![OXYGEN GAS [SKY OXYGEN]](https://medic.hrt.org//dailymed/images/27108fae-f84e-4d0f-836a-cdc23a58e470/oxygen.jpg)
| NDC | 57716-001-01, 57716-001-02, 57716-001-03, 57716-001-04, 57716-001-05, 57716-001-06, 57716-001-07, 57716-001-08, 57716-001-09, 57716-001-10, 57716-001-11, 57716-001-12, 57716-001-13, 57716-001-14, 57716-001-15, 57716-001-16, 57716-001-17, 57716-001-18, 57716-001-19, 57716-001-20 |
| Set ID | 27108fae-f84e-4d0f-836a-cdc23a58e470 |
| Category | HUMAN PRESCRIPTION DRUG LABEL |
| Packager | Sky Oxygen |
| Generic Name | |
| Product Class | |
| Product Number | |
| Application Number | NDA206023 |
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PRINCIPAL DISPLAY PANEL
Delivery Ticket
Sky Oxygen
2790 Idlewood Avenue
Pittsburgh, PA 15106
412-278-3001
412-278-3003 FAX
Invoice # P18407
Ship To
HCS PITTSBURGH
Hazardous Material Checklist
Yes No
Cylinders Properly Labeled
Shipping Paper Provided
Placards Required
Vehicle Properly Placarded
Customer Initials Employee Initials
Service Date Invoice Date
12/12/2017 12/12/2017
Cylinder Type: S=Steel A=Aluminum Ownership: R=Rental O=Owned
Shipped Returned Product Description Cyl Type/Ownership Price Amount
LG CERTIFICATE OF ANALYSIS 0.00 0.00
1 LS300 (D) Liquid Oxygen U.S.P. Lot # % 0.00 0.00
Vehicle #
Start: Finish:
1 LS300 (P) Liquid Oxygen U.S.P. Lot # % 0.00 0.00
Start: Finish:
1 INVOICE TO BE PRICED LATER 0.00
Witnessed By:
FOR CHEMICAL EMERGENCY: SPILL, LEAK, FIRE, EXPOSURE, OR ACCIDENT: CALL CHEM-TREC 800-424-9300 DAY OR NIGHT
ALL GASES PRODUCED BY AIR LIQUEFACTION TESTED VIA SERVOMEX OA244 5200 570A
Released By Date
THE UNDERSIGNED CERTIFIES THAT HE/SHE HAS READ THE FRONT OF THIS FORM AND HAS BEEN GIVEN A COPY OF THIS DOCUMENT
Customer Signature Date
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INGREDIENTS AND APPEARANCE
OXYGEN
oxygen gasProduct Information Product Type HUMAN PRESCRIPTION DRUG Item Code (Source) NDC:57716-001 Route of Administration RESPIRATORY (INHALATION) Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength OXYGEN (UNII: S88TT14065) (OXYGEN - UNII:S88TT14065) OXYGEN 990 mL in 1 L Packaging # Item Code Package Description Marketing Start Date Marketing End Date 1 NDC:57716-001-01 8888 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 2 NDC:57716-001-02 7981 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 3 NDC:57716-001-03 6452 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 4 NDC:57716-001-04 3198 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 5 NDC:57716-001-05 1698 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 6 NDC:57716-001-06 680 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 7 NDC:57716-001-07 413 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 8 NDC:57716-001-08 170 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 9 NDC:57716-001-09 113 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 10 NDC:57716-001-10 34 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 11 NDC:57716-001-11 196 L in 1 CYLINDER; Type 0: Not a Combination Product 04/01/2004 12 NDC:57716-001-12 160 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 13 NDC:57716-001-13 180 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 14 NDC:57716-001-14 200 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 15 NDC:57716-001-15 230 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 16 NDC:57716-001-16 36 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 17 NDC:57716-001-17 31 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 18 NDC:57716-001-18 41 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 19 NDC:57716-001-19 46 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 20 NDC:57716-001-20 119 L in 1 DEWAR; Type 0: Not a Combination Product 04/01/2004 Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date NDA NDA206023 04/01/2004 Labeler - Sky Oxygen (072165061) Establishment Name Address ID/FEI Business Operations Sky Oxygen 072165061 manufacture(57716-001)