August 2002

From Geneva

Given the recent communications received by Geneva voicing concerns regarding the lack of availability of Amoxicillin, Clavulanate Potassium (ACP), Geneva would like to provide you with the following relevant background information.

As you may know, Geneva Pharmaceuticals recently launched ACP, a generic version of GlaxoSmithKline's Augmentin®.  Geneva was able to launch at this time as a result of a favorable decision rendered by the Eastern District of Virginia.

While Geneva does no have any legal exclusivity in the marketplace for ACP, we are, as of this date, the only generic manufacturer that has received final approval from the FDA for any of the dosage forms.  However, Geneva does expect to have generic competition on ACP form at least two or three manufacturers, thereby satisfying the remaining demand in the marketplace. 

Due to the limited availability of ACP, Geneva does not at this time have adequate product to supply ongoing market demands.  As such, Geneva's initial distribution of ACP was focused on a limited group of direct buying customers versus a broad allocation of product among all potential customers.  It was Geneva's belief that this approach was the most responsible way to launch the ACP product, as any broad allocation to all customers would have provided minimal product to any single customer and would have resulted in significant and continuous supply interruptions, casing a multitude of operational problems for all customers.

It is important to note that FirstDataBank notified Geneva on July 25, 2002 that Augmentin will continue to be coded as single source in the FirstDataBank database for the time being due to limited supply.  The classification will not be changed to multi-source until there is an adequate market supply available.  FirstDataBank will be communicating this decision to customers under separate cover.

Geneva's supply situation forced us to make difficult choices that, Genova realizes, made an important product unavailable to many of our customers.  This situation is also unacceptable to Geneva and we are actively trying to increase the supply of ACP to the United States.  Geneva asks for your continued patience and will keep you apprised of product availability as it evolves.

Thank You.

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FROM: WYETH May 28, 2003 Data from the Women's Health Initiative Memory Study (WHIMS), a substudy of the Women's Health Initiative (WHI) conducted in women age 65 and older, have been published in the May 28, 2003, issue of the Journal of the American Medical Association (JAMA). These reports have added to our knowledge concerning the effects og postmenopausal estrogen plus progestin therapy in demantia and cognition. A third article published in the same issue of JAMA updates the WHI stroke data already published in July 2002. Because the findings from the stroke paper are consistant withthose already published and described in product labeling, the focus if this letter is to update you on WHIMS results. WHIMS RESULTS WHIMS, a substudy of WHI supported by Wyeth, was a randomized, placebo-controlled trail that evaluated whether postmenopausal estrogen and progestin hormorne therapy would reduce the risk of dementia in women age 65 and older. WHIMS followed 4,532 women for an average of 4.1 years. The auhors of the WHIMS publication state that women taking combination strogen plus progestin therapy has an increased relative risk (2.05, 95% CI 1.21-3.48) of developing probable demantia (PD) compared to women taking placebo. In both groups, the absolute risk for developing PD was low (45 cases/10,000 women per year for women taking the active drug, 22 cases/10,000 women per year for women taking placebo.) The increase in the relative risk was observed in all age groups studied, began in the second year, and persisted. The absolute risk was highest in the oldest age group studied (women 75 and older). In a seperate report in WHIMS, the effect of hormone therapy on global cognitive function was evaluated. Overall, there was no clinically significant difference between the groups. The average cognitive test score for these women impoved in both the active drug groups and the control group. However, the treated group improved somewhat less than the control group. An independant study arm of WHIMS evaluating the effect of estrogen alone on probable demantia and cognitive function in a similar population is continuing. PRESCRIBING CONSIDERATIONS Wyeth recognizes the potential relevance of this information to all women, paticularily for those age 65 and older. WHIMS evaluated women who were on average 71 years of age, and, therefore, the applicability of these results to younger women is unclear. Even so, the company believes that the WHIMS results should be considered part of the individual assessment or risk and benefit for women who are taking or considering initiating estrogen plus progestin therapy. Wyeht continues to support the appropraite use of hormone therapy for its labeled indications - releif of menopausal symptoms such as hot flashes, night sweats, and vaginal dryness and the concomitant prevention of postmenopausal osteoporosis. Hormone therapy should be prescribed at the lowest dose for the shortest duration consistant with individual treatment goals and risks for the individual woman. LABELING CHANGE Wyeth has updated the warnings and adverse events sections of product labeling for its hormone therapy products to include the following: WARNING Dementia. In a study of women 65 years of age and older (a randomized controlled sub-study of the Women's Health Initiative, the Women's Health Initiative Memory Study: n=4,532, 54% older than 70), those treated with PREMPOR (0.625 mg, conjugated equine estrogen, plus 2.5 mg medroxyprogesterone acetate) were reported to have a two-fold increase in the risk of developing probable dementia. After an average follow-up of 4 years, the absolute risk of probable dementia was 45 per 10,000 women-years in the PREMPRO group and 22 per 10,000 women-years in the placebo group. It is unknown whether these findings apply to younger postmenopausal women. The estrogen-alone sub-study of the Women;s Health Initiative Memory Study is currently ongoing. No data are available. It is unknown whether these findings apply to estrogen alone therapy. Adverse Reactions - CNS Headache, dizziness, mental depression, mood disturbances, aniety, irritability, nervousness, migrane, chorea, insomnia, somnolence, exacerbation of epilepsy, dementia. PREMPRO™ (conjugated estrogens/medroxyprogesterone acetate tablets) is indicated in women witha uterus for the treatment of moderate to severe vasomotor symptoms associated with the menopause, the treatment of moderate to severe symptoms of vulvar and vaginal atrophy associated with the menopause, and the prevention of postmenopaulas osteoporosis. When prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products should be considered. When prescribing solely for the prevention of postmenopausal osteoporosis, therapy should only be considered for women at significant risk of osteoporosis after non-estrogen medications have been carefully considered. WARNING Estrogens and progestins should not be used for the prevention of cardiovascular disease. The Women's Health Initiative (WHI) reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women during 5 years of treatment with conjugated equine estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) relative placebo (see CLINICAL PHARMACOLOGY, Clinical Studies section in the full Prescribing Information). Other doses of conjugated estrogens and medroxyprogesterone acetate, and other combinations of estrogens and progestins were not studied in the WHI and, in the absence of comparable data, these risks should be assumed to be similar. Because of these risks, estrogens with or without progestins should be prescribed at the lowest efective doses and for the shortest duration consistant with treatment goals and risks for the individual women. The most commonly reported side effects of PREMPRO are metrorrhagis, alopecia, and mastalgia. PREMPRO should not be used under any of the following conditions or circumstances: undiagnosed abnormal genital bleeding; known, suspected, or a history of breast cancer; known or suspected estrogen-dependant neoplasia; active venous thromboembolism; liver dysfunction or disease; in patients with a known hypersensitivity to its ingerdients; known or suspected pregnancy. Please see accompanying Prescribing Information If you have any questions about this information, please contact our Global Medicsl Communications group at 1-800-934-5556. Sincerely, Victoria Kusiak, M.D. Vice President, Clinical Affiars and  North American Medical Director for Wyeth Pharmaceuticals

August 2002

From: Mission Pharmacal

Dear Pharmacist,

With the current negative information in the medical journals about hormone replacement therapy (HRT), and the wide publicity in the lay press, we are sure you're being inundated with questions from confused patients, as we too have received similar questions.

Until a final assessment about the role of HRT is determined, supplemental calcium has never been more important.  Your recommendation of Citracal® (Ultradense® calcium citrate) means that with or without meals, your patients will benefit from the well absorbed calcium that CITRACAL® provides, and the excellent tolerability you and your staff have depended on for patient compliance.

Additionally, a new study in The American Journal of Medicine found that CITRACAL® helped with cholesterol levels.  Two-hundred-twenty-three healthy post-menopausal women participated.  For those women given 1000 mg of CITRACAL® each day, researchers found that after one year, the levels of HDL had risen significantly. DR. Ian Reid, the study's lead researcher, speculated that the degree of change could cut these women's risk of stroke or heart disease by 20% to 30%.

So, in this time of uncertainty regarding HRT, we wanted to remind you of the importance of CITRACAL® in the fight against osteoporosis and in the promotion of good heart health.  Thank you in advance for your continued support.  Please call anytime if we can be of assistance.

Yours truly,

Bennett Kenedy                                                                                                                                                                CITRACAL® Production Manager

1-800-292-7364

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FROM: COLUMBIA LABORATORIES, INC. March 2003  Important women's health care products...now available for pharmacies Columbia Laboratories, Inc. develops and commercializes a wide range of innovative prescription (Rx) and over-the-counter (OTC) products, meeting the health care needs of people around the world. With a newly created sales force and increased promotional efforts, Columbia Laboratories will be focusing on marketing its key women's health care products. As a result, you can anticipate increased interest from your patients, so now is the time to have your shelves adequately stocked. PROCHIEVE™ 8% (progesterone gel) (Rx only)       Progesterone supplementation specifically designed for vaginal administration Indicated for progesterone supplementation or replacement as part of an assisted reproductive technology (ART) treatment for infertile women with progesterone deficiency Delivers natural progesterone in an advanced bioadhesive gel; provides prolonged contact, promotes controlled and sustained absorption of progesterone, and minimizes leakage       The comfortable and convenient option women prefer More than 90% of patients preferred PROCHIEVE™ 8% to intramuscular progesterone and 87% preferred PROCHIEVE™ 8% to progesterone suppositories, in a study of over 1184 women Supplies simple, single-use applicators specific for vaginal administration of progesterone The most common side effects of PROCHIEVE™ 8%  include breast enlargement, constipation, somnolence, nausea, headache, and perineal pain. PROCHIEVE™ 8% is contraindicated in patients with current or past thrombophlebitis or thromboembolic disorders, missed abortion, undiagnosed vaginal bleeding, liver dysfunction, or disease, and known or suspected malignancy of the breast or genital organs. Contraindications should be reviewed with patients before prescribing. Please see enclosed full prescribing information. REFRESH VAGINAL GEL™ (OTC)       Feminine odor control in convenient, prefilled vaginal gel applicators Eliminates vaginal odor, often with the first dose, for up to 72 hours Offers a safer alternative to vaginal douches, which are associated with many potential health risks Works by maintaining normal vaginal pH ADVANTAGE-S® Bioadhesive Contraceptive Gel (OTC)       Low-dose contraceptive gel with uncompromised efficacy Contains the lowest effective dose of nonoxynol-9--the most widely used spermacide Minimizes the risk of irritation - a common side effect of nonoxynol-9 Less messy due to small amount of gel required per dose As an added convenience, Columbia Laboratories is introducing a pharmacy stocking program at the local level. For additional information, please contact our customer service department at 973-994-3999. Sincerely, Fred Wilkinson President and Chief Executive Officer Columbia Laboratories

  May 2nd, 2006

Official complaint of Unfair Business Practices and Severe Client Confidentiality violations by Meerdink & Associates and Russell Meerdink himself filed to the Greenville Market Condo Association by RxLink Pharmacy.  These unfair business practices are now being reported to State and Federal agencies for proper review. For more information, please contact the Town of Greenville, Wisconsin.