ISA*00*          *00*          *11*412333444      *11*122333444      *200119*1118*U*00401*000105125*0*P*:
GS*SH*412333444*122333444*20001109*1118*0*X*004010
ST*856*000000001
BSN*00*008001604*20200119*1118**AS
HL*1**S
TD1******G*261.9*LB
TD5**2*FXFE*M*FEDEX*CC
REF*BM*CMV444892
DTM*011*20200117*1438*ET
DTM*017*20200120*1438*ET
N1*ST*Grondin Pharmacy*11*122333444
N3*100 Main Street*
N4*Portsmouth*NH*03801*US
REF*D3*89123456*NH
N1*BT*Grondin Pharmacy*11*122333444
N3*100 Main Street*
N4*Portsmouth*NH*03801*US
N1*SF*Wilbur Pharmaceutical Imports*11*412333444
N3*154 Broadway
N4*Somerville*MA*02145*US
N1*SE*Wilbur Pharmaceutical Imports*11*412333444
N3*154 Broadway
N4*Somerville*MA*02145*US
YNQ**Y***The entity transferring ownership of the product in this transaction states that it is in compliance with 21 U.S.C. 360eee(27).***99*TS
HL*2**O
PRF*PO08105315***20200110
HL*3**T
MAN*GM*005434.40000000020
HL*4**I
LIN*000001*N4*05552660033*LT*L100551*UI*00992326050109
SN1**30*EA
PID*F*TRN***Migraine Med
PID*F*GEN***100 MG
PID*F*DF***100 MG
PID*F*ITQ***20
DTM*208*20220331
YNQ**Y
CTT*4
SE*27*000000001
GE*1*0
IEA*1*000105125