1650 N Indianwood Avenue, Broken Arrow, OK 74012Phone: 918.250.8101 • Fax: 918.250.1281 • Email : order@blessing.org • www.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

Name _______________________________________________________ Title _________________________________________________________Address _______________________________________________________________________________________________Zip ________________Phone ______________________ Alt Phone _____________________Email ________________________________________________________

Will you be accompanying the team on this trip? Yes NoIf not, who is responsible for proper distribution of medicine?Name & Position ____________________________________________Organization ________________________________________________

PLEASE SEE PAGE 2 FOR SIGNATURE & ADDITIONAL REQUIREMENTS.INCOMPLETE APPLICATIONS MAY BE DELAYED IN PROCESSING. RECEIPT OF YOUR ORDER WILL BE CONFIRMED VIA EMAIL SENT TO THE BILLING CONTACT PERSON. IF YOU DO NOT RECEIVE AN ORDER ACKNOWEDGE-MENT VIA EMAIL WITHIN 3 BUSINESS DAYS, PLEASE CONTACT US AT 918.250.8101. IT MEANS WE DID NOT RECEIVE YOUR ORDER.

BILLING INFORMATION

Foreign Mission Name ______________________________________Mission Director ____________________________________________Address _________________________________________________________________________________________________________________Email _______________________________________________________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.

CITY & COUNTRY MEDICINE WILL BE USED IN_____________________________________________________________DEPARTURE DATE ______________ RETURN DATE _______________LAST DATE YOU CAN ACCEPT BACKORDERS __________________SPECIAL INSTRUCTIONS? _____________________________________

MEDICAL PROFESSIONAL INFORMATION

Application must be signed by a physician (M.D. or D.O.) Copy of medical license required. Please see our instructions for complete details. SIGNATURE REQUIRED ON PAGE 2.

Organization Name ______________________________________E.I.N. (Federal Tax ID #) ___ ___ - ___ ___ ___ ___ ___ ___ ___Billing Contact ______________________________________________Billing Address _______________________________________________________________________________________Zip ________________Phone ______________________________________________________Is this a home address or a church/business address?Email _______________________________________________________*Please note this email will be used to transmit invoices. If there is anotherperson responsible for paying invoices for this account, please indicate below.

Alternate Billing Contact ____________________________________Alternate Billing Contact Phone _____________________________Alternate Billing Contact Email ______________________________

Is this the fi rst time the above ministry has used our services? Yes NoPlease tell us how you found about about Blessings___________________________________________________________________FIRST TIME USERS, PLEASE SEE OUR INSTRUCTIONS ONLINE. PREPAYMENT AND 501(C)3 LETTER MUST BE SUBMITTED.

*PLEASE NOTE SHIPPING ADDRESS MUST MATCH ADDRESS ONPHYSICIAN’S LICENSE.

SHIPPING OR PICKUP INFORMATION

Please ship order I will pick up orderIs this a residential address? Yes NoOrganization Name ________________________________________Contact Person _____________________________________________c/o Business Name _________________________________________Address _____________________________________________________________________________________________Zip ________________Phone ______________________ Alt Phone _____________________Email _______________________________________________________

Pharmaceutical Trip Application Page Form MED 1 of 11

INTERNATIONAL PHARMACEUTICAL TRIP APPLICATION - PA G E 2TO 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 l icensed 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.

1. IMPORT FOR EXPORT DISCLOSURE: All medicine withIMPORT FOR EXPORT or IFE in the description has been formulated for use outside of the USA only. If medicine of this cat-egory 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 practicemedicine in the country where the mission is located, if required.

3. If a clinic or hospital is operated, there must be a permit from theregion, 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 appropriateutilization, dispensation, and safety in storage of all drugs.

5. Pharmaceuticals obtained from Blessings International shouldbe 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.

6. Pharmaceuticals must not be used in a governmentoperated hospital or clinic except by specifi c permission.

7. Pharmaceuticals will be distributed and employed in a way thatglorifi es God.

8. Within 30 days of return from medical mission trip, anoriginal 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 Title

__________________________________________________________ __________________________________________________________Printed Name of Medical Professional/*Person Responsible Date

Pharmaceutical Trip Application Page 2Form MED 2 of 11

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)

EMAIL-- 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 2 4564 Naproxen sodium 220mg CAPS –BACK IN STOCKPage 3 3005 Cough drops cherry flavored 125 drops per box 3817 Terazosin HCl 5mg caps Page 4 2682U Cyclobenzaprine HCl 10mg tabs 100ct 4146 Singulair 4mg (Montelukast) 90ct Page 5 1172 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 6 5410 Sodium chloride 0.9%:1000mL in IV bag BACK IN STOCK Page 7 3682 Sunscreen SPF 30 lotion 4oz (118ml)flip top bottle, water resistant (80 mins) Page 8 3017 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 9 2405 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 04/2016 4450H Metoprolol 50mg tabs BID [LIKE LOPRESSOR] _____ 1M EXPIRES 02/20169052N 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.

International Pharmaceutical Order Form Page 2 Description Quantity Unit Charge

02/01/16

Blessings International 1650 North Indianwood Avenue Broken Arrow, OK 74012 USA

Telephone 918-250-8101 Fax 918-250-1281Email: order@blessing.org Website: www.blessing.org

“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

Description Quantity Unit Charge

000 TABLETS AND CAPSULES ANTACIDS AND ANTIFLATULENTS

4607 Calcium carbonate 500mg chewable tabs, asst flavors _____ x 500 $6.650057U Omeprazole 20mg caps, delayed-release [LIKE PRILOSEC] _____ x 100 $7.450054 Omeprazole 20mg caps, D. R.-FOR EXPORT ONLY[LIKE PRILOSEC] _____ x 1M $57.001947 Ranitidine 15mg/mL 16oz (75mg/5mL) _____ x 1 $15.00 0090 Ranitidine 150mg tabs FOR EXPORT ONLY _____ x 1M $27.45

ANALGESICS 2644 Acetaminophen 325mg tabs _____ x 1M $6.700208 Acetaminophen 500mg tabs (Paracetamol) FOR EXPORT ONLY _____ x 1M $9.95 2125 Acetaminophen 80mg children's chewable fruit flavored tabs _____ x 1M $10.152249 Acetaminophen suppositories 120mg (pediatric) _____ x 12 $3.00 2646 Aspirin 325mg enteric coated tabs _____ x 1M $9.004029 Aspirin 81mg enteric coated, adult, DR tabs: not chewable _____ x 1M $6.60 4417 Ibuprofen 200mg, tabs-- FOR EXPORT ONLY _____ x 1M $16.854564 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 tongue3946U Amoxicillin 250mg (chewable) tabs _____ x 100 $34.15 0214 Amoxicillin 250mg (chewable) tabs FOR EXPORT ONLY _____ x 1M $59.00 3954U Amoxicillin 250mg (chewable) tabs _____ x 500 $130.000215C Amoxicillin 500mg caps FOR EXPORT ONLY _____ x 1M $61.253469U Amoxicillin 500mg caps _____ x 500 $32.250240 Amoxicillin 500mg,clavulanate potassium 125mg, tabs FOR EXPORT ONLY _____ x 50 $29.950204 Azithromycin 250mg tab FOR EXPORT ONLY _____ x 500 $143.000202 Azithromycin 250mg tab FOR EXPORT ONLY _____ x 250 $71.503150U Cephalexin 250mg caps _____ x 100 $6.953157U Cephalexin 250mg caps _____ x 500 $39.003648U Cephalexin 500mg caps [LIKE KEFLEX] _____ x 100 $11.954631U Cephalexin 500mg caps [LIKE KEFLEX] _____ x 500 $45.104251 Ciprofloxacin 500mg tabs - FOR EXPORT ONLY [CIPROX] _____ x 500 $45.003423 Clindamycin 150mg caps _____ x 100 $11.001624 Cloxacillin 500mg caps FOR EXPORT ONLY _____ x 1M $91.30 0225 Doxycycline hyclate 100mg tabs FOR EXPORT ONLY _____ x 1M $41.004612 Erythromycin stearate BP 250mgtabs FOR EXPORT ONLY _____ x 500 $49.853158 Dicloxacillin sodium 250mg cap _____ x 100 $48.850700 Fluconazole 150mg, tab FOR EXPORT ONLY [LIKE DIFLUCAN] _____ x 100 $20.100700D Fluconazole 150mg, tab FOR EXPORT ONLY [LIKE DIFLUCAN] _____ x 500 $100.550291C Fluconazole 200mg, caps FOR EXPORT ONLY [LIKE DIFLUCAN] _____ x 100 $22.801253 Griseofulvin 125mg tabs FOR EXPORT ONLY _____ x 1M $42.851251D Griseofulvin 500mg tabs FOR EXPORT ONLY _____ x 500 $75.601375 Itraconazol 100mg caps FOR EXPORT ONLY OUT OF STOCK _____ x 28 $11.753306 Nitrofurantoin 100mg tabs FOR EXPORT ONLY _____ x 500 $22.15 0270 Nystatin 500,00 unit tabs (oral) FOR EXPORT ONLY _____ x 100 $19.852942 Minocycline HCl 100mg caps _____ x 50 $14.204613 Phenoxymethyl Penicillin 250mg(Pen VK) tabs, FOR EXPORT ONLY _____ x 1M $48.000217C Levofloxacin 500mg tabs FOR EXPORT ONLY _____ x 100 $19.000275 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

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

International Pharmaceutical Order Form Page 3 Description Quantity Unit Charge [LIKE BACTRIM SEPTRA]

ANTIAMEBICS 4651 Metronidazole 250mg tabs - FOR EXPORT ONLY [LIKE FLAGYL] _____ x 1M $35.95 0289 Tinidazole 500mg tabs FOR EXPORT ONLY _____ x 500 $36.65 ANTIVIRALS 0230 Aciclovir 200mg tabs FOR EXPORT ONLY[LIKE ZOVIRAX] _____ x 500 $35.60 4313U 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 $19.95 2324 Ivermectin 6mg tabs, scabies treatment 2 tabs per/ adult FOR EXPORT ONLY _____ x 500 $95.00 0350 Mebendazole 100mg chewable tab FOR EXPORT ONLY [LIKE VERMOX] _____ x 1M $24.95 4634D Albendazole 400mg chewable tab -- FOR EXPORT ONLY _____ x 500 $50.00

ANTIMALARIALS 0321 Artemether 20mg + Lumefantrine 120mg FOR EXPORT ONLY [Like Coartem] _____ x 24 $4.75 2744 Chloroquine phosphate tabs 150mg base _____ x 100 $3.25

ANTIDIARRHEALS & ANTISPASMOTIC 3430 Bismuth subsaliclate 262mg chewable tabs [LIKE PEPTOBISMAL TABS] _____ x 30 $3.00 2011 Loperamide HCl 2mg caps FOR EXPORT ONLY [LIKE IMMODIUM] _____ x 500 $25.00 2012 Loperamide HCl 2mg caps FOR EXPORT ONLY [LIKE IMMODIUM] _____ x 100 $5.00 ANTIHISTAMINE, DECONGESTANTS, 3100 Chlorpheniramine maleate 4mg tabs _____ x 1M $6.10 3005 Cough drops cherry flavored 125 drops per box _____ x 125 $6.60 4532 Cough drops cherry flavored (24bags/30ct) _____ x 720 $27.00 4034 Cough drops honey lemon flavor (24bags/30ct) _____ x 720 $27.00 4035 Cough drops Menthol flavor (24bags/30ct) _____ x 720 $27.00 4500 Diphenhydramine 50mg, caps [LIKE BENADRYL] _____ x 1M $17.00 2779 Diphenhydramine HCl 25mg caps [LIKE BENADRYL] _____ x 1M $15.30 0450D Guaifenesin 400mg, tabs USP _____ x 500 $22.95 4201U Loratadine 10mg tabs [LIKE CLARITIN] _____ x 100 $7.60 4611 Loratidine 10mg tabs, FOR EXPORT ONLY _____ x 500 $28.00 0415 Cetirizine HCI 10mg tab FOR EXPORT ONLY _____ x 500 $20.50 4213U Cetirizine HCl 10mg tabs ZYRTEC _____ x 100 $5.20 4246 Promethazine HCl 25mg tabs [LIKE PHENERNAN] _____ x 100 $6.00

MISCELLANEOUS 3519 Estradiol 0.5mg tabs _____ x 100 $7.45 3963C Atorvastatin 10mg tabs FOR EXPORT ONLY [LIKE LIPITOR] _____ x 100 $4.00 0602 Estradiol 1mg tabs _____ x 100 $18.75 0612U Simvastatin 10mg tabs _____ x 90 $2.70 0611U Simvastatin 10mg tabs _____ x 500 $18.90 0613U Simvastatin 20mg tabs _____ x 90 $4.10 6614U Simvastatin 20mg tabs _____ x 1M $24.75 6613U Simvastatin 20mg tabs _____ x 500 $16.65 0617U Simvastatin 40mg tabs _____ x 30 $5.05 ANTIHYPERTENSIVES AND DIURETIC 4573U Atenolol 50mg tabs _____ x 100 $3.40 4389 Atenolol 50mg tab FOR EXPORT ONLY _____ x 1M $17.10 3826 Captopril 25mg tabs FOR EXPORT ONLY _____ x 1M $21.95 1034 Chlorthalidone tabs 25mg _____ x 100 $4.70 4288C Enalapril 10mg tabs FOR EXPORT ONLY _____ x 100 $2.50 4288 Enalapril 10mg tabs FOR EXPORT ONLY _____ x 1M $21.05 4616 Furosemide 40mg tabs FOR EXPORT ONLY _____ x 1M $12.00 4659 Hydrochlorothiazide 25mg tabs FOR EXPORT ONLY _____ x 1M $9.75 0015M Lisinopril 10 mg tab, FOR EXPORT ONLY _____ x 1M $23.50 0730D Losartan potassium 50mg FOR EXPORT ONLY _____ x 500 $39.40 4220U Losartan potassium 50mg tabs _____ x 90 $4.45 4450 Metoprolol 50mg tabs BID [LIKE LOPRESSOR] _____ x 1M $21.70 4451 Metoprolol 50mg tabs BID [LIKE LOPRESSOR] _____ x 100 $2.65 3817 Terazosin HCl 5mg caps _____ x 100 $5.65 ANTIINFLAMMATORY AND ANTIGOUT 3985 Allopurinol 100mg tabs FOR EXPORT ONLY _____ x 50 $5.70 3717 Diclofenac sodium 50mg tabs (enteric coated) FOR EXPORT ONLY _____ x 1M $16.70 3495U Ibuprofen 400mg, tabs _____ x 500 $19.45 4608 Ibuprofen 400mg, tabs FOR EXPORT ONLY _____ x 1M $26.80 3495U Ibuprofen 400mg tabs _____ x 500 $19.45 0625 Ibuprofen 600mg film coated tabs--FOR EXPORT ONLY _____ x 1M $42.10 2918U Ibuprofen 600mg film coated tabs _____ x 500 $33.00 3384U Ibuprofen 800mg tabs _____ x 500 $22.35 4009U Meloxicam 7.5mg tabs _____ x 100 $2.25 4012U Meloxicam 7.5 mg tabs _____ x 1M $16.50 4011U Meloxicam 15mg tabs _____ x 100 $2.65 4013U Meloxicam 15 mg tabs _____ x 1M $17.95 0007M Prednisone 10mg tabs FOR EXPORT ONLY _____ x 1M $81.35 0005M Prednisolone 5mg tabs FOR EXPORT ONLY _____ x 1M $28.05 4253 Prednisone 20mg tabs _____ x 100 $20.65 ANTIPSYCHOTICS, ANTIDEPRESSANTS, 4161M Amitriptyline 25mg tabs FOR EXPORT ONLY _____ x 1M $17.50

International Pharmaceutical Order Form Page 4 Description Quantity Unit Charge 2030 Fluoxetine 20mg caps PROZAC _____ x 500 $15.85 0901 Sertraline HCL 25mg [LIKE ZOLOFT] _____ x 30 $1.80 0900 Sertraline HCL 25mg [LIKE ZOLOFT] _____ x 90 $5.55 0903 Sertraline HCL 25mg _____ x 500 $28.45 0905U Sertraline HCL 100mg [LIKE ZOLOFT] _____ x 30 $2.55 0906U Sertraline HCL 100mg [LIKE ZOLOFT] _____ x 500 $32.65 3744 Trazodone HCl 150mg tabs [LIKE DESYREL] _____ x 100 $14.25 4548 Trazodone HCI 150mg tabs _____ x 500 $49.90 ANTIEPILEPTIC & ANTIPARKINSON 1048 Carbamazepine 200mg tabs FOR EXPORT ONLY [LIKE TEGRETOL] _____ x 1M $47.50 3675U Gabapentin 100mg caps _____ x 100 $3.00 3676U Gabapentin 300mg caps _____ x 100 $6.85 3061U Gabapentin 300mg caps _____ x 500 $30.20 4466 Levetiracetam 250mg tabs [LIKE KEPPRA] _____ x 120 $15.00 1046 Phenytoin sodium 100mg caps FOR EXPORT ONLY _____ x 100 $8.20 ANTISPASMODIC, ANTICHOLENERGIC 4565 Dicyclomine HCl 10mg caps [LIKE BENTYL] _____ x 100 $7.35 3600 Metoclopramide 5mg tabs [LIKE REGLAN] _____ x 500 $26.35 1056 Promethazine 25mg tabs FOR EXPORT ONLY _____ x 100 $9.00

BRONCHIAL DILATORS 3989 Albuterol sulfate 0.083% 2.5mg/3mL inhalation solution _____ x 25 $3.60 4656D Salbutamol 2mg tabs/(Albuterol) FOR EXPORT ONLY _____ x 500 $14.00 4657D Salbutamol 4mg tabs scored/(Albuterol) FOR EXPORT ONLY _____ x 500 $16.75 4146 Singulair 4mg (Montelukast) _____ x 90 $17.40 0825 Beclomethasone .05mg/dose oral inhaler FOR EXPORT ONLY _____ x 1 $6.60 1100 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 $16.45 3848 Clopidogrel 75mg tabs [LIKE PLAVIX] _____ x 30 $4.55 3846 Clopidogrel 75mg tabs [LIKE PLAVIX] _____ x 90 $8.95 1512 Isosorbide Dinitrate 10mg tabs FOR EXPORT _____ x 500 $26.20 4261U Verapamil HCl 80mg tabs _____ x 100 $6.60 1255 Verapamil HCl 80mg tabs _____ x 1M $58.75 4212 Warfarin sodium 5mg tabs [LIKE COUMADIN] _____ x 100 $13.75 DIABETES, HYPOGLYCEMICS 1330 Glibenclamide 5mg tabs (Glyburide) FOR EXPORT ONLY _____ x 1M $20.75 3965U Glipizide 10mg tabs [LIKE GLUCOTROL] _____ x 500 $15.15 2356 Glipizide 10mg tabs (scored) FOR EXPORT ONLY [LIKE GLUCOTROL] _____ x 1M $37.00 4060U Glipizide 5mg tabs [LIKE GLUCOTROL] _____ x 500 $9.60 4364U Glipizide 5mg tabs [LIKE GLUCOTROL] _____ x 1M $20.65 1111M Metformin 1000mg tabs [LIKE GLUCOPHAGE] FOR EXPORT ONLY _____ x 1M $48.55 4306U Metformin 850mg tabs [LIKE GLUCOPHAGE] _____ x 500 $14.40 4624U Metformin HCl 850mg tabs [LIKE GLUCOPHAGE] _____ x 100 $6.00 0515 Metformin HCI 500mg tabs FOR EXPORT ONLY [LIKE GLUCOPHAGE] _____ x 1M $18.60 4004U Metformin HCI 500mg tabs [LIKE GLUCOPHAGE] _____ x 100 $2.25

LAXATIVES 3609 Bisacodyl 5mg delayed-release, tabs _____ x 1M $8.65 2973 Docusate sodium 100mg soft gels _____ x 1M $19.95 1605 Docusate sodium 100mg soft gels _____ x 100 $2.10 MUSCLE RELAXANT, MINOR TRANQUILIZERS 0875 Chlorzoxazone 500mg tabs FOR EXPORT ONLY _____ x 500 $40.00 2682U Cyclobenzaprine HCl 10mg tabs [LIKE FLEXERIL] _____ x 100 $3.00 3909U Cyclobenzaprine HCl 10mg tabs [LIKE FLEXERIL] _____ x 1M $25.35 3507 Methocarbamol 500mg tabs _____ x 500 $34.25 VITAMINS, MINERALS 2187 Vitamin A 200,000 IU caps FOR EXPORT ONLY _____ x 1M $71.05 3428 Ferrous sulfate 325mg tabs _____ x 1M $10.95 4233 Folic acid 800mcg tab _____ x 1M $9.00 2199 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+ $545.00 Vit-B2 1.2mg; Vit-B6:1.05mg; Vit-B124.5mcg; Vit-C 60mg; Vit-E 15IU; Niacin 13.5mg; Iron(as ferrous fumarate) 15mg.ZINC [BOX CT IS 27,273] 2196 Multivit: Children chew w/iron: Vit-A 2500IU;Vit-D 400IU; Vit-B1 1.05mg; _____ x 25M $420.00 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. 2195 Multivit: Children chew w/iron: (Same content as 51376-0236-25) 51376-0235-10 _____ x 1M $22.00

3076 Multivitamins w/Fe & I: VitA w/beta carotene 5000IU; VitD 400IU; VitC _____ x 25M $360.00 60mg; VitB1 1.5mg; VitB2 1.7mg; VitB6 2.0mg; niacinamide 20mg; Ca pantothenate 10mg; folic acid0.4mg;Vit-B12 6mcg;Iron as fumarate 18mg;IODI18mg;IODINE 0.225mg RDA VITAMINS W/IRON & IODINE[BOX CT 25,200]

3250 Multivitamins w/Fe &I: (Same content as 51376-0178-25) RDA _____ x 1M $17.00 VITAMINS/IRON/IODINE

International Pharmaceutical Order Form Page 5 Description Quantity Unit Charge

1900B Multivitamins:without IRON & IODINE:VitA 5000IU;VitC60mg; _____ x 25M $360.00 VitD-3 400IU;VitB-1VitB- 21.7mg;Niacin 20mg; VitB-6 2mg;VitB-12 6mcg; VitE30IU;Foliate 400mcg;Pantothenic Acid 1mg; 1900 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 51376-0239-14) _____ x 500 $20.00 3173 Prenatal vitamins: Vit-A 4,000IU; Vit-D 400 IU; Vit-E11 IU; Vit-C 100mg; _____ x 16M+ $450.00 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 $6.45 3968 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 $1.00 5999 DynaRub pain relieving cream non-greasy 3oz-methyl- sailcylate _____ x EA $2.70 30%-menthol 10%- camphor 4% 4499 Hemorrhoidal rectal suppositories [LIKE PREPARATION H] _____ x 12 $1.80 3488 Hydrocortisone 0.5% cream 15gm1/2oz tube FOR EXPORT ONLY _____ x 12 $13.50 1071 Hydrocortisone 1% 15mg tube FOR EXPORT ONLY _____ x 10 $13.85 3791 Hydrocortisone acetate 2.5% cream (15gm) tube _____ x 12 $24.50 1751 Hydrocortisone cream 1% foil packet _____ x 144 $14.25

2338 Vitamin A & D ointment foil packs 5g _____ x 144 $15.10 2342 White Petrolatum foil packs 5g _____ x 144 $11.35 3282 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 $15.50 2211 Bacitracin zinc, neomycin sulfate, polymyxin B sulfate ointment 0.9gm _____ x 144 $17.00 foilpackets [TRIPLE ANTIBIOTIC] 1999 15gm/Bacitracin zinc 400 unitsneomycin sulfate 5mg, polymyxin B ointment _____ x 12 $23.00 1/2 oz (14.17gm) tube [TRIPLE ANTIBIOTIC] 2735 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 $10.70 2173 Miconazole nitrate 2% cream 1oz (30gm) tube [LIKE MICOTIN] _____ x 6 $13.95 3902X Nystatin ointment 100,000 unit 1oz (30gm) tube, FOR EXPORT ONLY _____ x 10 $21.45 3902 Nystatin ointment 100,000 unit 1oz (30gm) tube, FOR EXPORT ONLY _____ x EA $2.15 3368 Povidone iodine 10% topical solution 128oz (3784mL)gallon _____ x 1 $23.50 4469 Povidone iodine 10% topical solution 16oz (473 mL) pint _____ x 1 $3.50 0950 Silver sulfadiazine 1% cream 50gm tubes [LIKE SILVADENE 1%] _____ x 1 $3.35 2181 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 $19.95 2324 Ivermectin 6mg tabs, scabies treatment 2 tabs per/ adult FOR EXPORT ONLY _____ x 500 $95.00 4202 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 $9.95 4502 Permethrin Lotion 1% 60mL cream rinse-w/lice combs _____ x 2 $13.50 4002 Permethrin Lotion 1% 100mL cream rinse FOR EXPORT ONLY _____ x EA $6.80 4125 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 $14.25 2020 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 $6.00 1172 Brimonidine tartrate 0.2% ophthalmic solution 5ml _____ x 1 $5.00 2291 Carbamide peroxide 6.5% ear drops 1/2oz(14.79mL) _____ x EA $1.75 2424 Ciprofloxacin 0.3% sterile ophthalmic solution 10mL _____ x 1 $6.00 3794 Gentamicin sulfate 0.3%-- ophthalmic solution; 5mL FOR EXPORT ONLY _____ x 10 $15.00 2994 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 $15.00 3346 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 $15.00 4700 Ofloxacin .3% ophthalmic 5 mL-drops-FOR EXPORT ONLY _____ x 10 $17.50 3045 Prednisolone acetate 1.0% ophthalmic suspension 5ml FOR EXPORT ONLY _____ x 10 $17.50 3207 Tetrahydrozoline HCl Ophthalmic drops 0.05% 1/2oz (15mL) OPTI-CLEAR _____ x 12 $19.65 3789 Timolol Maleate Ophthalmic solution 0.5%: 10mL _____ x 10 $15.25 4625 Timolol Maleate Ophthalmic solution 0.5%: 10mL _____ x 1 $3.30

International Pharmaceutical Order Form Page 6 Description Quantity Unit Charge 2397 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 $100.55 3194U Clotrimazole vaginal cm USP 1%antifungal 45gm (1.5 oz) w/app _____ x 1 $4.15 0750X Clotrimazole 500mg vaginal tab NO APPLICATOR FOR EXPORT ONLY _____ x 10 $4.15 0749 Clotrimazole 100mg vaginal tabw/applicator-6 tabs per box FOR EXPORT ONLY ____ x 6 $3.50 3245 Lubricating jelly sterile 2oz _____ x EA $1.20 9090S Vaginal specula (small) ready to use - disposable _____ x 10 $5.00 9090M Vaginal specula (medium) ready to use - disposable _____ x 10 $5.00 9090L Vaginal specula (large) ready to use-disposable _____ x 10 $5.00 300 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 9001 2 tsp child medicine spoon _____ x 10 $3.70 4491 2oz empty plastic cough syrup bottles _____ x 10 $3.00 8999 1tsp oral medicine syringe 5mL _____ x 10 $5.00 4575 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 $2.85 1947 Ranitidine 15mg/mL 16oz (75mg/5mL) _____ x 1 $19.90 4055 Oral rehydration salts- NaCl 3.5g, KCl 1.5g, trisodium Na 2.9g, glucose _____ x 100 $15.00 20g, sachet for 1 liter soln. FOR EXPORT ONLY

ANALGESIC LIQUIDS, SYRUPS 2437 Acetaminophen drops 80mg 0.8mL; 15mL _OUT x 1 $2.35 3509 Acetaminophen drops 80mg/0.8mL 30mL _OUT x 1 $2.85 3314 Acetaminophen elixir 160mg/5mL;4 fl.oz. (118mL) _____ x 1 $1.65 3239 Acetaminophen elixir 160mg/5mL; 16oz _____ x 1 $5.10 3931 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 $6.00 4205U Amoxicillin 600mg, clavulanate potassium 42.9mg:5mL/125mL for o/s _____ x EA $9.75 0650 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. 0655 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 $36.00 3677U Amoxicillin for o/s 125mg/5mL;100mL _____ x 12 $27.00 4650U Amoxicillin for o/s 400mg/5mL;50mL BID _____ x 6 $10.00 0675 Azithromycin for o/s 200mg/5mL;pwd- 15mL FOR EXPORT ONLY _____ x 10 $30.50

4445 Nystatin 100,000 units/mL oral solution; 30mL FOR EXPORT ONLY ___ x 1 $2.35 4432 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 $3.75 1673 Diphenhydramine HCL 12.5mg/5mL 4oz (118mL) _____ x 1 $1.45 1117 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 $6.10 2773 Guaifenesin 100mg/5mL 4 fl. oz. _____ x EA $1.45 3187 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 $5.00 4516 Nasal saline decongestant spray 15mL [LIKE AFRIN] _____ x 1 $1.35 4454 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 $4.05 3968 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 $19.25 4572 Epinephrine 1:1000(1mg/mL) 30 mL _____ x EA $9.70 2310 Lidocaine 1% w/epinephrine 10mg/mL;50mL _____ x 1 $4.45 5104 Lidocaine 2% w/ epinephrine 10mg/ml:30ml (MDV) _____ x 1 $6.50 3640 Lidocaine HCl 1% inj. 10mg/mL;50mL m.d.v. _____ x EA $4.45 3599 Lidocaine HCl 2% inj. 20mg/mL;50mL m.d.v. _____ x EA $1.95

International Pharmaceutical Order Form Page 7 Description Quantity Unit Charge DENTAL 3891 Lidocaine 2% 1:100,000 w/epinephrine 1.7mL per cartridge -dental cartridges _____ x 50 $47.50 2802 Needle 27g x 1" DENTAL disposable, sterile _____ x 100 $15.90 2803 Needle 30g x 1/2" DENTAL disposable, sterile _____ x 100 $15.90 1687 Toothbrushes,pre pasted _____ x 20 $ 5.00 1688 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 $6.40 0590 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 $2.05 0591 Ceftriaxone sodium 250mg str pwd/ IM or IV, 6ml s.d.v. IFE [LIKE ROCEPHIN] _____ x 10 $10.75 3577 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 $1.60 1150 Cyanocobalamin 1mg/ml inj:1ml FOR EXPORT ONLY _____ x 10 $7.85 3836 Dexamethasone inj. 4mg/mL; 30mL m.d.v. _____ x EA $36.00 1759 Dexamethasone inj. 5mg/ml; 1ml s.d.v. ampoule FOR EXPORT ONLY _____ x 10 $8.00 2506 Diphenhydramine HCl inj. 50mg/mL 1mL m.d.v. [LIKE BENADRYL] _____ x EA $1.70 1874 Furosemide 20mg/mL 2ml inj IM/IV:ampoule FOR EXPORT ONLY _____ x 10 $4.75 4067 Promethazine HCl 25mg/ml; 1mL s.d.v.:ampoule [LIKE PHENERGAN] _____ x EA $2.35 4574 Promethazine HCL 50mg/ml 1ml [LIKE PHENERGAN] _____ x EA $3.25 3967 Phenytoin sodium inj 100mg/2mL _____ x 1 $1.90 4497 Sodium chloride 0.9% inj. 10mL s.d.v. _____ x EA $1.30 5410 Sodium chloride 0.9%:1000mL in IV bag _____ x 1 $6.90

600 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 for anyone involved in foreign missions. FREE CD 6013 Coloring Books to help promote burn safety/Central America printed in Spanish _____ x 1 $1.50 w/crayons. 6014 Coloring Books to help promote good hygiene/Central America printed in ______ x 1 $1.50 Spanish w/crayons _____ x 1 $1.50 6009 Coloring Books to help promote good hygiene/Africa- printed in Swahili _____ x 1 $1.50 w/crayons 6011 Coloring Books to help promote good hygiene/Africa- printed in English _____ x 1 $1.50 w/crayons. 6012 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 $3.00 4068 Water purifier Outback bucket system, 5-gallon pour through, gravity- _____ x 1 $280.00 feed unit. No water pressure required Purifies 1,500gallons at 8 gal/hr. 4152 OutBack bucket purification replacement cartridge _____ x 1 $121.50

4363 OutBack bucket-Water sediment filter (prefilter) 30 micron replacement _____ x 1 $21.00 3682 Sunscreen SPF 30 lotion 4oz (118ml)flip top bottle, water resistant (80 mins) _____ x 1 $$3.40

700 BANDAGES & SURGICAL SYRINGES, TAPE, GAUZE, MISC. 3195 Adhesive bandage 1" x 3" sterile non-stick [LIKE BAND-AIDS] _____ x 100 $2.50 3732 Adhesive flexible fabric bandage 3/4"x3" sterile non-stick [LIKE BAND- _____ x 100 $2.70 4464 Alcohol prep pads 200/box _____ x 200 $1.95 2277 Benzalkonium chloride, 0.13% antiseptic cleansing towelette 5"x7" _____ x 100 $2.05 4563 Butterfly wound closures (M) 3/8x1 7/8 (medium) _____ x 100 $1.90 4562 Butterfly wound closures (LG)1/2x2 3/4 (large) _____ x 100 $2.95 4517 Cap Nurse's blue _____ x 100 $7.60 4593 Catheter foley, silicone coated, retention 5cc, 12 Fr _____ x 10 $18.00 4594 Catheter foley, silicone coated, retention 5cc, 14 Fr _____ x 10 $21.40 4595 Catheter foley, silicone coated, retention 5cc, 16 Fr _____ x 10 $18.00 4596 Catheter foley, silicone coated, retention 5cc, 18 Fr _____ x 10 $20.50 4506 Cotton tip applicators 6" non-sterile _____ x 100 $0.60 7100 Elastic bandage 2" x 5 yds. _____ x 10 $10.25 4513 Elastic bandage 3" x 4.5 yds. _____ x 10 $7.15 4512 Elastic bandage 4" x 4.5 yds. _____ x 10 $7.40 3209 Face mask ear loop _____ x 50 $4.25 7182 N95 Respirater mask w/nose cushion & tan straps (Medium) _____ x 20 $25.70 2098 Gauze-sterile 2x2x8ply (2 sponges/env)STERILE _____ x 50 $2.15 3208 Gauze sponge 2x2x8 ply in ready to sterilize bag _____ x 200 $1.80 3361 Gauze sponge 4x4x8 ply in read to sterilize bag _____ x 200 $2.80 4494 Gauze sponge 4x4x8 ply sterile bag(2 sponges/env) _____ x 50 $4.15 4337 Gauze sponge 4x4x8 ply sterilize bag(2 sponges/env) _____ x 25 $2.30 3141 Gauze sterile 4.5" x 147" 6 ply roll krinkled _____ x 1 $1.15 1756 Gloves light powder latex (XS)x-small _____ x 100 $7.50 4527 Gloves light powder latex (S) small _____ x 100 $5.95 4528 Gloves light powder latex (M) medium _____ x 100 $7.50

International Pharmaceutical Order Form Page 8 Description Quantity Unit Charge 4529 Gloves light powder latex (L) large _____ x 100 $7.50 4418 Gloves latex powder free small _____ x 100 $6.60 4525 Gloves powder free Nitrile (S)SMALL _____ x 100 $7.50 4524 Gloves powder free Nitrile (M) medium _____ x 100 $7.50 4523 Gloves powder free Nitrile (L) large _____ x 100 $7.50 4543 Gloves powder free Nitrile (XL) X-large _____ x 100 $7.50 4588 Gloves latex surgical sterile (pairs) size 6 1/2 _____ x 50 $27.65 4589 Gloves latex surgical sterile (pairs) size 7 _____ x 50 $25.22 4590 Gloves latex surgical sterile (pairs) size 7 1/2 _____ x 50 $27.29 4591 Gloves latex surgical sterile (pairs) size 8 _____ x 50 $25.22 4592 Gloves latex surgical sterile (pairs) size 8 1/2 _____ x 50 $25.22 3221 Hand Sanitizer w/moisturizing kills 99% germs-4oz flip top _____ x 1 $1.35 4575 Medicine cups 1oz disposable: 100 cups / bag _____ x 100 $1.45 9055 Instant Cold Packs 4"x5" squeeze-knead-apply _____ x 1 $0.45 3012 I.V. catheter/needle unit; 20G x 1" [NEEDLES ONLY] _____ x EA $2.00 3013 I.V. catheter/needle unit; 22G X 1" [NEEDLES ONLY] _____ x EA $2.00 3017 I.V. administration set 105"tube length-60 drops/ml-2 inject sites _____ x EA $4.40 3560 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 $6.30 7135 Needle ONLY 18G x 1.5" _____ x 100 $6.60 7139 Needle ONLY 21G x 1.5" _____ x 100 $6.35 7141 Needle only 25G x 5/8" _____ x 100 $6.30 3300 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 $4.75 3368 Povidone iodine 10% topical solution 128oz (3784mL)gallon _____ x 1 $23.50 4469 Povidone iodine 10% topical solution 16oz (473 mL) pint _____ x 1 $3.51 1194M Surgical gown reinforced (sterile):contents inculde-)1gown,2 hand towels, _____ x EA $3.75 1195L 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 $19.45 7500 Scalpel #10 blade sterile _____ x 100 $14.65 2118 Scalpel #10 blade sterile with attached to handle _____ x 10 $8.80 3140 Scalpel #11 blade sterile _____ x 100 $15.75 2122 Scalpel #11 blade sterile attached to handle _____ x 10 $6.90 3139 Scalpel #15 blade sterile _____ x 100 $15.55 2121 Scalpel #15 blade sterile attached to handle _____ x 10 $6.60 4509 Syringe 10cc 20Gx1 1/2" L/L _____ x 100 $26.10 7127 Syringe 10cc without needle _____ x 100 $15.00 4439 Syringe 1cc 25Gx5/8" L/L _____ x 100 $17.80 7130 Syringe 1cc 27G x 1/2" _____ x 100 $12.15 7125 Syringe 1cc without needle _____ x 100 $11.20 3391 Syringe 3cc 21G x 1 1/2" L/L _____ x 100 $9.20 4440 Syringe 3cc 22Gx1 1/2" L/L _____ x 100 $9.15 3387 Syringe 3cc 23G x 1" L/L _____ x 100 $12.60 4495 Syringe 3cc 23Gx 1 1/2" L/L _____ x 100 $12.20 7128 Syringe 3cc 25g x 1" _____ x 100 $9.45 7126 Syringe 3cc without needle _____ x 100 $10.65 3975 Syringe 5cc 21G x 1 " L/L _____ x 100 $18.15 3976 Syringe 5cc 21G x 1 1/2" L/L _____ x 100 $18.15 4121 Syringe 5cc 22G x 1 1/2" L/L _____ x 100 $27.30 7129 Syringe 5cc without needle _____ x 100 $12.50 1684 SPLINT 36"-lightweight, reusable, waterproof, compact, radiolucent, versatile, _____ x 1 $6.00 longitudinal bend to give the splint strength. works for double layer wrist splint- sugar tong arm - splint ankle stirrup splint c-curve to create 3783 Tape, adhesive surgical paper 1"x10 yards hypo allergenic _____ x 12 $6.00 3364 Tongue depressor blades adult 6" x 3/4" _____ x 500 $4.65 1161 Tongue depressor blades junior ____ x 500 $4.75 4467 Towel Drape disposable, sterile _____ x 50 $16.00 1785 Unna Boot Bandage _____ x 1 $5.85 4300 PICTURE DOSING LABELS ONLY/same design that's on 3x4 baggies- _____ x 10 $0.75 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 $85.70 7239 Suture silk 2/0 45cm 3/8 rc needle 24.5mm FOR EXPORT ONLY _____ x 36 $18.30 7240 Suture silk 2/0 45cm 3/8cc needle 24.5mm FOR EXPORT ONLY _____ x 36 $40.45 7245 Suture synth abs 2/0 70cm 1/2rb needle 26mm FOR EXPORT ONLY _____ x 36 $74.80

International Pharmaceutical Order Form Page 9 Description Quantity Unit Charge

900 EQUIPMENT & MISCELLANEOUS EQUIPMENT & MISCELLANEOUS 8999 1tsp oral medicine syringe 5mL _____ x 10 $5.00 9001 2 tsp child medicine spoon _____ x 10 $3.60 4491 2oz empty plastic cough syrup bottles _____ x 10 $3.00 9000 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 $2.75 4300 PICTURE DOSING LABELS ONLY/same design that's on 3x4 baggies- _____ x 10 $0.55 10 labels to unit 9006 Asthma Mentor-peak flow meter adult or pediatric _____ x 1 $24.40 9004K 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 $30.75 9009 Lancets; for use with either all monitors requiring 28g _____ x 100 $8.65 3740 Cauterie disposable fine tip, high temperature,4 year shelf life _____ x 1 $11.15 4599 Ear Syringe 1oz _____ x 1 $3.35 9054 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 $5.50 8100 Reading Glasses-variety pack assorted powers-from +1/+1.25/+1.5/+1.75/+2/+2.5 _____ x 19 $14.25 2020 Glasses for near-sighted (-1.0 to -4.5) adjustable on side of each ear piece. _____ x EA $13.50 9052N 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 $45.60 30 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 $15.00 3664 Nebulizer handheld AC adapter included _____ x 1 $116.45 3666 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 $109.00 2301A Otoscope Disposable Ear specula Adult _____ x 100 $12.75 2301C Otoscope Disposable Eat specula Child _____ x 100 $12.45

9080 Ophthalmoscope/Otoscope w/Eurolight (E10) requires 2 " C" batteries [KaWe] _____ x 1 $250.00 2330 Pregnancy test, one step, simple to read _____ x EA $4.00 3822 Pregnancy HCG test; quick stick one step FOR EXPORT ONLY _____ x 25 $15.00 2500 Pill Crush, crash tablets into powder _____ x 1 $4.40 9025 Sharps- container red large 10qt (biohazard waste) _____ x 1 $8.05 2405 Blood Pressure Monitor w/large cuff & AC adapter, comes w/4AAbatteries _____ x EA $61.50

2607 Sphygmomanometer adult precision aneroid nylon cuff _____ x 1 $11.00 2307 Sphygmomanometer child (precision aneroid) w/ blue nylon cuff _____ x 1 $15.00 4010 Sphygmomanometer infant (precision aneroid) w/ blue nylon cuff _____ x 1 $20.70 4032 Sphygmomanometer XL adult precision aneroid nylon cuff _____ x 1 $18.00 4343 Stethoscope fetal 29" black vinyl Y-tubing _____ x 1 $18.55 2305 Stethoscope spectrum dual head _____ x 1 $4.50 2304 Stethoscope spectrum nurse, black _____ x 1 $4.85 2552 Tablet cutter _____ x 1 $2.50 4368 Tablet/Pill, tray counter w/spa _____ x 1 $6.55 2115 Thermometer INFRARED forehead scan, guidebook in english & spanish _____ x 1 $60.00 3327 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 $5.65 battery included.(probe covers #3153) 4332 Thermometer probe covers DIGITAL EAR disposable TENDER TEMP _____ x 40 $6.25 PROBE COVERS 3153 Thermometer probe covers DIGITAL oral disposable _____ x 50 $3.40 3245 Lubricating jelly sterile 2oz _____ x EA $1.20 9090S Vaginal specula (small) ready to use - disposable _____ x 10 $5.00 9090M Vaginal specula (medium) ready to use - disposable _____ x 10 $5.00 9090L Vaginal specula (large) ready to use-disposable _____ x 10 $5.00 4016 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 EMAIL Proforma will be email to the email address (that you) provide for us_____ x 1 $6.00 Email 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 email to you also, please provide the email address it should go to_________________________________________

International Pharmaceutical Order Form Page 10 Description Quantity Unit Charge PAN Proforma- designed for the country of Panama ONLY _____ x 1 $10.00 These will be email to you also, please provide the email 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 51376 ndc's) IF YOU DO NOT RECEIVE AN EMAIL 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.