The easiest way to approach an issue like this is exporting the spreadsheet to CSV first, in order to help ensure that it imports correctly into Python.
Using a defaultdict, you can create a dictionary that has unique keys and then iterate through lines adding the final column's values to a list.
Finally you can write it back out to a CSV format:
from collections import defaultdict
results = defaultdict(list)
with open("in_file.csv") as f:
header = f.readline()
for line in f:
cols = line.split(",")
key = ",".join(cols[0:4])
results[key].append(cols[4])
with open("out_file.csv", "w") as f:
f.write(header)
for k, v in results.iteritems():
line = '{},"{}",\n'.format(k, ", ".join(v))
f.write(line)
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