NDC/PCode/UPC Mfr.
Item # Description
AWP Pkg
J-Code
17478-0107-20 AKO 38513 Levofloxacin 500Mg Sdv 20Ml
44.74
J1956
68180-0241-08 LUP 38131 Levofloxacin 500Mg Tab 50
964.40
68180-0242-20 LUP 38130 Levofloxacin 750Mg Tab 20
722.36
00781-5184-92 SAN 40562 Levothyroxine 100Mcg Tab 90
52.68
00781-5185-92 SAN 42845 Levothyroxine 112Mcg Tab 90
60.91
00781-5191-92 SAN 42618 Levothyroxine 137Mcg Tab 90
62.61
00781-5187-92 SAN 40690 Levothyroxine 150Mcg Tab 90
63.56
00781-5180-92 SAN 42915 Levothyroxine 25Mcg Tab 90
40.96
00781-5181-92 SAN 42916 Levothyroxine 50Mcg Tab 90
46.50
00781-5182-92 SAN 42917 Levothyroxine 75Mcg Tab 90
51.39
00409-4713-02 HOS 27359 Lido 1% P/F Amp 25X5Ml
34.20
00409-4277-02 HOS 26659 Lido 2% Ftv 25X50Ml
91.50
76329-3013-05 INT 39644 Lido 2% Jelly Urojet 25X10Ml
213.13
76329-3012-05 INT 39478 Lido 2% Jelly Urojet 25X5Ml
191.19
00409-4903-34 HOS 27319 Lido 2% Lfs Syg 10X5Ml
30.84
00409-4277-01 HOS 26553 Lido 2% Vl 25X20Ml
51.90
00409-1323-05 HOS 27452 Lido Ansyr 2% Syg 10X5Ml
32.76
00264-9594-10 B.B 28571 Lido/Dext 0.4/5% Sol 24X500Ml
8.00
J2001
50383-0667-30 HI-
37309 Lido/Priloc 2.5% Crm 30Gm
45.95
00409-4713-32 HOS 27154 Lidocaine 1% Amp P/F 50X2Ml
57.00
00409-4276-01 HOS 26663 Lidocaine 1% Ftv 25X20Ml
36.30
00409-4279-02 HOS 27155 Lidocaine 1% T/Tp Vl 25X30Ml
72.90
00409-3178-03 HOS 26828 Lidocaine 1% W/Epi Mdv 25X50Ml
88.50
17478-0711-30 AKO 27622 Lidocaine 2% Jelly 30Ml
16.67
00409-3182-01 HOS 27213 Lidocaine 2% W/Epi Ftv 25X20Ml
74.40
60432-0465-50 MOR 14718 Lidocaine 4% Top Sol 50Ml
15.78
51672-3008-03 TAR 36066 Lidocaine 5% Ont 50Gm
98.89
00591-3525-30 ACT 41974 Lidocaine 5% Patch 30/Bx
269.58
63323-0208-05 FRE 11490 Lidocaine Hcl P/F 2% Sdv25X5Ml
63.00
J3490
50383-0775-04 HI-
28170 Lidocaine Vis 2% Sol 100Ml
5.99
63481-0687-06 END 22080 Lidoderm Patch 5% Pat 30/Bx
312.01
47335-0049-40 CAR 40984 Liposome Doxo 20Mg/10Ml Sdv ( R )
1162.80
Q2050
47335-0050-40 CAR 40985 Liposome Doxo 50Mg/25Ml Sdv ( R )
2907.10
Q2050
68180-0518-01 LUP 36958 Lisino/Hctz 10/12.5Mg Tab 100
112.04
68180-0519-01 LUP 31839 Lisinop/Hctz 20/12.5Mg Tab 100
121.28
68001-0210-00 AME 42713 Lisinopril 10Mg Tab 100
100.42
68001-0208-00 AME 42729 Lisinopril 20Mg Tab 100
107.54
68001-0212-00 AME 43029 Lisinopril 30Mg Tab 100
150.76
68001-0209-00 AME 42914 Lisinopril 40Mg Tab 100
157.21
68001-0207-00 AME 42712 Lisinopril 5Mg Tab 100
97.25
68180-0520-01 LUP 33665 Lisnop/Hctz 20/25Mg Tb 100/Btl
122.75
00904-2687-60 MAJ 37890 L-Lysine 500Mg Tab 100
3.77
00496-0882-07 FER 23900 Lmx4 Plus 4% Cream 5X5Gm
48.07
58181-3032-05 NEX 42564 Lomustine 100Mg Cap 5
508.44
58181-3030-05 NEX 42562 Lomustine 10Mg Cap 5
102.82
58181-3031-05 NEX 42563 Lomustine 40Mg Cap 5
266.44
00378-2100-01 MYL 14719 Loperamide 2Mg 100 Cap
87.47
00093-0311-01 TEV 20078 Loperamide 2Mg Cap 100/Btl
61.10
( R ) - Indicates Refrigerated Drug Item
PRICES ARE SUBJECT TO CHANGE
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