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Orderform _2_ - Ascent Pharmaceuticals

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Orderform _2_ - Ascent Pharmaceuticals Powered By Docstoc
					                                           FAX YOUR ORDER TO 03 8677 6688

PHARMANNUITY ORDER FORM AUGUST 2011                                                                                                             DATE:     /        /

CUSTOMER NAME:                                                                        ASCENT ACCOUNT NUMBER:


DELIVERY ADDRESS:


ORDERED BY:                                                                           SIGNATURE:

                        Ascent Standard Trading Terms and Conditions (effective March 2009) shall apply to any supply of goods or services by
                                       Ascent in connection with this order. Orders under $150 will incur a $12 freight charge.

                                         FOR CUSTOMER SERVICE PHONE TOLL FREE 1800 678 302
GSK BRANDED PRODUCTS
                                                                      LIST                                                                                LIST
                                                           SHELF                                                                                SHELF
 Order Code                 PRODUCT NAME                             PRICE     QTY         Order Code                  PRODUCT NAME                      PRICE     QTY
                                                           PACK                                                                                 PACK
                                                                    (ex GST)                                                                            (ex GST)
 AMOC250       AMOXIL 250mg cap 20's                         1       $2.94                  LAMT50      LAMICTAL 50mg tab 56's                    10    $34.00
 AMOC500       AMOXIL 500mg cap 20's                         1       $4.68                 LAMT100      LAMICTAL 100mg tab 56's                   10    $54.87
  AMOPD        AMOXIL PAEDIATRIC 100mg/20ml                  1       $4.21                 LAMT200      LAMICTAL 200mg tab 56's                   10    $90.74
 AMOS3GM       AMOXIL Sachet 3g                              1       $2.21                MEST250GM MESASAL 250mg tab 100's                       10     $79.10
 AMOS125       AMOXIL SUSPENSION 125mg                       1       $2.75                  NART2   NARAMIG 2.5mg tab 2's                         10      $9.68
 AMOS250       AMOXIL SUSPENSION 250mg                       1       $3.44                   NART4  NARAMIG 2.5mg tab 4's                         10     $19.35
  AROT20       AROPAX 20mg tab 30's                          10     $16.91                  QUIT450 QUILONUM SR 450mg tab 100's                   3      $12.12
  AUGDUO       AUGMENTIN DUO 500mg tab 10's                  20      $6.78                  REPT0.5 REPREVE 0.5mg tab 28's                        20     $28.93
  AUGDFT       AUGMENTIN DUO FORTE 875mg tab 10's            20      $8.78                   REPT2  REPREVE 2mg tab 28's                          20     $96.45
 AUGDS400      AUGMENTIN DUO SUSPENSION 400mg                1       $6.20                  VENN2.5 VENTOLIN 2.5mg NEBULES 30's                   6       $5.76
 AUGS125       AUGMENTIN SUSPENSION 125mg                    1       $4.96                   VENN5  VENTOLIN 5mg NEBULES 30's                     6       $6.05
  ESKT400      ESKAZOLE 400mg tab 60's                       1     $162.57                  VENIGM  VENTOLIN CFC FREE INHALER 200 dose            10      $3.78
  IMIT100      IMIGRAN 100mg tab 2's                         10     $24.73                VENS150GM VENTOLIN SUSPENSION 150ml                     1       $6.86
   IMIS10      IMIGRAN 10mg Nasal Spray 2's                  1      $14.71                ZANE150GM ZANTAC 150mg Effervescent tab 31's            1       $6.11
   IMINS       IMIGRAN 20mg Nasal Spray 2's                  1      $11.16                  ZANT150 ZANTAC 150mg tab 60's                         10     $11.50
   IMIT50      IMIGRAN 50mg tab 2's                          10      $8.61                  ZANT300 ZANTAC 300mg tab 30's                         10     $11.50
   IMIT4       IMIGRAN 50mg tab 4'S                          10     $17.22                ZANS300GM ZANTAC SUSPENSION 150mg                       1       $7.61
 IMIFDT100     IMIGRAN FDT 100mg tab 2's                     10     $24.73                  ZEFT100 ZEFFIX 100mg tab 28's                         30    $160.59
  IMIFDT50     IMIGRAN FDT 50mg tab 2's                      10      $7.81                  ZENT200 ZENTEL 200mg tab 6's                          1      $23.20
   IMIFDT      IMIGRAN FDT 50mg tab 4's                      10     $15.61                 ZINT14GM ZINNAT 250mg tab 14's                         10     $10.61
 LAMT5GM       LAMICTAL 5mg tab 56's                         5      $10.57                   ZYBT30 ZYBAN 150mg tab 30's                          10     $61.34
  LAMT25       LAMICTAL 25mg tab 56's                        10     $21.03                  ZYBT90      ZYBAN 150mg tab 90's                      5     $139.44


MERCK BRANDED PRODUCTS
  COZT50       COZAAR 50mg tab 30's                                 $39.74                  RENT10      RENITEC 10mg tab 30's                           $13.16
  DECO50       DECA DURABOLIN 50mg injection 1ml                    $12.85                  RENT20      RENITEC 20mg tab 30's                           $15.65
  EULT250      EULEXIN 250mg tab 100's                             $177.52                  RENT5       RENITEC M 5mg tab 30's                           $9.60
  FART60       FARESTON 60mg tab 30's                               $61.20                  RENPL       RENITEC PLUS 20mg/6mg tab 30's                  $18.42
  FOST40       FOSAMAX 40mg tab 30's                                $88.90                   SANS       SANDRENA 1mg sachet 28's                         $9.28
  FOST70       FOSAMAX 70mg tab 4's                                 $29.09                  SINT100     SINEMET 100mg/25mg tab 100's                    $32.56
   LIPT10      LIPEX 10mg tab 30's                                  $18.28                  SINT250     SINEMET 250mg/25mg tab 100's                    $37.09
   LIPT20      LIPEX 20mg tab 30's                                  $25.01                  SINCR       SINEMET CR 200mg/50mg tab 100's                 $55.86
   LIPT40      LIPEX 40mg tab 30's                                  $35.18                  STRT3       STROMECTOL 3mg tab 4's                          $21.64
   LIPT80      LIPEX 80mg tab 30's                                  $48.79                 TIMED25      TIMOPTOL 2.5mg eye drop 5ml                      $7.09
   LIVT28      LIVIAL 2.5mg tab 28's                                $44.07                  TIMED5      TIMOPTOL 5mg eye drop 5ml                        $7.76
  MART28       MARVELON 30mg/150mg tab 28's                         $14.05                 TIMXE25      TIMOPTOL XE 2.5mg eye drop 2.5ml                 $4.45
   NITP5       NITRO-DUR 5mg trans patch 30's                       $18.17                  TIMXE5      TIMOPTOL XE 5mg eye drop 2.5ml                   $5.12
  NITP10       NITRO-DUR 10mg trans patch 30's                      $23.82                  ZOCT5       ZOCOR 5mg tab 30's                              $14.02
  NITP15       NITRO-DUR 15mg trans patch 30's                      $23.82                  ZOCT10      ZOCOR 10mg tab 30's                             $18.28
   OVET1       OVESTIN 1mg tab 30's                                 $22.47                  ZOCT20      ZOCOR 20mg tab 30's                             $25.01
   OVEO        OVESTIN OVULAR 500mcg pessaries 3x5                  $12.90                  ZOCT40      ZOCOR 40mg tab 30's                             $35.18
  OVEV15       OVESTIN 15mg vaginal cream                           $11.02                  ZOCT80      ZOCOR 80mg tab 30's                             $48.79
  PRII500      PRIMAXIN 500mg vial                                  $25.40


OTHER DISTRIBUTED LINES
   5555        CIPRAMIL 20mg tab 28                          15     $17.52                  VALT10      VALTREX 500 MG tab 10's                  10      $45.16
   90030       DRONALEN PLUS 70mg/140mcg 4                   10     $34.24                  VALT30      VALTREX 500 MG tab 30's                  10     $135.46
   70001       INTAL SPINCAPS                                10     $21.73                  VALT42      VALTREX 500 MG tab 42's                  10     $189.64
   31570       INTAL SPINHALER                                1      $4.30                 VALT100      VALTREX 500 MG tab 100's                 10     $455.00
   75015       KEPPRA 250mg tab 60                           10     $43.65                  VALT1       VALTREX 1000 MG tab 4's                  10      $21.50
   75020       KEPPRA 500mg tab 60                            5     $72.79                   50812      LUVOX 50mg tab 30                        10      $13.97
   75025       KEPPRA 1000mg tab 60                           5    $121.28                   50813      LUVOX 100mg tab 30                       10      $19.89
   90000       LEXAPRO 10mg tab 28                           10     $22.90                  ZANT10      ZANIDIP 10mg tab 28's                    10      $10.22
   90001       LEXAPRO 20mg tab 28                           15     $24.89                  ZANT20      ZANIDIP 20mg tab 28's                    10      $15.04


                                              Ascent Pharmaceuticals Limited ABN 17 003 854 626
            151 - 153 Clarendon Street South Melbourne VIC 3205 ■ Ph 03 8677 6600 ■ Fax 03 8677 6688 ■ www.ascentpharma.com.au
                                          FAX YOUR ORDER TO 03 8677 6688

PHARMANNUITY ORDER FORM AUGUST 2011                                                                                                             DATE:      /         /

CUSTOMER NAME:                                                                       ASCENT ACCOUNT NUMBER:


DELIVERY ADDRESS:


ORDERED BY:                                                                          SIGNATURE:

                        Ascent Standard Trading Terms and Conditions (effective March 2009) shall apply to any supply of goods or services by
                                       Ascent in connection with this order. Orders under $150 will incur a $12 freight charge.

                                          FOR CUSTOMER SERVICE PHONE TOLL FREE 1800 678 302
PFIZER BRANDED PRODUCTS
                                                                     LIST
                                                          SHELF                                                                                 SHELF   LIST PRICE
 Order Code                PRODUCT NAME                             PRICE      QTY        Order Code                  PRODUCT NAME                                       QTY
                                                          PACK                                                                                  PACK     (ex GST)
                                                                   (ex GST)
 P0079593     ACCUPRIL 10mg tab 30's                        10      $9.41                  P0130401    MINIPRESS 5mg tab 100's                   10      $11.92
 P0079595     ACCUPRIL 20mg tab 30's                        10     $11.82                  P0130397    MINIPRESS 1mg tab 100's                   10       $5.12
 P0079597     ACCUPRIL 5mg tab 30's                         10      $6.63                  P0130399    MINIPRESS 2mg tab 100's                   10       $7.03
 P0080299     ACCURETIC 10/12.5mg tab 30's                  10     $10.81                  P0079707    NEURONTIN 100mg cap 100's                 10      $15.19
 P0080301     ACCURETIC 20/12.5mg tab 30's                  10     $12.93                  P0079709    NEURONTIN 300mg cap 100's                 10      $48.87
 P0117509     ALDACTONE 100mg tab 100's                      5     $21.83                  P0079711    NEURONTIN 400mg cap 100's                 10      $66.35
 P0117511     ALDACTONE 25mg tab 100's                       5      $6.54                  P0088008    NEURONTIN 600mg tab 100's                 10     $104.80
 P0117515     ARTHROTEC 50mg tab 60's                        5     $27.27                  P0079713    NEURONTIN 800mg tab 100's                 10     $139.42
 P0117377     BREVINOR tab 4x28's                            8     $15.40                  P0117121    NORIDAY 350mcg tab 4x28's                 8       $12.12
 P0117381     BREVINOR-1 tab 4x28's                          8     $15.40                  P0117123    NORIMIN tab 4x28's                        8        $8.72
 P0117391     CABASER 1mg tab 30's                           1     $48.51                  P0117125    NORIMIN-1 tab 4x28's                      8        $8.72
 P0117393     CABASER 2mg tab 30's                           1     $65.02                  P0117127    NORINYL-1 tab 4x21's                      8        $8.72
 P0117417     CAVERJECT IMPULSE 10mcg injection 2's          1     $23.09                  P0117129    NORINYL-1 tab 4x28's                      8        $8.72
 P0117421     CAVERJECT IMPULSE 20mcg injection 2's          1     $29.45                  P0130421    NORVASC 10mg tab 30's                     10      $19.54
 P0096738     CHLOROMYCETIN EYE OINT 10mg/4g                12      $2.90                  P0147563    NORVASC 5mg tab 30's                      10      $11.70
 P0117453     COLESTID GRANULE 5g sachet 120's               4     $71.47                  P0117201    PROVERA 10mg tab 100's                    12      $22.44
 P0116577     CYKLOKAPRON 500mg tab 100's                   10     $40.76                  P0117203    PROVERA 2.5mg tab 56's                    12       $9.15
 P0117467     CYTOTEC 200mcg tab 120's                       4     $41.20                  P0116901    PROVERA 10mg tab 30's                     12       $9.21
 P0117156     DALACIN 150mg caps 100's                       1     $33.27                  P0116907    PROVERA 5mg tab 56's                      12       $8.62
 P0117158     DALACIN 150mg caps 24's                       12     $12.78                  P0116909    PYRALIN EN 500mg tab 100's                12      $21.66
 P0117221     DEPO-PROVERA 150mg/1mL                        10     $15.71                  P0116913    RALOVERA 10mg tab 100's                   12      $21.11
 P0117225     DEPO-RALOVERA 150mg/1mL                       12     $12.93                  P0116915    RALOVERA 10mg tab 30's                    12       $7.88
 P0117227     DIDROCAL KITS FG                              12     $58.43                  P0116917    RALOVERA 5mg tab 56's                     12       $7.34
 P0117231     DIDRONEL 200mg tab 60's                        1     $98.86                  P0116923    SALAZOPYRIN 500mg tab 100's               12      $19.68
 P0130443     DILANTIN 100mg cap 200's                      12     $20.61                  P0116919    SALAZOPYRIN EN 500mg tab 100's            12      $22.57
 P0130445     DILANTIN 30mg cap 200's                       12     $19.80                  P0130523    SIMPLOTAN 500mg tab 4's                   10       $3.80
 P0130447     DILANTIN 50mg cap 200's                       12     $27.60                 P03040010    SINEQUAN 10mg caps 50's                   10       $3.84
 P0084849     DILANTIN PAED. SUSP 30mg/5mL 500mL            12     $17.37                 P03040025    SINEQUAN 25mg caps 50's                   10       $3.96
 P0117239     DOSTINEX 0.5mg tab 2's                         1     $15.04                  P0116993    SYNAREL 8mL nasal spray                   1       $80.99
 P0117241     DOSTINEX 0.5mg tab 8's                         1     $53.32                  P0116995    SYNPHASIC tab 4X28's                      8       $15.40
 P0117247     EDRONAX 4mg tab 60's                           1     $28.12                 P08030050    VIBRA TABS 50mg tab 25's                  10       $4.05
 P0096130     FASIGYN 500mg tab 4's                         12      $5.90                 P08030100    VIBRAMYCIN 100mg tab 7's                  10       $2.68
 P0078295     FELDENE 10mg cap 50's                         10      $7.22                  P0117041    XANAX 0.25mg tab 50's                     12       $3.45
 P0078297     FELDENE 20mg cap 25's                         10      $6.95                  P0117043    XANAX 0.5mg tab 50's                      12       $5.10
 P0078315     FELDENE 20mg disp. tab 25's                   10      $6.95                  P0117045    XANAX 1mg tab 50's                        12       $8.37
 P0117335     HALCION 0.125mg tab 50's                       1      $4.85                  P0117047    XANAX 2mg tab 50's                        10      $12.59
 P0117363     IMPROVIL tab 4X28's                            8      $8.72                  P0130369    ZITHROMAX 500mg tab 2's                   10      $12.76
 P0117073     LINCOCIN 600mg/2mL vial 5's                   20     $23.76                  P0130371    ZITHROMAX 500mg tab 3's                   10      $21.82
 P0117075     LOCILAN 350mcg tab 4x28's                      8      $8.72                  P0130367    ZITHROMAX 600mg oral susp.                1       $10.56
 P0130449     LOPID 600mg tab 60's                          12     $21.67                 P03041053    ZOLOFT 50mg tab 30's                      10      $16.30
 P0117081     MACRODANTIN 50mg cap 30's                     10     $12.14                 P03041103    ZOLOFT 100mg tab 30's                     10      $16.30
 P0117079     MACRODANTIN 100mg cap 30's                    10     $17.25                  W01933      ZOTON FASTABS 15MG 28's                   10      $10.42
 P0117107     MINIDIAB 5mg tab 100's                        20      $7.73                  W01934      ZOTON FASTABS 30MG 28's                   10      $18.72

COMMENTS:




                                            Ascent Pharmaceuticals Limited ABN 17 003 854 626
          151 - 153 Clarendon Street South Melbourne VIC 3205 ■ Ph 03 8677 6600 ■ Fax 03 8677 6688 ■ www.ascentpharma.com.au

				
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