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Home My WebLink AboutFinal Agenda PacketCITY OF RENTON FIREMEN'S PENSION BOARD Regular Meeting 7th Floor -Mayor's Conference Room Thursday, October 21, 2010 2:00 P.M. 1. CALL TO ORDER 2. APPROVAL OF MINUTES OF SEPTEMBER 16, 2010 3. CORRESPONDENCE 4. MONTHLY STATEMENT TO SEPTEMBER 30, 2010 5. MONTHLY BILLS AND PENSION PAYMENTS 6. UNFINISHED BUSINESS 7. NEW BUSINESS 8. ADJOURNMENT �r►' v.r�' MINUTES FIREMEN'S PENSION BOARD CITY OF RENTON September 16, 2010 Denis Law, Mayor King Parker, Council Finance Committee Chair Bonnie Walton, City Clerk Ray Barilleaux, Fire Department Representative Bruce Phillips, Fire Department Representative Chuck Christensen, Fire Department Alternate The regular meeting of the Firemen's Pension Board was called to order by Acting Chairman King Parker at 2:00 p.m. in the Mayor's Conference room, 7th floor of Renton City Hall. In attendance were Board members King Parker, Bruce Phillips and Bonnie Walton, Alternate Board Member Chuck Christensen, and Finance Department representative,Jill Masunaga. � MINUTES APPROVAL MOVED BY PHILLIPS, SECONDED BY CHRISTENSEN, THE PENSION BOARD APPROVE THE MINUTES OF THE AUGUST 19, 2010 MEETING. CARRIED. MONTHLY STATEMENT The financial report as of August 31, 2010, was reviewed. Total cash/investment balance was $4,203,304.30. MONTHLY BILLS AND PENSION PAYMENTS MOVED BY PHILLIPS, SECONDED BY CHRISTENSEN, TO APPROVE THE PENSION/MEDICAL PAYMENTS FOR SEPTEMBER 2010, IN THE TOTAL AMOUNT OF$31,107.31,TO BE PAID FROM THE FIREMEN'S PENSION FUND. CARRIED. ADJOURNMENT MOVED BY PHILLIPS, SECONDED BY CHRISTENSEN, THE MEETING OF THE FIREMEN'S PENSION BOARD BE ADJOURNED. CARRIED. Time: 2:02 p.m. �� Bonnie I. Walton Firemen's Pension Board Member&Secretary +�.r� �.�r CITY OF RENTON - FIREMEN'S PENSION FUND CASH 8� INVESTMENT ACTIVITY REPORT AS OF SEPTEMBER 30, 2010 Fireman's Pension Fund Comparison of Cash and lnvestment Activitv s ❑2010 ■2009 5 � �a 0 4 0 0 c 3 0 � 2 1 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec CURRENT 2010 20t0 LAST YEAR 2009 - 2009 ACTIVITY: MONTH YTD BUDGET CURR MO ACTUAL ADJ BUDGET BEGINNING CASH/INV BALANCE $4,203,304.30 $4,332,817.48 $3,895,540 $4,258,347.97 $4,265,991.35 $3,895,540 RECEIPTS: Firelnsurance Premium Tax 0.00 112,686.00 100,000 0.00 106,622.90 90,000 Investmentinterest 947.73 12,637.53 200,000 209.56 437,266.28 200,000 DISBURSEMENTS: Fire Pension 30,020.92 280,504.06 525,000 35,071.71 443,617.54 500,000 Fire Pension Medical 1,086.39 4,392.96 25,000 35.43 12,835.48 20,000 Office/Operating Supplies 0.00 99.27 475 113.65 459.88 475 Actuarial/Firemen's Pens 0.00 0.00 0 0.00 11,200.00 10,000 Reimb General/Clerical&Acct 0.00 0.00 0 983.00 11,801.00 11,801 ENDING CASH/INV BALANCE $4,173,144.72 $4,173,144.72 $3,645,065 $4,222,353.74 $4,329,966.63 $3,643,264 CURRENT PREVIOUS LAST YEAR LAST YEAR ACTIVITY: MONTH MONTH CURR MO PREV MO CASH/State Investment Pool $1,299,267.67 $1,327,939.64 $1,138,700.94 $719,927.71 INVESTMENTS: CD's&State Investment Pool 0.00 0.00 0.00 454,767.46 Federal National Mortgage Assn 99,555.84 99,555.84 99,555.84 99,555.84 Treasury Strips 8�Zero Coupon Bonds 2,767,916.83 2,767,916.83 2,984,096.96 2,984,096.96 Interest Receivable 6,404.38 7,891.99 0.00 0.00 TOTAL CASH AND INVESTMENTS $4,173,144.72 $4,203,304.30 $4,222,353.74 $4,258,347.97 The State Investment Pool interest 0.2997% 0.2680% 0.4703% 0.5686% H:\FINANCE\FINPLAN\FIREPEN\1 Fire Pension 2010.x1s\Seo pa�A� ,n�,��n,r, �Vrry W,./ FIREMEN'S PENSION BOARD PENSION/MEDICAL PAYMENTS FOR OCTOBER, 2010 A- ;Recipient: ' _x.Pension'Amt. Medical, ;" ; 7�..'Total�. ="�' ' m , _._ ANKENY,Charlie(Captain) $117.69 117.69 BARILLEAUX, Ray(Battalion Chief) - _ BEATTEAY, Karlen(Widow) $218.62 218.62 BERGMAN,Claudette(Widow) $140.99 140.99 CHRISTENSON,Chuck(Firefighter) $244.14 244.14 GEISSLER, Dick(Fire Chief) - _ GOODWIN,Charles(Captain) $4,231.00 - 4,231.00 GOODWIN, Donald(Firefighter) $1,005.27 1,005.27 HAWORTH,Constance(Widow) $2,968.33 2,968.33 HAWORTH,1ack(Firefighter) $3,191.50 220.54 3,412.04 HENRY,William,Jr.(Captain) $1,322.82 1,322.82 HURST,Gerald(Firefighter) $531.13 531.13 JONES, Evelyn M. (Widow) $237.15 237.15 LARSON,William(Firefighter) - _ LAVALLEY,Theodele(Captain) $343.91 343.91 MATTHEW,James(Deputy Chie� - _ MC LAUGHLIN,JACK(Battalion Chief) $982.45 982.45 NEWTON,Gary(Lieutenant) $258.03 258.03 NICHOLS, Gerald(Battalion Chie� $516.96 516.96 PARKS-ANDREASON,Arlene(Widow) $319.23 319.23 PARKS,John(Firefighter) $3,312.50 - 3,312.50 PHILLIPS, Bruce H.(Deputy Chiefl $232.48 Z32.48 PRINGLE,Arthur(Captain) $464.52 464.52 PRINGLE,S.Joan(Widow) $2,550.14 2,550.14 RIGGLE, David E.(Firefighter D Step) $69.10 69.10 RUPPRECHT,Jim(Firefighter D Step) $104.20 104.20 SMITH, Leroy(Firefighter) $397.89 397.89 STROM, Doris(Widow) $3,255.33 3,255.33 TODD,Franklin(Firefighter) $458.00 458.00 TONDA, Lila Jean(Widow) - _ VACCA, Nick(Lieutenant) $297.25 297.25 WALLS,Camille(Widow) $131.71 131.71 WALLS, Mercedes(Widow) $92.23 92.23 WALSH, David(Firefighter) $1,052.07 1,052.07 WEISS,Cheryl (Widow) $747.56 ' 747.56 WILLIAMS,Alta (Widow) - _ WOOTEN, Marilyn E.(Widow) $226.72 226.72 `:; �.,^Totat F.�cpjen`ses:' Piension/Medical x�a�=� ��^$30;020 92., _",��;$220 54 ;�_��"�;"$30,241A6 : Prior Year Pension/Medical Payments: Total Pension Payments for October, 2009 35,071.71 Total Medical Bills Reimbursed in October,2009 1,251:94 Total Expenses: Medical/Pension 36,323.65 4_SUMMARY 2010.XLS 10/15/2010 °�wr` v.r� FIREMEN'S PENSION BOARD MEDICAL BILLS TO BE REIMBURSED IN OCTOBER,2010 PAYMENT Page. , ,,, :`Name < " :':'Pharmac lMedical�Facilit "' g -.�� Date..�>�:, :�Amountof,6il1� Charles Goodwin 0.00 2 Jack Haworth Harbor Drug Co. 04/05/10 5.00 2 Jack Haworth Harbor Drug Co. 04/05/10 5.00 2 Jack Haworth Harbor Drug Co. 04/13/10 14.98 2 Jack Haworth Harbor Drug Co. 04/13/10 5.00 2 Jack Haworth Harbor Drug Co. 04/13/10 7.78 2 Jack Haworth Harbor Drug Co. 04/13/10 5.00 2 Jack Haworth Harbor Drug Co. 04/24/10 5.00 2 Jack Haworth Harbor Drug Co. 05/03/10 5.00 3 Jack Haworth Harbor Drug Co. 05/03/10 5.00 3 Jack Haworth Harbor Drug Co. 05/11/10 5.00 3 Jack Haworth Harbor Drug Co. 05/11/10 5.00 3 Jack Haworth Harbor Drug Co. 05/11/10 5.00 3 Jack Haworth Harbor Drug Co. 05/24/10 5.00 3 Jack Haworth Harbor Drug Co. 06/02/10 5.00 3 Jack Haworth Harbor Drug Co. 06/02/10 5.00 3 Jack Haworth Harbor Drug Co. 06/02/10 5.00 4 Jack Haworth Harbor Drug Co. 06/03/10 35.00 4 Jack Haworth Harbor Drug Co. 06/24/10 5.00 4 Jack Haworth Harbor Drug Co. 06/14/10 5.00 4 Jack Haworth Harbor Drug Co. 06/14/10 7.78 4 Jack Haworth Harbor Drug Co. 06/14/10 5.00 4 Jack Haworth Harbor Drug Co. 07/06/10 5.00 4 Jack Haworth Harbor Drug Co. 07/06/10 10.00 5 Jack Haworth Harbor Drug Co. 07/06/10 5.00 5 Jack Haworth Harbor Drug Co. 07/06/10 5.00 5 Jack Haworth Harbor Drug Co. 07/06/10 5.00 5 Jack Haworth Harbor Drug Co. 07/06/10 5.00 5 Jack Haworth Harbor Drug Co. 07/27/10 5.00 5 Jack Haworth Harbor Drug Co. 08/06/10 5.00 5 Jack Haworth Harbor Drug Co. 08/06/10 5.00 5 Jack Haworth Harbor Drug Co. 08/06/10 5.00 6 Jack Haworth Harbor Drug Co. 08/12/10 5.00 6 Jack Haworth Harbor Drug Co. 08/09/10 5.00 6 Jack Haworth Harbor Drug Co. 08/24/10 5.00 220.54 John Parks 0.00 TQT�L` , . fht�� ,:220.54; 3_2010 FP Medical.XLS Page 1 of 1 10/15/2010 � �,,,r SENDCLAIMTO: �City of Renton Finance Dept.-Fire Pension 1055 South Grady Way Renton,WA 98057 O��Y �� n ,� * ,� + '��o� CITY OF RENTON FIREMEN'S PENSION BOARD Pharmacy/Medical Claim Reimbursement Request 1) DATE (5 Q�Q 2) BiSA�iLiTY RETllcEE'S N� (print) ��,t(:l� {...1/�G/� G!�Q/�'��J 3) ADDRESS t . O. ��( U1b�� .tr} c� (/U �L1C...K� 7 . / � 4} DISABILIT'Y AT TIME OF RETIREMENT DS•S' �� % �1 ' � e�/C, ! 5) DESCRIPTION OF CLAIM: (Supporting docufnentation must be attached.) (Effective 4/1/2008,pre-LEOFF retirees may submit all prescription drug egpenses for reimbursement, whether or not related to the retirement disability,nrovided that the eapense is not covered by another pian,source or insurance coverage. Supporting documentation for all must be attached.) 6) TOTAL AMOUNT OF CLAIM: $ � ��J,S� A*r��?rt of total �?�-�n (above; that is related t� t?:e Re±iremPnt I�?s�bi?ity: � 7} I certify that I have not been and will not be compensated by any other organization, insurance carrier or Medicare for the above-mentioned claim for reimbursement other than the City of Renton. I further certify that the above statements are complete and accurate to the best of my knowledge, and that any charges other than prescription drug charges, are related to my disability as determined at the time af my retirement from the Renton Fire Department. � Signature: � 1 � _,,, � ��. Note: Supporting documentation rnust be attached. p� f �`"' Narbor D�g Co.�Prescriptions Narbor Drug Co.Prescr�ptions �3,6��. Phone 360-532-3061 316 8th 54 Phone 360-532-3067 Hoquiam,WA 98550 24 Hr.kx Ra(111(360)53&9478 Hoquiam,WA98550 24 Hr.Wc kefli4(36Q)53B-9478 RX# 703320 R MORRIS, R., MD RX# 701042 R KONN, D., MD HAWORTH,JACK" 04/13/10 DS HAWORTH,JACK* 04/05/10 GS BOX 864, OCEAN SHORES,WA 9B551 BOX 864,OCEAN SHORES,WA 9B551 FUROSEMIDE 20 MG AMIODARONE HCL 200M�3 QTY#60 NDC#00054-4297-3� ROXANE QTY#30 NDC#00093-9133-52 TEVA US:, Generic for:AMIODARONE 200 MG REF# DNCHHWC REF#UEPTCDL 1 REFILLS 9 REFILLS COMC COMC COPAY: $7.78 INI�iII�Gl�l�l�9l�ll�l1!{�11�18�II�iNftll�i11�111�iIN�il�l��lll�ll��ll� IIII�lll�ll�lll�illllll�IIII��I��i��i��a��u►��►u��ii�ii� � Harbor Drug Co.Prescr�pt�ons 315 8th St Phone 360-532-3067 Hoquiam,WA 98550 24 Nr.i!x Refltl(360}536-9478 (all rour doctor for medical advi�e about side e((e�s.You ma�report side ef(ecu to fDA at I-B00-FDA-1068. RX# 706769 N KO N N, D., M D HA1h��RTH,JACK' 04/13l10 DS � Nar6or Drug Co.Preseriptions BOX e�,OCEAN SHORES,WA 98551 816 Sth�SL Phone 360-532-3067 ISOSOR BI DE M ONO 30MG Hoquiam,WA98550 24 Hr.itx kefftE(�66}538-44y& QTY# 15 NDC#001432230-01 WEST-WAF ' f�(�# 698108 R MORR�S: R., MD Generic For:ISOSORBI MON ER 30MG.-ETHEX HAWORTH,JACK* 04/05/10 DS REF#UE9QEWW BOX 864,OCEAN SHORES;WA 98551 5 REFILLS AMLODIPINE SMG TAB COMC QTY#45 NDC#68382-0122-05 ZYDUS ry COPAY: $5.00 REF#3NiPCHF IIIIINII��'IIIlI01IIIH��IlIIB�III�II�I�II�III�IUUIIIdIIINI7�II�I�AIIINII'�IIIIIA� MAY REFILL ' HBrIIOr DrIIJ CO.Prescriptions COMC COPAY: $5.00 �168th St' Pbone 360-532-3061 Illlp�IIHI�II�p�I�II�IIp1��11(B�IIIp�I�I�.��IIIIIIII iif�IIN il�nl �oquiam,NtA 9B550 24 Hr.Iac Rcfl�E(36Q}538-4478 � �i��ll�' RX#C701041 R KONN, D., MD � � HAWORTH,JACK" 04/24/10 D5 BOX 664,OCEAN SHORFS,WA 9B551 [all our docror for medial adri�e about side efleds.You mar report side el(ec�to fDh at I•600•fDA-1068. ZO L P I D EM 10 M G .� __ - l�..�� QTY# 30 NDC#13668-0008-05 TORRENT Generic For:ZOLPIDEM 10 NIG Narbor Drug Co.Prescriptions REF#3PWWMTF 1 REFILLS sts eu,se Phone 360-534-3061 COMC Hoquiam,WA 98550 24 Hr.ttx Refftt(36Qj 538•4478 RX# 705035 R LECHNER, J., MD lIIU�II�III�II�II��I�II�IIIIIIIIBUIN�IIaII�IdIII�II�II�IIi�IIII�IINlllhlll��(lo HAWORTH,JACK' 04/13l10 DS BOX 864,OCEAN SHORES,WA 9B551 FERROUS GLUCONATE 324MG. ' QTY# 9Q NDC#00574-050&01 PADDOCK r,ii„�,..,.,...�-•--,�--�-,• ,. •• - . •• 4 REFILLS PRICE: $14.98 N81'U01'Dfllg CO.Prescriptions InIpIII�IIIINIIIIII�IIIHIII�III�d�IIIBI'�III�11 IIII IIIIIIINI�II�IIlII�I��II�IIII � Hoa,u�m:tWA 98550 24 Hr.!tic Refi{f{360}536-4478 RX# 707825 N* MORRIS, R., 0�03/10 DS HAWORTH,JACK [allyourdoctorformedi�aladvice_aboutsideeffects..louma�reportsideeffects_mFDAatI•BDO•fDA•IOBB. eoXesa,OCEAN SHORES,WA98551 OMEPRAZOLE ER 20 MG CAPS Harbor Drug C � QTY#30 NDC#60505-DD65-01 APOTEX • 3i 6 Sth St, Noquiam,WA98550 2 REFt� DP19331 RX# 689201 R KO� , , 2 REFILLS HAW�RTH,JAGK* 04l13/10 DS COM� BOX Bfi4,OCEAN SHORES,VJA 98551 �OPAY: $5.00 L�VASTATIN 20 MG I�I�III�II�I�III�IINII6IIII�II�IIII�Il�iI�II�II�I��I�II�IIIIIIIIINI�INII QTY# 30 NDC#534&9-0608-10 MU i UAL REF#3PDFiX1 1 R E F I L LS [all yaur doctor for medial advice about side effear.You map report side eHects to fDA at I•8D0-fDA-ID88. COMG COPAY: $5.00 In�N�iII�I��A II�II�INNII�IInGIn�I�NI�I I�IIf�II�INI IIV lldll�lllll�ll fall rour docwr for medial advice about side ef(ects.You ma reY port side�ie�s to fDA at I-B00•fDA-IU88. �/K�G � �,,, � Nar6�lrug Co.Prescriptions 916 8tf�St. . Phone 366-532-306t � Narbor Drug Co.Prescriptions Hoquiam,WA 9855� 24 Hr.Rz ReRF4(360)538-44i8 316 8th S6 Phone 360-532-3061 �#C 701041 R KON N, �., M D Hoquiam,WA98550 24 Hr.Rn ke811(360J 53H-4978 HAWORTH,JACK* 05l24/10 DS RX# 701042 R KONN, D., MD BOX 864,OCEAN SHORES,WA 9B551 HAWORTH,JACK* 05/03/10 DS ZOLPIDEM 10MG aox esa,OCEAN SHORES,WA 9B551 QTY#30 ' NDC#13668-OOD8-05 TORRENT AMIODARONE HCL 20dMG Generic For:ZOLPIDEM 10 MG QTY# 30 NDC#00093-9133-52 TEVA USA REF# UK9HNX9 Generic For:AMIODARONE 200 MG NO REFILLS i REF# DPI3QAA COMC 8 REFILLS COPAY: $5.00 � CO�C COPAY: $5.00 I��II��I�I�I�II�I�I�I�INIII�III�I�IIN�I�NI�III�III�II�III�II�INIII� ' ��II�I�I�I�d��I�I�I��I�d��"��I�I'^�I�I��I�� [all your doctor(or medical advice about side effeects.You may report side e�ects to fDA at I•B00-fDA•IDBB. (allrourdoctorformedialadviceaboutsideeffects.Youma�reportsideeffectsmfDAatl-80D-fDA-1088. � Harbor Drug Co.Prescriptions 3f6 Sth St. Phone 360-532-3061 � Hardor Drug Co.Prescriptions Hoquiam,wA sssso 24 Hr.Rx Re$il(3b0)538-44�8 3168th5t Phone360-532-3061 �(# 7Q7$'2rj R MORRIS, R., M� � Hoquiam,WA 98550 Z4 lir.TOc Refifl(360)538-9976 HAWORTH,JACK* 06/02/10 DS RX# 698108 R MORRIS, R=., MD BOX 664,OCEAN SHORES,WA 9B551 HAWORTH,JACK* 05/11/10 DS OMEPRAZOLE ER 20 MG CAPS BOX 864,OCEaN SHORES,WA 98551 QTY# 30 NDC#60505-OD6�01 APOTEX AMLODIPINE 5MG TAB QTY#45 NDC#68382-0122-05 ZYDUS REF# UMA3371 1 REFILLS REF# UKLLXCI COMC MAY REFILL GOPAY: $5.00 �°""� I�I�Ii�lll�ll�l�l�I�II�I�N�N II�IIN��II�I�IIIN IIINlilll�ll�lll�� COPAY: $5.00 IIlI�I i�HI�IN�fII�II��NlII��I�llll�l�llf�ll�Il�lil�l�lll�l�l�II�IINRII fall your doctor for medial advice about side�fec�.You mar report side effects to fDA at I-800-f6A-1088. ( «�._m�.,i.onn_mA inAR � Harbor Drug Co.Prescriptions Narbor Drug Ca.Prescriptions 318 Bth SL Phone 360-532-3061 316$th St. Phone 360-532-3061 Hoquiam,WA 9B550 24 Wr.Rx RefEll(360)538-9478 Hoquiam,WA 98550 24 Hr.IYz Refil!(360J 538-9978 RX# 706769 R KGNN, D., MD RX# 706769 R KONN, D., MD HAWORTH,JACK* 05/11/10 DS HAWORTH,JACK" 06/02/10 DS , BOX 864,OCEAN SHORES,WA 98551 BOX 864,OCEAN SHORES,WA 98551 ISOSORBIDE MONO 30MG ISaSOR MON ER TB 30MG KRE 100 Q7Y# 15 NDC#00143-2230-01 WESTWARI QTY# 15 NDC#62175-0128-37 KREMERS Generic For:ISOSORB�MON ER 30MG.-ETHEX Generic For:ISOSORBI MON ER 30MG.-ETHEX REF#3RNLETL REF# 3WEEICQ 4 REFiLLS 3 REFILLS COMC COMC I�I�I!I�I�Il�lll�il�'II�II��IN�II�II�II�UIB��I�Ilfllll�ll�ll�l�ll�l I�� lil�ll�l�ll�l��l�III�iIIIII�II�IN�{�II��III�II�III�IINII�NII�III�II��II� II► � Har6or Drug Co.Prescriptions . � [all your doctor for medial adrice about side e(fec�.lou ma�report side efle�s ta fDA at I•800•fDA-1088. 3t6 8th St. Pf�one 360-532-3061 ' , Hoquiam,WA 98550 24 Hr.kx itefFlf(360}5:18-947& � Harbor Drug Co.Prescriptions RX# 6892�� R Ko r�rv, �., M D 316 Bth SC Phone 360-532-3061 � HAWORTH,JACK" 05/11/10 DS Hoquiam,�wa sesso 241ir.fGc Refl1E(360}538-94?& BOX Bfi4,OCEAN SHORES,WA9B551 RX# 701042 R KONN, D., MD LOVASTATIN 20 MG HAWORTH,JACK* 06/02/10 DS QTY# 30 NDC#53489-0605-10 MUTUAL BOX 864,OCEAN SHORES,WA 98551 AMIODARONE HCL 200MG REF# UKLLXAA QTY#30 NDC#00093-9133-52 TEVA USA NO REFILLS Generic For:AMIODARONE 2D0 MG COMC REF# DRNMLTH COPAY: $5.00 7 REFILLS � I��II��I�I�U�I�II�I�i�I�l�IIM�I9UI�II�I�IIdIliII1B�I�I�IHii COMC COPAY: $�.00 Lallyourdoctorfarmedicaladvi�ea6outsidee(fetf�.loumayreportsideeffe�srofDAatl-BDD•fDA•IDBB. ��)�II�I�I��I��II�III��I�II��II��II�I�I�III�I�II�� [all your doctor for medinl advice about side e8ec�.You mav reoort side e6e�ts to fDA at I-800-fDA-t086. �/�(>E 3 . � � ��++ ••••••,••• •••uy�u.rrCsl:�IpIl00S 316 Bth St. Phone 360-532-3061 HaI�dOI�DI�I19 CO.Prescriptions Hoquiam,WA 98550 24 Hr.Rt Reffll{36Q)538-9478 ��+ 709355 N RUYLE, S., (�1�p � � 31fi8th$t. Phone360-532-3061 HAWORTH,JACK* Hoquiam,WA 98550 24 Hr.iix Reflll(360)538-9478 BOX B64,OCEA�V SHORES,WA98551 06/03/1�DS RX#� 7OSJ24 N KONN, D., MD AZOP7 1°/, 1p ML HAWORTH,JACK"` 06/14/10 DS QTY# 10 NDC#00065-0275-10 ALCON VIS LOVASTATIN 20 MGS WA98551 Generic For:AZOpT 5ML QTY#30 NDC#68180-0468-07 LUPIN REF# DRQ39RH 4 REFILLS C��C REf#3XE7QKT NO REFlLLS COPAY: $35.00 COMC IN�IIIINNl�IIII�IIIII!(�II�I{��I��II�I�II�III�I�III�II�I��IR�III�II�� COPAY: $�.00 �_,�._._,_�.t_.__,:_�_,.:---�..y.:,._�_�.�..__...__�.:,..u.��,_.,o��„�po IBi�IIIN�I�I��lll�l{I�Il�li�l�l�li�ll�II�IIIbIIIh�II�II�II�N�llldlllh�� Harbor Drug Co.Prescriptions �•��...,.,J,�-.F•.m•a;ri�a�,�e,h��r��a>prrem r��m,�r�,�rtsideeffe�tsrofDAatl-800-fDA-IDBB. 3168th SI. Pbone 360-532-3067 Hoquiam,WA 99550 24 Hr.R�c Reflif(360}538-4978 �. H�I�qOI�DCU Rx#c��os22 N KONN, o., MD g Co.Prescriptions HAWORTH�JACK* 06/24/10 JR �Y6$fhSE. Phone360-532-306i BOX B64,OCEAN SHORES,WA 98551 ' Hoquiam,Wq se55o 24 Hr,tbc geflp�g6Q?538_4q78 ZOLPIDEM 10MG RX# 709924 R KONN, D., MD QTY# 30 NDC#13668-0008-05 TORRENT B X864ROCEAN HORES,Wqge557 ��10 DS Generic For:ZOLPIDEM 10 MG LOVASTATIN 20 MG REF#SAFCTPK 5 REFILLS QTY#30 NDC#68180-0468-D7 LUPIN COMc REF#31F3EMM COPAY: $5.00 MAY REFILL I�I�III�I�II�Ii�iIN�IINI��i�NI�I�Ii�IIftlIII�II�I�I�IIBiINIIIII�III�aN �°'�'� : --------- -- IIIlillllli�l�l�ll�ll�ll�ll�l�li[�Illl�lll�l�lillillli�ll�lli�lilla $5�00 Harbor Drug Co.Prescriptions II�III��I��I 31fi 8[h St. Phone 360-532-3061 [all�our doctor for�:��-�' CO.Prescript�ons Hoquiam,WA 98550 24 Hr.Rx Refll!(36QJ 538-9478 Harbor Dru9 Pho�e 360-532-3061 �� 698108 R* MORRIS, R., M� � H'q�m�p98550 441"ti°•�'�efl�t(3b0)538-qgT$ HAWORTH,JACK 06/14/10 DS R„MC BOX 864,OCEAN SHORES,WA 98551 �X# 7p3320 R MORRIS, p71D�10 D5 AMLODIPINE 5 MG �qCK" � QTY#45 ND�#64679-0422-02 WOCKHAR B0�$�Rp�EAN SHORES,WA9855� REF#n3XE7L3�LODIPINE 5MG TAB FUROSEM��E 2Q MG 4297-31 R�� N NpC#00054- � MAY REFILL p.TY#60 COMC I�I�II�I�II�II�III�III�II��I�IIII�II�iIWI{INll�i�lli�l�ll�li�lli�ll{IIN�O NO REFILLS � PR�CE� ��0.00 ��1�N II�'I�II�U�I�II�I nI II�II�II'�I��I�I��u GII your doaor for medial advice about side effe�s.You ma�report side effe�s ro fDA at I-8D0-fDA-1086. IIII�II�II��II�III�II�� at�BOaFDA-�OgB, Harbor Drug Co.Prescriptions � � m��ronnrtsideeNedstofDA [all ou�doclor for medical ad°��P ah""t°�'°��"' � � 3768th St. Phone 360-532-3061 . ' Hoquiam,WA 98550 24 Mr.t0�Reflll(360)538-44�$ RX# 703320 R MORRIS, R., MD HAWORTH,JACK* d6l14l10 DS BOX 864,OCEAN SHORES,WA 9B551 FUROSENIIDE 20 MG QTY# 60 NDC#000544297-31 ROXANE REF# UNC7CL1 NO REFILLS COMC GOPAY: $7.78 II��III�I�II�I�NI�i��I��I�Ii�II�IN�IN�ll�ll�ll�i�Nll�lll�III�IINflI �all y�our doctor for medical ad�ice about side efie�s.You maY report side eff�etcfs.ro FDA at I•BDO•fDA•1088. �T.._.,� .._ -- P� �C � Har6or Dr�►��:o.Prescriptions � 316 8th SL �,�/ Phone 360-532-3061 Hoquiam,WA98550 �14 Hr.i�Refift(36Qj 538-44}8 RX#C710522 R KONN, D., MD HAWORTH,JACK* 07/24/10 D5 � Harbor�rug Co.Pr�scriptions BOX 864,OCEAN SHORES,WA 98551 3T88LttSt. Phone360-532-3061 ZOLPIDEM 10MG Hoquiam,wq ses5o 2�E Hr,fGc ReftIE(366j 538-447g QTY#30 NDC#13668-0008-05 TORRENT RX# 698108 R MORRIS, R., MD Generic For:ZOLPIDEM 10 MG HAWORTH,JACK� 07106/10 DS REF# DiCiWAE BOX 864,OCEAN SHORES,wq se5s� 4 REFILLS AMLODIPINE 5 MG COMC QTY#45 NDC#64679-0422-02 WOCKHA COPAY: $5.00 ' Generic For:AMLODIPINE 5;��TAB 1NN�IIIIaI�iI�I�IIaNII�B�i�I�ii�il�Ii�IIIII�II�IBIIINNIIIIIIInlfllllll��ll REF# DWDPFF3 MAY REFILL COMC CO PAY: $5.00 [all your doctor for medial advice about side effeus.You may report side effecu to FDA at I-80D-fDA-1068. llll�lln�l�lll�u�ll�ill�ll�llllll►l�l�l�ll�Il�ll�l�ll�ll�lll�i�lll��ll Harbor urug eo.Prescriptions 3i6 9[h St. Pi�one 360-532-3067 � Narbor Drug Co.PI�PiSCI�I'ILIOIIS Hoquiam,WA 98550 24 Hr.ibc keflll{366}53B-44T8 3168LhSt, Phone360-532-3061 � �# 70�i769 R KONt�, �., MCJ Hoquiam,WA 98550 24 Hr,kx Reflll(366}538-9f78 HAWORTH JACK* 08l06/10 JR RX# 7OTH25 R MORRIS, R., MD BOX 864,OCEAN SHORES,WA 98551 HAWORTH,JACK* 07/06/10 DS ISOSOR MON ER TB 30MG KRE 10d BOx e64,oCEAN SHOREs,tNA 98551 QTY# 15 NDC#62175-012&37 KREMERS OMEPRAZOLE ER 20 MG CAPS Generic For:ISOSORBI MON ER 30MG.-ETHEX QTY# 3Q NDC#60505-0065-01 APOTEX REf# D3WFCH3 1 REFILLS REF#SAXENR9 COMC NO REFILLS COPA`1(: $5.00 �°""� COPAY: $5.00 1�11�118�I1ai�Iu�iI�I�II�Iv1�1�61��II�laNlip If�lfllillllllll�il�lhll�illll Ihl�llla�l�ll�lillNI�IINiII�I�IIII�ii�I�I�IIBIIII�I�I�II�lIINll�ilalill --- ------ -•---rn�_.IAMCI111f10A _ � Narbor Drug Co.Prescriptions � Narbor Drug Co.Prescriptions 316 Bth St. Phone 360-532-3067 Hoquiam,WN 98550 24 ffr.Rz RefifF(366)536-9978 37fi Bth St. Phone 360-532-3061 �(# ]09924 R Hoquiam,wR sesso 24 iir.RX RefifE(360y 538-4978 KONN, D., MD RX# 706769 R KONN, D., MD HAWORTH,JACK* 08/06/10 JR HAWORTH,JACK" 07/06/10 DS B�X 864,OCEAN SHORES,WA 9B551 Box esa,oCEAN SHOREs,WA se551 LOVASTATIN 20 MG ISOSOR MON ER TB 30MG KRE 100 QTY# 30 NDC##581gp_0468-07 LUPIN QTY# i5 NDC#6217b-012g_37 KREMERS REF# D3WFA79 Generic For:ISOSORBI MON ER 30MG.-ETHEX REF#31F3D99 ' MAY REFILL 2 REFILLS COMC COMC COPAY: $5.00 INBdIi�aI�II�II�II�N�iiNI��II�III�I�Iq�II�IIIGI AY: $$.�� Ip�lll�i�ll�IN�II�II�II�I�UId�!l�ilnilnill�Il�If�IIIN!IIIiIHl�llllll�� I�II�N�I�I�� [all�rour docror for medical advi�e about side effear,You mar report side efiec�to FDA at I-800-FDA-1088. � Narbnr�r�g Co.��scriptions 3T6 8th$f. Phone 360-532-3061 Hoquiam,WA 98550 24}{r.R�c Refllk(36Q}538-447'B RX# 701042 R KONN, D., MD _ � HAWORTH,JACK* 07/06110 DS r t RX# 706769 BOX 86�,OCEAN SHORES,WA 98551 IIIIIIIIIIIIIIIIIIIIII�II�I!lII�III�IIIIIIIIIIIIIIII��I ANIIODARONE HCL 200MG H.awoRrH,JACK•� � QTY#30 NDC#0009�9133-52 TEVA USA Generic For:AMtODARONE 200 MG � Harbor Dru REF#UPKMWCH g CO.Prescriptions 6 REFILLS 376 Bth S(. Phone 360-532-3061 Hoquiam,WA 98550 24 Hr.16c gefill(36Q)538-9478 COMC RX# 707825 R MORRIS, R., MD COPAY: $5.00 HAWORTH,JACK* 08/06l10 JR (,` I�I�II��I��I�I��IN�II�'l�u�llflll�ll�li�lll�lll�l�ll��il OMEPRAZOLE ER 20 MG CAPS QTY#30 NDC#60505-0065-01 APOTEX [all�our dodor for medial advire ahout side effects 1ou may r¢port side effear ro fDA at I-BDO-FDA-108B. R EF#3s�cKc R � 2 REFILLS ge COMC �� IN1I811�I�I�Ifl�I�iIIIII�I�NN�II�!D�I��I�i[a►ll�i�iu��5n°° �� Harbor Drug Co.PreSCript�ons 316 Bth St. Phone 360-532-306/ Hoquiam,WA 98550 74 Hr.tG�Refill(360)538-9978 RX# 698108 R MORRIS, R., MD HAWORTH,JACK" 08/12/10 JR BOX 864,OCEAN SHORES,WA 9B551 AMLODIPINE 5 MG � • A QTY#45 NDC#64679-0422-02 WOCKHARi Generic For:AMLODIPINE SMG TAB REF# UWXFCMW MAY REFILL 5 • {3�3"+` COMC 5 . pp�. COPAY: $5.00 II�I��I�INI�II��II�III��IN��I��I��II�I��I�I��I��II�III�I��I�I�M� 1 � • 9 8+ S �OD+ ? • ?�+ fall your doctor(or medical adrice about side effects,You map report side eHects ro fDA at I-B00-fDA-1088. �� Harbor Drug Co.Prescriptions � ' �� 356 8th St, phone 360-532-3061 �:s ��,.�. Hoquiam,WN 98550 24 Ha Rz Retilt(366}536-44T8 RX# 701042 R KONN, D., MD 5 •�p+ HAWORTH,JACK' 08/09/10 DS � � O�� BC�X B64,OCEAN SHORES,WA 98551 AMIODARONE HCL 20QMG S • O Q� QTY#30 NDC#00093-9133-52 TEVA USA Generic For.AMIODARONE 200 MG � • Q Q'�' REF#5HTK3ET 5 REFILLS � � •�Q�~�- COMC r� , ��.�, COPAY: $5.00 5 ��Q� IIII�III�NI�III�IIIIIII�I�I�IN�1�11�►lIBIIf�Iil�ilalll�I�I�Ii�I�IINRII � � .�o+ 35 •�0+ Lall�our do�or for medi�al advice about side e(fec�.You ma�repart side e8ecu to fDA at I-600-fDp-IOBB � w��+ �� Harbor Drug Co.Prescripiions 5-�o+ 316 8th St. Pbone 360-532-3061 7 • `��.+ � , Hoquiam,WA 98550 24 Hr.Rx Re81f(366j 538-9478 .. RX#C710522 R KONN, D., MD 5 , O d+ HAWORTH,JACK* 08/24/10 DS BOX 864,OCEAN SHORES,UVA 98551 �j' •[j t3+ ZOLPIDEM 10MG QTY# 30 NDC#13668-0008-05 TORRENT 1 � ��f Generic For:ZOLPIDEM 10 MG r) •.�O,�, REF#3A97WFF 3 REFILLS 5 • a(}+ connc � •�c� COPAY: $5.00 I��III�I�I�IIIaI�Nliplll�lll�lllull�ll�llplll�l�lll�ll�ll�ll�l�ll9�d � ' 4�+ 5 •a0+ . [all�our docror fa medial adeire about side eflecu.lou ma�report side e8ectr ro FDA at I-B00•fDA•IDBB. 5� (�Q+ 5 • OQ+ 5 • 00+ ` 5 � 00+ 5 • OD+. 215 4* '��--�f P� �