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![Page 1: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/1.jpg)
RUGBY Products
FIBERCON® FIBER-LAX POLYCARBOPHIL TABLETS
FLEET® ENEMA ENEMA DISPOSABLE
FLINTSTONES® CHEWABLE-VITE TABLETS
FLINTSTONES® PLUS IRON CHEWABLE-VITE W/IRON TABLETS
LACTAID® LAC-DOSE® CAPTABS
LIQUIFILM® TEARS ARTIFICIAL TEARS SOLUTION STERILE
MAALOX® ADVANCED REG. STRENGTH RULOX ANTACID SUSP-MINT FLAVOR
MEGA RED® KRILL OIL SOFTGEL CAPS
METAMUCIL® REGULOID® CAPSULES & POWDER
MINERAL ICE® BLUE GEL/MUSCULAR PAIN RELIEF
MYLANTA® ALMACONE® ANTACID LIQUID
MYLANTA® DOUBLE STRENGTH ALMACONE® DOUBLE STRENGTH ANTACID
MYLANTA® GAS SIMETHICONE GAS RELIEF TABLETS
MYLANTA® GAS MAX STR SIMETHICONE MAX STR GAS RELIEF TABLETS
MYLICON® SIMETHICONE GAS RELIEF DROPS
NEO-CALGLUCON® CALCIONATE SYRUP
NICORETTE® GUM NICOTINE POLACRILEX GUM
OCEAN® NASAL MIST SALINE MIST
OCUVITE® I-VITE TABLETS
OCUVITE® PRESERVISION® I-VITE PROTECT TABLETS
ONE-A-DAY® ESSENTIAL DAILY-VITE TABLETS
OS-CAL® 250+D TABS OYSCO® D TABLETS
OS-CAL® 500 OYSCO® 500 TABLETS
OS-CAL® CHEWABLE OYSCO® 500+D CHEW TABS
OS-CAL® 500+D OYSCO® 500+D TABLETS
OXY BALANCE® BENZOYL PEROX/ACNE MED 5% GEL
OXY-10 BALANCE® BENZOYL PEROX/ACNE MED 10% GEL
PEDIALYTE® ORALYTE® SOLUTION & FREEZER POPS
PEPTO-BISMOL® PEPTIC RELIEF CHEW TABLETS
PERCOGESIC® ACETA-GESIC® PAIN TABLETS
PERI-COLACE® DOC SOD & SENNA TABLETS
PHAZYME® SIMETHICONE GAS RELIEF SOFTGELS
PHILLIPS’® MILK OF MAGNESIA
BRAND TO GENERIC REFERENCE CHART
2
COMPARE TO DESCRIPTION
RUGBY Products
POLY-VI-SOL® POLY VITAMIN CHEW TABLETS & DROPS
POLY-VI-SOL® WITH IRON POLY VITAMIN W/IRON CHEW TABS & DROPS
PREVACID®24HR LANSOPRAZOLE DR CAPSULES
ROBITUSSIN® GUAIFENESIN COUGH SYRUP
ROBITUSSIN® DM GUAIFENESIN DM EXTRA ACTN COUGH SYRUP
SEBULEX® SEBEX SHAMPOO
SELSUN BLUE® SELENIUM SULF/ANTI-DANDRUFF SHAMPOO
SENOKOT® SENEXON® NATURAL VEG LAXATIVE LIQUID & TABS
SENOKOT-S® SENEXON®-S NATURAL VEG LAXATIVE TABS
SLOW FE® FERROUS SULFATE ER TABLETS
STRESSTABS® VI-STRESS TABLETS
STUART PRENATAL® PRENAVITE® TABLETS FC
SUDAFED® PSEUDOEPHEDRINE/NASAL DECON TABLETS
SURFAK® DOC CAL/STL SOFT-DC SGEL CAPS
TEARS NATURALE® NATURE’S TEARS
THERAGRAN® THEREMS® FILM COATED TABLETS
THERAGRAN-M® ADV THEREMS®-M FILM COATED TABLETS
TINACTIN® TOLNAFTATE 1% ANTIFUNGAL POWDER
TRIPLE FLEX® GLUCOSAMINE, CHONDROITIN AND MSM
TRI-VI-SOL® TRI-VITAMIN DROPS
TUMS® CAL-GEST® ANTACID CHEW TABLETS
TYLENOL® APAP PAIN/FEVER TABLETS
TYLENOL®, CHILDREN’S APAP PAIN/FEVER CHILDREN’S CHEW TABS
TYLENOL®, CHILDREN’S APAP PAIN/FEVER ORAL SOLUTION
TYLENOL® EXTRA STR APAP PAIN/FEVER X-STR TABLETS/CAPTABS
TYLENOL® INFANTS’ DROPS APAP PAIN/FEVER CONCENTRATED DROPS
TYLENOL® INFANTS’ ORAL SUSP APAP PAIN/FEVER CHILDREN’S ORAL SUSP
TYLENOL® PM APAP/DIPH CAPTABS
UNICAP-M® UNICOMPLEX-M TABLETS
VISINE® TETRAHYDROZOLINE/EYE DROPS
Z-BEC® BEE-ZEE TABLETS
ZOSTRIX® CAPSAICIN 0.025% CREAM
ZYRTEC® CETIRIZINE HCL TABLETS
BRAND TO GENERIC REFERENCE CHART
3
COMPARE TO DESCRIPTION
![Page 2: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/2.jpg)
4/A
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
360501 ACETA-GESIC® PAIN TABLETS 100 PERCOGESIC® $2.40 305363605016
718001 ACIDOPHILUS CAPTABS® 100 $4.43 005367180013
718101 ACIDOPHILUS EXTRA STRENGTH CAPTABS® 100 $4.43 005367181010
750001 ALCOHOL PREPS STERILE PADS 100 $3.01 305367500010
037097 ALLER-CHLOR® SYRUP 4 OZ CHLOR-TRIMETON® $3.27 305360370979
346701 ALLER-CHLOR®/CPM 4 MG TABLETS 100 CHLOR-TRIMETON® $5.70 305363467010
346710 ALLER-CHLOR®/CPM 4 MG TABLETS 1000 CHLOR-TRIMETON® $17.17 305363467102
346735 ALLER-CHLOR®/CPM 4 MG TABLETS BL/PK 24 CHLOR-TRIMETON® $3.06 305363467355
002583 ALMACONE® ANTACID LIQUID 12 OZ MYLANTA® $3.10 305360025831
350401 ALMACONE® CHEW TABS MLT 100 $3.78 305363504012
001583 ALMACONE® DOUBLE STRENGTH ANTACID 12 OZMYLANTA®
$4.45 305360015832DOUBLE STRENGTH
009185 ALUMINUM HYDROXIDE GEL PT AMPHOJEL® $5.60 305360091850
558806 ANTIOXIDANT FORMULA SGEL CAPS 50 $5.40 005365588064
558908 ANTIOXIDANT ULTRA FORMULA SGEL CAPS 60 $13.43 005365589085
193672 APAP PAIN/FEVER 15 ML TYLENOL® INFANTS’ DROPS $3.15 305361936723CONCENTRATED DROPS
012285 APAP ORAL SOL PAIN/FEVER – CHERRY PT TYLENOL®, CHILDREN’S $8.25 305360122851
012297 APAP ORAL SOL PAIN/FEVER – CHERRY 4 OZ TYLENOL®, CHILDREN’S $3.78 305360122974
322201 APAP 325 MG PAIN/FEVER TABLETS 100 TYLENOL® $4.20 305363222015
322210 APAP 325 MG PAIN/FEVER TABLETS 1000 TYLENOL® $22.42 305363222107
323307 APAP 80 MG PAIN/FEVER 30 TYLENOL®, CHILDREN’S $2.63 305363233073CHILD’S CHEWTABS – FRUIT
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
NO.
1
5
9
13
17
2
6
10
14
18
3
7
11
15
19
4
8
12
16
20
![Page 3: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/3.jpg)
21
25
29
33
37
22
26
30
34
38
23
27
31
35
39
24
28
32
36
40
360696 APAP 160 MG PAIN/FEVER 2 OZ INFANTS’ TYLENOL® $3.94 305363606969CHILD’S ORAL SUSP-CHERRY
321801 APAP 500 MG PAIN/FEVER X-STR CAPTABS 100 TYLENOL® EXTRA STR $5.10 305363218018
321810 APAP 500 MG PAIN/FEVER X-STR CAPTABS 1000 TYLENOL® EXTRA STR $29.93 305363218100
323101 APAP 500 MG PAIN/FEVER X-STR TABLETS 100 TYLENOL® EXTRA STR $4.72 305363231017
323110 APAP 500 MG PAIN/FEVER X-STR TABLETS 1000 TYLENOL® EXTRA STR $29.85 305363231109
347906 APAP 500 MG/DIPH 25 MG CAPTABS 50 TYLENOL® PM $5.27 305363479068
655091 ARTIFICIAL TEARS OPHTH OINTMENT 1 DZ $44.39 305366550917
197072 ARTIFICIAL TEARS SOLUTION STERILE 15 ML LIQUIFILM® TEARS $4.38 305361970727
329736 ASPIRIN 1 1/4 GR CHEW TABLETS 36 BAYER® CHILDREN’S $2.25 305363297365
308610 ASPIRIN 81 MG EC TABLETS 1000 BAYER®, ASPIRIN REGIMEN$45.66 305363086105
308641 ASPIRIN 81 MG EC TABLETS 120 BAYER®, ASPIRIN REGIMEN $5.48 305363086419
331301 ASPIRIN 325 MG TABLETS EC ORANGE 100 ECOTRIN® $4.20 305363313010
331310 ASPIRIN 325 MG TABLETS EC ORANGE 1000 ECOTRIN® $26.55 305363313102
330501 ASPIRIN 325 MG TABLETS 100 BAYER®, GENUINE $3.45 305363305015MICRO-COATED WHITE
330510ASPIRIN 325 MG TABLETS
1000 BAYER®, GENUINE $20.25 305363305107MICRO-COATED WHITE
335708 BEE-ZEE TABLETS 60 Z-BEC® $5.25 005363357082
409256 BENZOYL PEROX GEL/ACNE MED 10% TB OXY-10 BALANCE® $6.91 305364092563
408956 BENZOYL PEROX GEL/ACNE MED 5% TB OXY BALANCE® $5.68 305364089563
081595 BENZOYL PEROX LOTION/ACNE MED 10% 1 OZ $3.45 305360815951
081095 BENZOYL PEROX LOTION/ACNE MED 5% 1 OZ $3.02 305360810956
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
6/A-B
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.NDC
DESCRIPTION SIZE COMPARE
SWPUPC
00536- TO CODE
![Page 4: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/4.jpg)
41
45
49
53
57
42
46
50
54
58
43
47
51
55
59
44
48
52
56
60
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
8/B-C
490201 BETA CAROTENE 25,000 IU SGEL CAPS 100 $6.00 005364902014
665901 BIOTIN 300 MCG TABLETS 100 $3.74 005366659015
230259 BLUE GEL /MUSCULAR PAIN RELIEF 8 OZ MINERAL ICE® $3.97 305362302596
379201 CALCI-CHEW CHERRY 100 $11.66 005363792012
379101 CALCI-MIX 100 $13.71 005363791015
277085 CALCIONATE SYRUP PT NEO-CALGLUCON® $19.73 005362770851
342608 CALCIUM 600 TABLETS 60 CALTRATE® 600 $4.79 005363426085
342408 CALCIUM 600-D TABLETS 60 CALTRATE® 600 + D $4.79 005363424081
341410 CALCIUM CARBONATE 10 GR TABLETS 1000 $15.75 305363414106
688908 CALCIUM 500 MG CHEW TABLETS 60 $4.35 005366889085
341610 CALCIUM GLUCONATE 10 GR TABLETS 1000 $17.32 005363416109
342201 CALCIUM LACTATE 10 GR TABLETS 100 $3.46 005363422018
342210 CALCIUM LACTATE 10 GR TABLETS 1000 $18.15 005363422100
474297 CAL-GEST® ANTACID CHEW TABLETS 150 TUMS® $4.13 305364742970
252525 CAPSAICIN 0.025% CREAM 60 GM ZOSTRIX® $9.95 305362525254
344238 CEROVITE® TABLETS ADVANCED FORMULA 130 CENTRUM® $6.45 005363442382
344308 CEROVITE® JR. CHEW TABLETS 60 CENTRUM KIDS® COMPLETE $3.82 005363443082
279059 CEROVITE® LIQUID 8 OZ CENTRUM® LIQUID $5.40 005362790590
344508 CEROVITE® SENIOR TABLETS 60 CENTRUM® SILVER® $4.65 005363445086
408888 CETIRIZINE HCL 10 MG TABLETS 14 ZYRTEC® $3.69 305364088887
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 5: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/5.jpg)
61
65
69
73
77
62
66
70
74
78
63
67
71
75
79
64
68
72
76
80
408807 CETIRIZINE HCL 10 MG TABLETS 30 ZYRTEC® $4.60 305364088078
408811 CETIRIZINE HCL 10 MG TABLETS 90 ZYRTEC® $10.43 305364088115
344801 CHEWABLE VITE TABLETS 100 FLINTSTONES® $5.25 005363448018
344901 CHEWABLE VITE W/IRON TABLETS 100 FLINTSTONES® PLUS IRON $5.47 005363449015
345101 CHLOROPHYLL TABLETS 100 $2.78 005363451018
666808 CHROMIUM (PICOLINATE) 200 MCG 60 $7.43 005366668086SGEL CAPS
322408 CITRUS CALCIUM + D TABLETS 60 CITRACAL® MAXIMUM $5.10 005363224087
322301 CITRUS CALCIUM W/VITAMIN D TABLETS 100 CITRACAL® PETITES $5.10 005363223011
638401 COD LIVER OIL SGEL CAPS 100 $3.30 005366384016
193807 COENZYME Q10 100 MG SGEL CAPS 30 $14.85 005361938078
203007 COENZYME Q10 200 MG SGEL CAPS 30 $17.34 005362030078
999512 CONDOMS PREM. LUBRICATED (BOX 12) 1 $3.78 305369995128
354701 DAILY-VITE TABLETS 100 ONE-A-DAY® ESSENTIAL $4.19 005363547018
354710 DAILY-VITE TABLETS 1000 ONE-A-DAY® ESSENTIAL $20.92 005363547100
354601 DAILY-VITE TABLETS W/IRON 100 $3.52 005363546011
354610 DAILY-VITE TABLETS W/IRON 1000 $20.92 005363546103
059085 DIOCTO LIQUID PT COLACE® LIQUID $12.00 305360590858
060085 DIOCTO SYRUP PT COLACE® $5.70 305360600854
359701 DIPHENHIST® 25 MG CAPTABS 100 BENADRYL® ALLERGY $6.38 305363597014
359401 DIPHENHIST® 25 MG BANDED CAPSULES 100 BENADRYL® ALLERGY $6.38 305363594013
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
10/C-D
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 6: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/6.jpg)
81
85
89
93
97
82
86
90
94
98
83
87
91
95
99
84
88
92
96
100
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
12/D-F
077097 DIPHENHIST® ORAL SOLUTION BOXED 4 OZ BENADRYL® ALLERGY LIQ $3.78 305360770977
077085 DIPHENHIST® ORAL SOLUTION PT BENADRYL® ALLERGY LIQ $7.42 305360770854
377206 DIPHENHYDRAMINE HCL 50 MG TABLETS 50 COMPOZ® $4.43 305363772060
375501 DOC CAL/STL SOFT-DC 240 MG SGEL CAPS 100 SURFAK® $9.14 305363755018
375510 DOC CAL/STL SOFT-DC 240 MG SGEL CAPS 1000 SURFAK® $77.48 305363755100
375505 DOC CAL/STL SOFT-DC 240 MG SGEL CAPS 500 SURFAK® $40.91 305363755056
375701 DOC SOD/STL SOFT 250 MG X-STR SGEL CAPS 100 $6.57 305363757012
375710 DOC SOD/STL SOFT 250 MG X-STR SGEL CAPS 1000 $40.83 305363757104
375601 DOC SOD/STL SOFT 100 MG –RED SGEL CAPS 100 COLACE® $5.92 305363756015
375610 DOC SOD/STL SOFT 100 MG –RED SGEL CAPS 1000 COLACE® $32.40 305363756107
035510 DOCUSATE SODIUM 50 MG & 1000 PERI-COLACE® $31.95 305360355105SENNA 8.6 MG TABS
035501 DOCUSATE SODIUM 50 MG & 100 PERI-COLACE® $4.95 305360355013SENNA 8.6 MG TABS
300094 EARWAX TREATMENT DROPS 15 ML DEBROX® $2.54 305363000941
741551 ENEMA DISPOSABLE 4.5 OZ FLEET® ENEMA $0.79 305367415512
090197 EYE IRRIGATING SOLUTION 4 OZ $4.12 305360901975
589001 FERROUS SULFATE 325 MG 100 $4.04 005365890013(5 GR) FC RED TABLETS
071080 FER-IRON DROPS 50 ML FER-IN-SOL® DROPS $5.24 005360710804
065085 FERROUS SULFATE ELIXIR PT FEOSOL® ELIXIR $5.93 005360650858
348107 FERROUS SULFATE ER 140 MG TABLETS 30 SLOW FE® $5.81 005363481077
348108 FERROUS SULFATE ER 140 MG TABLETS 60 SLOW FE® $9.90 005363481084
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 7: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/7.jpg)
101
105
109
113
117
102
106
110
114
118
103
107
111
115
119
104
108
112
116
120
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
14/F-I
430605 FIBER-LAX POLYCARBOPHIL 500 MG TABLETS 500 FIBERCON® $44.62 305364306059
430608 FIBER-LAX POLYCARBOPHIL 500 MG TABLETS 60 FIBERCON® $6.59 305364306080
430611 FIBER-LAX POLYCARBOPHIL 500 MG TABLETS 90 FIBERCON® $11.24 305364306110
384401 FOLIC ACID 400 MCG TABLETS 100 $2.10 005363844018
384301 FOLIC ACID 800 MCG TABLETS 100 $2.40 005363843011
311108 GLUCOSAMINE, CHONDROITIN AND MSM 60 TRIPLE FLEX® $12.76 005363111080
082597 GUAIFENESIN COUGH SYRUP BOXED 4 OZ ROBITUSSIN® $2.79 305360825974
082585 GUAIFENESIN COUGH SYRUP PT ROBITUSSIN® $4.94 305360825851
097085 GUAIFENESIN DM EXTRA ACTN COUGH SYRUP PT ROBITUSSIN® DM $8.09 305360970858
097097 GUAIFENESIN DM EXTRA ACTN COUGH SYRUP 4 OZ ROBITUSSIN® DM $3.27 305360970971
138912 HEMORRHOIDAL SUPPOSITORIES 12 $3.30 305361389123
510895 HYDROCORTISONE 1% CREAM/HYDROSKIN® 1 OZ CORTIZONE-10® $2.85 305365108959
510597 HYDROCORTISONE 1% LOTION/HYDROSKIN® 4 OZ $8.09 305365105972
360330 IBUPROFEN 200 MG SOFTGEL CAPSULES 80 ADVIL® LIQUI-GELS® $6.32 305363603302
358701 IBUPROFEN 200 MG TAB BROWN ROUND 100 ADVIL® $4.67 305363587015
358710 IBUPROFEN 200 MG TAB BROWN ROUND 1000 ADVIL® $46.83 305363587107
358702 IBUPROFEN 200 MG TAB BROWN ROUND 250 ADVIL® $9.33 305363587022
358706 IBUPROFEN 200 MG TAB BROWN ROUND 50 ADVIL® $2.92 305363587060
398401 INOSITOL 500 MG TABLETS 100 $8.24 005363984011
509008 I-VITE TABLETS 60 OCUVITE® $4.64 005365090086
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 8: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/8.jpg)
121
129
133
137
122
126
130
134
138
123
127
131
135
139
124
128
132
136
140
125
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
16/I-M
417841 I-VITE PROTECT TABLETS 120 OCUVITE® PRESERVISION® $10.31 005364178419
231097 KIDKARE COUGH & COLD LIQUID 4 OZ $3.15 305362310973
348008 KRILL OIL 300 MG SOFTGEL CAPS 60 MEGA RED® $21.55 005363480087
408706 LAC-DOSE® CAPTABS 50 LACTAID® $5.70 005364087063
412288 LANSOPRAZOLE DR 15 MG CAPS 14 PREVACID®24HR $9.64 305364122888
338101 LAXATIVE EC TABS/BISACODYL 5 MG 100 DULCOLAX® $7.41 305363381019
338110 LAXATIVE EC TABS/BISACODYL 5 MG 1000 DULCOLAX® $27.55 305363381101
135501 LAXATIVE SUPPOSITORIES/BISACODYL 10 MG 100 DULCOLAX® SUPP $15.75 305361355012
135512 LAXATIVE SUPPOSITORIES/BISACODYL 10 MG 12 DULCOLAX® SUPP $4.17 305361355128
741008 L-CARNITINE 250 MG CAPS 60 $37.99 005367410080
390808 LIPOGEN SGEL CAPS 60 $6.45 005363908086
673101 L-LYSINE 500 MG TABLETS 100 $3.52 005366731018
704906 L-TYROSINE 500 MG CAPTABS® 50 $6.30 005367049068
668001 MAGNESIUM 27 MG CHELATED TABLETS 100 $3.37 005366680019
352141 MAGNESIUM OXIDE 400 MG TABLETS 120 $8.25 005363521414
398501 MECLIZINE HCL 12.5 MG TABLETS 100 $4.72 305363985019
398510 MECLIZINE HCL 12.5 MG TABLETS 1000 $42.48 305363985101
399001 MECLIZINE HCL 25 MG CHEW TABLETS 100 BONINE® $4.80 305363990013
399010 MECLIZINE HCL 25 MG CHEW TABLETS 1000 BONINE® $43.20 305363990105
641208 MELATONIN 3 MG TABLETS 60 $12.95 005366412085
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 9: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/9.jpg)
141
145
149
153
157
142
146
150
154
158
143
147
151
155
159
144
148
152
160
156
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
18/M-N
247083 MILK OF MAGNESIA 12 OZ PHILLIPS’® $2.92 305362470837
247085 MILK OF MAGNESIA PT PHILLIPS’® $3.60 305362470851
404401 MULTILEX TABLETS 100 $5.70 005364044011
406001 MULTILEX T&M TABLETS 100 $6.83 005364060011
404610 MULTIVITAMINS TABLETS (8 VITAMINS) 1000 $19.12 005364046107
411306 NAPROXEN SODIUM 220 MG CAPTABS 50 ALEVE® $4.53 305364113060
623772 NATURE’S TEARS 15 ML TEARS NATURALE® $4.35 305366237726
730001 NEPHRO-VITE® TABLETS 100 $16.54 005367300015
407601 NIACIN 100 MG TABLETS (NICOTINIC) 100 $2.55 005364076012
407610 NIACIN 100 MG TABLETS (NICOTINIC) 1000 $21.39 005364076104
407810 NIACIN 500 MG TABLETS (NICOTINIC) 1000 $27.50 005364078108
407001 NIACIN 50 MG TABLETS (NICOTINIC) 100 $2.10 005364070010
407401 NIACIN 250 MG ER CAPSULES (NICOTINIC) 100 $8.42 005364074018
407701 NIACIN 500 MG ER CAPSULES (NICOTINIC) 100 $11.21 005364077019
703801 NIACIN 1000 MG TR CAPTABS® (NICOTINIC) 100 $8.25 005367038017
703001 NIACIN 500 MG TR TABLETS (NICOTINIC) 100 $6.30 005367030011
703301 NIACIN 750 MG TR TABLETS (NICOTINIC) 100 $7.42 005367033012
406801 NIACINAMIDE 100 MG TABLETS 100 $2.40 005364068017
406901 NIACINAMIDE 500 MG TABLETS 100 $3.45 005364069014
136234 NICOTINE GUM 2 MG MINT 20 NICORETTE® GUM $11.99 305361362348
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 10: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/10.jpg)
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
20/N
136206 NICOTINE GUM 2 MG MINT 50 NICORETTE® GUM $21.36 305361362065
137234 NICOTINE GUM 4 MG MINT 20 NICORETTE® GUM $13.32 305361372347
137206 NICOTINE GUM 4 MG MINT 50 NICORETTE® GUM $25.81 305361372064
136223 NICOTINE GUM 2 MG MINT 110 NICORETTE® GUM $30.98 305361362232
137223 NICOTINE GUM 4 MG MINT 110 NICORETTE® GUM $41.96 305361372231
302934 NICOTINE GUM 2 MG ORIGINAL 20 NICORETTE® GUM $11.99 305363029348
302906 NICOTINE GUM 2 MG ORIGINAL 50 NICORETTE® GUM $21.36 305363029065
302923 NICOTINE GUM 2 MG ORIGINAL 110 NICORETTE® GUM $30.98 305363029232
303006 NICOTINE GUM 4 MG ORIGINAL 50 NICORETTE® GUM $25.81 305363030061
303023 NICOTINE GUM 4 MG ORIGINAL 110 NICORETTE® GUM $41.96 305363030238
340437 NICOTINE GUM 2 MG COATED CINNAMON 40NICORETTE® CINNAMONSURGE™ COATED GUM
$23.40 305363404374
340401 NICOTINE GUM 2 MG COATED CINNAMON 100 NICORETTE® CINNAMONSURGE™ COATED GUM
$39.50 305363404015
340537 NICOTINE GUM 4 MG COATED CINNAMON 40 NICORETTE® CINNAMONSURGE™ COATED GUM
$24.63 305363405371
340501 NICOTINE GUM 4 MG COATED CINNAMON 100 NICORETTE® CINNAMONSURGE™ COATED GUM
$41.58 305363405012
338637 NICOTINE GUM 2 MG COATED FRUIT 40 NICORETTE® FRUIT CHILL™COATED GUM
$23.40 305363386373
338601 NICOTINE GUM 2 MG COATED FRUIT 100 NICORETTE® FRUIT CHILL™COATED GUM
$39.50 305363386014
338737 NICOTINE GUM 4 MG COATED FRUIT 40 NICORETTE® FRUIT CHILL™$24.63 305363387370COATED GUM
338701 NICOTINE GUM 4 MG COATED FRUIT 100 NICORETTE® FRUIT CHILL™$41.58 305363387011COATED GUM
311237 NICOTINE GUM 2 MG COATED MINT 40 NICORETTE® FRESH MINT™$23.40 305363112378COATED GUM
311201 NICOTINE GUM 2 MG COATED MINT 100 NICORETTE® FRESH MINT™$39.50 305363112019COATED GUM
161
165
169
177
162
166
170
178
163
167
171
175
179
164
168
172
180
176174173
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 11: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/11.jpg)
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
22/N-P
NO.
311337 NICOTINE GUM 4 MG COATED MINT 40 NICORETTE® FRESH MINT™$24.63 305363113375COATED GUM
311301 NICOTINE GUM 4 MG COATED MINT 100 NICORETTE® FRESH MINT™$41.58 305363113016COATED GUM
500572 NRS®-NASAL RELIEF SPRAY 15 ML AFRIN® SPRAY $3.38 305365005722
500575 NRS®-NASAL RELIEF SPRAY 30 ML AFRIN® SPRAY $4.42 305365005753
139517 ORALYTE® FREEZER POPS 16 PEDIALYTE® $6.58 305361395179
093686 ORALYTE® SOLUTION – BUBBLE GUM 33 OZ PEDIALYTE® $6.58 305360936861
093586 ORALYTE® SOLUTION – FRUIT 33 OZ PEDIALYTE® $6.58 305360935864
138586 ORALYTE® SOLUTION – GRAPE 33 OZ PEDIALYTE® $6.58 305361385866
000486 ORALYTE® SOLUTION – UNFLAVORED 33 OZ PEDIALYTE® $6.58 305360004867
781708 OYSCO® 500 + D TABLETS 60 OS-CAL® 500 + D $4.35 005367817087
781710 OYSCO® 500 + D TABLETS 1000 OS-CAL® 500 + D $14.49 005367817100
339908 OYSCO® 500 + D CHEW TABS 60 OS-CAL® CHEWABLE $5.67 005363399082
410602 OYSCO® 500 TABLETS 250 OS-CAL® 500 $13.42 005364106023
410608 OYSCO® 500 TABLETS 60 OS-CAL® 500 $4.35 005364106085
410301 OYSCO® D/CALCIUM SUPPLEMENT TABLETS 100 OS-CAL® 250 + D TABS $3.52 005364103015
410310 OYSCO® D/CALCIUM SUPPLEMENT TABLETS 1000 OS-CAL® 250 + D TABS $22.43 005364103107
410302 OYSCO® D/CALCIUM SUPPLEMENT TABLETS 250 OS-CAL® 250 + D TABS $7.95 005364103022
671701 PANTOTHENIC ACID 500 MG TABLETS 100 $5.62 005366717012
650601 PAPAYA ENZYME TABLETS 100 $2.90 005366506012
430107 PEPTIC RELIEF CHEW TABLETS 30 PEPTO-BISMOL® $2.93 305364301078
181
185
189
193
197
182
186
190
194
198
183
187
191
195
199
184
192
196
200
188
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 12: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/12.jpg)
201
205
209
213
217
202
206
210
214
218
203
207
211
215
219
204
208
212
216
220
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
24/P-R
181059 PEPTIC RELIEF LIQUID 8 OZ $3.12 305361810597
242558 PHENASEPTIC THROAT SPRAY 6 OZ CHLORASEPTIC® $2.93 305362425585
430401 POLY VITAMIN CHEW TABLETS 100 POLY-VI-SOL® $4.43 005364304016
781601 POLY VITAMIN CHEW W/IRON TABS 100 POLY-VI-SOL® WITH IRON $4.65 005367816011
845080 POLY VITAMIN DROPS 50 ML POLY-VI-SOL® $5.24 005368450801
853080 POLY VITAMIN DROPS W/IRON 50 ML POLY-VI-SOL® WITH IRON $5.24 005368530800
408501 PRENAVITE® TABLETS FC 100 STUART PRENATAL® $6.21 005364085014
406301 PRENAVITE® TABLETS PROTEIN COATED 100 $6.21 005364063012
311607 PROBIOTIC FORMULA CAPSULES 30 $9.94 005363116078
185097 PSEUDOEPHEDRINE/NASAL DCON. 4 OZ $3.15 305361850975LIQUID BOX
185085 PSEUDOEPHEDRINE/NASAL DCON. LIQUID PT $7.42 305361850852
439135 PSEUDOEPHEDRINE/NASAL DCON. TABS BL/PK 24 SUDAFED® $2.47 305364391352
150060 REGULOID® CAPSULES 160 METAMUCIL® $9.70 305361500603
187579 REGULOID® S-FREE LAX POWDER ORANGE 10 OZ METAMUCIL® ORANGE $6.42 305361875794
187516 REGULOID® S-FREE LAX POWDER ORANGE 15 OZ METAMUCIL® ORANGE $7.96 305361875169
188179 REGULOID® S-FREE LAX POWDER REGULAR 10 OZ METAMUCIL® $6.42 305361881795
188116 REGULOID® S-FREE LAX POWDER REGULAR 15 OZ METAMUCIL® $7.96 305361881160
444554 REGULOID®/NAT VEGETABLE 13 OZ METAMUCIL® ORANGE $5.25 305364445543LAX POWDER ORANGE
444589 REGULOID®/NAT VEGETABLE 19 OZ METAMUCIL® ORANGE $7.42 305364445895LAX POWDER ORANGE
444454REGULOID®/NAT VEGETABLE
13 OZ METAMUCIL® $5.25 305364444546LAX POWDER REGULAR
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 13: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/13.jpg)
221
225
229
233
237
222
226
230
234
238
223
227
231
235
239
224
228
232
236
240
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
26/R-S
444489 REGULOID®/NAT VEGETABLE 19 OZ METAMUCIL® $7.42 305364444898LAX POWDER REGULAR
194583 RULOX ANTACID SUSP-MINT FLAVOR 19 OZMAALOX® ADVANCED
$2.85 305361945831REG. STRENGTH
250676 SALINE MIST 45 ML OCEAN® NASAL MIST $2.32 005362506764
718601 SEA OMEGA® 30 SGEL CAPS 100 $6.75 005367186015
718706 SEA OMEGA® 50 SGEL CAPS 50 $7.07 005367187067
196297 SEBEX SHAMPOO 4 OZ SEBULEX® $4.43 305361962975
199553 SELENIUM SULF/ANTI-DANDRUFF SHAMPOO 7 OZ SELSUN BLUE® $4.57 305361995539
127559 SENEXON® LIQUID 8 OZ SENOKOT® $17.52 305361275594
590401 SENEXON® NATURAL VEG LAXATIVE TABS 100 SENOKOT® $4.77 305365904018
590410 SENEXON® NATURAL VEG LAXATIVE TABS 1000 SENOKOT® $27.75 305365904100
408601 SENEXON®-S 50/8.6 MG TABS 100 SENOKOT-S® $4.95 305364086012
408610 SENEXON®-S 50/8.6 MG TABS 1000 SENOKOT-S® $31.95 305364086104
453408 SIMETHICONE 125 MG GAS RELIEF TABLETS 60 MYLANTA® GAS MAX STR $5.02 305364534087
453301 SIMETHICONE 80 MG GAS RELIEF TABLETS 100 MYLANTA® GAS $6.30 305364533011
222075 SIMETHICONE/GAS RELIEF DROPS 30 ML MYLICON® $7.05 305362220753
360408 SIMETHICONE 180 MG GAS RELIEF SOFTGELS 60 PHAZYME® $3.05 305363604088
454410 SODIUM BICARBONATE 10 GR TABLETS 1000 $13.65 305364544109
454010 SODIUM BICARBONATE 5 GR TABLETS 1000 $11.55 305364540101
991601 SYRINGE INS 1/2 CC 28 G X 1/2 IN U100 100 $23.85 005369916016
991501 SYRINGE INS 1 CC 28 G X 1/2 IN U100 100 $23.85 005369915019
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 14: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/14.jpg)
241
245
249
253
257
242
246
250
254
258
243
247
251
255
259
244
248
252
256
260
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
28/S-V
993001 SYRINGE INS 1CC 31 G X 5/16 IN U100 100 $16.55 005369930012
094094 TETRAHYDROZOLINE/EYE DROPS 15 ML VISINE® $2.10 305360940943
466010 THEREMS® FILM COATED TABLETS 1000 THERAGRAN® $36.83 005364660105
466038 THEREMS® FILM COATED TABLETS 130 THERAGRAN® $7.35 005364660389
466711 THEREMS®-H TABLETS 90 $8.50 005364667111
466110 THEREMS®-M FILM COATED TABLETS 1000 THERAGRAN-M® ADV $39.02 005364661102
466138 THEREMS®-M FILM COATED TABLETS 130 THERAGRAN-M® ADV $7.60 005364661386
515026 TOLNAFTATE 1% ANTIFUNGAL POWDER 45 GM TINACTIN® $3.37 305365150262
850180 TRI-VITAMIN DROPS 50 ML TRI-VI-SOL® $8.07 005368501800
475011 UNICOMPLEX-M TABLETS 90 UNICAP-M® $4.50 005364750110
475308 VI-STRESS TABLETS 60 STRESSTABS® $5.47 005364753081
478701 VIT B COMPLEX SGEL CAPS 100 $3.35 005364787017
355601 VIT B-12 1000 MCG TABLETS 100 $5.02 005363556010CYANOCOBALAMIN
354201VIT B-12 100 MCG TABLETS
100 $2.25 005363542013CYANOCOBALAMIN
355101 VIT B-12 500 MCG TABLETS 100 $3.60 005363551015CYANOCOBALAMIN
440601 VIT B-6 25 MG TABLETS PYRIDOX HCL 100 $3.44 005364406017
440901 VIT B-6 100 MG TABLETS PYRIDOX HCL 100 $3.30 005364409018
440801 VIT B-6 50 MG TABLETS PYRIDOX HCL 100 $3.89 005364408011
440810 VIT B-6 50 MG TABLETS PYRIDOX HCL 1000 $15.67 005364408103
468001 VIT B-1 100 MG TABLETS THIAMINE 100 $4.50 005364680011
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 15: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/15.jpg)
262
266
263 264
NDCDESCRIPTION SIZE
COMPARESWP
UPC00536- TO CODE
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
30/V-Z
468010 VIT B-1 100 MG TABLETS THIAMINE 1000 $20.25 005364680103
467801 VIT B-1 50 MG TABLETS THIAMINE 100 $2.17 005364678018
329201 VIT C 500 MG TABLETS 100 $4.12 005363292017
329210 VIT C 500 MG TABLETS 1000 $29.25 005363292109
329101 VIT C 500 MG CHEW TABLETS 100 $5.47 005363291010
016097 VIT C 500 MG SYRUP 4 OZ $4.88 005360160975
016085 VIT C 500 MG SYRUP PT $14.25 005360160852
333401 VIT D 1000 IU TABLETS 100 $2.85 005363334014
379001 VIT D 2000 IU SGEL CAPS 100 $6.80 005363790018
479301 VIT E 100 IU SGEL CAPS 100 $3.78 005364793018
479901 VIT E 400 IU SGEL CAPS 100 $6.44 005364799010
476301 VITA-BEE W/C CAPTABS® 100 ALLBEE® WITH C $4.58 005364763011
718301 ZINC & C LOZENGES 100 $3.90 005367183014
667101 ZINC CHELATED 50 MG TABLETS 100 $2.85 005366671017
570098 ZINC OXIDE OINTMENT 1 LB $6.75 305365700986
245001 ZINC SULFATE 220 MG TABLETS 100 $7.50 005362450012
268267
270
261
269
265
271 272
274273 275 276
Prices subject to change without notice. Third-party trademarks are the property of their respective owners.
Medicaid reimbursable in most states.
NO.
![Page 16: BRAND TO GENERIC REFERENCE CHARTBRAND TO GENERIC REFERENCE CHART 3 COMPARE TO DESCRIPTION 4/A NDC DESCRIPTION SIZE COMPARE SWP UPC 00536- TO CODE 360501 ACETA-GESIC ®PAIN TABLETS](https://reader030.vdocument.in/reader030/viewer/2022040112/5e8a36da921c8d2f876940d3/html5/thumbnails/16.jpg)
32
Other Useful Phone Numbers Important Contact InformationNOTES