GI4126, 1:02 AM
Service Date ¥
Moe 05, N96

Mar 05, 2026
Mar 05, 2026

Mar 05, 2026
Mar 05, 2076
Mor 04, 2026
‘Mor 04, 2026
‘Har 04, 2026
Mar 08, Os
Mae 04, 2078
Feb 25, 2026
Feb 25, 2026
feb 25, 2026
“Rb 2s, 2026
Feb OF, 224
Sankt, 2036
Jan 31. 2026
teh, 106
Jae Hi, 2028
Jandi, 226
Jan 30, URS
Jas 36, 206
“a3, mE
Dec 22, 2025
tov 14, 2025
Ney 14, 2025
OL 05, 2025
Aug 19, 2025
Aasg 18, 1025

= Fit («Previous |

Ee

Name

Mark Shand

Mark Holond
Mark Hotiad

‘Merk Holand
Mack Hosaret
Mark Holand
Mork Heatnd
Mork Hosa

Mark Holand

Mack Hobeet
Myk Hold

Mack Holand
Mark Boland

Mark Holand
ark Heung
Mark Holo
Mosk Hebond
Mork Hekaat
Mark Holand
Mark Hokie
Mark Heng
ad Halen
Mare Meine
Hak Heond
Hack Heian
Mark Hotsres

Mace Roland

Mark Kotand
Mark Holand

Expense/item

PMS TRATOOONE 13 TAN
ooMG

PUS-RISPERIDONE

APO-TRAZODONE TABLETS
TOMS

RISPERIDONE
SERTRAINE
QUSTIASINE
QUETIAPINE
Hecorette Gum % mg
Hcsrette Guar 7 may
Nexwclie Caen 2 ay
SUMATRIPTAN

AGRTES OT
PRNTOPRATLE

APG PREDNISONE TAR SOM:
SUMATRIFTAN DE
‘SRMATRIPTAN OF
APO-RILASTINE TASLETS
AMOVIG

SORTEC GOT
Kacoestoe Gr 3 op
APO-STLASTINE TABLETS
TEVA SUMATRIPTAN DF
APO-BULASTINE TARETS
ADO-RUASTINE TABLETS
TEVA SUMATRIPTAY DE
APO-RILASTINE TADLETS.
Page 1 Total

Grand Total
Page tof 2 | het» i iat»

Paciic Bue Gross
Amount Claimed

pire

OAS
sin02

319.45
$24.37

$3528
S$ta7
$88.38
“94346
5028
#21339
Hat
aan
$4348
‘SHOE
$5538
$6324
$219:32
$9834
$54.23
$45.03
3423
954.22
$104.05
$8840

$3,036.01
$4,311.41

Amount Paid
12.09

$isar
0.00

mw
SiR 7?
$3.75

008
ee
000

$35.25
san
S514
39.08
SAY
wae
pron
32
+4487
30D
$27.44
SO.
samt
$8.00
5rd
140.9%
$$ta4
S5t8
$0215
s5lis

$1,114.48

_ $2,004.16 |

Statement Date
Mar 055, 2026

Mor 05, 2026
Moe OF, 2626

Mor 65, 2026
Mar BS, 2026
Mar 04, 2006
Moet, 206
Mar D8, 2076
Me OM, 2026
Mor G1, 2026
Feb 25, 2028
Feb 25, 2026

Feb 2S. 026

Fob 25, 2026
Fabeo8, 2026
Sa 3t, 2024
Bah ME
ss 34, Bs
det 34 2G
don 34, 2026
In 2
dor WS
in B26

dan 14, 2026
See 22, 2025
Now 14, NBS
Noe 14, AS
De 0, 2025
Aug 19, 025
Aisy 3B, AS :

Detais
Detals
Detais
Detals
Oetais
Detats

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Lesternes iia rca tay Ro SE rman a koa vk BATRA ALLO Soya

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