disclaimer: price listing does not guarantee coverage pharmacy/smac/documents/wv... ·...

92
Generic Name Prev. SMAC Price Prev. Effective Date Current SMAC Price Current Effective Date 0.9 % SODIUM CHLORIDE INJECTION VIAL (ML) 0.9 % 0.05712 08/12/2014 0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 0.9 % 0.00196 03/06/2015 0.00196 08/21/2015 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK WITH THREADED PORT (ML) 0.03505 01/30/2015 0.03505 08/21/2015 0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK WITH VIAL PORT (NON-THREADED) 0.04175 07/18/2014 ABACAVIR SULFATE ORAL TABLET 300 MG 1.77633 11/25/2017 0.36867 05/22/2020 ABIRATERONE ACETATE ORAL TABLET 250 MG 3.78000 02/21/2020 4.56040 02/24/2020 ACAMPROSATE CALCIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 333 MG 0.74145 04/09/2020 0.70192 06/19/2020 ACARBOSE ORAL TABLET 100 MG 0.18990 03/02/2018 0.13000 11/16/2018 ACARBOSE ORAL TABLET 25 MG 0.23329 08/21/2015 0.13994 08/25/2017 ACARBOSE ORAL TABLET 50 MG 0.14640 05/25/2018 0.12500 11/16/2018 ACEBUTOLOL HCL ORAL CAPSULE 200 MG 0.40001 06/04/2019 0.60776 10/07/2019 ACEBUTOLOL HCL ORAL CAPSULE 400 MG 0.26000 03/27/2015 0.26000 08/21/2015 ACETAMINOPHEN ORAL CAPSULE 500 MG 0.01093 08/12/2014 ACETAMINOPHEN ORAL DROPS 80MG/0.8ML 0.17160 10/11/2013 0.17160 08/21/2015 ACETAMINOPHEN ORAL LIQUID (ML) 160 MG/5ML 0.00932 09/27/2013 0.00932 08/21/2015 ACETAMINOPHEN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 160 MG/5ML 0.02137 08/21/2015 0.02033 02/17/2017 ACETAMINOPHEN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 160 MG/5ML 0.01083 06/09/2017 0.02033 03/02/2018 ACETAMINOPHEN ORAL TABLET 325 MG 0.00830 06/20/2014 0.00830 08/21/2015 ACETAMINOPHEN ORAL TABLET 500 MG 0.01040 04/03/2015 0.01040 08/21/2015 ACETAMINOPHEN ORAL TABLET,CHEWABLE 80 MG 0.04651 04/03/2015 0.04651 08/21/2015 ACETAMINOPHEN ORAL TABLET,DISINTEGRATING 80 MG 0.05113 08/21/2015 ACETAMINOPHEN RECTAL SUPPOSITORY, RECTAL 120 MG 0.20324 08/22/2014 0.20324 08/21/2015 ACETAMINOPHEN RECTAL SUPPOSITORY, RECTAL 325 MG 0.46400 08/22/2014 0.46400 08/21/2015 ACETAMINOPHEN RECTAL SUPPOSITORY, RECTAL 650 MG 0.21762 08/22/2014 0.21762 08/21/2015 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL SOLUTION, ORAL 120-12MG/5 0.01332 01/30/2015 0.01332 08/21/2015 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL SOLUTION, ORAL 120-12MG/5 0.21394 03/27/2015 0.21394 08/21/2015 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL SOLUTION, ORAL 300MG/12.5 0.10079 03/27/2015 0.10079 08/21/2015 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG- 15MG 0.14344 09/19/2014 0.14344 08/21/2015 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG- 30MG 0.10480 10/20/2017 0.09167 12/22/2017 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG- 60MG 0.19101 05/20/2016 0.17150 08/17/2018 ACETAMINOPHEN/DIPHENHYDRAMINE HCL ORAL TABLET 500MG-25MG 0.04047 04/24/2015 0.04047 08/21/2015 ACETAZOLAMIDE ORAL CAPSULE, EXTENDED RELEASE 500 MG 0.94140 09/22/2017 0.70000 11/16/2018 ACETAZOLAMIDE ORAL TABLET 125 MG 1.52593 08/21/2015 1.29790 11/16/2018 ACETAZOLAMIDE ORAL TABLET 250 MG 1.02880 02/22/2019 0.69948 05/17/2019 ACETIC ACID IRRIGATION SOLUTION, IRRIGATION 0.25 % 0.00350 03/01/2013 ACETIC ACID OTIC SOLUTION, NON-ORAL 2 % 1.81591 08/21/2015 1.65333 02/21/2020 West Virginia Medicaid State Maximum Allowable Cost (SMAC) List Disclaimer: Price listing does not guarantee coverage Effective 6/19/2020

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Page 1: Disclaimer: Price listing does not guarantee coverage Pharmacy/SMAC/Documents/WV... · 2020-06-18 · Generic Name Prev. SMAC Price Prev. Effective Date Current SMAC Price Current

Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

0.9 % SODIUM CHLORIDE INJECTION VIAL (ML) 0.9 % 0.05712 08/12/2014

0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 0.9 % 0.00196 03/06/2015 0.00196 08/21/2015

0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK WITH THREADED PORT (ML)

0.03505 01/30/2015 0.03505 08/21/2015

0.9 % SODIUM CHLORIDE INTRAVENOUS PIGGYBACK WITH VIAL PORT (NON-THREADED)

0.04175 07/18/2014

ABACAVIR SULFATE ORAL TABLET 300 MG 1.77633 11/25/2017 0.36867 05/22/2020

ABIRATERONE ACETATE ORAL TABLET 250 MG 3.78000 02/21/2020 4.56040 02/24/2020

ACAMPROSATE CALCIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 333 MG

0.74145 04/09/2020 0.70192 06/19/2020

ACARBOSE ORAL TABLET 100 MG 0.18990 03/02/2018 0.13000 11/16/2018

ACARBOSE ORAL TABLET 25 MG 0.23329 08/21/2015 0.13994 08/25/2017

ACARBOSE ORAL TABLET 50 MG 0.14640 05/25/2018 0.12500 11/16/2018

ACEBUTOLOL HCL ORAL CAPSULE 200 MG 0.40001 06/04/2019 0.60776 10/07/2019

ACEBUTOLOL HCL ORAL CAPSULE 400 MG 0.26000 03/27/2015 0.26000 08/21/2015

ACETAMINOPHEN ORAL CAPSULE 500 MG 0.01093 08/12/2014

ACETAMINOPHEN ORAL DROPS 80MG/0.8ML 0.17160 10/11/2013 0.17160 08/21/2015

ACETAMINOPHEN ORAL LIQUID (ML) 160 MG/5ML 0.00932 09/27/2013 0.00932 08/21/2015

ACETAMINOPHEN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 160 MG/5ML

0.02137 08/21/2015 0.02033 02/17/2017

ACETAMINOPHEN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 160 MG/5ML

0.01083 06/09/2017 0.02033 03/02/2018

ACETAMINOPHEN ORAL TABLET 325 MG 0.00830 06/20/2014 0.00830 08/21/2015

ACETAMINOPHEN ORAL TABLET 500 MG 0.01040 04/03/2015 0.01040 08/21/2015

ACETAMINOPHEN ORAL TABLET,CHEWABLE 80 MG 0.04651 04/03/2015 0.04651 08/21/2015

ACETAMINOPHEN ORAL TABLET,DISINTEGRATING 80 MG 0.05113 08/21/2015

ACETAMINOPHEN RECTAL SUPPOSITORY, RECTAL 120 MG 0.20324 08/22/2014 0.20324 08/21/2015

ACETAMINOPHEN RECTAL SUPPOSITORY, RECTAL 325 MG 0.46400 08/22/2014 0.46400 08/21/2015

ACETAMINOPHEN RECTAL SUPPOSITORY, RECTAL 650 MG 0.21762 08/22/2014 0.21762 08/21/2015

ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL SOLUTION, ORAL 120-12MG/5

0.01332 01/30/2015 0.01332 08/21/2015

ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL SOLUTION, ORAL 120-12MG/5

0.21394 03/27/2015 0.21394 08/21/2015

ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL SOLUTION, ORAL 300MG/12.5

0.10079 03/27/2015 0.10079 08/21/2015

ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG-15MG

0.14344 09/19/2014 0.14344 08/21/2015

ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG-30MG

0.10480 10/20/2017 0.09167 12/22/2017

ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG-60MG

0.19101 05/20/2016 0.17150 08/17/2018

ACETAMINOPHEN/DIPHENHYDRAMINE HCL ORAL TABLET 500MG-25MG 0.04047 04/24/2015 0.04047 08/21/2015

ACETAZOLAMIDE ORAL CAPSULE, EXTENDED RELEASE 500 MG 0.94140 09/22/2017 0.70000 11/16/2018

ACETAZOLAMIDE ORAL TABLET 125 MG 1.52593 08/21/2015 1.29790 11/16/2018

ACETAZOLAMIDE ORAL TABLET 250 MG 1.02880 02/22/2019 0.69948 05/17/2019

ACETIC ACID IRRIGATION SOLUTION, IRRIGATION 0.25 % 0.00350 03/01/2013

ACETIC ACID OTIC SOLUTION, NON-ORAL 2 % 1.81591 08/21/2015 1.65333 02/21/2020

West Virginia MedicaidState Maximum Allowable Cost (SMAC) List

Disclaimer: Price listing does not guarantee coverage

Effective 6/19/2020

Page 2: Disclaimer: Price listing does not guarantee coverage Pharmacy/SMAC/Documents/WV... · 2020-06-18 · Generic Name Prev. SMAC Price Prev. Effective Date Current SMAC Price Current

Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

ACETIC ACID/ALUMINUM ACETATE DROPS 2 % 0.84000 01/25/2013 0.84000 08/21/2015

ACETYLCYSTEINE INTRAVENOUS VIAL (ML) 200 MG/ML 5.26400 03/06/2015 5.26400 08/21/2015

ACETYLCYSTEINE MISCELLANEOUS VIAL (ML) 100 MG/ML 0.45068 08/21/2015 0.35144 02/21/2020

ACETYLCYSTEINE MISCELLANEOUS VIAL (ML) 200 MG/ML 0.19900 02/21/2020 0.34100 03/27/2020

ACETYLCYSTEINE/MECOBALAMIN/LEVOMEFOLATE CALCIUM ORAL TABLET 600-2-6 MG

1.89794 02/20/2015 1.89794 08/21/2015

ACITRETIN ORAL CAPSULE 10 MG 6.66667 11/24/2017 9.53166 12/18/2017

ACITRETIN ORAL CAPSULE 17.5 MG 42.31920 03/21/2014

ACITRETIN ORAL CAPSULE 25 MG 12.56000 01/25/2019 9.33333 05/17/2019

ACYCLOVIR ORAL CAPSULE 200 MG 0.08844 08/21/2015 0.05480 09/22/2017

ACYCLOVIR ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 200 MG/5ML 0.37206 11/16/2018 0.40698 01/19/2020

ACYCLOVIR ORAL TABLET 400 MG 0.06655 07/14/2017 0.05351 11/16/2018

ACYCLOVIR ORAL TABLET 800 MG 0.13520 12/22/2017 0.11600 08/16/2019

ACYCLOVIR SODIUM INTRAVENOUS VIAL (EA) 500 MG 31.20600 08/22/2014 31.20600 08/21/2015

ACYCLOVIR SODIUM INTRAVENOUS VIAL (ML) 50 MG/ML 1.40750 07/25/2014

ACYCLOVIR TOPICAL OINTMENT (GRAM) 5 % 1.94109 11/15/2019 0.89933 05/22/2020

ADAPALENE TOPICAL CREAM (GRAM) 0.1 % 3.51289 04/26/2013

ADAPALENE TOPICAL GEL (GRAM) 0.1 % 1.82556 06/22/2018 1.58578 11/15/2019

ADAPALENE TOPICAL GEL (GRAM) 0.3 % 4.68580 08/21/2015 3.41117 06/16/2017

ADAPALENE TOPICAL GEL WITH PUMP (GRAM) 0.3 % 4.61985 04/10/2015 4.61985 08/21/2015

ADEFOVIR DIPIVOXIL ORAL TABLET 10 MG 26.52627 09/27/2013

ALBUMIN HUMAN INTRAVENOUS INTRAVENOUS SOLUTION 25 % 1.51200 05/01/2015 1.51200 08/21/2015

ALBUMIN HUMAN INTRAVENOUS INTRAVENOUS SOLUTION 5 % 0.21588 09/19/2014 0.21588 08/21/2015

ALBUTEROL SULFATE INHALATION SOLUTION, NON-ORAL 5 MG/ML 1.45230 10/23/2017 2.12250 12/27/2019

ALBUTEROL SULFATE INHALATION VIAL, NEBULIZER (EA) 2.5 MG/0.5 0.43876 08/01/2014

ALBUTEROL SULFATE INHALATION VIAL, NEBULIZER (ML) 0.63MG/3ML 0.15441 11/16/2018 0.11333 11/15/2019

ALBUTEROL SULFATE INHALATION VIAL, NEBULIZER (ML) 1.25MG/3ML 0.19073 06/21/2019 0.15240 12/20/2019

ALBUTEROL SULFATE INHALATION VIAL, NEBULIZER (ML) 2.5 MG/3ML 0.05253 08/21/2015 0.03400 01/19/2018

ALBUTEROL SULFATE ORAL SYRUP 2 MG/5 ML 0.01277 08/21/2015 0.03571 08/28/2019

ALBUTEROL SULFATE ORAL TABLET 2 MG 4.56651 08/21/2015 4.05000 12/25/2015

ALBUTEROL SULFATE ORAL TABLET 4 MG 4.11250 08/21/2015 3.62765 12/25/2015

ALBUTEROL SULFATE ORAL TABLET, EXTENDED RELEASE 12 HR 4 MG 1.18451 04/25/2014

ALBUTEROL SULFATE ORAL TABLET, EXTENDED RELEASE 12 HR 8 MG 1.71821 04/05/2013

ALCLOMETASONE DIPROPIONATE TOPICAL CREAM (GRAM) 0.05 % 0.88300 08/16/2019 0.62717 03/20/2020

ALCLOMETASONE DIPROPIONATE TOPICAL OINTMENT (GRAM) 0.05 % 0.58692 06/28/2013

ALENDRONATE SODIUM ORAL SOLUTION, ORAL 70 MG/75ML 2.45700 09/27/2013

ALENDRONATE SODIUM ORAL TABLET 10 MG 0.18750 08/21/2015 0.13200 10/20/2017

ALENDRONATE SODIUM ORAL TABLET 35 MG 0.35333 08/17/2018 0.23750 05/17/2019

ALENDRONATE SODIUM ORAL TABLET 40 MG 2.80060 03/27/2015

ALENDRONATE SODIUM ORAL TABLET 5 MG 0.18110 08/12/2014 0.18110 08/21/2015

ALENDRONATE SODIUM ORAL TABLET 70 MG 0.27875 10/20/2017 0.23250 09/21/2018

ALFUZOSIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 10 MG 0.11326 03/16/2018 0.05870 05/22/2020

West Virginia MedicaidState Maximum Allowable Cost (SMAC) List

Disclaimer: Price listing does not guarantee coverage

Effective 6/19/2020

Page 3: Disclaimer: Price listing does not guarantee coverage Pharmacy/SMAC/Documents/WV... · 2020-06-18 · Generic Name Prev. SMAC Price Prev. Effective Date Current SMAC Price Current

Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

ALLOPURINOL ORAL TABLET 100 MG 0.07267 11/16/2018 0.04709 01/25/2019

ALLOPURINOL ORAL TABLET 300 MG 0.11998 10/19/2018 0.09110 07/26/2019

ALMOTRIPTAN MALATE ORAL TABLET 12.5 MG 25.31000 08/25/2017 16.33370 10/19/2018

ALPHA LIPOIC ACID ORAL CAPSULE 200 MG 0.12771 08/08/2014 0.12771 08/21/2015

ALPHA LIPOIC ACID ORAL CAPSULE 50 MG 0.10210 08/12/2014 0.10210 08/21/2015

ALPRAZOLAM ORAL TABLET 0.25 MG 0.01509 05/16/2014 0.01509 08/21/2015

ALPRAZOLAM ORAL TABLET 0.5 MG 0.01780 04/17/2015 0.01780 08/21/2015

ALPRAZOLAM ORAL TABLET 1 MG 0.01970 02/06/2015 0.01970 08/21/2015

ALPRAZOLAM ORAL TABLET 2 MG 0.07213 09/28/2015 0.04891 12/22/2017

ALPRAZOLAM ORAL TABLET, EXTENDED RELEASE 24 HR 0.5 MG 0.36136 08/21/2015 0.18083 09/22/2017

ALPRAZOLAM ORAL TABLET, EXTENDED RELEASE 24 HR 1 MG 0.44913 08/21/2015 0.21717 09/22/2017

ALPRAZOLAM ORAL TABLET, EXTENDED RELEASE 24 HR 2 MG 0.41600 08/21/2015 0.40200 08/17/2018

ALPRAZOLAM ORAL TABLET, EXTENDED RELEASE 24 HR 3 MG 0.55483 11/20/2015 0.35500 09/22/2017

ALPRAZOLAM ORAL TABLET,DISINTEGRATING 0.25 MG 1.36123 03/01/2013 1.36123 08/21/2015

ALPRAZOLAM ORAL TABLET,DISINTEGRATING 0.5 MG 1.51669 01/25/2013 1.51669 08/21/2015

ALPRAZOLAM ORAL TABLET,DISINTEGRATING 1 MG 2.02358 01/25/2013 2.02358 08/21/2015

ALPRAZOLAM ORAL TABLET,DISINTEGRATING 2 MG 3.00202 01/25/2013 3.00202 08/21/2015

ALUMINUM HYDROXIDE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 320 MG/5ML

0.00813 08/21/2015

AMANTADINE HCL ORAL CAPSULE 100 MG 0.43730 12/22/2017 0.24644 08/17/2018

AMANTADINE HCL ORAL SOLUTION, ORAL 50 MG/5 ML 0.01733 04/03/2015 0.01733 08/21/2015

AMANTADINE HCL ORAL TABLET 100 MG 1.07830 09/21/2018 0.13100 08/16/2019

AMBRISENTAN ORAL TABLET 10 MG 38.40000 02/21/2020

AMBRISENTAN ORAL TABLET 5 MG 38.40000 02/21/2020

AMCINONIDE TOPICAL CREAM (GRAM) 0.1 % 2.82140 08/12/2014

AMCINONIDE TOPICAL LOTION (ML) 0.1 % 1.90000 08/12/2014

AMCINONIDE TOPICAL OINTMENT (GRAM) 0.1 % 4.53600 08/30/2013

AMIKACIN SULFATE INJECTION VIAL (ML) 1000MG/4ML 3.14373 12/05/2014 3.14373 08/21/2015

AMIKACIN SULFATE INJECTION VIAL (ML) 500 MG/2ML 2.95555 12/05/2014 2.95555 08/21/2015

AMILORIDE HCL ORAL TABLET 5 MG 0.14880 11/15/2019 0.13230 05/22/2020

AMILORIDE HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 5 MG-50 MG 0.42250 05/30/2014 0.42250 08/21/2015

AMINO ACIDS ORAL POWDER (GRAM) 0.25540 08/12/2014

AMINOCAPROIC ACID INTRAVENOUS VIAL (ML) 250 MG/ML 0.08148 02/06/2015 0.08148 08/21/2015

AMINOCAPROIC ACID ORAL TABLET 1000 MG 18.30610 08/12/2014 18.30610 08/21/2015

AMINOCAPROIC ACID ORAL TABLET 500 MG 5.37896 10/11/2013 5.37896 08/21/2015

AMINOPHYLLINE INTRAVENOUS VIAL (ML) 250MG/10ML 0.30912 01/30/2015 0.30912 08/21/2015

AMINOPHYLLINE INTRAVENOUS VIAL (ML) 500MG/20ML 0.07270 08/12/2014

AMIODARONE HCL INTRAVENOUS AMPUL (ML) 50 MG/ML 0.33600 01/25/2013

AMIODARONE HCL ORAL TABLET 100 MG 2.16500 11/24/2017 1.97100 03/20/2020

AMIODARONE HCL ORAL TABLET 200 MG 0.12724 09/30/2016 0.09890 11/16/2018

AMIODARONE HCL ORAL TABLET 400 MG 3.19526 08/22/2014 2.81936 12/02/2016

AMITRIPTYLINE HCL ORAL TABLET 10 MG 0.05742 11/16/2018 0.03550 08/16/2019

West Virginia MedicaidState Maximum Allowable Cost (SMAC) List

Disclaimer: Price listing does not guarantee coverage

Effective 6/19/2020

Page 4: Disclaimer: Price listing does not guarantee coverage Pharmacy/SMAC/Documents/WV... · 2020-06-18 · Generic Name Prev. SMAC Price Prev. Effective Date Current SMAC Price Current

Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

AMITRIPTYLINE HCL ORAL TABLET 100 MG 0.34700 08/16/2019 0.38720 09/13/2019

AMITRIPTYLINE HCL ORAL TABLET 150 MG 0.63350 01/24/2020 0.53600 06/19/2020

AMITRIPTYLINE HCL ORAL TABLET 25 MG 0.09537 11/16/2018 0.06874 05/22/2020

AMITRIPTYLINE HCL ORAL TABLET 50 MG 0.18572 03/20/2020 0.15000 06/19/2020

AMITRIPTYLINE HCL ORAL TABLET 75 MG 0.25740 11/15/2019 0.12500 04/17/2020

AMITRIPTYLINE HCL/CHLORDIAZEPOXIDE ORAL TABLET 12.5MG-5MG 1.07296 08/01/2014

AMITRIPTYLINE HCL/CHLORDIAZEPOXIDE ORAL TABLET 25 MG-10MG 1.51380 05/02/2014

AMLODIPINE BESYLATE ORAL TABLET 10 MG 0.02527 08/21/2015 0.01238 09/21/2018

AMLODIPINE BESYLATE ORAL TABLET 2.5 MG 0.05960 08/21/2015 0.01756 07/14/2017

AMLODIPINE BESYLATE ORAL TABLET 5 MG 0.06240 08/21/2015 0.01300 08/25/2017

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 10 MG-10MG

3.63000 09/30/2016 1.46667 11/15/2019

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 10 MG-20MG

3.93004 04/10/2015 3.93004 08/21/2015

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 10 MG-40MG

3.69400 05/25/2018 2.50000 09/20/2019

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 10 MG-80MG

6.55993 08/21/2015 5.53825 06/16/2017

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 2.5MG-10MG

5.07347 08/12/2014 5.07347 08/21/2015

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 2.5MG-20MG

3.01200 09/22/2017 2.46833 03/20/2020

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 2.5MG-40MG

6.55993 08/21/2015 5.92000 09/30/2016

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 5 MG-10 MG

4.55853 08/21/2015 3.16379 06/16/2017

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 5 MG-20 MG

3.93250 08/21/2015 2.74000 05/25/2018

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 5 MG-40 MG

3.35767 09/22/2017 3.09133 02/21/2020

AMLODIPINE BESYLATE/ATORVASTATIN CALCIUM ORAL TABLET 5 MG-80 MG

5.92000 09/30/2016 3.28900 05/17/2019

AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPSULE 10 MG-20MG 0.22277 09/30/2016 0.10120 08/25/2017

AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPSULE 10 MG-40MG 0.14950 11/24/2017 0.09950 07/26/2019

AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPSULE 2.5MG-10MG 0.46372 03/25/2016 0.08560 09/22/2017

AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPSULE 5 MG-10 MG 0.14570 08/25/2017 0.07450 08/17/2018

AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPSULE 5 MG-20 MG 0.17815 08/25/2017 0.10380 09/22/2017

AMLODIPINE BESYLATE/BENAZEPRIL HCL ORAL CAPSULE 5 MG-40 MG 0.17283 11/24/2017 0.09000 04/27/2018

AMLODIPINE BESYLATE/OLMESARTAN MEDOXOMIL ORAL TABLET 10 MG-20MG

0.52000 11/24/2017 0.31333 11/15/2019

AMLODIPINE BESYLATE/OLMESARTAN MEDOXOMIL ORAL TABLET 10 MG-40MG

0.69044 03/17/2017 0.49867 05/17/2019

AMLODIPINE BESYLATE/OLMESARTAN MEDOXOMIL ORAL TABLET 5 MG-20 MG

0.65033 10/20/2017 0.44433 12/22/2017

AMLODIPINE BESYLATE/OLMESARTAN MEDOXOMIL ORAL TABLET 5 MG-40 MG

0.72933 11/16/2018 0.35000 05/22/2020

AMLODIPINE BESYLATE/VALSARTAN ORAL TABLET 10MG-160MG 0.47493 04/22/2016 0.35000 03/15/2019

AMLODIPINE BESYLATE/VALSARTAN ORAL TABLET 10MG-320MG 0.53089 05/20/2016 0.43333 11/24/2017

AMLODIPINE BESYLATE/VALSARTAN ORAL TABLET 5 MG-160MG 0.42633 10/21/2019 0.33484 12/20/2019

West Virginia MedicaidState Maximum Allowable Cost (SMAC) List

Disclaimer: Price listing does not guarantee coverage

Effective 6/19/2020

Page 5: Disclaimer: Price listing does not guarantee coverage Pharmacy/SMAC/Documents/WV... · 2020-06-18 · Generic Name Prev. SMAC Price Prev. Effective Date Current SMAC Price Current

Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

AMLODIPINE BESYLATE/VALSARTAN ORAL TABLET 5 MG-320MG 0.45034 03/03/2017 0.37667 11/15/2019

AMLODIPINE BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 10-160-25

4.40212 01/01/2017 0.91533 05/25/2018

AMLODIPINE BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 10-320-25

1.41000 05/25/2018 0.94467 05/17/2019

AMLODIPINE BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 10MG-160MG

4.40212 01/01/2017 1.15000 03/15/2019

AMLODIPINE BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 5-160-12.5

3.88023 01/01/2017 1.74210 08/25/2017

AMLODIPINE BESYLATE/VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 5-160-25MG

3.88023 08/21/2015 3.88023 01/01/2017

AMMONIUM CHLORIDE VIAL (ML) 5 MEQ/ML 0.42630 01/25/2013

AMMONIUM LACTATE TOPICAL CREAM (GRAM) 12 % 0.03021 04/26/2019 0.05714 06/05/2019

AMMONIUM LACTATE TOPICAL LOTION (GRAM) 12 % 0.07500 03/25/2016 0.01588 05/22/2020

AMOXAPINE ORAL TABLET 100 MG 1.16865 11/22/2013

AMOXAPINE ORAL TABLET 150 MG 1.28830 01/25/2013

AMOXAPINE ORAL TABLET 25 MG 0.27027 01/25/2013

AMOXAPINE ORAL TABLET 50 MG 0.69923 11/22/2013

AMOXICILLIN ORAL CAPSULE 250 MG 0.04730 04/10/2015 0.04730 08/21/2015

AMOXICILLIN ORAL CAPSULE 500 MG 0.06941 08/21/2015 0.05236 06/16/2017

AMOXICILLIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML

0.01420 04/24/2015 0.01420 08/21/2015

AMOXICILLIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 200 MG/5ML

0.05684 08/21/2015 0.02500 08/25/2017

AMOXICILLIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML

0.02291 10/20/2017 0.01825 07/26/2019

AMOXICILLIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 400 MG/5ML

0.02680 08/21/2015 0.01901 07/26/2019

AMOXICILLIN ORAL TABLET 500 MG 0.25550 08/17/2018 0.13125 05/17/2019

AMOXICILLIN ORAL TABLET 875 MG 0.12230 06/16/2017 0.08590 12/22/2017

AMOXICILLIN ORAL TABLET,CHEWABLE 125 MG 0.15067 01/25/2013

AMOXICILLIN ORAL TABLET,CHEWABLE 250 MG 0.26748 10/03/2014 0.26748 08/21/2015

AMOXICILLIN ORAL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 775 MG

11.26813 12/26/2014 11.26813 08/21/2015

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 200-28.5/5

0.11239 08/21/2015 0.03290 11/24/2017

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250-62.5/5

0.55083 03/20/2020 0.30000 05/22/2020

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 400-57MG/5

0.08554 03/03/2017 0.06173 11/15/2019

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 600-42.9/5

0.08168 03/03/2017 0.06436 11/16/2018

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET 250-125 MG 4.14283 08/21/2015 3.35700 08/17/2018

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET 500-125 MG 0.26356 11/24/2017 0.25000 09/21/2018

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET 875-125 MG 0.24750 09/21/2018 0.23428 01/24/2020

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET, EXTENDED RELEASE 12 HR 1000-62.5

3.37383 10/31/2014

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET,CHEWABLE 200-28.5MG

1.00222 03/01/2013 1.00222 08/21/2015

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Current Effective Date

AMOXICILLIN/POTASSIUM CLAVULANATE ORAL TABLET,CHEWABLE 400-57MG

1.51840 08/22/2014 3.77335 04/22/2016

AMPHOTERICIN B INJECTION VIAL (EA) 50 MG 20.87400 05/30/2014

AMPICILLIN SODIUM INJECTION VIAL (EA) 1 G 2.89120 01/25/2013

AMPICILLIN SODIUM INJECTION VIAL (EA) 10 G 36.92358 12/26/2014 36.92358 08/21/2015

AMPICILLIN SODIUM INJECTION VIAL (EA) 125 MG 3.50250 08/12/2014

AMPICILLIN SODIUM INJECTION VIAL (EA) 2 G 6.57000 11/08/2013 6.49900 05/17/2019

AMPICILLIN SODIUM INJECTION VIAL (EA) 250 MG 1.41638 01/25/2013

AMPICILLIN SODIUM INJECTION VIAL (EA) 500 MG 1.62006 01/25/2013

AMPICILLIN SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 1 G

12.17907 08/12/2014

AMPICILLIN SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 2 G

23.62640 01/25/2013

AMPICILLIN SODIUM/SULBACTAM SODIUM INJECTION VIAL (EA) 1.5 G 2.57012 07/18/2014 2.57012 08/21/2015

AMPICILLIN SODIUM/SULBACTAM SODIUM INJECTION VIAL (EA) 15 G 20.70600 08/12/2014 20.70600 08/21/2015

AMPICILLIN SODIUM/SULBACTAM SODIUM INJECTION VIAL (EA) 3 G 6.47640 08/23/2013 6.47640 08/21/2015

AMPICILLIN SODIUM/SULBACTAM SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 1.5 G

3.24240 01/25/2013

AMPICILLIN SODIUM/SULBACTAM SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 3 G

5.22060 01/25/2013 5.22060 08/21/2015

AMPICILLIN TRIHYDRATE ORAL CAPSULE 250 MG 0.09000 08/12/2014 0.09000 08/21/2015

AMPICILLIN TRIHYDRATE ORAL CAPSULE 500 MG 0.14370 08/21/2015 0.46990 05/15/2020

AMPICILLIN TRIHYDRATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML

0.03950 02/08/2013 0.03950 08/21/2015

AMPICILLIN TRIHYDRATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML

0.06860 02/08/2013 0.06860 08/21/2015

ANAGRELIDE HCL ORAL CAPSULE 0.5 MG 0.60112 05/16/2014

ANAGRELIDE HCL ORAL CAPSULE 1 MG 1.29259 05/16/2014

ANASTROZOLE ORAL TABLET 1 MG 0.08533 06/16/2017 0.04100 08/16/2019

ANTIPYRINE/BENZOCAINE DROPS 5.4 %-1.4% 0.43271 02/06/2015 0.43271 08/21/2015

ANTIPYRINE/BENZOCAINE DROPS 5.5 %-1.4% 10.70600 12/26/2014 10.70600 08/21/2015

ANTIVENIN,LATRODECTUS MACTANS INJECTION VIAL (EA) 6000 UNIT 57.33000 12/12/2014 57.33000 08/21/2015

ANTIVENIN,MICRURUS FULVIUS INJECTION VIAL (EA) 1496.32000 01/25/2013

APRACLONIDINE HCL OPHTHALMIC DROPS 0.5 % 12.32550 08/21/2015 10.34900 08/16/2019

ARGATROBAN IN 0.9 % SODIUM CHLORIDE INTRAVENOUS VIAL (ML) 125 MG/125

11.61817 01/25/2013

ARGATROBAN IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS VIAL (ML) 50 MG/50ML

3.85000 08/12/2014

ARGATROBAN INTRAVENOUS VIAL (ML) 100 MG/ML 412.36020 05/01/2015 412.36020 08/21/2015

ARGININE HCL ORAL TABLET 1000 MG 0.14760 08/12/2014

ARGININE ORAL CAPSULE 500 MG 0.08386 08/12/2014 0.08386 08/21/2015

ARIPIPRAZOLE ORAL SOLUTION, ORAL 1 MG/ML 2.79055 03/17/2017 2.75841 04/21/2017

ARIPIPRAZOLE ORAL TABLET 10 MG 0.17992 03/20/2020 0.15550 05/22/2020

ARIPIPRAZOLE ORAL TABLET 15 MG 0.27900 04/26/2019 0.18774 11/15/2019

ARIPIPRAZOLE ORAL TABLET 2 MG 0.18274 05/17/2019 0.06467 04/17/2020

ARIPIPRAZOLE ORAL TABLET 20 MG 0.30522 06/21/2019 0.27600 09/20/2019

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Current Effective Date

ARIPIPRAZOLE ORAL TABLET 30 MG 0.26417 05/17/2019 0.22500 11/15/2019

ARIPIPRAZOLE ORAL TABLET 5 MG 0.19485 05/17/2019 0.14460 06/19/2020

ARMODAFINIL ORAL TABLET 150 MG 1.03341 08/01/2018

ARMODAFINIL ORAL TABLET 200 MG 1.37000 08/25/2017 1.27067 02/21/2020

ARMODAFINIL ORAL TABLET 250 MG 1.19665 08/01/2018 1.09333 01/25/2019

ASCORBIC ACID ORAL TABLET 1000 MG 0.05352 08/12/2014 0.05352 08/21/2015

ASCORBIC ACID ORAL TABLET 250 MG 0.01807 08/12/2014 0.01807 08/21/2015

ASCORBIC ACID ORAL TABLET 500 MG 0.02550 08/12/2014 0.02550 08/21/2015

ASCORBIC ACID ORAL TABLET, EXTENDED RELEASE 1000 MG 0.07311 08/12/2014 0.07311 08/21/2015

ASCORBIC ACID ORAL TABLET,CHEWABLE 250 MG 0.02510 01/25/2013

ASCORBIC ACID ORAL TABLET,CHEWABLE 500 MG 0.04768 08/12/2014 0.04768 08/21/2015

ASPIRIN ORAL TABLET 325 MG 0.00616 03/27/2015 0.00616 08/21/2015

ASPIRIN ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 325 MG 0.00872 05/01/2015 0.00872 08/21/2015

ASPIRIN ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 81 MG 0.00804 04/03/2015 0.00804 08/21/2015

ASPIRIN ORAL TABLET,CHEWABLE 81 MG 0.02048 05/01/2015 0.02048 08/21/2015

ASPIRIN/ACETAMINOPHEN/CAFFEINE ORAL TABLET 250-250-65 0.04476 04/24/2015 0.04476 08/21/2015

ASPIRIN/CALCIUM CARBONATE/MAGNESIUM ORAL TABLET 325 MG 0.02015 03/07/2014 0.02015 08/21/2015

ASPIRIN/SODIUM BICARBONATE/CITRIC ACID ORAL TABLET, EFFERVESCENT 325-1916MG

0.09644 08/12/2014 0.09644 08/21/2015

ATAZANAVIR SULFATE ORAL CAPSULE 150 MG 4.58000 02/21/2020

ATAZANAVIR SULFATE ORAL CAPSULE 200 MG 4.48000 02/21/2020

ATAZANAVIR SULFATE ORAL CAPSULE 300 MG 6.89000 02/21/2020

ATENOLOL ORAL TABLET 100 MG 0.03400 08/21/2015 0.01518 09/22/2017

ATENOLOL ORAL TABLET 25 MG 0.02659 04/03/2015 0.02659 08/21/2015

ATENOLOL ORAL TABLET 50 MG 0.01640 04/17/2015 0.01640 08/21/2015

ATENOLOL/CHLORTHALIDONE ORAL TABLET 100MG-25MG 0.45970 11/24/2017 0.39948 03/02/2018

ATENOLOL/CHLORTHALIDONE ORAL TABLET 50 MG-25MG 0.35135 03/02/2018 0.32495 11/16/2018

ATOMOXETINE HCL ORAL CAPSULE 10 MG 2.33485 10/24/2019 1.79000 05/22/2020

ATOMOXETINE HCL ORAL CAPSULE 100 MG 2.81100 05/17/2019 2.47000 12/20/2019

ATOMOXETINE HCL ORAL CAPSULE 18 MG 1.62233 02/21/2020 0.82333 06/19/2020

ATOMOXETINE HCL ORAL CAPSULE 25 MG 1.41167 01/24/2020 1.98117 05/22/2020

ATOMOXETINE HCL ORAL CAPSULE 40 MG 1.70867 03/20/2020 1.64600 05/22/2020

ATOMOXETINE HCL ORAL CAPSULE 60 MG 1.95000 06/21/2019 2.41600 07/17/2019

ATOMOXETINE HCL ORAL CAPSULE 80 MG 1.96534 09/20/2019 1.66667 11/15/2019

ATORVASTATIN CALCIUM ORAL TABLET 10 MG 0.05920 08/17/2018 0.04039 11/15/2019

ATORVASTATIN CALCIUM ORAL TABLET 20 MG 0.06926 02/22/2019 0.06114 07/26/2019

ATORVASTATIN CALCIUM ORAL TABLET 40 MG 0.09629 10/25/2019 0.05800 04/17/2020

ATORVASTATIN CALCIUM ORAL TABLET 80 MG 0.11409 10/20/2017 0.10064 11/15/2019

ATOVAQUONE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 750 MG/5ML

2.21000 12/21/2018 1.42857 11/15/2019

ATOVAQUONE/PROGUANIL HCL ORAL TABLET 250-100 MG 2.23250 05/17/2019 2.19550 11/15/2019

ATOVAQUONE/PROGUANIL HCL ORAL TABLET 62.5-25 MG 1.85045 06/06/2014 0.92151 01/13/2017

ATROPINE SULFATE INJECTION SYRINGE (ML) 0.05 MG/ML 2.23272 01/25/2013

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Current Effective Date

ATROPINE SULFATE INJECTION SYRINGE (ML) 0.1 MG/ML 0.43014 01/25/2013 0.43014 08/21/2015

ATROPINE SULFATE INJECTION VIAL (ML) 0.4 MG/ML 0.85480 08/12/2014 0.85480 08/21/2015

ATROPINE SULFATE INJECTION VIAL (ML) 1 MG/ML 1.50320 08/12/2014

ATROPINE SULFATE OPHTHALMIC DROPS 1 % 8.17320 08/22/2015 9.81029 01/31/2020

ATROPINE SULFATE OPHTHALMIC OINTMENT (GRAM) 1 % 3.98000 02/08/2013

AZATHIOPRINE ORAL TABLET 50 MG 0.21600 04/26/2019 0.18135 11/15/2019

AZELASTINE HCL NASAL AEROSOL, SPRAY WITH PUMP (ML) 137 MCG 0.33442 11/16/2018 0.27345 07/26/2019

AZELASTINE HCL NASAL AEROSOL, SPRAY WITH PUMP (ML) 205.5 MCG 1.16607 08/16/2019 1.02000 02/21/2020

AZELASTINE HCL OPHTHALMIC DROPS 0.05 % 2.20055 11/24/2017 1.31000 12/21/2018

AZITHROMYCIN INTRAVENOUS VIAL (EA) 500 MG 3.77260 08/12/2014 3.77260 08/21/2015

AZITHROMYCIN INTRAVENOUS VIAL WITH THREADED PORT (EA) 500 MG 12.68820 01/25/2013

AZITHROMYCIN ORAL PACKET (EA) 1 G 20.29440 01/17/2014 20.29440 08/21/2015

AZITHROMYCIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 100 MG/5ML

0.58000 08/16/2019 0.42933 05/22/2020

AZITHROMYCIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 200 MG/5ML

0.56816 02/21/2020 0.55000 04/17/2020

AZITHROMYCIN ORAL TABLET 250 MG 0.29000 10/20/2017 0.27106 01/19/2018

AZITHROMYCIN ORAL TABLET 500 MG 0.97640 03/03/2017 0.56111 06/16/2017

AZITHROMYCIN ORAL TABLET 600 MG 1.49833 05/17/2019 1.25500 09/20/2019

AZTREONAM INJECTION VIAL (EA) 1 G 27.67800 08/15/2014

AZTREONAM INJECTION VIAL (EA) 2 G 39.02640 01/30/2015 39.02640 08/21/2015

B-COMPLEX WITH VITAMIN C ORAL TABLET 0.02618 08/15/2014 0.02618 08/21/2015

BACITRACIN OPHTHALMIC OINTMENT (GRAM) 500 UNIT/G 13.86800 08/21/2015 27.98908 08/15/2018

BACITRACIN TOPICAL OINTMENT (GRAM) 500 UNIT/G 0.06722 04/19/2013 0.06722 08/21/2015

BACITRACIN ZINC TOPICAL OINTMENT (GRAM) 500 UNIT/G 0.10676 04/17/2015 0.10676 08/21/2015

BACITRACIN/POLYMYXIN B SULFATE OPHTHALMIC OINTMENT (GRAM) 500-10K/G

2.81450 08/21/2015 2.05714 08/16/2019

BACITRACIN/POLYMYXIN B SULFATE TOPICAL OINTMENT (GRAM) 500-10K/G

0.27376 01/25/2013 0.27376 08/21/2015

BACLOFEN MISCELLANEOUS POWDER (GRAM) 100 % 2.61831 02/13/2015 2.61831 08/21/2015

BACLOFEN ORAL TABLET 10 MG 0.07070 01/25/2019 0.05757 01/24/2020

BACLOFEN ORAL TABLET 20 MG 0.19580 02/04/2020 0.14090 05/22/2020

BALSALAZIDE DISODIUM ORAL CAPSULE 750 MG 0.35921 09/22/2017 0.22496 03/02/2018

BCG LIVE INTRAVESICAL VIAL (EA) 50 MG 291.39600 01/25/2013

BENAZEPRIL HCL ORAL TABLET 10 MG 0.03800 10/20/2017 0.01900 11/16/2018

BENAZEPRIL HCL ORAL TABLET 20 MG 0.05197 03/27/2015 0.05197 08/21/2015

BENAZEPRIL HCL ORAL TABLET 40 MG 0.06427 08/25/2017 0.04368 10/20/2017

BENAZEPRIL HCL ORAL TABLET 5 MG 0.05199 08/21/2015 0.03583 11/16/2018

BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 10-12.5MG 0.63132 06/16/2017 0.60520 12/22/2017

BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 20 MG-25MG 0.87187 03/03/2017 0.49535 06/16/2017

BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 20-12.5 MG 0.19990 08/17/2018 0.68974 08/25/2018

BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 5-6.25MG 0.45890 08/21/2015

BENZOCAINE/MENTHOL MUCOUS MEMBRANE LOZENGE 15MG-3.6MG 0.09806 02/13/2015 0.09806 08/21/2015

BENZONATATE ORAL CAPSULE 100 MG 0.09980 11/16/2018 0.08282 11/15/2019

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Current SMAC Price

Current Effective Date

BENZONATATE ORAL CAPSULE 200 MG 0.14064 09/30/2016 0.08920 08/16/2019

BENZOYL PEROXIDE TOPICAL CLEANSER (GRAM) 10 % 0.04197 05/01/2015 0.04197 08/21/2015

BENZOYL PEROXIDE TOPICAL CLEANSER (GRAM) 5 % 0.04075 08/09/2013 0.04075 08/21/2015

BENZOYL PEROXIDE TOPICAL FOAM (GRAM) 5.3% 2.00832 08/12/2014

BENZOYL PEROXIDE TOPICAL FOAM (GRAM) 9.8 % 1.60318 08/12/2014

BENZOYL PEROXIDE TOPICAL GEL (GRAM) 10 % 0.21574 03/20/2015 0.21574 08/21/2015

BENZOYL PEROXIDE TOPICAL GEL (GRAM) 2.5 % 0.23088 08/16/2013

BENZOYL PEROXIDE TOPICAL GEL (GRAM) 5 % 0.18789 02/27/2015 0.18789 08/21/2015

BENZPHETAMINE HCL ORAL TABLET 50 MG 0.43389 11/07/2014 0.43389 08/21/2015

BENZTROPINE MESYLATE INJECTION AMPUL (ML) 2 MG/2 ML 23.40625 08/12/2014

BENZTROPINE MESYLATE INJECTION VIAL (ML) 2 MG/2 ML 40.39560 01/25/2013 40.39560 08/21/2015

BENZTROPINE MESYLATE ORAL TABLET 0.5 MG 0.08100 09/22/2017 0.05221 07/26/2019

BENZTROPINE MESYLATE ORAL TABLET 1 MG 0.09106 08/25/2017 0.05550 09/21/2018

BENZTROPINE MESYLATE ORAL TABLET 2 MG 0.09210 02/22/2019 0.07071 08/16/2019

BETA-CAROTENE(A) W-C AND E/LUTEIN/MINERALS ORAL TABLET 1000-60-2

0.06145 08/12/2014 0.06145 08/21/2015

BETA-CAROTENE/ASCORBIC ACID/VITE AC/ZINC OXIDE/CUPRIC OXIDE ORAL CAPSULE 14320-226

0.16420 08/12/2014 0.16420 08/21/2015

BETA-CAROTENE/ASCORBIC ACID/VITE AC/ZINC OXIDE/CUPRIC OXIDE ORAL TABLET 7160-113

0.06620 08/12/2014

BETAMETHASONE ACETATE/BETAMETHASONE SODIUM PHOSPHATE INJECTION VIAL (ML) 6 MG/ML

5.60000 01/25/2013 5.60000 08/21/2015

BETAMETHASONE DIPROPIONATE TOPICAL CREAM (GRAM) 0.05 % 1.08858 11/15/2019 1.02000 05/22/2020

BETAMETHASONE DIPROPIONATE TOPICAL GEL (GRAM) 0.05 % 1.21450 01/25/2013

BETAMETHASONE DIPROPIONATE TOPICAL LOTION (ML) 0.05 % 0.23117 08/16/2019 0.45600 02/07/2020

BETAMETHASONE DIPROPIONATE TOPICAL OINTMENT (GRAM) 0.05 % 1.57591 03/29/2013 1.57591 08/21/2015

BETAMETHASONE DIPROPIONATE/PROPYLENE GLYCOL TOPICAL CREAM (GRAM) 0.05 %

0.34930 08/21/2015 0.17260 01/25/2019

BETAMETHASONE DIPROPIONATE/PROPYLENE GLYCOL TOPICAL LOTION (ML) 0.05 %

1.77637 08/16/2013

BETAMETHASONE DIPROPIONATE/PROPYLENE GLYCOL TOPICAL OINTMENT (GRAM) 0.05 %

1.66174 06/16/2017 0.86311 08/16/2019

BETAMETHASONE VALERATE TOPICAL CREAM (GRAM) 0.1 % 0.56720 07/08/2016 0.16667 02/21/2020

BETAMETHASONE VALERATE TOPICAL FOAM (GRAM) 0.12 % 3.31660 08/21/2015 2.50000 10/25/2019

BETAMETHASONE VALERATE TOPICAL LOTION (ML) 0.1 % 0.79430 03/29/2013 0.79430 08/21/2015

BETAMETHASONE VALERATE TOPICAL OINTMENT (GRAM) 0.1 % 0.69422 09/04/2018 0.56667 02/21/2020

BETAXOLOL HCL OPHTHALMIC DROPS 0.5 % 7.27680 01/25/2013

BETAXOLOL HCL ORAL TABLET 10 MG 0.51160 08/16/2019

BETHANECHOL CHLORIDE ORAL TABLET 10 MG 0.29680 08/25/2017 0.11950 05/17/2019

BETHANECHOL CHLORIDE ORAL TABLET 25 MG 0.27150 09/22/2017 0.17580 08/16/2019

BETHANECHOL CHLORIDE ORAL TABLET 5 MG 0.14400 09/22/2017 0.12190 11/15/2019

BETHANECHOL CHLORIDE ORAL TABLET 50 MG 0.28034 12/02/2016 0.25990 11/16/2018

BICALUTAMIDE ORAL TABLET 50 MG 0.21667 08/25/2017 0.10180 08/17/2018

BIOFLAVONOID, LEMON/VITAMIN B COMP AND C ORAL TABLET 200-100 MG

0.14285 05/03/2013

BIOTIN ORAL CAPSULE 2500 MCG 0.09390 08/12/2014

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BISACODYL ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 5 MG 0.00996 01/16/2015 0.00996 08/21/2015

BISACODYL RECTAL SUPPOSITORY, RECTAL 10 MG 0.09491 08/12/2014 0.09491 08/21/2015

BISMUTH SUBSALICYLATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 262MG/15ML

0.00732 03/20/2015 0.00732 08/21/2015

BISMUTH SUBSALICYLATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 525MG/15ML

0.01095 04/24/2015 0.01095 08/21/2015

BISMUTH SUBSALICYLATE ORAL TABLET,CHEWABLE 262 MG 0.09120 08/21/2015 0.05733 01/25/2019

BISOPROLOL FUMARATE ORAL TABLET 10 MG 0.42566 11/15/2019 0.52457 03/24/2020

BISOPROLOL FUMARATE ORAL TABLET 5 MG 0.56161 10/24/2019 0.38074 02/21/2020

BISOPROLOL FUMARATE/HYDROCHLOROTHIAZIDE ORAL TABLET 10-6.25MG

0.06432 04/17/2015 0.06432 08/21/2015

BISOPROLOL FUMARATE/HYDROCHLOROTHIAZIDE ORAL TABLET 2.5-6.25MG

0.04920 10/20/2017 0.03462 03/02/2018

BISOPROLOL FUMARATE/HYDROCHLOROTHIAZIDE ORAL TABLET 5-6.25MG

0.42720 10/25/2019 0.33813 02/21/2020

BRIMONIDINE TARTRATE OPHTHALMIC DROPS 0.15 % 16.27762 08/21/2015 16.27762 04/22/2016

BRIMONIDINE TARTRATE OPHTHALMIC DROPS 0.2 % 0.51810 02/22/2019 0.42067 06/19/2020

BROMFENAC SODIUM OPHTHALMIC DROPS 0.09 % 39.30875 09/26/2014 39.30875 08/21/2015

BROMOCRIPTINE MESYLATE ORAL CAPSULE 5 MG 6.00042 03/25/2016 4.25000 10/19/2018

BROMOCRIPTINE MESYLATE ORAL TABLET 2.5 MG 2.15134 05/28/2019 1.06633 11/15/2019

BROMPHENIRAMINE MALEATE/PHENYLEPHRINE HCL ORAL LIQUID (ML) 4-10MG/5ML

0.15294 01/25/2013 0.15294 08/21/2015

BROMPHENIRAMINE MALEATE/PHENYLEPHRINE HCL/DEXTROMETHORPHAN ORAL LIQUID (ML) 4-10-20/5

0.11830 09/13/2013 0.11830 08/21/2015

BROMPHENIRAMINE MALEATE/PHENYLEPHRINE HCL/DEXTROMETHORPHAN ORAL LIQUID (ML) 4-7.5-15/5

0.09960 12/12/2014 0.09960 08/21/2015

BROMPHENIRAMINE MALEATE/PHENYLEPHRINE HCL/DEXTROMETHORPHAN ORAL SOLUTION, ORAL 1-2.5-5/5

0.01700 02/06/2015 0.01700 08/21/2015

BROMPHENIRAMINE MALEATE/PSEUDOEPHEDRINE HCL/DEXTROMETHORPHAN ORAL ELIXIR 1-15-5MG/5

0.01880 03/27/2015

BROMPHENIRAMINE MALEATE/PSEUDOEPHEDRINE HCL/DEXTROMETHORPHAN ORAL SYRUP 2-30-10/5

0.12883 09/20/2017 0.05776 11/16/2018

BUDESONIDE INHALATION AMPUL FOR NEBULIZATION (ML) 0.25MG/2ML 2.80662 12/02/2016 0.51467 11/15/2019

BUDESONIDE INHALATION AMPUL FOR NEBULIZATION (ML) 0.5 MG/2ML 0.93000 06/21/2019 0.74983 11/15/2019

BUDESONIDE INHALATION AMPUL FOR NEBULIZATION (ML) 1 MG/2 ML 4.43100 11/15/2019 4.11367 06/19/2020

BUDESONIDE ORAL CAPSULE, DELAYED, AND EXTENDED RELEASE 3 MG

0.89630 08/16/2019 0.48290 04/17/2020

BUMETANIDE INJECTION VIAL (ML) 0.25 MG/ML 0.26572 01/25/2013 0.26572 08/21/2015

BUMETANIDE ORAL TABLET 0.5 MG 0.15517 02/20/2015 0.15517 08/21/2015

BUMETANIDE ORAL TABLET 1 MG 0.37153 05/17/2019 0.27990 05/22/2020

BUMETANIDE ORAL TABLET 2 MG 0.99030 05/24/2016 0.64435 03/03/2017

BUPIVACAINE HCL INJECTION VIAL (ML) 2.5 MG/ML 0.04200 04/25/2014

BUPIVACAINE HCL INJECTION VIAL (ML) 5 MG/ML 0.05090 04/25/2014 0.05090 08/21/2015

BUPIVACAINE HCL/EPINEPHRINE BITARTRATE INJECTION CARTRIDGE (ML) 0.5-1:200K

0.26130 08/12/2014

BUPIVACAINE HCL/EPINEPHRINE INJECTION VIAL (ML) 0.25-.0005 0.12253 01/25/2013

BUPIVACAINE HCL/EPINEPHRINE INJECTION VIAL (ML) 0.5-1:200K 0.11900 01/25/2013

BUPIVACAINE HCL/EPINEPHRINE/PF INJECTION VIAL (ML) 0.25-.0005 0.27733 01/25/2013

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Effective 6/19/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

BUPIVACAINE HCL/EPINEPHRINE/PF INJECTION VIAL (ML) 0.5-1:200K 0.25992 01/25/2013

BUPIVACAINE HCL/PF INJECTION AMPUL (ML) 2.5 MG/ML 0.11790 08/12/2014

BUPIVACAINE HCL/PF INJECTION AMPUL (ML) 5 MG/ML 0.08690 08/12/2014

BUPIVACAINE HCL/PF INJECTION AMPUL (ML) 7.5 MG/ML 0.10478 01/25/2013 0.10478 08/21/2015

BUPIVACAINE HCL/PF INJECTION VIAL (ML) 2.5 MG/ML 0.06089 08/12/2014

BUPIVACAINE HCL/PF INJECTION VIAL (ML) 5 MG/ML 0.06736 08/12/2014

BUPIVACAINE HCL/PF INJECTION VIAL (ML) 7.5 MG/ML 0.13428 08/12/2014

BUPRENORPHINE HCL INJECTION CARTRIDGE (ML) 0.3 MG/ML 12.18000 01/25/2013

BUPRENORPHINE HCL SUBLINGUAL TABLET, SUBLINGUAL 2 MG 1.05933 06/16/2017 0.43600 09/22/2017

BUPRENORPHINE HCL SUBLINGUAL TABLET, SUBLINGUAL 8 MG 0.95666 06/25/2019 0.65800 09/20/2019

BUPRENORPHINE HCL/NALOXONE HCL SUBLINGUAL TABLET, SUBLINGUAL 2 MG-0.5MG

2.60728 06/16/2017 1.19133 11/15/2019

BUPRENORPHINE HCL/NALOXONE HCL SUBLINGUAL TABLET, SUBLINGUAL 8 MG-2 MG

2.31650 09/21/2018 1.75693 11/15/2019

BUPROPION HCL ORAL TABLET 100 MG 0.18600 09/22/2017 0.11485 08/16/2019

BUPROPION HCL ORAL TABLET 75 MG 0.14167 11/15/2019 0.08950 05/22/2020

BUPROPION HCL ORAL TABLET, EXTENDED RELEASE 12 HR 150 MG 0.44367 03/25/2016 0.20967 07/14/2017

BUPROPION HCL ORAL TABLET, EXTENDED RELEASE 24 HR 150 MG 0.15723 11/15/2019 0.14598 06/19/2020

BUPROPION HCL ORAL TABLET, EXTENDED RELEASE 24 HR 300 MG 0.22833 01/25/2019 0.19016 05/22/2020

BUPROPION HCL ORAL TABLET,SUSTAINED-RELEASE 12 HR 100 MG 0.07644 03/02/2018 0.12200 07/23/2018

BUPROPION HCL ORAL TABLET,SUSTAINED-RELEASE 12 HR 150 MG 0.09350 06/16/2017 0.07500 06/19/2020

BUPROPION HCL ORAL TABLET,SUSTAINED-RELEASE 12 HR 200 MG 0.19271 07/14/2017 0.08490 02/22/2019

BUSPIRONE HCL ORAL TABLET 10 MG 0.03984 10/20/2017 0.04536 11/29/2018

BUSPIRONE HCL ORAL TABLET 15 MG 0.06612 11/14/2018 0.05500 07/26/2019

BUSPIRONE HCL ORAL TABLET 30 MG 0.26383 05/17/2019 0.21300 07/26/2019

BUSPIRONE HCL ORAL TABLET 5 MG 0.04020 08/21/2015 0.02551 11/16/2018

BUSPIRONE HCL ORAL TABLET 7.5 MG 0.35967 05/17/2019 0.33000 11/15/2019

BUTALBITAL/ACETAMINOPHEN ORAL TABLET 50MG-325MG 0.86233 03/14/2014 1.09000 08/07/2015

BUTALBITAL/ACETAMINOPHEN/CAFFEINE ORAL CAPSULE 50-300-40 2.36850 08/03/2018 1.86500 10/19/2018

BUTALBITAL/ACETAMINOPHEN/CAFFEINE ORAL CAPSULE 50-325-40 1.35905 03/27/2015

BUTALBITAL/ACETAMINOPHEN/CAFFEINE ORAL TABLET 50-325-40 0.22890 12/20/2019 0.15773 05/22/2020

BUTALBITAL/ACETAMINOPHEN/CAFFEINE/CODEINE PHOSPHATE ORAL CAPSULE 50-300-30

4.30822 03/06/2015

BUTALBITAL/ACETAMINOPHEN/CAFFEINE/CODEINE PHOSPHATE ORAL CAPSULE 50-325-30

1.04965 08/21/2015 1.01795 03/02/2018

BUTALBITAL/ASPIRIN/CAFFEINE ORAL CAPSULE 50-325-40 0.88420 01/24/2020 1.00000 05/04/2020

BUTALBITAL/ASPIRIN/CAFFEINE ORAL TABLET 50-325-40 0.29110 12/17/2018

BUTENAFINE HCL TOPICAL CREAM (GRAM) 1 % 0.40179 08/21/2015 0.40179 01/01/2019

BUTORPHANOL TARTRATE INJECTION VIAL (ML) 1 MG/ML 1.94300 01/25/2013 1.94300 08/21/2015

BUTORPHANOL TARTRATE INJECTION VIAL (ML) 2 MG/ML 1.94300 01/25/2013 1.94300 08/21/2015

BUTORPHANOL TARTRATE NASAL AEROSOL, SPRAY (ML) 10 MG/ML 16.32960 08/21/2015 12.19584 06/16/2017

CABERGOLINE ORAL TABLET 0.5 MG 2.93000 06/21/2019 2.12000 07/26/2019

CAFFEINE CITRATE INTRAVENOUS VIAL (ML) 60 MG/3 ML 3.35400 04/03/2015 3.35400 08/21/2015

CAFFEINE CITRATE ORAL SOLUTION, ORAL 60 MG/3 ML 6.70190 08/21/2015 6.66666 01/25/2019

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Effective 6/19/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

CAFFEINE/SODIUM BENZOATE INJECTION VIAL (ML) 250 MG/ML 2.73000 01/25/2013

CALCIPOTRIENE TOPICAL CREAM (GRAM) 0.005 % 1.70100 04/26/2019 0.88683 01/24/2020

CALCIPOTRIENE TOPICAL OINTMENT (GRAM) 0.005 % 4.22790 08/12/2014

CALCIPOTRIENE TOPICAL SOLUTION, NON-ORAL 0.005 % 2.64568 06/16/2017 1.56000 05/25/2018

CALCIPOTRIENE/BETAMETHASONE DIPROPIONATE TOPICAL OINTMENT (GRAM) 0.005-.064

8.11932 06/16/2017 8.11932 01/01/2018

CALCITONIN,SALMON,SYNTHETIC NASAL AEROSOL, SPRAY WITH PUMP (ML) 200/SPRAY

10.40270 09/25/2015 9.78378 09/30/2016

CALCITRIOL INTRAVENOUS AMPUL (ML) 1 MCG/ML 4.68130 05/10/2013

CALCITRIOL ORAL CAPSULE 0.25 MCG 0.17150 11/16/2018 0.13009 08/16/2019

CALCITRIOL ORAL CAPSULE 0.5 MCG 0.50783 02/08/2018 0.20400 11/16/2018

CALCITRIOL ORAL SOLUTION, ORAL 1 MCG/ML 5.49667 08/26/2016 4.59200 08/16/2019

CALCITRIOL TOPICAL OINTMENT (GRAM) 3 MCG/G 6.43120 01/09/2015 6.43120 01/01/2018

CALCIUM ACETATE ORAL CAPSULE 667 MG 0.09543 08/16/2019 0.51577 03/31/2020

CALCIUM ACETATE ORAL TABLET 667 MG 0.36813 01/03/2014 0.30825 11/16/2018

CALCIUM ACETATE/ALUMINUM SULFATE TOPICAL POWDER IN PACKET (EA) 952-1347MG

0.72740 01/25/2013

CALCIUM CARBONATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 500 MG/5ML

0.01799 01/25/2013

CALCIUM CARBONATE ORAL TABLET 500(1250) 0.01434 06/21/2013 0.01434 08/21/2015

CALCIUM CARBONATE ORAL TABLET 600 MG 0.02144 07/26/2013 0.02144 08/21/2015

CALCIUM CARBONATE ORAL TABLET,CHEWABLE 200(500)MG 0.01357 02/06/2015 0.01357 08/21/2015

CALCIUM CARBONATE ORAL TABLET,CHEWABLE 300MG(750) 0.02554 02/27/2015 0.02554 08/21/2015

CALCIUM CARBONATE ORAL TABLET,CHEWABLE 400(1000) 0.04240 08/21/2015 0.02986 08/17/2018

CALCIUM CARBONATE ORAL TABLET,CHEWABLE 500(1250) 0.03420 08/12/2014

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL CAPSULE 600 MG-400

0.04855 08/12/2014

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 250 MG-125

0.01032 01/25/2013 0.01032 08/21/2015

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 250 MG-125

0.02170 08/12/2014 0.02170 08/21/2015

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 500 MG-200

0.01599 08/12/2014 0.01599 08/21/2015

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 500 MG-400

0.03507 08/12/2014 0.03507 08/21/2015

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 600 MG-200

0.01899 01/25/2013 0.01899 08/21/2015

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 600 MG-400

0.01956 02/27/2015 0.01956 08/21/2015

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 600 MG-800

0.05873 02/13/2015 0.05873 08/21/2015

CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET,CHEWABLE 500 MG-100

0.03420 08/21/2015

CALCIUM CARBONATE/ERGOCALCIFEROL (VITAMIN D2) TABLET 250 MG-125

0.02170 08/12/2014 0.02170 08/21/2015

CALCIUM CARBONATE/MAGNESIUM HYDROXIDE ORAL TABLET,CHEWABLE 675-135 MG

0.01352 08/21/2015

CALCIUM CHLORIDE INTRAVENOUS SYRINGE (ML) 100 MG/ML 0.47124 08/12/2014 0.47124 08/21/2015

CALCIUM CHLORIDE INTRAVENOUS VIAL (ML) 100 MG/ML 0.17500 01/25/2013

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Effective 6/19/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

CALCIUM CITRATE ORAL TABLET 200(950)MG 0.03070 08/12/2014 0.03070 08/21/2015

CALCIUM CITRATE ORAL TABLET 250 MG 0.05565 01/25/2013

CALCIUM CITRATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 200 MG-250

0.04005 08/12/2014

CALCIUM CITRATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 315 MG-200

0.05724 08/12/2014 0.05724 08/21/2015

CALCIUM CITRATE/CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 315 MG-250

0.04615 11/21/2014 0.04615 08/21/2015

CALCIUM POLYCARBOPHIL ORAL TABLET 625 MG 0.06417 08/12/2014 0.06417 08/21/2015

CANDESARTAN CILEXETIL ORAL TABLET 16 MG 1.34663 05/17/2019 1.17100 11/15/2019

CANDESARTAN CILEXETIL ORAL TABLET 32 MG 1.54000 04/27/2018 1.06144 09/20/2019

CANDESARTAN CILEXETIL ORAL TABLET 4 MG 1.45322 11/15/2019 1.20000 02/21/2020

CANDESARTAN CILEXETIL ORAL TABLET 8 MG 1.45333 08/17/2018 1.25400 08/16/2019

CANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE ORAL TABLET 16-12.5MG

1.87708 11/07/2014 1.87708 08/21/2015

CANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE ORAL TABLET 32-12.5MG

2.91948 01/25/2013 2.91948 08/21/2015

CANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDE ORAL TABLET 32MG-25MG

3.15984 08/12/2014 3.15984 08/21/2015

CAPECITABINE ORAL TABLET 150 MG 8.21479 04/24/2015 8.21479 08/21/2015

CAPECITABINE ORAL TABLET 500 MG 5.07000 11/24/2017 3.86667 11/15/2019

CAPSAICIN TOPICAL CREAM (GRAM) 0.025 % 0.06709 04/05/2013 0.06709 08/21/2015

CAPSAICIN TOPICAL CREAM (GRAM) 0.075 % 0.09338 08/12/2014 0.09338 08/21/2015

CAPSAICIN/METHYL SALICYLATE/MENTHOL TOPICAL LOTION (GRAM) 0.002%-20%

2.36327 01/25/2013

CAPTOPRIL MISCELLANEOUS POWDER (GRAM) 100 % 56.85764 02/22/2013 56.85764 08/21/2015

CAPTOPRIL ORAL TABLET 100 MG 1.12780 05/09/2014 1.12780 08/21/2015

CAPTOPRIL ORAL TABLET 12.5 MG 0.46645 08/15/2014 0.46645 08/21/2015

CAPTOPRIL ORAL TABLET 25 MG 0.99791 08/21/2015 0.75000 08/25/2017

CAPTOPRIL ORAL TABLET 50 MG 0.99970 02/22/2019 0.77990 11/15/2019

CAPTOPRIL/HYDROCHLOROTHIAZIDE ORAL TABLET 25 MG-15MG 0.33384 12/27/2013 0.33384 08/21/2015

CAPTOPRIL/HYDROCHLOROTHIAZIDE ORAL TABLET 25 MG-25MG 1.10214 05/30/2014 1.10214 08/21/2015

CAPTOPRIL/HYDROCHLOROTHIAZIDE ORAL TABLET 50 MG-15MG 1.89163 05/30/2014 1.89163 08/21/2015

CAPTOPRIL/HYDROCHLOROTHIAZIDE ORAL TABLET 50 MG-25MG 1.89163 05/30/2014 1.89163 08/21/2015

CARBAMAZEPINE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 12HR 100 MG

1.26909 06/06/2019 1.25017 03/20/2020

CARBAMAZEPINE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 12HR 200 MG

1.25113 08/21/2015

CARBAMAZEPINE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 12HR 200 MG

1.55500 10/17/2019 1.45789 05/22/2020

CARBAMAZEPINE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 12HR 300 MG

0.93459 11/15/2019 1.46300 11/16/2019

CARBAMAZEPINE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 100 MG/5ML

0.11631 07/18/2014 0.11631 01/01/2020

CARBAMAZEPINE ORAL TABLET 200 MG 0.22000 12/20/2019 0.32256 03/02/2020

CARBAMAZEPINE ORAL TABLET, EXTENDED RELEASE 12 HR 100 MG 0.49080 11/15/2019 0.63951 01/21/2020

CARBAMAZEPINE ORAL TABLET, EXTENDED RELEASE 12 HR 200 MG 0.90340 11/15/2019 0.88980 04/17/2020

CARBAMAZEPINE ORAL TABLET, EXTENDED RELEASE 12 HR 400 MG 2.17370 02/03/2020 1.81858 05/22/2020

West Virginia MedicaidState Maximum Allowable Cost (SMAC) List

Disclaimer: Price listing does not guarantee coverage

Effective 6/19/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

CARBAMAZEPINE ORAL TABLET,CHEWABLE 100 MG 0.28300 02/24/2019 0.23768 09/20/2019

CARBAMIDE PEROXIDE OTIC DROPS 6.5 % 0.11614 08/21/2015 0.06800 08/25/2017

CARBIDOPA ORAL TABLET 25 MG 5.19620 10/19/2018 3.86500 01/25/2019

CARBIDOPA/LEVODOPA ORAL TABLET 10MG-100MG 0.09610 09/22/2017 0.06610 05/22/2020

CARBIDOPA/LEVODOPA ORAL TABLET 25MG-100MG 0.09799 07/14/2017 0.08025 03/16/2018

CARBIDOPA/LEVODOPA ORAL TABLET 25MG-250MG 0.12267 03/16/2018 0.09850 05/22/2020

CARBIDOPA/LEVODOPA ORAL TABLET, EXTENDED RELEASE 25MG-100MG

0.18200 08/17/2018 0.11510 10/19/2018

CARBIDOPA/LEVODOPA ORAL TABLET, EXTENDED RELEASE 50MG-200MG

0.42000 09/11/2019 0.31670 05/22/2020

CARBIDOPA/LEVODOPA ORAL TABLET,DISINTEGRATING 10MG-100MG 0.77305 01/25/2013 0.77305 08/21/2015

CARBIDOPA/LEVODOPA ORAL TABLET,DISINTEGRATING 25MG-100MG 0.94146 04/10/2015 0.94146 08/21/2015

CARBIDOPA/LEVODOPA ORAL TABLET,DISINTEGRATING 25MG-250MG 1.10100 01/25/2013 1.10100 08/21/2015

CARBIDOPA/LEVODOPA/ENTACAPONE ORAL TABLET 12.5-50 MG 2.13334 08/21/2015 2.13334 04/22/2016

CARBIDOPA/LEVODOPA/ENTACAPONE ORAL TABLET 18.75-75MG 2.62496 08/12/2014 2.62496 04/22/2016

CARBIDOPA/LEVODOPA/ENTACAPONE ORAL TABLET 25-100-200 1.37907 03/03/2017 0.83370 09/22/2017

CARBIDOPA/LEVODOPA/ENTACAPONE ORAL TABLET 31.25-125 2.62481 04/22/2016 1.13280 02/22/2019

CARBIDOPA/LEVODOPA/ENTACAPONE ORAL TABLET 37.5-150MG 0.84205 11/15/2019 0.62336 02/21/2020

CARBIDOPA/LEVODOPA/ENTACAPONE ORAL TABLET 50-200-200 0.83370 09/22/2017 0.54950 05/17/2019

CARBINOXAMINE MALEATE ORAL LIQUID (ML) 4 MG/5 ML 0.09112 03/15/2013 0.09112 08/21/2015

CARBINOXAMINE MALEATE ORAL TABLET 4 MG 0.49602 05/10/2013 0.49602 08/21/2015

CARBOXYMETHYLCELLULOSE SODIUM OPHTHALMIC DROPPERETTE, GEL 1 %

0.32162 03/29/2013

CARBOXYMETHYLCELLULOSE SODIUM OPHTHALMIC DROPPERETTE, SINGLE-USE DROP DISPENSER 0.5 %

0.20828 08/12/2014 0.20828 08/21/2015

CARBOXYMETHYLCELLULOSE SODIUM OPHTHALMIC DROPS 0.5 % 0.33524 08/12/2014 0.33524 08/21/2015

CARISOPRODOL ORAL TABLET 250 MG 2.31410 02/08/2013 1.93208 06/16/2017

CARISOPRODOL ORAL TABLET 350 MG 0.07909 08/21/2015 0.05359 07/14/2017

CARISOPRODOL/ASPIRIN ORAL TABLET 200-325 MG 1.52430 08/12/2014 1.52430 08/21/2015

CARISOPRODOL/ASPIRIN/CODEINE PHOSPHATE ORAL TABLET 200-325-16

1.94250 01/25/2013 1.94250 08/21/2015

CARTEOLOL HCL OPHTHALMIC DROPS 1 % 1.17210 01/25/2013

CARVEDILOL ORAL TABLET 12.5 MG 0.04968 08/21/2015 0.01920 06/16/2017

CARVEDILOL ORAL TABLET 25 MG 0.03886 08/21/2015 0.02489 11/16/2018

CARVEDILOL ORAL TABLET 3.125 MG 0.03629 08/21/2015 0.02240 10/20/2017

CARVEDILOL ORAL TABLET 6.25 MG 0.04950 08/21/2015 0.02150 07/14/2017

CASTOR OIL ORAL OIL (ML) 0.05545 01/25/2013

CEFACLOR ORAL CAPSULE 250 MG 1.39260 02/01/2013 1.39260 08/21/2015

CEFACLOR ORAL CAPSULE 500 MG 1.61040 08/12/2014 1.61040 08/21/2015

CEFACLOR ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML

0.68231 01/25/2013

CEFACLOR ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML

1.36453 01/25/2013 1.36453 08/21/2015

CEFACLOR ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 375 MG/5ML

2.04680 01/25/2013

CEFACLOR ORAL TABLET, EXTENDED RELEASE 12 HR 500 MG 3.48600 01/25/2013 3.48600 08/21/2015

West Virginia MedicaidState Maximum Allowable Cost (SMAC) List

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Effective 6/19/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

CEFADROXIL ORAL CAPSULE 500 MG 0.16550 03/16/2018 0.12410 02/22/2019

CEFADROXIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML

0.36218 02/06/2015 0.20630 11/15/2019

CEFADROXIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 500 MG/5ML

0.50605 02/06/2015 0.24250 11/16/2018

CEFADROXIL ORAL TABLET 1 G 2.32518 01/25/2013

CEFAZOLIN SODIUM INJECTION VIAL (EA) 1 G 5.80360 09/26/2014 5.80360 08/21/2015

CEFAZOLIN SODIUM INJECTION VIAL (EA) 10 G 6.55920 09/26/2014 6.55920 08/21/2015

CEFAZOLIN SODIUM INJECTION VIAL (EA) 500 MG 1.03662 01/25/2013

CEFAZOLIN SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 1 G 4.26300 01/25/2013

CEFAZOLIN SODIUM/DEXTROSE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 1 G/50 ML

0.20427 01/25/2013

CEFAZOLIN SODIUM/DEXTROSE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 2 G/50 ML

17.93574 01/25/2013

CEFAZOLIN SODIUM/DEXTROSE, ISO-OSMOTIC INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 1 G/50 ML

0.07526 07/18/2014

CEFDINIR ORAL CAPSULE 300 MG 0.40142 08/17/2018 0.33556 11/16/2018

CEFDINIR ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML 0.12375 11/16/2018 0.11329 05/22/2020

CEFDINIR ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML 0.12749 05/17/2019 0.08000 12/20/2019

CEFDITOREN PIVOXIL ORAL TABLET 200 MG 10.31835 11/28/2014 10.31835 08/21/2015

CEFDITOREN PIVOXIL ORAL TABLET 400 MG 10.31835 11/28/2014 10.31835 08/21/2015

CEFEPIME HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 1 G/50 ML

0.55476 01/25/2013

CEFEPIME HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 2 G/50 ML

14.59910 08/12/2014

CEFEPIME HCL IN ISO-OSMOTIC DEXTROSE INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 1 G/50 ML

1.09878 11/07/2014

CEFEPIME HCL IN ISO-OSMOTIC DEXTROSE INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 2 G/100 ML

0.88078 07/25/2014

CEFEPIME HCL INJECTION VIAL (EA) 1 G 4.04600 08/16/2019 3.99900 03/20/2020

CEFEPIME HCL INJECTION VIAL (EA) 2 G 3.93300 03/02/2018 6.00500 06/20/2018

CEFIXIME ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 100 MG/5ML 3.56300 05/01/2015 3.56300 08/21/2015

CEFIXIME ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 200 MG/5ML 7.12610 05/01/2015 7.12610 08/21/2015

CEFOTAXIME SODIUM INJECTION VIAL (EA) 1 G 2.12524 09/06/2013 2.12524 08/21/2015

CEFOTAXIME SODIUM INJECTION VIAL (EA) 10 G 18.35400 01/25/2013

CEFOTAXIME SODIUM INJECTION VIAL (EA) 2 G 4.12516 08/12/2014 4.12516 08/21/2015

CEFOTAXIME SODIUM INJECTION VIAL (EA) 500 MG 1.26000 10/04/2013 1.26000 08/21/2015

CEFOTETAN DISODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 1 G/50 ML

12.81880 08/12/2014

CEFOTETAN DISODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 2 G/50 ML

17.59800 01/25/2013

CEFOTETAN DISODIUM INJECTION VIAL (EA) 1 G 9.55920 01/25/2013

CEFOTETAN DISODIUM INJECTION VIAL (EA) 2 G 19.91500 01/25/2013

CEFOTETAN DISODIUM INTRAVENOUS VIAL (EA) 10 G 98.60200 01/25/2013

CEFOXITIN SODIUM INTRAVENOUS VIAL (EA) 1 G 4.45484 03/20/2015 4.45484 08/21/2015

CEFOXITIN SODIUM INTRAVENOUS VIAL (EA) 10 G 32.13068 01/25/2013

CEFOXITIN SODIUM INTRAVENOUS VIAL (EA) 2 G 7.94256 03/20/2015 7.94256 08/21/2015

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Current SMAC Price

Current Effective Date

CEFOXITIN SODIUM/DEXTROSE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 1 G/50 ML

0.45037 04/19/2013

CEFOXITIN SODIUM/DEXTROSE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 2 G/50 ML

0.92383 01/25/2013

CEFPODOXIME PROXETIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 100 MG/5ML

1.14772 03/29/2013

CEFPODOXIME PROXETIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 50 MG/5 ML

0.52444 08/12/2014

CEFPODOXIME PROXETIL ORAL TABLET 100 MG 4.71590 05/03/2013 3.61735 06/16/2017

CEFPODOXIME PROXETIL ORAL TABLET 200 MG 2.46500 10/19/2018 2.20000 05/22/2020

CEFPROZIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML

0.29385 08/22/2014 0.14400 02/22/2019

CEFPROZIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML

0.23730 09/22/2017 0.21875 11/16/2018

CEFPROZIL ORAL TABLET 250 MG 0.98670 08/21/2015 0.65800 06/16/2017

CEFPROZIL ORAL TABLET 500 MG 1.19535 06/16/2017 1.07200 02/21/2020

CEFTAZIDIME IN DEXTROSE 5% AND WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 1 G/50 ML

9.03846 01/25/2013

CEFTAZIDIME IN DEXTROSE 5% AND WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 2 G/50 ML

13.01154 01/25/2013

CEFTAZIDIME INJECTION VIAL (EA) 1 G 4.82560 11/08/2013 4.82560 08/21/2015

CEFTAZIDIME INJECTION VIAL (EA) 2 G 10.56045 11/01/2013 10.56045 08/21/2015

CEFTAZIDIME INJECTION VIAL (EA) 6 G 24.35825 08/12/2014 24.35825 08/21/2015

CEFTRIAXONE SODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 1 G/50 ML

0.54291 01/25/2013

CEFTRIAXONE SODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (EA) 2 G/50 ML

0.94697 01/25/2013

CEFTRIAXONE SODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 1 G/50 ML

0.23839 07/18/2014

CEFTRIAXONE SODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 2 G/50 ML

0.56464 04/04/2014

CEFTRIAXONE SODIUM INJECTION VIAL (EA) 1 G 1.40413 03/02/2018 0.92998 08/16/2019

CEFTRIAXONE SODIUM INJECTION VIAL (EA) 10 G 16.22880 08/21/2015 14.68000 08/17/2018

CEFTRIAXONE SODIUM INJECTION VIAL (EA) 2 G 2.30600 03/20/2020 0.21605 05/22/2020

CEFTRIAXONE SODIUM INJECTION VIAL (EA) 250 MG 0.63100 08/17/2018 0.12600 05/17/2019

CEFTRIAXONE SODIUM INJECTION VIAL (EA) 500 MG 1.32048 08/21/2015 0.85100 08/25/2017

CEFTRIAXONE SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 1 G

3.51120 02/15/2013

CEFTRIAXONE SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 2 G

6.39660 01/25/2013

CEFUROXIME AXETIL ORAL TABLET 250 MG 0.34339 08/16/2019 0.26250 05/22/2020

CEFUROXIME AXETIL ORAL TABLET 500 MG 0.42400 01/24/2020 0.38067 06/19/2020

CEFUROXIME SODIUM INJECTION VIAL (EA) 1.5 G 4.35422 08/12/2014 4.35422 08/21/2015

CEFUROXIME SODIUM INJECTION VIAL (EA) 750 MG 2.72428 11/14/2014 2.72428 08/21/2015

CEFUROXIME SODIUM INTRAVENOUS VIAL (EA) 1.5 G 4.35422 08/12/2014 4.35422 08/21/2015

CEFUROXIME SODIUM INTRAVENOUS VIAL (EA) 7.5 G 17.79645 08/12/2014 17.79645 08/21/2015

CELECOXIB ORAL CAPSULE 100 MG 0.15240 11/16/2018 0.12000 01/25/2019

CELECOXIB ORAL CAPSULE 200 MG 0.15090 06/21/2019 0.12861 05/22/2020

CELECOXIB ORAL CAPSULE 400 MG 1.25000 09/30/2016 0.71400 07/26/2019

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Current Effective Date

CELECOXIB ORAL CAPSULE 50 MG 0.28033 10/20/2017 0.06583 05/17/2019

CEPHALEXIN ORAL CAPSULE 250 MG 0.07390 09/22/2017 0.06050 03/16/2018

CEPHALEXIN ORAL CAPSULE 500 MG 0.10023 08/21/2015 0.08687 12/22/2017

CEPHALEXIN ORAL CAPSULE 750 MG 6.15000 04/17/2019 5.49950 05/22/2020

CEPHALEXIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML

0.14563 08/21/2015 0.09450 11/24/2017

CEPHALEXIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML

0.09433 11/16/2018 0.08460 10/25/2019

CEPHALEXIN ORAL TABLET 250 MG 0.40092 01/25/2013

CEPHALEXIN ORAL TABLET 500 MG 0.80132 01/25/2013

CETIRIZINE HCL ORAL SOLUTION, ORAL 1 MG/ML 0.03306 08/21/2015 0.01500 12/21/2018

CETIRIZINE HCL ORAL SOLUTION, ORAL 5 MG/5 ML 0.03306 07/07/2017

CETIRIZINE HCL ORAL TABLET 10 MG 0.04666 09/22/2017 0.03192 11/15/2019

CETIRIZINE HCL ORAL TABLET 5 MG 0.07567 08/21/2015 0.02870 11/15/2019

CETIRIZINE HCL ORAL TABLET,CHEWABLE 10 MG 1.66170 06/06/2014 1.66170 08/21/2015

CETIRIZINE HCL ORAL TABLET,CHEWABLE 5 MG 2.74179 08/21/2015 1.66166 01/25/2019

CETIRIZINE HCL/PSEUDOEPHEDRINE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 5 MG-120MG

0.50458 01/25/2019 0.65776 03/05/2019

CEVIMELINE HCL ORAL CAPSULE 30 MG 0.98965 12/10/2019 0.90460 03/20/2020

CHLORAMPHENICOL SOD SUCCINATE INTRAVENOUS VIAL (EA) 1 G 2.64689 01/25/2013

CHLORDIAZEPOXIDE HCL ORAL CAPSULE 10 MG 0.08863 08/21/2015 0.05930 12/22/2017

CHLORDIAZEPOXIDE HCL ORAL CAPSULE 25 MG 0.08949 08/21/2015 0.06297 03/02/2018

CHLORDIAZEPOXIDE HCL ORAL CAPSULE 5 MG 0.10875 08/15/2014 0.10875 08/21/2015

CHLORDIAZEPOXIDE/CLIDINIUM BROMIDE ORAL CAPSULE 5 MG-2.5MG 0.27604 02/27/2015 0.27604 08/21/2015

CHLORHEXIDINE GLUCONATE MUCOUS MEMBRANE MOUTHWASH 0.12 %

0.00598 03/13/2015 0.00598 08/21/2015

CHLOROQUINE PHOSPHATE ORAL TABLET 250 MG 0.86970 03/01/2013 0.86970 08/21/2015

CHLOROQUINE PHOSPHATE ORAL TABLET 500 MG 3.44058 08/12/2014 3.44058 08/21/2015

CHLOROTHIAZIDE ORAL TABLET 250 MG 0.15141 12/13/2013 0.15141 08/21/2015

CHLOROTHIAZIDE SODIUM INTRAVENOUS VIAL (EA) 500 MG 98.11300 04/17/2015 98.11300 08/21/2015

CHLORPHENIRAMINE MALEATE ORAL SYRUP 2 MG/5 ML 0.01798 01/25/2013 0.01798 08/21/2015

CHLORPHENIRAMINE MALEATE ORAL TABLET 4 MG 0.00634 02/06/2015 0.00634 08/21/2015

CHLORPHENIRAMINE MALEATE ORAL TABLET, EXTENDED RELEASE 12 MG

0.34709 08/21/2015

CHLORPHENIRAMINE MALEATE/PHENYLEPHRINE HCL ORAL LIQUID (ML) 4-10MG/5ML

0.02660 08/12/2014

CHLORPHENIRAMINE MALEATE/PHENYLEPHRINE HCL/DEXTROMETHORPHAN ORAL LIQUID (ML) 2-5-15MG/5

0.06860 08/12/2014 0.06860 08/21/2015

CHLORPHENIRAMINE MALEATE/PHENYLEPHRINE HCL/DEXTROMETHORPHAN ORAL LIQUID (ML) 4-10-15/5

0.04500 08/12/2014

CHLORPHENIRAMINE MALEATE/PSEUDOEPHEDRINE HCL ORAL TABLET 4 MG-60 MG

0.05310 08/12/2014

CHLORPHENIRAMINE MALEATE/PSEUDOEPHEDRINE/DEXTROMETHORPHAN ORAL LIQUID (ML) 1-15-5MG/5

0.01868 01/25/2013 0.01868 08/21/2015

CHLORPROMAZINE HCL INJECTION AMPUL (ML) 25 MG/ML 18.81600 11/08/2013

CHLORPROMAZINE HCL ORAL TABLET 10 MG 2.65000 01/22/2016 1.55000 05/22/2020

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Current SMAC Price

Current Effective Date

CHLORPROMAZINE HCL ORAL TABLET 100 MG 3.26785 05/17/2019 5.06490 06/13/2019

CHLORPROMAZINE HCL ORAL TABLET 200 MG 6.35000 10/25/2019 7.16716 12/16/2019

CHLORPROMAZINE HCL ORAL TABLET 25 MG 2.39250 05/17/2019 1.85000 02/21/2020

CHLORPROMAZINE HCL ORAL TABLET 50 MG 4.07080 11/16/2018 2.95200 04/26/2019

CHLORPROPAMIDE TABLET 100 MG 0.84154 06/27/2014 0.84154 08/21/2015

CHLORPROPAMIDE TABLET 250 MG 0.85230 08/12/2014

CHLORTHALIDONE ORAL TABLET 25 MG 0.32970 01/24/2020 0.21557 05/22/2020

CHLORTHALIDONE ORAL TABLET 50 MG 0.59540 01/25/2019 0.35950 08/16/2019

CHLORZOXAZONE ORAL TABLET 500 MG 0.23400 04/10/2015 0.23400 08/21/2015

CHOLECALCIFEROL (VIT D3)/FOLIC ACID ORAL CAPSULE 3775 UNIT 15.16153 05/01/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL CAPSULE 10 MCG 0.03240 05/01/2015 0.03240 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL CAPSULE 100 MCG 0.06993 02/08/2013

CHOLECALCIFEROL (VITAMIN D3) ORAL CAPSULE 1250 MCG 0.14700 09/26/2014

CHOLECALCIFEROL (VITAMIN D3) ORAL CAPSULE 250 MCG 0.64783 12/26/2014 0.64783 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL DROPS 125 MCG/ML 0.07303 08/12/2014

CHOLECALCIFEROL (VITAMIN D3) ORAL LIQUID (ML) 10MCG/5ML 0.02914 01/25/2013

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 10 MCG 0.01786 04/17/2015 0.01786 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 125 MCG 0.05258 05/01/2015 0.05258 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 25 MCG 0.01997 08/12/2014 0.01997 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 50 MCG 0.02861 12/05/2014 0.02861 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET 75 MCG 0.05516 01/25/2013

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET,CHEWABLE 10 MCG 0.02509 01/25/2013 0.02509 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) ORAL TABLET,CHEWABLE 25 MCG 0.06098 08/12/2014 0.06098 08/21/2015

CHOLECALCIFEROL (VITAMIN D3) SUBLINGUAL SPRAY, SUSPENSION (ML) 25MCG/SPRY

0.30847 01/25/2013

CHOLESTYRAMINE (WITH SUGAR) ORAL POWDER (GRAM) 4 G 0.17550 07/26/2019 0.14794 10/25/2019

CHOLESTYRAMINE (WITH SUGAR) ORAL POWDER IN PACKET (EA) 4 G 1.33367 08/25/2017 1.21063 02/21/2020

CHOLESTYRAMINE/ASPARTAME ORAL POWDER (GRAM) 4 G 0.23748 04/22/2019 0.19459 06/19/2020

CHOLESTYRAMINE/ASPARTAME ORAL POWDER IN PACKET (EA) 4 G 1.58483 02/22/2019 1.30321 11/15/2019

CHOLINE SALICYLATE/MAGNESIUM SALICYLATE ORAL LIQUID (ML) 500 MG/5ML

0.12848 01/25/2013

CHORIONIC GONADOTROPIN, HUMAN INTRAMUSCULAR VIAL (EA) 10000 UNIT

184.04000 07/12/2013

CICLOPIROX OLAMINE TOPICAL CREAM (GRAM) 0.77 % 0.14964 08/12/2014 0.10611 01/24/2020

CICLOPIROX OLAMINE TOPICAL SUSPENSION, TOPICAL (ML) 0.77 % 0.37748 01/25/2013

CICLOPIROX TOPICAL GEL (GRAM) 0.77 % 1.12739 06/16/2017 0.89877 11/15/2019

CICLOPIROX TOPICAL SHAMPOO 1 % 0.39030 05/25/2018 0.24717 11/15/2019

CICLOPIROX TOPICAL SOLUTION, NON-ORAL 8 % 1.49242 04/26/2019 1.45000 05/22/2020

CICLOPIROX/UREA/CAMPHOR/MENTHOL/EUCALYPTOL TOPICAL SOLUTION, NON-ORAL 8 %

266.99400 01/25/2013

CIDOFOVIR INTRAVENOUS VIAL (ML) 75 MG/ML 118.10400 08/12/2014

CILOSTAZOL ORAL TABLET 100 MG 0.11183 03/02/2018 0.08000 02/22/2019

CILOSTAZOL ORAL TABLET 50 MG 0.10087 11/16/2018 0.08083 04/17/2020

CIMETIDINE HCL ORAL SOLUTION, ORAL 300 MG/5ML 0.06283 05/17/2013 0.06283 08/21/2015

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Current SMAC Price

Current Effective Date

CIMETIDINE ORAL TABLET 200 MG 0.23684 08/21/2015 0.19530 06/19/2020

CIMETIDINE ORAL TABLET 300 MG 0.26286 08/21/2015 0.22900 08/25/2017

CIMETIDINE ORAL TABLET 400 MG 0.31057 08/21/2015 0.44250 08/24/2016

CIMETIDINE ORAL TABLET 800 MG 1.28479 08/21/2015 0.74363 06/16/2017

CINACALCET HCL ORAL TABLET 30 MG 5.76000 02/21/2020

CINACALCET HCL ORAL TABLET 60 MG 11.16000 02/21/2020

CINACALCET HCL ORAL TABLET 90 MG 13.00000 02/21/2020

CIPROFLOXACIN HCL OPHTHALMIC DROPS 0.3 % 0.56000 10/19/2018 2.30160 06/06/2019

CIPROFLOXACIN HCL ORAL TABLET 100 MG 10.65167 09/26/2014

CIPROFLOXACIN HCL ORAL TABLET 250 MG 0.10750 07/14/2017 0.09120 08/17/2018

CIPROFLOXACIN HCL ORAL TABLET 500 MG 0.20001 03/03/2017 0.09234 06/16/2017

CIPROFLOXACIN HCL ORAL TABLET 750 MG 0.34599 08/21/2015 0.23220 08/17/2018

CIPROFLOXACIN HCL OTIC DROPPERETTE, SINGLE-USE DROP DISPENSER 0.2 %

12.61951 08/01/2014

CIPROFLOXACIN LACTATE VIAL (ML) 200MG/20ML 0.08890 01/25/2013

CIPROFLOXACIN LACTATE VIAL (ML) 400MG/40ML 0.06320 08/12/2014

CIPROFLOXACIN LACTATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 200MG/0.1L

0.01697 01/25/2013 0.01697 08/21/2015

CIPROFLOXACIN LACTATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 400MG/0.2L

0.01204 03/01/2013

CIPROFLOXACIN ORAL SUSPENSION, MICROCAPSULE RECONSTITUTED 250 MG/5ML

0.85323 08/22/2014

CIPROFLOXACIN ORAL SUSPENSION, MICROCAPSULE RECONSTITUTED 500 MG/5ML

0.99890 08/22/2014

CIPROFLOXACIN/CIPROFLOXACIN HCL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 1000 MG

7.79233 01/25/2013 7.79233 08/21/2015

CIPROFLOXACIN/CIPROFLOXACIN HCL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 500 MG

6.85916 01/25/2013 6.85916 08/21/2015

CISATRACURIUM BESYLATE INTRAVENOUS VIAL (ML) 10 MG/ML 11.95425 01/16/2015 11.95425 08/21/2015

CISATRACURIUM BESYLATE INTRAVENOUS VIAL (ML) 2 MG/ML 2.36880 08/12/2014 2.36880 08/21/2015

CITALOPRAM HYDROBROMIDE ORAL SOLUTION, ORAL 10 MG/5 ML 0.42456 04/12/2018 0.24500 01/25/2019

CITALOPRAM HYDROBROMIDE ORAL TABLET 10 MG 0.02661 05/01/2015 0.02661 08/21/2015

CITALOPRAM HYDROBROMIDE ORAL TABLET 20 MG 0.03382 08/21/2015 0.02364 01/19/2018

CITALOPRAM HYDROBROMIDE ORAL TABLET 40 MG 0.04139 08/21/2015 0.02900 11/16/2018

CITRATE PHOSPHATE DEXTROS SOLN MISCELLANEOUS SOLUTION, NON-ORAL 2.63 G/100

0.08318 01/25/2013

CITRIC ACID/SODIUM CITRATE ORAL SOLUTION, ORAL 334-500MG 0.02013 11/14/2014 0.02013 08/21/2015

CLARITHROMYCIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 125 MG/5ML

0.36569 05/17/2013

CLARITHROMYCIN ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 250 MG/5ML

1.14740 12/11/2017 1.22798 04/16/2018

CLARITHROMYCIN ORAL TABLET 250 MG 2.64794 08/21/2015 0.34333 06/16/2017

CLARITHROMYCIN ORAL TABLET 500 MG 0.45686 03/03/2017 0.40642 05/22/2020

CLARITHROMYCIN ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG 3.50443 08/21/2015 3.18447 06/16/2017

CLINDAMYCIN HCL ORAL CAPSULE 150 MG 0.08641 08/21/2015 0.07460 09/21/2018

CLINDAMYCIN HCL ORAL CAPSULE 300 MG 0.25661 08/21/2015 0.19938 03/03/2017

CLINDAMYCIN HCL ORAL CAPSULE 75 MG 0.41720 01/25/2013

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Current Effective Date

CLINDAMYCIN PALMITATE HCL ORAL SOLUTION, RECONSTITUTED, ORAL 75 MG/5 ML

0.19640 09/22/2017 0.23180 02/15/2018

CLINDAMYCIN PHOSPHATE INJECTION VIAL (ML) 150 MG/ML 0.35600 08/12/2014

CLINDAMYCIN PHOSPHATE INTRAVENOUS VIAL WITH THREADED PORT (ML) 300 MG/2ML

2.99418 01/25/2013

CLINDAMYCIN PHOSPHATE INTRAVENOUS VIAL WITH THREADED PORT (ML) 600 MG/4ML

1.60881 01/25/2013

CLINDAMYCIN PHOSPHATE INTRAVENOUS VIAL WITH THREADED PORT (ML) 900MG/6ML

1.51899 01/25/2013

CLINDAMYCIN PHOSPHATE TOPICAL FOAM (GRAM) 1 % 3.71476 08/21/2015 3.56290 11/15/2019

CLINDAMYCIN PHOSPHATE TOPICAL GEL (GRAM) 1 % 1.04700 01/11/2020 0.87733 05/22/2020

CLINDAMYCIN PHOSPHATE TOPICAL LOTION (ML) 1 % 1.00375 03/20/2020 0.89300 05/22/2020

CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION, NON-ORAL 1 % 0.31316 06/16/2017 0.20259 02/22/2019

CLINDAMYCIN PHOSPHATE TOPICAL SWAB, MEDICATED 1 % 0.32269 03/19/2019 0.29097 11/15/2019

CLINDAMYCIN PHOSPHATE VAGINAL CREAM WITH APPLICATOR 2 % 1.37550 08/16/2019 1.71925 08/23/2019

CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE TOPICAL GEL (GRAM) 1 %-5 %

2.44740 02/22/2019 1.52390 03/20/2020

CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE TOPICAL GEL (GRAM) 1.2(1)%-5%

3.16462 08/12/2014 1.13000 08/16/2019

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 300MG/50ML

0.11749 08/12/2014

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 600MG/50ML

0.16505 11/07/2014 0.16505 08/21/2015

CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 900MG/50ML

0.21492 10/24/2014 0.21492 08/21/2015

CLOBAZAM ORAL TABLET 20 MG 0.80000 04/17/2020

CLOBETASOL PROPIONATE TOPICAL CREAM (GRAM) 0.05 % 0.89179 02/13/2020 0.63767 05/22/2020

CLOBETASOL PROPIONATE TOPICAL FOAM (GRAM) 0.05 % 1.24600 03/20/2020 1.03090 05/22/2020

CLOBETASOL PROPIONATE TOPICAL GEL (GRAM) 0.05 % 2.30000 05/25/2018 1.25150 08/16/2019

CLOBETASOL PROPIONATE TOPICAL LOTION (ML) 0.05 % 1.57000 12/21/2018 0.67797 11/15/2019

CLOBETASOL PROPIONATE TOPICAL OINTMENT (GRAM) 0.05 % 0.39284 01/24/2020 0.20242 06/19/2020

CLOBETASOL PROPIONATE TOPICAL SHAMPOO 0.05 % 1.53000 05/26/2018 1.47407 11/15/2019

CLOBETASOL PROPIONATE TOPICAL SOLUTION, NON-ORAL 0.05 % 0.63510 10/25/2019 0.51260 06/19/2020

CLOBETASOL PROPIONATE TOPICAL SPRAY, NON-AEROSOL (ML) 0.05 % 4.33264 03/06/2015

CLOBETASOL PROPIONATE/EMOLLIENT BASE TOPICAL CREAM (GRAM) 0.05 %

1.20000 12/20/2019 0.66483 03/20/2020

CLOBETASOL PROPIONATE/EMOLLIENT BASE TOPICAL FOAM (GRAM) 0.05 %

3.64100 08/12/2014 3.64100 08/21/2015

CLOCORTOLONE PIVALATE TOPICAL CREAM (GRAM) 0.1 % 5.01620 03/07/2014

CLOMIPHENE CITRATE ORAL TABLET 50 MG 1.01394 08/21/2015 0.58467 09/22/2017

CLOMIPRAMINE HCL ORAL CAPSULE 25 MG 3.50000 02/22/2019 2.85000 02/21/2020

CLOMIPRAMINE HCL ORAL CAPSULE 50 MG 3.40000 01/25/2019 1.98650 10/25/2019

CLOMIPRAMINE HCL ORAL CAPSULE 75 MG 2.72010 02/22/2019 1.58230 11/15/2019

CLONAZEPAM ORAL TABLET 0.5 MG 0.01635 12/12/2014 0.01635 08/21/2015

CLONAZEPAM ORAL TABLET 1 MG 0.02613 02/06/2015 0.02613 08/21/2015

CLONAZEPAM ORAL TABLET 2 MG 0.04039 08/21/2015 0.02645 11/16/2018

CLONAZEPAM ORAL TABLET,DISINTEGRATING 0.125 MG 0.72847 09/19/2014 0.70200 11/15/2019

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Current Effective Date

CLONAZEPAM ORAL TABLET,DISINTEGRATING 0.25 MG 0.62800 09/22/2017 0.51183 11/15/2019

CLONAZEPAM ORAL TABLET,DISINTEGRATING 0.5 MG 0.51100 11/15/2019 0.54183 03/02/2020

CLONAZEPAM ORAL TABLET,DISINTEGRATING 1 MG 0.58810 03/16/2018 0.74870 03/18/2020

CLONAZEPAM ORAL TABLET,DISINTEGRATING 2 MG 1.09330 01/25/2013

CLONIDINE HCL ORAL TABLET 0.1 MG 0.02704 08/21/2015 0.01272 09/21/2018

CLONIDINE HCL ORAL TABLET 0.2 MG 0.05338 08/21/2015 0.02868 08/25/2017

CLONIDINE HCL ORAL TABLET 0.3 MG 0.04301 08/21/2015 0.02763 04/27/2018

CLONIDINE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 0.1 MG 0.88817 07/26/2019 0.69150 05/22/2020

CLONIDINE HCL/PF EPIDURAL VIAL (ML) 1000MCG/10 2.29944 08/12/2014

CLONIDINE HCL/PF EPIDURAL VIAL (ML) 5000MCG/10 10.09700 08/12/2014 10.09700 08/21/2015

CLONIDINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.1MG/24HR 8.79250 11/15/2019 4.99750 05/22/2020

CLONIDINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.2MG/24HR 14.26950 11/15/2019 12.69000 12/20/2019

CLONIDINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.3MG/24HR 21.24500 11/15/2019 18.23000 12/20/2019

CLOPIDOGREL BISULFATE ORAL TABLET 300 MG 14.71960 04/17/2015 14.71960 08/21/2015

CLOPIDOGREL BISULFATE ORAL TABLET 75 MG 0.05800 06/16/2017 0.05198 10/25/2019

CLORAZEPATE DIPOTASSIUM ORAL TABLET 15 MG 0.26100 08/21/2015 2.39650 09/19/2016

CLORAZEPATE DIPOTASSIUM ORAL TABLET 3.75 MG 0.19698 08/15/2014 0.19698 08/21/2015

CLORAZEPATE DIPOTASSIUM ORAL TABLET 7.5 MG 0.30128 08/01/2014 0.30128 08/21/2015

CLOTRIMAZOLE MUCOUS MEMBRANE TROCHE 10 MG 0.97392 03/27/2015

CLOTRIMAZOLE TOPICAL CREAM (GRAM) 1 % 0.10907 08/21/2015 0.07533 06/19/2020

CLOTRIMAZOLE TOPICAL SOLUTION, NON-ORAL 1 % 0.32656 01/25/2013

CLOTRIMAZOLE VAGINAL CREAM WITH APPLICATOR 1 % 0.07865 03/01/2013 0.07865 08/21/2015

CLOTRIMAZOLE VAGINAL CREAM WITH APPLICATOR 2 % 0.32760 08/12/2014 0.32760 08/21/2015

CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE TOPICAL CREAM (GRAM) 1 %-0.05 %

0.20951 02/22/2019 0.19625 05/22/2020

CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE TOPICAL LOTION (ML) 1 %-0.05 %

3.46640 05/31/2013

CLOZAPINE ORAL TABLET 100 MG 0.25570 11/15/2019 0.32882 03/03/2020

CLOZAPINE ORAL TABLET 200 MG 0.93590 02/21/2020 0.87220 05/22/2020

CLOZAPINE ORAL TABLET 25 MG 0.28170 01/06/2020 0.18130 05/22/2020

CLOZAPINE ORAL TABLET 50 MG 0.59637 02/26/2020 0.46890 06/19/2020

CLOZAPINE ORAL TABLET,DISINTEGRATING 100 MG 4.61480 08/17/2018 4.51730 08/16/2019

CLOZAPINE ORAL TABLET,DISINTEGRATING 12.5 MG 1.55925 01/25/2013

CLOZAPINE ORAL TABLET,DISINTEGRATING 25 MG 2.09823 01/25/2013

COAL TAR TOPICAL SHAMPOO 1 % 0.03020 08/12/2014

COCAINE HCL SOLUTION, NON-ORAL 4 % 15.19980 01/25/2013

CODEINE PHOSPHATE/BUTALBITAL/ASPIRIN/CAFFEINE ORAL CAPSULE 30-50-325

1.89262 08/21/2015 1.23660 09/22/2017

CODEINE PHOSPHATE/GUAIFENESIN ORAL LIQUID (ML) 10-100MG/5 0.05079 08/21/2015 0.02594 08/25/2017

CODEINE PHOSPHATE/GUAIFENESIN ORAL LIQUID (ML) 6.3-100/5 0.03518 08/12/2014

CODEINE PHOSPHATE/GUAIFENESIN ORAL LIQUID (ML) 7.5-225/5 0.04970 08/12/2014

CODEINE SULFATE ORAL TABLET 15 MG 0.36736 03/01/2013

CODEINE SULFATE ORAL TABLET 30 MG 0.44059 09/19/2014 0.44059 08/21/2015

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

CODEINE SULFATE ORAL TABLET 60 MG 0.79681 09/19/2014 0.79681 08/21/2015

COLCHICINE ORAL CAPSULE 0.6 MG 4.16383 05/17/2019 3.83870 07/26/2019

COLCHICINE ORAL TABLET 0.6 MG 5.02150 03/20/2020 4.29990 06/19/2020

COLESTIPOL HCL ORAL GRANULES (GRAM) 5 G 0.20871 01/25/2013

COLESTIPOL HCL ORAL PACKET (EA) 5 G 2.75100 01/16/2015

COLESTIPOL HCL ORAL TABLET 1 G 0.66658 02/25/2020 0.57208 05/22/2020

COLISTIN (AS COLISTIMETHATE SODIUM) INJECTION VIAL (EA) 150 MG 26.57000 06/24/2019 22.52000 10/25/2019

CORTISONE ACETATE ORAL TABLET 25 MG 3.04785 02/20/2015 3.04785 08/21/2015

COSYNTROPIN INJECTION VIAL (EA) 0.25 MG 64.39973 04/19/2013 64.39973 08/21/2015

COSYNTROPIN VIAL (ML) 0.25 MG/ML 151.55280 01/25/2013

CROMOLYN SODIUM INHALATION AMPUL FOR NEBULIZATION (ML) 20 MG/2 ML

1.16380 10/03/2014

CROMOLYN SODIUM NASAL AEROSOL, SPRAY WITH PUMP (ML) 5.2 MG 0.33554 01/25/2013 0.33554 08/21/2015

CROMOLYN SODIUM OPHTHALMIC DROPS 4 % 0.67817 08/21/2015 0.46600 09/30/2016

CROMOLYN SODIUM ORAL CONCENTRATE, ORAL 20 MG/ML 0.87906 08/21/2015 0.25000 03/15/2019

CUPRIC CHLORIDE INTRAVENOUS VIAL (ML) 0.4 MG/ML 0.15460 08/12/2014

CYANOCOBALAMIN (VITAMIN B-12) ORAL TABLET 100 MCG 0.01365 02/13/2015 0.01365 08/21/2015

CYANOCOBALAMIN (VITAMIN B-12) ORAL TABLET 500 MCG 0.02101 02/13/2015 0.02101 08/21/2015

CYANOCOBALAMIN (VITAMIN B-12) ORAL TABLET, EXTENDED RELEASE 1000 MCG

0.03872 08/12/2014 0.03872 08/21/2015

CYANOCOBALAMIN (VITAMIN B-12) SUBLINGUAL TABLET, SUBLINGUAL 1000 MCG

0.05332 08/12/2014 0.05332 08/21/2015

CYANOCOBALAMIN (VITAMIN B-12) SUBLINGUAL TABLET, SUBLINGUAL 5000 MCG

0.10737 03/08/2013

CYANOCOBALAMIN/FOLIC ACID ORAL TABLET 0.5 MG-1MG 0.12600 01/25/2013

CYANOCOBALAMIN/FOLIC ACID/PYRIDOXINE ORAL TABLET 2-2.5-25MG 0.43177 03/20/2015 0.43177 08/21/2015

CYANOCOBALAMIN/LEVOMEFOLATE CALCIUM/PYRIDOXINE HCL (B6) ORAL TABLET 2-1.13-25

0.89950 07/18/2014

CYANOCOBALAMIN/LEVOMEFOLATE CALCIUM/PYRIDOXINE/RIBOFLAVIN ORAL TABLET 1-6-50-5MG

2.02075 02/20/2015 2.02075 08/21/2015

CYCLOBENZAPRINE HCL ORAL TABLET 10 MG 0.02680 08/21/2015 0.01476 11/16/2018

CYCLOBENZAPRINE HCL ORAL TABLET 5 MG 0.03457 10/20/2017 0.02130 01/24/2020

CYCLOBENZAPRINE HCL ORAL TABLET 7.5 MG 3.36504 08/21/2015 1.79990 05/17/2019

CYCLOPENTOLATE HCL OPHTHALMIC DROPS 1 % 1.65266 05/10/2013 1.65266 08/21/2015

CYCLOPENTOLATE HCL OPHTHALMIC DROPS 2 % 3.33840 02/08/2013

CYCLOPHOSPHAMIDE INTRAVENOUS VIAL (EA) 1 G 432.93460 12/12/2014

CYCLOPHOSPHAMIDE INTRAVENOUS VIAL (EA) 2 G 1063.88300 12/12/2014 1063.88300 08/21/2015

CYCLOPHOSPHAMIDE INTRAVENOUS VIAL (EA) 500 MG 266.22500 12/12/2014 266.22500 08/21/2015

CYCLOPHOSPHAMIDE ORAL CAPSULE 25 MG 8.29164 09/05/2014 5.41000 09/21/2018

CYCLOSPORINE ORAL CAPSULE 100 MG 5.25882 05/23/2014

CYCLOSPORINE ORAL CAPSULE 25 MG 3.39817 09/27/2018 1.82000 01/25/2019

CYCLOSPORINE, MODIFIED ORAL CAPSULE 100 MG 2.20106 02/27/2015 1.21667 03/03/2017

CYCLOSPORINE, MODIFIED ORAL CAPSULE 25 MG 0.51042 05/20/2016 0.23923 03/03/2017

CYCLOSPORINE, MODIFIED ORAL CAPSULE 50 MG 1.20163 07/25/2014

CYCLOSPORINE, MODIFIED ORAL SOLUTION, ORAL 100 MG/ML 2.00000 09/22/2017 1.76740 02/22/2019

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

CYPROHEPTADINE HCL ORAL SYRUP 2 MG/5 ML 0.08798 02/27/2015 0.06816 03/02/2018

CYPROHEPTADINE HCL ORAL TABLET 4 MG 0.23460 08/16/2019 0.14405 11/15/2019

CYTARABINE INJECTION VIAL (ML) 20 MG/ML 0.40080 08/12/2014 0.40080 08/21/2015

CYTARABINE/PF INJECTION VIAL (ML) 100 MG/5ML 1.97106 01/25/2013 1.97106 08/21/2015

CYTARABINE/PF INJECTION VIAL (ML) 2 G/20 ML 0.82997 08/12/2014 0.82997 08/21/2015

CYTARABINE/PF INJECTION VIAL (ML) 20 MG/ML 0.76440 01/16/2015 0.76440 08/21/2015

DACARBAZINE INTRAVENOUS VIAL (EA) 100 MG 7.93800 01/25/2013

DANAZOL ORAL CAPSULE 100 MG 3.38527 02/13/2015

DANAZOL ORAL CAPSULE 200 MG 4.80198 03/20/2015 4.80198 08/21/2015

DANAZOL ORAL CAPSULE 50 MG 2.25628 02/13/2015

DANTROLENE SODIUM INTRAVENOUS VIAL (EA) 20 MG 68.04000 01/25/2013

DANTROLENE SODIUM ORAL CAPSULE 100 MG 1.51750 02/08/2013 0.82590 03/20/2020

DANTROLENE SODIUM ORAL CAPSULE 25 MG 0.60000 08/30/2018 0.35000 11/16/2018

DANTROLENE SODIUM ORAL CAPSULE 50 MG 1.21009 03/22/2013 0.63900 05/25/2018

DAPSONE ORAL TABLET 100 MG 1.25033 01/25/2019 1.17600 03/20/2020

DARIFENACIN HYDROBROMIDE ORAL TABLET, EXTENDED RELEASE 24 HR 7.5 MG

2.60744 11/15/2019 2.41867 02/21/2020

DAUNORUBICIN HCL INTRAVENOUS VIAL (ML) 5 MG/ML 18.76077 08/12/2014 18.76077 08/21/2015

DECITABINE INTRAVENOUS VIAL (EA) 50 MG 1375.39150 12/12/2014 1375.39150 08/21/2015

DEFEROXAMINE MESYLATE INJECTION VIAL (EA) 2 G 26.33481 01/25/2013 26.33481 08/21/2015

DEMECLOCYCLINE HCL ORAL TABLET 150 MG 2.95730 03/16/2018 2.71000 11/16/2018

DEMECLOCYCLINE HCL ORAL TABLET 300 MG 7.13944 02/27/2015 7.13944 08/21/2015

DESIPRAMINE HCL ORAL TABLET 10 MG 0.71980 05/17/2019 0.57533 11/15/2019

DESIPRAMINE HCL ORAL TABLET 100 MG 2.97528 08/21/2015 1.78620 03/20/2020

DESIPRAMINE HCL ORAL TABLET 150 MG 4.38839 08/12/2014

DESIPRAMINE HCL ORAL TABLET 25 MG 0.96739 08/21/2015 0.42950 01/24/2020

DESIPRAMINE HCL ORAL TABLET 50 MG 1.74170 02/21/2018 1.31850 05/25/2018

DESIPRAMINE HCL ORAL TABLET 75 MG 2.22992 08/12/2014 1.19400 09/22/2017

DESLORATADINE ORAL TABLET 5 MG 0.33544 11/24/2017 0.25470 10/25/2019

DESLORATADINE ORAL TABLET,DISINTEGRATING 2.5 MG 10.07649 01/24/2014 10.07649 08/21/2015

DESLORATADINE ORAL TABLET,DISINTEGRATING 5 MG 4.07750 01/25/2013 4.07750 08/21/2015

DESMOPRESSIN ACETATE (NON-REFRIGERATED) NASAL AEROSOL, SPRAY WITH PUMP (ML) 10/SPRAY

14.44800 04/26/2019 13.10000 02/21/2020

DESMOPRESSIN ACETATE INJECTION AMPUL (ML) 4 MCG/ML 16.22800 08/30/2013

DESMOPRESSIN ACETATE INJECTION VIAL (ML) 4 MCG/ML 8.62810 05/16/2014

DESMOPRESSIN ACETATE NASAL AEROSOL, SPRAY WITH PUMP (ML) 10/SPRAY

28.62300 02/06/2015

DESMOPRESSIN ACETATE NASAL SOLUTION, NON-ORAL 0.1 MG/ML 25.31760 03/08/2013

DESMOPRESSIN ACETATE ORAL TABLET 0.1 MG 0.41720 11/15/2019 0.23400 06/19/2020

DESMOPRESSIN ACETATE ORAL TABLET 0.2 MG 0.50930 10/25/2019 0.44210 03/20/2020

DESOGESTREL-ETHINYL ESTRADIOL ORAL TABLET 0.15-0.03 0.21696 03/02/2018 0.10127 03/20/2020

DESOGESTREL-ETHINYL ESTRADIOL ORAL TABLET 7 DAYS X 3 0.81931 08/21/2015 0.52119 06/16/2017

DESOGESTREL-ETHINYL ESTRADIOL/ETHINYL ESTRADIOL ORAL TABLET 21-5 (28)

0.46310 03/03/2017 0.37988 03/02/2018

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

DESONIDE TOPICAL CREAM (GRAM) 0.05 % 1.15112 06/21/2019 0.91650 03/20/2020

DESONIDE TOPICAL LOTION (ML) 0.05 % 1.83560 12/05/2014 1.66017 11/15/2019

DESONIDE TOPICAL OINTMENT (GRAM) 0.05 % 1.28900 08/16/2019 0.70000 10/25/2019

DESOXIMETASONE TOPICAL CREAM (GRAM) 0.05 % 3.19548 02/07/2014

DESOXIMETASONE TOPICAL CREAM (GRAM) 0.25 % 0.73085 06/16/2017 0.57933 03/20/2020

DESOXIMETASONE TOPICAL GEL (GRAM) 0.05 % 2.73169 01/25/2013

DESOXIMETASONE TOPICAL OINTMENT (GRAM) 0.05 % 5.41981 02/07/2014 5.41981 08/21/2015

DESOXIMETASONE TOPICAL OINTMENT (GRAM) 0.25 % 3.72602 06/16/2017 0.79000 12/20/2019

DESVENLAFAXINE FUMARATE TABLET, EXTENDED RELEASE 24 HR 100 MG

4.64370 04/04/2014

DESVENLAFAXINE FUMARATE TABLET, EXTENDED RELEASE 24 HR 50 MG

4.64370 04/04/2014

DESVENLAFAXINE SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 100 MG

0.50550 11/15/2019 0.77253 02/06/2020

DESVENLAFAXINE SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 25 MG

0.82000 04/27/2018 0.76900 08/16/2019

DESVENLAFAXINE SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 50 MG

0.75488 01/25/2019 0.71833 05/17/2019

DEXAMETHASONE ORAL ELIXIR 0.5 MG/5ML 0.14107 04/21/2017 0.06692 09/22/2017

DEXAMETHASONE ORAL SOLUTION, ORAL 0.5 MG/5ML 0.03446 08/22/2014

DEXAMETHASONE ORAL TABLET 1.5 MG 0.09841 02/07/2014 0.09841 08/21/2015

DEXAMETHASONE ORAL TABLET 4 MG 0.34200 04/06/2018 0.93000 05/28/2019

DEXAMETHASONE SODIUM PHOSPHATE INJECTION VIAL (ML) 10 MG/ML 0.80490 08/12/2014 0.80490 08/21/2015

DEXAMETHASONE SODIUM PHOSPHATE INJECTION VIAL (ML) 4 MG/ML 0.28517 08/12/2014 0.28517 08/21/2015

DEXAMETHASONE SODIUM PHOSPHATE OPHTHALMIC DROPS 0.1 % 3.31265 08/21/2015 9.46200 04/16/2018

DEXAMETHASONE SODIUM PHOSPHATE/PF INJECTION VIAL (ML) 10 MG/ML

6.35376 01/25/2013

DEXCHLORPHENIRAMINE MALEATE/PSEUDOEPHEDRINE/CHLOPHEDIANOL ORAL LIQUID (ML) 1-30-12.5

0.08050 08/12/2014

DEXMETHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 50-50 10 MG

6.50059 03/27/2015 5.84742 12/02/2016

DEXMETHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 50-50 5 MG

5.46315 03/27/2015

DEXMETHYLPHENIDATE HCL ORAL TABLET 10 MG 0.41200 08/16/2019 0.39990 10/25/2019

DEXMETHYLPHENIDATE HCL ORAL TABLET 2.5 MG 0.47427 12/02/2016 0.19260 09/22/2017

DEXMETHYLPHENIDATE HCL ORAL TABLET 5 MG 0.31590 11/15/2019 0.20000 01/24/2020

DEXRAZOXANE HCL INTRAVENOUS VIAL (EA) 250 MG 165.25050 01/16/2015

DEXRAZOXANE HCL INTRAVENOUS VIAL (EA) 500 MG 286.43625 01/16/2015

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL CAPSULE, EXT RELEASE 24 HR 10 MG

1.42000 01/22/2020 1.42000 01/23/2020

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL CAPSULE, EXT RELEASE 24 HR 15 MG

1.80000 01/22/2020 1.69990 05/22/2020

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL CAPSULE, EXT RELEASE 24 HR 20 MG

1.57007 01/28/2020 1.38000 05/22/2020

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL CAPSULE, EXT RELEASE 24 HR 25 MG

1.89020 11/15/2019 1.89020 01/22/2020

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL CAPSULE, EXT RELEASE 24 HR 30 MG

1.51574 11/15/2019 1.51574 01/22/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL CAPSULE, EXT RELEASE 24 HR 5 MG

3.82332 01/22/2020 2.02485 03/20/2020

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL TABLET 10 MG

0.42600 06/25/2019 0.33058 11/15/2019

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL TABLET 12.5 MG

0.23110 09/22/2017 0.52690 01/08/2018

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL TABLET 15 MG

0.50545 03/16/2019 0.37100 09/20/2019

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL TABLET 20 MG

0.56320 03/08/2019 0.37150 09/20/2019

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL TABLET 30 MG

0.21010 03/20/2020 0.36280 05/16/2020

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL TABLET 5 MG

0.40500 06/22/2018 0.25450 11/16/2018

DEXTROAMPHETAMINE SULF-SACCHARATE/AMPHETAMINE SULF-ASPARTATE ORAL TABLET 7.5 MG

0.69359 12/02/2016 0.54333 03/03/2017

DEXTROAMPHETAMINE SULFATE ORAL CAPSULE, EXTENDED RELEASE 10 MG

0.46820 03/20/2020 1.19950 04/17/2020

DEXTROAMPHETAMINE SULFATE ORAL CAPSULE, EXTENDED RELEASE 15 MG

1.85122 11/14/2017 0.88868 09/21/2018

DEXTROAMPHETAMINE SULFATE ORAL CAPSULE, EXTENDED RELEASE 5 MG

2.62825 01/01/2017 2.06516 06/16/2017

DEXTROAMPHETAMINE SULFATE ORAL SOLUTION, ORAL 5 MG/5 ML 1.27716 01/24/2014 1.27716 08/21/2015

DEXTROAMPHETAMINE SULFATE ORAL TABLET 10 MG 0.42930 01/24/2020 0.40200 03/20/2020

DEXTROAMPHETAMINE SULFATE ORAL TABLET 5 MG 0.64600 03/22/2019 0.34350 05/17/2019

DEXTROMETHORPHAN HBR/ACETAMINOPHEN/DOXYLAMINE ORAL LIQUID (ML) 15-325/15

0.01469 08/22/2014 0.01469 08/21/2015

DEXTROMETHORPHAN HBR/PHENYLEPHRINE HCL/DEXBROMPHENIRAMINE ORAL SYRUP 20-10-2/5

0.05168 08/12/2014 0.05168 08/21/2015

DEXTROMETHORPHAN POLISTIREX ORAL SUSPENSION, EXTENDED RELEASE 12 HR 30 MG/5 ML

0.08530 03/20/2015 0.08530 08/21/2015

DEXTROSE 10 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS DEHP-FREE BAG, INJECTION (ML) 10 %-0.2 %

0.04179 01/25/2013

DEXTROSE 10 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 10 %-0.2 %

0.03704 01/25/2013

DEXTROSE 10 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 10%-0.45%

0.01077 01/25/2013

DEXTROSE 10 % IN WATER INTRAVENOUS DEHP-FREE BAG, INJECTION (ML) 10 %

0.00819 01/25/2013

DEXTROSE 10 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 10 %

0.00207 04/05/2013

DEXTROSE 2.5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 2.5%-0.45%

0.00250 08/12/2014 0.00250 08/21/2015

DEXTROSE 20 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 20 %

0.00864 01/25/2013

DEXTROSE 25 % IN WATER INTRAVENOUS SYRINGE (ML) 25 % 0.38140 08/12/2014

DEXTROSE 30 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 30 %

0.00877 01/25/2013 0.00877 08/21/2015

DEXTROSE 40 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 40 %

0.00870 08/12/2014

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 5 %-0.2 %

0.00228 01/25/2013

DEXTROSE 5 % AND 0.3 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 5 %-0.3 %

0.00230 01/25/2013

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 5 %-0.45 %

0.00181 08/22/2014 0.00181 08/21/2015

DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 5 %-0.9 %

0.00274 01/09/2015 0.00274 08/21/2015

DEXTROSE 5 % IN LACTATED RINGERS INTRAVENOUS INTRAVENOUS SOLUTION 5 %

0.00214 01/25/2013

DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 5 % 0.00275 07/25/2014 0.00275 08/21/2015

DEXTROSE 5 % IN WATER INTRAVENOUS PIGGYBACK WITH THREADED PORT (ML)

0.02997 01/30/2015 0.02997 08/21/2015

DEXTROSE 5 % IN WATER INTRAVENOUS PIGGYBACK WITH VIAL PORT (NON-THREADED)

0.07096 01/25/2013

DEXTROSE 5 % IN WATER INTRAVENOUS VIAL (ML) 5 % 0.53214 01/25/2013

DEXTROSE 50 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 50 %

0.00630 01/25/2013 0.00630 08/21/2015

DEXTROSE 50 % IN WATER INTRAVENOUS SYRINGE (ML) 50 % 0.09475 04/05/2013 0.09475 08/21/2015

DEXTROSE 50 % IN WATER INTRAVENOUS VIAL (ML) 50 % 0.02540 08/12/2014

DEXTROSE 70 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 70 %

0.00532 04/19/2013 0.00532 08/21/2015

DEXTROSE ORAL SOLUTION, ORAL 5 % 0.01679 01/16/2015 0.01679 08/21/2015

DIAZEPAM INJECTION SYRINGE (ML) 5 MG/ML 3.71280 01/25/2013

DIAZEPAM INJECTION VIAL (ML) 5 MG/ML 1.36920 07/12/2013

DIAZEPAM ORAL CONCENTRATE, ORAL 5 MG/ML 1.83609 01/16/2015

DIAZEPAM ORAL SOLUTION, ORAL 5 MG/5 ML 0.10010 05/09/2014

DIAZEPAM ORAL TABLET 10 MG 0.02396 09/19/2014 0.02396 08/21/2015

DIAZEPAM ORAL TABLET 2 MG 0.02372 04/17/2015 0.02372 08/21/2015

DIAZEPAM ORAL TABLET 5 MG 0.02230 01/23/2015 0.02230 08/21/2015

DIAZEPAM RECTAL KIT 12.5-15-20 234.84300 04/01/2019 232.00000 10/25/2019

DIAZEPAM RECTAL KIT 2.5 MG 197.11300 08/22/2014 197.11300 04/01/2019

DIAZEPAM RECTAL KIT 5-7.5-10MG 245.00000 10/25/2019 234.39000 11/15/2019

DICLOFENAC POTASSIUM ORAL TABLET 50 MG 0.42767 03/16/2018 0.25630 11/16/2018

DICLOFENAC SODIUM OPHTHALMIC DROPS 0.1 % 1.02376 05/02/2014 1.02376 08/21/2015

DICLOFENAC SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 25 MG

0.99526 03/28/2014

DICLOFENAC SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 50 MG

0.09565 03/03/2017 0.08500 01/24/2020

DICLOFENAC SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 75 MG

0.09565 07/14/2017 0.08230 01/24/2020

DICLOFENAC SODIUM ORAL TABLET, EXTENDED RELEASE 24 HR 100 MG 0.66130 12/19/2018 1.60000 06/04/2019

DICLOFENAC SODIUM TOPICAL DROPS 1.5 % 0.90000 04/27/2018 0.11873 11/15/2019

DICLOFENAC SODIUM TOPICAL GEL (GRAM) 1 % 0.17595 11/15/2019 0.14776 05/22/2020

DICLOFENAC SODIUM TOPICAL GEL (GRAM) 3 % 1.49000 05/25/2018 0.68850 03/20/2020

DICLOFENAC SODIUM/MISOPROSTOL ORAL TABLET,IMMEDIATE,DELAY RELEASE,BIPHASE 50 MG-200

2.34693 08/21/2015 1.56576 06/16/2017

DICLOFENAC SODIUM/MISOPROSTOL ORAL TABLET,IMMEDIATE,DELAY RELEASE,BIPHASE 75 MG-200

1.94983 03/03/2017 1.59850 05/22/2020

DICLOXACILLIN SODIUM ORAL CAPSULE 250 MG 0.33183 09/26/2014 0.33183 08/21/2015

DICLOXACILLIN SODIUM ORAL CAPSULE 500 MG 0.67080 09/26/2014 0.67080 08/21/2015

DICYCLOMINE HCL ORAL CAPSULE 10 MG 0.14349 11/15/2019 0.11241 04/17/2020

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Current Effective Date

DICYCLOMINE HCL ORAL SOLUTION, ORAL 10 MG/5 ML 0.21028 04/03/2015

DICYCLOMINE HCL ORAL TABLET 20 MG 0.14933 09/20/2019 0.18270 10/04/2019

DIDANOSINE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 125 MG

2.70223 01/25/2013

DIDANOSINE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 200 MG

4.32270 02/08/2013

DIDANOSINE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 250 MG

5.50853 01/25/2013

DIDANOSINE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 400 MG

8.60350 02/08/2013

DIETHYLPROPION HCL ORAL TABLET 25 MG 0.23090 08/21/2015 0.18070 11/24/2017

DIETHYLPROPION HCL ORAL TABLET, EXTENDED RELEASE 75 MG 0.88524 08/22/2014 0.88524 08/21/2015

DIFLORASONE DIACETATE TOPICAL CREAM (GRAM) 0.05 % 3.29067 08/21/2015

DIFLORASONE DIACETATE TOPICAL OINTMENT (GRAM) 0.05 % 2.47670 08/12/2014 2.47670 08/21/2015

DIFLUNISAL ORAL TABLET 500 MG 1.18611 05/17/2013 1.18611 08/21/2015

DIGOXIN INJECTION SYRINGE (ML) 250 MCG/ML 1.58760 01/25/2013

DIGOXIN ORAL SOLUTION, ORAL 50 MCG/ML 0.56138 04/17/2015 0.68654 08/24/2017

DIGOXIN ORAL TABLET 125 MCG 0.24247 05/17/2019 0.21936 03/20/2020

DIGOXIN ORAL TABLET 250 MCG 0.29347 08/16/2019 0.17780 10/25/2019

DIHYDROERGOTAMINE MESYLATE INJECTION AMPUL (ML) 1 MG/ML 104.81800 03/13/2015

DIHYDROERGOTAMINE MESYLATE INJECTION VIAL (ML) 1 MG/ML 37.55430 01/25/2013

DIHYDROERGOTAMINE MESYLATE NASAL AEROSOL, SPRAY WITH PUMP (ML) 0.5MG/SPRY

296.65500 07/05/2017 324.99800 09/24/2019

DILTIAZEM HCL INTRAVENOUS VIAL WITH THREADED PORT (EA) 100 MG 14.71680 01/25/2013

DILTIAZEM HCL ORAL CAPSULE, EXT RELEASE 24 HR 120 MG 0.18874 10/19/2018 0.13167 05/17/2019

DILTIAZEM HCL ORAL CAPSULE, EXT RELEASE 24 HR 180 MG 0.16256 10/25/2019 0.12444 04/17/2020

DILTIAZEM HCL ORAL CAPSULE, EXT RELEASE 24 HR 240 MG 0.25000 04/27/2018 0.23078 02/22/2019

DILTIAZEM HCL ORAL CAPSULE, EXT RELEASE 24 HR 300 MG 0.41122 10/20/2017 0.28339 11/16/2018

DILTIAZEM HCL ORAL CAPSULE, EXT RELEASE 24 HR 360 MG 4.13262 01/07/2019 2.89000 10/25/2019

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 12 HR 60 MG 1.97040 04/10/2015

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 12 HR 90 MG 1.05763 05/16/2014 2.33360 07/24/2018

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 120 MG 0.31426 08/21/2015 0.23822 03/02/2018

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 180 MG 0.32000 03/02/2018 0.26189 08/17/2018

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 240 MG 0.51111 07/14/2017 0.41667 11/24/2017

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 300 MG 0.64937 07/14/2017 0.33644 05/22/2020

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 360 MG 0.39467 02/22/2019 0.35344 11/15/2019

DILTIAZEM HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 420 MG 1.49711 09/30/2016 1.16224 06/16/2017

DILTIAZEM HCL ORAL CAPSULE,EXTENDED-RELEASE 24HR DEGRADABLE 120 MG

0.44907 09/30/2016 0.35690 09/22/2017

DILTIAZEM HCL ORAL CAPSULE,EXTENDED-RELEASE 24HR DEGRADABLE 180 MG

0.58869 08/21/2015 0.41490 03/17/2017

DILTIAZEM HCL ORAL CAPSULE,EXTENDED-RELEASE 24HR DEGRADABLE 240 MG

0.45397 03/02/2018 0.42815 03/16/2018

DILTIAZEM HCL ORAL TABLET 120 MG 0.28520 11/16/2018 0.26220 02/22/2019

DILTIAZEM HCL ORAL TABLET 30 MG 0.09900 08/21/2015 0.07598 09/22/2017

DILTIAZEM HCL ORAL TABLET 60 MG 0.21057 04/28/2016 0.14363 07/14/2017

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Current Effective Date

DILTIAZEM HCL ORAL TABLET 90 MG 0.24125 09/22/2017 0.22950 05/22/2020

DILTIAZEM HCL ORAL TABLET, EXTENDED RELEASE 24 HR 180 MG 2.04560 08/21/2015 1.63333 05/17/2019

DILTIAZEM HCL ORAL TABLET, EXTENDED RELEASE 24 HR 240 MG 2.33427 08/21/2015 1.94733 03/20/2020

DILTIAZEM HCL ORAL TABLET, EXTENDED RELEASE 24 HR 300 MG 2.97603 12/19/2014 2.97603 08/21/2015

DILTIAZEM HCL ORAL TABLET, EXTENDED RELEASE 24 HR 360 MG 2.40333 11/16/2018 2.18554 06/21/2019

DILTIAZEM HCL ORAL TABLET, EXTENDED RELEASE 24 HR 420 MG 3.54216 03/21/2014 3.13330 06/16/2017

DILUENT FOR EPOPROSTENOL SODIUM (GLYCINE) INTRAVENOUS VIAL (ML)

0.14700 01/25/2013

DIMENHYDRINATE INJECTION VIAL (ML) 50 MG/ML 4.98960 01/25/2013

DIMENHYDRINATE ORAL TABLET 50 MG 0.01809 01/25/2013 0.01809 08/21/2015

DIMETHICONE TOPICAL CREAM (ML) 5 % 0.03918 04/10/2015 0.03918 08/21/2015

DIMETHICONE TOPICAL SPRAY, NON-AEROSOL (ML) 2 % 0.03000 08/12/2014

DIPHENHYDRAMINE HCL INJECTION VIAL (ML) 50 MG/ML 0.59000 08/16/2019

DIPHENHYDRAMINE HCL ORAL CAPSULE 25 MG 0.03163 08/21/2015 0.02020 10/20/2017

DIPHENHYDRAMINE HCL ORAL CAPSULE 50 MG 0.01743 08/12/2014 0.01743 08/21/2015

DIPHENHYDRAMINE HCL ORAL CAPSULE 50 MG 0.17282 08/21/2015 0.01743 11/17/2017

DIPHENHYDRAMINE HCL ORAL ELIXIR 12.5MG/5ML 0.00512 01/25/2013 0.00512 08/21/2015

DIPHENHYDRAMINE HCL ORAL LIQUID (ML) 12.5MG/5ML 0.00578 01/16/2015 0.00578 08/21/2015

DIPHENHYDRAMINE HCL ORAL SYRUP 12.5MG/5ML 0.01260 08/12/2014

DIPHENHYDRAMINE HCL ORAL TABLET 25 MG 0.02104 02/06/2015 0.02104 08/21/2015

DIPHENOXYLATE HCL/ATROPINE SULFATE ORAL LIQUID (ML) 2.5-.025/5 0.10803 01/25/2013

DIPHENOXYLATE HCL/ATROPINE SULFATE ORAL TABLET 2.5-.025MG 0.29000 02/22/2019 0.21900 11/15/2019

DIPYRIDAMOLE ORAL TABLET 25 MG 0.05708 02/13/2015 0.05708 08/21/2015

DIPYRIDAMOLE ORAL TABLET 50 MG 0.10810 08/12/2014 0.10810 08/21/2015

DIPYRIDAMOLE ORAL TABLET 75 MG 0.13680 08/12/2014 0.13680 08/21/2015

DISOPYRAMIDE PHOSPHATE ORAL CAPSULE 100 MG 0.34801 05/01/2015 0.34801 08/21/2015

DISOPYRAMIDE PHOSPHATE ORAL CAPSULE 150 MG 0.35458 08/21/2015

DISULFIRAM ORAL TABLET 250 MG 0.78000 01/25/2019 1.50849 04/09/2019

DISULFIRAM ORAL TABLET 500 MG 3.76000 01/08/2018 0.87360 03/02/2018

DIVALPROEX SODIUM ORAL CAPSULE, DELAYED RELEASE SPRINKLE 125 MG

0.29874 03/20/2020 0.23220 06/19/2020

DIVALPROEX SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 125 MG

0.05896 08/21/2015 0.04414 03/02/2018

DIVALPROEX SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 250 MG

0.10366 08/21/2015 0.06000 08/25/2017

DIVALPROEX SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 500 MG

0.10326 01/19/2018 0.07662 12/20/2019

DIVALPROEX SODIUM ORAL TABLET, EXTENDED RELEASE 24 HR 250 MG 0.28108 04/01/2020 0.14808 06/19/2020

DIVALPROEX SODIUM ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG 0.20742 12/20/2019 0.14998 04/17/2020

DOBUTAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 1000MG/250

0.08730 08/12/2014

DOBUTAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 250 MG/250

0.04960 08/12/2014

DOBUTAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 500 MG/500

0.02810 08/12/2014

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Current SMAC Price

Current Effective Date

DOBUTAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 500MG/250

0.05620 08/12/2014

DOBUTAMINE HCL INTRAVENOUS VIAL (ML) 250MG/20ML 0.15780 08/12/2014

DOBUTAMINE HCL INTRAVENOUS VIAL (ML) 500MG/40ML 0.15830 08/12/2014

DOCETAXEL INTRAVENOUS VIAL (ML) 140 MG/7ML 43.50599 01/23/2015 43.50599 08/21/2015

DOCETAXEL INTRAVENOUS VIAL (ML) 160 MG/8ML 675.67500 08/12/2014

DOCETAXEL INTRAVENOUS VIAL (ML) 160MG/16ML 67.85567 08/12/2014 67.85567 08/21/2015

DOCETAXEL INTRAVENOUS VIAL (ML) 20 MG/2 ML 60.99275 08/12/2014 60.99275 08/21/2015

DOCETAXEL INTRAVENOUS VIAL (ML) 200MG/20ML 42.61540 05/01/2015

DOCETAXEL INTRAVENOUS VIAL (ML) 20MG/ML(1) 53.07450 02/27/2015 53.07450 08/21/2015

DOCETAXEL INTRAVENOUS VIAL (ML) 80 MG/4 ML 50.41463 02/27/2015 50.41463 08/21/2015

DOCETAXEL INTRAVENOUS VIAL (ML) 80 MG/8 ML 61.30313 08/12/2014 61.30313 08/21/2015

DOCETAXEL INTRAVENOUS VIAL (ML) FNL 20MG/2 148.61475 01/25/2013 148.61475 08/21/2015

DOCETAXEL INTRAVENOUS VIAL (ML) FNL 80MG/8 297.22950 01/25/2013 297.22950 08/21/2015

DOCUSATE CALCIUM ORAL CAPSULE 240 MG 0.05135 08/12/2014 0.05135 08/21/2015

DOCUSATE SODIUM ORAL CAPSULE 100 MG 0.01474 01/30/2015 0.01474 08/21/2015

DOCUSATE SODIUM ORAL CAPSULE 250 MG 0.04068 03/27/2015 0.04068 08/21/2015

DOCUSATE SODIUM ORAL LIQUID (ML) 50 MG/5 ML 0.00902 08/12/2014 0.00902 08/21/2015

DOCUSATE SODIUM ORAL SYRUP 60 MG/15ML 0.00788 08/12/2014 0.00788 08/21/2015

DOCUSATE SODIUM ORAL TABLET 100 MG 0.02938 08/21/2015 0.01740 08/17/2018

DOCUSATE SODIUM RECTAL ENEMA (ML) 283 MG/5ML 3.28266 08/21/2015

DOCUSATE SODIUM/BENZOCAINE RECTAL ENEMA (ML) 283-20MG/5 2.68029 08/21/2015

DOFETILIDE ORAL CAPSULE 125 MCG 4.55000 08/25/2017 3.55783 09/22/2017

DOFETILIDE ORAL CAPSULE 500 MCG 2.61000 10/25/2019 1.71667 03/20/2020

DONEPEZIL HCL ORAL TABLET 10 MG 0.05607 08/25/2017 0.03508 09/22/2017

DONEPEZIL HCL ORAL TABLET 23 MG 0.76656 08/16/2019 0.24733 02/21/2020

DONEPEZIL HCL ORAL TABLET 5 MG 0.04100 07/26/2019 0.03500 10/25/2019

DONEPEZIL HCL ORAL TABLET,DISINTEGRATING 10 MG 0.27257 01/30/2015

DONEPEZIL HCL ORAL TABLET,DISINTEGRATING 5 MG 0.37252 08/21/2015 0.22000 03/20/2020

DOPAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS PLASTIC BAG, INJECTION (ML) 200MG/.25L

0.02960 08/12/2014

DOPAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS PLASTIC BAG, INJECTION (ML) 400MG/.25L

0.03690 08/12/2014

DOPAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS PLASTIC BAG, INJECTION (ML) 400MG/0.5L

0.04060 08/12/2014

DOPAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS PLASTIC BAG, INJECTION (ML) 800MG/.25L

0.08010 08/12/2014

DOPAMINE HCL IN DEXTROSE 5 % IN WATER INTRAVENOUS PLASTIC BAG, INJECTION (ML) 800MG/0.5L

0.05100 08/12/2014

DOPAMINE HCL INTRAVENOUS VIAL (ML) 400 MG/5ML 0.50263 01/25/2013

DOPAMINE HCL INTRAVENOUS VIAL (ML) 400MG/10ML 0.07980 01/25/2013

DOPAMINE HCL INTRAVENOUS VIAL (ML) 800MG/10ML 0.20101 01/25/2013

DOPAMINE HCL INTRAVENOUS VIAL (ML) 800MG/5ML 0.62837 01/25/2013

DORZOLAMIDE HCL OPHTHALMIC DROPS 2 % 0.81880 08/25/2017 0.78900 12/20/2019

DORZOLAMIDE HCL/TIMOLOL MALEATE OPHTHALMIC DROPS 22.3-6.8/1 0.78900 09/20/2019 1.73621 01/29/2020

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Current Effective Date

DOXAZOSIN MESYLATE ORAL TABLET 1 MG 0.13300 09/22/2017 0.05640 09/20/2019

DOXAZOSIN MESYLATE ORAL TABLET 2 MG 0.09930 11/24/2017 0.05640 01/24/2020

DOXAZOSIN MESYLATE ORAL TABLET 4 MG 0.18871 08/01/2019 0.08960 01/24/2020

DOXAZOSIN MESYLATE ORAL TABLET 8 MG 0.10930 11/24/2017 0.08800 06/19/2020

DOXEPIN HCL ORAL CAPSULE 10 MG 0.37514 08/21/2015 0.22778 05/17/2019

DOXEPIN HCL ORAL CAPSULE 100 MG 0.96692 09/30/2019 0.55000 05/22/2020

DOXEPIN HCL ORAL CAPSULE 150 MG 0.92954 03/20/2015

DOXEPIN HCL ORAL CAPSULE 25 MG 0.36040 08/25/2017 0.24400 06/19/2020

DOXEPIN HCL ORAL CAPSULE 50 MG 0.45428 05/17/2019 0.58570 08/06/2019

DOXEPIN HCL ORAL CAPSULE 75 MG 1.19520 09/18/2016 0.65458 05/17/2019

DOXEPIN HCL ORAL CONCENTRATE, ORAL 10 MG/ML 0.05720 08/12/2014

DOXERCALCIFEROL ORAL CAPSULE 0.5 MCG 11.21120 01/01/2017 11.21120 01/02/2017

DOXERCALCIFEROL ORAL CAPSULE 1 MCG 22.42149 01/01/2017 22.42149 01/02/2017

DOXERCALCIFEROL ORAL CAPSULE 2.5 MCG 25.97343 01/01/2017 25.97343 01/02/2017

DOXORUBICIN HCL INTRAVENOUS VIAL (EA) 10 MG 40.96400 08/08/2014 40.96400 08/21/2015

DOXORUBICIN HCL INTRAVENOUS VIAL (EA) 50 MG 29.40000 03/07/2014 29.40000 08/21/2015

DOXORUBICIN HCL PEGYLATED LIPOSOMAL INTRAVENOUS VIAL (ML) 2 MG/ML

80.99070 04/05/2013

DOXYCYCLINE HYCLATE INTRAVENOUS VIAL (EA) 100 MG 13.86000 11/14/2014 13.86000 08/21/2015

DOXYCYCLINE HYCLATE ORAL CAPSULE 100 MG 0.16900 12/21/2018 0.13096 05/22/2020

DOXYCYCLINE HYCLATE ORAL CAPSULE 50 MG 0.28216 04/08/2019 0.21890 11/15/2019

DOXYCYCLINE HYCLATE ORAL TABLET 100 MG 0.12565 08/16/2019 0.09980 04/17/2020

DOXYCYCLINE HYCLATE ORAL TABLET 20 MG 0.62690 08/21/2015 0.20961 07/08/2016

DOXYCYCLINE HYCLATE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 100 MG

9.19320 08/17/2018 5.36500 10/19/2018

DOXYCYCLINE HYCLATE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 150 MG

8.72316 04/24/2015 5.65000 06/21/2019

DOXYCYCLINE HYCLATE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 75 MG

7.15693 08/12/2014

DOXYCYCLINE MONOHYDRATE ORAL CAPSULE 100 MG 0.16447 11/16/2018 0.14700 01/24/2020

DOXYCYCLINE MONOHYDRATE ORAL CAPSULE 150 MG 17.25512 01/25/2013

DOXYCYCLINE MONOHYDRATE ORAL CAPSULE 50 MG 0.20460 08/17/2018 0.12490 10/25/2019

DOXYCYCLINE MONOHYDRATE ORAL CAPSULE 75 MG 11.72204 01/30/2015 11.72204 08/21/2015

DOXYCYCLINE MONOHYDRATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 25 MG/5 ML

0.26565 03/20/2015 0.23433 05/17/2019

DOXYCYCLINE MONOHYDRATE ORAL TABLET 100 MG 0.56939 06/16/2017 0.22315 03/20/2020

DOXYCYCLINE MONOHYDRATE ORAL TABLET 150 MG 4.39361 01/25/2013 4.39361 08/21/2015

DOXYCYCLINE MONOHYDRATE ORAL TABLET 50 MG 0.65088 06/16/2017 0.32590 09/22/2017

DOXYCYCLINE MONOHYDRATE ORAL TABLET 75 MG 0.73370 08/12/2014 0.73370 08/21/2015

DOXYLAMINE SUCCINATE ORAL TABLET 25 MG 0.20563 08/21/2015

DRONABINOL ORAL CAPSULE 10 MG 9.55706 12/02/2016 7.63483 09/22/2017

DRONABINOL ORAL CAPSULE 2.5 MG 1.56000 12/21/2018 1.49667 11/15/2019

DRONABINOL ORAL CAPSULE 5 MG 3.24900 11/15/2019 2.50000 03/20/2020

DROPERIDOL INJECTION AMPUL (ML) 2.5 MG/ML 0.84840 01/25/2013

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

DROPERIDOL INJECTION VIAL (ML) 2.5 MG/ML 1.48750 01/25/2013

DROSPIRENONE/ETHINYL ESTRADIOL/LEVOMEFOLATE CALCIUM ORAL TABLET 3-0.02(24)

3.80020 02/26/2019 3.28512 11/15/2019

DULOXETINE HCL ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 20 MG

0.19211 11/16/2018 0.15437 08/16/2019

DULOXETINE HCL ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 MG

0.15200 12/21/2018 0.10633 12/20/2019

DULOXETINE HCL ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 40 MG

2.98102 04/23/2019 2.25600 02/21/2020

DULOXETINE HCL ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 60 MG

0.11663 08/16/2019 0.10200 06/19/2020

DUTASTERIDE ORAL CAPSULE 0.5 MG 0.17067 09/21/2018 0.13530 08/16/2019

DUTASTERIDE/TAMSULOSIN HCL ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 24HR 0.5-0.4 MG

2.40833 11/16/2018 2.18600 08/16/2019

ECONAZOLE NITRATE TOPICAL CREAM (GRAM) 1 % 0.44717 11/15/2019 0.24988 05/22/2020

ELECTROLYTE-48 SOLUTION/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 5 %

0.00430 08/12/2014

ELECTROLYTES/DEXTROSE ORAL SOLUTION, ORAL 0.00517 02/27/2015 0.00517 08/21/2015

ELETRIPTAN HYDROBROMIDE ORAL TABLET 20 MG 9.80000 04/27/2018 5.01000 12/20/2019

ELETRIPTAN HYDROBROMIDE ORAL TABLET 40 MG 5.31750 05/17/2019 3.67667 09/20/2019

EMOLLIENT COMBINATION NO.10 TOPICAL EMULSION (GRAM) 0.44835 01/25/2013 0.44835 08/21/2015

EMOLLIENT COMBINATION NO.32 TOPICAL EMULSION (GRAM) 0.72194 08/29/2014 0.72194 08/21/2015

EMOLLIENT COMBINATION NO.44 TOPICAL FOAM (GRAM) 0.90811 01/25/2013

EMOLLIENT COMBINATION NO.53 TOPICAL CREAM (GRAM) 0.49685 08/12/2014

EMOLLIENT COMBINATION NO.53 TOPICAL FOAM (GRAM) 1.01001 01/25/2013

ENALAPRIL MALEATE MISCELLANEOUS POWDER (GRAM) 100 % 3.35240 08/12/2014 3.35240 08/21/2015

ENALAPRIL MALEATE ORAL TABLET 10 MG 0.07090 09/20/2019 0.05510 11/15/2019

ENALAPRIL MALEATE ORAL TABLET 2.5 MG 0.06000 08/25/2017 0.05650 07/26/2019

ENALAPRIL MALEATE ORAL TABLET 20 MG 0.11706 11/16/2018 0.07320 01/24/2020

ENALAPRIL MALEATE ORAL TABLET 5 MG 0.13023 08/25/2017 0.07035 11/16/2018

ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE ORAL TABLET 10 MG-25MG

0.14036 08/21/2015 0.09050 06/16/2017

ENALAPRIL MALEATE/HYDROCHLOROTHIAZIDE ORAL TABLET 5MG-12.5MG

0.08740 05/31/2013 0.08740 08/21/2015

ENALAPRILAT DIHYDRATE INTRAVENOUS VIAL (ML) 1.25 MG/ML 1.78220 09/12/2014

ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 100 MG/ML 13.03766 04/21/2017 10.08000 08/01/2018

ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 120MG/.8ML 19.56825 02/26/2016 17.76502 04/21/2017

ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 150 MG/ML 12.95000 09/21/2018 11.45550 11/15/2019

ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 30MG/0.3ML 10.59000 08/22/2019 8.99667 03/20/2020

ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 40MG/0.4ML 9.79500 02/21/2020 11.98426 05/15/2020

ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 60MG/0.6ML 11.40870 03/17/2017 10.60666 06/19/2020

ENOXAPARIN SODIUM SUBCUTANEOUS SYRINGE (ML) 80MG/0.8ML 9.16000 12/27/2019 8.92000 05/22/2020

ENOXAPARIN SODIUM SUBCUTANEOUS VIAL (ML) 300MG/3ML 59.20133 03/06/2015 59.20133 08/21/2015

ENTACAPONE ORAL TABLET 200 MG 0.33480 11/15/2019 0.63276 12/27/2019

ENTECAVIR ORAL TABLET 0.5 MG 1.70800 05/17/2019 0.69967 11/15/2019

ENTECAVIR ORAL TABLET 1 MG 5.88033 09/22/2017 5.88030 09/23/2017

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Current SMAC Price

Current Effective Date

ENZYMES,DIGESTIVE ORAL CAPSULE 0.05940 08/12/2014 0.05940 08/21/2015

EPHEDRINE SULFATE VIAL (ML) 50 MG/ML 4.10130 01/25/2013 4.10130 08/21/2015

EPINASTINE HCL OPHTHALMIC DROPS 0.05 % 9.27130 08/21/2015 5.46126 06/16/2017

EPINEPHRINE HCL/PF INJECTION AMPUL (ML) 1 MG/ML(1) 682.71000 02/20/2015

EPINEPHRINE INJECTION SYRINGE (ML) 0.1 MG/ML 0.47910 08/12/2014 0.47910 08/21/2015

EPINEPHRINE INJECTION VIAL (ML) 1 MG/ML 0.20160 08/12/2014 0.20160 08/21/2015

EPIRUBICIN HCL INTRAVENOUS VIAL (EA) 200 MG 1992.09500 01/25/2013

EPLERENONE ORAL TABLET 25 MG 0.65000 05/22/2020 0.78922 05/28/2020

EPLERENONE ORAL TABLET 50 MG 1.26499 06/16/2017 0.98300 08/16/2019

EPOPROSTENOL SODIUM (GLYCINE) INTRAVENOUS VIAL (EA) 0.5 MG 12.85200 01/25/2013

EPOPROSTENOL SODIUM (GLYCINE) INTRAVENOUS VIAL (EA) 1.5 MG 24.45100 01/25/2013

EPROSARTAN MESYLATE ORAL TABLET 600 MG 2.39820 01/25/2013

ERGOCALCIFEROL (VITAMIN D2) ORAL CAPSULE 1250 MCG 0.16000 06/16/2017 0.09770 09/22/2017

ERGOCALCIFEROL (VITAMIN D2) ORAL TABLET 10 MCG 0.02380 02/08/2013

ERGOCALCIFEROL (VITAMIN D2) ORAL TABLET 50 MCG 0.05446 01/25/2013

ERGOLOID MESYLATES ORAL TABLET 1 MG 5.67287 02/06/2015

ERLOTINIB HCL ORAL TABLET 100 MG 12.50000 02/21/2020

ERLOTINIB HCL ORAL TABLET 150 MG 12.93000 02/21/2020

ERLOTINIB HCL ORAL TABLET 25 MG 9.50000 02/21/2020

ERYTHROMYCIN BASE IN ETHANOL TOPICAL GEL (GRAM) 2 % 2.23000 01/25/2019 1.68000 07/26/2019

ERYTHROMYCIN BASE IN ETHANOL TOPICAL SOLUTION, NON-ORAL 2 % 0.42017 06/21/2019 0.32978 11/15/2019

ERYTHROMYCIN BASE IN ETHANOL TOPICAL SWAB, MEDICATED 2 % 1.10370 02/08/2013

ERYTHROMYCIN BASE OPHTHALMIC OINTMENT (GRAM) 5 MG/GRAM 1.68401 06/16/2017 1.63247 02/22/2019

ERYTHROMYCIN BASE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 250 MG

2.41500 08/21/2015 4.82650 07/19/2019

ERYTHROMYCIN BASE ORAL TABLET 250 MG 9.39950 01/25/2019 7.81000 06/21/2019

ERYTHROMYCIN BASE ORAL TABLET 500 MG 9.78572 08/21/2015 12.26652 05/16/2016

ERYTHROMYCIN BASE/BENZOYL PEROXIDE TOPICAL GEL (GRAM) 3 %-5 %

2.91330 08/27/2019 1.97425 03/20/2020

ESCITALOPRAM OXALATE ORAL SOLUTION, ORAL 5 MG/5 ML 0.36009 02/26/2016 0.14983 04/26/2019

ESCITALOPRAM OXALATE ORAL TABLET 10 MG 0.06080 06/16/2017 0.04554 09/22/2017

ESCITALOPRAM OXALATE ORAL TABLET 20 MG 0.05913 02/22/2019 0.03570 10/25/2019

ESCITALOPRAM OXALATE ORAL TABLET 5 MG 0.06264 08/25/2017 0.03320 10/20/2017

ESOMEPRAZOLE MAGNESIUM ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 20 MG

0.23553 05/17/2019 0.19700 08/16/2019

ESOMEPRAZOLE MAGNESIUM ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 40 MG

0.22614 08/16/2019 0.15306 04/17/2020

ESOMEPRAZOLE SODIUM INTRAVENOUS VIAL (EA) 20 MG 9.22875 04/24/2015 9.22875 08/21/2015

ESOMEPRAZOLE SODIUM INTRAVENOUS VIAL (EA) 40 MG 10.43250 04/24/2015 10.43250 08/21/2015

ESTAZOLAM ORAL TABLET 1 MG 0.26770 08/12/2014

ESTAZOLAM ORAL TABLET 2 MG 0.29330 08/12/2014 0.29330 08/21/2015

ESTRADIOL ORAL TABLET 0.5 MG 0.10410 08/25/2017 0.06180 09/22/2017

ESTRADIOL ORAL TABLET 1 MG 0.11270 07/14/2017 0.07130 05/22/2020

ESTRADIOL ORAL TABLET 2 MG 0.13700 06/16/2017 0.11000 10/20/2017

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Current SMAC Price

Current Effective Date

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL SEMIWEEKLY .025MG/24H

8.45640 06/16/2017 7.60625 07/26/2019

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL SEMIWEEKLY .0375MG/24

7.27000 10/19/2018 6.67875 05/17/2019

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL SEMIWEEKLY .075MG/24H

6.63000 06/22/2018 5.61875 08/16/2019

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL SEMIWEEKLY 0.05MG/24H

6.18000 12/21/2018 8.09043 11/26/2019

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL SEMIWEEKLY 0.1MG/24HR

5.94125 05/17/2019 7.76750 05/29/2020

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL WEEKLY .025MG/24H 15.92223 09/20/2013 13.00000 03/03/2017

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL WEEKLY .0375MG/24 12.39250 12/22/2017 11.07000 01/24/2020

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL WEEKLY .075MG/24H 10.55000 05/02/2014

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.05MG/24H 9.98000 05/17/2019 13.11750 11/06/2019

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.06MG/24H 15.47000 04/25/2014 12.05375 06/16/2017

ESTRADIOL TRANSDERMAL PATCH, TRANSDERMAL WEEKLY 0.1MG/24HR

14.16352 12/25/2015 12.42131 06/16/2017

ESTRADIOL VAGINAL TABLET 10 MCG 9.30000 12/20/2019 8.45065 05/22/2020

ESTRADIOL/NORETHINDRONE ACETATE ORAL TABLET 0.5-0.1 MG 1.73571 03/15/2019 2.26160 04/13/2020

ESTRADIOL/NORETHINDRONE ACETATE ORAL TABLET 1 MG-0.5MG 2.83847 03/25/2016 2.29848 06/16/2017

ESTROGENS,ESTERIFIED/METHYLTESTOSTERONE ORAL TABLET 0.625-1.25

1.58654 08/12/2014 1.58654 08/21/2015

ESTROGENS,ESTERIFIED/METHYLTESTOSTERONE ORAL TABLET 1.25-2.5MG

1.74068 08/12/2014 1.74068 08/21/2015

ESTROPIPATE TABLET 0.75 MG 0.36322 04/25/2014 0.36322 08/21/2015

ESTROPIPATE TABLET 1.5 MG 0.50765 04/25/2014

ESTROPIPATE TABLET 3 MG 0.70270 08/12/2014

ESZOPICLONE ORAL TABLET 1 MG 0.29577 09/22/2017 0.26290 05/17/2019

ESZOPICLONE ORAL TABLET 2 MG 0.19400 09/22/2017 0.17820 11/16/2018

ESZOPICLONE ORAL TABLET 3 MG 0.34539 03/03/2017 0.20747 08/25/2017

ETHACRYNIC ACID ORAL TABLET 25 MG 5.52000 08/16/2019

ETHAMBUTOL HCL ORAL TABLET 100 MG 0.28000 11/24/2017 0.16920 08/17/2018

ETHINYL ESTRADIOL/DROSPIRENONE ORAL TABLET 0.02-3(28) 0.49000 03/15/2019 0.36702 08/16/2019

ETHINYL ESTRADIOL/DROSPIRENONE ORAL TABLET 0.03MG-3MG 0.49000 04/27/2018 0.39301 08/17/2018

ETHOSUXIMIDE ORAL CAPSULE 250 MG 1.08530 03/02/2018 0.70270 02/22/2019

ETHOSUXIMIDE ORAL SOLUTION, ORAL 250 MG/5ML 0.27221 01/25/2019 0.15389 06/19/2020

ETHYL ALCOHOL INJECTION AMPUL (ML) 98 % 7.48300 12/12/2014 7.48300 08/21/2015

ETHYL ALCOHOL INJECTION VIAL (ML) 98 % 12.09096 08/12/2014

ETHYNODIOL DIACETATE-ETHINYL ESTRADIOL ORAL TABLET 1 MG-35MCG

0.70226 03/03/2017 0.58262 11/24/2017

ETIDRONATE DISODIUM ORAL TABLET 200 MG 3.02458 01/24/2014

ETIDRONATE DISODIUM ORAL TABLET 400 MG 6.04777 11/22/2013 6.04777 08/21/2015

ETODOLAC ORAL CAPSULE 200 MG 0.89280 01/13/2017 0.84280 11/24/2017

ETODOLAC ORAL CAPSULE 300 MG 1.02950 11/24/2017 0.70490 03/02/2018

ETODOLAC ORAL TABLET 400 MG 0.42692 08/17/2018 0.34640 11/16/2018

ETODOLAC ORAL TABLET 500 MG 0.49930 08/25/2017 0.26330 11/15/2019

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Current SMAC Price

Current Effective Date

ETODOLAC ORAL TABLET, EXTENDED RELEASE 24 HR 400 MG 2.03084 08/21/2015 1.21731 06/16/2017

ETODOLAC ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG 0.96565 06/16/2017 0.16333 11/15/2019

ETODOLAC ORAL TABLET, EXTENDED RELEASE 24 HR 600 MG 2.29187 08/21/2015 1.36061 06/16/2017

ETOPOSIDE ORAL CAPSULE 50 MG 56.82120 02/15/2013

EXEMESTANE ORAL TABLET 25 MG 2.18833 07/25/2019 1.29833 11/15/2019

EZETIMIBE ORAL TABLET 10 MG 0.13771 01/15/2020 0.07384 04/17/2020

EZETIMIBE/SIMVASTATIN ORAL TABLET 10 MG-10MG 2.62000 04/27/2018 2.37300 11/16/2018

EZETIMIBE/SIMVASTATIN ORAL TABLET 10 MG-20MG 1.90000 06/21/2019

EZETIMIBE/SIMVASTATIN ORAL TABLET 10 MG-40MG 0.77689 03/20/2020 0.71933 05/22/2020

EZETIMIBE/SIMVASTATIN ORAL TABLET 10 MG-80MG 1.85700 10/02/2019 2.09682 11/26/2019

FAMCICLOVIR ORAL TABLET 125 MG 0.46454 08/21/2015 0.35833 11/16/2018

FAMCICLOVIR ORAL TABLET 250 MG 0.68028 08/21/2015 0.28887 06/16/2017

FAMCICLOVIR ORAL TABLET 500 MG 0.51583 11/16/2018 0.49467 11/15/2019

FAMOTIDINE IN SODIUM CHLORIDE, ISO-OSMOTIC/PF INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 20 MG/50ML

0.13650 01/25/2013

FAMOTIDINE INTRAVENOUS VIAL (ML) 10 MG/ML 0.26572 01/09/2015 0.26572 08/21/2015

FAMOTIDINE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 40MG/5ML 1.14744 03/03/2020 1.99680 05/18/2020

FAMOTIDINE ORAL TABLET 10 MG 0.08920 03/27/2015 0.08920 08/21/2015

FAMOTIDINE ORAL TABLET 20 MG 0.02905 10/25/2019 0.19960 04/13/2020

FAMOTIDINE ORAL TABLET 40 MG 0.08659 08/21/2015 0.05563 03/02/2018

FAMOTIDINE/PF INTRAVENOUS VIAL (ML) 20 MG/2 ML 0.37429 08/12/2014 0.37429 08/21/2015

FEBUXOSTAT ORAL TABLET 40 MG 4.80000 02/21/2020

FEBUXOSTAT ORAL TABLET 80 MG 4.97000 02/21/2020

FELBAMATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 600 MG/5ML 1.58070 12/02/2016 1.10721 05/22/2020

FELBAMATE ORAL TABLET 400 MG 1.34690 10/20/2017 0.86430 08/16/2019

FELBAMATE ORAL TABLET 600 MG 1.48180 02/22/2019 1.41430 03/20/2020

FELODIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 10 MG 0.34000 05/20/2016 0.09000 11/24/2017

FELODIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 2.5 MG 0.54257 08/21/2015 0.14760 09/22/2017

FELODIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 5 MG 0.19800 07/14/2017 0.07260 11/24/2017

FENOFIBRATE NANOCRYSTALLIZED ORAL TABLET 145 MG 0.16870 08/16/2019 0.15547 06/19/2020

FENOFIBRATE NANOCRYSTALLIZED ORAL TABLET 48 MG 0.14196 05/17/2019 0.10550 11/15/2019

FENOFIBRATE ORAL CAPSULE 150 MG 5.00920 01/23/2017 5.55870 09/05/2017

FENOFIBRATE ORAL CAPSULE 50 MG 1.73180 08/01/2014

FENOFIBRATE ORAL TABLET 160 MG 0.29844 02/11/2020 0.19590 04/17/2020

FENOFIBRATE ORAL TABLET 54 MG 0.18444 11/16/2018 0.16656 11/15/2019

FENOFIBRATE,MICRONIZED ORAL CAPSULE 130 MG 2.43400 08/17/2018 1.89200 10/19/2018

FENOFIBRATE,MICRONIZED ORAL CAPSULE 134 MG 0.19433 11/15/2019 0.14630 04/17/2020

FENOFIBRATE,MICRONIZED ORAL CAPSULE 200 MG 0.73900 02/14/2019 0.55315 08/16/2019

FENOFIBRATE,MICRONIZED ORAL CAPSULE 43 MG 1.64500 08/21/2015 0.58033 09/22/2017

FENOFIBRATE,MICRONIZED ORAL CAPSULE 67 MG 0.39699 08/24/2019 0.11000 11/15/2019

FENOFIBRIC ACID (CHOLINE) ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 135 MG

1.21444 08/01/2018 0.84544 02/22/2019

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Current SMAC Price

Current Effective Date

FENOFIBRIC ACID (CHOLINE) ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 45 MG

0.41211 09/22/2017 0.37988 01/25/2019

FENOFIBRIC ACID ORAL TABLET 105 MG 2.10232 05/30/2014 2.03967 08/25/2017

FENOFIBRIC ACID ORAL TABLET 35 MG 0.70070 08/12/2014

FENOPROFEN CALCIUM ORAL TABLET 600 MG 1.53587 02/07/2014 1.53587 08/21/2015

FENTANYL CITRATE BUCCAL LOZENGE ON A HANDLE 1200 MCG 31.46500 01/25/2013

FENTANYL CITRATE BUCCAL LOZENGE ON A HANDLE 1600 MCG 38.80683 01/25/2013

FENTANYL CITRATE BUCCAL LOZENGE ON A HANDLE 200 MCG 13.16280 01/25/2013 7.47933 09/22/2017

FENTANYL CITRATE BUCCAL LOZENGE ON A HANDLE 400 MCG 16.67657 01/25/2013

FENTANYL CITRATE BUCCAL LOZENGE ON A HANDLE 600 MCG 20.42600 01/25/2013

FENTANYL CITRATE BUCCAL LOZENGE ON A HANDLE 800 MCG 24.20180 10/25/2013

FENTANYL CITRATE/PF INTRAVENOUS SYRINGE (ML) 100MCG/2ML 0.65520 01/25/2013 0.65520 08/21/2015

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 100 MCG/HR

7.70600 08/17/2018 6.41480 02/22/2019

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 12 MCG/HR

7.16254 01/13/2020 7.60912 02/20/2020

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 25 MCG/HR

2.22000 10/25/2019 2.16000 05/22/2020

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 37.5MCG/HR

42.45400 05/01/2015

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 50MCG/HR 3.05057 11/15/2019 2.49800 01/24/2020

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 62.5MCG/HR

61.68800 05/01/2015

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 75MCG/HR 4.63650 11/15/2019 7.43407 02/12/2020

FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS 87.5MCG/HR

83.99000 05/01/2015

FERROUS FUMARATE/ASCORBIC ACID/B12-IF/FOLIC ACID ORAL CAPSULE 110-0.5MG

0.18226 08/30/2013

FERROUS GLUCONATE ORAL TABLET 240(27)MG 0.03859 08/12/2014

FERROUS SULFATE ORAL DROPS 15 MG/ML 0.06072 03/06/2015 0.06072 08/21/2015

FERROUS SULFATE ORAL SOLUTION, ORAL 220 (44)/5 0.00626 04/10/2015 0.00626 08/21/2015

FERROUS SULFATE ORAL TABLET 325(65) MG 0.00838 04/10/2015 0.00838 08/21/2015

FEXOFENADINE HCL ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 30 MG/5 ML

0.05664 02/27/2015

FEXOFENADINE HCL ORAL TABLET 180 MG 0.19000 11/16/2018 0.15500 08/16/2019

FEXOFENADINE HCL ORAL TABLET 60 MG 0.31707 08/21/2015 0.24340 08/16/2019

FEXOFENADINE HCL/PSEUDOEPHEDRINE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 60MG-120MG

0.66733 08/21/2015

FINASTERIDE ORAL TABLET 1 MG 0.31250 03/25/2016 0.09000 08/25/2017

FINASTERIDE ORAL TABLET 5 MG 0.13871 03/03/2017 0.05049 09/22/2017

FISH OIL/BORAGE OIL/FLAXSEED OIL/OMEGA 3,6,9 COMBINATION NO1 ORAL CAPSULE 400-400 MG

0.06168 08/12/2014

FISH OIL/DOCOSAHEXAENOIC ACID/EICOSAPENTAENOIC ACID ORAL CAPSULE 1200-144MG

0.01579 01/25/2013

FLAVOXATE HCL ORAL TABLET 100 MG 0.80990 08/21/2015 0.45341 06/16/2017

FLECAINIDE ACETATE ORAL TABLET 100 MG 0.20830 11/16/2018 0.17710 08/16/2019

FLECAINIDE ACETATE ORAL TABLET 150 MG 0.58174 08/21/2015 0.19130 08/17/2018

FLECAINIDE ACETATE ORAL TABLET 50 MG 0.14900 07/26/2019 0.13700 01/24/2020

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FLUCONAZOLE IN DEXTROSE, ISO-OSMOTIC INTRAVENOUS SOLUTION, PIGGYBACK (ML) 200MG/0.1L

0.09824 04/24/2015 0.09824 08/21/2015

FLUCONAZOLE IN DEXTROSE, ISO-OSMOTIC INTRAVENOUS SOLUTION, PIGGYBACK (ML) 400MG/0.2L

0.05315 04/24/2015 0.05315 08/21/2015

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 200MG/0.1L

0.01660 08/25/2017 0.03849 03/27/2020

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 400MG/0.2L

0.03369 04/24/2015 0.03369 08/21/2015

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS IV SOLUTION, PIGGYBACK, BOTTLE (ML) 200MG/0.1L

0.05285 03/06/2015 0.05285 08/21/2015

FLUCONAZOLE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS IV SOLUTION, PIGGYBACK, BOTTLE (ML) 400MG/0.2L

0.09450 01/25/2013 0.09450 08/21/2015

FLUCONAZOLE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 10 MG/ML

0.32278 08/21/2015 0.23000 09/22/2017

FLUCONAZOLE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 40 MG/ML

0.49314 09/22/2017 0.47400 10/25/2019

FLUCONAZOLE ORAL TABLET 100 MG 0.54328 11/16/2018 0.46613 11/15/2019

FLUCONAZOLE ORAL TABLET 150 MG 0.72107 02/22/2019 0.62917 06/19/2020

FLUCONAZOLE ORAL TABLET 200 MG 0.55972 11/16/2018 0.48000 06/19/2020

FLUCONAZOLE ORAL TABLET 50 MG 0.89200 08/21/2015 0.53200 06/16/2017

FLUCYTOSINE ORAL CAPSULE 250 MG 57.44830 11/21/2014 57.44830 08/21/2015

FLUCYTOSINE ORAL CAPSULE 500 MG 111.16350 11/21/2014 111.16350 08/21/2015

FLUDROCORTISONE ACETATE ORAL TABLET 0.1 MG 0.37080 12/06/2016 0.30660 10/20/2017

FLUNISOLIDE NASAL AEROSOL, SPRAY (ML) 25 MCG 1.92500 03/13/2015 1.92500 08/21/2015

FLUOCINOLONE ACETONIDE OIL OTIC DROPS 0.01 % 6.56750 10/19/2018 4.81200 12/21/2018

FLUOCINOLONE ACETONIDE TOPICAL CREAM (GRAM) 0.01 % 1.82185 08/12/2014 1.82185 08/21/2015

FLUOCINOLONE ACETONIDE TOPICAL CREAM (GRAM) 0.025 % 1.39143 08/21/2015 1.29967 02/21/2020

FLUOCINOLONE ACETONIDE TOPICAL OIL (ML) 0.01 % 1.30643 08/21/2015 0.55000 02/22/2019

FLUOCINOLONE ACETONIDE TOPICAL OINTMENT (GRAM) 0.025 % 1.18650 08/22/2014

FLUOCINOLONE ACETONIDE TOPICAL SOLUTION, NON-ORAL 0.01 % 1.56983 08/16/2019 0.90000 11/15/2019

FLUOCINOLONE ACETONIDE/SHOWER CAP TOPICAL OIL (ML) 0.01 % 1.31863 08/21/2015 0.50719 03/20/2020

FLUOCINONIDE TOPICAL CREAM (GRAM) 0.05 % 0.79753 11/24/2017 0.53592 10/25/2019

FLUOCINONIDE TOPICAL CREAM (GRAM) 0.1 % 13.23945 02/27/2015 11.07021 12/02/2016

FLUOCINONIDE TOPICAL GEL (GRAM) 0.05 % 1.04867 01/24/2020 1.50566 03/04/2020

FLUOCINONIDE TOPICAL OINTMENT (GRAM) 0.05 % 0.78790 08/30/2013 0.42932 07/08/2016

FLUOCINONIDE TOPICAL SOLUTION, NON-ORAL 0.05 % 1.13388 05/02/2014 0.79333 02/21/2020

FLUOCINONIDE/EMOLLIENT BASE TOPICAL CREAM (GRAM) 0.05 % 0.25684 06/07/2013 0.25684 08/21/2015

FLUORIDE (SODIUM) DENTAL CREAM (GRAM) 1.1 % 0.08013 08/21/2015 0.06294 10/25/2019

FLUORIDE (SODIUM) DENTAL GEL (GRAM) 1.1 % 0.06890 09/27/2013 0.06890 08/21/2015

FLUORIDE (SODIUM) ORAL DROPS 0.5 MG/ML 0.17316 08/21/2015 0.10320 11/24/2017

FLUORIDE (SODIUM) ORAL TABLET,CHEWABLE 0.25(0.55) 0.03738 03/01/2013 0.03738 08/21/2015

FLUORIDE (SODIUM) ORAL TABLET,CHEWABLE 0.5(1.1)MG 0.03740 02/22/2013 0.03740 08/21/2015

FLUORIDE (SODIUM) ORAL TABLET,CHEWABLE 1MG(2.2MG) 0.03852 04/19/2013 0.03852 08/21/2015

FLUOROMETHOLONE OPHTHALMIC SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 0.1 %

10.37820 02/20/2015 12.54792 04/27/2019

FLUOROURACIL INTRAVENOUS VIAL (ML) 1 G/20 ML 0.25200 03/27/2015 0.25200 08/21/2015

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FLUOROURACIL INTRAVENOUS VIAL (ML) 2.5 G/50ML 0.19859 03/27/2015

FLUOROURACIL INTRAVENOUS VIAL (ML) 5 G/100 ML 0.12840 09/22/2017 0.11050 03/20/2020

FLUOROURACIL INTRAVENOUS VIAL (ML) 500MG/10ML 0.25200 03/27/2015 0.25200 08/21/2015

FLUOROURACIL TOPICAL CREAM (GRAM) 0.5 % 41.44770 12/26/2014

FLUOROURACIL TOPICAL CREAM (GRAM) 5 % 4.05885 08/21/2015 4.05885 04/15/2016

FLUOROURACIL TOPICAL SOLUTION, NON-ORAL 2 % 4.95080 08/12/2014

FLUOROURACIL TOPICAL SOLUTION, NON-ORAL 5 % 7.93170 05/17/2013

FLUOXETINE HCL ORAL CAPSULE 10 MG 0.02814 05/01/2015 0.02814 08/21/2015

FLUOXETINE HCL ORAL CAPSULE 20 MG 0.02988 05/01/2015 0.02988 08/21/2015

FLUOXETINE HCL ORAL CAPSULE 40 MG 0.10783 02/01/2018 0.06800 01/25/2019

FLUOXETINE HCL ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 90 MG

29.33500 02/21/2014 29.33500 08/21/2015

FLUOXETINE HCL ORAL SOLUTION, ORAL 20 MG/5 ML 0.41658 07/27/2019 0.49922 04/23/2020

FLUOXETINE HCL ORAL TABLET 10 MG 0.05507 03/20/2015 0.05507 08/21/2015

FLUOXETINE HCL ORAL TABLET 20 MG 0.67167 07/26/2019 0.56167 11/15/2019

FLUOXETINE HCL ORAL TABLET 60 MG 2.97158 07/05/2013

FLUPHENAZINE DECANOATE INJECTION VIAL (ML) 25 MG/ML 13.83300 08/17/2018 16.70660 11/06/2019

FLUPHENAZINE HCL INJECTION VIAL (ML) 2.5 MG/ML 10.58000 03/01/2013

FLUPHENAZINE HCL ORAL CONCENTRATE, ORAL 5 MG/ML 0.81136 01/25/2013

FLUPHENAZINE HCL ORAL ELIXIR 2.5 MG/5ML 0.26710 01/25/2013

FLUPHENAZINE HCL ORAL TABLET 1 MG 3.20310 03/11/2019 2.52000 02/21/2020

FLUPHENAZINE HCL ORAL TABLET 10 MG 7.36791 01/06/2020 6.63180 06/19/2020

FLUPHENAZINE HCL ORAL TABLET 2.5 MG 0.47850 06/12/2018 3.16710 08/23/2019

FLUPHENAZINE HCL ORAL TABLET 5 MG 2.92200 08/17/2018 6.89950 11/27/2018

FLURAZEPAM HCL ORAL CAPSULE 15 MG 0.19583 08/22/2014 0.19583 08/21/2015

FLURAZEPAM HCL ORAL CAPSULE 30 MG 0.35100 08/22/2014 0.35100 08/21/2015

FLURBIPROFEN ORAL TABLET 100 MG 0.36823 02/20/2015 0.36823 08/21/2015

FLURBIPROFEN ORAL TABLET 50 MG 0.22113 09/19/2014 0.22113 08/21/2015

FLURBIPROFEN SODIUM OPHTHALMIC DROPS 0.03 % 1.57114 08/21/2015 1.14467 06/16/2017

FLUTAMIDE ORAL CAPSULE 125 MG 0.63643 08/21/2015 0.49639 11/24/2017

FLUTICASONE PROPIONATE NASAL SPRAY, SUSPENSION 50 MCG 0.32375 12/02/2016 0.15892 01/27/2017

FLUTICASONE PROPIONATE TOPICAL CREAM (GRAM) 0.05 % 0.23000 08/25/2017 0.18317 08/16/2019

FLUTICASONE PROPIONATE TOPICAL LOTION (ML) 0.05 % 4.54942 08/30/2013 4.54942 08/21/2015

FLUTICASONE PROPIONATE TOPICAL OINTMENT (GRAM) 0.005 % 0.48681 03/01/2013

FLUTICASONE PROPIONATE/SALMETEROL XINAFOATE INHALATION BLISTER, WITH INHALATION DEVICE 250-50 MCG

2.45000 04/17/2020 3.04950 05/02/2020

FLUVASTATIN SODIUM ORAL CAPSULE 20 MG 2.64600 03/27/2015 2.64600 04/22/2016

FLUVASTATIN SODIUM ORAL CAPSULE 40 MG 2.64297 08/23/2013 2.64297 04/22/2016

FLUVOXAMINE MALEATE ORAL CAPSULE, EXT RELEASE 24 HR 100 MG 7.12857 10/10/2014

FLUVOXAMINE MALEATE ORAL CAPSULE, EXT RELEASE 24 HR 150 MG 7.65030 10/10/2014

FLUVOXAMINE MALEATE ORAL TABLET 100 MG 0.42683 08/16/2019 0.33360 02/21/2020

FLUVOXAMINE MALEATE ORAL TABLET 25 MG 0.23769 08/21/2015 0.16767 08/25/2017

FLUVOXAMINE MALEATE ORAL TABLET 50 MG 0.31590 08/16/2019 0.23950 11/15/2019

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Current SMAC Price

Current Effective Date

FOLIC ACID INJECTION VIAL (ML) 5 MG/ML 1.79410 02/15/2013

FOLIC ACID ORAL TABLET 0.4 MG 0.01380 02/06/2015 0.01380 08/21/2015

FOLIC ACID ORAL TABLET 1 MG 0.02320 08/21/2015 0.00800 03/02/2018

FOLIC ACID/ARGININE HCL/CYANOCOBALAMIN/VIT B6/BLACK PEPPER TABLET 2-500-500

0.56210 01/25/2013

FOLIC ACID/MULTIVIT WITH MINERALS/LUTEIN ORAL TABLET 0.4MG-250 0.03600 01/25/2013

FOLIC ACID/PYRIDOXINE HCL/CA PHOS DIBASIC & TRIBASIC/GINGER ORAL TABLET 1.2-40-100

0.72360 01/25/2013 0.72360 08/21/2015

FOLIC ACID/VITAMIN B COMPLEX AND VITAMIN C ORAL TABLET 0.8 MG 0.09960 08/12/2014 0.09960 08/21/2015

FONDAPARINUX SODIUM SUBCUTANEOUS SYRINGE (ML) 10MG/0.8ML 94.71000 01/09/2015 94.71000 08/21/2015

FONDAPARINUX SODIUM SUBCUTANEOUS SYRINGE (ML) 2.5 MG/0.5 83.02000 08/21/2015 28.20200 02/21/2020

FONDAPARINUX SODIUM SUBCUTANEOUS SYRINGE (ML) 5MG/0.4ML 110.40650 01/09/2015 110.40650 08/21/2015

FONDAPARINUX SODIUM SUBCUTANEOUS SYRINGE (ML) 7.5MG/0.6 129.37800 01/09/2015 129.37800 08/21/2015

FORMALDEHYDE SOLUTION WITH APPLICATOR (ML) 10 % 0.36953 01/25/2013

FOSCARNET SODIUM INTRAVENOUS INFUSION BOTTLE (ML) 24 MG/ML 0.25326 01/30/2015 0.25326 08/21/2015

FOSINOPRIL SODIUM ORAL TABLET 10 MG 0.15448 08/21/2015 0.11000 12/21/2018

FOSINOPRIL SODIUM ORAL TABLET 20 MG 0.14428 08/21/2015 0.09833 02/22/2019

FOSINOPRIL SODIUM ORAL TABLET 40 MG 0.19096 08/21/2015 0.14144 02/22/2019

FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE ORAL TABLET 10-12.5MG 0.74360 08/12/2014 0.74360 08/21/2015

FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE ORAL TABLET 20-12.5 MG

1.06964 08/12/2014 1.06964 08/21/2015

FOSPHENYTOIN SODIUM INJECTION VIAL (ML) 100MG PE/2 0.91763 01/30/2015 0.91763 08/21/2015

FOSPHENYTOIN SODIUM INJECTION VIAL (ML) 500 PE/10 0.75985 01/30/2015 0.75985 08/21/2015

FUROSEMIDE INJECTION VIAL (ML) 10 MG/ML 0.40508 08/21/2015 0.36590 08/16/2019

FUROSEMIDE ORAL SOLUTION, ORAL 10 MG/ML 0.11127 05/17/2013

FUROSEMIDE ORAL SOLUTION, ORAL 40MG/5ML 0.14150 01/25/2013

FUROSEMIDE ORAL TABLET 20 MG 0.01363 04/24/2015 0.01363 08/21/2015

FUROSEMIDE ORAL TABLET 40 MG 0.02141 04/24/2015 0.02141 08/21/2015

FUROSEMIDE ORAL TABLET 80 MG 0.03476 08/21/2015 0.02408 10/20/2017

GABAPENTIN MISCELLANEOUS POWDER (GRAM) 100 % 1.14400 08/21/2015

GABAPENTIN ORAL CAPSULE 100 MG 0.03654 08/21/2015 0.02447 10/20/2017

GABAPENTIN ORAL CAPSULE 300 MG 0.05614 04/18/2019 0.04300 06/21/2019

GABAPENTIN ORAL CAPSULE 400 MG 0.06516 12/06/2019 0.04698 04/17/2020

GABAPENTIN ORAL SOLUTION, ORAL 250 MG/5ML 0.29166 01/25/2013

GABAPENTIN ORAL SOLUTION, ORAL 250 MG/5ML 0.15513 03/29/2019 0.11517 08/16/2019

GABAPENTIN ORAL SOLUTION, ORAL 300 MG/6ML 0.29164 01/25/2013

GABAPENTIN ORAL TABLET 600 MG 0.08738 01/27/2017 0.06198 04/17/2020

GABAPENTIN ORAL TABLET 800 MG 0.12078 07/14/2017 0.10138 12/22/2017

GALANTAMINE HBR ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 16 MG

1.31666 08/16/2019 1.18400 09/20/2019

GALANTAMINE HBR ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 24 MG

2.00142 06/16/2017 0.83300 03/02/2018

GALANTAMINE HBR ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 8 MG

1.22142 09/21/2018 0.43700 08/16/2019

GALANTAMINE HBR ORAL SOLUTION, ORAL 4 MG/ML 2.95575 01/25/2013 2.95575 08/21/2015

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Current Effective Date

GALANTAMINE HBR ORAL TABLET 12 MG 0.65067 09/22/2017 0.15067 08/16/2019

GALANTAMINE HBR ORAL TABLET 4 MG 0.89375 03/02/2018 0.76000 11/15/2019

GALANTAMINE HBR ORAL TABLET 8 MG 0.69000 04/22/2016 0.60633 03/16/2018

GANCICLOVIR SODIUM INTRAVENOUS VIAL (EA) 500 MG 62.00208 02/27/2015

GANIRELIX ACETATE SUBCUTANEOUS SYRINGE (ML) 250MCG/0.5 243.87300 01/25/2013

GATIFLOXACIN OPHTHALMIC DROPS 0.5 % 24.56800 05/25/2018 20.80000 10/19/2018

GEMCITABINE HCL INTRAVENOUS VIAL (EA) 1 G 39.64700 01/23/2015 39.64700 08/21/2015

GEMCITABINE HCL INTRAVENOUS VIAL (EA) 2 G 96.93425 08/08/2014 96.93425 08/21/2015

GEMCITABINE HCL INTRAVENOUS VIAL (EA) 200 MG 9.28800 01/23/2015 9.28800 08/21/2015

GEMCITABINE HCL INTRAVENOUS VIAL (ML) 1 G/26.3ML 2.87559 08/12/2014

GEMCITABINE HCL INTRAVENOUS VIAL (ML) 2 G/52.6ML 3.25580 08/12/2014

GEMCITABINE HCL INTRAVENOUS VIAL (ML) 200MG/5.26 3.55320 08/12/2014

GEMFIBROZIL ORAL TABLET 600 MG 0.07726 06/16/2017 0.06021 12/22/2017

GENTAMICIN SULFATE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 100MG/50ML

0.13213 01/25/2013

GENTAMICIN SULFATE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 120MG/0.1L

0.06630 01/25/2013

GENTAMICIN SULFATE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 70 MG/50ML

0.15469 01/25/2013

GENTAMICIN SULFATE IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 90MG/100ML

0.07491 01/25/2013

GENTAMICIN SULFATE INJECTION VIAL (ML) 20 MG/2 ML 1.45158 01/25/2013

GENTAMICIN SULFATE INJECTION VIAL (ML) 40 MG/ML 0.51161 08/12/2014 1.35660 01/16/2017

GENTAMICIN SULFATE OPHTHALMIC DROPS 0.3 % 0.68286 11/24/2017 0.62300 06/21/2019

GENTAMICIN SULFATE OPHTHALMIC OINTMENT (GRAM) 0.3 % 3.99600 08/21/2015 8.10000 10/23/2019

GENTAMICIN SULFATE TOPICAL CREAM (GRAM) 0.1 % 1.86566 07/18/2018

GENTAMICIN SULFATE TOPICAL OINTMENT (GRAM) 0.1 % 2.52733 02/07/2019 2.02650 03/20/2020

GENTAMICIN SULFATE/PF INJECTION VIAL (ML) 20 MG/2 ML 1.09954 08/12/2014

GENTAMICIN SULFATE/PF INTRAVENOUS VIAL WITH THREADED PORT (ML) 100MG/10ML

0.29434 01/25/2013

GENTAMICIN SULFATE/PF INTRAVENOUS VIAL WITH THREADED PORT (ML) 60 MG/6 ML

0.39255 01/25/2013

GLIMEPIRIDE ORAL TABLET 1 MG 0.03490 12/22/2017 0.01800 01/25/2019

GLIMEPIRIDE ORAL TABLET 2 MG 0.06095 09/22/2017 0.03695 12/22/2017

GLIMEPIRIDE ORAL TABLET 4 MG 0.08041 03/03/2017 0.04760 09/22/2017

GLIPIZIDE ORAL TABLET 10 MG 0.05265 08/21/2015 0.02000 08/25/2017

GLIPIZIDE ORAL TABLET 5 MG 0.03000 08/21/2015 0.01935 10/20/2017

GLIPIZIDE ORAL TABLET, EXTENDED RELEASE 24 HR 10 MG 0.19510 07/26/2019 0.14525 12/20/2019

GLIPIZIDE ORAL TABLET, EXTENDED RELEASE 24 HR 2.5 MG 0.15400 12/22/2017 0.10667 03/15/2019

GLIPIZIDE ORAL TABLET, EXTENDED RELEASE 24 HR 5 MG 0.10660 03/16/2018 0.07990 10/25/2019

GLIPIZIDE/METFORMIN HCL ORAL TABLET 2.5-250 MG 0.34151 11/08/2013 0.34151 08/21/2015

GLIPIZIDE/METFORMIN HCL ORAL TABLET 2.5-500 MG 0.43480 05/20/2016 0.23690 05/17/2019

GLIPIZIDE/METFORMIN HCL ORAL TABLET 5 MG-500MG 0.24565 11/24/2017 0.21777 11/16/2018

GLUCOSAMINE SULFATE ORAL TABLET 750 MG 0.33095 01/25/2013

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Current SMAC Price

Current Effective Date

GLUCOSAMINE SULFATE/CHONDROITIN SULFATE/METHYLSULFONYLMETHAN ORAL TABLET 500-200 MG

1.20120 01/25/2013

GLYBURIDE ORAL TABLET 1.25 MG 0.07710 03/02/2018 0.06020 02/22/2019

GLYBURIDE ORAL TABLET 2.5 MG 0.13169 08/21/2015 0.03220 09/22/2017

GLYBURIDE ORAL TABLET 5 MG 0.11240 08/25/2017 0.04420 09/22/2017

GLYBURIDE,MICRONIZED ORAL TABLET 1.5 MG 0.02590 08/12/2014 0.02590 08/21/2015

GLYBURIDE,MICRONIZED ORAL TABLET 3 MG 0.02840 08/12/2014 0.02840 08/21/2015

GLYBURIDE,MICRONIZED ORAL TABLET 6 MG 0.09900 05/17/2013 0.09900 08/21/2015

GLYBURIDE/METFORMIN HCL ORAL TABLET 1.25-250MG 0.09353 08/21/2015 0.03860 11/16/2018

GLYBURIDE/METFORMIN HCL ORAL TABLET 2.5-500 MG 0.08911 08/21/2015 0.05000 08/25/2017

GLYBURIDE/METFORMIN HCL ORAL TABLET 5 MG-500MG 0.04340 08/25/2017 0.02658 02/22/2019

GLYCINE ORAL POWDER (GRAM) 0.21190 08/12/2014

GLYCINE UROLOGIC SOLUTION IRRIGATION SOLUTION, IRRIGATION 1.5 %

0.00291 08/12/2014

GLYCOPYRROLATE INJECTION VIAL (ML) 0.2 MG/ML 0.22100 08/21/2015

GLYCOPYRROLATE ORAL TABLET 1 MG 0.11360 05/17/2019 0.06940 03/20/2020

GLYCOPYRROLATE ORAL TABLET 2 MG 0.26900 09/22/2017 0.17170 03/02/2018

GRANISETRON HCL INTRAVENOUS VIAL (ML) 1 MG/ML 4.71250 01/25/2013 4.71250 08/21/2015

GRANISETRON HCL INTRAVENOUS VIAL (ML) 1 MG/ML(1) 7.21995 01/25/2013 6.71000 05/17/2019

GRANISETRON HCL ORAL TABLET 1 MG 1.52404 02/27/2015 1.52404 08/21/2015

GRANISETRON HCL/PF INTRAVENOUS VIAL (ML) 100 MCG/ML 3.21880 08/12/2014

GRISEOFULVIN ULTRAMICROSIZE ORAL TABLET 125 MG 3.68837 10/17/2014 3.68837 08/21/2015

GRISEOFULVIN ULTRAMICROSIZE ORAL TABLET 250 MG 4.28393 08/21/2015 2.81345 06/16/2017

GRISEOFULVIN, MICROSIZE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 125 MG/5ML

0.12406 01/31/2014 0.12406 08/21/2015

GRISEOFULVIN, MICROSIZE ORAL TABLET 500 MG 5.95588 12/05/2014

GUAIFENESIN ORAL LIQUID (ML) 100 MG/5ML 0.00603 09/19/2014 0.00603 08/21/2015

GUAIFENESIN ORAL TABLET 200 MG 0.04248 10/31/2014 0.04248 08/21/2015

GUAIFENESIN ORAL TABLET 400 MG 0.05655 08/12/2014 0.05655 08/21/2015

GUAIFENESIN ORAL TABLET, EXTENDED RELEASE 12 HR 600 MG 0.31161 08/21/2015

GUAIFENESIN/DEXTROMETHORPHAN HBR ORAL LIQUID (ML) 100-10MG/5

0.01776 11/07/2014 0.01776 08/21/2015

GUAIFENESIN/DEXTROMETHORPHAN HBR ORAL SYRUP 100-10MG/5 0.00801 08/12/2014 0.00801 08/21/2015

GUAIFENESIN/DEXTROMETHORPHAN HBR ORAL TABLET 400MG-20MG 0.07778 08/21/2015

GUAIFENESIN/DEXTROMETHORPHAN HBR/PHENYLEPHRINE ORAL DROPS 5-2.5MG/ML

0.15389 10/10/2014

GUAIFENESIN/DEXTROMETHORPHAN HBR/PHENYLEPHRINE ORAL LIQUID (ML) 100-10-5MG

0.01987 04/24/2015 0.01987 08/21/2015

GUAIFENESIN/DEXTROMETHORPHAN HBR/PHENYLEPHRINE ORAL LIQUID (ML) 100-15-5/5

0.03941 08/12/2014 0.03941 08/21/2015

GUAIFENESIN/DEXTROMETHORPHAN HBR/PHENYLEPHRINE ORAL LIQUID (ML) 200-10-5/5

0.02590 08/12/2014

GUAIFENESIN/DEXTROMETHORPHAN HBR/PHENYLEPHRINE ORAL LIQUID (ML) 200-20-10

0.07980 08/12/2014 0.07980 08/21/2015

GUAIFENESIN/DEXTROMETHORPHAN HBR/PHENYLEPHRINE ORAL TABLET 380-15-10

0.47192 12/12/2014 0.47192 08/21/2015

GUAIFENESIN/PHENYLEPHRINE HCL ORAL TABLET 380MG-10MG 0.43170 08/12/2014

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Current Effective Date

GUANFACINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 1 MG 0.32400 07/26/2019 0.29290 12/20/2019

GUANFACINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 2 MG 0.31610 07/26/2019 0.24000 11/15/2019

GUANFACINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 3 MG 0.58000 08/25/2017 0.36520 01/25/2019

GUANIDINE HCL ORAL TABLET 125 MG 0.17724 01/25/2013

HALOBETASOL PROPIONATE TOPICAL CREAM (GRAM) 0.05 % 0.92200 08/16/2019 0.79908 11/15/2019

HALOBETASOL PROPIONATE TOPICAL OINTMENT (GRAM) 0.05 % 2.05920 06/16/2017 1.65860 03/20/2020

HALOPERIDOL DECANOATE INTRAMUSCULAR AMPUL (ML) 100 MG/ML 43.21000 04/15/2019 35.04600 05/17/2019

HALOPERIDOL DECANOATE INTRAMUSCULAR AMPUL (ML) 50 MG/ML 21.74667 01/25/2013

HALOPERIDOL DECANOATE INTRAMUSCULAR VIAL (ML) 100 MG/ML 43.24600 10/13/2015 38.75000 12/21/2018

HALOPERIDOL DECANOATE INTRAMUSCULAR VIAL (ML) 50 MG/ML 22.14000 08/21/2015 22.00000 01/25/2019

HALOPERIDOL LACTATE INJECTION AMPUL (ML) 5 MG/ML 5.15760 01/25/2013

HALOPERIDOL LACTATE INJECTION VIAL (ML) 5 MG/ML 1.02376 08/21/2015 0.63747 08/17/2018

HALOPERIDOL LACTATE ORAL CONCENTRATE, ORAL 2 MG/ML 0.03924 08/17/2018 0.06721 05/23/2019

HALOPERIDOL ORAL TABLET 0.5 MG 0.21117 10/11/2013 0.15250 08/25/2017

HALOPERIDOL ORAL TABLET 1 MG 0.33160 02/22/2018 0.28000 05/25/2018

HALOPERIDOL ORAL TABLET 10 MG 0.72503 01/04/2020 0.68650 03/20/2020

HALOPERIDOL ORAL TABLET 2 MG 0.31198 12/28/2017 0.50550 06/04/2020

HALOPERIDOL ORAL TABLET 20 MG 1.18740 03/02/2018 0.95065 08/16/2019

HALOPERIDOL ORAL TABLET 5 MG 0.46260 05/13/2019 0.44668 11/15/2019

HEPARIN SODIUM,PORCINE IN 0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 12500/250

0.04754 04/10/2015 0.04754 08/21/2015

HEPARIN SODIUM,PORCINE IN 0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 25000/250

0.02356 04/10/2015 0.02356 08/21/2015

HEPARIN SODIUM,PORCINE IN 0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 25000/500

0.01978 04/10/2015 0.01978 08/21/2015

HEPARIN SODIUM,PORCINE IN 0.9 % SODIUM CHLORIDE/PF INTRAVENOUS INTRAVENOUS SOLUTION 1000/500ML

0.00720 01/25/2013 0.00720 08/21/2015

HEPARIN SODIUM,PORCINE IN 0.9 % SODIUM CHLORIDE/PF INTRAVENOUS INTRAVENOUS SOLUTION 2K/1000ML

0.00440 08/12/2014 0.00440 08/21/2015

HEPARIN SODIUM,PORCINE INJECTION CARTRIDGE (ML) 5000/ML(1) 3.65400 01/25/2013

HEPARIN SODIUM,PORCINE INJECTION VIAL (ML) 1000/ML 0.20739 11/28/2014 0.20739 08/21/2015

HEPARIN SODIUM,PORCINE INJECTION VIAL (ML) 10000/ML 2.31659 05/01/2015 2.31659 08/21/2015

HEPARIN SODIUM,PORCINE INJECTION VIAL (ML) 20000/ML 8.04388 04/03/2015

HEPARIN SODIUM,PORCINE INJECTION VIAL (ML) 5000/ML 1.04000 08/25/2017 0.70240 08/16/2019

HEPARIN SODIUM,PORCINE INTRAVENOUS SYRINGE (ML) 500/5 ML 0.32928 11/15/2013

HEPARIN SODIUM,PORCINE INTRAVENOUS VIAL (ML) 100/ML 0.03983 04/05/2013 0.03983 08/21/2015

HEPARIN SODIUM,PORCINE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 12500/250

0.05431 04/24/2015 0.05431 08/21/2015

HEPARIN SODIUM,PORCINE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 20K/500ML

0.01097 04/17/2015 0.01097 08/21/2015

HEPARIN SODIUM,PORCINE/PF INJECTION CARTRIDGE (ML) 5000/0.5ML 3.99840 05/01/2015 3.99840 08/21/2015

HEPARIN SODIUM,PORCINE/PF INJECTION VIAL (ML) 1000/ML 3.64676 08/12/2014

HEPARIN SODIUM,PORCINE/PF INJECTION VIAL (ML) 5000/0.5ML 9.36923 01/25/2013

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS SYRINGE (ML) 1 UNIT/ML 0.53235 05/31/2013 0.53235 08/21/2015

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS SYRINGE (ML) 10 UNIT/ML 0.15678 05/31/2013 0.15678 08/21/2015

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Current SMAC Price

Current Effective Date

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS SYRINGE (ML) 100/ML (1) 0.14740 05/31/2013

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS SYRINGE (ML) 1000/10 ML 0.14740 05/31/2013

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS SYRINGE (ML) 200/2 ML 0.14740 05/31/2013

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS SYRINGE (ML) 300/3 ML 0.15513 07/25/2014 0.15513 08/21/2015

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS SYRINGE (ML) 500/5 ML 0.09299 03/07/2014 0.09299 08/21/2015

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS VIAL (ML) 10 UNIT/ML 1.27250 08/12/2014

HEPARIN SODIUM,PORCINE/PF INTRAVENOUS VIAL (ML) 100/ML (1) 1.63384 01/25/2013

HYDRALAZINE HCL INJECTION VIAL (ML) 20 MG/ML 4.60408 07/19/2013

HYDRALAZINE HCL ORAL TABLET 10 MG 0.05309 08/21/2015 0.03468 08/25/2017

HYDRALAZINE HCL ORAL TABLET 100 MG 0.11896 05/20/2016 0.06535 09/30/2016

HYDRALAZINE HCL ORAL TABLET 25 MG 0.05000 03/17/2017 0.03020 09/22/2017

HYDRALAZINE HCL ORAL TABLET 50 MG 0.05113 09/22/2017 0.03105 12/22/2017

HYDROCHLOROTHIAZIDE ORAL CAPSULE 12.5 MG 0.05352 08/21/2015 0.02000 08/25/2017

HYDROCHLOROTHIAZIDE ORAL TABLET 12.5 MG 0.08000 08/25/2017 0.05327 11/15/2019

HYDROCHLOROTHIAZIDE ORAL TABLET 25 MG 0.02250 08/21/2015 0.00892 10/20/2017

HYDROCHLOROTHIAZIDE ORAL TABLET 50 MG 0.04931 08/21/2015 0.01144 08/25/2017

HYDROCODONE BITARTRATE MISCELLANEOUS POWDER (GRAM) 100 % 7.56450 08/21/2015

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL SOLUTION, ORAL 2.5-108/5

0.56630 05/30/2014

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL SOLUTION, ORAL 2.5-167/5

0.47191 01/25/2013

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL SOLUTION, ORAL 5-217MG/10

0.59709 08/01/2014

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL SOLUTION, ORAL 7.5-325/15

0.16755 08/12/2014

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL SOLUTION, ORAL 7.5-325/15

0.07831 07/11/2017 0.04658 11/24/2017

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 10MG-300MG

1.78019 10/17/2014 0.60510 09/22/2017

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 10MG-325MG

0.16477 05/19/2017 0.10886 06/16/2017

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 2.5-325 MG

0.69069 04/03/2015

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 5 MG-300MG

0.65450 09/22/2017 0.32970 05/22/2020

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 5 MG-325MG

0.14569 03/03/2017 0.06500 08/25/2017

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 7.5-300 MG

1.07550 06/16/2017 0.70230 09/22/2017

HYDROCODONE BITARTRATE/ACETAMINOPHEN ORAL TABLET 7.5-325 MG

0.09087 01/25/2019 0.07087 08/16/2019

HYDROCODONE BITARTRATE/HOMATROPINE METHYLBROMIDE ORAL SYRUP 5-1.5 MG/5

0.52500 01/25/2013

HYDROCODONE BITARTRATE/HOMATROPINE METHYLBROMIDE ORAL SYRUP 5-1.5 MG/5

0.06580 08/12/2014

HYDROCODONE BITARTRATE/HOMATROPINE METHYLBROMIDE ORAL TABLET 5 MG-1.5MG

0.71674 01/30/2015 0.71674 08/21/2015

HYDROCODONE POLISTIREX/CHLORPHENIRAMINE POLISTIREX ORAL SUSPENSION, EXTENDED RELEASE 12 HR 10-8MG/5ML

0.40047 11/24/2017 0.38226 10/19/2018

HYDROCODONE/IBUPROFEN ORAL TABLET 10MG-200MG 3.99069 04/10/2015 3.99069 08/21/2015

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Current Effective Date

HYDROCODONE/IBUPROFEN ORAL TABLET 2.5-200 MG 2.04491 01/25/2013 2.04491 08/21/2015

HYDROCODONE/IBUPROFEN ORAL TABLET 5MG-200MG 2.49634 08/21/2015 2.23740 09/22/2017

HYDROCODONE/IBUPROFEN ORAL TABLET 7.5-200 MG 0.25323 05/20/2016 0.15400 07/14/2017

HYDROCORTISONE ACETATE MISCELLANEOUS POWDER (GRAM) 3.23180 01/25/2013 3.23180 08/21/2015

HYDROCORTISONE ACETATE RECTAL SUPPOSITORY, RECTAL 25 MG 2.93375 08/16/2019 2.38958 03/20/2020

HYDROCORTISONE ACETATE RECTAL SUPPOSITORY, RECTAL 30 MG 3.95180 08/12/2014

HYDROCORTISONE ACETATE/LIDOCAINE HCL/ALOE VERA RECTAL KIT 2.5-3%(7G)

251.09000 07/18/2014

HYDROCORTISONE ACETATE/PRAMOXINE HCL TOPICAL CREAM (GRAM) 2.5 %-1 %

1.29675 05/01/2015 1.29675 08/21/2015

HYDROCORTISONE BUTYRATE TOPICAL CREAM (GRAM) 0.1 % 1.02530 02/15/2013 1.02530 08/21/2015

HYDROCORTISONE BUTYRATE TOPICAL OINTMENT (GRAM) 0.1 % 1.88020 05/09/2014 1.88020 08/21/2015

HYDROCORTISONE BUTYRATE TOPICAL SOLUTION, NON-ORAL 0.1 % 0.21870 07/25/2014 0.21870 08/21/2015

HYDROCORTISONE BUTYRATE/EMOLLIENT BASE TOPICAL CREAM (GRAM) 0.1 %

6.29588 12/27/2013

HYDROCORTISONE MISCELLANEOUS POWDER (GRAM) 2.18774 08/12/2014 2.18774 08/21/2015

HYDROCORTISONE ORAL TABLET 10 MG 0.28362 05/20/2016 0.21970 09/22/2017

HYDROCORTISONE ORAL TABLET 20 MG 0.45000 11/24/2017 0.13960 08/17/2018

HYDROCORTISONE ORAL TABLET 5 MG 0.16140 09/22/2017 0.15020 11/16/2018

HYDROCORTISONE RECTAL ENEMA (ML) 100MG/60ML 0.06885 12/05/2014 0.06885 08/21/2015

HYDROCORTISONE TOPICAL CREAM (GRAM) 0.5 % 0.08224 04/05/2013 0.08224 08/21/2015

HYDROCORTISONE TOPICAL CREAM (GRAM) 1 % 0.05060 01/30/2015 0.05060 08/21/2015

HYDROCORTISONE TOPICAL CREAM (GRAM) 2.5 % 0.08792 10/25/2019 0.07675 05/22/2020

HYDROCORTISONE TOPICAL CREAM WITH PERINEAL APPLICATOR 1 % 0.66820 01/25/2013

HYDROCORTISONE TOPICAL CREAM WITH PERINEAL APPLICATOR 2.5 % 0.42190 12/23/2019 0.34234 05/22/2020

HYDROCORTISONE TOPICAL LOTION (GRAM) 1 % 0.04414 08/12/2014

HYDROCORTISONE TOPICAL LOTION (ML) 1 % 0.03153 08/12/2014 0.03153 08/21/2015

HYDROCORTISONE TOPICAL LOTION (ML) 2.5 % 0.23863 04/12/2013

HYDROCORTISONE TOPICAL OINTMENT (GRAM) 1 % 0.10490 01/30/2015 0.10490 08/21/2015

HYDROCORTISONE TOPICAL OINTMENT (GRAM) 2.5 % 0.11200 08/12/2014 0.11200 08/21/2015

HYDROCORTISONE VALERATE TOPICAL CREAM (GRAM) 0.2 % 1.43182 11/15/2019 1.04733 05/22/2020

HYDROCORTISONE VALERATE TOPICAL OINTMENT (GRAM) 0.2 % 4.59200 07/25/2014 4.59200 08/21/2015

HYDROCORTISONE/ACETIC ACID OTIC DROPS 1 %-2 % 9.82215 08/21/2015 8.85454 01/13/2017

HYDROCORTISONE/ALOE VERA TOPICAL CREAM (GRAM) 1 % 0.08883 08/21/2015 0.04374 01/25/2019

HYDROCORTISONE/IODOQUINOL TOPICAL CREAM (GRAM) 1 %-1 % 0.43200 08/12/2014

HYDROCORTISONE/MINERAL OIL/PETROLATUM,WHITE OINTMENT (GRAM) 1 %

0.12564 01/25/2013

HYDROMORPHONE HCL INJECTION AMPUL (ML) 1 MG/ML 0.87360 01/25/2013

HYDROMORPHONE HCL INJECTION AMPUL (ML) 4 MG/ML 1.33560 01/25/2013

HYDROMORPHONE HCL INJECTION SYRINGE (ML) 0.5MG/.5ML 8.44200 06/21/2013

HYDROMORPHONE HCL INJECTION SYRINGE (ML) 1 MG/ML 3.90600 01/25/2013

HYDROMORPHONE HCL INJECTION SYRINGE (ML) 2 MG/ML 1.88160 12/26/2014

HYDROMORPHONE HCL INJECTION SYRINGE (ML) 4 MG/ML 3.78000 01/25/2013

HYDROMORPHONE HCL INJECTION VIAL (ML) 2 MG/ML 0.87780 08/12/2014

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Current Effective Date

HYDROMORPHONE HCL ORAL LIQUID (ML) 1 MG/ML 0.27988 01/25/2013

HYDROMORPHONE HCL ORAL TABLET 2 MG 0.07780 08/25/2017 0.05790 05/22/2020

HYDROMORPHONE HCL ORAL TABLET 4 MG 0.08770 09/22/2017 0.07870 07/26/2019

HYDROMORPHONE HCL ORAL TABLET 8 MG 0.21960 02/22/2019 0.20310 03/20/2020

HYDROMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 12 MG

14.29670 08/01/2014 14.29670 08/21/2015

HYDROMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 16 MG

19.06219 08/21/2015 15.75000 05/25/2018

HYDROMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 32 MG

37.91137 08/01/2014

HYDROMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 8 MG 9.53110 08/01/2014 9.53110 08/21/2015

HYDROMORPHONE HCL RECTAL SUPPOSITORY, RECTAL 3 MG 8.58670 02/01/2013

HYDROMORPHONE HCL/PF INJECTION AMPUL (ML) 1 MG/ML 0.87360 01/25/2013

HYDROMORPHONE HCL/PF INJECTION AMPUL (ML) 2 MG/ML 0.94080 01/25/2013

HYDROMORPHONE HCL/PF INJECTION AMPUL (ML) 4 MG/ML 1.33560 01/25/2013

HYDROMORPHONE HCL/PF INJECTION SYRINGE (ML) 4 MG/ML 3.78000 01/25/2013

HYDROMORPHONE HCL/PF INJECTION VIAL (ML) 10 MG/ML 1.90750 01/30/2015 1.61638 12/02/2016

HYDROQUINONE MICROSPHERES TOPICAL CREAM, EXTENDED RELEASE (GRAM) 4 %

2.49387 01/25/2013

HYDROQUINONE TOPICAL CREAM (GRAM) 4 % 2.30566 08/21/2015 0.83056 11/15/2019

HYDROXOCOBALAMIN INTRAMUSCULAR VIAL (ML) 1000MCG/ML 0.89273 01/25/2013

HYDROXYUREA ORAL CAPSULE 500 MG 0.21423 11/24/2017 0.18352 03/02/2018

HYDROXYZINE HCL INTRAMUSCULAR VIAL (ML) 50 MG/ML 1.75000 01/25/2013 1.75000 08/21/2015

HYDROXYZINE HCL ORAL SOLUTION, ORAL 10 MG/5 ML 0.05916 08/21/2015 0.03692 03/02/2018

HYDROXYZINE HCL ORAL TABLET 10 MG 0.07338 08/21/2015 0.03772 09/22/2017

HYDROXYZINE HCL ORAL TABLET 25 MG 0.04000 08/25/2017 0.04986 06/06/2019

HYDROXYZINE HCL ORAL TABLET 50 MG 0.08702 10/03/2019 0.04500 06/19/2020

HYDROXYZINE PAMOATE ORAL CAPSULE 100 MG 0.52378 08/15/2014 0.52378 08/21/2015

HYDROXYZINE PAMOATE ORAL CAPSULE 25 MG 0.08300 02/25/2019 0.06010 10/25/2019

HYDROXYZINE PAMOATE ORAL CAPSULE 50 MG 0.08144 09/03/2019 0.06434 11/15/2019

HYOSCYAMINE SULFATE ORAL DROPS 0.125MG/ML 1.29622 04/24/2015 1.29622 08/21/2015

HYOSCYAMINE SULFATE ORAL ELIXIR 125MCG/5ML 0.04790 12/26/2014

HYOSCYAMINE SULFATE ORAL TABLET 0.125 MG 0.13030 09/22/2017 0.11025 08/16/2019

HYOSCYAMINE SULFATE ORAL TABLET, EXTENDED RELEASE 12 HR 0.375 MG

0.60697 07/18/2014 0.60697 08/21/2015

HYOSCYAMINE SULFATE ORAL TABLET,DISINTEGRATING 0.125 MG 0.18450 03/16/2018 0.12900 05/17/2019

HYOSCYAMINE SULFATE SUBLINGUAL TABLET, SUBLINGUAL 0.125 MG 0.19432 12/25/2015 0.07000 07/14/2017

HYPROMELLOSE OPHTHALMIC DROPS 0.3 % 0.35978 08/12/2014

HYPROMELLOSE OPHTHALMIC DROPS 0.4 % 0.17850 01/25/2013

IBANDRONATE SODIUM INTRAVENOUS SYRINGE (ML) 3 MG/3 ML 74.36375 11/14/2014

IBANDRONATE SODIUM ORAL TABLET 150 MG 4.66000 06/22/2018 4.34278 11/15/2019

IBUPROFEN ORAL CAPSULE 200 MG 0.10261 04/10/2015 0.10261 08/21/2015

IBUPROFEN ORAL SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 50 MG/1.25

0.22167 01/30/2015 0.22167 08/21/2015

IBUPROFEN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 100 MG/5ML 0.02262 04/17/2015 0.02262 08/21/2015

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Current Effective Date

IBUPROFEN ORAL TABLET 200 MG 0.01635 01/16/2015 0.01635 08/21/2015

IBUPROFEN ORAL TABLET 400 MG 0.06240 08/21/2015 0.04002 08/25/2017

IBUPROFEN ORAL TABLET 600 MG 0.06700 08/21/2015 0.03420 07/14/2017

IBUPROFEN ORAL TABLET 800 MG 0.07263 08/21/2015 0.03474 07/14/2017

IBUPROFEN ORAL TABLET,CHEWABLE 100 MG 0.12702 08/21/2015 0.12802 05/03/2019

IBUPROFEN/OXYCODONE HCL ORAL TABLET 400 MG-5MG 1.03130 08/12/2014 1.03130 08/21/2015

IFOSFAMIDE INTRAVENOUS VIAL (EA) 3 G 88.61300 01/25/2013

IFOSFAMIDE INTRAVENOUS VIAL (ML) 1 G/20 ML 2.09300 02/27/2015 2.09300 08/21/2015

IFOSFAMIDE INTRAVENOUS VIAL (ML) 3 G/60 ML 1.93007 10/17/2014 1.93007 08/21/2015

IFOSFAMIDE/MESNA KIT 3G-1G 281.14725 01/25/2013

IMIPENEM/CILASTATIN SODIUM INTRAVENOUS VIAL (EA) 250 MG 4.41000 08/12/2014 4.41000 08/21/2015

IMIPENEM/CILASTATIN SODIUM INTRAVENOUS VIAL (EA) 500 MG 8.82000 04/18/2014 8.82000 08/21/2015

IMIPRAMINE HCL ORAL TABLET 10 MG 0.10780 08/25/2017 0.06140 11/24/2017

IMIPRAMINE HCL ORAL TABLET 25 MG 0.10686 03/03/2017 0.06370 11/24/2017

IMIPRAMINE HCL ORAL TABLET 50 MG 0.13870 03/20/2020 0.10530 05/22/2020

IMIPRAMINE PAMOATE ORAL CAPSULE 100 MG 5.97100 03/07/2014

IMIPRAMINE PAMOATE ORAL CAPSULE 125 MG 8.87087 04/10/2015

IMIPRAMINE PAMOATE ORAL CAPSULE 150 MG 11.22875 04/10/2015

IMIPRAMINE PAMOATE ORAL CAPSULE 75 MG 7.95000 12/27/2013

IMIQUIMOD TOPICAL CREAM IN PACKET (EA) 5 % 2.07408 06/16/2017 1.89000 12/20/2019

INDAPAMIDE ORAL TABLET 1.25 MG 0.30448 08/01/2014 0.17220 09/22/2017

INDAPAMIDE ORAL TABLET 2.5 MG 0.17880 09/22/2017 0.14820 01/24/2020

INDOMETHACIN ORAL CAPSULE 25 MG 0.07340 12/22/2017 0.02910 11/16/2018

INDOMETHACIN ORAL CAPSULE 50 MG 0.09440 03/02/2018 0.07690 09/21/2018

INDOMETHACIN ORAL CAPSULE, EXTENDED RELEASE 75 MG 0.32783 07/14/2017 0.27750 03/02/2018

INDOMETHACIN SODIUM INTRAVENOUS VIAL (EA) 1 MG 365.86025 08/12/2014

IPRATROPIUM BROMIDE INHALATION SOLUTION, NON-ORAL 0.2 MG/ML 0.06013 08/21/2015 0.03720 07/26/2019

IPRATROPIUM BROMIDE NASAL AEROSOL, SPRAY (ML) 21 MCG 0.62500 12/25/2015 0.59969 04/21/2017

IPRATROPIUM BROMIDE NASAL AEROSOL, SPRAY (ML) 42 MCG 1.17400 03/03/2017 2.39930 05/03/2019

IPRATROPIUM BROMIDE/ALBUTEROL SULFATE INHALATION AMPUL FOR NEBULIZATION (ML) 0.5-3MG/3

0.05553 03/03/2017 0.04815 07/26/2019

IRBESARTAN ORAL TABLET 150 MG 0.13666 08/25/2017 0.11244 10/20/2017

IRBESARTAN ORAL TABLET 75 MG 0.14563 08/21/2015 0.08700 09/22/2017

IRBESARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 150-12.5MG 0.18022 03/02/2018 0.15667 08/17/2018

IRBESARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 300-12.5MG 0.19011 09/22/2017 0.17176 11/16/2018

IRON CARBONYL,GLUC/FOLIC ACID/VIT B12/VIT C/DOCUSATE SODIUM ORAL TABLET 90-1-50 MG

0.78945 08/21/2015 2.02566 12/13/2018

IRON POLYSACCHAR COMPLX/IRON HEME POLYPEPTIDE/FOLIC ACID/B12 ORAL TABLET 22-6-1-25

2.61148 01/25/2013 2.61148 08/21/2015

IRON POLYSACCHARIDE COMPLEX ORAL CAPSULE 150 MG 0.12990 08/16/2013 0.12990 08/21/2015

IRON POLYSACCHARIDE COMPLEX/CYANOCOBALAMIN/FOLIC ACID ORAL CAPSULE 150-25-1

0.19524 02/20/2015 0.19524 08/21/2015

IRON POLYSACCHARIDE COMPLEX/IRON HEME POLYPEPTIDE ORAL TABLET 28 MG

0.37090 08/12/2014

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Current Effective Date

IRON,CARBONYL ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 15MG/1.25

0.12650 08/12/2014

IRON,CARBONYL/ASCORBIC ACID/CYANOCOBALAMIN/FOLIC ACID ORAL TABLET 100-250-1

0.80738 08/12/2014

IRON,CARBONYL/DOCUSATE SODIUM/B12-IF/FOLIC ACID/MULTIVIT-MIN ORAL TABLET, EXTENDED RELEASE 24 HR 150-50-1MG

0.47055 01/25/2013

ISOMETHEPTENE MUCATE/DICHLORALPHENAZONE/ACETAMINOPHEN CAPSULE 65-100-325

4.71877 09/19/2014 4.71877 08/21/2015

ISONIAZID INJECTION VIAL (ML) 100 MG/ML 63.03150 01/25/2013

ISONIAZID ORAL SOLUTION, ORAL 50 MG/5 ML 0.09983 01/25/2013

ISONIAZID ORAL TABLET 100 MG 0.04221 12/13/2013 0.04221 08/21/2015

ISONIAZID ORAL TABLET 300 MG 0.06993 11/28/2014 0.06993 08/21/2015

ISOPROPYL ALCOHOL IN GLYCERIN OTIC DROPS 95 %-5 % 0.07020 08/12/2014 0.07020 08/21/2015

ISOSORBIDE DINITRATE ORAL TABLET 10 MG 0.68863 08/21/2015 0.22376 09/30/2016

ISOSORBIDE DINITRATE ORAL TABLET 20 MG 0.41250 03/02/2018 0.18870 09/21/2018

ISOSORBIDE DINITRATE ORAL TABLET 30 MG 0.83200 10/10/2014 0.83200 08/21/2015

ISOSORBIDE DINITRATE ORAL TABLET 5 MG 0.39000 12/21/2018 0.09160 02/21/2020

ISOSORBIDE DINITRATE ORAL TABLET, EXTENDED RELEASE 40 MG 1.24501 12/05/2014 1.24501 08/21/2015

ISOSORBIDE MONONITRATE ORAL TABLET 10 MG 0.19730 01/25/2013 0.19730 08/21/2015

ISOSORBIDE MONONITRATE ORAL TABLET 20 MG 0.12251 10/11/2013 0.09070 01/19/2018

ISOSORBIDE MONONITRATE ORAL TABLET, EXTENDED RELEASE 24 HR 120 MG

0.31550 09/22/2017 0.24000 11/24/2017

ISOSORBIDE MONONITRATE ORAL TABLET, EXTENDED RELEASE 24 HR 30 MG

0.10900 11/16/2018 0.07058 05/17/2019

ISOSORBIDE MONONITRATE ORAL TABLET, EXTENDED RELEASE 24 HR 60 MG

0.08680 01/24/2020 0.06790 03/20/2020

ISOSULFAN BLUE SUBCUTANEOUS VIAL (ML) 1 % 110.57218 04/03/2015 110.57218 08/21/2015

ISOTRETINOIN ORAL CAPSULE 10 MG 6.52054 01/22/2016 3.70100 10/19/2018

ISOTRETINOIN ORAL CAPSULE 20 MG 1.92767 08/16/2019 3.46933 02/07/2020

ISOTRETINOIN ORAL CAPSULE 30 MG 3.55000 12/20/2019 5.11994 04/08/2020

ISOTRETINOIN ORAL CAPSULE 40 MG 3.19000 10/25/2019 2.13833 01/24/2020

ISOXSUPRINE HCL ORAL TABLET 10 MG 0.80892 04/03/2015 0.80892 08/21/2015

ISRADIPINE ORAL CAPSULE 2.5 MG 0.95543 02/13/2015 0.95543 08/21/2015

ISRADIPINE ORAL CAPSULE 5 MG 1.39713 03/27/2015 1.39713 08/21/2015

ITRACONAZOLE ORAL CAPSULE 100 MG 1.62600 09/20/2019 1.09133 11/15/2019

IVERMECTIN ORAL TABLET 3 MG 7.57155 01/16/2015

KETOCONAZOLE ORAL TABLET 200 MG 0.98460 12/22/2017 0.93167 03/02/2018

KETOCONAZOLE TOPICAL CREAM (GRAM) 2 % 0.55784 11/15/2019 0.46671 02/21/2020

KETOCONAZOLE TOPICAL SHAMPOO 2 % 0.07500 03/17/2017 0.05789 08/25/2017

KETOPROFEN ORAL CAPSULE 75 MG 0.40169 03/06/2015 0.40169 08/21/2015

KETOPROFEN ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 200 MG

5.64648 03/13/2015 5.64648 08/21/2015

KETOROLAC TROMETHAMINE INJECTION SYRINGE (ML) 30 MG/ML 1.81000 04/25/2014

KETOROLAC TROMETHAMINE INJECTION VIAL (ML) 15 MG/ML 1.01304 02/13/2015 1.01304 08/21/2015

KETOROLAC TROMETHAMINE INJECTION VIAL (ML) 30 MG/ML 1.31943 01/25/2013

KETOROLAC TROMETHAMINE INJECTION VIAL (ML) 30MG/ML(1) 1.08696 02/13/2015 1.08696 08/21/2015

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Effective 6/19/2020

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Current SMAC Price

Current Effective Date

KETOROLAC TROMETHAMINE INTRAMUSCULAR VIAL (ML) 60 MG/2 ML 0.97981 02/13/2015 0.97981 08/21/2015

KETOROLAC TROMETHAMINE OPHTHALMIC DROPS 0.4 % 7.81600 03/27/2015 7.81600 08/21/2015

KETOROLAC TROMETHAMINE OPHTHALMIC DROPS 0.5 % 1.29534 08/21/2015 1.13433 08/25/2017

KETOROLAC TROMETHAMINE ORAL TABLET 10 MG 0.69950 11/16/2018 0.58960 05/22/2020

KETOTIFEN FUMARATE OPHTHALMIC DROPS 0.025 % 0.92080 03/27/2015 0.92080 08/21/2015

LABETALOL HCL INTRAVENOUS SYRINGE (ML) 20 MG/4 ML 0.65310 01/25/2013 0.65310 08/21/2015

LABETALOL HCL ORAL TABLET 100 MG 0.14153 05/17/2019 0.10450 09/20/2019

LABETALOL HCL ORAL TABLET 200 MG 0.18547 12/22/2017 0.12920 07/26/2019

LABETALOL HCL ORAL TABLET 300 MG 0.27700 11/24/2017 0.18370 09/20/2019

LACTIC ACID CREAM (GRAM) 10 % 0.08303 01/25/2013

LACTIC ACID LOTION (ML) 10 % 0.04280 08/12/2014

LACTULOSE ORAL SOLUTION, ORAL 10 G/15 ML 0.03407 04/03/2015

LACTULOSE ORAL SOLUTION, ORAL 10 G/15 ML 0.01396 04/24/2015

LACTULOSE ORAL SOLUTION, ORAL 10 G/15 ML 0.01301 11/21/2014 0.01301 08/21/2015

LACTULOSE ORAL SOLUTION, ORAL 20 G/30 ML 0.02205 02/07/2014 0.02205 08/21/2015

LAMIVUDINE ORAL SOLUTION, ORAL 10 MG/ML 0.34922 03/13/2015 0.27563 11/24/2017

LAMIVUDINE ORAL TABLET 150 MG 1.72083 03/17/2017 0.65500 11/15/2019

LAMIVUDINE ORAL TABLET 300 MG 1.61000 11/24/2017 1.31000 11/15/2019

LAMIVUDINE/ZIDOVUDINE ORAL TABLET 150-300 MG 0.91667 09/22/2017 0.33467 05/22/2020

LAMOTRIGINE ORAL TABLET 100 MG 0.05167 08/25/2017 0.03960 12/22/2017

LAMOTRIGINE ORAL TABLET 150 MG 0.10385 08/21/2015 0.06512 08/25/2017

LAMOTRIGINE ORAL TABLET 200 MG 0.08236 08/21/2015 0.06122 08/25/2017

LAMOTRIGINE ORAL TABLET 25 MG 0.03110 07/14/2017 0.02605 07/26/2019

LAMOTRIGINE ORAL TABLET, CHEWABLE DISPERSIBLE 25 MG 0.13440 02/21/2020 0.20031 04/08/2020

LAMOTRIGINE ORAL TABLET, CHEWABLE DISPERSIBLE 5 MG 0.08870 02/22/2019 0.17130 05/21/2019

LAMOTRIGINE ORAL TABLET, DOSE PACK 25MG (35) 2.90500 01/25/2013

LAMOTRIGINE ORAL TABLET, EXTENDED RELEASE 24 HR 100 MG 1.92966 01/25/2019 1.72650 06/21/2019

LAMOTRIGINE ORAL TABLET, EXTENDED RELEASE 24 HR 200 MG 2.06266 01/25/2019 2.01533 03/20/2020

LAMOTRIGINE ORAL TABLET, EXTENDED RELEASE 24 HR 25 MG 1.75000 06/22/2018 1.55055 06/21/2019

LAMOTRIGINE ORAL TABLET, EXTENDED RELEASE 24 HR 250 MG 7.24667 11/16/2018 8.57000 12/20/2018

LAMOTRIGINE ORAL TABLET, EXTENDED RELEASE 24 HR 300 MG 4.42467 06/22/2018 2.83067 10/25/2019

LAMOTRIGINE ORAL TABLET, EXTENDED RELEASE 24 HR 50 MG 1.94367 11/15/2019 1.60000 05/22/2020

LAMOTRIGINE ORAL TABLET,DISINTEGRATING 100 MG 5.81000 08/17/2018 3.93467 05/22/2020

LAMOTRIGINE ORAL TABLET,DISINTEGRATING 200 MG 23.77830 08/21/2015 6.30000 03/15/2019

LAMOTRIGINE ORAL TABLET,DISINTEGRATING 25 MG 5.75000 08/17/2018 4.72000 01/25/2019

LAMOTRIGINE ORAL TABLET,DISINTEGRATING 50 MG 18.68721 08/21/2015 3.33933 11/24/2017

LANOLIN/MINERAL OIL/PETROLATUM,WHITE OPHTHALMIC OINTMENT (GRAM)

0.91000 01/25/2013 0.91000 08/21/2015

LANSOPRAZOLE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 15 MG

0.28500 06/16/2017 0.13167 05/17/2019

LANSOPRAZOLE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 MG

0.15656 07/14/2017 0.08467 03/15/2019

LANSOPRAZOLE/AMOXICILLIN TRIHYDRATE/CLARITHROMYCIN ORAL COMBINATION PACKAGE (EA) 30-500-500

3.59300 03/20/2015

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

LATANOPROST OPHTHALMIC DROPS 0.005 % 1.67400 10/19/2018 1.62800 04/17/2020

LEFLUNOMIDE ORAL TABLET 10 MG 0.76500 02/22/2019 0.66667 05/17/2019

LEFLUNOMIDE ORAL TABLET 20 MG 1.34389 08/16/2019 1.03800 03/20/2020

LETROZOLE ORAL TABLET 2.5 MG 0.10433 07/14/2017 0.08978 04/17/2020

LEUCOVORIN CALCIUM INJECTION VIAL (EA) 200 MG 16.25400 08/12/2014 16.25400 08/21/2015

LEUCOVORIN CALCIUM INJECTION VIAL (EA) 50 MG 5.85200 08/12/2014 5.85200 08/21/2015

LEUCOVORIN CALCIUM INJECTION VIAL (EA) 500 MG 99.22500 01/25/2013

LEUCOVORIN CALCIUM INJECTION VIAL (ML) 10 MG/ML 0.29460 08/12/2014 0.29460 08/21/2015

LEUCOVORIN CALCIUM ORAL TABLET 10 MG 5.25150 08/12/2014

LEUCOVORIN CALCIUM ORAL TABLET 15 MG 5.85368 01/25/2013

LEUCOVORIN CALCIUM ORAL TABLET 25 MG 7.83744 05/17/2013 4.84400 03/02/2018

LEUCOVORIN CALCIUM ORAL TABLET 5 MG 0.64904 12/02/2016 0.60030 08/17/2018

LEUPROLIDE ACETATE SUBCUTANEOUS KIT 1 MG/0.2ML 129.30375 03/13/2015 129.30375 08/21/2015

LEVALBUTEROL HCL INHALATION VIAL, NEBULIZER (EA) 1.25MG/0.5 4.52639 12/26/2014 4.52639 08/21/2015

LEVALBUTEROL HCL INHALATION VIAL, NEBULIZER (ML) 0.31MG/3ML 0.78893 08/21/2015 0.54096 03/17/2017

LEVALBUTEROL HCL INHALATION VIAL, NEBULIZER (ML) 0.63MG/3ML 0.30400 05/17/2019 0.25156 11/15/2019

LEVALBUTEROL HCL INHALATION VIAL, NEBULIZER (ML) 1.25MG/3ML 0.38012 03/02/2018 0.29673 08/17/2018

LEVETIRACETAM IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 1000MG/100

0.59877 01/25/2013

LEVETIRACETAM IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 1500MG/100

0.77967 01/25/2013

LEVETIRACETAM IN SODIUM CHLORIDE, ISO-OSMOTIC INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 500MG/0.1L

0.36284 01/25/2013

LEVETIRACETAM INTRAVENOUS VIAL (ML) 500 MG/5ML 1.29524 08/12/2014 1.29524 08/21/2015

LEVETIRACETAM ORAL SOLUTION, ORAL 100 MG/ML 0.04966 08/21/2015 0.03332 10/20/2017

LEVETIRACETAM ORAL SOLUTION, ORAL 500 MG/5ML 1.06824 08/21/2015 0.05210 09/30/2016

LEVETIRACETAM ORAL TABLET 1000 MG 0.22030 03/22/2019 0.21650 07/26/2019

LEVETIRACETAM ORAL TABLET 250 MG 0.07448 08/21/2015 0.06112 05/22/2020

LEVETIRACETAM ORAL TABLET 500 MG 0.10089 05/19/2017 0.07706 08/01/2018

LEVETIRACETAM ORAL TABLET 750 MG 0.16433 03/04/2019 0.12917 07/26/2019

LEVETIRACETAM ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG 0.23278 11/16/2018 0.16667 07/26/2019

LEVETIRACETAM ORAL TABLET, EXTENDED RELEASE 24 HR 750 MG 0.27750 05/17/2019 0.21650 05/22/2020

LEVOBUNOLOL HCL OPHTHALMIC DROPS 0.5 % 2.15200 09/30/2016 0.58000 12/21/2018

LEVOCARNITINE (WITH SUGAR) ORAL SOLUTION, ORAL 100 MG/ML 0.27042 06/22/2018 0.19661 11/15/2019

LEVOCARNITINE ORAL TABLET 330 MG 0.53495 04/24/2015 0.72599 05/25/2018

LEVOCARNITINE ORAL TABLET 500 MG 0.24450 10/24/2014 0.24450 08/21/2015

LEVOCETIRIZINE DIHYDROCHLORIDE ORAL SOLUTION, ORAL 2.5 MG/5ML

0.43651 08/12/2014 0.43651 08/21/2015

LEVOCETIRIZINE DIHYDROCHLORIDE ORAL TABLET 5 MG 0.07215 11/16/2018 0.06111 04/26/2019

LEVOFLOXACIN INTRAVENOUS VIAL (ML) 25 MG/ML 0.55298 08/12/2014

LEVOFLOXACIN OPHTHALMIC DROPS 0.5 % 7.88880 01/25/2013

LEVOFLOXACIN ORAL SOLUTION, ORAL 250MG/10ML 0.88900 08/12/2014

LEVOFLOXACIN ORAL TABLET 250 MG 0.14767 08/21/2015 0.05240 03/15/2019

LEVOFLOXACIN ORAL TABLET 500 MG 0.12400 11/16/2018 0.10300 07/26/2019

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Effective 6/19/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

LEVOFLOXACIN ORAL TABLET 750 MG 0.24150 03/02/2018 0.22400 04/26/2019

LEVOFLOXACIN/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 250MG/50ML

0.11258 08/12/2014

LEVOFLOXACIN/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 500MG/0.1L

0.06601 08/12/2014 0.02228 11/24/2017

LEVOFLOXACIN/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 750MG/.15L

0.05357 08/12/2014 0.01569 11/24/2017

LEVOMEFOLATE CALCIUM ORAL TABLET 15 MG 2.04831 01/23/2015 2.04831 08/21/2015

LEVOMEFOLATE CALCIUM ORAL TABLET 7.5 MG 2.05620 02/20/2015 2.05620 08/21/2015

LEVONORGESTREL ORAL TABLET 0.75 MG 12.79600 01/25/2013 12.79600 08/21/2015

LEVONORGESTREL ORAL TABLET 1.5 MG 10.22000 05/17/2019 8.50000 12/20/2019

LEVONORGESTREL/ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL ORAL TABLET, DOSE PACK, 3 MONTHS 100-20(84)

0.99800 12/21/2018 0.41879 01/25/2019

LEVONORGESTREL/ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL ORAL TABLET, DOSE PACK, 3 MONTHS 150-30(84)

0.31610 03/20/2020 0.56003 05/12/2020

LEVONORGESTREL/ETHINYL ESTRADIOL ORAL TABLET 0.1-0.02MG 0.27345 08/17/2018 0.21078 03/15/2019

LEVONORGESTREL/ETHINYL ESTRADIOL ORAL TABLET 0.15-0.03 0.19619 09/30/2016 0.11607 03/02/2018

LEVONORGESTREL/ETHINYL ESTRADIOL ORAL TABLET 6-5-10 0.68718 08/12/2014 0.18904 07/08/2016

LEVONORGESTREL/ETHINYL ESTRADIOL ORAL TABLET 90-20 MCG 1.48500 04/24/2015

LEVONORGESTREL/ETHINYL ESTRADIOL ORAL TABLET, DOSE PACK, 3 MONTHS 0.15-0.03

0.40699 05/23/2018 0.32100 11/16/2018

LEVORPHANOL TARTRATE ORAL TABLET 2 MG 1.12600 08/12/2014 1.12600 08/21/2015

LEVOTHYROXINE SODIUM INTRAVENOUS VIAL (EA) 100 MCG 77.11900 11/07/2014 77.11900 08/21/2015

LEVOTHYROXINE SODIUM INTRAVENOUS VIAL (EA) 500 MCG 44.60050 01/25/2013 44.60050 08/21/2015

LEVOTHYROXINE SODIUM ORAL TABLET 100 MCG 0.20882 07/14/2017 0.32886 03/17/2020

LEVOTHYROXINE SODIUM ORAL TABLET 112 MCG 0.37767 10/19/2018 0.31907 06/21/2019

LEVOTHYROXINE SODIUM ORAL TABLET 125 MCG 0.39235 06/14/2019 0.36510 05/22/2020

LEVOTHYROXINE SODIUM ORAL TABLET 137 MCG 0.40522 05/19/2017 0.35260 10/20/2017

LEVOTHYROXINE SODIUM ORAL TABLET 150 MCG 0.38550 02/22/2019 0.24822 01/24/2020

LEVOTHYROXINE SODIUM ORAL TABLET 175 MCG 0.42570 12/20/2019 0.37844 05/22/2020

LEVOTHYROXINE SODIUM ORAL TABLET 200 MCG 0.49196 01/27/2017 0.33885 07/14/2017

LEVOTHYROXINE SODIUM ORAL TABLET 25 MCG 0.22294 11/16/2018 0.17105 04/17/2020

LEVOTHYROXINE SODIUM ORAL TABLET 300 MCG 0.59100 03/30/2019 0.55480 05/22/2020

LEVOTHYROXINE SODIUM ORAL TABLET 50 MCG 0.27192 07/14/2017 0.20082 12/20/2019

LEVOTHYROXINE SODIUM ORAL TABLET 75 MCG 0.30045 07/14/2017 0.22038 04/17/2020

LEVOTHYROXINE SODIUM ORAL TABLET 88 MCG 0.26722 07/14/2017 0.23539 04/17/2020

LIDOCAINE HCL IN DEXTROSE 5% IN WATER/PF INTRAVENOUS INTRAVENOUS SOLUTION 4 MG/ML

0.01280 08/12/2014

LIDOCAINE HCL IN DEXTROSE 5% IN WATER/PF INTRAVENOUS INTRAVENOUS SOLUTION 8 MG/ML

0.02029 01/25/2013

LIDOCAINE HCL IN DEXTROSE 7.5 % IN WATER/PF INTRATHECAL AMPUL (ML) 5 %

6.05930 08/12/2014

LIDOCAINE HCL INJECTION VIAL (ML) 10 MG/ML 0.05802 02/07/2014 0.05802 08/21/2015

LIDOCAINE HCL INJECTION VIAL (ML) 20 MG/ML 0.06084 01/25/2013

LIDOCAINE HCL MUCOUS MEMBRANE JELLY (ML) 2 % 0.27545 02/14/2014 0.27545 08/21/2015

LIDOCAINE HCL MUCOUS MEMBRANE JELLY WITH PREFILLED APPLICATOR (ML) 2 %

0.34943 12/12/2014 0.34943 08/21/2015

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Effective 6/19/2020

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

LIDOCAINE HCL MUCOUS MEMBRANE SOLUTION, NON-ORAL 40 MG/ML 0.06266 08/12/2014 0.06266 08/21/2015

LIDOCAINE HCL MUCOUS MEMBRANE SOLUTION, ORAL 2 % 0.02375 08/21/2015 0.07917 05/21/2018

LIDOCAINE HCL TOPICAL SOLUTION, ORAL 4 % 1.05248 01/25/2013

LIDOCAINE HCL/EPINEPHRINE BITARTRATE INJECTION CARTRIDGE (ML) 2 %-1:100K

0.14933 01/25/2013

LIDOCAINE HCL/EPINEPHRINE BITARTRATE INJECTION CARTRIDGE (ML) 2%-1:50000

0.14933 01/25/2013

LIDOCAINE HCL/EPINEPHRINE INJECTION VIAL (ML) 1%-1:100K 0.06995 01/25/2013 0.06995 08/21/2015

LIDOCAINE HCL/EPINEPHRINE INJECTION VIAL (ML) 2 %-1:100K 0.07910 08/12/2014 0.07910 08/21/2015

LIDOCAINE HCL/EPINEPHRINE/PF INJECTION VIAL (ML) 2%-1:200K 0.35740 08/12/2014 0.35740 08/21/2015

LIDOCAINE HCL/HYDROCORTISONE ACETATE RECTAL CREAM (GRAM) 3 %-0.5 %

1.78500 03/13/2015

LIDOCAINE HCL/HYDROCORTISONE ACETATE RECTAL CREAM WITH APPLICATOR 3 %-0.5 %

1.37036 02/06/2015 1.37036 08/21/2015

LIDOCAINE HCL/HYDROCORTISONE ACETATE RECTAL CREAM WITH APPLICATOR 3%-1%(7 G)

251.09000 01/25/2013

LIDOCAINE HCL/HYDROCORTISONE ACETATE RECTAL GEL WITH APPLICATOR (GRAM) 3-2.5%(7G)

251.09000 01/25/2013

LIDOCAINE HCL/HYDROCORTISONE ACETATE RECTAL KIT 3 %-0.5 % 7.69340 08/21/2015

LIDOCAINE HCL/PF INJECTION AMPUL (ML) 10 MG/ML 0.35751 12/20/2013 0.35751 08/21/2015

LIDOCAINE HCL/PF INJECTION AMPUL (ML) 15 MG/ML 0.66715 01/25/2013

LIDOCAINE HCL/PF INJECTION AMPUL (ML) 20 MG/ML 1.01535 12/27/2013

LIDOCAINE HCL/PF INJECTION AMPUL (ML) 40 MG/ML 0.56780 08/12/2014

LIDOCAINE HCL/PF INJECTION VIAL (ML) 20 MG/ML 0.48516 08/12/2014

LIDOCAINE HCL/PF INJECTION VIAL (ML) 5 MG/ML 0.11002 01/25/2013

LIDOCAINE HCL/PF INTRAVENOUS SYRINGE (ML) 100 MG/5ML 0.66080 01/25/2013 0.66080 08/21/2015

LIDOCAINE HCL/PF INTRAVENOUS SYRINGE (ML) 50 MG/5 ML 0.88790 08/12/2014

LIDOCAINE HCL/PF INTRAVENOUS VIAL (ML) 20 MG/ML 0.28224 01/25/2013

LIDOCAINE MISCELLANEOUS POWDER (GRAM) 0.19471 08/21/2015

LIDOCAINE TOPICAL ADHESIVE PATCH, MEDICATED 5 % 2.15204 02/21/2020 2.46633 05/14/2020

LIDOCAINE TOPICAL CREAM (GRAM) 4 % 0.79667 08/16/2019 0.31433 02/21/2020

LIDOCAINE TOPICAL CREAM (GRAM) 5 % 1.05645 12/26/2014 1.05645 08/21/2015

LIDOCAINE TOPICAL OINTMENT (GRAM) 5 % 0.26639 11/15/2019 0.22550 01/24/2020

LIDOCAINE/PRILOCAINE TOPICAL CREAM (GRAM) 2.5 %-2.5% 0.19392 11/15/2019 0.17500 05/22/2020

LIDOCAINE/PRILOCAINE TOPICAL KIT 2.5 %-2.5% 1.40764 01/25/2013 1.40764 08/21/2015

LINDANE TOPICAL LOTION (ML) 1 % 1.59670 02/08/2013 1.59670 08/21/2015

LINDANE TOPICAL SHAMPOO 1 % 1.59670 02/08/2013 1.59670 08/21/2015

LINEZOLID IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 600MG/300

0.50400 03/13/2015 0.50400 08/21/2015

LINEZOLID ORAL TABLET 600 MG 1.51000 02/21/2020 2.34734 03/04/2020

LIOTHYRONINE SODIUM ORAL TABLET 25 MCG 0.65000 03/17/2017 0.42480 07/14/2017

LIOTHYRONINE SODIUM ORAL TABLET 5 MCG 0.32485 05/19/2017 0.29155 07/14/2017

LIOTHYRONINE SODIUM ORAL TABLET 50 MCG 1.01491 04/24/2015 0.47406 03/03/2017

LISINOPRIL ORAL TABLET 10 MG 0.02112 04/17/2015 0.02112 08/21/2015

LISINOPRIL ORAL TABLET 2.5 MG 0.01635 05/01/2015 0.01635 08/21/2015

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Effective 6/19/2020

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Current SMAC Price

Current Effective Date

LISINOPRIL ORAL TABLET 20 MG 0.02086 10/20/2017 0.02569 04/06/2020

LISINOPRIL ORAL TABLET 30 MG 0.07504 08/21/2015 0.03142 06/16/2017

LISINOPRIL ORAL TABLET 40 MG 0.02100 08/25/2017 0.02610 07/25/2019

LISINOPRIL ORAL TABLET 5 MG 0.01809 08/21/2015 0.00832 10/20/2017

LISINOPRIL/HYDROCHLOROTHIAZIDE ORAL TABLET 10-12.5MG 0.02693 03/06/2015 0.02693 08/21/2015

LISINOPRIL/HYDROCHLOROTHIAZIDE ORAL TABLET 20 MG-25MG 0.05186 08/21/2015 0.02920 10/20/2017

LISINOPRIL/HYDROCHLOROTHIAZIDE ORAL TABLET 20-12.5 MG 0.04063 08/21/2015 0.02670 04/27/2018

LITHIUM CARBONATE ORAL CAPSULE 150 MG 0.06052 02/13/2015 0.06052 08/21/2015

LITHIUM CARBONATE ORAL CAPSULE 300 MG 0.03114 04/24/2015 0.03114 08/21/2015

LITHIUM CARBONATE ORAL CAPSULE 600 MG 0.14351 08/21/2015 0.08414 07/14/2017

LITHIUM CARBONATE ORAL TABLET 300 MG 0.14961 04/17/2015 0.14961 08/21/2015

LITHIUM CARBONATE ORAL TABLET, EXTENDED RELEASE 300 MG 0.14970 03/03/2017 0.12000 09/21/2018

LITHIUM CARBONATE ORAL TABLET, EXTENDED RELEASE 450 MG 0.17713 02/22/2019 0.10100 05/17/2019

LITHIUM CITRATE ORAL SOLUTION, ORAL 8 MEQ/5 ML 0.03921 01/25/2013

LOPERAMIDE HCL ORAL CAPSULE 2 MG 0.28182 03/10/2019 0.22363 11/15/2019

LOPERAMIDE HCL ORAL LIQUID (ML) 1MG/7.5ML 0.03361 08/12/2014 0.03361 08/21/2015

LOPERAMIDE HCL ORAL TABLET 2 MG 0.08953 08/12/2014 0.08953 08/21/2015

LORATADINE ORAL SOLUTION, ORAL 5 MG/5 ML 0.04500 08/21/2015 0.03325 11/16/2018

LORATADINE ORAL TABLET 10 MG 0.05136 08/21/2015 0.03157 10/20/2017

LORATADINE ORAL TABLET,DISINTEGRATING 10 MG 0.38100 02/01/2013 0.38100 08/21/2015

LORATADINE/PSEUDOEPHEDRINE SULFATE ORAL TABLET, EXTENDED RELEASE 12 HR 5 MG-120MG

0.58500 04/07/2017 0.75400 07/16/2018

LORATADINE/PSEUDOEPHEDRINE SULFATE ORAL TABLET, EXTENDED RELEASE 24 HR 10MG-240MG

0.36808 11/16/2018 0.30533 05/22/2020

LORAZEPAM INJECTION SYRINGE (ML) 2 MG/ML 1.76400 02/15/2013 1.76400 08/21/2015

LORAZEPAM INJECTION SYRINGE (ML) 4 MG/ML 2.46960 01/25/2013

LORAZEPAM INJECTION VIAL (ML) 2 MG/ML 0.59480 03/02/2018 0.46840 11/15/2019

LORAZEPAM INJECTION VIAL (ML) 4 MG/ML 1.14324 01/25/2013

LORAZEPAM ORAL CONCENTRATE, ORAL 2 MG/ML 0.29067 09/21/2018 0.26900 11/15/2019

LORAZEPAM ORAL TABLET 0.5 MG 0.03047 08/21/2015 0.02030 10/20/2017

LORAZEPAM ORAL TABLET 1 MG 0.03287 08/21/2015 0.01735 12/22/2017

LORAZEPAM ORAL TABLET 2 MG 0.05247 08/21/2015 0.03950 08/17/2018

LOSARTAN POTASSIUM ORAL TABLET 100 MG 0.06386 06/16/2017 0.04114 10/20/2017

LOSARTAN POTASSIUM ORAL TABLET 25 MG 0.03245 10/20/2017 0.02177 10/25/2019

LOSARTAN POTASSIUM ORAL TABLET 50 MG 0.42866 09/04/2019 0.09600 02/21/2020

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE ORAL TABLET 100-12.5MG

0.08772 08/25/2017 0.07169 12/22/2017

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE ORAL TABLET 100MG-25MG

0.06639 04/27/2018 0.19126 03/16/2020

LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE ORAL TABLET 50-12.5 MG

0.07450 08/21/2015 0.05099 11/16/2018

LOVASTATIN ORAL TABLET 10 MG 0.05820 09/22/2017 0.04733 05/22/2020

LOVASTATIN ORAL TABLET 20 MG 0.05223 06/16/2017 0.03900 10/20/2017

LOVASTATIN ORAL TABLET 40 MG 0.04717 09/22/2017 0.01901 11/16/2018

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Current SMAC Price

Current Effective Date

LOXAPINE SUCCINATE ORAL CAPSULE 10 MG 0.26000 03/02/2018 0.66531 06/03/2019

LOXAPINE SUCCINATE ORAL CAPSULE 25 MG 0.76809 08/21/2015 0.56280 08/25/2017

LOXAPINE SUCCINATE ORAL CAPSULE 5 MG 0.37172 08/21/2015 0.28570 03/02/2018

LOXAPINE SUCCINATE ORAL CAPSULE 50 MG 0.66820 08/17/2018 0.62000 08/16/2019

MAGNESIUM CARBONATE/ALUMINUM HYDROXIDE/ALGINIC ACID ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 358-95/15

0.01253 01/25/2013

MAGNESIUM CHLORIDE ORAL TABLET, EXTENDED RELEASE 64 MG 0.08364 01/25/2013

MAGNESIUM HYDROXIDE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 400 MG/5ML

0.00419 08/12/2014 0.00419 08/21/2015

MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE/SIMETHICONE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 200-200-20

0.00592 09/19/2014 0.00592 08/21/2015

MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE/SIMETHICONE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 400-400-40

0.00967 12/26/2014 0.00967 08/21/2015

MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE/SIMETHICONE ORAL TABLET,CHEWABLE 200-200-25

0.03062 08/12/2014 0.03062 08/21/2015

MAGNESIUM OXIDE ORAL CAPSULE 400 MG 0.08450 08/12/2014

MAGNESIUM OXIDE ORAL TABLET 400 MG 0.02077 02/06/2015 0.02077 08/21/2015

MAGNESIUM SULFATE IN STERILE WATER INTRAVENOUS INTRAVENOUS SOLUTION 20 G/500ML

0.01970 08/12/2014

MAGNESIUM SULFATE IN STERILE WATER INTRAVENOUS INTRAVENOUS SOLUTION 40G/1000ML

0.01440 08/12/2014

MAGNESIUM SULFATE IN STERILE WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 2 G/50 ML

0.24560 08/12/2014

MAGNESIUM SULFATE IN STERILE WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 4 G/100 ML

0.13419 07/25/2014

MAGNESIUM SULFATE IN STERILE WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 4 G/50 ML

0.23100 08/12/2014

MAGNESIUM SULFATE INJECTION SYRINGE (ML) 4 MEQ/ML 0.63168 01/25/2013

MAGNESIUM SULFATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 1 G/100 ML

0.11630 08/12/2014

MALATHION TOPICAL LOTION (ML) 0.5 % 2.54547 08/21/2015 3.71143 08/12/2019

MANGANESE CHLORIDE INTRAVENOUS VIAL (ML) 0.1 MG/ML 0.17390 08/12/2014

MANNITOL INTRAVENOUS INTRAVENOUS SOLUTION 10 % 0.01620 08/12/2014

MANNITOL INTRAVENOUS INTRAVENOUS SOLUTION 20 % 0.03980 01/25/2013

MANNITOL INTRAVENOUS INTRAVENOUS SOLUTION 5 % 0.00866 01/25/2013

MANNITOL/SORBITOL SOLUTION URETHRAL SOLUTION, IRRIGATION 0.54G-2.7G

0.00569 01/25/2013

MAPROTILINE HCL ORAL TABLET 25 MG 0.59890 08/12/2014

MAPROTILINE HCL ORAL TABLET 50 MG 0.93980 02/08/2013

MAPROTILINE HCL ORAL TABLET 75 MG 1.28950 08/12/2014

MECLIZINE HCL ORAL TABLET 12.5 MG 0.03685 02/27/2015 0.03685 08/21/2015

MECLIZINE HCL ORAL TABLET 25 MG 0.12062 03/03/2017 0.04200 11/15/2019

MECLOFENAMATE SODIUM ORAL CAPSULE 100 MG 3.34760 08/12/2014 3.34760 08/21/2015

MECLOFENAMATE SODIUM ORAL CAPSULE 50 MG 1.91160 08/12/2014

MECOBALAMIN/LEVOMEFOLATE CALCIUM/PYRIDOXAL PHOSPHATE ORAL TABLET 2-3-35 MG

0.88358 03/27/2015 0.88358 08/21/2015

MEDROXYPROGESTERONE ACETATE INTRAMUSCULAR VIAL (ML) 150 MG/ML

42.38726 11/13/2019 35.40500 05/22/2020

MEDROXYPROGESTERONE ACETATE ORAL TABLET 10 MG 0.12690 08/21/2015 0.09842 07/14/2017

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Current Effective Date

MEDROXYPROGESTERONE ACETATE ORAL TABLET 2.5 MG 0.10570 08/25/2017 0.07140 03/20/2020

MEDROXYPROGESTERONE ACETATE ORAL TABLET 5 MG 0.21370 05/19/2017 0.11870 03/02/2018

MEFENAMIC ACID ORAL CAPSULE 250 MG 6.03867 08/17/2018 1.46000 10/19/2018

MEFLOQUINE HCL ORAL TABLET 250 MG 3.74400 04/05/2013 3.74400 08/21/2015

MEGESTROL ACETATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 400MG/10ML

0.29429 08/08/2014 0.29429 08/21/2015

MEGESTROL ACETATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 400MG/10ML

0.08856 11/19/2019 0.07566 03/20/2020

MEGESTROL ACETATE ORAL TABLET 20 MG 0.11377 06/27/2014

MEGESTROL ACETATE ORAL TABLET 40 MG 0.14931 07/14/2017 0.10500 08/16/2019

MELATONIN ORAL TABLET, EXTENDED RELEASE 3 MG 0.06370 01/25/2013

MELATONIN/TRYPTOPHAN ORAL CAPSULE 3 MG-100MG 5.05750 01/31/2014

MELOXICAM ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 7.5 MG/5ML 1.33161 02/21/2014

MELOXICAM ORAL TABLET 15 MG 0.03190 08/21/2015 0.01655 08/17/2018

MELOXICAM ORAL TABLET 7.5 MG 0.02466 05/01/2015 0.02466 08/21/2015

MEMANTINE HCL ORAL CAPSULE SPRINKLE, EXTENDED RELEASE 24 HR 21 MG

2.50450 08/16/2019 2.41733 05/22/2020

MEMANTINE HCL ORAL CAPSULE SPRINKLE, EXTENDED RELEASE 24 HR 28 MG

1.93938 11/15/2019 0.97767 06/19/2020

MEMANTINE HCL ORAL TABLET 10 MG 0.08633 11/16/2018 0.06912 12/20/2019

MEMANTINE HCL ORAL TABLET 5 MG 0.18583 08/25/2017 0.09917 09/22/2017

MENTHOL MUCOUS MEMBRANE LOZENGE 8 MG 0.06420 08/12/2014

MENTHOL TOPICAL GEL (GRAM) 10 % 0.11397 01/25/2013

MEPERIDINE HCL INJECTION CARTRIDGE (ML) 10 MG/ML 0.49911 01/25/2013

MEPERIDINE HCL ORAL SOLUTION, ORAL 50 MG/5 ML 0.14191 01/25/2013

MEPERIDINE HCL ORAL TABLET 100 MG 0.32670 03/06/2015

MEPERIDINE HCL ORAL TABLET 50 MG 1.31433 08/21/2015 0.41454 06/16/2017

MEPERIDINE HCL/PF INJECTION VIAL (ML) 100 MG/ML 2.35200 01/25/2013

MEPERIDINE HCL/PF INJECTION VIAL (ML) 25 MG/ML 2.12100 01/25/2013

MEPERIDINE HCL/PF INJECTION VIAL (ML) 50 MG/ML 0.94080 01/25/2013

MEPIVACAINE HCL/PF INJECTION CARTRIDGE (ML) 30 MG/ML 0.17730 08/12/2014

MEPROBAMATE ORAL TABLET 200 MG 4.81285 10/17/2014 4.81285 08/21/2015

MEPROBAMATE ORAL TABLET 400 MG 0.98070 01/25/2013 0.98070 08/21/2015

MERCAPTOPURINE ORAL TABLET 50 MG 0.88334 09/22/2017 0.76000 05/17/2019

MEROPENEM INTRAVENOUS VIAL (EA) 1 G 11.34682 08/21/2015 16.85013 01/23/2017

MEROPENEM INTRAVENOUS VIAL (EA) 500 MG 4.50240 12/26/2014 4.50240 08/21/2015

MESALAMINE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 1.2 G

3.19075 01/29/2020 2.22400 04/17/2020

MESALAMINE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 800 MG

4.25000 11/15/2019 4.25000 01/01/2020

MESALAMINE RECTAL ENEMA (ML) 4 G/60 ML 0.19094 04/21/2017 0.16262 03/02/2018

MESALAMINE WITH CLEANSING WIPES RECTAL ENEMA KIT 4 G/60 ML 119.73500 12/26/2014 110.04250 06/16/2017

METAPROTERENOL SULFATE ORAL SYRUP 10 MG/5 ML 0.02460 08/12/2014 0.02460 08/21/2015

METAPROTERENOL SULFATE ORAL TABLET 10 MG 0.69965 01/25/2013 0.69965 08/21/2015

METAPROTERENOL SULFATE ORAL TABLET 20 MG 0.97496 01/25/2013 0.97496 08/21/2015

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Current Effective Date

METAXALONE ORAL TABLET 800 MG 0.52160 04/26/2019 0.45990 05/22/2020

METFORMIN HCL ORAL TABLET 1000 MG 0.03664 08/21/2015 0.02659 10/20/2017

METFORMIN HCL ORAL TABLET 500 MG 0.01932 08/21/2015 0.01435 07/26/2019

METFORMIN HCL ORAL TABLET 850 MG 0.02986 05/01/2015 0.02986 08/21/2015

METFORMIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 1000 MG 3.80000 05/17/2019 3.67350 11/15/2019

METFORMIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG 3.60978 12/26/2014 3.41667 11/24/2017

METFORMIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG 0.04020 08/21/2015 0.02600 01/25/2019

METFORMIN HCL ORAL TABLET, EXTENDED RELEASE 24 HR 750 MG 0.06915 08/17/2018 0.04510 04/17/2020

METHADONE HCL INJECTION VIAL (ML) 10 MG/ML 6.01720 01/25/2013

METHADONE HCL ORAL CONCENTRATE, ORAL 10 MG/ML 0.62300 02/01/2013

METHADONE HCL ORAL SOLUTION, ORAL 10 MG/5 ML 0.09670 07/18/2014

METHADONE HCL ORAL SOLUTION, ORAL 5 MG/5 ML 0.12491 01/25/2013

METHADONE HCL ORAL TABLET 10 MG 0.10562 05/19/2017 0.08790 11/16/2018

METHADONE HCL ORAL TABLET 5 MG 0.11840 10/25/2019 0.10660 01/24/2020

METHADONE HCL ORAL TABLET, SOLUBLE 40 MG 0.22381 01/25/2013 0.22381 08/21/2015

METHAMPHETAMINE HCL ORAL TABLET 5 MG 4.11749 05/01/2015 4.11749 08/21/2015

METHAZOLAMIDE ORAL TABLET 25 MG 2.68163 03/13/2015

METHAZOLAMIDE ORAL TABLET 50 MG 2.59840 12/05/2014

METHENAMINE HIPPURATE ORAL TABLET 1 G 0.63990 01/24/2020 0.59990 03/20/2020

METHENAMINE MANDELATE ORAL TABLET 500 MG 0.62041 01/25/2013

METHENAMINE/METHYLENE BLUE/SOD PHOS/P.SALICYLATE/HYOSCYAMINE ORAL CAPSULE 118-10-36

1.80978 03/06/2015 1.80978 08/21/2015

METHENAMINE/METHYLENE BLUE/SOD PHOS/P.SALICYLATE/HYOSCYAMINE ORAL TABLET 81-0.12MG

4.27272 03/06/2015 4.27272 08/21/2015

METHENAMINE/METHYLENE BLUE/SOD PHOS/P.SALICYLATE/HYOSCYAMINE ORAL TABLET 81.6-10.8

0.91000 09/12/2014

METHENAMINE/SOD PHOSPH,MONOBASIC/METHYLENE BLUE/HYOSCYAMINE ORAL TABLET 81.6-.12MG

2.26793 03/06/2015

METHIMAZOLE ORAL TABLET 10 MG 0.15839 08/21/2015 0.09155 03/03/2017

METHIMAZOLE ORAL TABLET 5 MG 0.08482 02/27/2015 0.04940 09/22/2017

METHOCARBAMOL INJECTION VIAL (ML) 100 MG/ML 4.14861 02/13/2015

METHOCARBAMOL ORAL TABLET 500 MG 0.05895 08/25/2017 0.03100 11/16/2018

METHOCARBAMOL ORAL TABLET 750 MG 0.05730 12/22/2017 0.10932 08/23/2019

METHOTREXATE SODIUM INJECTION VIAL (ML) 25 MG/ML 3.00720 01/30/2015

METHOTREXATE SODIUM ORAL TABLET 2.5 MG 0.38159 11/15/2019 0.35990 06/19/2020

METHOTREXATE SODIUM/PF INJECTION VIAL (ML) 25 MG/ML 0.58357 08/21/2015 2.87500 10/02/2019

METHOXSALEN ORAL CAPSULE, LIQUID-FILLED, RAPID RELEASE 10 MG 66.75860 09/05/2014

METHSCOPOLAMINE BROMIDE ORAL TABLET 2.5 MG 1.53056 08/21/2015 0.31450 08/17/2018

METHSCOPOLAMINE BROMIDE ORAL TABLET 5 MG 2.17750 05/20/2016 0.86350 09/22/2017

METHYCLOTHIAZIDE TABLET 5 MG 1.21660 01/25/2013

METHYL SALICYLATE MISCELLANEOUS OIL (ML) 0.47540 08/12/2014

METHYLDOPA ORAL TABLET 250 MG 0.12359 07/14/2017 0.06990 03/02/2018

METHYLDOPA ORAL TABLET 500 MG 0.32656 08/21/2015 0.16892 05/19/2017

METHYLDOPA/HYDROCHLOROTHIAZIDE ORAL TABLET 250MG-15MG 0.67180 08/12/2014

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Current Effective Date

METHYLDOPA/HYDROCHLOROTHIAZIDE ORAL TABLET 250MG-25MG 1.51046 12/26/2014

METHYLERGONOVINE MALEATE INJECTION AMPUL (ML) .2MG/ML(1) 4.75860 08/12/2014

METHYLERGONOVINE MALEATE INJECTION VIAL (ML) .2MG/ML(1) 6.39450 01/25/2013

METHYLERGONOVINE MALEATE ORAL TABLET 0.2 MG 53.75250 01/25/2019 27.26667 05/22/2020

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 30-70 10 MG

4.03956 12/09/2017 2.29720 07/26/2019

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 30-70 20 MG

2.94350 12/08/2017 2.94350 12/09/2017

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 30-70 30 MG

2.96640 12/09/2017 3.27270 05/16/2018

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 30-70 40 MG

4.30300 12/08/2017 4.30300 12/09/2017

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 30-70 50 MG

4.55740 12/09/2017 4.24000 07/26/2019

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 30-70 60 MG

6.76633 12/08/2017 6.76633 12/09/2017

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 50-50 20 MG

3.68500 10/19/2018 3.59850 05/17/2019

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 50-50 30 MG

4.36506 04/25/2014 3.78000 07/26/2019

METHYLPHENIDATE HCL ORAL CAPSULE,EXTENDED RELEASE BIPHASIC 50-50 40 MG

4.27230 11/24/2017 3.85000 06/22/2018

METHYLPHENIDATE HCL ORAL SOLUTION, ORAL 10 MG/5 ML 0.90135 04/10/2015

METHYLPHENIDATE HCL ORAL SOLUTION, ORAL 5 MG/5 ML 0.73600 02/27/2015 0.73600 03/02/2016

METHYLPHENIDATE HCL ORAL TABLET 10 MG 0.27063 08/17/2018 0.18500 01/25/2019

METHYLPHENIDATE HCL ORAL TABLET 20 MG 0.23000 01/25/2019 0.27814 04/18/2019

METHYLPHENIDATE HCL ORAL TABLET 5 MG 0.17340 08/17/2018 0.15000 01/25/2019

METHYLPHENIDATE HCL ORAL TABLET, EXTENDED RELEASE 10 MG 2.31000 05/25/2018 1.67990 08/16/2019

METHYLPHENIDATE HCL ORAL TABLET, EXTENDED RELEASE 20 MG 2.23490 03/16/2018 1.70023 08/17/2018

METHYLPHENIDATE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 18 MG

7.32227 01/05/2018 4.56290 11/15/2019

METHYLPHENIDATE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 27 MG

6.98215 01/05/2018 5.31480 11/15/2019

METHYLPHENIDATE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 36 MG

6.58990 07/09/2019 6.27617 11/15/2019

METHYLPHENIDATE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 54 MG

4.40970 11/15/2019 5.65671 12/05/2019

METHYLPREDNISOLONE ACETATE INJECTION VIAL (ML) 40 MG/ML 3.47672 08/12/2014 3.47672 08/21/2015

METHYLPREDNISOLONE ACETATE INJECTION VIAL (ML) 80 MG/ML 7.07957 08/12/2014 7.07957 08/21/2015

METHYLPREDNISOLONE ORAL TABLET 16 MG 2.47842 04/03/2015 1.95015 06/16/2017

METHYLPREDNISOLONE ORAL TABLET 32 MG 3.62572 04/03/2015

METHYLPREDNISOLONE ORAL TABLET 4 MG 0.31030 01/19/2018 0.21648 05/17/2019

METHYLPREDNISOLONE ORAL TABLET 8 MG 1.15600 11/24/2017 1.09220 11/15/2019

METHYLPREDNISOLONE ORAL TABLET, DOSE PACK 4 MG 0.20571 04/17/2020 0.19148 05/22/2020

METHYLPREDNISOLONE SODIUM SUCCINATE INJECTION VIAL (EA) 125 MG

4.08408 01/25/2013

METHYLPREDNISOLONE SODIUM SUCCINATE INJECTION VIAL (EA) 40 MG

3.53132 01/25/2013

METHYLPREDNISOLONE SODIUM SUCCINATE INTRAVENOUS VIAL (EA) 1000 MG

17.05200 01/25/2013

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Current SMAC Price

Current Effective Date

METIPRANOLOL OPHTHALMIC DROPS 0.3 % 2.91720 01/25/2013

METOCLOPRAMIDE HCL INJECTION SYRINGE (ML) 10 MG/2 ML 0.66573 05/24/2013 0.66573 08/21/2015

METOCLOPRAMIDE HCL INJECTION VIAL (ML) 5 MG/ML 0.37728 02/13/2015 0.37728 08/21/2015

METOCLOPRAMIDE HCL ORAL SOLUTION, ORAL 10 MG/10ML 0.04456 08/09/2013 0.04456 08/21/2015

METOCLOPRAMIDE HCL ORAL SOLUTION, ORAL 5 MG/5 ML 0.01217 08/21/2015 0.03870 07/16/2018

METOCLOPRAMIDE HCL ORAL TABLET 10 MG 0.04069 08/21/2015 0.02797 11/16/2018

METOCLOPRAMIDE HCL ORAL TABLET 5 MG 0.04126 08/21/2015 0.02200 09/22/2017

METOLAZONE ORAL TABLET 10 MG 0.84230 05/17/2013

METOLAZONE ORAL TABLET 2.5 MG 0.12540 05/22/2020 1.17600 06/06/2020

METOLAZONE ORAL TABLET 5 MG 0.68220 01/24/2020 1.11320 02/25/2020

METOPROLOL SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 100 MG

0.20520 09/21/2018 0.17251 05/22/2020

METOPROLOL SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 200 MG

0.43860 12/20/2019 0.32643 02/21/2020

METOPROLOL SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 25 MG

0.15329 11/24/2017 0.10200 06/21/2019

METOPROLOL SUCCINATE ORAL TABLET, EXTENDED RELEASE 24 HR 50 MG

0.18560 06/16/2017 0.09250 09/21/2018

METOPROLOL TARTRATE INTRAVENOUS AMPUL (ML) 5 MG/5 ML 0.23020 08/12/2014 0.23020 08/21/2015

METOPROLOL TARTRATE INTRAVENOUS SYRINGE (ML) 5 MG/5 ML 0.70560 01/25/2013

METOPROLOL TARTRATE ORAL TABLET 100 MG 0.03114 08/21/2015 0.02070 05/22/2020

METOPROLOL TARTRATE ORAL TABLET 25 MG 0.02399 05/01/2015 0.02399 08/21/2015

METOPROLOL TARTRATE ORAL TABLET 50 MG 0.02097 12/26/2014 0.02097 08/21/2015

METOPROLOL TARTRATE/HYDROCHLOROTHIAZIDE ORAL TABLET 100MG-25MG

0.84850 06/16/2017 0.63568 06/21/2019

METOPROLOL TARTRATE/HYDROCHLOROTHIAZIDE ORAL TABLET 100MG-50MG

1.53410 02/08/2013

METOPROLOL TARTRATE/HYDROCHLOROTHIAZIDE ORAL TABLET 50 MG-25MG

0.70970 11/24/2017 0.67570 03/02/2018

METRONIDAZOLE IN SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 500MG/0.1L

0.01400 04/05/2013 0.01400 08/21/2015

METRONIDAZOLE ORAL CAPSULE 375 MG 3.91048 01/31/2014 3.91048 08/21/2015

METRONIDAZOLE ORAL TABLET 250 MG 0.17910 12/22/2017 0.07480 08/16/2019

METRONIDAZOLE ORAL TABLET 500 MG 0.14590 09/22/2017 0.11483 11/16/2018

METRONIDAZOLE TOPICAL CREAM (GRAM) 0.75 % 1.18465 10/07/2019 0.88756 05/22/2020

METRONIDAZOLE TOPICAL GEL (GRAM) 0.75 % 1.23346 06/16/2017 0.81000 12/21/2018

METRONIDAZOLE TOPICAL LOTION (ML) 0.75 % 2.93220 01/17/2014 2.39124 06/16/2017

METRONIDAZOLE VAGINAL GEL WITH APPLICATOR (GRAM) 0.75 % 0.72500 06/26/2019 1.04743 06/04/2020

MEXILETINE HCL ORAL CAPSULE 150 MG 0.55042 01/30/2015 0.55042 08/21/2015

MEXILETINE HCL ORAL CAPSULE 200 MG 0.70746 10/03/2014

MEXILETINE HCL ORAL CAPSULE 250 MG 0.48191 08/09/2013

MICONAZOLE NITRATE TOPICAL CREAM (GRAM) 2 % 0.05700 03/07/2014 0.05700 08/21/2015

MICONAZOLE NITRATE TOPICAL OINTMENT (GRAM) 2 % 0.08500 08/12/2014

MICONAZOLE NITRATE TOPICAL TINCTURE 2 % 0.39340 08/12/2014

MICONAZOLE NITRATE VAGINAL CREAM WITH APPLICATOR 2 % 0.09470 04/24/2015 0.09470 08/21/2015

MICONAZOLE NITRATE VAGINAL KIT 200 MG-2 % 7.83470 08/21/2015 7.64000 01/25/2019

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Current SMAC Price

Current Effective Date

MICONAZOLE NITRATE VAGINAL SUPPOSITORY, VAGINAL 100 MG 0.44030 01/25/2013 0.44030 08/21/2015

MICONAZOLE NITRATE VAGINAL SUPPOSITORY, VAGINAL 200 MG 12.26633 01/25/2013

MIDODRINE HCL ORAL TABLET 10 MG 0.71570 08/05/2019 0.55753 02/21/2020

MIDODRINE HCL ORAL TABLET 2.5 MG 0.31350 12/04/2018 0.28820 11/15/2019

MIDODRINE HCL ORAL TABLET 5 MG 0.35870 08/16/2019 0.31930 10/25/2019

MILRINONE LACTATE INTRAVENOUS VIAL (ML) 1 MG/ML 0.29545 08/25/2017 0.27241 05/22/2020

MILRINONE LACTATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 20MG/100ML

0.13280 08/12/2014 0.13280 08/21/2015

MILRINONE LACTATE/DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 40MG/200ML

0.16676 10/03/2014 0.16676 08/21/2015

MINERAL OIL RECTAL ENEMA (ML) 0.01182 08/21/2015

MINERAL OIL TOPICAL LOTION (ML) 0.01828 08/12/2014

MINERAL OIL/PETROLATUM,WHITE OPHTHALMIC OINTMENT (GRAM) 15 %-83 %

0.81740 08/12/2014

MINERAL OIL/PETROLATUM,WHITE OPHTHALMIC OINTMENT (GRAM) 15%-85%

1.90107 01/16/2015 1.90107 08/21/2015

MINERAL OIL/PETROLATUM,WHITE OPHTHALMIC OINTMENT (GRAM) 3 %-94 %

4.48140 08/21/2015

MINOCYCLINE HCL ORAL CAPSULE 100 MG 0.30445 04/17/2015 0.30445 08/21/2015

MINOCYCLINE HCL ORAL CAPSULE 50 MG 0.19068 03/03/2017 0.13650 03/15/2019

MINOCYCLINE HCL ORAL CAPSULE 75 MG 0.35403 08/12/2014

MINOCYCLINE HCL ORAL TABLET 100 MG 2.20000 05/25/2018 1.80620 11/16/2018

MINOCYCLINE HCL ORAL TABLET 50 MG 1.14200 09/22/2017 1.03750 11/15/2019

MINOCYCLINE HCL ORAL TABLET 75 MG 1.69228 01/25/2013 1.69228 08/21/2015

MINOCYCLINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 135 MG 3.56811 01/25/2013 3.56811 08/21/2015

MINOCYCLINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 45 MG 3.56811 01/25/2013 3.56811 08/21/2015

MINOCYCLINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 90 MG 3.56811 01/25/2013 3.56811 08/21/2015

MINOXIDIL ORAL TABLET 10 MG 0.20050 11/24/2017 0.12250 11/16/2018

MINOXIDIL ORAL TABLET 2.5 MG 0.01538 08/25/2017 0.04230 09/05/2019

MIRTAZAPINE ORAL TABLET 15 MG 0.08134 06/16/2017 0.06475 11/15/2019

MIRTAZAPINE ORAL TABLET 30 MG 0.13332 05/19/2017 0.07067 06/16/2017

MIRTAZAPINE ORAL TABLET 45 MG 0.11133 11/15/2019 0.07467 05/22/2020

MIRTAZAPINE ORAL TABLET 7.5 MG 0.70950 02/21/2020 0.66000 04/17/2020

MIRTAZAPINE ORAL TABLET,DISINTEGRATING 15 MG 0.58000 08/25/2017 0.47533 11/24/2017

MIRTAZAPINE ORAL TABLET,DISINTEGRATING 30 MG 0.65247 03/03/2017 0.53400 09/22/2017

MIRTAZAPINE ORAL TABLET,DISINTEGRATING 45 MG 0.92063 06/03/2019 0.76367 11/15/2019

MISOPROSTOL ORAL TABLET 100 MCG 0.42254 09/19/2014 0.42254 08/21/2015

MISOPROSTOL ORAL TABLET 200 MCG 0.77996 07/29/2016 0.69441 03/03/2017

MITOMYCIN INTRAVENOUS VIAL (EA) 40 MG 256.23975 08/21/2015 990.94800 11/05/2015

MODAFINIL ORAL TABLET 100 MG 1.82967 03/02/2018 0.49100 10/19/2018

MODAFINIL ORAL TABLET 200 MG 0.35717 11/15/2019 0.63463 11/29/2019

MOEXIPRIL HCL ORAL TABLET 15 MG 0.37580 02/08/2013 0.37580 08/21/2015

MOEXIPRIL HCL ORAL TABLET 7.5 MG 0.37580 08/12/2014 0.37580 08/21/2015

MOEXIPRIL HCL/HYDROCHLOROTHIAZIDE TABLET 15-12.5MG 0.51310 08/12/2014

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Current SMAC Price

Current Effective Date

MOEXIPRIL HCL/HYDROCHLOROTHIAZIDE TABLET 15-25MG 0.37076 01/25/2013 0.37076 08/21/2015

MOEXIPRIL HCL/HYDROCHLOROTHIAZIDE TABLET 7.5-12.5MG 0.50960 01/25/2013 0.50960 08/21/2015

MOLYBDENUM (AMMONIUM MOLYBDATE) VIAL (ML) 25 MCG/ML 0.32672 01/25/2013

MOMETASONE FUROATE NASAL AEROSOL, SPRAY WITH PUMP (GRAM) 50 MCG

2.67456 08/16/2019 2.32029 02/21/2020

MOMETASONE FUROATE TOPICAL CREAM (GRAM) 0.1 % 0.49044 06/25/2019 0.18611 08/16/2019

MOMETASONE FUROATE TOPICAL OINTMENT (GRAM) 0.1 % 0.20169 11/15/2019 0.18244 03/20/2020

MOMETASONE FUROATE TOPICAL SOLUTION, NON-ORAL 0.1 % 0.22914 08/21/2015 0.30258 10/16/2019

MONTELUKAST SODIUM ORAL GRANULES IN PACKET (EA) 4 MG 2.29967 10/19/2018 1.78811 02/22/2019

MONTELUKAST SODIUM ORAL TABLET 10 MG 0.12093 03/03/2017 0.05967 06/16/2017

MONTELUKAST SODIUM ORAL TABLET,CHEWABLE 4 MG 0.12956 03/02/2018 0.10275 08/17/2018

MONTELUKAST SODIUM ORAL TABLET,CHEWABLE 5 MG 0.08100 06/21/2019 0.06795 06/19/2020

MORPHINE SULFATE INJECTION SYRINGE (ML) 10 MG/ML 1.83954 05/23/2014 1.83954 08/21/2015

MORPHINE SULFATE INJECTION SYRINGE (ML) 2 MG/ML 1.83954 04/25/2014 1.83954 08/21/2015

MORPHINE SULFATE INJECTION SYRINGE (ML) 4 MG/ML 1.83954 05/23/2014 1.83954 08/21/2015

MORPHINE SULFATE INJECTION SYRINGE (ML) 5 MG/ML 1.83954 05/23/2014

MORPHINE SULFATE INJECTION SYRINGE (ML) 8 MG/ML 1.83954 05/23/2014 1.83954 08/21/2015

MORPHINE SULFATE INJECTION VIAL (ML) 10 MG/ML 0.74480 01/25/2013

MORPHINE SULFATE INJECTION VIAL (ML) 15 MG/ML 0.69440 01/25/2013

MORPHINE SULFATE INJECTION VIAL (ML) 5 MG/ML 0.83160 01/25/2013

MORPHINE SULFATE INJECTION VIAL (ML) 8 MG/ML 0.94080 01/25/2013

MORPHINE SULFATE INTRAVENOUS CARTRIDGE (ML) 10 MG/ML 3.25500 01/25/2013

MORPHINE SULFATE INTRAVENOUS CARTRIDGE (ML) 15 MG/ML 3.25500 01/25/2013

MORPHINE SULFATE INTRAVENOUS CARTRIDGE (ML) 2 MG/ML 3.25500 01/25/2013

MORPHINE SULFATE INTRAVENOUS CARTRIDGE (ML) 4 MG/ML 3.25500 01/25/2013

MORPHINE SULFATE INTRAVENOUS CARTRIDGE (ML) 8 MG/ML 2.98200 01/25/2013

MORPHINE SULFATE INTRAVENOUS PATIENT CONTROLLED ANALGESIA SYRINGE 30 MG/30ML

0.33600 11/08/2013 0.33600 08/21/2015

MORPHINE SULFATE INTRAVENOUS SYRINGE (ML) 10 MG/ML 1.80600 12/26/2014

MORPHINE SULFATE INTRAVENOUS SYRINGE (ML) 2 MG/ML 1.80600 03/28/2014

MORPHINE SULFATE INTRAVENOUS SYRINGE (ML) 4 MG/ML 1.80600 03/28/2014

MORPHINE SULFATE INTRAVENOUS SYRINGE (ML) 8 MG/ML 1.80600 12/26/2014

MORPHINE SULFATE INTRAVENOUS VIAL (ML) 25 MG/ML 1.33770 07/26/2013

MORPHINE SULFATE INTRAVENOUS VIAL (ML) 50 MG/ML 1.03719 06/27/2014

MORPHINE SULFATE INTRAVENOUS VIAL WITH THREADED PORT (ML) 100 MG/4ML

4.96650 01/25/2013

MORPHINE SULFATE INTRAVENOUS VIAL WITH THREADED PORT (ML) 250MG/10ML

1.99080 01/25/2013

MORPHINE SULFATE ORAL CAPSULE, EXTENDED RELEASE PELLETS 10 MG

2.38833 09/22/2017 2.16080 11/24/2017

MORPHINE SULFATE ORAL CAPSULE, EXTENDED RELEASE PELLETS 100 MG

12.63000 08/21/2015 11.91976 12/02/2016

MORPHINE SULFATE ORAL CAPSULE, EXTENDED RELEASE PELLETS 20 MG

2.41414 06/16/2017 1.25730 09/22/2017

MORPHINE SULFATE ORAL CAPSULE, EXTENDED RELEASE PELLETS 30 MG

3.44336 06/16/2017 1.18850 11/15/2019

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Current Effective Date

MORPHINE SULFATE ORAL CAPSULE, EXTENDED RELEASE PELLETS 50 MG

6.65266 08/21/2015 4.71535 06/16/2017

MORPHINE SULFATE ORAL CAPSULE, EXTENDED RELEASE PELLETS 60 MG

7.95944 08/21/2015 5.37753 01/27/2017

MORPHINE SULFATE ORAL CAPSULE, EXTENDED RELEASE PELLETS 80 MG

10.60675 08/21/2015 8.45051 06/16/2017

MORPHINE SULFATE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 24HR 120 MG

13.81709 02/21/2014

MORPHINE SULFATE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 24HR 30 MG

4.01072 02/21/2014

MORPHINE SULFATE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 24HR 45 MG

5.94685 02/21/2014

MORPHINE SULFATE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 24HR 60 MG

7.78841 02/21/2014

MORPHINE SULFATE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 24HR 75 MG

9.91130 02/21/2014

MORPHINE SULFATE ORAL CAPSULE,EXTENDED RELEASE MULTIPHASE 24HR 90 MG

11.71044 02/21/2014

MORPHINE SULFATE ORAL SOLUTION, ORAL 10 MG/5 ML 0.05473 08/21/2015 0.04420 08/17/2018

MORPHINE SULFATE ORAL SOLUTION, ORAL 100 MG/5ML 0.23910 09/30/2016 0.22056 08/16/2019

MORPHINE SULFATE ORAL SOLUTION, ORAL 20 MG/5 ML 0.08307 01/16/2015 0.08307 08/21/2015

MORPHINE SULFATE ORAL TABLET 15 MG 0.11466 04/03/2015

MORPHINE SULFATE ORAL TABLET 30 MG 0.17240 04/11/2014 0.49746 11/05/2018

MORPHINE SULFATE ORAL TABLET, EXTENDED RELEASE 100 MG 0.98200 11/24/2017 1.07226 04/09/2018

MORPHINE SULFATE ORAL TABLET, EXTENDED RELEASE 15 MG 0.21670 03/07/2020 0.20054 05/22/2020

MORPHINE SULFATE ORAL TABLET, EXTENDED RELEASE 200 MG 2.23770 03/02/2018 1.86820 01/24/2020

MORPHINE SULFATE ORAL TABLET, EXTENDED RELEASE 30 MG 0.23720 04/17/2020 0.35780 05/21/2020

MORPHINE SULFATE ORAL TABLET, EXTENDED RELEASE 60 MG 0.63607 09/22/2017 0.54275 11/16/2018

MORPHINE SULFATE RECTAL SUPPOSITORY, RECTAL 10 MG 3.85880 08/12/2014

MORPHINE SULFATE RECTAL SUPPOSITORY, RECTAL 20 MG 5.25000 01/25/2013

MORPHINE SULFATE RECTAL SUPPOSITORY, RECTAL 30 MG 6.56250 01/25/2013

MORPHINE SULFATE RECTAL SUPPOSITORY, RECTAL 5 MG 3.50000 01/25/2013

MORPHINE SULFATE/PF INJECTION AMPUL (ML) 0.5 MG/ML 2.23713 01/25/2013

MORPHINE SULFATE/PF INJECTION AMPUL (ML) 1 MG/ML 3.80940 01/25/2013

MORPHINE SULFATE/PF INJECTION VIAL (ML) 0.5 MG/ML 0.42080 08/12/2014

MORPHINE SULFATE/PF INJECTION VIAL (ML) 1 MG/ML 0.41240 08/12/2014

MORPHINE SULFATE/PF INTRAVENOUS PATIENT CONTROLLED ANALGESIA VIAL 150MG/30ML

0.61320 01/25/2013

MORPHINE SULFATE/PF INTRAVENOUS PATIENT CONTROLLED ANALGESIA VIAL 30 MG/30ML

0.50469 01/25/2013

MOXIFLOXACIN HCL ORAL TABLET 400 MG 1.78867 03/15/2019 1.33333 11/15/2019

multivit no.49/ferrous fumarate/folic acid/levomefolate/dha CAPSULE 27-1.13 MG

1.81370 01/25/2013 1.81370 08/21/2015

multivitamin comb no.48/ferrous fumarate/folic acid/dha CAPSULE 28-1-250MG 3.34740 09/26/2014

MULTIVITAMIN COMBINATION NO.47/FERROUS FUM/FOLATE NO.1/DHA ORAL CAPSULE 27-1-300MG

1.43085 04/24/2015 0.81153 06/16/2017

multivitamin combination no.50/iron ps complex/folic acid CAPSULE 155 MG-1MG

0.20689 01/25/2013

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Current Effective Date

MULTIVITAMIN COMBINATION NO.51/FERROUS FUMARATE/FOLIC ACID ORAL CAPSULE 106.5-1MG

0.60753 01/23/2015 0.60753 08/21/2015

multivitamin combo no.52/iron/iron asparto gly/folic/omega-3 CAPSULE 27-1-330MG

0.98583 12/26/2014 0.98583 08/21/2015

MULTIVITAMIN ORAL TABLET 0.01441 02/20/2015 0.01441 08/21/2015

MULTIVITAMIN WITH IRON ORAL TABLET 0.01954 08/12/2014 0.01954 08/21/2015

MULTIVITAMIN WITH MINERALS NO.69/IRON,CARBONYL/FOLIC ACID ORAL TABLET 50-1.25 MG

1.05126 04/19/2013

MULTIVITAMIN WITH MINERALS NO.7/FOLIC ACID ORAL CAPSULE 1 MG 0.17550 02/15/2013

MULTIVITAMIN WITH MINERALS/FERROUS GLUCONATE ORAL LIQUID (ML) 9 MG/15 ML

0.01674 08/12/2014 0.01674 08/21/2015

MULTIVITAMIN WITH MINERALS/FOLIC ACID ORAL TABLET 0.4 MG 0.80780 08/12/2014 0.80780 08/21/2015

MULTIVITAMIN WITH MINERALS/FOLIC ACID/LYCOPENE/LUTEIN ORAL TABLET .4-300-250

0.04317 03/27/2015 0.04317 08/21/2015

MULTIVITAMIN WITH MINERALS/FOLIC ACID/LYCOPENE/LUTEIN ORAL TABLET 500-300MCG

0.05011 08/12/2014

MULTIVITAMIN WITH MINERALS/LUTEIN ORAL TABLET 0.04780 08/12/2014 0.04780 08/21/2015

MULTIVITAMIN,STRESS FORMULA/ZINC ORAL TABLET 0.04810 05/02/2014 0.04810 08/21/2015

MULTIVITAMIN,THERAPEUTIC ORAL TABLET 0.02440 08/12/2014

MULTIVITAMIN-MINERALS NO.71/IRON FUMARAT/FOLIC ACID NO.1/DHA ORAL CAPSULE 28-1-300MG

1.28123 10/10/2014

MULTIVITS WITH CALCIUM AND MINERALS/IRON FUMARATE/FOLIC ACID ORAL TABLET 9MG-400MCG

0.03495 08/12/2014

MUPIROCIN CALCIUM TOPICAL CREAM (GRAM) 2 % 2.58284 02/06/2015 2.58284 08/21/2015

MUPIROCIN TOPICAL OINTMENT (GRAM) 2 % 0.20477 11/24/2017 0.17500 12/21/2018

MV-MIN 75/FERROUS FUM/IRON PS CPLX/FOLIC AC/OMEGA-3/DHA/EPA ORAL CAPSULE 35-1-200MG

0.74013 04/10/2015

MV-MINS NO.74/FERROUS FUMARATE/IRON PS CPLX/FOLIC ACID ORAL CAPSULE 85 MG-1 MG

1.15359 01/25/2013

MYCOPHENOLATE MOFETIL ORAL CAPSULE 250 MG 0.19250 11/24/2017 0.12520 01/19/2018

MYCOPHENOLATE MOFETIL ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 200 MG/ML

4.24000 07/26/2019 5.06388 03/31/2020

MYCOPHENOLATE MOFETIL ORAL TABLET 500 MG 0.20142 03/03/2017 0.16100 06/21/2019

MYCOPHENOLATE SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 180 MG

1.39966 03/03/2017 0.82950 11/16/2018

MYCOPHENOLATE SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 360 MG

2.89000 03/15/2019 2.80967 09/20/2019

NABUMETONE ORAL TABLET 500 MG 0.14920 08/01/2018 0.12800 05/22/2020

NABUMETONE ORAL TABLET 750 MG 0.20923 05/19/2017 0.15891 09/22/2017

NADOLOL ORAL TABLET 20 MG 1.25218 01/08/2018 0.29000 11/15/2019

NADOLOL ORAL TABLET 40 MG 0.80040 01/01/2018 0.44895 06/19/2020

NADOLOL ORAL TABLET 80 MG 3.31195 12/02/2016 3.31195 01/01/2018

NADOLOL/BENDROFLUMETHIAZIDE ORAL TABLET 40 MG-5 MG 1.72368 01/25/2013

NADOLOL/BENDROFLUMETHIAZIDE ORAL TABLET 80 MG-5 MG 2.25914 01/25/2013

NAFCILLIN IN DEXTROSE, ISO-OSMOTIC INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 1 G/50 ML

0.25511 01/25/2013

NAFCILLIN IN DEXTROSE, ISO-OSMOTIC INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 2 G/100 ML

0.53762 07/25/2014

NAFCILLIN SODIUM INJECTION VIAL (EA) 1 G 11.78070 01/16/2015

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Current Effective Date

NAFCILLIN SODIUM INJECTION VIAL (EA) 10 G 69.68850 03/06/2015

NAFCILLIN SODIUM INJECTION VIAL (EA) 2 G 11.96470 03/06/2015 11.96470 08/21/2015

NAFCILLIN SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 1 G 12.56750 08/12/2014

NAFCILLIN SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 2 G 26.14500 03/29/2013

NALBUPHINE HCL INJECTION AMPUL (ML) 20 MG/ML 3.45670 01/25/2013

NALBUPHINE HCL INJECTION VIAL (ML) 10 MG/ML 1.19280 01/25/2013 1.19280 08/21/2015

NALBUPHINE HCL INJECTION VIAL (ML) 20 MG/ML 1.70020 08/12/2014

NALOXONE HCL INJECTION SYRINGE (ML) 0.4 MG/ML 3.15000 01/25/2013

NALOXONE HCL INJECTION SYRINGE (ML) 1 MG/ML 7.11900 11/15/2013 7.11900 08/21/2015

NALTREXONE HCL ORAL TABLET 50 MG 0.71722 10/25/2019 0.66875 11/15/2019

NAPHAZOLINE HCL DROPS 0.1 % 0.11787 01/25/2013 0.11787 08/21/2015

NAPHAZOLINE HCL/GLYCERIN OPHTHALMIC DROPS 0.012-0.25 0.13090 04/03/2015

NAPROXEN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 125 MG/5ML 0.81200 05/04/2018 0.85722 08/24/2018

NAPROXEN ORAL TABLET 250 MG 0.04181 08/12/2014 0.04181 08/21/2015

NAPROXEN ORAL TABLET 375 MG 0.05065 11/21/2014 0.05065 08/21/2015

NAPROXEN ORAL TABLET 500 MG 0.06330 08/21/2015 0.04180 10/20/2017

NAPROXEN ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 375 MG

0.12990 12/22/2017 0.11150 11/15/2019

NAPROXEN ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 500 MG

0.17979 08/21/2015 0.13450 03/15/2019

NAPROXEN SODIUM ORAL TABLET 220 MG 0.04739 04/03/2015 0.04739 08/21/2015

NAPROXEN SODIUM ORAL TABLET 275 MG 1.20510 08/01/2018 0.99950 11/16/2018

NAPROXEN SODIUM ORAL TABLET 550 MG 0.46647 11/15/2019 0.32180 05/22/2020

NARATRIPTAN HCL ORAL TABLET 1 MG 4.82300 09/30/2016 3.92785 06/16/2017

NARATRIPTAN HCL ORAL TABLET 2.5 MG 1.10278 11/15/2019 2.12614 05/07/2020

NATEGLINIDE ORAL TABLET 120 MG 0.36656 08/16/2019 0.14756 02/21/2020

NATEGLINIDE ORAL TABLET 60 MG 0.28945 08/16/2019 0.26967 05/22/2020

NEFAZODONE HCL ORAL TABLET 100 MG 1.09937 10/03/2014 1.09937 08/21/2015

NEFAZODONE HCL ORAL TABLET 150 MG 1.18018 02/13/2015 1.18018 08/21/2015

NEFAZODONE HCL ORAL TABLET 200 MG 1.18438 10/17/2014 1.18438 08/21/2015

NEFAZODONE HCL ORAL TABLET 250 MG 0.66582 08/23/2013

NEFAZODONE HCL ORAL TABLET 50 MG 0.56680 08/12/2014

NEOMYCIN SULF/BACITRACIN ZINC/POLYMYXIN B SULF/PRAMOXINE HCL TOPICAL OINTMENT (GRAM) 3.5-10K-10

0.16974 08/21/2015 0.07183 08/17/2018

NEOMYCIN SULFATE ORAL TABLET 500 MG 0.50000 11/24/2017 0.61422 08/18/2018

NEOMYCIN SULFATE/BACITRACIN ZINC/POLYMYXIN B TOPICAL OINTMENT (GRAM) 3.5-400-5K

0.08442 02/13/2015 0.08442 08/21/2015

NEOMYCIN SULFATE/BACITRACIN ZINC/POLYMYXIN B/HYDROCORTISONE OPHTHALMIC OINTMENT (GRAM) 3.5-10K-1

12.81263 08/21/2015 12.16571 03/02/2018

NEOMYCIN SULFATE/BACITRACIN/POLYMYXIN B OPHTHALMIC OINTMENT (GRAM) 3.5MG-400

8.09100 08/21/2015 3.90000 02/22/2019

NEOMYCIN SULFATE/POLYMYXIN B SULFATE IRRIGATION AMPUL (ML) 40-200K/ML

7.53960 04/12/2013

NEOMYCIN SULFATE/POLYMYXIN B SULFATE IRRIGATION VIAL (ML) 40-200K/ML

5.02645 01/25/2013

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Current SMAC Price

Current Effective Date

NEOMYCIN SULFATE/POLYMYXIN B SULFATE/GRAMICIDIN D OPHTHALMIC DROPS 1.75MG-10K

4.33580 05/24/2013 4.33580 08/21/2015

NEOMYCIN SULFATE/POLYMYXIN B SULFATE/HYDROCORTISONE OPHTHALMIC SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 3.5-10K-10

13.05287 03/08/2013

NEOMYCIN SULFATE/POLYMYXIN B SULFATE/HYDROCORTISONE OTIC SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 3.5-10K-1

2.05680 08/21/2015 7.04760 09/22/2015

NEOMYCIN/POLYMYXIN B SULFATE/DEXAMETHASONE OPHTHALMIC OINTMENT (GRAM) 3.5-10K-.1

2.52857 08/16/2019 1.53143 09/20/2019

NEOMYCIN/POLYMYXIN B SULFATE/DEXAMETHASONE OPHTHALMIC SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 0.1 %

2.83000 03/03/2017 2.60900 06/22/2018

NEVIRAPINE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 50 MG/5 ML 0.40225 01/25/2013

NEVIRAPINE ORAL TABLET 200 MG 0.19200 08/21/2015 0.10617 09/22/2017

NEVIRAPINE ORAL TABLET, EXTENDED RELEASE 24 HR 400 MG 15.82373 08/21/2015 3.59633 11/24/2017

NIACIN (INOSITOL NIACINATE) ORAL TABLET 500 MG 0.02737 08/21/2015

NIACIN ORAL CAPSULE, EXTENDED RELEASE 250 MG 0.04147 02/01/2013

NIACIN ORAL CAPSULE, EXTENDED RELEASE 500 MG 0.04930 08/12/2014

NIACIN ORAL TABLET 100 MG 0.01270 08/12/2014 0.01270 08/21/2015

NIACIN ORAL TABLET 50 MG 0.01274 01/25/2013

NIACIN ORAL TABLET 500 MG 0.02000 08/12/2014 0.02000 08/21/2015

NIACIN ORAL TABLET, EXTENDED RELEASE 1000 MG 0.05775 01/25/2013

NIACIN ORAL TABLET, EXTENDED RELEASE 24 HR 1000 MG 1.24189 10/20/2017 0.81100 11/15/2019

NIACIN ORAL TABLET, EXTENDED RELEASE 24 HR 500 MG 0.33656 07/26/2019 0.08178 11/15/2019

NIACIN ORAL TABLET, EXTENDED RELEASE 250 MG 0.03662 02/08/2013

NIACIN ORAL TABLET, EXTENDED RELEASE 500 MG 0.03081 08/12/2014 0.03081 08/21/2015

NIACIN ORAL TABLET, EXTENDED RELEASE 750 MG 0.05020 08/12/2014

NIACINAMIDE ORAL TABLET 500 MG 0.02737 04/05/2013

NICARDIPINE HCL ORAL CAPSULE 20 MG 0.34500 02/08/2013

NICARDIPINE HCL ORAL CAPSULE 30 MG 0.35170 08/12/2014

NICOTINE POLACRILEX BUCCAL GUM 2 MG 0.17264 11/16/2018 0.20629 04/02/2019

NICOTINE POLACRILEX BUCCAL GUM 4 MG 0.14927 01/19/2018 0.21527 05/15/2019

NICOTINE POLACRILEX BUCCAL LOZENGE 2 MG 0.36791 08/21/2015

NICOTINE POLACRILEX BUCCAL LOZENGE 4 MG 0.33277 05/26/2017 0.29250 08/16/2019

NICOTINE POLACRILEX BUCCAL MINI LOZENGE 4 MG 0.38277 05/26/2017

NICOTINE TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 14MG/24HR 1.24071 08/16/2019 1.16303 02/21/2020

NICOTINE TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 21 MG/24HR

1.36143 11/16/2018 1.30714 02/22/2019

NICOTINE TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 7MG/24HR 1.46910 06/21/2019 1.29714 11/15/2019

NIFEDIPINE MISCELLANEOUS POWDER (GRAM) 2.02800 08/21/2015

NIFEDIPINE ORAL CAPSULE 10 MG 0.43570 11/24/2017 0.40990 02/22/2019

NIFEDIPINE ORAL CAPSULE 20 MG 1.61182 08/21/2015 1.31822 06/16/2017

NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 30 MG 0.16274 08/17/2018 0.10000 12/20/2019

NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 60 MG 0.23630 12/22/2017 0.20292 08/17/2018

NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 90 MG 0.34796 03/19/2019 0.28610 10/25/2019

NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 30 MG 0.13326 08/25/2017 0.11185 11/16/2018

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Current Effective Date

NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 60 MG 0.30939 02/22/2019 0.16950 05/17/2019

NIFEDIPINE ORAL TABLET, EXTENDED RELEASE 90 MG 0.39300 05/17/2019 0.20555 08/16/2019

NIMODIPINE ORAL CAPSULE 30 MG 13.27890 08/21/2015 2.09000 05/17/2019

NISOLDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 17 MG 4.66057 04/22/2016 3.86000 05/20/2016

NISOLDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 20 MG 10.97514 03/13/2015

NISOLDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 25.5 MG 5.87636 01/25/2013

NISOLDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 30 MG 7.05270 02/08/2013

NISOLDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 34 MG 5.87636 01/25/2013

NISOLDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 40 MG 6.65350 01/25/2013

NISOLDIPINE ORAL TABLET, EXTENDED RELEASE 24 HR 8.5MG 3.94911 12/02/2016 3.89950 11/16/2018

NITROFURANTOIN MACROCRYSTAL ORAL CAPSULE 100 MG 0.91780 07/14/2017 0.74480 03/02/2018

NITROFURANTOIN MACROCRYSTAL ORAL CAPSULE 50 MG 0.47000 10/25/2019 0.39193 02/21/2020

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS ORAL CAPSULE 100 MG

0.52928 04/17/2020 0.46800 05/22/2020

NITROFURANTOIN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 25 MG/5 ML

1.31539 03/02/2018 9.40983 04/23/2019

NITROGLYCERIN IN 5 % DEXTROSE IN WATER INTRAVENOUS INFUSION BOTTLE (ML) 200MG/500

0.01110 08/12/2014

NITROGLYCERIN IN 5 % DEXTROSE IN WATER INTRAVENOUS INFUSION BOTTLE (ML) 50MG/500ML

0.02260 08/12/2014

NITROGLYCERIN INTRAVENOUS VIAL (ML) 50 MG/10ML 0.47040 01/25/2013

NITROGLYCERIN ORAL CAPSULE, EXTENDED RELEASE 2.5 MG 0.33267 05/17/2013 0.33267 08/21/2015

NITROGLYCERIN ORAL CAPSULE, EXTENDED RELEASE 6.5 MG 0.32960 02/15/2013 0.32960 08/21/2015

NITROGLYCERIN ORAL CAPSULE, EXTENDED RELEASE 9 MG 0.17330 08/12/2014 0.17330 08/21/2015

NITROGLYCERIN TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 0.1MG/HR

0.69594 08/21/2015 0.52033 08/16/2019

NITROGLYCERIN TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 0.2MG/HR

0.43967 03/03/2017 0.35275 11/24/2017

NITROGLYCERIN TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 0.4MG/HR

0.43334 09/30/2016 0.39678 02/22/2019

NITROGLYCERIN TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 0.6MG/HR

0.97601 08/21/2015 0.54533 10/20/2017

NITROGLYCERIN TRANSLINGUAL AEROSOL, SPRAY (GRAM) 400MCG/SPR

27.46701 01/25/2013

NITROGLYCERIN TRANSLINGUAL SPRAY, NON-AEROSOL (GRAM) 400MCG/SPR

31.99165 01/05/2018 23.27500 01/25/2019

NIZATIDINE ORAL CAPSULE 150 MG 0.26336 08/21/2015 0.18833 08/25/2017

NIZATIDINE ORAL CAPSULE 300 MG 0.56236 08/21/2015 0.36667 11/16/2018

NIZATIDINE ORAL SOLUTION, ORAL 150MG/10ML 0.49300 08/21/2015 1.00143 10/26/2019

NORETHINDRONE ACETATE ORAL TABLET 5 MG 0.65960 06/21/2019 0.99460 08/08/2019

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL ORAL TABLET 0.5MG-2.5

2.00956 04/27/2018

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL ORAL TABLET 1.5-0.03MG

0.57873 09/22/2017 0.42460 05/22/2020

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL ORAL TABLET 1MG-20MCG

0.20508 01/24/2020 0.13889 05/22/2020

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL ORAL TABLET 1MG-5MCG

1.65878 04/03/2019 1.33988 05/17/2019

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Current Effective Date

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE ORAL TABLET 1.5-30(21)

0.16679 11/15/2019 0.15557 05/22/2020

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE ORAL TABLET 1MG-20(21)

0.19802 02/22/2019 0.14387 06/21/2019

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE ORAL TABLET 1MG-20(24)

1.05273 11/24/2017 0.73809 01/25/2019

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE ORAL TABLET 5-7-9-7

1.42880 08/21/2015 0.91503 06/16/2017

NORETHINDRONE ACETATE-ETHINYL ESTRADIOL/FERROUS FUMARATE ORAL TABLET,CHEWABLE 1MG-20(24)

1.88500 04/17/2020

NORETHINDRONE ORAL TABLET 0.35 MG 0.10917 03/16/2018 0.07500 11/15/2019

NORETHINDRONE-ETHINYL ESTRADIOL ORAL TABLET 0.4-0.035 0.39583 06/16/2017 0.24429 02/21/2020

NORETHINDRONE-ETHINYL ESTRADIOL ORAL TABLET 0.5-0.035 0.70263 02/26/2016 0.66000 04/27/2018

NORETHINDRONE-ETHINYL ESTRADIOL ORAL TABLET 1 MG-35MCG 0.60029 03/25/2016 0.28925 06/16/2017

NORETHINDRONE-ETHINYL ESTRADIOL ORAL TABLET 7 DAYS X 3 0.37448 06/16/2017 0.15179 11/15/2019

NORETHINDRONE-ETHINYL ESTRADIOL ORAL TABLET 7-9-5 0.98375 01/25/2013 0.59237 06/16/2017

NORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE ORAL TABLET,CHEWABLE 0.4-35(21)

1.86241 08/21/2015 1.46607 10/20/2017

NORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE ORAL TABLET,CHEWABLE 0.8-25(24)

1.60596 04/27/2018

NORGESTIMATE-ETHINYL ESTRADIOL ORAL TABLET 0.25-0.035 0.21536 11/16/2018 0.12787 03/15/2019

NORGESTIMATE-ETHINYL ESTRADIOL ORAL TABLET 7DAYSX3 28 0.19123 11/16/2018 0.10250 03/15/2019

NORGESTIMATE-ETHINYL ESTRADIOL ORAL TABLET 7DAYSX3 LO 0.17845 01/24/2020 0.15456 06/19/2020

NORGESTREL-ETHINYL ESTRADIOL ORAL TABLET 0.3-0.03MG 0.41253 10/20/2017 0.26161 11/16/2018

NORTRIPTYLINE HCL ORAL CAPSULE 10 MG 0.07000 08/25/2017 0.05556 10/25/2019

NORTRIPTYLINE HCL ORAL CAPSULE 25 MG 0.06686 11/16/2018 0.05334 11/15/2019

NORTRIPTYLINE HCL ORAL CAPSULE 50 MG 0.11622 06/16/2017 0.07750 05/22/2020

NORTRIPTYLINE HCL ORAL CAPSULE 75 MG 0.15800 08/25/2017 0.12989 09/22/2017

NORTRIPTYLINE HCL ORAL SOLUTION, ORAL 10 MG/5 ML 0.26055 02/27/2015 0.26055 08/21/2015

NYSTATIN MISCELLANEOUS POWDER (EA) 10B UNIT 17265.36000 01/25/2013

NYSTATIN MISCELLANEOUS POWDER (EA) 150MM UNIT 98.76650 01/25/2013

NYSTATIN MISCELLANEOUS POWDER (EA) 1B UNIT 404.56500 01/25/2013

NYSTATIN MISCELLANEOUS POWDER (EA) 2B UNIT 459.38450 01/25/2013

NYSTATIN MISCELLANEOUS POWDER (EA) 500MM UNIT 156.49700 01/25/2013 156.49700 08/21/2015

NYSTATIN MISCELLANEOUS POWDER (EA) 50MM UNIT 47.31300 01/25/2013 47.31300 08/21/2015

NYSTATIN MISCELLANEOUS POWDER (EA) 5B UNIT 742.07950 01/25/2013

NYSTATIN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 100000/ML 0.06036 06/16/2017 0.04816 08/17/2018

NYSTATIN ORAL TABLET 500K UNIT 0.40617 05/19/2017 0.34870 08/17/2018

NYSTATIN TOPICAL CREAM (GRAM) 100000/G 0.17875 11/15/2019 0.16033 01/24/2020

NYSTATIN TOPICAL OINTMENT (GRAM) 100000/G 0.32875 11/16/2018 0.28593 06/21/2019

NYSTATIN TOPICAL POWDER (GRAM) 100000/G 0.29656 07/26/2019 0.26384 11/15/2019

NYSTATIN/TRIAMCINOLONE ACETONIDE TOPICAL CREAM (GRAM) 100000-0.1

0.95666 04/26/2019 0.38408 02/21/2020

NYSTATIN/TRIAMCINOLONE ACETONIDE TOPICAL OINTMENT (GRAM) 100000-0.1

0.55533 02/22/2019 0.18333 09/20/2019

OCTREOTIDE ACETATE INJECTION AMPUL (ML) 100 MCG/ML 4.02220 03/07/2014

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Current SMAC Price

Current Effective Date

OCTREOTIDE ACETATE INJECTION AMPUL (ML) 50 MCG/ML 2.84310 01/25/2013

OCTREOTIDE ACETATE INJECTION AMPUL (ML) 500 MCG/ML 21.50330 12/26/2014

OCTREOTIDE ACETATE INJECTION SYRINGE (ML) 100 MCG/ML 15.96000 03/21/2014

OCTREOTIDE ACETATE INJECTION SYRINGE (ML) 50 MCG/ML 5.98920 01/25/2013

OCTREOTIDE ACETATE INJECTION SYRINGE (ML) 500 MCG/ML 45.22560 01/25/2013

OCTREOTIDE ACETATE INJECTION VIAL (ML) 100 MCG/ML 5.15580 05/01/2015 5.15580 08/21/2015

OCTREOTIDE ACETATE INJECTION VIAL (ML) 1000MCG/ML 34.03343 02/27/2015 34.03343 08/21/2015

OCTREOTIDE ACETATE INJECTION VIAL (ML) 200 MCG/ML 8.03760 08/12/2014 8.03760 08/21/2015

OCTREOTIDE ACETATE INJECTION VIAL (ML) 50 MCG/ML 2.83010 09/05/2014 2.83010 08/21/2015

OCTREOTIDE ACETATE INJECTION VIAL (ML) 500 MCG/ML 20.95800 05/01/2015 20.95800 08/21/2015

OFLOXACIN OPHTHALMIC DROPS 0.3 % 2.10000 02/22/2019 1.83240 11/15/2019

OFLOXACIN OTIC DROPS 0.3 % 14.24520 06/04/2015 2.52000 05/22/2020

OLANZAPINE INTRAMUSCULAR VIAL (EA) 10 MG 29.05000 02/01/2013

OLANZAPINE ORAL TABLET 10 MG 0.13334 11/16/2018 0.10867 04/17/2020

OLANZAPINE ORAL TABLET 15 MG 0.15220 09/22/2017 0.11167 04/17/2020

OLANZAPINE ORAL TABLET 2.5 MG 0.10093 08/25/2017 0.07267 03/02/2018

OLANZAPINE ORAL TABLET 20 MG 0.16876 11/15/2019 0.10000 01/24/2020

OLANZAPINE ORAL TABLET 5 MG 0.09611 08/25/2017 0.07497 08/16/2019

OLANZAPINE ORAL TABLET 7.5 MG 0.10995 05/17/2019 0.08533 08/16/2019

OLANZAPINE ORAL TABLET,DISINTEGRATING 10 MG 0.35333 11/16/2018 0.76425 03/19/2020

OLANZAPINE ORAL TABLET,DISINTEGRATING 15 MG 0.57400 05/17/2019 0.55533 05/22/2020

OLANZAPINE ORAL TABLET,DISINTEGRATING 20 MG 3.18610 08/21/2015 0.61067 11/24/2017

OLANZAPINE ORAL TABLET,DISINTEGRATING 5 MG 0.72000 03/04/2019 0.18167 03/20/2020

OLANZAPINE/FLUOXETINE HCL ORAL CAPSULE 12MG-25MG 15.27470 08/15/2014

OLANZAPINE/FLUOXETINE HCL ORAL CAPSULE 12MG-50MG 15.27773 08/12/2014

OLANZAPINE/FLUOXETINE HCL ORAL CAPSULE 3 MG-25 MG 7.51917 11/14/2014 7.51917 08/21/2015

OLANZAPINE/FLUOXETINE HCL ORAL CAPSULE 6MG-25MG 10.13740 08/01/2014 10.13740 08/21/2015

OLANZAPINE/FLUOXETINE HCL ORAL CAPSULE 6MG-50MG 10.13740 08/01/2014 7.04000 01/25/2019

OLMESARTAN MEDOXOMIL ORAL TABLET 20 MG 0.10100 04/27/2018 0.08956 06/19/2020

OLMESARTAN MEDOXOMIL ORAL TABLET 40 MG 0.16863 04/27/2018

OLMESARTAN MEDOXOMIL ORAL TABLET 5 MG 0.08550 11/16/2018 0.05067 07/26/2019

OLMESARTAN MEDOXOMIL/AMLODIPINE BESYLATE/HYDROCHLOROTHIAZIDE ORAL TABLET 20-5-12.5

1.37855 11/15/2019 1.37855 01/01/2020

OLMESARTAN MEDOXOMIL/AMLODIPINE BESYLATE/HYDROCHLOROTHIAZIDE ORAL TABLET 40-10-12.5

1.82389 11/15/2019 1.82389 01/01/2020

OLMESARTAN MEDOXOMIL/AMLODIPINE BESYLATE/HYDROCHLOROTHIAZIDE ORAL TABLET 40-10-25MG

1.61800 11/16/2018 1.61800 01/01/2020

OLMESARTAN MEDOXOMIL/AMLODIPINE BESYLATE/HYDROCHLOROTHIAZIDE ORAL TABLET 40-5-12.5

1.00133 05/17/2019 1.00133 01/01/2020

OLMESARTAN MEDOXOMIL/AMLODIPINE BESYLATE/HYDROCHLOROTHIAZIDE ORAL TABLET 40-5-25 MG

1.71000 11/16/2018 1.71000 01/01/2020

OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE ORAL TABLET 20-12.5 MG

0.13000 08/17/2018 0.08333 03/15/2019

OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE ORAL TABLET 40 MG-25MG

0.20000 04/27/2018 0.17600 02/22/2019

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Current SMAC Price

Current Effective Date

OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE ORAL TABLET 40-12.5 MG

0.12000 04/27/2018

OLOPATADINE HCL NASAL AEROSOL, SPRAY WITH PUMP (GRAM) 0.6 % 2.15000 06/21/2019 2.35611 06/24/2019

OLOPATADINE HCL OPHTHALMIC DROPS 0.1 % 2.57629 11/15/2019 2.39000 05/22/2020

OMEGA-3 ACID ETHYL ESTERS ORAL CAPSULE 1 G 0.21378 01/01/2019 0.18871 05/22/2020

OMEGA-3 FATTY ACIDS/DOCOSAHEXAENOIC ACID/EPA/FISH OIL ORAL CAPSULE 1000 MG

0.05283 08/12/2014

OMEPRAZOLE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 10 MG

0.11633 08/25/2017 0.02056 08/17/2018

OMEPRAZOLE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 20 MG

0.08682 08/21/2015 0.03862 07/14/2017

OMEPRAZOLE ORAL CAPSULE,DELAYED RELEASE (ENTERIC COATED) 40 MG

0.05675 04/26/2019 0.04480 01/24/2020

OMEPRAZOLE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 20 MG

0.47857 08/25/2017 0.19321 02/21/2020

OMEPRAZOLE/SODIUM BICARBONATE ORAL CAPSULE 20MG-1.1G 6.58183 09/22/2017 1.95000 10/25/2019

OMEPRAZOLE/SODIUM BICARBONATE ORAL CAPSULE 40MG-1.1G 1.85000 10/25/2019 1.28050 11/15/2019

ONDANSETRON HCL INTRAVENOUS VIAL (ML) 2 MG/ML 0.07865 01/16/2015 0.07865 08/21/2015

ONDANSETRON HCL ORAL SOLUTION, ORAL 4 MG/5 ML 0.25940 07/26/2019 0.23744 11/15/2019

ONDANSETRON HCL ORAL TABLET 4 MG 0.07664 11/16/2018 0.05643 05/22/2020

ONDANSETRON HCL ORAL TABLET 8 MG 0.12277 11/16/2018 0.09415 05/22/2020

ONDANSETRON HCL/PF INJECTION AMPUL (ML) 4 MG/2 ML 8.31950 01/25/2013

ONDANSETRON HCL/PF INJECTION SYRINGE (ML) 4 MG/2 ML 0.93551 05/01/2015 0.93551 08/21/2015

ONDANSETRON HCL/PF INJECTION VIAL (ML) 4 MG/2 ML 0.25000 11/16/2018 0.14720 03/20/2020

ONDANSETRON ORAL TABLET,DISINTEGRATING 4 MG 0.24667 10/19/2018 0.22616 11/15/2019

ONDANSETRON ORAL TABLET,DISINTEGRATING 8 MG 0.24400 07/26/2019 0.22773 11/15/2019

OPIUM TINCTURE ORAL TINCTURE 10 MG/ML 3.65310 08/02/2013 2.38890 03/02/2018

OPIUM/BELLADONNA ALKALOIDS RECTAL SUPPOSITORY, RECTAL 30-16.2 MG

19.61500 07/18/2014

OPIUM/BELLADONNA ALKALOIDS RECTAL SUPPOSITORY, RECTAL 60-16.2 MG

23.41675 10/24/2014

ORPHENADRINE CITRATE ORAL TABLET, EXTENDED RELEASE 100 MG 0.18230 09/22/2017 0.14850 11/16/2018

OSELTAMIVIR PHOSPHATE ORAL CAPSULE 30 MG 5.33000 01/25/2019

OSELTAMIVIR PHOSPHATE ORAL CAPSULE 45 MG 5.55000 01/25/2019

OSELTAMIVIR PHOSPHATE ORAL CAPSULE 75 MG 2.92000 03/20/2020 1.84057 05/22/2020

OSELTAMIVIR PHOSPHATE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 6 MG/ML

1.02317 11/15/2019 0.63350 05/22/2020

OXACILLIN SODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 1 G/50 ML

0.25790 01/25/2013

OXACILLIN SODIUM IN ISO-OSMOTIC DEXTROSE INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 2 G/50 ML

0.23003 09/26/2014

OXACILLIN SODIUM INJECTION VIAL (EA) 1 G 8.82240 08/22/2014 8.82240 08/21/2015

OXACILLIN SODIUM INJECTION VIAL (EA) 10 G 86.55715 08/22/2014

OXACILLIN SODIUM INJECTION VIAL (EA) 2 G 15.23550 08/22/2014 15.23550 08/21/2015

OXACILLIN SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 1 G 0.86301 01/25/2013

OXACILLIN SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 2 G 2.23201 01/25/2013

OXANDROLONE ORAL TABLET 10 MG 9.27840 01/25/2013 9.27840 08/21/2015

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Generic Name Prev. SMAC Price Prev. Effective Date

Current SMAC Price

Current Effective Date

OXANDROLONE ORAL TABLET 2.5 MG 3.00096 08/12/2014 3.00096 08/21/2015

OXAPROZIN ORAL TABLET 600 MG 0.89000 10/19/2018 0.76500 03/20/2020

OXAZEPAM ORAL CAPSULE 10 MG 0.56183 01/13/2017 0.51416 01/27/2017

OXAZEPAM ORAL CAPSULE 15 MG 0.77475 12/02/2016 0.74047 04/21/2017

OXAZEPAM ORAL CAPSULE 30 MG 1.11314 04/24/2015

OXCARBAZEPINE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 300 MG/5ML

0.25400 12/21/2018 0.31168 01/07/2019

OXCARBAZEPINE ORAL TABLET 150 MG 0.09147 08/17/2018 0.07880 07/26/2019

OXCARBAZEPINE ORAL TABLET 300 MG 0.14390 11/16/2018 0.12910 07/26/2019

OXCARBAZEPINE ORAL TABLET 600 MG 0.30876 05/19/2017 0.27511 08/25/2017

OXYBUTYNIN CHLORIDE ORAL SYRUP 5 MG/5 ML 0.02124 05/17/2013 0.02124 08/21/2015

OXYBUTYNIN CHLORIDE ORAL TABLET 5 MG 0.11303 06/21/2019 0.07000 05/22/2020

OXYBUTYNIN CHLORIDE ORAL TABLET, EXTENDED RELEASE 24 HR 10 MG

0.22747 11/15/2019 0.21537 05/22/2020

OXYBUTYNIN CHLORIDE ORAL TABLET, EXTENDED RELEASE 24 HR 15 MG

0.28120 05/17/2019 0.20670 05/22/2020

OXYBUTYNIN CHLORIDE ORAL TABLET, EXTENDED RELEASE 24 HR 5 MG

0.31306 11/15/2019 0.18040 01/24/2020

OXYCODONE HCL ORAL CAPSULE 5 MG 1.29200 08/21/2015 0.41790 06/16/2017

OXYCODONE HCL ORAL CONCENTRATE, ORAL 20 MG/ML 3.73320 09/30/2016 2.80000 05/25/2018

OXYCODONE HCL ORAL SOLUTION, ORAL 5 MG/5 ML 0.15271 09/20/2019 0.09998 11/15/2019

OXYCODONE HCL ORAL TABLET 10 MG 0.15800 07/14/2017 0.13000 03/02/2018

OXYCODONE HCL ORAL TABLET 15 MG 0.14173 03/03/2017 0.11260 03/02/2018

OXYCODONE HCL ORAL TABLET 20 MG 0.24678 01/27/2017 0.19825 08/25/2017

OXYCODONE HCL ORAL TABLET 30 MG 0.25736 03/15/2019 0.19490 03/20/2020

OXYCODONE HCL ORAL TABLET 5 MG 0.09012 03/03/2017 0.07130 08/25/2017

OXYCODONE HCL ORAL TABLET,ORAL ONLY,EXTENDED RELEASE 12 HR 40 MG

5.78530 03/03/2017 5.78530 03/04/2017

OXYCODONE HCL ORAL TABLET,ORAL ONLY,EXTENDED RELEASE 12 HR 80 MG

9.41957 03/03/2017 9.41957 03/04/2017

OXYCODONE HCL/ACETAMINOPHEN ORAL TABLET 10MG-325MG 0.27202 07/17/2019 0.25078 08/16/2019

OXYCODONE HCL/ACETAMINOPHEN ORAL TABLET 2.5-325 MG 1.43437 05/01/2015 1.24120 11/24/2017

OXYCODONE HCL/ACETAMINOPHEN ORAL TABLET 5 MG-325MG 0.09991 03/03/2017 0.06530 09/21/2018

OXYCODONE HCL/ACETAMINOPHEN ORAL TABLET 7.5-325 MG 0.22515 05/17/2019 0.16020 11/15/2019

OXYCODONE HCL/ASPIRIN ORAL TABLET 4.8355-325 0.40759 11/07/2014 0.40759 08/21/2015

OXYMORPHONE HCL ORAL TABLET 10 MG 2.46947 07/14/2017 1.92770 11/24/2017

OXYMORPHONE HCL ORAL TABLET 5 MG 1.64692 08/21/2015 1.36790 11/24/2017

OXYMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 10 MG 2.43642 08/21/2015 2.81100 01/29/2018

OXYMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 15 MG 3.54294 04/03/2015

OXYMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 20 MG 5.11420 07/10/2017 5.38900 05/17/2018

OXYMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 30 MG 6.21979 08/21/2015 6.32123 07/13/2017

OXYMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 40 MG 8.11845 05/16/2014 8.11845 08/21/2015

OXYMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 5 MG 1.26886 05/16/2014 1.26886 08/21/2015

OXYMORPHONE HCL ORAL TABLET, EXTENDED RELEASE 12 HR 7.5 MG 1.91827 05/16/2014

PALIPERIDONE ORAL TABLET, EXTENDED RELEASE 24 HR 6 MG 17.55344 01/03/2017 8.99000 06/21/2019

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Current SMAC Price

Current Effective Date

PALIPERIDONE ORAL TABLET, EXTENDED RELEASE 24 HR 9 MG 13.28867 12/27/2019 12.64833 02/21/2020

PAMIDRONATE DISODIUM INTRAVENOUS VIAL (EA) 30 MG 10.37300 02/27/2015 10.37300 08/21/2015

PAMIDRONATE DISODIUM INTRAVENOUS VIAL (EA) 90 MG 26.85500 02/27/2015 26.85500 08/21/2015

PAMIDRONATE DISODIUM INTRAVENOUS VIAL (ML) 30MG/10ML 1.47400 08/12/2014 1.47400 08/21/2015

PAMIDRONATE DISODIUM INTRAVENOUS VIAL (ML) 60 MG/10ML 4.62000 01/25/2013

PAMIDRONATE DISODIUM INTRAVENOUS VIAL (ML) 90 MG/10ML 4.54740 08/08/2014 4.54740 08/21/2015

PANTOPRAZOLE SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 20 MG

0.05756 12/22/2017 0.04411 01/19/2018

PANTOPRAZOLE SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 40 MG

0.11779 08/21/2015 0.05189 06/16/2017

PAREGORIC LIQUID (ML) 2 MG/5 ML 0.46388 04/26/2013

PARICALCITOL INJECTION VIAL (ML) 2 MCG/ML 3.52800 03/27/2015

PARICALCITOL INJECTION VIAL (ML) 5 MCG/ML 8.82000 01/30/2015

PARICALCITOL ORAL CAPSULE 1 MCG 2.80000 05/25/2018 0.94067 08/17/2018

PARICALCITOL ORAL CAPSULE 2 MCG 15.52623 07/04/2014 8.23334 03/03/2017

PARICALCITOL ORAL CAPSULE 4 MCG 31.05270 07/04/2014

PAROMOMYCIN SULFATE ORAL CAPSULE 250 MG 2.95152 06/14/2013

PAROXETINE HCL ORAL TABLET 10 MG 0.05431 12/22/2017 0.04078 11/16/2018

PAROXETINE HCL ORAL TABLET 20 MG 0.05879 07/14/2017 0.04100 09/22/2017

PAROXETINE HCL ORAL TABLET 30 MG 0.14156 08/21/2015 0.08967 09/22/2017

PAROXETINE HCL ORAL TABLET 40 MG 0.17420 08/21/2015 0.07622 07/14/2017

PAROXETINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 25 MG 1.44307 05/17/2019 1.27800 03/20/2020

PEANUT OIL MISCELLANEOUS OIL (ML) 0.09990 08/12/2014 0.09990 08/21/2015

PEG 3350/SOD SULF/SOD BICARB/SOD CHLORIDE/POTASSIUM CHLORIDE ORAL SOLUTION, RECONSTITUTED, ORAL 236-22.74G

0.00288 12/05/2014

PEG 3350/SOD SULF/SOD BICARB/SOD CHLORIDE/POTASSIUM CHLORIDE ORAL SOLUTION, RECONSTITUTED, ORAL 240-22.72G

0.00219 08/22/2014 0.00219 08/21/2015

PENICILLIN G POTASSIUM INJECTION VIAL (EA) 20MM UNIT 24.80100 08/12/2014

PENICILLIN G POTASSIUM INJECTION VIAL (EA) 5MM UNIT 26.68167 04/17/2015 26.68167 08/21/2015

PENICILLIN G POTASSIUM/DEXTROSE-WATER INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 1MM/50ML

0.19490 01/25/2013

PENICILLIN G POTASSIUM/DEXTROSE-WATER INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 2MM/50ML

0.21880 01/25/2013

PENICILLIN G POTASSIUM/DEXTROSE-WATER INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 3MM/50ML

0.13440 01/25/2013

PENICILLIN G PROCAINE INTRAMUSCULAR SYRINGE (ML) 1.2MM/2 ML 11.84540 01/25/2013 11.84540 08/21/2015

PENICILLIN G PROCAINE INTRAMUSCULAR SYRINGE (ML) 600000/ML 13.05360 01/25/2013

PENICILLIN G SODIUM INJECTION VIAL (EA) 5MM UNIT 40.12055 08/09/2013

PENICILLIN V POTASSIUM ORAL SOLUTION, RECONSTITUTED, ORAL 125 MG/5ML

0.02349 04/05/2013

PENICILLIN V POTASSIUM ORAL SOLUTION, RECONSTITUTED, ORAL 250 MG/5ML

0.05111 04/03/2015

PENICILLIN V POTASSIUM ORAL TABLET 250 MG 0.17072 08/21/2015 0.07000 11/24/2017

PENICILLIN V POTASSIUM ORAL TABLET 500 MG 0.07250 11/15/2019 0.05740 01/24/2020

PENTAZOCINE HCL/NALOXONE HCL ORAL TABLET 50MG-0.5MG 2.10324 04/03/2015 2.10324 08/21/2015

PENTOXIFYLLINE ORAL TABLET, EXTENDED RELEASE 400 MG 0.14637 08/25/2017 0.12795 11/16/2018

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Current Effective Date

PERINDOPRIL ERBUMINE ORAL TABLET 2 MG 0.85163 01/25/2013

PERINDOPRIL ERBUMINE ORAL TABLET 4 MG 0.61627 08/21/2015 0.58980 11/15/2019

PERINDOPRIL ERBUMINE ORAL TABLET 8 MG 0.70278 08/29/2014 0.70278 08/21/2015

PERMETHRIN TOPICAL CREAM (GRAM) 5 % 0.45460 03/20/2019 0.29678 02/21/2020

PERMETHRIN TOPICAL LIQUID (ML) 1 % 0.04372 12/13/2013 0.04372 08/21/2015

PERPHENAZINE ORAL TABLET 16 MG 1.67330 10/24/2014 1.53480 09/22/2017

PERPHENAZINE ORAL TABLET 2 MG 0.45370 03/16/2018 0.31250 01/25/2019

PERPHENAZINE ORAL TABLET 4 MG 0.46600 01/25/2019 0.34360 02/22/2019

PERPHENAZINE ORAL TABLET 8 MG 0.52100 07/26/2019 0.29300 03/20/2020

PERPHENAZINE/AMITRIPTYLINE HCL ORAL TABLET 2 MG-10 MG 0.85974 03/13/2015

PERPHENAZINE/AMITRIPTYLINE HCL ORAL TABLET 2 MG-25 MG 1.09466 04/03/2015

PERPHENAZINE/AMITRIPTYLINE HCL ORAL TABLET 4 MG-25 MG 1.19224 03/13/2015

PERPHENAZINE/AMITRIPTYLINE HCL ORAL TABLET 4 MG-50 MG 1.96854 03/13/2015 2.47290 03/06/2018

PERPHENAZINE/AMITRIPTYLINE HCL ORAL TABLET 4MG-10MG 0.47570 08/12/2014

PETROLATUM,WHITE TOPICAL OINTMENT IN PACKET (GRAM) 13.09140 08/21/2015

PETROLATUM,WHITE/WATER TOPICAL LOTION (ML) 0.00860 08/12/2014

PHENAZOPYRIDINE HCL ORAL TABLET 100 MG 0.51200 11/24/2017 0.26500 06/21/2019

PHENAZOPYRIDINE HCL ORAL TABLET 200 MG 0.68905 11/16/2018 0.40000 05/22/2020

PHENDIMETRAZINE TARTRATE ORAL TABLET 35 MG 0.13406 08/12/2014 0.13406 08/21/2015

PHENELZINE SULFATE ORAL TABLET 15 MG 0.58450 01/25/2013 0.44016 09/30/2016

PHENOBARBITAL ORAL ELIXIR 20 MG/5 ML 0.12828 01/30/2015 0.11000 07/26/2019

PHENOBARBITAL ORAL TABLET 100 MG 0.22053 04/19/2013

PHENOBARBITAL ORAL TABLET 15 MG 0.11231 04/12/2013

PHENOBARBITAL ORAL TABLET 16.2 MG 0.16065 08/21/2015 0.37408 09/23/2015

PHENOBARBITAL ORAL TABLET 30 MG 0.12320 08/29/2014

PHENOBARBITAL ORAL TABLET 32.4 MG 0.50000 08/25/2017 0.36000 11/16/2018

PHENOBARBITAL ORAL TABLET 64.8 MG 0.58906 05/06/2019 0.49250 08/16/2019

PHENOBARBITAL ORAL TABLET 97.2MG 0.90673 03/01/2018 0.85000 05/25/2018

PHENOBARBITAL SODIUM INJECTION VIAL (ML) 130MG/ML 13.60800 01/25/2013

PHENOBARBITAL SODIUM INJECTION VIAL (ML) 65 MG/ML 10.58400 07/26/2013

PHENOBARBITAL/HYOSCYAMINE SULF/ATROPINE SULF/SCOPOLAMINE HB ORAL ELIXIR 16.2MG/5ML

0.11741 08/21/2015

PHENOBARBITAL/HYOSCYAMINE SULF/ATROPINE SULF/SCOPOLAMINE HB ORAL TABLET 16.2 MG

0.02701 08/21/2015

PHENTERMINE HCL ORAL CAPSULE 15 MG 0.76603 08/21/2015 0.16000 09/22/2017

PHENTERMINE HCL ORAL CAPSULE 30 MG 0.19443 08/21/2015 0.14830 08/25/2017

PHENTERMINE HCL ORAL CAPSULE 37.5 MG 0.32924 08/21/2015 0.10540 09/22/2017

PHENTERMINE HCL ORAL TABLET 37.5 MG 0.08429 08/21/2015 0.06571 04/26/2019

PHENYLEPHRINE HCL OPHTHALMIC DROPS 10 % 6.86000 02/27/2015 6.86000 08/21/2015

PHENYLEPHRINE HCL OPHTHALMIC DROPS 2.5 % 6.61924 02/27/2015 6.61924 08/21/2015

PHENYLEPHRINE HCL ORAL SOLUTION, ORAL 2.5 MG/5ML 0.04150 08/12/2014

PHENYLEPHRINE HCL ORAL TABLET 10 MG 0.04135 09/19/2014 0.04135 08/21/2015

PHENYLEPHRINE HCL/PROMETHAZINE HCL ORAL SYRUP 5-6.25MG/5 0.23791 10/31/2014 0.23791 08/21/2015

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Current Effective Date

PHENYTOIN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 100 MG/4ML 0.27300 08/12/2014

PHENYTOIN ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 125 MG/5ML 0.08026 03/17/2017 0.06283 08/17/2018

PHENYTOIN ORAL TABLET,CHEWABLE 50 MG 0.19360 08/17/2018 0.29720 12/18/2019

PHENYTOIN SODIUM EXTENDED ORAL CAPSULE 100 MG 0.17390 03/15/2019 0.16530 10/25/2019

PHENYTOIN SODIUM EXTENDED ORAL CAPSULE 200 MG 0.55990 08/12/2014

PHENYTOIN SODIUM INTRAVENOUS AMPUL (ML) 50 MG/ML 0.57670 08/12/2014

PHENYTOIN SODIUM INTRAVENOUS SYRINGE (ML) 50 MG/ML 0.68460 01/25/2013

PHENYTOIN SODIUM INTRAVENOUS VIAL (ML) 50 MG/ML 0.37563 08/12/2014

PHOSPHORATED CARBOHYDRATE (DEXTROSE AND FRUCTOSE) ORAL SOLUTION, ORAL

0.03038 08/12/2014

PHYTONADIONE (VIT K1) INJECTION AMPUL (ML) 10 MG/ML 26.38440 08/22/2014

PHYTONADIONE (VIT K1) ORAL TABLET 100 MCG 0.02140 08/12/2014 0.02140 08/21/2015

PHYTONADIONE (VIT K1) ORAL TABLET 5 MG 44.17600 08/16/2019

PILOCARPINE HCL OPHTHALMIC DROPS 1 % 4.34000 04/26/2013 4.34000 08/21/2015

PILOCARPINE HCL OPHTHALMIC DROPS 2 % 4.43940 08/21/2015 4.22200 05/22/2020

PILOCARPINE HCL OPHTHALMIC DROPS 4 % 4.65220 08/21/2015 4.14400 02/21/2020

PILOCARPINE HCL ORAL TABLET 5 MG 0.74470 02/22/2019 0.28990 11/15/2019

PILOCARPINE HCL ORAL TABLET 7.5 MG 1.15570 05/20/2016 1.04620 11/16/2018

PINDOLOL ORAL TABLET 10 MG 0.97925 06/16/2017 0.79990 02/22/2019

PINDOLOL ORAL TABLET 5 MG 0.85750 03/02/2018 0.65800 01/25/2019

PIOGLITAZONE HCL ORAL TABLET 15 MG 0.07000 08/25/2017 0.05857 11/16/2018

PIOGLITAZONE HCL ORAL TABLET 30 MG 0.12456 08/25/2017 0.07133 11/16/2018

PIOGLITAZONE HCL ORAL TABLET 45 MG 0.14678 03/16/2018 0.03389 11/16/2018

PIOGLITAZONE HCL/GLIMEPIRIDE ORAL TABLET 30 MG-2 MG 21.94569 03/01/2013 6.57850 06/16/2017

PIOGLITAZONE HCL/GLIMEPIRIDE ORAL TABLET 30 MG-4 MG 21.94569 03/01/2013 10.75527 06/16/2017

PIOGLITAZONE HCL/METFORMIN HCL ORAL TABLET 15MG-500MG 1.12650 08/17/2018 1.11033 03/20/2020

PIOGLITAZONE HCL/METFORMIN HCL ORAL TABLET 15MG-850MG 1.02022 11/24/2017 0.61100 02/21/2020

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM INTRAVENOUS VIAL (EA) 2.25 G

3.74530 08/21/2015 4.62000 10/05/2016

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM INTRAVENOUS VIAL (EA) 3.375 G

11.98000 08/21/2015 3.25000 05/22/2020

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM INTRAVENOUS VIAL (EA) 4.5 G

15.01360 07/19/2013 4.35700 05/22/2020

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM INTRAVENOUS VIAL (EA) 40.5 G

95.66330 08/21/2015 72.90000 01/25/2019

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 2.25 G

8.32230 01/25/2013

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 3.375 G

12.66720 01/31/2014

PIPERACILLIN SODIUM/TAZOBACTAM SODIUM INTRAVENOUS VIAL WITH THREADED PORT (EA) 4.5 G

15.73320 01/25/2013

PIPERONYL BUTOXIDE/PYRETHRINS TOPICAL SHAMPOO 4%-0.33% 0.03613 05/03/2013 0.03613 08/21/2015

PIROXICAM ORAL CAPSULE 10 MG 0.53490 11/24/2017 0.44020 03/15/2019

PIROXICAM ORAL CAPSULE 20 MG 0.57000 10/19/2018 0.23350 11/16/2018

PODOFILOX TOPICAL SOLUTION, NON-ORAL 0.5 % 16.47695 04/22/2016 12.20500 09/30/2016

POLYDIMETHYLSILOXANES/SILICON DIOXIDE TOPICAL GEL (GRAM) 3.96690 04/03/2015

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Current Effective Date

POLYETHYLENE GLYCOL 3350 ORAL POWDER (GRAM) 17G/DOSE 0.04100 08/21/2015 0.02099 05/19/2017

POLYETHYLENE GLYCOL 3350 ORAL POWDER IN PACKET (EA) 17G 1.48370 03/04/2020 1.03071 06/19/2020

POLYETHYLENE GLYCOL 400/HYPROMELLOSE/GLYCERIN OPHTHALMIC DROPS 1-0.2-0.2%

0.06720 01/25/2013

POLYMYXIN B SULFATE/TRIMETHOPRIM OPHTHALMIC DROPS 10000-1/ML

0.41400 12/22/2017 0.38700 09/20/2019

POLYVINYL ALCOHOL OPHTHALMIC DROPS 1.4 % 0.13400 01/25/2013 0.13400 08/21/2015

POTASSIUM ALUM/SALICYLIC ACID/TALC/BENTONITE TOPICAL POWDER (GRAM)

0.06740 08/12/2014

POTASSIUM ALUM/TALC/BENTONITE TOPICAL POWDER (GRAM) 0.07530 08/12/2014

POTASSIUM BICARBONATE/CITRIC ACID ORAL TABLET, EFFERVESCENT 25 MEQ

0.21200 05/01/2015 0.18200 08/17/2018

POTASSIUM CHLORIDE IN 0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00410 08/12/2014

POTASSIUM CHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00283 04/19/2013

POTASSIUM CHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 40 MEQ/L

0.00510 01/25/2013

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00310 08/12/2014

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 30 MEQ/L

0.00266 01/25/2013

POTASSIUM CHLORIDE IN 5 % DEXTROSE IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 40 MEQ/L

0.00209 01/25/2013 0.00209 08/21/2015

POTASSIUM CHLORIDE IN DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00320 08/12/2014

POTASSIUM CHLORIDE IN DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 40 MEQ/L

0.00540 08/12/2014

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 10 MEQ/L

0.00234 01/25/2013

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00322 01/25/2013

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 30 MEQ/L

0.00200 01/25/2013

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 40 MEQ/L

0.00227 01/25/2013

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 10 MEQ/L

0.00320 08/12/2014

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00230 08/12/2014

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 30 MEQ/L

0.00236 01/25/2013

POTASSIUM CHLORIDE IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 40 MEQ/L

0.00228 01/25/2013

POTASSIUM CHLORIDE IN DEXTROSE 5% AND 0.3 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00322 01/25/2013 0.00322 08/21/2015

POTASSIUM CHLORIDE IN LACTATED RINGERS AND 5 % DEXTROSE INTRAVENOUS INTRAVENOUS SOLUTION 20 MEQ/L

0.00610 08/12/2014

POTASSIUM CHLORIDE IN LACTATED RINGERS AND 5 % DEXTROSE INTRAVENOUS INTRAVENOUS SOLUTION 40 MEQ/L

0.00403 01/25/2013

POTASSIUM CHLORIDE IN WATER FOR INJECTION, STERILE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 10MEQ/0.1L

0.02218 01/25/2013

POTASSIUM CHLORIDE IN WATER FOR INJECTION, STERILE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 10MEQ/50ML

0.06570 08/12/2014

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Current Effective Date

POTASSIUM CHLORIDE IN WATER FOR INJECTION, STERILE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 20MEQ/0.1L

0.02180 01/25/2013

POTASSIUM CHLORIDE IN WATER FOR INJECTION, STERILE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 20MEQ/50ML

0.10610 08/12/2014

POTASSIUM CHLORIDE IN WATER FOR INJECTION, STERILE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 30MEQ/0.1L

0.04528 01/25/2013 0.04528 08/21/2015

POTASSIUM CHLORIDE IN WATER FOR INJECTION, STERILE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 40MEQ/0.1L

0.04897 01/25/2013

POTASSIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION 2 MEQ/ML

0.02779 08/22/2014

POTASSIUM CHLORIDE INTRAVENOUS VIAL (ML) 2 MEQ/ML 0.02303 04/19/2013 0.02303 08/21/2015

POTASSIUM CHLORIDE ORAL CAPSULE, EXTENDED RELEASE 10 MEQ 0.27000 08/25/2017 0.09794 09/22/2017

POTASSIUM CHLORIDE ORAL CAPSULE, EXTENDED RELEASE 8 MEQ 0.41723 02/26/2016 0.15000 08/16/2019

POTASSIUM CHLORIDE ORAL LIQUID (ML) 20MEQ/15ML 0.23230 10/25/2019 0.28252 12/09/2019

POTASSIUM CHLORIDE ORAL LIQUID (ML) 40MEQ/15ML 0.83849 07/19/2017 0.38055 11/16/2018

POTASSIUM CHLORIDE ORAL PACKET (EA) 20 MEQ 4.03333 11/15/2019 4.93300 01/13/2020

POTASSIUM CHLORIDE ORAL TABLET, EXT RELEASE, PARTICLES/CRYSTALS 10 MEQ

0.19245 11/16/2018 0.16745 08/16/2019

POTASSIUM CHLORIDE ORAL TABLET, EXT RELEASE, PARTICLES/CRYSTALS 20 MEQ

0.18912 02/22/2019 0.18056 10/25/2019

POTASSIUM CHLORIDE ORAL TABLET, EXTENDED RELEASE 10 MEQ 0.14650 12/21/2018 0.13899 07/26/2019

POTASSIUM CHLORIDE ORAL TABLET, EXTENDED RELEASE 8 MEQ 0.35868 08/21/2015 0.15500 08/25/2017

POTASSIUM CHLORIDE/POTASSIUM BICARBONATE/CITRIC ACID TABLET, EFFERVESCENT 25 MEQ

0.68997 01/25/2013

POTASSIUM CITRATE ORAL TABLET, EXTENDED RELEASE 10 MEQ 0.65371 04/25/2019 0.52180 07/26/2019

POTASSIUM CITRATE ORAL TABLET, EXTENDED RELEASE 15 MEQ 1.19990 09/20/2019 1.06610 03/20/2020

POTASSIUM CITRATE ORAL TABLET, EXTENDED RELEASE 5 MEQ 0.92685 09/30/2016 0.52180 11/15/2019

POVIDONE-IODINE TOPICAL OINTMENT (GRAM) 10 % 0.06258 01/25/2013 0.06258 08/21/2015

POVIDONE-IODINE TOPICAL SOLUTION, NON-ORAL 10 % 0.00639 04/17/2015 0.00639 08/21/2015

POVIDONE-IODINE TOPICAL SWAB, MEDICATED 10 % 0.15276 08/12/2014

POVIDONE-IODINE VAGINAL SOLUTION, NON-ORAL 0.3 % 0.00990 08/12/2014

PRAMIPEXOLE DI-HCL ORAL TABLET 0.125 MG 0.06600 08/25/2017 0.03978 09/22/2017

PRAMIPEXOLE DI-HCL ORAL TABLET 0.25 MG 0.04338 07/14/2017 0.03074 11/16/2018

PRAMIPEXOLE DI-HCL ORAL TABLET 0.5 MG 0.04834 08/25/2017 0.02844 12/20/2019

PRAMIPEXOLE DI-HCL ORAL TABLET 0.75 MG 0.09654 02/06/2015 0.09654 08/21/2015

PRAMIPEXOLE DI-HCL ORAL TABLET 1 MG 0.04395 08/25/2017 0.03333 05/22/2020

PRAMIPEXOLE DI-HCL ORAL TABLET 1.5 MG 0.06322 09/22/2017 0.04000 04/27/2018

PRAMIPEXOLE DI-HCL ORAL TABLET, EXTENDED RELEASE 24 HR 0.375 MG

11.95470 05/01/2015

PRAMIPEXOLE DI-HCL ORAL TABLET, EXTENDED RELEASE 24 HR 0.75 MG

11.29637 04/24/2015

PRAMIPEXOLE DI-HCL ORAL TABLET, EXTENDED RELEASE 24 HR 1.5 MG 11.29637 04/24/2015

PRAMOXINE HCL TOPICAL TOWELETTE (EA) 1 % 0.35233 01/25/2013

PRASUGREL HCL ORAL TABLET 10 MG 0.41000 04/17/2020 0.27733 05/22/2020

PRASUGREL HCL ORAL TABLET 5 MG 0.21000 01/25/2019 0.69533 04/06/2020

PRAVASTATIN SODIUM ORAL TABLET 10 MG 0.06264 09/20/2019 0.04363 03/20/2020

PRAVASTATIN SODIUM ORAL TABLET 20 MG 0.08000 08/25/2017 0.06396 05/22/2020

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PRAVASTATIN SODIUM ORAL TABLET 40 MG 0.14067 09/22/2017 0.06651 01/19/2018

PRAVASTATIN SODIUM ORAL TABLET 80 MG 0.21211 09/22/2017 0.11322 12/22/2017

PRAZOSIN HCL ORAL CAPSULE 1 MG 0.25364 11/15/2019 0.22789 05/22/2020

PRAZOSIN HCL ORAL CAPSULE 2 MG 0.44780 11/23/2019 0.27003 02/21/2020

PRAZOSIN HCL ORAL CAPSULE 5 MG 0.60000 11/15/2019 0.36400 04/17/2020

PREDNICARBATE TOPICAL CREAM (GRAM) 0.1 % 1.10483 12/26/2014 1.10483 08/21/2015

PREDNICARBATE TOPICAL OINTMENT (GRAM) 0.1 % 1.13044 04/24/2015 1.13044 08/21/2015

PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 1 %

5.55440 02/21/2020 4.86400 05/22/2020

PREDNISOLONE ORAL SOLUTION, ORAL 15 MG/5 ML 0.03992 08/30/2013 0.03992 08/21/2015

PREDNISOLONE SODIUM PHOSPHATE OPHTHALMIC DROPS 1 % 4.19720 02/08/2013 4.19720 08/21/2015

PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION, ORAL 15 MG/5 ML

0.08044 12/26/2014 0.08044 08/21/2015

PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION, ORAL 25 MG/5 ML

1.48119 12/05/2014

PREDNISOLONE SODIUM PHOSPHATE ORAL SOLUTION, ORAL 5 MG/5 ML 0.57224 02/21/2014 0.57224 08/21/2015

PREDNISOLONE SODIUM PHOSPHATE ORAL TABLET,DISINTEGRATING 10 MG

10.06877 02/13/2015 10.06877 08/21/2015

PREDNISOLONE SODIUM PHOSPHATE ORAL TABLET,DISINTEGRATING 15 MG

16.78133 02/13/2015

PREDNISOLONE SODIUM PHOSPHATE ORAL TABLET,DISINTEGRATING 30 MG

21.57604 02/13/2015

PREDNISONE ORAL SOLUTION, ORAL 5 MG/5 ML 0.25220 02/07/2018 0.58034 07/03/2018

PREDNISONE ORAL TABLET 1 MG 0.19015 03/27/2015 0.09709 09/30/2016

PREDNISONE ORAL TABLET 10 MG 0.11202 08/25/2017 0.07950 09/22/2017

PREDNISONE ORAL TABLET 2.5 MG 0.14040 08/21/2015 0.10130 11/15/2019

PREDNISONE ORAL TABLET 20 MG 0.11890 01/19/2018 0.07974 09/21/2018

PREDNISONE ORAL TABLET 5 MG 0.05260 09/22/2017 0.04580 10/25/2019

PREDNISONE ORAL TABLET 50 MG 0.28608 08/12/2014

PREDNISONE ORAL TABLET, DOSE PACK 10 MG 0.78000 02/06/2015 0.78000 08/21/2015

PREDNISONE ORAL TABLET, DOSE PACK 5 MG 0.45000 10/24/2014 0.45000 08/21/2015

PREGABALIN ORAL CAPSULE 100 MG 0.15800 02/21/2020

PREGABALIN ORAL CAPSULE 150 MG 0.19717 11/15/2019 0.16000 04/01/2020

PREGABALIN ORAL CAPSULE 200 MG 0.17000 02/21/2020

PREGABALIN ORAL CAPSULE 225 MG 0.17000 02/21/2020

PREGABALIN ORAL CAPSULE 25 MG 0.11111 11/15/2019

PREGABALIN ORAL CAPSULE 300 MG 0.28689 11/15/2019 0.17767 04/01/2020

PREGABALIN ORAL CAPSULE 50 MG 0.41000 11/15/2019 0.11222 04/01/2020

PREGABALIN ORAL CAPSULE 75 MG 0.16844 04/01/2020 0.11233 05/22/2020

PRENATAL VIT 17/IRON/FOLIC ACID/FISH OIL/DHA/OMEGA 3,6 NO.1 CAPSULE 35-5-1.2MG

1.61980 01/25/2013 1.61980 08/21/2015

PRENATAL VIT NO.21/IRON POLYSACCH,HEME POLYPEP/FOLIC ACID TABLET 28-6-1 MG

1.47032 08/12/2014

PRENATAL VIT NO.22/IRON CBN,GLUCON/FOLIC ACID/DOCUSATE/DHA COMBINATION PACKAGE (EA) 27-1-50 MG

0.63047 07/05/2013 0.63047 08/21/2015

PRENATAL VIT NO.81/SOD.FEREDETATE-IRON PS/FOLIC ACID/OMEGA-3 ORAL COMBINATION PACKAGE, TABLET AND DR CAP 27-1-430MG

0.86509 01/25/2013

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PRENATAL VIT WITH CALCIUM 15/IRON/FOLIC ACID/DOCUSATE SODIUM ORAL TABLET 90-1-50 MG

0.11873 08/29/2014 0.11873 08/21/2015

PRENATAL VIT WITH CALCIUM 16/IRON/FOLIC ACID/DOCUSATE SODIUM TABLET 90-1-50 MG

0.13967 08/29/2014 0.13967 08/21/2015

PRENATAL VIT WITH CALCIUM 18/IRON/FOLIC ACID/DOCUSATE SODIUM TABLET 90-1-50 MG

0.08180 08/12/2014 0.08180 08/21/2015

PRENATAL VIT WITH CALCIUM 53/IRON BIS,S-P/FOLIC ACID/OMEGA-3 ORAL COMBINATION PACKAGE (EA) 29-1-400MG

0.43260 01/25/2013

PRENATAL VIT WITH CALCIUM 95/FERROUS FUMARATE/FOLIC ACID/DHA ORAL COMBINATION PACKAGE (EA) 28-800-200

0.10500 04/19/2013

PRENATAL VIT WITH CALCIUM NO.126/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 28MG-0.8MG

0.04810 01/25/2016

PRENATAL VIT WITH CALCIUM NO.128/FERROUS FUMARATE/FOLIC ACID TABLET 28MG-0.8MG

0.04207 01/25/2016

PRENATAL VIT WITH CALCIUM NO.129/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 27MG-0.8MG

0.04257 01/25/2016

PRENATAL VIT WITH CALCIUM NO.130/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 27MG-0.8MG

0.04207 01/25/2016

PRENATAL VIT WITH CALCIUM NO.131/FERROUS FUMARATE/FOLIC ACID TABLET 28MG-0.8MG

0.04810 01/25/2016

PRENATAL VIT WITH CALCIUM NO.40/IRON FUMARATE/FOLATE NO.1 ORAL TABLET 27 MG-1 MG

1.33925 05/02/2014

PRENATAL VIT WITH CALCIUM NO.69/IRON/FOLIC ACID/DOCUSATE/DHA ORAL CAPSULE 28-1-50 MG

1.38343 01/31/2014

PRENATAL VITAMIN 27 WITH CALCIUM/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 60 MG-1 MG

0.20146 05/17/2013

PRENATAL VITAMIN CALCIUM,IRON,FOLIC ACID (LESS THAN 1 MG) ORAL TABLET

0.04207 04/05/2013 0.04207 08/21/2015

PRENATAL VITAMIN COMBO NO.22/IRON/FOLIC ACID/OMEGA-3/DHA COMBINATION PACKAGE (EA) 28-6-1-203

0.62446 08/12/2014

PRENATAL VITAMIN NO.19/IRON POLYSAC,IRON HEME/FOLIC ACID/DHA CAPSULE 22-6-1-200

2.08973 05/03/2013 2.08973 08/21/2015

PRENATAL VITAMIN NO.52/IRON/FOLIC ACID/OMEGA-3/DHA ORAL COMBINATION PACKAGE (EA) 29-1-200MG

0.36225 01/25/2013

PRENATAL VITAMIN NO.59/IRON CARB,FUM/FOLIC ACID/DOCUSATE/DHA ORAL CAPSULE 27-1-50 MG

4.46109 12/12/2014

PRENATAL VITAMIN NO.86/IRON BIS-GLYCINATE/FOLIC ACID ORAL TABLET 32 MG-1 MG

0.83875 09/05/2014 0.83875 08/21/2015

PRENATAL VITAMIN WITH CALCIUM NO.76/IRON,CARBONYL/FOLIC ACID ORAL TABLET 29 MG-1 MG

0.22547 08/12/2014 0.22547 08/21/2015

PRENATAL VITAMINS NO.11/FERROUS FUMARATE/FOLIC ACID/OMEGA-3 ORAL CAPSULE 28-1-200MG

2.01177 04/03/2015

PRENATAL VITAMINS NO.25/FERROUS FUMARATE/FOLIC ACID/DHA CAPSULE 30-975-200

0.55977 04/19/2013

PRENATAL VITAMINS WITH CALCIUM/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 27MG-0.8MG

0.04257 04/12/2013 0.04257 08/21/2015

PRENATAL VITAMINS WITH CALCIUM/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 28MG-0.8MG

0.04810 08/12/2014 0.04810 08/21/2015

PRENATAL VITS NO.115/IRON FUMARATE/FOLIC ACID/DOCUSATE SOD. ORAL TABLET 29-1-25 MG

0.61940 04/04/2014 0.61940 08/21/2015

PRENATAL VITS NO.119/IRON FUMARATE/FOLIC ACID/DOCUSATE SOD. ORAL TABLET 29-1-25 MG

0.44586 01/31/2014 0.44586 08/21/2015

PRENATAL VITS NO.151/IRON FUM/FOLIC ACID/OMEGA3/DHA/EPA/FISH ORAL CAPSULE 27-800-228

0.11428 08/12/2014

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PRENATAL VITS NO.24/IRON AMINO ACID CHELATE/FOLIC ACID/DHA COMBINATION PACKAGE (EA) 30-975-300

0.41988 04/19/2013

PRENATAL VITS NO.34/IRON,CARB/FOLIC ACID/DOCUSATE SODIUM/DHA ORAL CAPSULE 30-1-50 MG

1.58305 01/25/2013 1.58305 08/21/2015

PRENATAL VITS WITH CALCIUM 118/FERROUS FUMARATE/FOLIC ACID ORAL TABLET,CHEWABLE 29 MG-1 MG

0.60102 11/08/2013 0.60102 08/21/2015

PRENATAL VITS WITH CALCIUM 95/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 28MG-0.8MG

0.05924 12/19/2014 0.05924 08/21/2015

PRENATAL VITS WITH CALCIUM NO.21/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 14 MG-400

0.06411 01/25/2013

PRENATAL VITS WITH CALCIUM NO.72/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 27 MG-1 MG

0.06606 03/13/2015 0.06606 08/21/2015

PRENATAL VITS WITH CALCIUM NO.73/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 28 MG-1 MG

0.26832 08/29/2014 0.26832 08/21/2015

PRENATAL VITS WITH CALCIUM NO.74/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 27 MG-1 MG

0.02170 08/21/2015

PRENATAL VITS WITH CALCIUM NO.80/IRON FUM/FOLIC ACID/DSS/DHA ORAL CAPSULE 29-1.25-55

1.98769 01/25/2013 1.98769 08/21/2015

PRENATAL VITS WITH CALCIUM NO.87/IRON BISGLY/FOLIC ACID/DHA ORAL COMBINATION PACKAGE (EA) 32-1-230MG

0.59733 01/17/2014 0.59733 08/21/2015

PRENATAL VITS WITH CALCIUM NO.90/FERROUS FUMARATE/FOLIC ACID TABLET 9 MG-0.5MG

0.08394 01/25/2013

PRENATAL VITS WITH CALCIUM NO.93/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 9MG-267MCG

0.05495 04/19/2013

PRENATAL VITS WITH CALCIUM NO.96/FERROUS FUMARATE/FOLIC ACID ORAL TABLET 27MG-0.8MG

0.06924 08/12/2014

PRENATAL VITS, CALCIUM NO.91/FERROUS FUMARATE/FOLIC ACID/DHA ORAL COMBINATION PACKAGE (EA) 28-975-200

0.16328 04/19/2013

PRENATAL VITS,CALCIUM NO.66/IRON FUM/FOLIC ACID/DOCUSATE/DHA ORAL CAPSULE 26-1.2-55

1.21550 08/29/2014 1.21550 08/21/2015

PRENATAL VITS,CALCIUM NO.66/IRON FUM/FOLIC ACID/DOCUSATE/DHA ORAL CAPSULE 27-1.25-55

0.45240 09/26/2014 0.45240 08/21/2015

PRIMAQUINE PHOSPHATE ORAL TABLET 26.3 MG 1.17327 11/07/2014 1.17327 08/21/2015

PRIMIDONE ORAL TABLET 250 MG 0.16411 08/21/2015 0.14150 08/25/2017

PRIMIDONE ORAL TABLET 50 MG 0.08737 08/21/2015 0.06000 08/25/2017

PROBENECID ORAL TABLET 500 MG 0.51720 08/21/2015 0.79640 07/18/2019

PROBENECID/COLCHICINE ORAL TABLET 500-0.5 MG 0.67760 10/10/2014

PROCAINAMIDE HCL INJECTION VIAL (ML) 100 MG/ML 1.98490 08/12/2014

PROCAINAMIDE HCL INJECTION VIAL (ML) 500 MG/ML 8.23200 01/25/2013

PROCHLORPERAZINE EDISYLATE INJECTION VIAL (ML) 10 MG/2 ML 2.63900 01/17/2014 2.63900 08/21/2015

PROCHLORPERAZINE EDISYLATE INJECTION VIAL (ML) 5 MG/ML 1.68000 01/25/2013

PROCHLORPERAZINE MALEATE ORAL TABLET 10 MG 0.05210 10/20/2017 0.34730 12/05/2019

PROCHLORPERAZINE MALEATE ORAL TABLET 5 MG 0.24370 07/05/2019 0.18950 11/15/2019

PROCHLORPERAZINE RECTAL SUPPOSITORY, RECTAL 25 MG 8.90000 08/08/2014 8.90000 08/21/2015

PROGESTERONE INTRAMUSCULAR VIAL (ML) 50 MG/ML 2.02150 01/25/2013 1.55900 03/02/2018

PROGESTERONE MISCELLANEOUS POWDER (GRAM) 100 % 0.47840 08/21/2015

PROGESTERONE, MICRONIZED MISCELLANEOUS POWDER (GRAM) 100 %

0.37440 08/21/2015

PROGESTERONE, MICRONIZED ORAL CAPSULE 100 MG 0.24402 06/21/2019 0.19990 03/20/2020

PROGESTERONE, MICRONIZED ORAL CAPSULE 200 MG 0.96465 08/16/2019 0.71130 09/20/2019

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PROMETHAZINE HCL INJECTION AMPUL (ML) 25 MG/ML 1.67584 10/24/2014

PROMETHAZINE HCL INJECTION AMPUL (ML) 50 MG/ML 1.79970 08/12/2014

PROMETHAZINE HCL INJECTION VIAL (ML) 25 MG/ML 0.76113 11/22/2013 0.76113 08/21/2015

PROMETHAZINE HCL INJECTION VIAL (ML) 50 MG/ML 1.91280 08/12/2014

PROMETHAZINE HCL ORAL SYRUP 6.25MG/5ML 0.01454 02/27/2015 0.01454 08/21/2015

PROMETHAZINE HCL ORAL TABLET 12.5 MG 0.05630 09/22/2017 0.04160 12/22/2017

PROMETHAZINE HCL ORAL TABLET 25 MG 0.09320 08/21/2015 0.03140 07/14/2017

PROMETHAZINE HCL ORAL TABLET 50 MG 0.14740 08/21/2015 0.10467 04/21/2017

PROMETHAZINE HCL RECTAL SUPPOSITORY, RECTAL 12.5 MG 8.24914 01/13/2017 7.87258 06/16/2017

PROMETHAZINE HCL RECTAL SUPPOSITORY, RECTAL 25 MG 5.25000 02/21/2020 4.35583 05/22/2020

PROMETHAZINE HCL RECTAL SUPPOSITORY, RECTAL 50 MG 25.03550 10/17/2014

PROMETHAZINE HCL/CODEINE ORAL SYRUP 6.25-10/5 0.01528 01/25/2013 0.01528 08/21/2015

PROMETHAZINE HCL/DEXTROMETHORPHAN HBR ORAL SYRUP 6.25-15/5 0.04860 10/21/2019 0.06227 12/11/2019

PROMETHAZINE/PHENYLEPHRINE HCL/CODEINE ORAL SYRUP 6.25-5-10 0.08490 08/21/2015 0.01101 11/24/2017

PROPAFENONE HCL ORAL CAPSULE, EXTENDED RELEASE 12 HR 225 MG

3.07683 03/20/2020 1.88000 05/22/2020

PROPAFENONE HCL ORAL CAPSULE, EXTENDED RELEASE 12 HR 325 MG

5.37947 04/21/2017 3.30000 12/20/2019

PROPAFENONE HCL ORAL CAPSULE, EXTENDED RELEASE 12 HR 425 MG

6.99942 10/31/2014 5.15292 06/16/2017

PROPAFENONE HCL ORAL TABLET 150 MG 0.21963 08/21/2015 0.11450 08/25/2017

PROPAFENONE HCL ORAL TABLET 225 MG 0.29990 03/02/2018 0.19070 02/22/2019

PROPAFENONE HCL ORAL TABLET 300 MG 0.95600 07/29/2016 0.45365 06/16/2017

PROPANTHELINE BROMIDE ORAL TABLET 15 MG 0.59475 03/20/2015 0.59475 08/21/2015

PROPARACAINE HCL OPHTHALMIC DROPS 0.5 % 0.81433 04/05/2013 0.81433 08/21/2015

PROPRANOLOL HCL MISCELLANEOUS POWDER (GRAM) 17.22364 08/23/2013 17.22364 08/21/2015

PROPRANOLOL HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 120 MG 0.54990 01/24/2020 0.48840 03/20/2020

PROPRANOLOL HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 160 MG 1.30000 11/16/2018 0.79800 12/21/2018

PROPRANOLOL HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 60 MG 0.32273 08/16/2019 0.24880 10/25/2019

PROPRANOLOL HCL ORAL CAPSULE, EXTENDED RELEASE 24HR 80 MG 0.27910 09/20/2019 0.49490 02/26/2020

PROPRANOLOL HCL ORAL SOLUTION, ORAL 20 MG/5 ML 0.15914 07/18/2014

PROPRANOLOL HCL ORAL SOLUTION, ORAL 40MG/5ML 0.20614 03/15/2013

PROPRANOLOL HCL ORAL TABLET 10 MG 0.10768 01/24/2019 0.07170 04/26/2019

PROPRANOLOL HCL ORAL TABLET 20 MG 0.12333 11/16/2018 0.08990 09/20/2019

PROPRANOLOL HCL ORAL TABLET 40 MG 0.21556 03/03/2017 0.14630 02/22/2019

PROPRANOLOL HCL ORAL TABLET 60 MG 0.60253 01/13/2017 0.55290 03/02/2018

PROPRANOLOL HCL ORAL TABLET 80 MG 0.27250 11/16/2018 0.17910 01/24/2020

PROPRANOLOL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 40 MG-25MG

0.71600 08/12/2014

PROPRANOLOL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 80 MG-25MG

0.87940 08/12/2014

PROTAMINE SULFATE INTRAVENOUS VIAL (ML) 10 MG/ML 1.17782 08/12/2014

PROTECTIVES COMBINATION NO.2/CERAMIDES 1,3,6-11 TOPICAL CREAM (GRAM)

1.87360 08/12/2014

PROTRIPTYLINE HCL ORAL TABLET 10 MG 1.94520 08/21/2015 1.23085 06/16/2017

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PROTRIPTYLINE HCL ORAL TABLET 5 MG 1.43575 07/29/2016 1.10701 12/02/2016

PSEUDOEPHEDRINE HCL ORAL TABLET 30 MG 0.02680 11/21/2014 0.02680 08/21/2015

PSEUDOEPHEDRINE HCL ORAL TABLET 60 MG 0.02105 08/12/2014 0.02105 08/21/2015

PSEUDOEPHEDRINE HCL/CHLOPHEDIANOL HCL/GUAIFENESIN ORAL LIQUID (ML) 30-12.5/5

0.08600 08/12/2014

PSEUDOEPHEDRINE HCL/CODEINE PHOSPHATE/GUAIFENESIN ORAL SYRUP 30-10-100

0.15863 01/30/2015 0.15863 08/21/2015

PSYLLIUM HUSK (WITH SUGAR) ORAL POWDER (GRAM) 3.4 G/7 G 0.01464 12/26/2014 0.01464 08/21/2015

PSYLLIUM SEED (WITH SUGAR) ORAL POWDER (GRAM) 0.00920 08/12/2014 0.00920 08/21/2015

PSYLLIUM SEED ORAL POWDER (GRAM) 0.01780 01/25/2013 0.01780 08/21/2015

PYRANTEL PAMOATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 50 MG/ML

0.16310 01/25/2013

PYRAZINAMIDE ORAL TABLET 500 MG 1.88174 07/25/2014

PYRIDOSTIGMINE BROMIDE ORAL TABLET 60 MG 0.24830 01/24/2020 0.34550 02/17/2020

PYRIDOXINE HCL (VITAMIN B6) INJECTION VIAL (ML) 100 MG/ML 7.86632 01/25/2013

PYRIDOXINE HCL (VITAMIN B6) ORAL TABLET 100 MG 0.02559 08/12/2014 0.02559 08/21/2015

PYRIDOXINE HCL (VITAMIN B6) ORAL TABLET 25 MG 0.02190 08/12/2014

PYRIDOXINE HCL (VITAMIN B6) ORAL TABLET 50 MG 0.01407 09/27/2013 0.01407 08/21/2015

QUETIAPINE FUMARATE ORAL TABLET 100 MG 0.03670 09/21/2018 0.03110 07/26/2019

QUETIAPINE FUMARATE ORAL TABLET 200 MG 0.08270 06/16/2017 0.06540 06/19/2020

QUETIAPINE FUMARATE ORAL TABLET 25 MG 0.03890 09/22/2017 0.02259 03/16/2018

QUETIAPINE FUMARATE ORAL TABLET 300 MG 0.13924 03/03/2017 0.12517 09/21/2018

QUETIAPINE FUMARATE ORAL TABLET 400 MG 0.27326 01/13/2017 0.09749 01/27/2017

QUETIAPINE FUMARATE ORAL TABLET 50 MG 0.06000 11/24/2017 0.04945 05/22/2020

QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 150 MG

0.32842 11/15/2019 0.10817 03/20/2020

QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 200 MG

0.46666 01/25/2019 0.25400 11/15/2019

QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 300 MG

0.53330 07/26/2019 0.46206 11/15/2019

QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 400 MG

0.65533 04/11/2019 0.46000 06/21/2019

QUETIAPINE FUMARATE ORAL TABLET, EXTENDED RELEASE 24 HR 50 MG

0.28000 11/16/2018 0.11959 05/17/2019

QUINAPRIL HCL ORAL TABLET 10 MG 0.15690 08/21/2015 0.13756 12/22/2017

QUINAPRIL HCL ORAL TABLET 20 MG 0.08945 08/25/2017 0.07100 11/15/2019

QUINAPRIL HCL ORAL TABLET 40 MG 0.12089 10/20/2017 0.07200 08/17/2018

QUINAPRIL HCL ORAL TABLET 5 MG 0.14511 06/16/2017 0.09400 09/22/2017

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 10-12.5MG 0.56012 07/04/2014 0.56012 08/21/2015

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 20 MG-25MG 0.49945 08/21/2015 0.35755 11/16/2018

QUINAPRIL HCL/HYDROCHLOROTHIAZIDE ORAL TABLET 20-12.5 MG 0.42731 08/21/2015 0.36578 11/16/2018

QUINIDINE GLUCONATE ORAL TABLET, EXTENDED RELEASE 324 MG 0.84810 08/12/2014 0.84810 08/21/2015

QUINIDINE GLUCONATE VIAL (ML) 80 MG/ML 3.64770 01/25/2013

QUINIDINE SULFATE ORAL TABLET 200 MG 0.09930 01/25/2013

QUINIDINE SULFATE ORAL TABLET 300 MG 0.18360 08/12/2014

QUINIDINE SULFATE ORAL TABLET, EXTENDED RELEASE 300 MG 0.67330 08/12/2014

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QUININE SULFATE ORAL CAPSULE 324 MG 3.07125 08/21/2015 1.83367 09/22/2017

RABEPRAZOLE SODIUM ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 20 MG

0.31567 10/20/2017 0.19089 03/20/2020

RALOXIFENE HCL ORAL TABLET 60 MG 0.54147 11/16/2018 0.32133 05/17/2019

RAMELTEON ORAL TABLET 8 MG 3.03167 01/01/2020 2.79767 05/22/2020

RAMIPRIL ORAL CAPSULE 1.25 MG 0.12030 12/21/2018 0.09855 11/15/2019

RAMIPRIL ORAL CAPSULE 10 MG 0.05856 08/21/2015 0.03852 10/20/2017

RAMIPRIL ORAL CAPSULE 2.5 MG 0.09500 08/21/2015 0.04723 11/24/2017

RAMIPRIL ORAL CAPSULE 5 MG 0.06081 11/16/2018 0.02720 07/26/2019

RANITIDINE HCL CAPSULE 150 MG 0.31000 06/21/2019 0.41255 10/11/2019

RANITIDINE HCL CAPSULE 300 MG 1.03000 10/19/2018 0.81033 11/16/2018

RANITIDINE HCL SYRUP 15 MG/ML 0.03000 06/21/2019 0.05891 12/17/2019

RANITIDINE HCL TABLET 150 MG 0.04560 05/01/2015 0.04560 08/21/2015

RANITIDINE HCL TABLET 300 MG 0.10192 10/20/2017 0.08896 10/25/2019

RANITIDINE HCL TABLET 75 MG 0.09782 08/21/2015 0.05750 11/24/2017

RANITIDINE HCL VIAL (ML) 25 MG/ML 1.01383 02/20/2015 1.01383 08/21/2015

RANOLAZINE ORAL TABLET, EXTENDED RELEASE 12 HR 1000 MG 0.71411 01/24/2020

RANOLAZINE ORAL TABLET, EXTENDED RELEASE 12 HR 500 MG 0.37763 01/24/2020

RASAGILINE MESYLATE ORAL TABLET 1 MG 4.40000 11/15/2019 5.08438 11/27/2019

REPAGLINIDE ORAL TABLET 0.5 MG 0.17060 11/24/2017 0.08777 11/16/2018

REPAGLINIDE ORAL TABLET 1 MG 0.13355 11/16/2018 0.11823 05/22/2020

REPAGLINIDE ORAL TABLET 2 MG 0.18605 12/22/2017 0.10198 08/17/2018

RIBAVIRIN ORAL CAPSULE 200 MG 0.79060 03/13/2015 0.79060 08/21/2015

RIBAVIRIN ORAL TABLET 200 MG 0.72584 08/21/2015 0.61089 10/23/2015

RIBOFLAVIN (VITAMIN B2) ORAL TABLET 25 MG 0.02310 08/12/2014

RIFABUTIN ORAL CAPSULE 150 MG 12.24594 08/12/2014

RIFAMPIN ORAL CAPSULE 150 MG 1.02820 12/13/2013 0.91689 11/20/2015

RIFAMPIN ORAL CAPSULE 300 MG 0.48100 11/24/2017 0.47600 07/26/2019

RILUZOLE ORAL TABLET 50 MG 0.85000 09/21/2018 0.28500 04/17/2020

RIMANTADINE HCL ORAL TABLET 100 MG 1.70880 08/12/2014 1.70880 08/21/2015

RINGER'S SOLUTION INTRAVENOUS INTRAVENOUS SOLUTION 0.00250 08/12/2014

RINGER'S SOLUTION IRRIGATION SOLUTION, IRRIGATION 0.00710 08/12/2014

RINGER'S SOLUTION,LACTATED INTRAVENOUS INTRAVENOUS SOLUTION

0.03400 08/21/2015 0.00364 04/21/2017

RINGER'S SOLUTION,LACTATED IRRIGATION SOLUTION, IRRIGATION 0.00220 01/25/2013

RISEDRONATE SODIUM ORAL TABLET 150 MG 31.25000 03/15/2019 28.95000 06/21/2019

RISEDRONATE SODIUM ORAL TABLET 30 MG 29.56000 03/25/2016

RISEDRONATE SODIUM ORAL TABLET 35 MG 5.21000 03/15/2019 5.21000 10/25/2019

RISEDRONATE SODIUM ORAL TABLET 5 MG 3.95000 01/25/2019 2.33300 04/17/2020

RISPERIDONE ORAL SOLUTION, ORAL 1 MG/ML 0.21474 11/15/2019 0.16267 06/19/2020

RISPERIDONE ORAL TABLET 0.25 MG 0.04949 08/25/2017 0.02047 03/20/2020

RISPERIDONE ORAL TABLET 0.5 MG 0.04150 10/20/2017 0.02083 01/24/2020

RISPERIDONE ORAL TABLET 1 MG 0.06372 08/25/2017 0.03897 09/22/2017

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RISPERIDONE ORAL TABLET 2 MG 0.05984 05/14/2019 0.04430 11/15/2019

RISPERIDONE ORAL TABLET 3 MG 0.06627 08/25/2017 0.04333 12/22/2017

RISPERIDONE ORAL TABLET 4 MG 0.07709 09/22/2017 0.06578 05/22/2020

RISPERIDONE ORAL TABLET,DISINTEGRATING 0.25 MG 5.90310 03/22/2013

RISPERIDONE ORAL TABLET,DISINTEGRATING 0.5 MG 0.67437 06/16/2017 0.50000 04/27/2018

RISPERIDONE ORAL TABLET,DISINTEGRATING 1 MG 0.93124 01/27/2017 0.48786 03/02/2018

RISPERIDONE ORAL TABLET,DISINTEGRATING 2 MG 1.77337 12/25/2015 0.97357 03/17/2017

RISPERIDONE ORAL TABLET,DISINTEGRATING 3 MG 1.24500 11/16/2018 1.15500 11/15/2019

RISPERIDONE ORAL TABLET,DISINTEGRATING 4 MG 6.09630 02/06/2015

RIVASTIGMINE TARTRATE ORAL CAPSULE 1.5 MG 0.15325 11/16/2018 0.11583 05/17/2019

RIVASTIGMINE TARTRATE ORAL CAPSULE 3 MG 0.20075 11/16/2018 0.11583 05/17/2019

RIVASTIGMINE TARTRATE ORAL CAPSULE 4.5 MG 0.26333 09/22/2017 0.11583 05/17/2019

RIVASTIGMINE TARTRATE ORAL CAPSULE 6 MG 0.45891 09/22/2017 0.10250 08/16/2019

RIVASTIGMINE TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 13.3MG/24H

3.94122 08/16/2019 3.66667 03/20/2020

RIVASTIGMINE TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 4.6MG/24HR

3.44000 12/20/2019 2.53000 02/21/2020

RIVASTIGMINE TRANSDERMAL PATCH, TRANSDERMAL 24 HOURS 9.5MG/24HR

3.99967 11/15/2019 3.57000 02/21/2020

RIZATRIPTAN BENZOATE ORAL TABLET 10 MG 0.51667 03/15/2019 0.37778 07/26/2019

RIZATRIPTAN BENZOATE ORAL TABLET 5 MG 0.57750 03/20/2020 0.43333 04/17/2020

RIZATRIPTAN BENZOATE ORAL TABLET,DISINTEGRATING 10 MG 0.83889 09/22/2017 0.49000 12/21/2018

RIZATRIPTAN BENZOATE ORAL TABLET,DISINTEGRATING 5 MG 0.85000 09/21/2018 0.55500 08/16/2019

ROPINIROLE HCL ORAL TABLET 0.25 MG 0.10162 08/21/2015 0.06306 07/14/2017

ROPINIROLE HCL ORAL TABLET 0.5 MG 0.05230 03/16/2018 0.04000 12/20/2019

ROPINIROLE HCL ORAL TABLET 1 MG 0.05854 07/14/2017 0.04490 04/27/2018

ROPINIROLE HCL ORAL TABLET 2 MG 0.13261 08/21/2015 0.05812 07/14/2017

ROPINIROLE HCL ORAL TABLET 3 MG 0.08220 08/25/2017 0.06620 05/22/2020

ROPINIROLE HCL ORAL TABLET 4 MG 0.08150 10/20/2017 0.06920 01/19/2018

ROPINIROLE HCL ORAL TABLET 5 MG 0.14000 01/25/2019 0.08350 08/16/2019

ROPINIROLE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 12 MG 7.95362 08/21/2015 4.25900 08/17/2018

ROPINIROLE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 2 MG 1.09254 08/21/2015 0.74883 11/15/2019

ROPINIROLE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 4 MG 1.15000 06/22/2018 0.40520 10/19/2018

ROPINIROLE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 6 MG 4.97944 08/21/2015 1.06633 09/22/2017

ROPINIROLE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 8 MG 3.22530 08/12/2014 3.22530 08/21/2015

ROPIVACAINE HCL/PF INJECTION VIAL (ML) 10 MG/ML 0.49701 10/17/2014 0.49701 08/21/2015

ROPIVACAINE HCL/PF INJECTION VIAL (ML) 2 MG/ML 0.23912 12/05/2014

ROPIVACAINE HCL/PF INJECTION VIAL (ML) 5 MG/ML 0.29748 10/17/2014

ROPIVACAINE HCL/PF INJECTION VIAL (ML) 7.5 MG/ML 0.42672 12/05/2014

ROSUVASTATIN CALCIUM ORAL TABLET 10 MG 0.08622 03/16/2018 0.06033 09/21/2018

ROSUVASTATIN CALCIUM ORAL TABLET 20 MG 0.12200 10/20/2017 0.06520 12/21/2018

ROSUVASTATIN CALCIUM ORAL TABLET 40 MG 0.12344 09/21/2018 0.10000 12/21/2018

ROSUVASTATIN CALCIUM ORAL TABLET 5 MG 0.06722 11/15/2019 0.05389 04/17/2020

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SACCHAROMYCES BOULARDII ORAL CAPSULE 250 MG 0.55650 10/10/2014

SALICYLIC ACID TOPICAL FILM-FORMING LIQUID WITH APPLICATOR 27.5 %

7.24360 01/31/2014

SALICYLIC ACID TOPICAL LIQUID (ML) 26 % 6.03610 01/25/2013

SALICYLIC ACID/COAL TAR/SULFUR SHAMPOO 2 %-1 %-2% 0.20597 01/25/2013

SALSALATE ORAL TABLET 500 MG 0.24147 11/07/2014 0.24147 08/21/2015

SALSALATE ORAL TABLET 750 MG 1.38136 06/16/2017 0.60680 05/25/2018

SCOPOLAMINE HYDROBROMIDE VIAL (ML) 0.4 MG/ML 3.78000 01/25/2013

SELEGILINE HCL ORAL CAPSULE 5 MG 1.61219 08/12/2014 1.61219 08/21/2015

SELEGILINE HCL ORAL TABLET 5 MG 1.25290 11/28/2014 1.25290 08/21/2015

SELENIUM INTRAVENOUS VIAL (ML) 40 MCG/ML 0.24063 01/25/2013

SELENIUM ORAL TABLET 200 MCG 0.05669 08/12/2014 0.05669 08/21/2015

SELENIUM SULFIDE TOPICAL SHAMPOO 2.5 % 0.07952 09/19/2014 0.07952 08/21/2015

SENNOSIDES ORAL SYRUP 8.8MG/5ML 0.04146 08/12/2014 0.04146 08/21/2015

SENNOSIDES ORAL TABLET 8.6 MG 0.00978 05/01/2015 0.00978 08/21/2015

SENNOSIDES/DOCUSATE SODIUM ORAL TABLET 8.6MG-50MG 0.01946 11/07/2014 0.01946 08/21/2015

SERTRALINE HCL ORAL CONCENTRATE, ORAL 20 MG/ML 0.68521 05/19/2017 0.65250 08/16/2019

SERTRALINE HCL ORAL TABLET 100 MG 0.07310 08/21/2015 0.04255 10/20/2017

SERTRALINE HCL ORAL TABLET 25 MG 0.03430 10/20/2017 0.02144 01/25/2019

SERTRALINE HCL ORAL TABLET 50 MG 0.05250 08/21/2015 0.03376 06/16/2017

SILDENAFIL CITRATE ORAL TABLET 20 MG 0.18128 01/24/2020 0.10600 03/20/2020

SILVER NITRATE TOPICAL SOLUTION, NON-ORAL 0.5 % 0.03476 01/25/2013

SILVER SULFADIAZINE TOPICAL CREAM (GRAM) 1 % 0.08520 03/15/2019 0.07140 12/20/2019

SILVER TOPICAL GEL, EXTENDED RELEASE (ML) 48.44700 01/25/2013

SIMETHICONE ORAL CAPSULE 125 MG 0.08754 03/13/2015 0.08754 08/21/2015

SIMETHICONE ORAL CAPSULE 180 MG 0.07370 08/21/2015 0.03333 03/02/2018

SIMETHICONE ORAL SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 40MG/0.6ML

0.08040 08/21/2015 0.05634 11/16/2018

SIMETHICONE ORAL TABLET,CHEWABLE 125 MG 0.07236 02/06/2015 0.07236 08/21/2015

SIMETHICONE ORAL TABLET,CHEWABLE 80 MG 0.02452 11/21/2014 0.02452 08/21/2015

SIMVASTATIN ORAL TABLET 10 MG 0.03578 08/21/2015 0.02311 10/20/2017

SIMVASTATIN ORAL TABLET 20 MG 0.04000 08/21/2015 0.01895 09/22/2017

SIMVASTATIN ORAL TABLET 40 MG 0.06240 08/21/2015 0.03117 06/16/2017

SIMVASTATIN ORAL TABLET 5 MG 0.05868 08/21/2015 0.02917 11/24/2017

SIMVASTATIN ORAL TABLET 80 MG 0.09991 08/21/2015 0.05544 11/24/2017

SIROLIMUS ORAL TABLET 0.5 MG 3.99000 09/21/2018 5.70661 11/21/2019

SIROLIMUS ORAL TABLET 1 MG 7.15000 12/20/2019 7.77140 01/21/2020

SIROLIMUS ORAL TABLET 2 MG 22.65484 12/08/2017 16.95000 09/21/2018

SODIUM BENZOATE MISCELLANEOUS POWDER (GRAM) 0.04664 01/25/2013 0.04664 08/21/2015

SODIUM BICARBONATE INTRAVENOUS SYRINGE (ML) 0.5MEQ/ML 0.44100 01/25/2013

SODIUM BICARBONATE INTRAVENOUS SYRINGE (ML) 0.9MEQ/ML 0.12734 01/25/2013

SODIUM BICARBONATE INTRAVENOUS SYRINGE (ML) 1 MEQ/ML 0.09770 08/12/2014 0.09770 08/21/2015

SODIUM BICARBONATE INTRAVENOUS SYRINGE (ML) 10MEQ/10ML 0.74256 01/25/2013

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SODIUM BICARBONATE INTRAVENOUS VIAL (ML) 0.5MEQ/ML 0.42840 03/01/2013

SODIUM BICARBONATE INTRAVENOUS VIAL (ML) 1 MEQ/ML 0.13238 11/07/2014

SODIUM BICARBONATE ORAL TABLET 325 MG 0.02155 01/25/2013 0.02155 08/21/2015

SODIUM BICARBONATE ORAL TABLET 650 MG 0.00953 03/22/2013 0.00953 08/21/2015

SODIUM CHLORIDE 0.45 % INTRAVENOUS INTRAVENOUS SOLUTION 0.45 %

0.00260 03/07/2014

SODIUM CHLORIDE 0.45 % INTRAVENOUS PIGGYBACK WITH THREADED PORT (ML)

0.04345 01/30/2015 0.04345 08/21/2015

SODIUM CHLORIDE 3 % INTRAVENOUS INTRAVENOUS SOLUTION 3 % 0.00878 04/19/2013

SODIUM CHLORIDE 5 % INTRAVENOUS INTRAVENOUS SOLUTION 5 % 0.00770 08/12/2014

SODIUM CHLORIDE FOR INHALATION INHALATION VIAL, NEBULIZER (ML) 0.9 %

0.05389 03/06/2015 0.05389 08/21/2015

SODIUM CHLORIDE FOR INHALATION INHALATION VIAL, NEBULIZER (ML) 10 %

0.04183 03/01/2013

SODIUM CHLORIDE FOR INHALATION INHALATION VIAL, NEBULIZER (ML) 3 %

0.04633 04/03/2015 0.04980 03/28/2018

SODIUM CHLORIDE FOR INHALATION INHALATION VIAL, NEBULIZER (ML) 7 %

0.07000 11/01/2013

SODIUM CHLORIDE INTRAVENOUS VIAL (ML) 2.5 MEQ/ML 0.02780 04/05/2013 0.02780 08/21/2015

SODIUM CHLORIDE INTRAVENOUS VIAL (ML) 4 MEQ/ML 0.03239 11/22/2013

SODIUM CHLORIDE IRRIGATING SOLUTION IRRIGATION SOLUTION, IRRIGATION 0.9 %

0.00764 08/12/2014 0.00764 08/21/2015

SODIUM CHLORIDE MISCELLANEOUS TABLET, SOLUBLE 1000 MG 0.09895 12/26/2014

SODIUM CHLORIDE NASAL AEROSOL, SPRAY (ML) 0.65 % 0.02561 02/13/2015 0.02561 08/21/2015

SODIUM CHLORIDE OPHTHALMIC OINTMENT (GRAM) 5 % 2.49240 08/12/2014 1.85007 06/16/2017

SODIUM CHLORIDE/SODIUM BICARBONATE/POTASSIUM CHLORIDE/PEG ORAL SOLUTION, RECONSTITUTED, ORAL 420G

0.00401 06/27/2014 0.00401 08/21/2015

SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INTRAVENOUS VIAL (ML) 62.5MG/5ML

5.15944 05/01/2015 5.15944 08/21/2015

SODIUM HYPOCHLORITE MISCELLANEOUS SOLUTION, NON-ORAL 0.125 %

9.54390 08/12/2014

SODIUM HYPOCHLORITE MISCELLANEOUS SOLUTION, NON-ORAL 0.25 %

0.04024 01/25/2013

SODIUM HYPOCHLORITE MISCELLANEOUS SOLUTION, NON-ORAL 0.5 % 0.04024 01/25/2013

SODIUM LACTATE VIAL (ML) 5 MEQ/ML 0.39992 01/25/2013

SODIUM MORRHUATE VIAL (ML) 50 MG/ML 1.96000 01/25/2013

SODIUM PHOSPHATE,DIBASIC/POT PHOS,MONOB/SOD PHOSPHATE MONO ORAL TABLET 250 MG

0.21890 11/24/2017 0.16750 03/20/2020

SODIUM PHOSPHATE,MONOBASIC/SODIUM PHOSPHATE,DIBASIC RECTAL ENEMA (ML) 19G-7G/118

0.00578 08/12/2014 0.00578 08/21/2015

SODIUM POLYSTYRENE SULFONATE ENEMA (ML) 30 G/120ML 0.25725 07/26/2013

SODIUM POLYSTYRENE SULFONATE ENEMA (ML) 50 G/200ML 0.15435 07/26/2013

SODIUM POLYSTYRENE SULFONATE ORAL POWDER (GRAM) 0.19415 08/21/2015 0.08976 02/22/2019

SODIUM POLYSTYRENE SULFONATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 15 G/60 ML

0.11988 10/10/2014

SODIUM/POTASSIUM/POTASSIUM CITRATE/SODIUM CITRATE/CIT AC ORAL SOLUTION, ORAL 500-550/5

0.02493 01/23/2015 0.02493 08/21/2015

SOLIFENACIN SUCCINATE ORAL TABLET 10 MG 0.30000 04/17/2020 0.15733 06/19/2020

SORBITOL SOLUTION IRRIGATION SOLUTION, IRRIGATION 3 % 0.00351 01/25/2013

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SORBITOL SOLUTION IRRIGATION SOLUTION, IRRIGATION 3.3 % 0.00332 01/25/2013

SOTALOL HCL INTRAVENOUS VIAL (ML) 150MG/10ML 5.68750 01/25/2013

SOTALOL HCL ORAL TABLET 120 MG 0.09290 11/15/2019 0.07900 01/24/2020

SOTALOL HCL ORAL TABLET 160 MG 0.20247 08/12/2014 0.20247 08/21/2015

SOTALOL HCL ORAL TABLET 240 MG 0.35321 03/29/2013 0.35321 08/21/2015

SOTALOL HCL ORAL TABLET 80 MG 0.06730 09/22/2017 0.05260 12/22/2017

SPINOSAD TOPICAL SUSPENSION, TOPICAL (ML) 0.9 % 1.59301 08/18/2017 1.59301 01/01/2018

SPIRONOLACTONE MISCELLANEOUS POWDER (GRAM) 100 % 4.24580 08/12/2014 4.24580 08/21/2015

SPIRONOLACTONE ORAL TABLET 100 MG 0.23410 08/16/2019 0.16950 09/20/2019

SPIRONOLACTONE ORAL TABLET 25 MG 0.06122 08/21/2015 0.04580 11/16/2018

SPIRONOLACTONE ORAL TABLET 50 MG 0.14490 08/25/2017 0.12350 10/25/2019

SPIRONOLACTONE, MICRONIZED MISCELLANEOUS POWDER (GRAM) 100 %

9.66880 08/12/2014

SPIRONOLACTONE/HYDROCHLOROTHIAZIDE ORAL TABLET 25 MG-25MG 0.90011 03/29/2018 0.72980 08/17/2018

STAVUDINE ORAL CAPSULE 15 MG 1.32500 08/12/2014

STAVUDINE ORAL CAPSULE 20 MG 1.31140 08/12/2014

STAVUDINE ORAL CAPSULE 30 MG 1.09200 09/27/2013

STAVUDINE ORAL CAPSULE 40 MG 0.98233 02/26/2016 0.91833 11/24/2017

STAVUDINE ORAL SOLUTION, RECONSTITUTED, ORAL 1 MG/ML 0.27563 01/25/2013

STREPTOMYCIN SULFATE INTRAMUSCULAR VIAL (EA) 1 G 11.16500 01/25/2013

SUCRALFATE ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 1 G/10 ML 0.40574 03/04/2020 0.42860 04/06/2020

SUCRALFATE ORAL TABLET 1 G 0.19994 01/04/2018 0.15950 05/22/2020

SULFACETAMIDE SODIUM OPHTHALMIC DROPS 10 % 2.74986 08/21/2015 1.92000 12/21/2018

SULFACETAMIDE SODIUM OPHTHALMIC OINTMENT (GRAM) 10 % 13.17200 05/23/2014 13.17200 08/21/2015

SULFACETAMIDE SODIUM TOPICAL CLEANSER (ML) 10 % 0.37761 08/12/2014 0.37761 08/21/2015

SULFACETAMIDE SODIUM TOPICAL CLEANSER, GEL (ML) 10 % 1.02906 02/13/2015

SULFACETAMIDE SODIUM TOPICAL CLEANSER, GEL EXTENDED RELEASE 10 %

0.85753 10/25/2013

SULFACETAMIDE SODIUM TOPICAL SUSPENSION, TOPICAL (ML) 10 % 0.61247 01/25/2013 0.61247 08/21/2015

SULFACETAMIDE SODIUM/PREDNISOLONE SODIUM PHOSPHATE OPHTHALMIC DROPS 10 %-0.23%

2.56476 02/15/2013 2.56476 08/21/2015

SULFACETAMIDE SODIUM/SULFUR TOPICAL CLEANSER (GRAM) 10-5%(W/W)

0.07523 02/20/2015 0.07523 08/21/2015

SULFACETAMIDE SODIUM/SULFUR TOPICAL CLEANSER (GRAM) 9 %-4.5 %

0.26751 08/21/2015 0.09064 11/15/2019

SULFACETAMIDE SODIUM/SULFUR TOPICAL CLEANSER (ML) 9 %-4 % 0.22315 01/25/2013

SULFACETAMIDE SODIUM/SULFUR TOPICAL CREAM (GRAM) 10-5%(W/W) 4.86785 08/22/2014 4.86785 08/21/2015

SULFACETAMIDE SODIUM/SULFUR TOPICAL PADS, MEDICATED (EA) 10 %-5 %

4.47784 03/20/2015 4.47784 08/21/2015

SULFACETAMIDE SODIUM/SULFUR TOPICAL SUSPENSION, TOPICAL (GRAM) 10-5%(W/W)

1.58340 05/02/2014

SULFACETAMIDE SODIUM/SULFUR TOPICAL SUSPENSION, TOPICAL (ML) 8 %-4 %

0.20782 08/12/2014

SULFACETAMIDE SODIUM/SULFUR/AVOBENZONE/OCTINOXATE/OCTYL SAL TOPICAL COMBINATION PACKAGE, CLEANSER AND CREAM 9 %-4.5 %

0.47020 11/21/2014

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Current Effective Date

SULFACETAMIDE SODIUM/SULFUR/UREA TOPICAL CLEANSER (ML) 10%-5%-10%

0.49178 01/25/2013

SULFADIAZINE ORAL TABLET 500 MG 3.21496 12/05/2014 3.21496 08/21/2015

SULFAMETHOXAZOLE/TRIMETHOPRIM INTRAVENOUS VIAL (ML) 80-16MG/ML

0.78029 11/07/2014

SULFAMETHOXAZOLE/TRIMETHOPRIM ORAL SUSPENSION, ORAL (FINAL DOSE FORM) 200-40MG/5

0.13732 11/16/2018 0.12203 07/26/2019

SULFAMETHOXAZOLE/TRIMETHOPRIM ORAL TABLET 400MG-80MG 0.06393 08/17/2018 0.04490 08/16/2019

SULFAMETHOXAZOLE/TRIMETHOPRIM ORAL TABLET 800-160 MG 0.07643 08/25/2017 0.04090 12/22/2017

SULFASALAZINE ORAL TABLET 500 MG 0.15600 02/27/2015 0.15600 08/21/2015

SULFASALAZINE ORAL TABLET, DELAYED RELEASE (ENTERIC COATED) 500 MG

0.22563 09/30/2016 0.12670 08/25/2017

SULINDAC ORAL TABLET 150 MG 0.15930 08/21/2015 0.12100 09/22/2017

SULINDAC ORAL TABLET 200 MG 0.19673 03/02/2018 0.13438 08/17/2018

SUMATRIPTAN NASAL SPRAY, NON-AEROSOL (EA) 20 MG 45.17086 06/16/2017 40.67000 06/22/2018

SUMATRIPTAN NASAL SPRAY, NON-AEROSOL (EA) 5 MG 46.82000 04/05/2019 38.32500 05/22/2020

SUMATRIPTAN SUCCINATE ORAL TABLET 100 MG 0.44444 06/16/2017 0.36778 03/02/2018

SUMATRIPTAN SUCCINATE ORAL TABLET 25 MG 0.46722 11/15/2019 0.37556 03/20/2020

SUMATRIPTAN SUCCINATE ORAL TABLET 50 MG 0.46667 07/14/2017 0.36556 11/16/2018

SUMATRIPTAN SUCCINATE SUBCUTANEOUS CARTRIDGE (ML) 6 MG/0.5ML

129.12200 01/25/2013 129.12200 08/21/2015

SUMATRIPTAN SUCCINATE SUBCUTANEOUS PEN INJECTOR (ML) 6 MG/0.5ML

91.25000 01/25/2019 86.52000 06/21/2019

SUMATRIPTAN SUCCINATE SUBCUTANEOUS VIAL (ML) 6 MG/0.5ML 39.30000 10/19/2018 32.50000 01/25/2019

TACROLIMUS ORAL CAPSULE 0.5 MG 0.11703 03/03/2017 0.08055 08/17/2018

TACROLIMUS ORAL CAPSULE 1 MG 0.18660 03/03/2017 0.13478 11/16/2018

TACROLIMUS ORAL CAPSULE 5 MG 0.39610 09/21/2018 5.46000 01/17/2020

TACROLIMUS TOPICAL OINTMENT (GRAM) 0.03 % 5.17608 11/24/2017 4.11000 12/20/2019

TACROLIMUS TOPICAL OINTMENT (GRAM) 0.1 % 4.83523 11/24/2017 3.49000 05/22/2020

TADALAFIL ORAL TABLET 10 MG 1.05000 06/21/2019

TADALAFIL ORAL TABLET 20 MG 1.05000 06/21/2019 0.42967 08/16/2019

TADALAFIL ORAL TABLET 5 MG 0.28400 01/24/2020 0.25900 05/22/2020

TAMOXIFEN CITRATE ORAL TABLET 10 MG 0.24955 08/21/2015 0.15000 11/24/2017

TAMOXIFEN CITRATE ORAL TABLET 20 MG 0.24500 04/17/2020 0.46024 05/13/2020

TAMSULOSIN HCL ORAL CAPSULE 0.4 MG 0.09815 11/24/2017 0.06065 11/16/2018

TEA TREE OIL TOPICAL OIL (ML) 100 % 0.25509 08/12/2014

TELMISARTAN ORAL TABLET 20 MG 0.70000 01/01/2017 0.13809 06/16/2017

TELMISARTAN ORAL TABLET 40 MG 0.26333 09/22/2017 0.12822 11/16/2018

TELMISARTAN ORAL TABLET 80 MG 0.28902 06/16/2017 0.26433 08/17/2018

TELMISARTAN/AMLODIPINE BESYLATE ORAL TABLET 40 MG-10MG 3.87707 08/21/2015 3.87707 01/01/2020

TELMISARTAN/AMLODIPINE BESYLATE ORAL TABLET 40 MG-5 MG 3.87707 10/03/2014 3.87707 08/21/2015

TELMISARTAN/AMLODIPINE BESYLATE ORAL TABLET 80 MG-10MG 3.87707 08/21/2015 3.87707 01/01/2020

TELMISARTAN/AMLODIPINE BESYLATE ORAL TABLET 80 MG-5 MG 3.87707 08/21/2015 3.87707 01/01/2020

TELMISARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 40-12.5 MG 2.39935 06/16/2017 0.73000 05/25/2018

TELMISARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 80 MG-25MG 1.23867 08/17/2018 0.56667 11/15/2019

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TELMISARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 80-12.5MG 1.28950 09/21/2018 1.17000 02/22/2019

TEMAZEPAM ORAL CAPSULE 15 MG 0.06445 08/21/2015 0.04590 03/02/2018

TEMAZEPAM ORAL CAPSULE 22.5 MG 4.17825 06/16/2017 3.96400 04/17/2020

TEMAZEPAM ORAL CAPSULE 30 MG 0.08040 03/06/2015 0.08040 08/21/2015

TEMAZEPAM ORAL CAPSULE 7.5 MG 3.36810 06/16/2017 1.55470 09/22/2017

TEMOZOLOMIDE ORAL CAPSULE 100 MG 96.94428 10/28/2016 42.23000 09/21/2018

TEMOZOLOMIDE ORAL CAPSULE 140 MG 128.55828 07/29/2016

TEMOZOLOMIDE ORAL CAPSULE 180 MG 127.00000 09/22/2017 60.22000 05/22/2020

TEMOZOLOMIDE ORAL CAPSULE 20 MG 21.53000 07/29/2016

TEMOZOLOMIDE ORAL CAPSULE 250 MG 241.19000 07/29/2016

TEMOZOLOMIDE ORAL CAPSULE 5 MG 8.05000 07/29/2016

TENIPOSIDE INTRAVENOUS AMPUL (ML) 50 MG/5 ML 56.11060 08/16/2013 56.11060 08/21/2015

TERAZOSIN HCL ORAL CAPSULE 1 MG 0.05574 08/29/2014 0.05574 08/21/2015

TERAZOSIN HCL ORAL CAPSULE 10 MG 0.06888 08/21/2015 0.04130 08/25/2017

TERAZOSIN HCL ORAL CAPSULE 2 MG 0.05574 08/12/2014 0.05574 08/21/2015

TERAZOSIN HCL ORAL CAPSULE 5 MG 0.06266 08/21/2015 0.05040 12/22/2017

TERBINAFINE HCL ORAL TABLET 250 MG 0.10367 08/25/2017 0.08000 12/20/2019

TERBINAFINE HCL TOPICAL CREAM (GRAM) 1 % 0.39135 04/10/2015 0.39135 08/21/2015

TERBUTALINE SULFATE ORAL TABLET 2.5 MG 0.27990 12/26/2014 1.26973 10/01/2015

TERCONAZOLE VAGINAL CREAM WITH APPLICATOR 0.4 % 0.48888 03/03/2017 0.71068 01/16/2020

TERCONAZOLE VAGINAL CREAM WITH APPLICATOR 0.8 % 1.43255 07/05/2013 1.43255 08/21/2015

TERCONAZOLE VAGINAL SUPPOSITORY, VAGINAL 80 MG 22.83867 04/12/2013 22.83867 08/21/2015

TESTOSTERONE CYPIONATE INTRAMUSCULAR VIAL (ML) 100 MG/ML 4.13840 08/12/2014

TESTOSTERONE CYPIONATE INTRAMUSCULAR VIAL (ML) 200 MG/ML 15.27368 01/22/2020 16.21857 04/24/2020

TESTOSTERONE ENANTHATE INTRAMUSCULAR VIAL (ML) 200 MG/ML 11.89300 04/19/2013 11.89300 08/21/2015

TESTOSTERONE MISCELLANEOUS POWDER (GRAM) 0.19136 08/21/2015

TESTOSTERONE PROPIONATE MISCELLANEOUS POWDER (GRAM) 1.55480 08/21/2015

TESTOSTERONE TRANSDERMAL GEL (GRAM) 50 MG (1%) 1.92771 04/22/2016 1.28256 06/16/2017

TESTOSTERONE TRANSDERMAL GEL IN METERED-DOSE PUMP 10 MG (2%)

13.97550 11/14/2014 4.85000 10/25/2019

TESTOSTERONE TRANSDERMAL GEL IN METERED-DOSE PUMP 12.5/1.25G

1.92710 03/06/2015 1.92710 08/21/2015

TESTOSTERONE TRANSDERMAL GEL IN PACKET (GRAM) 25MG(1%) 4.08296 03/06/2015

TESTOSTERONE TRANSDERMAL GEL IN PACKET (GRAM) 50 MG (1%) 1.98413 01/01/2017 1.98413 01/03/2017

TETANUS AND DIPHTHERIA TOXOIDS, ADULT INTRAMUSCULAR VIAL (ML) 2-2 LF/0.5

30.27570 01/25/2013 30.27570 08/21/2015

TETANUS,DIPHTHERIA TOXOID PED/PF INTRAMUSCULAR VIAL (ML) 5-25/0.5ML

150.18360 11/07/2014 150.18360 08/21/2015

TETRACAINE HCL OPHTHALMIC DROPS 0.5 % 0.49187 01/25/2013 0.49187 08/21/2015

TETRACAINE HCL/PF OPHTHALMIC DROPS 0.5 % 8.12960 08/12/2014

TETRACYCLINE HCL MISCELLANEOUS POWDER (GRAM) 0.66757 05/01/2015 0.66757 08/21/2015

TETRACYCLINE HCL ORAL CAPSULE 250 MG 4.62950 08/21/2015 3.20000 09/21/2018

TETRACYCLINE HCL ORAL CAPSULE 500 MG 3.86019 09/21/2018 2.19010 11/15/2019

THEOPHYLLINE ANHYDROUS ORAL ELIXIR 80 MG/15ML 0.58429 07/05/2013 0.58429 08/21/2015

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THEOPHYLLINE ANHYDROUS ORAL SOLUTION, ORAL 80 MG/15ML 0.15122 08/12/2014 0.15122 08/21/2015

THEOPHYLLINE ANHYDROUS ORAL TABLET, EXTENDED RELEASE 12 HR 100 MG

0.31010 01/30/2015 0.31010 08/21/2015

THEOPHYLLINE ANHYDROUS ORAL TABLET, EXTENDED RELEASE 12 HR 200 MG

0.39893 01/30/2015 0.39893 08/21/2015

THEOPHYLLINE ANHYDROUS ORAL TABLET, EXTENDED RELEASE 12 HR 300 MG

2.59756 03/14/2018 2.59756 06/08/2018

THEOPHYLLINE ANHYDROUS ORAL TABLET, EXTENDED RELEASE 12 HR 450 MG

2.63490 07/12/2017 4.55210 01/11/2018

THEOPHYLLINE ANHYDROUS ORAL TABLET, EXTENDED RELEASE 400 MG

0.95030 02/01/2013

THEOPHYLLINE ANHYDROUS ORAL TABLET, EXTENDED RELEASE 600 MG

1.37320 02/01/2013

THEOPHYLLINE IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 200MG/0.1L

0.03335 01/25/2013

THEOPHYLLINE IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 200MG/50ML

0.09490 08/12/2014

THEOPHYLLINE IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 400MG/.25L

0.01852 01/25/2013

THEOPHYLLINE IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 400MG/0.5L

0.00730 01/25/2013

THEOPHYLLINE IN DEXTROSE 5 % IN WATER INTRAVENOUS INTRAVENOUS SOLUTION 800MG/.25L

0.01890 08/12/2014

THIAMINE HCL INJECTION VIAL (ML) 100 MG/ML 3.68193 08/12/2014

THIAMINE HCL ORAL TABLET 100 MG 0.01375 08/12/2014 0.01375 08/21/2015

THIAMINE HCL ORAL TABLET 50 MG 0.01586 01/25/2013

THIAMINE HCL/RIBOFLAVIN/NIACINAMIDE/DEXPANTHENOL/PYRIDOXINE INJECTION VIAL (ML) 100-2MG/ML

1.31319 01/25/2013

THIAMINE MONONITRATE (VIT B1) ORAL TABLET 100 MG 0.02524 04/24/2015 0.02524 08/21/2015

THIORIDAZINE HCL ORAL TABLET 10 MG 0.35490 05/30/2014

THIORIDAZINE HCL ORAL TABLET 100 MG 0.79650 07/21/2016 0.83510 01/20/2017

THIORIDAZINE HCL ORAL TABLET 25 MG 0.24040 02/15/2013

THIORIDAZINE HCL ORAL TABLET 50 MG 0.59970 05/19/2017 0.56010 11/16/2018

THIOTHIXENE ORAL CAPSULE 1 MG 0.44352 12/26/2014 0.44352 08/21/2015

THIOTHIXENE ORAL CAPSULE 10 MG 1.88013 04/10/2015 1.88013 08/21/2015

THIOTHIXENE ORAL CAPSULE 2 MG 0.85163 03/13/2015 0.85163 08/21/2015

THIOTHIXENE ORAL CAPSULE 5 MG 1.29668 08/21/2015 1.90520 01/02/2020

TIAGABINE HCL ORAL TABLET 2 MG 4.68720 03/27/2015 4.68720 08/21/2015

TIAGABINE HCL ORAL TABLET 4 MG 4.68720 03/27/2015 4.68720 08/21/2015

TICLOPIDINE HCL TABLET 250 MG 1.31502 11/14/2014 1.31502 08/21/2015

TIMOLOL MALEATE OPHTHALMIC DROPS 0.25 % 0.45600 11/24/2017 0.42400 02/22/2019

TIMOLOL MALEATE OPHTHALMIC DROPS 0.5 % 0.56636 02/22/2019 0.51000 04/26/2019

TIMOLOL MALEATE OPHTHALMIC GEL-FORMING SOLUTION 0.25 % 19.30600 06/27/2014

TIMOLOL MALEATE OPHTHALMIC GEL-FORMING SOLUTION 0.5 % 19.15060 07/18/2014

TIMOLOL MALEATE ORAL TABLET 10 MG 0.99344 06/06/2014

TIMOLOL MALEATE ORAL TABLET 20 MG 1.83281 06/06/2014

TIMOLOL MALEATE ORAL TABLET 5 MG 0.44560 08/12/2014

TINIDAZOLE ORAL TABLET 250 MG 0.87620 08/22/2014 0.87620 01/01/2017

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Current Effective Date

TINIDAZOLE ORAL TABLET 500 MG 2.65000 06/22/2018 1.67000 06/21/2019

TIZANIDINE HCL ORAL CAPSULE 2 MG 0.60000 12/21/2018 0.29733 02/21/2020

TIZANIDINE HCL ORAL CAPSULE 4 MG 0.78350 06/16/2017 0.40807 02/21/2020

TIZANIDINE HCL ORAL CAPSULE 6 MG 2.02220 05/20/2016 1.53533 12/22/2017

TIZANIDINE HCL ORAL TABLET 2 MG 0.02233 11/16/2018 0.07180 04/07/2020

TIZANIDINE HCL ORAL TABLET 4 MG 0.06003 08/21/2015 0.03761 05/22/2020

TOBRAMYCIN OPHTHALMIC DROPS 0.3 % 1.09667 06/16/2017 0.82800 11/24/2017

TOBRAMYCIN SULFATE INJECTION VIAL (EA) 1.2 G 67.77984 08/01/2014

TOBRAMYCIN SULFATE INJECTION VIAL (ML) 10 MG/ML 1.10250 01/25/2013

TOBRAMYCIN SULFATE INJECTION VIAL (ML) 40 MG/ML 0.57335 10/03/2014 0.57335 08/21/2015

TOBRAMYCIN SULFATE/SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 60 MG/50ML

0.31870 01/25/2013

TOBRAMYCIN SULFATE/SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 80MG/100ML

0.18270 01/25/2013

TOBRAMYCIN/DEXAMETHASONE OPHTHALMIC SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 0.3 %-0.1%

12.90400 08/25/2017 12.90400 01/01/2018

TOLAZAMIDE TABLET 250 MG 2.22090 08/12/2014 2.22090 08/21/2015

TOLAZAMIDE TABLET 500 MG 1.52140 08/12/2014

TOLBUTAMIDE TABLET 500 MG 0.73440 08/12/2014

TOLMETIN SODIUM ORAL CAPSULE 400 MG 1.16584 01/25/2013 1.16584 08/21/2015

TOLMETIN SODIUM ORAL TABLET 200 MG 0.52500 02/08/2013

TOLMETIN SODIUM ORAL TABLET 600 MG 2.47650 08/12/2014 2.47650 08/21/2015

TOLNAFTATE TOPICAL AEROSOL, POWDER (GRAM) 1 % 0.04750 08/21/2015

TOLNAFTATE TOPICAL CREAM (GRAM) 1 % 0.11078 01/09/2015 0.11078 08/21/2015

TOLNAFTATE TOPICAL POWDER (GRAM) 1 % 0.04750 08/12/2014 0.04750 08/21/2015

TOLTERODINE TARTRATE ORAL CAPSULE, EXT RELEASE 24 HR 2 MG 1.42833 09/20/2019 1.23116 03/20/2020

TOLTERODINE TARTRATE ORAL CAPSULE, EXT RELEASE 24 HR 4 MG 1.12667 05/17/2019 0.90000 05/22/2020

TOLTERODINE TARTRATE ORAL TABLET 1 MG 0.72917 11/16/2018 0.43100 11/15/2019

TOLTERODINE TARTRATE ORAL TABLET 2 MG 0.58475 05/17/2019 0.38750 05/22/2020

TOPIRAMATE ORAL CAPSULE SPRINKLE, EXTENDED RELEASE 24 HR 100 MG

12.64551 09/19/2014 16.13817 04/05/2019

TOPIRAMATE ORAL CAPSULE SPRINKLE, EXTENDED RELEASE 24 HR 150 MG

15.54000 09/19/2014 16.10700 05/21/2018

TOPIRAMATE ORAL CAPSULE SPRINKLE, EXTENDED RELEASE 24 HR 200 MG

20.06300 05/09/2019 22.09013 03/07/2020

TOPIRAMATE ORAL CAPSULE SPRINKLE, EXTENDED RELEASE 24 HR 25 MG

4.87551 09/19/2014 5.74233 09/12/2018

TOPIRAMATE ORAL CAPSULE SPRINKLE, EXTENDED RELEASE 24 HR 50 MG

6.72182 04/20/2018 7.40912 09/12/2018

TOPIRAMATE ORAL CAPSULE, SPRINKLE 15 MG 0.23103 04/21/2017 0.48250 03/10/2020

TOPIRAMATE ORAL CAPSULE, SPRINKLE 25 MG 0.46055 09/30/2016 0.44733 08/17/2018

TOPIRAMATE ORAL TABLET 100 MG 0.06500 08/25/2017 0.03583 02/22/2019

TOPIRAMATE ORAL TABLET 200 MG 0.09788 03/03/2017 0.08528 11/16/2018

TOPIRAMATE ORAL TABLET 25 MG 0.04470 08/21/2015 0.02750 06/16/2017

TOPIRAMATE ORAL TABLET 50 MG 0.03750 09/22/2017 0.02333 05/22/2020

TOPOTECAN HCL INTRAVENOUS VIAL (EA) 4 MG 81.26200 01/23/2015 81.26200 08/21/2015

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TOPOTECAN HCL INTRAVENOUS VIAL (ML) 4 MG/4 ML 30.38490 01/09/2015 30.38490 08/21/2015

TORSEMIDE ORAL TABLET 10 MG 0.06650 10/20/2017 0.04670 11/15/2019

TORSEMIDE ORAL TABLET 100 MG 0.25220 03/02/2018 0.12655 11/16/2018

TORSEMIDE ORAL TABLET 20 MG 0.07950 07/14/2017 0.06643 11/16/2018

TORSEMIDE ORAL TABLET 5 MG 0.09400 09/22/2017 0.05660 11/16/2018

TORSEMIDE VIAL (ML) 20 MG/2 ML 4.31340 01/25/2013

TORSEMIDE VIAL (ML) 50 MG/5 ML 2.34654 01/25/2013

TRAMADOL HCL ORAL TABLET 50 MG 0.01510 04/27/2018 0.01627 09/18/2018

TRAMADOL HCL ORAL TABLET, EXTENDED RELEASE 24 HR 100 MG 1.65067 05/25/2018 1.49967 03/20/2020

TRAMADOL HCL ORAL TABLET, EXTENDED RELEASE 24 HR 200 MG 4.20992 08/21/2015 1.30933 09/22/2017

TRAMADOL HCL ORAL TABLET, EXTENDED RELEASE 24 HR 300 MG 4.04500 09/30/2016 3.23534 06/16/2017

TRAMADOL HCL ORAL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 100 MG

1.86080 08/12/2014 1.86080 08/21/2015

TRAMADOL HCL ORAL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 200 MG

5.44880 08/15/2014 5.44880 08/21/2015

TRAMADOL HCL ORAL TABLET,EXTENDED RELEASE MULTIPHASE 24 HR 300 MG

3.77000 01/25/2013 3.77000 08/21/2015

TRAMADOL HCL/ACETAMINOPHEN ORAL TABLET 37.5-325MG 0.21668 08/21/2015 0.08010 09/22/2017

TRANDOLAPRIL ORAL TABLET 1 MG 0.25064 08/21/2015 0.21120 08/25/2017

TRANDOLAPRIL ORAL TABLET 2 MG 0.27372 08/21/2015 0.23910 06/16/2017

TRANDOLAPRIL ORAL TABLET 4 MG 0.25133 08/12/2014 0.25133 08/21/2015

TRANDOLAPRIL/VERAPAMIL HCL ORAL TABLET,IMMED AND EXTEND REL BIPHASE 24HR 1MG-240 MG

3.70321 05/01/2015

TRANDOLAPRIL/VERAPAMIL HCL ORAL TABLET,IMMED AND EXTEND REL BIPHASE 24HR 2 MG-180MG

3.70321 05/01/2015

TRANDOLAPRIL/VERAPAMIL HCL ORAL TABLET,IMMED AND EXTEND REL BIPHASE 24HR 2MG-240 MG

3.70321 05/01/2015

TRANDOLAPRIL/VERAPAMIL HCL ORAL TABLET,IMMED AND EXTEND REL BIPHASE 24HR 4MG-240 MG

3.70321 05/01/2015

TRANEXAMIC ACID INTRAVENOUS AMPUL (ML) 1000 MG/10 4.94036 04/10/2015 4.94036 08/21/2015

TRANEXAMIC ACID INTRAVENOUS VIAL (ML) 1000 MG/10 4.18675 02/13/2015 4.18675 08/21/2015

TRANEXAMIC ACID ORAL TABLET 650 MG 1.07400 05/17/2019 1.81496 05/09/2020

TRANYLCYPROMINE SULFATE ORAL TABLET 10 MG 1.49220 03/02/2018 1.01000 10/25/2019

TRAVOPROST (BENZALKONIUM) DROPS 0.004 % 29.13400 05/03/2013

TRAZODONE HCL ORAL TABLET 100 MG 0.10300 04/20/2016 0.06178 07/14/2017

TRAZODONE HCL ORAL TABLET 150 MG 0.13590 02/22/2019 0.08990 03/20/2020

TRAZODONE HCL ORAL TABLET 300 MG 2.76314 08/21/2015 2.19000 10/19/2018

TRAZODONE HCL ORAL TABLET 50 MG 0.08541 10/02/2015 0.03200 08/25/2017

TRETINOIN ORAL CAPSULE 10 MG 18.81170 12/05/2014

TRETINOIN TOPICAL CREAM (GRAM) 0.025 % 2.08949 03/20/2020 2.39910 03/30/2020

TRETINOIN TOPICAL CREAM (GRAM) 0.05 % 3.20000 10/25/2019 3.60262 03/23/2020

TRETINOIN TOPICAL CREAM (GRAM) 0.1 % 4.55930 04/01/2019 3.89489 07/26/2019

TRETINOIN TOPICAL GEL (GRAM) 0.01 % 1.51858 04/01/2019 3.77480 10/08/2019

TRETINOIN TOPICAL GEL (GRAM) 0.025 % 3.33916 08/19/2019 2.89600 03/20/2020

TRIAMCINOLONE ACETONIDE DENTAL PASTE (GRAM) 0.1 % 5.58000 12/21/2018 5.19600 03/20/2020

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TRIAMCINOLONE ACETONIDE INJECTION VIAL (ML) 10 MG/ML 1.52320 08/01/2014 1.52320 08/21/2015

TRIAMCINOLONE ACETONIDE INJECTION VIAL (ML) 40 MG/ML 2.89400 08/01/2014 2.89400 08/21/2015

TRIAMCINOLONE ACETONIDE NASAL AEROSOL, SPRAY (GRAM) 55 MCG 4.71467 03/27/2015 4.71467 08/21/2015

TRIAMCINOLONE ACETONIDE TOPICAL AEROSOL (GRAM) 0.147MG/G 2.72467 05/01/2015 2.64159 03/20/2020

TRIAMCINOLONE ACETONIDE TOPICAL CREAM (GRAM) 0.025 % 0.09310 08/12/2014 0.09310 08/21/2015

TRIAMCINOLONE ACETONIDE TOPICAL CREAM (GRAM) 0.1 % 0.05888 06/16/2017 0.04281 01/25/2019

TRIAMCINOLONE ACETONIDE TOPICAL CREAM (GRAM) 0.5 % 0.33419 07/14/2017 0.31333 10/25/2019

TRIAMCINOLONE ACETONIDE TOPICAL LOTION (ML) 0.025 % 0.76647 08/12/2014

TRIAMCINOLONE ACETONIDE TOPICAL LOTION (ML) 0.1 % 0.40833 11/24/2017 0.38000 11/15/2019

TRIAMCINOLONE ACETONIDE TOPICAL OINTMENT (GRAM) 0.025 % 0.28560 08/21/2015 0.13286 08/16/2019

TRIAMCINOLONE ACETONIDE TOPICAL OINTMENT (GRAM) 0.1 % 0.11910 02/20/2015 0.11910 08/21/2015

TRIAMCINOLONE ACETONIDE TOPICAL OINTMENT (GRAM) 0.5 % 0.38333 06/21/2019 0.35000 03/20/2020

TRIAMTERENE/HYDROCHLOROTHIAZIDE ORAL CAPSULE 37.5-25 MG 0.11056 03/03/2017 0.04697 12/22/2017

TRIAMTERENE/HYDROCHLOROTHIAZIDE ORAL TABLET 37.5-25 MG 0.15561 05/19/2017 0.07000 08/25/2017

TRIAMTERENE/HYDROCHLOROTHIAZIDE ORAL TABLET 75 MG-50MG 0.18148 08/21/2015 0.05500 09/22/2017

TRIAZOLAM ORAL TABLET 0.125 MG 0.20980 03/01/2013 0.20980 08/21/2015

TRIAZOLAM ORAL TABLET 0.25 MG 0.86737 02/13/2015 0.86737 08/21/2015

TRIFLUOPERAZINE HCL ORAL TABLET 1 MG 0.61215 04/24/2015 0.55090 11/24/2017

TRIFLUOPERAZINE HCL ORAL TABLET 10 MG 1.67825 04/24/2015 1.46378 06/21/2019

TRIFLUOPERAZINE HCL ORAL TABLET 2 MG 0.72000 08/17/2018 0.69000 11/16/2018

TRIFLUOPERAZINE HCL ORAL TABLET 5 MG 0.97490 01/19/2018 0.95030 03/02/2018

TRIFLURIDINE OPHTHALMIC DROPS 1 % 21.31330 07/09/2018 21.91752 04/15/2019

TRIHEXYPHENIDYL HCL ORAL ELIXIR 2 MG/5 ML 0.06175 02/13/2015

TRIHEXYPHENIDYL HCL ORAL TABLET 2 MG 0.05735 11/22/2013

TRIHEXYPHENIDYL HCL ORAL TABLET 5 MG 0.09110 08/25/2017 0.06878 01/19/2018

TRIMETHOBENZAMIDE HCL ORAL CAPSULE 300 MG 1.14618 04/12/2013

TRIMETHOPRIM ORAL TABLET 100 MG 0.27023 02/13/2015 0.16520 09/22/2017

TRIPROLIDINE HCL/PSEUDOEPHEDRINE HCL ORAL LIQUID (ML) 0.938-10/1

1.59900 08/12/2014 1.59900 08/21/2015

TRIPROLIDINE HCL/PSEUDOEPHEDRINE HCL ORAL SYRUP 1.25-30/5 0.05830 08/12/2014

TRIPROLIDINE HCL/PSEUDOEPHEDRINE HCL ORAL TABLET 2.5MG-60MG 0.05247 01/25/2013 0.05247 08/21/2015

TROPICAMIDE OPHTHALMIC DROPS 0.5 % 0.64860 08/12/2014

TROPICAMIDE OPHTHALMIC DROPS 1 % 0.52737 08/12/2014 0.34733 11/24/2017

TROSPIUM CHLORIDE ORAL CAPSULE, EXT RELEASE 24 HR 60 MG 4.06176 12/02/2016 3.77843 06/16/2017

TROSPIUM CHLORIDE ORAL TABLET 20 MG 0.37433 09/22/2017 0.25217 05/17/2019

UREA TOPICAL CREAM (GRAM) 40 % 0.16364 08/21/2015 1.75937 03/06/2019

UREA TOPICAL FOAM (GRAM) 35 % 0.88531 09/05/2014

UREA TOPICAL GEL WITH PREFILLED APPLICATOR (ML) 45 % 5.82575 01/25/2013

UREA TOPICAL KIT 40%-0.2% 282.72300 01/25/2013

UREA TOPICAL LOTION (GRAM) 45 % 0.17003 01/25/2013 0.17003 08/21/2015

UREA TOPICAL LOTION (ML) 40 % 0.07492 09/26/2014 0.07492 08/21/2015

UREA TOPICAL NAIL FILM SUSPENSION (ML) 40 % 11.93033 02/14/2014

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UREA/HYALURONATE SODIUM KIT 40%-0.2% 282.72300 01/25/2013

URSODIOL MISCELLANEOUS POWDER (GRAM) 100 % 1.52880 08/21/2015

URSODIOL ORAL CAPSULE 300 MG 1.28215 08/16/2019 0.79510 09/20/2019

URSODIOL ORAL TABLET 250 MG 0.89760 10/15/2018 0.71540 01/24/2020

URSODIOL ORAL TABLET 500 MG 1.05000 11/24/2017 0.63240 05/17/2019

VALACYCLOVIR HCL ORAL TABLET 1000 MG 0.37833 01/19/2018 0.34233 09/21/2018

VALACYCLOVIR HCL ORAL TABLET 500 MG 0.21606 06/21/2019 0.18200 07/26/2019

VALGANCICLOVIR HCL ORAL TABLET 450 MG 19.10000 09/22/2017 5.24417 11/15/2019

VALPROIC ACID (AS SODIUM SALT) (VALPROATE SODIUM) MISCELLANEOUS POWDER (GRAM) 100 %

0.69225 08/12/2014

VALPROIC ACID (AS SODIUM SALT) (VALPROATE SODIUM) ORAL SOLUTION, ORAL 250 MG/5ML

0.15149 05/01/2015 0.15149 08/21/2015

VALPROIC ACID (AS SODIUM SALT) (VALPROATE SODIUM) ORAL SOLUTION, ORAL 250 MG/5ML

0.01420 05/17/2013 0.01897 02/14/2020

VALPROIC ACID (AS SODIUM SALT) (VALPROATE SODIUM) ORAL SOLUTION, ORAL 500MG/10ML

0.08532 08/12/2014

VALPROIC ACID ORAL CAPSULE 250 MG 0.22504 04/12/2018 0.14010 02/22/2019

VALSARTAN ORAL TABLET 160 MG 0.46207 11/15/2019 0.32845 05/22/2020

VALSARTAN ORAL TABLET 320 MG 0.48608 10/02/2019 0.40033 04/17/2020

VALSARTAN ORAL TABLET 40 MG 0.05556 11/24/2017 0.18770 10/02/2019

VALSARTAN ORAL TABLET 80 MG 0.12753 05/19/2017 0.07372 03/02/2018

VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 160-12.5MG 0.11778 03/16/2018 0.66866 03/14/2020

VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 160-25MG 0.20035 03/03/2017 0.14689 03/16/2018

VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 320-12.5MG 0.25178 03/03/2017 0.20556 08/17/2018

VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 320MG-25MG 0.43524 12/19/2019 0.32422 05/22/2020

VALSARTAN/HYDROCHLOROTHIAZIDE ORAL TABLET 80-12.5MG 0.21031 03/03/2017 0.13678 08/25/2017

VANCOMYCIN HCL INTRAVENOUS VIAL (EA) 1 G 3.85000 05/17/2019 2.93100 03/20/2020

VANCOMYCIN HCL INTRAVENOUS VIAL (EA) 10 G 41.89000 09/16/2016 40.99000 08/17/2018

VANCOMYCIN HCL INTRAVENOUS VIAL (EA) 5 G 21.82000 07/04/2016 21.43000 08/17/2018

VANCOMYCIN HCL INTRAVENOUS VIAL (EA) 500 MG 2.11680 08/12/2014 2.11680 08/21/2015

VANCOMYCIN HCL INTRAVENOUS VIAL (EA) 750 MG 6.69900 01/25/2013

VANCOMYCIN HCL INTRAVENOUS VIAL WITH THREADED PORT (EA) 750 MG

10.90110 01/25/2013

VANCOMYCIN HCL ORAL CAPSULE 125 MG 2.25000 11/16/2018 2.10033 02/21/2020

VANCOMYCIN HCL ORAL CAPSULE 250 MG 7.23600 11/24/2017 6.49950 05/17/2019

VANCOMYCIN IN 5 % DEXTROSE IN WATER INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 1G/200ML

0.29786 07/25/2014

VANCOMYCIN IN 5 % DEXTROSE IN WATER INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 500MG/0.1L

0.18969 11/07/2014

VANCOMYCIN IN 5 % DEXTROSE IN WATER INTRAVENOUS IV SOLUTION, PIGGYBACK PREMIX FROZEN(ML) 750MG/.15L

0.17722 07/25/2014

VASOPRESSIN VIAL (ML) 20 UNIT/ML 3.14184 08/12/2014 3.14184 08/21/2015

VENLAFAXINE HCL ORAL CAPSULE, EXT RELEASE 24 HR 150 MG 0.14709 03/02/2018 0.14250 07/26/2019

VENLAFAXINE HCL ORAL CAPSULE, EXT RELEASE 24 HR 37.5 MG 0.10578 01/19/2018 0.09175 05/22/2020

VENLAFAXINE HCL ORAL CAPSULE, EXT RELEASE 24 HR 75 MG 0.15843 11/15/2019 0.09733 04/17/2020

VENLAFAXINE HCL ORAL TABLET 100 MG 0.09980 08/16/2019 0.05010 06/19/2020

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VENLAFAXINE HCL ORAL TABLET 25 MG 0.19030 08/25/2017 0.11520 11/16/2018

VENLAFAXINE HCL ORAL TABLET 37.5 MG 0.14520 08/17/2018 0.11380 07/26/2019

VENLAFAXINE HCL ORAL TABLET 50 MG 0.23880 09/22/2017 0.14160 08/17/2018

VENLAFAXINE HCL ORAL TABLET 75 MG 0.09780 12/22/2017 0.04630 05/22/2020

VENLAFAXINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 150 MG 3.19458 08/21/2015 2.62298 12/02/2016

VENLAFAXINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 225 MG 5.77550 01/09/2015 7.38620 12/11/2018

VENLAFAXINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 37.5 MG 3.22698 03/27/2015

VENLAFAXINE HCL ORAL TABLET, EXTENDED RELEASE 24 HR 75 MG 3.51130 03/27/2015 4.74492 12/31/2019

VERAPAMIL HCL INTRAVENOUS AMPUL (ML) 2.5 MG/ML 1.65480 01/25/2013

VERAPAMIL HCL INTRAVENOUS SYRINGE (ML) 2.5 MG/ML 4.46460 01/25/2013

VERAPAMIL HCL INTRAVENOUS VIAL (ML) 2.5 MG/ML 2.14400 01/25/2013 2.14400 08/21/2015

VERAPAMIL HCL MISCELLANEOUS POWDER (GRAM) 100 % 0.53976 08/21/2015

VERAPAMIL HCL ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 120 MG

1.35700 09/21/2016 0.86929 06/16/2017

VERAPAMIL HCL ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 180 MG

0.70015 04/10/2015 0.70015 08/21/2015

VERAPAMIL HCL ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 240 MG

0.89550 05/15/2015 0.89550 08/21/2015

VERAPAMIL HCL ORAL CAPSULE, EXTENDED RELEASE PELLETS 24 HR 360 MG

2.54807 04/10/2015 2.54807 08/21/2015

VERAPAMIL HCL ORAL CAPSULE,24HR EXTENDED RELEASE PELLET CT 100 MG

1.23210 08/12/2014 1.23210 08/21/2015

VERAPAMIL HCL ORAL CAPSULE,24HR EXTENDED RELEASE PELLET CT 200 MG

1.58723 01/25/2013 1.58723 08/21/2015

VERAPAMIL HCL ORAL CAPSULE,24HR EXTENDED RELEASE PELLET CT 300 MG

2.09080 02/27/2015 2.09080 08/21/2015

VERAPAMIL HCL ORAL TABLET 120 MG 0.06180 09/22/2017 0.04790 10/25/2019

VERAPAMIL HCL ORAL TABLET 40 MG 0.18824 05/30/2014

VERAPAMIL HCL ORAL TABLET 80 MG 0.05600 08/12/2014 0.05600 08/21/2015

VERAPAMIL HCL ORAL TABLET, EXTENDED RELEASE 120 MG 0.16750 03/16/2018 0.11030 08/17/2018

VERAPAMIL HCL ORAL TABLET, EXTENDED RELEASE 180 MG 0.16830 08/21/2015 0.10355 09/22/2017

VERAPAMIL HCL ORAL TABLET, EXTENDED RELEASE 240 MG 0.12965 10/20/2017 0.07657 03/02/2018

VINBLASTINE SULFATE INTRAVENOUS VIAL (ML) 1 MG/ML 2.22600 01/25/2013

VIT B COMPLEX/VIT C/FOLIC ACID/FERROUS FUMARATE/VIT E ACET ORAL TABLET 500-400-18

0.05547 01/25/2013

VITAMIN A/ASCORBIC ACID/ZINC/PROPOLIS (BEE GLUE) ORAL LOZENGE 15 MG

0.02440 08/12/2014

VITAMIN B COMPLEX AND VITAMIN C NO.20/FOLIC ACID ORAL CAPSULE 1 MG

0.16037 08/21/2015 0.09490 11/24/2017

VITAMIN B COMPLEX NO.3/FOLIC ACID/ASCORBIC ACID(VITC)/BIOTIN ORAL TABLET 1MG-60MG

0.12810 08/12/2014 0.12810 08/21/2015

VITAMIN B COMPLEX/LYSINE ORAL LIQUID (ML) 790MG/15ML 0.03270 01/25/2013

VITAMIN E (DL-ALPHA TOCOPHERYL ACETATE) ORAL CAPSULE 400 UNIT 0.04540 08/21/2015

VITAMIN E MIXED ORAL CAPSULE 400 UNIT 0.05369 08/12/2014 0.05369 08/21/2015

VITAMIN E ORAL CAPSULE 100 UNIT 0.02028 01/25/2013 0.02028 08/21/2015

VITAMIN E ORAL CAPSULE 1000 UNIT 0.12857 01/25/2013 0.12857 08/21/2015

VITAMIN E ORAL CAPSULE 200 UNIT 0.02860 08/12/2014

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VITAMIN E ORAL CAPSULE 400 UNIT 0.04540 08/12/2014 0.04540 08/21/2015

VITAMIN E ORAL DROPS 50 UNIT/ML 0.94477 01/31/2014

VITAMINS A AND D/WHITE PETROLATUM/LANOLIN TOPICAL OINTMENT IN PACKET (GRAM)

0.03450 08/12/2014

VORICONAZOLE INTRAVENOUS VIAL (EA) 200 MG 44.58750 08/12/2014

VORICONAZOLE ORAL SUSPENSION, RECONSTITUTED, ORAL (ML) 200 MG/5ML

9.84947 12/27/2013

VORICONAZOLE ORAL TABLET 200 MG 5.00600 08/17/2018 3.00000 05/17/2019

VORICONAZOLE ORAL TABLET 50 MG 5.86000 07/08/2016 4.93290 09/21/2018

WARFARIN SODIUM ORAL TABLET 1 MG 0.14230 01/19/2018 0.09226 08/16/2019

WARFARIN SODIUM ORAL TABLET 10 MG 0.21998 08/21/2015 0.12355 08/16/2019

WARFARIN SODIUM ORAL TABLET 2 MG 0.11277 08/16/2019 0.07090 05/22/2020

WARFARIN SODIUM ORAL TABLET 2.5 MG 0.20194 08/21/2015 0.06420 08/16/2019

WARFARIN SODIUM ORAL TABLET 3 MG 0.20206 08/21/2015 0.10730 07/26/2019

WARFARIN SODIUM ORAL TABLET 4 MG 0.10000 08/16/2019 0.08291 05/22/2020

WARFARIN SODIUM ORAL TABLET 5 MG 0.08184 06/21/2019 0.07560 07/26/2019

WARFARIN SODIUM ORAL TABLET 6 MG 0.23115 08/21/2015 0.07290 08/16/2019

WARFARIN SODIUM ORAL TABLET 7.5 MG 0.17462 08/21/2015 0.06695 08/16/2019

WATER FOR INJ.,BACTERIOSTATIC INJECTION VIAL (ML) 0.02828 03/20/2015 0.02828 08/21/2015

WATER FOR INJECTION,STERILE INJECTION AMPUL (ML) 0.08820 01/25/2013 0.08820 08/21/2015

WATER FOR INJECTION,STERILE INJECTION VIAL (ML) 0.07489 08/21/2015 0.05462 02/22/2019

WATER FOR INJECTION,STERILE INTRAVENOUS INTRAVENOUS SOLUTION

0.00226 05/01/2015 0.00226 08/21/2015

WATER FOR IRRIGATION,STERILE IRRIGATION SOLUTION, IRRIGATION 0.00545 08/12/2014 0.00545 08/21/2015

WATER ORAL LIQUID (ML) 0.01165 01/16/2015 0.01165 08/21/2015

WITCH HAZEL TOPICAL PADS, MEDICATED (EA) 50 % 0.07692 08/12/2014 0.07692 08/21/2015

ZAFIRLUKAST ORAL TABLET 10 MG 1.19188 01/25/2013 1.19188 01/01/2017

ZAFIRLUKAST ORAL TABLET 20 MG 1.11667 02/21/2020 0.82500 04/17/2020

ZALEPLON ORAL CAPSULE 10 MG 0.21311 08/21/2015 0.13820 09/22/2017

ZALEPLON ORAL CAPSULE 5 MG 0.21208 08/21/2015 0.17120 08/17/2018

ZIDOVUDINE ORAL CAPSULE 100 MG 0.82839 11/08/2013 0.82839 08/21/2015

ZIDOVUDINE ORAL SYRUP 10 MG/ML 0.12787 05/10/2013 0.09521 11/24/2017

ZIDOVUDINE ORAL TABLET 300 MG 0.37007 08/21/2015 0.30183 11/24/2017

ZINC CHLORIDE INTRAVENOUS VIAL (ML) 1 MG/ML 0.17050 08/12/2014

ZINC SULFATE INTRAVENOUS VIAL (ML) 1 MG/ML 0.21874 01/25/2013

ZINC SULFATE INTRAVENOUS VIAL (ML) 5 MG/ML 0.65343 01/25/2013

ZIPRASIDONE HCL ORAL CAPSULE 20 MG 0.22400 12/20/2019 0.19433 05/22/2020

ZIPRASIDONE HCL ORAL CAPSULE 40 MG 0.39000 11/16/2018 0.26000 12/21/2018

ZIPRASIDONE HCL ORAL CAPSULE 60 MG 0.43250 06/22/2018 0.24917 05/17/2019

ZIPRASIDONE HCL ORAL CAPSULE 80 MG 0.28483 03/20/2020 0.25617 05/22/2020

ZOLEDRONIC ACID IN MANNITOL AND 0.9 % SODIUM CHLORIDE INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 4 MG/100ML

10.14930 08/16/2013

ZOLEDRONIC ACID IN MANNITOL AND WATER FOR INJECTION INTRAVENOUS INTRAVENOUS SOLUTION, PIGGYBACK (ML) 5 MG/100ML

8.37592 10/25/2013

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ZOLMITRIPTAN ORAL TABLET 2.5 MG 5.62000 06/16/2017 0.96500 09/21/2018

ZOLMITRIPTAN ORAL TABLET 5 MG 2.88000 02/21/2020 2.65000 04/17/2020

ZOLMITRIPTAN ORAL TABLET,DISINTEGRATING 2.5 MG 7.56000 06/16/2017 5.64000 06/22/2018

ZOLMITRIPTAN ORAL TABLET,DISINTEGRATING 5 MG 5.50481 06/16/2017 3.89667 09/22/2017

ZOLPIDEM TARTRATE ORAL TABLET 10 MG 0.02680 03/27/2015 0.02680 08/21/2015

ZOLPIDEM TARTRATE ORAL TABLET 5 MG 0.02680 03/13/2015 0.02680 08/21/2015

ZOLPIDEM TARTRATE ORAL TABLET, EXTENDED RELEASE MULTIPHASE 12.5 MG

0.52530 12/22/2017 0.48879 03/16/2018

ZOLPIDEM TARTRATE ORAL TABLET, EXTENDED RELEASE MULTIPHASE 6.25 MG

0.38000 10/19/2018 0.18852 06/21/2019

ZONISAMIDE ORAL CAPSULE 100 MG 0.14126 04/05/2019 0.10150 03/20/2020

ZONISAMIDE ORAL CAPSULE 25 MG 0.12974 04/21/2017 0.07950 07/14/2017

ZONISAMIDE ORAL CAPSULE 50 MG 0.15682 04/28/2016 0.12410 08/25/2017

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