Prescription Pads

Item# PC4-HS-1 High Security Prescription Pads High Security Prescription Pads meets medicaid requirements, 1-part, 100 per pad, Size: 5 1/4" x 4 1/4". Black ink. Blue or green void pantograph. Padded, wrap around cover, not stapled. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $8.21 Quantity: 20-39 $5.75 Quantity: 40-59 $3.90 Quantity: 60 or more $3.49

Item# PC4-HS-2 High Security Prescription Pads High Security Prescription Pads,meets medicaid requirements, 2-part,duplicate copy printed, 50 per pad, Size: 5 1/4" x 4 1/4". Black ink, blue or green void pantograph, padded, wrap around cover, not stapled. PRICE IS PER PAD, MINIMUM ORDER IS 20 PADS. Quantity: Up to 19 $99,999.00 Quantity: 20-39 $6.59 Quantity: 40-59 $4.72 Quantity: 60 or more $4.11

Item# PC4-CA CA Tamper Resistant Prescription Pads Standard California Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 5 1/2" x 4 1/4". Black ink. Includes all security features required by California for non-electronically transmitted Medicaid prescriptions as well as Level 11 thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $10.60 Quantity: 20-39 $8.50 Quantity: 40-59 $6.10 Quantity: 60 or more $5.50

Item# PCCA-SCUST CA Semi-Custom Tamper Resistant Prescription Pads Semi-Custom California Tamper Resistant Prescription pad, 1-part, 100 per pad, Maximum Size: 8 1/2" x 5 1/2". Black ink. Includes all security features required by California for non-electronically transmitted Medicaid prescriptions as well as Level 11 thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $19.20 Quantity: 20-39 $13.40 Quantity: 40-59 $10.70 Quantity: 60 or more $9.80

Item# PC4-CA-2 CA Tamper Resistant Prescription Pads Standard California Tamper Resistant Prescription pad, 2-part, 100 per pad, Size: 5 1/2" x 4 1/4", black ink, part 2 not printed. Includes all security features required by California for non-electronically transmitted Medicaid prescriptions as well as Level 11 thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $16.50 Quantity: 20-39 $11.30 Quantity: 40-59 $9.00 Quantity: 60 or more $8.60

Item# PCCA2-SCUST CA Semi-Custom Tamper Resistant Prescription Pads Semi-Custom California Tamper Resistant Prescription pad, 2-part, 100 per pad, Maximum Size: 8 1/2" x 5 1/2", black ink, part 2 not printed. Includes all security features required by California for non-electronically transmitted Medicaid prescriptions as well as Level 11 thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $29.00 Quantity: 20-39 $20.60 Quantity: 40-59 $16.90 Quantity: 60 or more $15.90

Item# PC4-CA-3 CA Tamper Resistant Prescription Pads Standard California Tamper Resistant Prescription pad, 3-part, 50 per pad, Size: 5 1/2" x 4 1/4", black ink, part 2 not printed. Includes all security features required by California for non-electronically transmitted Medicaid prescriptions as well as Level 11 thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $28.00 Quantity: 20-39 $14.00 Quantity: 40-59 $12.00 Quantity: 60 or more $11.10

Item# PCCA3-SCUST CA Semi-Custom Tamper Resistant Prescription Pads Semi-Custom California Tamper Resistant Prescription pad, 3-part, 50 per pad, Maximum Size: 8 1/2" x 5 1/2", black in,part 2 not printed. Includes all security features required by California for non-electronically transmitted Medicaid prescriptions as well as Level 11 thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $34.90 Quantity: 20-39 $24.70 Quantity: 40-59 $21.20 Quantity: 60 or more $20.00

Item# PCFL-CUST FL Semi-Custom Tamper Resistant Prescription Pads Semi-Custom Florida Tamper Resistant Prescription pad, 1-part, 100 per pad, Choice of Sizes. 4 1/4 x 5 1/2 or 5 1/2 x 4 1/4. Must be blue or green ink. Includes all security features required by Florida for non-electronically transmitted Medicaid prescriptions, including security batch number. License Number Verification Required. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $10.20 Quantity: 20-29 $6.70 Quantity: 30-39 $6.10 Quantity: 40-59 $5.20 Quantity: 60 or more $4.70

Item# PCFL2-CUST FL Custom Tamper Resistant Prescription Pads Custom Florida Tamper Resistant Prescription pad, 2-part, 100 per pad, Choice of Sizes. 4 1/4 x 5 1/2 or 5 1/2 x 4 1/4, must be blue or green ink, 2nd part printed same. Includes all security features required by Florida for non-electronically transmitted Medicaid prescriptions, including security batch number. License Number Verification Required. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $16.70 Quantity: 20-29 $12.60 Quantity: 30-39 $9.80 Quantity: 40-59 $8.80 Quantity: 60 or more $7.90

Item# PC4-FL-2 FL Tamper Resistant Prescription Pads Standard Florida Tamper Resistant Prescription pad, 2-part, 100 per pad, Size: 5 1/2" x 4 1/4". Imprinted w/blue ink. 2nd part not printed. Includes all security features required by Florida for non-electronically transmitted Medicaid prescriptions. License Number Verification Required. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $13.20 Quantity: 20-29 $9.60 Quantity: 30-39 $7.70 Quantity: 40-59 $7.00 Quantity: 60 or more $6.80

Item# PC4-FL FL Tamper Resistant Prescription Pads Standard Florida Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 5 1/2" x 4 1/4". Imprinted w/blue ink. 2nd part not printed. Includes all security features required by Florida for non-electronically transmitted Medicaid prescriptions. License Number Verification Required. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $9.00 Quantity: 20-29 $6.20 Quantity: 30-39 $4.50 Quantity: 40-59 $4.20 Quantity: 60 or more $3.60

Item# PC4-IN-1MD or NT IN Tamper Resistant Prescription Pads Standard Indiana Tamper Resistant Prescription pad, 1-part, 50 per pad, Size: 5 1/2" x 4 1/4". Imprinted reflex blue ink. Includes all security features required by Indiana for non-electronically transmitted Medicaid prescriptions as well as narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $6.40 Quantity: 20-39 $4.50 Quantity: 40-59 $3.50 Quantity: 60 or more $3.30

Item# PC4-IN-2MD or NT IN Tamper Resistant Prescription Pads Standard Indiana Tamper Resistant Prescription pad, 2-part, 50 per pad, Size: 5 1/2" x 4 1/4". Imprinted reflex blue ink, duplicate copy printed on part 2. Includes all security features required by Indiana for non-electronically transmitted Medicaid prescriptions as well as narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $9.90 Quantity: 20-39 $6.90 Quantity: 40-59 $5.20 Quantity: 60 or more $4.50

Item# PC4-KY KY Tamper Resistant Prescription Pads Standard Kentucky Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 5 1/2" x 4 1/4". Imprinted w/black ink. Includes all security features required by Kentucky for non-electronically transmitted Medicaid prescriptions as well as narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $8.30 Quantity: 20-39 $5.50 Quantity: 40-59 $4.80 Quantity: 60 or more $3.80

Item# PC4-KY-2 KY Tamper Resistant Prescription Pads Standard Kentucky Tamper Resistant Prescription pad, 2-part, 100 per pad, Size: 5 1/2" x 4 1/4". Imprinted w/black, 2nd part not printed. Includes all security features required by Kentucky for non-electronically transmitted Medicaid prescriptions as well as narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $12.20 Quantity: 20-39 $8.70 Quantity: 40-59 $7.10 Quantity: 60 or more $6.40

Item# PC4-ME ME Tamper Resistant Prescription Pads Standard Maine Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 5 1/2" x 4 1/4". Imprinted black ink. Includes all security features required by Maine for non-electronically transmitted Medicaid prescriptions as well as narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $10.30 Quantity: 20-39 $7.00 Quantity: 40-59 $5.30 Quantity: 60 or more $4.50

Item# PC4-ME-2 ME Tamper Resistant Prescription Pads Standard Maine Tamper Resistant Prescription pad, 2-part, 100 per pad, Size: 5 1/2" x 4 1/4". Imprinted black ink. 2nd part not printed. Includes all security features required by Maine for non-electronically transmitted Medicaid prescriptions as well as narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.50 Quantity: 20-39 $10.50 Quantity: 40-59 $8.50 Quantity: 60 or more $8.10

Item# PC41-NJ NJ Tamper Resistant Prescription Pads Used by: MDs, DOs, DDSs, DMDs, DPMs & DVMs. Standard New Jersey Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 4" x 5 1/2", black ink, numbered. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC41-NJ2 NJ Tamper Resistant Prescription Pads Used by: MDs, DOs, DDSs, DMDs, DPMs & DVMs. Standard New Jersey Tamper Resistant Prescription pad , 2-part, 100 per pad, Size: 4" x 5 1/2", black ink, numbered. Second part blank. Price per pad. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC42-NJ NJ Tamper Resistant Prescription Pads Used by: Health Care Facilities. Standard New Jersey Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 4" x 5 1/2", black ink, numbered. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC42-NJ2 NJ Tamper Resistant Prescription Pads Used by: Health Care Facilities. Standard New Jersey Tamper Resistant Prescription pad , 2-part, 100 per pad, Size: 4" x 5 1/2", black ink, numbered. Second part blank. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC43-NJ NJ Tamper Resistant Prescription Pads Used by: TPA Certified Optometrists. Standard New Jersey Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 4" x 5 1/2", black ink, numbered. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC43-NJ2 NJ Tamper Resistant Prescription Pads Used by: TPA Certified Optometrists. Standard New Jersey Tamper Resistant Prescription pad, 2-part, 100 per pad, Size: 4" x 5 1/2", black ink, numbered. Second part blank. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC44-NJ-1 NJ Tamper Resistant Prescription Pads Used by: Nurse Practitioners & Clinical Nurse Specialists. Standard New Jersey Tamper Resistant Prescription pad , black ink, numbered, 1-part, 100 per pad, Size: 4" x 5 1/2". Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC44-NJ-2 NJ Tamper Resistant Prescription Pads Used by: Nurse Practitioners & Clinical Nurse Specialists. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 2-part, 100 per pad, Size: 4" x 5 1/2". Second part blank. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC45-NJ-1 NJ Tamper Resistant Prescription Pads Used by: Ceritfied Nurse Midwives. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 1-part, 100 per pad, Size: 4" x 5 1/2". Price per pad. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC45-NJ-2 NJ Tamper Resistant Prescription Pads Used by: Ceritfied Nurse Midwives. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 2-part, 100 per pad, Size: 4" x 5 1/2". Second part blank. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC46-NJ-1 NJ Tamper Resistant Prescription Pads Used to prescribe eye wear only. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 1-part, 100 per pad, Size: 4" x 5 1/2". Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC46-NJ-2 NJ Tamper Resistant Prescription Pads Used to prescribe eye wear only. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 2-part, 100 per pad, Size: 4" x 5 1/2". Second part blank. Price per pad. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC47-NJ-1 NJ Tamper Resistant Prescription Pads Used by: TPA Certified Prescription eye wear, topical pharmaceutical agents & oral medications. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 1-part, 100 per pad, Size: 4" x 5 1/2". Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC47-NJ-2 NJ Tamper Resistant Prescription Pads Used by: TPA Certified Prescription eye wear, topical pharmaceutical agents & oral medications. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 2-part, 100 per pad, Size: 4" x 5 1/2". Second part blank. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC48-NJ-1 NJ Tamper Resistant Prescription Pads Used by: Physician Assistants. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 1-part, 100 per pad, Size: 4" x 5 1/2". Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.00 Quantity: 20-29 $8.20 Quantity: 30-59 $5.90 Quantity: 60 or more $5.20

Item# PC48-NJ-2 NJ Tamper Resistant Prescription Pads Used by: Physician Assistants. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 2-part, 100 per pad, Size: 4" x 5 1/2". Second part blank. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.10 Quantity: 20-29 $11.50 Quantity: 30-59 $8.60 Quantity: 60 or more $8.30

Item# PC4-WV WV Tamper Resistant Prescription Pads Standard West Viginia Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 5 1/2" x 4 1/4", imprinted in black ink. Includes all security features required by West Virginia for non-electronically transmitted Medicaid prescriptions. Suggested for narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $8.30 Quantity: 20-39 $5.50 Quantity: 40-59 $4.80 Quantity: 60 or more $3.80

Item# PC4-WV-2 WV Tamper Resistant Prescription Pads Standard West Viginia Tamper Resistant Prescription pad, 2-part, 100 per pad, Size: 5 1/2" x 4 1/4", imprinted in black ink. Second part blank. Includes all security features required by West Virginia for non-electronically transmitted Medicaid prescriptions. Suggested for narcotic prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $12.20 Quantity: 20-39 $8.70 Quantity: 40-59 $7.10 Quantity: 60 or more $6.40

Item# PC4-WY WY Tamper Resistant Prescription Pads Standard Wyoming Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 5 1/2" x 4 1/4", black ink. Includes all security features required by Wyoming for non-electronically transmitted Medicaid prescriptions as well as Level II thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $8.30 Quantity: 20-39 $5.70 Quantity: 40-59 $4.30 Quantity: 60 or more $3.90

Item# PC-WY-1-CUST WY Semi-Custom Tamper Resistant Prescription Pads Semi-Custom Wyoming Tamper Resistant Prescription pad, 1-part, 100 per pad, Maximum size: 8 1/2" x 5 1/2", black ink. Price per pad, exclusive of artwork. Includes all security features required by Wyoming for non-electronically transmitted Medicaid prescriptions as well as Level II thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $17.60 Quantity: 20-39 $12.30 Quantity: 40-59 $9.80 Quantity: 60 or more $9.00

Item# PC4-WY-2 WY Tamper Resistant Prescription Pads Standard Wyoming Tamper Resistant Prescription pad, 2-part, 100 per pad, Size: 5 1/2" x 4 1/4", black ink. Second part blank. Includes all security features required by Wyoming for non-electronically transmitted Medicaid prescriptions as well as Level II thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $11.60 Quantity: 20-39 $8.40 Quantity: 40-59 $7.10 Quantity: 60 or more $6.80

Item# PC-WY-2-CUST WY Semi-Custom Tamper Resistant Prescription Pads Semi-Custom Wyoming Tamper Resistant Prescription pad, 2-part, 100 per pad, Maximum size: 8 1/2" x 5 1/2", black ink. Second part blank. Price per pad, exclusive of artwork. Includes all security features required by Wyoming for non-electronically transmitted Medicaid prescriptions as well as Level II thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $26.40 Quantity: 20-39 $18.80 Quantity: 40-59 $15.40 Quantity: 60 or more $14.50

Item# PC4-WY-3 WY Tamper Resistant Prescription Pads Standard Wyoming Tamper Resistant Prescription pad, 3-part, 50 per pad, Size: 5 1/2" x 4 1/4", black ink. Second part blank. Price per pad. Includes all security features required by Wyoming for non-electronically transmitted Medicaid prescriptions as well as Level II thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS. Quantity: Up to 9 $99,999.00 Quantity: 10-19 $15.80 Quantity: 20-39 $10.60 Quantity: 40-59 $9.10 Quantity: 60 or more $8.40