gpha pharmacy cdm and ndc formulary price list · cdm and ndc formulary price list . pink items...

CDM and NDC Formulary Price List Pink items indicate Cost has not been updated in past 9 months. Cost should be updated OR NDC inactivated to remove from this report. Orange Items have a Base Cost of 0.00. Add a Cost1, Cost2, or AWP value as appropriate. Red Items have a Final Price to Patient in Excess of 1000$

CDM Days Since Update

PRODUCT NDC Strength Charge Collected Type

Base Cost ( mL, each,

gm)

Per Dispense Unit

Final Price Cost Type Price Schedule

6340387 22 acetaminophen 10 mg/mL Sol 100 mL Vial [CHKS] 43825-0102-01 1000.000 mg On Admin 0.28790 50.38 50.38 COST1 CHKS Injectable 2640311 6 acetaminophen 120 mg Sup 45802-0732-30 120.000 mg On Admin 0.27750 0.49 1.00 COST1 CHKS Med 2640311 333 acetaminophen 120 mg Sup UD [CHKS] 00713-0118-12 120.000 mg On Admin 0.02800 0.05 1.00 COST1 CHKS Med 2643147 923 acetaminophen 160 mg/5 mL Oral Liq [CHKS] 00121-0657-00 160.000 mg On Admin 0.21000 1.84 1.84 COST1 CHKS Med 2641845 6 acetaminophen 160 mg/5 mL Sus 68094-0587-58 160.000 mg On Admin 0.15150 1.33 1.33 COST1 CHKS Med 2641845 6 acetaminophen 160 mg/5 mL SUSP [CHKS] 68094-0593-62 160.000 mg On Admin 0.15150 1.33 1.33 COST1 CHKS Med 2641845 6 acetaminophen 160 mg/5 mL SUSP [CHKS] 50580-0223-02 160.000 mg On Admin 0.15150 1.33 1.33 COST1 CHKS Med 2641845 6 acetaminophen 160 mg/5 mL SUSP [CHKS] 68094-0587-61 160.000 mg On Admin 0.15150 1.33 1.33 COST1 CHKS Med 2640312 954 acetaminophen 325 mg Supp [CHKS] 00713-0164-12 325.000 mg On Admin 0.43000 0.75 1.00 COST1 CHKS Med 2640559 954 acetaminophen 325 mg Tab [CHKS] 00904-1982-61 325.000 mg On Admin 0.02000 0.04 1.00 COST1 CHKS Med 2640559 308 acetaminophen 325 mg Tab [CHKS] 00904-6719-50 325.000 mg On Admin 0.01110 0.02 1.00 COST1 CHKS Med 2640559 264 acetaminophen 325 mg Tab [CHKS] 00904-6773-61 325.000 mg On Admin 0.02240 0.04 1.00 COST1 CHKS Med 2640649 954 acetaminophen 500 mg Tab [CHKS] 00904-1988-61 500.000 mg On Admin 0.03000 0.05 1.00 COST1 CHKS Med 2640649 392 acetaminophen 500 mg Tab [CHKS] 00904-6730-61 500.000 mg On Admin 0.02510 0.04 1.00 COST1 CHKS Med 2640313 954 acetaminophen 650 mg Supp [CHKS] 00713-0165-12 650.000 mg On Admin 0.42000 0.73 1.00 COST1 CHKS Med 2641153 954 acetaminophen-codeine 300 mg-30 mg Tab [CHKS] 00406-0484-62 1.000 tab( s) On Admin 0.13000 0.23 1.00 COST1 CHKS Med 2641404 270 acetaminophen-hydrocodone 325 mg-5 mg Tab 68084-0895-01 1.000 tab( s) On Admin 0.18600 0.33 1.00 COST1 CHKS Med 2641404 954 acetaminophen-HYDROcodone 325 mg-5 mg Tab

[CHKS] 68084-0895-09 1.000 tab( s) On Admin 0.18000 0.32 1.00 COST1 CHKS Med

2641404 923 acetaminophen-HYDROcodone 325 mg-5 mg Tab [CHKS]

00406-0123-62 1.000 tab( s) On Admin 0.18000 0.32 1.00 COST1 CHKS Med

2642719 447 acetaminophen-hydrocodone 325 mg-7.5 mg/15 mL Sol 00121-0772-04 15.000 mL On Admin 0.32346 8.49 8.49 COST1 CHKS Med 2642719 493 acetaminophen-HYDROcodone 325 mg-7.5 mg/15 mL

Sol 15 mL [CHKS] 64376-0640-40 15.000 mL On Admin 0.32788 8.61 8.61 COST1 CHKS Med




gm)

Per Dispense Unit


2640602 954 acetaminophen-oxyCODONE 325 mg-5 mg Tab [CHKS] 68084-0355-01 1.000 tab( s) On Admin 0.19000 0.33 1.00 COST1 CHKS Med 2640940 11 acetaminophen/butalbital/caffeine 325 mg-50 mg-40 mg

Tab [CHKS] 68084-0396-65 1.000 tab( s) On Admin 1.01740 1.78 1.78 COST1 CHKS Med

2640777 6 acetylcholine ophthalmic 1% Pwdr for Recon 1 EA [CHKS]

24208-0539-20 1.000 EA On Dispense/Manual

61.80000 108.15 108.15 COST1 CHKS Med

2641120 6 acetylcysteine 20% Inh Sol 30 mL [CHKS] 00409-3308-03 6000.000 mg On Admin 0.30680 16.11 16.11 COST1 CHKS Med 6340724 6 acyclovir 50 mg/mL IV Sol 10 mL [CHKS] 55150-0154-11 500.000 mg On Admin 0.31720 5.55 5.55 COST1 CHKS Injectable 2640750 6 acyclovir 800 mg Tab 68084-0109-01 800.000 mg On Admin 0.60830 1.06 1.06 COST1 CHKS Med 2640750 942 acyclovir 800 mg Tab [CHKS] 00093-8947-01 800.000 mg On Admin 4.22000 7.38 7.38 COST1 CHKS Med 6340981 6 adenosine 3 mg/mL IV Sol 2 mL [CHKS] 17478-0542-02 6.000 mg On Admin 0.80950 2.83 2.83 COST1 CHKS Injectable 6340981 6 adenosine 3 mg/mL IV Sol 2 mL [CHKS] 63323-0651-02 6.000 mg On Admin 1.24050 4.34 4.34 COST1 CHKS Injectable




gm)

Per Dispense Unit


6340981 6 adenosine 3 mg/mL Sol 67457-0855-02 6.000 mg On Admin 0.65100 2.28 2.28 COST1 CHKS Injectable 2640444 942 Al hydroxide/Mg hydroxide/simethicone 200 mg-200 mg-

20 mg/5 mL Oral Susp 355 mL [CHKS] 24385-0357-40 30.000 mL On Admin 0.05000 2.62 2.62 COST1 CHKS Med

2640444 830 Al hydroxide/Mg hydroxide/simethicone 200 mg-200 mg-20 mg/5 mL Sus

00904-0004-14 30.000 mL On Admin 0.00790 0.41 1.00 COST1 CHKS Med

6340862 954 albumin human 25% IV Sol 100 mL Vial [CHKS] 76179-0025-04 25.000 gm On Admin 0.84000 147.00 147.00 COST1 CHKS Injectable 6340862 6 albumin human 25% IV Sol 100 mL Vial [CHKS] 44206-0251-10 25.000 gm On Admin 0.60760 106.33 106.33 COST1 CHKS Injectable 6340862 6 albumin human 25% Sol 00053-7680-33 25.000 gm On Admin 0.60760 106.33 106.33 COST1 CHKS Injectable 2641763 6 albuterol 0.042% Inhalation Sol 3 mL [CHKS] 00487-9904-01 1.250 mg On Admin 0.18040 0.95 1.00 COST1 CHKS Med 2641339 954 albuterol 0.083% Inh Sol 3 mL [CHKS] 00487-9501-01 2.500 mg On Admin 0.05000 0.26 1.00 COST1 CHKS Med 2641339 6 albuterol 0.083% Inh Sol 3 mL [CHKS] 76204-0200-25 2.500 mg On Admin 0.04500 0.24 1.00 COST1 CHKS Med 2641339 195 albuterol 0.083% Inh Sol 3 mL [CHKS] 60687-0395-83 2.500 mg On Admin 0.04900 0.26 1.00 COST1 CHKS Med 2641463 922 albuterol 0.63 mg/3 mL ( 0.021%) Inh Sol UD[CHKS] 00591-3467-53 0.630 mg On Admin 0.27290 1.43 1.43 COST1 CHKS Med 2641463 690 albuterol 0.63 mg/3 mL ( 0.021%) Sol 00487-0301-01 0.630 mg On Admin 0.55330 2.90 2.90 COST1 CHKS Med 2640295 942 albuterol 5 mg/mL Sol 20 mL [CHKS] 24208-0347-20 100.000 mg On

Dispense/Manual 1.20000 42.00 42.00 COST1 CHKS Med

2640295 924 albuterol 5 mg/mL Sol 20 mL [CHKS] 50383-0741-20 100.000 mg On Dispense/Manual

1.19850 41.95 41.95 COST1 CHKS Med

2640431 924 albuterol 90 mcg/inh Aer 00173-0682-20 1.000 puff( s) On Dispense/Manual

3.37000 47.18 47.18 COST1 CHKS Med

2640431 447 albuterol 90 mcg/inh Aer 00173-0682-24 1.000 puff( s) On Dispense/Manual

2.92163 40.90 40.90 COST1 CHKS Med

2640431 954 albuterol CFC free 90 mcg/inh Inh Aer w/Adapt 8 gm [CHKS]

00173-0682-21 1.000 puff( s) On Dispense/Manual

2.39000 33.46 33.46 COST1 CHKS Med

2641562 323 albuterol-ipratropium 3-0.5 mg Inh Sol 3 mL [CHKS] 00487-0201-01 3.000 mL On Admin 0.10188 0.53 1.00 COST1 CHKS Med 2641562 252 albuterol-ipratropium 3-0.5 mg Inh Sol 3 mL [CHKS] 60687-0405-83 3.000 mL On Admin 0.07240 0.38 1.00 COST1 CHKS Med 2642187 6 albuterol-ipratropium CFC free 100 mcg-20 mcg/inh Aer

[CHKS] 00597-0024-02 1.000 puff( s) On


2641569 614 alendronate 70 mg Tab 65862-0329-04 70.000 mg On Admin 1.88000 3.29 3.29 COST1 CHKS Med




gm)

Per Dispense Unit


2641569 942 alendronate 70 mg Tab [CHKS] 00093-5171-44 70.000 mg On Admin 1.88000 3.29 3.29 COST1 CHKS Med 2641569 614 alendronate 70 mg Tab [CHKS] 16252-0601-44 70.000 mg On Admin 1.88000 3.29 3.29 COST1 CHKS Med 2640314 954 allopurinol 100 mg Tab UD [CHKS] 51079-0205-20 100.000 mg On Admin 0.27000 0.47 1.00 COST1 CHKS Med 2640314 952 allopurinol 100 mg Tab UD [CHKS] 00904-6571-61 100.000 mg On Admin 0.23930 0.42 1.00 COST1 CHKS Med 2640725 743 ALPRAZolam 0.5 mg Tab 51079-0789-20 0.500 mg On Admin 0.75970 1.33 1.33 COST1 CHKS Med 2640725 323 ALPRAZolam 0.5 mg Tab 00904-5859-61 0.500 mg On Admin 0.04940 0.09 1.00 COST1 CHKS Med 2640725 954 ALPRAZolam 0.5 mg Tab [CHKS] 68084-0672-01 0.500 mg On Admin 0.04000 0.07 1.00 COST1 CHKS Med 6340044 6 alteplase 100 mg IV Inj [CHKS] 50242-0085-27 100.000 mg On Admin 8331.31000 14996.36 14996.36 COST1 CHKS Injectable 6340045 6 alteplase 2 mg IV Inj Vial [CHKS] 50242-0041-64 2.000 mg On Admin 72.45500 126.80 126.80 COST1 CHKS Injectable 2640565 830 amantadine 100 mg Cap 51079-0247-20 100.000 mg On Admin 3.29700 5.77 5.77 COST1 CHKS Med 2640565 954 amantadine 100 mg Cap [CHKS] 50268-0069-15 100.000 mg On Admin 1.93000 3.38 3.38 COST1 CHKS Med




gm)

Per Dispense Unit


6340070 954 aminophylline 25 mg/mL IV Sol 10 mL [CHKS] 00409-5921-01 250.000 mg On Admin 1.05000 18.38 18.38 COST1 CHKS Injectable 6340071 419 aminophylline 25 mg/mL IV Sol 20 mL [CHKS] 00409-5922-01 500.000 mg On Admin 0.30940 10.83 10.83 COST1 CHKS Med 2641371 954 amiodarone 200 mg Tab UD [CHKS] 68084-0371-01 200.000 mg On Admin 0.20000 0.35 1.00 COST1 CHKS Med 6340365 6 amiodarone 360 mg/200 mL-D5% Sol [CHKS] 43066-0360-20 360.000 mg On Admin 0.21840 76.44 76.44 COST1 CHKS Injectable 6340970 954 amiodarone 50 mg/mL IV Sol 3 mL [CHKS] 63323-0616-03 150.000 mg On Admin 0.35000 1.84 1.84 COST1 CHKS Injectable 6340970 6 amiodarone 50 mg/mL Sol 55150-0180-03 150.000 mg On Admin 0.22430 1.18 1.18 COST1 CHKS Injectable 2640620 954 amitriptyline 25 mg Tab UD [CHKS] 51079-0107-20 25.000 mg On Admin 0.19000 0.33 1.00 COST1 CHKS Med 2641553 22 amLODIPine 5 mg Tab 00904-6370-61 5.000 mg On Admin 0.07520 0.13 1.00 COST1 CHKS Med 2641553 954 Amlodipine Besylate 5 mg Tab [CHKS] 51079-0451-20 5.000 mg On Admin 0.14000 0.25 1.00 COST1 CHKS Med 2641553 837 Amlodipine Besylate 5 mg Tab [CHKS] 60687-0263-01 5.000 mg On Admin 0.38550 0.67 1.00 COST1 CHKS Med 2642582 854 amoxicillin 400 mg/5 mL Oral Liq [CHKS] 00143-9887-75 6000.000 mg On


2642582 726 amoxicillin 400 mg/5 mL Pow 00781-6157-57 6000.000 mg On Dispense/Manual

0.09773 12.83 12.83 COST1 CHKS Med


0.09810 12.88 12.88 COST1 CHKS Med


0.09733 12.77 12.77 COST1 CHKS Med

2640318 954 amoxicillin 500 mg Cap [CHKS] 00093-3109-53 500.000 mg On Admin 0.12000 0.21 1.00 COST1 CHKS Med 2641284 954 amoxicillin-clavulanate 400 mg-57 mg/5 mL Pow [CHKS] 66685-1012-00 400.000 mg On Admin 0.12000 1.05 1.05 COST1 CHKS Med 2641263 337 amoxicillin-clavulanate 875 mg-125 mg Tab 65862-0503-20 875.000 mg On Admin 2.45000 4.29 4.29 COST1 CHKS Med 2641263 954 amoxicillin-clavulanate 875 mg-125 mg Tab [CHKS] 66685-1001-01 875.000 mg On Admin 0.50000 0.88 1.00 COST1 CHKS Med 6340075 6 ampicillin 2 g Inj Vial [CHKS] 00781-9408-95 2.000 gm On Admin 2.44600 4.28 4.28 COST1 CHKS Injectable 6340075 6 ampicillin 2 g Pow 67457-0352-10 2.000 gm On Admin 2.37700 4.16 4.16 COST1 CHKS Injectable 6340074 6 ampicillin 500 mg Inj [CHKS] 00781-9407-95 500.000 mg On Admin 0.73400 1.28 1.28 COST1 CHKS Injectable 2641902 954 Antioxidant Multiple Vitamins and Minerals Tab [CHKS] 00904-2641-13 1.000 tab( s) On Admin 0.03000 0.05 1.00 COST1 CHKS Med 6340857 6 antivenin ( Crotalidae) polyvalent - Pow [CHKS] 50633-0110-12 1.000 vial( s) On Admin 3027.55000 5449.59 5449.59 COST1 CHKS Injectable 2650011 315 apixaban 2.5 mg Tab [CHKS] 00003-0893-31 2.500 mg On Admin 5.37000 9.40 9.40 COST1 CHKS Med 2650011 315 apixaban 2.5 mg Tab [CHKS] 00003-0893-21 2.500 mg On Admin 5.37000 9.40 9.40 COST1 CHKS Med




gm)

Per Dispense Unit


2641527 6 arformoterol 15 mcg/2 mL Sol [CHKS] 63402-0911-30 15.000 mcg On Admin 6.01100 21.04 21.04 COST1 CHKS Med 2641008 942 aspirin 325 mg Oral EC Tab [CHKS] 68084-0848-25 325.000 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2641008 265 aspirin 325 mg Tab 69618-0015-01 325.000 mg On Admin 0.01700 0.03 1.00 COST1 CHKS Med 2640020 954 aspirin 81 mg Chew Tab [CHKS] 00904-4040-73 81.000 mg On Admin 0.02000 0.04 1.00 COST1 CHKS Med 2640240 954 aspirin 81 mg Oral EC Tab [CHKS] 63739-0522-10 81.000 mg On Admin 0.03000 0.05 1.00 COST1 CHKS Med 2640020 742 aspirin 81 mg Tab 66553-0002-01 81.000 mg On Admin 0.06226 0.11 1.00 COST1 CHKS Med 2640020 265 aspirin 81 mg Tab 63739-0434-01 81.000 mg On Admin 0.07555 0.13 1.00 COST1 CHKS Med 2640240 99 aspirin 81 mg Tab 00904-6713-18 81.000 mg On Admin 0.00987 0.02 1.00 COST1 CHKS Med 2640542 467 atenolol 50 mg Tab 51079-0684-20 50.000 mg On Admin 0.59150 1.04 1.04 COST1 CHKS Med 2640542 467 atenolol 50 mg Tab UD [CHKS] 62584-0467-01 50.000 mg On Admin 0.89900 1.57 1.57 COST1 CHKS Med 2640715 404 atorvastatin 40 mg Tab [CHKS] 68084-0099-01 40.000 mg On Admin 0.40640 0.71 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


6340081 954 atropine 1 mg/mL Inj Sol 1 mL [CHKS] 00517-1010-25 1.000 mg On Admin 5.00000 8.75 8.75 COST1 CHKS Injectable 2642931 6 atropine ophthalmic 1% Sol 00065-0303-55 2.000 mL On


2642931 6 atropine ophthalmic 1% Sol Drops [CHKS] 17478-0215-02 2.000 mL On Dispense/Manual

17.59500 61.58 61.58 COST1 CHKS Med

2640681 536 atropine-diphenoxylate 0.025 mg-2.5 mg Tab 62559-0490-01 1.000 tab( s) On Admin 0.50000 0.88 1.00 COST1 CHKS Med 2640681 954 atropine-diphenoxylate 0.025 mg-2.5 mg Tab [CHKS] 59762-1061-01 1.000 tab( s) On Admin 0.19000 0.33 1.00 COST1 CHKS Med 2642487 954 atropine/hyoscyamine/PB/scopolamine 0.0194 mg-

0.1037 mg-16.2 mg-0.0065 mg/5 mL Elixir 5 mL [CHKS] 59212-0423-04 5.000 mL On Admin 2.90000 25.38 25.38 COST1 CHKS Med

2642487 305 atropine/hyoscyamine/PB/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL Elixir 5 mL [CHKS]


2641334 954 azithromycin 200 mg/5 mL Oral Liq 30 mL [CHKS] 59762-3140-01 200.000 mg On Dispense/Manual

0.30000 15.75 15.75 COST1 CHKS Med

2641334 321 azithromycin 200 mg/5 mL Pow 00093-2026-31 200.000 mg On Dispense/Manual

0.37777 19.83 19.83 COST1 CHKS Med

2641458 398 azithromycin 250 mg Tab 50268-0098-15 250.000 mg On Admin 1.55000 2.71 2.71 COST1 CHKS Med 2641458 954 azithromycin 250 mg Tab [CHKS] 68084-0278-01 250.000 mg On Admin 1.13000 1.98 1.98 COST1 CHKS Med 2641458 923 azithromycin 250 mg Tab [CHKS] 60687-0282-01 250.000 mg On Admin 1.12780 1.97 1.97 COST1 CHKS Med 6340079 954 azithromycin 500 mg IV Inj [CHKS] 63323-0398-12 500.000 mg On Admin 2.60000 4.55 4.55 COST1 CHKS Injectable 6340079 368 azithromycin 500 mg Pow 55150-0174-10 500.000 mg On Admin 5.25000 9.19 9.19 COST1 CHKS Injectable 2640734 954 bacitracin Top 500 units/g Oint Packet [CHKS] 45802-0060-70 1.000 app On Admin 0.14000 0.25 1.00 COST1 CHKS Med 2642408 917 bacitracin/HC/neomycin/polymyxin B ophthalmic 400

units-10 mg-3.5 mg-10000 units/g Oin 24208-0785-55 1.000 app On


2640115 112 bacitracin/neomycin/polymyxin B Top Oint Packet [CHKS]

45802-0143-70 1.000 app On Admin 0.12120 0.21 1.00 COST1 CHKS Med

2640323 323 baclofen 10 mg Tab [CHKS] 68084-0855-01 10.000 mg On Admin 0.03251 0.06 1.00 COST1 CHKS Med 2642056 952 barium sulfate 2% Sus 450mL [CHKS] 32909-0715-03 450.000 mL On Admin 0.03670 28.90 28.90 COST1 CHKS Med 6340816 524 belimumab 400 mg Pow Vial [CHKS] 49401-0102-01 400.000 mg On Admin 1701.78000 3063.20 3063.20 COST1 CHKS Injectable 2641351 229 benazepril 10 mg Tab 50268-0110-15 10.000 mg On Admin 0.46630 0.82 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2641351 954 benazepril 10 mg Tab [CHKS] 51079-0145-20 10.000 mg On Admin 0.52000 0.91 1.00 COST1 CHKS Med 2640503 6 benoxinate-fluorescein Ophth Sol [CHKS] 54799-0508-05 1.000 drop( s) On


2640461 6 benzocaine Top 20% Spray 56 gm [CHKS] 75137-8552-00 1.000 spray( s) On Dispense/Manual

0.05819 5.70 5.70 COST1 CHKS Med

2640563 954 benzonatate 100 mg Cap [CHKS] 00904-5904-60 100.000 mg On Admin 0.22000 0.39 1.00 COST1 CHKS Med 2640563 690 benzonatate 100 mg Cap [CHKS] 60687-0346-01 100.000 mg On Admin 0.33780 0.59 1.00 COST1 CHKS Med 2640339 606 benztropine 0.5 mg Tab 68084-0381-01 0.500 mg On Admin 0.11000 0.19 1.00 COST1 CHKS Med 2640339 113 benztropine 0.5 mg Tab 60687-0356-01 0.500 mg On Admin 0.32200 0.56 1.00 COST1 CHKS Med 2640339 954 benztropine 0.5 mg Tab [CHKS] 00603-2433-21 0.500 mg On Admin 0.10000 0.18 1.00 COST1 CHKS Med 6340320 954 betamethasone 6 mg/mL Inj Susp 5 mL MDV [CHKS] 00517-0720-01 30.000 mg On Admin 6.97000 60.99 60.99 COST1 CHKS Injectable 2640329 435 bisacodyl 10 mg Sup 00904-5058-12 10.000 mg On Admin 0.20000 0.35 1.00 COST1 CHKS Med 2640329 113 bisacodyl 10 mg Sup 00574-7050-12 10.000 mg On Admin 0.16667 0.29 1.00 COST1 CHKS Med 2640329 435 bisacodyl 10 mg Supp [CHKS] 00713-0109-12 10.000 mg On Admin 0.20000 0.35 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2640054 954 bisacodyl 5 mg Oral EC Tab [CHKS] 00904-6407-61 5.000 mg On Admin 0.03000 0.05 1.00 COST1 CHKS Med 2641872 6 brimonidine Ophth 0.1% Sol 5 mL [CHKS] 00023-9321-05 1.000 app On


2641376 67 brimonidine ophthalmic 0.2% Sol 5mL [CHKS] 24208-0411-05 1.000 drop( s) On Dispense/Manual

0.72600 6.35 6.35 COST1 CHKS Med

2642016 6 budesonide 0.25 mg/2 mL Inh Susp [CHKS] 00093-6815-73 0.250 mg On Admin 2.05120 7.18 7.18 COST1 CHKS Med 2642016 6 budesonide 0.25 mg/2 mL Sus 00487-9601-01 0.250 mg On Admin 1.79330 6.28 6.28 COST1 CHKS Med 2642017 6 budesonide 0.5 mg/2 mL Inh Susp [CHKS] 00591-3768-30 0.500 mg On Admin 1.87899 6.58 6.58 COST1 CHKS Med 2642017 6 budesonide 0.5 mg/2 mL Inh Susp [CHKS] 00487-9701-01 0.500 mg On Admin 1.79373 6.28 6.28 COST1 CHKS Med 2640788 830 bumetanide 0.25 mg/mL Inj Sol 4 mL Vial [CHKS] 00641-6008-10 1.000 mg On Admin 0.42080 2.95 2.95 COST1 CHKS Injectable 2640788 336 bumetanide 0.25 mg/mL Inj Sol 4 mL Vial [CHKS] 00641-6161-10 1.000 mg On Admin 0.41880 2.93 2.93 COST1 CHKS Injectable 2640764 280 bumetanide 1 mg Tab 60687-0384-25 1.000 mg On Admin 1.22500 2.14 2.14 COST1 CHKS Med 2640764 954 bumetanide 1 mg Tab [CHKS] 00185-0129-01 1.000 mg On Admin 0.64000 1.12 1.12 COST1 CHKS Med 2640764 609 bumetanide 1 mg Tab [CHKS] 00832-0541-11 1.000 mg On Admin 0.31770 0.56 1.00 COST1 CHKS Med 2640441 265 bupivacaine 0.25% PF Inj Sol 10 mL [CHKS] 00409-1159-01 25.000 mg On Admin 0.21111 3.69 3.69 COST1 CHKS Med 2640441 954 bupivacaine 0.25% PF Inj Sol 10 mL [CHKS] 00409-1559-30 25.000 mg On Admin 0.09000 1.57 1.57 COST1 CHKS Med 2640441 860 bupivacaine 0.25% PF Inj Sol 10 mL [CHKS] 00409-1559-10 25.000 mg On Admin 0.24520 4.29 4.29 COST1 CHKS Med 2640441 112 bupivacaine 0.25% preservative-free Sol 55150-0167-10 25.000 mg On Admin 0.14660 2.57 2.57 COST1 CHKS Med 2641575 6 bupivacaine 0.5% Inj Sol 50 mL [CHKS] 63323-0467-57 50.000 mL On Admin 0.15900 13.91 13.91 COST1 CHKS Med 2640515 6 bupivacaine 0.5% PF Inj Sol 30 mL [CHKS] 63323-0466-17 150.000 mg On Admin 0.32380 17.00 17.00 COST1 CHKS Med 2640515 6 bupivacaine 0.5% preservative-free Sol 55150-0169-10 150.000 mg On Admin 0.22660 11.90 11.90 COST1 CHKS Med 2642129 954 bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol

30 mL [CHKS] 00409-9042-17 75.000 mg On Admin 0.07000 3.68 3.68 COST1 CHKS Med

2640776 6 bupivacaine-epinephrine 0.5%-1:200,000 preservative-free Sol [CHKS]

63323-0462-17 10.000 mL On Admin 0.35410 6.20 6.20 COST1 CHKS Injectable

2641329 348 buPROPion 150 mg/12 hours Tab 68084-0708-25 150.000 mg On Admin 0.44430 0.78 1.00 COST1 CHKS Med 2641329 954 buPROPion ER 150 mg Tab [CHKS] 51079-0392-20 150.000 mg On Admin 0.67000 1.17 1.17 COST1 CHKS Med 2641162 187 busPIRone 5 mg Tab 68382-0180-01 5.000 mg On Admin 0.52330 0.92 1.00 COST1 CHKS Med 2641162 942 busPIRone 5 mg Tab [CHKS] 51079-0985-20 5.000 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med




gm)

Per Dispense Unit


2641051 6 cadexomer iodine Top 0.9% gel 40 gm[CHKS] 40565-0122-49 1.000 app On Dispense/Manual

1.07360 75.15 75.15 COST1 CHKS Med

2642609 954 calcium carbonate 750 mg Chew Tab [CHKS] 00135-0456-03 750.000 mg On Admin 0.06000 0.10 1.00 COST1 CHKS Med 2640331 6 calcium chloride 100 mg/mL Inj Syringe 10 mL [CHKS] 00409-1631-10 1000.000 mg On Admin 0.61160 10.70 10.70 COST1 CHKS Injectable 2640331 6 calcium chloride 100 mg/mL Sol 00409-4928-34 1000.000 mg On Admin 0.76690 13.42 13.42 COST1 CHKS Injectable 2640331 6 calcium chloride 100 mg/mL Sol 76329-3304-01 1000.000 mg On Admin 0.80950 14.17 14.17 COST1 CHKS Injectable 6340592 954 calcium gluconate 100 mg/mL Inj Sol 10 mL Vial [CHKS] 63323-0311-19 1000.000 mg On Admin 0.41000 7.18 7.18 COST1 CHKS Injectable 6340592 6 calcium gluconate 100 mg/mL Sol 63323-0360-19 1000.000 mg On Admin 0.85770 15.01 15.01 COST1 CHKS Injectable 2641843 154 calcium-vitamin D 315 mg-250 intl units Tab 77333-0113-10 1.000 tab( s) On Admin 0.12110 0.21 1.00 COST1 CHKS Med 2641843 954 calcium-vitamin D 315 mg-250 intl units Tab [CHKS] 00904-5272-60 1.000 tab( s) On Admin 0.02000 0.04 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2640869 466 carBAMazepine ER 200 mg Tab UD [CHKS] 68084-0561-21 200.000 mg On Admin 2.72800 4.77 4.77 COST1 CHKS Med 2640570 954 carbidopa-levodopa 25 mg-100 mg Tab [CHKS] 68084-0093-01 1.000 tab( s) On Admin 0.16000 0.28 1.00 COST1 CHKS Med 2640535 6 carboprost 250 mcg/mL Inj Sol 1 mL [CHKS] 00009-0856-08 250.000 mcg On Admin 335.51800 587.16 587.16 COST1 CHKS Injectable 2641548 118 carvedilol 12.5 mg Tab 00904-6302-61 12.500 mg On Admin 1.10130 1.93 1.93 COST1 CHKS Med 2641548 923 carvedilol 12.5 mg Tab [CHKS] 68084-0865-01 12.500 mg On Admin 0.10000 0.18 1.00 COST1 CHKS Med 2641594 954 carvedilol 25 mg Tab [CHKS] 68084-0876-01 25.000 mg On Admin 0.08000 0.14 1.00 COST1 CHKS Med 2641552 299 carvedilol 3.125 mg Tab 68084-0843-01 3.125 mg On Admin 0.07130 0.12 1.00 COST1 CHKS Med 2641552 954 carvedilol 3.125 mg Tab [CHKS] 00904-6300-61 3.125 mg On Admin 0.08000 0.14 1.00 COST1 CHKS Med 6340275 5 ceFAZolin 1 g Inj [CHKS] 00409-2585-01 1.000 gm On Admin 2.21560 3.88 3.88 COST1 CHKS Injectable 2641530 5 cefdinir 125 mg/5 mL Oral Susp 100 mL [CHKS] 68180-0722-10 2500.000 mg On


6340093 5 cefTAZidime 1 g Inj Vial [CHKS] 25021-0127-20 1.000 gm On Admin 4.90400 8.58 8.58 COST1 CHKS Injectable 6340093 5 cefTAZidime 1 g Inj Vial [CHKS] 00409-5092-16 1.000 gm On Admin 4.82840 8.45 8.45 COST1 CHKS Injectable 6340093 5 cefTAZidime 1 g Pow 00409-5082-16 1.000 gm On Admin 3.11480 5.45 5.45 COST1 CHKS Injectable 6340093 5 cefTAZidime 1 g Pow 44567-0235-25 1.000 gm On Admin 4.26040 7.46 7.46 COST1 CHKS Injectable 6340310 954 cefTRIAXone 1 g Inj [CHKS] 00409-7333-04 1.000 gm On Admin 3.31000 5.79 5.79 COST1 CHKS Injectable 6340310 5 cefTRIAXone 1 g Inj [CHKS] 00409-7332-01 1.000 gm On Admin 1.24100 2.17 2.17 COST1 CHKS Injectable 6340310 411 cefTRIAXone 1 g Inj [CHKS] 60505-0752-04 1.000 gm On Admin 22.42000 39.23 39.23 COST1 CHKS Injectable 6340310 5 cefTRIAXone 1 g Inj [CHKS] 00409-7333-49 1.000 gm On Admin 3.25700 5.70 5.70 COST1 CHKS Injectable 6340310 704 cefTRIAXone 1 g Pow 64679-0983-02 1.000 gm On Admin 15.33000 26.83 26.83 COST1 CHKS Injectable 6340310 5 cefTRIAXone 1 g Pow 00409-7332-20 1.000 gm On Admin 1.22200 2.14 2.14 COST1 CHKS Injectable 6340267 5 cefTRIAXone 250 mg Inj [CHKS] 00409-7337-01 250.000 mg On Admin 0.67300 1.18 1.18 COST1 CHKS Injectable 6340267 5 cefTRIAXone 250 mg Inj [CHKS] 00409-7337-20 250.000 mg On Admin 0.66300 1.16 1.16 COST1 CHKS Injectable 6340248 5 cefTRIAXone 500 mg Inj Vial [CHKS] 00781-3207-95 500.000 mg On Admin 2.69900 4.72 4.72 COST1 CHKS Injectable 6340248 5 cefTRIAXone 500 mg Inj Vial [CHKS] 00409-7338-01 500.000 mg On Admin 0.85200 1.49 1.49 COST1 CHKS Injectable 6340248 5 cefTRIAXone 500 mg Pow 00409-7338-20 500.000 mg On Admin 0.84300 1.48 1.48 COST1 CHKS Injectable 2640888 5 celecoxib 200 mg Cap 68084-0976-01 200.000 mg On Admin 0.99410 1.74 1.74 COST1 CHKS Med 2640888 5 celecoxib 200 mg Cap [CHKS] 00904-6503-61 200.000 mg On Admin 1.88650 3.30 3.30 COST1 CHKS Med 2640335 232 cephalexin 500 mg Cap 50268-0152-15 500.000 mg On Admin 0.22820 0.40 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2640335 942 cephalexin 500 mg Cap [CHKS] 00093-3147-01 500.000 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2640335 923 cephalexin 500 mg Cap [CHKS] 60687-0163-01 500.000 mg On Admin 0.25000 0.44 1.00 COST1 CHKS Med 2641591 333 cetirizine 10 mg Tab 51079-0597-20 10.000 mg On Admin 0.11850 0.21 1.00 COST1 CHKS Med 2641591 466 cetirizine 10 mg Tab 60687-0165-01 10.000 mg On Admin 2.27760 3.99 3.99 COST1 CHKS Med 2641591 954 cetirizine 10 mg Tab [CHKS] 00904-5852-61 10.000 mg On Admin 0.11000 0.19 1.00 COST1 CHKS Med 2641656 5 charcoal 25 g Oral Susp 120 mL [CHKS] 66689-0202-04 120.000 mL On Admin 0.17600 36.96 36.96 COST1 CHKS Med 2640784 5 charcoal 50 g Oral Susp 240 mL [CHKS] 66689-0202-08 50.000 gm On Admin 0.12010 50.44 50.44 COST1 CHKS Med 2640748 5 charcoal-sorbitol 25 g Oral Susp 120 mL [CHKS] 00574-0120-74 25.000 gm On Admin 0.10540 22.13 22.13 COST1 CHKS Med




gm)

Per Dispense Unit


2640748 5 charcoal-sorbitol 25 g Sus 00574-0120-04 25.000 gm On Admin 0.10020 21.04 21.04 COST1 CHKS Med 2640126 5 charcoal-sorbitol 50 g Oral Susp 240 mL [CHKS] 00574-0120-76 50.000 gm On Admin 0.07470 31.37 31.37 COST1 CHKS Med 2641218 5 chlorpheniramine-HYDROcodone 8 mg-10 mg/5 mL

Oral Susp, ER 115 mL [CHKS] 62175-0490-64 115.000 mL On Admin 0.38130 20.02 20.02 COST1 CHKS Med

2641478 954 cholecalciferol 1000 intl units Tab [CHKS] 00904-5824-60 1000.000 unit( s) On Admin 0.02000 0.04 1.00 COST1 CHKS Med 2641478 336 cholecalciferol 1000 intl units Tab[CHKS] 00904-5824-61 1000.000 unit( s) On Admin 0.03610 0.06 1.00 COST1 CHKS Med 2641114 580 cholecalciferol 400 intl units Tab 50268-0863-15 400.000 unit( s) On Admin 0.18880 0.33 1.00 COST1 CHKS Med 2641114 954 cholecalciferol 400 intl units Tab [CHKS] 58526-0005-50 400.000 unit( s) On Admin 0.38000 0.67 1.00 COST1 CHKS Med 2640971 5 cholestyramine 4 g/9 g Pow 68382-0528-60 1.000 EA On Admin 0.35440 0.62 1.00 COST1 CHKS Med 2640971 954 cholestyramine 4 g/9 g Pow UD [CHKS] 49884-0465-65 1.000 EA On Admin 0.34000 0.60 1.00 COST1 CHKS Med 2642244 942 chondroitin-glucosamine 400 mg-500 mg oral capsule

[CHKS] 00904-5481-18 1.000 cap( s) On Admin 1.00000 1.75 1.75 COST1 CHKS Med

6340272 5 ciprofloxacin 400 mg/200 mL D5W IV Sol [CHKS] 36000-0009-24 400.000 mg On Admin 0.01020 3.57 3.57 COST1 CHKS Injectable 6340272 5 ciprofloxacin 400 mg/200 mL D5W IV Sol [CHKS] 00409-4777-50 400.000 mg On Admin 0.01250 4.38 4.38 COST1 CHKS Injectable 6340272 5 ciprofloxacin 400 mg/200 mL-5% Sol 00409-4777-02 400.000 mg On Admin 0.01400 4.90 4.90 COST1 CHKS Injectable 2641066 232 ciprofloxacin 500 mg Tab 68084-0070-01 500.000 mg On Admin 0.17323 0.30 1.00 COST1 CHKS Med 2641066 954 ciprofloxacin 500 mg Tab [CHKS] 51079-0182-20 500.000 mg On Admin 0.15000 0.26 1.00 COST1 CHKS Med 2641034 954 citalopram 20 mg Tab [CHKS] 00904-6085-61 20.000 mg On Admin 0.06000 0.10 1.00 COST1 CHKS Med 2643489 5 citric acid-sodium citrate 334 mg-500 mg/5 mL

*PROCEDURE* Sol[CHKS] 00121-0595-30 30.000 mL On


2640223 5 citric acid-sodium citrate 334 mg-500 mg/5 mL Sol 00121-1190-00 30.000 mL On Admin 0.07560 3.97 3.97 COST1 CHKS Med 2640223 926 citric acid-sodium citrate 334 mg-500 mg/5 mL Sol

UD[CHKS] 00121-0595-30 30.000 mL On Admin 0.70000 36.75 36.75 COST1 CHKS Med

2640619 5 clindamycin 150 mg Cap [CHKS] 00591-5708-01 150.000 mg On Admin 1.01900 1.78 1.78 COST1 CHKS Med 2640619 5 clindamycin 150 mg Cap [CHKS] 68084-0243-01 150.000 mg On Admin 0.16430 0.29 1.00 COST1 CHKS Med 2641908 5 clindamycin 600 mg/50 mL-D5W IV Sol [CHKS] 00781-9221-09 600.000 mg On Admin 0.10640 9.31 9.31 COST1 CHKS Injectable 2643408 237 clindamycin 600 mg/50 mL-NaCl 0.9% PREMIX Sol

[CHKS] 00338-9549-24 600.000 mg On Admin 0.09470 8.29 8.29 COST1 CHKS Injectable

2640792 435 clonazePAM 0.5 mg Tab 00228-3003-11 0.500 mg On Admin 0.74000 1.29 1.29 COST1 CHKS Med




gm)

Per Dispense Unit


2640792 942 clonazePAM 0.5 mg Tab UD [CHKS] 63739-0263-10 0.500 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2640338 942 cloNIDine 0.2 mg Tab [CHKS] 62584-0339-01 0.200 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2640338 900 cloNIDine 0.2 mg Tab [CHKS] 00904-5657-61 0.200 mg On Admin 0.30000 0.53 1.00 COST1 CHKS Med 2640716 954 clopidogrel 75 mg Tab [CHKS] 68084-0536-01 75.000 mg On Admin 0.16000 0.28 1.00 COST1 CHKS Med 2640946 5 clotrimazole Top 1% Cream 15 gm [CHKS] 45802-0434-01 1.000 app On


2640946 5 clotrimazole Top 1% Cream 15 gm [CHKS] 51672-2002-01 1.000 app On Dispense/Manual

0.21020 5.52 5.52 COST1 CHKS Med

2640876 5 collagenase Top 250 units/g Oint [CHKS] 50484-0010-30 1.000 app On Dispense/Manual

6.98170 366.54 366.54 COST1 CHKS Med

6341260 236 Copper contraceptive, intrauterine 1 EA [CHKS] 59365-5128-01 1.000 EA On Admin 808.60000 970.32 970.32 COST1 CHKS Med




gm)

Per Dispense Unit


2641004 942 cyanocobalamin 100 mcg Tab [CHKS] 50428-2134-47 100.000 mcg On Admin 0.01000 0.02 1.00 COST1 CHKS Med 2641005 942 cyanocobalamin 1000 mcg Tab [CHKS] 00904-4217-13 1000.000 mcg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2641005 565 cyanocobalamin 1000 mcg Tab [CHKS] 50268-0855-15 1000.000 mcg On Admin 0.14040 0.25 1.00 COST1 CHKS Med 6340225 5 cyanocobalamin 1000 mcg/mL Inj Sol 1 mL [CHKS] 63323-0044-01 1000.000 mcg On Admin 2.17760 3.81 3.81 COST1 CHKS Injectable 6340225 5 cyanocobalamin 1000 mcg/mL Inj Sol 1 mL [CHKS] 00517-0031-25 1000.000 mcg On Admin 3.01080 5.27 5.27 COST1 CHKS Injectable 6340225 5 cyanocobalamin 1000 mcg/mL Sol 70069-0005-01 1000.000 mcg On Admin 2.43320 4.26 4.26 COST1 CHKS Injectable 2640573 321 cyclobenzaprine 10 mg Tab 00904-7809-61 10.000 mg On Admin 0.05101 0.09 1.00 COST1 CHKS Med 2640573 76 cyclobenzaprine 10 mg Tab 63739-0531-10 10.000 mg On Admin 0.09220 0.16 1.00 COST1 CHKS Med 2640573 954 cyclobenzaprine 10 mg Tab UD [CHKS] 51079-0644-20 10.000 mg On Admin 0.06000 0.10 1.00 COST1 CHKS Med 2642768 5 cyclopentolate Ophth 1% Sol [CHKS] 00065-0396-02 1.000 drop( s) On


2642768 5 cyclopentolate Ophth 1% Sol [CHKS] 17478-0100-02 1.000 drop( s) On Dispense/Manual

5.59000 48.91 48.91 COST1 CHKS Med

2642768 5 cyclopentolate ophthalmic 1% Sol 61314-0396-01 1.000 drop( s) On Dispense/Manual

2.03500 17.81 17.81 COST1 CHKS Med

2642058 5 dantrolene 20 mg IV Inj [CHKS] 27505-0003-67 20.000 mg On Admin 61.66670 107.92 107.92 COST1 CHKS Injectable 6341280 5 DAPTOmycin 350 mg Pow-INJ [CHKS] 25021-0179-15 350.000 mg On

Dispense/Manual 3.37670 5.91 5.91 COST1 CHKS Injectable

6340231 43 DAPTOmycin 500 mg IV Inj [CHKS] 67919-0011-01 500.000 mg On Admin 117.82000 206.19 206.19 COST1 CHKS Injectable 6340231 5 DAPTOmycin 500 mg IV Inj [CHKS] 63323-0871-15 500.000 mg On Admin 118.34000 207.09 207.09 COST1 CHKS Injectable 6340231 42 DAPTOmycin 500 mg Pow 43598-0413-11 500.000 mg On Admin 108.87000 190.52 190.52 COST1 CHKS Injectable 6341218 5 degarelix 120 mg Pow-Inj [CHKS] 55566-8403-01 120.000 mg On Admin 1442.95000 2597.31 2597.31 COST1 CHKS Injectable 6341227 5 degarelix 80 mg Pow-Inj [CHKS] 55566-8303-01 80.000 mg On Admin 462.42000 809.24 809.24 COST1 CHKS Injectable 6340346 5 denosumab 120 mg/1.7 mL Sol Vial [CHKS] 55513-0730-01 120.000 mg On Admin 2162.02000 6615.78 6615.78 COST1 CHKS Injectable 6340318 5 denosumab 60 mg/mL Sol 1 mL [CHKS] 55513-0710-01 60.000 mg On Admin 1154.09000 2077.36 2077.36 COST1 CHKS Injectable 2642271 5 desflurane 100% Inh Liq 240 mL [CHKS] 10019-0644-24 240.000 mL On


2643488 40 dexameth/neomycin/polymyxin B Ophth Oint *PROCEDURE* 3.5 gm [CHKS]

00574-4160-35 1.000 app On Dispense/Manual

1.57000 8.24 8.24 COST1 CHKS Med




gm)

Per Dispense Unit


6340887 954 dexamethasone 10 mg/mL Inj Sol [CHKS] 63323-0506-01 10.000 mg On Admin 1.62000 2.83 2.83 COST1 CHKS Injectable 6340887 337 dexamethasone 10 mg/mL preservative-free Sol 70069-0021-25 10.000 mg On Admin 4.97520 8.71 8.71 COST1 CHKS Injectable 2640575 256 dexamethasone 4 mg Tab [CHKS] 00054-8175-25 4.000 mg On Admin 0.89040 1.56 1.56 COST1 CHKS Med 6340888 333 dexamethasone 4 mg/mL Inj Sol 1 mL [CHKS] 63323-0165-01 4.000 mg On Admin 0.58360 1.02 1.02 COST1 CHKS Injectable 6340713 925 dexamethasone 4 mg/mL Inj Sol 5 mL MDV [CHKS] 63323-0165-05 4.000 mg On Admin 0.16780 0.29 1.00 COST1 CHKS Injectable 6340888 168 dexamethasone 4 mg/mL Sol 67457-0423-12 4.000 mg On Admin 0.58983 1.03 1.03 COST1 CHKS Injectable 2640836 954 dexamethasone/neomycin/polymyxin B Ophth Oint 3.5

gm [CHKS] 00574-4160-35 1.000 app On


2640836 5 dexamethasone/neomycin/polymyxin B Ophth Oint 3.5 gm [CHKS]


4.30000 22.57 22.57 COST1 CHKS Med

2640836 5 dexamethasone/neomycin/polymyxin B Ophth Oint 3.5 gm [CHKS]


4.87140 25.57 25.57 COST1 CHKS Med




gm)

Per Dispense Unit


2641388 954 dexamethasone/neomycin/polymyxin B Ophth Susp 5 mL [CHKS]

24208-0830-60 1.000 drop( s) On Dispense/Manual

1.99000 17.41 17.41 COST1 CHKS Med

2640147 916 dextromethorphan-guaifenesin 10 mg-100 mg/5 mL Liq 50383-0062-06 5.000 mL On Admin 0.10480 0.92 1.00 COST1 CHKS Med 2640147 287 dextromethorphan-guaifenesin 10 mg-100 mg/5 mL Liq 24385-0578-26 5.000 mL On Admin 0.01267 0.11 1.00 COST1 CHKS Med 2640147 923 dextromethorphan-guaiFENesin 10 mg-100 mg/5 mL

Oral Liq 10 mL [CHKS] 00121-0638-00 5.000 mL On Admin 0.10480 0.92 1.00 COST1 CHKS Med

2641558 942 dextromethorphan-guaiFENesin ER 30 mg-600 mg Tab [CHKS]


2641558 924 dextromethorphan-guaiFENesin ER 30 mg-600 mg Tab [CHKS]


2641644 5 Dextrose 10% in Water IV Soln 250 mL [CHKS] 00409-7930-02 250.000 mL On Admin 0.01140 4.99 4.99 COST1 CHKS LVP 6341073 942 Dextrose 5% in Lactated Ringers IV Soln 1000 mL

[CHKS] 00264-7751-00 1000.000 mL On Admin 0.01000 17.50 17.50 COST1 CHKS LVP

6340204 5 Dextrose 5% in Water IV Soln 250 mL [CHKS] 00409-7922-02 250.000 mL On Admin 0.01140 4.99 4.99 COST1 CHKS LVP 6340201 5 Dextrose 5% in Water Sol 1000 mL [CHKS] 00409-7922-09 1000.000 mL On Admin 0.00280 4.90 4.90 COST1 CHKS LVP 6340945 942 Dextrose 5% in Water Sol 500 mL [CHKS] 00409-7922-55 500.000 mL On Admin 0.01000 8.75 8.75 COST1 CHKS LVP 6340710 1 Dextrose 5% with 0.45% NaCl Sol 1000 mL [CHKS] 00409-7926-09 1000.000 mL On Admin 0.00280 4.90 4.90 COST1 CHKS LVP 6340705 321 Dextrose 5% with 0.9% NaCl IV Soln 1000 mL [CHKS] 00264-7610-00 1000.000 mL On Admin 0.00242 4.23 4.23 COST1 CHKS LVP 2640280 5 dextrose 50% IV Sol 50 mL [CHKS] 00409-7517-16 25.000 gm On Admin 0.14450 12.64 12.64 COST1 CHKS Injectable 2640576 536 diazePAM 5 mg Tab 00904-5880-61 5.000 mg On Admin 0.31250 0.55 1.00 COST1 CHKS Med 2640576 954 diazepam 5 mg Tab [CHKS] 51079-0285-20 5.000 mg On Admin 0.06000 0.10 1.00 COST1 CHKS Med 6340059 954 diazepam 5 mg/mL Inj Sol [CHKS] 00409-1273-32 10.000 mg On Admin 11.46000 40.11 40.11 COST1 CHKS Injectable 6340059 5 diazepam 5 mg/mL Inj Sol [CHKS] 00409-3213-12 10.000 mg On Admin 3.28890 11.51 11.51 COST1 CHKS Injectable 2641621 5 diclofenac Ophth 0.1% Sol [CHKS] 16571-0101-25 1.000 drop( s) On


2641621 917 diclofenac Ophth 0.1% Sol [CHKS] 17478-0892-25 1.000 drop( s) On Dispense/Manual

4.11000 17.98 17.98 COST1 CHKS Med

2641621 5 diclofenac ophthalmic 0.1% Sol 61314-0014-05 1.000 drop( s) On Dispense/Manual

2.65200 11.60 11.60 COST1 CHKS Med




gm)

Per Dispense Unit


2641621 5 diclofenac ophthalmic 0.1% Sol 24208-0457-05 1.000 drop( s) On Dispense/Manual

1.33000 5.82 5.82 COST1 CHKS Med

2641675 942 diclofenac Top 1% gel 100 gm [CHKS] 63481-0684-47 2.000 gm On Dispense/Manual

0.55000 96.25 96.25 COST1 CHKS Med

2641675 5 diclofenac topical 1% Gel 69097-0524-44 2.000 gm On Dispense/Manual

0.17340 30.34 30.34 COST1 CHKS Med

2640347 954 digoxin 125 mcg ( 0.125 mg) Tab [CHKS] 00904-5921-61 125.000 mcg On Admin 1.30000 2.27 2.27 COST1 CHKS Med 2640347 421 digoxin 125 mcg ( 0.125 mg) Tab [CHKS] 68084-0366-01 125.000 mcg On Admin 1.77000 3.10 3.10 COST1 CHKS Med 6340104 5 digoxin 250 mcg/mL ( 0.25 mg/mL) Inj Sol 2 mL

[CHKS] 00781-3059-95 500.000 mcg On Admin 2.83100 9.91 9.91 COST1 CHKS Injectable

6340104 5 digoxin 250 mcg/mL ( 0.25 mg/mL) Sol 00641-6184-25 500.000 mcg On Admin 1.52000 5.32 5.32 COST1 CHKS Injectable 6340104 323 digoxin 250 mcg/mL ( 0.25 mg/mL) Sol 00641-1410-35 500.000 mcg On Admin 1.57860 5.53 5.53 COST1 CHKS Injectable 6340103 5 dihydroergotamine 1 mg/mL Inj Sol 1 mL [CHKS] 00574-0850-05 1.000 mg On Admin 73.55000 128.71 128.71 COST1 CHKS Injectable 2640537 830 dilTIAZem 180 mg/24 hours Cap 63739-0284-10 180.000 mg On Admin 1.80000 3.15 3.15 COST1 CHKS Med 2640537 447 dilTIAZem 180 mg/24 hours Cap 60687-0206-01 180.000 mg On Admin 0.50220 0.88 1.00 COST1 CHKS Med 2641671 954 diltiazem 5 mg/mL IV Sol 25 mL [CHKS] 00641-6015-10 125.000 mg On Admin 0.20000 8.75 8.75 COST1 CHKS Injectable




gm)

Per Dispense Unit


2640577 5 diltiazem 5 mg/mL IV Sol 5 mL [CHKS] 17478-0937-05 25.000 mg On Admin 0.25550 2.24 2.24 COST1 CHKS Injectable 2640577 5 diltiazem 5 mg/mL IV Sol 5 mL [CHKS] 00641-9217-10 25.000 mg On Admin 0.23660 2.07 2.07 COST1 CHKS Injectable 2640577 5 dilTIAZem 5 mg/mL Sol 00641-6013-10 25.000 mg On Admin 0.29160 2.55 2.55 COST1 CHKS Injectable 2641671 5 dilTIAZem 5 mg/mL Sol 00641-9219-10 125.000 mg On Admin 0.19690 8.61 8.61 COST1 CHKS Injectable 2640349 146 dilTIAZem 60 mg Tab 00093-0319-01 60.000 mg On Admin 1.01220 1.77 1.77 COST1 CHKS Med 2640349 954 diltiazem 60 mg Tab [CHKS] 51079-0746-20 60.000 mg On Admin 0.22000 0.39 1.00 COST1 CHKS Med 2640037 931 diltiazem ER 120 mg Cap [CHKS] 60687-0195-30 120.000 mg On Admin 0.45000 0.79 1.00 COST1 CHKS Med 2640537 954 diltiazem ER 180 mg Cap [CHKS] 68084-0053-01 180.000 mg On Admin 0.24000 0.42 1.00 COST1 CHKS Med 2640690 942 diltiazem ER 240 mg Cap [CHKS] 68084-0054-01 240.000 mg On Admin 1.78000 3.12 3.12 COST1 CHKS Med 2640690 292 diltiazem ER 240 mg Cap [CHKS] 60687-0217-01 240.000 mg On Admin 0.03290 0.06 1.00 COST1 CHKS Med 2640511 4 dinoprostone Vaginal Insert [CHKS] 55566-2800-01 10.000 mg On Admin 388.71000 680.24 680.24 COST1 CHKS Med 2640579 4 diphenhydrAMINE 12.5 mg/5 mL Liq 00121-0489-05 12.500 mg On


2640579 4 diphenhydrAMINE 12.5 mg/5 mL Liq 24385-0379-26 12.500 mg On Dispense/Manual

0.00620 1.28 1.28 COST1 CHKS Med

2640579 4 diphenhydrAMINE 12.5 mg/5 mL Liq 4 oz [CHKS] 50580-0534-04 12.500 mg On Dispense/Manual

0.03510 7.25 7.25 COST1 CHKS Med

2640578 321 diphenhydrAMINE 25 mg Cap [CHKS] 00904-5306-61 25.000 mg On Admin 0.02990 0.05 1.00 COST1 CHKS Med 6340109 954 diphenhydrAMINE 50 mg/mL Inj Sol 1 mL [CHKS] 63323-0664-01 50.000 mg On Admin 0.56000 0.98 1.00 COST1 CHKS Injectable 6340109 336 diphenhydrAMINE 50 mg/mL Sol 00641-0376-25 50.000 mg On Admin 0.56480 0.99 1.00 COST1 CHKS Injectable 2640350 954 dipyridamole 25 mg Tab [CHKS] 64980-0133-01 25.000 mg On Admin 0.36000 0.63 1.00 COST1 CHKS Med 2641690 954 divalproex sodium 250 mg Oral EC Tab [CHKS] 68084-0776-01 250.000 mg On Admin 0.15000 0.26 1.00 COST1 CHKS Med 2699999 952 DO NOT USE Dextrose 5% in Water 250 mL [CHKS] 99999-9909-99 250.000 mL On Admin 0.00000 0.00 0.00 AWP CHKS No Charge 2699999 952 DO NOT USE Dopamine IV Additive [CHKS] 99999-9099-99 400.000 mg On Admin 0.00000 0.00 0.00 AWP CHKS No Charge 2699999 952 DO NOT USE Heparin Additive IV [CHKS] 98998-9999-00 25000.000 unit( s) On Admin 0.00000 0.00 0.00 AWP CHKS No Charge 2699999 951 DO NOT USE nitroglycerin IV additive [CHKS] 99998-0999-99 50.000 mg On Admin 0.00000 0.00 0.00 AWP CHKS No Charge 2640452 942 docusate sodium 100 mg Cap [CHKS] 49348-0058-19 100.000 mg On Admin 0.05000 0.09 1.00 COST1 CHKS Med 2640798 954 docusate sodium 100 mg Cap [CHKS] 63739-0478-10 100.000 mg On Admin 0.03000 0.05 1.00 COST1 CHKS Med 2640798 924 docusate sodium 100 mg Cap [CHKS] 00904-6455-61 100.000 mg On Admin 1.17000 2.05 2.05 COST1 CHKS Med




gm)

Per Dispense Unit


2641296 154 docusate-senna 50 mg-8.6 mg Tab 00904-6724-61 1.000 tab( s) On Admin 0.02123 0.04 1.00 COST1 CHKS Med 2641296 35 docusate-senna 50 mg-8.6 mg Tab 63739-0432-10 1.000 tab( s) On Admin 0.12355 0.22 1.00 COST1 CHKS Med 2641296 954 docusate-senna 50 mg-8.6 mg Tab [CHKS] 00904-6339-61 1.000 tab( s) On Admin 0.03000 0.05 1.00 COST1 CHKS Med 2641296 924 docusate-senna 50 mg-8.6 mg Tab [CHKS] 57896-0455-01 1.000 tab( s) On Admin 0.23000 0.40 1.00 COST1 CHKS Med 2641802 4 donepezil 5 mg Tab 00904-6477-61 5.000 mg On Admin 0.09350 0.16 1.00 COST1 CHKS Med 2641802 954 donepezil 5 mg Tab [CHKS] 13668-0102-30 5.000 mg On Admin 0.04000 0.07 1.00 COST1 CHKS Med 2641802 4 donepezil 5 mg Tab [CHKS] 00904-6408-61 5.000 mg On Admin 4.53000 7.93 7.93 COST1 CHKS Med 6340259 4 dopamine 400 mg/250 mL D5W 250 mL [CHKS] 00409-7809-22 400.000 mg On Admin 0.02690 11.77 11.77 COST1 CHKS Injectable 2641285 4 doxazosin 2 mg Tab [CHKS] 51079-0958-20 2.000 mg On Admin 0.68100 1.19 1.19 COST1 CHKS Med 2641285 4 doxazosin 2 mg Tab [CHKS] 68084-0851-25 2.000 mg On Admin 0.68100 1.19 1.19 COST1 CHKS Med




gm)

Per Dispense Unit


2640356 4 doxycycline 100 mg IV Inj [CHKS] 63323-0130-13 100.000 mg On Admin 19.09500 33.42 33.42 COST1 CHKS Injectable 2640356 4 doxycycline 100 mg Pow 67457-0437-10 100.000 mg On Admin 12.30800 21.54 21.54 COST1 CHKS Injectable 2640356 4 doxycycline 100 mg Pow 63323-0130-11 100.000 mg On Admin 19.43400 34.01 34.01 COST1 CHKS Injectable 2641934 305 doxycycline 100 mg Tab [CHKS] 62584-0693-21 100.000 mg On Admin 0.16826 0.29 1.00 COST1 CHKS Med 2641357 292 DULoxetine 30 mg Cap 68001-0256-04 30.000 mg On Admin 0.27200 0.48 1.00 COST1 CHKS Med 2641357 954 DULoxetine 30 mg Cap-DR [CHKS] 68084-0683-01 30.000 mg On Admin 0.85000 1.49 1.49 COST1 CHKS Med 2641312 732 dutasteride 0.5 mg Cap [CHKS] 00173-0712-15 0.500 mg On Admin 5.75170 10.07 10.07 COST1 CHKS Med 2642295 4 Elta/Resta Cream [CHKS] 99999-9999-02 1.000 app On


2643492 4 emollient, Top Crm ( secura extra prot cream) 92gm *PROCEDURE*[CHKS]

69740-0324-00A

1.000 app On Dispense/Manual

0.04320 6.96 6.96 COST1 CHKS Med

2643276 678 emollients, Top Crm ( secura extra prot cream) 92gm [CHKS]


0.06000 9.66 9.66 COST1 CHKS Med

2642173 4 emollients, Top Crm ( secura extra prot cream) 98gm [CHKS]


0.04320 7.41 7.41 COST1 CHKS Med

2642060 954 emollients, Top Gel ( Surgilube 3gm) [CHKS] 00281-0205-43 1.000 app On Dispense/Manual

0.03000 0.16 1.00 COST1 CHKS Med

2642089 916 emollients, topical ( Carmex) Lip Therapy [CHKS] 083078113148 1.000 app On Dispense/Manual

0.50000 0.88 1.00 COST1 CHKS Med

2643491 4 emollients, topical - Ointment ( Aquaphor) 105gm *PROCEDURE* [CHKS]

72140-0032-63A

1.000 app On Dispense/Manual

0.06250 11.48 11.48 COST1 CHKS Med

2643116 4 emollients, topical - Ointment ( Aquaphor) 105gm [CHKS]


0.06250 11.48 11.48 COST1 CHKS Med

2642606 954 enalapril 1.25 mg/mL IV Sol 1 mL [CHKS] 00409-2122-01 1.250 mg On Admin 1.52000 2.66 2.66 COST1 CHKS Injectable 2642606 651 enalapril 1.25 mg/mL Sol 00143-9787-10 1.250 mg On Admin 3.60000 6.30 6.30 COST1 CHKS Injectable 6340035 4 enoxaparin 100 mg/mL Sol Syringe [CHKS] 63323-0568-84 100.000 mg On Admin 8.72900 15.28 15.28 COST1 CHKS Injectable 6340035 4 enoxaparin 100 mg/mL Sol Syringe [CHKS] 63323-0568-95 100.000 mg On Admin 8.87290 15.53 15.53 COST1 CHKS Injectable 6340030 4 enoxaparin 30 mg/0.3 mL SC Sol [CHKS] 63323-0568-83 30.000 mg On Admin 9.24670 4.85 4.85 COST1 CHKS Injectable 6340031 4 enoxaparin 40 mg/0.4 mL SC Sol [CHKS] 63323-0568-96 40.000 mg On Admin 3.50300 2.45 2.45 COST1 CHKS Injectable




gm)

Per Dispense Unit


6340031 4 enoxaparin 40 mg/0.4 mL Sol 00548-5602-00 40.000 mg On Admin 5.68100 3.98 3.98 COST1 CHKS Injectable 6340034 4 enoxaparin 80 mg/0.8 mL SC Sol [CHKS] 63323-0568-90 80.000 mg On Admin 6.97800 9.77 9.77 COST1 CHKS Injectable 2640281 4 ePHEDrine 50 mg/mL Inj Sol 1 mL [CHKS] 17478-0515-00 50.000 mg On Admin 34.27100 59.97 59.97 COST1 CHKS Injectable 2640752 4 ePHEDrine 50 mg/mL Sol 76014-0005-25 50.000 mg On Admin 10.41400 18.22 18.22 COST1 CHKS Injectable 2640752 4 ePHEDrine sulfate 50 mg/mL Sol 1 mL Vial [CHKS] 42023-0216-25 50.000 mg On Admin 12.11800 21.21 21.21 COST1 CHKS Injectable 6340069 333 EPINEPHrine 0.1 mg/mL Inj Sol 10 mL Syringe [CHKS] 00409-4921-34 1.000 mg On Admin 0.41430 7.25 7.25 COST1 CHKS Injectable 6340069 4 EPINEPHrine 0.1 mg/mL Sol 76329-3316-01 1.000 mg On Admin 0.71100 12.44 12.44 COST1 CHKS Injectable 6340602 4 EPINEPHrine 0.15 mg Inj kit [CHKS] 49502-0501-02 0.150 mg On Admin 285.20500 499.11 499.11 COST1 CHKS Injectable 6340602 4 EPINEPHrine 0.15 mg Kit 49502-0101-02 0.150 mg On Admin 134.90500 236.08 236.08 COST1 CHKS Injectable 6340738 4 EPINEPHrine 0.3 mg Inj kit [CHKS] 49502-0500-02 0.300 mg On Admin 285.20500 499.11 499.11 COST1 CHKS Injectable 6340738 4 EPINEPHrine 0.3 mg Kit 49502-0102-02 0.300 mg On Admin 134.90500 236.08 236.08 COST1 CHKS Injectable 6340560 4 EPINEPHrine 1 mg/mL Inj Sol 1 mL [CHKS] 00409-7241-25 1.000 mg On Admin 1.96920 3.45 3.45 COST1 CHKS Injectable 6340560 4 EPINEPHrine 1 mg/mL Inj Sol 1 mL [CHKS] 54288-0103-10 1.000 mg On Admin 8.28400 14.50 14.50 COST1 CHKS Injectable




gm)

Per Dispense Unit


6340560 4 EPINEPHrine 1 mg/mL Sol 42023-0159-25 1.000 mg On Admin 13.25400 23.19 23.19 COST1 CHKS Injectable 2640665 4 EPINEPHrine-lidocaine 1:100,000-1% Inj Sol 20 mL

MDV [CHKS] 63323-0482-27 20.000 mL On Admin 0.13300 4.66 4.66 COST1 CHKS Med

2641894 4 EPINEPHrine-lidocaine 1:200,000-2% PF Inj Sol 20 mL [CHKS]


6340265 4 epoetin alfa 20,000 units/mL Inj Sol 1 mL MDV [CHKS] 59676-0320-04 20000.000 unit( s) On Admin 273.24750 478.18 478.18 COST1 CHKS Injectable 2641418 504 ergocalciferol 50,000 intl units Cap 68084-0463-01 50000.000 unit( s) On Admin 0.08916 0.16 1.00 COST1 CHKS Med 2641418 42 ergocalciferol 50,000 intl units Cap 60687-0500-01 50000.000 unit( s) On Admin 0.99920 1.75 1.75 COST1 CHKS Med 2641418 942 ergocalciferol 50,000 intl units Cap [CHKS] 64380-0737-06 50000.000 unit( s) On Admin 1.21000 2.12 2.12 COST1 CHKS Med 6340286 954 ertapenem 1 g Inj [CHKS] 00006-3845-71 1.000 gm On Admin 109.48000 191.59 191.59 COST1 CHKS Injectable 6340286 4 ertapenem 1 g Inj [CHKS] 00006-3843-71 1.000 gm On Admin 121.80300 213.16 213.16 COST1 CHKS Injectable 6340286 4 ertapenem 1 g Inj [CHKS] 42023-0221-10 1.000 gm On Admin 60.92100 106.61 106.61 COST1 CHKS Injectable 2643091 4 erythromycin ophthalmic 0.5% Oin 00574-4024-35 1.000 app On Admin 3.07710 5.38 5.38 COST1 CHKS Med 2643091 4 erythromycin ophthalmic 0.5% Oin UD [CHKS] 24208-0910-19 1.000 app On Admin 7.27980 12.74 12.74 COST1 CHKS Med 2640157 954 escitalopram 10 mg Tab [CHKS] 00904-6426-61 10.000 mg On Admin 0.15000 0.26 1.00 COST1 CHKS Med 2641099 616 esomeprazole 40 mg Cap 60687-0246-01 40.000 mg On Admin 3.81000 6.67 6.67 COST1 CHKS Med 2641099 4 esomeprazole 40 mg Cap 43598-0510-90 40.000 mg On Admin 0.23630 0.41 1.00 COST1 CHKS Med 2641099 4 esomeprazole 40 mg Oral EC Cap [CHKS] 00093-6451-56 40.000 mg On Admin 4.84130 8.47 8.47 COST1 CHKS Med 2641228 4 estradiol 1 mg Tab [CHKS] 50268-0291-15 1.000 mg On Admin 0.11150 0.20 1.00 COST1 CHKS Med 2641529 4 etomidate 2 mg/mL IV Sol 20 mL [CHKS] 00409-6695-02 40.000 mg On Admin 0.30250 10.59 10.59 COST1 CHKS Injectable 2641529 714 etomidate 2 mg/mL Sol 00143-9507-10 40.000 mg On Admin 0.40320 14.11 14.11 COST1 CHKS Injectable 2641529 4 etomidate 2 mg/mL Sol 00143-9311-10 40.000 mg On Admin 0.18470 6.46 6.46 COST1 CHKS Injectable 2641259 4 ezetimibe 10 mg Tab 69238-1154-03 10.000 mg On Admin 0.63130 1.10 1.10 COST1 CHKS Med 2641259 4 ezetimibe 10 mg Tab UD [CHKS] 66582-0414-31 10.000 mg On Admin 10.88570 19.05 19.05 COST1 CHKS Med 2641131 4 famotidine 20 mg Tab 50268-0303-15 20.000 mg On Admin 0.10080 0.18 1.00 COST1 CHKS Med 2641131 4 famotidine 20 mg Tab UD [CHKS] 51079-0966-20 20.000 mg On Admin 0.08290 0.15 1.00 COST1 CHKS Med 6340739 4 fentaNYL 0.05 mg/mL Inj Sol 5 mL Amp [CHKS] 00409-9093-35 0.250 mg On Admin 0.06820 0.60 1.00 COST1 CHKS Injectable 6340052 4 fentaNYL 100 mcg/2mL Inj Sol [CHKS] 00409-9093-32 100.000 mcg On Admin 0.27450 0.96 1.00 COST1 CHKS Injectable 2640008 954 fentaNYL 100 mcg/hr Patch [CHKS] 60505-7009-02 100.000 mcg/hr On Admin 5.05000 8.84 8.84 COST1 CHKS Med




gm)

Per Dispense Unit


2640008 923 fentaNYL 100 mcg/hr Patch [CHKS] 60505-7014-00 100.000 mcg/hr On Admin 7.80000 13.65 13.65 COST1 CHKS Med 2640008 4 fentaNYL 100 mcg/hr Patch [CHKS] 00409-9000-76 100.000 mcg/hr On Admin 4.26000 7.46 7.46 COST1 CHKS Med 2641540 4 fentaNYL 12 mcg/hr Patch [CHKS] 00378-9119-98 12.000 mcg/hr On Admin 12.70600 22.24 22.24 COST1 CHKS Med 2641540 4 fentaNYL 12 mcg/hr Patch [CHKS] 00406-9012-76 12.000 mcg/hr On Admin 3.61400 6.32 6.32 COST1 CHKS Med 2641416 4 fentaNYL 25 mcg/hr Fil 00406-9025-76 25.000 mcg/hr On Admin 1.69800 2.97 2.97 COST1 CHKS Med 2641416 4 fentaNYL 25 mcg/hr Patch [CHKS] 60505-7006-02 25.000 mcg/hr On Admin 4.32600 7.57 7.57 COST1 CHKS Med 2641399 4 fentaNYL 50 mcg/hr Fil 00406-9050-76 50.000 mcg/hr On Admin 2.70400 4.73 4.73 COST1 CHKS Med




gm)

Per Dispense Unit


2641399 4 fentaNYL 50 mcg/hr Patch [CHKS] 60505-7012-02 50.000 mcg/hr On Admin 11.30800 19.79 19.79 COST1 CHKS Med 2641399 4 fentaNYL 50 mcg/hr Patch [CHKS] 60505-7007-00 50.000 mcg/hr On Admin 9.27800 16.24 16.24 COST1 CHKS Med 2641406 4 fentaNYL 75 mcg/hr Fil 00406-9075-76 1.000 patch( es) On Admin 4.04600 7.08 7.08 COST1 CHKS Med 2641406 4 fentaNYL 75 mcg/hr Patch [CHKS] 60505-7013-02 1.000 patch( es) On Admin 18.09600 31.67 31.67 COST1 CHKS Med 2641406 4 fentaNYL 75 mcg/hr Patch [CHKS] 60505-7008-00 1.000 patch( es) On Admin 11.71400 20.50 20.50 COST1 CHKS Med 2641406 923 fentaNYL 75 mcg/hr Patch [CHKS] 00591-3213-72 1.000 patch( es) On Admin 4.67000 8.17 8.17 COST1 CHKS Med 6340995 4 ferric carboxymaltose ( as elemental iron) 50 mg/mL

Sol 15 mL [CHKS] 00517-0650-01 750.000 mg On Admin 56.37870 1522.22 1522.22 COST1 CHKS Injectable

2641879 168 ferrous sulfate 324 mg Tab 00574-0608-01 324.000 mg On Admin 0.06000 0.10 1.00 COST1 CHKS Med 2641879 954 ferrous sulfate 324 mg Tab [CHKS] 00574-0608-11 324.000 mg On Admin 0.08000 0.14 1.00 COST1 CHKS Med 6340623 4 ferumoxytol 30 mg/mL Sol 17 mL Vial [CHKS] 59338-0775-01 510.000 mg On Admin 53.41470 1634.49 1634.49 COST1 CHKS Injectable 6340834 4 filgrastim 300 mcg/mL Inj Sol 1 mL [CHKS] 55513-0530-10 300.000 mcg On Admin 297.75500 521.07 521.07 COST1 CHKS Injectable 2640215 351 finasteride 5 mg Tab 65862-0149-30 5.000 mg On Admin 0.06600 0.12 1.00 COST1 CHKS Med 2640215 126 finasteride 5 mg Tab 50268-0314-15 5.000 mg On Admin 1.12660 1.97 1.97 COST1 CHKS Med 2640215 954 finasteride 5 mg Tab [CHKS] 50268-0323-15 5.000 mg On Admin 0.61000 1.07 1.07 COST1 CHKS Med 2641355 954 fluconazole 100 mg Tab [CHKS] 68001-0252-04 100.000 mg On Admin 0.60000 1.05 1.05 COST1 CHKS Med 6340315 4 fluconazole 200 mg in NS 100 mL Premix [CHKS] 00338-6046-48 200.000 mg On Admin 0.17650 30.89 30.89 COST1 CHKS Injectable 2641270 954 fludrocortisone 0.1 mg Tab [CHKS] 50268-0330-15 0.100 mg On Admin 0.50000 0.88 1.00 COST1 CHKS Med 2640608 4 flumazenil 0.1 mg/mL IV Sol 5 mL [CHKS] 00143-9784-10 0.500 mg On Admin 0.51920 4.54 4.54 COST1 CHKS Injectable 2640608 4 flumazenil 0.1 mg/mL Sol 00143-9684-10 0.500 mg On Admin 0.51920 4.54 4.54 COST1 CHKS Injectable 2640435 155 fluorescein ophthalmic 1 mg Tes 17238-0900-11 1.000 mg On Admin 0.17350 0.30 1.00 COST1 CHKS Med 2640435 954 fluorescein ophthalmic 1 mg Test [CHKS] 17478-0404-01 1.000 mg On Admin 0.09000 0.16 1.00 COST1 CHKS Med 2641191 197 FLUoxetine 20 mg Cap 00904-5785-61 20.000 mg On Admin 0.51110 0.89 1.00 COST1 CHKS Med 2641191 954 FLUoxetine 20 mg Cap [CHKS] 68084-0605-01 20.000 mg On Admin 0.07000 0.12 1.00 COST1 CHKS Med 2641471 4 fluticasone Nasal 0.05 mg/inh Spray 16 gm [CHKS] 60505-0847-03 0.050 mg On


2641471 4 fluticasone nasal 50 mcg/inh Spr 00054-3270-99 0.050 mg On Dispense/Manual

1.30190 36.45 36.45 COST1 CHKS Med

2641471 4 fluticasone nasal 50 mcg/inh Spr 60505-0829-01 0.050 mg On 0.24130 6.76 6.76 COST1 CHKS Med




gm)

Per Dispense Unit


Dispense/Manual 2641752 4 fluticasone-salmeterol 100 mcg-50 mcg Inh Pwdr

[CHKS] 00173-0695-04 1.000 EA On


2641732 4 fluticasone-salmeterol 250 mcg-50 mcg Inh Pwdr [CHKS]

00173-0696-04 1.000 puff( s) On Dispense/Manual

7.85860 192.54 192.54 COST1 CHKS Med

2641010 954 folic acid 0.4 mg Tab [CHKS] 00904-3197-60 0.400 mg On Admin 0.01000 0.02 1.00 COST1 CHKS Med 2640061 522 folic acid 1 mg Tab UD [CHKS] 62584-0897-01 1.000 mg On Admin 0.09990 0.17 1.00 COST1 CHKS Med 6340137 4 furosemide 10 mg/mL Inj Sol 4 mL [CHKS] 00409-6102-26 40.000 mg On Admin 0.17040 1.19 1.19 COST1 CHKS Injectable 6340137 4 furosemide 10 mg/mL Inj Sol 4 mL [CHKS] 00409-9631-04 40.000 mg On Admin 1.84850 12.94 12.94 COST1 CHKS Injectable 6340137 4 furosemide 10 mg/mL Sol 36000-0283-25 40.000 mg On Admin 0.28170 1.97 1.97 COST1 CHKS Injectable 2640362 954 furosemide 40 mg Tab UD [CHKS] 00904-5797-61 40.000 mg On Admin 0.04000 0.07 1.00 COST1 CHKS Med 2641375 348 gabapentin 100 mg Cap 68084-0783-01 100.000 mg On Admin 0.09570 0.17 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2641375 954 gabapentin 100 mg Cap UD [CHKS] 45963-0555-11 100.000 mg On Admin 0.03000 0.05 1.00 COST1 CHKS Med 2641375 924 gabapentin 100 mg Cap UD [CHKS] 60505-0112-00 100.000 mg On Admin 0.55240 0.97 1.00 COST1 CHKS Med 2641372 447 gabapentin 300 mg Cap 65862-0199-01 300.000 mg On Admin 1.03300 1.81 1.81 COST1 CHKS Med 2641372 321 gabapentin 300 mg Cap UD [CHKS] 68084-0762-01 300.000 mg On Admin 0.01152 0.02 1.00 COST1 CHKS Med 2641372 883 gabapentin 300 mg Cap UD [CHKS] 60505-0113-00 300.000 mg On Admin 1.10000 1.93 1.93 COST1 CHKS Med 6340922 4 gadodiamide 287 mg/mL Inj Sol 10 mL Vial [CHKS] 00407-0690-30 10.000 mL On Admin 5.38300 94.20 94.20 COST1 CHKS Injectable 2642240 4 gatifloxacin ophthalmic 0.5% Sol [CHKS] 00023-3615-25 1.000 drop( s) On


2640365 954 gemfibrozil 600 mg Tab [CHKS] 68084-0473-01 600.000 mg On Admin 0.17000 0.30 1.00 COST1 CHKS Med 6340958 4 gentamicin 10 mg/mL Inj Sol 2 mL [CHKS] 63323-0173-02 20.000 mg On Admin 0.08522 0.30 1.00 COST1 CHKS Injectable 6340115 4 gentamicin 40 mg/mL Inj Sol 2 mL [CHKS] 00409-1207-25 80.000 mg On Admin 0.39760 1.39 1.39 COST1 CHKS Injectable 6340115 4 gentamicin 40 mg/mL Sol 63323-0010-02 80.000 mg On Admin 1.52420 5.33 5.33 COST1 CHKS Injectable 2640526 4 gentamicin Ophth 0.3% Sol 5 mL [CHKS] 24208-0580-60 1.000 drop( s) On


2640526 4 gentamicin Ophth 0.3% Sol 5 mL [CHKS] 60758-0188-05 1.000 drop( s) On Dispense/Manual

0.68200 5.97 5.97 COST1 CHKS Med

2641954 4 GI Cocktail 50 mL [CHKS] 99999-9999-01 50.000 mg/mL On Admin 9.58740 16.78 16.78 COST1 CHKS Med 2640929 323 glipiZIDE 5 mg Tab UD [CHKS] 51079-0810-20 5.000 mg On Admin 0.24810 0.43 1.00 COST1 CHKS Med 6340117 4 glucagon recombinant 1 mg Inj Kit IM [CHKS] 00002-8031-01 1.000 mg On Admin 265.84000 465.22 465.22 COST1 CHKS Injectable 2640455 4 glucose 40% Oral gel 37.5 gm[CHKS] 00574-0070-30 1.000 app On Admin 0.07519 4.93 4.93 COST1 CHKS Med 2640455 4 glucose 40% Oral gel 37.5 gm[CHKS] 00574-0069-30 1.000 app On Admin 0.07510 4.93 4.93 COST1 CHKS Med 2640492 954 glycerin adult Supp [CHKS] 00713-0101-09 1.000 supp On Admin 0.59000 1.03 1.03 COST1 CHKS Med 2640492 379 glycerin adult Supp [CHKS] 00132-0079-12 1.000 supp On Admin 0.08500 0.15 1.00 COST1 CHKS Med 2640539 4 glycerin-witch hazel Top 10%-50% Pad 100 EA [CHKS] 00904-5059-60 1.000 app On Admin 0.03521 6.16 6.16 COST1 CHKS Med 2640539 4 glycerin-witch hazel Top 10%-50% Pad 100 EA [CHKS] 10331-0000-20 1.000 app On Admin 0.18212 31.87 31.87 COST1 CHKS Med 2640539 4 glycerin-witch hazel Top 10%-50% Pad 100 EA [CHKS] 50289-3250-01 1.000 app On Admin 0.04500 7.88 7.88 COST1 CHKS Med 2640661 4 glycopyrrolate 0.2 mg/mL Inj Sol 1 mL [CHKS] 00143-9682-25 0.200 mg On Admin 2.51080 4.39 4.39 COST1 CHKS Injectable 2640661 4 glycopyrrolate 0.2 mg/mL Sol 00143-9587-25 0.200 mg On Admin 2.51080 4.39 4.39 COST1 CHKS Injectable 2640661 4 glycopyrrolate 0.2 mg/mL Sol 70069-0011-25 0.200 mg On Admin 2.20640 3.86 3.86 COST1 CHKS Injectable




gm)

Per Dispense Unit


2640007 22 guaiFENesin 100 mg/5 mL Liq 00536-1182-97 2400.000 mg On Dispense/Manual

0.61440 129.02 129.02 COST1 CHKS Med

2640007 954 guaiFENesin 100 mg/5 mL Oral Liq 120 mL [CHKS] 00536-0825-85 2400.000 mg On Dispense/Manual

0.01000 2.10 2.10 COST1 CHKS Med

2641282 942 guaiFENesin ER 600 mg Tab [CHKS] 63824-0008-15 600.000 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2641282 673 guaiFENesin ER 600 mg Tab [CHKS] 68084-0572-01 600.000 mg On Admin 0.67550 1.18 1.18 COST1 CHKS Med 2640065 112 haloperidol 2 mg Tab 00378-0214-01 2.000 mg On Admin 0.42980 0.75 1.00 COST1 CHKS Med 2640065 954 haloperidol 2 mg Tab [CHKS] 51079-0735-20 2.000 mg On Admin 0.48000 0.84 1.00 COST1 CHKS Med 6340118 954 haloperidol 5 mg/mL Inj Sol 1 mL [CHKS] 67457-0426-12 5.000 mg On Admin 0.65000 1.14 1.14 COST1 CHKS Injectable 6340118 315 haloperidol 5 mg/mL Sol 63323-0474-01 5.000 mg On Admin 0.59990 1.05 1.05 COST1 CHKS Injectable 6340122 954 heparin 10,000 units/mL Inj Sol [CHKS] 63323-0542-01 10000.000 unit( s) On Admin 1.73000 3.03 3.03 COST1 CHKS Injectable 6340122 14 heparin 10000 units/mL Sol 00641-0410-12 10000.000 unit( s) On Admin 3.49920 6.12 6.12 COST1 CHKS Injectable




gm)

Per Dispense Unit


6341177 4 heparin 12,500 units/250mL-NaCl 0.45% Sol 250mL[CHKS]

00409-7651-62 12500.000 unit( s) On Admin 0.01890 8.27 8.27 COST1 CHKS Injectable

6340348 4 heparin 25,000 units/250 mL-NaCl 0.45% IV Sol [CHKS] 00409-7650-62 25000.000 unit( s) On Admin 0.02220 9.71 9.71 COST1 CHKS Injectable 6340349 4 heparin flush 100 units/mL Sol[CHKS] 64253-0333-33 300.000 unit( s) On Admin 0.13260 0.70 1.00 COST1 CHKS Injectable 6340725 4 hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [CHKS] 58160-0820-52 10.000 mcg On Admin 43.15600 37.76 37.76 COST1 CHKS Injectable 2640309 942 hetastarch 6%-NS IV Sol 500 mL [CHKS] 00409-7248-49 500.000 mL On Admin 0.03000 26.25 26.25 COST1 CHKS Injectable 2640309 4 hetastarch 60 mg/mL-NaCl 0.9% Sol 00409-7248-03 500.000 mL On Admin 0.02330 20.39 20.39 COST1 CHKS Injectable 6340078 954 hydrALAZINE 20 mg/mL Inj Sol 1 mL [CHKS] 63323-0614-55 20.000 mg On Admin 2.23000 3.90 3.90 COST1 CHKS Injectable 2640367 954 hydrALAZINE 25 mg Tab UD [CHKS] 62584-0733-01 25.000 mg On Admin 0.14000 0.25 1.00 COST1 CHKS Med 2640367 280 hydrALAZINE 25 mg Tab UD [CHKS] 00904-6441-61 25.000 mg On Admin 0.09991 0.17 1.00 COST1 CHKS Med 2640583 92 hydroCHLOROthiazide 25 mg Tab 43547-0397-10 25.000 mg On Admin 0.04890 0.09 1.00 COST1 CHKS Med 2640583 954 hydrochlorothiazide 25 mg Tab [CHKS] 68084-0086-01 25.000 mg On Admin 0.07000 0.12 1.00 COST1 CHKS Med 2640583 924 hydrochlorothiazide 25 mg Tab [CHKS] 63739-0128-10 25.000 mg On Admin 0.06000 0.10 1.00 COST1 CHKS Med 2640553 924 hydroCHLOROthiazide-triamterene 25 mg-37.5 mg Cap

UD[CHKS] 51079-0935-20 1.000 cap( s) On Admin 0.28110 0.49 1.00 COST1 CHKS Med

2641994 942 hydrochlorothiazide-triamterene 25 mg-37.5 mg Tab [CHKS]


2640188 49 hydrocortisone 10 mg Tab 59762-0074-01 10.000 mg On Admin 0.24296 0.43 1.00 COST1 CHKS Med 2640188 924 hydrocortisone 10 mg Tab [CHKS] 68084-0469-01 10.000 mg On Admin 0.62000 1.08 1.08 COST1 CHKS Med 6340126 4 hydrocortisone 100 mg preservative-free Pow [CHKS] 00009-0825-01 100.000 mg On Admin 9.18000 16.06 16.06 COST1 CHKS Injectable 2640156 4 hydrocortisone 25 mg Supp [CHKS] 00713-0503-12 25.000 mg On Admin 2.72170 4.76 4.76 COST1 CHKS Med 2641871 4 hydrocortisone Top 2.5% Cream 20 gm [CHKS] 45802-0004-02 1.000 app On


6340571 22 HYDROmorphone 1 mg/mL Inj Sol 1 mL [CHKS] 00409-1283-31 1.000 mg On Admin 0.89960 1.57 1.57 COST1 CHKS Injectable 2640370 439 HYDROmorphone 2 mg Tab 00527-1353-01 2.000 mg On Admin 0.37250 0.65 1.00 COST1 CHKS Med 2640370 954 HYDROmorphone 2 mg Tab [CHKS] 42858-0301-01 2.000 mg On Admin 0.08000 0.14 1.00 COST1 CHKS Med 6340106 954 HYDROmorphone 2 mg/mL Inj Sol [CHKS] 00409-3356-01 2.000 mg On Admin 1.15000 2.01 2.01 COST1 CHKS Injectable 6340106 518 HYDROmorphone 2 mg/mL Sol 00641-0121-25 2.000 mg On Admin 0.91000 1.59 1.59 COST1 CHKS Injectable 6340106 321 HYDROmorphone 2 mg/mL Sol 00409-3365-01 2.000 mg On Admin 0.90920 1.59 1.59 COST1 CHKS Injectable




gm)

Per Dispense Unit


6341095 4 HYDROXYprogesterone 250 mg/mL Sol 55150-0310-01 250.000 mg On Admin 189.34000 331.35 331.35 COST1 CHKS Med 6341095 4 HYDROXYprogesterone 250 mg/mL Sol[CHKS] 64011-0243-01 250.000 mg On Admin 803.00000 963.60 963.60 COST1 CHKS Med 2642437 924 hydrOXYzine hydrochloride 10 mg/5 mL Oral Syr[CHKS] 60432-0150-04 5.000 mL On Admin 0.09050 0.79 1.00 COST1 CHKS Med 2641219 954 hydrOXYzine hydrochloride 25 mg Tab [CHKS] 68084-0254-01 25.000 mg On Admin 0.16000 0.28 1.00 COST1 CHKS Med 6341187 4 hydrOXYzine hydrochloride 25 mg/mL Sol 00517-4201-25 25.000 mg On Admin 11.23920 19.67 19.67 COST1 CHKS Injectable 6340304 4 hylan G-F 20 48 mg/6 mL Sol [CHKS] 58468-0090-03 48.000 mg On Admin 74.79000 785.30 785.30 COST1 CHKS Med 2640197 942 ibuprofen 100 mg/5 mL Oral Susp 5 mL [CHKS] 66689-0009-01 100.000 mg On Admin 0.20000 1.75 1.75 COST1 CHKS Med 2640197 305 ibuprofen 100 mg/5 mL Sus 68094-0494-62 100.000 mg On Admin 0.12940 1.13 1.13 COST1 CHKS Med 2640586 954 ibuprofen 200 mg Tab [CHKS] 00904-7914-61 200.000 mg On Admin 0.03000 0.05 1.00 COST1 CHKS Med 6341050 354 imipenem-cilastatin 250 mg Inj [CHKS] 63323-0349-25 250.000 MBq On Admin 5.63840 9.87 9.87 COST1 CHKS Injectable




gm)

Per Dispense Unit


6340328 4 immune globulin ( Privigen) 10% IV Sol 5 gram/50 mL [CHKS]

44206-0436-05 5.000 gm On Admin 67.13000 6041.70 6041.70 COST1 CHKS Injectable

6340312 4 immune globulin 10% IV Sol 20 gram/200 mL [CHKS] 44206-0438-20 20.000 gm On Admin 67.13000 24166.80 24166.80 COST1 CHKS Injectable 2640588 634 indomethacin 25 mg Cap 50268-0430-15 25.000 mg On Admin 0.39660 0.69 1.00 COST1 CHKS Med 2640588 954 indomethacin 25 mg Cap UD [CHKS] 68462-0406-01 25.000 mg On Admin 0.07000 0.12 1.00 COST1 CHKS Med 6341120 4 influenza virus vaccine, inactivated high-dose PF

trivalent Sus 2018-19[CHKS] 49281-0403-65 0.500 mL On Admin 95.69000 83.73 83.73 COST1 CHKS Injectable

6340966 4 influenza virus vaccine, inactivated quad Sus 18-19[CHKS]

49281-0629-15 0.500 mL On Admin 8.56120 74.91 74.91 COST1 CHKS Injectable

6340230 4 insulin glargine 100 units/mL Sol 10 mL MDV [CHKS] 00088-2220-33 1000.000 unit( s) On Admin 8.48200 14.84 14.84 COST1 CHKS Injectable 6340131 4 insulin isophane-insulin regular human recombinant 70

units-30 units/mL SubQ MDV Inj 3 mL [CHKS] 00002-8715-17 300.000 unit( s) On

Dispense/Manual 1.52670 8.02 8.02 COST1 CHKS Injectable

6340902 4 insulin lispro 100 units/mL SubQ Inj MDV [CHKS] 00002-7510-17 300.000 unit( s) On Admin 5.53330 29.05 29.05 COST1 CHKS Injectable 6340389 4 insulin NPH human 100 units/mL Inj 10 mL MDV [CHKS] 00002-8315-17 1000.000 unit( s) On Admin 1.52670 2.67 2.67 COST1 CHKS Injectable 6340758 4 insulin regular human recombinant 100 units/mL Inj Sol

MDV [CHKS] 00002-8215-17 300.000 unit( s) On Admin 1.52670 2.67 2.67 COST1 CHKS Injectable

6340921 4 iohexol 180 mg/mL Inj Sol 10 mL Vial [CHKS] 00407-1411-10 1800.000 mg On Admin 1.35380 23.69 23.69 COST1 CHKS Injectable 6341157 4 iohexol 240 mg/mL Inj Sol 50 mL [CHKS] 00407-1412-30 12000.000 mg On Admin 0.08520 7.46 7.46 COST2 CHKS Covered Drug 6340631 952 iohexol 300 mg/mL Inj Sol 100 mL [CHKS] 00407-1413-87 30000.000 mg On Admin 5.02000 903.60 903.60 COST2 CHKS Covered Drug 6341142 397 iohexol 300 mg/mL Sol 150mL [CHKS] 00407-1413-88 45000.000 mg On Admin 5.00000 1350.00 1350.00 COST2 CHKS Covered Drug 2640300 323 ipratropium 0.02% Inh Sol 2.5 mL [CHKS] 00487-9801-01 0.500 mg On Admin 0.14833 0.52 1.00 COST1 CHKS Med 6340257 4 iron dextran 50 mg/mL Inj Sol 2 mL [CHKS] 00023-6082-10 100.000 mg On Admin 13.46250 47.12 47.12 COST1 CHKS Injectable 6340128 1 iron sucrose 20 mg/mL IV Sol 5 mL [CHKS] 00517-2340-10 100.000 mg On Admin 6.24840 54.67 54.67 COST1 CHKS Injectable 2640472 1 isosorbide ER mononitrate 30 mg Tab [CHKS] 50268-0451-15 30.000 mg On Admin 0.43960 0.77 1.00 COST1 CHKS Med 2642112 1 ketamine 10 mg/mL Inj Sol [CHKS] 42023-0113-10 200.000 mg On Admin 0.93640 32.77 32.77 COST1 CHKS Injectable 2642112 1 ketamine 10 mg/mL Sol 67457-0181-20 200.000 mg On Admin 0.91370 31.98 31.98 COST1 CHKS Injectable 2642113 1 ketamine 100 mg/mL Inj Sol 5 mL [CHKS] 00409-2051-05 500.000 mg On Admin 1.33300 11.66 11.66 COST1 CHKS Injectable 2642113 1 ketamine 100 mg/mL Sol 42023-0115-10 500.000 mg On Admin 2.52560 22.10 22.10 COST1 CHKS Injectable 2641079 1 ketoconazole Top 2% Crm 30 gm [CHKS] 00168-0099-30 1.000 app On 0.76230 40.02 40.02 COST1 CHKS Med




gm)

Per Dispense Unit


Dispense/Manual 6340133 22 ketorolac 30 mg/mL Inj Sol 1 mL [CHKS] 63323-0162-12 30.000 mg On Admin 0.77640 1.36 1.36 COST1 CHKS Injectable 6340133 22 ketorolac 30 mg/mL Sol 69543-0386-25 30.000 mg On Admin 0.92800 1.62 1.62 COST1 CHKS Injectable 6340133 22 ketorolac 30 mg/mL Sol 63323-0162-01 30.000 mg On Admin 0.77640 1.36 1.36 COST1 CHKS Injectable 2641002 323 labetalol 100 mg Tab 60687-0114-01 100.000 mg On Admin 0.02488 0.04 1.00 COST1 CHKS Med 2641002 924 labetalol 100 mg Tab UD [CHKS] 51079-0928-20 100.000 mg On Admin 0.30490 0.53 1.00 COST1 CHKS Med 2642937 1 labetalol 5 mg/mL IV Sol 20 mL MDV [CHKS] 00409-2267-25 100.000 mg On Admin 0.15900 0.28 1.00 COST1 CHKS Injectable 2642937 1 labetalol 5 mg/mL Sol 00143-9622-01 100.000 mg On Admin 0.33150 0.58 1.00 COST1 CHKS Injectable 2642937 1 labetalol 5 mg/mL Sol 47781-0586-29 100.000 mg On Admin 0.48550 0.85 1.00 COST1 CHKS Injectable




gm)

Per Dispense Unit


6340940 453 Lactated Ringers Injection Soln 1000 mL [CHKS] 00338-0117-04 1000.000 mL On Admin 0.00550 9.63 9.63 COST1 CHKS LVP 6340940 889 Lactated Ringers Injection Soln 1000 mL [CHKS] 00409-7953-09 1000.000 mL On Admin 0.00551 9.64 9.64 COST1 CHKS LVP 6340940 453 Lactated Ringers Injection Soln 1000 mL [CHKS] 00264-7750-00 1000.000 mL On Admin 0.00550 9.63 9.63 COST1 CHKS LVP 2642183 922 lactobacillus acidophilus - Cap[CHKS] 43292-0500-22 1.000 cap( s) On Admin 0.02680 0.05 1.00 COST1 CHKS Med 2642183 678 lactobacillus acidophilus - Cap[CHKS] 49100-3816-40 1.000 cap( s) On Admin 0.02680 0.05 1.00 COST1 CHKS Med 2640808 942 lactulose 10 g/15 mL Oral Syrup 30 mL [CHKS] 50383-0779-16 20.000 gm On Admin 0.01000 0.53 1.00 COST1 CHKS Med 2640808 305 lactulose 10 g/15 mL Syr 50383-0779-17 20.000 gm On Admin 0.03473 1.82 1.82 COST1 CHKS Med 2642166 1 lanolin Top Crm [CHKS] 44677-0100-20 1.000 app On


2641737 954 lansoprazole 30 mg Oral EC Cap [CHKS] 00378-8030-93 30.000 mg On Admin 0.30000 0.53 1.00 COST1 CHKS Med 2640270 1 latanoprost OPHTH 0.005% Sol 2.5mL [CHKS] 61314-0547-01 1.000 drop( s) On


6340822 1 leuprolide 3.75 mg/month IM Inj, ER [CHKS] 00074-3641-03 3.750 mg On Admin 1231.07000 2215.93 2215.93 COST1 CHKS Injectable 6340347 1 leuprolide 45 mg/6 months [CHKS] 00074-3473-03 45.000 mg On Admin 8802.14000 15843.85 15843.85 COST1 CHKS Injectable 2641303 954 levalbuterol 0.31 mg/3 mL Inh Sol [CHKS] 66993-0021-27 0.310 mg On Admin 0.39000 2.05 2.05 COST1 CHKS Med 2640957 1 levalbuterol 0.63 mg/3 mL Inh Sol [CHKS] 66993-0022-27 0.630 mg On Admin 0.44100 2.32 2.32 COST1 CHKS Med 2640957 1 levalbuterol 0.63 mg/3 mL Sol 76204-0800-24 0.630 mg On Admin 0.88880 4.67 4.67 COST1 CHKS Med 2641041 1 levalbuterol 1.25 mg/3 mL Inh Sol [CHKS] 66993-0023-27 1.250 mg On Admin 0.45570 2.39 2.39 COST1 CHKS Med 2641041 1 levalbuterol 1.25 mg/3 mL Sol 76204-0900-24 1.250 mg On Admin 0.89250 4.69 4.69 COST1 CHKS Med 6340692 1 levETIRAcetam 100 mg/mL IV Sol 5 mL Vial [CHKS] 00143-9574-10 500.000 mg On Admin 0.48990 4.29 4.29 COST1 CHKS Injectable 6340692 1 levETIRAcetam 100 mg/mL Sol 63323-0400-05 500.000 mg On Admin 0.68180 5.97 5.97 COST1 CHKS Injectable 6340692 323 levETIRAcetam 100 mg/mL Sol 67457-0790-05 500.000 mg On Admin 0.43060 3.77 3.77 COST1 CHKS Injectable 6340692 1 levETIRAcetam 100 mg/mL Sol 55150-0177-05 500.000 mg On Admin 0.31200 2.73 2.73 COST1 CHKS Injectable 2641639 22 levETIRAcetam 500 mg Tab 00904-6052-61 500.000 mg On Admin 0.15110 0.26 1.00 COST1 CHKS Med 2641639 343 levETIRAcetam 500 mg Tab 68084-0870-01 500.000 mg On Admin 0.43280 0.76 1.00 COST1 CHKS Med 2641639 954 levETIRAcetam 500 mg Tab [CHKS] 50268-0468-15 500.000 mg On Admin 0.23000 0.40 1.00 COST1 CHKS Med 2640434 270 levoFLOXacin 500 mg Tab 00904-6352-61 500.000 mg On Admin 0.02346 0.04 1.00 COST1 CHKS Med 2640434 954 levofloxacin 500 mg Tab [CHKS] 68084-0482-01 500.000 mg On Admin 0.23000 0.40 1.00 COST1 CHKS Med 6340139 1 levofloxacin 500 mg/100 mL Premix IV Sol [CHKS] 36000-0047-24 500.000 mg On Admin 0.02050 3.59 3.59 COST1 CHKS Injectable




gm)

Per Dispense Unit


6340139 1 levofloxacin 500 mg/100 mL Premix IV Sol [CHKS] 25021-0825-82 500.000 mg On Admin 0.04899 8.57 8.57 COST1 CHKS Injectable 6340139 1 levoFLOXacin 500 mg/100 mL Sol 00143-9316-24 500.000 mg On Admin 0.01940 3.40 3.40 COST1 CHKS Injectable 6340140 1 levofloxacin 750 mg in D5W 150 mL Sol [CHKS] 36000-0048-24 750.000 mg On Admin 0.01510 3.96 3.96 COST1 CHKS Injectable 6340140 925 levofloxacin 750 mg in D5W 150 mL Sol [CHKS] 25021-0825-83 750.000 mg On Admin 0.03000 7.88 7.88 COST1 CHKS Injectable 6340140 343 levoFLOXacin 750 mg/150 mL Sol 00143-9720-01 750.000 mg On Admin 0.02987 7.84 7.84 COST1 CHKS Injectable 2641215 424 levothyroxine 50 mcg ( 0.05 mg) Tab 00527-1342-01 50.000 mcg On Admin 0.51660 0.90 1.00 COST1 CHKS Med 2641215 112 levothyroxine 50 mcg ( 0.05 mg) Tab 69238-1831-01 50.000 mcg On Admin 0.26420 0.46 1.00 COST1 CHKS Med 2641215 323 levothyroxine 50 mcg ( 0.05 mg) Tab [CHKS] 51079-0440-20 50.000 mcg On Admin 0.37520 0.66 1.00 COST1 CHKS Med 2640498 954 levothyroxine 88 mcg ( 0.088 mg) Tab [CHKS] 00527-1344-01 88.000 mcg On Admin 0.25000 0.44 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2640498 917 levothyroxine 88 mcg ( 0.088 mg) Tab [CHKS] 42292-0038-20 88.000 mcg On Admin 0.43000 0.75 1.00 COST1 CHKS Med 2641013 1 lidocaine 1% preservative-free Sol 55150-0161-02 2.000 mL On Admin 0.78100 2.73 2.73 COST1 CHKS Med 2641013 942 lidocaine 1% preservative-free Sol 2mL Ampul [CHKS] 63323-0492-80 2.000 mL On Admin 0.69000 2.42 2.42 COST1 CHKS Med 2641013 1 lidocaine 1% preservative-free Sol 2mL Ampul [CHKS] 63323-0492-27 2.000 mL On Admin 0.89940 3.15 3.15 COST1 CHKS Med 2640610 1 lidocaine 1% Sol 20 mL Vial [CHKS] 00409-4276-01 20.000 mL On Admin 0.04590 1.61 1.61 COST1 CHKS Med 2642492 1 lidocaine 2% PF Inj Sol 10 mL [CHKS] 00409-4282-02 10.000 mL On Admin 0.19980 3.50 3.50 COST1 CHKS Med 2641345 337 lidocaine 2% preservative-free Sol [CHKS] 00409-1323-05 5.000 mL On Admin 0.48600 4.25 4.25 COST1 CHKS Injectable 2641186 201 lidocaine 2% Sol 20 mL MDV [CHKS] 00409-4277-01 20.000 mL On Admin 0.05900 0.10 1.00 COST1 CHKS Injectable 2640645 923 lidocaine Top 2% Gel w/Appl [CHKS] 76329-3011-05 1.000 app On Admin 0.86750 7.59 7.59 COST1 CHKS Med 2640645 923 lidocaine Top 2% Gel w/Appl [CHKS] 76329-3012-05 1.000 app On Admin 0.86750 7.59 7.59 COST1 CHKS Med 2640490 1 lidocaine Top 2% Sol 100 mL [CHKS] 50383-0775-04 100.000 mL On


2640634 1 lidocaine Top 4% Sol 50 mL [CHKS] 00054-3505-47 1.000 app On Dispense/Manual

0.74620 65.29 65.29 COST1 CHKS Med

2640634 1 lidocaine Top 4% Sol 50 mL [CHKS] 52565-0009-50 1.000 app On Dispense/Manual

0.56260 49.23 49.23 COST1 CHKS Med

2641144 1 lidocaine Top 5% Patch [CHKS] 00591-2679-30 1.000 patch( es) On Admin 2.06070 3.61 3.61 COST1 CHKS Med 2640490 1 lidocaine topical 2% Sol 00054-3500-49 100.000 mL On


2641144 22 lidocaine topical 5% Fil 00591-3525-30 1.000 patch( es) On Admin 2.06000 3.60 3.60 COST1 CHKS Med 2640728 280 lidocaine-prilocaine Top 2.5%-2.5% Cream 5 gm

[CHKS] 00115-1468-60 1.000 app On Admin 0.85760 7.50 7.50 COST1 CHKS Med

2640728 1 lidocaine-prilocaine topical 2.5%-2.5% Cre 00168-0357-55 1.000 app On Admin 1.40920 12.33 12.33 COST1 CHKS Med 2640728 1 lidocaine-prilocaine topical 2.5%-2.5% Cre 52565-0007-07 1.000 app On Admin 0.93760 8.20 8.20 COST1 CHKS Med 6340222 1 lincomycin 300 mg/mL Inj Sol [CHKS] 00009-0555-01 600.000 mg On Admin 20.76500 72.68 72.68 COST1 CHKS Injectable 2641143 1 linezolid 600 mg Tab 60687-0309-21 600.000 mg On Admin 2.01970 3.53 3.53 COST1 CHKS Med 2641143 1 linezolid 600 mg Tab UD [CHKS] 00093-8244-65 600.000 mg On Admin 4.40000 7.70 7.70 COST1 CHKS Med 6340141 1 linezolid 600 mg/300 mL IV Sol [CHKS] 00009-4992-02 600.000 mg On Admin 0.06940 36.44 36.44 COST1 CHKS Injectable 2640993 665 lisinopril 20 mg Tab 63739-0350-10 20.000 mg On Admin 1.32370 2.32 2.32 COST1 CHKS Med




gm)

Per Dispense Unit


2640993 462 lisinopril 20 mg Tab 60687-0333-01 20.000 mg On Admin 0.15000 0.26 1.00 COST1 CHKS Med 2640993 954 lisinopril 20 mg Tab [CHKS] 68084-0198-01 20.000 mg On Admin 0.07000 0.12 1.00 COST1 CHKS Med 2641245 954 lisinopril 5 mg Tab [CHKS] 51079-0981-20 5.000 mg On Admin 0.08000 0.14 1.00 COST1 CHKS Med 2650002 954 loperamide 1 mg/7.5 mL Sus [CHKS] 00904-6256-20 7.000 mL On Admin 0.03000 0.79 1.00 COST1 CHKS Med 2640810 420 loperamide 2 mg Cap 60687-0229-01 2.000 mg On Admin 0.77750 1.36 1.36 COST1 CHKS Med 2640810 954 loperamide 2 mg Cap UD [CHKS] 51079-0690-20 2.000 mg On Admin 0.62000 1.08 1.08 COST1 CHKS Med 2641341 265 loratadine 10 mg Tab 51079-0246-20 10.000 mg On Admin 0.02484 0.04 1.00 COST1 CHKS Med 2641341 954 loratadine 10 mg Tab [CHKS] 68084-0248-01 10.000 mg On Admin 0.19000 0.33 1.00 COST1 CHKS Med 2641629 1 loratadine 5 mg/5 mL Oral Syrup [CHKS] 54838-0558-40 120.000 mg On


2641542 954 loratadine-pseudoePHEDrine 10 mg-240 mg ER Tab [CHKS]


2640160 302 LORazepam 1 mg Tab 00591-0241-01 1.000 mg On Admin 0.02700 0.05 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2640160 954 LORazepam 1 mg Tab [CHKS] 68084-0742-01 1.000 mg On Admin 0.07000 0.12 1.00 COST1 CHKS Med 6340142 1 LORazepam 2 mg/mL Inj Sol 1 mL Vial [CHKS] 00409-1985-30 2.000 mg On Admin 2.40500 4.21 4.21 COST1 CHKS Injectable 6340142 1 LORazepam 2 mg/mL Inj Sol 1 mL Vial [CHKS] 17478-0040-01 2.000 mg On Admin 3.07700 5.38 5.38 COST1 CHKS Injectable 6340142 305 LORazepam 2 mg/mL Sol 00641-6048-25 2.000 mg On Admin 0.47560 0.83 1.00 COST1 CHKS Injectable 6340142 1 LORazepam 2 mg/mL Sol 00641-6044-25 2.000 mg On Admin 0.46560 0.81 1.00 COST1 CHKS Injectable 6340142 1 LORazepam 2 mg/mL Sol 00409-6778-02 2.000 mg On Admin 1.59100 2.78 2.78 COST1 CHKS Injectable 2641746 954 losartan 50 mg Tab [CHKS] 68084-0347-01 50.000 mg On Admin 0.45000 0.79 1.00 COST1 CHKS Med 2641195 942 lovastatin 20 mg Tab UD [CHKS] 51079-0975-20 20.000 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2641195 323 lovastatin 20 mg Tab UD [CHKS] 68084-0559-01 20.000 mg On Admin 0.17220 0.30 1.00 COST1 CHKS Med 2641426 50 Lutein 20 mg Cap [CHKS] 11845-0140-28 20.000 mg On Admin 0.21030 0.37 1.00 COST1 CHKS Med 2643202 974 Lutein 20 mg tab [CHKS] 35046-0038-76 20.000 mg On Admin 0.27230 0.48 1.00 COST1 CHKS Med 6340204 5 LVP solution Dextrose 5% in Water Sol 00338-0017-02 250.000 mL On Admin 0.01270 5.56 5.56 COST1 CHKS LVP 6340710 375 LVP solution Dextrose 5% with 0.45% NaCl Sol 00264-7612-00 1000.000 mL On Admin 0.00215 3.76 3.76 COST1 CHKS LVP 6340190 1 LVP solution Sodium Chloride 0.9% Sol 00264-7800-00 1000.000 mL On Admin 0.00200 3.50 3.50 COST1 CHKS LVP 6340192 68 LVP solution Sodium Chloride 0.9% Sol 63323-0623-75 500.000 mL On Admin 0.00960 8.40 8.40 COST1 CHKS LVP 6340195 524 LVP solution Sodium Chloride 0.9% Sol 00409-7984-36 50.000 mL On Admin 0.02900 2.54 2.54 COST1 CHKS LVP 6340925 378 LVP solution Sodium Chloride 0.9% Sol 00409-7984-37 100.000 mL On Admin 0.01956 3.42 3.42 COST1 CHKS LVP 6340925 378 LVP solution Sodium Chloride 0.9% Sol 00338-0049-48 100.000 mL On Admin 0.01950 3.41 3.41 COST1 CHKS LVP 6340926 68 LVP solution Sodium Chloride 0.9% Sol 00264-7800-20 250.000 mL On Admin 0.01120 4.90 4.90 COST1 CHKS LVP 6340192 333 LVP solution Sodium Chloride 0.9% Sol 500 mL [CHKS] 00338-0049-03 500.000 mL On Admin 0.00680 5.95 5.95 COST1 CHKS LVP 2641667 1 LVP solution with potassium Sodium Chloride 0.9% with

KCl 40 mEq/L Sol 00338-0695-04 1000.000 mL On Admin 0.00880 15.40 15.40 COST1 CHKS LVP

2640120 1 magnesium citrate 1.745 g/30 mL Liq 24385-0675-10 300.000 mL On Admin 0.00460 2.42 2.42 COST1 CHKS Med 2640120 1 magnesium citrate 8.85% Oral Liq 300 mL [CHKS] 00869-0686-38 300.000 mL On Admin 0.00456 2.39 2.39 COST1 CHKS Med 2640134 954 magnesium hydroxide 8% Oral Susp 30 mL [CHKS] 00121-0431-30 30.000 mL On Admin 0.04000 2.10 2.10 COST1 CHKS Med 2640494 118 magnesium oxide 400 mg Tab 68585-0006-41 400.000 mg On Admin 0.54750 0.96 1.00 COST1 CHKS Med 2640494 954 magnesium oxide 400 mg Tab [CHKS] 63739-0354-10 400.000 mg On Admin 0.05000 0.09 1.00 COST1 CHKS Med 6341273 1 magnesium sulfate 4 gm/50 mL Inj Sol [CHKS] 63323-0107-05 4.000 gm On Admin 0.10260 8.98 8.98 COST1 CHKS Injectable 6340575 1 magnesium sulfate 80 mg/mL Inj Sol [CHKS] 00409-6730-13 4000.000 mg On Admin 0.10960 9.59 9.59 COST1 CHKS Injectable




gm)

Per Dispense Unit


2650004 1 mannitol 20% IV Sol 500 mL [CHKS] 00409-7715-03 500.000 mL On Admin 0.02520 22.05 22.05 COST1 CHKS Injectable 2640385 954 meclizine 25 mg Tab [CHKS] 68084-0491-01 25.000 mg On Admin 0.44000 0.77 1.00 COST1 CHKS Med 2641104 1 megestrol 40 mg/mL Oral Susp 240 mL [CHKS] 49884-0907-38 9600.000 mg On


2640803 76 melatonin 3 mg Tab [CHKS] 77333-0516-10 3.000 mg On Admin 0.19470 0.34 1.00 COST1 CHKS Med 2641566 954 meloxicam 7.5 mg Tab [CHKS] 50268-0525-15 7.500 mg On Admin 0.10000 0.18 1.00 COST1 CHKS Med 2641318 954 memantine 10 mg Tab UD [CHKS] 42292-0006-06 10.000 mg On Admin 0.33000 0.58 1.00 COST1 CHKS Med 2642744 690 Menthol lozenge [CHKS] 12546-6326-39 1.000 lozenge( s) On Admin 0.06500 0.11 1.00 COST1 CHKS Med




gm)

Per Dispense Unit


2642813 1 menthol topical 4% Gel 118mL [CHKS] 59316-0102-20 1.000 app On Dispense/Manual

0.07900 16.31 16.31 COST1 CHKS Med

2643373 343 menthol topical 4% Gel 3mL [CHKS] 31124-0007-74 1.000 app On Dispense/Manual

0.07940 0.42 1.00 COST1 CHKS Med

2641672 145 menthol-zinc oxide Top 0.44%-20.625% Oint 113 gm [CHKS]


0.03628 7.17 7.17 COST1 CHKS Med

6340049 1 meperidine 50 mg/mL Inj Sol 1 mL [CHKS] 00409-1178-30 50.000 mg On Admin 5.25550 9.20 9.20 COST1 CHKS Injectable 6340049 621 meperidine 50 mg/mL Sol 00641-6053-25 50.000 mg On Admin 2.22200 3.89 3.89 COST1 CHKS Injectable 6340049 1 meperidine 50 mg/mL Sol 00409-1253-01 50.000 mg On Admin 3.30400 5.78 5.78 COST1 CHKS Injectable 6340280 1 meropenem 1 g IV Inj [CHKS] 63323-0508-31 1.000 gm On Admin 0.33860 0.59 1.00 COST1 CHKS Injectable 6340280 1 meropenem 1000 mg Pow 55150-0208-30 1.000 gm On Admin 0.29900 0.52 1.00 COST1 CHKS Injectable 6340251 1 meropenem 500 mg IV Inj [CHKS] 63323-0507-21 500.000 mg On Admin 0.26380 0.46 1.00 COST1 CHKS Injectable 2641249 393 metFORMIN 500 mg Tab 60687-0155-01 500.000 mg On Admin 0.70120 1.23 1.23 COST1 CHKS Med 2641249 954 metFORMIN 500 mg Tab [CHKS] 51079-0172-20 500.000 mg On Admin 0.08000 0.14 1.00 COST1 CHKS Med 6341170 1 methacholine 100 mg Powder [CHKS] 64281-0100-00 100.000 mg On Admin 72.50330 126.88 126.88 COST1 CHKS Med 2640885 174 methadone 10 mg Tab 68084-0738-01 10.000 mg On Admin 0.23420 0.41 1.00 COST1 CHKS Med 2640885 942 methadone 10 mg Tab UD [CHKS] 00406-5771-62 10.000 mg On Admin 1.00000 1.75 1.75 COST1 CHKS Med 2640386 287 methocarbamol 500 mg Tab 76385-0123-01 500.000 mg On Admin 0.07450 0.13 1.00 COST1 CHKS Med 2640386 954 methocarbamol 500 mg Tab [CHKS] 31722-0533-01 500.000 mg On Admin 0.03000 0.05 1.00 COST1 CHKS Med 2640012 954 methyldopa 250 mg Tab [CHKS] 51079-0200-20 250.000 mg On Admin 0.15000 0.26 1.00 COST1 CHKS Med 2643224 839 methylene blue 5 mg/mL Sol 10 mL [CHKS] 00517-0374-05 50.000 mg On Admin 15.49300 27.11 27.11 COST1 CHKS Med 2640073 141 methylergonovine 0.2 mg Tab [CHKS] 00054-0639-05 0.200 mg On Admin 31.50830 55.14 55.14 COST1 CHKS Med 6340143 659 methylergonovine 0.2 mg/mL Inj Sol 1 mL [CHKS] 17478-0501-01 0.200 mg On Admin 8.57700 15.01 15.01 COST1 CHKS Injectable 6340143 1 methylergonovine 0.2 mg/mL Sol 51991-0144-17 0.200 mg On Admin 18.70700 32.74 32.74 COST1 CHKS Injectable 2642024 1 methylPREDNISolone 4 mg Tab 59746-0001-06 4.000 mg On Admin 0.30360 11.16 11.16 COST1 CHKS Med 2642024 954 methylPREDNISolone 4 mg Tab Dose Pack [CHKS] 00009-0056-04 4.000 mg On Admin 2.47000 90.77 90.77 COST1 CHKS Med 6340171 954 methylPREDNISolone 40 mg preservative-free Pow

[CHKS] 00009-0039-32 40.000 mg On Admin 4.29000 7.51 7.51 COST1 CHKS Injectable

6340050 1 methylPREDNISolone 40 mg/mL Sus 00009-3073-22 40.000 mg On Admin 6.62000 11.59 11.59 COST1 CHKS Injectable




gm)

Per Dispense Unit

Final Price Cost Type Price Sch

gpha pharmacy cdm and ndc formulary price list · cdm and ndc formulary price list . pink items...

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