Drug Form Current MAC Effective Date Price Date Updated...2012/04/06 · Drug Form Current MAC...

Drug Form Current MAC

Price

Effective

Date

Date

Updated

1ST CHOICE LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

1ST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

1ST CHOICE LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

1ST TIER UNILET COMFORTOU (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

4-N-1 (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 12/15/2010

A & D ZINC OXIDE (Dimethicone-Zinc Oxide-Vitamin

A-Vitamin D

CREA 0.02730 04/28/2005 04/25/2005

A + D PERSONAL CARE LOTIO (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

A+D FIRST AID (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 03/13/2007

A1C NOW (Blood Glucose Monitoring Kit w/ Device***) KIT 0.71000 10/01/2003 04/07/2004

ABSORBASE (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 04/25/2005

Acarbose Tab 100 MG TABS 0.65500 06/26/2008 06/16/2008



ACCU-CHEK ACTIVE STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK ADVANTAGE DIABE (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 04/07/2004

ACCU-CHEK ADVANTAGE TEST (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK AVIVA (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK AVIVA PLUS (Blood Glucose Monitoring Kit w/

Device

KIT 0.71000 10/01/2003 02/29/2012

ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK COMFORT CURVE T (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK COMPACT STRIPS (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK COMPACT TEST DR (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK FASTCLIX LANCET (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACCU-CHEK MULTICLIX LANCE (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACCU-CHEK NANO SMARTVIEW (Blood Glucose

Monitoring Kit w/ De

KIT 0.71000 10/01/2003 02/08/2012

ACCU-CHEK SAFE-T-PRO LANC (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACCU-CHEK SAFE-T-PRO PLUS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACCU-CHEK SMARTVIEW STRIP (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ACCU-CHEK SOFT TOUCH LANC (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACCU-CHEK SOFTCLIX LANCET (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACCU-CHEK VOICEMATE (Blood Glucose Monitoring Kit w/

Device*

KIT 0.71000 10/01/2003 04/07/2004

ACCUTREND GLUCOSE (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

Acebutolol HCl Cap 200 MG CAPS 0.18512 01/13/2012 01/09/2012

Acebutolol HCl Cap 400 MG CAPS 0.26985 06/26/2009 06/09/2009

ACERFLEX (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011

Acetaminophen Cap 500 MG CAPS 0.03450 03/13/2008 03/05/2008

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Effective

Date

Date

Updated

Acetaminophen Chew Tab 160 MG CHEW 0.10010 03/13/2008 03/05/2008

Acetaminophen Chew Tab 80 MG CHEW 0.04180 03/13/2008 03/05/2008

Acetaminophen Elixir 160 MG/5ML ELIX 0.01230 03/13/2008 03/05/2008

Acetaminophen Liquid 160 MG/5ML LIQD 0.00772 08/27/2010 08/25/2010

Acetaminophen Liquid 167 MG/5ML LIQD 0.01930 04/28/2005 08/09/2005

Acetaminophen Soln 100 MG/ML SOLN 0.04507 04/24/2009 04/13/2009

Acetaminophen Soln 160 MG/5ML SOLN 0.01230 03/13/2008 02/22/2012

Acetaminophen Suppos 120 MG SUPP 0.25480 12/25/2009 12/16/2009



Acetaminophen Susp 160 MG/5ML SUSP 0.01509 03/25/2011 03/21/2011

Acetaminophen Susp 80 MG/0.8ML SUSP 0.02060 04/28/2005 04/25/2005

Acetaminophen Susp 80 MG/0.8ML SUSP 0.04507 04/24/2009 04/13/2009

Acetaminophen Tab 325 MG TABS 0.00686 08/27/2010 08/25/2010

Acetaminophen Tab 500 MG TABS 0.01092 01/13/2012 01/09/2012

Acetaminophen Tab CR 650 MG TBCR 0.05936 03/13/2008 03/05/2008

Acetaminophen w/ Codeine Soln 120-12 MG/5ML SOLN 0.01600 04/15/2002 02/22/2012

Acetaminophen w/ Codeine Tab 300-15 MG TABS 0.15000 01/22/2002 02/22/2012



Acetaminophen-Isometheptene-Dichloral Cap 325-65-100

MG

CAPS 0.98020 10/14/2011 10/12/2011

Acetazolamide Cap SR 12HR 500 MG CP12 3.28094 02/10/2012 02/09/2012

Acetazolamide Tab 125 MG TABS 0.41000 02/07/2012 03/06/2012

Acetazolamide Tab 250 MG TABS 0.42000 06/13/2011 08/16/2011

Acetic Acid 2% in Aluminum Acetate Otic Soln SOLN 0.09490 08/27/2010 08/25/2010

Acetic Acid Otic Soln 2% SOLN 1.55420 11/27/2010 11/16/2010

Acetylcysteine Inhal Soln 10% SOLN 0.20540 04/24/2009 04/13/2009

Acetylcysteine Inhal Soln 20% SOLN 0.24093 05/28/2010 05/26/2010

ACID BLOCKERS DEPLETION (Nutritional Supplement

Therapy Pack

MISC 8.07500 12/20/2006 08/05/2009

ACTEMRA (Tocilizumab IV Inj 400 MG/20ML) SOLN 68.77961 04/13/2012 04/09/2012

ACTEMRA (Tocilizumab IV Inj 80 MG/4ML) SOLN 68.77795 04/13/2012 04/09/2012

ACTHAR HP (Corticotropin Inj Gel 80 Unit/ML) GEL 4,675.00000 11/28/2009 11/19/2009

ACTI-LANCE LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACTI-LANCE LITE SAFETY LA (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ACTIQ (Fentanyl Citrate Lollipop 1200 MCG) LPOP 25.20000 01/23/2009 01/09/2009






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Effective

Date

Date

Updated

ACURA BLOOD GLUCOSE MONIT (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 09/10/2009

ACURA BLOOD GLUCOSE TEST (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ACURA PLUS BLOOD GLUCOSE (Blood Glucose Monitoring

Kit w/ De

KIT 0.71000 10/01/2003 07/28/2010

Acyclovir Cap 200 MG CAPS 0.08550 08/29/2008 07/31/2008

Acyclovir Susp 200 MG/5ML SUSP 0.20262 07/29/2011 07/12/2011

Acyclovir Tab 400 MG TABS 0.12455 07/14/2010 08/25/2010

Acyclovir Tab 800 MG TABS 0.19550 08/29/2008 07/31/2008

Adapalene Cream 0.1% CREA 5.14889 02/10/2012 02/09/2012

Adapalene Gel 0.1% GEL 2.85250 01/28/2011 01/14/2011

ADULT GROWTH HORMONE SUPP (Nutritional Supplement

Therapy Pa

MISC 8.07500 12/20/2006 08/05/2009

ADULT ONE DAILY GUMMIES (Multiple Vitamins w/ Minerals

Chew

CHEW 0.29485 03/20/2008 01/19/2011

ADVANCE INTUITION BLOOD G (Blood Glucose Monitoring

Kit w/ D

KIT 0.71000 04/23/2010 04/19/2010

ADVANCE INTUITION TEST ST (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ADVANCE MICRO-DRAW TEST S (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ADVANCED DIABETIC MULTIVI (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 08/12/2009

ADVATE (Antihemophilic Factor rAHF-PFM For Inj 1000 Unit) SOLR 1.03365 04/23/2010 04/19/2010






ADVERA (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

ADVIL (Ibuprofen Tab 200 MG) TABS 0.04570 03/20/2008 03/14/2008

ADVOCATE BLOOD GLUCOSE MO (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 03/17/2010

ADVOCATE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ADVOCATE REDI-CODE/TALKIN (Blood Glucose Monitoring

Kit w/ D

KIT 0.71000 10/01/2003 03/31/2010

ADVOCATE SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ADVOCATE TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

AF CAPSICUM OLEORESIN (Capsicum Oleoresin Cream

0.075%)

CREA 0.16320 04/28/2005 04/25/2005

AF LANCETS SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

AFINITOR (Everolimus Tab 10 MG) TABS 266.31588 04/13/2012 04/09/2012

AFINITOR (Everolimus Tab 5 MG) TABS 252.51742 04/13/2012 04/09/2012

AK-CON (Naphazoline HCl Ophth Soln 0.1%) SOLN 0.24500 04/15/2002 02/22/2012

AKWA TEARS (Artificial Tear Ophth Ointment***) OINT 0.94400 03/13/2008 03/05/2008

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Date

Date

Updated

Albuterol Sulfate Soln Nebu 0.083% (2.5 MG/3ML) NEBU 0.04911 09/24/2010 09/17/2010

Albuterol Sulfate Soln Nebu 0.5% (5 MG/ML) NEBU 0.49000 09/26/2011 11/07/2011

Albuterol Sulfate Soln Nebu 0.63 MG/3ML (Base Equiv) NEBU 0.46500 07/28/2011 08/16/2011

Albuterol Sulfate Soln Nebu 1.25 MG/3ML (Base Equiv) NEBU 0.41450 09/24/2010 09/17/2010

Albuterol Sulfate Syrup 2 MG/5ML SYRP 0.01017 09/24/2010 09/17/2010

Albuterol Sulfate Tab 2 MG TABS 0.08025 08/26/2011 08/16/2011

Albuterol Sulfate Tab 4 MG TABS 0.09376 11/11/2011 11/07/2011

Albuterol Sulfate Tab SR 12HR 4 MG TB12 0.77520 04/13/2012 04/09/2012

Alclometasone Dipropionate Cream 0.05% CREA 0.68185 12/25/2009 12/16/2009

Alclometasone Dipropionate Oint 0.05% OINT 0.68185 12/25/2009 12/16/2009

Alendronate Sodium Tab 10 MG TABS 0.16863 08/26/2011 08/16/2011





ALEVE (Naproxen Sodium Tab 220 MG) TABS 0.06800 03/20/2008 03/14/2008

ALEVE ARTHRITIS (Naproxen Sodium Tab 220 MG) TABS 0.06800 03/20/2008 07/20/2011

Alfuzosin HCl Tab SR 24HR 10 MG TB24 0.50556 02/10/2012 02/09/2012

ALIMENTUM (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 01/15/2007

ALIMENTUM (Infant Foods Powder**) POWD 0.04649 04/24/2008 07/09/2008

ALITRAQ (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 07/12/2011

ALKERAN (Melphalan Tab 2 MG) TABS 4.71440 07/30/2010 07/26/2010

Allopurinol Tab 100 MG TABS 0.02531 01/13/2012 01/09/2012

Allopurinol Tab 300 MG TABS 0.06729 02/25/2011 02/11/2011

ALOE AFTERSUN LOTION (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

ALOE VESTA 2-N-1 PROTECTI (Skin Protectants Misc -

Ointment*

OINT 0.03040 04/28/2005 09/12/2006

ALOE VESTA PROTECTIVE (Skin Protectants Misc -

Ointment***)

OINT 0.03040 04/28/2005 10/21/2009

ALOXI (Palonosetron HCl IV Soln 0.25 MG/5ML (Base

Equivalent

SOLN 73.90320 04/13/2012 04/09/2012

ALPHANATE/VON WILLEBRAND (Antihemophilic

Factor/VWF (Human)

SOLR 0.79520 12/24/2010 12/15/2010


Factor/VWF (Human)

SOLR 0.79520 12/24/2010 12/15/2010


Factor/VWF (Human)

SOLR 0.79520 12/24/2010 12/15/2010


Factor/VWF (Human)

SOLR 0.79520 12/24/2010 12/15/2010

ALPHANINE SD (Coagulation Factor IX For Inj 1000 Unit) SOLR 0.74750 12/24/2010 12/15/2010



Alprazolam Orally Disintegrating Tab 0.25 MG TBDP 1.55760 04/29/2011 04/15/2011

Alprazolam Orally Disintegrating Tab 1 MG TBDP 1.87452 12/24/2010 12/15/2010

Alprazolam Orally Disintegrating Tab 2 MG TBDP 4.19515 04/13/2012 04/09/2012

Alprazolam Tab 0.25 MG TABS 0.02956 07/23/2010 07/21/2010

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Effective

Date

Date

Updated

Alprazolam Tab 0.5 MG TABS 0.03540 10/29/2010 10/25/2010

Alprazolam Tab 1 MG TABS 0.01937 01/13/2012 01/09/2012

Alprazolam Tab 2 MG TABS 0.07527 05/27/2011 05/16/2011

Alprazolam Tab SR 24HR 0.5 MG TB24 0.36958 04/13/2012 04/09/2012

Alprazolam Tab SR 24HR 1 MG TB24 0.74000 01/06/2012 02/09/2012



ALSOY SOY FORMULA (Infant Foods Conc**) CONC 0.01190 04/28/2005 04/25/2005

ALSOY SOY FORMULA (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 01/15/2007

ALSOY SOY FORMULA (Infant Foods Powder**) POWD 0.04649 04/24/2008 07/09/2008

ALSUMA (Sumatriptan Succinate Inj 6 MG/0.5ML) SOLN 136.79400 10/29/2010 10/27/2010

Alum & Mag Hydroxide-Simethicone Susp 200-200-20

MG/5ML

LIQD 0.00420 03/13/2008 02/22/2012


MG/5ML

SUSP 0.00420 03/13/2008 02/22/2012


MG/5ML

LIQD 0.00690 03/13/2008 03/05/2008


MG/5ML

SUSP 0.00690 03/13/2008 03/05/2008

Aluminum Chloride Soln 20% SOLN 0.15656 02/25/2011 02/11/2011

Aluminum Hydroxide Gel Susp 320 MG/5ML SUSP 0.01156 03/13/2008 03/05/2008

Amantadine HCl Cap 100 MG CAPS 0.29500 08/24/2006 08/23/2006

Amantadine HCl Syrup 50 MG/5ML SYRP 0.04398 12/24/2010 12/15/2010

AMBI ESSENTIALS DAILY MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 09/29/2010

AMBI EVEN & CLEAR DAILY M (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010

AMBI SOFT & EVEN CREAMY O (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010

AMBIEN (Zolpidem Tartrate Tab 5 MG) TABS 0.13650 04/23/2010 04/19/2010

Amcinonide Cream 0.1% CREA 0.79540 08/27/2010 08/25/2010

Amiloride & Hydrochlorothiazide Tab 5-50 MG TABS 0.05525 08/26/2011 08/16/2011

Amiloride HCl Tab 5 MG TABS 0.66044 04/13/2012 04/09/2012

Amino Acids Tab*** TABS 0.41080 04/28/2005 04/25/2005

Aminocaproic Acid Inj 250 MG/ML SOLN 0.07275 11/11/2011 11/07/2011

Aminocaproic Acid Syrup 25% SYRP 0.96940 04/29/2011 04/15/2011

Amiodarone HCl Tab 200 MG TABS 0.15959 04/13/2012 04/09/2012

Amiodarone HCl Tab 400 MG TABS 2.85000 11/15/2011 12/07/2011

Amitriptyline HCl Tab 10 MG TABS 0.02007 03/25/2011 03/21/2011






AMLACTIN XL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

Amlodipine Besylate Tab 10 MG TABS 0.04348 04/29/2011 04/15/2011

Amlodipine Besylate Tab 2.5 MG TABS 0.02933 02/25/2011 02/11/2011

Amlodipine Besylate Tab 5 MG TABS 0.02663 02/25/2011 02/11/2011

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Date

Date

Updated

Amlodipine Besylate-Benazepril HCl Cap 10-20 MG CAPS 0.83300 04/13/2012 04/09/2012

Amlodipine Besylate-Benazepril HCl Cap 2.5-10 MG CAPS 1.05550 06/26/2009 06/09/2009



Amoxicillin & K Clavulanate Chew Tab 200-28.5 MG CHEW 0.22200 05/25/2006 05/19/2006

Amoxicillin & K Clavulanate Chew Tab 400-57 MG CHEW 1.11200 04/29/2011 04/15/2011

Amoxicillin & K Clavulanate For Susp 200-28.5 MG/5ML SUSR 0.11591 02/10/2012 02/09/2012


Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML SUSR 0.15025 02/10/2012 02/09/2012


Amoxicillin & K Clavulanate Tab 250-125 MG TABS 2.48000 02/23/2007 02/12/2007



Amoxicillin (Trihydrate) Cap 250 MG CAPS 0.06500 04/15/2002 02/22/2012

Amoxicillin (Trihydrate) Cap 500 MG CAPS 0.07301 08/27/2010 08/25/2010

Amoxicillin (Trihydrate) Chew Tab 125 MG CHEW 0.09000 04/15/2002 02/22/2012

Amoxicillin (Trihydrate) Chew Tab 250 MG CHEW 0.15950 01/30/2003 04/07/2004

Amoxicillin (Trihydrate) For Susp 125 MG/5ML SUSR 0.01427 08/27/2010 08/25/2010




Amoxicillin (Trihydrate) Tab 500 MG TABS 0.18070 12/09/2011 12/07/2011

Amoxicillin (Trihydrate) Tab 875 MG TABS 0.22132 04/13/2012 04/09/2012

Amphetamine-Dextroamphetamine Tab 10 MG TABS 1.06000 09/22/2011 10/12/2011

Amphetamine-Dextroamphetamine Tab 12.5 MG TABS 0.40500 06/28/2007 06/13/2007





Amphetamine-Dextroamphetamine Tab 7.5 MG TABS 0.41500 06/28/2007 06/13/2007

Ampicillin & Sulbactam Sodium For Inj 1-0.5 GM SOLR 4.84900 12/25/2009 12/16/2009

Ampicillin & Sulbactam Sodium For Inj 2-1 GM SOLR 6.39600 11/11/2011 11/07/2011

Ampicillin & Sulbactam Sodium For IV Soln 1-0.5 GM SOLR 4.84900 12/25/2009 12/16/2009

Ampicillin & Sulbactam Sodium For IV Soln 10-5 GM SOLR 46.74800 12/25/2009 12/16/2009

Ampicillin & Sulbactam Sodium For IV Soln 2-1 GM SOLR 8.00800 12/25/2009 12/16/2009

Ampicillin Cap 250 MG CAPS 0.08600 01/13/2012 01/09/2012

Ampicillin Cap 500 MG CAPS 0.14613 02/10/2012 02/09/2012

Ampicillin For Susp 125 MG/5ML SUSR 0.02030 12/07/2000 02/22/2012

Ampicillin For Susp 250 MG/5ML SUSR 0.01950 04/15/2002 02/22/2012

AMPYRA (Dalfampridine Tab SR 12HR 10 MG) TB12 17.53223 01/28/2011 01/14/2011

Anagrelide HCl Cap 0.5 MG CAPS 0.16750 01/23/2009 01/09/2009

Anagrelide HCl Cap 1 MG CAPS 0.32550 01/23/2009 01/09/2009

Anastrozole Tab 1 MG TABS 0.17680 01/13/2012 01/09/2012

ANTABUSE (Disulfiram Tab 250 MG) TABS 3.24000 03/26/2010 03/12/2010

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Date

Date

Updated

ANTIOXIDANT FORTE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008

ANTI-SEIZURE DEPLETION (Nutritional Supplement

Therapy Pack*

MISC 8.07500 12/20/2006 08/05/2009

ANTI-SEIZURE SUPPORT (Nutritional Supplement Therapy

Pack**)

MISC 8.07500 12/20/2006 08/05/2009

ANTIVERT (Meclizine HCl Tab 12.5 MG) TABS 0.02920 04/23/2010 04/19/2010

ANTIVERT (Meclizine HCl Tab 25 MG) TABS 0.04090 04/23/2010 04/19/2010

ANTIVERT (Meclizine HCl Tab 25 MG) TABS 0.04203 03/20/2008 08/04/2010

APATATE FORTE (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 03/14/2008

APEXICON E (Diflorasone Diacetate Emollient Base Cream

0.05%

CREA 1.35900 09/27/2007 09/21/2007

AQUA LACTEN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

AQUADEKS (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 11/24/2010

AQUADERM TREATMENT/MOISTU (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

AQUAMED (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

AQUAPHILIC (Emollient - Ointment**) OINT 0.04583 03/13/2008 03/05/2008

AQUAPHOR (Emollient - Ointment**) OINT 0.04583 03/13/2008 03/05/2008

AQUAPHOR ADVANCED THERAPY (Emollient - Ointment**) OINT 0.04583 03/13/2008 09/21/2011

AQUAPHOR LIP REPAIR (Skin Protectants Misc -

Ointment***)

OINT 0.03040 04/28/2005 02/15/2012

ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV

Soln

SOLR 0.43160 01/28/2011 01/14/2011


Soln

SOLR 0.42330 07/30/2010 07/26/2010


Soln

SOLR 0.43160 01/28/2011 01/14/2011


Soln

SOLR 0.43160 07/30/2010 07/26/2010

ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate

80 Soln I

SOLN 1,192.41120 04/13/2012 04/09/2012


80 Soln I

SOLN 596.20560 04/13/2012 04/09/2012


80 Soln I

SOLN 2,981.02800 04/13/2012 04/09/2012


80 Soln I

SOLN 1,192.41120 04/13/2012 04/09/2012


80 Soln I

SOLN 2,981.02800 04/13/2012 04/09/2012


80 Soln I

SOLN 1,192.41120 04/13/2012 04/09/2012


80 Soln I

SOLN 354.88429 04/13/2012 04/09/2012


80 Soln I

SOLN 149.05140 04/13/2012 04/09/2012


80 Soln I

SOLN 2,981.02800 04/13/2012 04/09/2012


80 Soln I

SOLN 1,788.61680 04/13/2012 04/09/2012

Page 7 of 1134/17/2012


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Date

Date

Updated


80 Soln I

SOLN 596.23050 04/13/2012 04/09/2012


80 Soln I

SOLN 238.49220 04/13/2012 04/09/2012


80 Soln I

SOLN 2,981.02800 04/13/2012 04/09/2012


80 Soln I

SOLN 1,192.37800 04/13/2012 04/09/2012


80 Soln I

SOLN 357.71340 04/13/2012 04/09/2012

ARIXTRA (Fondaparinux Sodium Inj 2.5 MG/0.5ML) SOLN 100.80350 04/13/2012 04/09/2012

Artificial Tear Ophth Ointment*** OINT 0.94400 03/13/2008 03/05/2008

Artificial Tear Ophth Solution*** SOLN 0.23859 03/13/2008 03/05/2008

ASCENSIA AUTODISC TEST ST (Glucose Blood Test Disk) DISK 0.74500 11/22/2007 11/15/2007

Ascorbic Acid Cap CR 500 MG CPCR 0.01400 01/01/1988 02/22/2012

Ascorbic Acid Chew Tab 250 MG CHEW 0.02545 03/13/2008 03/05/2008



Ascorbic Acid Syrup 500 MG/5ML SYRP 0.03598 09/22/2011 10/12/2011

Ascorbic Acid Tab 1000 MG TABS 0.04950 03/13/2008 03/05/2008



Ascorbic Acid Tab CR 1000 MG TBCR 0.04950 03/13/2008 03/05/2008

Ascorbic Acid Tab CR 500 MG TBCR 0.01400 01/01/1988 02/22/2012

A-SOY (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

ASPERCREME/ALOE (Trolamine Salicylate Cream 10%) CREA 0.04250 04/28/2005 04/25/2005

Aspirin Buffered (Ca Carb-Mg Carb-Mg Ox) Tab 325 MG TABS 0.01833 08/27/2010 08/25/2010

Aspirin Chew Tab 81 MG CHEW 0.03650 08/29/2008 07/31/2008

Aspirin Tab 81 MG TABS 0.01655 08/29/2008 07/31/2008

Aspirin Tab Delayed Release 325 MG TBEC 0.01920 03/13/2008 03/05/2008

Aspirin Tab Delayed Release 81 MG TBEC 0.00780 11/27/2010 11/16/2010

Aspirin-Acetaminophen-Caffeine Tab 250-250-65 MG TABS 0.02925 12/24/2010 12/15/2010

ASSURE 3 TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ASSURE 4 TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ASSURE HAEMOLANCE PLUS HI (Lancets***) MISC 0.08772 06/17/2011 03/07/2012

ASSURE HAEMOLANCE PLUS LO (Lancets***) MISC 0.08772 06/17/2011 03/07/2012

ASSURE HAEMOLANCE PLUS MI (Lancets***) MISC 0.08772 06/17/2011 03/07/2012

ASSURE HAEMOLANCE PLUS NO (Lancets***) MISC 0.08772 06/17/2011 03/07/2012

ASSURE HAEMOLANCE PLUS PE (Lancets***) MISC 0.08772 06/17/2011 03/07/2012

ASSURE II (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ASSURE II CHECK STRIP (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ASSURE II TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

ASSURE LANCE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

ASSURE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

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Date

Date

Updated

ASSURE PLATINUM TEST STRI (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

ASSURE PRO TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

AT LAST LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

AT LAST TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

Atenolol & Chlorthalidone Tab 100-25 MG TABS 0.11700 04/13/2012 04/09/2012

Atenolol & Chlorthalidone Tab 50-25 MG TABS 0.06438 12/09/2011 12/07/2011

Atenolol Tab 100 MG TABS 0.03289 02/25/2011 02/11/2011



Atorvastatin Calcium Tab 10 MG (Base Equivalent) TABS 2.65000 01/13/2012 01/09/2012




Atropine Sulfate Ophth Soln 1% SOLN 2.79717 07/29/2011 07/12/2011

Attapulgite Liq 750 MG/15ML LIQD 0.01200 04/28/2005 04/25/2005

AURORA HEALTHCARE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

AURORA LANCET SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

AURORA LANCET THIN 23G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

AVEENO CONTINUOUS RADIANC (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010

AVEENO DAILY FIRMING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 11/24/2010

AVEENO DAILY MOISTURIZING (Dimethicone Lotion 1.3%) LOTN 0.01940 03/13/2008 03/05/2008

AVEENO DAILY MOISTURIZING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010

AVEENO POSITIVELY AGELESS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 04/21/2010

AVEENO POSITIVELY RADIANT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 04/21/2010

AVEENO POSITIVELY SMOOTH (Emollient - Lotion**) LOTN 0.01940 03/13/2008 11/24/2010

AVEENO STRESS RELIEF MOIS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 04/21/2010

AVONEX (Interferon Beta-1a For IM Inj Kit 30MCG

(33MCG(6.6 M

KIT 719.11200 01/28/2011 01/14/2011

AVONEX (Interferon Beta-1a IM Inj Kit 30 MCG/0.5ML) KIT 762.43800 06/20/2011 08/16/2011

AVONEX PEN (Interferon Beta-1a IM Inj Kit 30

MCG/0.5ML)

KIT 762.43800 06/20/2011 04/04/2012

Azathioprine Tab 50 MG TABS 0.15419 08/26/2011 08/16/2011

Azelastine HCl Nasal Spray 137 MCG/SPRAY (1 MG/ML) SOLN 0.76350 04/29/2011 04/15/2011

Azelastine HCl Ophth Soln 0.05% SOLN 11.28465 10/29/2010 10/25/2010

Azithromycin For Susp 100 MG/5ML SUSR 0.91256 04/29/2011 04/15/2011

Azithromycin For Susp 200 MG/5ML SUSR 0.66085 08/26/2011 08/16/2011

Azithromycin IV For Soln 500 MG SOLR 9.47700 12/25/2009 12/16/2009

Azithromycin Tab 250 MG TABS 0.70523 11/27/2010 11/16/2010



BABYS ONLY ORGANIC/DAIRY (Infant Foods Powder**) POWD 0.04649 04/24/2008 06/16/2010

BABYS ONLY ORGANIC/LACTOS (Infant Foods Powder**) POWD 0.04649 04/24/2008 06/16/2010

BABYS ONLY ORGANIC/SOY (Infant Foods Powder**) POWD 0.04649 04/24/2008 06/16/2010

BACIGUENT (Bacitracin Oint 500 Unit/GM) OINT 0.08300 03/13/2008 03/05/2008

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Date

Date

Updated

Bacitracin Oint 500 Unit/GM OINT 0.08300 03/13/2008 03/05/2008

Bacitracin Ophth Oint 500 Unit/GM OINT 4.05910 05/28/2010 05/26/2010

Bacitracin Zinc Oint 500 Unit/GM OINT 0.08300 03/13/2008 03/05/2008

Bacitracin-Polymyxin B Oint*** OINT 0.15070 12/01/1993 02/22/2012

Bacitracin-Polymyxin B Ophth Oint OINT 4.07320 03/04/2011 04/15/2011

Bacitracin-Polymyxin-Neomycin-HC Ophth Oint 1% OINT 2.44285 05/28/2010 05/26/2010

Baclofen Powder POWD 2.37120 05/28/2010 05/26/2010

Baclofen Tab 10 MG TABS 0.05235 02/25/2011 02/11/2011

Baclofen Tab 20 MG TABS 0.06760 01/13/2012 01/09/2012

BACMIN (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008

Balsalazide Disodium Cap 750 MG CAPS 0.27818 08/26/2011 08/16/2011

BARACLUDE (Entecavir Oral Soln 0.05 MG/ML) SOLN 2.84567 04/13/2012 04/09/2012

BARACLUDE (Entecavir Tab 0.5 MG) TABS 28.45738 04/13/2012 04/09/2012

BARACLUDE (Entecavir Tab 1 MG) TABS 28.45738 04/13/2012 04/09/2012

BASIC AM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 08/05/2009

BASIC PM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 08/05/2009

BAYER BREEZE 2 BLOOD GLUC (Blood Glucose Monitoring

Kit w/ D

KIT 0.71000 04/23/2010 04/19/2010

BAYER CONTOUR BLOOD GLUCO (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 08/20/2008

BAYER CONTOUR BLOOD GLUCO (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

BAYER MICROLET LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

BCAD 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011

BCAD 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011

B-Complex Vitamin Cap** CAPS 0.03890 03/13/2008 03/05/2008

B-Complex Vitamin Tab CR** TBCR 0.02250 01/01/1988 02/22/2012

B-Complex Vitamin Tab** TABS 0.03270 03/13/2008 03/05/2008

B-Complex w/ C & E + Zn Tab*** TABS 0.02200 10/01/1997 02/22/2012

B-Complex w/ C & Folic Acid Cap 1 MG*** CAPS 0.16675 06/24/2011 06/14/2011

B-Complex w/ C & Folic Acid Tab 0.8 MG*** TABS 0.08400 03/13/2008 03/05/2008

B-Complex w/ C & Folic Acid Tab 1 MG*** TABS 0.12100 08/29/2008 07/31/2008

B-Complex w/ C & Folic Acid Tab*** TABS 0.02200 10/01/1997 02/22/2012

B-Complex w/ C Cap** CAPS 0.02200 01/01/1988 02/22/2012

B-Complex w/ C Tab CR** TBCR 0.02200 01/01/1988 02/22/2012

B-Complex w/ C Tab** TABS 0.02200 10/01/1997 02/22/2012

B-Complex w/ Folic Acid Tab CR** TBCR 0.02250 01/01/1988 02/22/2012

B-Complex w/ Folic Acid Tab** TABS 0.02250 01/01/1988 02/22/2012

B-Complex w/Biotin & Folic Acid Tab CR*** TBCR 0.02250 01/01/1988 02/22/2012

B-Complex w/Biotin & Folic Acid Tab*** TABS 0.02250 01/01/1988 02/22/2012

BD GLUCOSE (Glucose Chew Tab 5 GM) CHEW 0.15300 04/28/2005 04/25/2005

BD LANCET ULTRAFINE 30G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

BD LANCET ULTRAFINE 33G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

BD LATITUDE DIABETES MANA (Blood Glucose Monitoring

Kit w/ D

KIT 0.71000 10/01/2003 04/07/2004

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Date

Date

Updated

BD LOGIC BLOOD GLUCOSE MO (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 04/23/2010 04/19/2010

BD MICROTAINER LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

BD TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

BD ULTRA FINE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

BEBULIN (Factor IX Complex For Inj 200-1200 Unit) SOLR 0.94350 06/26/2009 06/01/2011

BEBULIN VH (Factor IX Complex For Inj 200-1200 Unit) SOLR 0.94350 06/26/2009 06/09/2009

BENADRYL (Diphenhydramine HCl Cap 25 MG) CAPS 0.05620 03/13/2008 03/05/2008

BENADRYL (Diphenhydramine HCl Tab 25 MG) TABS 0.05620 03/13/2008 03/05/2008

BENADRYL ALLERGY (Diphenhydramine HCl Cap 25 MG) CAPS 0.05620 03/13/2008 03/05/2008

BENADRYL ALLERGY (Diphenhydramine HCl Tab 25 MG) TABS 0.05620 03/13/2008 03/05/2008

BENADRYL ALLERGY CHILDREN (Diphenhydramine HCl

Liquid 12.5 M

LIQD 0.01872 03/13/2008 06/03/2009

BENADRYL DYE-FREE ALLERGY (Diphenhydramine HCl

Cap 25 MG)

CAPS 0.05620 03/13/2008 03/05/2008

Benazepril & Hydrochlorothiazide Tab 10-12.5 MG TABS 0.13679 08/26/2011 08/16/2011


Benazepril & Hydrochlorothiazide Tab 20-25 MG TABS 0.15431 01/13/2012 01/09/2012


Benazepril HCl Tab 10 MG TABS 0.06499 10/14/2011 10/12/2011




BENEFIX (Coagulation Factor IX (Recombinant) For Inj 1000

Un

SOLR 1.07900 01/01/2012 02/15/2012


Un

SOLR 1.07900 01/01/2012 02/15/2012


Uni

SOLR 0.83750 07/24/2009 08/17/2011


Uni

SOLR 1.07900 01/01/2012 02/15/2012

BENGAY ARTHRITIS FORMULA (Menthol-Methyl Salicylate

Cream***

CREA 0.02880 04/28/2005 04/25/2005

BENGAY GREASELESS (Menthol-Methyl Salicylate

Cream***)

CREA 0.02880 04/28/2005 04/25/2005

BENGAY ULTRA STRENGTH (Camphor-Menthol-Methyl

Salicylate Cre

CREA 0.02880 04/28/2005 04/25/2005

BENLYSTA (Belimumab For IV Soln 120 MG) SOLR 441.41060 04/13/2012 04/09/2012

BENLYSTA (Belimumab For IV Soln 400 MG) SOLR 1,471.34930 04/13/2012 04/09/2012

BENZAMYCIN (Benzoyl Peroxide-Erythromycin Gel 5-3%) GEL 0.96550 05/28/2010 05/26/2010

Benzocaine-Antipyrine Otic Soln 1.4-5.4% SOLN 0.83373 08/05/2009 09/18/2009

Benzonatate Cap 100 MG CAPS 0.12155 12/25/2009 12/16/2009

Benzonatate Cap 200 MG CAPS 0.13572 04/29/2011 04/15/2011

Benzoyl Peroxide Cream 10% CREA 0.16940 04/28/2005 01/23/2007

Benzoyl Peroxide Gel 10% GEL 0.23159 05/03/2011 06/14/2011

Benzoyl Peroxide Gel 5% GEL 0.28966 06/06/2011 08/16/2011

Benzoyl Peroxide Liq 10% LIQD 0.08642 04/13/2012 04/09/2012

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Benzoyl Peroxide Lotion 5% LOTN 0.09450 02/27/2009 02/10/2009

Benzoyl Peroxide Lotion 6% LOTN 0.21965 10/14/2011 10/12/2011

Benzoyl Peroxide Pad 3% PADS 2.59177 05/28/2010 05/26/2010

Benzoyl Peroxide Pad 6% PADS 2.59177 05/28/2010 05/26/2010

Benzoyl Peroxide-Erythromycin Gel 5-3% GEL 0.86564 02/25/2011 02/11/2011

Benztropine Mesylate Tab 0.5 MG TABS 0.04500 06/01/2002 02/22/2012

Benztropine Mesylate Tab 1 MG TABS 0.04800 04/15/2002 02/22/2012

Benztropine Mesylate Tab 2 MG TABS 0.06968 01/13/2012 01/09/2012

BETA CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

BETADINE (Povidone-Iodine Soln 10%) SOLN 0.01751 03/20/2008 03/14/2008

Betahistine Hydrochloride (Bulk) Powder POWD 4.24550 05/28/2010 05/26/2010

Betamethasone Dipropionate Augmented Cream 0.05% CREA 0.32891 02/10/2012 02/09/2012

Betamethasone Dipropionate Augmented Gel 0.05% GEL 0.12249 12/25/2009 12/16/2009

Betamethasone Dipropionate Augmented Lotion 0.05% LOTN 1.41400 09/27/2007 09/21/2007

Betamethasone Dipropionate Augmented Oint 0.05% OINT 1.81000 08/19/2011 09/15/2011

Betamethasone Dipropionate Cream 0.05% CREA 1.33000 06/17/2011 07/12/2011

Betamethasone Dipropionate Lotion 0.05% LOTN 0.14370 01/22/2002 02/22/2012

Betamethasone Dipropionate Oint 0.05% OINT 1.59400 12/20/2010 02/11/2011

Betamethasone Valerate Cream 0.1% CREA 0.11970 03/07/2011 04/15/2011

Betamethasone Valerate Lotion 0.1% LOTN 0.06450 01/23/2009 01/09/2009

Betamethasone Valerate Oint 0.1% OINT 0.88000 06/21/2011 07/12/2011

BETASERON (Interferon Beta-1b For Inj 0.3 MG) SOLR 204.09463 01/28/2011 01/14/2011

Betaxolol HCl Tab 10 MG TABS 1.06331 04/29/2011 04/15/2011

Bethanechol Chloride Tab 10 MG TABS 0.16601 12/25/2009 12/16/2009




Bicalutamide Tab 50 MG TABS 0.48566 02/10/2012 02/09/2012

Bioflavonoid Products Tab** TABS 0.01400 01/01/1988 02/22/2012

BIOSCANNER GLUCOSE TEST S (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

BIOSUPP (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 11/04/2009

BIOTECT PLUS (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 11/04/2009

Biotin Tab 5 MG TABS 0.23360 04/28/2005 04/25/2005

Bisacodyl Suppos 10 MG SUPP 0.19380 03/13/2008 03/05/2008

Bisacodyl Tab Delayed Release 5 MG TBEC 0.04600 03/13/2008 03/05/2008

Bismuth Subsalicylate Chew Tab 262 MG CHEW 0.06830 03/13/2008 03/05/2008

Bismuth Subsalicylate Susp 262 MG/15ML SUSP 0.00915 03/13/2008 03/05/2008

Bismuth Subsalicylate Susp 525 MG/15ML SUSP 0.01640 04/28/2005 04/25/2005

Bismuth Subsalicylate Tab 262 MG TABS 0.06450 03/13/2008 03/05/2008

Bisoprolol & Hydrochlorothiazide Tab 10-6.25 MG TABS 0.06619 08/26/2011 08/16/2011

Bisoprolol & Hydrochlorothiazide Tab 2.5-6.25 MG TABS 0.06188 02/25/2011 02/11/2011

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Updated

Bisoprolol & Hydrochlorothiazide Tab 5-6.25 MG TABS 0.05530 08/26/2011 08/16/2011

Bisoprolol Fumarate Tab 10 MG TABS 0.67125 04/13/2012 04/09/2012

Bisoprolol Fumarate Tab 5 MG TABS 0.61936 02/10/2012 02/09/2012

BL TEST STRIP (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

Blood Glucose Monitoring Kit w/ Device*** KIT 0.71000 10/01/2003 04/07/2004

BLUE-EMU SUPER STRENGTH (Liniments & Rubs -

Cream**)

CREA 0.02880 04/28/2005 11/19/2009

BONINE (Meclizine HCl Chew Tab 25 MG) CHEW 0.06215 03/20/2008 03/14/2008

BOOST (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOOST DIABETIC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOOST GLUCOSE CONTROL (Nutritional Supplement

Liquid**)

LIQD 0.01410 04/28/2005 02/22/2012

BOOST HIGH PROTEIN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOOST KID ESSENTIALS 1.0 (Nutritional Supplement

Liquid**)

LIQD 0.01410 04/28/2005 02/22/2012

BOOST KID ESSENTIALS 1.5 (Nutritional Supplement

Liquid**)

LIQD 0.01410 04/28/2005 02/22/2012

BOOST KIDS ESSENTIALS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOOST PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOOST PUDDING (Nutritional Supplement Pudding**) PUDG 0.01090 04/28/2005 04/25/2005

BOOST SMOOTHIE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOOST VHC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOOST/BENEFIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

BOTOX (OnabotulinumtoxinA For Inj 100 Unit) SOLR 522.90000 01/28/2011 01/14/2011

BOTOX (OnabotulinumtoxinA For Inj 200 Unit) SOLR 1,045.80000 01/28/2011 01/14/2011

BOTOX COSMETIC (OnabotulinumtoxinA (Cosmetic) For Inj

100 Un

SOLR 522.90000 01/28/2011 01/14/2011

BOTOX COSMETIC (OnabotulinumtoxinA (Cosmetic) For Inj

50 Uni

SOLR 287.84400 01/28/2011 04/13/2011

BRIGHT BEGINNINGS SOY (Infant Foods Liquid**) LIQD 0.01680 04/23/2010 04/19/2010

Brimonidine Tartrate Ophth Soln 0.15% SOLN 11.94200 12/01/2010 01/14/2011

Brimonidine Tartrate Ophth Soln 0.2% SOLN 0.92981 02/10/2012 02/09/2012

Bromocriptine Mesylate Cap 5 MG CAPS 4.56105 10/14/2011 10/12/2011

Bromocriptine Mesylate Tab 2.5 MG TABS 0.92560 01/28/2011 01/14/2011

Budesonide Cap SR 24HR 3 MG CP24 14.81766 01/13/2012 01/09/2012

Budesonide Inhalation Susp 0.25 MG/2ML SUSP 2.30150 12/27/2008 12/08/2008

Budesonide Inhalation Susp 0.5 MG/2ML SUSP 2.70550 12/27/2008 12/08/2008

BUFFERIN (Aspirin Buffered (Ca Carb-Mg Carb-Mg Ox) Tab

325 M

TABS 0.03544 03/13/2008 03/05/2008

BUFFERIN LOW DOSE (Aspirin Buffered (Ca Carb-Mg

Carb-Mg Ox)

TABS 0.02030 03/13/2008 04/07/2010

BULLSEYE MINI SAFETY LANC (Lancets***) MISC 0.08772 06/17/2011 11/30/2011

BULLSEYE SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

Bumetanide Tab 0.5 MG TABS 0.12500 04/15/2002 02/22/2012

Bumetanide Tab 1 MG TABS 0.12857 02/25/2011 02/11/2011

Bumetanide Tab 2 MG TABS 0.16532 01/28/2011 01/14/2011

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Updated

BUPHENYL (Sodium Phenylbutyrate Oral Powder***) POWD 15.11688 08/15/2011 08/16/2011

BUPHENYL (Sodium Phenylbutyrate Tab 500 MG) TABS 6.45250 11/28/2009 11/19/2009

Bupivacaine HCl Inj 0.25% SOLN 0.05460 12/25/2009 12/16/2009

Bupivacaine HCl Inj 0.5% SOLN 0.06370 12/25/2009 12/16/2009

Bupivacaine HCl Preservative Free (PF) Inj 0.25% SOLN 0.05460 12/25/2009 12/16/2009

Bupivacaine HCl Preservative Free (PF) Inj 0.5% SOLN 0.06370 12/25/2009 12/16/2009

Buprenorphine HCl Inj 0.3 MG/ML (Base Equiv) SOLN 3.21100 05/27/2011 05/16/2011

Buprenorphine HCl SL Tab 2 MG (Base Equiv) SUBL 1.56833 04/13/2012 04/09/2012

Buprenorphine HCl SL Tab 8 MG (Base Equiv) SUBL 2.71490 04/29/2011 04/15/2011

Bupropion HCl (Smoking Deterrent) Tab SR 12HR 150 MG TB12 0.70180 04/29/2011 04/15/2011

Bupropion HCl Tab 100 MG TABS 0.47625 04/13/2012 04/09/2012

Bupropion HCl Tab 75 MG TABS 0.41000 01/27/2012 02/09/2012

Bupropion HCl Tab SR 12HR 100 MG TB12 0.41243 07/29/2011 07/12/2011





Buspirone HCl Tab 10 MG TABS 0.04931 02/25/2011 02/11/2011




Buspirone HCl Tab 7.5 MG TABS 0.60000 08/12/2004 09/16/2004

Butalbital-Acetaminophen Tab 50-325 MG TABS 0.33423 03/25/2011 03/21/2011

Butalbital-Acetaminophen-Caff w/ COD Cap 50-325-40-30

MG

CAPS 0.11400 03/27/2008 03/20/2008

Butalbital-Acetaminophen-Caffeine Cap 50-325-40 MG CAPS 0.26900 08/24/2006 08/23/2006

Butalbital-Acetaminophen-Caffeine Tab 50-325-40 MG TABS 0.05696 12/09/2011 12/07/2011

Butalbital-Acetaminophen-Caffeine Tab 50-500-40 MG TABS 0.09165 01/13/2012 01/09/2012

Butalbital-Aspirin-Caff w/ Codeine Cap 50-325-40-30 MG CAPS 0.70400 03/27/2008 03/20/2008

Butalbital-Aspirin-Caffeine Cap 50-325-40 MG CAPS 0.35600 08/24/2006 08/23/2006

Butalbital-Aspirin-Caffeine Tab 50-325-40 MG TABS 0.10969 07/29/2011 07/12/2011

Butorphanol Tartrate Nasal Soln 10 MG/ML SOLN 7.03500 07/29/2011 07/12/2011

Cabergoline Tab 0.5 MG TABS 14.12370 06/10/2011 07/12/2011

Caffeine Citrate Inj 60 MG/3ML (10 MG/ML Base Equiv) SOLN 11.48333 06/24/2011 06/14/2011

Caffeine Citrate Oral Soln 60 MG/3ML (10 MG/ML Base

Equiv)

SOLN 12.70000 05/22/2008 05/12/2008

CALCILO XD (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011

CALCI-MIX (Calcium Carbonate Cap 1250 MG (500 MG

Elemental C

CAPS 0.11650 04/28/2005 03/18/2009

Calcipotriene Soln 0.005% (50 MCG/ML) SOLN 2.25312 02/10/2012 02/09/2012

Calcitonin (Salmon) Nasal Soln 200 Unit/ACT SOLN 13.82000 09/27/2007 12/17/2008

Calcitriol Cap 0.25 MCG CAPS 0.69995 01/29/2010 01/22/2010

Calcitriol Cap 0.5 MCG CAPS 1.28500 03/20/2012 04/09/2012

Calcitriol Oral Soln 1 MCG/ML SOLN 8.46208 07/29/2011 07/12/2011

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Updated

Calcium Acetate (Phosphate Binder) Cap 667 MG (169 MG

Ca)

CAPS 0.59118 01/13/2012 01/09/2012

Calcium Carbonate (Antacid) Chew Tab 420 MG CHEW 0.02500 06/01/2002 02/22/2012



Calcium Carbonate (Antacid) Tab 648 MG TABS 0.00640 04/28/2005 04/25/2005

Calcium Carbonate (Antacid) Tab 648 MG TABS 0.01613 03/13/2008 03/05/2008

Calcium Carbonate Chew Tab 1250 MG (500 MG Elemental

Ca)

CHEW 0.06222 03/13/2008 03/05/2008

Calcium Carbonate Susp 1250 MG/5ML (500 MG/5ML

Elemental Ca)

SUSP 0.01800 03/13/2008 03/05/2008

Calcium Carbonate Tab 1250 MG (500 MG Elemental Ca) TABS 0.07990 05/02/2008 06/16/2008

Calcium Carbonate Tab 1500 MG (600 MG Elemental Ca) TABS 0.05700 03/13/2008 03/05/2008

Calcium Carbonate Tab 600 MG TABS 0.05700 03/13/2008 02/22/2012

Calcium Carbonate-Cholecalciferol Tab 250 MG-250 Unit TABS 0.02833 03/13/2008 03/05/2008







Calcium Carbonate-Ergocalciferol Tab 500MG-200 Unit TABS 0.02087 03/13/2008 03/05/2008

Calcium Carbonate-Vitamin D Tab 250 MG-125 Unit TABS 0.03500 03/13/2008 03/05/2008








Calcium Carb-Vit D w/ Minerals Chew Tab 600 MG-400

Unit***

CHEW 0.09205 03/13/2008 11/12/2008

Calcium Carb-Vit D w/ Minerals Tabs 600 MG-200 Unit*** TABS 0.07814 03/13/2008 03/05/2008

Calcium Carb-Vit D w/ Minerals Tabs 600 MG-400 Unit*** TABS 0.09205 03/13/2008 03/05/2008

Calcium Citrate Malate-Cholecalciferol Tab 250 MG-100 Unit TABS 0.02833 03/13/2008 03/05/2008

Calcium Citrate Tab 950 MG (200 MG Elemental Ca) TABS 0.03450 03/13/2008 03/05/2008

Calcium Citrate-Vitamin D Tab 200 MG-125 Unit (Elemental

Ca)

TABS 0.03450 03/13/2008 03/05/2008


Ca)

TABS 0.05485 03/13/2008 03/05/2008


Ca)

TABS 0.07597 03/13/2008 03/05/2008


Ca)

TABS 0.07597 03/13/2008 03/05/2008

Calcium Gluconate Tab 500 MG TABS 0.15000 09/13/2004 05/15/2007

Calcium Gluconate Tab 650 MG TABS 0.01580 04/28/2005 04/25/2005

Page 15 of 1134/17/2012


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Effective

Date

Date

Updated

Calcium Lactate Tab 650 MG TABS 0.02630 04/28/2005 04/25/2005

Calcium Polycarbophil Tab 625 MG TABS 0.09185 03/13/2008 03/05/2008

Calcium Tab 600 MG TABS 0.02500 01/01/1988 02/22/2012

Calcium w/ Vitamin D & K Chew Tab 500 MG-100 Unit-40

MCG

CHEW 0.08476 03/13/2008 03/05/2008

Calcium w/ Vitamin D Tab 600 MG-200 Unit TABS 0.04283 03/13/2008 03/05/2008

CAL-DAY 1000 (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 10/21/2009

CALTRATE 600+D PLUS (Calcium Carb-Vit D w/ Minerals

Chew Tab

CHEW 0.09210 05/28/2010 05/26/2010

CALTRATE 600+D PLUS (Calcium Carb-Vit D w/ Minerals

Tabs 600

TABS 0.09205 03/13/2008 03/05/2008

CAM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

CAMINO PRO 15 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

CAMINO PRO 15 BETTERMILK (Nutritional Supplement

Pack**)

PACK 9.02000 06/15/2011 07/12/2011

CAMINO-PRO RESTORE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

Camphor & Menthol Lotion 0.5-0.5% LOTN 0.03110 04/28/2005 04/25/2005

Camphor-Menthol-Methyl Salicylate Cream 4-10-30% CREA 0.02880 04/28/2005 04/25/2005

Capsaicin Cream 0.025% CREA 0.10050 03/13/2008 03/05/2008

Capsaicin Cream 0.075% CREA 0.06771 02/10/2012 02/09/2012

Capsicum Oleoresin Cream 0.025% CREA 0.10050 04/28/2005 03/05/2008

Captopril & Hydrochlorothiazide Tab 25-25 MG TABS 0.06521 01/28/2011 01/14/2011

Captopril & Hydrochlorothiazide Tab 50-25 MG TABS 0.32084 08/27/2010 08/25/2010

Captopril Tab 100 MG TABS 0.07163 01/13/2012 01/09/2012

Captopril Tab 12.5 MG TABS 0.01346 08/27/2010 08/25/2010



CAPZASIN-P (Capsaicin Cream 0.035%) CREA 0.18740 04/28/2005 04/25/2005

Carbamazepine Cap SR 12HR 200 MG CP12 1.54365 02/10/2012 02/09/2012

Carbamazepine Cap SR 12HR 300 MG CP12 1.48000 04/13/2012 04/09/2012

Carbamazepine Chew Tab 100 MG CHEW 0.07241 08/27/2010 08/25/2010

Carbamazepine Susp 100 MG/5ML SUSP 0.12949 06/27/2011 07/12/2011

Carbamazepine Tab 200 MG TABS 0.04144 08/27/2010 08/25/2010

Carbamazepine Tab SR 12HR 200 MG TB12 0.75575 01/29/2010 01/22/2010

Carbamazepine Tab SR 12HR 400 MG TB12 1.47230 03/28/2011 04/15/2011

Carbamide Peroxide 6.5% Otic Soln SOLN 0.09967 01/28/2011 01/14/2011

Carbidopa & Levodopa Orally Disintegrating Tab 25-100 MG TBDP 1.14127 10/14/2011 10/12/2011

Carbidopa & Levodopa Tab 10-100 MG TABS 0.18780 01/28/2011 01/14/2011



Carbidopa & Levodopa Tab CR 25-100 MG TBCR 0.22750 01/13/2012 01/09/2012

Carbidopa & Levodopa Tab CR 50-200 MG TBCR 0.31025 01/13/2012 01/09/2012

Carboplatin IV Soln 150 MG/15ML SOLN 1.20553 12/25/2009 12/16/2009



Page 16 of 1134/17/2012


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Effective

Date

Date

Updated


Carboxymethylcellulose Sodium Ophth Soln 0.5% SOLN 0.48950 07/06/2011 09/15/2011

CARDENZ (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 03/14/2008

CAREONE LANCET THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CAREONE LANCET ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

Carisoprodol Tab 350 MG TABS 0.05785 12/25/2009 12/16/2009

Carisoprodol w/ Aspirin Tab 200-325 MG TABS 0.31000 04/15/2002 02/22/2012

CARMOL 20 (Urea Cream 20%) CREA 0.08452 03/20/2008 03/14/2008

CARNATION INSTANT BREAKFA (Nutritional Supplement

Liquid**)

LIQD 0.01410 04/28/2005 02/22/2012

CAROMEGA (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008

CARRINGTON ORAL WOUND RIN (Oral Wound Care

Products - For So

SOLR 0.10360 04/28/2005 04/25/2005

Carteolol HCl Ophth Soln 1% SOLN 1.65667 12/09/2011 12/07/2011

Carvedilol Tab 12.5 MG TABS 0.04859 08/27/2010 08/25/2010

Carvedilol Tab 25 MG TABS 0.05453 08/27/2010 08/25/2010



CAVAN PRENATAL/EC CALCIUM (Prenatal w/o A Vit w/ Fe

Fumarate

TBEC 0.18187 01/23/2009 07/08/2009

CAYSTON (Aztreonam Lysine For Inhal Soln 75 MG (Base

Equival

SOLR 52.49157 01/28/2011 01/14/2011

CEENU (Lomustine Cap 10 MG) CAPS 8.78721 04/13/2012 04/09/2012

CEENU (Lomustine Cap 40 MG) CAPS 26.46165 04/13/2012 04/09/2012

Cefaclor Cap 250 MG CAPS 0.36000 10/31/2005 10/28/2005

Cefaclor Cap 500 MG CAPS 0.56000 10/31/2005 10/28/2005

Cefadroxil Cap 500 MG CAPS 0.18125 04/13/2012 04/09/2012

Cefadroxil For Susp 250 MG/5ML SUSR 0.40300 12/09/2011 12/07/2011

Cefadroxil For Susp 500 MG/5ML SUSR 0.69720 03/27/2008 03/20/2008

Cefadroxil Tab 1 GM TABS 3.15000 07/07/2003 02/06/2007

Cefazolin Sodium For Inj 1 GM SOLR 0.92300 10/14/2011 10/12/2011

Cefazolin Sodium For Inj 10 GM SOLR 10.20500 12/25/2009 12/16/2009

Cefazolin Sodium For IV Soln 1 GM SOLR 1.36500 12/25/2009 12/16/2009

Cefdinir Cap 300 MG CAPS 1.95000 10/12/2011 11/07/2011

Cefdinir For Susp 125 MG/5ML SUSR 0.30207 10/14/2011 10/12/2011

Cefdinir For Susp 250 MG/5ML SUSR 0.48738 04/13/2012 04/09/2012

Cefepime HCl For Inj 1 GM SOLR 7.91570 05/28/2010 05/26/2010

Cefepime HCl For Inj 2 GM SOLR 13.10920 09/24/2010 09/17/2010

Cefpodoxime Proxetil For Susp 100 MG/5ML SUSR 0.81757 03/26/2010 03/12/2010

Cefpodoxime Proxetil For Susp 50 MG/5ML SUSR 0.47995 10/23/2009 10/16/2009

Cefpodoxime Proxetil Tab 100 MG TABS 4.14000 08/03/2011 09/15/2011

Cefpodoxime Proxetil Tab 200 MG TABS 5.30000 02/08/2012 03/06/2012

Cefprozil For Susp 125 MG/5ML SUSR 0.13572 06/24/2011 06/14/2011

Cefprozil For Susp 250 MG/5ML SUSR 0.56500 12/27/2011 02/15/2012

Cefprozil Tab 250 MG TABS 1.09500 07/29/2011 07/12/2011

Page 17 of 1134/17/2012


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Effective

Date

Date

Updated

Cefprozil Tab 500 MG TABS 1.56231 01/28/2011 01/14/2011

Ceftazidime For Inj 1 GM SOLR 4.95300 05/28/2010 05/26/2010



Ceftazidime For IV Soln 1 GM SOLR 5.23900 12/25/2009 12/16/2009

Ceftazidime For IV Soln 2 GM SOLR 13.67600 12/25/2009 12/16/2009

Ceftriaxone Sodium For Inj 1 GM SOLR 2.55450 09/24/2010 09/17/2010



Ceftriaxone Sodium For Inj 250 MG SOLR 1.65450 09/24/2010 09/17/2010

Ceftriaxone Sodium For Inj 500 MG SOLR 1.71600 08/27/2010 08/25/2010

Ceftriaxone Sodium For IV Soln 1 GM SOLR 4.14500 09/24/2010 09/17/2010

Ceftriaxone Sodium For IV Soln 2 GM SOLR 4.88800 12/25/2009 12/16/2009

Cefuroxime Axetil Tab 250 MG TABS 0.30215 07/29/2011 07/12/2011

Cefuroxime Axetil Tab 500 MG TABS 0.50050 04/13/2012 04/09/2012

CELLCEPT (Mycophenolate Mofetil Cap 250 MG) CAPS 5.04016 04/13/2012 04/09/2012

CELLCEPT (Mycophenolate Mofetil For Oral Susp 200

MG/ML)

SUSR 5.19045 04/13/2012 04/09/2012

CELLUVISC (Carboxymethylcellulose Sodium Ophth Soln

1%)

SOLN 0.30762 03/13/2008 03/05/2008

CENTRUM (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 03/14/2008

CENTRUM (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 07/28/2010

CENTRUM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008

CENTRUM CARDIO (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 06/17/2009

CENTRUM SILVER (Multiple Vitamins w/ Minerals Chew

Tab**)

CHEW 0.29485 03/20/2008 03/14/2008

CENTRUM SILVER (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008

CENTRUM SILVER ULTRA MENS (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 11/19/2009

CENTRUM SILVER ULTRA WOME (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 11/19/2009

CENTRUM SPECIALIST HEART (Multiple Vitamins w/

Minerals Tab*

TABS 0.07430 03/20/2008 01/11/2012

CENTRUM SPECIALIST VISION (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 01/11/2012

CENTRUM ULTRA WOMENS (Multiple Vitamins w/ Minerals

Tab**)

TABS 0.07430 03/20/2008 11/19/2009

Cephalexin Cap 250 MG CAPS 0.10500 12/27/2008 12/08/2008

Cephalexin Cap 500 MG CAPS 0.12500 12/27/2008 12/08/2008

Cephalexin For Susp 125 MG/5ML SUSR 0.03020 04/02/2001 02/22/2012

Cephalexin For Susp 250 MG/5ML SUSR 0.06266 04/29/2011 04/15/2011

CERALYTE 70 (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 03/05/2008

CERASPORT (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/18/2010

CERAVE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 05/11/2011

CERAVE AM SPF 30 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 07/08/2010

CERAVE PM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 01/20/2010

Page 18 of 1134/17/2012


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Effective

Date

Date

Updated

CERAVE SA RENEWING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 12/21/2011

CETAKLENZ (Soap & Cleansers - Liquid***) LIQD 0.01940 03/13/2008 05/28/2008

CETAPHIL DAILY ADVANCE UL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

CETAPHIL DAILY FACIAL MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

CETAPHIL GENTLE CLEANSER (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

CETAPHIL MOISTURIZING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

CETAPHIL RESTORADERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 07/14/2010

Cetirizine HCl Chew Tab 10 MG CHEW 0.57308 07/24/2009 07/17/2009

Cetirizine HCl Chew Tab 5 MG CHEW 0.57308 07/24/2009 07/17/2009

Cetirizine HCl Syrup 1 MG/ML (5 MG/5ML) SOLN 0.04100 09/22/2011 10/12/2011

Cetirizine HCl Syrup 1 MG/ML (5 MG/5ML) SYRP 0.04100 09/22/2011 10/12/2011

Cetirizine HCl Tab 10 MG TABS 0.05785 01/28/2011 01/14/2011

Cetirizine HCl Tab 5 MG TABS 0.12754 04/24/2009 04/13/2009

Cetirizine-Pseudoephedrine Tab SR 12HR 5-120 MG TB12 0.60558 08/27/2010 08/25/2010

CHAPSTICK OVERNIGHT (Skin Protectants Misc -

Ointment***)

OINT 0.03040 04/28/2005 01/13/2010

CHAPSTICK ULTRA MOISTURE (Skin Protectants Misc -

Ointment**

OINT 0.03040 04/28/2005 02/16/2011

CHAPSTICK ULTRASMOOTH FOR (Skin Protectants Misc -

Ointment*

OINT 0.03040 04/28/2005 07/28/2010

CHAPSTICK ULTRASMOOTH NOU (Skin Protectants Misc -

Ointment*

OINT 0.03040 04/28/2005 07/28/2010

CHAPSTICK ULTRASMOOTH REJ (Skin Protectants Misc -

Ointment*

OINT 0.03040 04/28/2005 07/28/2010

CHAPSTICK ULTRASMOOTH SOO (Skin Protectants Misc -

Ointment*

OINT 0.03040 04/28/2005 07/28/2010

CHEMET (Succimer Cap 100 MG) CAPS 7.13800 07/30/2010 07/26/2010

Chlordiazepoxide HCl Cap 10 MG CAPS 0.07000 04/15/2002 02/22/2012



Chlordiazepoxide-Amitriptyline Tab 10-25 MG TABS 0.94600 08/01/2003 04/07/2004

Chlorhexidine Gluconate Liquid 4% LIQD 0.01798 03/13/2008 03/05/2008

Chlorhexidine Gluconate Soln 0.12% SOLN 0.00591 02/25/2011 02/11/2011

Chloroquine Phosphate Tab 250 MG TABS 1.35637 11/11/2011 11/07/2011

Chloroquine Phosphate Tab 500 MG TABS 2.27318 08/26/2011 08/16/2011

Chlorothiazide Tab 250 MG TABS 0.11256 01/28/2011 01/14/2011

Chlorothiazide Tab 500 MG TABS 0.15000 04/03/2001 02/22/2012

Chlorpheniramine Maleate Syrup 2 MG/5ML SYRP 0.01750 03/13/2008 03/05/2008

Chlorpheniramine Maleate Tab 4 MG TABS 0.00599 08/27/2010 08/25/2010

Chlorpheniramine Maleate Tab CR 12 MG TBCR 0.36000 04/28/2005 06/09/2010

Chlorpromazine HCl Tab 10 MG TABS 0.13438 07/29/2011 07/12/2011





Chlorpropamide Tab 100 MG TABS 0.16000 04/15/2002 02/22/2012

Page 19 of 1134/17/2012


Price

Effective

Date

Date

Updated

Chlorpropamide Tab 250 MG TABS 0.34000 04/15/2002 02/22/2012

Chlorthalidone Tab 25 MG TABS 0.41000 02/23/2012 03/06/2012

Chlorthalidone Tab 50 MG TABS 0.46480 10/04/2011 10/12/2011

CHLOR-TRIMETON (Chlorpheniramine Maleate Syrup 2

MG/5ML)

SYRP 0.01750 03/13/2008 03/05/2008

CHLOR-TRIMETON (Chlorpheniramine Maleate Tab 4 MG) TABS 0.02960 03/13/2008 03/05/2008

CHLOR-TRIMETON ALLERGY (Chlorpheniramine Maleate

Tab CR 12 M

TBCR 0.36000 04/28/2005 04/25/2005

Chlorzoxazone Tab 500 MG TABS 0.04381 01/13/2012 01/09/2012

CHOICE DM (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

CHOICE DM COMPLETE FORA G (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

CHOICE DM FORA G20 TEST S (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

CHOICE DM TF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

Cholecalciferol Cap 1000 Unit CAPS 0.03550 11/28/2009 11/19/2009



Cholecalciferol Tab 1000 Unit TABS 0.03550 11/28/2009 11/19/2009

Cholecalciferol Tab 400 Unit TABS 0.03764 03/13/2008 03/05/2008

Cholestyramine Light Powder 4 GM/DOSE POWD 0.13488 07/29/2011 07/12/2011

Cholestyramine Light Powder Packets 4 GM PACK 0.76600 02/28/2008 03/05/2008

Cholestyramine Powder 4 GM/DOSE POWD 0.07414 02/10/2012 02/09/2012

Cholestyramine Powder Packets 4 GM PACK 0.88500 02/23/2007 02/12/2007

Choline & Magnesium Salicylates Tab 1000 MG TABS 0.23000 02/23/2007 02/12/2007



Chorionic Gonadotropin For Inj 10000 Unit SOLR 55.75500 04/29/2011 04/15/2011

Ciclopirox Gel 0.77% GEL 1.23750 04/13/2012 04/09/2012

Ciclopirox Olamine Cream 0.77% (Base Equiv) CREA 0.27436 07/29/2011 07/12/2011

Ciclopirox Olamine Susp 0.77% (Base Equiv) SUSP 0.72725 07/29/2011 07/12/2011

Ciclopirox Shampoo 1% SHAM 0.83328 04/13/2012 04/09/2012

Ciclopirox Solution 8% SOLN 1.02273 04/13/2012 04/09/2012

Cilostazol Tab 100 MG TABS 0.16597 01/13/2012 01/09/2012

Cilostazol Tab 50 MG TABS 0.16708 08/26/2011 08/16/2011

Cimetidine HCl Soln 300 MG/5ML SOLN 0.03677 08/26/2011 08/16/2011

Cimetidine Tab 200 MG TABS 0.06613 08/26/2011 08/16/2011




CIMZIA (Certolizumab Pegol For Inj Kit 2 X 200 MG) KIT 1,960.56790 04/13/2012 04/09/2012

CIMZIA (Certolizumab Pegol Inj Kit 2 X 200 MG/ML) KIT 1,960.56790 04/13/2012 04/09/2012

CIMZIA STARTER KIT (Certolizumab Pegol Inj Kit 6 X 200

MG/ML

KIT 5,881.71200 04/13/2012 04/09/2012

CINRYZE (C1 Esterase Inhibitor (Human) For IV Inj 500 Unit) SOLR 2,076.51060 01/28/2011 01/14/2011

Page 20 of 1134/17/2012


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Effective

Date

Date

Updated

Ciprofloxacin 400 MG/200ML in D5W SOLN 0.01428 01/13/2012 01/09/2012

Ciprofloxacin HCl Ophth Soln 0.3% SOLN 0.88205 03/25/2011 03/21/2011

Ciprofloxacin HCl Tab 100 MG (Base Equiv) TABS 0.44600 04/26/2007 04/19/2007




Citalopram Hydrobromide Oral Soln 10 MG/5ML SOLN 0.15841 08/26/2011 08/16/2011

Citalopram Hydrobromide Tab 10 MG (Base Equiv) TABS 0.03042 01/13/2012 01/09/2012



CITRUCEL (Methylcellulose Tab 500 MG) TABS 0.10545 03/20/2008 03/14/2008

CITRUCEL CLEAR-MIX (Methylcellulose Powder Laxative) POWD 0.02291 07/28/2011 10/12/2011

CITRUCEL FIBER LAXATIVE (Methylcellulose Powder

Laxative)

POWD 0.02291 07/28/2011 10/12/2011

CITRUCEL FIBERSHAKE (Methylcellulose Powder Laxative) POWD 0.02291 07/28/2011 10/12/2011

Clarithromycin For Susp 125 MG/5ML SUSR 0.30100 07/29/2011 07/12/2011

Clarithromycin For Susp 250 MG/5ML SUSR 0.55665 08/27/2010 08/25/2010

Clarithromycin Tab 250 MG TABS 0.38526 01/28/2011 01/14/2011

Clarithromycin Tab 500 MG TABS 3.98000 10/13/2011 11/07/2011

Clarithromycin Tab SR 24HR 500 MG TB24 2.50200 01/28/2011 01/14/2011

CLARITIN (Loratadine Syrup 5 MG/5ML) SYRP 0.03850 04/23/2010 04/19/2010

CLARITIN (Loratadine Tab 10 MG) TABS 0.10500 05/28/2010 05/26/2010

CLARITIN (Loratadine Tab 10 MG) TABS 0.27350 03/20/2008 03/28/2012

CLARITIN REDITABS (Loratadine Rapidly-Disintegrating Tab

10

TBDP 0.10500 04/23/2010 04/19/2010

CLEAN & CLEAR MORNING BUR (Emollient - Lotion**) LOTN 0.01940 03/13/2008 05/05/2010

CLEAN & CLEAR SOFT MOISTU (Emollient - Lotion**) LOTN 0.01940 03/13/2008 11/24/2010

CLEANLET LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CLEAR EYES REDNESS RELIEF (Naphazoline-Glycerin

Ophth Soln 0

SOLN 0.17790 04/28/2005 04/25/2005

Clemastine Fumarate Syrup 0.67 MG/5ML (0.5 MG/5ML Base

Eq)

SYRP 0.04950 01/28/2011 01/14/2011

Clemastine Fumarate Tab 1.34 MG (1 MG Base Equiv) TABS 0.14420 03/13/2008 03/05/2008

Clemastine Fumarate Tab 2.68 MG TABS 0.22800 03/27/2008 03/20/2008

CLEVER CHEK AUTO CODE VOI (Blood Glucose Monitoring

Devices*

DEVI 0.71000 10/01/2003 02/12/2008

CLEVER CHEK AUTO-CODE BLO (Blood Glucose

Monitoring Devices*

DEVI 0.71000 10/01/2003 09/17/2008

CLEVER CHEK AUTO-CODE TES (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

CLEVER CHEK AUTO-CODE VOI (Blood Glucose Monitoring

Devices*

DEVI 0.71000 10/01/2003 09/17/2008

CLEVER CHEK AUTO-CODE VOI (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

CLEVER CHEK BLOOD GLUCOSE (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 09/05/2007

CLEVER CHEK LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

Page 21 of 1134/17/2012


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Effective

Date

Date

Updated

CLEVER CHEK TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

CLEVER CHOICE AUTO-CODE P (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

CLEVER CHOICE MICRO BLOOD (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 03/21/2011

CLEVER CHOICE MICRO TEST (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

Clidinium & Chlordiazepoxide Cap 2.5-5 MG CAPS 1.02700 10/14/2011 10/12/2011

Clindamycin HCl Cap 150 MG CAPS 0.09563 12/24/2010 12/15/2010



Clindamycin Phosphate Foam 1% FOAM 2.86039 07/29/2011 07/12/2011

Clindamycin Phosphate Gel 1% GEL 0.49330 08/12/2011 09/15/2011

Clindamycin Phosphate Lotion 1% LOTN 0.24592 02/10/2012 02/09/2012

Clindamycin Phosphate Soln 1% SOLN 0.15125 04/13/2012 04/09/2012

Clindamycin Phosphate Swab 1% SWAB 0.44000 10/05/2011 12/07/2011

Clindamycin Phosphate Vaginal Cream 2% CREA 0.75710 03/27/2008 03/20/2008

CLINDAREACH (Clindamycin Phosphate Swab Kit 1%) KIT 0.30900 09/27/2007 09/21/2007

CLINICAL NUTRIENTS 45-PLU (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 12/07/2011

CLINICAL NUTRIENTS 50-PLU (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 12/07/2011

CLINICAL NUTRIENTS FOR FE (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 12/07/2011

CLINICAL NUTRIENTS FOR MA (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 12/07/2011

CLINICAL NUTRIENTS FOR ME (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 12/07/2011

CLINICAL NUTRIENTS FOR WO (Multiple Vitamins w/

Minerals Tab

TABS 0.07430 03/20/2008 12/07/2011

Clobetasol Propionate Cream 0.05% CREA 0.41000 09/12/2011 10/12/2011

Clobetasol Propionate Emollient Base Cream 0.05% CREA 0.23515 08/26/2011 08/16/2011

Clobetasol Propionate Foam 0.05% FOAM 2.06150 02/10/2012 02/09/2012

Clobetasol Propionate Gel 0.05% GEL 0.32448 04/13/2012 04/09/2012

Clobetasol Propionate Oint 0.05% OINT 0.34000 02/10/2012 03/06/2012

Clobetasol Propionate Soln 0.05% SOLN 0.26500 03/02/2012 04/09/2012

Clomiphene Citrate Tab 50 MG TABS 1.72970 09/24/2010 09/17/2010

Clomipramine HCl Cap 25 MG CAPS 0.31500 12/15/2011 02/09/2012



Clonazepam Orally Disintegrating Tab 0.125 MG TBDP 0.85600 12/27/2007 12/14/2007



Clonazepam Orally Disintegrating Tab 1 MG TBDP 0.99200 12/27/2007 12/14/2007

Clonazepam Orally Disintegrating Tab 2 MG TBDP 1.35500 12/27/2007 12/14/2007

Clonazepam Tab 0.5 MG TABS 0.01801 03/25/2011 03/21/2011

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Effective

Date

Date

Updated

Clonazepam Tab 1 MG TABS 0.02930 02/25/2011 02/11/2011

Clonazepam Tab 2 MG TABS 0.04350 10/29/2010 10/25/2010

Clonidine HCl Tab 0.1 MG TABS 0.03649 04/29/2011 04/15/2011



Clonidine HCl TD Patch Weekly 0.1 MG/24HR PTWK 23.12500 01/13/2012 01/09/2012



Clorazepate Dipotassium Tab 15 MG TABS 0.15605 08/26/2011 08/16/2011

Clorazepate Dipotassium Tab 3.75 MG TABS 0.09167 11/11/2011 11/07/2011

Clorazepate Dipotassium Tab 7.5 MG TABS 0.09487 04/13/2012 04/09/2012

Clotrimazole Cream 1% CREA 0.34000 02/03/2012 03/06/2012

Clotrimazole Soln 1% SOLN 0.24959 04/13/2012 04/09/2012

Clotrimazole Troche 10 MG LOZG 0.64286 04/13/2012 04/09/2012

Clotrimazole Troche 10 MG TROC 0.64286 04/13/2012 04/09/2012

Clotrimazole Vaginal Cream 1% CREA 0.11556 01/28/2011 01/14/2011

Clotrimazole Vaginal Cream 2% CREA 0.35240 03/13/2008 03/05/2008

Clotrimazole w/ Betamethasone Cream 1-0.05% CREA 1.24511 02/10/2012 02/09/2012

Clotrimazole w/ Betamethasone Lotion 1-0.05% LOTN 0.63967 04/29/2011 04/15/2011

Clozapine Tab 100 MG TABS 1.01562 12/24/2010 12/15/2010




COAGUCHEK LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

Coal Tar Shampoo 0.5% SHAM 0.02261 03/13/2008 03/05/2008

Coenzyme Q10 Cap 100 MG CAPS 0.42075 08/14/2010 09/17/2010



Coenzyme Q10 Oral Powder POWD 0.06700 04/28/2005 04/25/2005

Coenzyme Q10 Tab 200 MG TABS 1.51270 04/28/2005 04/25/2005

Coenzyme Q10 Tab 60 MG TABS 0.39217 03/13/2008 03/05/2008

COLACE (Docusate Sodium Cap 100 MG) CAPS 0.03000 03/13/2008 03/05/2008

COLACE (Docusate Sodium Cap 50 MG) CAPS 0.07520 04/28/2005 04/25/2005

COLACE (Docusate Sodium Syrup 60 MG/15ML) SYRP 0.00521 03/13/2008 03/05/2008

Colchicine w/ Probenecid Tab 0.5-500 MG TABS 0.62623 01/13/2012 01/09/2012

Colestipol HCl Granule Packets 5 GM PACK 0.23500 11/29/2008 11/12/2008

Colestipol HCl Granules 5 GM GRAN 0.18500 11/29/2008 11/12/2008

Colestipol HCl Tab 1 GM TABS 0.52490 04/13/2012 04/09/2012

Colistimethate Sodium For Inj 150 MG SOLR 14.87200 01/13/2012 01/09/2012

COMFORT ASSURED LANCETS M (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

COMFORT ASSURED LANCETS S (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

COMFORT LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

COMPLEAT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

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Price

Effective

Date

Date

Updated

COMPLEAT CLOSED SYSTEM (Nutritional Supplement

Liquid**)

LIQD 0.01410 04/28/2005 02/22/2012

COMPLETE AMINO ACID MIX (Amino Acids Oral Powder***) POWD 0.43345 08/24/2010 09/17/2010

COMPLETENATE (Prenatal Vit w/ Fe Fumarate-FA Chew

Tab 29-1 M

CHEW 0.29950 08/29/2008 03/04/2009

COMPLEX 15 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

COMPLEX ESSENTIAL MSD (Amino Acids Oral Powder***) POWD 0.19640 04/28/2005 07/08/2008

COMPLEX JUNIOR MSD (Amino Acids Oral Powder***) POWD 0.19640 04/28/2005 06/30/2010

COMPLEX MSUD (Amino Acids Oral Powder***) POWD 0.19640 04/28/2005 04/25/2005

CO-NATAL FA (Prenatal Vit w/ Fe Fumarate-FA Tab 29-1

MG***)

TABS 0.15587 01/23/2009 01/09/2009

CONTOUR BLOOD GLUCOSE MON (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 04/08/2009

CONTOUR USB BLOOD GLUCOSE (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 10/01/2003 11/25/2009

CONTROL AST (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

CONTROL BLOOD GLUCOSE MON (Blood Glucose

Monitoring Kit w/ D

KIT 0.71000 04/23/2010 04/19/2010

CONTROL TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012

COOL BOTTOMS (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 08/18/2010

COPEGUS (Ribavirin Tab 200 MG) TABS 1.05475 10/23/2009 10/16/2009

CORN HUSKERS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

Cosyntropin For Inj 0.25 MG SOLR 104.26000 10/14/2011 10/12/2011

CRINONE (Progesterone Vaginal Gel 8%) GEL 8.57056 04/13/2012 04/09/2012

CRITIC-AID CLEAR MOISTURE (Skin Protectants Misc -

Ointment*

OINT 0.03040 04/28/2005 04/15/2008

CRITICARE HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

Cromolyn Sodium Nasal Aerosol Soln 5.2 MG/ACT (4%) AERS 0.38197 03/13/2008 03/05/2008

Cromolyn Sodium Ophth Soln 4% SOLN 0.62075 08/26/2011 08/16/2011

Cromolyn Sodium Soln Nebu 20 MG/2ML NEBU 0.16000 06/01/2002 02/22/2012

CRUCIAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

CVS BLOOD GLUCOSE STRIPS (Glucose Blood Test

Strip)

STRP 1.08074 03/09/2012 04/09/2012

CVS GENTLE SKIN CLEANSER (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

CVS LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CVS LANCETS MICRO THIN 33 (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CVS LANCETS ORIGINAL (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CVS LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CVS LANCETS THIN 26G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CVS LANCETS ULTRA THIN 30 (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

CVS MINERAL OIL (Mineral Oil) OIL 0.01529 03/20/2008 02/22/2012

CVS NUTRITION LIQUID (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

CVS NUTRITION PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

CVS PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 28-0.8

MG**

TABS 0.07255 02/27/2009 02/10/2009

CVS ULTRA THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011

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Effective

Date

Date

Updated

CVS VITAMIN D3 (Cholecalciferol Cap 400 Unit) CAPS 0.02008 03/13/2008 02/15/2012

Cyanocobalamin Inj 1000 MCG/ML SOLN 1.06141 11/11/2011 11/07/2011

Cyanocobalamin Tab 100 MCG TABS 0.03928 03/13/2008 03/05/2008




CYCLINEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011

CYCLINEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011

Cyclobenzaprine HCl Tab 10 MG TABS 0.02265 01/13/2012 01/09/2012

Cyclobenzaprine HCl Tab 5 MG TABS 0.03579 04/13/2012 04/09/2012

Cyclopentolate HCl Ophth Soln 1% SOLN 0.41687 05/28/2010 05/26/2010

Cyclophosphamide For Inj 1 GM SOLR 43.88210 07/30/2010 07/26/2010

Cyclophosphamide For Inj 2 GM SOLR 43.88210 07/30/2010 07/26/2010

Cyclophosphamide Tab 25 MG TABS 1.73470 07/30/2010 07/26/2010

Cyclophosphamide Tab 50 MG TABS 3.18720 07/30/2010 07/26/2010

Cyclosporine Cap 100 MG CAPS 2.85550 03/26/2010 03/12/2010

Cyclosporine Cap 25 MG CAPS 0.77655 03/26/2010 03/12/2010

Cyclosporine Modified Cap 100 MG CAPS 2.42500 11/27/2010 11/16/2010

Cyclosporine Modified Cap 25 MG CAPS 0.70729 04/13/2012 04/09/2012

Cyclosporine Modified Oral Soln 100 MG/ML SOLN 3.18225 07/29/2011 07/12/2011

Cyproheptadine HCl Syrup 2 MG/5ML SYRP 0.09790 02/06/2012 03/06/2012

Cyproheptadine HCl Tab 4 MG TABS 0.09494 12/09/2011 12/07/2011

CYSTADANE (Betaine Powder For Oral Solution***) POWD 4.28229 04/13/2012 04/09/2012

Cytarabine For Inj 100 MG SOLR 3.98400 04/13/2012 04/09/2012

Cytarabine Inj 100 MG/ML SOLN 0.65404 04/13/2012 04/09/2012

D.H.E. 45 (Dihydroergotamine Mesylate Inj 1 MG/ML) SOLN 36.52000 04/13/2012 04/09/2012

D400 (Cholecalciferol Cap 400 Unit) CAPS 0.03760 04/23/2010 04/19/2010

DAILY CONDITIONING TREATM (Emollient - Ointment**) OINT 0.04583 03/13/2008 03/05/2008

Danazol Cap 200 MG CAPS 2.91562 12/24/2010 12/15/2010

Dantrolene Sodium Cap 100 MG CAPS 1.50600 03/27/2008 03/20/2008

Dantrolene Sodium Cap 50 MG CAPS 1.39360 02/10/2011 03/21/2011

DEBROX (Carbamide Peroxide 6.5% Otic Soln) SOLN 0.14970 03/13/2008 03/05/2008

Deferoxamine Mesylate For Inj 2 GM SOLR 39.32000 06/25/2010 06/18/2010

Deferoxamine Mesylate For Inj 500 MG SOLR 10.14000 06/25/2010 06/18/2010

Demeclocycline HCl Tab 150 MG TABS 6.20000 05/26/2005 05/23/2005

Demeclocycline HCl Tab 300 MG TABS 2.81802 05/27/2011 05/16/2011

DEPO-PROVERA CONTRACEPTIV (Medroxyprogesterone

Acetate IM Su

SUSP 68.22600 07/30/2010 07/26/2010

DEQUASINE (Amino Acids Tab***) TABS 0.41080 04/28/2005 04/25/2005

DERMADROX (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 04/25/2005

DERMAL THERAPY EXTRA STRE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

DERMAL THERAPY FACE CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

DERMAL THERAPY FOOT MASSA (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

DERMAL THERAPY HAND, ELBO (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

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Effective

Date

Date

Updated

DERMAL THERAPY HEEL CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

DERMAVITE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008

Desipramine HCl Tab 10 MG TABS 0.71235 08/20/2009 09/18/2009






Desmopressin Acetate Nasal Spray Soln 0.01% SOLN 12.56615 05/28/2010 05/26/2010

Desmopressin Acetate Nasal Spray Soln 0.01%

(Refrigerated)

SOLN 13.88000 10/29/2010 10/25/2010

Desmopressin Acetate Tab 0.1 MG TABS 1.26500 03/24/2012 04/09/2012

Desmopressin Acetate Tab 0.2 MG TABS 1.31000 03/29/2012 04/09/2012

Desogest-Eth Estrad & Eth Estrad Tab 0.15-0.02/0.01

MG(21/5)

TABS 1.33000 07/10/2011 08/16/2011

Desogest-Ethin Est Tab

0.1-0.025/0.125-0.025/0.15-0.025MG-MG

TABS 0.92600 08/24/2006 08/23/2006

Desogestrel & Ethinyl Estradiol Tab 0.15 MG-30 MCG TABS 0.62351 12/24/2010 12/15/2010

Desonide Cream 0.05% CREA 0.82000 05/31/2011 10/12/2011

Desonide Lotion 0.05% LOTN 1.35000 02/27/2012 04/09/2012

Desonide Oint 0.05% OINT 0.32000 01/26/2012 03/06/2012

Desoximetasone Cream 0.05% CREA 1.89267 08/27/2010 08/25/2010

Desoximetasone Cream 0.25% CREA 1.31474 04/13/2012 04/09/2012

Desoximetasone Gel 0.05% GEL 2.24423 03/25/2011 03/21/2011

Desoximetasone Oint 0.25% OINT 2.27838 08/27/2010 08/25/2010

Dexamethasone Elixir 0.5 MG/5ML ELIX 0.03960 01/22/2002 02/22/2012

Dexamethasone Sodium Phosphate Ophth Soln 0.1% SOLN 2.41406 08/26/2011 08/16/2011

Dexamethasone Tab 0.5 MG TABS 0.06750 03/27/2008 03/20/2008

Dexamethasone Tab 0.75 MG TABS 0.06400 04/15/2002 02/22/2012

Dexamethasone Tab 4 MG TABS 0.10036 11/27/2010 11/16/2010

Dexamethasone Tab 6 MG TABS 0.44500 03/27/2008 03/20/2008

Dexmethylphenidate HCl Tab 10 MG TABS 1.07500 03/14/2012 04/09/2012

Dexmethylphenidate HCl Tab 2.5 MG TABS 0.47500 03/27/2008 03/20/2008

Dexmethylphenidate HCl Tab 5 MG TABS 0.66100 03/27/2008 03/20/2008

Dextroamphetamine Sulfate Cap SR 24HR 10 MG CP24 1.52500 07/22/2008 09/15/2008



Dextroamphetamine Sulfate Tab 10 MG TABS 0.24000 10/26/2006 10/20/2006



Dextromethorphan-Guaifenesin Liquid 10-100 MG/5ML LIQD 0.02981 03/13/2008 03/05/2008

Dextromethorphan-Guaifenesin Syrup 10-100 MG/5ML SYRP 0.00819 11/27/2010 11/16/2010

Dextromethorphan-Guaifenesin Tab 20-400 MG TABS 0.07778 08/27/2010 08/25/2010

Dextrose Inj 5% SOLN 0.00449 10/29/2010 10/25/2010

DHS TAR (Coal Tar Shampoo 0.5%) SHAM 0.02261 03/13/2008 03/05/2008

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Date

Date

Updated

DHS TAR GEL (Coal Tar Shampoo 0.5%) SHAM 0.02261 03/13/2008 03/05/2008

DIABETA (Glyburide Tab 2.5 MG) TABS 0.18000 12/28/2001 04/07/2004

DIABETIC TF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012

DIABETIDERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008

DIABETIDERM HAND & BODY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 12/28/2011

DIABETISOUR

Drug Form Current MAC Effective Date Price Date Updated...2012/04/06 · Drug Form Current MAC...

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