hcpcs outpatient ndc code medication name & amount ... · calcium gluconate 100 mg/ml (10 %)...

NDC CodeHCPCS Code

Medication Name & Amount Inpatient Fee Outpatient Fee

00904525646 J8499 ACETAMINOPHEN 80 MG CHEWABLE TABLET 1.00$ 1.00$

00904198261 J3490 ACETAMINOPHEN 325 MG TABLET 1.00$ 1.00$




00713011850 J8499 ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY 59.00$ 59.00$



51672402301 J8499 ACETAZOLAMIDE 250 MG TABLET 2.79$ 2.79$

39822019001 J1120 ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION 2,244.47$ 2,244.47$

63323069030 J3490 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION 452.06$ 452.06$

63323069404 J3490 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION 441.36$ 441.36$

99999003179 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION 302.00$ 302.00$

23155001701 J8499 TETRACYCLINE 250 MG CAPSULE 359.97$ 359.97$

44206025105 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 2,207.58$ 2,207.58$






00093066116 J8499 ALBUTEROL SULFATE 2 MG/5 ML SYRUP 1,774.93$ 1,774.93$

17478050305 J3490 ETHANOL (ETHYL ALCOHOL) 98 % INJECTION SOLUTION 3,893.40$ 3,893.40$

51079020501 J8499 ALLOPURINOL 100 MG TABLET 1.00$ 1.00$

62584071311 J8499 ALLOPURINOL 300 MG TABLET 1.00$ 1.00$

00904585861 J8499 ALPRAZOLAM 0.25 MG TABLET 59.00$ 59.00$

00904585961 J8499 ALPRAZOLAM 0.5 MG TABLET 59.00$ 59.00$

00536009185 J8499

ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL

SUSPENSION 205.42$ 205.42$

99999003184

ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL

SUSPENSION 59.00$ 59.00$

00832201200 J8499 AMANTADINE HCL 100 MG CAPSULE 1.00$ 1.00$

00409592101 J0280 AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION 586.99$ 586.99$

51079013101 J8499 AMITRIPTYLINE 10 MG TABLET 1.00$ 1.00$



39822990001 J3490

AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR

INHALATION 59.00$ 59.00$

00781202001 J8499 AMOXICILLIN 250 MG CAPSULE 59.00$ 59.00$



00781603955 J8499 AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION 83.84$ 83.84$



39822105505 J0285 AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION 1,533.89$ 1,533.89$

67253018010 J8499 AMPICILLIN 250 MG CAPSULE 59.00$ 59.00$



00781340485 J0290 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION 302.00$ 302.00$



00781340078 J0290 AMPICILLIN 125 MG SOLUTION FOR INJECTION 319.96$ 319.96$





00904052260 J8499 ASCORBIC ACID (VITAMIN C) 250 MG TABLET 1.00$ 1.00$

00904052361 J8499 ASCORBIC ACID (VITAMIN C) 500 MG TABLET 1.00$ 1.00$

66553000201 J8499 ASPIRIN 81 MG CHEWABLE TABLET 59.00$ 59.00$

00904628889 J8499 ASPIRIN 81 MG CHEWABLE TABLET 59.00$ 59.00$

00904201360 J8499 ASPIRIN 325 MG TABLET,DELAYED RELEASE 1.00$ 1.00$

00904770418 J8499 ASPIRIN 81 MG TABLET,DELAYED RELEASE 1.00$ 1.00$

00904539261 J8499 ATENOLOL 25 MG TABLET 1.00$ 1.00$

62584046711 J8499 ATENOLOL 50 MG TABLET 59.00$ 59.00$

00409163010 J0461 ATROPINE 0.1 MG/ML INJECTION SYRINGE 180.44$ 180.44$



00517040125 J0461 ATROPINE 0.4 MG/ML INJECTION SOLUTION 150.94$ 150.94$

00641600601 J0461 ATROPINE 0.4 MG/ML INJECTION SOLUTION 1,124.15$ 1,124.15$

17478021505 J3490 ATROPINE 1 % EYE DROPS 1,934.13$ 1,934.13$

96295011845 J8499 B‐COMPLEX WITH VITAMIN C TABLET 59.00$ 59.00$

00009023344 J3490 BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION 371.42$ 371.42$

00574402235 J3490 BACITRACIN 500 UNIT/GRAM EYE OINTMENT 3,372.43$ 3,372.43$

00810073088 J3490

NEOMYCIN‐BACITRACN ZN‐POLYMYX 3.5 MG‐400 UNIT‐

5,000 UNIT/GRAM TOP OINT 159.29$ 159.29$

00501379801 J3490

BACITRACIN‐POLYMYXIN B 500 UNIT‐10,000 UNIT/GRAM

TOPICAL OINTMENT 316.33$ 316.33$

00574402135 J3490

BACITRACIN‐POLYMYXIN B 500 UNIT‐10,000 UNIT/GRAM

EYE OINTMENT 342.88$ 342.88$

00904647561 J8499 BACLOFEN 10 MG TABLET 59.00$ 59.00$

00409397701 J3490

WATER FOR INJECTION, BACTERIOSTATIC INJECTION

SOLUTION 138.00$ 138.00$

60687011511 J8499 BENZONATATE 100 MG CAPSULE 1.00$ 1.00$

00904656460 J8499 BENZONATATE 100 MG CAPSULE 1.00$ 1.00$

68084038811 J8499 BENZTROPINE 1 MG TABLET 59.00$ 59.00$

00832051289 J8499 BETHANECHOL CHLORIDE 25 MG TABLET 1.00$ 1.00$

00713010950 J8499 BISACODYL 10 MG RECTAL SUPPOSITORY 59.00$ 59.00$

00713010906 J8499 BISACODYL 10 MG RECTAL SUPPOSITORY 59.00$ 59.00$

00409115902 J3490

BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION

SOLUTION 138.00$ 138.00$

00409155918 J3490


SOLUTION 138.00$ 138.00$

00409115901 J3490


SOLUTION 138.00$ 138.00$

55150016710 J3490


SOLUTION 138.00$ 138.00$

00409116201 J3490 BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION 138.00$ 138.00$



55150017230 J3490


SOLUTION 138.00$ 138.00$

37205019573 J8499 CAFFEINE 200 MG TABLET 59.00$ 59.00$

00904188361 J8499

CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG)

TABLET 1.00$ 1.00$

00409163110 J3490

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS

SYRINGE 243.52$ 243.52$

76329330401 J3490

CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS

SYRINGE 322.16$ 322.16$

00517390025 J0610

CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS

SOLUTION 646.71$ 646.71$

63323031119 J0610


SOLUTION 295.81$ 295.81$

63323036019 J0610


SOLUTION 445.51$ 445.51$

00904385461 J8499 CARBAMAZEPINE 100 MG CHEWABLE TABLET 59.00$ 59.00$

51672404709 J8499 CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION 2,098.09$ 2,098.09$

99999003271 J8499 CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION 59.00$ 59.00$

51672400501 J8499 CARBAMAZEPINE 200 MG TABLET 1.55$ 1.55$

00904322035 J3490 CARBAMIDE PEROXIDE 6.5 % EAR DROPS 138.00$ 138.00$

68084038011 J8499 CARISOPRODOL 350 MG TABLET 59.00$ 59.00$

00143992490 J0690 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION 302.00$ 302.00$

60505076900 J0690 CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION 660.00$ 660.00$

00781345070 J0690 CEFAZOLIN 500 MG SOLUTION FOR INJECTION 302.00$ 302.00$

00143997790 J0697 CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION 138.00$ 138.00$

00143997990 J0697 CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION 302.00$ 302.00$

00093314501 J8499 CEPHALEXIN 250 MG CAPSULE 59.00$ 59.00$

50268015211 J8499 CEPHALEXIN 500 MG CAPSULE 59.00$ 59.00$

00395266216 J8499 CHERRY FLAVOR (BULK) SYRUP 453.18$ 453.18$

63323047827 J2400

CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION

SOLUTION 842.32$ 842.32$

00143921001 J2400


SOLUTION 593.22$ 593.22$

00143921010 J2400


SOLUTION 593.22$ 593.22$

00641139831 J3230 CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION 1,155.77$ 1,155.77$

00832030100 J8499 CHLORPROMAZINE 25 MG TABLET 4.52$ 4.52$

51079005801 J8499 CHLORTHALIDONE 25 MG TABLET 2.39$ 2.39$

63739005910 J8499 CLINDAMYCIN HCL 150 MG CAPSULE 59.00$ 59.00$

00009090211 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION 302.00$ 302.00$





51079029901 J8499 CLONIDINE HCL 0.1 MG TABLET 59.00$ 59.00$



51672200202 J3490 CLOTRIMAZOLE 1 % TOPICAL CREAM 124.56$ 124.56$

51672200306 J3490 CLOTRIMAZOLE 1 % VAGINAL CREAM 100.60$ 100.60$

66553000101 J8499 ASPIRIN 325 MG TABLET 1.00$ 1.00$

00527172874 J3490 COCAINE 4 % TOPICAL SOLUTION 7,401.00$ 7,401.00$

00054024425 J8499 CODEINE SULFATE 30 MG TABLET 59.00$ 59.00$

64764011907 J8499 COLCHICINE 0.6 MG TABLET 8.90$ 8.90$

00517003125 J3420

CYANOCOBALAMIN (VIT B‐12) 1,000 MCG/ML INJECTION

SOLUTION 265.07$ 265.07$

63323004401 J3420

CYANOCOBALAMIN (VIT B‐12) 1,000 MCG/ML INJECTION

SOLUTION 275.85$ 275.85$

51079064401 J8499 CYCLOBENZAPRINE 10 MG TABLET 59.00$ 59.00$

24208073501 J3490 CYCLOPENTOLATE 1 % EYE DROPS 608.78$ 608.78$

51991083801 J8499 CYPROHEPTADINE 4 MG TABLET 59.00$ 59.00$

63739047810 J8499 DOCUSATE SODIUM 100 MG CAPSULE 59.00$ 59.00$

49938010230 J8499 DAPSONE 25 MG TABLET 133.64$ 133.64$

00054817925 J8540 DEXAMETHASONE 0.5 MG TABLET 59.00$ 59.00$

00054817525 J8540 DEXAMETHASONE 4 MG TABLET 81.13$ 81.13$

63323051610 J1100 DEXAMETHASONE 10 MG/ML INJECTION SOLUTION 138.00$ 138.00$



00338002303 J3490

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS

SOLUTION 317.00$ 317.00$

00338002304 J3490


SOLUTION 319.00$ 319.00$

00409177510 J3490 DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE 300.20$ 300.20$

00338001702 J7060 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION ‐$ ‐$

00338001703 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION 314.50$ 314.50$

00338001704 J7070 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION 315.00$ 315.00$


00338001738 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION ‐$ ‐$




00409712007 J3490


SOLUTION 658.04$ 658.04$

51079028401 J8499 DIAZEPAM 2 MG TABLET 1.00$ 1.00$

00904588061 J8499 DIAZEPAM 5 MG TABLET 1.00$ 1.00$

54162001101 J3490 DIBUCAINE 1 % TOPICAL OINTMENT 248.15$ 248.15$

51079011801 J8499 DICYCLOMINE 10 MG CAPSULE 59.00$ 59.00$

00054005746 J3490 DIGOXIN 50 MCG/ML ORAL SOLUTION 152.63$ 152.63$

68094075159 J3490 DIGOXIN 50 MCG/ML ORAL SOLUTION 4.24$ 4.24$

49884049401 J8499 DIGOXIN 250 MCG TABLET 2.23$ 2.23$

51079074501 J8499 DILTIAZEM 30 MG TABLET 1.00$ 1.00$



63323066401 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION 138.00$ 138.00$



00904530661 J8499 DIPHENHYDRAMINE 25 MG CAPSULE 1.00$ 1.00$

00904205661 J8499 DIPHENHYDRAMINE 50 MG CAPSULE 59.00$ 59.00$

00121048905 J8499 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR 109.31$ 109.31$

00054319446 J8499

DIPHENOXYLATE‐ATROPINE 2.5 MG‐0.025 MG/5 ML ORAL

LIQUID 2,868.76$ 2,868.76$

99999002817 J8499

DIPHENOXYLATE‐ATROPINE 2.5 MG‐0.025 MG/5 ML ORAL

LIQUID 270.55$ 270.55$

00378041501 J8499 DIPHENOXYLATE‐ATROPINE 2.5 MG‐0.025 MG TABLET 59.00$ 59.00$

00536106505 J3490 DOCUSATE CALCIUM 240 MG CAPSULE 59.00$ 59.00$

51079043701 J8499 DOXEPIN 25 MG CAPSULE 1.00$ 1.00$

25021020751 J9000 DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION 209.76$ 209.76$

00703504001 J9000 DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION 203.80$ 203.80$

63323013011 J3490

DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER

FOR SOLUTION 1,151.50$ 1,151.50$

12496120403 J3490

BUPRENORPHINE 4 MG‐NALOXONE 1 MG SUBLINGUAL

FILM 351.65$ 351.65$

96295010818 J8499 DOXYLAMINE SUCCINATE 25 MG TABLET 59.00$ 59.00$

37205067164 J8499 DOXYLAMINE SUCCINATE 25 MG TABLET 59.00$ 59.00$

17478051500 J3490 EPHEDRINE SULFATE 50 MG/ML INJECTION SOLUTION 1,234.21$ 1,234.21$

00409490118 J0171 EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE 297.41$ 297.41$

00409492134 J0171 EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE 163.28$ 163.28$

17478007035 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT 406.45$ 406.45$



24338013402 J8499

ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL

POWDER FOR SUSPENSION 9,217.53$ 9,217.53$

00409648201 J1364

ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS

SOLUTION 2,849.61$ 2,849.61$

00409909332 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION 138.00$ 138.00$






00121053005 J8499

FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL

LIQUID 2.01$ 2.01$

00245010889 J3490

FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED

RELEASE 1.00$ 1.00$

51672125302 J3490 FLUOCINONIDE 0.05 % TOPICAL CREAM 1,052.70$ 1,052.70$

00378607401 J8499 FLUPHENAZINE 5 MG TABLET 59.00$ 59.00$

63323018410 J3490 FOLIC ACID 5 MG/ML INJECTION SOLUTION 1,878.40$ 1,878.40$

63739053710 J8499 FOLIC ACID 1 MG TABLET 1.00$ 1.00$

00904319760 J8499 FOLIC ACID 400 MCG TABLET 1.00$ 1.00$

36000028225 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION 138.00$ 138.00$



00904579661 J8499 FUROSEMIDE 20 MG TABLET 1.00$ 1.00$




63323001002 J1580 GENTAMICIN 40 MG/ML INJECTION SOLUTION 302.00$ 302.00$

63323001020 J1580 GENTAMICIN 40 MG/ML INJECTION SOLUTION 940.68$ 940.68$

51079087301 J8499 GLYBURIDE 5 MG TABLET 1.00$ 1.00$

00713010209 J8499 GLYCERIN (CHILD) RECTAL SUPPOSITORY 59.00$ 59.00$

00132008112 J8499 GLYCERIN (CHILD) RECTAL SUPPOSITORY 59.00$ 59.00$

00143968101 J3490 GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION 437.85$ 437.85$

00781139213 J8499 HALOPERIDOL 1 MG TABLET 59.00$ 59.00$

00781139613 J8499 HALOPERIDOL 5 MG TABLET 59.00$ 59.00$

63323047401 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION 225.39$ 225.39$

25021080601 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION 138.00$ 138.00$

59390019205 J3490 HOMATROPINE 5 % EYE DROPS 900.60$ 900.60$

63323061401 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION 479.04$ 479.04$



68084044711 J8499 HYDRALAZINE 10 MG TABLET 1.00$ 1.00$



63739012810 J8499 HYDROCHLOROTHIAZIDE 25 MG TABLET 1.00$ 1.00$

00713050312 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY 207.07$ 207.07$

59741030112 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY 192.42$ 192.42$

00409128331 J1170 HYDROMORPHONE 1 MG/ML INJECTION SYRINGE 138.00$ 138.00$

00409131230 J1170 HYDROMORPHONE 2 MG/ML INJECTION SYRINGE 138.00$ 138.00$

42858030125 J8499 HYDROMORPHONE 2 MG TABLET 59.00$ 59.00$


00517560125 J3410 HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION 367.47$ 367.47$

60432015004 J8499 HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION 395.69$ 395.69$

68084025311 J8499 HYDROXYZINE HCL 10 MG TABLET 1.00$ 1.00$

23155050101 J8499 HYDROXYZINE HCL 25 MG TABLET 59.00$ 59.00$

76439030910 J8499 HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET 59.00$ 59.00$

63739067210 J8499 IBUPROFEN 400 MG TABLET 59.00$ 59.00$




49884005401 J8499 IMIPRAMINE 10 MG TABLET 59.00$ 59.00$

49884005501 J8499 IMIPRAMINE 25 MG TABLET 1.00$ 1.00$

00378008001 J8499 INDAPAMIDE 2.5 MG TABLET 1.00$ 1.00$

51079019001 J8499 INDOMETHACIN 25 MG CAPSULE 59.00$ 59.00$

00555007101 J8499 ISONIAZID 300 MG TABLET 59.00$ 59.00$

00781155601 J8499 ISOSORBIDE DINITRATE 10 MG TABLET 74.03$ 74.03$



42023011310 J3490 KETAMINE 10 MG/ML INJECTION SOLUTION 571.66$ 571.66$

00409205105 J3490 KETAMINE 100 MG/ML INJECTION SOLUTION 267.67$ 267.67$

00536673101 J3490 LYSINE 500 MG TABLET 1.00$ 1.00$

00074662411 J8499 LEVOTHYROXINE 100 MCG TABLET 1.60$ 1.60$


00338011704 J7120 LACTATED RINGERS INTRAVENOUS SOLUTION 315.00$ 315.00$

00703514001 J0640 LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION 138.00$ 138.00$


00054449613 J8499 LEUCOVORIN CALCIUM 5 MG TABLET 59.00$ 59.00$




00054350547 J3490 LIDOCAINE 4 % (40 MG/ML) MUCOSAL SOLUTION 1,285.43$ 1,285.43$

63323048457 J3490 LIDOCAINE 5 MG/ML (0.5 %) INJECTION SOLUTION 138.00$ 138.00$

00409427501 J3490 LIDOCAINE 5 MG/ML (0.5 %) INJECTION SOLUTION 151.70$ 151.70$

00409427601 J3490 LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION 138.00$ 138.00$




68180051501 J8499 LISINOPRIL 20 MG TABLET 1.00$ 1.00$

00054252625 J8499 LITHIUM CARBONATE 150 MG CAPSULE 59.00$ 59.00$

00054852725 J8499 LITHIUM CARBONATE 300 MG CAPSULE 1.00$ 1.00$

00054352763 J8499 LITHIUM CITRATE 8 MEQ/5 ML ORAL SOLUTION 129.27$ 129.27$

51079069001 J8499 LOPERAMIDE 2 MG CAPSULE 59.00$ 59.00$

50383061810 J8499 LOPERAMIDE 1 MG/5 ML ORAL LIQUID 110.73$ 110.73$

63739049910 J8499 LORAZEPAM 0.5 MG TABLET 59.00$ 59.00$

51079038601 J8499 LORAZEPAM 1 MG TABLET 1.00$ 1.00$

96295038243 J8499 MAGNESIUM CITRATE ORAL SOLUTION 59.00$ 59.00$

63323006402 J3475

MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION

SOLUTION 138.00$ 138.00$

63323006410 J3475

MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION

SOLUTION 138.00$ 138.00$

00338035703 J3490 MANNITOL 20 % INTRAVENOUS SOLUTION 360.50$ 360.50$

00409403101 J2150 MANNITOL 25 % INTRAVENOUS SOLUTION 138.00$ 138.00$

00555077902 J8499 MEDROXYPROGESTERONE 10 MG TABLET 1.00$ 1.00$

00555087202 J8499 MEDROXYPROGESTERONE 2.5 MG TABLET 1.00$ 1.00$

51079043401 J8499 MEGESTROL 20 MG TABLET 1.00$ 1.00$

00054355563 J8499 METHADONE 5 MG/5 ML ORAL SOLUTION 41.70$ 41.70$

99999003180 J8499 METHADONE 5 MG/5 ML ORAL SOLUTION 1.00$ 1.00$

00054855424 J8499 METHADONE 10 MG TABLET 1.00$ 1.00$

00054855324 J8499 METHADONE 5 MG TABLET 1.00$ 1.00$

00641610325 J2800 METHOCARBAMOL 100 MG/ML INJECTION SOLUTION 1,080.64$ 1,080.64$

63739016610 J8499 METHOCARBAMOL 500 MG TABLET 1.00$ 1.00$

00703367101 J9260

METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION

SOLUTION 138.00$ 138.00$

16729027735 J9260

METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION

SOLUTION 138.00$ 138.00$

16729003001 J8499 METHYLDOPA 250 MG TABLET 1.00$ 1.00$

00517037401 C9399

METHYLENE BLUE (ANTIDOTE) 5 MG/ML (0.5 %)

INTRAVENOUS SOLUTION 6,681.02$ 6,681.02$

00406114201 J8499 METHYLPHENIDATE 5 MG TABLET 59.00$ 59.00$

59762444003 J7509 METHYLPREDNISOLONE 4 MG TABLET 77.09$ 77.09$

00009347501 J1040

METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION

FOR INJECTION 539.32$ 539.32$

00409341401 J2765 METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION 138.00$ 138.00$

00121057616 J8499 METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION 1,621.57$ 1,621.57$

00121157610 J8499 METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION 88.73$ 88.73$

00093220305 J8499 METOCLOPRAMIDE 10 MG TABLET 59.00$ 59.00$

51079088601 J8499 METOCLOPRAMIDE 5 MG TABLET 1.00$ 1.00$

00409177805 J3490

METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS

SOLUTION 138.00$ 138.00$

00378003210 J8499 METOPROLOL TARTRATE 50 MG TABLET 59.00$ 59.00$

29300022601 J8499 METRONIDAZOLE 250 MG TABLET 59.00$ 59.00$





00409781137 J3490

METRONIDAZOLE 500 MG/100 ML‐SODIUM CHLORIDE(ISO)

INTRAVENOUS PIGGYBACK 302.00$ 302.00$

00603780550 J3490 MICONAZOLE NITRATE 2 % TOPICAL CREAM 99.77$ 99.77$

00713025237 J3490 MICONAZOLE NITRATE 2 % VAGINAL CREAM 107.79$ 107.79$

00574061816 J3490 MINERAL OIL ORAL 269.16$ 269.16$

00132030140 J3490 MINERAL OIL ENEMA 132.03$ 132.03$

53489038601 J8499 MINOXIDIL 2.5 MG TABLET 1.00$ 1.00$

00641607201 J2270 MORPHINE 15 MG/ML INJECTION SOLUTION 295.41$ 295.41$

55150012215 J3490 NAFCILLIN 1 GRAM SOLUTION FOR INJECTION 386.63$ 386.63$


55150012499 J3490 NAFCILLIN 10 GRAM SOLUTION FOR INJECTION 2,735.08$ 2,735.08$

00409146501 J2300 NALBUPHINE 20 MG/ML INJECTION SOLUTION 223.52$ 223.52$

00409121901 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION 3,229.93$ 3,229.93$

00641613201 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION 342.96$ 342.96$






65162018810 J8499 NAPROXEN 250 MG TABLET 59.00$ 59.00$

65162018910 J8499 NAPROXEN 375 MG TABLET 59.00$ 59.00$

39822031007 J8499 NEOMYCIN 500 MG TABLET 64.06$ 64.06$

00536407001 J8499 NIACIN 50 MG TABLET 59.00$ 59.00$

00904227260 J8499 NIACIN 500 MG TABLET 59.00$ 59.00$

43386044024 J8499 NIFEDIPINE 10 MG CAPSULE 1.00$ 1.00$

51079058401 J8499 NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE 2.88$ 2.88$

00071041813 J8499 NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET 1.64$ 1.64$

00281032608 J3490 NITROGLYCERIN 2 % TRANSDERMAL OINTMENT 131.67$ 131.67$

51672400105 J8499 NORTRIPTYLINE 10 MG CAPSULE 1.00$ 1.00$

68084003211 J8499 NORTRIPTYLINE 25 MG CAPSULE 1.00$ 1.00$

00603781874 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM 698.21$ 698.21$

00603781878 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM 1,047.90$ 1,047.90$

45802005935 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM 149.70$ 149.70$

60432053760 J3490 NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION 261.08$ 261.08$

66689003701 J3490 NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION 59.00$ 59.00$

51672126302 J3490

NYSTATIN‐TRIAMCINOLONE 100,000 UNIT/G‐0.1 %

TOPICAL CREAM 3,629.93$ 3,629.93$

00832003800 J8499 OXYBUTYNIN CHLORIDE 5 MG TABLET 1.00$ 1.00$

68084035511 J8499 OXYCODONE‐ACETAMINOPHEN 5 MG‐325 MG TABLET 59.00$ 59.00$


00904571135 J3490 OXYMETAZOLINE 0.05 % NASAL SPRAY 59.00$ 59.00$

63323001201 J2590 OXYTOCIN 10 UNIT/ML INJECTION SOLUTION 302.00$ 302.00$



00049053028 J2540

PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR

INJECTION 1,416.92$ 1,416.92$

00049052084 J2540

PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR

INJECTION 401.36$ 401.36$

00093412773 J8499 PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION 155.69$ 155.69$

00093117201 J8499 PENICILLIN V POTASSIUM 250 MG TABLET 59.00$ 59.00$

00781165501 J8499 PENICILLIN V POTASSIUM 500 MG TABLET 59.00$ 59.00$

51293081001 J8499 PHENAZOPYRIDINE 100 MG TABLET 124.57$ 124.57$

75826011510 J8499 PHENAZOPYRIDINE 200 MG TABLET 99.31$ 99.31$

00603150858 J8499 PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR 2,270.19$ 2,270.19$

63739020110 J8499 PHENOBARBITAL 32.4 MG TABLET 1.00$ 1.00$

00603516821 J8499 PHENOBARBITAL 97.2 MG TABLET 1.25$ 1.25$

00641047721 J2560

PHENOBARBITAL SODIUM 130 MG/ML INJECTION

SOLUTION 2,172.97$ 2,172.97$

59212042204 J8499

PHENOBARB‐HYOSCY‐ATROPINE‐SCOP 16.2 MG‐0.1037 MG‐

0.0194 MG/5 ML ELIXIR 15,605.40$ 15,605.40$

99999000493 J8499

PHENOBARB‐HYOSCY‐ATROPINE‐SCOP 16.2 MG‐0.1037 MG‐

0.0194 MG/5 ML ELIXIR 667.14$ 667.14$

17478020605 J3490 PHENYLEPHRINE 10 % EYE DROPS 1,366.47$ 1,366.47$

17478020102 J3490 PHENYLEPHRINE 2.5 % EYE DROPS 1,139.32$ 1,139.32$

00641049321 J1165 PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION 302.00$ 302.00$

00641255541 J1165 PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION 302.00$ 302.00$

00071036940 J8499 PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE 1.79$ 1.79$

17478051002 J3490 PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION 1,562.79$ 1,562.79$

76329124001 J3430

PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION

SYRINGE 838.16$ 838.16$

61314020315 J3490 PILOCARPINE 1 % EYE DROPS 2,953.29$ 2,953.29$

00409818301 J3490 POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

5020124001 J8499

POTASSIUM BICARBONATE‐CITRIC ACID 25 MEQ

EFFERVESCENT TABLET 59.00$ 59.00$

63323096505 J3480

POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS

SOLUTION 138.00$ 138.00$

63323096510 J3480


SOLUTION 138.00$ 138.00$

63323096520 J3480


SOLUTION 138.00$ 138.00$

63323096730 J3480


SOLUTION 138.00$ 138.00$

00409665119 J3480


SOLUTION 138.00$ 138.00$

68382070101 J8499

POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED

RELEASE 1.05$ 1.05$

00121146515 J8499 POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID 216.17$ 216.17$

66689004701 J8499 POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID 440.72$ 440.72$

00409729501 J3490

POTASSIUM PHOSPHATES‐MBASIC AND DIBASIC 3

MMOL/ML INTRAVENOUS SOLUTION 760.44$ 760.44$

51079063001 J8499 PRAZOSIN 1 MG CAPSULE 1.58$ 1.58$

51079063101 J8499 PRAZOSIN 2 MG CAPSULE 2.18$ 2.18$

61314063705 J3490 PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION 1,487.42$ 1,487.42$

00054474125 J7512 PREDNISONE 1 MG TABLET 59.00$ 59.00$




00409190301 J2690 PROCAINAMIDE 500 MG/ML INJECTION SOLUTION 2,691.65$ 2,691.65$

00093965201 J8597 PROCHLORPERAZINE MALEATE 10 MG TABLET 59.00$ 59.00$



00641092821 J2550 PROMETHAZINE 25 MG/ML INJECTION SOLUTION 138.00$ 138.00$



65162074510 J8597 PROMETHAZINE 12.5 MG TABLET 59.00$ 59.00$

51079089501 J8597 PROMETHAZINE 25 MG TABLET 59.00$ 59.00$

00603158558 J8499 PROMETHAZINE 6.25 MG‐CODEINE 10 MG/5 ML SYRUP 269.16$ 269.16$

99999002815 J8499 PROMETHAZINE 6.25 MG‐CODEINE 10 MG/5 ML SYRUP 59.00$ 59.00$

61314001601 J3490 PROPARACAINE 0.5 % EYE DROPS 874.85$ 874.85$

50111046701 J8499 PROPRANOLOL 10 MG TABLET 1.00$ 1.00$



00228234810 J8499 PROPYLTHIOURACIL 50 MG TABLET 1.00$ 1.00$

63323022905 J2720 PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION 439.92$ 439.92$

63323018001 J3415

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION

SOLUTION 740.28$ 740.28$

00536440601 J8499 PYRIDOXINE (VITAMIN B6) 25 MG TABLET 1.00$ 1.00$

00904052060 J8499 PYRIDOXINE (VITAMIN B6) 50 MG TABLET 1.00$ 1.00$

43598021040 J3490 SILVER SULFADIAZINE 1 % TOPICAL CREAM 1,660.68$ 1,660.68$

67877012450 J3490 SILVER SULFADIAZINE 1 % TOPICAL CREAM 351.30$ 351.30$

00536102008 J3490 SIMETHICONE 125 MG CHEWABLE TABLET 59.00$ 59.00$

00536222075 J8499 SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION 69.47$ 69.47$

00395266116 J8499 SIMPLE SYRUP 526.58$ 526.58$

00409729973 J3490 SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

76329335201 J3490

SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS

SYRINGE 367.27$ 367.27$

00223172101 J8499 SODIUM BICARBONATE 650 MG TABLET 59.00$ 59.00$

08290306500 A4216 SODIUM CHLORIDE 0.9 % INJECTION SYRINGE 138.00$ 138.00$




00338004304 J3490 SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION 316.00$ 316.00$

00409488803 A4216 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION 138.00$ 138.00$



63323018730 J7131 SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION 189.23$ 189.23$

00409114102 J7131 SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00487930133 J3490 SODIUM CHLORIDE 0.9 % FOR NEBULIZATION 59.00$ 59.00$

00223176001 J8499 SODIUM CHLORIDE 1 GRAM TABLET 1.00$ 1.00$

17478062312 J3490 SODIUM CHLORIDE 5 % EYE DROPS 357.49$ 357.49$

63323017005 J3490

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS

SOLUTION 520.96$ 520.96$

00409739172 J3490

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS

SOLUTION 581.44$ 581.44$

60267070550 J3490

SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML)

INTRAVENOUS SOLUTION 482.38$ 482.38$

46287050030 J8499 SORBITOL 70 % SOLUTION 59.00$ 59.00$

00338029547 J3490 SORBITOL 3 % IRRIGATION SOLUTION 332.00$ 332.00$

00904595161 J8499 SPIRONOLACTONE 25 MG TABLET 1.00$ 1.00$


00338000347 A4217 WATER FOR IRRIGATION, STERILE SOLUTION 323.00$ 323.00$



39822070602 J3000 STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION 3,018.88$ 3,018.88$

00409662902 J0330

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION

SOLUTION 686.63$ 686.63$

00781300970 J0330

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION

SOLUTION 1,203.99$ 1,203.99$

00703951401 J3490

SULFAMETHOXAZOLE 400 MG‐TRIMETHOPRIM 80 MG/5

ML INTRAVENOUS SOLUTION 633.69$ 633.69$

00703952601 J3490


ML INTRAVENOUS SOLUTION 1,543.07$ 1,543.07$

53746027101 J8499

SULFAMETHOXAZOLE 400 MG‐TRIMETHOPRIM 80 MG

TABLET 59.00$ 59.00$

59762500001 J8499 SULFASALAZINE 500 MG TABLET 1.00$ 1.00$

00378014491 J8499 TAMOXIFEN 10 MG TABLET 1.00$ 1.00$

51079041801 J8499 TEMAZEPAM 15 MG CAPSULE 1.00$ 1.00$

00009041701 J1071

TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR

OIL 358.09$ 358.09$

23155001801 J8499 TETRACYCLINE 500 MG CAPSULE 719.94$ 719.94$

00225052547 J3490 SODIUM CHLORIDE‐ALOE VERA NASAL GEL 117.65$ 117.65$

27808003301 J3490 THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION 2,058.16$ 2,058.16$

63323001302 J3411

THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION

SOLUTION 496.53$ 496.53$

58160089841 90686

FLU VACCINE QS 2018‐19(6 MOS UP)(PF)60 MCG(15

MCGX4)/0.5 ML IM SYRINGE 652.30$ 652.30$

63323030602 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION 348.19$ 348.19$

63323030630 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION 1,277.20$ 1,277.20$

67457047300 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION 302.00$ 302.00$

17478011430 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION 1,010.14$ 1,010.14$

24208029005 J3490 TOBRAMYCIN 0.3 % EYE DROPS 131.74$ 131.74$

50111043401 J8499 TRAZODONE 100 MG TABLET 59.00$ 59.00$

50111043301 J8499 TRAZODONE 50 MG TABLET 1.00$ 1.00$

00168000315 J3490 TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM 82.04$ 82.04$




00003029305 J3301

TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR

INJECTION 352.90$ 352.90$

60505265601 J8499

TRIAMTERENE 37.5 MG‐HYDROCHLOROTHIAZIDE 25 MG

TABLET 1.00$ 1.00$

59762371803 J8499 TRIAZOLAM 0.25 MG TABLET 88.59$ 88.59$

00781103401 J8499 TRIFLUOPERAZINE 5 MG TABLET 80.64$ 80.64$

16571016010 J8499 TRIHEXYPHENIDYL 2 MG TABLET 1.00$ 1.00$

42023011925 J3250

TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR

SOLUTION 1,214.61$ 1,214.61$

00409653301 J3370 VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION 302.00$ 302.00$

00409433201 J3370 VANCOMYCIN 500 MG INTRAVENOUS SOLUTION 302.00$ 302.00$

67457034105 J3370 VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION 4,438.87$ 4,438.87$

00409650901 J3370 VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION 838.48$ 838.48$

51754020304 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION 866.83$ 866.83$

51754020301 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION 866.83$ 866.83$

00409114405 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION 1,073.77$ 1,073.77$

23155005901 J8499 VERAPAMIL 40 MG TABLET 1.00$ 1.00$

00904292061 J8499 VERAPAMIL 80 MG TABLET 1.00$ 1.00$

63323027810 J9360 VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION 220.22$ 220.22$

61703030906 J9370 VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00904208560 J8499 VITAMIN A 10,000 UNIT CAPSULE 1.00$ 1.00$

30768003268 J8499 VITAMIN E 400 UNIT CAPSULE 1.00$ 1.00$

00056017001 J8499 WARFARIN 2 MG TABLET 1.00$ 1.00$

00056017601 J8499 WARFARIN 2.5 MG TABLET 1.00$ 1.00$


00056017301 J8499 WARFARIN 7.5 MG TABLET 1.00$ 1.00$

68084037211 J8499 ACETAMINOPHEN 300 MG‐CODEINE 30 MG TABLET 59.00$ 59.00$

00904578961 J8499 ACYCLOVIR 200 MG CAPSULE 59.00$ 59.00$

50268006111 J8499 ACYCLOVIR 400 MG TABLET 59.00$ 59.00$

00009316901 J0270 ALPROSTADIL 500 MCG/ML INJECTION SOLUTION 4,330.77$ 4,330.77$

00009316906 J0270 ALPROSTADIL 500 MCG/ML INJECTION SOLUTION 4,330.77$ 4,330.77$

63323061609 J0282 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION 302.00$ 302.00$




51079062001 J7500 AZATHIOPRINE 50 MG TABLET 1.00$ 1.00$

63323013610 J9040 BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION 1,262.43$ 1,262.43$

00409141204 J3490 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION 138.00$ 138.00$



00093423201 J8499 BUMETANIDE 0.5 MG TABLET 1.22$ 1.22$

00185012901 J8499 BUMETANIDE 1 MG TABLET 1.00$ 1.00$

00409361301 J3490

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 %

DEXTROSE INJECTION 138.00$ 138.00$

00781105301 J8499 BUPROPION HCL 75 MG TABLET 1.00$ 1.00$

51079098601 J8499 BUSPIRONE 10 MG TABLET 1.00$ 1.00$

51079098501 J8499 BUSPIRONE 5 MG TABLET 1.00$ 1.00$

00409162601 J0595 BUTORPHANOL TARTRATE 2 MG/ML INJECTION SOLUTION 175.25$ 175.25$

23155011803 J8499 CALCITRIOL 0.25 MCG CAPSULE 1.00$ 1.00$

51079086301 J8499 CAPTOPRIL 12.5 MG TABLET 76.17$ 76.17$

51079086401 J8499 CAPTOPRIL 25 MG TABLET 1.62$ 1.62$

62756051788 J8499 CARBIDOPA 10 MG‐LEVODOPA 100 MG TABLET 59.00$ 59.00$


68180018001 J8499 CEFADROXIL 500 MG CAPSULE 59.00$ 59.00$

00143993101 J0698 CEFOTAXIME 1 GRAM SOLUTION FOR INJECTION 302.00$ 302.00$

00143993501 J0698 CEFOTAXIME 10 GRAM SOLUTION FOR INJECTION 1,493.57$ 1,493.57$

00143993001 J0698 CEFOTAXIME 500 MG SOLUTION FOR INJECTION 302.00$ 302.00$

25021010910 J0694 CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION 325.99$ 325.99$



49884046564 J8499

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR

SUSP IN A PACKET 111.09$ 111.09$

44567051001 J9060 CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00009337501 J3490

CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE


00009338201 J3490



63739026310 J8499 CLONAZEPAM 0.5 MG TABLET 59.00$ 59.00$

00904610261 J8499 CLONAZEPAM 1 MG TABLET 1.00$ 1.00$

60505013400 J7502 CYCLOSPORINE 100 MG CAPSULE 312.35$ 312.35$

60505013300 J7515 CYCLOSPORINE 25 MG CAPSULE 116.06$ 116.06$

62756052940 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION 6,818.10$ 6,818.10$

55566220000 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION 1,913.29$ 1,913.29$

17478093705 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION 302.00$ 302.00$




51079095801 J8499 DOXAZOSIN 2 MG TABLET 144.37$ 144.37$

49884072703 J3490 DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE 69.45$ 69.45$

68180065208 J3490 DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE 59.00$ 59.00$

00904550261 J8499 ENALAPRIL MALEATE 5 MG TABLET 1.00$ 1.00$

64679092602 J8499 ENALAPRIL MALEATE 20 MG TABLET 1.00$ 1.00$

00143978701 J3490 ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00555088602 J8499 ESTRADIOL 1 MG TABLET 1.00$ 1.00$

68850001201 J8499 ETHAMBUTOL 400 MG TABLET 59.00$ 59.00$

00703565301 J9181 ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00703565601 J9181 ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION 174.80$ 174.80$

63739064510 J8499 FAMOTIDINE 20 MG TABLET 1.00$ 1.00$

51079096601 J8499 FAMOTIDINE 20 MG TABLET 1.00$ 1.00$

65162064210 J8499 FLECAINIDE 100 MG TABLET 1.00$ 1.00$

65162064110 J8499 FLECAINIDE 50 MG TABLET 1.00$ 1.00$

00115703301 J8499 FLUDROCORTISONE 0.1 MG TABLET 59.00$ 59.00$

31722090301 J8499 FLUOXETINE 10 MG CAPSULE 1.00$ 1.00$

00781282210 J8499 FLUOXETINE 20 MG CAPSULE 1.00$ 1.00$

00121472105 J8499 FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION 5.76$ 5.76$

24208031425 J3490 FLURBIPROFEN 0.03 % EYE DROPS 126.55$ 126.55$

51079081001 J8499 GLIPIZIDE 5 MG TABLET 1.00$ 1.00$

00904515460 J3490 GUAIFENESIN 200 MG TABLET 59.00$ 59.00$

00378116001 J8499 GUANFACINE 1 MG TABLET 59.00$ 59.00$

25021040001 J1644 HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION 138.00$ 138.00$




62559013807 J8499 HYDROCORTISONE 100 MG/60 ML ENEMA 235.89$ 235.89$


68084026911 J8499 HYDROXYCHLOROQUINE 200 MG TABLET 1.97$ 1.97$

49884072401 J8499 HYDROXYUREA 500 MG CAPSULE 1.00$ 1.00$

68094060059 J3490 IBUPROFEN 100 MG/5 ML ORAL SUSPENSION 59.75$ 59.75$

51672129802 J3490 KETOCONAZOLE 2 % TOPICAL CREAM 1,211.98$ 1,211.98$

25021070102 J1885 KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION 138.00$ 138.00$

00409379619 J1885 KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION 138.00$ 138.00$

00093031401 J8499 KETOROLAC 10 MG TABLET 73.13$ 73.13$

17478042020 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00409226720 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00904592861 J8499 LABETALOL 100 MG TABLET 1.00$ 1.00$

24208050505 J3490 LEVOBUNOLOL 0.5 % EYE DROPS 186.43$ 186.43$





68084024811 J8499 LORATADINE 10 MG TABLET 59.00$ 59.00$

68084024801 J8499 LORATADINE 10 MG TABLET 59.00$ 59.00$

00409677802 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION 138.00$ 138.00$



68585000698 J8499

MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM)

TABLET 59.00$ 59.00$

25021020110 J9209 MESNA 100 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00904632661 J8499 METFORMIN 500 MG TABLET 1.00$ 1.00$

23155007101 J8499 METHIMAZOLE 10 MG TABLET 1.00$ 1.00$

23155007001 J8499 METHIMAZOLE 5 MG TABLET 1.00$ 1.00$

63323041112 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION 138.00$ 138.00$




43386016006 J8499 MISOPROSTOL 100 MCG TABLET 1.00$ 1.00$

16729011638 J9280 MITOMYCIN 40 MG INTRAVENOUS SOLUTION 42,433.13$ 42,433.13$

00406800330 J8499

MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML)

ORAL SOLUTION 252.70$ 252.70$

76282025705 J8499 NABUMETONE 500 MG TABLET 59.00$ 59.00$

00536100294 J3490 TETRAHYDROZOLINE 0.05 % EYE DROPS 59.00$ 59.00$

00409337504 J3490

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS

SOLUTION 857.80$ 857.80$

66689002530 J8499 OXYCODONE 20 MG/ML ORAL CONCENTRATE 9,998.15$ 9,998.15$

00406055223 J8499 OXYCODONE 5 MG TABLET 59.00$ 59.00$


59923060110 J2430 PAMIDRONATE 30 MG INTRAVENOUS SOLUTION 501.16$ 501.16$

00472024260 J3490 PERMETHRIN 5 % TOPICAL CREAM 1,755.69$ 1,755.69$

63736012002 J3490 PERMETHRIN 1 % TOPICAL LIQUID 402.76$ 402.76$

00409707514 J3480

POTASSIUM CHLORIDE 10 MEQ/50 ML IN STERILE WATER


00409707526 J3480

POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER


63739044710 J8499

POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED

RELEASE(PART/CRYST) 1.00$ 1.00$

50383004224 J7510 PREDNISOLONE 15 MG/5 ML ORAL SOLUTION 362.03$ 362.03$

99999000748 J7510 PREDNISOLONE 15 MG/5 ML ORAL SOLUTION 59.00$ 59.00$

50383004004 J7510

PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7

MG/5 ML) ORAL SOLN 2,589.02$ 2,589.02$

00527130101 J8499 PRIMIDONE 50 MG TABLET 1.00$ 1.00$

00713013512 J8499 PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY 231.10$ 231.10$

00713052606 J8499 PROMETHAZINE 25 MG RECTAL SUPPOSITORY 240.04$ 240.04$

00409469924 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION 347.31$ 347.31$



00115351101 J8499 PYRIDOSTIGMINE BROMIDE 60 MG TABLET 1.31$ 1.31$

68180065806 J8499 RIFAMPIN 150 MG CAPSULE 59.00$ 59.00$

00338004746 J3490 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION 321.00$ 321.00$


00338004802 J3490 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION ‐$ ‐$



60505008000 J8499 SOTALOL 80 MG TABLET 1.00$ 1.00$


51079075301 J8499 SUCRALFATE 1 GRAM TABLET 1.00$ 1.00$

61314022705 J3490 TIMOLOL MALEATE 0.5 % EYE DROPS 125.35$ 125.35$

39822041201 J3260 TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION 2,600.39$ 2,600.39$

61314004475 J3490 TRIFLURIDINE 1 % EYE DROPS 6,385.61$ 6,385.61$

24208031510 J3490

POLYMYXIN B SULFATE 10,000 UNIT‐TRIMETHOPRIM 1

MG/ML EYE DROPS 162.48$ 162.48$

50268079611 J8499 URSODIOL 300 MG CAPSULE 6.48$ 6.48$


53489014601 J8499


TABLET 59.00$ 59.00$

63739022810 J8499


TABLET 59.00$ 59.00$

00904110231 J3490 POVIDONE‐IODINE 10 % TOPICAL OINTMENT 59.00$ 59.00$

00536101701 J8499 MECLIZINE 12.5 MG TABLET 59.00$ 59.00$

59746012106 J8499 MECLIZINE 25 MG TABLET 1.00$ 1.00$

00904651761 J8499 MECLIZINE 25 MG TABLET 1.00$ 1.00$

66758011006 J3490


RELEASE 1.00$ 1.00$

00555089902 J8499 ESTRADIOL 0.5 MG TABLET 1.00$ 1.00$

00603082354 J8499 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID 59.00$ 59.00$

00536077097 J8499 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID 59.00$ 59.00$

00487980101 J3490

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR


76204010030 J3490

IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR


68180051201 J8499 LISINOPRIL 2.5 MG TABLET 1.00$ 1.00$

51079089401 J8499 VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE 2.02$ 2.02$

00904643459 J8499 SENNOSIDES 8.6 MG TABLET 59.00$ 59.00$

00904652261 J8499 SENNOSIDES 8.6 MG TABLET 59.00$ 59.00$

00536002583 J3490

ALUMINUM‐MAG HYDROXIDE‐SIMETHICONE 200 MG‐200

MG‐20 MG/5 ML ORAL SUSP 59.00$ 59.00$

00121176130 J3490

ALUMINUM‐MAG HYDROXIDE‐SIMETHICONE 200 MG‐200

MG‐20 MG/5 ML ORAL SUSP 85.03$ 85.03$

57664060088 J8499

ISOSORBIDE DINITRATE ER 40 MG TABLET,EXTENDED

RELEASE 81.67$ 81.67$

68084050311 J8499

PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED

RELEASE 2.78$ 2.78$

51991081801 J8499

PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED

RELEASE 1.47$ 1.47$

51079067001 J8610 METHOTREXATE SODIUM 2.5 MG TABLET 2.82$ 2.82$

00904640761 J8499 BISACODYL 5 MG TABLET,DELAYED RELEASE 59.00$ 59.00$

24338010213 J8499 ERYTHROMYCIN 250 MG TABLET 350.55$ 350.55$

00904588761 J8499

THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12

HR 59.00$ 59.00$

50111048301 J8499

THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12

HR 59.00$ 59.00$

00121174410 J8499 GUAIFENESIN 100 MG/5 ML ORAL LIQUID 59.00$ 59.00$



00168011109 J3490 BACITRACIN ZINC 500 UNIT/GRAM TOPICAL PACKET 1.00$ 1.00$

45802043803 J3490 HYDROCORTISONE 1 % TOPICAL CREAM 59.00$ 59.00$

00904386575 J3490 SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL 59.00$ 59.00$

00536355101 J8499 CYANOCOBALAMIN (VIT B‐12) 500 MCG TABLET 1.00$ 1.00$

51079093601 J8499 TERAZOSIN 1 MG CAPSULE 1.00$ 1.00$



51079089901 J8499 VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE 2.17$ 2.17$

63739067110 J8499 TRAMADOL 50 MG TABLET 59.00$ 59.00$



57664050389 J8499 TIZANIDINE 4 MG TABLET 59.00$ 59.00$

00409710709 J3490

POTASSIUM CHLORIDE 20 MEQ/L IN D5‐0.9 % SODIUM

CHLORIDE INTRAVENOUS 313.00$ 313.00$

00409710909 J3490

POTASSIUM CHLORIDE 40 MEQ/L IN D5‐0.9 % SODIUM


00409799309 J3490

POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 %‐0.45 %

SODIUM CHLORIDE IV 313.00$ 313.00$

00409790109 J3490



00409790103



00409790209 J3490 D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION 313.00$ 313.00$

00409790203 J3490 D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION 313.00$ 313.00$

00409790309 J3490



00409790409 J3490



63323048157 J3490

LIDOCAINE‐EPINEPHRINE 0.5 %‐1:200,000 INJECTION

SOLUTION 138.00$ 138.00$

00409790509 J3490

POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE


00121059530 J8499

SODIUM CITRATE‐CITRIC ACID 500 MG‐334 MG/5 ML ORAL

SOLUTION 1.34$ 1.34$

00641601901 J2274 MORPHINE (PF) 1 MG/ML INJECTION SOLUTION 652.70$ 652.70$

00338104902 J3490

NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 %

DEXTROSE INTRAVENOUS 698.60$ 698.60$

00338008503 J3490

DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE


00338008504 J3490



00338007703



00338007704 J3490



00338008903 J7042



00338008904 J7042



00409318201 J3490

LIDOCAINE 20 MG/ML (2 %)‐EPINEPHRINE 1:100,000

INJECTION SOLUTION 138.00$ 138.00$

00409317801 J3490

LIDOCAINE 1 %‐EPINEPHRINE 1:100,000 INJECTION

SOLUTION 138.00$ 138.00$

63323048837 J3490

LIDOCAINE‐EPINEPHRINE (PF) 1.5 %‐1:200,000 INJECTION

SOLUTION 213.18$ 213.18$

00338107502 J1250

DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 %

DEXTROSE IV 1,397.20$ 1,397.20$

63323048927 J3490

LIDOCAINE‐EPINEPHRINE (PF) 2 %‐1:200,000 INJECTION

SOLUTION 211.58$ 211.58$

66689069479 J8499 METHADONE 10 MG/ML ORAL CONCENTRATE 1,417.01$ 1,417.01$

99999003183 J8499 METHADONE 10 MG/ML ORAL CONCENTRATE 59.00$ 59.00$

00338012504 J3490

DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS

SOLUTION 315.00$ 315.00$

57565006310 J3490 GLUCOSE 4 GRAM CHEWABLE TABLET 85.18$ 85.18$

00409711509 J3480

POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM


00409711609 J3490



66553000401 J8499

CALCIUM CARBONATE 200 MG CALCIUM (500 MG)

CHEWABLE TABLET 1.00$ 1.00$

61703032322 J9040 BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION 3,550.65$ 3,550.65$

60505005501 J8499 SELEGILINE 5 MG CAPSULE 1.04$ 1.04$

63739035510 J8499 MIRTAZAPINE 15 MG TABLET 59.00$ 59.00$

29300012701 J8499 BISOPROLOL FUMARATE 10 MG TABLET 1.00$ 1.00$

68084048711 J8499 BISOPROLOL FUMARATE 5 MG TABLET 1.29$ 1.29$

31722053001 J8499 TORSEMIDE 10 MG TABLET 59.00$ 59.00$

00046110281 J8499 CONJUGATED ESTROGENS 0.625 MG TABLET 7.03$ 7.03$

49884051401 J8499 DIGOXIN 125 MCG TABLET 2.40$ 2.40$

00187430202 J3490

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS

SOLUTION 6,802.93$ 6,802.93$

00904505359 J8499 PSEUDOEPHEDRINE 30 MG TABLET 1.00$ 1.00$


24208083060 J3490

NEOMYCIN‐POLYMYXIN‐DEXAMETH 3.5 MG/ML‐10,000

UNIT/ML‐0.1% EYE DROPS 556.49$ 556.49$

00603254421 J8499

BUTALBITAL‐ACETAMINOPHEN‐CAFFEINE 50 MG‐325 MG‐

40 MG TABLET 59.00$ 59.00$

00409669501 J3490 ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION 199.21$ 199.21$

63323049405 J3490

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML)


00406839062 J8499 MORPHINE ER 100 MG TABLET,EXTENDED RELEASE 211.87$ 211.87$




51079088901 J8499 PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE 1.00$ 1.00$

65862049647 J8499


ML ORAL SUSPENSION 3,191.09$ 3,191.09$

99999000522 J8499


ML ORAL SUSPENSION 59.00$ 59.00$

63323032510 J0133 ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION 887.19$ 887.19$

63323032520 J0133 ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION 1,497.96$ 1,497.96$



00270131630 Q9967 IOPAMIDOL 76 % INTRAVENOUS SOLUTION 277.45$ 277.45$





00168006231 J3490 ZINC OXIDE 20 % TOPICAL OINTMENT 80.36$ 80.36$

00006542402 J3490

ANTIVENIN LATRODECTUS MACTANS 6,000 UNIT

SOLUTION FOR INJECTION 1,106.19$ 1,106.19$

68382065101 J8499

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED

RELEASE 24 HR 59.00$ 59.00$

00904644961 J8499

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED

RELEASE 24 HR 59.00$ 59.00$

00574704012 J3490

BELLADONNA ALKALOIDS‐OPIUM 16.2 MG‐60 MG RECTAL

SUPPOSITORY 895.17$ 895.17$

14428000944 J3490 BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT 59.00$ 59.00$

68084028211 J8499

CARBIDOPA ER 50 MG‐LEVODOPA 200 MG

TABLET,EXTENDED RELEASE 1.00$ 1.00$

00378910293 J3490

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR

PATCH 59.00$ 59.00$

00378910216 J3490


PATCH 59.00$ 59.00$

00904549546 J3490


PATCH 59.00$ 59.00$

47781029803 J3490


PATCH 59.00$ 59.00$

49730011330 J3490


PATCH 59.00$ 59.00$

68084005211 J8499 DILTIAZEM CD 120 MG CAPSULE,EXTENDED RELEASE 24 HR 1.00$ 1.00$

49648008402 J3490 DIBUCAINE 1 % RECTAL OINTMENT 291.99$ 291.99$



00264180032 J7030 SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION ‐$ ‐$






00536589488 J3490 NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH 99.02$ 99.02$

00093961413 J3490 SILVER NITRATE 0.5 % TOPICAL SOLUTION 843.12$ 843.12$

00406012523 J8499 HYDROCODONE 10 MG‐ACETAMINOPHEN 325 MG TABLET 59.00$ 59.00$


63323025410 J3490 MINERAL OIL (STERILE) 18.23$ 18.23$

00338001304 WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION 319.00$ 319.00$

47781020604 J3490 ESTRADIOL 0.05 MG/24 HR WEEKLY TRANSDERMAL PATCH 615.26$ 615.26$

47781020904 J3490 ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH 640.08$ 640.08$


00093574019 J7515 CYCLOSPORINE MODIFIED 25 MG CAPSULE 59.00$ 59.00$

00591222315 J7502 CYCLOSPORINE MODIFIED 100 MG CAPSULE 227.41$ 227.41$

24208063562 J3490

NEOMYCIN‐POLYMYXIN‐HYDROCORT 3.5 MG‐10,000

UNIT/ML‐1 % EAR DROPS,SUSP 1,780.04$ 1,780.04$

00007440701 J0883 ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION 49,683.00$ 49,683.00$


00143987201 J1800 PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

57896045208 SENNOSIDES 8.8 MG/5 ML SYRUP 552.50$ 552.50$

99999003332 J8499 SENNOSIDES 8.8 MG/5 ML SYRUP 59.00$ 59.00$

64980030130 J3490

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL

APPLICATOR 1,900.60$ 1,900.60$

62559043130 J3490


APPLICATOR 2,628.74$ 2,628.74$

64980032430 J3490


APPLICATOR 1,027.55$ 1,027.55$

10939097433 J3490 GLYCERIN TOPICAL LIQUID 219.05$ 219.05$

00168025815 J3490

CLOTRIMAZOLE‐BETAMETHASONE 1 %‐0.05 % TOPICAL

CREAM 404.79$ 404.79$

66993089845 J3490

CLOTRIMAZOLE‐BETAMETHASONE 1 %‐0.05 % TOPICAL

CREAM 2,019.16$ 2,019.16$


61553011148 J3010

FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE

INTRAVENOUS 897.56$ 897.56$

70004022932 J3010



70004020232 J3010





61553020437 J3490

FENTANYL (PF) 2 MCG/ML‐BUPIVACAINE 0.125 %‐NACL

INJECTION SOLUTION 1,105.15$ 1,105.15$

70004023140 J3490

FENTANYL (PF) 2 MCG/ML‐BUPIVACAINE 0.125 %‐NACL


61703034250 J9267 PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS 320.06$ 320.06$



63739044610 J8499



66758017013 J8499



66758017006 J8499



55150011899 J0295

AMPICILLIN‐SULBACTAM 15 GRAM SOLUTION FOR

INJECTION 650.06$ 650.06$

00641611601 J0295

AMPICILLIN‐SULBACTAM 1.5 GRAM SOLUTION FOR

INJECTION 346.63$ 346.63$

55150011620 J0295

AMPICILLIN‐SULBACTAM 1.5 GRAM SOLUTION FOR

INJECTION 302.00$ 302.00$

55150011720 J0295

AMPICILLIN‐SULBACTAM 3 GRAM SOLUTION FOR

INJECTION 302.00$ 302.00$

66685100200 J8499

AMOXICILLIN 500 MG‐POTASSIUM CLAVULANATE 125 MG

TABLET 59.00$ 59.00$

66685100101 J8499


TABLET 59.00$ 59.00$

00085126001 J3490 CLOTRIMAZOLE 2 % VAGINAL CREAM 299.29$ 299.29$


00406012423 J8499 HYDROCODONE 7.5 MG‐ACETAMINOPHEN 325 MG TABLET 1.00$ 1.00$

00395051592 CASTOR OIL 127.19$ 127.19$

61314064175 J3490

NEOMYCIN 3.5 MG‐POLYMYXIN 10,000 UNIT‐HYDROCORT

10 MG/ML EYE DROP,SUSP 4,452.98$ 4,452.98$

65862020290 J8499 LOSARTAN 50 MG TABLET 1.00$ 1.00$

42799040401 J8499 ZIDOVUDINE 10 MG/ML SYRUP 1,877.84$ 1,877.84$

59762669008 J8499 NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR 1.69$ 1.69$

00054022025 J8499 QUETIAPINE 25 MG TABLET 59.00$ 59.00$

59762151701 J8499 CELECOXIB 200 MG CAPSULE 141.18$ 141.18$

00093205056 J8499

TOLTERODINE ER 2 MG CAPSULE,EXTENDED RELEASE 24

HR 5.00$ 5.00$

54505033105 J8499 HYDROCORTISONE 5 MG TABLET 59.00$ 59.00$

47781058393 J1885 KETOROLAC 15 MG/ML INJECTION SOLUTION 138.00$ 138.00$

25021070001 J1885 KETOROLAC 15 MG/ML INJECTION SOLUTION 138.00$ 138.00$

00173068101 J3490

ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR

INHALATION 399.77$ 399.77$

25021045201 J2354 OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION 333.54$ 333.54$

31722020090 J8499 FOSINOPRIL 10 MG TABLET 1.00$ 1.00$

69097085605 J8499 FOSINOPRIL 10 MG TABLET 1.00$ 1.00$

68462033390 J8499 PRAMIPEXOLE 1 MG TABLET 1.00$ 1.00$

51991079306 J8499 RIVASTIGMINE 1.5 MG CAPSULE 4.02$ 4.02$

55111035260 J8499 RIVASTIGMINE 1.5 MG CAPSULE 1.00$ 1.00$

61314054701 J3490 LATANOPROST 0.005 % EYE DROPS 223.96$ 223.96$

51079002301 J8499 METOLAZONE 2.5 MG TABLET 2.76$ 2.76$

16729002010 J8499 PIOGLITAZONE 15 MG TABLET 1.00$ 1.00$

68462010230 J8499 FLUCONAZOLE 100 MG TABLET 61.64$ 61.64$



00904629261 J8499 ATORVASTATIN 40 MG TABLET 59.00$ 59.00$

43386051087 J3490 MESALAMINE 4 GRAM/60 ML ENEMA 536.53$ 536.53$

00054814622 J8499 CLOTRIMAZOLE 10 MG TROCHE 59.00$ 59.00$

68180065701 J3490

DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL

SUSPENSION 541.32$ 541.32$

59676096001 Q2050

DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML

INTRAVENOUS SUSPENSION 45,866.65$ 45,866.65$

59676096002 Q2050

DOXORUBICIN, PEGYLATED LIPOSOMAL 2 MG/ML


00185022360 J8499 CILOSTAZOL 100 MG TABLET 1.11$ 1.11$

55150022099 J1327 EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION 3,850.37$ 3,850.37$

51672130406 J3490 TERCONAZOLE 0.4 % VAGINAL CREAM 1,164.07$ 1,164.07$

49281075278 J3490

TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL


16729003510 J8499 ANASTROZOLE 1 MG TABLET 1.00$ 1.00$

54092018981 J8499 MESALAMINE CR 250 MG CAPSULE,CONTROLLED RELEASE 177.87$ 177.87$

51079039201 J8499

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED‐

RELEASE 1.00$ 1.00$

00093022056 J8499 BICALUTAMIDE 50 MG TABLET 1.00$ 1.00$

60429017705 J8499 BICALUTAMIDE 50 MG TABLET 1.00$ 1.00$

50580019101 J3490 ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION 221.56$ 221.56$

00597000160 J8499

ASPIRIN 25 MG‐DIPYRIDAMOLE 200 MG

CAPSULE,EXT.RELEASE 12 HR MULTIPHASE 368.02$ 368.02$

00904630361 J8499 CARVEDILOL 25 MG TABLET 1.00$ 1.00$

65862052730 J8499

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24

HR 59.00$ 59.00$

50242013468 J9355 TRASTUZUMAB 440 MG INTRAVENOUS SOLUTION 24,055.16$ 24,055.16$

51079093001 J8499 CARVEDILOL 6.25 MG TABLET 1.00$ 1.00$


00065024610 J3490 BETAXOLOL 0.25 % EYE DROPS,SUSPENSION 11,645.07$ 11,645.07$

48433023015 J8499 IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION 1,217.25$ 1,217.25$

68382009716 J8499 PAROXETINE 10 MG TABLET 1.00$ 1.00$

68180030260 J8499 CEFUROXIME AXETIL 250 MG TABLET 3.10$ 3.10$

44567080401 J2543

PIPERACILLIN‐TAZOBACTAM 40.5 GRAM INTRAVENOUS

SOLUTION 2,849.65$ 2,849.65$

68382001014 J8499 LAMOTRIGINE 200 MG TABLET 59.00$ 59.00$

43547027503 J8499 DONEPEZIL 5 MG TABLET 1.00$ 1.00$

00088222033 J1815 INSULIN GLARGINE 100 UNIT/ML SUB‐Q VIAL 3,376.44$ 3,376.44$

25021012120 J0692 CEFEPIME 1 GRAM SOLUTION FOR INJECTION 343.64$ 343.64$

00555100916 J3490 CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH 258.14$ 258.14$

00378087116 J3490 CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH 651.14$ 651.14$

00338051909 B4185 LIPID INJECTABLE EMULSION 20 % INTRAVENOUS 1,925.50$ 1,925.50$

00143992950 J8499 CIPROFLOXACIN 750 MG TABLET 59.00$ 59.00$


62756079788 J8499 DIVALPROEX 250 MG TABLET,DELAYED RELEASE 59.00$ 59.00$

00409915801 J3430

PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION

SOLUTION 1,686.98$ 1,686.98$

11523723401 J8499

POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER

PACKET 80.14$ 80.14$

68084043098 J8499


PACKET 91.92$ 91.92$

68084043099 J8499


PACKET 91.92$ 91.92$

13668013201 J8499 FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR 1.00$ 1.00$

51079054701 J8499 FEXOFENADINE 60 MG TABLET 76.88$ 76.88$

51079059701 J8499 CETIRIZINE 10 MG TABLET 59.00$ 59.00$

51079020801 J8499 ATORVASTATIN 10 MG TABLET 1.00$ 1.00$

42211010243 J3490 INDOMETHACIN 50 MG RECTAL SUPPOSITORY 3,203.55$ 3,203.55$

00781196160 J8499 CLARITHROMYCIN 250 MG TABLET 66.85$ 66.85$

42023012306 J3490 DANTROLENE 20 MG INTRAVENOUS SOLUTION 2,473.37$ 2,473.37$

00555101016 J3490 CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH 2,041.55$ 2,041.55$

68462019790 J8499 PRAVASTATIN 40 MG TABLET 1.26$ 1.26$


00186000431 J8499 CANDESARTAN 4 MG TABLET 4.67$ 4.67$

64980051505 J3490 OFLOXACIN 0.3 % EYE DROPS 251.90$ 251.90$

00009027101 J1000 ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL 3,958.87$ 3,958.87$

42858070101 J3490

THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24

HR 62.98$ 62.98$

00904632361 J8499

METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED

RELEASE 24 HR 1.00$ 1.00$

00904605261 J8499 LEVETIRACETAM 500 MG TABLET 1.00$ 1.00$

00270044540 Q9963

DIATRIZOATE MEGLUMINE‐DIATRIZOATE SODIUM 66 %‐10

% ORAL SOLUTION 581.44$ 581.44$

00019481604 Q9963

DIATRIZOATE MEGLUMINE‐DIATRIZOATE SODIUM 66 %‐10

% ORAL SOLUTION 943.46$ 943.46$

00904608461 J8499 CITALOPRAM 10 MG TABLET 1.00$ 1.00$

17478071710 J8499 KETOTIFEN 0.025 % (0.035 %) EYE DROPS 301.40$ 301.40$

68084017511 J8597 DRONABINOL 5 MG CAPSULE 355.13$ 355.13$

00378427693 J8499 VALACYCLOVIR 1 GRAM TABLET 59.00$ 59.00$

00023114501 J0585

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR

INJECTION 3,257.42$ 3,257.42$

00781613948 J8499

AMOXICILLIN 600 MG‐POTASSIUM CLAVULANATE 42.9

MG/5 ML ORAL SUSPENSION 1,453.09$ 1,453.09$

50242012001 J3101 TENECTEPLASE 50 MG INTRAVENOUS KIT 29,995.31$ 29,995.31$

43598020451 J8499

AMOXICILLIN 250 MG‐POTASSIUM CLAVULANATE 62.5

MG/5 ML ORAL SUSPENSION 1,362.27$ 1,362.27$

00009519104 J8499

TOLTERODINE ER 4 MG CAPSULE,EXTENDED RELEASE 24

HR 16.13$ 16.13$

58468002101 J8499 SEVELAMER HCL 800 MG TABLET 9.27$ 9.27$

51672130803 J3490 CLOTRIMAZOLE‐BETAMETHASONE 1 %‐0.05 % LOTION 3,658.67$ 3,658.67$

16729009401 J7517 MYCOPHENOLATE MOFETIL 250 MG CAPSULE 59.00$ 59.00$

00409233610 J0895 DEFEROXAMINE 500 MG SOLUTION FOR INJECTION 510.86$ 510.86$

36000000306 J1450

FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO)


00121074710 J8499 SUCRALFATE 100 MG/ML ORAL SUSPENSION 268.67$ 268.67$

64281010000 J7674

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR

INHALATION 2,174.61$ 2,174.61$

55390030803 J0207

AMIFOSTINE CRYSTALLINE 500 MG INTRAVENOUS

SOLUTION 3,387.50$ 3,387.50$

67871479006 J1430 ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION 16,112.28$ 16,112.28$

61787006204 J3490

DEXTROMETHORPHAN‐GUAIFENESIN 10 MG‐100 MG/5 ML

ORAL LIQUID 7.06$ 7.06$

44567024110 J0692 CEFEPIME 2 GRAM SOLUTION FOR INJECTION 539.80$ 539.80$

68084089695 J8499 VENLAFAXINE 25 MG TABLET 59.00$ 59.00$

63304009711 J8499 SUMATRIPTAN 25 MG TABLET 134.37$ 134.37$

00037663104 J3490 SULFANILAMIDE 15 % VAGINAL CREAM 8,522.13$ 8,522.13$

00245086070 J3490 METRONIDAZOLE 0.75 % VAGINAL GEL 4,607.97$ 4,607.97$

00904649235 J3490 POLYVINYL ALCOHOL 1.4 % EYE DROPS 59.00$ 59.00$

51079052401 J8597 ONDANSETRON HCL 4 MG TABLET 59.00$ 59.00$

76439013120 J8499 ALENDRONATE 70 MG TABLET 1.00$ 1.00$

00409733701 J0696 CEFTRIAXONE 250 MG SOLUTION FOR INJECTION 302.00$ 302.00$

25021012850 J0713 CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION 518.21$ 518.21$

10019005561 J3490

ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM

CHLORIDE (ISO‐OSMOTIC) IV 16,775.74$ 16,775.74$

00409477702 J0744

CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE


00781324048 J0744



00904564361 J3490 SENNOSIDES 8.6 MG‐DOCUSATE SODIUM 50 MG TABLET 1.00$ 1.00$

00574006930 J3490 DEXTROSE 40 % ORAL GEL 130.24$ 130.24$

37000002410 J8499 PSYLLIUM ORAL PACKET 59.00$ 59.00$

51079045401 J8499 SIMVASTATIN 10 MG TABLET 1.00$ 1.00$

00338111504 J3490

AMINO ACIDS 4.25 % WITH LYTES AND CALCIUM IN D10W


00093576801 J8499 OLANZAPINE 5 MG TABLET 59.00$ 59.00$

68084091233 J8499 NIMODIPINE 30 MG CAPSULE 10.50$ 10.50$

59762503201 J8499 GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR 1.00$ 1.00$

00245021289 J8499 MIDODRINE 5 MG TABLET 164.10$ 164.10$

10147088106 J8499 GALANTAMINE 4 MG TABLET 4.32$ 4.32$

00065009265 J3490

FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS

SOLUTION 1,746.70$ 1,746.70$

65293000511 C9248 CLEVIDIPINE 50 MG/100 ML INTRAVENOUS EMULSION 5,129.08$ 5,129.08$



00008200101 C9113 PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION 138.00$ 138.00$

63304009811 J8499 SUMATRIPTAN 50 MG TABLET 59.00$ 59.00$

00002871501 J1815

INSULIN HUMAN U‐100 NPH‐REGULR 70‐30 MIX 100

UNIT/ML SUBCUTANEOUS SUSP 651.10$ 651.10$

00069580043 J8499 DOFETILIDE 125 MCG CAPSULE 475.07$ 475.07$

00703877701 J0153

ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS

SOLUTION 5,095.79$ 5,095.79$

25021030730 J0153

ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS

SOLUTION 9,544.88$ 9,544.88$

10019064664 J7699 DESFLURANE 100 % INHALATION LIQUID 6,362.84$ 6,362.84$

43386014007 J8499 METHYLERGONOVINE 0.2 MG TABLET 29.54$ 29.54$

43547036809 J8499 VALSARTAN 80 MG TABLET 1.00$ 1.00$

00781187431 J8499


TABLET 193.94$ 193.94$

68382013814 J8499 TOPIRAMATE 25 MG TABLET 1.00$ 1.00$

17478052603 J0470 DIMERCAPROL 100 MG/ML INTRAMUSCULAR SOLUTION 5,637.11$ 5,637.11$

00548590000 J0833 COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION 798.60$ 798.60$

00781322075 J3490 ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

67457022805 J3490 ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION 241.92$ 241.92$



51079045001 J8499 AMLODIPINE 2.5 MG TABLET 59.00$ 59.00$

00904636961 J8499 AMLODIPINE 2.5 MG TABLET 59.00$ 59.00$

62756018488 J3490 OXCARBAZEPINE 300 MG TABLET 1.09$ 1.09$

51079012901 J8499 PHENYTOIN 50 MG CHEWABLE TABLET 59.00$ 59.00$

00904629461 J8499 CLOPIDOGREL 75 MG TABLET 59.00$ 59.00$

00115051101 J3490 FENOFIBRATE MICRONIZED 67 MG CAPSULE 59.00$ 59.00$




00019318309 Q9960

IOTHALAMATE MEGLUMINE 43 % INTRAVENOUS

SOLUTION 19,041.84$ 19,041.84$

00121063810 J3490


SYRUP 59.00$ 59.00$

00121127610 J3490


SYRUP 108.60$ 108.60$

00904637061 J8499 AMLODIPINE 5 MG TABLET 1.00$ 1.00$

67457058200 J1652

FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS

SOLUTION SYRINGE 438.57$ 438.57$

00143968901 J3490 NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION 784.59$ 784.59$

00378427593 J8499 VALACYCLOVIR 500 MG TABLET 59.00$ 59.00$

61703035038 J9250 METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION 392.74$ 392.74$



00904628361 J8499 OLANZAPINE 2.5 MG TABLET 59.00$ 59.00$

63833038602 C9132 PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) 31,316.60$ 31,316.60$

63833038702 C9132 PROTHROMBIN COMPLEX CONCENTRATE (HUMAN) 67,005.08$ 67,005.08$

00574085005 J1110 DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION 4,040.31$ 4,040.31$

11994001101 Q9957

PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML


00781324494 J9070 CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS SOLUTION 2,660.85$ 2,660.85$

00641141035 J1160 DIGOXIN 250 MCG/ML INJECTION SOLUTION 138.00$ 138.00$

00641141031 J1160 DIGOXIN 250 MCG/ML INJECTION SOLUTION 138.00$ 138.00$

00054022125 J8499 QUETIAPINE 100 MG TABLET 59.00$ 59.00$

99999003193 J3535

BECLOMETHASONE DIPROPIONATE 80 MCG/ACTUATION

AEROSOL INHALER 44.90$ 44.90$

25021070101 J1885 KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION 138.00$ 138.00$

00185041060 J8499


RELEASE 1.00$ 1.00$

68084069711 J8499


RELEASE 1.00$ 1.00$



17478019005 J3490 LIDOCAINE‐PRILOCAINE 2.5 %‐2.5 % TOPICAL CREAM 282.64$ 282.64$

00115146853 J3490 LIDOCAINE‐PRILOCAINE 2.5 %‐2.5 % TOPICAL CREAM 140.12$ 140.12$

00517821025 J3490

TRACE ELEMENTS CR‐CU‐MN‐SE‐ZN 10 MCG‐1 MG‐0.5 MG‐

60 MCG‐5MG/ML IV SOLN 609.58$ 609.58$

16729000101 J8499 GLIMEPIRIDE 1 MG TABLET 59.00$ 59.00$




00074463701 J2501 PARICALCITOL 2 MCG/ML INTRAVENOUS SOLUTION 228.39$ 228.39$

50268063611 J8499 PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE 1.00$ 1.00$

00409662502 J3490

SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS

SOLUTION 329.34$ 329.34$

00409488717 WATER FOR INJECTION, STERILE INJECTION SOLUTION 138.00$ 138.00$




13533061811 90375

RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML

INTRAMUSCULAR SOLUTION 16,848.56$ 16,848.56$

13533061820 90375

RABIES IMMUNE GLOBULIN (PF) 150 UNIT/ML


49884086702 J8597 DRONABINOL 2.5 MG CAPSULE 3.89$ 3.89$

60505040205 J3490 PAROXETINE 10 MG/5 ML ORAL SUSPENSION 11,486.98$ 11,486.98$

36000000210 J1450

FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO)


68382005001 J8499 MELOXICAM 7.5 MG TABLET 1.00$ 1.00$

00338110904 J3490

AMINO ACID 2.75 % NO.2‐DEXTROSE 10 %‐ELECTROLYTES

NO.29 IV SOLUTION 2,175.00$ 2,175.00$

17478050101 J2210

METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION

SOLUTION 273.94$ 273.94$

00517072001 J0702

BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML

SUSPENSION FOR INJECTION 1,510.26$ 1,510.26$

00009513601 J8499 LINEZOLID 100 MG/5 ML ORAL SUSPENSION 50,317.17$ 50,317.17$

31722026890 J8499 QUINAPRIL 10 MG TABLET 1.00$ 1.00$

00409741903 J7100

DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE


51079027301 J8499 ENTACAPONE 200 MG TABLET 218.15$ 218.15$

00409733201 J0696 CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION 302.00$ 302.00$


00245000331 J8499 POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION 414.37$ 414.37$

55150017301 J3030 SUMATRIPTAN 6 MG/0.5 ML SUBCUTANEOUS SOLUTION 277.37$ 277.37$

00049396060 J8499 ZIPRASIDONE 20 MG CAPSULE 25.25$ 25.25$

67457018200 J3490

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS

SOLUTION 397.37$ 397.37$

55150019410 J3490

ESMOLOL 100 MG/10 ML (10 MG/ML) INTRAVENOUS

SOLUTION 302.00$ 302.00$

59676032000 Q4081 EPOETIN ALFA 20,000 UNIT/ML INJECTION SOLUTION 2,718.51$ 2,718.51$

55253080230 J8499 MODAFINIL 200 MG TABLET 387.31$ 387.31$


00121043130 J8499 MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION 2.30$ 2.30$

00378912416 J3490 FENTANYL 100 MCG/HR TRANSDERMAL PATCH 1,070.35$ 1,070.35$

00409335601 J1170 HYDROMORPHONE 2 MG/ML INJECTION SOLUTION 138.00$ 138.00$



17478040303 J3490 FLUORESCEIN 0.6 MG EYE STRIPS 59.00$ 59.00$


57665010141 J0287

AMPHOTERICIN B LIPID COMPLEX 5 MG/ML INTRAVENOUS

SUSPENSION 7,584.96$ 7,584.96$

63739056710 J8499 TAMSULOSIN 0.4 MG CAPSULE 59.00$ 59.00$

00904655304 J8499 LINEZOLID 600 MG TABLET 197.97$ 197.97$

64376013699 J8499 LEVETIRACETAM 250 MG TABLET 59.00$ 59.00$

43547026810 J8499 ROPINIROLE 0.25 MG TABLET 59.00$ 59.00$

49884016111 J3490

CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL

SPRAY 723.75$ 723.75$

59676034000 Q4081 EPOETIN ALFA 40,000 UNIT/ML INJECTION SOLUTION 5,437.01$ 5,437.01$

11701006723 J3490 MICONAZOLE NITRATE 2 % TOPICAL OINTMENT 293.54$ 293.54$

55150012030 J2543


SOLUTION 322.68$ 322.68$

63323030030 J2543


SOLUTION 732.74$ 732.74$

67457052237 J2543


SOLUTION 732.74$ 732.74$

64679005602 J2543


SOLUTION 328.98$ 328.98$

64679005601 J2543


SOLUTION 328.98$ 328.98$

67457021102 J1451 FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION 45,386.43$ 45,386.43$

65597070118 J8499 COLESEVELAM 625 MG TABLET 4.56$ 4.56$

00832051000 J3490 BETHANECHOL CHLORIDE 5 MG TABLET 59.00$ 59.00$

59762054001 J8499 GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR 1.00$ 1.00$

50323000604 J3490 PHENYLEPHRINE 1 % NASAL SPRAY 20,802.32$ 20,802.32$

69536010015 J3490 PHENYLEPHRINE 1 % NASAL SPRAY 173.06$ 173.06$

10019065364 J3490 SEVOFLURANE INHALATION LIQUID 3,188.28$ 3,188.28$

51079077401 J8499 PAROXETINE 20 MG TABLET 1.00$ 1.00$

25021016648 J2543


SOLUTION 698.16$ 698.16$

55150012150 J2543


SOLUTION 381.76$ 381.76$

00904647461 J8499 PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE 1.00$ 1.00$


51079048001 J8499 VENLAFAXINE 37.5 MG TABLET 59.00$ 59.00$

00009307301 J1030

METHYLPREDNISOLONE ACETATE 40 MG/ML SUSPENSION

FOR INJECTION 263.48$ 263.48$

00004080085 J8499 OSELTAMIVIR 75 MG CAPSULE 655.44$ 655.44$

00591329315 J8499 TELMISARTAN 40 MG TABLET 6.71$ 6.71$

00093417773 J8499 CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION 463.08$ 463.08$

17478004532 J3490

TETRACAINE HCL (PF) 1 % (10 MG/ML) INJECTION

SOLUTION 1,473.61$ 1,473.61$

00046087221 J3490

CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL

CREAM 13,408.33$ 13,408.33$

00074334603 J9217

LEUPROLIDE 22.5 MG (3 MONTH) INTRAMUSCULAR

SYRINGE KIT 22,349.32$ 22,349.32$

50633011012 J0840

CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR

INJECTION 15,965.10$ 15,965.10$

00904131309 J8499

BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL

SUSPENSION 59.00$ 59.00$

00409350511 J2185 MEROPENEM 500 MG INTRAVENOUS SOLUTION 368.35$ 368.35$

00781300094 J2185 MEROPENEM 500 MG INTRAVENOUS SOLUTION 302.00$ 302.00$

00003257016 J3490 AZTREONAM 2 GRAM SOLUTION FOR INJECTION 2,102.63$ 2,102.63$

00074437805 J3490 CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION 769.82$ 769.82$

57894005427 J3358 USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION 48,485.88$ 48,485.88$

63323065104 J0153 ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION 304.51$ 304.51$

17478054202 J0153 ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION 138.00$ 138.00$

68084026611 J8499 RAMIPRIL 2.5 MG CAPSULE 59.00$ 59.00$

00409350601 J2185 MEROPENEM 1 GRAM INTRAVENOUS SOLUTION 557.69$ 557.69$





00169183311 J1815

INSULIN U‐100 REGULAR HUMAN 100 UNIT/ML INJECTION

SOLUTION 1,233.13$ 1,233.13$

00002821517 J1815

INSULIN U‐100 REGULAR HUMAN 100 UNIT/ML INJECTION

SOLUTION 209.94$ 209.94$

57894003001 J1745 INFLIXIMAB 100 MG INTRAVENOUS SOLUTION 6,168.29$ 6,168.29$

00603188010 J3490 LIDOCAINE 5 % TOPICAL PATCH 185.13$ 185.13$

00065002315 J3490 CARBACHOL 0.01 % INTRAOCULAR SOLUTION 480.90$ 480.90$

00591329415 J8499 TELMISARTAN 80 MG TABLET 6.71$ 6.71$

00781593831 J8499 CANDESARTAN 16 MG TABLET 3.39$ 3.39$

00517234010 J1756

IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS

SOLUTION 204.69$ 204.69$

00168032346 J3490 METRONIDAZOLE 0.75 % TOPICAL CREAM 3,134.72$ 3,134.72$

65862020190 J8499 LOSARTAN 25 MG TABLET 1.00$ 1.00$

24208041105 J3490 BRIMONIDINE 0.2 % EYE DROPS 723.36$ 723.36$

50633012011 J1162 DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION 133,973.28$ 133,973.28$

62756079688 J8499 DIVALPROEX 125 MG TABLET,DELAYED RELEASE 1.00$ 1.00$

00169183411 J1815

INSULIN NPH ISOPHANE U‐100 HUMAN 100 UNIT/ML

SUBCUTANEOUS SUSPENSION 1,233.13$ 1,233.13$

00002831517 J1815

INSULIN NPH ISOPHANE U‐100 HUMAN 100 UNIT/ML

SUBCUTANEOUS SUSPENSION 209.94$ 209.94$

55111026379 J8499 OLANZAPINE 10 MG DISINTEGRATING TABLET 12.72$ 12.72$

55566280000 J3490

DINOPROSTONE ER 10 MG VAGINAL INSERT,CONTROLLED

RELEASE 12,645.06$ 12,645.06$

60977014127 J2730 PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION 19,779.97$ 19,779.97$

00069040001 J0456 AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION 302.00$ 302.00$

00536741551 J8499 SODIUM PHOSPHATES 19 GRAM‐7 GRAM/118 ML ENEMA 71.70$ 71.70$

65197000201 J8499 TRIAMTERENE 50 MG CAPSULE 416.93$ 416.93$

49884030402 J8499 ZAFIRLUKAST 20 MG TABLET 99.09$ 99.09$

00074368303 J9217

LEUPROLIDE 30 MG (4 MONTH) INTRAMUSCULAR SYRINGE

KIT 29,799.16$ 29,799.16$

00409660902 J3490 SODIUM BICARBONATE 4 % INTRAVENOUS SOLUTION 150.70$ 150.70$

68462033190 J8499 PRAMIPEXOLE 0.25 MG TABLET 1.00$ 1.00$

00054458111 J8499 MERCAPTOPURINE 50 MG TABLET 81.63$ 81.63$

00904563261 J8499 GABAPENTIN 300 MG CAPSULE 1.00$ 1.00$


17478041940 J1205

CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS

SOLUTION 1,945.46$ 1,945.46$

68084018011 J8499 SERTRALINE 25 MG TABLET 1.00$ 1.00$

00065064435 J3490 TOBRAMYCIN 0.3 % EYE OINTMENT 8,038.66$ 8,038.66$

00603139364 J3490 LIDOCAINE 2 % MUCOSAL SOLUTION 161.31$ 161.31$



00093681645 J3490

BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR

NEBULIZATION 174.96$ 174.96$

38779247109 J3490 GLUTAMINE (BULK) POWDER 123.71$ 123.71$

66993066130 J8499 RALOXIFENE 60 MG TABLET 1.56$ 1.56$

63323037805 J2354 OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION 3,947.85$ 3,947.85$

76478061102 J0515 BENZTROPINE 2 MG/2 ML INJECTION SOLUTION 5,564.61$ 5,564.61$

00486112501 J8499

SODIUM DI‐ AND MONOPHOSPHATE‐POTASSIUM PHOS

MONOBASIC 250 MG TABLET 59.00$ 59.00$

00409796809 J3490

ELECTROLYTE‐R IN DEXTROSE 5 % INTRAVENOUS

SOLUTION 316.00$ 316.00$

00472173803 J3490 MICONAZOLE NITRATE 200 MG VAGINAL SUPPOSITORY 435.25$ 435.25$

00548560700 J1650 ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE 452.26$ 452.26$

51079022301 J8499 MONTELUKAST 10 MG TABLET 59.00$ 59.00$

00121177505 J8499 CODEINE 10 MG‐GUAIFENESIN 100 MG/5 ML ORAL LIQUID 59.00$ 59.00$

00378092393 J0571 BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET 59.00$ 59.00$

00409733801 J0696 CEFTRIAXONE 500 MG SOLUTION FOR INJECTION 302.00$ 302.00$

45802017944 J3490 ZINC OXIDE‐COD LIVER OIL 40 % TOPICAL OINTMENT 81.20$ 81.20$





45802011222 J3490 MUPIROCIN 2 % TOPICAL OINTMENT 221.32$ 221.32$

60793070001 J0561

PENICILLIN G BENZATHINE 600,000 UNIT/ML

INTRAMUSCULAR SYRINGE 3,423.42$ 3,423.42$

50268056411 J8499 MIDODRINE 2.5 MG TABLET 59.00$ 59.00$

68084018911 J8499 ZOLPIDEM 5 MG TABLET 59.00$ 59.00$

00270111102 A9579 GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION 1,283.23$ 1,283.23$

00270111103 A9579 GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION 1,710.98$ 1,710.98$

00270111104 A9579 GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION 434.73$ 434.73$

00013872789 J1190 DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION 1,310.45$ 1,310.45$

67457020850 J1190 DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION 2,260.69$ 2,260.69$

00641614201 J2370 PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION 344.83$ 344.83$




54162055501 J3490 METHYL SALICYLATE‐MENTHOL TOPICAL OINTMENT 59.00$ 59.00$

68084065911 J8499

METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED

RELEASE 24 HR 1.00$ 1.00$

54505033210 J8499 HYDROCORTISONE 10 MG TABLET 59.00$ 59.00$

00832046515 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER 250.30$ 250.30$

00064501030 J3490

COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250

UNIT/GRAM TOPICAL OINTMENT 8,180.81$ 8,180.81$

50484001030 J3490

COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250

UNIT/GRAM TOPICAL OINTMENT 7,982.01$ 7,982.01$

43547027803 J8499 IRBESARTAN 150 MG TABLET 1.00$ 1.00$

00409796509 J3490

ELECTROLYTE‐M IN 5 % DEXTROSE INTRAVENOUS

SOLUTION 315.00$ 315.00$

00003256016 J3490 AZTREONAM 1 GRAM SOLUTION FOR INJECTION 1,140.80$ 1,140.80$

29300013101 J8499 ZALEPLON 5 MG CAPSULE 1.00$ 1.00$

49884050101 J8499

BUDESONIDE DR ‐ ER 3 MG CAPSULE,DELAYED,EXTENDED

RELEASE 784.89$ 784.89$

00002751017 J1815

INSULIN LISPRO (U‐100) 100 UNIT/ML SUBCUTANEOUS

SOLUTION 660.72$ 660.72$

49502050001 J0171 EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO‐INJECTOR 11,468.62$ 11,468.62$



00093202631 J8499 AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION 429.94$ 429.94$

00378912116 J3490 FENTANYL 25 MCG/HR TRANSDERMAL PATCH 313.49$ 313.49$

55111028050 J8499 LEVOFLOXACIN 500 MG TABLET 59.00$ 59.00$


00024279210 J2916

SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5

MG/5 ML INTRAVENOUS 138.00$ 138.00$

65862002106 J8499 MIRTAZAPINE 15 MG DISINTEGRATING TABLET 1.00$ 1.00$

62756051183 J8499 LETROZOLE 2.5 MG TABLET 59.00$ 59.00$

00093762056 J8499 LETROZOLE 2.5 MG TABLET 59.00$ 59.00$

00338114403 J3490



00338111304 J3490



63824005632 J3490

DEXTROMETHORPHAN‐GUAIFENESIN 30 MG‐600 MG

TABLET EXTENDED RELEASE12 HR 59.00$ 59.00$

10019055388 J3490 SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH 612.52$ 612.52$



99999003192 J3535

ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL

INHALER 43.86$ 43.86$

00004029830 J3490 MYCOPHENOLATE 500 MG INTRAVENOUS SOLUTION 4,069.57$ 4,069.57$

00009379401 J1742

IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS

SOLUTION 9,422.32$ 9,422.32$



51079014501 J8499 BENAZEPRIL 10 MG TABLET 1.00$ 1.00$

63256010030 J3490 STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER 5,535.87$ 5,535.87$


49884067801 J8499 NIFEDIPINE ER 60 MG TABLET,EXTENDED RELEASE 1.00$ 1.00$

55150011930 J2543


SOLUTION 302.00$ 302.00$


68462015740 J8499 ONDANSETRON 4 MG DISINTEGRATING TABLET 59.00$ 59.00$

68084034411 J8499 TOPIRAMATE 100 MG TABLET 1.00$ 1.00$

00054327099 J3490

FLUTICASONE 50 MCG/ACTUATION NASAL

SPRAY,SUSPENSION 107.95$ 107.95$

59676031000 Q4081 EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION 734.02$ 734.02$

53746017801 J8499 METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR 1.00$ 1.00$




00074611411 J8499 DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE 113.79$ 113.79$

00006382210 J0637 CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION 3,106.34$ 3,106.34$

65862055260 J8499 LAMIVUDINE 150 MG TABLET 200.27$ 200.27$

50242005121 J9310 RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS 4,526.90$ 4,526.90$

50242005306 J9310 RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS 22,634.47$ 22,634.47$

00904635961 J8499 RISPERIDONE 1 MG TABLET 1.00$ 1.00$

50242004164 J2997 ALTEPLASE 2 MG INTRA‐CATHETER SOLUTION 5,768.44$ 5,768.44$

10147170007 J8499 ITRACONAZOLE 100 MG CAPSULE 320.27$ 320.27$

74312001140 J8499 CHOLECALCIFEROL (VITAMIN D3) 400 UNIT TABLET 1.00$ 1.00$

16729004201 J7507 TACROLIMUS 1 MG CAPSULE 59.00$ 59.00$

00069582043 J8499 DOFETILIDE 500 MCG CAPSULE 475.07$ 475.07$

00781323394 J9070 CYCLOPHOSPHAMIDE 500 MG INTRAVENOUS SOLUTION 1,330.45$ 1,330.45$

50268032311 J8499 FINASTERIDE 5 MG TABLET 1.00$ 1.00$



64980025901 J3490 GLYCOPYRROLATE 2 MG TABLET 59.00$ 59.00$

39822120101 J3490

NEOMYCIN 40 MG‐POLYMYXIN B 200,000 UNIT/ML GU

IRRIGATION SOLUTION 423.99$ 423.99$

51991079406 J3490 RIVASTIGMINE 3 MG CAPSULE 4.02$ 4.02$

00904635861 J8499 RISPERIDONE 0.5 MG TABLET 1.00$ 1.00$

63323028720 J2795

ROPIVACAINE (PF) 7.5 MG/ML (0.75 %) INJECTION

SOLUTION 290.62$ 290.62$

68084046111 J8499 ZIDOVUDINE 100 MG CAPSULE 150.45$ 150.45$

78112069480 J3490 PHENOL 1.4 % MUCOSAL AEROSOL SPRAY 85.43$ 85.43$

00169008281 J8499 REPAGLINIDE 1 MG TABLET 8.29$ 8.29$

00046074905 J1410

CONJUGATED ESTROGENS 25 MG SOLUTION FOR

INJECTION 11,185.99$ 11,185.99$

00046110081 J8499 CONJUGATED ESTROGENS 0.3 MG TABLET 7.03$ 7.03$


00009085605 J3490

CARBOPROST TROMETHAMINE 250 MCG/ML


24208029525 J3490

TOBRAMYCIN 0.3 %‐DEXAMETHASONE 0.1 % EYE

DROPS,SUSPENSION 1,335.73$ 1,335.73$

00378551093 J8499 OLANZAPINE 5 MG DISINTEGRATING TABLET 73.04$ 73.04$

63323042405 J3490 FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION 255.09$ 255.09$

00143978401 J3490 FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION 157.49$ 157.49$

00574416035 J3490

NEOMYCIN 3.5 MG/G‐POLYMYXIN B 10,000 UNIT/G‐

DEXAMETH 0.1 % EYE OINT 336.87$ 336.87$

54766014923 J0630 CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION 138.00$ 138.00$

67457067502 J0630 CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION 101,874.65$ 101,874.65$

55513019001 J2505 PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE 27,791.22$ 27,791.22$

53489037601 J8499 TRIMETHOBENZAMIDE 300 MG CAPSULE 116.20$ 116.20$

36000000824 J0744



00781323946 J0744



00006384371 J1335 ERTAPENEM 1 GRAM SOLUTION FOR INJECTION 5,027.81$ 5,027.81$

54162060002 J3490 WHITE PETROLATUM‐MINERAL OIL TOPICAL CREAM 157.89$ 157.89$

32909072301 J8499

BARIUM SULFATE 2.1 % (W/V), 2.0 % (W/W) ORAL

SUSPENSION 232.79$ 232.79$

00436093616 J3490 SODIUM HYPOCHLORITE 0.25 % SOLUTION 547.59$ 547.59$

00436094616 J3490 SODIUM HYPOCHLORITE 0.5 % SOLUTION 547.59$ 547.59$

11845014770 J8499 CHOLECALCIFEROL (VITAMIN D3) 1,000 UNIT CAPSULE 1.00$ 1.00$

65597010330 J8499 OLMESARTAN 20 MG TABLET 9.17$ 9.17$

00310072010 J9395 FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE 5,046.97$ 5,046.97$

00548563100 J1650 ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE 138.00$ 138.00$



00548563500 J1650 ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE 480.52$ 480.52$


00378092493 J8499 BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET 102.78$ 102.78$

51079016501 J8499 VORICONAZOLE 200 MG TABLET 1,164.65$ 1,164.65$

00904647104 J8499 VORICONAZOLE 200 MG TABLET 794.35$ 794.35$

00781341694 J3465 VORICONAZOLE 200 MG INTRAVENOUS SOLUTION 1,458.04$ 1,458.04$

25021030167 J0153 ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE 356.17$ 356.17$

63851050102 90675

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5

UNIT IM SUSP 11,831.89$ 11,831.89$

58160096412 90675

RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5

UNIT IM SUSP 12,033.49$ 12,033.49$

00006483701 90732

PNEUMOCOCCAL 23 POLYVALENT VACCINE 25 MCG/0.5

ML INJECTION SYRINGE 3,455.24$ 3,455.24$

00409751716 J3490 DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SYRINGE 287.43$ 287.43$

00009514001 J2020

LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML

INTRAVENOUS PIGGYBACK 1,292.77$ 1,292.77$

00409127332 J3360 DIAZEPAM 5 MG/ML INJECTION SYRINGE 981.80$ 981.80$

13533063120 J2790

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)


00409198530 J2060 LORAZEPAM 2 MG/ML INJECTION SYRINGE 138.00$ 138.00$


60793070102 J0561

PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML


60793060102 J0558

PENICILLIN G BENZATHINE AND PROCAINE 1,200,000

UNIT/2 ML IM SYRINGE 4,726.77$ 4,726.77$

59762453802 J1050

MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR

SYRINGE 3,312.97$ 3,312.97$

00409178269 J2310 NALOXONE 0.4 MG/ML INJECTION SYRINGE 554.01$ 554.01$

00904642661 J8499 ESCITALOPRAM 10 MG TABLET 1.00$ 1.00$

43547036703 J8499 VALSARTAN 40 MG TABLET 1.00$ 1.00$

59762171002 J8499 EPLERENONE 25 MG TABLET 5.80$ 5.80$

66582041431 J8499 EZETIMIBE 10 MG TABLET 496.23$ 496.23$

00173071204 J8499 DUTASTERIDE 0.5 MG CAPSULE 8.33$ 8.33$

61553019648 J2250

MIDAZOLAM 1 MG/ML IN 0.9 % SODIUM CHLORIDE

INTRAVENOUS 1,173.01$ 1,173.01$

70004041132 J2250

MIDAZOLAM 1 MG/ML IN 0.9 % SODIUM CHLORIDE

INTRAVENOUS 1,133.09$ 1,133.09$

16729028110 J8499 ARIPIPRAZOLE 15 MG TABLET 1.00$ 1.00$




00378047201 J8499 DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR 1.90$ 1.90$

00023916330 J3490 CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE 366.14$ 366.14$

00075062603 J1650 ENOXAPARIN 300 MG/3 ML SUBCUTANEOUS SOLUTION 2,127.86$ 2,127.86$

25021080166 J3489 ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION 281.47$ 281.47$

00187099445 J3490 ACYCLOVIR 5 % TOPICAL CREAM 30,019.05$ 30,019.05$

63020004901 J9041 BORTEZOMIB 3.5 MG SOLUTION FOR INJECTION 8,688.26$ 8,688.26$

00781334246 J1956

LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE


00781334355 J1956



00781334152 J1956



44567043524 J1956



00409174910 J3490

BUPIVACAINE‐EPINEPHRINE (PF) 0.5 %‐1:200,000


00409904517 J3490



00409904201 J3490



63323046837 J3490



00409925739 J3480


CHLORIDE INTRAVENOUS SOLN 313.00$ 313.00$

50323000603 J3490 PHENYLEPHRINE 0.5 % NASAL SPRAY 1,234.73$ 1,234.73$

69536005015 J3490 PHENYLEPHRINE 0.5 % NASAL SPRAY 153.90$ 153.90$

68455010763 J3490 ZINC OXIDE 3" X 10 YARD BANDAGE 532.98$ 532.98$

08080431302 J3490 BISMUTH TRIBROM‐PETROLATUM,WH 1" X 8" BANDAGE 59.00$ 59.00$



00065853302 J3490

CIPROFLOXACIN 0.3 %‐DEXAMETHASONE 0.1 % EAR


62856079701 J2469 PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION 4,652.68$ 4,652.68$

00781331275 J2469 PALONOSETRON 0.25 MG/5 ML INTRAVENOUS SOLUTION 4,258.67$ 4,258.67$

00310075590 J8499 ROSUVASTATIN 5 MG TABLET 11.41$ 11.41$

42023016801 J0171 EPINEPHRINE 1 MG/ML INJECTION SOLUTION 7,160.46$ 7,160.46$

61703033950 J9045 CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION 182.69$ 182.69$

67919001101 J0878 DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION 16,968.96$ 16,968.96$

00703012501 J0878 DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION 7,464.40$ 7,464.40$

00591387045 J8499 MEMANTINE 5 MG TABLET 1.00$ 1.00$

00904634061 J8499 METOPROLOL TARTRATE 25 MG TABLET 1.00$ 1.00$

66689002301 J3490

HYDROCODONE 7.5 MG‐ACETAMINOPHEN 325 MG/15 ML


50242006001 J9035 BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION 4,319.42$ 4,319.42$

50242006101 J9035 BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION 16,856.20$ 16,856.20$

51079062182 J3490

TRYPSIN‐BALSAM‐CASTOR OIL 0.12 MG‐87 MG/GRAM

TOPICAL SPRAY 353.11$ 353.11$

00781315972 J3490 OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION 866.67$ 866.67$

00517095501 J3490 OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION 906.99$ 906.99$

00597007575 J3490

TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH

INHALATION DEVICE 273.76$ 273.76$

00065079515 J3490

BALANCED SALT SOLUTION COMBINATION NO.2

INTRAOCULAR IRRIGATION 109.59$ 109.59$

00713010109 J8499 GLYCERIN (ADULT) RECTAL SUPPOSITORY 59.00$ 59.00$

00143974601 J3105 TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION 138.00$ 138.00$

00574080530 J0132

ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS

SOLUTION 6,498.74$ 6,498.74$

00781325394 J9025 AZACITIDINE 100 MG SOLUTION FOR INJECTION 11,523.87$ 11,523.87$



00487590199 J3490 RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION 115.77$ 115.77$

00487990130 J7611

ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML

SOLUTION FOR NEBULIZATION 59.00$ 59.00$

00574012074 J3490

ACTIVATED CHARCOAL‐SORBITOL 25 GRAM/120 ML ORAL

SUSPENSION 536.53$ 536.53$

00574012174 J3490

ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL

SUSPENSION 536.53$ 536.53$

51079034801 J8499

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100

MG CAPSULE 214.54$ 214.54$

68180013415 J8499 CALCIUM ACETATE 667 MG CAPSULE 1.00$ 1.00$

63402051530 J3490

LEVALBUTEROL CONCENTRATE 1.25 MG/0.5 ML SOLUTION

FOR NEBULIZATION 321.25$ 321.25$

00574014560 J3490 TROSPIUM 20 MG TABLET 59.00$ 59.00$

68084067511 J8499 DULOXETINE 20 MG CAPSULE,DELAYED RELEASE 1.24$ 1.24$



59584013801 J3490

CANDIDA ALBICANS SKIN TEST FDA STANDARD

INTRADERMAL 7,236.30$ 7,236.30$

00386000803 J3490 NORFLURANE‐PENTAFLUOROPROPANE TOPICAL SPRAY 1,111.44$ 1,111.44$

55111067911 J1652

FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION

SYRINGE 1,217.37$ 1,217.37$

00169720501 J7189

COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG)


51552032302 J3490 TETRACAINE (BULK) 100 % WAX 685.65$ 685.65$

50383079516 J8499 LACTULOSE 10 GRAM/15 ML ORAL SOLUTION 6.58$ 6.58$

64406000801 J2323 NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION 33,495.60$ 33,495.60$

51248015001 J8499 SOLIFENACIN 5 MG TABLET 15.01$ 15.01$

61553073503 J7999

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE


70004008544 J7999



24208035805 J3490

TOBRAMYCIN 0.3 %‐LOTEPRED 0.5 % EYE


68817013450 J9264

PACLITAXEL‐PROTEIN BOUND 100 MG INTRAVENOUS

SUSPENSION 7,035.82$ 7,035.82$

58281056201 J0476 BACLOFEN 50 MCG/ML INTRATHECAL SOLUTION 3,093.16$ 3,093.16$

99999003194 J3535

IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA

AEROSOL INHALER 1,750.57$ 1,750.57$


68180036309 J8499 FENOFIBRATE 160 MG TABLET 59.00$ 59.00$

68084032811 J8499 FENOFIBRATE 160 MG TABLET 136.71$ 136.71$

00703398501 J9263

OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS

SOLUTION 165.21$ 165.21$

00703398601 J9263 OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION 330.52$ 330.52$

63739029101 J8499

CALCIUM CARBONATE 500 MG (1,250 MG)‐VITAMIN D3

200 UNIT TABLET 1.00$ 1.00$

68084086911 J8499 SILDENAFIL (ANTIHYPERTENSIVE) 20 MG TABLET 59.00$ 59.00$

68084086921 J8499 SILDENAFIL (ANTIHYPERTENSIVE) 20 MG TABLET 59.00$ 59.00$

00071101268 J8499 PREGABALIN 25 MG CAPSULE 9.76$ 9.76$



49884001908 J3490 OMEGA‐3 ACID ETHYL ESTERS 1 GRAM CAPSULE 2.88$ 2.88$

61553066976 J7999

FENTANYL (PF) 1,100 MCG/55 ML (20 MCG/ML) IN 0.9 %

NACL PCA SYRINGE 565.43$ 565.43$

63256020005 J3490 STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION 4,291.40$ 4,291.40$

00116200116 J3490 CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH 134.30$ 134.30$

99999000515 J3490 CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH 59.00$ 59.00$

00409464601 J3490 PANCURONIUM 1 MG/ML INTRAVENOUS SOLUTION 169.66$ 169.66$

00409117630 J2175 MEPERIDINE (PF) 25 MG/ML INJECTION SYRINGE 213.70$ 213.70$

00409117830 J2175 MEPERIDINE (PF) 50 MG/ML INJECTION SYRINGE 220.84$ 220.84$

00904188261 J8499

CALCIUM CARBONATE‐VITAMIN D3 250 MG‐125 UNIT

TABLET 1.00$ 1.00$

54092025410 J8499 LANTHANUM 1,000 MG CHEWABLE TABLET 518.17$ 518.17$

61553076904 J2590

OXYTOCIN IN LACTATED RINGERS 20 UNIT/1,000 ML


70004008346 J2590

OXYTOCIN IN LACTATED RINGERS 20 UNIT/1,000 ML


00270141125 Q9966 IOPAMIDOL 41 % INTRATHECAL SOLUTION 779.24$ 779.24$

00270141111 Q9966 IOPAMIDOL 41 % INTRATHECAL SOLUTION 568.86$ 568.86$

59148000613 J8499 ARIPIPRAZOLE 2 MG TABLET 1,283.08$ 1,283.08$

00003218710 J0129

ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS

SOLUTION 5,528.89$ 5,528.89$

25021082273 J1740 IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE 665.20$ 665.20$

61958100301 J8499 RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR 7.81$ 7.81$

64764024060 J3490 LUBIPROSTONE 24 MCG CAPSULE 299.06$ 299.06$

00264958720 J1644

HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN

DEXTROSE 5 % IV 508.34$ 508.34$

63807060055 J1642

HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS

SYRINGE 138.00$ 138.00$

08290306512 J1642

HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS

SYRINGE 138.00$ 138.00$

00409131632 J1644

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION

SYRINGE 138.00$ 138.00$

18657010201 J3473

HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML


18657011701 J3473



18657011702 J3473



53270005201 J1571

HEPATITIS B IMMUNE GLOBULIN‐MALTOSE >312 UNIT/ML


63323049257 J3490 LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION 138.00$ 138.00$








63323049527 LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION 138.00$ 138.00$

00409132305 J3490

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS

SYRINGE 138.00$ 138.00$

71019017316 J3490

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS

SYRINGE 177.65$ 177.65$

00338040903 J2001

LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE


00069046911 J8499 VARENICLINE 1 MG TABLET 14.61$ 14.61$

00006046401 J8501 APREPITANT 40 MG CAPSULE 5,091.64$ 5,091.64$

00781232106 J8501 APREPITANT 40 MG CAPSULE 3,011.38$ 3,011.38$

60258017201 J8499

MAGNESIUM GLUCONATE 27 MG MAGNESIUM (500 MG)

TABLET 1.00$ 1.00$

55513002801 J0882

DARBEPOETIN ALFA 200 MCG/0.4 ML IN POLYSORBATE

INJECTION SYRINGE 7,853.21$ 7,853.21$

55513005704 J0882


INJECTION SYRINGE 981.65$ 981.65$

55513011101 J0882



55513002304 J0882



55513002504 J0882



00409188602 J1953 LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION 302.00$ 302.00$

55150017705 J1953 LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION 302.00$ 302.00$

00731040106 J8499 ZINC SULFATE 220 MG (50 MG) CAPSULE 1.00$ 1.00$

00006011231 J8499 SITAGLIPTIN 50 MG TABLET 18.80$ 18.80$

55150012502 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION 138.00$ 138.00$

00409475518 J2405 ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION 138.00$ 138.00$

00574050811 J8499 FERROUS GLUCONATE 324 MG (38 MG IRON) TABLET 1.00$ 1.00$

63323050601 J1100

DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML


12870000101 J3490 SILVER NITRATE APPLICATORS 75 %‐25 % TOPICAL STICK 59.00$ 59.00$

16729018201 J8499 HYDROCHLOROTHIAZIDE 12.5 MG TABLET 1.00$ 1.00$

63736020418 J8499 PHENOL 14.5 MG LOZENGES 1.00$ 1.00$

00132020220 J8499 SODIUM PHOSPHATES 9.5 GRAM‐3.5 GRAM/59 ML ENEMA 60.60$ 60.60$

32909016802 J8499

BARIUM SULFATE 105 % (W/V), 58 % (W/W) ORAL

SUSPENSION 607.95$ 607.95$

32909076401 J8499 BARIUM SULFATE 98 % ORAL POWDER FOR SUSPENSION 167.51$ 167.51$

58160082052 90744

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML

IM SYRINGE 640.48$ 640.48$

58160082043 90744

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML

IM SYRINGE 640.48$ 640.48$

00186037220 J3535

BUDESONIDE‐FORMOTEROL HFA 80 MCG‐4.5

MCG/ACTUATION AEROSOL INHALER 1,352.65$ 1,352.65$

00186037020 J3535

BUDESONIDE‐FORMOTEROL HFA 160 MCG‐4.5

MCG/ACTUATION AEROSOL INHALER 1,546.12$ 1,546.12$

54162010002 J3490

BENZOIN‐ALOE VERA‐STORAX‐TOLU BALSAM 10 %‐2 %‐8 %‐

4 % TOPICAL TINCTURE 134.30$ 134.30$

17478054005 J1170 HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION 223.16$ 223.16$

00078050115 J3490 RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH 28.03$ 28.03$

00078050215 J8499 RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH 921.66$ 921.66$

61553068176 J7999

HYDROMORPHONE 11 MG/55 ML IN 0.9 % SODIUM

CHLORIDE PCA SYRINGE 523.71$ 523.71$

70004030023 J7999

HYDROMORPHONE 11 MG/55 ML IN 0.9 % SODIUM

CHLORIDE PCA SYRINGE 526.31$ 526.31$

00395041396 J3490 CALAMINE 8 %‐ZINC OXIDE 8 % LOTION 148.39$ 148.39$

63323017302 J1580

GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML


00536108691 J3490

WHITE PETROLATUM‐MINERAL OIL 83 %‐15 % EYE

OINTMENT 101.86$ 101.86$

00006022761 J8499 RALTEGRAVIR 400 MG TABLET 1,114.19$ 1,114.19$

63323073912 J3490 FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00641602201 J3490 FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION 138.00$ 138.00$

60258000601 J8499

POTASSIUM, SODIUM PHOSPHATES 280 MG‐160 MG‐250

MG ORAL POWDER PACKET 59.00$ 59.00$

00409672723 J3475

MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 %


00409672909 J3475

MAGNESIUM SULFATE 40 GRAM/1,000 ML (4 %) IN WATER


00456140230 J3490 NEBIVOLOL 2.5 MG TABLET 5.73$ 5.73$

00456141030 J8499 NEBIVOLOL 10 MG TABLET 5.73$ 5.73$

63323031801 J1626

GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS

SOLUTION 175.25$ 175.25$

67457086301 J1626

GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS

SOLUTION 478.65$ 478.65$

00904646707 J8499 CLOPIDOGREL 300 MG TABLET 404.31$ 404.31$

17478054602 J1626

GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS

SOLUTION 138.00$ 138.00$

00338064406 J3490

PARENTERAL AMINO ACID 10 % COMBINATION NO.6


65293000641 C9399

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL

SOLUTION 2,246.19$ 2,246.19$

43825060641 C9399

THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL

SOLUTION 2,783.29$ 2,783.29$

00703443411 J9206 IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00703443211 J9206 IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00008084402 J8499

PANTOPRAZOLE DR 40 MG GRANULES DELAYED‐RELEASE

FOR SUSP IN PACKET 619.15$ 619.15$

66689003601 J3490 PHENYTOIN 100 MG/4 ML ORAL SUSPENSION 241.28$ 241.28$

00006468101 90707

MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000‐

12,500TCID50/0.5 ML SUBCUT 2,548.46$ 2,548.46$

49281040015 90715

DIPHTH,PERTUS(AC)TETANUS(PF)2 LF‐(2.5‐5‐3‐5MCG)‐5

LF/0.5 ML IM SYRINGE 1,323.43$ 1,323.43$

13811000710 J8499

PRENATAL VIT,CALCIUM 27‐FERROUS FUM 60 MG IRON‐

FOLIC ACID 1 MG TABLET 1.00$ 1.00$

13533063402 J1670

TETANUS IMMUNE GLOBULIN (PF) 250 UNIT


65649055102 J2212

METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS

SOLUTION 4,107.77$ 4,107.77$

00409104130 J0670 MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION 200.00$ 200.00$

00469650189 J2785 REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE 8,308.16$ 8,308.16$

52544018976 J3315

TRIPTORELIN PAMOATE 3.75 MG/2 ML INTRAMUSCULAR

SYRINGE 3,235.09$ 3,235.09$

00409277623 J2260

MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 %

DEXTROSE INTRAVENOUS PIGGYBK 327.35$ 327.35$

63323011720 J9190 FLUOROURACIL 1 GRAM/20 ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00703301911 J9190 FLUOROURACIL 5 GRAM/100 ML INTRAVENOUS SOLUTION 138.00$ 138.00$

00409762013 J1644

HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 %


67919002010 J8499 ALVIMOPAN 12 MG CAPSULE 7,193.39$ 7,193.39$

25021020405 J9390 VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION 199.30$ 199.30$

67457017750 J1212 DIMETHYL SULFOXIDE 50 % INTRAVESICAL SOLUTION 3,266.37$ 3,266.37$

76329301305 J8499 LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR 223.16$ 223.16$

61703030916 J9370 VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION 561.44$ 561.44$

39822200001 J0735

CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML)

EPIDURAL SOLUTION 414.77$ 414.77$

00023391950 J0585

ONABOTULINUMTOXINA 50 UNIT INTRAMUSCULAR

SOLUTION 13,213.52$ 13,213.52$

00338100702 J1265

DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 %

DEXTROSE INTRAVENOUS SOLN 668.02$ 668.02$

66733094823 J9055 CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION 3,205.12$ 3,205.12$

66733095823 J9055 CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION 6,410.24$ 6,410.24$

61553061975 J7999

MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM

CHLORIDE IV PCA SYRINGE 691.98$ 691.98$

70004010022 J7999

MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM

CHLORIDE IV PCA SYRINGE 480.40$ 480.40$

00517481025 J3490

NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS

SOLUTION 334.14$ 334.14$

00121479905 J8499 LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION 221.49$ 221.49$

52544015130 J3490 SILODOSIN 4 MG CAPSULE 358.60$ 358.60$

55566830301 J9155 DEGARELIX 80 MG SUBCUTANEOUS SOLUTION 1,549.64$ 1,549.64$

55566840301 J9155 DEGARELIX 120 MG SUBCUTANEOUS SOLUTION 2,417.79$ 2,417.79$

00131247935 J8499 LACOSAMIDE 150 MG TABLET 615.31$ 615.31$


00904549261 J3490

MULTIVITAMIN‐IRON 9 MG‐FOLIC ACID 400 MCG‐CALCIUM

AND MINERALS TABLET 1.00$ 1.00$

59148002050 J8499 TOLVAPTAN 15 MG TABLET 596.77$ 596.77$

00032121201 J8499

LIPASE‐PROTEASE‐AMYLASE 12,000‐38,000‐60,000 UNIT

CAPSULE,DELAYED REL 3.85$ 3.85$

00032122401 J8499

LIPASE‐PROTEASE‐AMYLASE 24,000‐76,000‐120,000 UNIT

CAPSULE,DELAYED REL 7.62$ 7.62$

59338077501 Q0139

FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS

SOLUTION 4,008.92$ 4,008.92$

00024414260 J8499 DRONEDARONE 400 MG TABLET 444.53$ 444.53$

00574030216 J3490 COMPOUNDING VEHICLE SUGAR‐FREE NO.9 ORAL LIQUID 735.11$ 735.11$

00002512330 J8499 PRASUGREL 10 MG TABLET 660.29$ 660.29$

43386062230 J8499 LEVONORGESTREL 1.5 MG TABLET 12.39$ 12.39$

68382042202 J2780

RANITIDINE 50 MG/2 ML (25 MG/ML) INJECTION

SOLUTION 342.76$ 342.76$

00456045901 J8499 THYROID (PORK) 60 MG TABLET 64.87$ 64.87$

48818000101 J9307

PRALATREXATE 20 MG/ML (1 ML) INTRAVENOUS

SOLUTION 25,360.18$ 25,360.18$

00121065711 J8499 ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLUTION 59.00$ 59.00$

50242013501 J3262

TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS

SOLUTION 2,202.58$ 2,202.58$

00009003930 J2920

METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML

SOLUTION FOR INJECTION 183.56$ 183.56$

00009004725 J2930

METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML


00004003909 J8499 VALGANCICLOVIR 50 MG/ML ORAL SOLUTION 40,332.30$ 40,332.30$

59572098301 J9315 ROMIDEPSIN 10 MG/2 ML INTRAVENOUS SOLUTION 15,865.48$ 15,865.48$

54838001070 J3490

MULTIVIT AND MINERALS‐FERROUS GLUCONATE 9 MG

IRON/15 ML ORAL LIQUID 257.47$ 257.47$

99999002964 J3490



00005434462



00009001612 J1720

HYDROCORTISONE SOD SUCCINATE (PF) 500 MG/4 ML


00009001305 J1720



00009001103 J1720



00009000501 J1720

HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML


65649030303 J8499 RIFAXIMIN 550 MG TABLET 1,525.39$ 1,525.39$

00574704512 J3490

BELLADONNA ALKALOIDS‐OPIUM 16.2 MG‐30 MG RECTAL

SUPPOSITORY 736.29$ 736.29$

50383018902 J3490 GATIFLOXACIN 0.5 % EYE DROPS 2,502.59$ 2,502.59$

55513071001 J0897 DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE 8,101.08$ 8,101.08$

00597005345 J1610

GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION

FOR INJECTION 3,995.00$ 3,995.00$

52268001201 J3490

SODIUM,POTASSIUM,MAG SULFATES 17.5 GRAM‐3.13

GRAM‐1.6 GRAM ORAL SOLN 2,642.63$ 2,642.63$

00597013560 J8499 DABIGATRAN ETEXILATE 150 MG CAPSULE 293.47$ 293.47$



00006394132 J1453 FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION 11,658.24$ 11,658.24$

62856038901 J9179

ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS

SOLUTION 44,550.72$ 44,550.72$

55513073001 J0897

DENOSUMAB 120 MG/1.7 ML (70 MG/ML)

SUBCUTANEOUS SOLUTION 11,345.58$ 11,345.58$

13533080071 J1561

IMMUNE GLOB G 10 GRAM/100 ML(10%)‐GLY‐IGA AVE 46

MCG/ML INJECTION SOLN 4,458.50$ 4,458.50$

13533080072 J1561



13533080024 J1561



43825010201 J0131

ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML)


00536348108 J3490

FERROUS SULFATE ER 140 MG (45 MG IRON)

TABLET,EXTENDED RELEASE 1.00$ 1.00$

52015008001 J8499 FIDAXOMICIN 200 MG TABLET 3,892.53$ 3,892.53$

00074364203 J9217 LEUPROLIDE 7.5 MG INTRAMUSCULAR SYRINGE KIT 7,449.79$ 7,449.79$

00409724101 J0171 EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION 302.00$ 302.00$

50458058030 J8499 RIVAROXABAN 10 MG TABLET 13.75$ 13.75$

00004082205 J8499 OSELTAMIVIR 6 MG/ML ORAL SUSPENSION 6,554.82$ 6,554.82$

99999003243 J8499 OSELTAMIVIR 6 MG/ML ORAL SUSPENSION 546.24$ 546.24$

00186077760 J8499 TICAGRELOR 90 MG TABLET 285.86$ 285.86$

63323028620 J2795 ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION 203.60$ 203.60$

63323028631 J2795 ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION 306.59$ 306.59$

00904625549 J3490 BENZOCAINE‐MENTHOL 15 MG‐3.6 MG LOZENGES 1.00$ 1.00$

51144005001 J9042 BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION 35,636.50$ 35,636.50$

11704037001 J3490 HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION 30,954.37$ 30,954.37$

23155029431 J0780

PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML)


38341010677 J3490 BENZOCAINE 20 % MUCOSAL PASTE 59.00$ 59.00$

65250026620 C9290

BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML)

SUSPENSION FOR INFILTRATION 12,574.80$ 12,574.80$

00409018101 J9201

GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML)


00409018301 J9201

GEMCITABINE 200 MG/5.26 ML (38 MG/ML)




00409233934 J3490

LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS

SYRINGE 242.72$ 242.72$

42192060510 J3490

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML)


00013111401 J3490

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML)


63323064907 J3490 LEVOTHYROXINE 100 MCG INTRAVENOUS SOLUTION 3,978.03$ 3,978.03$




68094019359 J3490

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML)


16500002324 J3490

CALCIUM ACETATE‐ALUMINUM 952 MG‐1,347 MG

TOPICAL POWDER IN PACKET 59.00$ 59.00$

50242014501 J9306

PERTUZUMAB 420 MG/14 ML (30 MG/ML) INTRAVENOUS

SOLUTION 25,608.52$ 25,608.52$

16729026765 J9171

DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS

SOLUTION 996.55$ 996.55$

68094075401 J2270

MORPHINE CONCENTRATE 20 MG/ML ORAL SYRINGE (FOR

ORAL USE ONLY) 119.61$ 119.61$

76075010101 J9047 CARFILZOMIB 60 MG INTRAVENOUS SOLUTION 10,685.53$ 10,685.53$

84521000686 J3490 WHITE PETROLATUM TOPICAL OINTMENT IN PACKET 1.00$ 1.00$

00409490034 J3490

SODIUM BICARBONATE 10 MEQ/10 ML (8.4 %)

INTRAVENOUS SYRINGE 416.77$ 416.77$

50383031105 J8499 GABAPENTIN 250 MG/5 ML (5 ML) ORAL SOLUTION 89.44$ 89.44$

00409189001 J2270 MORPHINE 2 MG/ML INTRAVENOUS CARTRIDGE 138.00$ 138.00$



54643564901 J3490

MVI,ADULT NO.4 WITH VIT K 3300 UNIT‐150 MCG/10 ML


00536853080 J3490

PEDI MULTIVIT NO.46 1,500 UNIT‐400 UNIT‐IRON 10

MG/ML ORAL DROPS 176.82$ 176.82$

66689002001 J8499 MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION 193.57$ 193.57$

00121050405 J8499

ACETAMINOPHEN 120 MG‐CODEINE 12 MG/5 ML (5 ML)


00003089321 J8499 APIXABAN 2.5 MG TABLET 255.81$ 255.81$

00003089431 J8499 APIXABAN 5 MG TABLET 255.81$ 255.81$

52544093107 J1750 IRON DEXTRAN 50 MG/ML INJECTION SOLUTION 1,175.81$ 1,175.81$

00023585318 J3490

MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE

TABLETS INSIDE) 207.53$ 207.53$

50242008701 J9354

ADO‐TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS

SOLUTION 24,779.32$ 24,779.32$

10119000252 J3490

SODIUM BORATE‐BORIC ACID‐SODIUM CHLORIDE‐WATER

EYE WASH SOLN 146.03$ 146.03$

00409166010 J3490

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9

% SODIUM CHLORIDE IV 3,013.96$ 3,013.96$

63323014397 J3490

TRACE ELEMENTS #1 5.33 MCG‐0.34 MG‐0.54 MG/ML


49100036374 J3490

LACTOBACILLUS RHAMNOSUS GG 15 BILLION CELL

SPRINKLE CAPSULE 59.00$ 59.00$

25021083082 J3489

ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %‐WATER

INTRAVENOUS PIGGYBCK 665.04$ 665.04$

00409422801 J3489



55111068852 J3489



64764058030 J3490 VORTIOXETINE 20 MG TABLET 484.76$ 484.76$

25021082682 J3489

ZOLEDRONIC ACID 4 MG/100 ML‐MANNITOL‐0.9 % NACL


76014000333 J2710

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS

SOLUTION 1,729.74$ 1,729.74$

00573287110 J3490

PHENYLEPHRINE 0.25 %‐MINERAL OIL 14 %‐PETROLATM

74.9 % RECTAL OINTMENT 267.15$ 267.15$

63402030630 J8499 LURASIDONE 60 MG TABLET 1,724.64$ 1,724.64$

00409230801 J2250 MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION 138.00$ 138.00$


63459091012 J1447

TBO‐FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS

SYRINGE 1,201.56$ 1,201.56$

63459091211 J1447


SYRINGE 1,923.02$ 1,923.02$

63459091212 J1447


SYRINGE 1,923.02$ 1,923.02$

00409189011 J2270 MORPHINE 2 MG/ML INTRAVENOUS SYRINGE 138.00$ 138.00$

63824000815 J3490

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12

HR 59.00$ 59.00$

63459039602 J9033 BENDAMUSTINE 180 MG/2 ML INTRAVENOUS SOLUTION 23,027.31$ 23,027.31$

42023016401 C9399 VASOPRESSIN 20 UNIT/ML INTRAVENOUS SOLUTION 5,735.43$ 5,735.43$

00003377412 J9299 NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION 14,211.68$ 14,211.68$

59011041020 J8499

OXYCODONE ER 10 MG TABLET,CRUSH

RESISTANT,EXTENDED RELEASE 12 HR 185.69$ 185.69$

59011042020 J8499



59011044020 J8499



65597020330 J8499 EDOXABAN 60 MG TABLET 363.17$ 363.17$

00078064781 J2353

OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR

SUSP, EXTENDED RELEASE 4,165.22$ 4,165.22$

00078081881 J2353



00078064881 J2353



00078082581 J2353



68982084003 J1568

IMMUNE GLOB,GAMM(IGG) 5 %‐MALT‐IGA OVER 50

MCG/ML INTRAVENOUS SOLUTION 2,113.80$ 2,113.80$

68982084004 J1568

IMMUNE GLOB,GAMM(IGG) 5 %‐MALT‐IGA OVER 50


00078077720 J3490 SACUBITRIL 49 MG‐VALSARTAN 51 MG TABLET 329.89$ 329.89$

00186077660 J8499 TICAGRELOR 60 MG TABLET 285.86$ 285.86$

00597019705 C9399

IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS

SOLUTION 69,860.00$ 69,860.00$

57894050205 J9145 DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION 2,570.01$ 2,570.01$

57894050220 J9145 DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION 10,280.01$ 10,280.01$

00003229111 J9176 ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION 9,770.31$ 9,770.31$

00003452211 J9176 ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION 13,027.08$ 13,027.08$

36652026769 J3490

FERROUS FUMARATE 200 MG (65 MG IRON)‐VIT C 25 MG

TABLET,EXTEND RELEASE 59.00$ 59.00$

00338001718 D5W 100ML ‐$ ‐$

00264780010 J3490 NACL 0.9% 500ML 313.50$ 313.50$

00264780020 J7050 NACL 0.9% 250ML CARRIER ‐$ ‐$

00409798353 NACL 0.9% 250ML CARRIER ‐$ ‐$

00338004941 J7050 NACL 0.9% 50ML ‐$ ‐$

00169720801 J7189



43547027010 J8499 ROPINIROLE 1 MG TABLET 1.00$ 1.00$

00338005403 J7131

SODIUM CHLORIDE 3 % INTRAVENOUS INJECTION

SOLUTION 316.50$ 316.50$

59310057922 J3535 ALBUTEROL INHALER (BEDSIDE USE) 395.51$ 395.51$

59310020412 J3535

BECLOMETHASONE DIPROPIONATE 80 MCG INHALER

(BEDSIDE USE) 1,504.91$ 1,504.91$

00597008717 J3535 IPRATROPIUM INHALER (BEDSIDE USE) 2,459.62$ 2,459.62$

00574030316 J3490

COMPOUNDING VEHICLE SUSPENSION SUGAR‐FREE NO.20

ORAL 1.00$ 1.00$

61958070101 J8499

EMTRICITABINE 200 MG‐TENOFOVIR DISOPROXIL

FUMARATE 300 MG TABLET 2,489.51$ 2,489.51$

17478071130 J3490 LIDOCAINE 2 % MUCOSAL JELLY 288.63$ 288.63$

17478071110 J3490 LIDOCAINE 2 % MUCOSAL JELLY 93.82$ 93.82$

00009069801 J2930

METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG


00009075801 J2930

METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG


46287000660 J8499

SODIUM POLYSTYRENE SULFONATE 15 GRAM‐SORBITOL 20

GRAM/60 ML ORAL SUSP 237.13$ 237.13$

46287000601 J8499

SODIUM POLYSTYRENE SULFONATE 15 GRAM‐SORBITOL 20

GRAM/60 ML ORAL SUSP 1,227.35$ 1,227.35$

00068059701 J3490 RIFAMPIN 600 MG INTRAVENOUS SOLUTION 3,304.18$ 3,304.18$

63323035120 J3490 RIFAMPIN 600 MG INTRAVENOUS SOLUTION 5,766.05$ 5,766.05$

70004096686 J3490 LET GEL 263.83$ 263.83$

99999000385 REMOVE NITROGLYCERIN OINTMENT ‐$ ‐$

99999000774 REMOVE RIVASTIGMINE PATCH ‐$ ‐$

99999000380 REMOVE SCOPOLAMINE PATCH ‐$ ‐$

99999000378 REMOVE LIDOCAINE PATCH ‐$ ‐$

99999000375 REMOVE CLONIDINE PATCH ‐$ ‐$

99999000377 REMOVE FENTANYL PATCH ‐$ ‐$

99999000373 REMOVE NITROGLYCERIN PATCH ‐$ ‐$

99999000379 REMOVE NICOTINE PATCH ‐$ ‐$

99999000376 REMOVE ESTRADIOL PATCH ‐$ ‐$

23155029041 J0278 AMIKACIN 500 MG/2 ML INJECTION SOLUTION 392.18$ 392.18$

00409434673 J3490

AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS

SOLUTION 410.54$ 410.54$

63323087715 J2545 PENTAMIDINE 300 MG SOLUTION FOR INHALATION 6,467.60$ 6,467.60$

00517890510 J0210 METHYLDOPATE 250 MG/5 ML INTRAVENOUS SOLUTION 1,629.94$ 1,629.94$

50242008527 J2997 ALTEPLASE 100 MG INTRAVENOUS SOLUTION 45,031.64$ 45,031.64$

00338055311 NACL 0.9% MINI‐BAG PLUS 50 ML ‐$ ‐$

00338055318 NACL 0.9% MINI‐BAG PLUS 100 ML ‐$ ‐$

52268040001 J8499 PEG‐ELECTROLYTE SOLUTION 420 GRAM ORAL SOLUTION 479.04$ 479.04$

00409724813 J3490

HETASTARCH 6 % IN 0.9 % SODIUM CHLORIDE


00006542312 C9399 SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION 3,580.27$ 3,580.27$

00006542302 C9399 SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION 3,580.27$ 3,580.27$

10223020103 J3490

BUTAMBEN‐TETRACAINE‐BENZOCAINE 2 %‐2 %‐14 % (200

MG/SEC) TOPICAL SPRAY 2,073.45$ 2,073.45$

58468004101 J0180 AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION 33,120.19$ 33,120.19$

50242091701 J9022

ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML)


49401010101 J0490 BELIMUMAB 120 MG INTRAVENOUS SOLUTION 20,308.66$ 20,308.66$

63459034804 J9034 BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION 13,072.83$ 13,072.83$

00024582411 J9043

CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS

SOLUTION 221,479.19$ 221,479.19$

38779251008 J3490 COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL 540.53$ 540.53$

25682000101 J1300 ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION 33,891.21$ 33,891.21$

00517065001 J1439

FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS

SOLUTION 4,207.20$ 4,207.20$

57894035001 J1602 GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION 67,619.05$ 67,619.05$


50242007001 J9301

OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS

SOLUTION 32,342.45$ 32,342.45$

00002762301 J9305 PEMETREXED 500 MG INTRAVENOUS SOLUTION 17,875.38$ 17,875.38$

64764030020 J3380 VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION 149,104.96$ 149,104.96$

25021020401 J9390 VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION 524.31$ 524.31$

00409910420 J1265

DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS

SOLUTION 302.00$ 302.00$

00517651025 J3490 SELENIUM 40 MCG/ML INTRAVENOUS SOLUTION 672.26$ 672.26$

00517611025 J3490 ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION 736.13$ 736.13$

99999002967 PATIENT'S OWN MEDICATION WITH COMPOUNDING FEE 179.00$ 179.00$

99999002968 J8499

HYDROCODONE 5 MG‐ACETAMINOPHEN 325 MG STARTER

PACK (FOR ED USE) 59.00$ 59.00$

99999002969 J8499

HYDROCODONE 10 MG‐ACETAMINOPHEN 325 MG

STARTER PACK (FOR ED USE) 59.00$ 59.00$

99999002970 J8499

ACETAMINOPHEN 300 MG‐CODEINE 30 MG STARTER PACK

(FOR ED USE) 59.00$ 59.00$

68094001562 J3490 ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION 84.47$ 84.47$



65862052890 J8499

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24

HR 59.00$ 59.00$

67457019015 J3490

EDROPHONIUM CHLORIDE 10 MG/ML INJECTION

SOLUTION 2,328.74$ 2,328.74$

76014000525 C9399 EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION 847.99$ 847.99$

00517037510 J3490

INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %)


76329630005 J3490 LIDOCAINE 4 % LARYNGOTRACHEAL SOLUTION 724.79$ 724.79$

00407141310 Q9967 IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION 1,604.79$ 1,604.79$

39822017001 J3490

POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR

INJECTION 417.57$ 417.57$

53746025301 J8499 RANITIDINE 150 MG TABLET 59.00$ 59.00$

51645090599 J8499 THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET 1.00$ 1.00$



00270052330 Q9963

IODIPAMIDE AND DIATRIZOATE MEGLUMINE 52.7 %‐26.8

% INJECTION SOLUTION 2,147.30$ 2,147.30$

59310061031 J2786 RESLIZUMAB 10 MG/ML INTRAVENOUS SOLUTION 35,228.76$ 35,228.76$

99999002957 GENTAMICIN RX TO DOSE (CC) ‐$ ‐$

99999002960 TPN RX TO DOSE (CC) ‐$ ‐$

99999002959 VANCOMYCIN RX TO DOSE (CC) ‐$ ‐$

99999002961 WARFARIN RX TO DOSE (CC) ‐$ ‐$

99999002958 TOBRAMYCIN RX TO DOSE (CC) ‐$ ‐$

24208061577 J3490 ACETIC ACID‐ALUMINUM ACETATE 2 % EAR DROPS 1,913.77$ 1,913.77$

84389012178 J3490 OCTYL 2‐CYANOACRYLATE TOPICAL TISSUE ADHESIVE 99.80$ 99.80$

32909018601 J3490 BARIUM SULFATE 60 % (W/V) ORAL SUSPENSION 1,042.19$ 1,042.19$

32909094503 J8499

BARIUM SULFATE 0.1 % (W/V), 0.1 % (W/W) ORAL

SUSPENSION 325.90$ 325.90$

00270111101 A9579

GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION ‐

10 ML VIAL 864.67$ 864.67$

00169720101 J7189



00169720201 J7189





49781010339 J3490 NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE 59.00$ 59.00$

99999000334 J3370 VANCOMYCIN ORAL SOLUTION 50 MG/ML 678.64$ 678.64$

00904655661 J8499 AMIODARONE 200 MG TABLET 59.00$ 59.00$

68585000575 J3490

MAGNESIUM 64 MG (MAGNESIUM CHLORIDE)

TABLET,DELAYED RELEASE 59.00$ 59.00$

00944284310 J7192 ANTIHEMOPHILIC FACTOR VIII (RECOMB) 1 UNIT IV KIT 302.00$ 302.00$

68516320302 J7194 FACTOR IX COMPLEX (HUMAN) 1 UNIT IV SOLR 302.00$ 302.00$

68516320202 J7194 FACTOR IX COMPLEX (HUMAN) 1 UNIT IV SOLR 302.00$ 302.00$

43066015010 J0282

AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE,

ISO‐OSMOTIC IV 1,488.38$ 1,488.38$

61553072548 J7999

AMIODARONE 150 MG/100 ML (1.5 MG/ML) IN DEXTROSE

5 % INTRAVENOUS SOLN 661.64$ 661.64$

71019000601 J7999


5 % INTRAVENOUS SOLN 661.64$ 661.64$

43066036020 J0282

AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE,

ISO‐OSMOTIC IV 1,919.52$ 1,919.52$

61553072111 J7999


5 % INTRAVENOUS SOLN 1,248.46$ 1,248.46$

71019000701 J7999


5 % INTRAVENOUS SOLN 1,248.46$ 1,248.46$

61553008041 J7999 CALCIUM GLUCONATE 1 GRAM/50 ML IN DEXTROSE 5% IV 670.02$ 670.02$



17478012050 J3490



71019005501 J7999

DILTIAZEM 125 MG/125 ML (1 MG/ML) IN DEXTROSE 5 %

IV 1,000.56$ 1,000.56$

71019009201 J7999

FUROSEMIDE 100 MG/100 ML (1 MG/ML) IN 0.9 % SOD

CHLORIDE IV PIGGYBACK 1,674.01$ 1,674.01$

61553072648 J7999

FUROSEMIDE 100 MG/100 ML (1 MG/ML) IN 0.9 % SOD

CHLORIDE IV PIGGYBACK 1,674.01$ 1,674.01$

67457025510 J1953

LEVETIRACETAM 500 MG/100 ML IN SODIUM CHLORIDE

(ISO‐OSM) IV PIGGYBACK 666.03$ 666.03$

67457026510 J1953

LEVETIRACETAM 1,000 MG/100 ML IN SODIUM

CHLORIDE(ISO‐OSM) IV PIGGYBACK 973.41$ 973.41$

10122032510 J3490

NICARDIPINE 40 MG/200 ML IN SODIUM CHLORIDE(ISO)


61553089411 J3490



71019020801 J3490



61553011502 J7999

NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML)

IN DEXTROSE 5 % IV 1,982.19$ 1,982.19$

71019022001 J7999

NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML)

IN DEXTROSE 5 % IV 1,985.38$ 1,985.38$

71019030704 J3490

POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 %

SODIUM CHLORIDE IV SOLN 501.56$ 501.56$

61553029111 J3490

POTASSIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 %

SODIUM CHLORIDE IV SOLN 501.56$ 501.56$

61553071648 J7999

SODIUM PHOSPHATE 7.5 MMOL/100 ML IN 0.9 % SODIUM

CHLORIDE IV SOLUTION 657.65$ 657.65$

71019033901 J7999

SODIUM PHOSPHATE 7.5 MMOL/100 ML IN 0.9 % SODIUM


61553071811 J7999

SODIUM PHOSPHATE 15 MMOL/250 ML IN 0.9 % SODIUM


71019033402 J7999



71019033701


CHLORIDE IV SOLUTION 1,444.87$ 1,444.87$

70004092940 J3370

VANCOMYCIN 750 MG/250 ML IN 0.9 % SODIUM

CHLORIDE INTRAVENOUS SOLUTION 697.96$ 697.96$

71019036003 J3370

VANCOMYCIN 750 MG/250 ML IN 0.9 % SODIUM

CHLORIDE INTRAVENOUS SOLUTION 655.65$ 655.65$

70004092059 J3370

VANCOMYCIN 1 GRAM/250 ML IN 0.9 % SODIUM


71019034804 J3370



70004082359 J3370

VANCOMYCIN 1.25 GRAM/250 ML IN 0.9 % SODIUM


71019035005 J3370



70004092359 J3370



70004092444 J7999


CHLORIDE INTRAVENOUS SOLN 1,025.31$ 1,025.31$

71019035208 J7999


CHLORIDE INTRAVENOUS SOLN 980.20$ 980.20$

70004092644 J3370


CHLORIDE INTRAVENOUS 1,173.01$ 1,173.01$

71019035404 J3370


CHLORIDE INTRAVENOUS 1,035.69$ 1,035.69$

70004092844 J7999


CHLORIDE INTRAVENOUS (IVPB) 1,212.93$ 1,212.93$

71019035603 J7999


CHLORIDE INTRAVENOUS (IVPB) 1,062.43$ 1,062.43$

70004093132 J7999

VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 %

SODIUM CHLORIDE IV 14,128.65$ 14,128.65$

71019036401 J7999

VASOPRESSIN 40 UNIT/100 ML (0.4 UNIT/ML) IN 0.9 %

SODIUM CHLORIDE IV 8,250.83$ 8,250.83$

00713053606 J8499 PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY 227.79$ 227.79$

99999003027 REMOVE LIDOCAINE‐PRILOCAINE (EMLA) CREAM ‐$ ‐$

00006482700 90716

VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML

SUBCUTANEOUS SUSP 4,629.05$ 4,629.05$

00904640506 J8499 AZITHROMYCIN 250 MG TABLET 72.87$ 72.87$

00006382310 J0637 CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION 3,220.51$ 3,220.51$

00574703412 J8499 ASPIRIN 300 MG RECTAL SUPPOSITORY 59.00$ 59.00$

99999998507 OVERFILL VOLUME ‐$ ‐$

71019033201 J7999

SODIUM CITRATE 4 % (3 ML) INTRA‐CATHETER INJECTION

SYRINGE 138.00$ 138.00$

10122051001 J3490

PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL

SUSPENSION 17,530.70$ 17,530.70$

49281040388 90662

FLU VACCINE TS2018‐19(65YR UP)(PF)180 MCG/0.5 ML


00536302934 J8499 NICOTINE (POLACRILEX) 2 MG GUM 59.00$ 59.00$

99999‐0006‐70 TUBERCULIN PPD TEST RESULT (IP USE ONLY) ‐$ ‐$

50419042201 J7301

LEVONORGESTREL 14 MCG/24 HOUR (3 YEARS)

INTRAUTERINE DEVICE 30,214.26$ 30,214.26$

50419042301 J7298

LEVONORGESTREL 20 MCG/24 HR (5 YEARS) INTRAUTERINE

DEVICE 36,286.09$ 36,286.09$

50419042401 J7296

LEVONORGESTREL 17.5 MCG/24 HOUR (5 YEARS)

INTRAUTERINE DEVICE 36,286.09$ 36,286.09$

63029850401 J3490 BENZOCAINE‐MENTHOL 20 %‐0.5 % TOPICAL AEROSOL 221.32$ 221.32$

16864068002 J3490 BENZOCAINE‐MENTHOL 20 %‐0.5 % TOPICAL AEROSOL 183.32$ 183.32$

17478020919 J3490 KETOROLAC 0.5 % EYE DROPS 123.00$ 123.00$

59365503000 J3490

OXYQUINOLINE 0.025 %‐SODIUM LAURYL SULFATE 0.01 %

VAGINAL GEL 1,059.31$ 1,059.31$



00270055615 J2805 SINCALIDE 5 MCG SOLUTION FOR INJECTION 3,812.96$ 3,812.96$

69740032400 A6250 ZINC OXIDE 30.6 % TOPICAL CREAM 191.62$ 191.62$

00234057504 J3490 CHLORHEXIDINE GLUCONATE 4 % TOPICAL LIQUID 179.01$ 179.01$

48783011208 J3490

FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL

SOLN AND APPLICATOR 672.26$ 672.26$

63323046357 J3490

BUPIVACAINE‐EPINEPHRINE 0.5 %‐1:200,000 INJECTION

SOLUTION 141.72$ 141.72$

00206886201 J2543

PIPERACILLIN‐TAZOBACTAM 4.5 GRAM/100 ML

DEXTROSE(ISO‐OSM) IV PIGGYBACK 693.97$ 693.97$

00206886101 J2543

PIPERACILLIN‐TAZOBACTAM 3.375 GRAM/50 ML

DEXTROSE(ISO‐OS) IV PIGGYBACK 592.18$ 592.18$

00002764001 J9305 PEMETREXED 100 MG INTRAVENOUS SOLUTION 3,575.09$ 3,575.09$

63323014010 J9065 CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION 984.44$ 984.44$



16729010811 J9280 MITOMYCIN 20 MG INTRAVENOUS SOLUTION 2,861.82$ 2,861.82$

64193042402 J7198

ANTI‐INHIBITOR COAGULANT CMPLX (HUMAN) 1 UNIT IV

SOLR 302.00$ 302.00$

64193042502 J7198

ANTI‐INHIBITOR COAGULANT CMPLX (HUMAN) 1 UNIT IV

SOLR 302.00$ 302.00$

62559015304 J8499 OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL 13,193.19$ 13,193.19$

99999003181 J8499 OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL 151.75$ 151.75$

68094080101 J3490

OXYCODONE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE

ONLY) 208.09$ 208.09$

69536002515 J3490 PHENYLEPHRINE 0.25 % NASAL SPRAY 153.90$ 153.90$

67457019803 J3490 REMIFENTANIL 1 MG INTRAVENOUS SOLUTION 2,240.67$ 2,240.67$

37205033816 J3490 DIPHENHYDRAMINE 2 % TOPICAL SPRAY 103.64$ 103.64$

00009454402 J8499 TOLTERODINE 2 MG TABLET 358.86$ 358.86$

00093001806 J8499 TOLTERODINE 2 MG TABLET 78.35$ 78.35$

55513095601 J9303

PANITUMUMAB 400 MG/20 ML (20 MG/ML)


00536101801 J8499 MECLIZINE 25 MG CHEWABLE TABLET 59.00$ 59.00$

59730420201 90371

HEPATITIS B IMMUNE GLOBULIN GREATR THAN 312

UNIT/ML INTRAMUSCULAR SOLN 5,513.76$ 5,513.76$

00074436510 C9399 MIVACURIUM CHLORIDE 2 MG/ML INJECTION SOLUTION 1,126.15$ 1,126.15$


12496120803 J0574

BUPRENORPHINE 8 MG‐NALOXONE 2 MG SUBLINGUAL

FILM 351.65$ 351.65$

76075010201 J9047 CARFILZOMIB 30 MG INTRAVENOUS SOLUTION 5,823.14$ 5,823.14$

00944265804 J1566

IMMUNE GLOB,GAMMA(IGG) 10 GRAM‐GLY‐GLUC‐IGA 0

TO 50 MCG/ML IV SOLUTION 6,192.35$ 6,192.35$

68982085003 J1568

IMMUNE GLOB,GAMM(IGG)10 %‐MALT‐IGA OVER 50


50242013201 J9355 TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION 7,961.77$ 7,961.77$

55513019201 J2505

PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE

SUBCUTANEOUS INJECTOR 27,132.69$ 27,132.69$


48433020510 J8499 DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID 86.60$ 86.60$

71019034902 J7999

VANCOMYCIN 1 GRAM/250 ML IN DEXTROSE 5 %


71019035102 J3370

VANCOMYCIN 1.25 GRAM/250 ML IN DEXTROSE 5 %


55513007330 J8499 CINACALCET 30 MG TABLET 1,160.44$ 1,160.44$

00781118201 J8499 NADOLOL 40 MG TABLET 207.55$ 207.55$

99999003195 AMIKACIN RX TO DOSE (CC) ‐$ ‐$

00338055111 J3490 D5W MINI‐BAG PLUS 50 ML ‐$ ‐$

00338055118 J3490 D5W MINI‐BAG PLUS 100 ML ‐$ ‐$

51991060401 J8499 ERGOCALCIFEROL (VITAMIN D2) 50,000 UNIT CAPSULE 59.00$ 59.00$

61314031201 Q5101 FILGRASTIM‐SNDZ 480 MCG/0.8 ML INJECTION SYRINGE 1,391.92$ 1,391.92$

61953000404 J1572

IMMUNE GLOB,GAMM(IGG) 5 %‐SORB‐IGA 0 TO 50


47781046813 J8499 OSELTAMIVIR 30 MG CAPSULE 371.58$ 371.58$

00409163802 J3490

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS

SOLUTION 921.44$ 921.44$

00173052000 J3535

SALMETEROL 50 MCG/DOSE BLISTER POWDER FOR

INHALATION 1,505.25$ 1,505.25$

70004076129 J3490

NITROGLYCERIN 1000 MCG/10 ML (100 MCG/ML) IN 5 %

DEXTROSE INTRAVENOUS ‐ TEMPORARY ENTRY 207.59$ 207.59$

00703301812 J9190 FLUOROURACIL 2.5 GRAM/50 ML INTRAVENOUS SOLUTION 138.00$ 138.00$

55513095401 J9303

PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS

SOLUTION 6,268.72$ 6,268.72$

00003232711 J9228

IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS

SOLUTION 38,306.94$ 38,306.94$

00338109104 J3490

AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS

SOLUTION 2,973.40$ 2,973.40$

00338113403 J3490

AMINO ACID 4.25 % IN 10 % DEXTROSE INTRAVENOUS

SOLUTION 1,456.44$ 1,456.44$

00338109904 J3490

AMINO ACID 5 % IN 15 % DEXTROSE INTRAVENOUS

SOLUTION 3,133.08$ 3,133.08$

00338110104 J3490

AMINO ACID 5 % IN 20 % DEXTROSE INTRAVENOUS

SOLUTION 2,733.88$ 2,733.88$

00338112304 J3490

AMINO ACIDS 5 %‐DEXTROSE 15 %‐ELECTROLYTES




31604001894 J3490 COENZYME Q10 100 MG CAPSULE 59.00$ 59.00$

54838055550 J8499 ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION 932.49$ 932.49$

99999003262 J8499 ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION 126.57$ 126.57$

63323012020 J9100

CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION

SOLUTION 138.00$ 138.00$

99999003272 J8499 GABAPENTIN 250 MG/5 ML ORAL SOLUTION 59.00$ 59.00$

00469325010 J2248 MICAFUNGIN 50 MG INTRAVENOUS SOLUTION 3,504.98$ 3,504.98$

57664034788 J8499 CLOZAPINE 100 MG TABLET 59.00$ 59.00$

60505296607 J7518

MYCOPHENOLATE SODIUM 360 MG TABLET,DELAYED

RELEASE 299.94$ 299.94$

52244010010 J3490

THEOPHYLLINE ER 100 MG CAPSULE,EXTENDED RELEASE

24 HR 133.94$ 133.94$

31604002741 J8499 MELATONIN 3 MG TABLET 59.00$ 59.00$

00955173530 J8499 LEFLUNOMIDE 10 MG TABLET 245.72$ 245.72$

55513022101 J2796 ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION 72,033.65$ 72,033.65$

00069080901 Q5103 INFLIXIMAB‐DYYB 100 MG INTRAVENOUS SOLUTION 3,434.93$ 3,434.93$

59781066688 J3490

ARGININE 7 GRAM‐GLUTAM 7 GRAM‐CAHMB 1.5 GRAM‐

COLLA‐MV‐MIN ORAL PWD PKT 139.97$ 139.97$


13668002101 J3490 ALFUZOSIN ER 10 MG TABLET,EXTENDED RELEASE 24 HR 59.00$ 59.00$

24208048610 J3490 DORZOLAMIDE 22.3 MG‐TIMOLOL 6.8 MG/ML EYE DROPS 464.27$ 464.27$

50242015001 J2350 OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION 648,879.00$ 648,879.00$

00005197105 90670

PNEUMOCOCCAL 13‐VAL CONJ VACCINE‐DIP CRM (PF) 0.5

ML IM SYRINGE 6,999.18$ 6,999.18$

70004030022 J7999

HYDROMORPHONE (PF) 10 MG/50 ML (0.2 MG/ML) IN

0.9% NACL IV PCA SYRINGE 518.32$ 518.32$


64896066401 J3490

CARBIDOPA ER 61.25 MG‐LEVODOPA 245 MG

CAPSULE,EXTENDED RELEASE 195.37$ 195.37$

67066000501 J2850 SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION 20,958.00$ 20,958.00$

65162067384 J8499 RISPERIDONE 1 MG/ML ORAL SOLUTION 389.45$ 389.45$

99999003417 J8499 RISPERIDONE 1 MG/ML ORAL SOLUTION 59.00$ 59.00$

55513022201 J2796 ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION 144,067.29$ 144,067.29$

70004043009 J3490

KETAMINE 50 MG/5 ML (10 MG/ML) IN 0.9 % SODIUM

CHLORIDE IV SYRINGE 179.64$ 179.64$

00574402535 J3490

WHITE PETROLATUM‐MINERAL OIL 85 %‐15 % EYE

OINTMENT 286.29$ 286.29$

00310461150 C9492 DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION 140,095.01$ 140,095.01$


59310030480 J3535

BECLOMETHASONE DIPROP 80 MCG/ACTUATION HFA

BREATH ACTIVATED AEROSOL 1,504.88$ 1,504.88$

51862032001 J8499 LIOTHYRONINE 5 MCG TABLET 86.74$ 86.74$

70004008446 J7999



63323054302 J1644

HEPARIN, PORCINE (PF) 5,000 UNIT/0.5 ML INJECTION

SOLUTION 195.97$ 195.97$

00378830501 J3490

CARBIDOPA 50 MG‐LEVODOPA 200 MG‐ENTACAPONE 200

MG TABLET 86.25$ 86.25$

68546022956 J8499 RASAGILINE 1 MG TABLET 1,026.65$ 1,026.65$

63323010605 J3475

MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER


64764091830 J8499 FEBUXOSTAT 40 MG TABLET 455.32$ 455.32$

51991031190 J8499

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED

RELEASE 24 HR 63.88$ 63.88$

00456270001 J0714

CEFTAZIDIME‐AVIBACTAM 2.5 GRAM INTRAVENOUS

SOLUTION 12,495.08$ 12,495.08$

00574010603 J8499 BROMOCRIPTINE 2.5 MG TABLET 165.84$ 165.84$

63481068447 J3490 DICLOFENAC 1 % TOPICAL GEL 2,031.93$ 2,031.93$

00641605325 J2175 MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION 138.00$ 138.00$

00527131301 J8499 PILOCARPINE 5 MG TABLET 118.75$ 118.75$

hcpcs outpatient ndc code medication name & amount ... · calcium gluconate 100 mg/ml (10 %)...

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