125 R3682126 R3682121 R3682123 R3683378 R3684747 R3684746 R3684752 R3683305 R3683306 R3691610 R3683307 R3688262 R3688263 R3688264 R3696918 R3693965
00378-1807-10 00185-0144-05 65162-0627-50 00603-1378-59 00182-4141-26 00075-0620-40 65162-0627-50 51660-0526-28 00310-0751-90 00025-1525-51 00378-1807-10 00185-0144-05 65162-0627-50 00182-4141-26 00310-0751-90 51660-0526-28 00025-1525-51 31722-0237-10 00378-1807-10
SCALERA, SOPHIE RESIDENT# : 417 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID) AMIODARONE HCL 200MG TABLET TRAMADOL 50MG TABLET (RP:ULTRAM) LACTULOSE 10GM/15ML SOLUTION CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) LOVENOX 40MG/0.4ML DISP SYRIN TRAMADOL 50MG TABLET (RP:ULTRAM) LORATADINE 10MG TABLET (RP:CLARITIN) CRESTOR 10MG TABLET CELEBREX 200MG CAPSULE LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID) AMIODARONE HCL 200MG TABLET TRAMADOL 50MG TABLET (RP:ULTRAM) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) CRESTOR 10MG TABLET LORATADINE 10MG TABLET (RP:CLARITIN) CELEBREX 200MG CAPSULE AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) LEVOTHYROXINE SODIUM 88MCG TABLET (RP:SYNTHROID)
10 10 15 946 10 2 15 7 7 14 15 15 30 15 15 15 30 11 15
2.96 7.38 2.88 20.81 2.88 118.15 2.88 2.88 20.71 40.62 4.44 11.07 2.88 2.88 44.38 2.88 87.03 2.88 4.44
RX RX RX RX OTC RX RX OTC RX RX RX RX RX OTC RX OTC RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3693966 R3701177 R3693967 R3693968 R3693969 R3693970 R3716306
00185-0144-05 31722-0237-10 00182-4141-26 00310-0751-90 51660-0526-28 00025-1525-51 65162-0627-50
521.75 17.28
SCALERA, SOPHIE RESIDENT# : 417 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
AMIODARONE HCL 200MG TABLET AMLODIPINE BESYLATE 2.5MG TABLET (RP:NORVASC) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D) CRESTOR 10MG TABLET LORATADINE 10MG TABLET (RP:CLARITIN) CELEBREX 200MG CAPSULE TRAMADOL 50MG TABLET (RP:ULTRAM)
15 15 15 15 15 30 30
11.07 2.88 2.88 44.38 2.88 87.03 2.88
RX RX OTC RX OTC RX RX
0.00 539.03
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SCARPULLA, GIUSEPINA RESIDENT# : 41 STATION : 3 STATUS : MEDICAID
09/17/09 10/15/09
CHARGE CHARGE
R3708121 R3698400
17714-0020-01 00054-3117-63
RENNER RENNER
10/27/09
CHARGE
R3712869
63736-0105-06
RENNER
PATIENT RECAP
OTC
29.67
DIPHENHYDRAMINE HCL 25MG CAPSULE (RP:BENADRYL) CALCIUM CARBONATE (ELEM.CALCIUM 500MG/5ML) 1250MG/5ML ORAL SUSP BACID CAPLET
1 500
2.88 15.98
OTC OTC
28
10.81
OTC
0.00 29.67
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/22/09 10/25/09 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09 10/29/09 10/29/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
OTC RX
R3706282 R3706284 R3706286 R3706292 R3706299 R3706288 R3709327 R3709499 R3709500 R3709501 R3709502 R3709503 R3716554 R3716555
63736-0105-06 00781-2822-01 63304-0579-10 42043-0141-05 00228-2888-50 00006-0951-54 63653-1171-05 63736-0105-06 00781-2822-01 63304-0579-10 00006-0951-54 63653-1171-05 67253-0900-11 00406-0357-05
29.34 130.27
SCHNEPEL, RESIDENT# STATION STATUS
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
ANNA : 431 : SUB : MEDICARE
BACID CAPLET FLUOXETINE 20MG CAPSULE (RP:PROZAC) METOPROLOL TARTRATE 25MG TABLET CEPHALEXIN 500MG CAPSULE (RP:KEFLEX) ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) COZAAR 25MG TABLET PLAVIX 75MG TABLET BACID CAPLET FLUOXETINE 20MG CAPSULE (RP:PROZAC) METOPROLOL TARTRATE 25MG TABLET COZAAR 25MG TABLET PLAVIX 75MG TABLET ALPRAZOLAM 0.25MG TABLET (RP:XANAX) HYDROCODONE/APAP 5MG/500MG TABLET (RP:VICODIN)
16 4 8 30 15 4 1 60 15 30 15 15 30 30
6.17 2.88 2.88 10.92 2.88 5.14 3.96 23.17 2.88 2.88 19.28 59.41 2.88 14.28
OTC RX RX RX RX RX RX OTC RX RX RX RX RX RX
0.00 159.61
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09 09/28/09
PATIENT RECAP
CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT CHARGE CREDIT
RX
R3671858 R3671858 R3671859 R3671859 R3671860 R3671860 R3671861 R3671861
31722-0238-10 31722-0238-10 00781-1599-05 00781-1599-05 00186-5040-54 00186-5040-54 57664-0458-88 57664-0458-88
-160.33
SCIMECA, VIOLA RESIDENT# : 89 STATION : 2 STATUS : MEDICARE
RENNER RENNER RENNER RENNER RENNER RENNER RENNER RENNER
AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) SPIRONOLACTONE 25MG TABLET (RP:ALDACTONE) NEXIUM 40MG CAPSULE SA NEXIUM 40MG CAPSULE SA METHIMAZOLE 5MG TABLET (RP:TAPAZOLE) METHIMAZOLE 5MG TABLET (RP:TAPAZOLE)
8 30 8 30 8 30 8 30
2.88 -3.87 2.88 -9.00 49.54 -193.50 3.37 -12.63
RX RX RX RX RX RX RX RX
0.00 -160.33
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 10/10/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3649223 R3690698
00023-0667-04 00023-0667-04
20.88
SETTANI, THERESA RESIDENT# : 71 STATION : 2 STATUS : MEDICAID
WIENER WIENER
REFRESH PM OPHTH OINT REFRESH PM OPHTH OINT
3.5 3.5
10.44 10.44
OTC OTC
0.00 20.88
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
00338-0049-04 00006-3843-71
SHAYNE, BETTY RESIDENT# : 413 STATION : 2 STATUS : MEDICARE
09/28/09 10/01/09
CHARGE CHARGE
R3686111 R3679973
SILVERMAN SILVERMAN
2000 2
19.72 148.98
10/01/09 IVSPL 10/01/09
CHARGE
S822714
2
0.00
CHARGE
R3679974
64253-0111-35
SILVERMAN
10/01/09
CHARGE
R3679978
64253-0333-35
SILVERMAN
10/01/09 10/05/09
CHARGE CHARGE
R3681093 R3683557
00378-0208-10 00006-3843-71
SILVERMAN SILVERMAN
10/05/09 IVSPL 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09
CHARGE
S822714
SILVERMAN
SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN FUROSEMIDE 20MG TABLET (RP:LASIX) INVANZ INJ 1 GM 110 MLS (SODIUM CHLORIDE 0.9% MINI-BAG PLUS (100ML BAG)) IV ADMIN.SET NON-FILTER
4
2.88
RX
2
2.88
IV
81 7
4.54 501.20
RX IV
7
0.00
CHARGE
S822713
SILVERMAN
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S822712
SILVERMAN
INJECTION SITE NEEDLELESS VALVE
1
0.00
CHARGE
R3683554
64253-0333-35
SILVERMAN
7
2.88
IV
R3683556
64253-0111-35
SILVERMAN
14
2.88
RX
R3684662
00064-5010-15
SILVERMAN
HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN SANTYL OINTMENT
10/05/09
CHARGE
10/05/09
CHARGE
30
85.21
RX
SILVERMAN
SODIUM CHLORIDE 0.9% (1000ML BAG) IV SOLN. INVANZ INJ 1 GM 110 MLS (SODIUM CHLORIDE 0.9% MINI-BAG PLUS (100ML BAG)) IV ADMIN.SET NON-FILTER
IV IV
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/06/09 IVSPL
PATIENT RECAP
CHARGE
IV IVSPLY
M832505
SHAYNE, BETTY RESIDENT# : 413 STATION : 2 STATUS : MEDICARE
SILVERMAN
675.66 31.50
RX
95.51
OCT 2009 IV SUPPLY PER DIEM
1
31.50
0.00 802.67
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/24/09 09/29/09 10/01/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX
R3708169 R3682995 R3681074 R3676430 R3676637 R3688280 R3688281 R3692980 R3692981 R3676635 R3676636
51672-4027-03 51672-4027-03 51672-4027-03 00527-1324-10 13668-0009-05 00378-0208-10 00245-0057-10 51672-4027-03 51672-4030-03 00006-0951-54 49884-0404-01
58.44
SIEGLEN, CAROL RESIDENT# : 377 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) WARFARIN SODIUM 1MG TABLET (RP:COUMADIN) WARFARIN SODIUM 1MG TABLET DIGOXIN 0.125MG TABLET CITALOPRAM 10MG TABLET (RP:CELEXA) FUROSEMIDE 20MG TABLET (RP:LASIX) KLOR-CON M 10 10MEQ TABLET SA WARFARIN SODIUM 1MG TABLET WARFARIN SODIUM 3MG TABLET COZAAR 25MG TABLET METOPROLOL SUCCINATE ER 25MG TABLET (RP:TOPROL XL)
3 1 8 6 15 15 15 3 4 15 15
2.88 2.88 4.32 2.88 2.88 2.88 3.81 2.88 2.88 19.28 10.87
RX RX RX RX RX RX RX RX RX RX RX
0.00 58.44
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/01/09 10/02/09 10/05/09 10/09/09 10/10/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
RX OTC
R3680354 R3681857 R3684820 R3689531 R3690890 R3683332 R3683333 R3683335 R3683336 R3683334 R3694119
64679-0714-04 00245-0058-15 50111-0990-01 00075-0620-40 00574-0412-02 63304-0579-10 16252-0505-90 55111-0158-10 00245-0058-15 07431-2011-40 00245-0057-10
347.21 2.88
SIEGLEN, EVELYN RESIDENT# : 415 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
ZOLPIDEM TARTRATE 5MG TABLET (RP:AMBIEN) KLOR-CON M 20 20MEQ TABLET SA VITAMIN D 50000IU CAPSULE LOVENOX 40MG/0.4ML DISP SYRIN POLYETHYLENE GLYCOL POWDER (RP:MIRALAX) METOPROLOL TARTRATE 25MG TABLET SIMVASTATIN 5MG TABLET (RP:ZOCOR) OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) KLOR-CON M 20 20MEQ TABLET SA VITAMIN D 400IU TABLET KLOR-CON M 10 10MEQ TABLET SA (RP:K-DUR (750MG))
7.5 20 2 4 255 45 15 15 30 15 13
2.88 9.26 2.88 236.29 12.90 3.24 2.88 59.69 13.89 2.88 3.30
RX RX RX RX RX RX RX RX RX OTC RX
0.00 350.09
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693547 R3693548
54900-0001-22 00182-4141-26
5.76
SKLENAR, FLORENCE RESIDENT# : 2 STATION : 3 STATUS : MEDICAID
KIM KIM
VITAMIN E 400IU SOFTGEL CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
30 60
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/10/09 09/10/09 09/10/09 09/10/09 09/10/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN RETURN
RX OTC
R3636494 R3636493 R3605686 R3624741 R3624736 R3625567 R3627736 R3625566 R3627736
00781-1966-10 00228-2672-11 00378-1903-01 63304-0579-10 65649-0301-03 00228-2672-11 63736-0105-06 63736-0105-06 63736-0105-06
-68.38 -41.17
SMITH, CHARLES RESIDENT# : 347 STATION : SUB STATUS : MEDICARE
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
FUROSEMIDE 40MG TABLET SPIRONOLACTONE 50MG TABLET (RP:ALDACTONE) MIDODRINE 10MG TABLET METOPROLOL TARTRATE 25MG TABLET XIFAXAN 200MG TABLET SPIRONOLACTONE 50MG TABLET (RP:ALDACTONE) BACID CAPLET BACID CAPLET BACID CAPLET
-11 -12 -13 -0.5 -5 -3 -28 -22 -30
-0.66 -6.46 -40.74 -0.04 -18.86 -1.62 -14.41 -11.32 -15.44
RX RX RX RX RX RX OTC OTC OTC
0.00 -109.55
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SPADARO, ANNA RESIDENT# : 55 STATION : 3 STATUS : MEDICARE
10/26/09 10/26/09
CHARGE CHARGE
R3711245 R3711246
00781-2128-01 00143-2260-01
TESTA TESTA
10/26/09
CHARGE
R3711247
49884-0405-01
TESTA
10/26/09
CHARGE
R3711249
00409-6533-01
TESTA
PATIENT RECAP
RX
112.34
RAMIPRIL 5MG CAPSULE ISOSORBIDE MONONITRATE ER 60MG TABLET SA (RP:IMDUR) METOPROLOL SUCCINATE ER 50MG TAB.SR 24H (RP:TOPROL XL) C-VANCOMYCIN ORAL SOLUTION 500MG/10CC SOLUTION
30 30
15.36 18.00
RX RX
30
21.73
RX
210
57.25
RX
0.00 112.34
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/02/09 10/06/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3681741 R3686227
63736-0105-06 63736-0105-06
9.27
SPADARO, ANNA RESIDENT# : 55 STATION : 3 STATUS : MEDICAID
TESTA TESTA
BACID CAPLET BACID CAPLET
10 14
3.86 5.41
OTC OTC
0.00 9.27
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SPIEGEL, PHILIP RESIDENT# : 393 STATION : SUB STATUS : MEDICARE
10/05/09 IVSPL 10/05/09 IVSPL 10/05/09 IVSPL 10/05/09
CHARGE
S817031
GOLDFARB
IV ADMIN.SET NON-FILTER
3
0.00
CHARGE
S817030
GOLDFARB
CENTRAL DRESSING CHANGE KIT
1
0.00
CHARGE
S817029
GOLDFARB
INJECTION SITE NEEDLELESS VALVE
1
0.00
CHARGE
R3684947
64253-0111-35
GOLDFARB
14
2.88
RX
10/05/09
CHARGE
R3684948
64253-0333-35
GOLDFARB
7
2.88
IV
10/05/09
CHARGE
R3684950
00409-6533-01
GOLDFARB
3
65.82
IV
10/06/09 10/09/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 IVSPL
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3686152 R3689832 R3676659 R3676662 R3676663 R3676664 R3676660 R3676661 M832504
00045-1525-50 00781-6141-16 51079-0007-56 55111-0532-01 49884-0545-04 16729-0005-17 63736-0105-06 00597-0058-01
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
SODIUM CHLORIDE 5CC IN 12CC SYR (FLUSH) 0.9% DISP SYRIN HEPARIN 5CC IN 12CC SYR (FLUSH) 100U/1ML DISP SYRIN VANCOMYCIN HCL 1.5 GM 280 MLS (SODIUM CHLORIDE 0.9% (250ML BAG) ) LEVAQUIN 500MG TABLET LEVETIRACETAM 100MG/1ML SOLUTION (RP:KEPPRA) OMEPRAZOLE (B) 20MG CAPSULE DR DIVALPROEX SODIUM SPRINKLES 125MG CAPSULE RANITIDINE 300MG TABLET (RP:ZANTAC) SIMVASTATIN 20MG TABLET BACID CAPLET FLOMAX 0.4MG CAPSULE SA OCT 2009 IV SUPPLY PER DIEM
7 473 30 270 15 15 15 15 1
70.70 165.08 119.37 221.67 3.05 3.15 5.80 44.34 10.50
PATIENT RECAP
IVSPLY RX
10.50 630.24
IV OTC
68.70 5.80
RX RX RX RX RX RX OTC RX
0.00 715.24
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
RX
R3646861
50111-0334-02
-0.22
SPITALNIAK, RESIDENT# : STATION : STATUS :
TANK
SR MARY (THERESA) 388 SUB MEDICARE
METRONIDAZOLE 500MG TABLET (RP:FLAGYL)
-1
-0.22
RX
0.00 -0.22
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC RX
R3693799 R3693802
00904-3232-92 00486-1125-01
2.88 4.74
SPRAGUER, RESIDENT# STATION STATUS
TESTA TESTA
JENNIE : 58 : 3 : MEDICAID
CALCIUM CARBONATE 600MG TABLET (RP:CALTRATE-600) K-PHOS NEUTRAL 250MG TABLET
60 30
2.88 4.74
OTC RX
0.00 7.62
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
SUAREZ, JOAN RESIDENT# : 335 STATION : SUB STATUS : MEDICARE
10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3714963 R3714964 R3714965 R3714966 R3714967 R3714968 R3714969
16714-0061-05 00378-1803-01 00054-3542-58 00143-1473-10 00527-1325-10 00173-0697-00 16252-0097-22
TESTA TESTA TESTA TESTA TESTA TESTA TESTA
10/28/09 10/28/09
CHARGE CHARGE
R3714970 R3714971
00008-0833-22 00536-3442-38
TESTA TESTA
10/28/09 10/28/09 10/28/09 10/28/09 10/28/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3714972 R3714975 R3714976 R3714977 R3714978
00245-0057-10 00182-4141-26 00006-0117-54 00597-0075-41 60505-0829-01
TESTA TESTA TESTA TESTA TESTA
10/28/09
CHARGE
R3714979
67253-0900-11
TESTA
PATIENT RECAP
RX OTC
607.06 5.76
METOCLOPRAMIDE 5MG TABLET (RP:REGLAN) LEVOTHYROXINE SODIUM 50MCG TABLET MEGESTROL ACETATE 40MG/1ML ORAL SUSP PREDNISONE 10MG TABLET DIGOXIN 0.25MG TABLET ADVAIR DISKUS 500MCG/50MCG INHALER ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) EFFEXOR XR 75MG CAP.SR 24H CEROVITE ADVANCED FORMULA 27-0.4MG TABLET (RP:CENTRUM) KLOR-CON M 10 10MEQ TABLET SA CALCARB/VIT D 600/400 TABLET SINGULAIR 10MG TABLET SPIRIVA HANDIHALER (30 CAPS) 18MCG INHALER FLUTICASONE PROPIONATE NASAL SPRAY 50MCG (RP:FLONASE NASAL) ALPRAZOLAM 0.25MG TABLET (RP:XANAX)
36 12 240 12 12 60 75
6.62 3.16 98.97 2.88 2.88 206.59 8.63
RX RX RX RX RX RX RX
12 12
39.24 2.88
RX OTC
12 12 12 30 16
3.05 2.88 36.09 137.45 58.62
RX OTC RX RX RX
30
2.88
RX
0.00 612.82
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
TOBIN, DOROTHY RESIDENT# : 402 STATION : SUB STATUS : MEDICARE
10/01/09 10/02/09
CHARGE CHARGE
R3681088 R3681411
59762-5016-01 16252-0097-22
GOLDFARB GOLDFARB
10/02/09
CHARGE
R3681412
49502-0685-26
GOLDFARB
10/02/09 10/05/09 10/05/09 10/10/09
CHARGE CHARGE CHARGE CHARGE
R3681655 R3683423 R3683431 R3690597
00093-7254-01 59762-5016-01 00075-0620-40 49502-0685-26
GOLDFARB GOLDFARB GOLDFARB GOLDFARB
10/10/09
CHARGE
R3690598
16252-0097-22
GOLDFARB
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3676456 R3676458 R3676459 R3676460 R3676461 R3683289 R3676455
00378-0032-10 31722-0238-10 00172-3760-60 60505-0065-01 00781-1966-10 00093-7254-01 00182-4141-26
GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB GOLDFARB
FLUCONAZOLE 100MG TABLET (RP:DIFLUCAN) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) GLIMEPIRIDE 1MG TABLET (RP:AMARYL) FLUCONAZOLE 100MG TABLET (RP:DIFLUCAN) LOVENOX 40MG/0.4ML DISP SYRIN IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) METOPROLOL TARTRATE 50MG TABLET (RP:LOPRESSOR) AMLODIPINE BESYLATE 5MG TABLET (RP:NORVASC) LISINOPRIL 20MG TABLET (RP:ZESTRIL ) OMEPRAZOLE 20MG CAPSULE DR (RP:PRILOSEC) FUROSEMIDE 40MG TABLET (RP:LASIX) GLIMEPIRIDE 1MG TABLET (RP:AMARYL) CALCARB/VIT D 600/400 TABLET (RP:CALTRATE-600 + D)
2 75
2.88 8.63
RX RX
62.5
6.75
RX
10 5 4 62.5
2.88 4.42 236.29 6.75
RX RX RX RX
75
8.63
RX
30 15 15 30 15 15 15
2.88 2.88 2.88 119.37 2.88 2.88 2.88
RX RX RX RX RX RX OTC
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
TOBIN, DOROTHY RESIDENT# : 402 STATION : SUB STATUS : MEDICARE
10/12/09 10/16/09
CHARGE CHARGE
R3676454 R3699554
00456-3210-60 16252-0097-22
GOLDFARB GOLDFARB
10/16/09
CHARGE
R3699116
50111-0990-01
GOLDFARB
PATIENT RECAP
RX OTC
456.73 2.88
NAMENDA 10MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION (RP:PROVENTIL ) VITAMIN D 50000IU CAPSULE
15 75
34.22 8.63
RX RX
2
2.88
RX
0.00 459.61
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/07/09 10/26/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3687819 R3693458
63736-0105-06 00182-1576-26
10.60
TRENTACOSTE, MARY RESIDENT# : 74 STATION : 2 STATUS : MEDICAID
TESTA TESTA
BACID CAPLET OYST-CAL 500MG TABLET (RP:OS-CAL 500)
20 30
7.72 2.88
OTC OTC
0.00 10.60
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
VERLINGO, RESIDENT# STATION STATUS
10/02/09 10/05/09
CHARGE CHARGE
R3681479 R3682839
16252-0097-22 49502-0685-26
TANK TANK
10/05/09 10/06/09 10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/13/09 10/14/09 10/19/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3683391 R3686296 R3676577 R3676578 R3676579 R3676580 R3676576 R3693285 R3695919 R3701353
59676-0320-04 59676-0320-04 00143-1248-10 57664-0397-58 00527-1116-10 00378-1903-01 00597-0058-01 00075-0624-30 00169-1833-11 59676-0320-04
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
PATIENT RECAP
RX OTC
1653.27 2.88
FREDERICK : 404 : SUB : MEDICARE
ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION (RP:ATROVENT INH U-D) PROCRIT 20MU/1ML VIAL PROCRIT 20MU/1ML VIAL FOLIC ACID 1MG TABLET METFORMIN 500MG TABLET SODIUM CHLORIDE 1GM TABLET MIDODRINE 10MG TABLET FLOMAX 0.4MG CAPSULE SA LOVENOX 30MG/0.3ML DISP SYRIN NOVOLIN R 100U/1ML VIAL-INSUL PROCRIT 20MU/1ML VIAL
75 62.5
8.63 6.75
1 2 15 30 15 45 30 3 10 2
238.26 476.52 2.88 2.88 2.88 141.03 88.69 177.24 33.87 476.52
RX RX RX RX RX RX OTC RX RX RX RX RX
0.00 1656.15
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
OTC
R3636487
17714-0019-01
-0.14
VERRIEST, RESIDENT# STATION STATUS
GOLDFARB
JANET : 362 : SUB : HMO PATIENTS
SIMETHICONE 80MG TAB CHEW (RP:GAS-X)
-5
-0.14
OTC
0.00 -0.14
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/30/09
PATIENT RECAP
CHARGE CHARGE
OTC
R3693675 S831868
00182-4141-26 17191-0051-04
5.76
VITA, ANGELA RESIDENT# : 30 STATION : 3 STATUS : MEDICAID
TANK TANK
CALCARB/VIT D 600/400 TABLET ADAPTA-CAP 28MM/SIZE K (PHENYTOIN) EACH
60 1
2.88 2.88
OTC OTC
0.00 5.76
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
VRANA, MURIEL RESIDENT# : 365 STATION : SUB STATUS : MEDICARE
10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09 10/09/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3690264 R3690266 R3690267 R3690268 R3690273 R3690274 R3690276 R3690280 R3690393 R3690282 R3690270 R3690281 R3690310
00378-1805-01 57664-0434-88 00904-5062-60 65580-0643-71 16252-0097-22 49502-0685-26 60505-2607-01 65162-0627-50 00378-0208-10 11523-7162-01 00006-0951-54 00065-8533-02 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK TANK
10/09/09 10/10/09 10/11/09 10/12/09 10/12/09
CHARGE CHARGE CHARGE CHARGE CHARGE
R3690391 R3690893 R3691106 R3691447 R3691465
49884-0035-10 00168-0006-80 60505-2608-01 57664-0434-88 00378-1805-01
TANK TANK TANK TANK TANK
LEVOTHYROXINE SODIUM 75MCG TABLET ALLOPURINOL 100MG TABLET CALCIUM CITRATE 200MG TABLET METOLAZONE 2.5MG TABLET ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION CARVEDILOL 6.25MG TABLET (RP:COREG) TRAMADOL 50MG TABLET FUROSEMIDE 20MG TABLET CLARITIN D 12 HOUR 5MG/120MG TABLET SA COZAAR 25MG TABLET CIPRODEX 0.3% DROPS SUSP HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN MECLIZINE HCL 25MG TABLET TRIAMCINOLONE ACETONIDE 0.1% OINTMENT CARVEDILOL 12.5MG TABLET (RP:COREG) ALLOPURINOL 100MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET
3 2 3 3 75 62.5 6 15 3 30 3 7.5 5
2.88 2.88 2.88 2.88 8.63 6.75 2.88 2.88 2.88 43.09 3.86 79.78 13.61
7.5 80 2 6 15
2.88 4.00 2.88 2.88 4.37
RX RX OTC RX RX RX RX RX RX OTC RX RX RX RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
VRANA, MURIEL RESIDENT# : 365 STATION : SUB STATUS : MEDICARE
10/12/09 10/12/09 10/12/09 10/12/09 10/12/09 10/14/09 10/15/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3691467 R3691469 R3691470 R3691466 R3691468 R3696165 R3698197
65580-0643-71 00378-0208-10 60505-2608-01 00904-5062-60 00006-0951-54 00072-5760-04 00409-1316-25
TANK TANK TANK TANK TANK TANK TANK
15 15 30 15 15 120 5
13.37 2.88 4.29 2.88 19.28 8.36 13.61
RX RX RX OTC RX OTC RX
TANK TANK TANK TANK TANK TANK
METOLAZONE 2.5MG TABLET FUROSEMIDE 20MG TABLET CARVEDILOL 12.5MG TABLET (RP:COREG) CALCIUM CITRATE 200MG TABLET COZAAR 25MG TABLET LAC-HYDRIN 5 5% LOTION HEPARIN SODIUM (P/F) 10/BOX 5000UNIT/0.5ML DISP SYRIN IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION KLOR-CON M 20 20MEQ TABLET SA METOLAZONE 2.5MG TABLET SODIUM CHLORIDE 0.9% (1000ML BAG) 1000 MLS IV SOLUTION SET W/ REGULATOR
10/16/09 10/16/09 10/20/09 10/21/09 10/23/09 10/23/09 IVSPL 10/26/09 10/26/09 10/26/09 10/26/09 10/26/09
CHARGE CHARGE CHARGE CHARGE CHARGE CHARGE
R3698626 R3698628 R3704107 R3704323 R3708239 S830267
49502-0685-26 16252-0097-22 00245-0058-15 65580-0643-71 00338-0049-04
62.5 75 1 5 4 4
6.75 8.63 2.88 4.46 27.88 0.00
RX RX RX RX IV
CHARGE CHARGE CHARGE CHARGE CHARGE
R3693841 R3694019 R3694024 R3709524 R3709592
57664-0434-88 00378-1805-01 60505-2608-01 00378-0208-10 49502-0685-26
TANK TANK TANK TANK TANK
ALLOPURINOL 100MG TABLET LEVOTHYROXINE SODIUM 75MCG TABLET CARVEDILOL 12.5MG TABLET (RP:COREG) FUROSEMIDE 20MG TABLET (RP:LASIX) IPRATROPIUM BROMIDE U.D. 0.5MG/2.5ML SOLUTION
6 15 30 15 62.5
2.88 4.37 4.29 2.88 6.75
RX RX RX RX RX
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/26/09 10/26/09 10/26/09 10/31/09 IVSPL
PATIENT RECAP
CHARGE CHARGE CHARGE CHARGE
RX OTC
R3709611 R3694020 R3694022 M832503
16252-0097-22 00904-5062-60 00006-0951-54
272.15 60.09
IV IVSPLY
VRANA, MURIEL RESIDENT# : 365 STATION : SUB STATUS : MEDICARE
TANK TANK TANK TANK
ALBUTEROL SULF. U/D 0.83MG/1ML SOLUTION CALCIUM CITRATE 200MG TABLET COZAAR 25MG TABLET OCT 2009 IV SUPPLY PER DIEM
27.88 10.50
75 15 15 1
8.63 2.88 19.28 10.50
RX OTC RX
0.00 370.62
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
WYMAN, DOROTHY RESIDENT# : 312 STATION : 3 STATUS : MEDICAID
10/08/09
CHARGE
R3689585
62261-0112-01
TANK
10/26/09 10/28/09
CHARGE CHARGE
R3693759 R3714535
74312-0813-80 63736-0105-06
TANK TANK
PATIENT RECAP
OTC
9.62
CARBAMIDE PEROXIDE OTIC 6.5% DROPS (RP:DEBROX OTIC) VITAMIN B12 1000MCG TABLET BACID CAPLET
15
2.88
OTC
30 10
2.88 3.86
OTC OTC
0.00 9.62
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09 09/17/09 09/17/09 09/17/09 09/17/09 09/17/09
PATIENT RECAP
RETURN RETURN RETURN RETURN RETURN RETURN
RX
R3650030 R3657063 R3642636 R3642634 R3642633 R3642637
51672-4030-03 51672-4028-03 00781-2272-01 00591-0347-01 00310-0751-90 62175-0118-43
-56.95
ZAKRZEWSKI, RESIDENT# : STATION : STATUS :
TANK TANK TANK TANK TANK TANK
CORA 385 SUB MEDICARE
WARFARIN SODIUM 3MG TABLET WARFARIN SODIUM 2MG TABLET AMLODIPINE/BENAZEPRIL 5-10MG CAPSULE (RP:LOTREL) HYDROCHLOROTHIAZIDE 12.5MG CAPSULE CRESTOR 10MG TABLET OMEPRAZOLE 20MG CAPSULE DR
-8 -14 -3 -3 -5 -6
-4.67 -7.90 -5.36 -0.36 -14.79 -23.87
RX RX RX RX RX RX
0.00 -56.95
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CTR FOR HEALTH & REHAB 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
09/17/09
PATIENT RECAP
RETURN
RX
R3658285
50111-0333-01
-2.04
ZVYURNIE, RESIDENT# STATION STATUS
ARNOUK
ANGELINA : 373 : SUB : MEDICARE
METRONIDAZOLE 250MG TABLET (RP:FLAGYL)
-24
-2.04
RX
0.00 -2.04
GERISCRIPT 100 I Commerce Way Totowa, NJ 07512-1158 800-209-4143
10/31/09
Invoice# PH61821
MAYWOOD CENTER FOR HEALTH & REHABILITATION 100 W MAGNOLIA AVE MAYWOOD, NJ 07607
10/13/09 10/26/09 10/31/09
CASH CASH PH
CK# 00015 CK# 00163
MAYWOOD CTR FOR HEALTH & REHAB CUSTOMER# 24M
THANK YOU FOR YOUR PAYMENT.... - JUNE 2009 PYMT THANK YOU FOR YOUR PAYMENT.... NEW CHARGES
0-30 32866.85
31-60 41412.93
61-90 32446.24
91-120 0.00
121+ 0.00
155211.52
33537.21
0.00
188748.73
82022.71
-42418.39 -39604.32 33537.21
0.00
106726.02
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