ATTENTION!
Alliance Medical, Inc. must have on file written authorization from the physician acting as Medical Director for your service (or the responsible physician at your place of business) for us to be able to ship you any pharmaceuticals and legend products.

Please download our form, fill it out and return a signed copy to us via fax or mail.
(Please note that you will need adobe acrobat reader in order to view this form, you may download a copy free here
If your organization is licensed to purchase prescription drugs but does not have a Medical Director, please send a copy of your license along with our form.
Thank You,
Alliance Medical, Inc
P.O. Box 147
Russellville, MO 65074
Fax: 1-800-4ALLMED (1-800-425-5633)

	CATHLON® IV Catheters	This catheter offers all the features and high performance and quality of the JELCO® catheter combined with the added feature of a metal hub, allowing for optimal balance, weight and suturing.
	JELCO® IV Catheter	JELCO® I.V. Catheter is the leading standard short peripheral I.V. catheter. The FEP polymer construction and “J”-point needle design allow clinicians to easily feel the vein entry. Radioplaque, striped or winged hub.
	PROTECTIV® & PROTECTIV® Plus	Unique V-Point needle and advanced catheter tip provide for ultra-smooth insertions.  No blood splattering on activation of the safety mechanism. Push-off tab helps keep both your hands behind the needle!
	OPTIVA® IV Catheters	The OPTIVA® I.V. Catheter combines all of the benefits of an electropolished “V”-Point needle, finely tapered catheter shoulders, thin walled construction, radiopacity and incorporates OCRILON® polyurethane.
	Y-type blood/solution set	Y-type blood/solution set with standard blood filter (170-260 micron), drip chamber pump and male luer lock adapter. 85".
	60 drop ContROLL®, 1 Site, 2-Piece Male Luer Lock -- 66 In	ContROLL® clamp, injection site 28" above distal end, two-piece male luer lock. 66", 60 drop.
	LifeShield® Macrobore Prepierced Reseal Extension Set	LifeShield® Macrobore prepierced reseal extension set with 2 prepierced Y-injection sites 6" and 27" from Option-Lok®. 32" (11316-48)
	15 drop ContROLL®, 1 Site, 2-Piece Male Luer Lock -- 73 In	Universal spike, roller clamp, slide clmp, injection site 6” above distal end, Spin-Lock® connector 73”, 15 drop.
	60 drop LifeShield® Vented Microdrip Piggyback Set	LifeShield® Microdrip® Piggyback Set — with convertible pin, inline backcheck valve, CAIR® clamp, slide clamp, 2 CLAVE® Y-sites and Option-Lok® . 100”
	10 drop LifeSheild® with CAIR® clamp -- 100 in	LifeSheild® Convertible Pin Primary I.V. Set with CAIR® clamp, one lower CLAVE® port and Option-Lok®. 100", 15 drop. (11960-68)
	Interlink® Vial Adapter	Interlink® 20 mm Vial Adapter. Sterile package.
	LifeShield® Vial Adapter with CLAVE®	LifeShield® Vial Adapter with CLAVE® allows vial access with luer tip syringes
	LifeShield® CLAVE® Port Male Adapter Plug	LifeShield® CLAVE® Port Male Adapter Plug, Luer Lock.
	Needleless Injection Adapter	Needleless Injection Adapter allows a luer attachment to either injection site of the unit.
	SELEC-3+NIS (Needleless Injection Site)	Designed with 2 "Y" ports to accommodate blunt tip needleless devices as well as conventional needles
	Extension Sets	While the Selec-3® system has a built-in extension set, the IQ (Inject Quik) was developed for those using a competitive I.V. product.
	I.V. Prep Kits	Kits available with or without bioclusive.  Sterile.
	Terumo® SURFLO® Catheter	Ultra-sharp double-bevel introducer needle plus a medical grade lubricant.  Flexible thinwall catheter with large inner diameter, preview chamber, straight  and clear sure-grip hub.  Safe, easy-to-handle, tamper-evident packaging.
	60 drop Interlink®, 2 Sites, Male Luer Lock Adapter -- 90 In	Interlink® solution set. 2 injection sites 6" and 30" from male luer lock adapter. 90", 60 drop.
	10 drop Interlink®, 1 Site	Interlink® Solution Set. 1 injection site 6" from male Luer lock adapter. Lever lock cannula (detached). 70"
	10 drop Interlink®	Interlink® Solution Set. 2 injection sites 6" and 30" from male Luer lock adapter. 100"
	60 drop Interlink®, 1 Site, Male Luer Lock Adapter -- 70 In	Interlink® solution set. 1 injection site 6" from male luer lock adapter. Lever lock cannula (detached). 70", 60 drop.
	3-Way Standard Bore Stopcock	3-Way Standard Bore Stopcock with extension tubing and male Luer lock adapter. 21" Sterile package.
	Interlink® Extension with 2 Sites	Interlink® 42" extension set. 2 injection sites 6" and 34" from male luer lock adapter.
	SELEC-3+SC (Stopcock)	This I.V. ser offers all the features of the original SELEC-3® plus a 4-way stopcock
	Selec-3® I.V. Administration Sets	The Selec-3® I.V. administration set is designed to save time, reduce storage space and minimize the risk of contamination by offering 3 different drop settings, all in the same system.
	Interlink® Luer Lock Injection Site	Luer Lock Injection Site
	Monoject® Syringe	12cc syringe with bold graduations and color-coded translucent needle hub and rigid pack cap.  Oriented, compact package. Sterile.
	BD® Luer-Lok Tip Syringes	30cc syringe featuring a clear barrel with bold scale markings, tapered plunger rod for ease of aspiration, positive plunger rod stop, and an added BD Luer-Lok™ thread for increased secure connection.
	Terumo® Luer Lock & Eccentric Tip Syringes	Clear syringe barrel with bold, precise scale markings.  Peel-pack plastic blister package is tamper evident, for assurance of sterility.  Does not include needle.  Choose luer lock or eccentric tips.  Item is being discontinued.  Limited quantities available.
	Terumo® Needles	Terumo® needles:  known worldwide for extreme sharpness!  They are ground and honed with a unique double-bevel design to provide a comfortable injection. Item is being discontinued.  Limited stock available.
	Intraosseous Infusion Needle	Disposable intraosseous infusion needles feature a sharp lancet point to facilitate entry into the bone and Luer slip/Luer lock connection for secure fit to any syringe.  15g or 18g.
	Abbott Locking Luer Male Adapter Plug
	ConMed Stat 2® I.V. Flow Controller	One hand operation gravity control device for the control of IV therapy when electronic infusion monitoring is not medically necessary.
	Toomey Tip Syringe	Bold dual graduations: 60cc in 5cc increments.  Oriented, compact package and sterile.
	Carpuject® Holder	Reusable clear plastic, full length holder designed to provide both stability during injection and easy safe disposal of the cartridge needle unit after use. Holder accepts both 2 ml and 5 ml pre-filled cartridges. Designed for compatibility with Y-injection sites and male adapter plugs.
	Ethox Infu-Surg® Pressure Infusor Bag	Pressurizes and deflates easily with just one hand using the oval shaped bulb. Transparent front panel allows visual checking of fluids, area to write patient information, and more!
	Dial-A-Flo Extension	LifeShield® Dial-A-Flo® extension set with Clave® Y-site and Option-Lok®. 18”
	Dial-A-Flo extension Sets	LifeShield® Dial-A-Flo® Extension Set — with number scale, pre-pierced Y-site and Option-Lok®. 18”
	I.V. Heparin Lock	LifeShield® pre-pierced reseal male adapter plug.
	Clave Heparin Lock	Heparin lock Clave® with 7” extension
	15 drop, piggyback, 2 Y-sites	LifeShield® primary piggyback set with convertible pin, inline backcheck valve, 2 Clave® Y-sites, side clamp, CAIR® clamp and Option-Lok®. 100”, 15 drop.
	PediaPals® I.V. Guard	Friendly beaver or tiger helps calm your little patient, while you have easy access to I.V. lines and clear window gives you a vew of injection site.  Medical grade foam tape for secure hold and easy-to-write surface.
	15 Drop, 2 Sites, 78 Inches	Universal spike with drip chamber, slide clamp, roller clamp, injection site, rotating male luer lock. 78”, 15 drop.
	Clearlink™ luer activated	Clearlink™ luer activated valve with male luer lock adapter.
	Clearlink™, 10 drop, luer, 1 site, 76	Solution set with 1 Clearlink™ luer activated valve 6” from male luer lock adapter. 76”, 10 drop.
	Cardinal Health, Alaris® Full IV Sets for use with MedSystem III®	Infusion Set with 2 SmartSite® Needle-Free Valve Ports.
	AMSINO 60 drop, 2 sites, 83 Inch	Non-vented spike with drip chamber, roller clamp, split-septum injection site, AMSafe™ needleless injection site, rotating male luer lock. 83”, 60 drop. Septum needleless injection site requires use of blunt cannula.
	Clearlink™ universal vial adapter	Clearlink™ universal vial adapter. Sterile packaging.
	MONOJECT® 3cc,6cc,12cc Safety Syringes	Ultra-sharp, tri-beveled, anti-coring needle with luer lock syringe tip.
	AMSINO 10 drop, 2 site, 83 Inch	Non-vented spike with drip chamber, roller clamp, AMSafe® needleless injection site, and rotating male luer lock. 83”, 10 drop.
	AMSINO 8 Inch Extension with Clave Port	Extension set with AMSafe® needleless injection site, male and female luer, slide clamp, and approximate priming volume 2 mL. 8”.
	Interlink® Standard Bore Catheter Extension	Interlink® Standard Bore Catheter Extension Sets with preattached Injection Sites. 5"
	60 drop ULTRASITE®	Non-vented set. Roller clamp, UTRASITE® Y-site 3" above distal end, SAFELINE® Y-site 8" above distal end and SPIN-LOCK® connection. 84", 60 drop.
	10 drop Blood Administration Set	Y-Type, three roller clamps, drip chamber with 170 micron blood filter, flashtube, male luer slip connector. 87"
	15 drop ContROLL® Clamp, 1 Site, 2-Piece Male Luer Lock -- 106 In	Universal spike, roller clamp, slide clamp, injection site 26” above distal end, Spin-Lock® connector. 106”, 15 drop.
	15 drop Primary ADDitIV with Check Valve	Primary ADDitIV administration set with check valve, ContROLL® clamp, injection sites 6" and 60" above distal end, two-piece male luer lock. 86".
	15 drop Vented Spike, 2 Sites, 2-Piece Male Luer Lock -- 106 In	Vented spike, ContROLL® clamp, injection sites 6" and 28" above distal end, two-piece male luer lock. 106", 15 drop. Item being discontinued.  Limited quantities available.
	15 drop ContROLL®, 2 Sites, 2-Piece Male Luer Lock -- 106 in	Non-vented spike, slide clamp, roller clamp, injection sites 28” and 6” above distal end, Spin-Lock® connector. 106”, 15 drop.
	60 drop ContROLL®, 2 Sites, 2-Piece Male Luer Lock -- 94 In	ContROLL® clamp, side clamp, injection sites 6" and 28" above distal end, two-piece male luer lock. 94", 60 drop.
	Extension Set with Female Adapter and Rate Flow Regulator -- 19 In	Rate flow regulator with female luer connector, injection site 6” above distal end, Spin-Lock® connector. 19”.
	J-Loop Extension Set with I.V. Catheter Plug and Adjustable Bridge -- 4 In	Injection cap, adjustable bridge, male luer slip connector. 4”
	Extension Set with Female Adapter and Male Luer Slip -- 21 In	Female adapter, male luer slip. 21". (V5406)
	Extension Set with Female Adapter, 1 Site and Male Luer Slip -- 7 In	Female luer connector, injectionsite 4" above distal end, male luer slip connector, DEHP-free,  7”.
	Extension Set with Female Adapter and 2 sites -- 33 In	Female adapter, injection sites 6" and 24" above distal end, slide clamp, male luer slip. 33".
	B.Braun Introcan® Safety™ I.V. Catheter	Unique design allows pre-attachment of a syringe to the IV catheter.  Push-off plate on the hub ensures smooth insertion, allowing a single-handed technique. Sharp needle bevel and rounded catheter tip, safety clip, color coded hubs, and more!
	Multi Sample Luer Adapter	Box of 100.
	Multi-Sample Luer Holder	Multi-sample luer holder, non-latex.
	Multi-Sample Needle	Multi-sample needles permit several samples to be taken with a single puncture. Sharp and smooth edges make penetration painless for patients and provides easy connection to rubber stoppers.
	Deltec GRIPPER PLUS® Safety Needle with Y-site	This exclusive design allows you to de-access in one safe, easy, natural motion!  Audible click upon activation, cushioned needle platform, removable contoured grip, and more!
	3M™ Tegaderm™ Transparent Dressings	A sterile, waterproof, clear, thin film dressing. Designed to be applied over I.V. devices, clean skin or wounds and provides a breathable bacterial and viral barrier to outside contaminants.  Two different frame types to choose from.
	AMSINO 20 Inch Extension Set with Flow Control	Extension set with female luer, FLOWSafe™ flow controller and slide clamp 2-piece rotating male luer lock. 20”.
	AMSINO AMSafe™ PRN Connector	AMSafe™ PRN connector, sterile in individual package.
	Amsino 15 drop, 83 in. with AMSafe® needleless injection site	Non-vented spike with drip chamber, roller clamp, split septum injection site, AMSafe® needleless injection site, rotating male luer lock.  83", 15 drop.
	Interlink Y-type blood solutions set	Interlink® Y-type blood/solution set with standard blood filter (170-260 micron) and 1 Interlink injection site 6" from male luer lock adapter. 104"
	Standard Bore T-connector Extension Set	Standard bore T-connector extension set with 1 Interlink® T-connector injection site and rotating male luer lock adapter. 5"
	ACUVANCE® Safety I.V. Catheters	Offers passive safety technology and the comfortable feel of a conventional catheter with a smooth, tapered hub for insertion ease and patient comfort. Straight or winged hub.
	Baxter Interlink® Universal Vial Adapter	Baxter #2N3395.  Each, count/40 and case/240.
	Safeline® Needle-Free Injection Site	SafeLine® valve injection site: split septum access with Spin-Lock® connector.
	Standard Bore Extension Set, Safesite®, distal luer, 8	Standard bore extension set with in-line check valve, low profile Safesite® valve injection site, distal luer slip connector. 8”.
	10 drop, 2 sites, 83" w/backcheck valve	Universal spike with drip chamber, back check valve, roller clamp, split septum injection site, AMSafe® needleless injection site, rotating male luer lock. 83”, 10 drop.
	10 drop, 2 sites, 83" w/6" pre-attached extension set	Non-vented spike with drip chamber, roller clamp, split septum injection site, AMSafe® needleless injection site, rotating male luer lock. 83”, 10 drop, pre-attached extension set.
	ConMed® Veni-Gard® I.V. Dressing	Waterproof dressing that stabilizes I.V. catheter during therapy.  Comfortable, low profile, with foam border you can write on.
	Small Bore Extension Set w/ULTRASITE Valve	8" extension set, no sites, with Ultrasite valve.
	Standard Bore Extension Set w/2 ULTRASITE Valve, Spin Lock	35" extension set with 2 Ultrasites, spin-lock.
	Needle Free Filter Straw®	A needle free flexible partical filter straw.
	MICRO PIN® Needle Free Dispensing Pin	Non-vented, single use dispensing pin for withdrawal of injection of medication from rubber-stoppered vials. Luer-lock connection.
	Ultrasite T-port	Standard bore T-port extension set with bonded ULTRASITE valve, SPIN-LOCK® connector. 7.5”.
	BD® Angiocath™ I.V. Catheters	DEHP free. FEP polymer.  Various gauges and lengths.
	BD Twinpak™ Dual Cannula Device	The BD Twinpak™ is a truly universal device that simplifies needleless IV access.
	AMSINO 60 drop, 1 site, 72	72" I.V. Administration set , 60 drop, one injection site.  DEHP-free & Latex-free.
	15 drops/ml, 2 sites, non-vented, 84"	Universal spike, roller clamp, injection sites 28” and 6” above distal end, SPIN-LOCK connector. 84”.  V1421-20
	Hypodermic Needles	Each needle is individually packaged, sterilized and ready for use.  Needles and boxes are color-coded for easy identification.  18/8 stainless steel.
	Tuberculin Needle and Syringe	25, 26, or 27 gauge, non-latex.
	Syringes	Positive plunger stop with smooth motion to prevent spillage when drawing. Polypropylene, sterile, non-toxic, and pyrogen free.
	Terumo® Insulin Needle & Syringe	Low Dead Space design, for use with U-100 insulin only. Extreme needle sharpness and smooth plunger movement, TERUMO® insulin syringes are designed for maximum comfort.
	Hypodermic Syringes & Needles	3cc, 5cc or 10cc syringes with needles.  Non-Latex.
	Butterfly/Small Vein Infusion Sets	Color-coded blood collection sets with flexible wings to hold the needle in position and help to prevent inadvertent pull out. Sterilized with Ethylen Oxide and ready for immediate use.
	MAD® Nasal Drug Delivery System	Fine mist-like spray targets desired mucosal region.
	Baksnap® Retractable Safety Syringe & Needle	BakSnap® Retractable Safety Syringe is used for hypodermic injection. It’s non-reusable, auto-destructive, and 99% identical to the conventional syringe. The BakSnap Retractable Safety Syringe’s operation is simple and easy to handle. In only two seconds, the plunger and retractable needle can be pulled back, snapped, and the entire unit disposed of, complete with needle safely inside. Otherwise, the BakSnap Retractable Safety Syringe is used in the same way as the conventional syringe.

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