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CONTROLLEDSUBSTANCESINVENTORY LOGName of Pharmacy:Address:City: State:Zip Code:Name of REGISTRANT on DEA Registration:DEA Registration Number:Date of Inventory:Inventory Taken At:Opening of BusinessClosing of BusinessORTime Started: Time Ended:Signature of Person Responsible for Taking InventoryPrint Name of Person Responsible for Taking Inventory
CII Inventory forDate: / /PharmacyDrug DescriptionSchACTIQ LONZENGE 1200 MCGACTIQ LONZENGE 1600 MCGACTIQ LONZENGE 400 MCGADDERALL 10 MGADDERALL 15 MGADDERALL 20 MGADDERALL 30 MGADDERALL XR CAP 10 MGADDERALL XR CAP 15 MGADDERALL XR CAP 20 MGADDERALL XR CAP 25 MGADDERALL XR CAP 30 MGADDERALL XR CAP 5 MGADHANSIA XR CAP 25 MGADHANSIA XR CAP 35 MGADHANSIA XR CAP 45 MGADHANSIA XR CAP 55 MGADHANSIA XR CAP 70 MGADHANSIA XR CAP 85 MGADZENYS ER ORAL SUSP 1.25MG/ML450 MLADZENYS XR ODT TAB 12.5 MGADZENYS XR ODT TAB 15.7 MGADZENYS XR ODT TAB 18.8 MGADZENYS XR ODT TAB 3.1 MGADZENYS XR ODT TAB 6.3 MGADZENYS XR ODT TAB 9.4 MGAMPHET IR TAB 10 MGAMPHET IR TAB 5 MGAMPHET SALTS ER CAP 10 MGAMPHET SALTS ER CAP 15 MGAMPHET SALTS ER CAP 15 BTABTABCAPCAPCAPNDCOn 0100228-3063-11Write-in Items Not Listed Above2222222222222Page 1
CII Inventory forDate: / /PharmacyDrug DescriptionSchAMPHET SALTS ER CAP 20 MGAMPHET SALTS ER CAP 20 MGAMPHET SALTS ER CAP 20 MGAMPHET SALTS ER CAP 25 MGAMPHET SALTS ER CAP 30 MGAMPHET SALTS ER CAP 5 MGAMPHET SALTS TAB 10 MGAMPHET SALTS TAB 10 MGAMPHET SALTS TAB 10 MGAMPHET SALTS TAB 12.5 MGAMPHET SALTS TAB 15 MGAMPHET SALTS TAB 15 MGAMPHET SALTS TAB 15 MGAMPHET SALTS TAB 20 MGAMPHET SALTS TAB 20 MGAMPHET SALTS TAB 20 MGAMPHET SALTS TAB 30 MGAMPHET SALTS TAB 30 MGAMPHET SALTS TAB 30 MGAMPHET SALTS TAB 5 MGAMPHET SALTS TAB 7.5 MGAPTENSIO XR CAP 10 MGAPTENSIO XR CAP 15 MGAPTENSIO XR CAP 20 MGAPTENSIO XR CAP 30 MGAPTENSIO XR CAP 40 MGAPTENSIO XR CAP 50 MGAPTENSIO XR CAP 60 MGBELLADONNA & OPIUM 16.2/30 MGBELLADONNA & OPIUM 16.2/60 MGCODEINE SULFATE TAB 30 MGCODEINE SULFATE TAB 30 PCAPCAPCAPCAPCAPSUPSUPTABTABNDCOn 1200527-1698-0100054-0244-25Write-in Items Not Listed Above222222222222Page 2
CII Inventory forDate: / /PharmacyDrug DescriptionSchCONCERTA TAB 18 MGCONCERTA TAB 27 MGCONCERTA TAB 36 MGCONCERTA TAB 54 MGCOTEMPLA XR ODT TAB 17.3 MGCOTEMPLA XR ODT TAB 25.9 MGCOTEMPLA XR ODT TAB 8.6 MGDAYTRANA 10 MGDAYTRANA 15 MGDAYTRANA 20 MGDAYTRANA 30 MGDEXEDRINE SPAN CAP 10 MGDEXEDRINE SPAN CAP 15 MGDEXMETHYLPHENIDATE HCL ER CAP 10 MGDEXMETHYLPHENIDATE HCL ER CAP 15 MGDEXMETHYLPHENIDATE HCL ER CAP 15 MGDEXMETHYLPHENIDATE HCL ER CAP 20 MGDEXMETHYLPHENIDATE HCL ER CAP 25 MGDEXMETHYLPHENIDATE HCL ER CAP 30 MGDEXMETHYLPHENIDATE HCL ER CAP 35 MGDEXMETHYLPHENIDATE HCL ER CAP 40 MGDEXMETHYLPHENIDATE HCL ER CAP 5 MGDEXMETHYLPHENIDATE HCL TAB 10 MGDEXMETHYLPHENIDATE HCL TAB 10 MGDEXMETHYLPHENIDATE HCL TAB 2.5 MGDEXMETHYLPHENIDATE HCL TAB 5 MGDEXTROAMPHETAMINE SULF ER CAP 10MGDEXTROAMPHETAMINE SULF ER CAP 10MGDEXTROAMPHETAMINE SULF ER CAP 15MGDEXTROAMPHETAMINE SULF ER CAP 15MGDEXTROAMPHETAMINE SULF ER CAP 5 MGDEXTROAMPHETAMINE SULF IR TAB 10 TABTABTABTABCAPCAPCAPCAPCAPTABNDCOn 1000406-8960-0100406-8959-01Write-in Items Not Listed Above222222222222Page 3
CII Inventory forDate: / /PharmacyDrug DescriptionSchDEXTROAMPHETAMINE SULF SOL 5MG/5MLDEXTROAMPHETAMINE SULF TAB 10 MGDEXTROAMPHETAMINE SULF TAB 5 MGDILAUDID TAB 4 MGDILAUDID TAB 8 MGDURAGESIC TRANSDERM SYS 100MCG/HRDURAGESIC TRANSDERM SYS 12 MCG/HRDURAGESIC TRANSDERM SYS 25 MCG/HRDURAGESIC TRANSDERM SYS 50 MCG/HRDURAGESIC TRANSDERM SYS 75 MCG/HRDYANAVEL XR ORAL SUSP 2.5MG/MLEMBEDA CAP 100/4 MGEMBEDA CAP 20/0.8 MGEMBEDA CAP 30/1.2 MGEMBEDA CAP 50/2.0 MGEMBEDA CAP 60/2.4 MGEMBEDA CAP 80/3.2 MGENDOCET TAB 10/325 MGENDOCET TAB 5/325 MGEVEKEO ODT TAB 10 MGEVEKEO ODT TAB 15 MGEVEKEO ODT TAB 20 MGEVEKEO TAB 10 MGEVEKEO TAB 5 MG 100FENTANYL CIT ORAL TRANS 1200 MCGFENTANYL CIT ORAL TRANS 1600 MCGFENTANYL CIT ORAL TRANS 200 MCGFENTANYL CIT ORAL TRANS 400 MCGFENTANYL CIT ORAL TRANS 600 MCGFENTANYL CIT ORAL TRANS 800 MCGFENTANYL CIT ORAL TRANS 800 MCGFENTANYL CIT VIAL 50 MCG/ML 2 TMLNDCOn 6500406-9208-3000641-6027-25Write-in Items Not Listed Above222222222222Page 4
CII Inventory forDate: / /PharmacyDrug DescriptionSchFENTANYL TR SYS MATRIX 100 MCG/HRFENTANYL TR SYS MATRIX 100 MCG/HRFENTANYL TR SYS MATRIX 100 MCG/HRFENTANYL TR SYS MATRIX 12 MCG/HRFENTANYL TR SYS MATRIX 25 MCG/HRFENTANYL TR SYS MATRIX 25 MCG/HRFENTANYL TR SYS MATRIX 37.5 MCG/HRFENTANYL TR SYS MATRIX 50 MCG/HRFENTANYL TR SYS MATRIX 50 MCG/HRFENTANYL TR SYS MATRIX 62.5 MCG/HRFENTANYL TR SYS MATRIX 75 MCG/HRFENTANYL TR SYS MATRIX 75MCG/HRFENTANYL TR SYS MATRIX 87.5 MCG/HRFENTORA TAB 400 MCGFOCALIN TAB 10MGFOCALIN TAB 2.5MGFOCALIN TAB 5MGFOCALIN XR CAP 10 MGFOCALIN XR CAP 15 MGFOCALIN XR CAP 20 MGFOCALIN XR CAP 25 MGFOCALIN XR CAP 30 MGFOCALIN XR CAP 35 MGFOCALIN XR CAP 40 MGFOCALIN XR CAP 5 MGHYDROCODONE APAP SOL 7.5/325MG/15MLHYDROCODONE APAP SOL 7.5/325MG/15MLHYDROCODONE APAP SOL 7.5/325MG/15MLHYDROCODONE BIT/APAP TAB 10/300 MGHYDROCODONE BIT/APAP TAB 10/325 MGHYDROCODONE BIT/APAP TAB 10/325 MGHYDROCODONE BIT/APAP TAB 10/325 COn 0110702-0191-0100406-0125-01Write-in Items Not Listed Above222222222222Page 5
CII Inventory forDate: / /PharmacyDrug DescriptionSchHYDROCODONE BIT/APAP TAB 10/325 MGHYDROCODONE BIT/APAP TAB 10/325 MGHYDROCODONE BIT/APAP TAB 10/325 MGHYDROCODONE BIT/APAP TAB 10/325 MGHYDROCODONE BIT/APAP TAB 10/325 MGHYDROCODONE BIT/APAP TAB 5/300 MGHYDROCODONE BIT/APAP TAB 5/325 MGHYDROCODONE BIT/APAP TAB 5/325 MGHYDROCODONE BIT/APAP TAB 5/325 MGHYDROCODONE BIT/APAP TAB 5/325 MGHYDROCODONE BIT/APAP TAB 5/325 MGHYDROCODONE BIT/APAP TAB 7.5/300 MGHYDROCODONE BIT/APAP TAB 7.5/300 MGHYDROCODONE BIT/APAP TAB 7.5/325 MGHYDROCODONE BIT/APAP TAB 7.5/325 MGHYDROCODONE BIT/APAP TAB 7.5/325 MGHYDROCODONE BIT/APAP TAB 7.5/325 MGHYDROCODONE BIT/APAP TAB 7.5/325 MGHYDROCODONE BIT/APAP TAB 7.5/325 MGHYDROCODONE BIT/HOM MBR TAB 5/1.5MGHYDROCODONE BIT/HOM MBR TAB 5/1.5MGHYDROCODONE BIT/IBUPR TAB 10/200 MGHYDROCODONE BIT/IBUPR TAB 5/200 MGHYDROCODONE BIT/IBUPR TAB 7.5/200 MGHYDROCODONE BIT/IBUPR TAB 7.5/200MGHYDROCODONE BIT/IBUPR TAB 7.5/200MGHYDROCOD CHLOR/POLI ER SUSP 118 MLHYDROCOD CHLOR/POLI ER SUSP 473 MLHYDROCODONE/APAP TAB 7.5/325 MGHYDROCODONE/APAP TAB 7.5/325 MGHYDROCOD/HOMATROP SYR 5/1.5MG/5MLHYDROMORPHONE HCL ER TAB 12 ABTABTABTABTABTABMLMLTABTABMLTABNDCOn 5050383-0043-1613811-0702-10Write-in Items Not Listed Above222222222222Page 6
CII Inventory forDate: / /PharmacyDrug DescriptionSchHYDROMORPHONE HCL ER TAB 16 MGHYDROMORPHONE HCL ER TAB 32 MGHYDROMORPHONE HCL ER TAB 8 MGHYDROMORPHONE HCL SUPP 3 MGHYDROMORPHONE HCL TAB 2 MGHYDROMORPHONE HCL TAB 2 MGHYDROMORPHONE HCL TAB 4 MGHYDROMORPHONE HCL TAB 4 MGHYDROMORPHONE HCL TAB 8 MGHYDROMORPHONE HCL TAB 8 MGHYDROMORPHONE HCL TAB 8 MGHYDROMORPHONE INJ 0.5 MG/0.5MLHYDROMORPHONE INJ 2 MG/MLHYDROMORPHONE INJ 2 MG/MLHYDROMORPHONE ORAL SOL 1 MG/MLHYDROMORPHONE ORAL SOL 1 MG/MLHYSINGLA ER TAB 100 MGHYSINGLA ER TAB 120 MGHYSINGLA ER TAB 20 MGHYSINGLA ER TAB 30 MGHYSINGLA ER TAB 40 MGHYSINGLA ER TAB 60 MGHYSINGLA ER TAB 80 MGJORNAY PM ER CAP 100 MGJORNAY PM ER CAP 20 MGJORNAY PM ER CAP 40 MGJORNAY PM ER CAP 60 MGJORNAY PM ER CAP 80 MGKADIAN CAP 10 MGKADIAN CAP 20 MGKADIAN CAP 200 MGKADIAN CAP 30 APCAPCAPNDCOn 6000023-6019-6000023-6013-60Write-in Items Not Listed Above222222222222Page 7
CII Inventory forDate: / /PharmacyDrug DescriptionSchKADIAN CAP 40 MGKADIAN CAP 50 MGKADIAN CAP 60 MGLEVORPHANOL TARTRATE TAB 2 MGLEVORPHANOL TARTRATE TAB 2 MGLEVORPHANOL TARTRATE TAB 3 MGLORTAB ELIXIR 10/300 MG/15 MLMEPERIDINE HCL ORAL SOL 50 MG/5 MLMEPERIDINE INJ 100 MG/MLMEPERIDINE INJ 25 MG/MLMEPERIDINE INJ 50MG/ML 1 MLMETHADONE HCL ORAL SOL 5 MG/5MLMETHADONE HCL TAB 10 MGMETHADONE HCL TAB 10MGMETHADONE HCL TAB 5 MGMETHADONE INTENSOL 10 MG/ MLMETHADONE ORAL CONC 10 MG/MLMETHADONE ORAL SOL 10 MG/5MLMETHADONE ORAL SOL 10 MG/MLMETHADONE TAB 10 MGMETHADONE TAB 5 MGMETHAMPHETAMINE HCL TAB 5 MGMETHYLIN ORAL SOLUTION 10 MG/5MLMETHYLIN ORAL SOLUTION 5 MG/5MLMETHYLPHENIDATE ER (LA) CAP 10 MGMETHYLPHENIDATE ER (LA) CAP 30 MGMETHYLPHENIDATE ER TAB (AG) 18 MGMETHYLPHENIDATE ER TAB (AG) 27 MGMETHYLPHENIDATE ER TAB (AG) 36 MGMETHYLPHENIDATE ER TAB (AG) 54 MGMETHYLPHENIDATE ER TAB 10 MGMETHYLPHENIDATE ER TAB 18 LMLTABTABTABMLMLCAPCAPTABTABTABTABTABTABNDCOn 0110702-0075-0147781-0415-01Write-in Items Not Listed Above222222222222Page 8
CII Inventory forDate: / /PharmacyDrug DescriptionSchMETHYLPHENIDATE ER TAB 18 MGMETHYLPHENIDATE ER TAB 20 MGMETHYLPHENIDATE ER TAB 27 MGMETHYLPHENIDATE ER TAB 27 MGMETHYLPHENIDATE ER TAB 27 MGMETHYLPHENIDATE ER TAB 36 MGMETHYLPHENIDATE ER TAB 36 MGMETHYLPHENIDATE ER TAB 36 MGMETHYLPHENIDATE ER TAB 54 MGMETHYLPHENIDATE ER TAB 54 MGMETHYLPHENIDATE ER TAB 72 MGMETHYLPHENIDATE HCL ER CAP (CD) 10MGMETHYLPHENIDATE HCL ER CAP (CD) 20MGMETHYLPHENIDATE HCL ER CAP (CD) 30MGMETHYLPHENIDATE HCL ER CAP (CD) 40MGMETHYLPHENIDATE HCL ER CAP (CD) 50MGMETHYLPHENIDATE HCL ER CAP (CD) 60MGMETHYLPHENIDATE HCL ER CAP (CD) 60MGMETHYLPHENIDATE HCL ER CAP (R) 40 MGMETHYLPHENIDATE HCL ER CAP 20 MGMETHYLPHENIDATE HCL ER CAP 20 MGMETHYLPHENIDATE HCL ER CAP 30 MGMETHYLPHENIDATE
CII Inventory for _ Date: _/_/_ Pharmacy Page 1 Drug Description Sch Pkg Size Dose Unit NDC On Hand Quantity ACTIQ LONZENGE 1200 MCG 2 30 LOZ 63459-0512-30 ACTIQ LONZENGE 1600 MCG 2 30 LOZ 63459-0516-30 ACTIQ LONZENGE 400 MCG 2 100 LOS 63459-0504-30 ADDERALL 10 MG 2 100 TAB 57844-0110-01File Size: 214KBPage Count: 30
