NDC/PCode/UPC Mfr.
Item # Description
AWP Pkg
J-Code
00597-0137-30
BOE 41632 Gilotrif 30Mg Tab 30
6660.00
00597-0138-30
BOE 41633 Gilotrif 40Mg Tab 30
6660.00
00078-0401-34 NOV 31332 Gleevec 100Mg Tab 90/Btl
6964.13
00078-0438-15 NOV 26150 Gleevec 400Mg Tab 30
8364.79
45802-0947-78 PER 41362 Glimepiride 4Mg Tab 100
121.60
60505-0141-00 APO 41954 Glipizide 5Mg Tab 100
36.35
00002-8031-01 ELI
13683 Glucagon Emer Kit 8030/8031
181.80
J1610
00574-0070-30 PAD 31398 Glutose 15 Tube Gel 3X15Gm
11.85
00574-0069-30 PAD 10464 Glutose Gel 3X15Gm
11.85
00093-7485-20 TEV 31083 Granisetron 1Mg Tab 20/Pk
1180.05
Q0166
66758-0035-01 SAN 32814 Granisetron 1Mg/1Ml For Pf Osc
50.00
J1626
66758-0035-01 SAN 32265 Granisetron 1Mg/1Ml Sdv Sol
50.00
J1626
66758-0035-01 SAN 32813 Granisetron 1Mg/Ml For Pf
50.00
J1626
25021-0781-04 SAG 37339 Granisetron 1Mg/Ml Mdv 4Ml
30.00
J1626
66758-0036-01 SAN 32266 Granisetron 4Mg/4Ml Mdv Sol
200.00
J1626
63459-0910-15 TEV 41987 Granix 300Mcg/0.5Ml Syg 10/Pk ( R )
2868.00
NEW05
63459-0910-11 TEV 41986 Granix 300Mcg/0.5Ml Syringe ( R )
286.80
NEW05
63459-0912-15 TEV 41989 Granix 480Mcg/0.8Ml Syg 10/Pk ( R )
4590.00
NEW07
63459-0912-11 TEV 41988 Granix 480Mcg/0.8Ml Syringe ( R )
459.00
NEW07
62856-0389-01 EIS 37122 Halaven 1Mg/2Ml Sdv
1114.80
J9179
58160-0826-11 GLA 30445 Havrix Adult Sdv P/F 10X1Ml ( R )
763.19
90632
46122-0103-46 AME 41140 Hemorrhoid Ointment 2Oz
63807-0600-51 EXC 34546 Hep Sod Syr 100U 5Ml 30X10Ml
3.50
J1642
64253-0222-23 MED 39379 Hep Syr 10U 3Ml Fill 6Ml 60/Cs
2.99
J1642
63323-0540-31 FRE 11778 Heparin 1000 U/Ml Mdv25X30Ml
213.90
J1644
306528
BEC 37973 Heparin Iv Flush Syr2Ml 120/Cs
00409-1152-78 HOS 26023 Heparin Lf 100U/Ml 25X30Ml
43.20
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 )
4091.74
J9355
00264-1965-10 B.B 23770 Hespan Iv Inf Bag 12X500Ml
15.43
63833-0616-02 CSL 39113 Humate-P Pds 1015 Rcof Vl ( R )
1.27
J7187
63833-0617-02 CSL 40850 Humate-P Pds 2029 Rcof Vl ( R )
1.27
J7187
63833-0617-02 CSL 36421 Humate-P Pds 2095 Rcof Vl ( R )
1.27
J7187
63833-0615-02 CSL 39977 Humate-P Pds 466 Rcof Vl ( R )
1.27
J7187
63833-0615-02 CSL 41712 Humate-P Pds 492 Rcof Vl ( R )
1.27
J7187
63833-0615-02 CSL 40370 Humate-P Pds 493 Rcof Vl ( R )
1.27
J7187
63833-0615-02 CSL 39370 Humate-P Pds 543 Rcof Vl ( R )
1.27
J7187
00074-3799-02 ABB 23034 Humira 40Mg Pfs Kit 2X0.8Ml ( R )
2809.30
J0135
00283-0679-02 BEU 14696 Hurricane Spray 2Oz Beutlich
26.51
00007-4205-11 GLA 32931 Hycamtin 0.25Mg Cap 10 ( R )
1071.43
J8705
( R ) - Indicates Refrigerated Drug Item
PRICES ARE SUBJECT TO CHANGE
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