INTERNATIONAL PHARMACEUTICAL TRIP APPLICATION

Transcription

1 1650 N Indianwood Avenue, Broken Arrow, OK Phone: Fax: order@blessing.org INTERNATIONAL PHARMACEUTICAL TRIP APPLICATION *PLEASE FILL OUT COMPLETELY*A NEW APPLICATION IS REQUIRED FOR EVERY TRIP* *PLEASE FILL OUT ACTUAL FOREIGN COUNTRY INFO* FOREIGN COUNTRY INFORMATION Foreign Mission Name Mission Director Address Will you be working with a physician from this country? Yes No WE REQUIRE AT LEAST 20 BUSINESS/WORKING DAYS PLUS SHIPPING TIME TO PROCESS YOUR ORDER. ORDERS WILL BE SHIPPED BASED ON PRODUCT AVAILABILITY AND TRIP DEPARTURE DATE. Name Title Address Zip Phone Alt Phone Will you be accompanying the team on this trip? Yes No If not, who is responsible for proper distribution of medicine? Name & Position Organization BILLING INFORMATION Organization Name E.I.N. (Federal Tax ID #) - Billing Contact Billing Address Zip Phone Is this a home address or a church/business address? *Please note this will be used to transmit invoices. If there is another person responsible for paying invoices for this account, please indicate below. Alternate Billing Contact Alternate Billing Contact Phone Alternate Billing Contact CITY & COUNTRY MEDICINE WILL BE USED IN Is this the fi rst time the above ministry has used our services? DEPARTURE DATE RETURN DATE Yes No LAST DATE YOU CAN ACCEPT BACKORDERS Please tell us how you found about about Blessings SPECIAL INSTRUCTIONS? FIRST TIME USERS, PLEASE SEE OUR INSTRUCTIONS ONLINE. PREPAYMENT AND 501(C)3 LETTER MUST BE SUBMITTED. MEDICAL PROFESSIONAL INFORMATION *PLEASE NOTE SHIPPING ADDRESS MUST MATCH ADDRESS ON Application must be signed by a physician (M.D. or D.O.) Copy of PHYSICIAN S LICENSE. medical license required. Please see our instructions for complete details. SHIPPING OR PICKUP INFORMATION SIGNATURE REQUIRED ON PAGE 2. Please ship order I will pick up order Is this a residential address? Yes No Organization Name Contact Person c/o Business Name Address Zip Phone Alt Phone PLEASE SEE PAGE 2 FOR SIGNATURE & ADDITIONAL REQUIREMENTS. INCOMPLETE APPLICATIONS MAY BE DELAYED IN PROCESSING. RECEIPT OF YOUR ORDER WILL BE CONFIRMED VIA SENT TO THE BILLING CONTACT PERSON. IF YOU DO NOT RECEIVE AN ORDER ACKNOWEDGE- MENT VIA WITHIN 3 BUSINESS DAYS, PLEASE CONTACT US AT IT MEANS WE DID NOT RECEIVE YOUR ORDER. Form MED 1 of 11 Pharmaceutical Trip Application Page

2 INTERNATIONAL PHARMACEUTICAL TRIP APPLICATION - PAGE 2 TO BE FILLED OUT AND SIGNED BY MEDICAL PROFESSIONAL AND RETURNED WITH COPY OF YOUR MEDICAL LICENSE & MINISTRY S 501(C)3 LETTER (IF NOT ALREADY ON FILE) SIGNED COPY MUST BE FAXED BEFORE ORDER CAN BE PROCESSED If your destination country REQUIRES medicine to have a future expiration date, please enter that date here: (mm/dd/yy) Not applicable REQUIREMENTS OF MEDICAL MISSIONS Signature by physician licensed in the state to where the order is being shipped is required for ALL orders. If ordering only vitamins or over-the-counter medicines, signature may be by any person responsible for the order. The following is a list of operational requirements which medical missions must meet and concur with before Blessings International will commence and/or continue shipments of pharmaceuticals and supplies to them. 5. Pharmaceuticals obtained from Blessings International should be used only for the treatment of indigent patients; for short term medical mission teams (those less than 3 months), the medicines are not to be sold or exchanged or transferred for money, property, or services. 1. IMPORT FOR EXPORT DISCLOSURE: All medicine with IMPORT FOR EXPORT or IFE in the description has been formulated for use outside of the USA only. If medicine of this category has been ordered, you hereby agree that it will not be used within the USA or any of its possessions & territories. Additionally, you agree that medicine of this category will not be returned to the USA. Further, you agree that all medicine on the accompanying order will not be used in or returned to the USA. 2. A physician must obtain proper approval to practice medicine in the country where the mission is located, if required. 3. If a clinic or hospital is operated, there must be a permit from the region, state, or province of its location. A permit must be obtained for importation of drugs duty free, if required. 4. A physician must be responsible for the appropriate utilization, dispensation, and safety in storage of all drugs. 6. Pharmaceuticals must not be used in a government operated hospital or clinic except by specifi c permission. 7. Pharmaceuticals will be distributed and employed in a way that glorifi es God. 8. Within 30 days of return from medical mission trip, an original signed Pharmaceutical Feedback Form must be returned to Blessings International. Failure to do so will prevent our ability to serve you in the future. I have read and accept responsibilty to fulfi ll all of the Requirements of Medical Missions as the conditions for the management and distribution of all pharmaceuticals and/or medical supplies obtained through Blessings International. If the person signing below is not accompanying the trip, they agree that the above requirements are met by those who are going. Signature of Medical Professional/*Person Responsible Printed Name of Medical Professional/*Person Responsible Title Date Pharmaceutical Trip Application Page 2 Form MED 2 of 11

3 ALL PAGES OF THE ORDER FORM HAVE TO BE FAXED SPECIAL NOTICES Important Documentation Notification: Recently mission teams to Nicaragua and El Salvador have told us of increased government requirements to bring in medicines. Blessings encourages you to research the requirements for drug importation prior to your departure to any country. If you want Blessings to provide additional documentation, we will be glad to do that. We need to charge $2.00 for each document (Proforma, Certificate of Analysis, Gift Certificate, Certificate of Authenticity) to cover our cost. Documents cannot be sent until an order is ready to ship. PRO -- Proforma (signed, stamped and sealed) -- Proforma ELS--Proforma PAN--Proforma COQ --Certificate of Quality and Authenticity GC -- Gift Certificate COA--Certificate of Analysis issued by manufacturer (only available on For Export Only products) To order the above Documents check the last page; they are the last items on the order form. Documents cannot be sent until an order is ready to ship. New Items to Blessings order form-(these are not for donation) Page Naproxen sodium 220mg CAPS BACK IN STOCK Page Cough drops cherry flavored 125 drops per box 3817 Terazosin HCl 5mg caps Page U Cyclobenzaprine HCl 10mg tabs 100ct 4146 Singulair 4mg (Montelukast) 90ct Page Brimonidine tartrate 0.2% ophthalmic solution 5ml 2735 Bacitracin zinc, neomycin sulfate, polymyxin B sulfate ointment 1oz tubes - triple antibiotic ointment 5999 DynaRub pain relieving cream non-greasy 3oz-methyl- sailcylate 30%-menthol 10%- camphor 4% 3791 Hydrocortisone acetate 2.5% cream (15gm) tube SUNG Sun Glasses 10 to pack 3282 Zinc oxide 1oz 28.4g ointment tube 3789 Timolol Maleate Ophthalmic solution 0.5%: 10mL Page Sodium chloride 0.9%:1000mL in IV bag BACK IN STOCK Page Sunscreen SPF 30 lotion 4oz (118ml)flip top bottle, water resistant (80 mins) Page I.V. administration set 78" tube-15 drops/ml-1-2 inject sites 9055 Instant Cold Packs 4"x5" squeeze-knead-apply 3976 Syringe 5cc 21G x 1 1/2" L/L PAGE Blood Pressure Monitor w/large cuff & AC adapter, comes w/4aabatteries DONATIONS B.I. will donate to you any of the following items that we have in our stock donation inventory. If you need any of these, just mark how many you want on this page, then fax it in with your order. Please note that we have limited stock on items so they will be donated on first come, first serve basis. 4445H Nystatin 100,000 units/ml oral solution; 30mL FOR EXPORT ONLY 1 EXPIRES 04/ H Metoprolol 50mg tabs BID [LIKE LOPRESSOR] 1M EXPIRES 02/ N Malaria RDT for plasmodia falciparuma :results in 15 mins; 25 EXPIRES 02/2016 Like us on facebook! Look for us in your newsfeed regarding product availability updates, surveys, and feedback from other medical mission teams.

4 02/01/16 International Pharmaceutical Order Form Page 2 Unit Legend 1M = 1,000 EA= Each IFE=FOR EXPORT ONLY OUT OF STOCK=NOT AVAILABLE FOR THIS TRIP BACKORDER WITH DATE IN BLANK=IS THE DATE BI EXPECTS IT DUE IN (STOCK) IF IT IS STAMPED NOT IN DATE RANGE= MEANS IT IS NOT IN THE DATE RANGE YOU ASKED FOR. Examples: 15M = 15,000 25M = 25,000 Blessings International 1650 North Indianwood Avenue Broken Arrow, OK USA Telephone Fax order@blessing.org Website: Surely blessing I will bless thee.. HEB 6:14 February 2016 These medicines are to be used solely for the ill, needy, or infants. Medicines are not for sale or resale. The handling charge may be changed at any time. Please note all charges are subject to change due to market price fluctuations and availability. We make every attempt to secure the absolute lowest charge. PLEASE FAX ALL PAGES OF THE ORDER FORM TO INSURE WE HAVE THE COMPLETE ORDER. IF ALL PAGES ARE NOT FAXED THIS COULD HOLD YOUR ORDER UP. THANK YOU 000 TABLETS AND CAPSULES ANTACIDS AND ANTIFLATULENTS 4607 Calcium carbonate 500mg chewable tabs, asst flavors x 500 $ U Omeprazole 20mg caps, delayed-release [LIKE PRILOSEC] x 100 $ Omeprazole 20mg caps, D. R.-FOR EXPORT ONLY[LIKE PRILOSEC] x 1M $ Ranitidine 15mg/mL 16oz (75mg/5mL) x 1 $ Ranitidine 150mg tabs FOR EXPORT ONLY x 1M $27.45 ANALGESICS 2644 Acetaminophen 325mg tabs x 1M $ Acetaminophen 500mg tabs (Paracetamol) FOR EXPORT ONLY x 1M $ Acetaminophen 80mg children's chewable fruit flavored tabs x 1M $ Acetaminophen suppositories 120mg (pediatric) x 12 $ Aspirin 325mg enteric coated tabs x 1M $ Aspirin 81mg enteric coated, adult, DR tabs: not chewable x 1M $ Ibuprofen 200mg, tabs-- FOR EXPORT ONLY x 1M $ Naproxen sodium 220mg CAPS x 100 $7.50 ANTIBIOTICS, ANTIBACTERIALS, ANTIFUNGAL, ANTIVIRAL 1281 Amoxicillin 125mg, dispersible tabs, in 5mL FOR EXPORT ONLY x 100 $6.00 (dissolvable) on tongue 3946U Amoxicillin 250mg (chewable) tabs x 100 $ Amoxicillin 250mg (chewable) tabs FOR EXPORT ONLY x 1M $ U Amoxicillin 250mg (chewable) tabs x 500 $ C Amoxicillin 500mg caps FOR EXPORT ONLY x 1M $ U Amoxicillin 500mg caps x 500 $ Amoxicillin 500mg,clavulanate potassium 125mg, tabs FOR EXPORT ONLY x 50 $ Azithromycin 250mg tab FOR EXPORT ONLY x 500 $ Azithromycin 250mg tab FOR EXPORT ONLY x 250 $ U Cephalexin 250mg caps x 100 $ U Cephalexin 250mg caps x 500 $ U Cephalexin 500mg caps [LIKE KEFLEX] x 100 $ U Cephalexin 500mg caps [LIKE KEFLEX] x 500 $ Ciprofloxacin 500mg tabs - FOR EXPORT ONLY [CIPROX] x 500 $ Clindamycin 150mg caps x 100 $ Cloxacillin 500mg caps FOR EXPORT ONLY x 1M $ Doxycycline hyclate 100mg tabs FOR EXPORT ONLY x 1M $ Erythromycin stearate BP 250mgtabs FOR EXPORT ONLY x 500 $ Dicloxacillin sodium 250mg cap x 100 $ Fluconazole 150mg, tab FOR EXPORT ONLY [LIKE DIFLUCAN] x 100 $ D Fluconazole 150mg, tab FOR EXPORT ONLY [LIKE DIFLUCAN] x 500 $ C Fluconazole 200mg, caps FOR EXPORT ONLY [LIKE DIFLUCAN] x 100 $ Griseofulvin 125mg tabs FOR EXPORT ONLY x 1M $ D Griseofulvin 500mg tabs FOR EXPORT ONLY x 500 $ Itraconazol 100mg caps FOR EXPORT ONLY OUT OF STOCK x 28 $ Nitrofurantoin 100mg tabs FOR EXPORT ONLY x 500 $ Nystatin 500,00 unit tabs (oral) FOR EXPORT ONLY x 100 $ Minocycline HCl 100mg caps x 50 $ Phenoxymethyl Penicillin 250mg(Pen VK) tabs, FOR EXPORT ONLY x 1M $ C Levofloxacin 500mg tabs FOR EXPORT ONLY x 100 $ Sulfamethoxazole 400mg,trimethoprim 80mg tabs FOR EXPORT ONLY x 1M $34.00 [LIKE BACTRIM OR SEPTRA] 4396 Sulfamethoxazole 800mg, trimethoprin 160mg DS tabs IFE x 500 $30.00

5 Description International Pharmaceutical Order Form Quantity Unit Charge Page 3 [LIKE BACTRIM SEPTRA] ANTIAMEBICS 4651 Metronidazole 250mg tabs - FOR EXPORT ONLY [LIKE FLAGYL] x 1M $ Tinidazole 500mg tabs FOR EXPORT ONLY x 500 $36.65 ANTIVIRALS 0230 Aciclovir 200mg tabs FOR EXPORT ONLY[LIKE ZOVIRAX] x 500 $ U Acyclovir 200mg tabs [LIKE ZOVIRAZ] x 100 $8.65 ANTHELMENTICS 2325 Ivermectin 6mg tabs, scabies treatment 2 tabs per/ adult FOR EXPORT ONLY x 100 $ Ivermectin 6mg tabs, scabies treatment 2 tabs per/ adult FOR EXPORT ONLY x 500 $ Mebendazole 100mg chewable tab FOR EXPORT ONLY [LIKE VERMOX] x 1M $ D Albendazole 400mg chewable tab -- FOR EXPORT ONLY x 500 $50.00 ANTIMALARIALS 0321 Artemether 20mg + Lumefantrine 120mg FOR EXPORT ONLY [Like Coartem] x 24 $ Chloroquine phosphate tabs 150mg base x 100 $3.25 ANTIDIARRHEALS & ANTISPASMOTIC 3430 Bismuth subsaliclate 262mg chewable tabs [LIKE PEPTOBISMAL TABS] x 30 $ Loperamide HCl 2mg caps FOR EXPORT ONLY [LIKE IMMODIUM] x 500 $ Loperamide HCl 2mg caps FOR EXPORT ONLY [LIKE IMMODIUM] x 100 $5.00 ANTIHISTAMINE, DECONGESTANTS, 3100 Chlorpheniramine maleate 4mg tabs x 1M $ Cough drops cherry flavored 125 drops per box x 125 $ Cough drops cherry flavored (24bags/30ct) x 720 $ Cough drops honey lemon flavor (24bags/30ct) x 720 $ Cough drops Menthol flavor (24bags/30ct) x 720 $ Diphenhydramine 50mg, caps [LIKE BENADRYL] x 1M $ Diphenhydramine HCl 25mg caps [LIKE BENADRYL] x 1M $ D Guaifenesin 400mg, tabs USP x 500 $ U Loratadine 10mg tabs [LIKE CLARITIN] x 100 $ Loratidine 10mg tabs, FOR EXPORT ONLY x 500 $ Cetirizine HCI 10mg tab FOR EXPORT ONLY x 500 $ U Cetirizine HCl 10mg tabs ZYRTEC x 100 $ Promethazine HCl 25mg tabs [LIKE PHENERNAN] x 100 $6.00 MISCELLANEOUS 3519 Estradiol 0.5mg tabs x 100 $ C Atorvastatin 10mg tabs FOR EXPORT ONLY [LIKE LIPITOR] x 100 $ Estradiol 1mg tabs x 100 $ U Simvastatin 10mg tabs x 90 $ U Simvastatin 10mg tabs x 500 $ U Simvastatin 20mg tabs x 90 $ U Simvastatin 20mg tabs x 1M $ U Simvastatin 20mg tabs x 500 $ U Simvastatin 40mg tabs x 30 $5.05 ANTIHYPERTENSIVES AND DIURETIC 4573U Atenolol 50mg tabs x 100 $ Atenolol 50mg tab FOR EXPORT ONLY x 1M $ Captopril 25mg tabs FOR EXPORT ONLY x 1M $ Chlorthalidone tabs 25mg x 100 $ C Enalapril 10mg tabs FOR EXPORT ONLY x 100 $ Enalapril 10mg tabs FOR EXPORT ONLY x 1M $ Furosemide 40mg tabs FOR EXPORT ONLY x 1M $ Hydrochlorothiazide 25mg tabs FOR EXPORT ONLY x 1M $ M Lisinopril 10 mg tab, FOR EXPORT ONLY x 1M $ D Losartan potassium 50mg FOR EXPORT ONLY x 500 $ U Losartan potassium 50mg tabs x 90 $ Metoprolol 50mg tabs BID [LIKE LOPRESSOR] x 1M $ Metoprolol 50mg tabs BID [LIKE LOPRESSOR] x 100 $ Terazosin HCl 5mg caps x 100 $5.65 ANTIINFLAMMATORY AND ANTIGOUT 3985 Allopurinol 100mg tabs FOR EXPORT ONLY x 50 $ Diclofenac sodium 50mg tabs (enteric coated) FOR EXPORT ONLY x 1M $ U Ibuprofen 400mg, tabs x 500 $ Ibuprofen 400mg, tabs FOR EXPORT ONLY x 1M $ U Ibuprofen 400mg tabs x 500 $ Ibuprofen 600mg film coated tabs--for EXPORT ONLY x 1M $ U Ibuprofen 600mg film coated tabs x 500 $ U Ibuprofen 800mg tabs x 500 $ U Meloxicam 7.5mg tabs x 100 $ U Meloxicam 7.5 mg tabs x 1M $ U Meloxicam 15mg tabs x 100 $ U Meloxicam 15 mg tabs x 1M $ M Prednisone 10mg tabs FOR EXPORT ONLY x 1M $ M Prednisolone 5mg tabs FOR EXPORT ONLY x 1M $ Prednisone 20mg tabs x 100 $20.65 ANTIPSYCHOTICS, ANTIDEPRESSANTS, 4161M Amitriptyline 25mg tabs FOR EXPORT ONLY x 1M $17.50

6 International Pharmaceutical Order Form Page Fluoxetine 20mg caps PROZAC x 500 $ Sertraline HCL 25mg [LIKE ZOLOFT] x 30 $ Sertraline HCL 25mg [LIKE ZOLOFT] x 90 $ Sertraline HCL 25mg x 500 $ U Sertraline HCL 100mg [LIKE ZOLOFT] x 30 $ U Sertraline HCL 100mg [LIKE ZOLOFT] x 500 $ Trazodone HCl 150mg tabs [LIKE DESYREL] x 100 $ Trazodone HCI 150mg tabs x 500 $49.90 ANTIEPILEPTIC & ANTIPARKINSON 1048 Carbamazepine 200mg tabs FOR EXPORT ONLY [LIKE TEGRETOL] x 1M $ U Gabapentin 100mg caps x 100 $ U Gabapentin 300mg caps x 100 $ U Gabapentin 300mg caps x 500 $ Levetiracetam 250mg tabs [LIKE KEPPRA] x 120 $ Phenytoin sodium 100mg caps FOR EXPORT ONLY x 100 $8.20 ANTISPASMODIC, ANTICHOLENERGIC 4565 Dicyclomine HCl 10mg caps [LIKE BENTYL] x 100 $ Metoclopramide 5mg tabs [LIKE REGLAN] x 500 $ Promethazine 25mg tabs FOR EXPORT ONLY x 100 $9.00 BRONCHIAL DILATORS 3989 Albuterol sulfate 0.083% 2.5mg/3mL inhalation solution x 25 $ D Salbutamol 2mg tabs/(albuterol) FOR EXPORT ONLY x 500 $ D Salbutamol 4mg tabs scored/(albuterol) FOR EXPORT ONLY x 500 $ Singulair 4mg (Montelukast) x 90 $ Beclomethasone.05mg/dose oral inhaler FOR EXPORT ONLY x 1 $ Salbutamol (Albuterol) oral inhaler 0.1mg; 200 doses FOR EXPORT ONLY x 1 $5.75 CARDIAC GLYCOSIDES, ANTIARRHYMICS, 1250M Amlodipine 5mg tabs [LIKE NORVASC] x 1M $ Clopidogrel 75mg tabs [LIKE PLAVIX] x 30 $ Clopidogrel 75mg tabs [LIKE PLAVIX] x 90 $ Isosorbide Dinitrate 10mg tabs FOR EXPORT x 500 $ U Verapamil HCl 80mg tabs x 100 $ Verapamil HCl 80mg tabs x 1M $ Warfarin sodium 5mg tabs [LIKE COUMADIN] x 100 $13.75 DIABETES, HYPOGLYCEMICS 1330 Glibenclamide 5mg tabs (Glyburide) FOR EXPORT ONLY x 1M $ U Glipizide 10mg tabs [LIKE GLUCOTROL] x 500 $ Glipizide 10mg tabs (scored) FOR EXPORT ONLY [LIKE GLUCOTROL] x 1M $ U Glipizide 5mg tabs [LIKE GLUCOTROL] x 500 $ U Glipizide 5mg tabs [LIKE GLUCOTROL] x 1M $ M Metformin 1000mg tabs [LIKE GLUCOPHAGE] FOR EXPORT ONLY x 1M $ U Metformin 850mg tabs [LIKE GLUCOPHAGE] x 500 $ U Metformin HCl 850mg tabs [LIKE GLUCOPHAGE] x 100 $ Metformin HCI 500mg tabs FOR EXPORT ONLY [LIKE GLUCOPHAGE] x 1M $ U Metformin HCI 500mg tabs [LIKE GLUCOPHAGE] x 100 $2.25 LAXATIVES 3609 Bisacodyl 5mg delayed-release, tabs x 1M $ Docusate sodium 100mg soft gels x 1M $ Docusate sodium 100mg soft gels x 100 $2.10 MUSCLE RELAXANT, MINOR TRANQUILIZERS 0875 Chlorzoxazone 500mg tabs FOR EXPORT ONLY x 500 $ U Cyclobenzaprine HCl 10mg tabs [LIKE FLEXERIL] x 100 $ U Cyclobenzaprine HCl 10mg tabs [LIKE FLEXERIL] x 1M $ Methocarbamol 500mg tabs x 500 $34.25 VITAMINS, MINERALS 2187 Vitamin A 200,000 IU caps FOR EXPORT ONLY x 1M $ Ferrous sulfate 325mg tabs x 1M $ Folic acid 800mcg tab x 1M $ Multivit: Children chewable without iron Vit-A 2500IU;Vit-D3 400IU; x 1M $17.00 Vit-B1 1.05mg; Vit-B2 1.2mg; Vit-B6 1.05mg; Vit-B12 4.5mcg; Vit-C 60mg; Vit-E 15IU;Niacin 13.5mg 2196ZMC1 Multivit: Child chew w/iron,zn: Vit-A 2500IU;Vit-D 400IU; Vit-B1 1.05mg; x 27M+ $ Vit-B2 1.2mg; Vit-B6:1.05mg; Vit-B124.5mcg; Vit-C 60mg; Vit-E 15IU; Niacin 13.5mg; 2196 Iron(as ferrous fumarate) 15mg.ZINC [BOX CT IS 27,273] Multivit: Children chew w/iron: Vit-A 2500IU;Vit-D 400IU; Vit-B1 1.05mg; x 25M $ Vit-B2 1.2mg; Vit-B6 1.05mg; Vit-B124.5mcg; Vit-C 60mg; Vit-E 15IU; Niacin 13.5mg; Iron(as ferrous fumerate) 15mg Multivit: Children chew w/iron: (Same content as ) x 1M $ Multivitamins w/fe & I: VitA w/beta carotene 5000IU; VitD 400IU; VitC x 25M $ mg; VitB1 1.5mg; VitB2 1.7mg; VitB6 2.0mg; niacinamide 20mg; Ca pantothenate 10mg; folic acid0.4mg;vit-b12 6mcg;Iron as fumarate mg;IODI18mg;IODINE 0.225mg RDA VITAMINS W/IRON & IODINE[BOX CT 25,200] Multivitamins w/fe &I: (Same content as ) RDA x 1M $17.00 VITAMINS/IRON/IODINE

7 International Pharmaceutical Order Form Page B Multivitamins:without IRON & IODINE:VitA 5000IU;VitC60mg; x 25M $ VitD-3 400IU;VitB-1VitB- 21.7mg;Niacin 20mg; VitB-6 2mg;VitB-12 6mcg; 1900 VitE30IU;Foliate 400mcg;Pantothenic Acid 1mg; Multivitamins: without IRON & IODINE :VitA 5000IU;VitC60mg;VitD-3 400IU; x 1M $17.00 VitB-1VitB- 2,1.7mg;Niacin 20mg; VitB-6 2mg;VitB-12 6mcg; VitE30IU;Foliate 400mcg;Pantothenic Acid 1mg; 3199 Prenatal vitamins: (Same content as ) x 500 $ Prenatal vitamins: Vit-A 4,000IU; Vit-D 400 IU; Vit-E11 IU; Vit-C 100mg; x 16M+ $ Vit-B1 1.84mg; f olic acid 0.8mg;VitB2 1.7mg; niacinamide 18mg; Vit-B6 2.6mg; Vit-B12 4mcg;Ca 200mg; Fe 60m g (as fumerate); Zn 25mg (as o25mg (as oxide) [BOX CT IS 16,667] 1731 Zinc sulfate monohydrate 20mg (DISPERSIBLE) FOR EXPORT ONLY x 100 $ Infant Multivitamin drops w/iron: A-1500 IU, D-400 IU,E-5 IU, C-35mg, x 6 $25.30 B1-0.5mg, B2-0.6mg, Niacin 8mg,B6-0.4mg, Iron 10mg/1mL (50mL) 1 2/3oz dropper bottle LIQUID[LIKE POLY-VI-SOL W/IRON] 200 TOPICALS GENERAL TOPICALS 1077 Betamethazone 0.1% cream 15gr (1/2 oz) FOR EXPORT ONLY x EA $ DynaRub pain relieving cream non-greasy 3oz-methyl- sailcylate x EA $ %-menthol 10%- camphor 4% 4499 Hemorrhoidal rectal suppositories [LIKE PREPARATION H] x 12 $ Hydrocortisone 0.5% cream 15gm1/2oz tube FOR EXPORT ONLY x 12 $ Hydrocortisone 1% 15mg tube FOR EXPORT ONLY x 10 $ Hydrocortisone acetate 2.5% cream (15gm) tube x 12 $ Hydrocortisone cream 1% foil packet x 144 $ Vitamin A & D ointment foil packs 5g x 144 $ White Petrolatum foil packs 5g x 144 $ Zinc oxide 1oz 28.4g ointment tube x ea $0.80 ANTIBIOTICS AND ANTISEPTICS 9000 Empty-1/2oz round hinged lid plastic container-can be used to divide up x 30 $7.50 creams/ointments 4392 Bacitracin 500 units ointment 1.0gm foil packets x 144 $ Bacitracin zinc, neomycin sulfate, polymyxin B sulfate ointment 0.9gm x 144 $ foilpackets [TRIPLE ANTIBIOTIC] 15gm/Bacitracin zinc 400 unitsneomycin sulfate 5mg, polymyxin B ointment x 12 $ /2 oz (14.17gm) tube [TRIPLE ANTIBIOTIC] Bacitracin zinc, neomycin sulfate, polymyxin B sulfate ointment 1oz tubes - x EA $2.95 triple antibiotic ointment 2004 Clotrimazole 1% antifungal cream 20gm IFE ONLY [LIKE LOTRIMIN] x 10 $ Miconazole nitrate 2% cream 1oz (30gm) tube [LIKE MICOTIN] x 6 $ X Nystatin ointment 100,000 unit 1oz (30gm) tube, FOR EXPORT ONLY x 10 $ Nystatin ointment 100,000 unit 1oz (30gm) tube, FOR EXPORT ONLY x EA $ Povidone iodine 10% topical solution 128oz (3784mL)gallon x 1 $ Povidone iodine 10% topical solution 16oz (473 ml) pint x 1 $ Silver sulfadiazine 1% cream 50gm tubes [LIKE SILVADENE 1%] x 1 $ Tolnaftate 1% cream 1/2oz (15gm) tube x 6 $10.65 ANTILICE - PEDICULICIDES 2325 Ivermectin 6mg tabs, scabies treatment 2 tabs per/ adult FOR EXPORT ONLY x 100 $ Ivermectin 6mg tabs, scabies treatment 2 tabs per/ adult FOR EXPORT ONLY x 500 $ Lice Shampoo - non-toxic enzyme concentrate 16oz;32 treatments per x 1 $27.00 bottle. Includes instructions BLESSINGS LICE SHAMPOO 4108 Permethrin 5% cream; 60gm tube - FOR EXPORT ONLY x 1 $ Permethrin Lotion 1% 60mL cream rinse-w/lice combs x 2 $ Permethrin Lotion 1% 100mL cream rinse FOR EXPORT ONLY x EA $ Scabies Solution - non-toxic enzyme concentrate 32 oz; 16 treatments x 1 $34.50 per bottle. instructions included. ITCH B GONE OPHTHALMICS & OTICS 8100 Reading Glasses-variety pack assorted powers-from +1/+1.25/+1.5/+1.75/+2/+2.5 x 19 $ Glasses for near-sighted (-1.0 to -4.5) adjustable on side of each ear piece. x EA $13.50 SUNG Sun Glasses x 10 $ Brimonidine tartrate 0.2% ophthalmic solution 5ml x 1 $ Carbamide peroxide 6.5% ear drops 1/2oz(14.79mL) x EA $ Ciprofloxacin 0.3% sterile ophthalmic solution 10mL x 1 $ Gentamicin sulfate 0.3%-- ophthalmic solution; 5mL FOR EXPORT ONLY x 10 $ Ketorolac tromethamine 0.5% ophthmic solution;5ml sterile x 10 $15.75 FOR EXPORT ONLY 4000 Lubricant eye drops 8 pks of 4 sterile 0.02 fl oz x 32 $ Lubricant eye drops polyvinyl alcohol 1.4%,benzalkonium chloride.01%-5ml- x 10 $15.00 FOR EXPORT ONLY [llike LIQUITEARS] 2997 Naphazoline HCl.01% USP ophthmic solution;5ml sterilefor EXPORT ONLY x 10 $ Ofloxacin.3% ophthalmic 5 ml-drops-for EXPORT ONLY x 10 $ Prednisolone acetate 1.0% ophthalmic suspension 5ml FOR EXPORT ONLY x 10 $ Tetrahydrozoline HCl Ophthalmic drops 0.05% 1/2oz (15mL) OPTI-CLEAR x 12 $ Timolol Maleate Ophthalmic solution 0.5%: 10mL x 10 $ Timolol Maleate Ophthalmic solution 0.5%: 10mL x 1 $3.30

8 International Pharmaceutical Order Form Page Tobramycin 0.3%, dexamethasone0.1% ophthalmic 5mL FOR EXPORT ONLY x 10 $12.50 VAGINALS 0700 Fluconazole 150mg, tab FOR EXPORT ONLY [LIKE DIFLUCAN] x 100 $20.65` 0700D Fluconazole 150mg, tab FOR EXPORT ONLY [LIKE DIFLUCAN] x 500 $ U Clotrimazole vaginal cm USP 1%antifungal 45gm (1.5 oz) w/app x 1 $ X Clotrimazole 500mg vaginal tab NO APPLICATOR FOR EXPORT ONLY x 10 $ Clotrimazole 100mg vaginal tabw/applicator-6 tabs per box FOR EXPORT ONLY x 6 $ Lubricating jelly sterile 2oz x EA $ S Vaginal specula (small) ready to use - disposable x 10 $ M Vaginal specula (medium) ready to use - disposable x 10 $ L Vaginal specula (large) ready to use-disposable x 10 $ Obsterical Kit:1 pr str gloves1 drape sheet,2 umbilical clamps str,2 O.B. x 1 $9.00 towelettes 1-O.B.Pad str, 1plastic bag for placenta,6 gauze sponges 1 bulb syringe,4 disposable towels 2 nylon tie-offs,scalpel twist ties, rec-ing blanket 2 alcohol preps medium, 400 LIQUIDS tsp child medicine spoon x 10 $ oz empty plastic cough syrup bottles x 10 $ tsp oral medicine syringe 5mL x 10 $ Medicine cups 1oz disposable: 100 cups / bag x 100 $1.45 ANTACIDS AND ELECTROLYTES 4120U Magnesium hydroxide 400mg;12oz (Milk of Magnesia) Mint x 1 $ Ranitidine 15mg/mL 16oz (75mg/5mL) x 1 $ Oral rehydration salts- NaCl 3.5g, KCl 1.5g, trisodium Na 2.9g, glucose x 100 $ g, sachet for 1 liter soln. FOR EXPORT ONLY ANALGESIC LIQUIDS, SYRUPS 2437 Acetaminophen drops 80mg 0.8mL; 15mL _OUT x 1 $ Acetaminophen drops 80mg/0.8mL 30mL _OUT x 1 $ Acetaminophen elixir 160mg/5mL;4 fl.oz. (118mL) x 1 $ Acetaminophen elixir 160mg/5mL; 16oz x 1 $ Ibuprofen o/s 100mg/5mL; 4oz [LIKE MOTRIN] x 1 $4.75 ANTIBIOTICS, LIQUID OR FOR SUSPENSIONS 1281 Amoxicillin 125mg, dispersible tabs, in 5mL water FOR EXPORT ONLY x 100 $ U Amoxicillin 600mg, clavulanate potassium 42.9mg:5mL/125mL for o/s x EA $ Amoxicillin for o/s 125mg/5mL;pwd-100mL FOR EXPORT ONLY x 40 $52.70 THESE ARE IN PLASTIC BOTTLES - WT. 6 lbs PER CASE Amoxicillin for o/s 250mg/5ml;100ml FOR EXPORT ONLY x 10 $19.50 These are in GLASS BOTTLES wt. 3.4 lbs 3171U Amoxicillin for o/s 250mg/5ml;100ml in plastic wt. 2.3lbs x 12 $ U Amoxicillin for o/s 125mg/5mL;100mL x 12 $ U Amoxicillin for o/s 400mg/5mL;50mL BID x 6 $ Azithromycin for o/s 200mg/5mL;pwd- 15mL FOR EXPORT ONLY x 10 $ Nystatin 100,000 units/ml oral solution; 30mL FOR EXPORT ONLY x 1 $ Sulfamethoxazole 200mg, trimethoprim 40mg/5mL;100mL pediatric susp: x 12 $21.65 FOR EXPORT ONLY [LIKE BACTRIM OR SEPTRA] ANTIHISTAMINE, DECONGESTANTS, COUGH & 3807 Diphenhydramine HCl elixir 12.5mg/5mL; 16oz [LIKE BENADRYL] x 1 $ Diphenhydramine HCL 12.5mg/5mL 4oz (118mL) x 1 $ Guaifenesin 100mg dextromethorphan 10mg/5mL expectorant x 12 $16.95 suppressant 4oz [like ROBITUSSIN DM] 3434 Guaifenesin syrup 100mg/5mL; 16oz [LIKE ROBITUSSIN] x 1 $ Guaifenesin 100mg/5mL 4 fl. oz. x EA $ Loratadine 5mg/5ml solution 4 fl.oz. (118ml) x 1 $6.00 ANTIHISTAMINE, NASAL SPRAYS AND ASTHMA 2268 Albuterol sulfate syrup 2mg 5m : 1 pint (473mL) [LIKE VENTOLIN] x 1 $ Nasal saline decongestant spray 15mL [LIKE AFRIN] x 1 $ Nasal saline spray PLAIN (ocean spray)15ml x 1 $1.05 VITAMINS - LIQUID, POWDER AND NUTRITIONAL 3082 Ferrous sulfate elixir 220mg/5mL; 16oz (473mL) x 1 $ Infant Multivitamin drops w/iron: A-1500 IU, D-400 IU,E-5 IU, C-35mg, x 6 $23.40 B1-0.5mg, B2-0.6mg, Niacin 8mg,B6-0.4mg, Iron 10mg/1mL (50mL) 1 2/3oz dropper bottle [LIKE POLY-VI-SOL W/IRON] MISCELLANEOUS 500 INJECTABLES ANTIMALARIALS 0491 Artemether 80mg/1ml s.d.v. ampoule FOR EXPORT ONLY x 6 $10.80 ANESTHETICS 3814 Epinephrine inj. 1:1000 1mg/ml1ml s.d.v.-for EXPORT ONLY x 10 $ Epinephrine 1:1000(1mg/mL) 30 ml x EA $ Lidocaine 1% w/epinephrine 10mg/mL;50mL x 1 $ Lidocaine 2% w/ epinephrine 10mg/ml:30ml (MDV) x 1 $ Lidocaine HCl 1% inj. 10mg/mL;50mL m.d.v. x EA $ Lidocaine HCl 2% inj. 20mg/mL;50mL m.d.v. x EA $1.95

9 International Pharmaceutical Order Form Page 7 DENTAL 3891 Lidocaine 2% 1:100,000 w/epinephrine 1.7mL per cartridge -dental cartridges x 50 $ Needle 27g x 1" DENTAL disposable, sterile x 100 $ Needle 30g x 1/2" DENTAL disposable, sterile x 100 $ Toothbrushes,pre pasted x 20 $ Toothpaste w/flouride 1.5oz x 12 $ 3.20 ANTIBIOTIC 4632 Ceftriaxone sodium 1gm str pdr for IM or IV, 6mL s.d.v. [LIKE ROCEPHIN] x EA $ Ceftriaxone sodium 1gm str pdrfor IM or IV, 6ml s.d.v. FOR EXPORT ONLY x 10 $20.00 [LIKE ROCEPHIN] 4645 Ceftriaxone sodium 250mg str pdr for IM or IV, 6mL s.d.v. [LIKE ROCEPHIN] x EA $ Ceftriaxone sodium 250mg str pwd/ IM or IV, 6ml s.d.v. IFE [LIKE ROCEPHIN] x 10 $ Ceftriaxone sodium 500mg pwd for IM or IV, 6mL s.d.v. [LIKE ROCEPHIN] x EA $3.00 MISCELLANEOUS, VITAMINS 2946 Bacteriostatic inj.(not for newborns)sterile 30ml m.d.v. x EA $ Cyanocobalamin 1mg/ml inj:1ml FOR EXPORT ONLY x 10 $ Dexamethasone inj. 4mg/mL; 30mL m.d.v. x EA $ Dexamethasone inj. 5mg/ml; 1ml s.d.v. ampoule FOR EXPORT ONLY x 10 $ Diphenhydramine HCl inj. 50mg/mL 1mL m.d.v. [LIKE BENADRYL] x EA $ Furosemide 20mg/mL 2ml inj IM/IV:ampoule FOR EXPORT ONLY x 10 $ Promethazine HCl 25mg/ml; 1mL s.d.v.:ampoule [LIKE PHENERGAN] x EA $ Promethazine HCL 50mg/ml 1ml [LIKE PHENERGAN] x EA $ Phenytoin sodium inj 100mg/2mL x 1 $ Sodium chloride 0.9% inj. 10mL s.d.v. x EA $ Sodium chloride 0.9%:1000mL in IV bag x 1 $ PERSONAL PROTECTION BOOKS 4252 A Comprehensive Guide To Missions / Karen Bean, RN. book, written by x 1 $35.00 a missionary vast experience, is designed to be a practical manual 6013 for anyone involved in foreign missions. FREE CD Coloring Books to help promote burn safety/central America printed in Spanish x 1 $1.50 w/crayons Coloring Books to help promote good hygiene/central America printed in x 1 $1.50 Spanish w/crayons x 1 $ Coloring Books to help promote good hygiene/africa- printed in Swahili x 1 $ w/crayons Coloring Books to help promote good hygiene/africa- printed in English x 1 $ w/crayons. Coloring Books to help promote good hygiene/haiti- printed in Creole w/crayons x 1 $1.50 PERSONAL PROTECTION PRODUCTS 6200 Water purification tabs (Potable Aqua) 2 tabs = 1qt. / 1 bottle = 6 galsarssm1964 x 50 $ Water purifier Outback bucket system, 5-gallon pour through, gravity- x 1 $ feed unit. No water pressure required Purifies 1,500gallons at 8 gal/hr OutBack bucket purification replacement cartridge x 1 $ OutBack bucket-water sediment filter (prefilter) 30 micron replacement x 1 $ Sunscreen SPF 30 lotion 4oz (118ml)flip top bottle, water resistant (80 mins) x 1 $$ BANDAGES & SURGICAL SYRINGES, TAPE, GAUZE, MISC Adhesive bandage 1" x 3" sterile non-stick [LIKE BAND-AIDS] x 100 $ Adhesive flexible fabric bandage 3/4"x3" sterile non-stick [LIKE BAND- x 100 $ Alcohol prep pads 200/box x 200 $ Benzalkonium chloride, 0.13% antiseptic cleansing towelette 5"x7" x 100 $ Butterfly wound closures (M) 3/8x1 7/8 (medium) x 100 $ Butterfly wound closures (LG)1/2x2 3/4 (large) x 100 $ Cap Nurse's blue x 100 $ Catheter foley, silicone coated, retention 5cc, 12 Fr x 10 $ Catheter foley, silicone coated, retention 5cc, 14 Fr x 10 $ Catheter foley, silicone coated, retention 5cc, 16 Fr x 10 $ Catheter foley, silicone coated, retention 5cc, 18 Fr x 10 $ Cotton tip applicators 6" non-sterile x 100 $ Elastic bandage 2" x 5 yds. x 10 $ Elastic bandage 3" x 4.5 yds. x 10 $ Elastic bandage 4" x 4.5 yds. x 10 $ Face mask ear loop x 50 $ N95 Respirater mask w/nose cushion & tan straps (Medium) x 20 $ Gauze-sterile 2x2x8ply (2 sponges/env)sterile x 50 $ Gauze sponge 2x2x8 ply in ready to sterilize bag x 200 $ Gauze sponge 4x4x8 ply in read to sterilize bag x 200 $ Gauze sponge 4x4x8 ply sterile bag(2 sponges/env) x 50 $ Gauze sponge 4x4x8 ply sterilize bag(2 sponges/env) x 25 $ Gauze sterile 4.5" x 147" 6 ply roll krinkled x 1 $ Gloves light powder latex (XS)x-small x 100 $ Gloves light powder latex (S) small x 100 $ Gloves light powder latex (M) medium x 100 $7.50

10 International Pharmaceutical Order Form Page Gloves light powder latex (L) large x 100 $ Gloves latex powder free small x 100 $ Gloves powder free Nitrile (S)SMALL x 100 $ Gloves powder free Nitrile (M) medium x 100 $ Gloves powder free Nitrile (L) large x 100 $ Gloves powder free Nitrile (XL) X-large x 100 $ Gloves latex surgical sterile (pairs) size 6 1/2 x 50 $ Gloves latex surgical sterile (pairs) size 7 x 50 $ Gloves latex surgical sterile (pairs) size 7 1/2 x 50 $ Gloves latex surgical sterile (pairs) size 8 x 50 $ Gloves latex surgical sterile (pairs) size 8 1/2 x 50 $ Hand Sanitizer w/moisturizing kills 99% germs-4oz flip top x 1 $ Medicine cups 1oz disposable: 100 cups / bag x 100 $ Instant Cold Packs 4"x5" squeeze-knead-apply x 1 $ I.V. catheter/needle unit; 20G x 1" [NEEDLES ONLY] x EA $ I.V. catheter/needle unit; 22G X 1" [NEEDLES ONLY] x EA $ I.V. administration set 105"tube length-60 drops/ml-2 inject sites x EA $ IV Start Kit:1/tourniquet- 2/gauze sponge(2x2-8ply)-1/id label-1/transparent dress x 1 $1.25 1/tape (3/4x18)-1/PVP pad- 1/alcohol pad 7140 Needle ONLY 25G x 1" x 100 $ Needle ONLY 18G x 1.5" x 100 $ Needle ONLY 21G x 1.5" x 100 $ Needle only 25G x 5/8" x 100 $ Obsterical Kit:1 pr str gloves1 drape sheet,2 umbilical clamps str,2 O.B. x 1 $9.00 towelettes 1-O.B.Pad str, 1plastic bag for placenta,6 gauze sponges 1 bulb syringe,4 disposable towels 2 nylon tie-offs,scalpel twist ties, rec-ing blanket 2 alcohol preps medium, 4468 Povidone Iodine prep pads x 100 $ Povidone iodine 10% topical solution 128oz (3784mL)gallon x 1 $ Povidone iodine 10% topical solution 16oz (473 ml) pint x 1 $ M Surgical gown reinforced (sterile):contents inculde-)1gown,2 hand towels, x EA $ L Surgical gown reinforced (sterile):contents inculde- ) x EA $3.75 (MED) 1gown,2 hand towels,(large) 1196XL Surgical gown reinforced (sterile):contents inculde- x EA $3.75 1gown,2 hand towels,(x-large) 1781 Sterilization Pouch 7.5x13 self-sealing (if you need more deals please call office) x 200 $ Scalpel #10 blade sterile x 100 $ Scalpel #10 blade sterile with attached to handle x 10 $ Scalpel #11 blade sterile x 100 $ Scalpel #11 blade sterile attached to handle x 10 $ Scalpel #15 blade sterile x 100 $ Scalpel #15 blade sterile attached to handle x 10 $ Syringe 10cc 20Gx1 1/2" L/L x 100 $ Syringe 10cc without needle x 100 $ Syringe 1cc 25Gx5/8" L/L x 100 $ Syringe 1cc 27G x 1/2" x 100 $ Syringe 1cc without needle x 100 $ Syringe 3cc 21G x 1 1/2" L/L x 100 $ Syringe 3cc 22Gx1 1/2" L/L x 100 $ Syringe 3cc 23G x 1" L/L x 100 $ Syringe 3cc 23Gx 1 1/2" L/L x 100 $ Syringe 3cc 25g x 1" x 100 $ Syringe 3cc without needle x 100 $ Syringe 5cc 21G x 1 " L/L x 100 $ Syringe 5cc 21G x 1 1/2" L/L x 100 $ Syringe 5cc 22G x 1 1/2" L/L x 100 $ Syringe 5cc without needle x 100 $ SPLINT 36"-lightweight, reusable, waterproof, compact, radiolucent, versatile, x 1 $6.00 longitudinal bend to give the splint strength. works for double layer wrist splintsugar tong arm - splint ankle stirrup splint c-curve to create 3783 Tape, adhesive surgical paper 1"x10 yards hypo allergenic x 12 $ Tongue depressor blades adult 6" x 3/4" x 500 $ Tongue depressor blades junior x 500 $ Towel Drape disposable, sterile x 50 $ Unna Boot Bandage x 1 $ PICTURE DOSING LABELS ONLY/same design that's on 3x4 baggies- x 10 $ labels to unit 4257 Zip lock bags 3"x4"x2mil; with picture dosing & white block for writing x 100 $2.50 FDA approved materials 4542 Zip lock bags 3"x5"x2mil; plain double bagged will hold up 120mL liquid x 100 $3.00 SUTURES & SUTURE NEEDLES 7211 Suture catgut chromic 0 1x150cm FOR EXPORT ONLY x 36 $ Suture silk 2/0 45cm 3/8 rc needle 24.5mm FOR EXPORT ONLY x 36 $ Suture silk 2/0 45cm 3/8cc needle 24.5mm FOR EXPORT ONLY x 36 $ Suture synth abs 2/0 70cm 1/2rb needle 26mm FOR EXPORT ONLY x 36 $74.80

11 International Pharmaceutical Order Form Page EQUIPMENT & MISCELLANEOUS EQUIPMENT & MISCELLANEOUS tsp oral medicine syringe 5mL x 10 $ tsp child medicine spoon x 10 $ oz empty plastic cough syrup bottles x 10 $ Empty-1/2oz round hinged lid plastic container-can be used to divide up x 30 $7.50 creams/ointments 9008 Empty-plastic 60cc bts w/lids and labels x 10 $ PICTURE DOSING LABELS ONLY/same design that's on 3x4 baggies- x 10 $ labels to unit 9006 Asthma Mentor-peak flow meter adult or pediatric x 1 $ K Blood glucose monitor; include monitor,manual,battery,carring case, 10 lancets, x 1 $15.00 Lancing device,10 test strips and log book MONITOR IS A TRUE TRACK 9004 Blood glucose monitor; include monitor, manual, battery, carrying case, x 1 $2.00 [MONITOR IS A TRUE TRACK] 9002 Blood glucose test strips; for TrueTrack x 50 $ Lancets; for use with either all monitors requiring 28g x 100 $ Cauterie disposable fine tip, high temperature,4 year shelf life x 1 $ Ear Syringe 1oz x 1 $ HIV 1 & 2 Test Kits for 1 and 2:results in 20 mins-for EXPORT ONLY OUT OF STOCK x 25 $78.40 PMTR Patient Medical Treatment Record- in packs of 50 x 50 $ Reading Glasses-variety pack assorted powers-from +1/+1.25/+1.5/+1.75/+2/+2.5 x 19 $ Glasses for near-sighted (-1.0 to -4.5) adjustable on side of each ear piece. x EA $ N Malaria RDT for plasmodia falciparuma :results in 15 mins; x 25 $41.00 includes 25 individually sealed test, lancets, alcohol swab, sample applicator, pipette s, developing buffer store at 6 to 45 degree C 9051N Malaria Rapid Detection Test for both falciparum and vivax malaria:results in out of stock x 25 $ mins includes 25 individually sealed test, lancets, alcohol swab, sample applicator, pipette s, developing buffer store at 6 to 45 degree C 9095 Mosquito Nets: treated w/ deltamethrin-130cmx180cmx150cm(rectangular) x 1 $ Nebulizer handheld AC adapter included x 1 $ Nebulizer handhld AC adapter Pediatric-Margo-Moo portable red barn x 1 $57.75 carrying case 3666D Nebulizer handheld AC adapter Pediatric-Digger Dog w/dog House carrying bag-5m x 1 $45.00 Medicine cup, angled mouthpiece, 7" air tubing, child mask, and instructions in Spanish 2301R Otoscope economy (requires 2 C batteries) x 1 $ A Otoscope Disposable Ear specula Adult x 100 $ C Otoscope Disposable Eat specula Child x 100 $ Ophthalmoscope/Otoscope w/eurolight (E10) requires 2 " C" batteries [KaWe] x 1 $ Pregnancy test, one step, simple to read x EA $ Pregnancy HCG test; quick stick one step FOR EXPORT ONLY x 25 $ Pill Crush, crash tablets into powder x 1 $ Sharps- container red large 10qt (biohazard waste) x 1 $ Blood Pressure Monitor w/large cuff & AC adapter, comes w/4aabatteries x EA $ Sphygmomanometer adult precision aneroid nylon cuff x 1 $ Sphygmomanometer child (precision aneroid) w/ blue nylon cuff x 1 $ Sphygmomanometer infant (precision aneroid) w/ blue nylon cuff x 1 $ Sphygmomanometer XL adult precision aneroid nylon cuff x 1 $ Stethoscope fetal 29" black vinyl Y-tubing x 1 $ Stethoscope spectrum dual head x 1 $ Stethoscope spectrum nurse, black x 1 $ Tablet cutter x 1 $ Tablet/Pill, tray counter w/spa x 1 $ Thermometer INFRARED forehead scan, guidebook in english & spanish x 1 $ Thermometer DIGISCAN multi-function ear &forehead scan-talking x 1 $25.00 in,english & Spanish (no probe covers with this one) -(probe covers # 4332) 3707 Thermometer DIGITAL w/beeper, memory, and fever alarm, x 1 $ battery included.(probe covers #3153) Thermometer probe covers DIGITAL EAR disposable TENDER TEMP x 40 $6.25 PROBE COVERS 3153 Thermometer probe covers DIGITAL oral disposable x 50 $ Lubricating jelly sterile 2oz x EA $ S Vaginal specula (small) ready to use - disposable x 10 $ M Vaginal specula (medium) ready to use - disposable x 10 $ L Vaginal specula (large) ready to use-disposable x 10 $ Urine dip test strips: 10 PARAMETERS-glucose, protein, nitrite, ph, blood, and x 100 $29.25 leukocytes; Uroblinogen Specific Gravity: Ketone: Bilirubin: visual testing PRO Proforma (signed, stamped and sealed) in box only x 1 $2.00 Proforma will be to the address (that you) provide for us x 1 $6.00 address: Then Proforma will be sent with order in Box 1 ELS Proforma - designed for the country of El Salvador ONLY x 1 $7.00 These will be to you also, please provide the address it should go to

12 Description International Pharmaceutical Order Form Quantity Unit Charge Page 10 PAN Proforma- designed for the country of Panama ONLY x 1 $10.00 These will be to you also, please provide the address it should go to COQ Certificate of Quality and Authenticity x 1 $2.00 GC Gift Certificate x 1 $2.00 COA Certificate of Analysis issued by manufacturer for every IFE product x per item $2.00 on your order.(only available on For Export Only products and ndc's) IF YOU DO NOT RECEIVE AN FROM US WITH A ORDER ACKNOWLEDGEMENT IN 3 BUSNIESS DAYS PLEASE CALL OUR OFFICE. Due to the increased volume of orders and our turnaround time from our suppliers you will see BK(back orders) on some of your orders. Blessings cannot guarantee that you will get your BK, we will do everything we can to have it to you by the date that is written in the blank on the packing list of your original order, that is the day that we expect to ship it OUT to you. PLEASE FAX ALL PAGES OF THE ORDER FORM TO INSURE WE HAVE THE COMPLETE ORDER. IF ALL PAGES ARE NOT FAXED THIS COULD HOLD YOUR ORDER UP. THANK YOU IFE=FOR EXPORT ONLY OUT OF STOCK=NOT AVAILABLE FOR THIS TRIP BACKORDER WITH DATE IN BLANK=IS THE DATE BI EXPECTS TO RECEIVE THIS ITEM BACK IN STOCK. IF IT IS STAMPED NOT IN DATE RANGE=THIS MEANS THE PRODUCT IS NOT IN THE DATE RANGE YOU REQUESTED.