NDC/PCode/UPC Mfr.
Item # Description
AWP Pkg
J-Code
63323-0540-31 FRE 11778 Heparin 1000 U/Ml Mdv25X30Ml
213.90
J1644
306528
BEC 37973 Heparin Iv Flush Syr2Ml 120/Cs
63323-0545-01 FRE 21123 Heparin L-F 100U/Ml Mdv25X1Ml
50.31
J1642
63323-0542-01 FRE 11480 Heparin Sod 10M Un Mdv 25X1Ml
218.75
J1644
63323-0540-01 FRE 20636 Heparin Sod 1M Un/Ml Mdv25X1Ml
120.31
J1644
63323-0915-01 FRE 12737 Heparin Sod 20Mun Mdv 25X1Ml
523.75
J1644
63323-0262-01 FRE 11479 Heparin Sod 5M Un Mdv 25X1Ml
130.00
J1644
63323-0047-10 FRE 17773 Heparin Sod 5Mun Mdv25X10Ml
498.43
J1644
63323-0276-02 FRE 10051 Heparin Sod P 1Mun/Ml 25X2Ml
412.18
J1644
64253-0333-23 MED 34854 Heparin Syr 100U 3Ml 60X6Ml
3.09
J1642
50242-0134-68 GEN 23961 Herceptin 440Mg Mdv 20Ml ( R )
4214.48
J9355
00264-1965-10 B.B 23770 Hespan Iv Inf Bag 12X500Ml
15.43
62856-0001-10 EIS 38608 Hexalen 50Mg Cap 100
1634.40
63833-0616-02 CSL 42990 Humate-P Pds 1067 Rcof Vl
1.27
J7187
63833-0617-02 CSL 42479 Humate-P Pds 2148 Rcof Vl ( R )
1.27
J7187
63833-0615-02 CSL 42421 Humate-P Pds 508 Rcof Vl
1.27
J7187
00074-3799-02 ABB 23034 Humira 40Mg Pfs Kit 2X0.8Ml ( R )
3003.13
J0135
00283-0679-02 BEU 14696 Hurricane Spray 2Oz Beutlich
26.51
00007-4205-11 GLA 32931 Hycamtin 0.25Mg Cap 10 ( R )
1103.58
J8705
00007-4207-11 GLA 32932 Hycamtin 1Mg Cap 10 ( R )
4414.25
J8705
00168-0146-30 SAN 30501 Hydocort 2.5% Ont 1Oz
11.00
00003-0830-50 BRI
13050 Hydrea 500Mg Cap 100
154.54
59746-0382-06 CAD 35524 Hydrochloro 12.5 Mg Cap 100
42.40
00172-2083-60 TEV 14537 Hydrochlorothiaz 25Mg Tab 100
8.48
00168-0015-31 SAN 32858 Hydrocort 1% Crm 1Oz
7.20
54505-0332-10 AME 42699 Hydrocortisone 10Mg Tab 100
57.30
54505-0333-10 AME 42700 Hydrocortisone 20Mg Tab 100
108.70
45802-0004-02 PER 13324 Hydrocortisone Crm 2.5% 20Gm
4.90
00591-2888-30 ACT 38067 Hydroxocobal 1000Mcg/Ml 30Ml
38.26
00555-0882-02 TEV 26072 Hydroxyurea 500Mg Cap 100
127.73
00185-0613-01 SAN 30324 Hydroxyz Pam 25Mg Cap 100
29.94
23155-0106-01 HER 40589 Hydroxyzine 25Mg Tab 100
91.46
18657-0102-04 HAL 39835 Hylenex 150U/Ml 4X1Ml Vl ( R )
267.84
J3473
24486-0602-10 ARI
33653 Hyomax Sr .375Mg Tab 100/Btl
161.48
76439-0309-10 VIR 42146 Hyoscyamine .125Mg Sub Tab 100
109.64
00591-3770-31 ACT 41354 Ibandronate 150Mg Tab 3/Pk
399.54
62756-0218-40 CAR 42550 Ibandronate Sodium 3Mg/3Ml Inj
J1740
57896-0941-01 AME 30037 Ibuprofen 200Mg Tab 100
1.60
00904-7914-61 MAJ 28519 Ibuprofen 200Mg Tab 100 Ud
6.77
00904-7915-24 MAJ 40570 Ibuprofen 200Mg Tab 24
2.20
53746-0464-01 AMN 41503 Ibuprofen 400Mg Tab 100
39.25
53746-0465-01 AMN 41453 Ibuprofen 600Mg Tab 100
54.75
53746-0466-01 AMN 41504 Ibuprofen 800Mg Tab 100
80.25
00013-2586-91 PFI
20278 Idamycin Pfs 10Mg/10Ml Vl ( R )
600.00
J9211
00013-2596-91 PFI
20279 Idamycin Pfs 20Mg/20Ml Vl ( R )
1200.00
J9211
00013-2576-91 PFI
20277 Idamycin Pfs 5Mg/5Ml Vl ( R )
300.00
J9211
00703-4155-11 TEV 22769 Idarubicin 10Mg/10Ml Sdv Sol ( R )
197.64
J9211
00703-4156-11 TEV 22770 Idarubicin 20Mg/20Ml Sdv Sol ( R )
395.28
J9211
( R ) - Indicates Refrigerated Drug Item
PRICES ARE SUBJECT TO CHANGE
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