Drug Prices 2018 - SPRHC

40
Procedure Code Description NDC Number Charge Type Charge 4330000851 SODIUM CHLORIDE 0.45% W/ 20mEq KCL in 1,000 ML BAG 00338067104A PREMIX $75.00 4330000000 NORMAL SALINE 0.45% 1,000 ML BAG 00409798509 IVF $75.00 4330000857 ABATACEPT 250 MG/10 ML VIAL 00003218710 CSPMED $3,661.88 4330000857 ABATACEPT 250 MG/10 ML VIAL 00003218710 CSP $3,711.88 4330000003 ACETAMINOPHEN IV 1000 MG/100 ML *PREMIX* 43825010201 PREMIX $140.53 4330000001 ACETAMINOPHEN 120 MG SUPP 00713011812 UD $2.50 4330000002 ACETAMINOPHEN PEDS 160 MG/5ML CUP 68094058759 UD $3.50 4330000004 ACETAMINOPHEN 325 MG TABLET 00904198261 UD $2.50 4330000005 ACETAMINOPHEN 500 MG TABLET 00904198861 UD $2.50 4330000006 ACETAMINOPHEN 650 MG SUPP 45802073032 UD $2.50 4330000007 acetaZOLAMIDE 250 MG TABLET 68084054101 UD $14.67 4330000008 acetaZOLAMIDE 500 MG SR CAPSULE 68084040121 UD $17.12 4330000009 ACETYLCYSTEINE 20% 30ML ORAL/INHALATION 00409330803 UD $35.81 4330000010 ACETYLCYSTEINE 20% 30ML INJECTION 63323096330 INJ $658.00 4330000010 ACETYLCYSTEINE 20% 30ML INJECTION 63323096330 CSP $708.00 4330000011 ACETYLCYSTEINE 20% 4 ML ORAL/INHALATION 63323069404 UD $44.77 4330000748 ACYCLOVIR 5% CREAM 5 GM TUBE 00187099445 BULK $2,787.75 4330000012 ACYCLOVIR 200MG CAPSULE 00093894001 UD $3.40 4330000013 ACYCLOVIR 500 MG/10ML INJ 55150015410 INJ $56.00 4330000013 ACYCLOVIR 500 MG/10ML INJ 55150015410 CSP $106.00 Drug Prices 2018

Transcript of Drug Prices 2018 - SPRHC

Page 1: Drug Prices 2018 - SPRHC

Procedure

Code

Description NDC Number Charge

Type

Charge

4330000851 SODIUM CHLORIDE 0.45% W/ 20mEq

KCL in 1,000 ML BAG

00338067104A PREMIX $75.00

4330000000 NORMAL SALINE 0.45% 1,000 ML BAG 00409798509 IVF $75.00

4330000857 ABATACEPT 250 MG/10 ML VIAL 00003218710 CSPMED $3,661.88

4330000857 ABATACEPT 250 MG/10 ML VIAL 00003218710 CSP $3,711.88

4330000003 ACETAMINOPHEN IV 1000 MG/100 ML

*PREMIX*

43825010201 PREMIX $140.53

4330000001 ACETAMINOPHEN 120 MG SUPP 00713011812 UD $2.50

4330000002 ACETAMINOPHEN PEDS 160 MG/5ML

CUP

68094058759 UD $3.50

4330000004 ACETAMINOPHEN 325 MG TABLET 00904198261 UD $2.50

4330000005 ACETAMINOPHEN 500 MG TABLET 00904198861 UD $2.50

4330000006 ACETAMINOPHEN 650 MG SUPP 45802073032 UD $2.50

4330000007 acetaZOLAMIDE 250 MG TABLET 68084054101 UD $14.67

4330000008 acetaZOLAMIDE 500 MG SR CAPSULE 68084040121 UD $17.12

4330000009 ACETYLCYSTEINE 20% 30ML

ORAL/INHALATION

00409330803 UD $35.81

4330000010 ACETYLCYSTEINE 20% 30ML

INJECTION

63323096330 INJ $658.00

4330000010 ACETYLCYSTEINE 20% 30ML

INJECTION

63323096330 CSP $708.00

4330000011 ACETYLCYSTEINE 20% 4 ML

ORAL/INHALATION

63323069404 UD $44.77

4330000748 ACYCLOVIR 5% CREAM 5 GM TUBE 00187099445 BULK $2,787.75

4330000012 ACYCLOVIR 200MG CAPSULE 00093894001 UD $3.40

4330000013 ACYCLOVIR 500 MG/10ML INJ 55150015410 INJ $56.00

4330000013 ACYCLOVIR 500 MG/10ML INJ 55150015410 CSP $106.00

Drug Prices 2018

Page 2: Drug Prices 2018 - SPRHC

4330000665 ADENOSINE 6 MG/2ML VIAL 63323065102A INJ $38.33

4330000665 ADENOSINE 6 MG/2ML VIAL 63323065102A CSP $88.33

4330000014 FLUTICASONE 100 / SALMETEROL 50

(14 DISK BOX)

00173069504 BULK $584.64

4330000015 FULTICASONE 250 / SALMETEROL 50

(14 DISK BOX)

00173069604 BULK $584.64

4330000016 FLUTICASONE 500/ SALMETEROL 50

(14 DISK BOX)

00173069704 BULK $1,038.66

4330000759 DIPYRDAMOLE/ASPIRIN 200/25 MG

CAPSULE

00597000160 UD $30.45

4330000159 COMBIVENT

(ALBUTEROL/IPRATROPIUM) ORAL

00597002402 BULK $1,303.79

4330000743 ALBUTEROL *PED* 2.5 MG/0.5 ML NEB

SOL

50383074120 BULK $3.50

4330000017 ALBUMIN 25% 25GM/100ML BAG

*PREMIX*

00944049302 PREMIX $486.01

4330000018 ALBUTEROL 2.5 MG/3 ML NEB

SOLUTION

00487950160 UD $3.00

4330000019 ALBUTEROL 200 INH/8.5 GM 59310057922A BULK $208.50

4330000020 ALENDRONATE 70 MG TABLET 51079094205 UD $71.61

4330000021 ALFUZOSIN HCL 10 MG ER TAB 24H 47335095688 UD $2.50

4330000022 ALKA SELTZER GOLD 1 PKT (2 TABS) 16500004108 UD $2.50

4330000023 ALLOPURINOL 100 MG TABLET 51079020520 UD $2.50

4330000024 ALLOPURINOL 300 MG TABLET 51079020620 UD $2.66

4330000025 ALPRAZolam 0.25 MG TABLET 51079078820 CSPO $9.50

4330000026 ALPRAZolam 0.5 MG TABLET 00904585961 CSPO $9.50

4330000027 ALTEPLASE CATHFLO 2 MG VIAL 50242004164 CSP $585.71

4330000029 AMANTADINE HCL 100 MG CAPSULE 51079024720 UD $11.55

4330000031 aMILoride 5 MG TABLET 64980015101 UD $4.48

4330000773 AA 4.25%/CALCIUM/LYTES/D5W 1,000

ML IV BAG *PREMIX*

00338114403 PREMIX $131.60

4330000667 AMINOPHYLLINE 500 MG / 20 ML 00409592201 INJ $24.50

4330000667 AMINOPHYLLINE 500 MG / 20 ML 00409592201 CSP $74.50

4330000814 AMIODARONE 360 MG/200ML BAG

*PREMIX*

43066036020 PREMIX $161.49

Page 3: Drug Prices 2018 - SPRHC

4330000034 AMIODARONE 450 MG/9 ML VIAL (50

MG/ML)

63323061609 INJ $17.25

4330000034 AMIODARONE 450 MG/9 ML VIAL (50

MG/ML)

63323061609 CSP $65.33

4330000032 AMIODARONE 200 MG TABLET 00904655661A UD $2.50

4330000033 AMIODARONE HCL 150 MG/3ML VIAL 63323061603 INJ $17.25

4330000033 AMIODARONE HCL 150 MG/3ML VIAL 63323061603 CSP $54.94

4330000035 AMITRIPTYLINE 10 MG TABLET 51079013120 UD $2.50

4330000036 AMITRIPTYLINE 25 MG TABLET 00904020161 UD $2.50

4330000037 amLODIPine BESYLATE 5 MG TABLET 51079045120 UD $6.06

4330000038 AMMONIA AROMATIC 1 VAPOROLES 39822990001 UD $2.50

4330000040 AMOXICILLIN 250 MG/5 ML SUSP

100ML BOTTLE

00093415573 BULK $21.46

4330000039 AMOXICILLIN 250 MG CAPSULE 00093310701 UD $2.50

4330000041 AMOXICILLIN 500 MG CAPSULE 00093310953 UD $2.50

4330000834 AMPICILLIN 2,000 MG VIAL 67457035210 INJ $55.72

4330000834 AMPICILLIN 2,000 MG VIAL 67457035210 CSP $105.72

4330000043 AMPICILLIN 1,000 MG VIAL 44567010210 INJ $25.20

4330000043 AMPICILLIN 1,000 MG VIAL 44567010210 CSP $75.20

4330000046 HYDROCORTISONE 30 GM CREAM 64980030130 BULK $305.66

4330000045 ANUSOL HC (HYDROCORTISONE) 25

MG SUPPOSITORY

00574709012 UD $50.51

4330000835 APIXABAN 2.5 MG TABLET 00003089321 UD $24.43

4330000047 PETROLATUM,WHITE 50 APP/50 GM

TUBE

72140045231A BULK $19.04

4330000768 PETROLATUM,WHITE 400 APP/400 GM

JAR

72140003147A BULK $56.53

4330000048 ARIPiprazole 10 MG TAB 59148000813A UD $104.06

4330000049 ARTIFICIAL TEARS 15 ML BOT 300

DROP/15 ML BOTTLE

00536108494A BULK $15.33

4330000052 ASPIRIN ENTERIC COATED 325 MG

TABLET

00904201360A UD $2.50

4330000053 ASPIRIN 300 MG SUPP 00574703412 UD $5.11

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4330000054 ASPIRIN 325 MG TABLET 00536105301 UD $2.50

4330000051 ASPIRIN ENTERIC COATED 81 MG

TABLET

00280210012A UD $2.50

4330000055 ASPIRIN 81 MG CHEW TABLET 63739043401 UD $2.50

4330000056 ATENOLOL 25 MG TABLET 51079075920A UD $2.80

4330000057 ATENOLOL 50 MG TABLET 00093075201A UD $2.91

4330000058 ATORVASTATIN 10 MG TABLET 51079020820 UD $2.50

4330000059 ATORVASTATIN 20 MG TABLET 51079020920 UD $2.50

4330000670 ATROPINE 0.4 MG/1 ML VIAL 00517040125 INJ $30.63

4330000791 EDROPHONIUM CL/ATRO 10-0.14MG 5

ML AMPUL

67457019205 INJ $92.40

4330000061 ATROPINE 1MG/10 ML SYRINGE 00409491134 INJ $32.38

4330000060 ATROPINE 0.4MG/1 ML -20ML VIAL 00641600610 INJ $122.85

4330000062 AMOXICIL/CLAVUL 250MG/5ML SUSP

BOTTLE

60432006500A BULK $302.51

4330000063 AMOXICILLIN/CLAV 500 MG TABLET 43598020614 UD $13.23

4330000042 AMOXICILLIN/CLAV 875 MG TABLET 66685100100 UD $17.68

4330000064 AMOXICILLIN/CLAV XR 1000 MG TAB 00781194382 UD $24.43

4330000066 AZITHROMYCIN 100MG/5 ML SUSP

(300MG/15ML BOTTLE)

59762311001A BULK $122.08

4330000067 AZITHROMYCIN 200MG/5 ML SUSP

(600MG/15ML BOTTLE)

59762312001 BULK $122.08

4330000747 AZITHROMYCIN 250 MG TAB 50268009815A UD $25.87

4330000065 AZITHROMYCIN 500 MG VIAL 00069315084 INJ $38.50

4330000065 AZITHROMYCIN 500 MG VIAL 00069315084 CSP $88.50

4330000068 AZTREONAM 1000 MG VIAL 00003256016 INJ $101.50

4330000068 AZTREONAM 1000 MG VIAL 00003256016 CSP $151.50

4330000070 BACITRACIN ZINC OINT 0.9 GM

PACKET

45802006070 UD $2.50

4330000069 BACITRACIN OINT 30 GM TUBE 45802006001 BULK $26.99

4330000071 BACLOFEN 10 MG TABLET 68084085501 UD $2.59

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4330000073 BECLOMETHASONE 40 MCG/PUFF 120

INH

59310020212 BULK $592.48

4330000706 BENAZEPRIL 10 MG TABLET 51079014520 UD $3.33

4330000074 BEN-GAY 60 APP/2 OZ TUBE 00363368004A BULK $22.05

4330000075 BENZOCAINE 20% LIQ 0.45 OZ 50428711641A BULK $2.50

4330000077 BENZONATATE 100 MG PERLES 60687011501 UD $2.56

4330000078 BETAMETHASONE 6MG/1ML 5ML VIAL 00085056605 INJ $130.90

4330000079 BETAXOLOL-S OPTH 0.25% DROPS

10ML

00065024610 BULK $1,086.86

4330000505 PENICILLIN G BENZATHINE 1,200,000

UNIT/2 ML TUBEX

60793070110 INJ $550.80

4330000506 PENICILLIN G BENZATHINE 600000

TUBEX

60793070010 INJ $318.01

4330000080 BISACODYL 10 MG SUPP 00713010950 UD $2.50

4330000081 BISACODYL 5 MG DR TABLET 00904640761A UD $2.50

4330000082 BISMUTH SUBSALICYLATE 262 MG

CHEW TABLET

00904131546A UD $2.50

4330000083 PEPTO-BISMOL (BISMUTH

SUBSALICYLATE) 8OZ BOTTLE

00904131309 BULK $8.26

4330000072 BALANCED OPTH SALT SOLUTION 15

ML BOTTLE

00065079515 BULK $28.91

4330000086 BUDESONIDE 0.25 MG/2ML NEB

SOLUTION

00186198804 UD $30.52

4330000087 BUDESONIDE 0.5 MG/2 ML NEB

SOLUTION

00186198904 UD $35.91

4330000088 BUMETANIDE 0.5 MG TABLET 00093423201 UD $3.50

4330000089 BUMETANIDE 1 MG/4ML VIAL 00409141204 INJ $17.25

4330000089 BUMETANIDE 1 MG/4ML VIAL 00409141204 CSP $57.35

4330000730 BUPIVACAINE HCL 0.25% 50 ML MDV 00409158750A INJ $20.44

4330000731 BUPIVACAINE HCL 0.5% 50 ML MDV 00409161050A INJ $17.68

4330000091 BUPIVACAINE-EPI 0.5%/1:200000 10 ML

VIAL

00409904517 INJ $17.25

4330000091 BUPIVACAINE-EPI 0.5%/1:200000 10 ML

VIAL

00409904517 CSP $52.84

4330000095 BUPIVACAINE LIPOSOME 1.3% 20ML

VIAL

65250026620 INJ $1,102.50

4330000095 BUPIVACAINE LIPOSOME 1.3% 20ML

VIAL

65250026620 CSP $1,152.50

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4330000090 BUPIVACAINE 0.25%/EPI MPF 30 ML

VIAL

63323046837 INJ $26.95

4330000803 BUPIVACAINE-EPI /PF 0.25% 1:200000

VIAL 30 ML

63323046837A INJ $26.95

4330000803 BUPIVACAINE-EPI /PF 0.25% 1:200000

VIAL 30 ML

63323046837A CSP $76.95

4330000804 BUPIVACAINE 0.5%/EPI 1:200,000SDV

30 ML VIAL

00409904517A INJ $17.25

4330000093 BUPIVACAINE-MPF 0.5% 10 ML VIAL 63323046617 INJ $17.25

4330000093 BUPIVACAINE-MPF 0.5% 10 ML VIAL 63323046617 CSP $65.96

4330000092 BUPIVACAINE 0.25% PF 30 ML SDV 00409115901 INJ $17.25

4330000092 BUPIVACAINE 0.25% PF 30 ML SDV 00409115901 CSP $66.91

4330000094 BUPIVACAINE 0.5% PF 30 ML SDV 00409116202A INJ $17.25

4330000094 BUPIVACAINE 0.5% PF 30 ML SDV 00409116202A CSP $56.37

4330000096 buPROPion SR 150MG TAB 12-HR 51079039220 UD $6.34

4330000097 busPIRone 5 MG TAB 51079098520A UD $2.70

4330000098 BUTORPHANOL 2 MG/ML-1 ML VIAL 00409162601 CSINJ $17.25

4330000099 CAFFEINE 200MG TABLET 46017001816 UD $2.50

4330000100 CAFFEINE/SODIUM BENZOATE

500MG/2ML VIAL

00517250210 INJ $76.58

4330000100 CAFFEINE/SODIUM BENZOATE

500MG/2ML VIAL

00517250210 CSP $126.58

4330000101 CALADRYL LOTION (CALAMINE

8%/PRAMOXINE 1%) 177 ML BOTT

37205013030 BULK $17.47

4330000675 CALCITONIN-SALMON INJ 400IU/2ML

VIAL

67457067502A INJ $11,352.88

4330000200 CALCIUM CARBONATE 500MG CHEW

TABLET

00536104815A UD $2.50

4330000104 CALCIUM CHLORIDE 1GM/10ML

SYRINGE

00409492834 INJ $29.86

4330000104 CALCIUM CHLORIDE 1GM/10ML

SYRINGE

00409492834 CSP $79.86

4330000102 CALCITONIN NASAL SPRAY (200

UNIT/SPRAY) 3.7 ML

60505082306 BULK $414.89

4330000676 CALCIUM GLUCONATE 1000MG/10ML

VIAL

63323031119 INJ $24.57

4330000676 CALCIUM GLUCONATE 1000MG/10ML

VIAL

63323031119 CSP $74.57

4330000878 MENTHOL/ZINC OXIDE 113 GM TUBE 46876000040A BULK $26.25

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4330000103 CALCIUM CARBONATE/VITAMIN D3

600/200 MG TAB

00904585692 UD $2.50

4330000105 CAPTOPRIL 25 MG TABLET 51079086420 UD $6.51

4330000106 carBAMazepine 100 MG CHEW TABLET 51079087020 UD $2.50

4330000107 carBAMazepine 200 MG TABLET 00093010901 UD $5.60

4330000108 carBAMazepine 200 MG/10ML CUP 68094000859 UD $15.93

4330000188 CARBAMIDE PEROXIDE OTIC DROPS

15 ML

00536112494A BULK $4.87

4330000109 CARISOPRODOL 350 MG TABLET 63739004910 CSPO $9.50

4330000111 CARVEDILOL 3.125 MG TABLET 51079077120 UD $7.46

4330000110 CARVEDILOL 6.25 MG TABLET 51079093020 UD $7.46

4330000112 ceFAZolin 1000 MG VIAL 44567070725 INJ $17.25

4330000112 ceFAZolin 1000 MG VIAL 44567070725 CSP $56.93

4330000113 CEFEPIME 1000 MG VIAL 44567024010 INJ $23.94

4330000113 CEFEPIME 1000 MG VIAL 44567024010 CSP $73.94

4330000867 CEFEPIME 2000 MG VIAL 44567024110A INJ $41.16

4330000867 CEFEPIME 2000 MG VIAL 44567024110A CSP $91.16

4330000114 CEFOTAXIME 1,000 MG VIAL 00143993125 INJ $17.25

4330000114 CEFOTAXIME 1,000 MG VIAL 00143993125 CSP $57.70

4330000114 CEFOTAXIME 1,000 MG VIAL 00143993125 CSP $75.00

4330000707 CEFOXITIN 1,000 MG VIAL 44567024525A INJ $25.20

4330000707 CEFOXITIN 1,000 MG VIAL 44567024525A CSP $75.20

4330000115 CEFTAROLINE 400 MG VIAL 00456040010 INJ $614.08

4330000115 CEFTAROLINE 400 MG VIAL 00456040010 CSP $664.08

4330000116 CEFTAROLINE 600 MG VIAL 00456060010 INJ $614.08

4330000116 CEFTAROLINE 600 MG VIAL 00456060010 CSP $664.08

4330000117 cefTAZidime 1000MG VIAL 00409508216 INJ $17.25

Page 8: Drug Prices 2018 - SPRHC

4330000117 cefTAZidime 1000MG VIAL 00409508216 CSP $64.70

4330000118 cefTRIAXONE SODIUM 1,000 MG VIAL 00143985701 INJ $17.25

4330000118 cefTRIAXONE SODIUM 1,000 MG VIAL 00143985701 CSP $56.30

4330000120 cefTRIAXONE SODIUM 250 MG VIAL 00409733701 INJ $17.25

4330000120 cefTRIAXONE SODIUM 250 MG VIAL 00409733701 CSP $52.63

4330000119 cefTRIAXONE SODIUM 2,000MG VIAL 64679070301 INJ $316.37

4330000119 cefTRIAXONE SODIUM 2,000MG VIAL 64679070301 CSP $366.37

4330000728 cefTRIAXONE SODIUM 500 MG VIAL 00409733801 INJ $17.25

4330000728 cefTRIAXONE SODIUM 500 MG VIAL 00409733801 CSP $53.33

4330000121 cefUROXime 250 MG TABLET 68180030260 UD $15.40

4330000122 CELECOXIB 100 MG CAPSULE 00025152034 UD $25.73

4330000123 BENZOCAINE/MENTHOL 1 EACH

LOZENGE

63824071316A BULK $2.50

4330000124 cephALEXin 250 MG CAPSULE 50268015115 UD $2.50

4330000125 cephALEXin 250MG/5ML SUSP 100ML

BOTTLE

00093417773 BULK $100.63

4330000126 CEPHALEXIN 500 MG CAPSULE 50268015215 UD $4.27

4330000127 CETIRIZINE 10 MG TABLET 51079059720 UD $8.72

4330000128 CHARCOAL ACTIVATED 25 GM/120 ML

TUBE

00574012174 BULK $58.45

4330000130 chlordiazePOXIDE 25 MG CAPSULE 00555015902 CSPO $9.50

4330000131 chlordiazePOXIDE 5 MG CAPSULE 51079037420 CSPO $9.50

4330000132 chlorproMAZINE 25 MG/ML AMP 00641139735 INJ $87.71

4330000132 chlorproMAZINE 25 MG/ML AMP 00641139735 CSP $137.71

4330000839 CHOLESTYRAMINE (QUESTRAN) 4 GM

PACKET

49884046565 UD $11.80

4330000136 CIPROFLOXACIN 200 MG/100 ML D5W

*PREMIX*

36000000824 CSP $60.50

4330000136 CIPROFLOXACIN 200 MG/100 ML D5W

*PREMIX*

36000000824 CSP $75.00

4330000137 CIPROFLOXACIN 250MG TABLET 68084006901 UD $19.11

Page 9: Drug Prices 2018 - SPRHC

4330000139 CIPROFLOXACIN 500 MG TABLET 68084007001 UD $11.13

4330000138 CIPROFLOXACIN 400 MG/200 ML D5W

*PREMIX*

36000000924 CSP $64.00

4330000138 CIPROFLOXACIN 400 MG/200 ML D5W

*PREMIX*

36000000924 CSP $75.00

4330000135 CIPROFLOXACIN 0.3% OPH SOL 5 ML

BOTTLE

61314065605 BULK $165.59

4330000140 CITALOPRAM 20 MG TABLET 00904608561 UD $2.50

4330000141 CLARITHROMYCIN 500 MG TABLET 00781196260 UD $21.07

4330000142 CLINDAMYCIN 150 MG CAPSULE 63739005910 UD $2.50

4330000143 CLINDAMYCIN 600MG/50 ML D5W

*PREMIX*

00781328991 CSP $75.00

4330000144 CLINDAMYCIN PHOSPHATE 600 MG/4

ML VIAL

00009077520A INJ $17.25

4330000144 CLINDAMYCIN PHOSPHATE 600 MG/4

ML VIAL

00009077520A CSP $62.18

4330000145 CLINDAMYCIN 75 MG/5ML ORAL

SOLUTION

59762001601 BULK $217.11

4330000347 clonazePAM 1 MG TABLET 51079088220 CSPO $9.50

4330000148 cloNIDine HCL 1,000 MCG/10 ML VIAL 39822200001 INJ $87.50

4330000148 cloNIDine HCL 1,000 MCG/10 ML VIAL 39822200001 CSP $137.50

4330000149 cloNIDine 0.1 MG/DAY WEEKLY PATCH 00378087116A UD $116.06

4330000147 cloNIDine 0.1 MG TABLET 51079029920 UD $2.50

4330000150 cloNIDine 0.2 MG/DAY WEEKLY PATCH 51862045404 UD $195.41

4330000151 cloNIDine 0.3 MG/DAY WEEKLY PATCH 51862045504A UD $271.08

4330000152 CLOPIDOGREL 75 MG TABLET 68084053601 UD $23.84

4330000154 CLOTRIMAZOLE 10 MG TROCHE 00054414622 UD $11.27

4330000153 CLOTRIMAZOLE 1 % CREAM 15GM 00904782236 BULK $4.55

4330000155 CLOTRIMAZOLE 1% VAGINAL CR

21GM TUBE

51672206200 BULK $37.10

4330000156 CODEINE 30 MG TABLET 00054024424 CSPO $9.50

4330000218 DOCUSATE SODIUM 10MG/ML LIQUID

CUP

50383077116 UD $2.50

4330000157 COLCHICINE 0.6 MG CAP 00143301801 UD $22.89

Page 10: Drug Prices 2018 - SPRHC

4330000158 COLLAGENASE (SANTYL) 30 GM TUBE 50484001030A BULK $790.13

4330000162 CONJUGATED ESTROGENS 25MG

VIAL

00046074905 INJ $1,038.80

4330000162 CONJUGATED ESTROGENS 25MG

VIAL

00046074905 CSP $1,088.80

4330000160 CONJUGATED ESTROGENS 0.3 MG

TAB

00046110081 UD $18.76

4330000161 CONJUGATED ESTROGENS 0.625 MG

TAB

00046110281 UD $18.76

4330000163 ESTROGENS, CONJUGATED VAG CR

30 GM TUBE

00046087221A BULK $1,245.20

4330000164 CORTISPORIN OPTHALMIC OINT 3.5

GM TUBE

17478071935 BULK $215.88

4330000165 NEOMYCIN/POLYMYXIN B SULF/HC 20

DROP/7.5 ML BOTTLE

61314064175A BULK $544.18

4330000166 CORTISPORIN OTIC SUSP 10 ML

BOTTLE

24208063110 BULK $293.65

4330000167 COSYNTROPIN 250 MCG/1 ML VIAL 00548590000 INJ $373.03

4330000167 COSYNTROPIN 250 MCG/1 ML VIAL 00548590000 CSP $423.03

4330000858 LIPASE/PROTEASE/AMYLASE 1 EACH

CAPSULE.DR

00032121201B UD $10.26

4330000169 CYANOCOBALAMIN 1000MCG TAB 00536355601A UD $2.50

4330000168 CYANOCOBALAMIN 100 MCG TAB 00536354201A UD $2.50

4330000170 CYANOCOBALAMIN 1000 MCG/1 ML

VIAL

63323004401B INJ $24.19

4330000171 CYCLOBENZAPRINE 10 MG TAB 43063005004A UD $18.87

4330000173 CYPROHEPTADINE 4 MG TAB 00093292901 UD $3.75

4330000174 DEXTROSE 10% 1000ML BAG 00409793009 CSP $75.00

4330000820 DEXTROSE 10% 250 ML BAG 00409793002A IVF $75.00

4330000185 DEXTROSE 50% 50ML SYRINGE 00409490234 INJ $28.67

4330000185 DEXTROSE 50% 50ML SYRINGE 00409490234 CSP $78.67

4330000180 D5W 100 ML BAG 00409792337 CSP $75.00

4330000181 D5W 1000ML BAG 00409792209 CSP $75.00

4330000182 D5W 250 ML BAG 00409792202 CSP $75.00

4330000183 D5W 50 ML BAG 00409792336 CSP $75.00

Page 11: Drug Prices 2018 - SPRHC

4330000184 D5W 500 ML BAG 00409792203 CSP $75.00

4330000176 D5 1/2 NORMAL SALINE 1,000 ML BAG 00409792609 CSP $75.00

4330000808 D5 1/2 NORMAL SALINE 250 ML BAG 00409792602 CSP $75.00

4330000177 D5 1/2 NORMAL SALINE 500 ML BAG 00409792603 CSP $75.00

4330000179 D5/LACTATED RINGER 1000 ML BAG 00409792909 CSP $75.00

4330000178 D5 NORMAL SALINE 1,000 ML BAG 00409794109 CSP $75.00

4330000807 D5 NORMAL SALINE 500 ML BAG 00409794103 CSP $75.00

4330000175 D5 1/4 NORMAL SALINE 1,000 ML BAG 00409792409 CSP $75.00

4330000186 DANTROLENE 20 MG VIAL 42023012306 HCOST $88.64

4330000186 DANTROLENE 20 MG VIAL 42023012306 CSP $360.24

4330000187 DAPTOmycin 500 MG VIAL 67919001101 HCOST $445.49

4330000187 DAPTOmycin 500 MG VIAL 67919001101 CSP $1,609.22

4330000831 DARBEPOETIN ALFA 100 MCG/0.5 ML

SYRINGE

55513002501A INJ $2,709.00

4330000786 DENOSUMAB 60 MG/ML SYRINGE 55513071001A HCOST $2,958.88

4330000863 DESMOPRESSIN ACETATE 10

MCG/0.1 ML 5 ML NASAL SPRAY

55566250000A BULK $1,630.02

4330000190 DESOXIMETASONE 0.25% CREAM

15GM TUBE

45802049535 BULK $203.98

4330000738 DESOXIMETASONE 0.05% CREAM

60GM TUBE

51672127103A BULK $1,286.04

4330000191 DEXAMETHASONE 10 MG/ML 1ML VIAL 63323050601A INJ $18.38

4330000191 DEXAMETHASONE 10 MG/ML 1ML VIAL 63323050601A CSP $68.38

4330000192 DEXAMETHASONE 2 MG TAB 00054817625 UD $2.59

4330000194 DEXAMETHASONE 4 MG TABLET 00054817525A UD $4.20

4330000193 DEXAMETHASONE 4 MG/ML VIAL 63323016501 INJ $17.25

4330000196 DEXAMETHASONE OPHTH SUSP 0.1%

15 DROP/5 ML BOTTLE

00998061505A BULK $263.94

4330000195 DEXAMETHASONE 0.5 MG/5 ML ORAL

240ML

00054317757A BULK $4.66

4330000787 MAGNESIUM SULFATE 1GM/100 ML

D5W *PREMIX*

00409672723 CSP $75.00

Page 12: Drug Prices 2018 - SPRHC

4330000199 diazePAM 10 MG/2 ML SYRINGE 00409127332 CSINJ $95.73

4330000197 DIAZEPAM 2 MG TABLET 51079028420 CSPO $9.50

4330000198 DIAZEPAM 5 MG TABLET 63739007310 CSPO $9.50

4330000793 DICLOFENAC SODIUM 1% GEL 100 GM 63481068447 BULK $189.07

4330000202 DICYCLOMINE HCL 10 MG CAPSULE 51079011820 UD $2.50

4330000201 DICYCLOMINE HCL 20 MG/2 ML AMPUL 58914008052 INJ $280.46

4330000203 DIGOXIN IMMUNE FAB 40 MG VIAL 50633012011 HCOST $8,875.00

4330000203 DIGOXIN IMMUNE FAB 40 MG VIAL 50633012011 CSP $12,475.00

4330000206 DIGOXIN 500 MCG/2 ML AMP 70515026010 INJ $322.56

4330000205 DIGOXIN 125 MCG/2.5 ML SOLUTION 00054005746 BULK $24.50

4330000204 DIGOXIN 125 MCG TABLET 68084036601 UD $8.96

4330000210 dilTIAZem 120 MG ER CAP **24 HR** 68084005201 UD $2.50

4330000211 dilTIAZem HCL 180 MG ER CAP

**24HR**

68084005301 UD $2.50

4330000208 dilTIAZem 50 MG/10ML VIAL 17478093710 INJ $17.25

4330000208 dilTIAZem 50 MG/10ML VIAL 17478093710 CSP $62.74

4330000859 dilTIAZem 125 MG/ 25 ML VIAL 00641601501A INJ $24.40

4330000859 dilTIAZem 125 MG/ 25 ML VIAL 00641601501A CSP $74.40

4330000207 dilTIAZem HCL 30 MG TABLET 51079074520 UD $2.50

4330000209 dilTIAZem 25 MG/5 ML VIAL 00641601310 INJ $17.25

4330000209 dilTIAZem 25 MG/5 ML VIAL 00641601310 CSP $58.40

4330000677 dilTIAZem ER 60 MG CAPSULE 51079092420A UD $13.90

4330000666 TETANUS AND DIPHTHERIA TOX/PF

0.5 ML VIAL

49281021510 INJ $109.87

4330000212 diphenhydrAMINE 25MG TAB 00904555124 UD $2.50

4330000672 diphenhydrAMINE 25MG/10ML CUP 00121048900A UD $18.24

4330000213 diphenhydrAMINE 50MG/ML INJ (1ml) 63323066401 INJ $17.25

Page 13: Drug Prices 2018 - SPRHC

4330000214 TETANUS,DIPHTHERIA TOXD

PEDIATRIC 0.5 ML VIAL

49281022558 INJ $177.00

4330000215 DIVALPROEX SODIUM 125 MG

SPRINKLE CAP

68084031301 UD $4.97

4330000216 DIVALPROEX SODIUM 250 MG *24 HR*

EXTENDED RELEASE TAB

68084031001 UD $8.58

4330000217 DOBUTamine 500MG/250ML BAG

*PREMIX*

00409234732 CSP $93.82

4330000217 DOBUTamine 500MG/250ML BAG

*PREMIX*

00409234732 CSP $75.00

4330000679 DOCUSATE SODIUM 100 MG CAP 00904645561A UD $2.50

4330000668 DONEPEZIL HCL 5 MG TABLET 00904640861 UD $2.50

4330000219 PHENOBARB/HYOSCY/ATROPINE/SCO

P 5 ML/16.2 MG ELIXIR

59212042304 UD $13.90

4330000220 DOPamine HCL 400 MG/10 ML VIAL 00409910420 INJ $17.25

4330000220 DOPamine HCL 400 MG/10 ML VIAL 00409910420 CSP $56.58

4330000221 DOPAMINE HCL 400MG /D5W 250 ML

*PREMIX*

00338100702 CSP $75.00

4330000853 DORZOLAMIDE 2% OPH SOL 10 ML 00006351936 BULK $295.02

4330000222 DOXAZOSIN 2 MG TABLET 51079095820 UD $13.16

4330000223 DOXEPIN HCL 25 MG CAPSULE 51079043720 UD $2.94

4330000744 DOXYCYCLINE 100 MG CAPSULE 00143314250 UD $4.20

4330000224 DOXYCYCLINE 100 MG/5 ML VIAL 63323013011 INJ $84.56

4330000224 DOXYCYCLINE 100 MG/5 ML VIAL 63323013011 CSP $134.56

4330000696 DROPERIDOL 5MG/2ML VIAL 00517970225 INJ $17.25

4330000769 DULOXETINE HCL 30 MG DR CAPSULE 00002324030A UD $27.97

4330000225 DUTASTERIDE 0.5 MG CAPSULE 00173071204 UD $22.44

4330000229 ENALAPRILAT 2.5 MG/2 ML VIAL 00409212202 INJ $17.25

4330000645 ENALAPRIL MAL 5 MG TABLET 51079095120 UD $6.48

4330000761 ENOXAPARIN 40 MG/0.4 ML SYRINGE 00075062040A INJ $115.78

4330000232 ENOXAPARIN 60 MG/0.6 ML SYRINGE 00781335603A INJ $262.61

4330000230 ENOXAPARIN 100 MG/1 ML SYRINGE 00781350005A INJ $321.37

Page 14: Drug Prices 2018 - SPRHC

4330000231 ENOXAPARIN 30 MG/0.3 ML SYRINGE 00781313301A INJ $85.23

4330000233 ePHEDrine SULFATE 50MG/ML AMP 17478051500 INJ $184.73

4330000233 ePHEDrine SULFATE 50MG/ML AMP 17478051500 CSP $234.73

4330000866 EPINEPHRINE HCL 1MG/ML AMPUL

PRESERVATIVE FREE

54288010310A INJ $61.25

4330000866 EPINEPHRINE HCL 1MG/ML AMPUL

PRESERVATIVE FREE

54288010310A CSP $111.25

4330000235 EPINEPHrine 1 MG/ML 30 ML MDV 76329906100 INJ $206.50

4330000235 EPINEPHrine 1 MG/ML 30 ML MDV 76329906100 CSP $256.50

4330000237 EPINEPHrine 1 MG/ML VIAL 42023015925 INJ $52.36

4330000237 EPINEPHrine 1 MG/ML VIAL 42023015925 CSP $102.36

4330000234 EPINEPHrine 1 MG/10 ML SYRINGE 00409492134 INJ $17.25

4330000236 EPINEPHrine HCL 1 MG/ML TOPICAL

NASAL SOLN 30 ML BOTTLE

42023010301 BULK $665.00

4330000238 EPOETIN ALFA 10,000 UNIT/1 ML VIAL 55513014410 INJ $580.30

4330000685 MAGNESIUM SULFATE 1 LB BOX 10

APP/1 LB BOX

37205060243A BULK $2.50

4330000818 EPTIFIBATIDE 75 MG/100 ML VIAL

*PREMIX*

00085113601B CSP $1,954.18

4330000818 EPTIFIBATIDE 75 MG/100 ML VIAL

*PREMIX*

00085113601B CSP $1,088.10

4330000763 EPTIFIBATIDE 20,000 MCG/10ML VIAL 00085117701 INJ $608.44

4330000763 EPTIFIBATIDE 20,000 MCG/10ML VIAL 00085117701 CSP $658.44

4330000240 ERTAPENEM SODIUM 1000 MG VIAL 00006384371 INJ $450.31

4330000240 ERTAPENEM SODIUM 1000 MG VIAL 00006384371 CSP $500.31

4330000243 ERYTHROMYCIN BASE 250 MG ER

CAPSULE

68308025010 UD $21.11

4330000832 ERYTHROMYCIN 0.5% OPHTH OINT

1GM TUBE

17478007031A BULK $35.77

4330000833 ERYTHROMYCIN 0.5% OPHTH OINT

3.5 GM TUBE

17478007035 BULK $65.28

4330000687 ERYTHROMYCIN ETHYLSUCC

200MG/5 ML 100ML BOTTLE

24338013402 BULK $65.84

4330000242 ERYTHROMYCIN BASE 500 MG

TABLET

24338010413 UD $61.22

4330000244 ESCITALOPRAM OXALATE 10 MG

TABLET

68084061701 UD $15.12

Page 15: Drug Prices 2018 - SPRHC

4330000245 ESMOLOL 100 MG/10 ML VIAL 67457018210 INJ $29.40

4330000245 ESMOLOL 100 MG/10 ML VIAL 67457018210 CSP $79.40

4330000850 ESOMEPRAZOLE 40 mg SUSP 40 MG

SUSPDR.PKT

00186405001 UD $31.61

4330000246 ESOMEPRAZOLE SODIUM 40 MG VIAL 00186604001 INJ $156.28

4330000246 ESOMEPRAZOLE SODIUM 40 MG VIAL 00186604001 CSP $206.28

4330000247 ETHYL CHLORIDE SPRAY 3.5 OZ BOT 00386000104 BULK $129.50

4330000248 ETOMIDATE 20 MG/10 ML VIAL 00409669501 INJ $19.46

4330000249 EYE IRRIGATING SOLN 120 ML

BOTTLE

59390017518A BULK $23.80

4330000250 EZETIMIBE 10 MG TABLET 66582041431 UD $40.25

4330000251 FAMOTIDINE 20 MG TABLET 51079096620 UD $6.09

4330000252 FAMOTIDINE 20 MG/2 ML VIAL 63323073912 INJ $17.25

4330000252 FAMOTIDINE 20 MG/2 ML VIAL 63323073912 CSP $53.15

4330000733 fentaNYL CITRATE 100 MCG/2 ML VIAL 00409909422A CSINJ $17.25

4330000734 fentaNYL CITRATE 250 MCG/5 ML VAIL 00409909425A CSINJ $17.25

4330000253 fentaNYL TRANSDERMAL PATCH 12

MCG/HR X 72 HR PATCH

00378911998 CSPO $71.05

4330000254 fentaNYL TRANSDERMAL PATCH 25

MCG/HR X 72 HR PATCH

00378912198 CSPO $50.47

4330000255 fentaNYL TRANSDERMAL PATCH 50

MCG/HR X 72 HR PATCH

60505700702 CSPO $136.08

4330000256 fentaNYL TRANSDERMAL PATCH 75

MCG/HR X 72 HR PATCH

60505700802 CSPO $207.59

4330000865 FERROUS GLUCONATE 324 MG

(ELEMENTAL IRON 37.5MG) TABLET

00904213761A UD $2.50

4330000688 FERROUS SULFATE LIQUID 220 MG/5

ML LIQ

50383077816A BULK $2.50

4330000257 FERROUS SULFATE (65MG)= 325MG

(ELEMENTAL IRON 65MG) 1 TAB

00245010801 UD $2.87

4330000258 FINASTERIDE 5MG TABLET 50268032315 UD $11.03

4330000259 OMEGA-3 FISH OIL 1,000 MG CAPSULE 00904404360 UD $2.50

4330000260 FLEET ENEMA 1 BOTTLE 00132020140 BULK $4.66

4330000261 MINERAL OIL 1 ENEMA BOTTLE 00132030140A BULK $6.06

Page 16: Drug Prices 2018 - SPRHC

4330000269 FLUoxetine HCL 10MG CAPSULE 00904578461 UD $2.50

4330000872 FLU VACC HD 2018-19(65YR+)/PF 180

MCG/0.5 ML SYRINGE

49281040365A INJ $161.67

4330000874 FLU VACC QD PEDS 2018-19(6-

35MOS)PF 30 MCG/0.25 ML SYRINGE

49281051825A INJ $64.79

4330000267 FLUCONAZOLE 100 MG TABLET 00172541146 UD $30.63

4330000263 FLUCONAZOLE 150MG TABLET 00172541211 UD $48.76

4330000264 FLUCONAZOLE 200MG/100ML NS

*PREMIX*

25021011382A CSP $81.50

4330000264 FLUCONAZOLE 200MG/100ML NS

*PREMIX*

25021011382A CSP $75.00

4330000265 FLUCONAZOLE 400MG/200ML NS

*PREMIX*

70655008806 CSP $75.00

4330000266 FLUCONAZOLE 40MG/ML SUSP 35ML

BOTTLE

59762503001 BULK $455.11

4330000877 FLUDROCORTISONE ACETATE 0.1 MG

TABLET

00115703301 UD $2.63

4330000842 FLU VACC HD 2017-18(65YR+)/PF 180

MCG/0.5 ML SYRINGE

49281040165B INJ $148.33

4330000268 FLUMAZENIL 0.1MG/ML 10ML VIAL 63323042410A INJ $218.40

4330000705 FLUOCINONIDE 0.05% CREAM 15

APP/15 GM TUBE

00093026215A BULK $159.43

4330000752 FLUOCINONIDE 0.05% OINT 15 APP/15

GM TUBE

00093026415A BULK $247.63

4330000690 FLUORESCEIN OPHTHALMIC 0.6 MG

STRIP

17478040303A UD $2.50

4330000844 FLU VACC QS 2017-18(6-35MOS)PF

30MCG/0.25 ML SYRINGE

49281051725A INJ $62.90

4330000873 FLU VACC QUAD 2018-19(36MOS+)PF

60 MCG/0.5 ML SYRINGE

49281041850A INJ $60.27

4330000843 FLU VACC QUAD 2017-18(36MOS+)PF

60MCG/0.5 ML SYRINGE

49281041750B INJ $60.27

4330000270 FLUTICASONE HFA 110 MCG ORAL

INH ** 12 GM **

00173071920 BULK $851.52

4330000753 FLUTICASONE HFA 220 MCG ORAL

INH **12 GM **

00173072020A BULK $1,322.62

4330000271 FLUTICASONE HFA 44 MCG ORAL INH

** 10.6 GM **

00173071820 BULK $636.06

4330000262 FLUTICASONE NASAL SPRAY**50

MCG/SPRAY**120 SPRAY/16 GM

60505082901 BULK $298.41

4330000272 FOLIC ACID 1 MG TABLET 62584089701 UD $2.50

4330000273 FOLIC ACID 5 MG/ML 10ML VIAL 63323018410 INJ $17.25

4330000273 FOLIC ACID 5 MG/ML 10ML VIAL 63323018410 CSP $65.79

Page 17: Drug Prices 2018 - SPRHC

4330000274 FOSPHENYTOIN SODIUM 500 PE/10

ML VIAL

00069600110 INJ $398.09

4330000274 FOSPHENYTOIN SODIUM 500 PE/10

ML VIAL

00069600110 CSP $448.09

4330000702 FUROSEMIDE SOLUTION 10 MG/ML

SOLUTION

00054329446 BULK $2.50

4330000277 FUROSEMIDE 20 MG TABLET 00904579661 UD $2.50

4330000276 FUROSEMIDE 20 MG/2 ML VIAL 36000028225 INJ $17.25

4330000278 FUROSEMIDE 40 MG TABLET 51079007320 UD $2.50

4330000275 FUROSEMIDE 40 MG/4 ML VIAL 36000028325 INJ $17.25

4330000279 GABAPENTIN 100 MG CAPSULE 60505011200 UD $2.50

4330000281 GABAPENTIN 300 MG CAPSULE 60505011308 UD $4.66

4330000280 GABAPENTIN 400 MG CAPSULE 60505011400 UD $5.67

4330000283 GEMFIBROZIL 600 MG TABLET 68084047301 UD $15.51

4330000286 GENTAMICIN SULFATE 3% OPHTH 5

ML

17478028310 BULK $67.13

4330000285 GENTAMICIN 0.3% OPHTHALMIC OINT

3.5 GM

17478028435 BULK $124.04

4330000284 GENTAMICIN SULF 80 MG/2 ML VIAL 63323001002 INJ $17.25

4330000284 GENTAMICIN SULF 80 MG/2 ML VIAL 63323001002 CSP $61.31

4330000284 GENTAMICIN SULF 80 MG/2 ML VIAL 63323001002 CSP $75.00

4330000289 glipiZIDE 2.5 MG ER TABLET 24-HR 68084029521 UD $4.17

4330000288 glipiZIDE 5 MG TABLET 51079081020 UD $2.50

4330000287 glipiZIDE XL 5 MG ER TABLET 68084011101 UD $2.52

4330000290 GLUCAGON 1 MG/ML VIAL 55390000410 INJ $600.60

4330000291 glyBURIDE 5 MG TABLET 51079087320 UD $2.50

4330000292 GLYCERIN ADULT 1 SUPP 00713010109 UD $2.73

4330000293 GLYCERIN SUPPOSITORY **CHILD** 00713010209 UD $2.66

4330000294 GLYCOPYRROLATE 0.2MG/ML 5ML

VIAL

00517460525 INJ $37.56

4330000788 guaiFENesin/PSEUDOEPHED HCL

600/60MG ER TABLET

63824005736 UD $2.50

Page 18: Drug Prices 2018 - SPRHC

4330000295 guaiFENesin 100 MG/5 ML CUP 00121174405 UD $2.50

4330000306 guaiFENesin 600 MG ER TABLET

(MUCINEX)

63824000815 UD $2.50

4330000297 HALOPERIDOL DECANOATE 50MG/ML

1ML AMP

10147092103 INJ $90.62

4330000298 HALOPERIDOL 0.5 MG TABLET 51079073320 UD $2.50

4330000299 HALOPERIDOL 5 MG TABLET 51079073620A UD $3.82

4330000300 HALOPERIDOL 5 MG/ML VIAL 63323047401 INJ $20.97

4330000310 hydroCHLOROthiazide 25 MG TABLET 63739012810 UD $2.50

4330000304 HEPARIN LOCK FLUSH 500 UNITS/5 ML

(100 UNITS/ML) SYRINGE**PF**

08290306515 INJ $17.25

4330000775 HEPARIN LOCK FLUSH 300 UNITS/3 ML

(100 UNITS/ML) SYRINGE

08290306517 INJ $17.25

4330000856 HEPARIN SODIUM 10,000 UNITS/10 ML

(1000 UNIT/ML) VIAL

63323054011A INJ $25.45

4330000303 HEPARIN SODIUM 1,000 UNIT/1 ML

VIAL

63323054001A INJ $17.25

4330000693 HEPARIN 5,000 UNIT/1 ML VIAL 25021040201B INJ $17.25

4330000823 HEPARIN 25,000 UNITS/250ML

*PREMIX* (100 UNITS/ML)

00409779362A CSP $78.88

4330000823 HEPARIN 25,000 UNITS/250ML

*PREMIX* (100 UNITS/ML)

00409779362A CSP $75.00

4330000302 HEPATITIS B VACCINE ADULT 20

MCG/ML SYRINGE

58160082152 INJ $197.75

4330000848 HONEY LEPTOSPERMUM 44 ML

PASTE

09958003361A BULK $50.47

4330000326 INSULIN NovoLIN 70/30 100 UNIT/1ML 00002871501 INSULIN $40.00

4330000330 INSULIN-HumaLOG MIX 75/25 100

UNIT/1ML

00002751101 INSULIN $40.00

4330000329 INSULIN LISPRO 100 UNIT/1ML 00002751001 INSULIN $40.00

4330000327 INSULIN-HUMAN NPH 100 UNIT/1 ML 00002831501 INSULIN $40.00

4330000328 INSULIN-HUMAN REGULAR 100 UNIT/1

ML

00002821501 INSULIN $40.00

4330000328 INSULIN-HUMAN REGULAR 100 UNIT/1

ML

00002821501 CSP $102.05

4330000811 HYDROGEN PEROXIDE 240 ML

SOLUTION

00363087143A BULK $8.40

4330000308 hydrALAZINE HCL 10 MG TABLET 51079007420 UD $2.50

4330000307 hydrALAZINE 20 MG/ML 1ML VIAL 63323061416A INJ $17.25

Page 19: Drug Prices 2018 - SPRHC

4330000309 hydrALAZINE HCL 25 MG TABLET 62584073301 UD $2.50

4330000312 HYDROCORTISONE 1% CREAM 28 GM

TUBE

45802043803 BULK $13.97

4330000311 HYDROCORTISONE 0.5% CREAM 30

GM TUBE

00168001431 BULK $10.01

4330000694 HYDROCORTISONE 20 MG TABLET 00115170001A UD $3.82

4330000681 HYDROmorphone 2 MG TABLET 00406324301A CSPO $9.50

4330000314 HYDROmorphone HCL 2 MG/1 ML VIAL 00409336501 CSINJ $17.25

4330000313 HYDROCORTISONE (Solu-CORTEF)

100 MG/2 ML VIAL

00009001103 INJ $47.01

4330000315 hydrOXYzine HCL 25mg TABLET 68084025401 UD $2.50

4330000316 hydrOXYzine HCL 25 MG/ML VIAL 00517420125 INJ $84.70

4330000317 HYOSCYAMINE SULFATE 0.125 MG

TAB (SL, CHEWABLE OR ORAL)

51525011301 UD $2.50

4330000319 IBUPROFEN 200 MG TABLET 00904791461 UD $2.50

4330000320 IBUPROFEN 400 MG TABLET 00904585361 UD $2.50

4330000321 IBUPROFEN 800 MG TABLET 63739069110 UD $2.50

4330000318 IBUPROFEN 100 MG/5 ML UNIT DOSE

CUP

00121477405 UD $6.58

4330000324 INDOMETHACIN 25 MG CAPSULE 00093402901 UD $2.50

4330000799 FLU VACC HD 2016-17 (65YR+)/PF 180

MCG/0.5 ML SYRINGE

49281040165A INJ $148.33

4330000325 inFLIXimab 100 MG VIAL 57894003001 HCOST $2,919.55

4330000325 inFLIXimab 100 MG VIAL 57894003001 CSP $4,137.37

4330000691 FLU VACC QUAD 2016-17(36MOS+)/PF

0.5 ML SYRINGE

49281041750A INJ $60.27

4330000692 FLU VACC QS 2016-17(6-35MOS)PF

0.25 ML SYRINGE

49281051700A INJ $62.90

4330000331 INSULIN LANTUS 100 UNIT/1ML 00088222033 INSULIN $40.00

4330000333 IPRATROPIUM BROMIDE 0.2 MG/ML

SOLUTION

00378797091 UD $6.65

4330000335 IPRATROPIUM/ALBUTEROL 3 ML NEB

SOL

00487020160 UD $7.35

4330000334 IPRATROPIUM HFA ORAL INHALER

12.9 GM(17 MCG/PUFF 200 PUFF)

00597008717 BULK $1,257.73

4330000336 IRON DEXTRAN 100 MG/2ML VIAL 52544093102 INJ $92.82

Page 20: Drug Prices 2018 - SPRHC

4330000336 IRON DEXTRAN 100 MG/2ML VIAL 52544093102 CSP $142.82

4330000337 IRON SUCROSE INJ 100 MG/5 ML VIAL 00517234010 INJ $210.00

4330000337 IRON SUCROSE INJ 100 MG/5 ML VIAL 00517234010 CSP $260.00

4330000339 ISOSORBIDE MONONITRATE 10 MG

TABLET

62175010601 UD $2.50

4330000695 ISOSORBIDE MONONITRATE 60 MG

ER TAB

00143226001 UD $5.01

4330000816 IOPAMIDOL 61% 50ML VIAL 00270131530A INJ $157.75

4330000815 IOPAMIDOL 61% 100ML VIAL 00270131535 INJ $308.28

4330000783 IOPAMIDOL 76 % 100 ML VIAL 00270131635 INJ $342.16

4330000776 IOPAMIDOL 41% 20 ML VIAL 00270141125 INJ $309.89

4330000531 POTASSIUM CHLORIDE 10 MEQ ER

TABLET

63739044610A UD $3.01

4330000532 POTASSIUM CHLORIDE IV 20 MEQ/10

ML VIAL

00409665106 INJ $17.25

4330000532 POTASSIUM CHLORIDE IV 20 MEQ/10

ML VIAL

00409665106 CSP $60.40

4330000530 POTASSIUM CHLORIDE LIQUID 20

MEQ/15 ML LIQUID

00121146515 UD $18.97

4330000860 KCL 20 MEQ IN SWI 100 ML PREMIX 00409707526A PREMIX $75.00

4330000528 POTASSIUM CHLORIDE 20 MEQ ER

TABLET

66758019013 UD $2.50

4330000533 POTASSIUM CHLORIDE 8MEQ ER CAP

8 MEQ ERCAP

68382070201 UD $3.29

4330000806 KETAMINE 500 MG/5 ML VIAL 42023011510A CSINJ $34.58

4330000806 KETAMINE 500 MG/5 ML VIAL 42023011510A CSP $84.58

4330000341 KETOCONAZOLE 2% CREAM 15 GM

TUBE

00168009915 BULK $108.15

4330000346 KETOROLAC TROMETHAMINE 10 MG

TABLET

00093031401 UD $7.56

4330000343 KETOROLAC 15 MG/ 1 ML VIAL 00409379301 INJ $17.25

4330000344 KETOROLAC 30 MG/ 1 ML VIAL 00409379501 INJ $20.13

4330000345 KETOROLAC 60 MG/2 ML VIAL 00409379601 INJ $17.25

4330000348 LABETALOL HCL 100MG/20 ML INJ

VIAL

00409226720 INJ $17.25

4330000348 LABETALOL HCL 100MG/20 ML INJ

VIAL

00409226720 CSP $61.87

Page 21: Drug Prices 2018 - SPRHC

4330000348 LABETALOL HCL 100MG/20 ML INJ

VIAL

00409226720 CSP $75.00

4330000349 LABETALOL HCL 200 MG TABLET 51079092920 UD $2.50

4330000700 LACRI LUBE 3.5 GM TUBE 00023031204A BULK $34.20

4330000701 ACIDOPHILUS 175 MG CAP 175 MG

CAPSULE

40985021339A UD $2.50

4330000351 LACTULOSE 20 GM/30 ML CUP 66689003801 UD $5.85

4330000352 lamoTRIgine 100MG TABLET 51079049920 UD $16.63

4330000353 LANSOPRAZOLE 30 MG CAPSULE 51079012108 UD $19.81

4330000767 LATANOPROST 0.005% OPH 20

DROP/2.5 ML BOTTLE

61314054701 BULK $332.50

4330000354 LEVALBUTEROL 0.31 MG/3 ML NEB

SOLUTION

00093414564 UD $23.49

4330000758 LEVALBUTEROL 1.25 MG/3 ML NEB

SOLUTION

00093414864B UD $34.00

4330000355 LEVALBUTEROL 0.63 MG/3 ML NEB

SOLUTION

00093414664 UD $23.49

4330000356 levETIRAcetam 500 MG TABLET 50268046815 UD $11.69

4330000357 levETIRAcetam 500 MG/5 ML INJ VIAL 50474000263 INJ $185.64

4330000357 levETIRAcetam 500 MG/5 ML INJ VIAL 50474000263 CSP $235.64

4330000703 levoFLOXacin 250 MG/D5 50ML

*PREMIX*

36000004624A CSP $64.88

4330000703 levoFLOXacin 250 MG/D5 50ML

*PREMIX*

36000004624A CSP $75.00

4330000358 levoFLOXacin 250MG TABLET 68084048101 UD $57.72

4330000359 levoFLOXacin 500 MG/D5 100 ML

*PREMIX*

36000004724 CSP $71.74

4330000359 levoFLOXacin 500 MG/D5 100 ML

*PREMIX*

36000004724 CSP $75.00

4330000360 Levofloxacin 500Mg Tab 68084048201 UD $66.15

4330000361 levoFLOXacin 750 MG/D5 150 ML

*PREMIX*

36000004824 CSP $74.05

4330000361 levoFLOXacin 750 MG/D5 150 ML

*PREMIX*

36000004824 CSP $75.00

4330000362 LEVONORGESTREL 1.5 MG TABLET 68180085211A UD $127.96

4330000365 LEVOTHYROXINE SODIUM 112 MCG

TABLET

00074929690 UD $4.13

4330000368 LEVOTHYROXINE SODIUM 100 MCG

TABLET

00074662411 UD $4.24

Page 22: Drug Prices 2018 - SPRHC

4330000736 LEVOTHYROXINE SODIUM 200 MCG

INJ VIAL

63323064710A UD $739.06

4330000366 LEVOTHYROXINE SODIUM 25 MCG

TABLET

51079044420 UD $2.50

4330000367 LEVOTHYROXINE SODIUM 50 MCG

TABLET

51079044020 UD $2.50

4330000363 LEVOTHYROXINE SODIUM 75 MCG

TABLET

51079044120 UD $2.50

4330000364 LEVOTHYROXINE SODIUM 88 MCG

TABLET

00378180777 UD $2.50

4330000374 LIDOCAINE HCL 2% 100 MG/5 ML

SYRINGE

76329339001 INJ $17.25

4330000369 LIDOCAINE HCL 1% W\EPI 1:100,000 20

ML VIAL

63323048227 INJ $17.25

4330000373 LIDOCAINE HCL 1% MDV 10 MG/ML

VIAL

63323048527 INJ $17.25

4330000371 LIDOCAINE HCL 2% W/EPI 1:100,000

20ML MDV

63323048327 INJ $17.25

4330000377 LIDOCAINE 2GM/D5W 500ML *PREMIX* 00338040903 CSP $70.41

4330000377 LIDOCAINE 2GM/D5W 500ML *PREMIX* 00338040903 CSP $75.00

4330000375 LIDOCAINE HCL 2% 10 ML MDV VIAL 63323048617 INJ $17.25

4330000376 LIDOCAINE 2% VISCOUS SOLUTION 15

ML CUP

50383077515A UD $2.70

4330000370 LIDOCAINE HCL 2% 5 ML UROJET

SYRINGE

76329301205 UD $20.13

4330000378 LIDOCAINE PF 4% INJ SOLUTION

[40MG/ML] 5 ML

00409428311A INJ $17.25

4330000379 LIDOCAINE HCL 4% TOPICAL

SOLUTION 50 ML BOTTLE

00054350547 BULK $168.00

4330000380 LIDOCAINE 5% OINTMENT 35 GM

TUBE

50383093335A BULK $1,036.98

4330000372 LIDOCAINE-MPF 0.5% 50ML SDV [5

MG/ML ]

63323049157 INJ $44.07

4330000228 LIDOCAINE 4% CREAM 5 GM TUBE (L-

M-X-4)

00496088206 UD $29.40

4330000381 LIDOCAINE PATCH 5% SINGLE

PATCH""

63481068706 BULK $55.30

4330000864 LINAGLIPTIN 5 MG TABLET 00597014030 UD $48.02

4330000382 LINEZOLID 600 MG TABLET 00009513502 UD $595.25

4330000383 LINEZOLID 600 MG/300 ML *PREMIX* 00703906031 CSP $246.60

4330000772 FAT EMULSIONS 20% 500 ML BAG 00338051913A CSP $177.33

4330000724 LISINOPRIL 10 MG TABLET 51079098220 UD $3.29

Page 23: Drug Prices 2018 - SPRHC

4330000723 LISINOPRIL 5 MG TABLET 51079098120 UD $3.19

4330000725 LISINOPRIL 20 MG TAB 00172376060A UD $3.68

4330000384 LITHIUM CARBONATE 300 MG TABLET 00054852825 UD $2.50

4330000385 DIPHENOXYLATE-ATROPINE 1 TAB 59762106101 CSPO $9.50

4330000386 DIPHENOXYLATE-ATROPINE 2.5 MG/5

ML LIQUID

00054319446 CSPO $24.50

4330000387 LOPERAMIDE HCL 2 MG CAPSULE 51079069020 UD $3.05

4330000790 LORazepam 2MG/ML ORAL CONC 30

ML BOTTLE

00121077001A CSPO $9.50

4330000388 LORATADINE 10 MG TABLET 68084024801A UD $2.50

4330000391 LORazepam 1 MG TABLET 51079038620 CSPO $9.50

4330000389 LORazepam 2 MG/ML 1 ML VIAL 00641604425 CSINJ $17.25

4330000389 LORazepam 2 MG/ML 1 ML VIAL 00641604425 CSP $53.43

4330000390 LORazepam 0.5 MG TABLET 51079041720 CSPO $9.50

4330000392 LOSARTAN POTASSIUM 25 MG

TABLET

00904639161 UD $2.50

4330000680 LOSARTAN POTASSIUM 50 MG

TABLET

68084034701A UD $7.88

4330000393 CLOTRIMAZOLE/BETAMETHASONE

DIP 15 APP/15 GM TUBE

00085092401 BULK $204.75

4330000394 CLOTRIMAZOLE/BETAMETHASONE

DIP 30 ML LOTION

00168037030 BULK $433.30

4330000395 LOVASTATIN 20 MG TABLET 51079097520 UD $8.30

4330000350 LACTATED RINGERS 1,000 ML BAG 00409795309 CSP $75.00

4330000817 LACTATED RINGERS 500 ML BAG 00338011703A CSP $75.00

4330000396 SURGICAL LUBRICANT 5 GM PACKET 00281020545 UD $2.50

4330000397 SURGICAL LUBRICANT 56.7 GM TUBE 00281020502 BULK $5.53

4330000399 MAGNESIUM CITRATE 300 ML BOTTLE 37205036238 BULK $10.50

4330000756 MAGNESIUM OXIDE 400MG TABLET 63739035410A UD $2.50

4330000400 MAGNESIUM SULFATE 1GM/2ML VIAL 63323006402 INJ $17.25

4330000400 MAGNESIUM SULFATE 1GM/2ML VIAL 63323006402 CSP $55.53

Page 24: Drug Prices 2018 - SPRHC

4330000401 MAGNESIUM SULFATE 10 GM/20 ML

VIAL

00409216802 INJ $17.25

4330000401 MAGNESIUM SULFATE 10 GM/20 ML

VIAL

00409216802 CSP $63.27

4330000402 MANNITOL 20 % 100 GM/500 ML BAG 00338035703 CSP $242.78

4330000402 MANNITOL 20 % 100 GM/500 ML BAG 00338035703 CSP $110.16

4330000847 NEOMYCIN/POLYMYXIN

B/DEXAMETHA 3.5 GM OPHTH OINT

00065063136A BULK $682.12

4330000403 MAXZIDE-25 (TRIAMTERENE 37.5

MG/HCTZ 25MG) TAB

00591042401 UD $2.50

4330000405 MECLIZINE 25 MG TABLET 68084049101 UD $3.01

4330000407 medroxyPROGESTERone 10 MG

TABLET

59762374202 UD $2.50

4330000406 medroxyPROGESTERone 2.5 mg

TABLET

59762005501 UD $2.50

4330000408 MEGESTROL ACETATE 400 MG/10 ML

SUSP CUP

00121477610A UD $2.50

4330000825 MELATONIN 3 MG TABLET 00904518252 UD $2.50

4330000876 MELATONIN 1 MG TABLET 00536111411A UD $2.50

4330000841 MELOXICAM 7.5 MG TABLET 00440584100 UD $2.50

4330000409 MEMANTINE HCL 5 MG TABLET 00456320511 UD $25.94

4330000821 HALLS COUGH 5.8 MG LOZENGE 12546062544 UD $2.50

4330000410 MEPERIDINE 50 MG/1 ML INJ SYRINGE 00409117830 CSINJ $21.53

4330000411 MEPERIDINE 50MG TABLET 00054859511 CSPO $10.57

4330000412 MEPERIDINE 75 MG/1 ML INJ SYRINGE 00409117930 CSINJ $20.16

4330000413 MEPERIDINE PCA 300 MG/30 ML

CARTRIDGE

00409603004 CSINJ $29.19

4330000414 MEROPENEM 500MG VIAL 00409350501 INJ $50.75

4330000414 MEROPENEM 500MG VIAL 00409350501 CSP $100.75

4330000669 MESALAMINE 400 MG DR CAPSULE 00023585318 UD $12.39

4330000837 METAXALONE 800 MG TABLET 55289073615 UD $46.76

4330000829 METFORMIN HCL 500 MG TAB.ER.24H 53746017810 UD $2.63

4330000415 metFORMIN 500 MG TABLET 63739064010 UD $2.50

Page 25: Drug Prices 2018 - SPRHC

4330000854 METHYLNALTREXONE 12 MG/0.6 ML

INJ

65649055102 INJ $381.50

4330000774 METHOHEXITAL 500 MG/ 5 ML VIAL 42023010501 INJ $231.95

4330000774 METHOHEXITAL 500 MG/ 5 ML VIAL 42023010501 CSP $281.95

4330000809 METHADONE HCL 10 MG TABLET 00406577162A CSPO $9.50

4330000416 METHOCARBAMOL 1,000 MG/10 ML

VIAL

00641610301 INJ $277.52

4330000416 METHOCARBAMOL 1,000 MG/10 ML

VIAL

00641610301 CSP $327.52

4330000417 METHOCARBAMOL 500 MG TABLET 68084005601 UD $2.50

4330000418 METHYLENE BLUE 1% (10 MG/ML) 1

ML VIAL

17478050401A INJ $70.49

4330000421 methylPPREDNISolone SS 125 MG/2 ML

VIAL

00009004725 INJ $21.28

4330000421 methylPPREDNISolone SS 125 MG/2 ML

VIAL

00009004725 CSP $71.28

4330000420 methylPREDNISolone SS 1,000 MG/8 ML

VIAL

00009001820 INJ $198.80

4330000420 methylPREDNISolone SS 1,000 MG/8 ML

VIAL

00009001820 CSP $248.80

4330000422 methylPREDNISolone SS 40 MG/1 ML

VIAL

00009003930 INJ $20.62

4330000422 methylPREDNISolone SS 40 MG/1 ML

VIAL

00009003930 CSP $70.62

4330000423 methylPREDNISolone 4MG DOSEPAK 00603459315 BULK $5.01

4330000424 methylPREDNISolone 4MG TABLET 59762444003 UD $5.01

4330000419 methylPREDNISolone ACETATE 40

MG/ML 1 ML VIAL

00009028002 INJ $32.10

4330000427 METOCLOPRAMIDE HCL 10MG/10ML

ORAL SOLN

00121057616 UD $2.63

4330000426 METOCLOPRAMIDE HCL 10 MG/2 ML

VIAL

00703450204 INJ $17.25

4330000426 METOCLOPRAMIDE HCL 10 MG/2 ML

VIAL

00703450204 CSP $61.73

4330000425 METOCLOPRAMIDE HCL 5MG TABLET 51079088620 UD $3.15

4330000428 metOLazone 2.5 MG TABLET 51079002320 UD $11.52

4330000429 METOPROLOL SUCC XL 25MG TABLET 68084065901 UD $3.92

4330000430 METOPROLOL TART 50MG TABLET 62584026601 UD $2.50

4330000431 METOPROLOL TART 5 MG/5 ML VIAL 63323066005 INJ $17.25

Page 26: Drug Prices 2018 - SPRHC

4330000432 metroNIDAZOLE 500 MG/100 ML

*PREMIX*

00409781137 CSP $75.00

4330000433 metronDIAZOLE 250 MG TABLET 00904145361 UD $2.50

4330000689 metroNIDAZOLE 500 MG TABLET 42292000120A UD $2.91

4330000434 MICONAZOLE 7 VAG CREAM 2% 45 GM 00713025237 BULK $30.10

4330000435 MIDAZOLAM HCL 10 MG/5 ML ORAL

SYRUP

00054356699 CSPO $37.73

4330000436 MIDAZOLAM 5 MG/1 ML 1ML VIAL 00641606125A CSINJ $17.25

4330000438 MINERAL OIL 30 ML CUP 00574061816 UD $2.50

4330000526 POLYETHYLENE GLYCOL /LYTES 17

GM PKT

51079030601 UD $6.58

4330000757 MIRTAZAPINE 15 MG TAB 51079008601A UD $9.52

4330000404 MEASLES MUMPS RUBELLA VACCINE 00006468100 INJ $240.35

4330000437 MILK OF MAGNESIA 30 ML CUP 00121043130 UD $8.19

4330000684 MOMETASONE FUROATE 0.1% CREAM

15 APP/15 GM TUBE

45802025735 BULK $21.18

4330000439 MOMETASONE FUROATE 0.1% OINT

15 APP/15 GM TUBE

00168027115 BULK $53.73

4330000440 MONTELUKAST 10MG TABLET 51079022320 UD $19.78

4330000846 morphine IR 10MG/0.5ML ORAL SOL 68094075458A CSPO $9.50

4330000826 morphine IR 20 MG/ML ORAL SOL 68094075501 CSPO $15.37

4330000709 morphine SULFATE 2 MG/ML 1 ML INJ

CARPJECT

00409189001 CSINJ $17.25

4330000710 morphine SULFATE 4 MG/ML 1 ML INJ

CARPJECT

00409189101 CSINJ $17.25

4330000445 morphine SULFATE 10 MG/ML 1 ML INJ

CARPJECT

00409189301 CSINJ $17.25

4330000444 morphine PCA 30 MG/30 ML

CARTRIDGE

00409202902 CSINJ $27.93

4330000441 morphine 15 MG SR *12 HR* TABLET

(MS CONTIN)

00406831562 CSPO $9.50

4330000442 MORPHINE SO4 ORAL 20MG/ML 30ML

BULK

00406800330 CSPO $9.50

4330000443 morphine 30 MG SR*12 HR*TABLET (MS

CONTIN)

00406833062 CSPO $11.83

4330000446 MUPIROCIN 2% CREAM 15 GM TUBE 68462056417 BULK $858.06

4330000447 MUPIROCIN 2% OINTMENT 22 GM

TUBE

45802011222 BULK $39.38

Page 27: Drug Prices 2018 - SPRHC

4330000448 MVI-12 10ML VIAL 54643564901 INJ $70.81

4330000448 MVI-12 10ML VIAL 54643564901 CSP $120.81

4330000449 NYSTATIN /TRIAMCINOLONE CRM 30

APP/30 GM TUBE

51672126302 BULK $558.32

4330000450 NYSTATIN/TRIAMCIN OINT 15 APP/15

GM TUBE

51672127201 BULK $391.79

4330000451 MAG HYDROX/AL HYDROX/SIMETH SU

30 ML ORAL.SUSP

00121176130 UD $9.73

4330000459 NAFCILLIN SOD 2000MG VIAL 55150012315 INJ $98.98

4330000459 NAFCILLIN SOD 2000MG VIAL 55150012315 CSP $148.98

4330000460 NALOXONE 0.4MG /1 ML VIAL 00409121501 INJ $55.41

4330000460 NALOXONE 0.4MG /1 ML VIAL 00409121501 CSP $105.41

4330000461 NALOXONE 2 MG/ 2 ML SYRINGE 76329336901 INJ $115.50

4330000461 NALOXONE 2 MG/ 2 ML SYRINGE 76329336901 CSP $165.50

4330000462 NAPROXEN 250 MG TABLET 65162018810 UD $2.70

4330000463 NEOMYCIN 500 MG TABLET 39822031005 UD $4.76

4330000712 NEOSPORIN OPTHALMIC OINT 3.5 GM 24208078055A BULK $199.33

4330000714 NEOMYCN/BACI ZN/PMYX BS/PRAMOX

15 APP/15 GM TUBE

00810073794A BULK $15.23

4330000465 POLYMIXI/BACITRACIN/NEOMYCIN 15

APP/15 GM TUBE

45802014301 BULK $14.88

4330000464 NEOSPORIN PKT 1/32 OZ 45802014370 UD $2.50

4330000713 NEOMYCIN/POLYMYXN B/GRAMICIDIN

10 ML BOTTLE

24208079062A BULK $216.79

4330000466 NEOSTIGMINE METHYLSULFATE 1

MG/ML VIAL

63323041510 INJ $41.06

4330000466 NEOSTIGMINE METHYLSULFATE 1

MG/ML VIAL

63323041510 CSP $91.06

4330000715 FILGRASTIM 300 MCG/1 ML 55513053001A INJ $1,101.91

4330000868 FILGRASTIM 300 MCG/0.5 ML SYRINGE 55513092491A INJ $1,167.95

4330000467 NIACIN ER 500 MG TABLET 54629071201A UD $2.50

4330000856 niCARdipine 20 MG/200 ML NS PREMIX

BAG

10122031310B PREMIX $426.93

4330000855 niCARdipine 20 MG/NS 200 ML

*PREMIX*

10122031310C PREMIX $426.93

Page 28: Drug Prices 2018 - SPRHC

4330000468 NICOTINE TRANSDERMAL PATCH 14

MG PATCH

00536589588 UD $7.49

4330000469 NICOTINE TRANSDERMAL PATCH 21

MG PATCH

00536589653A UD $6.97

4330000471 NIFEdipine CC 30 MG 24-HR TABLET 68084059701 UD $4.73

4330000470 NIFEdipine 10 MG CAPSULE 43386044024 UD $4.52

4330000472 NITROFURANTOIN 100 MG CAP

(MACROBID)

51079034820 UD $17.85

4330000593 NITROPRUSSIDE SODIUM 50 MG/2 ML

VIAL

00187430202A INJ $1,050.00

4330000593 NITROPRUSSIDE SODIUM 50 MG/2 ML

VIAL

00187430202A CSP $1,100.00

4330000798 HYDROC 2.5 MG/APAP 108MG SUSP 5

ML CUP

00121477205A CSPO $24.78

4330000332 INSULIN ASPART 100 UNIT/1ML 00169750111A INSULIN $40.00

4330000771 HYDROcodone 5 MG/APAP 325 MG

TABLET

00406012362 CSPO $9.50

4330000704 NORepinephrine BITARTRATE 4 MG/4

ML INJ

00409337504 INJ $70.81

4330000704 NORepinephrine BITARTRATE 4 MG/4

ML INJ

00409337504 CSP $120.81

4330000454 NORMAL SALINE 0.9% 100 ML BAG 00409798437 CSP $75.00

4330000475 NORMAL SALINE 0.9% 1,000 ML BAG 00409798309 CSP $75.00

4330000849 POTASSIUM CHLORIDE IN 0.9%NACL

1,000 ML BAG

00338069104A CSPMED $35.00

4330000849 POTASSIUM CHLORIDE IN 0.9%NACL

1,000 ML BAG

00338069104A PREMIX $75.00

4330000452 NORMAL SALINE 0.9% 25 ML BAG 00409798420 CSP $75.00

4330000476 NORMAL SALINE 0.9% 250ML BAG 00409798302 CSP $75.00

4330000453 NORMAL SALINE 0.9% 50ML BAG 00409798436 CSP $75.00

4330000477 NORMAL SALINE 0.9% 500 ML BAG 00409798303 CSP $75.00

4330000664 SODIUM CHLORIDE 0.9% 3ML NEB

SOLN

00487930103 UD $2.50

4330000473 NITROGLYCERIN OINTMENT 2% 1GM

FOIL PKG

00281032608 UD $9.66

4330000716 NITROGLYCERIN 0.1 MG/HR PATCH 00378910293 UD $6.51

4330000478 NITROGLYCERIN 0.2 MG/HR PATCH 00904549546 UD $2.50

4330000479 NITROGLYCERIN 0.4MG/HR PATCH 00904549646 UD $2.50

Page 29: Drug Prices 2018 - SPRHC

4330000480 NITROGLYCERIN SUBLINGUAL 0.4MG

0.4 MG/TAB BOTTLE

00071041813 UD $4.38

4330000482 NYSTATIN 100,000 U/ML 60ML ORAL

SUSP

51672411704 BULK $59.29

4330000717 NYSTATIN CREAM 15 GM TUBE 45802005935A BULK $61.25

4330000483 NYSTATIN OINTMENT 15GM TUBE 45802004835 BULK $61.25

4330000481 NYSTATIN POWDER 15 GM BOTTLE 00574200815 BULK $96.11

4330000484 OCEAN SALINE NASAL SPRAY 44 ML

BOTTLE

45802035758 BULK $13.65

4330000875 OCTREOTIDE ACETATE 200 MCG/ML

(1000MCG\5 ML)VIAL

63323037805A INJ $83.48

4330000875 OCTREOTIDE ACETATE 200 MCG/ML

(1000MCG\5 ML)VIAL

63323037805A CSP $133.48

4330000485 OCTREOTIDE 100MCG/ 1 ML AMPUL 00078018101 INJ $93.98

4330000485 OCTREOTIDE 100MCG/ 1 ML AMPUL 00078018101 CSP $143.98

4330000749 OLANZapine 2.5 MG TABLET 68084052501 UD $39.10

4330000486 OLANZapine 5 MG ODTABLET 00002445385 UD $50.51

4330000819 OLOPATADINE 0.1% OPTH SOLN 5ML

BOTTLE

00065027105 BULK $959.56

4330000487 OMEPRAZOLE 20 MG SR CAPSULE 00904568461 UD $2.50

4330000489 ONDANSETRON 4 MG/5 ML ORAL

SOLUTION

00054006447 UD $83.93

4330000488 ONDANSETRON 4 MG/2 ML VIAL 00641607825 INJ $17.25

4330000488 ONDANSETRON 4 MG/2 ML VIAL 00641607825 CSP $53.33

4330000490 ONDANSETRON 4 MG ORALLY

DISINTERGRATING TABLET

00781523864 UD $28.00

4330000491 ORITAVANCIN 400 MG/40 ML VIAL 70842014003 HCOST $2,489.18

4330000491 ORITAVANCIN 400 MG/40 ML VIAL 70842014003 CSP $3,534.85

4330000492 ORPHENADRINE CIT 60 MG/ 2ML VIAL 17478053802 INJ $77.70

4330000493 OSELTAMIVIR PHOSPHATE 30 MG

CAPSULE

00004080285 UD $48.76

4330000494 OSELTAMIVIR PHOSPHATE 6 MG/ML

60 ML BOT

00004082205 BULK $531.58

4330000495 OSELTAMIVIR PHOSPHATE 75 MG

CAPSULE

00004080085 UD $53.17

4330000496 OXYBUTYNIN CHLORIDE 5 MG

TABLET

68084040001 UD $2.50

Page 30: Drug Prices 2018 - SPRHC

4330000499 oxyCODONE 5 MG IR TABLET 68084035401 CSPO $9.50

4330000497 oxyCODONE CR 10 MG TABLET 59011041010 CSPO $12.88

4330000498 oxyCODONE CR 20 MG TABLET 59011042020 CSPO $24.61

4330000500 OXYMETAZOLINE HCL 0.05% NASAL

SPRAY 15 ML

00904571135 BULK $2.70

4330000721 OXYTOCIN 10 UNITS/ML VIAL 42023011601A INJ $17.25

4330000721 OXYTOCIN 10 UNITS/ML VIAL 42023011601A CSP $53.71

4330000501 PANTOPRAZOLE SODIUM 40 MG/10 ML

VIAL

00008092355 INJ $17.50

4330000501 PANTOPRAZOLE SODIUM 40 MG/10 ML

VIAL

00008092355 CSP $67.50

4330000501 PANTOPRAZOLE SODIUM 40 MG/10 ML

VIAL

00008092355 CSP $75.00

4330000502 PANTOPRAZOLE SODIUM 40MG DR

TABLET

51079005120 UD $18.45

4330000503 PARoxetine 20 MG TABLET 51079077420 UD $9.56

4330000880 PATIROMER 8.4 GM ORAL SUSP

PACKET

53436008404A UD $128.31

4330000559 PROTHROMBIN CPLX(PCC)4FACT 500

U/20 ML (KCENTRA)

63833038602A HCOST $2,219.20

4330000559 PROTHROMBIN CPLX(PCC)4FACT 500

U/20 ML (KCENTRA)

63833038602A CSP $3,156.88

4330000718 PENICILLIN V POT 250MG TABLET 00781120501 UD $2.50

4330000504 PENICILLIN G POTASSIUM 5,000,000

UNIT VIAL

00049052083 INJ $44.31

4330000504 PENICILLIN G POTASSIUM 5,000,000

UNIT VIAL

00049052083 CSP $94.31

4330000629 PENTOXIFYLLINE ER 400 MG TABLET 51079088920 UD $5.25

4330000507 OXYCODONE 5MG/APAP 325 MG

TABLET (PERCOCET)

00406051262 CSPO $9.50

4330000227 PERMETHRIN 5% CREAM 60 GM 00472024260 BULK $433.13

4330000742 PETROLATUM, WHITE 5 GR PKT 00168005316A BULK $2.50

4330000678 CHLORASEPTIC SPRAY 6OZ BOTTLE 00536242558 BULK $7.18

4330000508 PHENAZOPYRIDINE HCL 100 MG

TABLET

51293080101 UD $9.45

4330000720 PHENobarbital 20 MG/5 ML ELIXIR 00603150858 CSPO $9.50

4330000802 PHENobarbital 32.4 MG TABLET 63739020110 CSPO $9.50

Page 31: Drug Prices 2018 - SPRHC

4330000719 PHENobarbital SODIUM 65 MG/ML VIAL 00641047625 CSINJ $72.80

4330000726 PHENTOLAMINE MESYL 5MG/2ML VIAL 00143956410 INJ $1,487.50

4330000726 PHENTOLAMINE MESYL 5MG/2ML VIAL 00143956410 CSP $1,537.50

4330000514 PHENYLEPHRINE 10 MG/ML VIAL 00641614225 INJ $42.00

4330000514 PHENYLEPHRINE 10 MG/ML VIAL 00641614225 CSP $92.00

4330000510 PHENYLEPHRINE 1% NASAL SPRAY

15 ML

00024135202 BULK $22.72

4330000511 PHENYLEPHRINE 1/2 % NASAL 15 ML 00024135301 BULK $22.72

4330000519 PHENYTOIN SODIUM ER 100 MG

CAPSULE

51079090520 UD $2.50

4330000518 PHENYTOIN SODIUM 125MG/5ML

SUSP

60432013108 UD $2.52

4330000517 PHENYTOIN SODIUM 250 MG/5 ML

VIAL

39822405006 INJ $17.25

4330000517 PHENYTOIN SODIUM 250 MG/5 ML

VIAL

39822405006 CSP $60.50

4330000516 PHENYTOIN SODIUM 50 MG CHEW

TABLET

00071000740 UD $5.74

4330000520 K-PHOS NEUTRAL PHOSPHORUS 250

MG TABLET

64980010401 UD $2.50

4330000522 PHYTONADIONE 10 MG 1 ML AMP 00409915801 INJ $168.84

4330000522 PHYTONADIONE 10 MG 1 ML AMP 00409915801 CSP $218.84

4330000521 PHYTONADIONE NEONATAL 1 MG/0.5

ML PFS

76329124001 INJ $78.75

4330000708 PHYTONADIONE 5 MG TABLET 00187170405 UD $205.66

4330000525 PNEUMOCOCCAL 23 VACCINE 0.5 ML

VIAL

00006494300 INJ $330.79

4330000810 BACITRACIN/POLYMYXIN B PKT 1 APP

PACKET

52959005444A UD $2.50

4330000527 POLYSPORIN OINTMENT 15 GM TUBE 54569402300A BULK $17.50

4330000529 POTASSIUM PHOSPHATE 4.4 MEQ/ML

15 ML VIAL

63323008615A INJ $105.98

4330000529 POTASSIUM PHOSPHATE 4.4 MEQ/ML

15 ML VIAL

63323008615A CSP $155.98

4330000534 PRALIDOXIME CHLORIDE 1 GM/20 ML

VIAL

60977014101 INJ $303.45

4330000534 PRALIDOXIME CHLORIDE 1 GM/20 ML

VIAL

60977014101 CSP $353.45

4330000535 PRAMIPEXOLE 0.125 MG TABLET 68462033090 UD $11.69

Page 32: Drug Prices 2018 - SPRHC

4330000828 PRAMIPEXOLE DI-HCL 1 MG TABLET 68462033390 UD $11.69

4330000536 PRAVASTATIN 20 MG TABLET 51079045820 UD $11.45

4330000540 predniSONE 10 MG TABLET 63739051910 UD $2.50

4330000539 predniSONE 1 MG TABLET 00054873925 UD $2.50

4330000541 predniSONE 20 MG TABLET 00054001820 UD $2.50

4330000542 predniSONE 5 MG TABLET 63739051810 UD $2.50

4330000538 prednisoLONE 15 MG/5 ML SOL 00121075908 UD $2.50

4330000543 PREGABALIN 25MG CAPSULE 00071101268 CSPO $26.01

4330000544 PREGABALIN 50MG CAPSULE 00071101341 CSPO $28.60

4330000322 IMIPENEM/CILASTATIN 250MG VIAL 00409350801A INJ $17.47

4330000322 IMIPENEM/CILASTATIN 250MG VIAL 00409350801A CSP $67.47

4330000322 IMIPENEM/CILASTATIN 250MG VIAL 00409350801A CSP $75.00

4330000545 IMIPENEM/CILASTATIN 500MG VIAL 00409350701 INJ $33.99

4330000545 IMIPENEM/CILASTATIN 500MG VIAL 00409350701 CSP $83.99

4330000545 IMIPENEM/CILASTATIN 500MG VIAL 00409350701 CSP $75.00

4330000546 PROCAINAMIDE HCL 1000 MG/10ML

VIAL

00409190201 INJ $302.33

4330000546 PROCAINAMIDE HCL 1000 MG/10ML

VIAL

00409190201 CSP $352.33

4330000547 PROCHLORPERAZINE EDISYLATE 10

MG/2 ML VIAL

23155029442 INJ $64.75

4330000547 PROCHLORPERAZINE EDISYLATE 10

MG/2 ML VIAL

23155029442 CSP $114.75

4330000548 PROCHLORPERAZINE 5 MG TABLET 51079054120 UD $2.50

4330000800 EPOETIN ALFA 20,000 UNIT/1 ML VIAL 59676032004A INJ $1,800.51

4330000812 PROMETH/COD 6.25-10MG/5ML SYR 5

ML BOTTLE

00603158554 CSPO $31.68

4330000551 PROMETHAZINE 12.5 MG SUPP 00713053612 UD $61.99

4330000552 PROMETHAZINE 25 MG SUPP 00591299239 UD $61.99

4330000553 PROMETHAZINE HCL 25 MG TABLET 68084015501 UD $2.50

Page 33: Drug Prices 2018 - SPRHC

4330000549 PROMETHAZINE 25MG 25 MG/ML VIAL 00641092821 INJ $17.25

4330000549 PROMETHAZINE 25MG 25 MG/ML VIAL 00641092821 CSP $53.01

4330000509 PROMETHAZINE HCL 6.25 MG/5 ML LIQ 00603158454A UD $2.50

4330000550 PROMETHAZINE VC/CODEINE 5 ML

CUP

70408018531 CSPO $9.50

4330000697 PROPRANOLOL HCL 10 MG TAB 00115165901A UD $2.50

4330000554 PROPOFOL 10,000 MCG/ML-100ML 63323026965 CSP $155.00

4330000554 PROPOFOL 10,000 MCG/ML-100ML 63323026965 CSP $75.00

4330000555 PROPOFOL 200 MG/20 ML VIAL 63323026970 INJ $17.25

4330000556 PROPRANOLOL HCL 40 MG TABLET 00378018401A UD $2.52

4330000323 PROPRANOLOL LONG ACTING 60MG

SRCAPSULE

00228277811 UD $7.21

4330000557 PROPYLTHIOURICIL 50 MG TABLET 00228234810 UD $3.15

4330000558 PROTAMINE SULFATE 250 MG/25 ML

VIAL

63323022930 INJ $129.01

4330000558 PROTAMINE SULFATE 250 MG/25 ML

VIAL

63323022930 CSP $179.01

4330000560 PSYLLIUM PACKET 37000002404 UD $2.50

4330000562 QUEtiapine FUMARATE 25 MG TABLET 68084053001 UD $13.23

4330000869 RABIES VACCINE (PCEC)/PF 2.5

UNIT/1 ML VIAL

58160096412A INJ $1,179.50

4330000563 RACEMIC EPINEPHRINE 2.25% 0.5 ML

NEBSOL

00487590199 UD $4.38

4330000746 raNITIdine 50 MG/2 ML VIAL 68382042202 INJ $54.15

4330000746 raNITIdine 50 MG/2 ML VIAL 68382042202 CSP $104.15

4330000565 raNITIdine HCL 150 MG TABLET 51079087920 UD $5.57

4330000564 raNITIdine HCL 150 MG/10 ML SYRUP 68094020459 UD $28.39

4330000870 RHO(D) IMMUNE GLOBULIN 300 MCG

(1500 UNIT) 2 ML SYRINGE

00562780501A INJ $413.00

4330000727 risperiDONE 1 MG TABLET 51079046220 UD $15.89

4330000566 risperiDONE-M 0.5 MG ODT 49884031191 UD $17.22

4330000567 RIVAROXABAN 10 MG TABLET 50458058010 UD $48.90

Page 34: Drug Prices 2018 - SPRHC

4330000568 RIVAROXABAN 15 MG TABLET 50458057810 UD $48.90

4330000852 RIVASTIGMINE 4.6 MG/24 HOUR

PATCH

00078050261 UD $75.50

4330000569 RIZATRIPTAN 5 MG TABLET 23155024446 UD $116.38

4330000830 guaiFENesin 200

MG/DEXTROMETHORPHAN 20 MG-10

00121127600A UD $7.42

4330000296 guaiFENesin 100

MG/DEXTROMETHORPHAN 10 MG-5

00121063805 UD $2.50

4330000762 guaiFENesin 200 MG/CODEINE 20MG-

10ML CUP(ROBITUSSIN AC SUGAR

00121177510A CSPO $9.50

4330000845 guaiFENesin/COD 100/10MG 5ML CUP 00121177500A CSPO $9.50

4330000570 ROCURONIUM 50 MG/5 ML VIAL 00409955805 INJ $17.25

4330000571 ROSUVASTATIN CALCIUM 10 MG

TABLET

00310075139 UD $30.45

4330000779 SODIUM CHLORIDE 3% INHALATION

SOL 15ML

00378699789 UD $2.50

4330000572 SALMETEROL 50 MCG/PUFF 28 DISK

INHALER

00173052000 BULK $739.80

4330000840 BIOTENE SALIVA SUBSTITUTE 237 ML 48582080220 BULK $10.33

4330000573 SCOPOLAMINE 1.5 MG PATCH-3 DAY 1

PATCH PATCH

10019055303 UD $74.55

4330000682 SENNOSIDES 8.6/DOCUSATE 50MG 1

TABLET

00904564361 UD $2.50

4330000574 SENNOSIDES 8.6 MG TAB 1 TAB

TABLET

67618030010A UD $2.50

4330000671 BACTRIM (SMX 800MG/TMP 160MG) 10

ML VIAL

00703951403A INJ $43.89

4330000671 BACTRIM (SMX 800MG/TMP 160MG) 10

ML VIAL

00703951403A CSP $93.89

4330000575 BACTRIM DOUBLE STRENGTH (SMX

800MG/TMP 160MG) 1 DS TAB

61971012001A UD $4.03

4330000805 BACTRIM SUSP (SMX 800MG/TMP

160MG) 20 ML CUP

50383082420A UD $17.29

4330000577 SERTRALINE 50 MG TABLET 68084018101 UD $2.50

4330000838 SEVELAMER CARBONATE 800 MG

TABLET

58468013001 UD $19.74

4330000578 SILVER NITRATE 5 STICK BAG G 12870000101 UD $2.50

4330000579 SILVER sulfADIAZINE CREAM 400 GM

JAR

67877012440 BULK $227.33

4330000580 SILVER sulfADIAZINE CREAM 50 GM

TUBE

43598021050 BULK $52.08

4330000582 SIMETHICONE 80 MG CHEWABLE

TABLET

63739022510 UD $2.50

Page 35: Drug Prices 2018 - SPRHC

4330000581 SIMETHICONE 40MG/0.6ML DROPS 30

ML BOTTLE

00904589430 BULK $6.51

4330000584 SIMVASTATIN 20 MG TABLET 68084051201 UD $17.22

4330000583 SIMVASTATIN 40 MG TABLET 51079045620 UD $17.22

4330000585 SINEMET (CARBIDOPA/LEVODOPA)

10/100 MG TAB

63739004610 UD $4.03

4330000586 SINEMET (CARBIDOPA/LEVODOPA)

25/100 MG TAB

68084009301 UD $2.87

4330000587 SINEMET (CARBIDOPA/LEVODOPA)

25/250 MG TAB

63739001310 UD $2.50

4330000588 SINEMET-CR

(CARBIDOPA/LEVODOPA) 50/200 MG

68084028201 UD $5.53

4330000398 MAGNESIUM CHLORIDE 64 MG SR

TABLET

68585000575A UD $2.50

4330000044 CROTALIDAE IMMUNE FAB(OVINE) 1

VIAL

50633011012 HCOST $7,995.00

4330000044 CROTALIDAE IMMUNE FAB(OVINE) 1

VIAL

50633011012 CSP $11,243.00

4330000590 SODIUM BICARBONATE 8.4%

*PEDIATRIC* 10 MEQ/10 ML SYRINGE

00409490034 INJ $49.18

4330000589 SODIUM BICARBONATE 8.4% 50

MEQ/50 ML SYRINGE

76329335201 INJ $35.00

4330000589 SODIUM BICARBONATE 8.4% 50

MEQ/50 ML SYRINGE

76329335201 CSP $85.00

4330000591 SODIUM BICARBONATE 8.4% 50

MEQ/50 ML VIAL

00409662502 INJ $33.92

4330000591 SODIUM BICARBONATE 8.4% 50

MEQ/50 ML VIAL

00409662502 CSP $83.92

4330000592 SODIUM BICARBONATE 650 MG

TABLET

00223172101 UD $2.50

4330000457 SODIUM CHLORIDE 1 GM TABLET 00223176001 UD $2.50

4330000458 SODIUM CHLORIDE 3% 500 ML BAG 00338005403 PREMIX $19.08

4330000458 SODIUM CHLORIDE 3% 500 ML BAG 00338005403 PREMIX $75.00

4330000711 SODIUM CHLORIDE 23.4% 120 MEQ/30

ML VIAL

63323018730A INJ $17.25

4330000711 SODIUM CHLORIDE 23.4% 120 MEQ/30

ML VIAL

63323018730A CSP $65.72

4330000871 SOLIFENACIN SUCCINATE 10 MG

TABLET

51248015101A UD $42.42

4330000594 SORBITOL SOLUTION 70% W/W 30 ML

BOTTLE

46287050030A UD $7.84

4330000595 SOTALOL 80 MG TABLET 00245001201 UD $9.14

4330000596 SPIRONOLACTONE 25 MG TABLET 51079010320 UD $2.50

Page 36: Drug Prices 2018 - SPRHC

4330000597 SODIUM POLYSTYRENE SULFONATE

15 GM/60 ML CUP

00574200202 UD $39.38

4330000598 SUCCINYLCHOLINE 200 MG/10 ML

VIAL

00409662902 INJ $67.13

4330000600 SUCRALFATE 1 GM TABLET 51079075320 UD $2.50

4330000599 SUCRALFATE 1 GM/10 ML SUSP 00121074710 UD $35.21

4330000879 SUGAMMADEX SODIUM 200 MG/2 ML

VIAL

00006542312A INJ $332.50

4330000601 SULFACETAMIDE SODIUM 10%

OPHTHALMIC SOL 15 ML BOTTLE

61314070101 BULK $194.78

4330000602 SUMAtriptan 50 MG TABLET 65862014736 UD $87.99

4330000603 SUMAtriptan SUCCINATE 6 MG/0.5 ML

VIAL

55150017301 INJ $297.50

4330000604 BUDESONIDE 160 MCG/FORMOTEROL

4.5 MCG- 60 INH ORAL INHALER

00186037028 BULK $894.92

4330000605 BUDESONIDE 80 MCG/FORMOTEROL

4.5 MCG -60 INH ORAL INHALER

00186037228 BULK $676.48

4330000636 APAP 300/CODEINE 30MG (TYLENOL

#3) TABLET

00406048462 CSPO $9.50

4330000607 TAMSULOSIN HCL 0.4 MG CAPSULE 51079029420 UD $14.74

4330000606 TAMOXIFEN CITRATE 10 MG TAB 10

MG TABLET

00591247260 UD $6.62

4330000635 TUBERCULIN PPD 5 TU/0.1 ML SKIN

TEST

49281075221 INJ $27.13

4330000615 TETRACYCLINE 250 MG CAPSULE 23155001701 UD $27.58

4330000751 APAP 120MG + CODEINE 12MG

(TYLENOL+CODEINE ELIXIR) 5 ML CUP

00121050405A CSPO $9.50

4330000608 BOOSTRIX

(TETANUS/DIPHTHERIA/PERTUSSIS

58160084252 INJ $132.30

4330000609 TEMAZEPAM 15 MG CAPSULE 51079041820 CSPO $9.50

4330000611 TERAZOSIN 1 MG CAPSULE 51079093620 UD $5.64

4330000612 TERAZOSIN 5 MG CAPSULE 51079093820 UD $5.64

4330000673 TERBUTALINE SULFATE 1MG/ML 1 ML

VIAL

00143974610A INJ $17.25

4330000614 TETRACAINE HCL 0.5% OPHTHALMIC

SOLUTION 2 ML BOTTLE

00065074114A BULK $17.89

4330000617 MULTIVITAMIN LIQUID 5 ML 00005434462A BULK $16.00

4330000618 THERAGRAN M 1 TABLET 00904053060 UD $2.50

4330000620 THIAMINE HCL 100 MG TABLET 00904054460 UD $2.50

Page 37: Drug Prices 2018 - SPRHC

4330000619 THIAMINE HCL 100 MG/ML 2 ML VIAL 63323001302 INJ $34.83

4330000619 THIAMINE HCL 100 MG/ML 2 ML VIAL 63323001302 CSP $84.83

4330000622 TIMOLOL MALEATE 0.25% OPHTH SOL

5 ML

61314022605 BULK $52.50

4330000621 TIMOLOL MALEATE 0.5% OPHTH SOL

5 ML

61314022705 BULK $59.50

4330000623 TIOTROPIUM BROMIDE 18 MCG

HANDIHALER (5 CAPS PER BOX)

00597007575 BULK $517.41

4330000610 TENECTEPLASE 50 MG VIAL 50242012001 HCOST $14,654.68

4330000624 TOBRADEX (TOBRAMYCIN

0.3%/DEXAMETHASONE 0.1%) OPHTH

00065064835 BULK $753.52

4330000625 TOLTERODINE 2 MG LA CAPSULE 00009519004 UD $43.02

4330000028 TPA 100 MG VIAL 50242008527 HCOST $22,000.90

4330000028 TPA 100 MG VIAL 50242008527 CSP $30,851.26

4330000146 TPN-CLINIMIX E 5/20 1000ML BAG

1,000 ML BAG

00338114803 CSP $79.10

4330000626 traMADol 50 MG TABLET 51079099120 CSPO $9.50

4330000627 TRANEXAMIC ACID 1000 MG/10 ML

AMP

39822100001 INJ $107.45

4330000627 TRANEXAMIC ACID 1000 MG/10 ML

AMP

39822100001 CSP $157.45

4330000765 TRAVOPROST 0.004% OPTH SOL 5 ML 00065026005A BULK $1,191.68

4330000628 traZODone 50 MG TABLET 60505265300 UD $2.50

4330000634 TRIAMCINOLONE ACETONIDE 0.1%

CREAM 15 GM TUBE

00603786274 BULK $19.53

4330000631 TRIAMCINOLONE ACETONIDE 0.1%

OINTMENT 15 GM TUBE

00168000615 BULK $16.28

4330000630 TRIAMCINOLONE ACETONIDE 0.025%

CREAM 15 GM TUBE

00168000315 BULK $13.02

4330000632 TRIAMCINOLONE ACETONIDE 0.5%

CREAM 15 GM TUBE

00168000215 BULK $32.38

4330000699 TRIAMCINOLONE ACETONIDE 0.5%

OINTMENT 15 GM TUBE

45802004935A BULK $35.35

4330000633 TRIAMCINOLONE ACETONIDE 40

MG/ML 1ML VIAL

00003029305 INJ $32.76

4330000637 UNASYN (AMPICILLIN/SULBACTAM) 1.5

GM VIAL

55150011620 INJ $27.09

4330000637 UNASYN (AMPICILLIN/SULBACTAM) 1.5

GM VIAL

55150011620 CSP $77.09

4330000638 UNASYN(AMPICILLIN/SULBACTAM) 3

GM VIAL

44567021110 INJ $66.99

Page 38: Drug Prices 2018 - SPRHC

4330000638 UNASYN(AMPICILLIN/SULBACTAM) 3

GM VIAL

44567021110 CSP $116.99

4330000639 URSODIOL 300 MG CAP 50268079615A UD $33.53

4330000861 USTEKINUMAB 90 MG/ML SQ 57894006103 HCOST $51,460.75

4330000862 USTEKINUMAB 130 MG/26 ML VIAL 57894005427A INJ $5,600.00

4330000862 USTEKINUMAB 130 MG/26 ML VIAL 57894005427A CSP $5,650.00

4330000739 valACYclovir HCL 500 MG TABLET 00054011413 UD $25.31

4330000640 VALPROIC ACID 250 MG/5 ML UD LIQ 00121467505 UD $7.56

4330000641 VALSARTAN 80 MG TABLET 00078035834 UD $25.94

4330000740 VANCOMYCIN HCL 500MG INJ VIAL 63323022110A INJ $24.50

4330000740 VANCOMYCIN HCL 500MG INJ VIAL 63323022110A CSP $74.50

4330000643 VANCOMYCIN HCL 125 MG CAPSULE 17478074102 UD $109.66

4330000642 VANCOMYCIN 1000 MG VIAL 00409653301 INJ $56.14

4330000642 VANCOMYCIN 1000 MG VIAL 00409653301 CSP $106.14

4330000644 VANCOMYCIN HCL 250 MG CAPSULE 68180016713 UD $202.02

4330000741 VARICELLA VIRUS VACCINE 00006482700 INJ $424.45

4330000722 VASOPRESSIN 20 UNITS/ML VIAL 42023016425B INJ $585.38

4330000722 VASOPRESSIN 20 UNITS/ML VIAL 42023016425B CSP $635.38

4330000646 VECURONIUM INJ 10 MG VIAL 47335093140 INJ $26.25

4330000646 VECURONIUM INJ 10 MG VIAL 47335093140 CSP $76.25

4330000646 VECURONIUM INJ 10 MG VIAL 47335093140 CSP $75.00

4330000226 VENLAFAXINE XR 37.5 MG CAPSULE 65862052790A UD $14.56

4330000755 VENLAFAXINE HCL 75 MG TABLET 68084085601A UD $7.63

4330000760 VERAPAMIL ER 180 MG ER TABLET 51079089920A UD $8.72

4330000674 VERAPAMIL ER 240 MG TABLET 51079086920A UD $8.86

4330000647 VERAPAMIL HCL 5 MG/2 ML VIAL 00409114405 INJ $101.29

Page 39: Drug Prices 2018 - SPRHC

4330000648 VERAPAMIL 80 MG TABLET 23155002601 UD $2.50

4330000745 VITAMIN E 400 UNIT CAPSULE 00904027460A UD $2.50

4330000649 VITAMIN B COMPLEX CAPSULE 00536478701 UD $2.50

4330000050 ASCORBIC ACID (VIT C) 500 MG

TABLET

00904052361 UD $2.50

4330000133 CHOLECALCIFEROL (VIT D 3) 1000

UNIT TABLET

00904582461 UD $2.50

4330000134 CHOLECALCIFEROL (VIT D 3) 400 UNIT

TABLET

00904582360A UD $2.50

4330000655 WARFARIN SODIUM 1 MG TABLET 00056016975 UD $7.21

4330000651 WARFARIN SODIUM 2.5 MG TABLET 00056017675 UD $7.77

4330000652 WARFARIN SODIUM 2 MG TABLET 00832121201 UD $2.50

4330000653 WARFARIN SODIUM 3 MG TABLET 00056018875 UD $7.81

4330000650 WARFARIN SODIUM 4 MG TABLET 00056016875 UD $7.81

4330000654 WARFARIN SODIUM 5 MG TABLET 00056017075 UD $7.53

4330000301 ZIAC (BISOPROLOL 2.5 MG/HCTZ 6.25

MG) TAB

29300018701 UD $12.53

4330000084 ZIAC (BISOPROLOL 5 MG/HCTZ 6.25

MG) TAB

29300018813 UD $11.80

4330000782 MULTITRACE-5=ZI/CO/MAN/CHR/SEL 1

ML VIAL

00517820125 INJ $54.71

4330000782 MULTITRACE-5=ZI/CO/MAN/CHR/SEL 1

ML VIAL

00517820125 CSP $104.71

4330000657 ZINC OXIDE 20% OINTMENT 28GM

TUBE

00168006231 BULK $9.03

4330000658 ZINC SULFATE 220 MG CAP (50 MG

ELEMENTAL ZINC)

00904533260 UD $2.50

4330000659 ZIPRASIDONE HCL 20 MG CAPSULE 00904626908 UD $16.91

4330000660 ZOLEDRONIC ACID (RECLAST) 5

MG/100 ML INJ

55111068852 PREMIX $3,515.47

4330000661 ZOLPIDEM 5 MG TABLET 00904608261 CSPO $9.50

4330000524 PIPERACILLIN/TAZOBACTAM 2.25 GM

VIAL

00409338302 INJ $24.05

4330000524 PIPERACILLIN/TAZOBACTAM 2.25 GM

VIAL

00409338302 CSP $74.05

4330000662 PIPERACILLIN/TAZOBACTAM 3.375 GM

VIAL

00781335094 INJ $83.48

4330000662 PIPERACILLIN/TAZOBACTAM 3.375 GM

VIAL

00781335094 CSP $133.48

Page 40: Drug Prices 2018 - SPRHC

4330000663 PIPERACILLIN/TAZOBACTAM 4.5 GM

VIAL

55150012150 INJ $96.43

4330000663 PIPERACILLIN/TAZOBACTAM 4.5 GM

VIAL

55150012150 CSP $146.43