FOUR STAR PHARMACY

FOUR STAR PHARMACY

FOUR STAR PHARMACY

(Regional)

(Regional)

(Regional)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

Rx

Rx

Rx

FOUR STAR PHARMACY

FOUR STAR PHARMACY

(Regional)

(Regional)

(Regional)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

Rx

Rx

FOUR STAR PHARMACY

Rx

FOUR STAR PHARMACY

FOUR STAR PHARMACY

FOUR STAR PHARMACY

(Regional)

(Regional)

(Regional)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

Rx

Rx

Rx

FOUR STAR PHARMACY

FOUR STAR PHARMACY

(Regional)

(Regional)

(Regional)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

REGION 12 (SOCCSKSARGEN)

Rx

Rx

FOUR STAR PHARMACY

Rx

FOUR STAR PHARMACY

FOUR STAR PHARMACY

FOUR STAR PHARMACY

FOUR STAR PHARMACY

(Regional)
REGION 12 (SOCCSKSARGEN)

(Regional)
REGION 12 (SOCCSKSARGEN)

(Regional)
REGION 12 (SOCCSKSARGEN)

(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR

Rx
STAR PHARMACY

Rx
FOUR STAR PHARMACY

Rx
FOUR STAR PHARMACY

(Regional)
(Regional)
(Regional)
Generic Name:______________
Generic Name:______________
Generic Name:______________
Generic Name:______________
REGION 12 (SOCCSKSARGEN) Dosage:________
REGION 12 (SOCCSKSARGEN)
REGION 12 (SOCCSKSARGEN)
Dosage:________
Dosage:________
Dosage:________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Qty:__________
Qty:__________
Qty:__________
Qty:__________
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
_____________
_____________
_____________
_____________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
__
__
__
__

FOUR
PHARMACY
FOR STAR
EXTERNAL
USE ONLY
(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR

FOUR STAR
FOUR STAR PHARMACY
FOUR
STAR PHARMACY
FOR PHARMACY
EXTERNAL USE ONLY
FOR EXTERNAL USE
ONLY

Rx
STAR PHARMACY

(Regional)
REGION 12 (SOCCSKSARGEN)

(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR STAR PHARMACY

(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR STAR PHARMACY

(Regional)
(Regional)
(Regional)
Generic Name:______________
Generic Name:______________
Generic Name:______________
Generic Name:______________
REGION 12 (SOCCSKSARGEN) Dosage:________
REGION 12 (SOCCSKSARGEN)
REGION 12 (SOCCSKSARGEN)
Dosage:________
Dosage:________
Dosage:________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Qty:__________
Qty:__________
Qty:__________
Qty:__________
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
_____________
_____________
_____________
_____________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
__
__
__
__

FOUR
PHARMACY
FOR STAR
EXTERNAL
USE ONLY
(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR

FOUR STAR
FOUR STAR PHARMACY
FOUR
STAR PHARMACY
FOR PHARMACY
EXTERNAL USE ONLY
FOR EXTERNAL USE
ONLY

Rx
STAR PHARMACY

(Regional)
REGION 12 (SOCCSKSARGEN)

(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR STAR PHARMACY

(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR STAR PHARMACY

(Regional)
(Regional)
(Regional)
Generic Name:______________
Generic Name:______________
Generic Name:______________
Generic Name:______________
REGION 12 (SOCCSKSARGEN) Dosage:________
REGION 12 (SOCCSKSARGEN)
REGION 12 (SOCCSKSARGEN)
Dosage:________
Dosage:________
Dosage:________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Qty:__________
Qty:__________
Qty:__________
Qty:__________
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
_____________
_____________
_____________
_____________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
__
__
__
__

FOUR
PHARMACY
FOR STAR
EXTERNAL
USE ONLY
(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR

FOUR STAR
FOUR STAR PHARMACY
FOUR
STAR PHARMACY
FOR PHARMACY
EXTERNAL USE ONLY
FOR EXTERNAL USE
ONLY

Rx
STAR PHARMACY

(Regional)
REGION 12 (SOCCSKSARGEN)

(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR STAR PHARMACY

(Regional)
REGION 12 (SOCCSKSARGEN)

Rx
FOUR STAR PHARMACY

(Regional)

(Regional)
(Regional)
Generic Name:______________
Generic Name:______________
Generic Name:______________
Generic Name:______________
REGION 12 (SOCCSKSARGEN)
REGION 12 (SOCCSKSARGEN) Dosage:________
REGION 12 (SOCCSKSARGEN)
Dosage:________
Dosage:________
Dosage:________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Brand Name:________________
Qty:__________
Qty:__________
Qty:__________
Qty:__________
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
Lot No.:_____________Exp. Date:
_____________
_____________
_____________
_____________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
Signa:__________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
__
__
__
__

FOR EXTERNAL USE ONLY

FOR EXTERNAL USE ONLY

FOR EXTERNAL USE ONLY