30
Oct-2017 NAME OF GENERIC DRUG STRENGTH FORM October 1, 2017 Price Update Add Delete Increase Decrease Reactivate ABACAVIR SULFATE/LAMIVUDINE 600-300MG TABLET $6.5784/EACH Decrease ABACAVIR SULFATE 300 MG TABLET $2.0671/EACH Decrease ACAMPROSATE CALCIUM 333 mg TABLET $0.9000/EACH ACARBOSE 100 mg TABLET $0.2500/EACH ACARBOSE 25 mg TABLET $0.2400/EACH ACARBOSE 50 mg TABLET $0.2700/EACH ACEBUTOLOL HCL 200 mg CAPSULE $0.2668/EACH ACEBUTOLOL HCL 400 mg CAPSULE $0.3198/EACH ACETAMINOPHEN W/CODEINE 120 mg; 12 mg ELIXIR $0.0180/MILLILITER ACETAMINOPHEN W/CODEINE 300 mg; 15 mg TABLET $0.1200/EACH ACETAMINOPHEN W/CODEINE 300 mg; 30 mg TABLET $0.1496/EACH ACETAMINOPHEN W/CODEINE 300 mg; 60 mg TABLET $0.2782/EACH ACETAMINOPHEN/BUTALBITAL/CAFFEINE 500 mg/50 mg/40 mg TABLET $0.0000 ACETAMINOPHEN/DIPHENHYDRAMINE TABLETS 500 mg; 25 mg TABLET $0.0000 ACETAMINOPHEN 100 mg/ml DROPS $0.0000 ACETAMINOPHEN 120 mg SUPP $0.3840/EACH ACETAMINOPHEN 160 mg/5 ml ELIXIR $0.0000 ACETAMINOPHEN 160 MG/5ML LIQ $0.0203/MILLILITER ACETAMINOPHEN 160 mg/5ml SUSP $0.0000 ACETAMINOPHEN 325 mg TABLET $0.0120/EACH ACETAMINOPHEN 500 mg CAPSULE $0.0000 ACETAMINOPHEN 500 mg TABLET $0.0240/EACH Reactivate ACETAMINOPHEN 650 mg SUPP $0.3900/EACH Reactivate ACETAMINOPHEN 80 mg TABLET $0.0386/EACH ACETAMINOPHEN 80mg/0.8ml DROPS $0.1318/MILLILITER ACETAZOLAMIDE 125 mg TABLET $0.0000 ACETAZOLAMIDE 250 mg TABLET $1.8234/EACH ACETAZOLAMIDE 500 mg CAPSULE $1.8678/EACH ACETIC ACID 2% 15 ml SOLN $2.0800/MILLILITER ACETIC ACID\ALUMINUM ACETATE 0.02 DROPS $0.0000 ACETIC ACID\HYDROCORTISONE 2% - 1% DROPS $6.6680/MILLILITER Decrease ACETIC ACID 0.25 % SOLN $0.0046/MILLILITER ACETYLCYSTEINE 10% 10 ml VIAL $0.0000 ACETYLCYSTEINE 10% 30 ml VIAL $0.0000 ACETYLCYSTEINE 10% 4 ml VIAL $0.0000 ACETYLCYSTEINE 20% 10 ml VIAL $0.0000 ACETYLCYSTEINE 20% 30 ml VIAL $0.0000 ACETYLCYSTEINE 20% 4 ml VIAL $0.0000 ACETYLCYSTEINE 100 mg/ml VIAL $0.3908/MILLILITER ACETYLCYSTEINE 200 mg/ml VIAL $0.5015/MILLILITER ACITRETIN 10 MG CAPSULE $17.1992/EACH ACITRETIN 17.5 MG CAPSULE $23.0775/EACH ACITRETIN 25 MG CAPSULE $16.3404/EACH ACYCLOVIR SODIUM 1 gm/vial VIAL $0.0000 ACYCLOVIR SODIUM 500 mg/vial VIAL $0.0000 ACYCLOVIR 200 mg/5 ml SUSP $0.0000 Delete ACYCLOVIR 200 mg CAPSULE $0.1602/EACH ACYCLOVIR 400 mg TABLET $0.1200/EACH ACYCLOVIR 5 % OINT $11.3568/GRAM ACYCLOVIR 800 mg TABLET $0.2398/EACH ADAPALENE 0.3% GEL 0.3% GEL $0.0000 Delete ADAPALENE 0.001 CRM $0.0000 ADAPALENE 0.001 GEL $0.0000 ADAPALENE 0.3 % GEL $0.0000 ALBUTEROL SULFATE 4 mg TABLET $1.5360/EACH ALBUTEROL SULFATE 8 mg TABLET $2.4100/EACH ALBUTEROL SULFATE 0.083% VIAL $0.0720/MILLILITER ALBUTEROL SULFATE 0.5% (5mg/ml) SOLN $0.8910/MILLILITER ALBUTEROL SULFATE 0.63 mg/3 ml VIAL $0.3000/MILLILITER ALBUTEROL SULFATE 1.25 mg/3 ml VIAL $0.2619/MILLILITER ALBUTEROL SULFATE 2 mg/5 ml SYRUP $0.0134/MILLILITER ALBUTEROL SULFATE 2 mg TABLET $5.0100/EACH Reactivate ALBUTEROL SULFATE 4 mg TABLET $4.7000/EACH ALBUTEROL 90 mcg AERO (GM) $0.0000 ALCLOMETASONE DIPROPIONATE 0.0005 OINT $1.2512/GRAM ALCLOMETASONE DIPROPIONATE 0.05% CRM $1.4090/GRAM ALENDRONATE SODIUM 10 mg TABLET $0.3020/EACH ALENDRONATE SODIUM 35 mg TABLET $0.4238/EACH ALENDRONATE SODIUM 40 mg TABLET $2.3520/EACH ALENDRONATE SODIUM 5 mg TABLET $0.1440/EACH ALENDRONATE SODIUM 70 mg TABLET $0.3488/EACH ALFUZOSIN HCL 10 mg TABLET $0.1341/EACH ALLOPURINOL 100 mg TABLET $0.1100/EACH Decrease ALLOPURINOL 300 mg TABLET $0.1900/EACH Decrease ALMOTRIPTAN MALATE 12.5 mg TABLET $25.4402/EACH ALMOTRIPTAN MALATE 6.25 mg TABLET $35.5520/EACH ALOSETRON HCL 0.5 mg TABLET $18.7000/EACH ALOSETRON HCL 1 mg TABLET $37.4000/EACH ALPRAZOLAM 2 mg TABLET $0.4440/EACH ALPRAZOLAM 3 mg TABLET $0.6960/EACH ALPRAZOLAM 0.25 mg TABLET $0.0240/EACH ALPRAZOLAM 0.5 mg TABLET $0.2760/EACH ALPRAZOLAM 0.5 mg TABLET $0.0274/EACH ALPRAZOLAM 0.5 MG TABLET $1.1760/EACH ALPRAZOLAM 1 mg TABLET $0.3360/EACH ALPRAZOLAM 1 mg TABLET $0.0258/EACH ALPRAZOLAM 1 MG TABLET $1.5600/EACH ALPRAZOLAM 2 mg TABLET $0.0676/EACH AMANTADINE HCL 100 mg CAPSULE $0.9550/EACH AMANTADINE HCL 50 mg/5 ml SOLN $0.0480/MILLILITER AMIKACIN SULFATE/PRESERVATIVE FREE 100 mg/2 ml VIAL $0.0000 Page 1 of 30

Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

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Page 1: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

Oct-2017

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

ABACAVIR SULFATE/LAMIVUDINE 600-300MG TABLET $6.5784/EACH Decrease

ABACAVIR SULFATE 300 MG TABLET $2.0671/EACH Decrease

ACAMPROSATE CALCIUM 333 mg TABLET $0.9000/EACH

ACARBOSE 100 mg TABLET $0.2500/EACH

ACARBOSE 25 mg TABLET $0.2400/EACH

ACARBOSE 50 mg TABLET $0.2700/EACH

ACEBUTOLOL HCL 200 mg CAPSULE $0.2668/EACH

ACEBUTOLOL HCL 400 mg CAPSULE $0.3198/EACH

ACETAMINOPHEN W/CODEINE 120 mg; 12 mg ELIXIR $0.0180/MILLILITER

ACETAMINOPHEN W/CODEINE 300 mg; 15 mg TABLET $0.1200/EACH

ACETAMINOPHEN W/CODEINE 300 mg; 30 mg TABLET $0.1496/EACH

ACETAMINOPHEN W/CODEINE 300 mg; 60 mg TABLET $0.2782/EACH

ACETAMINOPHEN/BUTALBITAL/CAFFEINE 500 mg/50 mg/40 mg TABLET $0.0000

ACETAMINOPHEN/DIPHENHYDRAMINE TABLETS 500 mg; 25 mg TABLET $0.0000

ACETAMINOPHEN 100 mg/ml DROPS $0.0000

ACETAMINOPHEN 120 mg SUPP $0.3840/EACH

ACETAMINOPHEN 160 mg/5 ml ELIXIR $0.0000

ACETAMINOPHEN 160 MG/5ML LIQ $0.0203/MILLILITER

ACETAMINOPHEN 160 mg/5ml SUSP $0.0000

ACETAMINOPHEN 325 mg TABLET $0.0120/EACH

ACETAMINOPHEN 500 mg CAPSULE $0.0000

ACETAMINOPHEN 500 mg TABLET $0.0240/EACH Reactivate

ACETAMINOPHEN 650 mg SUPP $0.3900/EACH Reactivate

ACETAMINOPHEN 80 mg TABLET $0.0386/EACH

ACETAMINOPHEN 80mg/0.8ml DROPS $0.1318/MILLILITER

ACETAZOLAMIDE 125 mg TABLET $0.0000

ACETAZOLAMIDE 250 mg TABLET $1.8234/EACH

ACETAZOLAMIDE 500 mg CAPSULE $1.8678/EACH

ACETIC ACID 2% 15 ml SOLN $2.0800/MILLILITER

ACETIC ACID\ALUMINUM ACETATE 0.02 DROPS $0.0000

ACETIC ACID\HYDROCORTISONE 2% - 1% DROPS $6.6680/MILLILITER Decrease

ACETIC ACID 0.25 % SOLN $0.0046/MILLILITER

ACETYLCYSTEINE 10% 10 ml VIAL $0.0000

ACETYLCYSTEINE 10% 30 ml VIAL $0.0000

ACETYLCYSTEINE 10% 4 ml VIAL $0.0000

ACETYLCYSTEINE 20% 10 ml VIAL $0.0000

ACETYLCYSTEINE 20% 30 ml VIAL $0.0000

ACETYLCYSTEINE 20% 4 ml VIAL $0.0000

ACETYLCYSTEINE 100 mg/ml VIAL $0.3908/MILLILITER

ACETYLCYSTEINE 200 mg/ml VIAL $0.5015/MILLILITER

ACITRETIN 10 MG CAPSULE $17.1992/EACH

ACITRETIN 17.5 MG CAPSULE $23.0775/EACH

ACITRETIN 25 MG CAPSULE $16.3404/EACH

ACYCLOVIR SODIUM 1 gm/vial VIAL $0.0000

ACYCLOVIR SODIUM 500 mg/vial VIAL $0.0000

ACYCLOVIR 200 mg/5 ml SUSP $0.0000 Delete

ACYCLOVIR 200 mg CAPSULE $0.1602/EACH

ACYCLOVIR 400 mg TABLET $0.1200/EACH

ACYCLOVIR 5 % OINT $11.3568/GRAM

ACYCLOVIR 800 mg TABLET $0.2398/EACH

ADAPALENE 0.3% GEL 0.3% GEL $0.0000 Delete

ADAPALENE 0.001 CRM $0.0000

ADAPALENE 0.001 GEL $0.0000

ADAPALENE 0.3 % GEL $0.0000

ALBUTEROL SULFATE 4 mg TABLET $1.5360/EACH

ALBUTEROL SULFATE 8 mg TABLET $2.4100/EACH

ALBUTEROL SULFATE 0.083% VIAL $0.0720/MILLILITER

ALBUTEROL SULFATE 0.5% (5mg/ml) SOLN $0.8910/MILLILITER

ALBUTEROL SULFATE 0.63 mg/3 ml VIAL $0.3000/MILLILITER

ALBUTEROL SULFATE 1.25 mg/3 ml VIAL $0.2619/MILLILITER

ALBUTEROL SULFATE 2 mg/5 ml SYRUP $0.0134/MILLILITER

ALBUTEROL SULFATE 2 mg TABLET $5.0100/EACH Reactivate

ALBUTEROL SULFATE 4 mg TABLET $4.7000/EACH

ALBUTEROL 90 mcg AERO (GM) $0.0000

ALCLOMETASONE DIPROPIONATE 0.0005 OINT $1.2512/GRAM

ALCLOMETASONE DIPROPIONATE 0.05% CRM $1.4090/GRAM

ALENDRONATE SODIUM 10 mg TABLET $0.3020/EACH

ALENDRONATE SODIUM 35 mg TABLET $0.4238/EACH

ALENDRONATE SODIUM 40 mg TABLET $2.3520/EACH

ALENDRONATE SODIUM 5 mg TABLET $0.1440/EACH

ALENDRONATE SODIUM 70 mg TABLET $0.3488/EACH

ALFUZOSIN HCL 10 mg TABLET $0.1341/EACH

ALLOPURINOL 100 mg TABLET $0.1100/EACH Decrease

ALLOPURINOL 300 mg TABLET $0.1900/EACH Decrease

ALMOTRIPTAN MALATE 12.5 mg TABLET $25.4402/EACH

ALMOTRIPTAN MALATE 6.25 mg TABLET $35.5520/EACH

ALOSETRON HCL 0.5 mg TABLET $18.7000/EACH

ALOSETRON HCL 1 mg TABLET $37.4000/EACH

ALPRAZOLAM 2 mg TABLET $0.4440/EACH

ALPRAZOLAM 3 mg TABLET $0.6960/EACH

ALPRAZOLAM 0.25 mg TABLET $0.0240/EACH

ALPRAZOLAM 0.5 mg TABLET $0.2760/EACH

ALPRAZOLAM 0.5 mg TABLET $0.0274/EACH

ALPRAZOLAM 0.5 MG TABLET $1.1760/EACH

ALPRAZOLAM 1 mg TABLET $0.3360/EACH

ALPRAZOLAM 1 mg TABLET $0.0258/EACH

ALPRAZOLAM 1 MG TABLET $1.5600/EACH

ALPRAZOLAM 2 mg TABLET $0.0676/EACH

AMANTADINE HCL 100 mg CAPSULE $0.9550/EACH

AMANTADINE HCL 50 mg/5 ml SOLN $0.0480/MILLILITER

AMIKACIN SULFATE/PRESERVATIVE FREE 100 mg/2 ml VIAL $0.0000

Page 1 of 30

Page 2: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

AMIKACIN SULFATE/PRESERVATIVE FREE 1000 mg/4 ml VIAL $0.0000

AMIKACIN SULFATE/PRESERVATIVE FREE 500 mg/2 ml VIAL $0.0000

AMIKACIN SULFATE 1000MG/4ML VIAL $0.0000

AMIKACIN SULFATE 500 MG/2ML VIAL $4.8000/MILLILITER

AMILORIDE HCL 5 mg TABLET $0.5360/EACH

AMINOCAPROIC ACID 250 mg/ml SOLN $0.0000

AMINOCAPROIC ACID 500 mg TABLET $0.0000

AMINOPHYLLINE 200 mg TABLET $0.0000

AMIODARONE HCL 100 MG TABLET $2.6760/EACH

AMIODARONE HCL 200 mg TABLET $0.1700/EACH

AMIODARONE HCL 400 MG TABLET $3.7350/EACH

AMITRIPTYLINE HCL 10 mg TABLET $0.1159/EACH

AMITRIPTYLINE HCL 100 mg TABLET $0.9995/EACH Decrease

AMITRIPTYLINE HCL 150 mg TABLET $1.9440/EACH

AMITRIPTYLINE HCL 25 mg TABLET $0.2584/EACH

AMITRIPTYLINE HCL 50 mg TABLET $0.4621/EACH

AMITRIPTYLINE HCL 75 mg TABLET $0.7411/EACH

AMITRIPTYLINE; PERPHENAZINE 10 mg; 2 mg TABLET $0.0000

AMITRIPTYLINE; PERPHENAZINE 10 mg; 4 mg TABLET $0.0000

AMITRIPTYLINE; PERPHENAZINE 25 mg; 2 mg TABLET $0.0000

AMITRIPTYLINE; PERPHENAZINE 25 mg; 4 mg TABLET $0.0000

AMITRIPTYLINE; PERPHENAZINE 50 mg; 4 mg TABLET $0.0000

AMLODIPINE BESYLATE/BENAZEPRIL HCL 10 mg-40 mg CAPSULE $0.3061/EACH

AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 mg-40 mg CAPSULE $0.5443/EACH

AMLODIPINE BESYLATE/BENAZEPRIL 10 mg; 20 mg CAPSULE $0.1722/EACH

AMLODIPINE BESYLATE/BENAZEPRIL 2.5 mg; 10 mg CAPSULE $0.6720/EACH

AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 10 mg CAPSULE $0.3068/EACH Decrease

AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 20 mg CAPSULE $0.1681/EACH

AMLODIPINE BESYLATE 10 mg TABLET $0.0227/EACH

AMLODIPINE BESYLATE 2.5 mg TABLET $0.0150/EACH

AMLODIPINE BESYLATE 5 mg TABLET $0.0150/EACH

AMLODIPINE/ATORVASTATIN 10 MG-10MG TABLET $3.7560/EACH

AMLODIPINE/ATORVASTATIN 10 MG-20MG TABLET $3.7560/EACH

AMLODIPINE/ATORVASTATIN 10 MG-40MG TABLET $5.4960/EACH

AMLODIPINE/ATORVASTATIN 10 MG-80MG TABLET $4.5800/EACH Decrease

AMLODIPINE/ATORVASTATIN 2.5MG-10MG TABLET $3.7320/EACH

AMLODIPINE/ATORVASTATIN 2.5MG-40MG TABLET $5.1000/EACH

AMLODIPINE/ATORVASTATIN 5 MG-80 MG TABLET $5.1000/EACH

AMLODIPINE/VALSARTAN/HCTHIAZID 10 mg-160 mg TABLET $2.5379/EACH

AMLODIPINE/VALSARTAN/HCTHIAZID 10-160-25 TABLET $3.9600/EACH Reactivate

AMLODIPINE/VALSARTAN/HCTHIAZID 10-320-25 TABLET $3.9780/EACH Reactivate

AMLODIPINE/VALSARTAN 10MG-160MG TABLET $0.5700/EACH Reactivate

AMLODIPINE/VALSARTAN 10MG-320MG TABLET $0.5820/EACH

AMLODIPINE/VALSARTAN 5MG-160MG TABLET $0.4480/EACH Reactivate

AMLODIPINE/VALSARTAN 5MG-320MG TABLET $0.6578/EACH Reactivate

AMMONIUM LACTATE 12% CRM $0.0739/GRAM

AMOX/POTASSIUM CLAVULANATE 200-28.5/5 SUSP, RECON $0.3449/MILLILITER

AMOX/POTASSIUM CLAVULANATE 200-28.5mg TABLET $2.3755/EACH

AMOX/POTASSIUM CLAVULANATE 400-57 mg TABLET $2.6771/EACH

AMOX/POTASSIUM CLAVULANATE 400-57/5 SUSP, RECON $0.1061/MILLILITER

AMOX/POTASSIUM CLAVULANATE 500-125 mg TABLET $0.4575/EACH

AMOX/POTASSIUM CLAVULANATE 600-42.9/5 SUSP, RECON $0.0948/MILLILITER

AMOX/POTASSIUM CLAVULANATE 875-125 mg TABLET $0.4115/EACH Decrease

AMOXAPINE 100 mg TABLET $0.0000

AMOXAPINE 150 mg TABLET $0.0000

AMOXAPINE 25 mg TABLET $0.0000

AMOXAPINE 50 mg TABLET $0.0000

AMOXICILLIN (TRIHYDRATE) 250 mg CAPSULE $0.0754/EACH

AMOXICILLIN (TRIHYDRATE) 500 mg CAPSULE $0.0650/EACH Decrease

AMOXICILLIN OS 400 mg/5 ml SUSP, RECON $0.0353/MILLILITER

AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE 1000-62.5 TABLET $2.5873/EACH

AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE 250 - 62.5/5 ml SUSP, RECON $0.6252/MILLILITER

AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE 250-125mg TABLET $3.7080/EACH

AMOXICILLIN TRIHYDRATE 500 mg TABLET $0.2641/EACH

AMOXICILLIN 125 mg/5 ml SUSP, RECON $0.0216/MILLILITER

AMOXICILLIN 125 mg TABLET $0.0000

AMOXICILLIN 200 mg/5 ml SUSP, RECON $0.0957/MILLILITER

AMOXICILLIN 250 mg/5 ml SUSP, RECON $0.0276/MILLILITER

AMOXICILLIN 250 mg TABLET $0.2707/EACH

AMOXICILLIN 400 mg TABLET $0.0000

AMOXICILLIN 875 mg TABLET $0.1343/EACH Decrease

AMPHET ASP/AMPHET/D-AMPHET 10 mg CAPSULE $0.0000

AMPHET ASP/AMPHET/D-AMPHET 15 mg CAPSULE $0.0000

AMPHET ASP/AMPHET/D-AMPHET 15 mg TABLET $0.5261/EACH

AMPHET ASP/AMPHET/D-AMPHET 20 mg CAPSULE $0.0000

AMPHET ASP/AMPHET/D-AMPHET 25 mg CAPSULE $0.0000

AMPHET ASP/AMPHET/D-AMPHET 30 mg CAPSULE $0.0000

AMPHET ASP/AMPHET/D-AMPHET 5 mg CAPSULE $0.0000

AMPHETAMINE/D-AMPHETAMINE SALTS 10 mg TABLET $0.5500/EACH

AMPHETAMINE/D-AMPHETAMINE SALTS 12.5 mg TABLET $0.9600/EACH

AMPHETAMINE/D-AMPHETAMINE SALTS 20 mg TABLET $0.5478/EACH

AMPHETAMINE/D-AMPHETAMINE SALTS 30 mg TABLET $0.5483/EACH

AMPHETAMINE/D-AMPHETAMINE SALTS 5 mg TABLET $0.5595/EACH

AMPHETAMINE/D-AMPHETAMINE SALTS 7.5 mg TABLET $0.9600/EACH

AMPICILLIN SODIUM/SULBACTAM SODIUM 3 gm VIAL $5.6280/EACH

AMPICILLIN TRIHYDRATE 125 mg/5 ml SUSP, RECON $0.0000

AMPICILLIN TRIHYDRATE 250 mg CAPSULE $0.0895/EACH

AMPICILLIN TRIHYDRATE 500 mg CAPSULE $0.1528/EACH

AMYLASE/LIPASE/PROTEASE 20,000 units; 4,500 units; 25,000 units CAPSULE $0.0000

AMYLASE/LIPASE/PROTEASE 33,200 units; 10,000 units; 38,000 units CAPSULE $0.0000

AMYLASE/LIPASE/PROTEASE 48,000 units; 16,000 units; 48,000 units CAPSULE $0.0000

AMYLASE/LIPASE/PROTEASE 56,000 units; 20,000 units; 44,000 units CAPSULE $0.0000

Page 2 of 30

Page 3: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

AMYLASE/LIPASE/PROTEASE 65,000 units; 20,000 units; 65,000 units CAPSULE $0.0000

AMYLASE/LIPASE/PROTEASE 66,400 units; 20,000 units; 75,000 units CAPSULE $0.0000

ANAGRELIDE HCL 0.5 mg CAPSULE $0.7805/EACH

ANAGRELIDE HCL 1 mg CAPSULE $1.6782/EACH

ANASTROZOLE 1 mg TABLET $0.1070/EACH

ANTIPYRINE/BENZOCAINE OTIC 5.4%/1.4% DROPS $0.2920/MILLILITER

ARIPIPRAZOLE 1 MG/ML SOLN $3.5527/MILLILITER

ARIPIPRAZOLE 10 MG TABLET $0.9150/EACH Decrease

ARIPIPRAZOLE 15 MG TABLET $0.9547/EACH Decrease

ARIPIPRAZOLE 2 MG TABLET $0.9159/EACH Decrease

ARIPIPRAZOLE 20 MG TABLET $1.3001/EACH Decrease

ARIPIPRAZOLE 30 MG TABLET $1.3650/EACH Decrease

ARIPIPRAZOLE 5 MG TABLET $0.7031/EACH Decrease

ARMODAFINIL 150 MG TABLET $1.8000/EACH Decrease

ARMODAFINIL 200 MG TABLET $2.0400/EACH Decrease

ARMODAFINIL 250 MG TABLET $1.8000/EACH Decrease

ARMODAFINIL 50 MG TABLET $0.6194/EACH Decrease

ASPIRIN BUFFERED 325 mg TABLET $0.0000

ASPIRIN W/CODEINE 325 mg; 30 mg TABLET $0.0000

ASPIRIN W/CODEINE 325 mg; 60 mg TABLET $0.0000

ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE 30 mg CAPSULE $2.1360/EACH

ASPIRIN/DIPYRIDAMOLE 25mg-200mg CAPSULE $0.0000

ASPIRIN 325 mg TABLET $0.0120/EACH

ASPIRIN 5 gr TABLET $0.0150/EACH

ASPIRIN 81 mg TABLET $0.0300/EACH

ASPIRIN 81 mg TABLET $0.0150/EACH

ATENOLOL; CHLORTHAL 100 mg; 25 mg TABLET $0.6840/EACH

ATENOLOL; CHLORTHAL 50 mg; 25 mg TABLET $0.4024/EACH

ATENOLOL 100 mg TABLET $0.0210/EACH

ATENOLOL 25 mg TABLET $0.0150/EACH

ATENOLOL 50 mg TABLET $0.0150/EACH

ATORVASTATIN CALCIUM 10 mg TABLET $0.1110/EACH Decrease

ATORVASTATIN CALCIUM 20 mg TABLET $0.1302/EACH Decrease

ATORVASTATIN CALCIUM 40 mg TABLET $0.1302/EACH Decrease

ATORVASTATIN CALCIUM 80 mg TABLET $0.1528/EACH

ATOVAQUONE/PROGUANIL HCL 250-100 MG TABLET $5.0983/EACH

ATOVAQUONE 750 mg/5 ml SUSP $3.1881/MILLILITER

ATROPINE SULFATE 0.01 DROPS $0.0000

ATROPINE SULFATE 1%, 15 ml DROPS $0.0000

AZATHIOPRINE 50 mg TABLET $0.3900/EACH

AZELASTINE HCL 0.0005 DROPS $3.2480/MILLILITER

AZELASTINE HCL 137 mcg AERO (ML) $0.7556/MILLILITER

AZELASTINE HCL 205.5MCG AERO (ML) $2.6650/MILLILITER Reactivate

AZITHROMYCIN 100 mg/5 ml SUSP, RECON $1.0372/MILLILITER

AZITHROMYCIN 200 mg/5 ml SUSP, RECON $0.6188/MILLILITER

AZITHROMYCIN 200 MG/5ML SUSP RECON $0.8440/MILLILITER Add

AZITHROMYCIN 200 MG/5ML SUSP RECON $0.5130/MILLILITER Add

AZITHROMYCIN 250 mg TABLET $0.4593/EACH

AZITHROMYCIN 500 mg TABLET $0.8813/EACH

AZITHROMYCIN 600 mg TABLET $2.5000/EACH

BACITRACIN/NEOMYCIN SULFATE/POLYMYXIN B 400 units/3.5 mg/5,000 units per gm OINT $0.1246/GRAM

BACITRACIN/NEOMYCIN/POLYMYXIN B/HC 3.5 gr OINT $0.0000

BACITRACIN/POLYMYXIN B SULFATE 15 gr OINT $0.0000

BACITRACIN/POLYMYXIN B SULFATE 500-10K/G OINT $0.4268/GRAM

BACITRACIN/POLYMYXIN B SULFATE 500-10K/G OINT $2.7000/GRAM

BACITRACIN 500 units/gm OINT $0.0766/GRAM

BACLOFEN 10 mg TABLET $0.1602/EACH

BACLOFEN 20 mg TABLET $0.2591/EACH Decrease

BALSALAZIDE DISODIUM 750 mg CAPSULE $0.4800/EACH

BENAZEPRIL HCL 10 mg TABLET $0.0822/EACH

BENAZEPRIL HCL 20 mg TABLET $0.0589/EACH

BENAZEPRIL HCL 40 mg TABLET $0.0600/EACH

BENAZEPRIL HCL 5 mg TABLET $0.0252/EACH

BENAZEPRIL/HCTZ 10-12.5 mg TABLET $0.7548/EACH

BENAZEPRIL/HCTZ 20-12.5 mg TABLET $0.9817/EACH

BENAZEPRIL/HCTZ 20-25 mg TABLET $0.9817/EACH

BENAZEPRIL/HCTZ 5-6.25 mg TABLET $1.7880/EACH

BENZONATATE 100 mg CAPSULE $0.1807/EACH

BENZONATATE 200 mg CAPSULE $0.2358/EACH

BENZOYL PEROXIDE 0.05 GEL $0.2520/GRAM

BENZOYL PEROXIDE 10 % CLEANSER $0.0480/GRAM

BENZOYL PEROXIDE 10 % GEL $0.2468/GRAM

BENZOYL PEROXIDE 3 % CLEANSER $0.2269/GRAM

BENZOYL PEROXIDE 4 % CLEANSER $0.0000

BENZOYL PEROXIDE 5 % CLEANSER $0.0936/GRAM

BENZOYL PEROXIDE 6 % CLEANSER $0.0845/GRAM

BENZOYL PEROXIDE 8 % CLEANSER $0.0410/GRAM

BENZOYL PEROXIDE 9% CLEANSER $0.2864/GRAM

BENZTROPINE MESYLATE 0.5 mg TABLET $0.1080/EACH

BENZTROPINE MESYLATE 1 mg TABLET $0.0933/EACH

BENZTROPINE MESYLATE 2 mg TABLET $0.1145/EACH

BETAMETHASONE DIPROPIONATE AUGMENTED 0.0005 OINT $1.9200/GRAM

BETAMETHASONE DIPROPIONATE AUGMENTED 0.05% CRM $0.4050/GRAM

BETAMETHASONE DIPROPIONATE 0.0005 OINT $1.8360/GRAM Reactivate

BETAMETHASONE DIPROPIONATE 0.05%, 15 gm CRM $2.5270/GRAM

BETAMETHASONE DIPROPIONATE 0.05%, 15 gm OINT $3.2480/GRAM

BETAMETHASONE DIPROPIONATE 0.05%, 45 gm CRM $1.7620/GRAM

BETAMETHASONE DIPROPIONATE 0.05%, 45 gm OINT $1.8360/GRAM

BETAMETHASONE DIPROPIONATE 0.05%, 50 gm OINT $0.0000

BETAMETHASONE DIPROPIONATE 0.05%, 60 ml LOTION $0.0840/MILLILITER Reactivate

BETAMETHASONE DIPROPIONATE 0.05% GEL $0.6204/GRAM Reactivate

BETAMETHASONE VALERATE 0.001 OINT $0.8595/GRAM

Page 3 of 30

Page 4: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

BETAMETHASONE VALERATE 0.1 % CRM $0.9513/GRAM

BETAMETHASONE VALERATE 0.1%, 15 gm CRM $0.0791/GRAM Reactivate

BETAMETHASONE VALERATE 0.1%, 15 gm OINT $0.7795/GRAM Reactivate

BETAMETHASONE VALERATE 0.1%, 45 gm CRM $0.0696/GRAM Reactivate

BETAMETHASONE VALERATE 0.1%, 45 gm OINT $1.0064/GRAM Reactivate

BETAMETHASONE VALERATE 0.1%, 60 ml LOTION $0.5442/MILLILITER

BETAMETHASONE VALERATE 0.12 % FOAM $5.0213/GRAM

BETAXOLOL HCL 0.5 % DROPS $7.2000/MILLILITER

BETHANECHOL CHLORIDE 10 mg TABLET $0.5253/EACH

BETHANECHOL CHLORIDE 25 mg TABLET $0.4865/EACH

BETHANECHOL CHLORIDE 5 mg TABLET $0.0840/EACH

BETHANECHOL CHLORIDE 50 mg TABLET $1.1040/EACH

BEXAROTENE 75 MG CAPSULE $168.1900/EACH

BICALUTAMIDE 50 mg TABLET $0.3000/EACH

BISACODYL 10 mg SUPP $0.0840/EACH

BISACODYL 5 mg TABLET $0.0216/EACH

BISACODYL 5 mg TABLET $0.0000

BISMUTH SUBSALICYLATE 262 mg TABLET $0.0538/EACH

BISMUTH SUBSALICYLATE 262mg/15ml SUSP $0.0088/MILLILITER

BISOPROLOL FUMARATE 10 mg TABLET $0.4377/EACH

BISOPROLOL FUMARATE 5 mg TABLET $0.3017/EACH

BISOPROLOL/HCTZ 10/6.25 TABLET $0.0393/EACH

BISOPROLOL/HCTZ 2.5/6.25 TABLET $0.0447/EACH

BISOPROLOL/HCTZ 5/6.25 TABLET $0.0606/EACH

BLEOMYCIN SULFATE 15 unit VIAL $44.3850/EACH

BLEOMYCIN SULFATE 30 unit VIAL $82.6210/EACH

BRIMONIDE TARTRATE 0.15% DROPS $20.7060/MILLILITER

BRIMONIDINE TARTRATE 0.002 DROPS $0.3756/MILLILITER

BROMFENAC SODIUM 0.09% DROPS $42.0400/MILLILITER

BROMOCRIPTINE MESYLATE 2.5 mg TABLET $2.5920/EACH

BROMOCRIPTINE MESYLATE 5 mg CAPSULE $5.1600/EACH

BUDESONIDE 3 mg CAPSULE $0.0000 Delete

BUDESONIDE 32 mcg AERO (GM) $9.9220/GRAM

BUMETANIDE 0.5 mg TABLET $0.5105/EACH

BUMETANIDE 1 mg TABLET $0.4460/EACH

BUMETANIDE 2 mg TABLET $1.1240/EACH

BUPRENORPHINE HCL/NALOXONE HCL 2 mg-0.5mg TABLET $4.6560/EACH

BUPRENORPHINE HCL/NALOXONE HCL 8 mg-2 mg TABLET $3.2367/EACH

BUPRENORPHINE HCL 2 mg TABLET $1.1985/EACH

BUPRENORPHINE HCL 8 mg TABLET $1.7196/EACH

BUPROPION HCL 100 mg TABLET $0.1950/EACH

BUPROPION HCL 100 mg TABLET $0.3605/EACH Decrease

BUPROPION HCL 150 mg TABLET $0.4488/EACH

BUPROPION HCL 150 mg TABLET $0.4200/EACH

BUPROPION HCL 150 mg TABLET $0.1518/EACH

BUPROPION HCL 200 mg TABLET $0.3435/EACH Decrease

BUPROPION HCL 300 mg TABLET $0.4636/EACH Decrease

BUPROPION HCL 75 mg TABLET $0.2707/EACH

BUSPIRONE HCL 10 mg TABLET $0.0683/EACH

BUSPIRONE HCL 15 mg TABLET $0.0605/EACH

BUSPIRONE HCL 30 mg TABLET $0.4799/EACH

BUSPIRONE HCL 5 mg TABLET $0.5460/EACH

BUSPIRONE HCL 7.5 MG TABLET $0.7526/EACH Decrease

BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50-300-40 CAPSULE $2.3500/EACH Decrease

BUTALBITAL/ACETAMINOPHEN 50MG-325MG TABLET $1.2000/EACH

BUTALBITAL/APAP/CAFFEINE COMPOUND 50 mg/325 mg/40 mg TABLET $0.4812/EACH

BUTALBITAL/APAP/CAFFEINE/CODEINE 50 mg/325 mg/40 mg/30 mg CAPSULE $0.0000

BUTALBITAL/ASPIRIN/CAFF 50 mg/325 mg/40 mg CAPSULE $1.2024/EACH

BUTALBITAL/ASPIRIN/CAFFEINE 50 mg/325 mg/40 mg TABLET $0.0983/EACH

BUTORPHANOL TARTRATE 10 mg/ml AERO (ML) $0.0000

CABERGOLINE 0.5 mg TABLET $6.5022/EACH

CAFFEINE CITRATED 60 mg/3 ml SOLN $0.0000

CALCIPOTRIENE/BETAMETHASONE 0.005-.064 OINT $9.1650/GRAM

CALCIPOTRIENE 0.00005 SOLN $3.1300/MILLILITER

CALCIPOTRIENE 0.005 % CRM $0.0000

CALCITONIN,SALMON,SYNTHETIC 200 units/dose AERO (ML) $0.0000

CALCITRIOL 0.25 mcg CAPSULE $0.3700/EACH

CALCITRIOL 0.5 mcg CAPSULE $0.8124/EACH

CALCITRIOL 1 mcg/ml SOLN $6.4832/MILLILITER

CALCIUM ACETATE 667 mg CAPSULE $0.3876/EACH

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) 500 mg-200 TABLET $0.0316/EACH

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) 600 mg-400 TABLET $0.0240/EACH

CALCIUM CARBONATE/CYANOCOBALAMIN/FOLIC ACID/PYRIDOXINE 200-12-1 TABLET $0.2000/EACH

CALCIUM CARBONATE 1250 mg TABLET $0.0240/EACH

CALCIUM CARBONATE 200(500)mg TABLET $0.0150/EACH

CALCIUM POLYCARBOPHIL 625 mg TABLET $0.0600/EACH

CANDESARTAN CILEXETIL 16 mg TABLET $1.3800/EACH

CANDESARTAN CILEXETIL 32 mg TABLET $1.8464/EACH

CANDESARTAN CILEXETIL 4 mg TABLET $0.5597/EACH

CANDESARTAN CILEXETIL 8 mg TABLET $0.5640/EACH

CANDESARTAN/HYDROCHLOROTHIAZID 16-12.5mg TABLET $2.3700/EACH Increase

CANDESARTAN/HYDROCHLOROTHIAZID 32-12.5mg TABLET $1.9320/EACH

CANDESARTAN/HYDROCHLOROTHIAZID 32mg-25mg TABLET $2.1000/EACH

CAPECITABINE 150 MG TABLET $8.6350/EACH

CAPECITABINE 500 mg TABLET $10.9800/EACH Decrease

CAPTOPRIL; HYDROCHLOROTHIAZIDE 25 mg; 15 mg TABLET $0.0263/EACH Reactivate

CAPTOPRIL; HYDROCHLOROTHIAZIDE 25 mg; 25 mg TABLET $0.0568/EACH Reactivate

CAPTOPRIL; HYDROCHLOROTHIAZIDE 50 mg; 15 mg TABLET $0.0665/EACH Reactivate

CAPTOPRIL; HYDROCHLOROTHIAZIDE 50 mg; 25 mg TABLET $0.0240/EACH Reactivate

CAPTOPRIL 100 mg TABLET $1.4640/EACH

CAPTOPRIL 12.5 mg TABLET $0.6000/EACH

CAPTOPRIL 25 mg TABLET $0.9800/EACH

Page 4 of 30

Page 5: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

CAPTOPRIL 50 mg TABLET $1.1040/EACH

CARBAMAZEPINE 100 mg/5 ml SUSP $0.1680/MILLILITER

CARBAMAZEPINE 100 mg CAPSULE $0.9700/EACH

CARBAMAZEPINE 100 mg TABLET $0.3113/EACH

CARBAMAZEPINE 100 MG TABLET $0.8084/EACH Decrease

CARBAMAZEPINE 200 mg CAPSULE $0.8515/EACH Decrease

CARBAMAZEPINE 200 mg TABLET $1.2713/EACH

CARBAMAZEPINE 200 mg TABLET $0.5940/EACH Decrease

CARBAMAZEPINE 300 mg CAPSULE $1.0117/EACH

CARBAMAZEPINE 400 mg TABLET $2.7330/EACH

CARBAMIDE PEROXIDE 6.5 % DROPS $0.2072/MILLILITER

CARBETAPENTANE/EPHEDRINE/PHENYLEPHRINE/CHLORPHENIRAMINE 30-5-5-4 mg/5 ml SUSP $0.0000

CARBIDOPA/LEVODOPA/ENTACAPONE 12.5-50 MG TABLET $1.2960/EACH

CARBIDOPA/LEVODOPA/ENTACAPONE 18.75-75MG TABLET $1.2960/EACH

CARBIDOPA/LEVODOPA/ENTACAPONE 25-100-200 TABLET $1.2960/EACH

CARBIDOPA/LEVODOPA/ENTACAPONE 31.25-125 TABLET $1.2960/EACH

CARBIDOPA/LEVODOPA/ENTACAPONE 37.5-150MG TABLET $1.2960/EACH

CARBIDOPA/LEVODOPA/ENTACAPONE 50-200-200 TABLET $1.2960/EACH

CARBIDOPA/LEVODOPA 10mg-100mg TABLET $0.6300/EACH

CARBIDOPA; LEVODOPA ER 25 mg; 100 mg TABLET $0.1650/EACH

CARBIDOPA; LEVODOPA ER 50 mg; 200 mg TABLET $0.3382/EACH

CARBIDOPA; LEVODOPA 10 mg; 100 mg TABLET $0.2280/EACH

CARBIDOPA; LEVODOPA 25 mg; 100 mg TABLET $0.0974/EACH

CARBIDOPA; LEVODOPA 25 mg; 250 mg TABLET $0.2021/EACH

CARBIDOPA 25 MG TABLET $5.5725/EACH Decrease

CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 15-60-4/5 SYRUP $0.0000

CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 4 mg; 60 mg; 15 mg per 5 ml SYRUP $0.0000

CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 4-15-1 DROPS $0.0000

CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 4-15-2 DROPS $0.0000

CARBINOXAMINE MALEATE 4 mg/5 ml LIQ $0.1740/MILLILITER

CARBOPLATIN 10 mg/ ml VIAL $1.2720/MILLILITER

CARBOPLATIN 150 mg VIAL $0.0000

CARBOPLATIN 450 mg VIAL $0.0000

CARBOPLATIN 50 mg VIAL $0.0000

CAR-B-PEN TA/PHENYLEPHRINE/PYR 30 mg; 5 mg; 30 mg/5 ml SUSP $0.0000

CARISOPRODOL/ASA COMPOUND 200 mg; 325 mg TABLET $0.4334/EACH Reactivate

CARISOPRODOL 350 mg TABLET $0.0621/EACH

CARTEOLOL HCL 0.01 DROPS $0.9528/MILLILITER

CARVEDILOL 12.5 mg TABLET $0.0292/EACH

CARVEDILOL 25 mg TABLET $0.0329/EACH

CARVEDILOL 3.125 mg TABLET $0.0474/EACH

CARVEDILOL 6.25 mg TABLET $0.0308/EACH

CEFACLOR 125 mg/5 ml SUSP, RECON $0.0000

CEFACLOR 187 mg/5 ml SUSP, RECON $0.0000

CEFACLOR 250 mg/5 ml SUSP, RECON $0.0000

CEFACLOR 250 mg CAPSULE $1.6708/EACH

CEFACLOR 375 mg/5 ml SUSP, RECON $0.0000

CEFACLOR 500 mg CAPSULE $1.7280/EACH

CEFACLOR 500 mg TABLET $0.0000

CEFADROXIL HYDRATE 250 mg/5 ml SUSP, RECON $0.6384/MILLILITER

CEFADROXIL HYDRATE 500 mg/5 ml SUSP, RECON $0.8838/MILLILITER

CEFADROXIL 1 gm TABLET $3.9000/EACH

CEFADROXIL 500 mg CAPSULE $0.3450/EACH

CEFAZOLIN SODIUM 1 gm VIAL $1.1550/EACH

CEFAZOLIN SODIUM 10 gm VIAL $10.5798/EACH

CEFDINIR 125 mg/5 ml SUSP, RECON $0.2650/MILLILITER Decrease

CEFDINIR 250 mg/5 ml SUSP, RECON $0.3290/MILLILITER Decrease

CEFDINIR 300 mg CAPSULE $0.7600/EACH

CEFEPIME HCL 2 gm VIAL $9.4103/EACH

CEFIXIME 100 MG/5ML SUSP, RECON $3.8942/MILLILITER

CEFIXIME 200 MG/5ML SUSP, RECON $6.4952/MILLILITER

CEFPODOXIME PROXETIL 100 mg/5 ml SUSP, RECON $1.3248/MILLILITER

CEFPODOXIME 100 mg TABLET $5.3900/EACH

CEFPODOXIME 200 mg TABLET $0.0000

CEFPROZIL 125 mg/5 ml SUSP, RECON $0.4395/MILLILITER

CEFPROZIL 250 mg/5 ml SUSP, RECON $0.3367/MILLILITER

CEFPROZIL 250 mg TABLET $0.8640/EACH

CEFPROZIL 500 mg TABLET $1.8200/EACH

CEFTAZIDIME PENTAHYDRATE 1 gm VIAL $5.3880/EACH

CEFTAZIDIME PENTAHYDRATE 2 gm VIAL $9.8062/EACH

CEFTAZIDIME PENTAHYDRATE 6 gm VIAL $24.0786/EACH

CEFTRIAXONE SODIUM 1 gm VIAL $2.4192/EACH

CEFTRIAXONE SODIUM 10 gm VIAL $26.9500/EACH

CEFTRIAXONE SODIUM 2 gm VIAL $4.4352/EACH

CEFTRIAXONE SODIUM 250 mg VIAL $1.5926/EACH

CEFTRIAXONE SODIUM 500 mg VIAL $1.8144/EACH

CEFUROXIME AXETIL 125 mg/5 ml SUSP, RECON $0.0000

CEFUROXIME AXETIL 250 mg/5 ml SUSP, RECON $0.0000

CEFUROXIME 250 mg TABLET $1.2328/EACH

CEFUROXIME 500 mg TABLET $1.4987/EACH

CELECOXIB 50 MG CAPSULE $0.3742/EACH

CEPHALEXIN 125 mg/5 ml SUSP, RECON $0.1075/MILLILITER

CEPHALEXIN 250 mg/5 ml SUSP, RECON $0.1355/MILLILITER Decrease

CEPHALEXIN 250 mg CAPSULE $0.1080/EACH

CEPHALEXIN 500 mg CAPSULE $0.0877/EACH Decrease

CETIRIZINE HCL 1 mg/ml SOLN $0.0000 Delete

CETIRIZINE HCL 10 mg TABLET $5.6280/EACH

CETIRIZINE HCL 10 mg TABLET $0.0000 Delete

CETIRIZINE HCL 5 mg TABLET $1.5120/EACH

CETIRIZINE HCL 5 mg TABLET $0.0480/EACH

CEVIMELINE HCL 30 mg CAPSULE $1.6503/EACH

CHLORAL HYDRATE 500 mg CAPSULE $0.0000

Page 5 of 30

Page 6: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

CHLORDIAZEPOXIDE 10 mg CAPSULE $0.0883/EACH

CHLORDIAZEPOXIDE 25 mg CAPSULE $0.0972/EACH

CHLORDIAZEPOXIDE 5 mg CAPSULE $0.0874/EACH

CHLORHEXIDINE 0.12% MOUTHWASH $0.0000

CHLOROTHIAZIDE 250 mg TABLET $0.0000

CHLOROTHIAZIDE 500 mg TABLET $0.0000

CHLORPHENIRAMINE MALEATE 4 mg TABLET $0.0000

CHLORPROMAZINE HCL 10 mg TABLET $3.0000/EACH

CHLORPROMAZINE HCL 100 mg TABLET $6.1614/EACH

CHLORPROMAZINE HCL 200 mg TABLET $9.0538/EACH

CHLORPROMAZINE HCL 25 mg TABLET $3.9825/EACH

CHLORPROMAZINE HCL 50 mg TABLET $4.1040/EACH Decrease

CHLORPROPAMIDE 100 mg TABLET $0.0000

CHLORPROPAMIDE 250 mg TABLET $0.0000

CHLORTHALIDONE 100 mg TABLET $0.0000

CHLORTHALIDONE 25 mg TABLET $0.5738/EACH

CHLORTHALIDONE 50 mg TABLET $1.0288/EACH

CHLORZOXAZONE 500 mg TABLET $0.2284/EACH

CHOLECALCIFEROL (VITAMIN D3) 1000 UNIT TABLET $0.0219/EACH

CHOLECALCIFEROL (VITAMIN D3) 2000 UNIT CAPSULE $0.0375/EACH

CHOLESTYRAMINE LITE 4 gm PACKET $1.8606/EACH

CHOLESTYRAMINE LITE 4 gm PWDR $0.3000/GRAM

CHOLESTYRAMINE/SUCROSE 4 gm PACKET $1.2183/EACH

CHOLESTYRAMINE 4 gm PWDR $0.2176/GRAM

CHOLINE MAGNESIUM TRISALICYLATE 1000 mg TABLET $0.0000

CHOLINE MAGNESIUM TRISALICYLATE 500 mg TABLET $0.0000

CHOLINE MAGNESIUM TRISALICYLATE 750 mg TABLET $0.0000

CICLOPIROX 0.0077 GEL $1.5450/GRAM

CICLOPIROX 0.01 SHAMPOO $0.4581/MILLILITER

CICLOPIROX 0.08 SOLN $1.8720/MILLILITER

CICLOPIROX 0.77% CRM $0.3048/GRAM

CICLOPIROX 0.77% SUSP $1.0320/MILLILITER

CILOSTAZOL 100 mg TABLET $0.1257/EACH

CILOSTAZOL 50 mg TABLET $0.0845/EACH

CIMETIDINE 200 mg TABLET $0.2520/EACH

CIMETIDINE 300 mg TABLET $0.3670/EACH

CIMETIDINE 400 mg TABLET $0.6032/EACH

CIMETIDINE 800 mg TABLET $0.5656/EACH

CIPROFLOXACIN LACTATE/D5W 400 mg/200 ml SOLN $0.0210/MILLILITER

CIPROFLOXACIN/CIPROFLOXA HCL 1000 mg TABLET $11.1165/EACH Reactivate

CIPROFLOXACIN/CIPROFLOXA HCL 500 mg TABLET $9.3741/EACH Reactivate

CIPROFLOXACIN 0.003 DROPS $0.9450/MILLILITER

CIPROFLOXACIN 250 mg TABLET $0.1721/EACH

CIPROFLOXACIN 500 mg TABLET $0.1661/EACH

CIPROFLOXACIN 750 mg TABLET $0.6360/EACH

CITALOPRAM 10 mg/5 ml SOLN $0.2563/MILLILITER

CITALOPRAM 10 mg TABLET $0.0348/EACH

CITALOPRAM 20 mg TABLET $0.0373/EACH

CITALOPRAM 40 mg TABLET $0.0476/EACH

CLADRIBINE 10 mg/10 ml VIAL $28.3030/MILLILITER

CLARITHROMYCIN 500 mg TABLET $3.1582/EACH

CLARITHROMYCIN 125 mg/5 ml SUSP, RECON $0.8157/MILLILITER

CLARITHROMYCIN 250 mg/5 ml SUSP, RECON $1.0364/MILLILITER

CLARITHROMYCIN 250 mg TABLET $1.3052/EACH

CLARITHROMYCIN 500 mg TABLET $0.7600/EACH

CLIDINIUM/CHLORDIAZEPOXIDE 2.5 mg/5 mg CAPSULE $0.0000

CLINDAMYCIN HCL 150 mg CAPSULE $0.1313/EACH

CLINDAMYCIN HCL 300 mg CAPSULE $0.2129/EACH

CLINDAMYCIN PALMITATE HCL 75 mg/5 ml SOLN $0.2175/MILLILITER

CLINDAMYCIN PHOS/BENZOYL PEROX 1 %-5 % GEL $0.0000

CLINDAMYCIN PHOSPHATE 1% 0.01 FOAM $4.4640/GRAM

CLINDAMYCIN PHOSPHATE 1% 1% SWAB $0.3725/EACH

CLINDAMYCIN PHOSPHATE 1% 1% GEL $1.4475/GRAM

CLINDAMYCIN PHOSPHATE 1% 1% LOTION $1.1111/MILLILITER

CLINDAMYCIN PHOSPHATE 1% 1% SOLN $0.5892/MILLILITER

CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE 1% - 5% GEL $4.5094/GRAM

CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE 1.2(1)%-5% GEL $3.3873/GRAM Reactivate

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER 300MG/50ML SOLN $0.1722/MILLILITER

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER 600MG/50ML SOLN $0.2597/MILLILITER

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER 900MG/50ML SOLN $0.3172/MILLILITER

CLINDAMYCIN PHOSPHATE 0.02 CRM $1.7010/GRAM

CLINDAMYCIN PHOSPHATE 150 mg/ml VIAL $0.9231/MILLILITER

CLOBETASOL PROPIONATE/EMOLLIENT 0.05 % FOAM $3.8100/GRAM

CLOBETASOL PROPIONATE/EMOLLIENT 0.05% CRM $2.9640/GRAM

CLOBETASOL PROPIONATE 0.0005 FOAM $4.1030/GRAM

CLOBETASOL PROPIONATE 0.0005 SHAMPOO $1.6775/MILLILITER

CLOBETASOL PROPIONATE 0.05 % LOTION $3.2980/MILLILITER

CLOBETASOL PROPIONATE 0.05 % SPRAY $2.8840/MILLILITER

CLOBETASOL PROPIONATE 0.05% CRM $2.1516/GRAM Decrease

CLOBETASOL PROPIONATE 0.05% GEL $4.2000/GRAM

CLOBETASOL PROPIONATE 0.05% OINT $3.5604/GRAM

CLOBETASOL PROPIONATE 0.05% SOLN $1.2742/MILLILITER Decrease

CLOMIPHENE CITRATE 50 mg TABLET $0.0000

CLOMIPRAMINE HCL 25 mg CAPSULE $5.2800/EACH Decrease

CLOMIPRAMINE HCL 50 mg CAPSULE $6.2160/EACH Decrease

CLOMIPRAMINE HCL 75 mg CAPSULE $5.6437/EACH

CLONAZEPAM ODT 0.125 mg TABLET $0.5499/EACH

CLONAZEPAM ODT 0.25 mg TABLET $1.0743/EACH

CLONAZEPAM ODT 0.5 mg TABLET $0.7392/EACH

CLONAZEPAM ODT 1 mg TABLET $0.8441/EACH

CLONAZEPAM ODT 2 mg TABLET $1.6845/EACH

CLONAZEPAM 0.5 mg TABLET $0.0150/EACH

Page 6 of 30

Page 7: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

CLONAZEPAM 1 mg TABLET $0.0281/EACH

CLONAZEPAM 2 mg TABLET $0.0417/EACH

CLONIDINE HCL 0.1 MG TABLET $2.4119/EACH

CLONIDINE HCL 0.1 mg TABLET $0.0246/EACH

CLONIDINE HCL 0.2 mg TABLET $0.0375/EACH

CLONIDINE HCL 0.3 mg TABLET $0.0450/EACH

CLONIDINE 0.1 mg/24 hr PATCH $0.0000

CLONIDINE 0.2 mg/24 hr PATCH $0.0000

CLONIDINE 0.3 mg/24 hr PATCH $0.0000

CLOPIDOGREL 75 MG TABLET $0.0792/EACH Decrease

CLORAZEPATE DIPOTASSIUM 15 mg CAPSULE $0.0000

CLORAZEPATE DIPOTASSIUM 15 mg TABLET $1.6143/EACH

CLORAZEPATE DIPOTASSIUM 3.75 mg CAPSULE $0.0000

CLORAZEPATE DIPOTASSIUM 3.75 mg TABLET $1.0746/EACH

CLORAZEPATE DIPOTASSIUM 7.5 mg CAPSULE $0.0000

CLORAZEPATE DIPOTASSIUM 7.5 mg TABLET $0.0000

CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 1-0.05%, 15 gm CRM $0.5780/GRAM

CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 1-0.05%, 45 gm CRM $0.5020/GRAM

CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 1-0.05% LOTION $3.9203/MILLILITER

CLOTRIMAZOLE 0.01 CRM $0.0000 Delete

CLOTRIMAZOLE 0.01 CRM $0.0739/GRAM

CLOTRIMAZOLE 0.01 SOLN $1.4404/MILLILITER

CLOTRIMAZOLE 10 mg TROCHE $0.3631/EACH

CLOZAPINE 100 mg TABLET $0.9196/EACH Decrease

CLOZAPINE 200 mg TABLET $2.2500/EACH Decrease

CLOZAPINE 25 mg TABLET $0.4015/EACH Decrease

CLOZAPINE 50 mg TABLET $0.7260/EACH

CODEINE SULFATE 15 MG TAB $0.4374/TABLET Add

CODEINE SULFATE 30 MG TAB $0.4657/TABLET Add

CODEINE SULFATE 60 MG TAB $0.7832/TABLET Add

COLCHICINE 0.6 mg TABLET $5.4036/EACH

COLESTIPOL HCL 1 gm TABLET $0.8783/EACH

COLISTIMETHATE SODIUM 150 mg VIAL $23.4410/EACH

CROMOLYN SODIUM 0.04 DROPS $0.9000/MILLILITER

CROMOLYN SODIUM 10 mg/ml AMPUL $0.0000

CROMOLYN SODIUM 20 MG/ML CONC $0.9394/MILLILITER Decrease

CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG TABLET $0.0693/EACH

CYCLOBENZAPRINE HCL 5 mg TABLET $0.0360/EACH

CYCLOBENZAPRINE HCL 10 mg TABLET $0.0240/EACH

CYCLOPENTOLATE HCL 1%, 2 ml DROPS $2.4840/MILLILITER

CYCLOPHOSPHAMIDE 50 mg TABLET $0.0000

CYCLOSPORINE, MODIFIED 100 mg/ml SOLN $2.4000/MILLILITER

CYCLOSPORINE, MODIFIED 100 mg CAPSULE $2.7720/EACH

CYCLOSPORINE, MODIFIED 25 mg CAPSULE $0.6540/EACH

CYCLOSPORINE, MODIFIED 50 MG CAPSULE $1.2960/EACH

CYCLOSPORINE 100 MG CAPSULE $8.2800/EACH

CYCLOSPORINE 25 MG CAPSULE $1.7640/EACH

CYPROHEPTADINE HCL 2 mg/5 ml SYRUP $0.1282/MILLILITER

CYPROHEPTADINE HCL 4 mg TABLET $0.3883/EACH

CYTARABINE/PF 2 g/20 ml VIAL $0.9720/MILLILITER

DACARBAZINE 200 mg VIAL $14.2010/EACH

DANAZOL 200 mg CAPSULE $4.0501/EACH

DANTROLENE SODIUM 100 mg CAPSULE $1.4500/EACH Reactivate

DANTROLENE SODIUM 25 mg CAPSULE $0.8400/EACH

DANTROLENE SODIUM 50 mg CAPSULE $1.2600/EACH Reactivate

DAPSONE 100 MG TABLET $2.1840/EACH

DAPSONE 25 MG TABLET $1.7880/EACH

DAUNORUBICIN HCL 5 mg/ml VIAL $18.2247/MILLILITER

DEFEROXAMINE MESYLATE 2 gm VIAL $39.6550/EACH

DEFEROXAMINE MESYLATE 500 mg VIAL $12.4643/EACH

DEMECLOCYCLINE 150 mg TABLET $4.4500/EACH

DEMECLOCYCLINE 300 mg TABLET $8.4000/EACH

DESIPRAMINE HCL 10 mg TABLET $0.6292/EACH

DESIPRAMINE HCL 100 mg TABLET $0.0000

DESIPRAMINE HCL 150 mg TABLET $0.0000

DESIPRAMINE HCL 25 mg TABLET $0.9300/EACH

DESIPRAMINE HCL 50 mg TABLET $2.1473/EACH

DESIPRAMINE HCL 75 mg TABLET $2.9153/EACH

DESLORATADINE 5 mg TABLET $0.4581/EACH

DESMOPRESSIN ACETATE 0.1 mg TABLET $0.7229/EACH

DESMOPRESSIN ACETATE 0.2 mg TABLET $0.9000/EACH Decrease

DESMOPRESSIN ACETATE 4 mcg/ml AMPUL $0.0000

DESMOPRESSIN ACETATE 4 mcg/ml VIAL $0.0000

DESMOPRESSIN 0.1 mg/ml AERO (ML) $17.5316/MILLILITER

DESOGESTREL/ETHINY ESTRADIOL (DESOGEN, ORTHO-CEPT, APRI) 0.15 mg/30 mcg TABLET $0.4216/EACH

DESOGESTREL/ETHINY ESTRADIOL (KARIVA, MIRCETTE) 0.15 mg/20 mcg TABLET $0.8194/EACH

DESOGESTREL/ETHINY ESTRADIOL 7-7-7 (CYCLESSA, VELIVET) 0.1-25/0.125-25/0.15-25 mg-mcg TABLET $0.4920/EACH

DESONIDE 0.0005 LOTION $2.1720/MILLILITER

DESONIDE 0.05%; 15 gm CRM $2.9705/GRAM Decrease

DESONIDE 0.05%; 15 gm OINT $1.7304/GRAM Reactivate

DESONIDE 0.05%; 60 gm CRM $3.6294/GRAM

DESONIDE 0.05%; 60 gm OINT $1.1242/GRAM Reactivate

DESOXIMETASONE 0.0025 CRM $0.6880/GRAM Reactivate

DESOXIMETASONE 0.05%; 15 gm CRM $2.7872/GRAM

DESOXIMETASONE 0.05%; 15 gm GEL $4.6920/GRAM

DESOXIMETASONE 0.05%; 60 gm CRM $5.8788/GRAM

DESOXIMETASONE 0.05%; 60 gm GEL $2.5030/GRAM

DESOXIMETASONE 0.25%; 15 gm CRM $2.5490/GRAM

DESOXIMETASONE 0.25%; 15 gm OINT $5.9088/GRAM

DESOXIMETASONE 0.25%; 60 gm CRM $1.3940/GRAM

DESOXIMETASONE 0.25%; 60 gm OINT $5.6442/GRAM

DESVENLAFAXINE SUCCINATE 100 MG TAB, ER 24 HR $0.9595/TABLET Add

Page 7 of 30

Page 8: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

DESVENLAFAXINE SUCCINATE 50 MG TAB, ER 24 HR $0.9595/TABLET Add

DEXAMETHASONE 0.5 mg/5 ml ELIXIR $0.0000

DEXAMETHASONE 0.5 mg TABLET $0.0674/EACH Reactivate

DEXAMETHASONE 4 mg TABLET $0.0000

DEXMETHYLPHENIDATE HCL 10 mg CAPSULE $4.3666/EACH Decrease

DEXMETHYLPHENIDATE HCL 10 mg TABLET $0.9070/EACH Decrease

DEXMETHYLPHENIDATE HCL 15 MG CAPSULE $4.5588/EACH

DEXMETHYLPHENIDATE HCL 2.5 mg TABLET $0.5537/EACH

DEXMETHYLPHENIDATE HCL 20 mg CAPSULE $5.6320/EACH

DEXMETHYLPHENIDATE HCL 30 MG CAPSULE $4.5812/EACH

DEXMETHYLPHENIDATE HCL 40 MG CAPSULE $5.7992/EACH

DEXMETHYLPHENIDATE HCL 5 mg CAPSULE $5.4160/EACH

DEXMETHYLPHENIDATE HCL 5 mg TABLET $0.6865/EACH Decrease

DEXTROAMPHETAMINE SULFATE 10 mg CAPSULE $1.7550/EACH

DEXTROAMPHETAMINE SULFATE 10 mg TABLET $1.0937/EACH

DEXTROAMPHETAMINE SULFATE 15 mg CAPSULE $1.8749/EACH

DEXTROAMPHETAMINE SULFATE 5 mg CAPSULE $2.8351/EACH

DEXTROAMPHETAMINE SULFATE 5 mg TABLET $1.1431/EACH

DEXTROMETHORPHAN HBR/PHENYLEPHRINE HCL/CHLORPHENIRAMINE 15-12.5-4 SYRUP $0.0198/MILLILITER

DHCODEINE BT/ACETAMINOPHN/CAFF 32-713-60 TABLET $0.0000

DIAZEPAM 10 mg TABLET $0.0271/EACH

DIAZEPAM 2 mg TABLET $0.0240/EACH

DIAZEPAM 5 mg TABLET $0.0297/EACH

DICLOFENAC POTASSIUM 50 mg TABLET $0.6000/EACH

DICLOFENAC SODIUM XR 100 mg TABLET $0.2698/EACH

DICLOFENAC SODIUM/MISOPROSTOL 50 MG-200 TABLET $2.4720/EACH

DICLOFENAC SODIUM/MISOPROSTOL 75 MG-200 TABLET $2.5545/EACH

DICLOFENAC SODIUM 0.001 DROPS $1.5173/MILLILITER

DICLOFENAC SODIUM 1 % GEL $0.4038/GRAM

DICLOFENAC SODIUM 25 mg TABLET $0.8100/EACH Reactivate

DICLOFENAC SODIUM 3 % GEL $2.4360/GRAM Decrease

DICLOFENAC SODIUM 50 mg TABLET $0.2054/EACH

DICLOFENAC SODIUM 75 mg TABLET $0.1580/EACH

DICLOXACILLIN SODIUM 250 mg CAPSULE $0.2990/EACH

DICLOXACILLIN SODIUM 500 mg CAPSULE $0.5700/EACH

DICYCLOMINE HCL 10 mg CAPSULE $0.0438/EACH

DICYCLOMINE HCL 20 mg TABLET $0.0567/EACH

DIDANOSINE 125 mg CAPSULE $1.5960/EACH

DIDANOSINE 200 mg CAPSULE $6.4841/EACH

DIDANOSINE 250 mg CAPSULE $5.8440/EACH

DIDANOSINE 400 mg CAPSULE $4.3500/EACH

DIFLORASONE DIACETATE 0.05% CRM $0.0000

DIFLORASONE DIACETATE 0.05% OINT $2.8476/GRAM

DIFLUNISAL 250 mg TABLET $0.0000

DIFLUNISAL 500 mg TABLET $1.2720/EACH

DIGOXIN .125 mg TABLET $0.5535/EACH

DIGOXIN .250 mg TABLET $0.6776/EACH

DILTIAZEM HCL 420 mg CAPSULE $1.2360/EACH

DILTIAZEM HCL 120 mg CAPSULE $0.5600/EACH

DILTIAZEM HCL 120 mg CAPSULE $0.2250/EACH

DILTIAZEM HCL 120 mg CAPSULE $3.1996/EACH

DILTIAZEM HCL 120 mg CAPSULE $0.3122/EACH

DILTIAZEM HCL 120 mg TABLET $0.3000/EACH

DILTIAZEM HCL 180 mg CAPSULE $0.5640/EACH

DILTIAZEM HCL 180 mg CAPSULE $0.4560/EACH

DILTIAZEM HCL 180 mg CAPSULE $0.3460/EACH

DILTIAZEM HCL 180 MG TABLET $2.0880/EACH

DILTIAZEM HCL 240 mg CAPSULE $0.8520/EACH

DILTIAZEM HCL 240 mg CAPSULE $0.3750/EACH

DILTIAZEM HCL 240 mg CAPSULE $0.3840/EACH

DILTIAZEM HCL 240 MG TABLET $2.3400/EACH

DILTIAZEM HCL 30 mg TABLET $0.2494/EACH

DILTIAZEM HCL 300 mg CAPSULE $0.8280/EACH

DILTIAZEM HCL 300 mg CAPSULE $0.4151/EACH

DILTIAZEM HCL 300 MG TABLET $3.0360/EACH

DILTIAZEM HCL 360 mg CAPSULE $4.8388/EACH

DILTIAZEM HCL 360 mg CAPSULE $0.5498/EACH

DILTIAZEM HCL 360 MG TABLET $3.2710/EACH

DILTIAZEM HCL 420 MG TABLET $3.5520/EACH

DILTIAZEM HCL 60 mg CAPSULE $2.1480/EACH

DILTIAZEM HCL 60 mg TABLET $0.1699/EACH

DILTIAZEM HCL 90 mg CAPSULE $2.4600/EACH

DILTIAZEM HCL 90 mg TABLET $0.3480/EACH

DIPHENHYDRAMINE 25 mg CAPSULE $0.0240/EACH

DIPHENHYDRAMINE 50 mg CAPSULE $0.0235/EACH

DIPHENOXYLATE HCL; ATROPINE SULFATE 2.5 mg; 0.025 mg/5 ml LIQ $0.0000

DIPHENOXYLATE HCL; ATROPINE SULFATE 2.5 mg; 0.025 mg TABLET $0.3750/EACH

DIPYRIDAMOLE 25 mg TABLET $0.0630/EACH

DIPYRIDAMOLE 50 mg TABLET $0.0834/EACH

DIPYRIDAMOLE 75 mg TABLET $0.1200/EACH

DISOPYRAMIDE CR 150 mg CAPSULE $0.0000

DISOPYRAMIDE 100 mg CAPSULE $0.5520/EACH

DISOPYRAMIDE 150 mg CAPSULE $0.0000

DISULFIRAM 250 mg TABLET $1.9800/EACH

DIVALPROEX SODIUM 125 mg CAPSULE $0.5150/EACH Decrease

DIVALPROEX SODIUM 125 mg TABLET $0.0450/EACH

DIVALPROEX SODIUM 250 mg TABLET $0.0692/EACH

DIVALPROEX SODIUM 250 mg TABLET $0.8280/EACH Decrease

DIVALPROEX SODIUM 500 mg TABLET $0.1296/EACH

DIVALPROEX SODIUM 500 mg TABLET $0.6437/EACH

D-METHORP TAN/P-EPD TAN/D-CP 25 mg; 75 mg; 2.5 mg/5 ml SUSP $0.0000

D-METHORPHAN HB/PE/CHLORPHENIR 15 mg; 6 mg; 2 mg/5 ml SYRUP $0.0000

Page 8 of 30

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NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

D-METHORPHAN HB/P-EPD HCL/BPM 3 mg; 12.5 mg;1 mg/ml DROPS $0.0000

D-METHORPHAN HB/P-EPD HCL/BPM 10 mg; 30 mg; 2 mg/5 ml SYRUP $0.0000

D-METHORPHAN HB/P-EPD HCL/BPM 15 mg; 45 mg; 4 mg/5 ml SYRUP $0.0000

D-METHORPHAN HB/P-EPD HCL/BPM 30 mg; 60 mg; 4 mg/5 ml SYRUP $0.0000

D-METHORPHAN HB/P-EPD HCL/BPM 4 mg; 15 mg; 1 mg/ml DROPS $0.0000

DOCUSATE CALCIUM 240 mg CAPSULE $0.0600/EACH

DOCUSATE SODIUM/CASANTHRANOL 100 mg/30 mg CAPSULE $0.0000

DOCUSATE SODIUM/CASANTHRANOL 60 mg/30 mg per 15 ml SYRUP $0.0000

DOCUSATE SODIUM/SENNA 50 mg/8.6 mg TABLET $0.0000

DOCUSATE SODIUM 100 mg CAPSULE $0.0204/EACH Decrease

DOCUSATE SODIUM 150 mg/15 ml LIQ $0.0109/MILLILITER

DOCUSATE SODIUM 283 mg ENEMA $2.0647/EACH

DOCUSATE SODIUM 50 mg CAPSULE $0.2760/EACH

DOFETILIDE 125 MCG CAPSULE $4.7280/EACH

DOFETILIDE 250 MCG CAPSULE $4.8343/EACH

DOFETILIDE 500 MCG CAPSULE $4.9616/EACH

DONEPEZIL HCL 10 mg TABLET $0.3500/EACH

DONEPEZIL HCL 10 mg TABLET $0.0367/EACH

DONEPEZIL HCL 23 mg TABLET $1.8343/EACH

DONEPEZIL HCL 5 mg TABLET $0.1680/EACH

DONEPEZIL HCL 5 mg TABLET $0.0367/EACH

DORZOLAMIDE HCL 0.02 DROPS $1.3296/MILLILITER

DOXAZOSIN MESYLATE 1 mg TABLET $0.5540/EACH

DOXAZOSIN MESYLATE 2 mg TABLET $0.3423/EACH Decrease

DOXAZOSIN MESYLATE 4 mg TABLET $0.4734/EACH

DOXAZOSIN MESYLATE 8 mg TABLET $0.3646/EACH

DOXEPIN HCL 10 MG/ML CONC $0.0600/MILLILITER

DOXEPIN HCL 10 mg CAPSULE $0.4412/EACH

DOXEPIN HCL 100 mg CAPSULE $1.3848/EACH

DOXEPIN HCL 150 mg CAPSULE $0.0000

DOXEPIN HCL 25 mg CAPSULE $0.6000/EACH

DOXEPIN HCL 50 mg CAPSULE $0.8232/EACH

DOXEPIN HCL 75 mg CAPSULE $1.2046/EACH

DOXERCALCIFEROL 0.5 MCG CAPSULE $10.2700/EACH

DOXERCALCIFEROL 1 MCG CAPSULE $17.3800/EACH

DOXERCALCIFEROL 2.5 MCG CAPSULE $23.6340/EACH

DOXORUBICIN HCL 10 mg/5 ml VIAL $2.2680/MILLILITER

DOXORUBICIN HCL 2 mg/ ml VIAL $1.6797/MILLILITER

DOXORUBICIN HCL 20 mg/10 ml VIAL $2.6250/MILLILITER

DOXORUBICIN HCL 50 mg/25 ml VIAL $2.8200/MILLILITER

DOXYCYCLINE HYCLATE 100 mg CAPSULE $0.2689/EACH

DOXYCYCLINE HYCLATE 100 mg TABLET $0.7635/EACH Decrease

DOXYCYCLINE HYCLATE 100 MG TABLET $9.4050/EACH

DOXYCYCLINE HYCLATE 150 MG TABLET $13.2000/EACH

DOXYCYCLINE HYCLATE 20 mg TABLET $0.4440/EACH

DOXYCYCLINE HYCLATE 50 mg CAPSULE $0.6840/EACH

DOXYCYCLINE MONOHYDRATE 100 mg TABLET $0.5941/EACH

DOXYCYCLINE MONOHYDRATE 50 mg TABLET $0.4099/EACH

DOXYCYCLINE MONOHYDRATE 100 mg CAPSULE $0.4318/EACH

DOXYCYCLINE MONOHYDRATE 150 mg CAPSULE $10.5710/EACH

DOXYCYCLINE MONOHYDRATE 150 mg TABLET $6.1440/EACH

DOXYCYCLINE MONOHYDRATE 50 mg CAPSULE $0.3047/EACH

DRONABINOL 5 mg CAPSULE $5.0272/EACH Decrease

DRONABINOL 10 mg CAPSULE $8.4627/EACH

DRONABINOL 2.5 mg CAPSULE $2.9095/EACH Decrease

DULOXETINE HCL 20 mg CAPSULE $0.3173/EACH

DULOXETINE HCL 30 mg CAPSULE $0.2635/EACH Decrease

DULOXETINE HCL 60 mg CAPSULE $0.2265/EACH Decrease

DUTASTERIDE/TAMSULOSIN HCL 0.5-0.4 MG CAPSULE $3.8760/EACH

ECONAZOLE NITRATE 1% CRM $0.0000

ECONAZOLE NITRATE 1% CRM $1.8900/GRAM Decrease

ECONAZOLE NITRATE 1% CRM $2.5086/GRAM Decrease

ECONAZOLE NITRATE 1% CRM $2.3465/GRAM

ELECTROLYTE ORAL SOLUTION 1000 ml SOLN $0.0000

ELECTROLYTE ORAL SOLUTION 540 ml SOLN $0.0000

ENALAPRIL MALEATE/HCTZ 10 mg/25 mg TABLET $0.1890/EACH

ENALAPRIL MALEATE/HCTZ 5 mg/12.5 mg TABLET $0.2040/EACH

ENALAPRIL MALEATE 10 mg TABLET $0.3053/EACH

ENALAPRIL MALEATE 2.5 mg TABLET $0.1645/EACH

ENALAPRIL MALEATE 20 mg TABLET $0.2700/EACH

ENALAPRIL MALEATE 5 mg TABLET $0.3000/EACH

ENALAPRILAT DIHYDRATE 1.25 mg/ml VIAL $3.0240/MILLILITER

ENOXAPARIN SODIUM 100 mg/ml SYRINGE $0.0000

ENOXAPARIN SODIUM 120 mg/0.8 ml SYRINGE $0.0000

ENOXAPARIN SODIUM 150 mg/ml SYRINGE $0.0000

ENOXAPARIN SODIUM 30 mg/0.3 ml SYRINGE $0.0000

ENOXAPARIN SODIUM 300MG/3ML VIAL $0.0000

ENOXAPARIN SODIUM 40 mg/0.4 ml SYRINGE $0.0000

ENOXAPARIN SODIUM 60 mg/0.6 ml SYRINGE $0.0000

ENOXAPARIN SODIUM 80 mg/0.8 ml SYRINGE $0.0000

ENTACAPONE 200 MG TABLET $2.3700/EACH

ENTECAVIR 0.5 MG TABLET $6.3030/EACH Decrease

ENTECAVIR 1 mg TABLET $6.3030/EACH Decrease

EPINASTINE HCL 0.05 % DROPS $5.8200/MILLILITER

EPIRUBICIN HCL 200 mg/0.1 l VIAL $1.9688/MILLILITER

EPIRUBICIN HCL 50 mg/25 ml VIAL $2.1175/MILLILITER

EPLERENONE 25 mg TABLET $2.2200/EACH

EPLERENONE 50 mg TABLET $1.9459/EACH

EPOPROSTENOL NA 0.5 mg VIAL $0.0000

EPOPROSTENOL NA 1.5 mg VIAL $0.0000

ERGOCALCIFEROL (VITAMIN D2) 50000 unit CAPSULE $0.1793/EACH

ERGOCALCIFEROL (VITAMIN D2) 8000/ML DROPS $0.5400/MILLILITER

Page 9 of 30

Page 10: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

ERYTHROMYCIN BASE/BENZOYL PEROXIDE 3%; 5% GEL $5.9800/GRAM

ERYTHROMYCIN BASE/ETHANOL 2% GEL $3.3360/GRAM

ERYTHROMYCIN BASE 250 mg TABLET $0.0000

ERYTHROMYCIN BASE 333 mg TABLET $0.0000

ERYTHROMYCIN BASE 500 mg TABLET $0.0000

ERYTHROMYCIN ETHYLSUCCINATE (EES) 400 mg TABLET $0.0000

ERYTHROMYCIN/SULFISOXAZOLE 200 mg/600 mg per 5 ml SUSP, RECON $0.0000

ERYTHROMYCIN 0.005 OINT $1.4160/GRAM

ERYTHROMYCIN 2% SOLN $0.7712/MILLILITER

ESCITALOPRAM OXALATE 10 MG TABLET $0.0955/EACH

ESCITALOPRAM OXALATE 20 MG TABLET $0.1078/EACH

ESCITALOPRAM OXALATE 5 MG/5 ML SOLN $0.7050/MILLILITER

ESCITALOPRAM OXALATE 5 MG TABLET $0.0931/EACH

ESOMEPRAZOLE MAGNESIUM 20 mg CAPSULE $0.0000

ESOMEPRAZOLE MAGNESIUM 40 mg CAPSULE $0.0000

ESTAZOLAM 1 mg TABLET $0.5160/EACH

ESTAZOLAM 2 mg TABLET $0.8520/EACH

ESTERIFIED ESTROGENS/METHYLTESTOSTERONE (H.S.) 0.625-1.25 mg TABLET $0.0000

ESTERIFIED ESTROGENS/METHYLTESTOSTERONE (H.S.) 1.25-2.5 mg TABLET $0.0000

ESTRADIOL VALERATE/DIENOGEST 3-2-1(28) TABLET $0.0000

ESTRADIOL .025 mg/24hr PATCH $8.6050/EACH

ESTRADIOL .025 mg PATCH $15.0920/EACH

ESTRADIOL .0375 mg/24hr PATCH $7.3495/EACH

ESTRADIOL .0375mg/24 PATCH $13.7200/EACH

ESTRADIOL .05 mg PATCH $16.0762/EACH

ESTRADIOL .075 mg/24hr PATCH $9.4848/EACH Decrease

ESTRADIOL .075 mg PATCH $15.0920/EACH

ESTRADIOL .1 mg PATCH $15.0920/EACH

ESTRADIOL/NORETHINDRONE ACETATE (ACTIVELLA) 1-0.5 mg TABLET $3.3000/EACH

ESTRADIOL/NORETHINDRONE ACETATE 0.5-0.1mg TABLET $3.7791/EACH

ESTRADIOL 0.05 mg/24hr PATCH $9.0854/EACH

ESTRADIOL 0.06mg/24h PATCH $13.7200/EACH

ESTRADIOL 0.1 mg/24 hr PATCH $8.9870/EACH

ESTRADIOL 0.5 mg TABLET $0.0850/EACH

ESTRADIOL 1 mg TABLET $0.1086/EACH

ESTRADIOL 2 mg TABLET $0.1320/EACH

ESTROPIPATE 0.75 mg TABLET $0.3397/EACH

ESTROPIPATE 1.5 mg TABLET $0.4800/EACH

ESTROPIPATE 3 mg TABLET $0.0000

ESZOPICLONE 1 mg TABLET $0.6017/EACH

ESZOPICLONE 2 mg TABLET $0.3789/EACH

ESZOPICLONE 3 mg TABLET $0.3159/EACH

ETHACRYNIC ACID 25 MG TABLET $17.1270/EACH

ETHAMBUTOL HCL 100 MG TABLET $0.9858/EACH

ETHAMBUTOL HCL 400 mg TABLET $0.7320/EACH

ETHINYL ESTRADIOL/DROSPIRENONE (YASMIN, OCELLA) 0.03-3 mg TABLET $0.7200/EACH

ETHINYL ESTRADIOL/DROSPIRENONE 0.02-3(24) TABLET $1.3000/EACH Decrease

ETHOSUXIMIDE 250 mg/5 ml SOLN $0.2333/MILLILITER

ETHOSUXIMIDE 250 mg CAPSULE $0.9884/EACH

ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (DEMULEN 1/35, ZOVIA 1/35E) 1 mg/35 mcg TABLET $0.6565/EACH

ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (DEMULEN 1/50, ZOVIA 1/50E) 1 mg/50 mcg TABLET $0.8520/EACH

ETODOLAC 500 mg TABLET $2.0520/EACH

ETODOLAC 200 mg CAPSULE $1.2484/EACH

ETODOLAC 300 mg CAPSULE $1.2480/EACH Reactivate

ETODOLAC 400 mg TABLET $1.9320/EACH

ETODOLAC 400 mg TABLET $0.6253/EACH

ETODOLAC 500 mg TABLET $0.9720/EACH

ETODOLAC 600 mg TABLET $2.2398/EACH

ETOPOSIDE 20 mg/ml VIAL $1.8300/MILLILITER

ETOPOSIDE 50 mg CAPSULE $67.2980/EACH

EXEMESTANE 25 mg TABLET $6.2707/EACH

EZETIMIBE/SIMVASTATIN 10 MG-10MG TAB $3.6240/TABLET Add

EZETIMIBE/SIMVASTATIN 10 MG-20MG TAB $3.6240/TABLET Add

EZETIMIBE/SIMVASTATIN 10 MG-40MG TAB $3.6240/TABLET Add

EZETIMIBE/SIMVASTATIN 10 MG-80MG TAB $3.6240/TABLET Add

EZETIMIBE 10 MG TAB $0.2466/TABLET Add

FAMCICLOVIR 125 mg TABLET $0.4050/EACH

FAMCICLOVIR 250 mg TABLET $0.5240/EACH

FAMCICLOVIR 500 mg TABLET $0.9735/EACH

FAMOTIDINE/CALCIUM CARBONATE/MAGNESIUM 10-800-165 TABLET $0.3360/EACH

FAMOTIDINE 10 mg TABLET $0.0842/EACH

FAMOTIDINE 20 mg TABLET $0.0347/EACH

FAMOTIDINE 40 mg/5 ml SUSP $0.6396/MILLILITER

FAMOTIDINE 40 mg TABLET $0.0480/EACH

FELBAMATE 400 mg TABLET $3.3450/EACH

FELBAMATE 600 mg/5 ml SUSP $1.8960/MILLILITER

FELBAMATE 600 mg TABLET $3.3300/EACH Decrease

FELODIPINE 10 mg TABLET $0.2154/EACH

FELODIPINE 2.5 mg TABLET $0.5050/EACH

FELODIPINE 5 mg TABLET $0.2167/EACH

FENOFIBRATE NANOCRYSTALLIZED 145MG TABLET $0.6129/EACH Reactivate

FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET $0.4933/EACH Reactivate

FENOFIBRATE,MICRONIZED 130 mg CAPSULE $1.8240/EACH

FENOFIBRATE,MICRONIZED 134 mg CAPSULE $1.3713/EACH

FENOFIBRATE,MICRONIZED 200 mg CAPSULE $2.2055/EACH

FENOFIBRATE,MICRONIZED 43 mg CAPSULE $0.6480/EACH

FENOFIBRATE,MICRONIZED 67 mg CAPSULE $0.7395/EACH

FENOFIBRATE 120 MG TABLET $23.9479/EACH

FENOFIBRATE 160 mg TABLET $0.5040/EACH Decrease

FENOFIBRATE 54 mg TABLET $0.8640/EACH

FENOFIBRIC ACID (CHOLINE) 135 MG CAPSULE $1.5465/EACH Decrease

FENOFIBRIC ACID (CHOLINE) 45 MG CAPSULE $0.9900/EACH

Page 10 of 30

Page 11: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

FENOPROFEN CALCIUM 600 mg TABLET $0.0000

FENTANYL CITRATE 1,200 mcg LOZENGE $15.1382/EACH

FENTANYL CITRATE 1,600 mcg LOZENGE $25.5566/EACH

FENTANYL CITRATE 200 mcg LOZENGE $17.1116/EACH

FENTANYL CITRATE 400 mcg LOZENGE $21.6796/EACH

FENTANYL CITRATE 600 mcg LOZENGE $24.5112/EACH

FENTANYL CITRATE 800 mcg LOZENGE $14.5211/EACH Decrease

FENTANYL 100 mcg PATCH $9.0900/EACH

FENTANYL 12 mcg/hr PATCH $11.5000/EACH Decrease

FENTANYL 25 mcg PATCH $3.3531/EACH

FENTANYL 50 mcg PATCH $5.6412/EACH

FENTANYL 75 mcg PATCH $8.2169/EACH

FERROUS FUMARATE/DOCUSATE SODIUM/FOLIC ACID 106-50-1mg TABLET $0.2000/EACH

FERROUS FUMARATE/FOLIC ACID 106 mg; 1 mg TABLET $0.0000

FERROUS SULFATE 220 mg/5 ml ELIXIR $0.0000

FERROUS SULFATE 325 mg TABLET $0.0150/EACH

FERROUS SULFATE 75 mg/0.6 ml; 50 ml DROPS $0.0000

FEXOFENADINE HCL/PSEUDOEPHEDRINE HCL 60mg-120mg TABLET $0.7680/EACH

FEXOFENADINE HCL 180 mg TABLET $0.3960/EACH

FEXOFENADINE HCL 30 mg TABLET $0.3390/EACH

FEXOFENADINE HCL 60 mg TABLET $0.3360/EACH

FINASTERIDE 5 mg TABLET $0.1126/EACH Decrease

FINASTERIDE 1 MG TABLET $0.0000

FLAVOXATE HCL 100 mg TABLET $0.7245/EACH

FLECAINIDE ACETATE 100 mg TABLET $0.4200/EACH

FLECAINIDE ACETATE 150 mg TABLET $0.6225/EACH Decrease

FLECAINIDE ACETATE 50 mg TABLET $0.4080/EACH

FLUCONAZOLE IN SALINE, ISO-OSMOTIC 400 mg/200 ml SOLN $0.0580/MILLILITER

FLUCONAZOLE 10 mg/ml SUSP, RECON $0.3442/MILLILITER

FLUCONAZOLE 100 mg TABLET $0.9955/EACH

FLUCONAZOLE 150 mg TABLET $1.1890/EACH

FLUCONAZOLE 200 mg TABLET $1.8584/EACH

FLUCONAZOLE 40 mg/ml SUSP, RECON $0.5643/MILLILITER

FLUCONAZOLE 50 mg TABLET $1.0350/EACH

FLUDARABINE PHOSPHATE 50 mg/2 ml VIAL $125.6101/MILLILITER

FLUDARABINE PHOSPHATE 50 mg VIAL $95.2560/EACH

FLUDROCORTISONE ACETATE 0.1 mg TABLET $0.4873/EACH

FLUNISOLIDE 0.00025 AERO (ML) $2.0429/MILLILITER Reactivate

FLUNISOLIDE 0.00025 AERO (ML) $1.7606/MILLILITER

FLUOCINOLONE ACETONIDE 0.01 % OIL $0.8858/MILLILITER

FLUOCINOLONE 0.01%, 60 mL SOLN $0.0000

FLUOCINOLONE 0.01% CRM $0.0000

FLUOCINOLONE 0.025% CRM $0.0000

FLUOCINOLONE 0.025% OINT $0.0000

FLUOCINONIDE/EMOLLIENT 0.05% CRM $1.7048/GRAM

FLUOCINONIDE 0.05% CRM $1.0624/GRAM

FLUOCINONIDE 0.05% GEL $2.2208/GRAM

FLUOCINONIDE 0.05% OINT $1.5120/GRAM

FLUOCINONIDE 0.05% SOLN $1.3436/MILLILITER

FLUOCINONIDE 0.1 % CRM $6.9000/GRAM

FLUOROMETHOLONE 0.1% DROPS $0.0000

FLUOROURACIL 0.05 CRM $3.3680/GRAM

FLUOROURACIL 0.05 SOLN $6.6742/MILLILITER Reactivate

FLUOROURACIL 50 mg/ml; 10 ml VIAL $0.3282/MILLILITER

FLUOROURACIL 50 mg/ml; 100 ml VIAL $0.3356/MILLILITER

FLUOROURACIL 50 mg/ml; 20 ml VIAL $0.0000

FLUOROURACIL 50 mg/ml; 50 ml VIAL $0.3911/MILLILITER

FLUOROURACIL 50 mg/ml VIAL $0.0000

FLUOXETINE HCL 10 mg CAPSULE $0.0389/EACH

FLUOXETINE HCL 10 mg TABLET $0.0389/EACH

FLUOXETINE HCL 20 mg/5 ml SOLN $0.0450/MILLILITER

FLUOXETINE HCL 20 mg CAPSULE $0.0360/EACH

FLUOXETINE HCL 20 mg TABLET $0.0360/EACH

FLUOXETINE HCL 40 mg CAPSULE $0.1535/EACH Decrease

FLUOXETINE HCL 90 mg CAPSULE $30.8688/EACH

FLUPHENAZINE DECANOATE 25 mg/ml VIAL $15.5156/MILLILITER

FLUPHENAZINE 1 mg TABLET $0.0000

FLUPHENAZINE 10 mg TABLET $0.0000

FLUPHENAZINE 2.5 mg TABLET $0.0000

FLUPHENAZINE 5 mg TABLET $0.0000

FLURAZEPAM HCL 15 mg CAPSULE $0.3442/EACH

FLURAZEPAM HCL 30 mg CAPSULE $0.4148/EACH

FLURBIPROFEN SODIUM 0.03 % DROPS $1.1580/MILLILITER

FLURBIPROFEN 100 mg TABLET $0.3900/EACH

FLURBIPROFEN 50 mg TABLET $0.2160/EACH

FLUTICASONE PROPIONATE 0.005% OINT $0.4240/GRAM

FLUTICASONE PROPIONATE 0.05% CRM $0.4200/GRAM

FLUTICASONE PROPIONATE 50 mcg SUSP $0.2701/GRAM

FLUVASTATIN SODIUM 20 MG CAP $3.7175/CAPSULE Add

FLUVASTATIN SODIUM 40 MG CAP $3.7175/CAPSULE Add

FLUVASTATIN SODIUM 80 mg TABLET $5.2137/EACH

FLUVOXAMINE MALEATE 100 mg CAPSULE $6.8860/EACH

FLUVOXAMINE MALEATE 150 mg CAPSULE $7.0730/EACH

FLUVOXAMINE 100 mg TABLET $0.2791/EACH

FLUVOXAMINE 25 mg TABLET $0.1200/EACH

FLUVOXAMINE 50 mg TABLET $0.1992/EACH

FOLIC ACID/VITAMIN B COMP W-C 1 mg CAPSULE $0.1500/EACH

FOLIC ACID 1 mg TABLET $0.0138/EACH

FONDAPARINUX SODIUM 10mg/0.8ml SYRINGE $73.1940/MILLILITER

FONDAPARINUX SODIUM 2.5 mg/0.5 SYRINGE $33.6480/MILLILITER

FONDAPARINUX SODIUM 5mg/0.4ml SYRINGE $190.1400/MILLILITER

FONDAPARINUX SODIUM 7.5mg/0.6 SYRINGE $97.5920/MILLILITER

Page 11 of 30

Page 12: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

FOSINOPRIL SODIUM/HCTZ 10-12.5 mg TABLET $0.7440/EACH Decrease

FOSINOPRIL SODIUM/HCTZ 20-12.5 mg TABLET $0.7440/EACH Decrease

FOSINOPRIL SODIUM 10 mg TABLET $0.1193/EACH

FOSINOPRIL SODIUM 20 mg TABLET $0.1237/EACH

FOSINOPRIL SODIUM 40 mg TABLET $0.2097/EACH

FROVATRIPTAN SUCCINATE 2.5 MG TABLET $37.0598/EACH

FUROSEMIDE 10 mg/ml SOLN $0.1080/MILLILITER

FUROSEMIDE 20 mg TABLET $0.0135/EACH

FUROSEMIDE 40 mg TABLET $0.0120/EACH

FUROSEMIDE 80 mg TABLET $0.0340/EACH

GABAPENTIN 100 mg CAPSULE $0.0360/EACH

GABAPENTIN 250 mg/5 ml SOLN $0.1257/MILLILITER

GABAPENTIN 300 mg CAPSULE $0.0473/EACH

GABAPENTIN 400 mg CAPSULE $0.0666/EACH Decrease

GABAPENTIN 600 mg TABLET $0.1300/EACH Decrease

GABAPENTIN 800 mg TABLET $0.1661/EACH

GALANTAMINE HYDROBROMIDE 12 mg TABLET $1.6264/EACH

GALANTAMINE HYDROBROMIDE 16 mg CAPSULE $2.3167/EACH

GALANTAMINE HYDROBROMIDE 24 mg CAPSULE $1.6800/EACH

GALANTAMINE HYDROBROMIDE 4 mg TABLET $2.2000/EACH

GALANTAMINE HYDROBROMIDE 8 mg CAPSULE $1.6800/EACH

GALANTAMINE HYDROBROMIDE 8 mg TABLET $1.6264/EACH

GEMCITABINE HCL 1 g VIAL $41.5800/EACH

GEMCITABINE HCL 2 g VIAL $123.8743/EACH

GEMCITABINE HCL 200 mg VIAL $10.1617/EACH

GEMFIBROZIL 600 mg TABLET $0.1062/EACH

GENTAMICIN SULFATE 0.1% CRM $1.8872/GRAM

GENTAMICIN SULFATE 0.1% OINT $1.8840/GRAM

GENTAMICIN SULFATE 0.3 % OINT $2.8457/GRAM

GENTAMICIN SULFATE 0.3%, 15 ml DROPS $0.0000

GENTAMICIN SULFATE 0.3% DROPS $1.6944/MILLILITER

GENTAMICIN SULFATE 40 mg/ml VIAL $0.6000/MILLILITER Decrease

GLIMEPIRIDE 1 mg TABLET $0.0743/EACH

GLIMEPIRIDE 2 mg TABLET $0.1286/EACH

GLIMEPIRIDE 4 mg TABLET $0.1594/EACH

GLIPIZIDE/METFORMIN HCL 2.5-250 mg TABLET $0.8132/EACH

GLIPIZIDE/METFORMIN HCL 2.5-500 mg TABLET $0.3370/EACH

GLIPIZIDE/METFORMIN HCL 5 mg; 500 mg TABLET $0.3713/EACH

GLIPIZIDE 10 mg TABLET $0.3130/EACH

GLIPIZIDE 10 mg TABLET $0.0300/EACH

GLIPIZIDE 2.5 mg TABLET $0.2804/EACH

GLIPIZIDE 5 mg TABLET $0.1670/EACH

GLIPIZIDE 5 mg TABLET $0.0251/EACH

GLYBURIDE, Micronized 1.5 mg TABLET $0.0345/EACH

GLYBURIDE, Micronized 3 mg TABLET $0.0323/EACH

GLYBURIDE, Micronized 6 mg TABLET $0.1524/EACH

GLYBURIDE/METFORMIN HCL 1.25/250 mg TABLET $0.0450/EACH

GLYBURIDE/METFORMIN HCL 2.5/500 mg TABLET $0.0506/EACH

GLYBURIDE/METFORMIN HCL 5/500 mg TABLET $0.0540/EACH

GLYBURIDE 1.25 mg TABLET $0.1200/EACH

GLYBURIDE 2.5 mg TABLET $0.1680/EACH

GLYBURIDE 5 mg TABLET $0.1418/EACH Decrease

GLYCERIN pediatric SUPP $0.0668/EACH

GLYCOPYRROLATE 1 mg TABLET $0.4399/EACH

GLYCOPYRROLATE 2 mg TABLET $0.6518/EACH

GRANISETRON HCL 1 mg/ml; MDV VIAL $7.1094/MILLILITER

GRANISETRON HCL 1 mg/ml; SDV VIAL $6.6000/MILLILITER

GRANISETRON HCL 1 mg TABLET $1.8900/EACH

GRISEOFULVIN ULTRAMICROSIZE 250 MG TABLET $5.2190/EACH

GRISEOFULVIN, MICROSIZE 500 MG TABLET $6.4130/EACH

GRISEOFULVIN,MICROSIZE 125 mg/5 ml SUSP $0.2378/MILLILITER

GUAIFEN/DM HB/P-EPHEDRINE 100 mg; 15 mg; 40 mg/5 ml SYRUP $0.0000

GUAIFENESIN; CODEINE PHOSPHATE (Sugar-Free) 100 mg; 10 mg LIQ $0.0000 Delete

GUAIFENESIN; CODEINE PHOSPHATE 100 mg; 10 mg SYRUP $0.0000

GUAIFENESIN; DEXTROMETHORPHAN HBr 100 mg; 10 mg LIQ $0.0000 Delete

GUAIFENESIN; DEXTROMETHORPHAN HBr 100 mg; 10 mg SYRUP $0.0000

GUAIFENESIN; HYDROCODONE BITARTRATE 100 mg; 5 mg SYRUP $0.0000

GUAIFENESIN; PHENYLEPHRINE HCL 600 mg; 40 mg TABLET $0.0000

GUAIFENESIN; PSEUDOEPHEDRINE HCL; CODEINE 100 mg; 30 mg; 10 mg SYRUP $0.0000

GUAIFENESIN; PSEUDOEPHEDRINE HCL 100 mg; 30 mg SYRUP $0.0000

GUAIFENESIN; PSEUDOEPHEDRINE HCL 600 mg; 120 mg TABLET $0.0000

GUAIFENESIN 100 mg/5 ml LIQ $0.0000 Delete

GUAIFENESIN 100 mg/5 ml SYRUP $0.0000

GUAIFENESIN 1200 mg TABLET $0.0000

GUAIFENESIN 200 mg TABLET $0.0000

GUAIFENESIN 600 mg TABLET $0.0000

GUANFACINE HCL 1 mg TABLET $0.5284/EACH

GUANFACINE HCL 2 mg TABLET $0.5284/EACH

GUANFACINE HCL 3 mg TABLET $0.5284/EACH

GUANFACINE HCL 4 mg TABLET $0.5284/EACH

GUANFACINE 1 mg TABLET $0.0702/EACH Decrease

GUANFACINE 2 mg TABLET $0.0900/EACH

HALOBETASOL PROPIONATE 0.05% CRM $3.2772/GRAM

HALOBETASOL PROPIONATE 0.05% OINT $3.1056/GRAM

HALOPERIDOL DECANOATE 100 mg/ml VIAL $0.0000

HALOPERIDOL DECANOATE 100 mg/ml VIAL $0.0000

HALOPERIDOL DECANOATE 50 mg/ml VIAL $0.0000

HALOPERIDOL LACTATE 2 mg/ml; 120 ml CONC $0.0449/MILLILITER

HALOPERIDOL LACTATE 2 mg/ml; 15 ml CONC $0.0000

HALOPERIDOL 0.5 mg TABLET $0.2477/EACH

HALOPERIDOL 1 mg TABLET $0.4950/EACH

HALOPERIDOL 10 mg TABLET $0.6051/EACH

Page 12 of 30

Page 13: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

HALOPERIDOL 2 mg TABLET $0.4445/EACH Decrease

HALOPERIDOL 20 mg TABLET $1.3329/EACH Decrease

HALOPERIDOL 5 mg TABLET $0.4600/EACH

HC ACETATE/LIDOCAINE HCL 0.5%; 3% CRM $0.8252/GRAM

HYDRALAZINE HCL 10 mg TABLET $0.0448/EACH Decrease

HYDRALAZINE HCL 100 mg TABLET $0.0900/EACH

HYDRALAZINE HCL 25 mg TABLET $0.0542/EACH

HYDRALAZINE HCL 50 mg TABLET $0.0607/EACH

HYDROCHLOROTHIAZIDE 12.5 mg CAPSULE $0.0374/EACH

HYDROCHLOROTHIAZIDE 12.5 MG TABLET $0.0720/EACH

HYDROCHLOROTHIAZIDE 25 mg TABLET $0.0150/EACH

HYDROCHLOROTHIAZIDE 50 mg TABLET $0.0177/EACH

HYDROCODONE BIT/ACETAMINOPHEN 10MG-300MG TABLET $1.8240/EACH

HYDROCODONE BIT/ACETAMINOPHEN 7.5-325/15 SOLN $0.2163/MILLILITER Decrease

HYDROCODONE BIT/HOMATROPINE 5-1.5 mg/5 SYRUP $0.1080/MILLILITER

HYDROCODONE/ACETAMINOPHEN 5MG-300MG TABLET $1.0800/EACH Decrease

HYDROCODONE/ACETAMINOPHEN 7.5-300MG TABLET $1.6800/EACH

HYDROCODONE/APAP 10 mg; 325 mg TABLET $0.1866/EACH

HYDROCODONE/APAP 10 mg; 500 mg TABLET $0.0000

HYDROCODONE/APAP 10 mg; 650 mg TABLET $0.0000

HYDROCODONE/APAP 10 mg; 660 mg TABLET $0.0000

HYDROCODONE/APAP 10 mg; 750 mg TABLET $0.0000

HYDROCODONE/APAP 2.5 mg; 500 mg TABLET $0.0000

HYDROCODONE/APAP 5 mg; 325 mg TABLET $0.1275/EACH

HYDROCODONE/APAP 5 mg; 500 mg TABLET $0.0000

HYDROCODONE/APAP 7.5 mg; 325 mg TABLET $0.1800/EACH

HYDROCODONE/APAP 7.5 mg; 500 mg TABLET $0.0000

HYDROCODONE/APAP 7.5 mg; 650 mg TABLET $0.0000

HYDROCODONE/APAP 7.5 mg; 750 mg TABLET $0.0000

HYDROCODONE/APAP 7.5/500 mg SOLN $0.0000

HYDROCODONE/CPM/PSEUDOEPHED 5-4-60MG/5 SOLN $0.5729/MILLILITER

HYDROCODONE/IBUPROFEN 7.5 mg; 200 mg TABLET $0.3751/EACH

HYDROCORTISONE ACETATE 1 % CRM $0.0000 Delete

HYDROCORTISONE ACETATE 25 mg SUPP $0.0000

HYDROCORTISONE BUTYRATE/EMOLL 0.1 % CRM $6.0720/GRAM

HYDROCORTISONE BUTYRATE 0.001 CRM $4.9410/GRAM Reactivate

HYDROCORTISONE BUTYRATE 0.1 % OINT $1.2224/GRAM

HYDROCORTISONE BUTYRATE 0.1 % SOLN $1.2224/MILLILITER

HYDROCORTISONE POWDER NA PWDR $0.0000

HYDROCORTISONE VALERATE 0.2% CRM $3.8900/GRAM

HYDROCORTISONE VALERATE 0.2% OINT $4.8150/GRAM Reactivate

HYDROCORTISONE 0.5% CRM $0.0000

HYDROCORTISONE 0.5% OINT $0.0000

HYDROCORTISONE 1% CRM $0.0000

HYDROCORTISONE 1% OINT $0.0000 Delete

HYDROCORTISONE 1% LOTION $0.0662/MILLILITER

HYDROCORTISONE 10 MG TABLET $0.1680/EACH

HYDROCORTISONE 2.5 % CRM $0.0000 Delete

HYDROCORTISONE 2.5% CRM $0.0000

HYDROCORTISONE 2.5% CRM $3.9652/GRAM

HYDROCORTISONE 2.5% OINT $0.1339/GRAM

HYDROCORTISONE 2.5% LOTION $0.7741/MILLILITER

HYDROCORTISONE 20 mg TABLET $0.4443/EACH

HYDROCORTISONE 5 MG TABLET $0.1128/EACH

HYDROMORPHONE HCL 12 MG TABLET $10.7745/EACH

HYDROMORPHONE HCL 16 MG TABLET $19.9450/EACH

HYDROMORPHONE HCL 2 mg TABLET $0.0806/EACH

HYDROMORPHONE HCL 4 mg TABLET $0.1173/EACH

HYDROMORPHONE HCL 8 MG TABLET $9.0761/EACH

HYDROMORPHONE HCL 8 mg TABLET $0.6720/EACH

HYDROQUINONE 4% 0.04 CRM $1.9018/GRAM

HYDROQUINONE 4% 4% GEL $0.0000

HYDROQUINONE 4% w/ SUNSCREEN 0.04 CRM $0.0000

HYDROXYCHLOROQUINE SULFATE 200 mg TABLET $0.6013/EACH

HYDROXYUREA 500 mg CAPSULE $0.3658/EACH

HYDROXYZINE HCL 10 mg TABLET $0.0000

HYDROXYZINE HCL 25 mg TABLET $0.0806/EACH

HYDROXYZINE HCL 50 mg TABLET $0.1085/EACH Decrease

HYDROXYZINE PAM 25 mg CAPSULE $0.0723/EACH

HYDROXYZINE PAM 50 mg CAPSULE $0.0750/EACH

HYDROXYZINE 10 mg/5 ml SOLN $0.0444/MILLILITER

HYOSCYAMINE SULFATE 0.125 mg/ml DROPS $1.2861/MILLILITER

HYOSCYAMINE SULFATE 0.125 mg TABLET $0.0918/EACH

HYOSCYAMINE SULFATE 0.125 mg TABLET $0.2153/EACH

HYOSCYAMINE SULFATE 0.125 mg TABLET $0.1200/EACH

HYOSCYAMINE SULFATE 0.375 mg CAPSULE $0.0000

HYOSCYAMINE SULFATE 0.375 mg TABLET $0.1666/EACH

IBANDRONATE SODIUM 150 MG TABLET $8.7550/EACH

IBANDRONATE SODIUM 3 mg/3 ml SYRINGE $72.8090/MILLILITER

IBUPROFEN/OXYCODONE HCL 400 mg; 5 mg TABLET $1.2370/EACH

IBUPROFEN 100 mg/5 ml SUSP $0.0000 Delete

IBUPROFEN 200 mg CAPSULE $0.0000 Delete

IBUPROFEN 200 mg TABLET $0.0000 Delete

IBUPROFEN 400 mg TABLET $0.0600/EACH

IBUPROFEN 50 mg/1.25 DROPS $0.0000 Delete

IBUPROFEN 600 mg TABLET $0.0600/EACH

IBUPROFEN 800 mg TABLET $0.0500/EACH

IDARUBICIN HCL 1 mg/ml VIAL $16.8714/MILLILITER

IFOSFAMIDE 1 g VIAL $35.5152/EACH

IFOSFAMIDE 3 g VIAL $110.2046/EACH

IMATINIB MESYLATE 100 MG TABLET $48.4500/EACH Decrease

IMATINIB MESYLATE 400 MG TABLET $158.3400/EACH Decrease

Page 13 of 30

Page 14: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

IMIPENEM/CILASTATIN SODIUM 250 mg VIAL $5.9063/EACH

IMIPENEM/CILASTATIN SODIUM 500 mg VIAL $9.1000/EACH

IMIPRAMINE HCL 10 mg TABLET $0.1410/EACH

IMIPRAMINE HCL 25 mg TABLET $0.2075/EACH

IMIPRAMINE HCL 50 mg TABLET $0.3096/EACH

IMIPRAMINE PAMOATE 100 mg CAPSULE $7.6670/EACH Decrease

IMIPRAMINE PAMOATE 125 mg CAPSULE $14.3818/EACH

IMIPRAMINE PAMOATE 150 mg CAPSULE $6.4800/EACH

IMIPRAMINE PAMOATE 75 mg CAPSULE $4.9800/EACH

IMIQUIMOD 5 % PACKET $1.3915/EACH

INDAPAMIDE 1.25 mg TABLET $0.2080/EACH

INDAPAMIDE 2.5 mg TABLET $0.3431/EACH

INDOMETHACIN SR 75 mg CAPSULE $0.9241/EACH

INDOMETHACIN 25 mg CAPSULE $0.1440/EACH

INDOMETHACIN 50 mg CAPSULE $0.1398/EACH

IPRATROPIUM BROMIDE 0.0003 AERO (ML) $1.0356/MILLILITER

IPRATROPIUM BROMIDE 0.0006 AERO (ML) $1.3708/MILLILITER

IPRATROPIUM BROMIDE 0.2 mg/ml SOLN $0.0720/MILLILITER

IPRATROPIUM/ALBUTEROL SULFATE 0.5-2.5 mg/3 ml AMPUL $0.0727/MILLILITER

IRBESARTAN/HYDROCHLOROTHIAZIDE 150-12.5MG TABLET $0.0960/EACH

IRBESARTAN/HYDROCHLOROTHIAZIDE 300-12.5MG TABLET $0.2964/EACH

IRBESARTAN 150 MG TABLET $0.1223/EACH

IRBESARTAN 300 MG TABLET $0.1539/EACH

IRBESARTAN 75 MG TABLET $0.0668/EACH

IRINOTECAN HCL 100 mg/5 ml VIAL $3.1440/MILLILITER

IRINOTECAN HCL 40 mg/2 ml VIAL $6.4793/MILLILITER

IRINOTECAN HCL 500 mg/25 ml VIAL $0.0000

IRON POLYSACCHARIDES COMPLEX 150 mg CAPSULE $0.1427/EACH

IRON,CARBONYL/ASCORBIC ACID/CYANOCOBALAMIN/FOLIC ACID 100-250-1 TABLET $1.2480/EACH

IRON,CARBONYL/ASCORBIC ACID/CYANOCOBALAMIN/FOLIC ACID 100-320-1 CAPSULE $0.2000/EACH

IRON,CARBONYL/FOLIC ACID/MULTIVITAMINS W-MINERALS 50-1.25mg TABLET $0.0000

ISONIAZID 300 mg TABLET $0.1215/EACH

ISOSORBIDE DINITRATE 10 mg TABLET $0.6480/EACH

ISOSORBIDE DINITRATE 2.5 mg TABLET $0.0000

ISOSORBIDE DINITRATE 20 mg TABLET $0.7127/EACH

ISOSORBIDE DINITRATE 30 mg TABLET $0.7800/EACH

ISOSORBIDE DINITRATE 40 mg TABLET $1.2120/EACH

ISOSORBIDE DINITRATE 5 mg TABLET $0.0000

ISOSORBIDE DINITRATE 5 mg TABLET $0.6755/EACH

ISOSORBIDE MONONITRATE 10 mg TABLET $0.1920/EACH

ISOSORBIDE MONONITRATE 120 mg TABLET $0.4200/EACH

ISOSORBIDE MONONITRATE 20 mg TABLET $0.1560/EACH

ISOSORBIDE MONONITRATE 30 mg TABLET $0.1582/EACH Decrease

ISOSORBIDE MONONITRATE 60 mg TABLET $0.2340/EACH

ISOTRETINOIN 10 mg CAPSULE $3.0509/EACH

ISOTRETINOIN 20 mg CAPSULE $5.3540/EACH Decrease

ISOTRETINOIN 40 mg CAPSULE $5.1027/EACH Decrease

ITRACONAZOLE 200 mg CAPSULE $4.6950/EACH

KETOCONAZOLE 2% SHAMPOO $0.0734/MILLILITER

KETOCONAZOLE 2 % FOAM $3.2959/GRAM

KETOCONAZOLE 2% CRM $0.8450/GRAM

KETOCONAZOLE 200 mg TABLET $1.7848/EACH

KETOPROFEN 200 mg CAPSULE $6.1160/EACH

KETOPROFEN 50 mg CAPSULE $0.3840/EACH

KETOPROFEN 75 mg CAPSULE $0.4560/EACH

KETOROLAC TROMETHAMINE 0.4% DROPS $6.5885/MILLILITER

KETOROLAC TROMETHAMINE 0.5% DROPS $1.6800/MILLILITER

KETOROLAC TROMETHAMINE 10 mg TABLET $0.8280/EACH

KETOROLAC TROMETHAMINE 15 mg/ml CARTRIDGE $0.0000

KETOROLAC TROMETHAMINE 30 mg/ml CARTRIDGE $0.0000

KETOROLAC TROMETHAMINE 60 mg/2 ml VIAL $1.2199/MILLILITER

LABETALOL HCL 100 mg TABLET $0.2863/EACH

LABETALOL HCL 200 mg TABLET $0.2596/EACH

LABETALOL HCL 300 mg TABLET $0.2342/EACH Decrease

LACTULOSE 10 gm/15 ml SOLN $0.0150/MILLILITER

LACTULOSE 10 gm/15 ml SOLN $0.0120/MILLILITER

LACTULOSE 10 gm/15 ml SYRUP $0.0000

LAMIVUDINE/ZIDOVUDINE 150 - 300 mg TABLET $1.6800/EACH Decrease

LAMIVUDINE 100 mg TABLET $5.6718/EACH

LAMIVUDINE 150 MG TAB $1.4784/TABLET Add

LAMIVUDINE 300 MG TABLET $4.4400/EACH

LAMOTRIGINE 100 mg TABLET $6.8640/EACH

LAMOTRIGINE 100 MG TABLET $6.0700/EACH Decrease

LAMOTRIGINE 100 mg TABLET $0.0600/EACH

LAMOTRIGINE 150 mg TABLET $0.0755/EACH

LAMOTRIGINE 200 mg TABLET $8.5900/EACH Decrease

LAMOTRIGINE 200 MG TABLET $6.5040/EACH

LAMOTRIGINE 200 mg TABLET $0.1092/EACH

LAMOTRIGINE 25 mg TABLET $0.0000

LAMOTRIGINE 25 mg TABLET $0.2738/EACH

LAMOTRIGINE 25 MG TABLET $2.9800/EACH

LAMOTRIGINE 25 mg TABLET $0.0532/EACH

LAMOTRIGINE 250 MG TABLET $11.7600/EACH Decrease

LAMOTRIGINE 300 MG TABLET $9.4268/EACH

LAMOTRIGINE 5 mg TABLET $0.3516/EACH

LAMOTRIGINE 50 mg TABLET $6.4320/EACH

LAMOTRIGINE 50 MG TABLET $5.9600/EACH

LANSOPRAZOLE/AMOXICILLIN/CLARITHROMYCIN 30-500-500 COMBINATION PACKAGE $3.7186/EACH

LANSOPRAZOLE 15 mg CAPSULE $0.5100/EACH

LANSOPRAZOLE 15 mg TABLET $4.8342/EACH Reactivate

LANSOPRAZOLE 30 mg CAPSULE $0.2600/EACH Decrease

LANSOPRAZOLE 30 mg TABLET $4.8342/EACH Reactivate

Page 14 of 30

Page 15: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

LATANOPROST 0.00005 DROPS $1.8288/MILLILITER

LEFLUNOMIDE 10 mg TABLET $3.9626/EACH

LEFLUNOMIDE 20 mg TABLET $3.1700/EACH Decrease

LETROZOLE 2.5 mg TABLET $0.1396/EACH

LEUCOVORIN CALCIUM 25 mg TABLET $5.9607/EACH

LEUCOVORIN CALCIUM 5 mg TABLET $0.6000/EACH

LEUPROLIDE ACETATE 1 mg/0.2 ml KIT $183.0000/EACH

LEVALBUTEROL HCL 0.31MG/3ML VIAL $0.5400/MILLILITER

LEVALBUTEROL HCL 0.63MG/3ML VIAL $0.5332/MILLILITER

LEVALBUTEROL HCL 1.25MG/3ML VIAL $0.5382/MILLILITER Decrease

LEVETIRACETAM 100 mg/ml SOLN $0.0475/MILLILITER Decrease

LEVETIRACETAM 1000 mg TABLET $0.3000/EACH

LEVETIRACETAM 250 mg TABLET $0.0900/EACH

LEVETIRACETAM 500 mg/5 ml VIAL $1.3126/MILLILITER

LEVETIRACETAM 500 mg TABLET $0.3450/EACH

LEVETIRACETAM 500 mg TABLET $0.0901/EACH

LEVETIRACETAM 750 mg TABLET $0.4956/EACH

LEVETIRACETAM 750 mg TABLET $0.2170/EACH

LEVOBUNOLOL HCL 0.25% DROPS $0.0000

LEVOBUNOLOL HCL 0.50% DROPS $2.2904/MILLILITER

LEVOCARNITINE 100 mg/ml SOLN $0.0000

LEVOCARNITINE 200 mg/ml VIAL $2.1370/MILLILITER

LEVOCARNITINE 330 mg TABLET $0.6338/EACH Increase

LEVOCETIRIZINE DIHYDROCHLORIDE 2.5 mg/5 ml SOLN $0.5640/MILLILITER

LEVOCETIRIZINE DIHYDROCHLORIDE 5 mg TABLET $0.1700/EACH

LEVOFLOXACIN 250 mg TABLET $0.1406/EACH

LEVOFLOXACIN 250MG/10ML SOLN $1.1112/MILLILITER

LEVOFLOXACIN 500 mg TABLET $0.1939/EACH Decrease

LEVOFLOXACIN 750 mg TABLET $0.5664/EACH

LEVONORGESTREL/ETHINYL ESTRADIOL (ALESSE, LEVLITE, AVIANE) 0.1 mg/20 mcg TABLET $0.4097/EACH

LEVONORGESTREL/ETHINYL ESTRADIOL (LEVLEN, NORDETTE, LEVORA 0.15/30)0.15 mg/30 mcg TABLET $0.3360/EACH

LEVONORGESTREL/ETHINYL ESTRADIOL (SEASONALE, JOLESSA, QUASENSE) 0.15 mg/30 mcg TABLET $0.6600/EACH

LEVONORGESTREL/ETHINYL ESTRADIOL TRIPHASIC (TRI-LEVLEN, TRIPHASIL, TRIVORA-28)0.05 mg/30 mcg; 0.075 mg/40 mcg; 0.125 mg/30 mcg TABLET $0.5550/EACH

LEVONORGESTREL 0.75 mg TABLET $0.0000

LEVONORGESTREL 1.5 mg TABLET $21.9375/EACH

LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL 100-20(84) TABLET $1.7836/EACH

LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL 150-30 (84) TABLET $1.2480/EACH

LEVONORGESTREL-ETH ESTRA 90-20mcg TABLET $0.8640/EACH

LEVOTHYROXINE 100 mcg TABLET $0.4180/EACH

LEVOTHYROXINE 112 mcg TABLET $0.4782/EACH

LEVOTHYROXINE 125 mcg TABLET $0.4848/EACH

LEVOTHYROXINE 137 mcg TABLET $0.4915/EACH

LEVOTHYROXINE 150 mcg TABLET $0.4990/EACH

LEVOTHYROXINE 175 mcg TABLET $0.5930/EACH

LEVOTHYROXINE 200 mcg TABLET $0.4291/EACH

LEVOTHYROXINE 25 mcg TABLET $0.3146/EACH

LEVOTHYROXINE 300 mcg TABLET $0.7800/EACH

LEVOTHYROXINE 50 mcg TABLET $0.3250/EACH Decrease

LEVOTHYROXINE 75 mcg TABLET $0.3990/EACH

LEVOTHYROXINE 88 mcg TABLET $0.4104/EACH

LIDOCAINE HCL 2% SOLN $0.0409/MILLILITER

LIDOCAINE HCL 3 % CRM $1.3500/GRAM

LIDOCAINE/PRILOCAINE 2.5-2.5% CRM $0.6224/GRAM

LIDOCAINE 2% JEL $0.3750/MILLILITER

LIDOCAINE 5 % OINT $1.3120/GRAM Decrease

LINDANE 1% LOTION $0.0000

LINDANE 1% SHAMPOO $0.0000

LINEZOLID 600 mg TABLET $5.0686/EACH

LIOTHYRONINE SODIUM 25 mcg TABLET $0.7619/EACH

LIOTHYRONINE SODIUM 5 mcg TABLET $0.4762/EACH

LIOTHYRONINE SODIUM 50 mcg TABLET $1.3560/EACH

LISINOPRIL/HCTZ 10 mg/12.5 mg TABLET $0.0296/EACH

LISINOPRIL/HCTZ 20 mg/12.5 mg TABLET $0.0479/EACH

LISINOPRIL/HCTZ 20 mg/25 mg TABLET $0.0534/EACH

LISINOPRIL 10 mg TABLET $0.0180/EACH

LISINOPRIL 2.5 mg TABLET $0.0141/EACH

LISINOPRIL 20 mg TABLET $0.0360/EACH

LISINOPRIL 30 mg TABLET $0.0450/EACH

LISINOPRIL 40 mg TABLET $0.0500/EACH Decrease

LISINOPRIL 5 mg TABLET $0.0232/EACH

LITHIUM CARBONATE 150 mg CAPSULE $0.0552/EACH

LITHIUM CARBONATE 300 mg CAPSULE $0.0360/EACH

LITHIUM CARBONATE 300 mg TABLET $0.1922/EACH

LITHIUM CARBONATE 300 mg TABLET $0.1666/EACH

LITHIUM CARBONATE 450 mg TABLET $0.2329/EACH

LITHIUM CARBONATE 600 MG CAPSULE $0.1080/EACH

LITHIUM CITRATE 8 mEq/5 ml SOLN $0.0480/MILLILITER

LOPERAMIDE HCL 1 mg/5 ml LIQ $0.0362/MILLILITER

LOPERAMIDE HCL 2 mg CAPSULE $0.2520/EACH

LOPERAMIDE HCL 2 mg TABLET $0.1030/EACH

LORATADINE 10 mg TABLET $0.0000 Delete

LORATADINE 10 mg TABLET $0.0000 Delete

LORATADINE 5 mg/5 ml SOLN $0.0000 Delete

LORAZEPAM 0.5 mg TABLET $0.0240/EACH

LORAZEPAM 1 mg TABLET $0.0274/EACH

LORAZEPAM 2 mg/ml CONC $0.4808/MILLILITER

LORAZEPAM 2 mg/ml SYRINGE $0.0000

LORAZEPAM 2 mg/ml VIAL $0.8898/MILLILITER

LORAZEPAM 2 mg TABLET $0.0450/EACH

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 100 mg-25 mg TABLET $0.0968/EACH

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 100-12.5 mg TABLET $0.1048/EACH

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 50-12.5 mg TABLET $0.0750/EACH

Page 15 of 30

Page 16: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

LOSARTAN POTASSIUM 100 mg TABLET $0.0625/EACH

LOSARTAN POTASSIUM 25 mg TABLET $0.0413/EACH

LOSARTAN POTASSIUM 50 mg TABLET $0.0483/EACH

LOVASTATIN 10 mg TABLET $0.0804/EACH

LOVASTATIN 20 mg TABLET $0.0747/EACH Decrease

LOVASTATIN 40 mg TABLET $0.0960/EACH

LOXAPINE SUCCINATE 10 mg CAPSULE $0.4800/EACH

LOXAPINE SUCCINATE 25 mg CAPSULE $0.7080/EACH

LOXAPINE SUCCINATE 5 mg CAPSULE $0.3480/EACH

LOXAPINE SUCCINATE 50 mg CAPSULE $1.2720/EACH

MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE/SIMETHICONE 200-200-20 SUSP $0.0074/MILLILITER

MAGNESIUM OXIDE 400 mg TABLET $0.0240/EACH

MALATHION 0.005 LOTION $3.7098/MILLILITER

MAPROTILINE HCL 25 mg TABLET $0.0000

MAPROTILINE HCL 50 mg TABLET $0.0000

MAPROTILINE HCL 75 mg TABLET $0.0000

MECLIZINE HCL 12.5 mg TABLET $0.0720/EACH

MECLIZINE HCL 25 mg TABLET $0.1500/EACH

MECLOFENAMATE SODIUM 100 mg CAPSULE $0.0000

MECLOFENAMATE SODIUM 50 mg CAPSULE $0.0000

MEDROXYPROGESTERONE ACET 150 mg/ml SYRINGE $85.9305/MILLILITER Decrease

MEDROXYPROGESTERONE ACET 150 mg/ml VIAL $0.0000

MEDROXYPROGESTERONE ACETATE 10 mg TABLET $0.1680/EACH

MEDROXYPROGESTERONE ACETATE 2.5 mg TABLET $0.1360/EACH

MEDROXYPROGESTERONE ACETATE 5 mg TABLET $0.1560/EACH

MEFENAMIC ACID 250 mg CAPSULE $7.6208/EACH

MEFLOQUINE HCL 250 MG TABLET $5.6472/EACH

MEGESTROL ACETATE 20 mg TABLET $0.2753/EACH

MEGESTROL ACETATE 40 mg/ml SUSP $0.0981/MILLILITER

MEGESTROL ACETATE 40 mg TABLET $0.2076/EACH

MEGESTROL ACETATE 625mg/5ml SUSP $4.0325/MILLILITER

MELOXICAM 15 mg TABLET $0.0300/EACH

MELOXICAM 7.5 mg TABLET $0.0251/EACH

MEMANTINE HCL 10 mg TABLET $0.2183/EACH

MEMANTINE HCL 5 mg TABLET $0.2508/EACH Decrease

MEPERIDINE HCL 100 mg TABLET $1.1760/EACH

MEPERIDINE HCL 50 mg TABLET $0.7680/EACH

MEPROBAMATE 200 mg TABLET $0.0000

MEPROBAMATE 400 mg TABLET $0.0000

MERCAPTOPURINE 50 mg TABLET $1.6180/EACH

MEROPENEM 1 G VIAL $10.9200/EACH

MEROPENEM 500 mg VIAL $6.1688/EACH

MESALAMINE 4g/60ml ENEMA $0.1317/MILLILITER

MESALAMINE 800 MG TAB, EC $6.3800/TABLET Add

METAXALONE 800 mg TABLET $2.4863/EACH Reactivate

METFORMIN HCL 1000 MG TABLET $9.5260/EACH

METFORMIN HCL 500 mg TABLET $0.0393/EACH

METFORMIN HCL 500 MG TABLET $7.4750/EACH

METFORMIN HCL 750 mg TABLET $0.1096/EACH Decrease

METFORMIN 1000 mg TABLET $0.0237/EACH Decrease

METFORMIN 500 mg TABLET $0.0200/EACH

METFORMIN 850 mg TABLET $0.0404/EACH

METHADONE HCL 10 mg/ml CONC $0.0494/MILLILITER

METHADONE HCL 10 mg TABLET $0.1324/EACH

METHADONE HCL 40 mg TABLET $0.3125/EACH

METHADONE HCL 5 mg TABLET $0.2171/EACH

METHAMPHETAMINE HYDROCHLORIDE 5 mg TABLET $0.0000

METHENAMINE HIPPURATE 1 g TABLET $1.8800/EACH

METHIMAZOLE 10 mg TABLET $0.1320/EACH

METHIMAZOLE 5 mg TABLET $0.1260/EACH

METHOCARBAMOL 500 mg TABLET $0.0717/EACH

METHOCARBAMOL 750 mg TABLET $0.0996/EACH

METHOTREXATE SODIUM/PF 25 mg/ml VIAL $1.4160/MILLILITER

METHOTREXATE SODIUM 25 mg/ml VIAL $1.8840/MILLILITER

METHOTREXATE 2.5 mg TABLET $1.1375/EACH

METHSCOPOLAMINE BROMIDE 2.5 MG TABLET $0.3595/EACH

METHSCOPOLAMINE BROMIDE 5 mg TABLET $2.1360/EACH

METHYLDOPA 250 mg TABLET $0.1300/EACH

METHYLDOPA 500 mg TABLET $0.2880/EACH

METHYLERGONOVINE MALEATE 0.2 MG TABLET $22.5240/EACH

METHYLPHENIDATE HCL 10 MG CAPSULE $2.6028/EACH

METHYLPHENIDATE HCL 10 MG TABLET $4.9100/EACH

METHYLPHENIDATE HCL 10 mg TABLET $0.5988/EACH

METHYLPHENIDATE HCL 18 MG TABLET $6.1422/EACH

METHYLPHENIDATE HCL 20 MG CAPSULE $3.2625/EACH

METHYLPHENIDATE HCL 20 MG CAPSULE $0.0000

METHYLPHENIDATE HCL 20 mg TABLET $0.0000

METHYLPHENIDATE HCL 20 mg TABLET $0.7013/EACH

METHYLPHENIDATE HCL 27 mg TABLET $6.8740/EACH

METHYLPHENIDATE HCL 30 MG CAPSULE $3.1950/EACH

METHYLPHENIDATE HCL 30 MG CAPSULE $4.9080/EACH

METHYLPHENIDATE HCL 36 MG TABLET $7.0848/EACH

METHYLPHENIDATE HCL 40 MG CAPSULE $0.0000

METHYLPHENIDATE HCL 40 MG CAPSULE $3.5160/EACH

METHYLPHENIDATE HCL 5 mg TABLET $0.5040/EACH

METHYLPHENIDATE HCL 50 MG CAPSULE $5.6478/EACH

METHYLPHENIDATE HCL 54 MG TABLET $7.7040/EACH

METHYLPHENIDATE HCL 60 MG CAPSULE $4.3200/EACH

METHYLPREDNISOLONE DOSEPAK 4 mg TABLET $0.5133/EACH Decrease

METHYLPREDNISOLONE 4 mg TABLET $0.6282/EACH

METIPRANOLOL 0.3 % DROPS $3.7800/MILLILITER

METOCLOPRAMIDE HCL 10 mg TABLET $0.0240/EACH

Page 16 of 30

Page 17: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

METOCLOPRAMIDE HCL 5 mg/5 ml SOLN $0.0150/MILLILITER

METOCLOPRAMIDE HCL 5 mg TABLET $0.0274/EACH

METOLAZONE 10 mg TABLET $2.1966/EACH

METOLAZONE 2.5 mg TABLET $1.0285/EACH

METOLAZONE 5 mg TABLET $1.3578/EACH

METOPROLOL SUCCINATE 25 mg TABLET $0.2100/EACH

METOPROLOL SUCCINATE 100 mg TABLET $0.3524/EACH

METOPROLOL SUCCINATE 200 mg TABLET $0.9840/EACH

METOPROLOL SUCCINATE 50 mg TABLET $0.2363/EACH

METOPROLOL TARTRATE 100 mg TABLET $0.0510/EACH

METOPROLOL TARTRATE 25 mg TABLET $0.0168/EACH

METOPROLOL TARTRATE 50 mg TABLET $0.0240/EACH

METOPROLOL/HYDROCHLOROTHIAZIDE 50 MG-25MG TABLET $0.9600/EACH

METRONIDAZOLE 0.75% GEL $0.0000 Delete

METRONIDAZOLE 0.0075 CRM $1.8014/GRAM

METRONIDAZOLE 0.0075 GEL $1.8890/GRAM

METRONIDAZOLE 0.75 % LOTION $2.7375/MILLILITER

METRONIDAZOLE 1 % GEL $2.5044/GRAM

METRONIDAZOLE 1 % GEL $3.4324/GRAM

METRONIDAZOLE 250 mg TABLET $0.2502/EACH

METRONIDAZOLE 375 mg CAPSULE $3.1080/EACH

METRONIDAZOLE 500 mg TABLET $0.3487/EACH

METRONIDAZOLE 750 mg TABLET $0.0000

MEXILETINE HCL 150 mg CAPSULE $0.0000

MEXILETINE HCL 200 mg CAPSULE $0.0000

MEXILETINE HCL 250 mg CAPSULE $0.0000

MICONAZOLE NITRATE 2 % CRM $0.1050/GRAM

MICONAZOLE NITRATE 2 % CRM $0.0000 Delete

MIDODRINE HCL 10 mg TABLET $0.9360/EACH

MIDODRINE HCL 2.5 mg TABLET $1.0511/EACH

MIDODRINE HCL 5 mg TABLET $0.4715/EACH

MILRINONE LACTATE/D5W 20MG/100ML SOLN $0.1596/MILLILITER

MILRINONE LACTATE/D5W 40MG/200ML SOLN $0.1675/MILLILITER

MILRINONE LACTATE 1 mg/ml VIAL $0.8204/MILLILITER

MINERAL OIL/PETROLATUM,HYDROPHILIC OINT $0.0263/GRAM

MINOCYCLINE HCL 100 mg CAPSULE $0.3300/EACH

MINOCYCLINE HCL 100 mg TABLET $3.2858/EACH

MINOCYCLINE HCL 135MG TABLET $3.0280/EACH

MINOCYCLINE HCL 45 MG TABLET $3.0280/EACH

MINOCYCLINE HCL 50 mg CAPSULE $0.1919/EACH

MINOCYCLINE HCL 75 mg CAPSULE $0.4200/EACH

MINOCYCLINE HCL 90 MG TABLET $5.9832/EACH

MINOXIDIL 10 mg TABLET $0.2400/EACH

MINOXIDIL 2.5 mg TABLET $0.1300/EACH

MIRTAZAPINE SOLTAB 15 mg TABLET $0.9450/EACH

MIRTAZAPINE SOLTAB 30 mg TABLET $0.8440/EACH

MIRTAZAPINE SOLTAB 45 mg TABLET $0.8280/EACH

MIRTAZAPINE 15 mg TABLET $0.0930/EACH

MIRTAZAPINE 30 mg TABLET $0.1532/EACH Decrease

MIRTAZAPINE 45 mg TABLET $0.3453/EACH

MIRTAZAPINE 7.5 mg TABLET $1.6616/EACH

MISOPROSTOL 100 mcg TABLET $0.4863/EACH

MISOPROSTOL 200 mcg TABLET $0.9260/EACH

MITOMYCIN 20 mg VIAL $410.0200/EACH

MITOMYCIN 40 MG VIAL $772.4200/EACH

MITOMYCIN 5 mg VIAL $102.5000/EACH

MITOXANTRONE HCL 2 mg/ml VIAL $23.3718/MILLILITER

MODAFINIL 100 mg TABLET $0.9402/EACH

MODAFINIL 200 mg TABLET $1.6680/EACH

MOEXIPRIL HCL/HCTZ 15-12.5 mg TABLET $0.7500/EACH

MOEXIPRIL HCL/HCTZ 15-25 mg TABLET $0.9600/EACH

MOEXIPRIL HCL/HCTZ 7.5-12.5 mg TABLET $0.6750/EACH

MOEXIPRIL HCL 15 mg TABLET $0.7186/EACH

MOEXIPRIL HCL 7.5 mg TABLET $1.0800/EACH

MOMETASONE FUROATE 0.1% CRM $0.3050/GRAM

MOMETASONE FUROATE 0.1% OINT $0.2700/GRAM

MOMETASONE FUROATE 0.1 % SOLN $0.2620/MILLILITER

MONTELUKAST SODIUM 10 mg TABLET $0.0900/EACH Decrease

MONTELUKAST SODIUM 4 MG PACKET $4.1000/EACH

MONTELUKAST SODIUM 4 mg TABLET $0.1740/EACH Decrease

MONTELUKAST SODIUM 5 mg TABLET $0.1502/EACH Decrease

MORPHINE SULFATE 10 MG/5 ML SOLN $0.0690/MILLILITER

MORPHINE SULFATE 10 MG CAPSULE $2.7480/EACH

MORPHINE SULFATE 100 MG CAPSULE $12.2100/EACH Decrease

MORPHINE SULFATE 100 mg TABLET $1.5321/EACH

MORPHINE SULFATE 15 mg TABLET $0.3099/EACH

MORPHINE SULFATE 15 mg TABLET $0.1980/EACH

MORPHINE SULFATE 20 mg/ml SOLN $0.4100/MILLILITER

MORPHINE SULFATE 20 MG CAPSULE $3.8224/EACH

MORPHINE SULFATE 200 mg TABLET $2.3020/EACH

MORPHINE SULFATE 30 MG CAPSULE $2.9813/EACH

MORPHINE SULFATE 30 mg TABLET $0.4489/EACH Decrease

MORPHINE SULFATE 30 mg TABLET $0.2315/EACH

MORPHINE SULFATE 50 MG CAPSULE $6.3900/EACH

MORPHINE SULFATE 60 MG CAPSULE $7.6349/EACH

MORPHINE SULFATE 60 mg TABLET $0.8550/EACH Decrease

MORPHINE SULFATE 80 MG CAPSULE $8.2773/EACH Decrease

MOXIFLOXACIN HCL 400 MG TABLET $5.8208/EACH Reactivate

MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET $0.0367/EACH

MULTIVITAMIN WITH MINERALS TABLET $0.0568/EACH

MULTIVITAMIN W-MINERALS/LUTEIN TABLET $0.0665/EACH

MULTIVITAMIN TABLET $0.0240/EACH

Page 17 of 30

Page 18: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

MULTIVITAMIN TABLET $0.0272/EACH

MULTIVITAMINS WITH IRON TABLET $0.0342/EACH

MUPIROCIN CALCIUM 2 % CRM $0.0000

MUPIROCIN 2% OINT $0.2416/GRAM

MYCOPHENOLATE MOFETIL 200 MG/ML SUSP, RECON $5.8712/MILLILITER Increase

MYCOPHENOLATE MOFETIL 250 mg CAPSULE $0.3016/EACH

MYCOPHENOLATE MOFETIL 500 mg TABLET $0.2780/EACH Decrease

MYCOPHENOLATE SODIUM 180 MG TABLET $2.7371/EACH

MYCOPHENOLATE SODIUM 360 MG TABLET $5.2450/EACH

NABUMETONE 500 mg TABLET $0.2214/EACH

NABUMETONE 750 mg TABLET $0.2690/EACH

NADOLOL 120 mg TABLET $0.0000

NADOLOL 160 mg TABLET $0.0000

NADOLOL 20 mg TABLET $1.6300/EACH

NADOLOL 40 mg TABLET $1.7760/EACH

NADOLOL 80 mg TABLET $2.4300/EACH

NALTREXONE HCL 50 mg TABLET $0.8181/EACH

NAPROXEN EC 375 mg TABLET $0.3240/EACH

NAPROXEN EC 500 mg TABLET $0.1913/EACH

NAPROXEN SODIUM 220 mg TABLET $0.0000 Delete

NAPROXEN SODIUM 275 mg TABLET $1.1160/EACH

NAPROXEN SODIUM 375 MG TABLET $11.5280/EACH

NAPROXEN SODIUM 500 mg TABLET $0.0000

NAPROXEN SODIUM 550 mg TABLET $1.8038/EACH

NAPROXEN 250 mg TABLET $0.0488/EACH

NAPROXEN 375 mg TABLET $0.0604/EACH

NAPROXEN 500 mg TABLET $0.0750/EACH

NARATRIPTAN HCL 1 MG TABLET $1.0200/EACH

NARATRIPTAN HCL 2.5 MG TABLET $3.1892/EACH

NATEGLINIDE 120 mg TABLET $0.6750/EACH

NATEGLINIDE 60 mg TABLET $0.6900/EACH

NEFAZODONE HCL 100 mg TABLET $0.0000

NEFAZODONE HCL 150 mg TABLET $0.0000

NEFAZODONE HCL 200 mg TABLET $0.0000

NEFAZODONE HCL 250 mg TABLET $0.0000

NEFAZODONE HCL 50 mg TABLET $0.0000

NEOMY SULF/POLYMYX B SULF/HC 3.5-10,000-10 DROPS $0.0000

NEOMYCIN SULFATE/POLYMYXIN B SULFATE/GRAMICIDIN D 1.75 mg-10k DROPS $0.0000

NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 0.1% OINT $3.7436/GRAM Decrease

NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 3.5 mg/10,000 units/0.1% per gm OINT $0.0000

NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 3.5 mg/10,000 units/0.1% per ml DROPS $3.6540/MILLILITER

NEOMYCIN/POLYMYXIN B/HC 0.01 SOLN $5.0470/MILLILITER

NEOMYCIN/POLYMYXIN B/HC 3.5 mg/10,000 units/10 mg per ml DROPS $4.3297/MILLILITER

NEVIRAPINE 200 mg TABLET $0.1950/EACH

NEVIRAPINE 400 mg TABLET $11.1600/EACH

NIACIN 1000 mg TABLET $1.5298/EACH Reactivate

NIACIN 250 mg CAPSULE $0.0000

NIACIN 500 mg TABLET $1.0050/EACH Reactivate

NIACIN 500 mg TABLET $0.0000

NIACIN 750 mg TABLET $1.5298/EACH Reactivate

NICARDIPINE HCL 20 mg CAPSULE $0.0000

NICARDIPINE HCL 30 mg CAPSULE $0.0000

NICOTINE 14 mg/24 hr PATCH $1.7134/EACH

NICOTINE 21 mg/24 hr PATCH $1.0613/EACH

NICOTINE 7 mg/24 hr PATCH $2.3803/EACH

NIFEDIPINE CC 30 mg TABLET $0.3208/EACH

NIFEDIPINE CC 60 mg TABLET $0.4650/EACH

NIFEDIPINE CC 90 mg TABLET $0.7600/EACH

NIFEDIPINE ER 30 mg TABLET $0.0000 Delete

NIFEDIPINE ER 60 mg TABLET $0.0000 Delete

NIFEDIPINE ER 90 mg TABLET $0.4800/EACH

NIFEDIPINE 10 mg CAPSULE $0.7875/EACH

NIFEDIPINE 20 mg CAPSULE $0.0000

NIMODIPINE 30 mg CAPSULE $7.9750/EACH

NISOLDIPINE 17 mg TABLET $5.1920/EACH

NISOLDIPINE 25.5 mg TABLET $5.8925/EACH

NISOLDIPINE 34 mg TABLET $5.7310/EACH

NISOLDIPINE 8.5mg TABLET $3.5860/EACH

NITROFURANTOIN MACROCRYSTALS 100 mg CAPSULE $0.9812/EACH

NITROFURANTOIN MACROCRYSTALS 50 mg CAPSULE $0.6305/EACH

NITROFURANTOIN 100 mg CAPSULE $0.8276/EACH Decrease

NITROFURANTOIN 25 MG/5 ML SUSP $1.8282/MILLILITER

NITROGLYCERIN 0.2 mg/HR PATCH $0.5825/EACH

NITROGLYCERIN 0.3 mg TABLET $0.0000

NITROGLYCERIN 0.4 mg/HR PATCH $0.5640/EACH

NITROGLYCERIN 0.4 mg TABLET $0.0000

NITROGLYCERIN 0.6 mg/HR PATCH $1.0300/EACH

NITROGLYCERIN 0.6 mg TABLET $0.0000

NITROGLYCERIN 2.5 mg CAPSULE $0.0000

NITROGLYCERIN 6.5 mg CAPSULE $0.0000

NITROGLYCERIN 9 mg CAPSULE $0.0000

NIZATIDINE 150 mg/10 ml SOLN $0.5520/MILLILITER

NIZATIDINE 150 mg CAPSULE $0.3480/EACH

NIZATIDINE 300 mg CAPSULE $0.9450/EACH

NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE)1.5-0.03 mg TABLET $0.3056/EACH

NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE) 1-0.02mg TABLET $0.3056/EACH

NORETH-ETHINYL ESTRADIOL/IRON 0.8-25(24) TABLET $2.6175/EACH

NORETHINDRONE (ERRIN, CAMILA, JOLIVETTE, ORTHO MICRONOR) 0.35 mg TABLET $0.3834/EACH

NORETHINDRONE ACETATE/ETHINYL ESTRADIOL BIPHASIC (ORTHO-NOVUM 10/11, NECON 10/11)0.5 mg/35 mcg; 1 mg/35 mcg TABLET $0.0000

NORETHINDRONE ACETATE 5 mg TABLET $1.0957/EACH

NORETHINDRONE AC-ETH ESTRADIOL 0.5MG-2.5 TABLET $2.5105/EACH

NORETHINDRONE AC-ETH ESTRADIOL 1MG-5MCG TABLET $1.7160/EACH

Page 18 of 30

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NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

NORETHINDRONE A-E ESTRADIOL (JUNEL, MICROGESTIN, LOESTRIN) 1.5-0.030 mg TABLET $0.6000/EACH

NORETHINDRONE A-E ESTRADIOL (JUNEL, MICROGESTIN, LOESTRIN) 1-0.02mg TABLET $0.4952/EACH

NORETHINDRONE A-E ESTRADIOL/FERROUS FUMARATE (ESTROSTEP FE, TRI-LEGEST FE, TILIA FE)5-7-9-7 TABLET $0.9983/EACH

NORETHINDRONE/ETHINYL ESTRADIOL (BALZIVA, OVCON-35, ZENCHENT) 0.4 mg/35 mcg TABLET $0.8625/EACH

NORETHINDRONE/ETHINYL ESTRADIOL (BREVICON, MODICON, NECON 0.5/35) 0.5 mg/35 mcg TABLET $0.5160/EACH

NORETHINDRONE/ETHINYL ESTRADIOL (NECON 1/35, NORINYL 1+35, ORTHO-NOVUM 1/35)1 mg/35 mcg TABLET $0.3156/EACH

NORETHINDRONE/ETHINYL ESTRADIOL (NECON 7/7/7, NORTREL 7/7/7, ORTHO-NOVUM 7/7/7).5-35/0.75-35/1-35 mg-mcg TABLET $0.5348/EACH

NORETHINDRONE/MESTRANOL (NECON 1/50, NORINYL 1+50, ORTHO-NOVUM 1/501 mg/50 mcg TABLET $0.0000

NORETHINDRONE-E.ESTRADIOL-IRON 1 mg-20(24) TABLET $1.1760/EACH

NORETHINDRONE-E.ESTRADIOL-IRON 1MG-20(24) TABLET $4.0545/EACH

NORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE 0.4-35(21) TABLET $1.3320/EACH

NORETHINDRONE-ETHINYL ESTRADIOL 7-9-5 TABLET $0.6480/EACH

NORGESTIMATE-ETHINYL ESTRADIOL (ORTHO-CYCLEN, SPRINTEC, MONONESSA)0.25 mg/35 mcg TABLET $0.2664/EACH

NORGESTIMATE-ETHINYL ESTRADIOL (TRI-SPRINTEC, ORTHO TRI-CYCLEN, TRINESSA)7-7-7 TABLET $0.2690/EACH

NORGESTIMATE-ETHINYL ESTRADIOL 7 days X 3 LO TABLET $0.3068/EACH

NORGESTREL/ETHINYL ESTRADIOL (LO/OVRAL, LOW-OGESTREL) 0.3 mg/30 mcg TABLET $0.4682/EACH

NORGESTREL/ETHINYL ESTRADIOL (OGESTREL) 0.5 mg/50 mcg TABLET $0.0000

NORTRIPTYLINE HCL 10 mg/5 ml SOLN $0.3556/MILLILITER

NORTRIPTYLINE HCL 10 mg CAPSULE $0.1205/EACH

NORTRIPTYLINE HCL 25 mg CAPSULE $0.1321/EACH Decrease

NORTRIPTYLINE HCL 50 mg CAPSULE $0.1619/EACH

NORTRIPTYLINE HCL 75 mg CAPSULE $0.2804/EACH

NYSTATIN/TRIAMCINOLONE 100,000 units/gm; 0.1% CRM $0.0000

NYSTATIN/TRIAMCINOLONE 100,000 units/gm; 0.1% OINT $3.7855/GRAM

NYSTATIN 100,000 units/gm CRM $0.3888/GRAM

NYSTATIN 100,000 units/gm OINT $0.4584/GRAM

NYSTATIN 100,000 units/gm PWDR $0.0000

NYSTATIN 100,000 units/ml SUSP $0.1200/MILLILITER

NYSTATIN 500,000 units TABLET $0.5508/EACH

OCTREOTIDE ACETATE 100 mcg/ml VIAL $4.9440/MILLILITER

OCTREOTIDE ACETATE 1000 mcg/ml VIAL $30.8000/MILLILITER

OCTREOTIDE ACETATE 200 mcg/ml VIAL $8.0600/MILLILITER

OCTREOTIDE ACETATE 500 mcg/ml VIAL $0.0000

OFLOXACIN 0.003 DROPS $10.6345/MILLILITER

OFLOXACIN 0.3% DROPS $3.8832/MILLILITER

OFLOXACIN 200 mg TABLET $4.0186/EACH

OFLOXACIN 300 mg TABLET $0.0000

OFLOXACIN 400 mg TABLET $5.2532/EACH

OLANZAPINE/FLUOXETINE HCL 3 mg-25 mg CAPSULE $8.8100/EACH

OLANZAPINE/FLUOXETINE HCL 6MG-25MG CAPSULE $8.2940/EACH

OLANZAPINE/FLUOXETINE HCL 6MG-50MG CAPSULE $9.0516/EACH

OLANZAPINE 10 mg TABLET $0.7440/EACH

OLANZAPINE 10 mg TABLET $0.2085/EACH Decrease

OLANZAPINE 10 MG VIAL $36.0938/EACH

OLANZAPINE 15 mg TABLET $1.9800/EACH

OLANZAPINE 15 mg TABLET $0.3454/EACH

OLANZAPINE 2.5 mg TABLET $0.1680/EACH

OLANZAPINE 20 mg TABLET $2.6760/EACH

OLANZAPINE 20 mg TABLET $0.3743/EACH Decrease

OLANZAPINE 5 mg TABLET $0.9360/EACH

OLANZAPINE 5 mg TABLET $0.1325/EACH Decrease

OLANZAPINE 7.5 mg TABLET $0.1680/EACH

OLMESARTAN/HYDROCHLOROTHIAZIDE 20-12.5 MG TAB $0.1401/TABLET Add

OLOPATADINE HCL 0.1 % DROPS $5.8938/MILLILITER

OLOPATADINE HCL 0.6 % AERO (GM) $0.0000

OMEGA-3 ACID ETHYL ESTERS 1 G CAPSULE $0.5008/EACH Decrease

OMEPRAZOLE MAGNESIUM 20 mg TABLET $0.0000

OMEPRAZOLE/SODIUM BICARBONATE 20MG-1.1G CAPSULE $7.9736/EACH

OMEPRAZOLE/SODIUM BICARBONATE 40-1680MG PACKET $68.1340/EACH

OMEPRAZOLE/SODIUM BICARBONATE 40MG-1.1G CAPSULE $11.3259/EACH Decrease

OMEPRAZOLE 10 mg CAPSULE $0.2568/EACH

OMEPRAZOLE 20 mg CAPSULE $0.0528/EACH

OMEPRAZOLE 20 mg TABLET $0.6836/EACH

OMEPRAZOLE 40 mg CAPSULE $0.1107/EACH

ONDANSETRON HCL 4 mg/5 ml SOLN $0.2100/MILLILITER Decrease

ONDANSETRON HCL/D5W/PF 32 mg/50 ml SOLN $0.5167/MILLILITER

ONDANSETRON HCL 2 mg/ml; MDV VIAL $0.0000

ONDANSETRON HCL 4 mg/2 ml; SDV VIAL $0.2280/MILLILITER Reactivate

ONDANSETRON HCL 4 mg TABLET $0.1360/EACH

ONDANSETRON HCL 8 mg TABLET $0.1575/EACH

ONDANSETRON 4 mg TABLET $0.3641/EACH

ONDANSETRON 8 mg TABLET $0.0384/EACH

ORPHENADRINE CITRATE 100 mg TABLET $0.6150/EACH

ORPHENADRINE WITH ASPIRIN AND CAFFEINE 25 mg; 385 mg; 30 mg TABLET $0.0000

ORPHENADRINE WITH ASPIRIN AND CAFFEINE 50 mg; 770 mg; 60 mg TABLET $0.0000

OSELTAMIVIR PHOSPHATE 30 MG CAPSULE $8.3272/EACH

OSELTAMIVIR PHOSPHATE 45 MG CAPSULE $8.3030/EACH

OSELTAMIVIR PHOSPHATE 75 MG CAPSULE $9.0506/EACH

OXALIPLATIN 100 mg/20 ml VIAL $8.7318/MILLILITER

OXALIPLATIN 50 mg/10 ml VIAL $8.7326/MILLILITER

OXANDROLONE 10 mg TABLET $13.3980/EACH

OXANDROLONE 2.5 mg TABLET $2.7960/EACH

OXAPROZIN 600 mg TABLET $1.9308/EACH

OXAZEPAM 10 mg CAPSULE $0.7251/EACH

OXAZEPAM 15 mg CAPSULE $0.4406/EACH

OXAZEPAM 30 mg CAPSULE $1.7640/EACH

OXCARBAZEPINE 150 mg TABLET $0.1146/EACH

OXCARBAZEPINE 300 mg/5 ml SUSP $0.4429/MILLILITER

OXCARBAZEPINE 300 mg TABLET $0.1818/EACH

OXCARBAZEPINE 600 mg TABLET $0.3511/EACH

OXICONAZOLE NITRATE 1 % CRM $15.1560/GRAM

OXYBUTYNIN CHLORIDE 10 mg TABLET $0.6440/EACH Decrease

Page 19 of 30

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NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

OXYBUTYNIN CHLORIDE 15 mg TABLET $0.5294/EACH

OXYBUTYNIN CHLORIDE 5 mg TABLET $0.7881/EACH

OXYBUTYNIN 5 mg/5 ml SYRUP $0.0198/MILLILITER

OXYBUTYNIN 5 mg TABLET $0.3728/EACH

OXYCODONE / APAP 10 mg; 650 mg TABLET $0.0000

OXYCODONE / APAP 10/325 mg TABLET $0.4924/EACH

OXYCODONE / APAP 5 mg; 325 mg TABLET $0.1359/EACH

OXYCODONE / APAP 5 mg; 500 mg CAPSULE $0.0000

OXYCODONE / APAP 7.5 mg; 325 mg TABLET $0.4356/EACH

OXYCODONE / APAP 7.5 mg; 500 mg TABLET $0.0000

OXYCODONE HCL 15 mg TABLET $0.2000/EACH

OXYCODONE HCL 20 mg/ml CONC $5.1042/MILLILITER

OXYCODONE HCL 5 mg CAPSULE $0.0000

OXYCODONE HCL/ASPIRIN 4.8355-325 TABLET $0.3341/EACH

OXYCODONE HCL 10 MG TABLET $0.1650/EACH

OXYCODONE HCL 10 mg TABLET $0.0000

OXYCODONE HCL 20 MG TABLET $0.3120/EACH

OXYCODONE HCL 20 mg TABLET $0.0000

OXYCODONE HCL 30 mg TABLET $0.3165/EACH Decrease

OXYCODONE HCL 40 mg TABLET $0.0000

OXYCODONE HCL 5 MG/5 ML SOLN $0.3563/MILLILITER

OXYCODONE HCL 5 mg TABLET $0.1016/EACH Decrease

OXYCODONE HCL 80 mg TABLET $0.0000

OXYCODONE/ASPIRIN 4.88-325 mg TABLET $0.8110/EACH

OXYMORPHONE HCL 10 mg TABLET $2.9640/EACH

OXYMORPHONE HCL 10 mg TABLET $2.1699/EACH

OXYMORPHONE HCL 20 mg TABLET $5.2560/EACH

OXYMORPHONE HCL 30 mg TABLET $7.1268/EACH

OXYMORPHONE HCL 40 mg TABLET $9.0640/EACH

OXYMORPHONE HCL 5 mg TABLET $1.9826/EACH

OXYMORPHONE HCL 5 mg TABLET $1.4160/EACH

PACLITAXEL 6 mg/ml VIAL $2.1416/MILLILITER

PALIPERIDONE 1.5 mg TABLET $15.4546/EACH

PALIPERIDONE 3 mg TABLET $14.2205/EACH Decrease

PALIPERIDONE 6 mg TABLET $14.1015/EACH Decrease

PALIPERIDONE 9 mg TABLET $22.1025/EACH

PAMIDRONATE DISODIUM 3 mg/ml VIAL $1.7399/MILLILITER

PAMIDRONATE DISODIUM 30 mg VIAL $0.0000

PAMIDRONATE DISODIUM 9 mg/ml VIAL $8.2031/MILLILITER

PAMIDRONATE DISODIUM 90 mg VIAL $0.0000

PANTOPRAZOLE SODIUM 20 mg TABLET $0.1055/EACH Decrease

PANTOPRAZOLE SODIUM 40 mg TABLET $0.0751/EACH

PARICALCITOL 1 MCG CAPSULE $3.4680/EACH

PARICALCITOL 2 MCG CAPSULE $8.6160/EACH

PARICALCITOL 4MCG CAPSULE $17.2320/EACH

PAROXETINE HCL 10 mg/5 ml SUSP $0.0000

PAROXETINE HCL 10 mg TABLET $0.0750/EACH

PAROXETINE HCL 12.5 mg TABLET $3.8300/EACH

PAROXETINE HCL 20 mg TABLET $0.0750/EACH

PAROXETINE HCL 25 mg TABLET $4.2220/EACH

PAROXETINE HCL 30 mg TABLET $0.1587/EACH

PAROXETINE HCL 37.5 mg TABLET $3.7500/EACH

PAROXETINE HCL 40 mg TABLET $0.1372/EACH

PEG 3350/SOD SULF ANHYD/SODIUM BICARBONATE/SOD CHLORIDE/KCL 236 - 22.74 g SOLN $0.0046/MILLILITER

PEMOLINE 18.75 mg TABLET $0.0000

PEMOLINE 37.5 mg TABLET $0.0000

PEMOLINE 75 mg TABLET $0.0000

PENICILLIN V POTASSIUM 125 mg/5 ml, 100 ml SOLN $0.0613/MILLILITER

PENICILLIN V POTASSIUM 250 mg/5 ml SOLN $0.0507/MILLILITER

PENICILLIN V POTASSIUM 250 mg TABLET $0.1050/EACH Decrease

PENICILLIN V POTASSIUM 500 mg TABLET $0.1639/EACH Decrease

PENTAZOCINE/NALOXONE HCL 50 mg/0.5 mg TABLET $2.2680/EACH

PENTOXIFYLLINE 400 mg TABLET $0.1800/EACH

P-EPHED HCL/BROMPHENIRAMIN 45 mg; 4 mg/5 ml SYRUP $0.0000

P-EPHED HCL/CARBINOX MAL 15-1 mg/ml DROPS $0.0000

PERINDOPRIL ERBUMINE 2 mg TABLET $0.6720/EACH

PERINDOPRIL ERBUMINE 4 mg TABLET $0.3210/EACH

PERINDOPRIL ERBUMINE 8 mg TABLET $0.7151/EACH

PERMETHRIN 5% CRM $0.8872/GRAM

PERPHENAZINE 16 mg TABLET $0.0000

PERPHENAZINE 2 mg TABLET $1.1640/EACH

PERPHENAZINE 4 mg TABLET $0.8577/EACH

PERPHENAZINE 8 mg TABLET $1.5456/EACH

PHENAZOPYRIDINE HCL 100 mg TABLET $1.1880/EACH

PHENAZOPYRIDINE HCL 200 mg TABLET $1.5925/EACH

PHENELZINE SULFATE 15 MG TABLET $0.8040/EACH

PHENOBARBITAL 100 mg TABLET $0.0000

PHENOBARBITAL 15 mg TABLET $0.0302/EACH

PHENOBARBITAL 16.2 mg TABLET $0.4488/EACH

PHENOBARBITAL 20 mg/5 ml ELIXIR $0.2100/MILLILITER

PHENOBARBITAL 30 mg TABLET $0.0000

PHENOBARBITAL 60 mg TABLET $0.0000

PHENTERMINE HCL 30 mg CAPSULE $0.0000

PHENTERMINE HCL 37.5 mg TABLET $0.0000

PHENYLEPHRINE HCL/CHLOR-MAL 12.5-4 mg/5 SYRUP $0.0194/MILLILITER

PHENYLEPHRINE HCL/COD/PROMETH 5-10-6.25 SYRUP $0.0000

PHENYLEPHRINE/CHLORPHENIRAMINE 5-4.5 mg/5 ml SUSP $0.4092/MILLILITER

PHENYLEPHRINE/HYDROCODONE/CHLORPHENIRAMINE 5-2.5-2 mg/5 ml SYRUP $0.0000

PHENYLEPHRINE/PYRIL TAN/CP 5 mg; 12.5 mg; 2 mg/5 ml SUSP $0.0000

PHENYTOIN SODIUM EXTENDED 300 MG CAPSULE $1.0140/EACH

PHENYTOIN SODIUM 100 mg CAPSULE $0.2874/EACH

PHENYTOIN SODIUM 125 mg/5 ml SUSP $0.1332/MILLILITER

Page 20 of 30

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NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

PHENYTOIN 50 MG TABLET $0.5684/EACH

PILOCARPINE HCL 5 mg TABLET $1.2100/EACH

PILOCARPINE HCL 0.5% DROPS $0.0000

PILOCARPINE HCL 1% DROPS $3.6176/MILLILITER

PILOCARPINE HCL 2% DROPS $0.0000

PILOCARPINE HCL 4% DROPS $5.2000/MILLILITER

PILOCARPINE HCL 6% DROPS $0.0000

PILOCARPINE HCL 7.5 mg TABLET $1.2566/EACH Decrease

PINDOLOL 10 mg TABLET $0.0000

PINDOLOL 5 mg TABLET $0.0000

PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg-2 mg TABLET $11.5170/EACH

PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg-4 mg TABLET $11.5170/EACH

PIOGLITAZONE HCL/METFORMIN HCL 15MG-500MG TABLET $0.4500/EACH

PIOGLITAZONE HCL/METFORMIN HCL 15MG-850MG TABLET $0.4500/EACH

PIOGLITAZONE HCL 15 MG TABLET $0.0888/EACH

PIOGLITAZONE HCL 30 MG TABLET $0.0600/EACH

PIOGLITAZONE HCL 45 MG TABLET $0.0840/EACH

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 2.25 gm VIAL $5.7750/EACH

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 3.375 gm VIAL $0.0000

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 4.5 gm VIAL $13.9563/EACH

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 40.5 gm VIAL $128.9178/EACH

PIROXICAM 10 mg CAPSULE $1.1489/EACH

PIROXICAM 20 mg CAPSULE $1.1790/EACH Decrease

PNV #116/IRON FUMARATE/FA/DHA 28-800-200 KIT $0.2000/EACH

PNV #78/IRON ASP GLY/FA#1/DHA 18-1-300MG CAPSULE $0.2000/EACH

PNV #86/IRON POLY/FA/DHA/EPA 32-1-120MG KIT $0.2000/EACH

PNV 112/IRON/FA/OM-3S/DHA/EPA 3.33-.33MG TABLET $0.2000/EACH

PNV CMB#82/IRON PS CMPLX/FOLIC ACID/OMEGA 3/DHA/EPA/FISH OIL 13.5-0.5mg TABLET $0.2000/EACH

PNV CMB#95/FERROUS FUMARATE/FA 28mg-0.8mg TABLET $0.2000/EACH

PNV COMB.12/IRON,CARBONYL/FA CMB #1/DOCUSATE SODIUM/DHA 90-0.4-250 KIT $0.2000/EACH

PNV COMB.NO26/IRON ASP GLY/FA/DOCUSATE SODIUM/FAT COMBO NO.7 30-1-50mg TAB & CAP $0.2000/EACH

PNV COMB.NO5/FE ASP GLY/DOCUSATE/FOLIC ACID/FAT COMBO NO.4 30-50-1mg TAB & CAP $0.2000/EACH

PNV COMB.NO58/IRON BISGLY/FA 10MG-0.4MG CAPSULE $0.2000/EACH

PNV NO.100/IRON/FA/DHA/EPA 27 MG-1 MG CAPSULE $0.2000/EACH

PNV NO.106/IRON/FOLATE #6/DHA 27.5MG-1MG CAPSULE $0.2000/EACH

PNV NO.111/IRON/FOLATE/DHA 38-1-225MG CAP $0.2000/CAPSULE Add

PNV NO.115/IRON FUMARATE/FA 29 MG-1 MG TABLET $0.2000/EACH

PNV NO.118/IRON FUMARATE/FA 29 MG-1 MG TABLET $0.2000/EACH

PNV NO.121/IRON/FOLIC ACID 28MG-0.8MG TAB $0.2000/TABLET Add

PNV NO.122/IRON/FOLIC ACID 27MG-0.8MG TABLET $0.2000/EACH

PNV NO.20/IRON FUMARATE/FA/DOCUSATE NA/FISH OIL CONC/DHA/EPA 27-1-500mg CAPSULE $0.2000/EACH

PNV NO.35/IRON FUMARATE/FOLATE COMB. #6/DHA 29-1-300mg CAPSULE $0.2000/EACH

PNV NO.63/IRON,CARBONYL/FA/DHA 27-800-200 CAPSULE $0.2000/EACH

PNV NO.66/IRON,CARBONYL/FA/DHA 20-1-320MG CAPSULE $0.2000/EACH

PNV NO.74/IRON FUM/FA/COQ10 18-1-125MG KIT $0.2000/EACH

PNV NO.74/IRON FUM/FA/DHA 27-1-300MG KIT $0.2000/EACH

PNV NO.80/IRON/MFOLATE/DSS/DHA 38-1-25 MG CAPSULE $0.2000/EACH

PNV NO.81/IRON CBN&GLUC/FA/DSS 27-1-50 MG TABLET $0.2000/EACH

PNV NO.86/IRON/MFOLATE/DSS/DHA 38-1-50 MG KIT $0.2000/EACH

PNV NO.88/IRON PS,HEME/FA/DHA 28-6-1 MG KIT $0.2000/EACH

PNV NO.90/IRON FUM & PS/FA/DHA 32-1.25 MG CAPSULE $0.2000/EACH

PNV NO17/IRON,CARB/IRON BISGLY/FA/FISH OIL/DHA/OMEGA 3,6 #1 35-5-1.2mg CAPSULE $0.2000/EACH

PNV NO18/IRON,CARBONYL/FOLIC ACID/DOCUSATE NA/UBIDECAR/DHA 15-0.5-25 TABLET $0.2000/EACH

PNV WITH CA #37/IRON CARB, ASP, & GLY/FA/OMEGA-3 FATTY ACIDS 27-1-330mg CAPSULE $0.2000/EACH

PNV WITH CA NO.37/IRON CARB & ASP GLY/FA/OMEGA-3 FATTY ACIDS 27-1-330mg CAPSULE $0.2000/EACH

PNV WITH CA,NO.72/IRON,CARB/FA 29 MG-1 MG TABLET $0.2000/EACH

PNV#102/IRON/FA/DHA/LUTEIN 27-800-200 KIT $0.2000/EACH

PNV#102/IRON/FOLATE #1/DSS/DHA 90-1-200mg CAPSULE $0.2000/EACH

PNV#31/IRON,EL.&GLU/FA/DSS/DHA 35-1-50 MG KIT $0.2000/EACH

PNV#64/IRON/LMFOLATE/ALGAL/SOY 27-1.13 MG CAPSULE $0.2000/EACH

PNV#64/IRON/LMFOLATE/ALGAL/SOY 27-1.13 MG CAPSULE $0.2000/EACH

PNV#67/IRON PS/FA CMB#1/DHA 29-1-200MG CAPSULE $0.2000/EACH

PNV#71/IRON/FOLIC ACID/DHA 30-1.4-200 CAPSULE $0.2000/EACH

PNV#75/IRON FUM/FA/OM3/DHA/EPA 28-800-223 KIT $0.2000/EACH

PNV#85/IRON CARB./IRON ASP.GLYCINATE/FOLIC ACID/DHA/FISH OIL 40-10-1 mg CAPSULE $0.2000/EACH

PNV,CA,NO.35/IRON,CARBONYL & ASP GLY/FA/DSS/OMEGA-3 27-1-50mg CAPSULE $0.2000/EACH

PNV/FA/B6/CALCIUM CARB/GINGER 1.2-42 MG TABLET $0.2000/EACH

PNV/FA/B6/CALCIUM PHOS/GINGER 1.2-40-100 TABLET $0.2000/EACH

PNV/FA/B6/CALCIUM PHOS/GINGER 1.2-42 MG TABLET $0.2000/EACH

PNV/FE BISGLY/OMEGA-3/FA 29-250-1MG KIT $0.2000/EACH

PNV/FE SULF/FA/MIN AA CHEL 14-0.25MG TABLET $0.2000/EACH

PNV/FERROUS FUMARATE/DOSS/FA 65 MG-1 MG TABLET $0.2000/EACH

PNV/FERROUS SULFATE/FOLIC ACID 27-<0.5MG TABLET $0.2000/EACH

PNV/FERROUS SULFATE/FOLIC ACID 27MG-0.8MG TABLET $0.2000/EACH

PNV/FERROUS SULFATE/FOLIC ACID 40-1MG/15 LIQ $0.2000/MILLILITER

PNV/IRON,CARBONYL/DOCUSATE/FA 100-1MG TABLET $0.2000/EACH

PNV/IRON,CARBONYL/DOCUSATE/FA 95-50-1MG CAPSULE $0.2000/EACH

PNV/IRON,CARBONYL/FOLIC ACID 65 MG-1 MG TABLET $0.2000/EACH

PNV/IRON/DHA/EPA/OMEGA-3/FA 60 MG-1 MG KIT $0.2000/EACH

PNV/IRON/DOCUSATE/FA/LMEFOLATE 90-50-1MG TABLET $0.2000/EACH

PNV/IRON/FOLIC ACID 40-1MG TABLET $0.2000/EACH

PNV100/IRON EDTA&PS/FA/OMEGA3 27-1-374MG KIT $0.2000/EACH

PNV103/FA/OMEGA3/DHA/FISH OIL 0.4-32.5mg TABLET $0.2000/EACH

PNV103/FE/FA/DHA/EPA/OTHER OM3 27 MG-1 MG KIT $0.2000/EACH

PNV105/IRON/FA/OMEGA 3/DHA/EPA 27-1-380MG KIT $0.2000/EACH

PNV106/IRON/FA/OM3/DHA/EPA 25-1-400MG KIT $0.2000/EACH

PNV106/IRON/FA/OM3/DHA/EPA 25-1-430MG KIT $0.2000/EACH

PNV107/IRON/FA/OM3/DHA/EPA 25-1-400MG KIT $0.2000/EACH

PNV107/IRON/FA/OM3/DHA/EPA 25-1-430MG KIT $0.2000/EACH

PNV110/IRON/FA/OMEGA 3/DHA/EPA 26-1-278 mg KIT $0.2000/EACH

PNV113/FE/L-MEF/OM3/DHA/EPA/FS 4.5-1-150 COMBINATION PACKAGE $0.2000/EACH

PNV113/IRON/FA/OMEGA-3/DHA/EPA 24-1-272MG KIT $0.2000/EACH

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NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

PNV115/IRON FUMARATE/FA/DSS 29-1-25 MG TABLET $0.2000/EACH

PNV117/IRON/FA/OM3/DHA/EPA 25 MG-1 MG KIT $0.2000/EACH

PNV119/IRON FUMARATE/FA/DSS 29-1-25 MG TABLET $0.2000/EACH

PNV120/LEVOMEFOLATE/OMEGA3/DHA 267MCG-321 TABLET $0.2000/EACH

PNV123/IRON CAR/FA/OM3/DHA/EPA 28-800-235 CAPSULE $0.2000/EACH

PNV133/FERROUS FUMARATE/FA 28MG-0.8MG TABLET $0.2000/EACH

PNV135/IRON/L-MEFOL/OMEGA3/DHA 18-800-290 COMBINATION PACKAGE $0.2000/EACH

PNV14/FE FUM/FA#1/DHA/DOSS CA 27-1-50 MG CAPSULE $0.2000/EACH

PNV2/IRON B-G SUC-P/FA/OMEGA-3 29-1-300MG KIT $0.2000/EACH

PNV2/IRON B-G SUC-P/FA/OMEGA-3 29-1-300MG KIT $0.2000/EACH

PNV34/IRON,CARB&FUM/FA/DSS/DHA 27-1-50 MG CAPSULE $0.2000/EACH

PNV34/IRON,CARBONYL/FA/DSS/DHA 29-1-50 MG CAPSULE $0.2000/EACH

PNV50/IRON FUM&BISGLYCINATE/FA 25 MG-1 MG TABLET $0.2000/EACH

PNV51/IRON FUM/FA/OM-3/DHA/EPA 27-800-228 CAPSULE $0.2000/EACH

PNV53/IRON FUM/FA/DOCUSATE/DHA 29-1.25-55 CAPSULE $0.2000/EACH

PNV59/IRON,CARB&FUM/FA/DSS/DHA 27-1-50MG CAPSULE $0.2000/EACH

PNV59/IRON,CARBONYL/FA/DSS/DHA 29-1-50 MG CAPSULE $0.2000/EACH

PNV62/FA/OM3/DHA/EPA/FISH OIL 400-35-25 TABLET $0.2000/EACH

PNV72/IRON,CARB&GLU/FA/DSS/DHA 90-1-300MG KIT $0.2000/EACH

PNV73/IRON,CARB&GLU/FA/DSS/DHA 35-1-50 MG KIT $0.2000/EACH

PNV76/IRON,CARB&GLU/FA/DSS/DHA 27-1-50 MG KIT $0.2000/EACH

PODOFILOX 0.5 % SOLN $14.1900/MILLILITER

POLYETHYLENE GLYCOL 17 gm PACKET $1.1640/EACH

POLYETHYLENE GLYCOL NA PWDR $0.0290/GRAM

POTASSIUM BICARB/CITRATE 25 mEq TABLET $0.2160/EACH

POTASSIUM CHLORIDE 40 mEq/15 ml LIQ $0.9157/MILLILITER

POTASSIUM CHLORIDE/BICARB 25 mEq TABLET $0.0000

POTASSIUM CHLORIDE 10 mEq CAPSULE $0.2850/EACH Decrease

POTASSIUM CHLORIDE 10 mEq TABLET $0.2400/EACH

POTASSIUM CHLORIDE 10 mEq TABLET $0.2904/EACH

POTASSIUM CHLORIDE 20 mEq/15 ml LIQ $0.5517/MILLILITER

POTASSIUM CHLORIDE 20 mEq PACKET $1.0605/EACH

POTASSIUM CHLORIDE 20 MEQ TABLET $0.3687/EACH

POTASSIUM CHLORIDE 20 mEq TABLET $0.2233/EACH

POTASSIUM CHLORIDE 8 MEQ CAPSULE $0.3360/EACH

POTASSIUM CHLORIDE 8 mEq TABLET $0.4920/EACH

POTASSIUM CITRATE 10 MEQ TABLET $1.1880/EACH

POTASSIUM CITRATE 15 MEQ TABLET $1.9146/EACH

POVIDONE IODINE 0.1 SOLN $0.0177/MILLILITER

POVIDONE IODINE 0.1 OINT $0.0000

PRAMIPEXOLE DI-HCL 0.375 mg TABLET $11.6610/EACH

PRAMIPEXOLE DI-HCL 0.75 mg TABLET $9.8670/EACH

PRAMIPEXOLE DI-HCL 0.75 mg TABLET $0.1217/EACH

PRAMIPEXOLE DI-HCL 1.5 mg TABLET $12.2430/EACH

PRAMIPEXOLE DI-HCL 3 mg TABLET $10.8832/EACH

PRAMIPEXOLE DIHYDROCHLORIDE 0.125 mg TABLET $0.0450/EACH

PRAMIPEXOLE DIHYDROCHLORIDE 0.25 mg TABLET $0.0515/EACH

PRAMIPEXOLE DIHYDROCHLORIDE 0.5 mg TABLET $0.0515/EACH

PRAMIPEXOLE DIHYDROCHLORIDE 1 mg TABLET $0.0683/EACH

PRAMIPEXOLE DIHYDROCHLORIDE 1.5 mg TABLET $0.1200/EACH

PRAVASTATIN SODIUM 10 mg TABLET $0.1762/EACH

PRAVASTATIN SODIUM 20 mg TABLET $0.1583/EACH

PRAVASTATIN SODIUM 40 mg TABLET $0.2050/EACH Decrease

PRAVASTATIN SODIUM 80 mg TABLET $0.3294/EACH

PRAZOSIN HCL 1 mg CAPSULE $0.3921/EACH

PRAZOSIN HCL 2 mg CAPSULE $0.4693/EACH

PRAZOSIN HCL 5 mg CAPSULE $1.1550/EACH

PREDNISOLONE ACETATE 1% DROPS $5.3046/MILLILITER

PREDNISOLONE SODIUM PHOSPHATE 15 mg/5 ml SOLN $0.0902/MILLILITER

PREDNISOLONE 15 mg/5 ml SOLN $0.0340/MILLILITER

PREDNISONE 1 mg TABLET $0.1596/EACH

PREDNISONE 10 mg TABLET $0.6880/EACH

PREDNISONE 10 mg TABLET $0.1249/EACH

PREDNISONE 2.5 mg TABLET $0.1368/EACH

PREDNISONE 20 mg TABLET $0.1211/EACH

PREDNISONE 5 mg TABLET $0.1440/EACH

PRENATAL #103/IRON FUMARATE/FA 27 MG-1 MG TABLET $0.2000/EACH

PRENATAL #108/IRON,CARBONYL/FA 30 MG-1 MG TABLET $0.2000/EACH

PRENATAL #48/IRON CB&GLU/FA/B6 20-1-25 MG TABLET $0.2000/EACH

PRENATAL #57/IRON/FA/DSS/DHA 29-1.25-55 CAPSULE $0.2000/EACH

PRENATAL #58/IRON/FA/DSS/DHA 29-1.25-55 CAPSULE $0.2000/EACH

PRENATAL #79/IRON ASP GLY/FA#1 20 MG-1 MG TABLET $0.2000/EACH

PRENATAL #92/IRON/FA #8/PS-DHA 1.5-8.73MG CAPSULE $0.2000/EACH

PRENATAL CMB#95/IRON/FA/DHA 28-800-200 KIT $0.2000/EACH

PRENATAL COMB NO.42/FOLIC ACID 1.4 MG TABLET $0.2000/EACH

PRENATAL NO.123/IRON/FOLIC AC 50-1.25 MG TABLET $0.2000/EACH

PRENATAL NO.13/IRON PS/FA CB#1 29 MG-1 MG TABLET $0.2000/EACH

PRENATAL NO.25/IRON/FA #6/DHA 30-1-200MG CAPSULE $0.2000/EACH

PRENATAL NO.29/IRON CARB & ASP.GLYCINATE/FA/DHA/FISH OIL 40-10-1 mg CAPSULE $0.2000/EACH

PRENATAL NO.30/IRON CARBONLY & ASPARTO GLYCINATE/FA/OMEGA3 30-10-1 mg CAPSULE $0.2000/EACH

PRENATAL NO.40/IRON/FA/DHA 27-0.8-250 CAPSULE $0.2000/EACH

PRENATAL NO.52/IRON/FA/DHA 28-1-200MG CAPSULE $0.2000/EACH

PRENATAL NO.56/IRON CARBONYL & ASPARTO GLYCINATE/FA/DHA 35-5-1 mg CAPSULE $0.2000/EACH

PRENATAL NO.75/IRON/FOLATE #1 18 MG-1 MG TABLET $0.2000/EACH

PRENATAL NO.77/IRON ASP GLY/FA 20 MG-1 MG TABLET $0.2000/EACH

PRENATAL NO.82/IRON/FOLATE #2 27 MG-1 MG TABLET $0.2000/EACH

PRENATAL NO.93/IRON/FA #9/DHA 31-1-200 mg CAPSULE $0.2000/EACH

PRENATAL VIT #105/IRON/FA/DHA 30-1.4-300 COMBINATION PACKAGE $0.2000/EACH

PRENATAL VIT #108/IRON/FA 30-0.8MG TABLET $0.2000/EACH

PRENATAL VIT #113/IRON/FOLATE 4.5 MG-1MG TABLET $0.2000/EACH

PRENATAL VIT #116/IRON/FA/DHA 28-800-200 CAPSULE $0.2000/EACH

PRENATAL VIT #16/IRON FUM & PS COMPLEX/FOLIC ACID/OMEGA-3 35-1-200mg CAPSULE $0.2000/EACH

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Page 23: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

PRENATAL VIT #49/IRON FUM/FA 6.75-0.2MG TABLET $0.2000/EACH

PRENATAL VIT #60/IRON FUM/FA 27 MG-1 MG TABLET $0.2000/EACH

PRENATAL VIT #68/IRON/FA#6/DHA 28-1-400MG CAPSULE $0.2000/EACH

PRENATAL VIT #69/IRON/FA#6/DHA 27-1-400MG CAPSULE $0.2000/EACH

PRENATAL VIT #83/IRON/FA#6/DHA 29-1-150MG CAPSULE $0.2000/EACH

PRENATAL VIT #91/FE FUM/FA/DHA 28-975-200 KIT $0.2000/EACH

PRENATAL VIT COMB NO.4/IRON CARBONYL-IRON GLUCONATE/FA/DOSS 27-1-50mg TABLET $0.2000/EACH

PRENATAL VIT NO.109/IRON/FA 40-1MG TABLET $0.2000/EACH

PRENATAL VIT NO.112/FOLIC ACID 1 MG TABLET $0.2000/EACH

PRENATAL VIT NO.114/FA/GINGER 1MG-500MG TABLET $0.2000/EACH

PRENATAL VIT NO.124/IRON/FA 27MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT NO.126/IRON/FA 28MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT NO.128/IRON/FA 28MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT NO.129/IRON/FA 27MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT NO.130/IRON/FA 27MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT NO.131/IRON/FA 28MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT NO.44/IRON/FA/DHA 29-1-350MG CAPSULE $0.2000/EACH

PRENATAL VIT NO.87/IRON/FA/DHA 18-1-350MG CAPSULE $0.2000/EACH

PRENATAL VIT W/O CALC NO.10/IRON FUM&POLYSAC COMP/FA/OMEGA-3 30-1-310.1 CAPSULE $0.2000/EACH

PRENATAL VIT W-CA,FE,FA(<1 MG) CAPSULE $0.2000/EACH

PRENATAL VIT W-CA,FE,FA(<1 MG) KIT $0.2000/EACH

PRENATAL VIT WITH CA #75/IRON FUM/FOLIC ACID/OMEGA-3/DHA/EPA 28-800-440 KIT $0.2000/EACH

PRENATAL VIT WITH CA NO.64/IRON CARB&GLUC/FOLIC ACID/DSS/DHA 90-1-300mg KIT $0.2000/EACH

PRENATAL VIT WITH CA NO.68/IRON FUMARATE/FOLIC ACID #1/DHA 28-1-300mg CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM #32/IRON/FA/FISH OIL 27-1-880mg CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM #34/IRON/FOLIC ACID/DHA 28-1-250mg KIT $0.2000/EACH

PRENATAL VIT WITH CALCIUM #34/IRON/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH

PRENATAL VIT WITH CALCIUM #60/IRON/FOLIC ACID/DHA 27-1-250mg KIT $0.2000/EACH

PRENATAL VIT WITH CALCIUM #69/IRON,CARBON/FOLIC ACID/DSS/DHA 27-1-50mg CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM #69/IRON,CARBON/FOLIC ACID/DSS/DHA 28-1-50 mg CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM CMB 11/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg TABLET $0.2000/EACH

PRENATAL VIT WITH CALCIUM COMB NO.63/IRON,CARBONYL/FA/B6 20-1-25 mg TABLET $0.2000/EACH

PRENATAL VIT WITH CALCIUM COMB NO.65/IRON POLYSACCH CMPLX/FA 60 mg-1 mg CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO. 40/IRON FUMARATE/FA CMB NO.1 27 mg-1 mg TABLET $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO.39/IRON FUM/FOLIC ACID/DSS/DHA 30-1.24-55 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO.39/IRON FUM/FOLIC ACID/DSS/DHA 30-1.2-55 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO.61/IRON FUMARATE/FOLIC ACID/DHA 28-975-200 KIT $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO.66/IRON FUM/FOLIC ACID/DSS/DHA 26-1.2-55 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO.66/IRON FUM/FOLIC ACID/DSS/DHA 27-1.25-55 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO.80/IRON FUM/FOLIC ACID/DSS/DHA 27-1.25-55 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO.80/IRON FUM/FOLIC ACID/DSS/DHA 29-1.25-55 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO42/IRON FUM/FA/L-MEFOLATE CA/DHA 27-1.13 mg CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO42/IRON FUM/FA/L-MEFOLATE CA/DHA 27-400-1 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO42/IRON FUM/FA/L-MEFOLATE CA/DHA 27mg-400 CAPSULE $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO8-IRON PS CMPLX,FA& LEVOMEFOLATE 29-400-1 TABLET $0.2000/EACH

PRENATAL VIT WITH CALCIUM NO8-IRON PS CMPLX,FA,L-MEFOLATE CA 29-1.13 mg TABLET $0.2000/EACH

PRENATAL VIT#101/IRON/FA/DHA 27-800-200 KIT $0.2000/EACH

PRENATAL VIT#118/IRON/FA#6/DHA 30-1-300MG CAPSULE $0.2000/EACH

PRENATAL VIT#42/FA CMB#6 1 mg TABLET $0.2000/EACH

PRENATAL VIT#65/IRON FUM&PS/FA 40-1.25 MG CAPSULE $0.2000/EACH

PRENATAL VIT#84/IRON/FA#1/DHA 18-1-300MG CAPSULE $0.2000/EACH

PRENATAL VIT#85/IRON/FA#1/DHA 10-1-200MG CAPSULE $0.2000/EACH

PRENATAL VIT#96/FERROUS FUM/FA 27MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT#98/FERROUS FUM/FA 9MG-267MCG TABLET $0.2000/EACH

PRENATAL VIT/FE FUMARATE/FA 27 mg; 1 mg TABLET $0.2000/EACH

PRENATAL VIT/FE FUMARATE/FA 28-1 mg TABLET $0.2000/EACH

PRENATAL VIT/IRON FUMARATE/FA 108.9-0.4 TABLET $0.2000/EACH

PRENATAL VIT/IRON FUMARATE/FA 29 MG-1 MG TABLET $0.2000/EACH

PRENATAL VIT/IRON FUMARATE/FA 29MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT/IRON FUMARATE/FA 45-1MG TABLET $0.2000/EACH

PRENATAL VIT/IRON FUMARATE/FA 45MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT/IRON FUMARATE/FA 60MG-0.8MG TABLET $0.2000/EACH

PRENATAL VIT/IRON,CARB/DOSS/FA 90 mg; 50 mg; 1 mg TABLET $0.2000/EACH

PRENATAL VIT/IRON,CARBONYL/FA 60 MG-1 MG TABLET $0.2000/EACH

PRENATAL VIT28&CALCIUM/IRON/FA 60 MG-1 MG TABLET $0.2000/EACH

PRENATAL VITAMIN #55/IRON FUMARATE & BISGLYCINATE/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMIN 27 WITH CALCIUM/FERROUS FUMARATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMIN COMB NO.42/IRON FUMARAT/FA/LEVOMEFOLATE/DHA 27-400-1 CAPSULE $0.2000/EACH

PRENATAL VITAMIN COMB NO.79/IRON FUMARAT/FA/LMEFOLATE CA/DHA 27-1.13 mg CAPSULE $0.2000/EACH

PRENATAL VITAMIN COMBINATION NO.19/IRON/FOLIC ACID/DHA 22-6-1-200 CAPSULE $0.2000/EACH

PRENATAL VITAMIN COMBINATION NO.8/IRON/FOLIC ACID/DHA 22-6-1-200 KIT $0.2000/EACH

PRENATAL VITAMIN COMBO NO.22/IRON/FOLIC ACID/OMEGA-3/DHA 28-6-1-203 KIT $0.2000/EACH

PRENATAL VITAMIN COMBO NO.8/IRON PS CMPLX & ASPGL/FA/DHA 22-6-1-200 KIT $0.2000/EACH

PRENATAL VITAMIN NO.15/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH

PRENATAL VITAMIN NO.16/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH

PRENATAL VITAMIN NO.17/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH

PRENATAL VITAMIN NO.18/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH

PRENATAL VITAMIN NO.67/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 27-1-300mg KIT $0.2000/EACH

PRENATAL VITAMIN NO.77/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 27-1-430mg KIT $0.2000/EACH

PRENATAL VITAMIN NO.81/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 27-1-430mg KIT $0.2000/EACH

PRENATAL VITAMIN NO.86/IRON BIS-GLYCINATE/FOLIC ACID 32 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMIN NO.88/IRON PS COMPLEX/FA/L-MEFOLATE CA/DHA 29-0.5-1.4 KIT $0.2000/EACH

PRENATAL VITAMIN NO.94/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 26-1-374mg KIT $0.2000/EACH

PRENATAL VITAMIN W-O CALCIUM/FE BISGLY/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O CALCIUM/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O CALCIUM/FERROUS GLUCONATE/FOLIC ACID 30-0.8mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O CALCIUM/IRON POLYSACCHARIDES COMPLEX/FA 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O CALCIUM/IRON,CARBONYL/DOCUSATE/FA 29-50-1mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O CALCIUM/IRON,CARBONYL/DOCUSATE/FA 29-50-1mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O VIT A/FE CARBONYL-FE FUMARATE/FA 30mg-1mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O VIT A/FE CARBONYL-FE FUMARATE/FA 40-1mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/DOCUSATE/FA/ZINC 28-1-66mg CAPSULE $0.2000/EACH

Page 23 of 30

Page 24: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

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Delete

Increase

Decrease

Reactivate

PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/DOCUSATE/FA 28 mg-1 mg CAPSULE $0.2000/EACH

PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/FOLIC ACID 40-1mg TABLET $0.2000/EACH

PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/FOLIC ACID 40-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS #39/IRON AMINO ACID CHELATE/FA COMBO#6/DHA 30-1-300 mg KIT $0.2000/EACH

PRENATAL VITAMINS #45/IRON/FA 28 MG-1 MG TABLET $0.2000/EACH

PRENATAL VITAMINS COMB #83/IRON,CARBONYL/IRON ASPARTO GLY/FA 30-20-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB 10/FERROUS FUMARATE/FOLIC ACID/DHA 65-1-250mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB 10/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.1/IRON,CARBONYL/DOCUSATE/FA 90-50-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.19/IRON BG HCL SUC-PROT/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.19/IRON BG HCL&SUCC-P2/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.19/IRON B-G SUC CHE-PR/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.2/IRON B-G SUC-P/FA/OMEGA-3 29-1-250mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.20/IRON BISGLY/FOLIC ACID/DHA 26-1-200mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.21/IRON/FOLIC ACID 14mg-0.4mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.25/IRON BISGLY/FOLIC ACID 25mg-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.3/FE FUMARATE-FE GLUCONATE/FA 20mg-0.8mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.43/IRON,CARBONYL/FA/DOCUSATE SOD 29-1-50mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.44/IRON,CARBONYL/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.47/FERROUS FUMARATE/FA CMB #1/DHA 27-1-300mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS COMB NO.48/IRON NA FEREDETATE/FA/OMEGA-3 30-1-440mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.52/IRON B-G SUC-P/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.53/IRON B-G HCL SUC-P/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.53/IRON B-G SUC-P/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.54/IRON B-G HCL SUC-P/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.54/IRON B-G SUC-P/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.55/IRON BG HCL SUC-PROT/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.55/IRON BG HCL&SUCC-P2/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.55/IRON B-G SUC CHE-PR/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.59/FERROUS SULFATE/FOLIC ACID/DHA 28-975-200 PACKET $0.2000/EACH

PRENATAL VITAMINS COMB NO.62/FERROUS FUMARATE/FOLIC ACID/DHA 27-1-250mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS COMB NO.7/FE ASP GLY/DOCUSATE/FOLIC ACID 30-50-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.70/FERROUS FUMARATE/FOLIC ACID/DHA 28-1-250mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS COMB NO.71/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.0000

PRENATAL VITAMINS COMB NO.72/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.73/FERROUS FUMARATE/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.74/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.76/IRON,CARBONYL/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.78/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.84/IRON,CARBONYL/FOLIC ACID/DHA 20-1-100mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.87/IRON BISGLY/FOLIC ACID/DHA 32-1-230mg KIT $0.2000/EACH

PRENATAL VITAMINS COMB NO.89/FERROUS FUMARATE/FOLIC ACID 25mg-0.8mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB NO.90/FERROUS FUMARATE/FOLIC ACID 9 mg-0.5mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMB. NO.21 WITH IRON & FOLIC ACID 28-6-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMBO #36/FERROUS FUMARATE/FOLATE COMBO #6 26 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMBO NO.14/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMBO NO.23/IRON PS COMPLEX/FOLIC ACID 155 mg-1mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS COMBO NO.25/FERROUS FUMARATE/FA/DHA 30-975-200 CAPSULE $0.2000/EACH

PRENATAL VITAMINS COMBO NO.28/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMBO NO.33/IRON PS CMPLX/FOLIC ACID/DHA 29-1-250mg KIT $0.2000/EACH

PRENATAL VITAMINS COMBO NO.34/IRON,CARB/FOLIC ACID/DSS/DHA 30-1-50 mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS COMBO NO.37/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS COMBO NO.8/IRON PS CMPLX & ASPGLY/FA 22-6-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS NO.11/FERROUS FUMARATE/FOLIC ACID/OMEGA-3 28-1-200mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS NO.12/IRON,CARBONYL/FA/DOCUSATE NA/OMEGA-3 29-1-50mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.13/IRON POLYSACCHARIDES COMPLEX/FA/DHA 29-1-250mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.13/IRON,CARBONYL/FA/DOCUSATE NA/DHA 90-1-250mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.15/IRON FUMARATE & POLYSAC COMP/FA 85 mg-1 mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS NO.18/IRON,CARBONYL/FA/UBIDECARENONE/DHA 15-0.5-50 TABLET $0.2000/EACH

PRENATAL VITAMINS NO.22/IRON CBN & GLUC/FOLIC ACID/DSS 27-1-50mg TABLET $0.2000/EACH

PRENATAL VITAMINS NO.22/IRON CBN&GLUCON/FOLIC ACID/DSS/DHA 27-1-50mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.22/IRON,CARBONYL/FA/DOCUSATE NA/DHA 90-1-250mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.24/IRON AMINO ACID CHELATE/FA/DHA 30-975-300 KIT $0.2000/EACH

PRENATAL VITAMINS NO.24/IRON AMINO ACID CHELATE/FOLIC ACID 30 mg-975 TABLET $0.2000/EACH

PRENATAL VITAMINS NO.24/IRON CBN&GLUCON/FOLIC ACID/DOSS/DHA 30-1-75mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.26/IRON POLYSACCHARIDES/FA/DHA 29-1-200 mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS NO.27/IRON CARBONYL & FUMARATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS NO.38/IRON CBN&GLUCON/FOLIC ACID/DSS/DHA 35-1-50mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.38/IRON FUMARATE/FOLATE COMB NO.6/DHA 28-1-300mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS NO.4/FERROUS FUMARATE/FOLIC ACID 106 mg-1mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS NO.4/IRON CBN&GLUCONAT/FOLIC ACID/DOSS/DHA 27-1-50mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.45/IRON,CARBONYL/FA/DOCUSATE SOD/DHA 90-1-250mg KIT $0.2000/EACH

PRENATAL VITAMINS NO.46/IRON,CARBONYL/FOLIC ACID/DHA 7-400-100 TABLET $0.2000/EACH

PRENATAL VITAMINS WITHOUT CALCIUM NO.9/IRON/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS W-O CA COMB. NO. 8 WITH IRON & FOLIC ACID 22-6-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FE CARBONYL-FE SULFATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS BIS-GLYCINATE CHELATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS BIS-GLYCINATE CHELATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/DOCUSATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/DOCUSATE/FOLIC ACID 40-25-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/DOCUSATE/FOLIC ACID 90-50-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID/FATTY ACIDS 30mg-1mg KIT $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID/SELENIUM 27 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 15-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 17mg-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg BAR $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 27-0.5mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 27mg-0.8mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 28 mg-1 mg BAR $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 28mg-0.8mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 35-1mg TABLET $0.2000/EACH

Page 24 of 30

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NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 40-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 66-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 75-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS FUMARATE/OMEGA-3/FA/FAT COMBO NO.1 30-300-1mg KIT $0.2000/EACH

PRENATAL VITAMINS/FERROUS GLUCONATE/FOLIC ACID 2.2-.1-455 PWDR $0.2000/GRAM

PRENATAL VITAMINS/FERROUS GLUCONATE/FOLIC ACID 30-0.4mg TABLET $0.2000/EACH

PRENATAL VITAMINS/FERROUS GLUCONATE/FOLIC ACID 30-0.8mg TABLET $0.2000/EACH

PRENATAL VITAMINS/IRON FUMARATE & BIS-GLYCINAT/FA/ASPARTAME 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/IRON FUMARATE & BIS-GLYCINAT/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/IRON POLYSACCHARIDES COMPLEX/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/IRON,CARBONYL/DOCUSATE/CALCIUM/FOLIC ACID 90-1-600mg KIT $0.2000/EACH

PRENATAL VITAMINS/IRON,CARBONYL/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITAMINS/IRON,CARBONYL/FOLIC ACID 50-1mg TABLET $0.2000/EACH

PRENATAL VITAMINS/IRON,CARBONYL/OMEGA-3/FA/FAT COMBO NO.1 27-300-1mg CAPSULE $0.2000/EACH

PRENATAL VITAMINS/IRON,CARBONYL/OMEGA-3/FA/MIN AA CHEL 29-600-1mg KIT $0.2000/EACH

PRENATAL VITS #32/IRON/FA/DHA 27-1-150MG KIT $0.2000/EACH

PRENATAL VITS #4/IRON FUMARATE & POLYSACC COMPLEX/FOLIC ACID 106 mg-1mg CAPSULE $0.2000/EACH

PRENATAL VITS #43/IRON/FA/DHA 27-1-200mg CAPSULE $0.2000/EACH

PRENATAL VITS #92/IRON/FA/DHA 28MG-0.8MG KIT $0.2000/EACH

PRENATAL VITS #93/IRON FUM/FA 9MG-267MCG TABLET $0.2000/EACH

PRENATAL VITS CMB W-O CA NO.1/FE BISGLY/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH

PRENATAL VITS CMB W-O CA NO.2 106 mg-1mg CAPSULE $0.2000/EACH

PRENATAL VITS W-CA,FE,FA(<1MG) TABLET $0.2000/EACH

PRENATAL VITS W-CA,FE,FA(1MG)/SELENIUM TABLET $0.2000/EACH

PRENATAL VITS W-CA,FE,FA(1MG) CAPSULE $0.2000/EACH

PRENATAL VITS W-CA,FE,FA(1MG) TABLET $0.2000/EACH

PRENATAL VITS WITH CALCIUM #36/FERROUS FUMARATE/FOLIC ACID 13.5-0.4mg CAPSULE $0.2000/EACH

PRENATAL VITS WITHOUT CALC NO3/FERROUS FUMARATE/FOLIC ACID 106 mg-1mg CAPSULE $0.2000/EACH

PRENATAL VITS WITHOUT CALC NO4/FERROUS FUMARATE/FOLIC ACID 106.5-1mg CAPSULE $0.2000/EACH

PRENATAL VITS WITHOUT CALC NO5/FERROUS FUMARATE/FOLIC ACID 106.5-1mg CAPSULE $0.2000/EACH

PRENATAL VITS W-O CA COMB. NO. 7 W/ IRON & FOLIC ACID & DHA 28-1.25mg CAPSULE $0.2000/EACH

PRENATAL72/IRON FUM/FA/OM3/DHA 27-1-250MG COMBINATION PACKAGE $0.2000/EACH

PRENATL VIT6/IRON/FA/B12/CA/D3 35 MG-5 MG TABLET $0.2000/EACH

PRENATL VIT6/IRON/FA/B12/CA/D3 35MG-1.1MG TABLET $0.2000/EACH

PRIMIDONE 50 mg TABLET $0.0621/EACH

PRIMIDONE 250 mg TABLET $0.1340/EACH

PROBENECID W/COLCHICINE 0.5 gm/0.5 mg TABLET $0.0000

PROBENECID 0.5 gm TABLET $0.7800/EACH

PROCHLORPERAZINE MALEATE 10 mg TABLET $0.0584/EACH

PROCHLORPERAZINE MALEATE 25 mg SUPP $7.5110/EACH

PROCHLORPERAZINE MALEATE 5 mg TABLET $0.0421/EACH

PROGESTERONE,MICRONIZED 100 MG CAPSULE $0.9123/EACH

PROGESTERONE,MICRONIZED 200 MG CAPSULE $1.5264/EACH Decrease

PROMETHAZINE HCL 12.5 mg SUPP $9.4500/EACH

PROMETHAZINE HCL 12.5 mg TABLET $0.1314/EACH

PROMETHAZINE HCL 25 mg/ml AMPUL $1.1025/MILLILITER

PROMETHAZINE HCL 25 mg/ml VIAL $1.0315/MILLILITER

PROMETHAZINE HCL 25 mg SUPP $7.4375/EACH

PROMETHAZINE HCL 25 mg TABLET $0.0408/EACH

PROMETHAZINE HCL 50 mg/ml AMPUL $2.3310/MILLILITER

PROMETHAZINE HCL 50 mg/ml VIAL $2.4192/MILLILITER

PROMETHAZINE HCL 50 mg SUPP $29.0400/EACH

PROMETHAZINE HCL 50 mg TABLET $0.0750/EACH

PROMETHAZINE HCL 6.25 mg/5 ml SYRUP $0.0120/MILLILITER

PROMETHAZINE VC W/CODEINE 6.25 mg/5 mg/10 mg per 5 ml SYRUP $0.0000

PROMETHAZINE VC 6.25 mg/5 mg per 5 ml SYRUP $0.0000

PROMETHAZINE W/DM 6.25-15/5 SYRUP $0.0122/MILLILITER

PROMETHAZINE/CODEINE 10-6.25/5 ml SYRUP $0.0205/MILLILITER

PROPAFENONE HCL 150 mg TABLET $0.1920/EACH

PROPAFENONE HCL 225 mg CAPSULE $4.9313/EACH

PROPAFENONE HCL 225 mg TABLET $0.2700/EACH

PROPAFENONE HCL 300 mg TABLET $1.1640/EACH

PROPAFENONE HCL 325 mg CAPSULE $6.2477/EACH

PROPAFENONE HCL 425 mg CAPSULE $6.2477/EACH

PROPOXYPHENE HCL 65 mg CAPSULE $0.0000

PROPOXYPHENE NAPSYLATE; APAP 100 mg; 650 mg TABLET $0.0000

PROPOXYPHENE; APAP 65/650 mg TABLET $0.0000

PROPRANOLOL HCL 10 mg TABLET $0.0746/EACH

PROPRANOLOL HCL 120 mg CAPSULE $1.4639/EACH

PROPRANOLOL HCL 160 mg CAPSULE $2.2034/EACH

PROPRANOLOL HCL 20 mg TABLET $0.2295/EACH Decrease

PROPRANOLOL HCL 40 mg TABLET $0.3045/EACH Decrease

PROPRANOLOL HCL 60 mg CAPSULE $1.2608/EACH Decrease

PROPRANOLOL HCL 60 mg TABLET $0.8400/EACH

PROPRANOLOL HCL 80 mg CAPSULE $1.4961/EACH Decrease

PROPRANOLOL HCL 80 mg TABLET $0.4920/EACH

PROPRANOLOL/HCTZ 40 mg; 25 mg TABLET $0.0000

PROPRANOLOL/HCTZ 80 mg; 25 mg TABLET $0.0000

PROPYLTHIOURACIL 50 mg TABLET $0.6360/EACH

PROTRIPTYLINE HCL 10 mg TABLET $2.2500/EACH

PROTRIPTYLINE HCL 5 mg TABLET $1.3800/EACH

PSEUDOEPHEDRINE HCL/CETIRIZINE HCL 120 mg; 5 mg TABLET $0.0000 Delete

PSEUDOEPHEDRINE HCL; CHLORPHENIRAMINE MALEATE 120 mg; 8 mg CAPSULE $0.0000

PSEUDOEPHEDRINE HCL; CHLORPHENIRAMINE MALEATE 30 mg; 2 mg per 5 ml SOLN $0.0000

PSEUDOEPHEDRINE HCL 30 mg TABLET $0.0361/EACH

PSEUDOEPHEDRINE HCL 60 mg TABLET $0.0329/EACH

PSEUDOEPHEDRINE SULFATE/LORATADINE 240-10 mg TABLET $0.0000 Delete

PSYLLIUM SEED (WITH DEXTROSE) PWDR $0.0137/GRAM

PSYLLIUM SEED/SUCROSE ORAL POWDER NA PWDR $0.0122/GRAM

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Page 26: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

PSYLLIUM/SUCROSE ORAL PACKET NA PACKET $0.0000

PSYLLIUM NA PWDR $0.0346/GRAM

PV W-O VIT A/FE FUMARATE/FA 106 MG-1MG CAPSULE $0.2000/EACH

PV W-O VIT A/IRON,CARBONYL/FA 29 MG-1 MG TABLET $0.2000/EACH

PYRIDOSTIGMINE BROMIDE 60 mg TABLET $0.6718/EACH

PYRIDOSTIGMINE BROMIDE 180 mg TABLET $12.5760/EACH

QUETIAPINE FUMARATE 100 mg TABLET $0.0768/EACH

QUETIAPINE FUMARATE 150 MG TAB, ER 24 HR $0.9666/TABLET Add

QUETIAPINE FUMARATE 200 mg TABLET $0.1653/EACH

QUETIAPINE FUMARATE 200 MG TAB, ER 24 HR $1.2359/TABLET Add

QUETIAPINE FUMARATE 25 mg TABLET $0.0683/EACH

QUETIAPINE FUMARATE 300 mg TABLET $0.1582/EACH

QUETIAPINE FUMARATE 300 MG TAB, ER 24 HR $1.4227/TABLET Add

QUETIAPINE FUMARATE 400 mg TABLET $0.2475/EACH Decrease

QUETIAPINE FUMARATE 400 MG TAB, ER 24 HR $1.6214/TABLET Add

QUETIAPINE FUMARATE 50 mg TABLET $0.1065/EACH Decrease

QUINAPRIL HCL/HCTZ 10-12.5 mg TABLET $0.5400/EACH Decrease

QUINAPRIL HCL/HCTZ 20-12.5 mg TABLET $0.2760/EACH

QUINAPRIL HCL/HCTZ 20-25 mg TABLET $0.6760/EACH

QUINAPRIL HCL 10 mg TABLET $0.2160/EACH

QUINAPRIL HCL 20 mg TABLET $0.1508/EACH

QUINAPRIL HCL 40 mg TABLET $0.1588/EACH

QUINAPRIL HCL 5 mg TABLET $0.1588/EACH

QUINIDINE GLUCONATE 324 mg TABLET $0.0000

QUINIDINE SULFATE 200 mg TABLET $0.0000

QUININE SULFATE 260 mg TABLET $0.0000

QUININE SULFATE 324 MG CAPSULE $3.3450/EACH

QUININE SULFATE 325 mg CAPSULE $0.0000

RABEPRAZOLE SODIUM 20 MG TABLET $0.4800/EACH

RALOXIFENE HCL 60 MG TABLET $1.2140/EACH Decrease

RAMIPRIL 1.25 mg CAPSULE $0.1787/EACH

RAMIPRIL 10 mg CAPSULE $0.0750/EACH

RAMIPRIL 2.5 mg CAPSULE $0.0598/EACH

RAMIPRIL 5 mg CAPSULE $0.1560/EACH

RANITIDINE HCL 150 mg/10 ml SYRUP $0.0225/MILLILITER

RANITIDINE HCL 150 mg CAPSULE $0.6480/EACH

RANITIDINE HCL 150 mg TABLET $0.0673/EACH

RANITIDINE HCL 300 mg CAPSULE $1.1760/EACH

RANITIDINE HCL 300 mg TABLET $0.1283/EACH

REPAGLINIDE 0.5 MG TABLET $0.3600/EACH

REPAGLINIDE 1 MG TABLET $0.2586/EACH

REPAGLINIDE 2 MG TABLET $0.2635/EACH

RIBAVIRIN 200 mg CAPSULE $0.3515/EACH

RIBAVIRIN 200 mg TABLET $1.0500/EACH

RIFABUTIN 150 mg CAPSULE $14.1680/EACH

RIFAMPIN 300 mg CAPSULE $0.8894/EACH

RIFAMPIN 150 MG CAPSULE $1.1258/EACH

RILUZOLE 50 MG TABLET $2.5100/EACH

RIMANTADINE HCL 100 mg TABLET $2.6040/EACH

RISEDRONATE SODIUM 150 mg TABLET $85.3050/EACH Reactivate

RISEDRONATE SODIUM 35 mg TABLET $30.1000/EACH Reactivate

RISEDRONATE SODIUM 35 mg TABLET $6.2361/EACH Reactivate

RISPERIDONE 0.25 MG TABLET $2.4750/EACH

RISPERIDONE 0.25 mg TABLET $0.0763/EACH

RISPERIDONE 0.5 mg TABLET $0.9302/EACH

RISPERIDONE 0.5 mg TABLET $0.0708/EACH

RISPERIDONE 1 mg/ml SOLN $0.4400/MILLILITER

RISPERIDONE 1 mg TABLET $2.2080/EACH

RISPERIDONE 1 mg TABLET $0.1035/EACH Decrease

RISPERIDONE 2 mg TABLET $1.3600/EACH

RISPERIDONE 2 mg TABLET $0.0720/EACH

RISPERIDONE 3 mg TABLET $4.7421/EACH

RISPERIDONE 3 mg TABLET $0.0993/EACH Decrease

RISPERIDONE 4 mg TABLET $5.8000/EACH

RISPERIDONE 4 mg TABLET $0.1469/EACH Decrease

RIVASTIGMINE TARTRATE 1.5 MG CAPSULE $0.7800/EACH

RIVASTIGMINE TARTRATE 3 MG CAPSULE $0.5902/EACH Decrease

RIVASTIGMINE TARTRATE 4.5 MG CAPSULE $2.4840/EACH

RIVASTIGMINE TARTRATE 6 MG CAPSULE $0.7800/EACH

RIZATRIPTAN BENZOATE 10 MG TABLET $1.2513/EACH

RIZATRIPTAN BENZOATE 10 MG TABLET $1.1583/EACH Decrease

RIZATRIPTAN BENZOATE 5 MG TABLET $1.6320/EACH

RIZATRIPTAN BENZOATE 5 MG TABLET $1.7640/EACH

ROPINIROLE HCL 0.25 mg TABLET $0.0840/EACH

ROPINIROLE HCL 0.5 mg TABLET $0.0780/EACH

ROPINIROLE HCL 1 mg TABLET $0.0930/EACH

ROPINIROLE HCL 12 MG TABLET $6.3840/EACH

ROPINIROLE HCL 2 MG TABLET $1.1280/EACH

ROPINIROLE HCL 2 mg TABLET $0.1248/EACH

ROPINIROLE HCL 3 mg TABLET $0.0960/EACH

ROPINIROLE HCL 4 MG TABLET $1.7160/EACH

ROPINIROLE HCL 4 mg TABLET $0.0960/EACH

ROPINIROLE HCL 5 mg TABLET $0.0966/EACH

ROPINIROLE HCL 6 MG TABLET $3.8550/EACH

ROPINIROLE HCL 8 MG TABLET $3.3840/EACH

ROSUVASTATIN CALCIUM 10 MG TABLET $0.1874/EACH Decrease

ROSUVASTATIN CALCIUM 20 MG TABLET $0.1785/EACH Decrease

ROSUVASTATIN CALCIUM 40 MG TABLET $0.1981/EACH Decrease

ROSUVASTATIN CALCIUM 5 MG TABLET $0.2270/EACH Decrease

SALICYLIC ACID 6 % SHAMPOO $0.1320/MILLILITER

SALSALATE 500 mg TABLET $0.8400/EACH

SALSALATE 750 mg TABLET $1.0080/EACH

Page 26 of 30

Page 27: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

SANCTURA 20 MG TABLET $1.2386/EACH

SELEGILINE HCL 5 mg CAPSULE $0.0000

SELEGILINE HCL 5 mg TABLET $1.3114/EACH

SELENIUM SULFIDE 2.5% SUSP $0.1133/MILLILITER

SENNOSIDES/DOCUSATE SODIUM 8.6mg-50mg TABLET $0.0282/EACH

SENNOSIDES 8.6 mg TABLET $0.0197/EACH Decrease

SERTRALINE HCL 100 mg TABLET $0.0600/EACH

SERTRALINE HCL 20 mg/ml CONC $1.0532/MILLILITER

SERTRALINE HCL 25 mg TABLET $0.0450/EACH

SERTRALINE HCL 50 mg TABLET $0.0639/EACH

SILDENAFIL CITRATE 20 MG TABLET $0.3706/EACH

SILVER SULFADIAZINE 1% CRM $0.2397/GRAM

SIMETHICONE 40mg/0.6ml DROPS $0.0720/MILLILITER

SIMETHICONE 80 mg TABLET $0.0260/EACH

SIMVASTATIN 10 mg TABLET $0.0360/EACH

SIMVASTATIN 20 mg TABLET $0.0212/EACH

SIMVASTATIN 40 mg TABLET $0.0371/EACH

SIMVASTATIN 5 mg TABLET $0.0600/EACH

SIMVASTATIN 80 mg TABLET $0.0903/EACH

SIROLIMUS 0.5 mg TABLET $6.3830/EACH

SIROLIMUS 1 mg TABLET $9.1390/EACH

SIROLIMUS 2 mg TABLET $20.3720/EACH

SODIUM CHLORIDE/SODIUM BICARBONATE 420 g SOLN $0.0041/MILLILITER

SODIUM CHLORIDE 0.65 % AERO (ML) $0.0240/MILLILITER

SODIUM CHLORIDE 0.9%; 10 ml VIAL $0.0000

SODIUM CHLORIDE 0.9%; 100 ml SOLN $0.0155/MILLILITER

SODIUM CHLORIDE 0.9%; 1000 ml SOLN $0.0024/MILLILITER

SODIUM CHLORIDE 0.9%; 150 ml SOLN $0.0134/MILLILITER

SODIUM CHLORIDE 0.9%; 25 ml SOLN $0.0641/MILLILITER

SODIUM CHLORIDE 0.9%; 250 ml SOLN $0.0120/MILLILITER

SODIUM CHLORIDE 0.9%; 3 ml VIAL $0.1207/MILLILITER

SODIUM CHLORIDE 0.9%; 50 ml SOLN $0.0360/MILLILITER

SODIUM CHLORIDE 0.9%; 500 ml SOLN $0.0066/MILLILITER

SODIUM CHLORIDE 5 % OINT $2.1943/GRAM

SODIUM FLUORIDE .5 mg TABLET $0.0300/EACH

SODIUM FLUORIDE 0.25(0.55) TABLET $0.0450/EACH

SODIUM FLUORIDE 0.5 mg/ml DROPS $0.1950/MILLILITER

SODIUM FLUORIDE 1 mg TABLET $0.0450/EACH

SODIUM FLUORIDE 1.1% CRM $0.0720/GRAM Decrease

SODIUM PHOSPHATE,MONOBASIC/SODIUM PHOSPHATE,DIBASIC 19g-7g/118 ENEMA $0.0065/MILLILITER

SODIUM POLYSTYRENE SULFONATE PWDR $0.2040/GRAM

SODIUM SULFATE/SODIUM CHLORIDE/SODIUM BICARBONATE/POTASSIUM CHLORIDE/POLYETHYLENE GLYCOLN/A SOLN $0.0035/MILLILITER

SOTALOL HCL 120 mg TABLET $0.2147/EACH

SOTALOL HCL 160 mg TABLET $0.2400/EACH

SOTALOL HCL 240 mg TABLET $0.1500/EACH

SOTALOL HCL 80 mg TABLET $0.0756/EACH

SPIRONOLACTONE/HCTZ 25 mg/25 mg TABLET $1.1520/EACH

SPIRONOLACTONE 100 mg TABLET $0.1856/EACH

SPIRONOLACTONE 25 mg TABLET $0.0613/EACH Decrease

SPIRONOLACTONE 50 mg TABLET $0.1151/EACH

STAVUDINE 15 mg CAPSULE $6.3890/EACH

STAVUDINE 20 mg CAPSULE $0.8880/EACH

STAVUDINE 30 mg CAPSULE $2.4514/EACH

STAVUDINE 40 mg CAPSULE $0.8160/EACH

SUCRALFATE 1 gm TABLET $0.2114/EACH Increase

SULFACETAMIDE SODIUM/SULFUR 10 %-2 % CRM $5.9160/GRAM

SULFACETAMIDE SODIUM/SULFUR 10%-5% PAD $7.6612/EACH

SULFACETAMIDE SODIUM/SULFUR 10-5%(w/w) CLEANSER $0.2835/GRAM

SULFACETAMIDE SODIUM/SULFUR 10-5%(w/w) CRM $0.0000

SULFACETAMIDE SODIUM 10 % SUSP $1.2544/MILLILITER

SULFACETAMIDE SODIUM 10% DROPS $3.7632/MILLILITER

SULFASALAZINE 500 mg TABLET $0.3202/EACH

SULFASALAZINE 500 mg TABLET $0.0000 Delete

SULINDAC 150 mg TABLET $0.2100/EACH

SULINDAC 200 mg TABLET $0.2550/EACH

SUMATRIPTAN SUCCINATE 100 mg TABLET $0.6572/EACH

SUMATRIPTAN SUCCINATE 25 mg TABLET $0.8100/EACH

SUMATRIPTAN SUCCINATE 4 mg/0.5 ml CARTRIDGE $161.0620/MILLILITER Reactivate

SUMATRIPTAN SUCCINATE 4 mg/0.5 ml PEN INJECTOR $185.5080/MILLILITER Reactivate

SUMATRIPTAN SUCCINATE 50 mg TABLET $0.6453/EACH

SUMATRIPTAN SUCCINATE 6 mg/0.5 ml CARTRIDGE $131.8900/MILLILITER Reactivate

SUMATRIPTAN SUCCINATE 6 mg/0.5 ml PEN INJECTOR $125.9880/MILLILITER Reactivate

SUMATRIPTAN SUCCINATE 6 mg/0.5 ml VIAL $52.6478/MILLILITER Reactivate

SUMATRIPTAN 20 mg AERO (ML) $44.3370/EACH Reactivate

SUMATRIPTAN 5 mg AERO (ML) $43.9114/EACH Reactivate

TACROLIMUS ANHYDROUS 0.5 mg CAPSULE $0.2111/EACH Decrease

TACROLIMUS ANHYDROUS 1 mg CAPSULE $0.2880/EACH

TACROLIMUS ANHYDROUS 5 mg CAPSULE $1.8150/EACH

TACROLIMUS 0.03 % OINT $6.1160/GRAM

TACROLIMUS 0.1 % OINT $5.8648/GRAM

TAMOXIFEN CITRATE 10 mg TABLET $0.2700/EACH

TAMOXIFEN CITRATE 20 mg TABLET $0.5440/EACH

TAMSULOSIN HCL 0.4 mg CAPSULE $0.1500/EACH Decrease

TELMISARTAN/AMLODIPINE 40 MG-10MG TABLET $3.8804/EACH

TELMISARTAN/AMLODIPINE 40 MG-5 MG TABLET $3.8804/EACH

TELMISARTAN/AMLODIPINE 80 MG-10MG TABLET $4.5840/EACH

TELMISARTAN/AMLODIPINE 80 MG-5 MG TABLET $3.5072/EACH

TELMISARTAN/HYDROCHLOROTHIAZID 80-12.5 mg TABLET $0.0000

TELMISARTAN 20 mg TABLET $0.0000

TELMISARTAN 40 MG TABLET $0.0000

TELMISARTAN 80 MG TABLET $0.0000

TEMAZEPAM 15 mg CAPSULE $0.0471/EACH

Page 27 of 30

Page 28: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

TEMAZEPAM 22.5 mg CAPSULE $4.0680/EACH

TEMAZEPAM 30 mg CAPSULE $0.0644/EACH

TEMAZEPAM 7.5 mg CAPSULE $3.2526/EACH

TEMOZOLOMIDE 100 MG CAPSULE $81.0647/EACH

TEMOZOLOMIDE 140 MG CAPSULE $136.0080/EACH

TEMOZOLOMIDE 180 MG CAPSULE $219.3620/EACH

TEMOZOLOMIDE 20 MG CAPSULE $9.7500/EACH Decrease

TEMOZOLOMIDE 250 MG CAPSULE $90.2500/EACH Decrease

TEMOZOLOMIDE 5 MG CAPSULE $5.8080/EACH

TERAZOSIN 1 mg CAPSULE $0.1038/EACH

TERAZOSIN 10 mg CAPSULE $0.0845/EACH

TERAZOSIN 2 mg CAPSULE $0.1012/EACH

TERAZOSIN 5 mg CAPSULE $0.0915/EACH

TERBINAFINE HCL 250 mg TABLET $0.1940/EACH

TERBUTALINE SULFATE 2.5 MG TABLET $0.0000

TERBUTALINE SULFATE 5 MG TABLET $1.4154/EACH

TERCONAZOLE 0.4% CRM $0.4488/GRAM

TERCONAZOLE 0.8% CRM $0.0000

TERCONAZOLE 80 mg SUPP $24.3200/EACH

TESTOSTERONE 1.25g (1%) GEL $0.0000

TESTOSTERONE 25mg(1%) GEL $0.0000

TESTOSTERONE 50 mg (1%) GEL $0.0000

TESTOSTERONE 50 mg (1%) GEL $2.0137/GRAM

TETRABENAZINE 12.5 MG TABLET $69.3440/EACH

TETRABENAZINE 25 MG TABLET $138.6990/EACH

TETRACYCLINE HCL 250 mg CAPSULE $6.0480/EACH

TETRACYCLINE HCL 500 mg CAPSULE $7.3800/EACH Decrease

THEOPHYLLINE ANHYDROUS 100 MG TABLET $0.3603/EACH

THEOPHYLLINE ANHYDROUS 400 MG TABLET $0.5100/EACH

THEOPHYLLINE ANHYDROUS 600 MG TABLET $0.8100/EACH

THEOPHYLLINE 200 mg TABLET $0.4446/EACH

THEOPHYLLINE 300 mg CAPSULE $0.0000

THEOPHYLLINE 300 mg TABLET $2.4324/EACH

THIORIDAZINE HCL 10 mg TABLET $0.3720/EACH

THIORIDAZINE HCL 100 mg/ml CONC $0.0000

THIORIDAZINE HCL 100 mg TABLET $0.7320/EACH

THIORIDAZINE HCL 15 mg TABLET $0.0000

THIORIDAZINE HCL 200 mg TABLET $0.0000

THIORIDAZINE HCL 25 mg TABLET $0.5111/EACH

THIORIDAZINE HCL 30 mg/ml CONC $0.0000

THIORIDAZINE HCL 50 mg TABLET $0.3720/EACH

THIOTHIXENE 1 mg CAPSULE $0.6120/EACH

THIOTHIXENE 10 mg CAPSULE $1.7400/EACH

THIOTHIXENE 2 mg CAPSULE $1.1346/EACH

THIOTHIXENE 5 mg CAPSULE $1.2360/EACH

TIAGABINE HCL 2 mg TABLET $5.5550/EACH

TIAGABINE HCL 4 mg TABLET $5.2432/EACH

TICLOPIDINE HCL 250 mg TABLET $0.0000

TIMOLOL MALEATE/DORZOLAMIDE HCL 0.5%-2% DROPS $0.8970/MILLILITER

TIMOLOL MALEATE 0.0025 DROPS $0.7560/MILLILITER

TIMOLOL MALEATE 0.0025 SOLN $22.6700/MILLILITER

TIMOLOL MALEATE 0.005 DROPS $0.7950/MILLILITER

TIMOLOL MALEATE 0.005 SOLN $15.5100/MILLILITER

TIMOLOL MALEATE 10 mg TABLET $0.0000

TIZANIDINE HCL 2 MG CAPSULE $1.7160/EACH

TIZANIDINE HCL 2 mg TABLET $0.1175/EACH Decrease

TIZANIDINE HCL 4 MG CAPSULE $1.7040/EACH

TIZANIDINE HCL 4 mg TABLET $0.1315/EACH Decrease

TIZANIDINE HCL 6 MG CAPSULE $3.2520/EACH

TOBRAMYCIN IN 0.225% NACL 300 MG/5ML AMPUL $12.0560/MILLILITER Reactivate

TOBRAMYCIN SULFATE/DEXAMETHASONE 0.3 - 0.1% DROPS $13.1040/MILLILITER

TOBRAMYCIN SULFATE 1.2 gm VIAL $101.9813/EACH

TOBRAMYCIN SULFATE 40 mg/ml VIAL $0.0000

TOBRAMYCIN 0.003 DROPS $2.4461/MILLILITER

TOLBUTAMIDE 500 mg TABLET $0.0000

TOLCAPONE 100 MG TABLET $94.2004/EACH

TOLMETIN SODIUM 200 mg TABLET $0.0000

TOLMETIN SODIUM 400 mg CAPSULE $0.0000

TOLMETIN SODIUM 600 mg TABLET $0.0000

TOLNAFTATE 1 % CRM $0.0000 Delete

TOLTERODINE TARTRATE 1 MG TABLET $0.7920/EACH

TOLTERODINE TARTRATE 2 MG CAPSULE $4.4532/EACH

TOLTERODINE TARTRATE 2 MG TABLET $1.0650/EACH

TOLTERODINE TARTRATE 4 MG CAPSULE $3.1950/EACH Decrease

TOPIRAMATE 100 mg TABLET $0.1214/EACH

TOPIRAMATE 15 mg CAPSULE $0.4500/EACH

TOPIRAMATE 200 mg TABLET $0.1327/EACH Decrease

TOPIRAMATE 25 mg CAPSULE $0.4440/EACH

TOPIRAMATE 25 mg TABLET $0.0400/EACH

TOPIRAMATE 50 mg TABLET $0.0587/EACH

TOPOTECAN HCL 4 mg VIAL $126.0000/EACH

TORSEMIDE 10 mg TABLET $0.0960/EACH

TORSEMIDE 100 mg TABLET $0.2400/EACH

TORSEMIDE 20 mg TABLET $0.0969/EACH

TORSEMIDE 5 mg TABLET $0.1264/EACH

TRAMADOL HCL/APAP 37.5/325 mg TABLET $0.3761/EACH

TRAMADOL HCL 100 mg TABLET $0.7745/EACH

TRAMADOL HCL 100 mg TABLET $1.8344/EACH

TRAMADOL HCL 200 mg TABLET $1.3200/EACH

TRAMADOL HCL 200 MG TAB, ER 24 HR $3.1553/TABLET Add

TRAMADOL HCL 300 MG TABLET $2.5410/EACH

TRAMADOL HCL 300 mg TABLET $4.4600/EACH

Page 28 of 30

Page 29: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

TRAMADOL 50 mg TABLET $0.0176/EACH

TRANDOLAPRIL 1 mg TABLET $0.1910/EACH

TRANDOLAPRIL 2 mg TABLET $0.3163/EACH

TRANDOLAPRIL 4 mg TABLET $0.1910/EACH

TRANEXAMIC ACID 650 MG TABLET $2.3433/EACH

TRANYLCYPROMINE SULFATE 10 mg TABLET $1.7694/EACH

TRAZODONE HCL 100 mg TABLET $0.0700/EACH

TRAZODONE HCL 150 mg TABLET $0.2113/EACH

TRAZODONE HCL 300 mg TABLET $3.0300/EACH

TRAZODONE HCL 50 mg TABLET $0.0631/EACH

TRETINOIN MICROSPHERES 0.04 % GEL $8.8330/GRAM

TRETINOIN MICROSPHERES 0.04 % GEL $10.4990/GRAM

TRETINOIN MICROSPHERES 0.1 % GEL $8.8330/GRAM

TRETINOIN MICROSPHERES 0.1 % GEL $9.2391/GRAM

TRETINOIN 0.0001 GEL $0.0000

TRETINOIN 0.00025 CRM $0.0000

TRETINOIN 0.00025 GEL $0.0000

TRETINOIN 0.0005 CRM $0.0000

TRETINOIN 0.0005 LIQ $0.0000

TRETINOIN 0.001 CRM $0.0000

TRETINOIN 10 mg CAPSULE $0.0000

TRIAMCINOLONE ACETONIDE 0.00025 LOTION $0.4656/MILLILITER

TRIAMCINOLONE ACETONIDE 0.001 CRM $0.0951/GRAM

TRIAMCINOLONE ACETONIDE 0.001 OINT $0.1780/GRAM Decrease

TRIAMCINOLONE ACETONIDE 0.001 PASTE $8.7900/GRAM

TRIAMCINOLONE ACETONIDE 0.001 LOTION $0.4800/MILLILITER

TRIAMCINOLONE ACETONIDE 0.005 CRM $0.7380/GRAM

TRIAMCINOLONE ACETONIDE 0.025%, 15gm CRM $0.2928/GRAM

TRIAMCINOLONE ACETONIDE 0.025%, 80gm CRM $0.1251/GRAM

TRIAMCINOLONE ACETONIDE 0.025%, 80gm OINT $0.1050/GRAM

TRIAMTERENE & HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg CAPSULE $0.1643/EACH

TRIAMTERENE & HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg TABLET $0.1505/EACH Decrease

TRIAMTERENE & HYDROCHLOROTHIAZIDE 50 mg; 25 mg CAPSULE $0.0000

TRIAMTERENE & HYDROCHLOROTHIAZIDE 75 mg; 50 mg TABLET $0.0840/EACH

TRIAZOLAM 0.125 mg TABLET $0.8412/EACH

TRIAZOLAM 0.25 mg TABLET $1.0253/EACH

TRIFLUOPERAZINE HCL 1 mg TABLET $0.6611/EACH

TRIFLUOPERAZINE HCL 10 mg TABLET $1.8480/EACH

TRIFLUOPERAZINE HCL 2 mg TABLET $0.9720/EACH

TRIFLUOPERAZINE HCL 5 mg TABLET $1.2240/EACH

TRIHEXYPHENIDYL HCL 2 mg TABLET $0.0660/EACH

TRIHEXYPHENIDYL HCL 5 mg TABLET $0.1080/EACH

TRIMETHOBENZAMIDE HCL 300 mg CAPSULE $0.9628/EACH

TRIMETHOBENZAMIDE 100 mg SUPP $0.0000

TRIMETHOBENZAMIDE 200 mg SUPP $0.0000

TRIMETHOPRIM AND SULFAMETHOXAZOLE DS 160 mg; 800 mg TABLET $0.0480/EACH

TRIMETHOPRIM AND SULFAMETHOXAZOLE SS 80 mg; 400 mg TABLET $0.0832/EACH

TRIMETHOPRIM AND SULFAMETHOXAZOLE 40 mg; 200 mg per 5 ml SUSP $0.1945/MILLILITER Decrease

TRIMETHOPRIM/POLYMYXIN B 1 mg/10,000 units/ml DROPS $0.3828/MILLILITER

TRIMETHOPRIM 100 mg TABLET $0.0000

TROPICAMIDE 0.5 % DROPS $0.0000

TROPICAMIDE 1 % DROPS $0.0000

UREA 10 % CRM $0.0969/GRAM

UREA 40 % CRM $0.0000

UREA 40 % FOAM $2.0615/GRAM

UREA 50 % CRM $0.0600/GRAM

UREA 50 % OINT $1.2557/GRAM

URSODIOL 250 mg TABLET $1.5200/EACH

URSODIOL 300 mg CAPSULE $3.4284/EACH

URSODIOL 500 mg TABLET $1.8000/EACH

VALACYCLOVIR HCL 1000 mg TABLET $0.5516/EACH Reactivate

VALACYCLOVIR HCL 500 mg TABLET $0.3300/EACH Reactivate

VALGANCICLOVIR HCL 450 mg TABLET $17.3832/EACH

VALPROIC ACID 250 mg/5 ml SOLN $0.0150/MILLILITER

VALPROIC ACID 250 mg CAPSULE $0.1548/EACH

VALSARTAN/HYDROCHLOROTHIAZIDE 160-12.5MG TABLET $0.1956/EACH Reactivate

VALSARTAN/HYDROCHLOROTHIAZIDE 160-25MG TABLET $0.2640/EACH Reactivate

VALSARTAN/HYDROCHLOROTHIAZIDE 320-12.5MG TABLET $0.2880/EACH Reactivate

VALSARTAN/HYDROCHLOROTHIAZIDE 320MG-25MG TABLET $0.3240/EACH Reactivate

VALSARTAN/HYDROCHLOROTHIAZIDE 80-12.5MG TABLET $0.2085/EACH Reactivate

VALSARTAN 160 MG TABLET $0.1590/EACH Reactivate

VANCOMYCIN HCL 1 gm VIAL $14.2538/EACH

VANCOMYCIN HCL 125 MG CAPSULE $5.9153/EACH

VANCOMYCIN HCL 250 MG CAPSULE $10.9200/EACH

VANCOMYCIN HCL 5 gm VIAL $28.9713/EACH

VANCOMYCIN HCL 500 mg VIAL $0.0000

VANCOMYCIN HCL 500 mg VIAL $3.8536/EACH

VENLAFAXINE HCL 37.5 mg TABLET $0.2700/EACH

VENLAFAXINE HCL 75 mg TABLET $0.2420/EACH

VENLAFAXINE HCL 100 mg TABLET $0.4080/EACH

VENLAFAXINE HCL 150 MG CAPSULE $0.2093/EACH

VENLAFAXINE HCL 150 MG TABLET $4.5720/EACH

VENLAFAXINE HCL 225 MG TAB, ER 24 HR $8.9600/TABLET Add

VENLAFAXINE HCL 25 mg TABLET $0.2640/EACH

VENLAFAXINE HCL 37.5 MG CAPSULE $0.1440/EACH

VENLAFAXINE HCL 37.5 MG TABLET $2.9636/EACH

VENLAFAXINE HCL 50 mg TABLET $0.2160/EACH

VENLAFAXINE HCL 75 MG CAPSULE $0.1457/EACH

VENLAFAXINE HCL 75 MG TABLET $2.5360/EACH

VERAPAMIL HCL 100 mg CAPSULE $1.0680/EACH

VERAPAMIL HCL 120 mg CAPSULE $0.8213/EACH

VERAPAMIL HCL 120 mg TABLET $0.1891/EACH

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Page 30: Oct-2017 Add Delete Increase October 1, 2017 Price ... · amoxicillin 250 mg/5 ml susp, recon $0.0276/milliliter amoxicillin 250 mg tablet $0.2707/each amoxicillin 400 mg tablet $0.0000

NAME OF GENERIC DRUG STRENGTH FORM

October 1, 2017 Price

Update

Add

Delete

Increase

Decrease

Reactivate

VERAPAMIL HCL 120 mg TABLET $0.0923/EACH

VERAPAMIL HCL 180 mg CAPSULE $1.0650/EACH

VERAPAMIL HCL 180 mg TABLET $0.2742/EACH

VERAPAMIL HCL 200 mg CAPSULE $1.9542/EACH

VERAPAMIL HCL 240 mg CAPSULE $0.9672/EACH

VERAPAMIL HCL 240 mg TABLET $0.0826/EACH

VERAPAMIL HCL 300 mg CAPSULE $1.8600/EACH

VERAPAMIL HCL 360 mg CAPSULE $4.2588/EACH

VERAPAMIL HCL 80 mg TABLET $0.1080/EACH

VINCRISTINE SULFATE 1 mg/ ml VIAL $5.9400/MILLILITER

VINCRISTINE SULFATE 2 mg/2 ml VIAL $7.0274/MILLILITER

VINORELBINE TARTRATE 10 mg/ml VIAL $20.4750/MILLILITER

VINORELBINE TARTRATE 50 mg/5 ml VIAL $17.3250/MILLILITER

VORICONAZOLE 200 mg TABLET $5.8200/EACH

VORICONAZOLE 50 mg TABLET $11.0044/EACH

WARFARIN SODIUM 1 mg TABLET $0.1274/EACH

WARFARIN SODIUM 10 mg TABLET $0.1500/EACH

WARFARIN SODIUM 2 mg TABLET $0.1585/EACH

WARFARIN SODIUM 2.5 mg TABLET $0.1320/EACH

WARFARIN SODIUM 3 mg TABLET $0.1500/EACH

WARFARIN SODIUM 4 mg TABLET $0.1261/EACH

WARFARIN SODIUM 5 mg TABLET $0.1842/EACH

WARFARIN SODIUM 6 mg TABLET $0.1262/EACH

WARFARIN SODIUM 7.5 mg TABLET $0.1127/EACH

WATER FOR INJECTION, BACTERIOSTATIC VIAL NA VIAL $0.0000

WATER FOR INJECTION, STERILE IV SOLUTION NA SOLN $0.0000

WATER FOR IRRIGATION, STERILE SOLUTION NA SOLN $0.0000

ZAFIRLUKAST 10 mg TABLET $1.3542/EACH Reactivate

ZAFIRLUKAST 20 mg TABLET $1.4550/EACH Reactivate

ZALEPLON 10 mg CAPSULE $0.1728/EACH

ZALEPLON 5 mg CAPSULE $0.1724/EACH

ZIDOVUDINE 100 mg CAPSULE $1.3950/EACH

ZIDOVUDINE 300 mg TABLET $0.3600/EACH

ZIDOVUDINE 50 mg/5 ml SYRUP $0.1750/MILLILITER

ZIPRASIDONE HCL 20 mg CAPSULE $0.6100/EACH

ZIPRASIDONE HCL 40 mg CAPSULE $0.5956/EACH

ZIPRASIDONE HCL 60 mg CAPSULE $0.7800/EACH

ZIPRASIDONE HCL 80 mg CAPSULE $0.7100/EACH

ZOLMITRIPTAN 2.5 MG TABLET $8.1730/EACH

ZOLMITRIPTAN 2.5 MG TABLET $7.6050/EACH

ZOLMITRIPTAN 5 MG TABLET $8.7120/EACH

ZOLMITRIPTAN 5 MG TABLET $8.7120/EACH

ZOLPIDEM TARTRATE 10 mg TABLET $0.0318/EACH

ZOLPIDEM TARTRATE 12.5 mg TABLET $1.0284/EACH

ZOLPIDEM TARTRATE 5 mg TABLET $0.0318/EACH

ZOLPIDEM TARTRATE 6.25 mg TABLET $1.2810/EACH

ZONISAMIDE 100 mg CAPSULE $0.2034/EACH

ZONISAMIDE 25 mg CAPSULE $0.0845/EACH

ZONISAMIDE 50 mg CAPSULE $0.1350/EACH

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