Patent Publication Number: US-2023136271-A1

Title: Plural-mode automatic medicament packaging system

Description:
RELATED APPLICATIONS 
     The present application is a continuation of and claims priority to U.S. patent application Ser. No. 17/338,790, filed Jun. 4, 2021, now U.S. Pat. No. 11,542,054, which is a continuation of and claims priority to U.S. patent application Ser. No. 16/571,368, filed Sep. 16, 2019, now U.S. Pat. No. 11,027,872, which is a continuation of and claims priority to U.S. patent application Ser. No. 15/243,613, filed Aug. 22, 2016, now U.S. Pat. No. 10,427,819, and claims priority from and the benefit of U.S. Provisional Patent Application No. 62/209,659, filed Aug. 25, 2015, the disclosure of each of which is hereby incorporated herein by reference in its entirety. 
    
    
     FIELD OF THE INVENTION 
     The invention relates to packaging systems and, more particularly, to packaging systems capable of dispensing and packaging medicaments in selected different types of packages. 
     BACKGROUND OF THE INVENTION 
     Automatic dispensing machines are utilized by retail and mail order pharmacies and by pharmacies of hospitals, nursing homes and other long-term care facilities to automatically provide medicaments and nutriceuticals required to fulfill patient prescription orders. Such automatic dispensing machines are computer controlled and can automatically dispense loose, bulk form medicaments from on-board storage units, such as cassettes. The dispensed medicaments can subsequently be packaged in pouch packages by means of an on-board form, fill and seal packaging unit. 
     The automatic dispensing machines are efficient and have a high rate of dispensing and packaging throughput. However, the automatic dispensing machines are also relatively expensive and can cost hundreds of thousands of dollars because of the sophisticated automation necessary to program and operate the machines. 
     Increasingly, medicaments are required to be delivered to the patient packaged in what is known as a “compliance” or “multi-dose” package. A compliance package is a type of packaging in which the medicaments are arranged in a package or packages by medicament type and quantity and in a sequence in which each medicament is to be taken by the patient. Each medicament represents a separate dosage unit. For example, a plurality of compliance packages could be serially organized by patient and by time of day at which the medicaments are to be taken by the patient (e.g., breakfast, lunch, dinner, bed time). The medicaments in the compliance package are taken by the patient in the sequence, first-to-last, in which medicaments are provided in the compliance package. 
     The compliance package represents an important improvement over conventional containers such as vials and bottles which include a 30, 60, or 90 day count of medicaments. With conventional medicament containers, the responsibility for following the physician&#39;s prescription order lies with the patient who must select and access the required medicament from the containers at the correct time of day. This may be difficult for some patients because the containers may look alike and because the patient must remember the sequence in which the medicaments are to be taken. In contrast, compliance packaging shifts responsibility for following the physician&#39;s prescription order to the pharmacy by enabling the pharmacy to place the medicaments in the proper sequence for the patient. In short, compliance packaging which can be provided by the pharmacy encourages the patient to comply with the doctor&#39;s prescription order, potentially resulting in improved health outcomes. 
     Pouch packages of the type output from the aforementioned automatic dispensing machines can represent a type of compliance packaging. This is because the individual pouch packages can be grouped and loaded by the patient and arranged serially in a pouch package web (also referred to as a “strip” or “vine”). Each individual pouch package can contain each required medicament to be taken at a particular time and the pouch packages collectively can be arranged in the web in the sequence one-after-the-other in which the medicaments are to be taken by the patient. Pouch packages are not limited to multi dose compliance packaging and can also be utilized for “unit dose” packaging in which all or a certain number of packaged medicaments are alike. 
     Pouch packages are excellent packages in which to deliver medicaments for reasons such as those just described. However, pouch packages may not be an optimal packaging solution for all applications and patients. Pouch packages in the form of a long pouch package web can be unwieldy to handle and can require winding on a spool. Pouch package segments require careful management to avoid loss or co-mingling with pouch packages for another patient. Other types of medicament packaging, such as blister packaging, may be more optimally suitable for use in certain applications. 
     A limitation of automatic medicament dispensing machines, including machines that package medicaments in pouch packages, is that such machines can package medicaments in just a single type of package. This limitation prevents a pharmacy from utilizing the automatic dispensing machine with a type of package other than that for which the machine was designed. Many pharmacies are unable to afford more than one of the sophisticated and costly automatic dispensing machines and are thereby limited to providing medicaments in just a single type of package which may not be optimal for all applications. 
     There is a need for an improved automatic medicament packaging system which would improve the medicament dispensing process, which would make the medicament dispensing process more responsive to the needs of the pharmacy and the patients served by the pharmacy, which would reduce cost, and which would generally improve the quality of patient care. 
     SUMMARY OF THE INVENTION 
     The present invention is an improvement in medicament packaging systems. In one embodiment, a plural-mode automatic medicament packaging system is provided. A packaging system may include an automatic medicament dispensing unit, a pouch packaging unit, a blister package packaging unit and a plural-position medicament diverter. 
     The automatic medicament dispensing unit may include a plurality of medicament storage and dispensing units. The medicament storage and dispensing units may dispense medicaments stored therein in any sequence required for packaging. 
     In one packaging mode, the pouch packaging unit may be paired or positioned for operation with the automatic dispensing machine. The pouch packaging unit may package medicaments from a storage and dispensing unit in one or more pouch package. 
     In a further packaging mode, the blister package packaging unit is used in place of the pouch packaging unit. The blister package packaging unit receives medicaments from the automatic dispensing machine and packages the medicaments in blister packages. In embodiments, a blister packaging unit may include a robotic pick-and-place device which loads medicament into a cell of the blister package and a sealer unit which seals the blister package after loading. 
     In a first-mode position, medicaments may be delivered from the medication and storage units of the automatic medicament dispensing unit without interference by the diverter. As a result, medicaments may be received by the pouch packaging unit and packaged in pouch packages by the pouch packaging unit. In a second-mode position, the diverter redirects medicaments from the medication and storage units of the automatic medicament dispensing unit to the blister package packaging unit. Medicaments received by the blister package packaging unit may be packaged in blister packages by the blister package packaging unit. 
     Further aspects of the plural-mode automatic medicament packaging system are described in the drawings and detailed description which follow. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Exemplary systems and apparatus for a plural-mode automatic medicament packaging system may be understood by reference to the following description taken in conjunction with the accompanying drawings, in which like reference numerals identify like elements throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. The drawings depict only embodiments of the invention and are not therefore to be considered to be limiting of the scope of the invention. In the accompanying drawings: 
         FIG.  1    is a perspective view of an embodiment of a plural-mode automatic medicament packaging system according to the invention illustrated in a first packaging mode enabling medicament packaging in pouch packages; 
         FIG.  2    is a front elevation view of the packaging system of  FIG.  1   ; 
         FIG.  3    is a top plan view of the packaging system of  FIG.  1   ; 
         FIG.  4    is a perspective view of the packaging system of  FIG.  1   , but with certain components removed to facilitate understanding; 
         FIG.  5    is a section view of the packaging system taken along section  5 - 5  of  FIG.  3   ; 
         FIG.  6    is a view of medicament storage and dispensing units of the packaging system of  FIG.  1    with certain surfaces cut away to facilitate understanding; 
         FIG.  7    is a perspective view of the pouch packaging unit of the packaging system of  FIG.  1   ; 
         FIG.  8    is a section view of the packaging system taken along section  8 - 8  of  FIG.  3   ; 
         FIG.  9    is a section view of the packaging system taken along section  9 - 9  of  FIG.  2    showing removal of a pouch packaging unit; 
         FIG.  10    is a section view of the packaging system taken along section  9 - 9  of  FIG.  2    showing transfer of the pouch packaging unit to a cart; 
         FIG.  11    is a perspective view of the packaging system of  FIG.  1    but in a second mode enabling medicament packaging in blister packages; 
         FIG.  12    is a perspective view of the packaging system of  FIG.  11   , but with certain components removed to facilitate understanding; 
         FIG.  13    is a front elevation view of the packaging system of  FIG.  11   ; 
         FIG.  14    is a section view of the packaging system taken along section  14 - 14  of  FIG.  13    with certain components removed to facilitate understanding; 
         FIGS.  14 A- 14 G  are perspective views illustrating manipulation of a blister package with certain components removed to facilitate understanding; 
         FIG.  15    is a section view in perspective of the packaging system taken along section  15 - 15  of  FIG.  14   ; 
         FIGS.  15 A and  15 B  are perspective views of an embodiment of a robotic pick-and-place unit; 
         FIG.  16    is a section view in perspective of the packaging system taken along section  16 - 16  of  FIG.  14   ; 
         FIG.  17    is a block diagram illustrating components of a control system for the packaging system of  FIG.  1   ; 
         FIGS.  18 - 19    illustrate an exemplary pouch package web including discrete pouch packages formed therein; 
         FIGS.  20 - 22    illustrate an exemplary blister package; and 
         FIG.  23    illustrates an exemplary user interface with packaging system  10 . 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Referring first to  FIGS.  1 - 17   , there is shown an embodiment of a plural-mode automatic medicament packaging system  10  according to the invention. In the embodiment, packaging system  10  may include an automatic dispensing machine  11  having an automatic medicament dispensing unit  13 . Packaging system  10  may further include a pouch packaging unit  15  and a blister package packaging unit  17  which cooperate with dispensing machine  11  to package medicaments, such as medicaments  19 ,  21 ,  23 ,  25 ,  27 ,  29 ,  31 , in different types of packages. For convenience and brevity, medicaments  19 - 31  will generally be referred to by the single reference number  19 . 
     Packaging system  10  may operate in one of a plurality of packaging modes to package medicaments  19  in different package types. In a first packaging mode, medicaments dispensed from medicament dispensing unit  13  may be packaged by pouch packaging unit  15  into pouch packages such as pouch packages  33 ,  35 ,  37 ,  39 ,  41 ,  43  illustrated in  FIGS.  18 - 19   . For convenience and brevity, all pouch packages will be referred to by reference number  33 , it being understood that the other pouch packages  35 - 43  may be identical. In a second packaging mode, medicaments  19  dispensed from dispensing machine  11  may be packaged by blister package packaging unit  17  into blister packages, such as blister package  45  illustrated in  FIGS.  20 - 22   . 
     Pouch packages  33 - 43  and blister packages  45  may be of a compliance or multi-dose type in which such packages contain medicaments  19  in a sequence in which the medicaments  19  are to be taken by a patient in accordance with a physician&#39;s instructions. Alternatively, such packages could be of a unit dose type, for example, containing the same type of medicament  19  which may then be provided to any patient. 
     Packaging system  10 , therefore, enables a pharmacy to automate medicament  19  dispensing and packaging utilizing different types of packages by means of a single packaging system  10 . Costs are significantly reduced because one packaging system  10  can do the work of many packaging systems, enabling delivery of health care at a lower price and generally improving the quality of patient care. 
     Referring again to  FIGS.  1 - 17   , packaging system  10  may be controlled by a controller  12  ( FIG.  17   ) which may be one or more programmable computer with one or more central processing unit (“CPU”) and associated memory. Controller  12  may be programmed with a set of instructions, which may be in the memory of controller  12 , for execution by packaging system  10 . 
     Controller  12  may, for example, consist of a main frame computer, a computer server, a personal computer (“PC”), or plural operably-connected servers or PCs. Controller  12  may include a computer  14  illustrated as being within automatic dispensing machine  11 . Controller  12  through computer  14  may control all aspects of operation of packaging system  10  including automatic dispensing machine  11 , medicament dispensing unit  13  of automatic dispensing machine  11 , pouch packaging unit  15 , blister package packaging unit  17  as well as a diverter  163 . 
     One of ordinary skill in the art will appreciate that controller  12  can be dedicated to packaging system  10  or can be a computer which is shared by multiple modules, including a pharmacy information system which controls the overall operation of a pharmacy in addition to operating packaging system  10 . Controller  12  may be in data-transmission relationship with automatic dispensing machine  11 , medicament dispensing unit  13  of automatic dispensing machine  11 , pouch packaging unit  15 , blister package packaging unit  17  as well as a diverter  163 . 
     Referring to  FIGS.  1 - 10   , automatic dispensing machine  11  and dispensing unit may include a housing  47  which may enclose medicament dispensing unit  13  and pouch packaging unit  15  when pouch packaging unit  15  is mounted in dispensing machine  11 . Housing  47  may include top and bottom walls  49 ,  51 , left and right side walls  53 ,  55 , and front and rear walls  57 ,  59 . In one embodiment, side wall  53  may include a removable access panel  61  which may enable dispensing machine  11  to operate with blister package packaging unit  17  as described herein. Access panel  61  may be removably secured to housing  47  by any suitable means including by fasteners, clips, latches or the like which enable easy removal of access panel  61  from housing  47 . 
     Housing  47  may further include a pair of access doors  63 ,  65  in front wall  57 . Doors  63 ,  65  close and open to allow a technician to access components internal to housing  47 , such as pouch packaging unit  15 . Doors  63 ,  65  may also be opened to mount and remove pouch packaging unit  15  from dispensing machine  11  as described herein. In certain embodiments, packaging system  10  may be configured so that pouch packaging unit  15  could simply be moved aside while remaining in automatic dispensing machine  11  or so that pouch packaging unit  15  could remain in place with diverter  163  redirecting medicaments  19  to pouch package packaging unit  17 . 
     In the example, medicament dispensing unit  13  of automatic dispensing machine  11  may be located at least partially within housing  47  above the position of pouch packaging unit  15 . Medicament dispensing unit  13  may include a plurality of pull-out drawers indicated by reference number  67 . For convenience and brevity, reference number  67  designates each such drawer, it being understood that the drawers are identical in the example. In the example, the drawers  67  are organized into five rows and four columns of drawers for twenty total drawers  67 . Any number of drawers may be provided. Structure other than drawers may also be provided. 
     As illustrated in  FIGS.  6  and  8   , each drawer  67  may support a plurality of removable medicament storage and dispensing units indicated by reference number  69 . For convenience and brevity, reference number  69  designates each storage and dispensing unit, it being understood that the storage and dispensing units are identical in the example. Any number of storage and dispensing unit  69  may be provided. Storage and dispensing units  69  may be of a cassette type as illustrated or may be of another type capable of storing and dispensing medicaments  19  or other items therefrom. 
     Each storage and dispensing unit  69  is provided to store a bulk quantity of loose, free flowing medicaments such as the solid tablet-form medicaments  19 - 31  described previously and illustrated in  FIG.  20   . Each storage and dispensing unit  69  can also dispense, or output, such medicaments  19  for subsequent packaging. 
     One type of medicament  19  is typically stored in each storage and dispensing unit  69 . The type of medicament  19  in each storage and dispensing unit  69  may be stored in a database associated with controller  12 , enabling packaging system  10  to activate only the storage and dispensing unit(s)  69  containing the necessary medicament  19 . 
     Typically, medicaments  19  stored in such storage and dispensing units  69  are of types which are prescribed and used more frequently to fulfill patient prescription orders. Such frequently-used medicaments  19  may be referred to as “fast movers.” Medicament  19  (and medicaments  21 - 31 ) is merely an example because any flowable item could be stored in a storage and dispensing unit  69 . 
     In one embodiment, storage and dispensing units  69  may each include a cassette  71  removably mounted on a motor base  73 . Motor base  73  may be controlled by controller  12 . Motor base  73  may be supported on a drawer such as a drawer  67 . Cassette  71  may include a hopper  75  which receives and stores medicaments  19 . Cassette  71  and hopper  75  may be covered by a removable lid  77 . Cassette  71  may be initially loaded or replenished with medicaments  19  by removing lid  77  and pouring medicaments  19  into hopper  75  with the quantity loaded being updated in the database associated with controller  12 . Such loading may occur with cassette  71  mounted on motor base  73  or at a workstation spaced from packaging system  10  after first removing cassette  71  from motor base  73 . 
     Each storage and dispensing unit  69  may further include a rotor  79  toward a bottom of hopper  75  in medicament-flow relationship with the hopper bottom opening  80 . A motor  81  associated with motor base  73  controlled directly or indirectly by controller  12  may be in power-transmission relationship with rotor  79  when hopper  75  is mounted on motor base  73  to power rotation of rotor  79 . As rotor  79  rotates under power of motor  81 , medicaments  19  flow by means of gravity downward in hopper  75  toward rotor  79  and are dispensed, or output, from a port  82  in the storage and dispensing unit  69  as illustrated in  FIG.  6    in a singulated manner one-after-the-other. 
     A counter  84  registers a count each time a medicament  19  passes counter  81  and is dispensed or output from a storage and dispensing unit  69 . For example, a medicament passing counter  84  could break an infra-red energy source (not shown) across port  82  to register a count. The count information may be used directly or indirectly by packaging system  10  controller  12  to track the quantity of medicaments  19  dispensed or output in each operation of the storage and dispensing unit  69  and may be a first control to ensure that the correct quantity of medicaments  19  have been dispensed. Motor  81  is deactivated to stop further medicament  19  dispensing when the required count has been reached. 
     Each storage and dispensing unit  69  may be replenished as medicaments  19  stored therein are dispensed during repeated medicament  19  packaging operations. Replenishment may be accomplished merely by manually pulling or sliding out the drawer  67  on which the storage and dispensing unit  69  to be replenished is mounted followed by refilling the storage and dispensing unit  69  with a bulk quantity of medicaments  19  as described previously. As previously stated, any number or type of storage and dispensing units may be provided as components of medicament dispensing unit  13  of automatic dispensing machine  11 , and storage and dispensing units  69  are merely examples. 
     After being dispensed, or output, from a storage and dispensing unit  69 , medicaments such as medicament  19  may fall down by means of gravity through one or more vertical chutes  83 ,  85 ,  87 ,  89  and into a funnel-shaped hoppers  91 ,  92  beneath medicament dispensing unit  13  chutes  83 ,  85 ,  87 ,  89 . Movable valve-like shutters  93 ,  94  control flow of medicaments  19  from hoppers  91 ,  93  into guide  95  so as to permit simultaneous staging of two different types of medicaments  19  in hoppers  91 ,  92 . Guide  95  has a wide top opening  97  which receives the medicaments  19 , downwardly-sloped angled walls  99  and a narrow bottom opening  101  which directs medicaments  19  toward a packaging unit, which may be pouch packaging unit  15  or blister package packaging unit  17  depending on the mode in which packaging system  10  is configured as explained in more detail below. 
     Any number and size of automatic dispensing machines  11  may be utilized as the packaging system  10  may be scaled to meet the needs of the pharmacy. Automatic dispensing machine  11  is intended to be an example. 
     As stated, packaging system  10 , automatic dispensing machine  11  and medicament dispensing unit  13  may operate under control of instructions from controller  12  to operate storage and dispensing units  69  to dispense, or output, all medicaments  19  required to fulfill any pending prescription order (i.e., a prescription order that has been approved for fulfillment). Instructions for dispensing each medicament  19  may reside in a separate file residing in a database in memory of such controller  12 . Each file may contain all information necessary for dispensing and packaging of each medicament  19  including patient name, physician name, medicament type and strength, medicament lot number, time of day on which medicament  19  is to be taken and any other pertinent information. 
     Each file may also be updated to create a record of each count from counter  81  as each medicament  19  is dispensed from a storage and dispensing unit  69  to confirm that the actual medicament count matches the required medicament count for each pouch package  33  or blister package  45 . 
     It will be understood that “file” is intended to be a broad term which means or refers to one or more elements of data stored in memory which may be recalled by packaging system  10 . It will be further understood that multiple memory locations may be utilized for storing the data elements relating to each file. Therefore, the term “file” as used herein refers to the data elements for any given pouch package  33  or blister package  45 . 
     Storage and dispensing units  69  may dispense such medicaments  19  in any sequence to fulfill the pending prescription orders. Thus, all medicaments  19  for a patient may be dispensed from a storage and dispensing unit  69  in the sequence in which the medicaments  19  are to be taken by the patient according to the physician&#39;s instructions embodied in the physician&#39;s prescription order. 
     Referring now to  FIGS.  1 - 13    there is shown an embodiment of a pouch packaging unit  15  which may be utilized when packaging system  10  is in the first packaging mode. Pouch packaging unit  15  may be controlled directly or indirectly by controller  12 . As described in detail below, pouch packaging unit  15  may package medicaments  19  dispensed from medicament dispensing unit  13  into pouch packages  33 - 43  formed in a pouch package web  103  ( FIGS.  18 - 19   ). 
     In the example, pouch packaging unit  15  may be a modular, self-contained and integrated packaging unit. Pouch packaging unit  15  may be mounted within housing  47  of automatic dispensing machine  11  on platform  105 . Doors  63 ,  65  may be opened to access pouch packaging unit  15  for service or for removal or mounting of pouch packaging unit  15  within dispensing machine  11  to accommodate a change in packaging modes of packaging system  10 . 
     In the example, platform  105  is mounted for back-and-forth sliding movement on telescoping rails  107 ,  109  between the operating position of pouch packaging unit  15  illustrated in  FIGS.  1 - 5  and  8    and the position in which pouch packaging unit  15  is removed from automatic dispensing machine  11 . The operating position of pouch packaging unit  15  refers to the state in which packaging system  10  is ready to function in the mode for pouch packaging. Pouch packaging unit  15  may be secured to platform  105  in any manner, including by quick-release latches or the like. This structure enables pouch packaging unit  15  to be slid into or out of (i.e., to translate) automatic dispensing machine  11  housing  47 . When slid on platform  105  out of housing  47 , pouch packaging unit  15  may be detached from platform  105  and transferred to cart  111  as illustrated in  FIGS.  10 - 13   . Cart  111  may include caster wheels (one wheel indicated as  113 ) to enable cart  111  and pouch packaging unit  15  loaded thereon to be easily moved away from packaging system  10  ( FIGS.  11 - 13   ) when packaging system  10  is in a packaging mode for use with blister package packaging unit  17  or a further packaging module. 
     Referring again to  FIGS.  1 - 8  and  18 - 19   , when pouch packaging unit  15  is in the operating position, pouch packaging unit  15  packages medicaments  19  dispensed from storage and dispensing units  69  into separate pouch packages  33  to generate, or create, a pouch package web  103 . The material comprising web  103  may be supplied before use as a thin flexible film material wound into a supply roll  114  mounted for rotation on a motor-driven spindle (not shown) of frame  115  of pouch packaging unit  15 . The material which may be used for web  103  may be a lightweight low density polyethylene (“LDPE”) film. 
     Exemplary pouch packaging unit  15  may further comprise a printer  117 , and a sealer and perforation unit  119  supported by frame  115 . The operation of pouch packaging unit  15  is carefully synchronized directly or indirectly by controller  12  with operation of dispensing unit  13  and each motor base  73  to dispense and package medicaments  19  in accordance with file information as described herein so that the automatic dispensing machine  11  can preferably produce any desired arrangement of pouch packages  33 . 
     Referring to  FIGS.  4 - 8   , each medicament  19  falls from guide  95  and into tube  121  of pouch packaging unit  15 . When pouch packaging unit  15  is mounted for operation in automatic dispensing machine  11 , tube  121  is aligned with guide  95  bottom opening  101  ( FIGS.  4 - 5  and  8   ). A valve-like shutter  123  across tube  121  may open and close to limit or allow movement of a medicament  19  through tube  121 . When shutter  123  opens, a medicament  19  falls through tube  121  and exits tube  121  through nozzle  125  toward a lower end of tube  121 . 
     After exiting nozzle  125 , medicaments  19  are packaged as represented schematically in  FIG.  7   . Pouch packaging unit  15  forms by folding a pocket  127  in pouch package web  103  as web  103  is unwound from supply roll  114 . The pouch package web  103  may be folded in half by rollers (not shown) while web  103  is under tension to form pocket  127 . 
     As illustrated in the example of  FIGS.  7  and  18   , pouch package web  103  may include an opaque or semi-opaque portion  129  which receives printed information  131  thereon and a transparent portion  133 . Once a pouch package  33  is formed in pouch package web  103  as described above, opaque portion  129  becomes a first side of the pouch package  33  and the transparent portion  133  becomes a second side of the pouch package  33 . Opaque portion  129  preferably contrasts with printed information  131  applied thereto and facilitates reading or machine detection (e.g., barcode recognition or optical character recognition) of the printed information  131 . The transparent portion  133  permits each medicament  19  to be easily viewed within each pouch package  33  so that the contents of each pouch package  33  can be compared with the printed information  131  on the pouch package  33  for accuracy. 
     In the example, the folded web  103  is delivered to printer  117  shown schematically in  FIG.  7   . Printer  117  prints information on the folded web  103  opaque portion  129  adjacent the location where each pouch package  33  will be formed. In the example, the printing occurs before each medicament  19  for the pouch package  33  is loaded into pocket  127  from nozzle  125 . Any suitable type of information-application device could be used in place of a printer  117 . Advancement of web  103  is stopped momentarily by controller  112  so that printer  117  can apply printed information  131  to web  103  adjacent where each pouch package  33  will be formed. 
     Information  131  applied to pouch package web  103  adjacent the location of pouch package  33  may include any information deemed appropriate. Information  131  may include, for example: the patient name, instructions for taking the medicament  19  (e.g., date and time of day the medicament is to be taken), medicament information (e.g., medicament strength and type, medicament appearance information, quantity, lot number, and expiration date), and a machine-readable code, such as a barcode. 
     Referring further to  FIG.  7   , pouch packaging unit  15  fills, or loads, each required medicament  19  into pocket  127  formed in web  103  adjacent the corresponding printed information  131  for the pouch package  33 . Nozzle  125  guides each medicament  19  into pocket  127 . Dispensing of each medicament  19  from a storage and dispensing unit  69 , or other storage and dispensing apparatus, for each pouch package  33  and loading of each medicament  19  into pocket  127  is carefully synchronized with application of information  131  by printer  117 . At the same time that web  103  is momentarily stopped for printing, one or more medicament  19  is loaded into pocket  127  downstream from printer  117  adjacent the corresponding printed information  131  for the pouch package  33  into which each such medicament  19  is loaded. 
     A sealer and perforator unit  119  shown schematically in  FIG.  7   , is used to seal each medicament  19  into a discrete, separate pouch package  33  formed in the pouch package web  103 . Sealer and perforator unit  119  may seal web  103  into separate pouch packages  33  by advancing web  103  between heated sealing rollers such as illustrated in  FIGS.  7  and  9 - 10    or by other means, such as sonic welding. The sealer and perforator unit  119  may also perforate web  103 , making a perforation line  135  between each adjacent pouch package  33  to permit each formed pouch package  33  to be easily separated from the pouch package web  103  by tearing. In embodiments, packaging system  10  and automatic dispensing machine  11  may be capable of generating a separate pouch package  33  approximately every one second. 
     Web  103  and the pouch packages  33  formed therein are advanced from sealer and perforator unit  119  to outlet port  137  in front wall  57  of housing  47 . Therefore, web  103  and pouch packages  33  formed therein exit port  137  even as further pouch packages  33  are being formed in web  103  by pouch packaging unit  15 . After exiting port  137 , web  103  including pouch packages  33  may fall into a collection bin, or may be wound onto a spool, or may simply fall onto a floor surface adjacent automatic dispensing machine  11  and outlet port  137 . Exiting port  137  completes the packaging process for each pouch package  33  provided by the pouch packaging unit  15 . 
     Packaging system  10  continues to operate in the first mode for packaging of medicaments  19  in pouch packages  33  until such time as the pharmacy desires to package medicaments  19  in a different type of package and packaging mode. When it is desired to configure packaging system  10  for operation in a further packaging mode, operation of packaging system  10  is temporarily stopped. In the example, pouch packaging unit  15  may be removed from dispensing machine  11  as described above. With pouch packaging unit  15  removed, packaging system  10  may be configured for operation in a further packaging mode such as for use with blister package packaging unit  17 , as will now be described. 
     Referring now to  FIGS.  1 - 5 ,  8 - 17  and  20 - 22   , there is shown an embodiment of a blister package packaging unit  17  which may be utilized when packaging system  10  is in the second packaging mode. Blister package packaging unit  17  may be adapted to function with medicament dispensing unit  13  once pouch package packaging unit  15  is removed from automatic dispensing machine  11  as described above. Blister package packaging unit  17  may be provided to package medicaments  19  dispensed from medicament dispensing unit  13  into a blister package  45 . Efficiencies are provided to the pharmacy because the same automatic dispensing machine  11  can be used with different packaging units  15 ,  17 , or other packaging units, freeing the pharmacy from purchasing separate packaging systems for each different package type and increasing the utility of automatic dispensing machine  11  to the pharmacy. 
     A representative blister package  45  embodiment which could be utilized with packaging system  10  is illustrated in  FIGS.  20 - 22   . Blister package  45  may include a top and a bottom side  139 ,  141  and cells, of which cell  143  is representative. Blister package  45  cells  143  are referred to by some in industry as “wells.” Each cell  143  is defined by a cell wall, of which cell wall  145  is representative. Blister package  45  derives its name from the outwardly protruding appearance of the walls defining cells  143 . For purposes of simplicity and brevity, each cell  143  of blister package  29  is indicated by reference number  143  and each cell wall  145  is indicated by reference number  145 . 
     Referring again to  FIGS.  20 - 22   , each wall  145  defines a cell  143  upper opening, or inlet,  147  and a cell bottom  149 . As shown in the example, the cell inlets  147  extend through, and are included in and along, top side  139 . In the embodiment, medicaments  19  are loaded into each cell  143  through inlet  147  by means of blister package packaging unit  17  as described herein. 
     In the blister package  45  embodiment illustrated, each cell  143  is identical. However, it is possible that cells  143  and cell walls  145  of blister package  45  may have a structure which is not identical and which may differ depending on the needs of the user. For example, certain cells  143  of blister package  45  could have a depth or a cross-sectional shape which differs from the depth and cross-sectional shape of other cells of blister package  45 . 
     Referring yet again to  FIGS.  20 - 22   , the blister package  45  example includes thirty two total cells  143  organized into four rows and eight columns of cells  143 . The organization of cells  143  is merely exemplary. Cells  143  can be of any number and need not be arranged in rows and columns as illustrated. For example, cells  143  could be arranged in any number of rows and columns, in a circular pattern, or any other suitable arrangement. Blister package  45  may, by way of example only, be of a thin sheet of thermoformed or vacuum-formed transparent plastic of a polyvinyl chloride (“PVC”) material. A transparent blister package  45  would permit packaged medicaments  19  to be viewable therein. 
     A closure  151  of paperboard, or of aluminum foil, or plastic may be placed over all of the cells  143  of a loaded blister package top side  139  to close blister package  45 . The closed blister package  45  is then ready for delivery to the patient. 
     Certain blister package containers  45  are referred to as “push-through-packs.” In a push-through-pack, the cell wall  145  material in which the cells  143  are formed is collapsible by pushing with a human finger. The seal provided by closure  151  is breakable so that the medicament  19  within the selected cell  143  can be pushed through the closure and out of blister package  45  for use. 
     Blister package  45  may be used as a compliance or multi-dose container by, for example, printing the days of the week above each cell  143  and arranging the medicaments  19  in cells  143  according to the order in which the medicaments  19  are to be taken by the patient. Such an arrangement ensures that the medicaments  19  can be taken by the patient one-after-another at the correct date and time. Blister package  45  could also be used as a unit-dose package with identical medicaments packaged therein. 
     Referring to  FIGS.  1 - 5  and  8 - 16   , a blister package packaging unit  17  may generally comprise a blister package delivery unit  153 , an information application unit  155 , a blister package conveyor  157 , a robotic pick-and-place unit  159  and a sealer unit  161 . The operating position of blister package packaging unit  17  refers to the state in which packaging system  10  is ready to function in the mode for packaging medicaments  19  in blister packages  45 . In the example, blister package delivery unit  153  delivers an empty blister package  45  with information provided by information application unit  155  to blister package conveyor  157 . Blister package conveyor  157  delivers the empty blister package  45  to robotic pick-and-place unit  159  for filling with medicaments  19 . The cells  143  of the filled blister package  45  are closed and the blister package  45  sealed by attachment of a sheet of closure material  151  across the cells  143  by sealer unit  161 . 
     A plural-position medicament diverter  163  may be provided to move medicaments  19  from automatic dispensing machine  11  to pouch packaging unit  17 . In the example, diverter  163  may be extended into housing  47  to divert or change the direction of movement of medicaments  19  from a path which would be toward the pouch packaging unit  15  were it mounted in dispensing machine  11  and to a different path toward blister pack packaging unit  17 . Diverter  163  may include a medicament conveyor  165  which delivers medicaments  19  to the blister pack packaging unit  17 . 
     The diverter  163  embodiment will now be described in more detail in connection with  FIGS.  1 - 5  and  8 - 16   . In the example, diverter  163  may be located adjacent dispensing machine  11  housing  47  side wall  53 . When not in an operational position or state, diverter  163  front end  167  may be adjacent and spaced from side wall  53 . Removal of access panel  61  permits extension of diverter  163  front end  167  into and within housing  47  so as to position diverter  163  in the path of medicaments  19  falling from guide  95 , thereby enabling the medicament  19  diversion. 
     In one embodiment, diverter  163  may include a frame  169  which supports diverter  163  on a floor surface and which enables movement of diverter  163  into the path of medicaments  19  falling from and exiting guide  95 . Frame  169  may include a pair of fixed-position parallel elongate frame rails  171 ,  173  which lie in a horizontal plane and may further include pairs of vertical legs  175 ,  177 ,  179 ,  181  at opposite ends of frame rails  171 ,  173  to support frame rails  171 ,  173  and diverter  163  on a floor surface adjacent dispensing machine  11 . 
     Riding on frame rails  171 ,  173  are a pair of sliding parallel elongate slide rails  183 ,  185  which slide (i.e., translate) in a horizontal plane alternatively in the directions of dual-headed arrow  187 . Slide rails  183 ,  185  easily ride back-and-forth on a respective frame rail  171 ,  173  by means of rollers (not shown). Slide rails  183 ,  185  slide between a retracted position illustrated in  FIGS.  1 - 5  and  8 - 10    and an extended position illustrated in  FIGS.  12 - 16   . A first latch  189  may secure and lock slide rails  183 ,  185  in either the extended position or the retracted position. Handle  191  may be grasped and turned to release or engage first latch  189 . 
     Medicament conveyor  165  may ride on slide rails  183 ,  185  which may be components of diverter  163  frame  169 . Medicament conveyor  165  may be supported within a pair of parallel elongate side walls  195 ,  197  which slide (i.e., translate) in a horizontal plane alternatively in the directions of dual-headed arrow  187 . Side walls  195 ,  197  easily ride back-and-forth on a respective slide rail  183 ,  185  by means of rollers (not shown). Side walls  195 ,  197  and slide rails  183 ,  185  slide between the retracted position illustrated in  FIGS.  1 - 5  and  8 - 10    and the extended position illustrated in  FIGS.  12 - 16   . A second latch  199  may secure side walls  195 ,  197  in either the extended position or the retracted position. Handle  201  may be grasped and turned to release second latch  199 . Medicament conveyor  165  may be moved laterally in a telescoping manner to position medicament conveyor  165  under guide  95  to receive medicaments  19  falling from guide  95  bottom opening  101 . In the example, sliding of slide rails  183 ,  185  and side walls  195 ,  197  may be accomplished by manual pushing or pulling after release of latches  189 ,  199 . 
     Side walls  195 ,  197  of medicament conveyor  165  may also support a front idler roller  203 , a rear driven roller  205  and an endless belt  207  supported on rollers  203 ,  205  between side walls  195 ,  197 . An electric motor  209  may be in power-transmission relationship with rear driven roller  205  to power movement of belt  207  in the rearward direction of arrow  275 . Motor  209  and stepwise movement of belt  207  may be controlled by controller  12  ( FIG.  17   ) which controls overall operation of packaging system  10 . A sensor or any appropriate control may be used to stop and start motor  209  for each step. 
     Referring next to  FIGS.  12 ,  14 - 16   , belt  207  may support a plurality of carriers  211 ,  212 ,  213 ,  214 ,  215 ,  216 ,  217 ,  218 ,  219 ,  221 . Each carrier  211 - 221  is provided to hold medicaments  19  dispensed from medicament dispensing unit  13  while diverter  163  transports such medicaments  19  to blister package packaging unit  17 . To accomplish this, each carrier  211 - 222  may be attached to belt  207  in a manner permitting carrier  211 - 222  to be upside down on belt  207  without falling off belt  207 . Indexed or stepwise movement of belt  207  driven by motor  209  in the direction of arrow  275  positions one carrier  211 - 222  under bottom opening  101  of guide  95  during each step. Carriers  211 - 222  may each include a bowl  224 . Bowl  224  may include a rim for holding medicaments  19  which fall from guide  95  into a carrier  211 - 222  when the carrier  211 - 222  is positioned under guide  95  bottom opening  101 . A carrier  211 - 222  loaded with one or more medicament  19  may then be moved by belt  207  to blister package packaging unit  17  for transfer and packaging of medicaments  19  into a cell or cells  143  of blister package  45 . Therefore, diverter  163  redirects movement of medicaments  19  toward blister package packaging unit  17 . 
     Any quantity of medicaments  19  required for loading a blister package  45  may be loaded into a carrier  211 - 222  by medicament dispensing unit  13 . For example, if blister package  45  were to have 32 cells  143  and each cell  143  were to require one identical medicament  19  to fulfil the prescription order, then 32 identical medicaments  19  could be output from the storage and dispensing unit(s)  69  holding such medicament  19  and loaded into a single carrier  211 - 222  for delivery to the robotic pick-and-place unit  159 . Further, if different types of medicaments  19  are to be loaded into a single blister package  45 , then the required quantity of each type of medicament  19  may be loaded into separate carriers  211 - 222  and each carrier may be delivered to the robotic pick-and-place unit  159  so that each medicament  19  can be loaded into a blister package  45 . 
     Referring next to  FIGS.  4 - 5  and  15 - 16   , an imager  223  may be provided to capture an image record of the medicament contents of each carrier  211 - 222  before packaging of the medicaments  19  into a blister package  45  by robotic pick-and-place unit  159 . Imager  223  may capture an image of the quantity, color, size, shape and other physical characteristics of medicaments  19  in carrier (e.g., carrier  211 ). The video image may be stored in the file associated with computer  12  for the blister package  45 . Computer  12  may inspect the video image for a match (i.e., pass/fail) with the medicament count and type expected to be in the carrier (e.g., carrier  211 ) as stored in the file. If there is a match, then a record may be kept in the file for the blister package  45 . If there is no match, then an alarm may be generated so that the technician can correct the mismatch error. System  10  may be momentarily stopped by controller  12  for this error correction. The image record may be used to keep an archive in a database associated with controller  12 , indicative that the correct medicament  19  for the blister package  45  was supplied in accordance with the file information for the blister package  45 . Imager  223  may be a second control to ensure that the correct quantity and type of medicaments  19  have been dispensed. 
     Imager  223  may include a housing  225  and an imaging device  227 . Housing  225  may be an enclosure which may be positioned over one carrier (e.g., carrier  211 ) to cover carrier  211  while belt  207  is momentarily stopped by controller  12 . Imager  223  may be supported above belt  207  and carriers  211 - 222  by a cover  230 . In addition to supporting imager  223 , cover  230  can prevent medicaments  19  from bouncing out of a carrier  211 - 222  during transport on medicament conveyor  165 . And, cover  230  can protect medicaments  19  from contact by contaminants. Cover  230  may be raised or lowered to space imager  223  above a carrier  211 - 222  as desired to produce the required image of medicaments  19  in a carrier  211 - 222 . 
     Imaging device  227  may be supported on housing  225  to capture an image of medicaments  19  in bowl  224  of carrier  211 . Imaging device  227  may be a charged coupled device (“CCD”). A preferred CCD captures light and converts it to digital data that is stored through processing in each file for each blister package  45  by controller  12 . It is preferred that imaging device  227  has a resolution of about 8 megapixels or greater. A dome-like lamp  229  may be provided within housing  225  to illuminate medicaments  19  for image capture by imaging device  227 . 
     Controller  12  may power motor  209  to momentarily power belt  207  back-and-forth alternatively in the directions of arrow  187 . Back-and-forth movement of belt  207  may serve to shake medicaments  19  within a carrier  211 - 222  so as to avoid stacking of medicaments  19  and to ensure medicaments are uniformly spread out within a carrier  211 - 222  so as to provide for more accurate imaging of such medicaments  19 . 
     Referring next to  FIGS.  1 - 5  and  8 - 16   , components of one embodiment of a blister package packaging unit  17  will now be described. Components of blister package packaging unit  17  may include blister package delivery unit  153 , information application unit  155 , blister package conveyor  157 , robotic pick and place unit  159  and sealer unit  161 . All of these components may be controlled by controller  12 . 
     In the example, bin  231  may be provided as a storage location for a source of empty blister packages  45 . Bin  231  may hold a stack of empty blister packages  45  nested one on top of the other in bin  231 . 
     Referring to  FIGS.  14 A- 14 C , information application unit  155  may include a label printer  233  and a transport mechanism  235 . Information application unit  155  may be provided to apply information  237  to each empty blister package  45  describing the medicaments  19  which will be packaged in each such blister package  45 . It is not required that information application unit  155  apply information  237  to each empty blister package. For example, a unit dose blister package  45  not intended for a specific patient may not need application of information  237 . If applied, information  237  may include patient-specific information  237  from the file associated with controller  12  for the blister package  45 . The information  237  may include all information necessary for dispensing of each medicament  19  packaged in the blister package  45  including patient name, physician name, medicament type and strength, medicament lot number and any other pertinent information. 
     In the example, label printer  233  may include any suitable printer which affixes the information  237  to an adhesive-backed label  239 . In the example, label printer  233  may output the adhesive-backed label  239  for a blister package  45  onto platform  241 . 
     Transport mechanism  235  may include an arm  241  which may be moved in an x-y coordinate system. Transport mechanism  235  may include a vacuum source (not shown) which utilizes a negative pressure to momentarily adhere arm  241  to label  239  on platform  243  and may press and affix the label  239  to the topmost empty blister package  45  from the blister package  45  stack in bin  231  as illustrated in  FIG.  14 C . 
     Referring next to  FIGS.  14 D- 14 G , blister package delivery unit  153  may be a robot controlled by controller  12  provided to move the empty and labeled blister package  45  from the stack of blister packages  45  in bin  231  adjacent information application unit  155  and to and onto blister package conveyor  157 . Such robot may include an articulated arm  245  which may be moved in an x-y-z coordinate system. A gripper  246  may be carried at an end of arm  245 . Blister package delivery unit  153  may include a vacuum source (not shown) which utilizes a negative pressure to momentarily adhere gripper  246  to the topmost labeled empty blister package  45  from the blister package  45  stack in bin  231 . As illustrated in  FIGS.  14 D and  14 E , arm  238  may be moved from a start position ( FIG.  14 D ) to a further position in which to gripper  246  contacts and grips the blister package  45  ( FIG.  14 E ). Gripping may occur by generation of the vacuum. 
     As illustrated in the sequence of  FIGS.  14 F- 14 G , arm  245  may then lift the gripped blister package  45  as illustrated in  FIG.  14 E , flip the gripped blister package  45  as illustrated in  FIG.  14 F , and place the blister package  45  onto one blister package holder  247 ,  249 ,  250 ,  251 ,  252 ,  253 ,  254 ,  255  on blister package conveyor  157  as illustrated in  FIG.  14 G . Arm  245  may then gently push blister package  45  down onto a holder (e.g., holder  247 ) so that blister package  45  nests onto such holder with cells  143  in positions known to controller  12  as described next. Arm  245  may then return to the position of  FIG.  14 A  to begin another cycle. 
     Blister package conveyor  157  may include a frame  257  including a pair of parallel elongate side walls  259 ,  261 . Frame  257  may be supported on a floor surface by attachment of sidewall  259  to frame rail  173  of diverter  163  frame  169  and by vertical legs  263 ,  265 . In the embodiment, blister package conveyor  157  and medicament conveyor  165  may be parallel to each other. 
     Frame  257  of blister package conveyor  157  may also support a front idler roller  267 , a rear driven roller  269  and an endless (i.e., continuous) flexible belt  271  supported on rollers  267 ,  269 . An electric motor  273  may be in power-transmission relationship with rear driven roller  269  to power rearward movement of belt  271  in an indexed or stepwise manner in the direction of arrow  275 . Motor  273  may be controlled by computer  12  which controls overall operation of packaging system  10 . A sensor or any appropriate control may be used to stop and start motor  273  for each step. 
     Referring next to  FIGS.  1 ,  3 - 4 ,  9 - 12  and  14 - 16   , belt  271  may support a plurality of blister package holders  247 - 255  which may have a structure each identical to the other. Each holder  247 - 255  may be attached to belt  271  in a manner permitting holder  247 - 255  to be upside down on belt  271  without falling off belt  271  allowing belt  271  to be driven entirely around rollers  267 ,  269  in the direction of arrow  275 . Each holder  247 - 255  may be provided to receive an empty labeled blister package  45  from transport mechanism  235 , to hold the labeled blister package  45  during loading of medicaments  19  into cells  143  by robotic pick-and-place unit  159 , to hold the loaded and labeled blister package  45  during sealing by sealer unit  161  and to tip so that the sealed blister package  45  can be ejected from the holder  247 - 255 . 
     Each holder  247 - 255  may define a top surface  277  and a plurality of concave pockets  279  which may be arranged in a shape and pattern identical to the arrangement of cells  143  of blister package  45  so that a blister package  45  can be nested on any holder  247 - 255 . For example, if blister package  45  includes thirty two total cells  143  organized into four rows and eight columns of cells  143 , then each holder  247 - 255  may have a pattern of pockets  279  identical to the pattern of the blister package cells  143  and cell walls  145  defining cells  143 . The location of each pocket  279  may be known to controller  12 . 
     Blister package  45  may be set on a holder  247 - 255  by arm  238  with each cell  143  nested in a corresponding pocket  279 . This arrangement enables each cell  143  location to be identified by computer  12  which controls operation of packaging system  10  for purposes of precisely loading any medicament  19  into any desired cell  143  of a labeled blister package  45  by robotic pick-and-place unit  159 . 
     Rearward indexed or stepwise movement of belt  271  in the direction of arrow  275  delivers a holder  247 - 255  and an empty labeled blister package  45  nested thereon to robotic pick-and-place unit  159  for filling with medicaments  19  as described next. 
     In one embodiment, a robotic pick-and-place unit  159  may be a floor mounted unit supported on a floor stand  281 . Stand  281  may support robotic pick-and-place unit  159  above and straddling both the parallel blister package conveyor  157  and medicament conveyor  165  with robotic pick-and-place unit above conveyor belt  207  of blister package conveyor  157  and conveyor belt  271  of medicament conveyor  165 . Robotic pick-and-place unit  159  may be under control of computer  12  which controls operation of packaging system  10 . In the example, robotic pick-and-place unit  159  may be capable of picking a medicament  19  from a carrier  211 - 222  and placing the medicament  19  into any cell  143  as specified by instructions associated with controller  12  for the blister package  45 . 
     A supply of medicaments  19  and an empty labeled blister package  45  may be delivered to robotic pick-and-place unit  159  for loading of each medicament  19  into the required cell  143  of blister package  45 . Imaging of medicaments  19  in carrier  211 - 222  may occur before delivery of carrier  211 - 222  to robotic pick-and-place unit  159  as described above. 
     In the exemplary embodiment, the blister package loading process may be as follows. A carrier  211 - 222  on belt  271  with one or more medicament  19  in bowl  224  may be delivered by medicament conveyor  165  to a loading station  283  adjacent to and preferably beneath robotic pick-and-place unit  159 . A carrier  211 - 222  at loading station  283  is referred to herein as being at a “delivery position” at which medicaments can be transferred to a blister package  45 . Belt  271  may be stopped with one carrier  211 - 222  at loading station  283 . Because of the indexed stepwise movement of belt  271  and carriers  211 - 222  thereon, each carrier  211 - 222  is identified to packaging system  10 . A sensor or any appropriate control may be used to stop and start motor  273  for each step. 
     Simultaneously, a holder  247 - 255  holding an empty labeled blister package  45  may be delivered in an indexed manner by blister package conveyor  157  to loading station  283  whereupon belt  271  may be stopped with one holder  247 - 255  at loading station  283 . The indexed stepwise movement of belt  271  and holder  247 - 255  thereon permits each cell  143  position to be identified to packaging system  10 . By identification, it is meant that packaging system  10  may have a record of both each cell  143  location (e.g., row 1, column 1 of blister package  45 ) and of each medicament  19  that is required to be loaded in each cell  143  location. Consequently, a carrier  211 - 222  containing medicaments  19  and a blister package  45  to be loaded with the medicaments  19  are both at loading station  283  for transfer of medicaments to blister package  45  by robotic pick-and-place unit  159 . 
     Robotic pick-and-place unit  159  may be any device capable of loading medicaments  19  into the labeled blister package  45  at loading station  283 . One example of a device which may be utilized as robotic pick-and-place unit  159  is a Fanuc robot M-1iA/1HL available from Fanuc America Corporation of Hoffman Estates, Ill. Such Fanuc robot may include three computer-controlled  12  articulated  285 ,  287 ,  289  arms. Arms  285 ,  287 ,  289  of robotic pick-and-place unit  159 , may be interconnected to hold a single control head  317  toward the ends of such arms  285 - 289 . Control head  317  may have a probe end  319  connected to a vacuum source (not shown). The vacuum source permits probe end  319  to pick and hold a medicament  19  from carrier (e.g.,  211 ) for transport to blister package  45 . 
     Under control of computer  12 , each arm  285 - 289  can be coordinated to move control head  317  toward carrier  211 - 222  at loading station  283  to allow probe end  319  to grip or “pick” one medicament  19  in bowl  224 . Negative pressure from the vacuum mechanism at probe end  319  momentarily grips a medicament  19 . Arms  285 - 289  are then moved to move control head  317  to the appropriate cell  143  of labeled blister package  45  also at loading station  283 . A momentary cessation of the vacuum at probe end  319  causes control head  317  to drop or “place” a medicament  19  into a specified cell  143 . 
     The combination of all three arms  285 - 289  and their individual motion, control the location of control head  317  and probe end  319  in a controlled range of motion. The combination of the arms  285 - 289 , control head  317 , and a video camera  321  give the robotic pick-and-place unit  159  the ability to locate the desired medicament  19  to be picked and the location and orientation of the cell  143  into which the medicament  19  will be placed. This video image may be taken for each picking cycle of the robotic pick-and-place unit  159  to insure target medicaments  19  and cells  143  have not been moved during the last cycle of arms  285 - 289 . The control head  317  may have a 360 degree rotary control axis that allows the robotic pick-and-place unit  159  to control the orientation of the medicament  19  should it have a larger profile (e.g., an elongate oval tablet) which needs manipulation to fit through cell inlet  147 . 
     Video camera  321  may capture an image of the quantity, color, size, shape and other physical characteristics of medicaments  19  in carrier (e.g., carrier  211 ). The video image may be stored in the file associated with computer  12  for the blister package  45 . Computer  12  may inspect the video image for a match (i.e., pass/fail) with the medicament count and type expected to be in the carrier (e.g., carrier  211 ) as stored in the file. If there is a match, then a record may be kept in the file for the blister package  45 . If there is no match, then an alarm may be generated so that the technician can correct the mismatch error. System  10  may be momentarily stopped by controller  12  for this error correction. 
     In the example, packaging system  10  may provide three checks of medicaments  19  before loading in a blister package  45 . A first check may occur when a count is generated by counter  84 . A second check may occur based on analysis of the image captured by imager  223 . A third check may occur based on analysis of the image captured by video camera  321  of robotic pick-and-place unit  159 . 
     Robotic pick-and-place unit  159  may have the capability to place any medicament  19  in any cell  143  of blister package  45  as required for fulfillment of the prescription order associated with the blister package  45 . For example, if different types of medicaments, such as medicaments  19  and  21  ( FIG.  19   ), are to be loaded in a single blister package  45 , then first single-type medicaments  19  from a first carrier  211  could be loaded in the required cells  143  in any required sequence, including by potentially skipping cells  143  in which a different type medicament  21  is to be loaded. 
     Next, a second carrier  213  with a second and different type of medicament  21  could be delivered by medicament conveyor  165  to loading station  283  while the partially-loaded blister package  45  remains stopped at loading station  283 . The second type of medicament  21  could then be loaded in the required cells  143  for that medicament  21 , once again in any required sequence potentially skipping cells  143  in which a further different type medicament  23  is to be loaded. The process is continued until all cells  143  of a single blister package  45  are loaded with a medicament (e.g., medicament  19 ,  21 ,  23 ) as required by the patient&#39;s prescription order. 
     The foregoing process enables a single blister package  45  to be loaded with an identical type of medicament  19  or with different types of medicaments  19 ,  21 ,  23  in, for example, the order in which the medicaments  19 ,  21 ,  23  are to be taken by the patient. As an example, three different medicaments  19 ,  21 ,  23  to be taken serially at different times of the day (e.g., breakfast, lunch and dinner) could be loaded in three consecutive cells  143  to be taken one after the other by the patient. 
     Following loading of blister package  45 , belt  271  of blister package conveyor  157  may be restarted permitting further rearward indexed movement of belt  271  in the direction of arrow  275 . Such movement delivers the next empty blister package  45  to be loaded and holder  247 - 255  in which the blister package  45  is nested to loading station  283 . Such movement further delivers the loaded blister package  45  and holder  247 - 255  in which blister package  45  is nested to the sealer unit  161  for sealing of blister package  45  as described next. 
     Any number or size of robotic pick-and-place units  159  may be utilized as the packaging system  10  may be scaled to meet the needs of the pharmacy. Robotic pick-and-place unit  159  is intended to be an example. 
     Referring now to  FIGS.  1 - 5  and  9 - 15   , sealer unit  161  may be provided to seal blister package  45  and the medicaments  19  loaded therein. Sealer unit  161  may be controlled directly or indirectly by controller  12 . Sealer unit  161  may be provided to close and seal each filled and loaded blister package  45  by attachment of a closure  151  across the cells  143 . In the example, sealer unit  161  may also print information on closure  151  to assist the patient in taking medicaments  19  packaged in blister package  45 . 
     Sealer unit  161  may include a supply roll  293  including a web  295  of a carrier or backing material and a plurality of die-cut closures  151  supported on the carrier web  295 . Each closure  151  may, for example, be a of a thin sheet of paperboard, aluminum foil or plastic material and may include a thin layer of adhesive (not shown) on a side which will face top side  139  of blister package  45 . Closure  151  may be of a material type which can be easily broken by a patient pushing on cell bottom  149  so as to provide a “push-through-pack” as previously described. 
     Web carrier  295  carrying closures  151  may be unwound from roll  293  through a series of idler rollers  297 ,  299 ,  301  and onto a take-up roller  303  driven by take-up roller motor  305 . Web carrier  295  wound onto take-up roller  303  may subsequently be discarded. 
     As illustrated in  FIGS.  5  and  13   , after unwinding from supply roll  293  carrier web  295  may pass through an information-application device such as printer unit  307 . Printer unit  307  may print information (not shown) on closure  151  at a position visible to a patient. The data and instructions used by printer unit  307  to print the information on closure  151  may be from the file for the blister package  45  stored directly or indirectly by controller  12 . The printed information may include any information relevant to blister package  45  and medicaments  19  therein. The printed information may be patient specific and may include the patient name, identification of each cell  133  or the cell  133  contents, instructions for taking each medicament  19  (e.g., date and time of day the medicament is to be taken), medicament information (e.g., medicament strength and type, medicament appearance information, quantity, lot number, and expiration date), and a machine-readable code, such as a barcode. The information may include instructions for the sequence in which each cell  133  is to be accessed for purposes of taking the medicaments in blister package  45  in the correct sequence. The printed information need not be patient specific information and may include information, for example, relevant to a unit dose package not intended for any specific patient at the point of packaging by packaging system  10 . Such information applied by printer unit  307  may be used in place of or in addition to information  237  that could be applied by information-application unit  155 . 
     Closure  151  separates from carrier web  295  after traveling over idler roller  297  and between pressure roller  309  and top side  139  of blister package  45 . Pressure roller  309  applies a force pushing closure  151  onto top side  139  of blister package  45 . Adhesive on closure  151  side facing top side  139  of blister package  45  joins closure  151  to blister package  45 , thereby sealing blister package  45 . After sealing, each blister package  45  is considered to be complete and the finished package  45  is ready for delivery to the patient or for any other purpose such as providing an inventory of medicaments  19 . 
     Further movement of belt  271  in the direction of arrow  275  causes holder (e.g., holder  247 ) in which blister package  45  is nested to tip as such holder passes over roller  269 . Tipping of the holder (e.g., holder  247 ) causes the sealed blister package  45  to fall off of blister package conveyor  157 . The sealed blister package  45  may fall into a tote or other container (not shown) completing the packaging process provided by the example of the blister package packaging unit  17 . 
     Referring now to  FIGS.  1 - 23   , overall operation of the example of packaging system  10  will now be described. In operation, the mode in which packaging system  10  is to operate may first be determined. Controller  12  may be set to the desired packaging mode through an appropriate user interface such as a keyboard  311 , touch screen video display  313 , mouse  315  or the like in data-transmission relationship with controller  12  ( FIG.  23   ). In the example, controller  12  may be set to either a first mode for pouch  33  packaging or to a second mode for blister package  45  packaging. Further or different modes of packaging may be provided with other embodiments of packaging system  10 . For example, packaging system  10  could be configured to function with packaging units other than pouch packaging unit  15  or blister package packaging unit  17  to thereby package medicaments  19  in other types of packages. 
     A record of medicament  19  type and quantity within each storage and dispensing unit  69  of medicament dispensing unit  13  may reside in memory of controller  12 . Instructions and data for packaging of medicaments  19  in the selected packaging mode may be stored in a separate file residing in a database in memory of controller  12 . Each file may contain all information necessary for dispensing and packaging of each medicament  19  as previously described. Thus, a separate file may exist for each pouch package  33  and a separate file may exist for each blister package  45 . The files may be arranged by a technician or controller  12  in a “batch” of files containing all files for a given packaging run by packaging system  10 . Controller  12  may cause packaging system  10  to process the files of the batch so as to serially dispense and package medicaments  19  in the sequence in which the medicaments  19  are to be taken by the patient. Such an arrangement can provide for compliance or multi-dose packaging in which the packaging itself orders the medicaments  19  in a manner which encourages patient compliance with the physician&#39;s prescription order. 
     Packaging other than in compliance packaging is contemplated. For example, all pouch packages  33  or blister packages  45  in a particular batch of files could include an identical medicament  19 . Such an arrangement may be desirable when a pharmacy seeks to build an inventory of like medicaments  19  or to provide unit dose packages for patients. Other packaging arrangements and combinations of packaging arrangements are contemplated for processing by packaging system  10 . 
     When packaging system  10  is in a first mode for pouch packaging of medicaments  19 , pouch packaging unit  15  may be mounted on platform  105 . Pouch packaging unit  15  may be loaded with a supply roll  114  and web material  103  from supply roll  114  may be pulled from supply roll  114  and guided by rollers or other structure to printer  117  and sealer and perforation unit  119 . Platform  105  with pouch packaging unit  15  thereon is slid into automatic dispensing machine  11  housing  47 . Tube  121  of pouch packaging unit  15  may be aligned with guide  93  bottom opening  101  to receive medicaments  19  falling or otherwise output from medicament dispensing unit  13 . Doors  63 ,  65  may be closed after pouch packaging unit  15  on platform  105  is slid into housing  47  to enclose and protect pouch packaging unit  15  for operation. 
     Access panel  61  is preferably in place on housing  47  to further enclose pouch packaging unit  15  within housing  47 . Diverter  163  may be in a non-operational state with medicament conveyor  165  in a retracted position and with diverter front end  167  outside of housing  47  proximate access panel  61 . Packaging system  10  is ready for operation in a first mode for the pouch packaging process. 
     The pouch packaging operation begins with activation of the storage and dispensing unit(s) holding medicaments  19  required to be packaged in each pouch package  33 . For example, if one unit of a medicament  19  is required for a first pouch package  33 , then motor  81  of storage and dispensing unit  69  holding that medicament  19  is activated to rotate rotor  79  until a single count is made by counter  84  and recorded by controller  12 . Control of the storage and dispensing unit  69  activated and the count from counter  84  of that unit  69  may be a first control over the correct type and quantity of medicaments  19  dispensed for a given pouch package  33  or blister package  45 . Controller  12  may adjust motor  81  speed to rotate at a slower or faster speed depending on whether one or a greater quantity of medicaments  19  are to be dispensed or output from the storage and dispensing unit  69 . 
     Medicament  19  may fall in a path through port  82  and chute  83  and into guide  95 . Medicament  19  further falls in a path from guide lower opening  101 , through tube  121  and nozzle  125  and into pocket  127  formed in web material  103  by pouch packaging unit  15 . Printer  117  may provide printed information  131  for the pouch package  33  adjacent pocket  127  containing medicament  19 . Sealer and perforation unit  119  subsequently forms a discrete pouch package  33  in pouch package web  103 . 
     The foregoing pouch packaging process is repeated by pouch packaging unit  15  for each pouch package  33 . The lengthening pouch package web  103  with discrete pouch packages  33 - 43  formed therein produced by pouch packaging unit  15  may be output through port  137 . The pouch packages  33  may then be collected and provided to each patient or for other purposes as required. The files associated with controller  12  are updated accordingly to indicate that each required medicament  19  has been packaged as required by the instructions associated with each file. This concludes the pouch packaging process of the first packaging mode. 
     When it is desired to package medicaments in a blister package  45 , controller  12  may be set to the second mode through any of the user interfaces discussed above. In the example, pouch packaging unit  15  on platform  105  may be slid out and away from housing  47  of automatic dispensing machine  11 . Pouch packaging unit  15  may then be transferred to cart  111 . Platform  105  may then be slid back into housing  47  and doors  61 ,  63  closed. As stated previously, packaging system  10  may be configured so that pouch packaging unit  15  could remain in place or moved while packaging system  10  operates in a different packaging mode. 
     With access panel  61  first removed, diverter  163  may be moved into its extended operational position and state. Medicament conveyor  165  of diverter may be partially extended into housing by releasing latches  189 ,  199  and by pushing frame rails  171 ,  173  and slide rails  183 ,  185  toward guide  93  such that a carrier  211 - 217  on conveyor belt  271  may be located under guide  93  bottom opening  101 . Such position of a carrier  211 - 217  under guide  93  lower opening  101  in position to receive medicaments  19  therein may be referred to as a “receiving position.” Closing of latches  189 ,  199  locks medicament conveyor  165  in the extended position. Packaging system  10  is ready for operation in a second mode for the blister package packaging process. 
     In the example of packaging system  10 , diverter  163  and blister package packaging unit  17  may comprise parallel lines of conveyors. Medicament conveyor  165  serves to deliver medicaments  19  from medicament dispensing unit  13  to loading station  283  and the delivery position. Blister package conveyor  157  parallel to medicament conveyor  165  receives medicaments  19  transferred to blister package  45  for packaging. 
     Like the pouch packaging operation, the blister package packaging operation begins with activation of the storage and dispensing unit(s)  69  holding medicaments  19  required to be packaged in each blister package  45 . For example, if three different types of medicaments  19 ,  21 ,  23  are required to fill all the cells  143  of a single blister package  45 , then the required quantity of the first type medicaments  19  are first output from the storage and dispensing unit  69  holding the such medicaments  19 . This is accomplished once again by activating motor  81  until the required quantity of medicaments  19  are counted by counter  84  and the file associated with controller  12  is updated. 
     The first type of medicaments  19  may fall in the path through port  82  and chute  83  and into guide  95 . Medicaments  19  further fall in a path from guide lower opening  101 . 
     The second mode of packaging differs from the first mode of packaging because diverter  163  diverts, changes and re-directs the path of movement of the medicaments  19  so that the medicaments  19  fall into a carrier  211 - 222  in the receiving position under guide  93  lower opening  101  rather than fall toward pouch packaging unit  15  which had been previously removed from automatic dispensing machine  11  in the example. A record of the quantity of medicaments  19  counted by counter  84  and the carrier (e.g., carrier  211 ) in which the medicaments  19  were collected is made by controller  12 . 
     Diverter motor  209  powering medicament conveyor  165  may next be activated directly or indirectly by controller  12  to advance belt  207  with carrier  211  one step in the rearward direction of arrow  275  so that the next carrier  213  is under guide bottom opening  101  in the receiving position. The second type of medicaments  21  required for blister package  45  may then be dispensed into carrier  213  in the same manner as previously described. The process is repeated for the third type of medicament  23  which may fall into further carrier  215  advanced stepwise to the receiving position under lower guide opening  101 . 
     Imager  223  may capture an image of the medicaments  19  in carrier  211 , and subsequently in the other carriers (e.g., carriers  213 ,  215 ). The image can be utilized by controller  12  to confirm that the correct quantity and type of medicaments  19  were dispensed into carrier  211 , providing a second level of control over the quantity and type of medicaments  19  dispensed. Computer imagery of the physical characteristics of the medicaments  19  (i.e., shape, color, size, markings, etc.) can be utilized for the recognition. An alarm may be provided and the packaging process stopped if an error is detected as a result of the imaging. 
     Through repeated cycles of loading of carriers  211 - 222 , belt  207  is advanced stepwise so that carrier  211  with the first type of medicament  19  arrives at loading station  283  in the delivery position for transfer of medicaments  19  to a blister package  45  by robotic pick-and-place unit  159 . A sensor or any appropriate control may be used to stop and start motor  209  for each step. 
     Packaging unit  17  operation may be synchronized with diverter  163  operation by controller  12 . Transport mechanism  235  arm  241  may affix a label  239  output by label printer  233  to the topmost empty blister package  45  in bin  231 . Label  239  may include patient-specific information  237  (or any other type of information) to empty blister package  45 . Arm  245  of blister package delivery unit  153  may next lift and deliver the labeled blister package  45  into one holder  247 - 255  so that cells  143  are nested into corresponding pockets  279 . Since controller  12  tracks the position of each pocket  279 , controller necessarily can track the position of each cell  143  in the corresponding pocket  279 . 
     Blister package conveyor motor  273  may next be activated directly or indirectly by controller  12  to advance belt  271  with holder  247  one step in the rearward direction of arrow  275  so that holder  247  is at loading station  283  and the next holder  249  is in position to receive an empty labeled blister package  45  from transport mechanism  235  of blister package delivery unit  153 . A sensor or any appropriate control may be used to stop and start motor  273  for each step. 
     Operation of blister package packaging unit  17  may be synchronized with medicament dispensing unit  13  and diverter  153  so that the blister package  45  in holder  247  may be the patient-specific blister package  45  for which the first through third types of medicaments  19 - 23  are required in this example. With both carrier  211  containing the first type of medicaments  19  and holder  247  with the blister package  45  into which the first type of medicaments  19  are to be loaded at loading station  283 , transfer of such medicaments  19  can occur by means of robotic pick-and-place unit  159  in the example. 
     Arms  285 - 289  of robotic pick-and-place unit  159  may each position control head  317  and probe end  319  to grip or pick a medicament  19  by means of vacuum and move the medicament  19  into the specific cell  143  of blister package  45  into which the medicament  19  is to be loaded or placed as determined by controller  12 . The medicament  19  is then dropped into the specific cell  143  by momentary stoppage of the vacuum. Video camera  321  may capture an image of medicaments in the carrier  211 - 222  and such image maybe be used by controller  12  to determine that the correct quantity and type of medicaments  19  are in the carrier  211 - 222  providing a further level of control. 
     When all of the first type of medicaments  19  have been transferred from carrier  211  to blister package  45 , motor  209  powering medicament conveyor  165  belt  207  advances the next carrier  213  one step to loading station  283 . The aforementioned loading process is repeated for the second type of medicaments  21  with the second type of medicaments  21  being loaded by robotic pick-and-place unit  159  into the specific cells  143  of blister package  45  into which such medicaments  21  are to be loaded as determined by controller  12 . The foregoing process is repeated for the third type of medicaments  23  until all required medicaments  19 ,  21 ,  23  have been transferred from carriers  211 ,  213 ,  215  to blister package  45  in this example. 
     Once blister package  45  has been loaded, motor  273  powering blister package conveyor  157  belt  271  advances holder  211  one step to sealer unit  161 . At sealer unit  161 , a closure  151  which may include printed information applied to closure  151  by printer, is attached to blister package  45  creating a sealed, finished-form blister package  45 . Further advancement of belt  271  causes the sealed blister package  45  to be ejected from holder  247  as previously described. This concludes the pouch packaging process of the second packaging mode according to the example. 
     While the principles of this invention have been described in connection with specific embodiments, it should be understood clearly that these descriptions are made only by way of example and are not intended to limit the scope of the invention.