Crystal Reports ActiveX Designer - ListingMedication.rpt - PATHS PDF
Preview Crystal Reports ActiveX Designer - ListingMedication.rpt - PATHS
Medication Listing Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer 8-MOP 10 MG CAPSULE(S) METHOXSALEN 00187-0651-42 1,843.80 Valeant Pharmaceuticals International ABELCET 5 MG/ML (20M G AMPHOTERICIN B LIPID 57665-0101-41 $240.00 Sigma-Tau Pharmaceuticals, Inc. COMPLEX ABILIFY 1 MG/ML (15M0 L ARIPIPRAZOLE 59148-0013-15 $758.60 Bristol-Myers Squibb Patient Assistance Foundation ABILIFY 10 MG TABLET(S) ARIPIPRAZOLE 59148-0008-35 2,297.75 Bristol-Myers Squibb Patient Assistance Foundation ABILIFY 15 MG TABLET(S) ARIPIPRAZOLE 59148-0009-35 2,297.75 Bristol-Myers Squibb Patient Assistance Foundation ABILIFY 2 MG TABLET(S) ARIPIPRAZOLE 59148-0006-13 $689.36 Bristol-Myers Squibb Patient Assistance Foundation ABILIFY 20 MG TABLET(S) ARIPIPRAZOLE 59148-0010-35 3,249.50 Bristol-Myers Squibb Patient Assistance Foundation ABILIFY 30 MG TABLET(S) ARIPIPRAZOLE 59148-0011-35 3,249.50 Bristol-Myers Squibb Patient Assistance Foundation ABILIFY 5 MG TABLET(S) ARIPIPRAZOLE 59148-0007-35 2,297.75 Bristol-Myers Squibb Patient Assistance Foundation ABRAXANE 100 MG MG PACLITAXEL 68817-0134-50 1,119.60 Abraxis Oncology PROTEIN-BOUND ACCOLATE 10 MG TABLET(S) ZAFIRLUKAST 00310-0401-60 $130.04 AstraZeneca Foundation ACCOLATE 20 MG TABLET(S) ZAFIRLUKAST 00310-0402-60 $130.04 AstraZeneca Foundation ACCUPRIL 10 MG TABLET(S) QUINAPRIL 00071-0530-23 $211.51 Pfizer, Inc. HYDROCHLORIDE ACCUPRIL 20 MG TABLET(S) QUINAPRIL 00071-0532-23 $235.01 Pfizer, Inc. HYDROCHLORIDE ACCUPRIL 40 MG TABLET(S) QUINAPRIL 00071-0535-23 $211.51 Pfizer, Inc. HYDROCHLORIDE ACCUPRIL 5 MG TABLET(S) QUINAPRIL 00071-0527-23 $211.51 Pfizer, Inc. HYDROCHLORIDE ACCURETIC 10/12.5 MG-MG TABLET(S) HYDROCHLOROTHIAZID 00071-0222-23 $209.48 Pfizer, Inc. E/QUINAPRIL HYDROCHLORIDE Printed Date: 8/10/2012 Page 1 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer ACCURETIC 20/12.5 MG-MG TABLET(S) HYDROCHLOROTHIAZID 00071-0220-23 $209.48 Pfizer, Inc. E/QUINAPRIL HYDROCHLOR ACCURETIC 20/25 MG-MG TABLET(S) HYDROCHLOROTHIAZID 00071-0223-23 $209.48 Pfizer, Inc. E/QUINAPRIL HYDROCHLORIDE ACIPHEX 20 MG TABLET(S) RABEPRAZOLE SODIUM 62856-0243-90 $863.39 Johnson & Johnson Health Care Systems, Inc. ACIPHEX 20 MG TABLET(S) RABEPRAZOLE SODIUM 62856-0243-30 $287.80 Johnson & Johnson Health Care Systems, Inc. ACTIMMUNE 2,000,000 iu/0.5 ml 12SOL INTERFERON 64116-0011-12 5,372.35 Intermune Pharmaceuticals GAMMA-1B ACTIVASE 100 MG UNIT(S) ALTEPLASE, 50242-0085-27 5,863.49 Genentech, Inc. RECOMBINANT ACTIVASE 50 MG UNIT(S) ALTEPLASE, 50242-0044-13 2,931.74 Genentech, Inc. RECOMBINANT ACTIVELLA 0.5/0.1 MG-MG TABLET(S) ESTRADIOL/NORETHIN 00169-5175-10 $114.42 Novo Nordisk Pharmaceuticals, DRONE ACETATE Inc ACTOPLUS MET 15/500 MG/MG TABLET(S) METFORMIN 64764-0155-18 $969.74 Takeda Pharmaceuticals HYDROCHLORIDE/PIOG America, Inc. LITAZONE HYDROCHLORIDE ACTOPLUS MET 15/850 MG/MG TABLET(S) METFORMIN 64764-0158-18 $969.74 Takeda Pharmaceuticals HYDROCHLORIDE/PIOG America, Inc. LITAZONE HYDROCHLORIDE ACTOPLUS MET XR 1000/15 MG TABLET(S) METFORMIN 64764-0510-30 $175.00 Takeda Pharmaceuticals HYDROCHLORIDE/PIOG America, Inc. LITAZONE HYDROCHLORIDE ACTOPLUS MET XR 1000/30 MG TABLET(S) METFORMIN 64764-0310-30 $346.88 Takeda Pharmaceuticals HYDROCHLORIDE/PIOG America, Inc. LITAZONE HYDROCHLORIDE ACTOS 15 MG TABLET(S) PIOGLITAZONE 64764-0151-05 $638.14 Takeda Pharmaceuticals HYDROCHLORIDE America, Inc. ACTOS 30 MG TABLET(S) PIOGLITAZONE 64764-0301-15 $975.26 Takeda Pharmaceuticals HYDROCHLORIDE America, Inc. ACTOS 45 MG TABLET(S) PIOGLITAZONE 64764-0451-25 1,057.94 Takeda Pharmaceuticals HYDROCHLORIDE America, Inc. Printed Date: 8/10/2012 Page 2 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer ACUVAIL 0.45 % (0.4 ML)DROP(S) KETOROLAC 00023-3507-30 $174.59 Allergan TROMETHAMINE ACZONE 5 % (30 GM)GEL/JELLY DAPSONE 00023-3670-30 $175.27 Allergan ADACEL 2.5/0.5/2 MCG/ML LFIN UJECTION(S) TDAP VACCINE 49281-0400-10 $474.65 Sanofi-Aventis Pharmaceuticals ADAGEN 250 U/ML INJECTION(S) PEGADEMASE BOVINE 57665-0001-01 4,410.00 Accredo Therapeutics ADALAT CC 30 MG TABLET(S) NIFEDIPINE 00085-1701-02 $161.34 Bayer HealthCare Pharmaceuticals ADALAT CC 60 MG TABLET(S) NIFEDIPINE 00085-1716-02 $287.44 Bayer HealthCare Pharmaceuticals ADALAT CC 90 MG TABLET(S) NIFEDIPINE 00085-1722-01 $336.84 Bayer HealthCare Pharmaceuticals ADCETRIS 50 MG MG brentuximab vedotin 51144-0050-01 5,400.00 Seattle Genetics ADCIRCA 20 MG TABLET(S) TADALAFIL 66302-0467-60 1,600.56 United Therapeutics Corporation ADENOSCAN 3 MG/ML (20INJECTION(S) ADENOSINE 00469-0871-20 $261.29 Astellas Pharma US, Inc. ADVAIR DISKUS 100/50 0.01;0.05 MG/ACTUAPTUIOFFN(;SM)G FLUTICASONE 00173-0695-00 $225.55 GlaxoSmithKline PROPIONATE ADVAIR DISKUS 250/50 0.25;0.05 MG/ACTUAPTUIOFFN(;SM)G FLUTICASONE 00173-0696-00 $280.24 GlaxoSmithKline PROPIONATE ADVAIR DISKUS 500/50 0.5;0.05 MG/ACTUAPTUIOFFN(;SM)G FLUTICASONE 00173-0697-00 $368.59 GlaxoSmithKline PROPIONATE ADVAIR HFA 115/21 MCT (12 GPMUFF(S) FLUTICASONE 00173-0716-00 $226.64 GlaxoSmithKline PROPIONATE/SALMETE ROL XINAFOATE ADVAIR HFA 115/30.45 MCG/ACTUPAUTFIFO(NS ) FLUTICASONE/SALMET 00173-0716-20 $261.90 GlaxoSmithKline EROL ADVAIR HFA 230/21 MCG/ACTUPAUTFIFO(NS ) FLUTICASONE/SALMET 00173-0717-00 $313.01 GlaxoSmithKline EROL ADVAIR HFA 230/30.45 MCG PUFF(S) FLUTICASONE/SALMET 00173-0717-20 $344.48 GlaxoSmithKline EROL ADVAIR HFA 45/21 MCG/ACTUPAUTFIFO(NS ) FLUTICASONE/SALMET 00173-0715-00 $174.66 GlaxoSmithKline EROL ADVICOR 1000/20 MG-MG TABLET(S) LOVASTATIN/NIACIN 00074-3007-90 $446.46 Abbott Laboratories ADVICOR 1000/40 MG-MG TABLET(S) LOVASTATIN/NIACIN 00074-3010-90 $516.86 Abbott Laboratories ADVICOR 500/20 MG TABLET(S) LOVASTATIN/NIACIN 00074-3005-90 $388.26 Abbott Laboratories ADVICOR 750/20 MG-MG TABLET(S) LOVASTATIN/NIACIN 00074-3072-90 $416.45 Abbott Laboratories AEROCHAMBER - - DEVICE SPACER, INHALATION 00456-3154-67 $39.62 Forest Pharmaceuticals, Inc. AEROCHAMBER w/MASK LARGE - DEVICE SPACER, INHALATION 00456-0746-13 $53.42 Forest Pharmaceuticals, Inc. Printed Date: 8/10/2012 Page 3 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer AEROCHAMBER w/MASK MEDIUM - DEVICE SPACER, INHALATION 00456-0745-13 $53.42 Forest Pharmaceuticals, Inc. AEROCHAMBER w/MASK SMALL - DEVICE SPACER, INHALATION 00456-0744-13 $53.42 Forest Pharmaceuticals, Inc. AFINITOR 10 MG TABLET(S) EVEROLIMUS 00078-0567-51 8,396.40 Novartis Pharmaceuticals Corporation AFINITOR 5 MG TABLET(S) EVEROLIMUS 00078-0566-61 7,961.36 Novartis Pharmaceuticals Corporation AGGRASTAT 0.05 mg/100ml SOL TIROFIBAN 25208-0002-01 $287.55 Merck & Co., Inc. HYDROCHLORIDE AGGRASTAT 0.05 mg/250ml SOL TIROFIBAN 25208-0002-02 $602.10 Merck & Co., Inc. HYDROCHLORIDE AGGRASTAT 0.25 mg/50ml SOL TIROFIBAN 00006-3713-50 $557.50 Merck & Co., Inc. HYDROCHLORIDE AGGRENOX 25-200 MG CAPSULE(S) ASPIRIN/DIPYRIDAMOLE 00597-0001-60 $267.35 Boehringer Ingelheim Pharmaceuticals, Inc. ALBENZA 200 mg TABLET(S) ALBENDAZOLE 52054-0550-28 $966.00 GlaxoSmithKline ALCAINE 0.5 % (15 ML)DROP(S) PROPARACAINE 00998-0016-15 $32.88 Alcon Laboratories, Inc. HYDROCHLORIDE ALDACTAZIDE 25-25 MG-MG TABLET(S) HYDROCHLOROTHIAZID 00025-1011-31 $111.72 Pfizer, Inc. E/SPIRONOLACTONE ALDACTAZIDE 50-50 MG-MG TABLET(S) HYDROCHLOROTHIAZID 00025-1021-31 $206.05 Pfizer, Inc. E/SPIRONOLACTONE ALDACTONE 100 MG TABLET(S) SPIRONOLACTONE 00025-1031-31 $320.47 Pfizer, Inc. ALDACTONE 25 MG TABLET(S) SPIRONOLACTONE 00025-1001-31 $108.84 Pfizer, Inc. ALDACTONE 50 MG TABLET(S) SPIRONOLACTONE 00025-1041-31 $191.16 Pfizer, Inc. ALIMTA 500 MG MG PEMETREXED 00002-7623-01 3,204.36 Eli Lilly and Company ALINIA 500 MG TABLET(S) NITAZOXANIDE 67546-0111-11 1,365.60 Romark Laboratories ALODOX 20 MG TABLET(S) DOXYCYCLINE 54799-0534-66 $94.80 OcuSOFT, Inc. HYCLATE ALOMIDE 0.1 % (10 ML)DROP(S) LODOXAMIDE 00065-0345-10 $100.56 Alcon Laboratories, Inc. TROMETHAMINE ALOXI 0.05 MG/ML (5 MG PALONOSETRON 62856-0797-01 $445.20 Eisai, Inc. HYDROCHLORIDE ALPHAGAN P 0.1 % 15ml DROP(S) BRIMONIDINE 00023-9321-15 $215.98 Allergan TARTRATE ALREX 0.2 % (10ML) DROP(S) LOTEPREDNOL 24208-0353-10 $263.51 Bausch & Lomb Incorporated ETABONATE ALTABAX OINTMENT 1 % (15 GM)APPLICATION RETAPAMULIN 00007-5180-22 $93.96 GlaxoSmithKline Printed Date: 8/10/2012 Page 4 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer AMBISOME 50 MG INJECTION(S) AMPHOTERICIN B 00469-3051-30 $188.40 Astellas Pharma US, Inc. LIPOSOME AMERGE 1 mg TABLET(S) NARATRIPTAN 00173-0561-00 $280.86 GlaxoSmithKline HYDROCHLORIDE AMERGE 2.5 mg TABLET(S) NARATRIPTAN 00173-0562-00 $280.86 GlaxoSmithKline HYDROCHLORIDE AMITIZA 24 MCG CAPSULE(S) LUBIPROSTONE 64764-0240-60 $296.30 Takeda Pharmaceuticals America, Inc. AMITIZA 8 MCG CAPSULE(S) LUBIPROSTONE 64764-0080-60 $296.30 Takeda Pharmaceuticals America, Inc. AMTURNIDE 150-5-12.5 MG-MG-MGTABLET(S) ALISKIREN/AMLODIPINE 00078-0610-15 $89.28 Novartis Pharmaceuticals BESYLATE/HYDROCHLO Corporation ROTHIAZIDE AMTURNIDE 300-10-12.5 MG-MG-MGTABLET(S) ALISKIREN/AMLODIPINE 00078-0613-15 $112.68 Novartis Pharmaceuticals BESYLATE/HYDROCHLO Corporation ROTHIAZIDE AMTURNIDE 300-10-25 MG-MG-MGTABLET(S) ALISKIREN/AMLODIPINE 00078-0614-15 $112.68 Novartis Pharmaceuticals BESYLATE/HYDROCHLO Corporation ROTHIAZIDE AMTURNIDE 300-5-12.5 MG-MG-MGTABLET(S) ALISKIREN/AMLODIPINE 00078-0611-15 $112.68 Novartis Pharmaceuticals BESYLATE/HYDROCHLO Corporation ROTHIAZIDE AMTURNIDE 300-5-25 MG-MG-MGTABLET(S) ALISKIREN/AMLODIPINE 00078-0612-15 $112.68 Novartis Pharmaceuticals BESYLATE/HYDROCHLO Corporation ROTHIAZIDE ANADROL-50 50 MG TABLET(S) OXYMETHOLONE 68220-0055-10 2,993.50 Meda Pharmaceuticals ANAFRANIL 25 MG CAPSULE(S) CLOMIPRAMINE 00406-9906-03 $420.48 Mallinckrodt Pharmaceuticals HYDROCHLORIDE ANAFRANIL 50 MG CAPSULE(S) CLOMIPRAMINE 00406-9907-03 $420.48 Mallinckrodt Pharmaceuticals HYDROCHLORIDE ANAFRANIL 75 MG CAPSULE(S) CLOMIPRAMINE 00406-9908-03 $420.48 Mallinckrodt Pharmaceuticals HYDROCHLORIDE ANALPRAM-HC CREAM 1-1 %-% (30 GAMPPLICATION HYDROCORTISONE 00496-0778-04 $74.16 Ferndale Laboratories, Inc. ACETATE/PRAMOXINE HYDROCHLORIDE ANALPRAM-HC CREAM 2.5-1 %-% (30 GAMPPLICATION HYDROCORTISONE 00496-0800-04 $74.16 Ferndale Laboratories, Inc. ACETATE/PRAMOXINE HYDROCHLORIDE Printed Date: 8/10/2012 Page 5 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer ANALPRAM-HC LOTION 2.5-1 %-% (60 MALPPLICATION HYDROCORTISONE 00496-0829-04 $90.95 Ferndale Laboratories, Inc. ACETATE/PRAMOXINE HYDROCHLORIDE ANCOBON 250 MG CAPSULE(S) FLUCYTOSINE 00187-3554-10 2,570.49 Valeant Pharmaceuticals International ANCOBON 500 MG CAPSULE(S) FLUCYTOSINE 00187-3555-10 4,973.94 Valeant Pharmaceuticals International ANDROGEL 1 % (2.5 GM PACKET(S) TESTOSTERONE 00051-8425-30 $387.04 Abbott Laboratories ANDROGEL 1 % (5gm 30PACKET TESTOSTERONE 00051-8450-30 $397.76 Abbott Laboratories ANDROGEL 1 % (75 GM)PUMP(S) TESTOSTERONE 00051-8488-88 $397.76 Abbott Laboratories ANDROGEL 1.62 % (75 GM)PUMP(S) TESTOSTERON 00051-8462-33 $375.25 Abbott Laboratories ANGELIQ 0.5-1 MG-MG TABLET(S) DROSPIRENONE/ESTRA 50419-0483-03 $215.82 Bayer HealthCare DIOL Pharmaceuticals ANGIOMAX 250 MG MG BIVALIRUDIN 65293-0001-01 6,912.00 The Medicine Company ANTIVERT 12.5 MG TABLET(S) MECLIZINE 00049-2100-66 $67.62 Pfizer, Inc. HYDROCHLORIDE ANTIVERT/25 25 MG TABLET(S) MECLIZINE 00049-2110-66 $106.93 Pfizer, Inc. HYDROCHLORIDE ANTIVERT/50 50 MG TABLET(S) MECLIZINE 00049-2140-66 $203.20 Pfizer, Inc. HYDROCHLORIDE ANUSOL-HC 2.5 % (30 GM)CREAM HYDROCORTISONE 65649-0401-30 $118.96 Salix Pharmaceuticals, Inc. ACETATE ANUSOL-HC 25 MG SUPPOSITORYHYDROCORTISONE 65649-0411-12 $132.40 Salix Pharmaceuticals, Inc. ACETATE ANUSOL-HC 25 MG SUPPOSITORYHYDROCORTISONE 65649-0411-24 $231.92 Salix Pharmaceuticals, Inc. ACETATE APIDRA 100 U/ML UNIT(S) INSULIN GLULISINE 00088-2500-33 $107.36 Sanofi-Aventis Pharmaceuticals APIDRA SOLOSTAR 100 U/ML (3 MLUNIT(S) INSULIN GLULISINE 00088-2500-52 $207.42 Sanofi-Aventis Pharmaceuticals APLIGRAF n/a n/a SHEET GRAFTSKIN 09978-0001-99 1,900.80 Organogenesis, Inc. APRISO 0.375 GM CAPSULE(S) MESALAMINE 65649-0103-02 $300.56 Salix Pharmaceuticals, Inc. APTIVUS 250 MG CAPSULE(S) TIPRANAVIR 00597-0003-02 1,335.14 Boehringer Ingelheim Pharmaceuticals, Inc. ARANESP 100 MCG/ML SYRINGES(S) DARBEPOETIN ALFA 55513-0013-04 2,371.20 Amgen, Inc. ARANESP 200 MCG/ML SYRINGE(S) DARBEPOETIN ALFA 55513-0014-04 4,533.12 Amgen, Inc. ARANESP 25 MCG/ML MCG DARBEPOETIN ALFA 55513-0002-04 $718.32 Amgen, Inc. ARANESP 300 MCG/ML MCG DARBEPOETIN ALFA 55513-0015-01 1,778.40 Amgen, Inc. ARANESP 40 MCG/ML MCG DARBEPOETIN ALFA 55513-0003-04 1,149.36 Amgen, Inc. Printed Date: 8/10/2012 Page 6 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer ARANESP 60 MCG/ML MCG DARBEPOETIN ALFA 55513-0004-04 1,544.88 Amgen, Inc. ARANESP-PRE FILLED SYRINGE 150/0.3 MCG/ML MCG DARBEPOETIN ALFA 55513-0043-04 3,556.80 Amgen, Inc. ARANESP-PRE FILLED SYRINGE 500 MCG/ML MCG DARBEPOETIN ALFA 55513-0048-01 2,964.00 Amgen, Inc. ARCAPTA NEOHALER 75 MCG CAPSULE(S) INDACATEROL 00078-0619-15 $195.84 Novartis Pharmaceuticals MALEATE Corporation ARICEPT 10 MG TABLET(S) DONEPEZIL 62856-0246-90 1,018.76 Eisai, Inc. HYDROCHLORIDE ARICEPT 23 MG TABLET(S) DONEPEZIL 62856-0247-90 $910.08 Eisai, Inc. HYDROCHLORIDE ARICEPT 5 MG TABLET(S) DONEPEZIL 62856-0245-90 1,018.76 Eisai, Inc. HYDROCHLORIDE ARIMIDEX 1 MG TABLET(S) ANASTROZOLE 00310-0201-30 $495.96 AstraZeneca Foundation ARIXTRA 10/0.8 MG/ML (0.MG FONDAPARINUX 00007-3236-11 1,429.02 GlaxoSmithKline SODIUM ARIXTRA 2.5/0.5 MG/ML (0.MG FONDAPARINUX 00007-3230-11 $607.25 GlaxoSmithKline SODIUM ARIXTRA 5/0.4 MG/ML (0.MG FONDAPARINUX 00007-3232-11 1,429.02 GlaxoSmithKline SODIUM ARIXTRA 7.5/0.6 MG/ML MG FONDAPARINUX 00007-3234-11 1,429.02 GlaxoSmithKline SODIUM ARMOUR THYROID 120 MG TABLET(S) THYROID 00456-0461-01 $29.74 Forest Pharmaceuticals, Inc. ARMOUR THYROID 15 MG TABLET(S) THYROID 00456-0457-01 $12.34 Forest Pharmaceuticals, Inc. ARMOUR THYROID 180 MG TABLET(S) THYROID 00456-0462-01 $47.18 Forest Pharmaceuticals, Inc. ARMOUR THYROID 240 MG TABLET(S) THYROID 00456-0463-01 $70.73 Forest Pharmaceuticals, Inc. ARMOUR THYROID 30 MG TABLET(S) THYROID 00456-0458-01 $14.48 Forest Pharmaceuticals, Inc. ARMOUR THYROID 300 MG TABLET(S) THYROID 00456-0464-01 $87.67 Forest Pharmaceuticals, Inc. ARMOUR THYROID 60 MG TABLET(S) THYROID 00456-0459-01 $16.08 Forest Pharmaceuticals, Inc. ARMOUR THYROID 90 MG TABLET(S) THYROID 00456-0460-01 $25.38 Forest Pharmaceuticals, Inc. AROMASIN 25 MG TABLET(S) EXEMESTANE 00009-7663-04 $519.00 Pfizer, Inc. ARRANON 5 MG/ML (50I NJECTION(S) NELARABINE 00007-4401-06 3,824.95 GlaxoSmithKline ARTHROTEC 50-0.2 MG-MG TABLET(S) DICLOFENAC 00025-1411-90 $335.26 Pfizer, Inc. SODIUM/MISOPROSTOL ARTHROTEC 75-0.2 MG-MG TABLET(S) DICLOFENAC 00025-1421-60 $223.52 Pfizer, Inc. SOD/MISOPROSTOL ARZERRA 20 MG/ML (5MINLJECTION(S) OFATUMUMAB 00173-0808-02 1,584.00 GlaxoSmithKline Printed Date: 8/10/2012 Page 7 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer ASMANEX TWISTHALER 110 MCG (110)PUFF(S) MOMETASONE 00085-1461-02 $135.50 Merck & Co., Inc. FUROATE ASMANEX TWISTHALER 220 MCG (120)PUFF(S) MOMETASONE 00085-1341-01 $246.38 Merck & Co., Inc. FUROATE ASMANEX TWISTHALER 220 MCG (30) PUFF(S) MOMETASONE 00085-1341-03 $146.30 Merck & Co., Inc. FUROATE ASMANEX TWISTHALER 220 MCG (60) PUFF(S) MOMETASONE 00085-1341-02 $171.91 Merck & Co., Inc. FUROATE ATACAND 16 MG TABLET(S) CANDESARTAN 00186-0016-54 $274.96 AstraZeneca Foundation CILEXETIL ATACAND 32 MG TABLET(S) CANDESARTAN 00186-0032-54 $371.93 AstraZeneca Foundation CILEXETIL ATACAND 4 MG TABLET(S) CANDESARTAN 00186-0004-31 $91.57 AstraZeneca Foundation CILEXETIL ATACAND 8 MG TABLET(S) CANDESARTAN 00186-0008-31 $91.57 AstraZeneca Foundation CILEXETIL ATACAND HCT 16-12.5 MG-MG TABLET(S) CANDESARTAN 00186-0162-54 $371.93 AstraZeneca Foundation CILEXETIL/HCTZ ATACAND HCT 32-12.5 MG-MG TABLET(S) CANDESARTAN 00186-0322-54 $379.33 AstraZeneca Foundation CILEXETIL/HCTZ ATACAND HCT 32-25 MG-MG TABLET(S) CANDESARTAN 00186-0322-54 $410.60 AstraZeneca Foundation CILEXETIL/HYDROCHLO ROTHIAZIDE ATRIPLA 600-200-300MG-MG-MGTABLET(S) EFAVIRENZ/EMTRICITA 15584-0101-01 2,080.97 Bristol-Myers Squibb/Gilead BINE/TENOFOVIR ATROVENT HFA 0.017 MG/ACTUAPTUIOFFN(S) IPRATROPIUM 00597-0087-17 $239.09 Boehringer Ingelheim BROMIDE Pharmaceuticals, Inc. AVALIDE 12.5-150 MG TABLET(S) HYDROCHLOROTHIAZID 00087-2775-32 $305.68 Bristol-Myers Squibb Patient E/IRBESARTAN Assistance Foundation AVALIDE 12.5-300 MG TABLET(S) HYDROCHLOROTHIAZID 00087-2776-32 $333.08 Bristol-Myers Squibb Patient E/IRBESARTAN Assistance Foundation AVANDAMET 1000-2 MG TABLET(S) METFORMIN 00007-3163-18 $165.31 GlaxoSmithKline HYDROCHLORIDE/ROSI GLITAZONE MALEATE AVANDAMET 1000-4 MG TABLET(S) METFORMIN 00007-3164-18 $280.07 GlaxoSmithKline HYDROCHLORIDE/ROSI GLITAZONE MALEATE AVANDAMET 500-2 MG-MG TABLET(S) METFORMIN 00007-3167-20 $165.31 GlaxoSmithKline HCL/ROSIGLITAZONE MALEATE Printed Date: 8/10/2012 Page 8 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer AVANDAMET 500-4 MG-MG TABLET(S) METFORMIN 00007-3168-20 $280.07 GlaxoSmithKline HCL/ROSIGLITAZONE MALEATE AVANDAMET 500;1 MG;MG TABLET(S) METFORMIN 00007-3166-20 $113.00 GlaxoSmithKline HCL/ROSIGLITAZONE MALEATE AVANDARYL 1-4 MG TABLET(S) ROSIGLITAZONE 00173-0841-13 $156.64 GlaxoSmithKline MALEATE/GLIMEPIRIDE AVANDARYL 2-4 MG TABLET(S) ROSIGLITAZONE 00173-0842-13 $156.64 GlaxoSmithKline MALEATE/GLIMEPIRIDE AVANDARYL 4-4 MG TABLET(S) ROSIGLITAZONE 00173-0843-13 $156.64 GlaxoSmithKline MALEATE/GLIMEPIRIDE AVANDIA 2 MG TABLET(S) ROSIGLITAZONE 00173-0834-18 $189.25 GlaxoSmithKline MALEATE AVANDIA 4 mg TABLET(S) ROSIGLITAZONE 00173-0835-13 $140.45 GlaxoSmithKline MALEATE AVANDIA 8 MG TABLET(S) ROSIGLITAZONE 00173-0836-13 $255.17 GlaxoSmithKline MALEATE AVAPRO 150 MG TABLET(S) IRBESARTAN 00087-2772-32 $307.22 Bristol-Myers Squibb Patient Assistance Foundation AVAPRO 300 MG TABLET(S) IRBESARTAN 00087-2773-32 $369.25 Bristol-Myers Squibb Patient Assistance Foundation AVAPRO 75 MG TABLET(S) IRBESARTAN 00087-2771-32 $291.84 Bristol-Myers Squibb Patient Assistance Foundation AVASTIN 25 MG/ML (4 MG BEVACIZUMAB 50242-0060-01 $700.38 Genentech, Inc. AVELOX 400 MG TABLET(S) MOXIFLOXACIN 00085-1733-03 $107.60 Merck & Co., Inc. HYDROCHLORIDE AVELOX 400 MG TABLET(S) MOXIFLOXACIN 00085-1733-01 $645.60 Merck & Co., Inc. HYDROCHLORIDE AVELOX I.V. 400 MG/250MLUNIT(S) MOXIFLOXACIN 00085-1737-01 $504.00 Bayer HealthCare HYDROCHLORIDE Pharmaceuticals AVODART 0.5 MG CAPSULE(S) DUTASTERIDE 00173-0712-04 $411.05 GlaxoSmithKline AVONEX 30/0.5 MCG/ML INJECTION(S) INTERFERON BETA-1A 59627-0002-05 2,762.40 Biogen Idec AXERT 12.5 MG TABLET(S) ALMOTRIPTAN MALATE 00025-2085-12 $383.09 Johnson & Johnson Health Care Systems, Inc. AXERT 6.25 MG TABLET(S) ALMOTRIPTAN MALATE 00025-2080-06 $191.51 Johnson & Johnson Health Care Systems, Inc. AXID 150 MG CAPSULE(S) NIZATIDINE 65726-0144-15 $192.76 GlaxoSmithKline AXID 300 MG CAPSULE(S) NIZATIDINE 65726-0145-10 $188.93 GlaxoSmithKline Printed Date: 8/10/2012 Page 9 of 94 Medication Name Strength Units Dosage Form Generic Name NDC Price Manufacturer AZASAN 100 MG TABLET(S) AZATHIOPRINE 65649-0241-41 $667.13 Salix Pharmaceuticals, Inc. AZASAN 75 MG TABLET(S) AZATHIOPRINE 65649-0231-41 $498.60 Salix Pharmaceuticals, Inc. AZILECT 0.5 MG TABLET(S) RASAGILINE 68546-0142-56 $448.20 Teva Pharmaceuticals AZILECT 1 MG TABLET(S) RASAGILINE 68546-0229-56 $448.20 Teva Pharmaceuticals AZOPT 1 % 15 ML DROP(S) BRINZOLAMIDE 00065-0275-15 $193.98 Alcon Laboratories, Inc. AZOR 10-20 MG-MG TABLET(S) AMLODIPINE 65597-0111-90 $387.72 Daiichi Sankyo, Inc. BESYLATE/OLMESARTA N MEDOXOMIL AZOR 10-40 MG-MG TABLET(S) AMLODIPINE 65597-0113-90 $492.48 Daiichi Sankyo, Inc. BESYLATE/OLMESARTA N MEDOXOMIL AZOR 5-20 MG-MG TABLET(S) AMLODIPINE 65597-0110-90 $387.72 Daiichi Sankyo, Inc. BESYLATE/OLMESARTA N MEDOXOMIL AZOR 5-40 MG-MG TABLET(S) AMLODIPINE 65597-0112-90 $492.48 Daiichi Sankyo, Inc. BESYLATE/OLMESARTA N MEDOXOMIL AZULFIDINE 500 MG TABLET(S) SULFASALAZINE 00013-0101-01 $57.76 Pfizer, Inc. AZULFIDINE ENTABS 500 MG TABLET(S) SULFASALAZINE 00013-0102-01 $95.68 Pfizer, Inc. BACTROBAN 2 % 15gm CREAM APPLICMAUTPIOIRNOCIN CALCIUM 00029-1527-22 $51.06 GlaxoSmithKline BACTROBAN 2 % 22gm OINTMENT MUPIROCIN 00029-1525-44 $74.05 GlaxoSmithKline BACTROBAN 2 % 30gm CREAM APPLICMAUTPIOIRNOCIN CALCIUM 00029-1527-25 $86.53 GlaxoSmithKline BACTROBAN NASAL OINTMENT 2 % (1 GM) BOX MUPIROCIN CALCIUM 00029-1526-11 $95.51 GlaxoSmithKline BANZEL 200 MG TABLET(S) RUFINAMIDE 62856-0582-30 $126.74 Eisai, Inc. BANZEL 400 MG TABLET(S) RUFINAMIDE 62856-0583-52 1,114.36 Eisai, Inc. BARACLUDE 0.5 MG TABLET(S) ENTECAVIR 00003-1611-13 3,085.72 Bristol-Myers Squibb BARACLUDE 1 MG TABLET(S) ENTECAVIR 00003-1612-12 1,028.58 Bristol-Myers Squibb BARACLUDE ORAL SOLUTION 0.05 MG/ML (21M0 L ENTECAVIR 00003-1614-12 $719.99 Bristol-Myers Squibb BECONASE AQ 0.042 MG/INH(25PUFF(S) BECLOMETHASONE 00173-0388-79 $148.74 GlaxoSmithKline DIPROPIONATE MONOHYDRATE BENEFIX 1 IU (1000 IUINJECTION COAGULATION FACTOR 58394-0001-06 $1.08 Pfizer, Inc. IX RECOMBINANT BENEFIX 1 IU (2000 IUINJECTION COAGULATION FACTOR 58394-0008-02 $1.08 Pfizer, Inc. IX RECOMBINANT Printed Date: 8/10/2012 Page 10 of 94
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