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UNITDRUGCO ORDER FORM
Prices effective thru 06/30/07
Cost #Unit Doses Cost
Name of Drug Dose mg. per Dose per Pack per Pack
Amoxicillin 250 cap $0.19 32 $5.92
Amoxicillin 250 cap $11.43 bottle of 100 $11.43
Amoxicillin 500 cap $0.26 32 $8.32
Amoxicillin 500 cap $22.87 bottle of 100 $22.87
Amoxicillin150cc bottle 250 / 5ml $3.83 Full course $3.83
Penicillin Vee K 250 tab $0.29 32 $9.28
Penicillin Vee K 250 tab $24.30 bottle of 100 $24.30
Penicillin Vee K 500 tab $0.47 32 $15.04
Penicillin Vee K 500 tab $42.89 bottle of 100 $42.89
Cephalexin (like Keflex) 250 cap $0.29 32 $9.28
Cephalexin (like Keflex) 250 cap $25.32 bottle of 100 $25.32
Cephalexin (like Keflex) 500 cap $0.34 32 $10.72
Cephalexin (like Keflex) 500 cap $41.37 bottle of 100 $41.37
Trimeth/Sulfa (like Bactrim) DS $0.23 32 $7.36
Trimeth/Sulfa (like Bactrim) DS $20.01 bottle of 100 $20.01
Dexamethasone 4 tab $0.26 32 $8.32
Dexamethasone 4 tab $10.37 bottle of 50 $10.37
Prednisone 20 tab $0.19 32 $6.04
Prednisone 20 tab $14.29 bottle of 100 $14.29
Prednisone 20 tab $2.00 12 btls of 10 @ $24.00
Prednisilone liquid 15 ml $1.50 12 btls of 15 ml $18.00
Prednisilone liquid 30 ml $2.00 12 btls of 30 ml $24.00
Acetaminophen 500 tab $0.05 32 $1.60
Acetaminophen 500 tab $3.13 bottle of 100 $3.13
Ibuprofen 200 tab $0.07 32 $2.24
Ibuprofen 200 tab $4.29 bottle of 100 $4.29
Diphenhydramine (like Benadryl)25 cap $0.09 32 $2.80
Diphenhydramine (like Benadryl)25 cap $3.99 bottle of 100 $3.99
Gentamicin Opth. Qtts. 5 ml $3.77 Full Course $3.77
Just D Infant Vitamin Supplement50 mg. $5.00 bottle $5.00
Add Shipping/Handling $8.95
UNITDRUGCO PURCHASE AND SHIPPING INFORMATION
FAX, CALL OR MAIL ORDERS TO:
UnitDrugCo
7000 South Broadway, Suite 1A
Centennial, CO 80122
Phone: 303-730-2522 Fax: 303-730-7477
Outside Denver Area 877-730-2522
___________________________________________ ______________________________ ___________
Signature - Required State License Number - Required State
(person with prescriptive authority)
_____________________________________________
DEA Number - Required for controlled substances
Your Phone:___________________________________
Your Fax: ____________________________________
Please Print Name and Address or Use Stamp
Ship to Address: Bill to Address:
Name:____________________________________________ Name:________________________________________
Clinic:____________________________________________ Clinic:________________________________________
Street:____________________________________________ Street:________________________________________
City, State Zip:_____________________________________ City, State Zip:_________________________________
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