NDC Ingredient AWP Unit Price Quantity Invoice Amount Actual After Audit Difference

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Patient 1

62756018588 OXCARBAZEPINE 600 MG TABLET 4.8521 38 229.26 134.20 95.06

13107003105 MIRTAZAPINE 15 MG TABLET 2.70 20 71.80 42.80 29.00

51672413304 LAMOTRIGINE 200 MG TABLET 6.1355 20 155.25 90.80 64.45

00093724306 RISPERIDONE 4 MG TABLET 12.0005 20 296.01 173.00 123.01

00591044401 GUANFACINE 1 MG TABLET 0.872 38 46.77 28.20 18.57

50458025115 ORTHO TRI-CYCLEN LO TABLET 3.39642 28 130.65 87.60 43.05

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Patient 1Totals 929.74 556.60 373.14

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Patient 2

68382011405 RISPERIDONE 1 MG TABLET 4.5506 15 89.91 52.85 37.06

64376060501 CARBINOXAMINE MALEATE 4 MG TAB 0.7837 30 35.21 21.50 13.71

68462013801 OXCARBAZEPINE 300 MG TABLET 2.6103 60 195.94 114.80 81.14

68382011305 RISPERIDONE 0.5 MG TABLET 4.2807 90 470.31 275.00 195.31

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Patient 2Totals 791.37 464.15 327.22

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Patient 3

50111044102 TRAZODONE 150 MG TABLET 1.3223 16 32.39 19.88 12.51

00228212710 CLONIDINE HCL 0.1 MG TABLET 0.259 12 10.73 7.16 3.57

00228212710 CLONIDINE HCL 0.1 MG TABLET 0.259 16 11.97 7.88 4.09

59762141505 MIRTAZAPINE 7.5 MG TABLET 2.63334 4 19.64 12.36 7.28

59762141505 MIRTAZAPINE 7.5 MG TABLET 2.63334 30 102.80 60.20 42.60

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Patient 3Totals 177.53 107.48 70.05

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Patient 4 Page 5

00904531360 PRENATAL TABLET (OTC) 0.00752 31 2.00 2.00 0

45802065078 LORATADINE 10 MG TABLET (OTC) 0.3007 31 3.69 3.69 0

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Patient 4Totals 5.69 5.69 0

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Patient 5

63717090101 REPREXAIN 5-200 MG TABLET 0.8624 20 20.70 20.00 0.70

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Patient 5Totals 20.70 20.00 0.70

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Patient 6

59417010310 VYVANSE 30 MG CAPSULE 5.8524 30 242.83 157.70 85.13

59417010410 VYVANSE 40 MG CAPSULE 5.8524 30 242.83 157.70 85.13

54092051302 INTUNIV ER 1 MG TABLET 6.4699 16 125.38 95.08 30.30

54092051302 INTUNIV ER 1 MG TABLET 6.4699 60 527.21 342.80 184.41

59417010310 VYVANSE 30 MG CAPSULE 5.8524 30 242.83 157.70 85.13

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Patient 6Totals 1381.08 910.98 470.10