NDC/PCode/UPC Mfr.
Item # Description
AWP Pkg
J-Code
00781-1061-01 SAN 13532 ALPRAZOLAM 0.25MG TAB 100
69.52
00781-1077-01 SAN 13534 ALPRAZOLAM 0.5MG TAB 100
86.61
00781-1079-01 SAN 20032 ALPRAZOLAM 1MG TAB 100
115.56
00555-0777-02 TEV 32928 AMPHETAM SALT 15MG TAB 100
171.40
51525-5901-01 MED 36747 CARISOPRODOL TAB 100 250MG
330.59
42192-0336-01 ACE 40471 CHLORDIAZ/CLD 5/2.5MG CAP 100
158.49
00228-3004-11 ACT 29731 CLONAZEPAM 1MG TAB 100
85.51
00185-0065-01 SAN 29736 CLONAZEPAM 2MG TAB 100
112.82
00409-1180-69 HOS 26874 DEMEROL 100MG/ML C/J 10X1ML
26.28
J2175
00409-1201-20 HOS 27976 DEMEROL 100MG/ML VL 20ML
48.23
J2175
00409-1176-30 HOS 27024 DEMEROL 25MG/ML CJ 10X1ML
27.24
J2175
00409-1203-01 HOS 27853 DEMEROL 50MG/ML AMP 25X0.5ML
23.40
J2175
00409-1253-01 HOS 27832 DEMEROL 50MG/ML AMP 25X1ML
42.00
J2175
00409-1178-30 HOS 27347 DEMEROL 50MG/ML C/J 10X1ML
28.08
J2175
00009-0347-02 PFI
10942 DEPO TESTOST 100MG VL 10ML
76.68
J1070
00009-0417-02 PFI
10657 DEPO TESTOSTERON 200MG VL 10ML
139.37
J1080
00009-0417-01 PFI
10658 DEPO TESTOSTERONE 200MG VL 1ML
28.63
J1080
00591-5619-01 ACT 27700 DIAZEPAM 5MG TAB 100/BTL
3.53
00409-3213-12 HOS 30723 DIAZEPAM 5MG/ML FTV 10X10ML
226.80
J3360
00409-1273-32 HOS 26770 DIAZEPAM LL 5MG/ML C/J 10X2ML
106.08
J3360
00378-0415-01 MYL 27374 DIPHXYL/ATR2.5/.025MGTAB100/BT
53.33
00591-3592-60 ACT 33138 DRONABINOL 5MG CAP 60
706.45
00406-9025-76 MAL 41353 FENTANYL 25 MCG/HR PATCH 5/pk
72.10
00378-9122-98 MYL 32776 FENTANYL 50MCG PATCH 5/PK
131.80
00409-9093-32 HOS 27223 FENTANYL CIT/05MG/ML AMP10X2ML
4.44
J3010
00406-9000-76 MAL 40395 FENTANYL MTX 100 MCG PAT 5/PK
266.80
00406-9050-76 MAL 41323 FENTANYL MTX 50MCG PAT 5
131.80
00406-9075-76 MAL 41324 FENTANYL MTX 75MCG PAT 5
201.05
00078-0382-05 NOV 33352 FOCALIN 10MG TAB 100
155.65
62175-0490-64 KRE 41337 HYDRO/CHLOR 10-8MG/5MLSUS 4OZ
76.96
53746-0110-01 AMN 40513 HYDROCOD ACET 10/325MG TAB 100
69.89
00603-3887-28 QUA 40369 HYDROCOD/APAP 10/325MG TAB 500
337.28
00406-0365-01 MAL 29800 HYDROCOD/APAP 5/325MG TAB 100
54.20
00406-0357-01 MAL 29804 HYDROCOD/APAP 5/500MG TAB 100
31.75
00591-0349-05 ACT 26755 HYDROCOD/APAP 5/500MG TAB 500
39.53
00603-3891-21 QUA 40733 HYDROCOD/APAP 7.5/325MGTAB 100
61.86
00121-0655-16 PHA 29812 HYDROCOD/APAP 7.5/500 ELX 16OZ
58.24
00409-1312-30 HOS 27345 HYDROMORPH 2MG/ML LH82T 10X1ML
26.88
J1170
00409-2552-01 HOS 31094 HYDROMORPHONE 1MG/MLAMP 10X1ML
12.84
J1170
42858-0301-01 RHO 41411 HYDROMORPHONE 2MG TAB 100
49.88
00409-3356-01 HOS 32517 HYDROMORPHONE 2MG/ML AMP10X1ML
13.44
J1170
00641-2341-41 WES 21007 HYDROMORPHONE 2MG/ML MDV 20ML
15.60
J1170
42858-0302-01 RHO 41338 HYDROMORPHONE 4MG TAB 100
72.81
( R ) - Indicates Refrigerated Drug Item
PRICES ARE SUBJECT TO CHANGE
1...,42,43,44,45,46,47,48,49,50,51 53,54,55,56,57,58,59,60,61,62,...112