Form 8947 - Report Of Branded Prescription Drug Information Page 3

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Form 8947 (Rev. 10-2011)

Page

Schedule B

Branded Prescription Drug Information NDC Additions and Deletions (see instructions)

Caution: Use Schedule B only for additions and deletions of National Drug Codes (NDCs) at the covered entity level. Do not report the movement of NDCs between members of

the controlled group.

Entity name

If you have more NDC additions and deletions to report than can be shown on this

page, complete and attach as many Schedules B as you need to list them all,

Employer identification number (EIN).

Page

numbering each page (for example, Page B1 of B5).

Section I

Additions

(d)

(f)

(c)