NDC/PCode/UPC Mfr.
Item # Description
AWP Pkg
J-Code
16729-0276-38 ACC 42400 Fluorouracil 5Gm/100Ml Pbp
J9190
63323-0117-61 FRE 10745 Fluorouracil 5Gm/100Ml Pbp
32.12
J9190
00054-3270-99 ROX 28154 Fluticasone 50Mcg Spray 16Gm
75.27
00603-3162-21 QUA 36587 Folic Acid 1 Mg Tab 100
35.99
00603-3162-32 QUA 36536 Folic Acid 1 Mg Tab 1000
79.49
63323-0184-10 FRE 10101 Folic Acid 5Mg/Ml Mdv 10Ml
32.04
J3490
48818-0001-01 ALL 34637 Folotyn 20 Mg Injection ( R )
4463.15
J9307
48818-0001-02 ALL 34636 Folotyn 40 Mg Injection ( R )
8926.30
J9307
55111-0681-10 DR 39833 Fondaparinux 10Mg Syg 10X0.8Ml
1286.10
J1652
55111-0681-02 DR 39826 Fondaparinux 10Mg Syg 2X0.8Ml
271.60
J1652
55111-0678-02 DR 39823 Fondaparinux 2.5Mg Syg 2X0.5Ml
115.40
J1652
55111-0678-10 DR 39830 Fondaparinux 2.5Mg Syg10X0.5Ml
546.52
J1652
55111-0679-10 DR 39831 Fondaparinux 5Mg Syg 10X0.4Ml
1286.10
J1652
55111-0679-02 DR 39824 Fondaparinux 5Mg Syg 2X0.4Ml
271.60
J1652
55111-0680-02 DR 39825 Fondaparinux 7.5Mg Syg 2X0.6Ml
271.60
J1652
55111-0680-10 DR 39832 Fondaparinux 7.5Mg Syg10X0.6Ml
1286.10
J1652
62856-0101-10 EIS 28857 Fragmin 10M Iu Pfs 10X1Ml
850.82
J1645
62856-0125-10 EIS 31731 Fragmin 12500Iu Pfs 10X.5Ml
1063.54
J1645
62856-0150-10 EIS 30745 Fragmin 15000Iu Pfs 10X.6Ml
1276.25
J1645
62856-0180-10 EIS 30767 Fragmin 18000Iu Pfs 10X.72Ml
1531.46
J1645
62856-0251-01 EIS 27986 Fragmin 25000Iu/Ml Mdv 3.8Ml
731.30
J1645
62856-0250-10 EIS 33888 Fragmin 2500Iu Pfs 10X0.2Ml
262.25
J1645
62856-0500-10 EIS 27983 Fragmin 5000Iu Pfs 10X0.2Ml
425.42
J1645
62856-0750-10 EIS 29225 Fragmin 7500Iu Pfs 10X0.3Ml
638.16
J1645
00409-6102-02 HOS 26089 Furosemide 10Mg/Ml Ftv 25X2Ml
42.90
00409-6102-04 HOS 26110 Furosemide 10Mg/Ml Ftv 25X4Ml
52.80
00409-9631-04 HOS 28180 Furosemide 10Mg/Ml Syg 10X4Ml
78.72
J1940
50742-0104-01 ING 38707 Furosemide 20Mg Tab 100
14.30
50742-0105-01 ING 38727 Furosemide 40Mg Tab 100
16.30
68152-0101-00 SPE 32424 Fusilev Levoleuco 50Mgvl10Ml
256.80
J0641
53746-0101-01 AMN 33599 Gabapentin 100Mg Cap 100
53.69
53746-0102-01 AMN 33647 Gabapentin 300Mg Cap 100
134.18
53746-0103-01 AMN 33535 Gabapentin 400Mg Cap 100
159.71
68382-0204-01 ZYD 41277 Gabapentin 600Mg Tab 100
252.62
00944-2700-02 BAX 26746 Gammagard Liq 1Gm 10Ml Nonret ( R )
149.29
J1569
00944-2700-03 BAX 26747 Gammagard Liq 2.5Gm25Ml Nonret ( R )
373.24
J1569
00944-2700-04 BAX 26748 Gammagard Liq 5Gm 50Ml Nonret ( R )
746.46
J1569
00944-2700-05 BAX 26749 Gammagard Liq10Gm 100Ml Nonret ( R )
1492.92
J1569
00944-2700-06 BAX 26750 Gammagard Liq20Gm 200Ml Nonret ( R )
2985.84
J1569
00944-2700-07 BAX 38110 Gammagard Liq30Gm 300Ml Nonret ( R )
4478.76
J1569
00944-2658-04 BAX 41016 Gammagard S/D Low Iga 10Gm Vl
1772.04
J1566
00944-2656-03 BAX 41015 Gammagard S/D Low Iga 5Gm Vl
886.02
J1566
13533-0800-71 GRI
37282 Gamunex-C 10% 10Gm 100Ml ( R )
1216.44
J1561
13533-0800-24 GRI
37285 Gamunex-C 10% 20Gm 200Ml ( R )
2432.88
J1561
13533-0800-20 GRI
37286 Gamunex-C 10% 5Gm 50Ml ( R )
608.22
J1561
00006-4045-00 MER 28210 Gardasil Hpv Vaccine Vl Ea ( R )
169.85
00270-0445-40 BRA 22242 Gastrografin 37%Sol120Ml 12/Cs
957.90
Q9963
50242-0070-01 GEN 41963 Gazyva Inj 1000Mg/40Ml ( R )
6192.00
NEW01
( R ) - Indicates Refrigerated Drug Item
PRICES ARE SUBJECT TO CHANGE
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