Packing Slip - 13374 - SAP

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Packing Slip

Delivery 500234418
Ship To: Ship From:
Fundacion Arturo Lopez Perez FALP Novofarma
Camila Gonzalez/Denisse Vilches Victor Uribe 2280
Av. Rancagua 878 Providencia Comuna de Quilicura
7500921 SANTIAGO 8710022
CHILE CHILE

Order Type: RESUPPLY Requested Delivery Date: 02-07-2021


Protocol ID: 3475-966 Order Number: 2000282512
Site Number: 0623 IRT Vendor: Almac 2.0 Platform
Principal Investigator: Barajas, Olga IRT Order Number: 13374

Shipping Condition: +2°C to +8°C


Storage Condition: +2 to +8C: Do Not Freeze: Do not shake; Protect from light

Line Material Description Batch CID Quantity UOM


1 3475_966_3475 T027786 31411992,31411993,31411994, 9 EA
v1_25mg/mL_4mL/VL_2VL 31411995,31411996,31411997,
_M1 31411998,31411999,31412000

ATTENTION:
THIS MEDICATION WILL NOT BE ACTIVATED FOR USE UNTIL THIS SHIPMENT IS
CONFIRMED IN THE IRT SYSTEM.

Directions for confirming and activating drug via the IRT:


1. Access the IRT, enter your User ID and Password
2. Utilize the appropriate IRT module
3. Enter the IRT Order Number located in the header section of this Packing Slip
4. Follow the directions in the system to activate shipment

Signature: _________________________ Date: _____________


Please file this document in the appropriate Regulatory binder

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