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Oct-2017
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
ABACAVIR SULFATE/LAMIVUDINE 600-300MG TABLET $6.5784/EACH Decrease
ABACAVIR SULFATE 300 MG TABLET $2.0671/EACH Decrease
ACAMPROSATE CALCIUM 333 mg TABLET $0.9000/EACH
ACARBOSE 100 mg TABLET $0.2500/EACH
ACARBOSE 25 mg TABLET $0.2400/EACH
ACARBOSE 50 mg TABLET $0.2700/EACH
ACEBUTOLOL HCL 200 mg CAPSULE $0.2668/EACH
ACEBUTOLOL HCL 400 mg CAPSULE $0.3198/EACH
ACETAMINOPHEN W/CODEINE 120 mg; 12 mg ELIXIR $0.0180/MILLILITER
ACETAMINOPHEN W/CODEINE 300 mg; 15 mg TABLET $0.1200/EACH
ACETAMINOPHEN W/CODEINE 300 mg; 30 mg TABLET $0.1496/EACH
ACETAMINOPHEN W/CODEINE 300 mg; 60 mg TABLET $0.2782/EACH
ACETAMINOPHEN/BUTALBITAL/CAFFEINE 500 mg/50 mg/40 mg TABLET $0.0000
ACETAMINOPHEN/DIPHENHYDRAMINE TABLETS 500 mg; 25 mg TABLET $0.0000
ACETAMINOPHEN 100 mg/ml DROPS $0.0000
ACETAMINOPHEN 120 mg SUPP $0.3840/EACH
ACETAMINOPHEN 160 mg/5 ml ELIXIR $0.0000
ACETAMINOPHEN 160 MG/5ML LIQ $0.0203/MILLILITER
ACETAMINOPHEN 160 mg/5ml SUSP $0.0000
ACETAMINOPHEN 325 mg TABLET $0.0120/EACH
ACETAMINOPHEN 500 mg CAPSULE $0.0000
ACETAMINOPHEN 500 mg TABLET $0.0240/EACH Reactivate
ACETAMINOPHEN 650 mg SUPP $0.3900/EACH Reactivate
ACETAMINOPHEN 80 mg TABLET $0.0386/EACH
ACETAMINOPHEN 80mg/0.8ml DROPS $0.1318/MILLILITER
ACETAZOLAMIDE 125 mg TABLET $0.0000
ACETAZOLAMIDE 250 mg TABLET $1.8234/EACH
ACETAZOLAMIDE 500 mg CAPSULE $1.8678/EACH
ACETIC ACID 2% 15 ml SOLN $2.0800/MILLILITER
ACETIC ACID\ALUMINUM ACETATE 0.02 DROPS $0.0000
ACETIC ACID\HYDROCORTISONE 2% - 1% DROPS $6.6680/MILLILITER Decrease
ACETIC ACID 0.25 % SOLN $0.0046/MILLILITER
ACETYLCYSTEINE 10% 10 ml VIAL $0.0000
ACETYLCYSTEINE 10% 30 ml VIAL $0.0000
ACETYLCYSTEINE 10% 4 ml VIAL $0.0000
ACETYLCYSTEINE 20% 10 ml VIAL $0.0000
ACETYLCYSTEINE 20% 30 ml VIAL $0.0000
ACETYLCYSTEINE 20% 4 ml VIAL $0.0000
ACETYLCYSTEINE 100 mg/ml VIAL $0.3908/MILLILITER
ACETYLCYSTEINE 200 mg/ml VIAL $0.5015/MILLILITER
ACITRETIN 10 MG CAPSULE $17.1992/EACH
ACITRETIN 17.5 MG CAPSULE $23.0775/EACH
ACITRETIN 25 MG CAPSULE $16.3404/EACH
ACYCLOVIR SODIUM 1 gm/vial VIAL $0.0000
ACYCLOVIR SODIUM 500 mg/vial VIAL $0.0000
ACYCLOVIR 200 mg/5 ml SUSP $0.0000 Delete
ACYCLOVIR 200 mg CAPSULE $0.1602/EACH
ACYCLOVIR 400 mg TABLET $0.1200/EACH
ACYCLOVIR 5 % OINT $11.3568/GRAM
ACYCLOVIR 800 mg TABLET $0.2398/EACH
ADAPALENE 0.3% GEL 0.3% GEL $0.0000 Delete
ADAPALENE 0.001 CRM $0.0000
ADAPALENE 0.001 GEL $0.0000
ADAPALENE 0.3 % GEL $0.0000
ALBUTEROL SULFATE 4 mg TABLET $1.5360/EACH
ALBUTEROL SULFATE 8 mg TABLET $2.4100/EACH
ALBUTEROL SULFATE 0.083% VIAL $0.0720/MILLILITER
ALBUTEROL SULFATE 0.5% (5mg/ml) SOLN $0.8910/MILLILITER
ALBUTEROL SULFATE 0.63 mg/3 ml VIAL $0.3000/MILLILITER
ALBUTEROL SULFATE 1.25 mg/3 ml VIAL $0.2619/MILLILITER
ALBUTEROL SULFATE 2 mg/5 ml SYRUP $0.0134/MILLILITER
ALBUTEROL SULFATE 2 mg TABLET $5.0100/EACH Reactivate
ALBUTEROL SULFATE 4 mg TABLET $4.7000/EACH
ALBUTEROL 90 mcg AERO (GM) $0.0000
ALCLOMETASONE DIPROPIONATE 0.0005 OINT $1.2512/GRAM
ALCLOMETASONE DIPROPIONATE 0.05% CRM $1.4090/GRAM
ALENDRONATE SODIUM 10 mg TABLET $0.3020/EACH
ALENDRONATE SODIUM 35 mg TABLET $0.4238/EACH
ALENDRONATE SODIUM 40 mg TABLET $2.3520/EACH
ALENDRONATE SODIUM 5 mg TABLET $0.1440/EACH
ALENDRONATE SODIUM 70 mg TABLET $0.3488/EACH
ALFUZOSIN HCL 10 mg TABLET $0.1341/EACH
ALLOPURINOL 100 mg TABLET $0.1100/EACH Decrease
ALLOPURINOL 300 mg TABLET $0.1900/EACH Decrease
ALMOTRIPTAN MALATE 12.5 mg TABLET $25.4402/EACH
ALMOTRIPTAN MALATE 6.25 mg TABLET $35.5520/EACH
ALOSETRON HCL 0.5 mg TABLET $18.7000/EACH
ALOSETRON HCL 1 mg TABLET $37.4000/EACH
ALPRAZOLAM 2 mg TABLET $0.4440/EACH
ALPRAZOLAM 3 mg TABLET $0.6960/EACH
ALPRAZOLAM 0.25 mg TABLET $0.0240/EACH
ALPRAZOLAM 0.5 mg TABLET $0.2760/EACH
ALPRAZOLAM 0.5 mg TABLET $0.0274/EACH
ALPRAZOLAM 0.5 MG TABLET $1.1760/EACH
ALPRAZOLAM 1 mg TABLET $0.3360/EACH
ALPRAZOLAM 1 mg TABLET $0.0258/EACH
ALPRAZOLAM 1 MG TABLET $1.5600/EACH
ALPRAZOLAM 2 mg TABLET $0.0676/EACH
AMANTADINE HCL 100 mg CAPSULE $0.9550/EACH
AMANTADINE HCL 50 mg/5 ml SOLN $0.0480/MILLILITER
AMIKACIN SULFATE/PRESERVATIVE FREE 100 mg/2 ml VIAL $0.0000
Page 1 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
AMIKACIN SULFATE/PRESERVATIVE FREE 1000 mg/4 ml VIAL $0.0000
AMIKACIN SULFATE/PRESERVATIVE FREE 500 mg/2 ml VIAL $0.0000
AMIKACIN SULFATE 1000MG/4ML VIAL $0.0000
AMIKACIN SULFATE 500 MG/2ML VIAL $4.8000/MILLILITER
AMILORIDE HCL 5 mg TABLET $0.5360/EACH
AMINOCAPROIC ACID 250 mg/ml SOLN $0.0000
AMINOCAPROIC ACID 500 mg TABLET $0.0000
AMINOPHYLLINE 200 mg TABLET $0.0000
AMIODARONE HCL 100 MG TABLET $2.6760/EACH
AMIODARONE HCL 200 mg TABLET $0.1700/EACH
AMIODARONE HCL 400 MG TABLET $3.7350/EACH
AMITRIPTYLINE HCL 10 mg TABLET $0.1159/EACH
AMITRIPTYLINE HCL 100 mg TABLET $0.9995/EACH Decrease
AMITRIPTYLINE HCL 150 mg TABLET $1.9440/EACH
AMITRIPTYLINE HCL 25 mg TABLET $0.2584/EACH
AMITRIPTYLINE HCL 50 mg TABLET $0.4621/EACH
AMITRIPTYLINE HCL 75 mg TABLET $0.7411/EACH
AMITRIPTYLINE; PERPHENAZINE 10 mg; 2 mg TABLET $0.0000
AMITRIPTYLINE; PERPHENAZINE 10 mg; 4 mg TABLET $0.0000
AMITRIPTYLINE; PERPHENAZINE 25 mg; 2 mg TABLET $0.0000
AMITRIPTYLINE; PERPHENAZINE 25 mg; 4 mg TABLET $0.0000
AMITRIPTYLINE; PERPHENAZINE 50 mg; 4 mg TABLET $0.0000
AMLODIPINE BESYLATE/BENAZEPRIL HCL 10 mg-40 mg CAPSULE $0.3061/EACH
AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 mg-40 mg CAPSULE $0.5443/EACH
AMLODIPINE BESYLATE/BENAZEPRIL 10 mg; 20 mg CAPSULE $0.1722/EACH
AMLODIPINE BESYLATE/BENAZEPRIL 2.5 mg; 10 mg CAPSULE $0.6720/EACH
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 10 mg CAPSULE $0.3068/EACH Decrease
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 20 mg CAPSULE $0.1681/EACH
AMLODIPINE BESYLATE 10 mg TABLET $0.0227/EACH
AMLODIPINE BESYLATE 2.5 mg TABLET $0.0150/EACH
AMLODIPINE BESYLATE 5 mg TABLET $0.0150/EACH
AMLODIPINE/ATORVASTATIN 10 MG-10MG TABLET $3.7560/EACH
AMLODIPINE/ATORVASTATIN 10 MG-20MG TABLET $3.7560/EACH
AMLODIPINE/ATORVASTATIN 10 MG-40MG TABLET $5.4960/EACH
AMLODIPINE/ATORVASTATIN 10 MG-80MG TABLET $4.5800/EACH Decrease
AMLODIPINE/ATORVASTATIN 2.5MG-10MG TABLET $3.7320/EACH
AMLODIPINE/ATORVASTATIN 2.5MG-40MG TABLET $5.1000/EACH
AMLODIPINE/ATORVASTATIN 5 MG-80 MG TABLET $5.1000/EACH
AMLODIPINE/VALSARTAN/HCTHIAZID 10 mg-160 mg TABLET $2.5379/EACH
AMLODIPINE/VALSARTAN/HCTHIAZID 10-160-25 TABLET $3.9600/EACH Reactivate
AMLODIPINE/VALSARTAN/HCTHIAZID 10-320-25 TABLET $3.9780/EACH Reactivate
AMLODIPINE/VALSARTAN 10MG-160MG TABLET $0.5700/EACH Reactivate
AMLODIPINE/VALSARTAN 10MG-320MG TABLET $0.5820/EACH
AMLODIPINE/VALSARTAN 5MG-160MG TABLET $0.4480/EACH Reactivate
AMLODIPINE/VALSARTAN 5MG-320MG TABLET $0.6578/EACH Reactivate
AMMONIUM LACTATE 12% CRM $0.0739/GRAM
AMOX/POTASSIUM CLAVULANATE 200-28.5/5 SUSP, RECON $0.3449/MILLILITER
AMOX/POTASSIUM CLAVULANATE 200-28.5mg TABLET $2.3755/EACH
AMOX/POTASSIUM CLAVULANATE 400-57 mg TABLET $2.6771/EACH
AMOX/POTASSIUM CLAVULANATE 400-57/5 SUSP, RECON $0.1061/MILLILITER
AMOX/POTASSIUM CLAVULANATE 500-125 mg TABLET $0.4575/EACH
AMOX/POTASSIUM CLAVULANATE 600-42.9/5 SUSP, RECON $0.0948/MILLILITER
AMOX/POTASSIUM CLAVULANATE 875-125 mg TABLET $0.4115/EACH Decrease
AMOXAPINE 100 mg TABLET $0.0000
AMOXAPINE 150 mg TABLET $0.0000
AMOXAPINE 25 mg TABLET $0.0000
AMOXAPINE 50 mg TABLET $0.0000
AMOXICILLIN (TRIHYDRATE) 250 mg CAPSULE $0.0754/EACH
AMOXICILLIN (TRIHYDRATE) 500 mg CAPSULE $0.0650/EACH Decrease
AMOXICILLIN OS 400 mg/5 ml SUSP, RECON $0.0353/MILLILITER
AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE 1000-62.5 TABLET $2.5873/EACH
AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE 250 - 62.5/5 ml SUSP, RECON $0.6252/MILLILITER
AMOXICILLIN TRIHYDRATE/POTASSIUM CLAVULANATE 250-125mg TABLET $3.7080/EACH
AMOXICILLIN TRIHYDRATE 500 mg TABLET $0.2641/EACH
AMOXICILLIN 125 mg/5 ml SUSP, RECON $0.0216/MILLILITER
AMOXICILLIN 125 mg TABLET $0.0000
AMOXICILLIN 200 mg/5 ml SUSP, RECON $0.0957/MILLILITER
AMOXICILLIN 250 mg/5 ml SUSP, RECON $0.0276/MILLILITER
AMOXICILLIN 250 mg TABLET $0.2707/EACH
AMOXICILLIN 400 mg TABLET $0.0000
AMOXICILLIN 875 mg TABLET $0.1343/EACH Decrease
AMPHET ASP/AMPHET/D-AMPHET 10 mg CAPSULE $0.0000
AMPHET ASP/AMPHET/D-AMPHET 15 mg CAPSULE $0.0000
AMPHET ASP/AMPHET/D-AMPHET 15 mg TABLET $0.5261/EACH
AMPHET ASP/AMPHET/D-AMPHET 20 mg CAPSULE $0.0000
AMPHET ASP/AMPHET/D-AMPHET 25 mg CAPSULE $0.0000
AMPHET ASP/AMPHET/D-AMPHET 30 mg CAPSULE $0.0000
AMPHET ASP/AMPHET/D-AMPHET 5 mg CAPSULE $0.0000
AMPHETAMINE/D-AMPHETAMINE SALTS 10 mg TABLET $0.5500/EACH
AMPHETAMINE/D-AMPHETAMINE SALTS 12.5 mg TABLET $0.9600/EACH
AMPHETAMINE/D-AMPHETAMINE SALTS 20 mg TABLET $0.5478/EACH
AMPHETAMINE/D-AMPHETAMINE SALTS 30 mg TABLET $0.5483/EACH
AMPHETAMINE/D-AMPHETAMINE SALTS 5 mg TABLET $0.5595/EACH
AMPHETAMINE/D-AMPHETAMINE SALTS 7.5 mg TABLET $0.9600/EACH
AMPICILLIN SODIUM/SULBACTAM SODIUM 3 gm VIAL $5.6280/EACH
AMPICILLIN TRIHYDRATE 125 mg/5 ml SUSP, RECON $0.0000
AMPICILLIN TRIHYDRATE 250 mg CAPSULE $0.0895/EACH
AMPICILLIN TRIHYDRATE 500 mg CAPSULE $0.1528/EACH
AMYLASE/LIPASE/PROTEASE 20,000 units; 4,500 units; 25,000 units CAPSULE $0.0000
AMYLASE/LIPASE/PROTEASE 33,200 units; 10,000 units; 38,000 units CAPSULE $0.0000
AMYLASE/LIPASE/PROTEASE 48,000 units; 16,000 units; 48,000 units CAPSULE $0.0000
AMYLASE/LIPASE/PROTEASE 56,000 units; 20,000 units; 44,000 units CAPSULE $0.0000
Page 2 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
AMYLASE/LIPASE/PROTEASE 65,000 units; 20,000 units; 65,000 units CAPSULE $0.0000
AMYLASE/LIPASE/PROTEASE 66,400 units; 20,000 units; 75,000 units CAPSULE $0.0000
ANAGRELIDE HCL 0.5 mg CAPSULE $0.7805/EACH
ANAGRELIDE HCL 1 mg CAPSULE $1.6782/EACH
ANASTROZOLE 1 mg TABLET $0.1070/EACH
ANTIPYRINE/BENZOCAINE OTIC 5.4%/1.4% DROPS $0.2920/MILLILITER
ARIPIPRAZOLE 1 MG/ML SOLN $3.5527/MILLILITER
ARIPIPRAZOLE 10 MG TABLET $0.9150/EACH Decrease
ARIPIPRAZOLE 15 MG TABLET $0.9547/EACH Decrease
ARIPIPRAZOLE 2 MG TABLET $0.9159/EACH Decrease
ARIPIPRAZOLE 20 MG TABLET $1.3001/EACH Decrease
ARIPIPRAZOLE 30 MG TABLET $1.3650/EACH Decrease
ARIPIPRAZOLE 5 MG TABLET $0.7031/EACH Decrease
ARMODAFINIL 150 MG TABLET $1.8000/EACH Decrease
ARMODAFINIL 200 MG TABLET $2.0400/EACH Decrease
ARMODAFINIL 250 MG TABLET $1.8000/EACH Decrease
ARMODAFINIL 50 MG TABLET $0.6194/EACH Decrease
ASPIRIN BUFFERED 325 mg TABLET $0.0000
ASPIRIN W/CODEINE 325 mg; 30 mg TABLET $0.0000
ASPIRIN W/CODEINE 325 mg; 60 mg TABLET $0.0000
ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE 30 mg CAPSULE $2.1360/EACH
ASPIRIN/DIPYRIDAMOLE 25mg-200mg CAPSULE $0.0000
ASPIRIN 325 mg TABLET $0.0120/EACH
ASPIRIN 5 gr TABLET $0.0150/EACH
ASPIRIN 81 mg TABLET $0.0300/EACH
ASPIRIN 81 mg TABLET $0.0150/EACH
ATENOLOL; CHLORTHAL 100 mg; 25 mg TABLET $0.6840/EACH
ATENOLOL; CHLORTHAL 50 mg; 25 mg TABLET $0.4024/EACH
ATENOLOL 100 mg TABLET $0.0210/EACH
ATENOLOL 25 mg TABLET $0.0150/EACH
ATENOLOL 50 mg TABLET $0.0150/EACH
ATORVASTATIN CALCIUM 10 mg TABLET $0.1110/EACH Decrease
ATORVASTATIN CALCIUM 20 mg TABLET $0.1302/EACH Decrease
ATORVASTATIN CALCIUM 40 mg TABLET $0.1302/EACH Decrease
ATORVASTATIN CALCIUM 80 mg TABLET $0.1528/EACH
ATOVAQUONE/PROGUANIL HCL 250-100 MG TABLET $5.0983/EACH
ATOVAQUONE 750 mg/5 ml SUSP $3.1881/MILLILITER
ATROPINE SULFATE 0.01 DROPS $0.0000
ATROPINE SULFATE 1%, 15 ml DROPS $0.0000
AZATHIOPRINE 50 mg TABLET $0.3900/EACH
AZELASTINE HCL 0.0005 DROPS $3.2480/MILLILITER
AZELASTINE HCL 137 mcg AERO (ML) $0.7556/MILLILITER
AZELASTINE HCL 205.5MCG AERO (ML) $2.6650/MILLILITER Reactivate
AZITHROMYCIN 100 mg/5 ml SUSP, RECON $1.0372/MILLILITER
AZITHROMYCIN 200 mg/5 ml SUSP, RECON $0.6188/MILLILITER
AZITHROMYCIN 200 MG/5ML SUSP RECON $0.8440/MILLILITER Add
AZITHROMYCIN 200 MG/5ML SUSP RECON $0.5130/MILLILITER Add
AZITHROMYCIN 250 mg TABLET $0.4593/EACH
AZITHROMYCIN 500 mg TABLET $0.8813/EACH
AZITHROMYCIN 600 mg TABLET $2.5000/EACH
BACITRACIN/NEOMYCIN SULFATE/POLYMYXIN B 400 units/3.5 mg/5,000 units per gm OINT $0.1246/GRAM
BACITRACIN/NEOMYCIN/POLYMYXIN B/HC 3.5 gr OINT $0.0000
BACITRACIN/POLYMYXIN B SULFATE 15 gr OINT $0.0000
BACITRACIN/POLYMYXIN B SULFATE 500-10K/G OINT $0.4268/GRAM
BACITRACIN/POLYMYXIN B SULFATE 500-10K/G OINT $2.7000/GRAM
BACITRACIN 500 units/gm OINT $0.0766/GRAM
BACLOFEN 10 mg TABLET $0.1602/EACH
BACLOFEN 20 mg TABLET $0.2591/EACH Decrease
BALSALAZIDE DISODIUM 750 mg CAPSULE $0.4800/EACH
BENAZEPRIL HCL 10 mg TABLET $0.0822/EACH
BENAZEPRIL HCL 20 mg TABLET $0.0589/EACH
BENAZEPRIL HCL 40 mg TABLET $0.0600/EACH
BENAZEPRIL HCL 5 mg TABLET $0.0252/EACH
BENAZEPRIL/HCTZ 10-12.5 mg TABLET $0.7548/EACH
BENAZEPRIL/HCTZ 20-12.5 mg TABLET $0.9817/EACH
BENAZEPRIL/HCTZ 20-25 mg TABLET $0.9817/EACH
BENAZEPRIL/HCTZ 5-6.25 mg TABLET $1.7880/EACH
BENZONATATE 100 mg CAPSULE $0.1807/EACH
BENZONATATE 200 mg CAPSULE $0.2358/EACH
BENZOYL PEROXIDE 0.05 GEL $0.2520/GRAM
BENZOYL PEROXIDE 10 % CLEANSER $0.0480/GRAM
BENZOYL PEROXIDE 10 % GEL $0.2468/GRAM
BENZOYL PEROXIDE 3 % CLEANSER $0.2269/GRAM
BENZOYL PEROXIDE 4 % CLEANSER $0.0000
BENZOYL PEROXIDE 5 % CLEANSER $0.0936/GRAM
BENZOYL PEROXIDE 6 % CLEANSER $0.0845/GRAM
BENZOYL PEROXIDE 8 % CLEANSER $0.0410/GRAM
BENZOYL PEROXIDE 9% CLEANSER $0.2864/GRAM
BENZTROPINE MESYLATE 0.5 mg TABLET $0.1080/EACH
BENZTROPINE MESYLATE 1 mg TABLET $0.0933/EACH
BENZTROPINE MESYLATE 2 mg TABLET $0.1145/EACH
BETAMETHASONE DIPROPIONATE AUGMENTED 0.0005 OINT $1.9200/GRAM
BETAMETHASONE DIPROPIONATE AUGMENTED 0.05% CRM $0.4050/GRAM
BETAMETHASONE DIPROPIONATE 0.0005 OINT $1.8360/GRAM Reactivate
BETAMETHASONE DIPROPIONATE 0.05%, 15 gm CRM $2.5270/GRAM
BETAMETHASONE DIPROPIONATE 0.05%, 15 gm OINT $3.2480/GRAM
BETAMETHASONE DIPROPIONATE 0.05%, 45 gm CRM $1.7620/GRAM
BETAMETHASONE DIPROPIONATE 0.05%, 45 gm OINT $1.8360/GRAM
BETAMETHASONE DIPROPIONATE 0.05%, 50 gm OINT $0.0000
BETAMETHASONE DIPROPIONATE 0.05%, 60 ml LOTION $0.0840/MILLILITER Reactivate
BETAMETHASONE DIPROPIONATE 0.05% GEL $0.6204/GRAM Reactivate
BETAMETHASONE VALERATE 0.001 OINT $0.8595/GRAM
Page 3 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
BETAMETHASONE VALERATE 0.1 % CRM $0.9513/GRAM
BETAMETHASONE VALERATE 0.1%, 15 gm CRM $0.0791/GRAM Reactivate
BETAMETHASONE VALERATE 0.1%, 15 gm OINT $0.7795/GRAM Reactivate
BETAMETHASONE VALERATE 0.1%, 45 gm CRM $0.0696/GRAM Reactivate
BETAMETHASONE VALERATE 0.1%, 45 gm OINT $1.0064/GRAM Reactivate
BETAMETHASONE VALERATE 0.1%, 60 ml LOTION $0.5442/MILLILITER
BETAMETHASONE VALERATE 0.12 % FOAM $5.0213/GRAM
BETAXOLOL HCL 0.5 % DROPS $7.2000/MILLILITER
BETHANECHOL CHLORIDE 10 mg TABLET $0.5253/EACH
BETHANECHOL CHLORIDE 25 mg TABLET $0.4865/EACH
BETHANECHOL CHLORIDE 5 mg TABLET $0.0840/EACH
BETHANECHOL CHLORIDE 50 mg TABLET $1.1040/EACH
BEXAROTENE 75 MG CAPSULE $168.1900/EACH
BICALUTAMIDE 50 mg TABLET $0.3000/EACH
BISACODYL 10 mg SUPP $0.0840/EACH
BISACODYL 5 mg TABLET $0.0216/EACH
BISACODYL 5 mg TABLET $0.0000
BISMUTH SUBSALICYLATE 262 mg TABLET $0.0538/EACH
BISMUTH SUBSALICYLATE 262mg/15ml SUSP $0.0088/MILLILITER
BISOPROLOL FUMARATE 10 mg TABLET $0.4377/EACH
BISOPROLOL FUMARATE 5 mg TABLET $0.3017/EACH
BISOPROLOL/HCTZ 10/6.25 TABLET $0.0393/EACH
BISOPROLOL/HCTZ 2.5/6.25 TABLET $0.0447/EACH
BISOPROLOL/HCTZ 5/6.25 TABLET $0.0606/EACH
BLEOMYCIN SULFATE 15 unit VIAL $44.3850/EACH
BLEOMYCIN SULFATE 30 unit VIAL $82.6210/EACH
BRIMONIDE TARTRATE 0.15% DROPS $20.7060/MILLILITER
BRIMONIDINE TARTRATE 0.002 DROPS $0.3756/MILLILITER
BROMFENAC SODIUM 0.09% DROPS $42.0400/MILLILITER
BROMOCRIPTINE MESYLATE 2.5 mg TABLET $2.5920/EACH
BROMOCRIPTINE MESYLATE 5 mg CAPSULE $5.1600/EACH
BUDESONIDE 3 mg CAPSULE $0.0000 Delete
BUDESONIDE 32 mcg AERO (GM) $9.9220/GRAM
BUMETANIDE 0.5 mg TABLET $0.5105/EACH
BUMETANIDE 1 mg TABLET $0.4460/EACH
BUMETANIDE 2 mg TABLET $1.1240/EACH
BUPRENORPHINE HCL/NALOXONE HCL 2 mg-0.5mg TABLET $4.6560/EACH
BUPRENORPHINE HCL/NALOXONE HCL 8 mg-2 mg TABLET $3.2367/EACH
BUPRENORPHINE HCL 2 mg TABLET $1.1985/EACH
BUPRENORPHINE HCL 8 mg TABLET $1.7196/EACH
BUPROPION HCL 100 mg TABLET $0.1950/EACH
BUPROPION HCL 100 mg TABLET $0.3605/EACH Decrease
BUPROPION HCL 150 mg TABLET $0.4488/EACH
BUPROPION HCL 150 mg TABLET $0.4200/EACH
BUPROPION HCL 150 mg TABLET $0.1518/EACH
BUPROPION HCL 200 mg TABLET $0.3435/EACH Decrease
BUPROPION HCL 300 mg TABLET $0.4636/EACH Decrease
BUPROPION HCL 75 mg TABLET $0.2707/EACH
BUSPIRONE HCL 10 mg TABLET $0.0683/EACH
BUSPIRONE HCL 15 mg TABLET $0.0605/EACH
BUSPIRONE HCL 30 mg TABLET $0.4799/EACH
BUSPIRONE HCL 5 mg TABLET $0.5460/EACH
BUSPIRONE HCL 7.5 MG TABLET $0.7526/EACH Decrease
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50-300-40 CAPSULE $2.3500/EACH Decrease
BUTALBITAL/ACETAMINOPHEN 50MG-325MG TABLET $1.2000/EACH
BUTALBITAL/APAP/CAFFEINE COMPOUND 50 mg/325 mg/40 mg TABLET $0.4812/EACH
BUTALBITAL/APAP/CAFFEINE/CODEINE 50 mg/325 mg/40 mg/30 mg CAPSULE $0.0000
BUTALBITAL/ASPIRIN/CAFF 50 mg/325 mg/40 mg CAPSULE $1.2024/EACH
BUTALBITAL/ASPIRIN/CAFFEINE 50 mg/325 mg/40 mg TABLET $0.0983/EACH
BUTORPHANOL TARTRATE 10 mg/ml AERO (ML) $0.0000
CABERGOLINE 0.5 mg TABLET $6.5022/EACH
CAFFEINE CITRATED 60 mg/3 ml SOLN $0.0000
CALCIPOTRIENE/BETAMETHASONE 0.005-.064 OINT $9.1650/GRAM
CALCIPOTRIENE 0.00005 SOLN $3.1300/MILLILITER
CALCIPOTRIENE 0.005 % CRM $0.0000
CALCITONIN,SALMON,SYNTHETIC 200 units/dose AERO (ML) $0.0000
CALCITRIOL 0.25 mcg CAPSULE $0.3700/EACH
CALCITRIOL 0.5 mcg CAPSULE $0.8124/EACH
CALCITRIOL 1 mcg/ml SOLN $6.4832/MILLILITER
CALCIUM ACETATE 667 mg CAPSULE $0.3876/EACH
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) 500 mg-200 TABLET $0.0316/EACH
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) 600 mg-400 TABLET $0.0240/EACH
CALCIUM CARBONATE/CYANOCOBALAMIN/FOLIC ACID/PYRIDOXINE 200-12-1 TABLET $0.2000/EACH
CALCIUM CARBONATE 1250 mg TABLET $0.0240/EACH
CALCIUM CARBONATE 200(500)mg TABLET $0.0150/EACH
CALCIUM POLYCARBOPHIL 625 mg TABLET $0.0600/EACH
CANDESARTAN CILEXETIL 16 mg TABLET $1.3800/EACH
CANDESARTAN CILEXETIL 32 mg TABLET $1.8464/EACH
CANDESARTAN CILEXETIL 4 mg TABLET $0.5597/EACH
CANDESARTAN CILEXETIL 8 mg TABLET $0.5640/EACH
CANDESARTAN/HYDROCHLOROTHIAZID 16-12.5mg TABLET $2.3700/EACH Increase
CANDESARTAN/HYDROCHLOROTHIAZID 32-12.5mg TABLET $1.9320/EACH
CANDESARTAN/HYDROCHLOROTHIAZID 32mg-25mg TABLET $2.1000/EACH
CAPECITABINE 150 MG TABLET $8.6350/EACH
CAPECITABINE 500 mg TABLET $10.9800/EACH Decrease
CAPTOPRIL; HYDROCHLOROTHIAZIDE 25 mg; 15 mg TABLET $0.0263/EACH Reactivate
CAPTOPRIL; HYDROCHLOROTHIAZIDE 25 mg; 25 mg TABLET $0.0568/EACH Reactivate
CAPTOPRIL; HYDROCHLOROTHIAZIDE 50 mg; 15 mg TABLET $0.0665/EACH Reactivate
CAPTOPRIL; HYDROCHLOROTHIAZIDE 50 mg; 25 mg TABLET $0.0240/EACH Reactivate
CAPTOPRIL 100 mg TABLET $1.4640/EACH
CAPTOPRIL 12.5 mg TABLET $0.6000/EACH
CAPTOPRIL 25 mg TABLET $0.9800/EACH
Page 4 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
CAPTOPRIL 50 mg TABLET $1.1040/EACH
CARBAMAZEPINE 100 mg/5 ml SUSP $0.1680/MILLILITER
CARBAMAZEPINE 100 mg CAPSULE $0.9700/EACH
CARBAMAZEPINE 100 mg TABLET $0.3113/EACH
CARBAMAZEPINE 100 MG TABLET $0.8084/EACH Decrease
CARBAMAZEPINE 200 mg CAPSULE $0.8515/EACH Decrease
CARBAMAZEPINE 200 mg TABLET $1.2713/EACH
CARBAMAZEPINE 200 mg TABLET $0.5940/EACH Decrease
CARBAMAZEPINE 300 mg CAPSULE $1.0117/EACH
CARBAMAZEPINE 400 mg TABLET $2.7330/EACH
CARBAMIDE PEROXIDE 6.5 % DROPS $0.2072/MILLILITER
CARBETAPENTANE/EPHEDRINE/PHENYLEPHRINE/CHLORPHENIRAMINE 30-5-5-4 mg/5 ml SUSP $0.0000
CARBIDOPA/LEVODOPA/ENTACAPONE 12.5-50 MG TABLET $1.2960/EACH
CARBIDOPA/LEVODOPA/ENTACAPONE 18.75-75MG TABLET $1.2960/EACH
CARBIDOPA/LEVODOPA/ENTACAPONE 25-100-200 TABLET $1.2960/EACH
CARBIDOPA/LEVODOPA/ENTACAPONE 31.25-125 TABLET $1.2960/EACH
CARBIDOPA/LEVODOPA/ENTACAPONE 37.5-150MG TABLET $1.2960/EACH
CARBIDOPA/LEVODOPA/ENTACAPONE 50-200-200 TABLET $1.2960/EACH
CARBIDOPA/LEVODOPA 10mg-100mg TABLET $0.6300/EACH
CARBIDOPA; LEVODOPA ER 25 mg; 100 mg TABLET $0.1650/EACH
CARBIDOPA; LEVODOPA ER 50 mg; 200 mg TABLET $0.3382/EACH
CARBIDOPA; LEVODOPA 10 mg; 100 mg TABLET $0.2280/EACH
CARBIDOPA; LEVODOPA 25 mg; 100 mg TABLET $0.0974/EACH
CARBIDOPA; LEVODOPA 25 mg; 250 mg TABLET $0.2021/EACH
CARBIDOPA 25 MG TABLET $5.5725/EACH Decrease
CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 15-60-4/5 SYRUP $0.0000
CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 4 mg; 60 mg; 15 mg per 5 ml SYRUP $0.0000
CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 4-15-1 DROPS $0.0000
CARBINOXAMINE MALEATE; PSEUDOEPHEDRINE; DEXTROMETH HBR 4-15-2 DROPS $0.0000
CARBINOXAMINE MALEATE 4 mg/5 ml LIQ $0.1740/MILLILITER
CARBOPLATIN 10 mg/ ml VIAL $1.2720/MILLILITER
CARBOPLATIN 150 mg VIAL $0.0000
CARBOPLATIN 450 mg VIAL $0.0000
CARBOPLATIN 50 mg VIAL $0.0000
CAR-B-PEN TA/PHENYLEPHRINE/PYR 30 mg; 5 mg; 30 mg/5 ml SUSP $0.0000
CARISOPRODOL/ASA COMPOUND 200 mg; 325 mg TABLET $0.4334/EACH Reactivate
CARISOPRODOL 350 mg TABLET $0.0621/EACH
CARTEOLOL HCL 0.01 DROPS $0.9528/MILLILITER
CARVEDILOL 12.5 mg TABLET $0.0292/EACH
CARVEDILOL 25 mg TABLET $0.0329/EACH
CARVEDILOL 3.125 mg TABLET $0.0474/EACH
CARVEDILOL 6.25 mg TABLET $0.0308/EACH
CEFACLOR 125 mg/5 ml SUSP, RECON $0.0000
CEFACLOR 187 mg/5 ml SUSP, RECON $0.0000
CEFACLOR 250 mg/5 ml SUSP, RECON $0.0000
CEFACLOR 250 mg CAPSULE $1.6708/EACH
CEFACLOR 375 mg/5 ml SUSP, RECON $0.0000
CEFACLOR 500 mg CAPSULE $1.7280/EACH
CEFACLOR 500 mg TABLET $0.0000
CEFADROXIL HYDRATE 250 mg/5 ml SUSP, RECON $0.6384/MILLILITER
CEFADROXIL HYDRATE 500 mg/5 ml SUSP, RECON $0.8838/MILLILITER
CEFADROXIL 1 gm TABLET $3.9000/EACH
CEFADROXIL 500 mg CAPSULE $0.3450/EACH
CEFAZOLIN SODIUM 1 gm VIAL $1.1550/EACH
CEFAZOLIN SODIUM 10 gm VIAL $10.5798/EACH
CEFDINIR 125 mg/5 ml SUSP, RECON $0.2650/MILLILITER Decrease
CEFDINIR 250 mg/5 ml SUSP, RECON $0.3290/MILLILITER Decrease
CEFDINIR 300 mg CAPSULE $0.7600/EACH
CEFEPIME HCL 2 gm VIAL $9.4103/EACH
CEFIXIME 100 MG/5ML SUSP, RECON $3.8942/MILLILITER
CEFIXIME 200 MG/5ML SUSP, RECON $6.4952/MILLILITER
CEFPODOXIME PROXETIL 100 mg/5 ml SUSP, RECON $1.3248/MILLILITER
CEFPODOXIME 100 mg TABLET $5.3900/EACH
CEFPODOXIME 200 mg TABLET $0.0000
CEFPROZIL 125 mg/5 ml SUSP, RECON $0.4395/MILLILITER
CEFPROZIL 250 mg/5 ml SUSP, RECON $0.3367/MILLILITER
CEFPROZIL 250 mg TABLET $0.8640/EACH
CEFPROZIL 500 mg TABLET $1.8200/EACH
CEFTAZIDIME PENTAHYDRATE 1 gm VIAL $5.3880/EACH
CEFTAZIDIME PENTAHYDRATE 2 gm VIAL $9.8062/EACH
CEFTAZIDIME PENTAHYDRATE 6 gm VIAL $24.0786/EACH
CEFTRIAXONE SODIUM 1 gm VIAL $2.4192/EACH
CEFTRIAXONE SODIUM 10 gm VIAL $26.9500/EACH
CEFTRIAXONE SODIUM 2 gm VIAL $4.4352/EACH
CEFTRIAXONE SODIUM 250 mg VIAL $1.5926/EACH
CEFTRIAXONE SODIUM 500 mg VIAL $1.8144/EACH
CEFUROXIME AXETIL 125 mg/5 ml SUSP, RECON $0.0000
CEFUROXIME AXETIL 250 mg/5 ml SUSP, RECON $0.0000
CEFUROXIME 250 mg TABLET $1.2328/EACH
CEFUROXIME 500 mg TABLET $1.4987/EACH
CELECOXIB 50 MG CAPSULE $0.3742/EACH
CEPHALEXIN 125 mg/5 ml SUSP, RECON $0.1075/MILLILITER
CEPHALEXIN 250 mg/5 ml SUSP, RECON $0.1355/MILLILITER Decrease
CEPHALEXIN 250 mg CAPSULE $0.1080/EACH
CEPHALEXIN 500 mg CAPSULE $0.0877/EACH Decrease
CETIRIZINE HCL 1 mg/ml SOLN $0.0000 Delete
CETIRIZINE HCL 10 mg TABLET $5.6280/EACH
CETIRIZINE HCL 10 mg TABLET $0.0000 Delete
CETIRIZINE HCL 5 mg TABLET $1.5120/EACH
CETIRIZINE HCL 5 mg TABLET $0.0480/EACH
CEVIMELINE HCL 30 mg CAPSULE $1.6503/EACH
CHLORAL HYDRATE 500 mg CAPSULE $0.0000
Page 5 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
CHLORDIAZEPOXIDE 10 mg CAPSULE $0.0883/EACH
CHLORDIAZEPOXIDE 25 mg CAPSULE $0.0972/EACH
CHLORDIAZEPOXIDE 5 mg CAPSULE $0.0874/EACH
CHLORHEXIDINE 0.12% MOUTHWASH $0.0000
CHLOROTHIAZIDE 250 mg TABLET $0.0000
CHLOROTHIAZIDE 500 mg TABLET $0.0000
CHLORPHENIRAMINE MALEATE 4 mg TABLET $0.0000
CHLORPROMAZINE HCL 10 mg TABLET $3.0000/EACH
CHLORPROMAZINE HCL 100 mg TABLET $6.1614/EACH
CHLORPROMAZINE HCL 200 mg TABLET $9.0538/EACH
CHLORPROMAZINE HCL 25 mg TABLET $3.9825/EACH
CHLORPROMAZINE HCL 50 mg TABLET $4.1040/EACH Decrease
CHLORPROPAMIDE 100 mg TABLET $0.0000
CHLORPROPAMIDE 250 mg TABLET $0.0000
CHLORTHALIDONE 100 mg TABLET $0.0000
CHLORTHALIDONE 25 mg TABLET $0.5738/EACH
CHLORTHALIDONE 50 mg TABLET $1.0288/EACH
CHLORZOXAZONE 500 mg TABLET $0.2284/EACH
CHOLECALCIFEROL (VITAMIN D3) 1000 UNIT TABLET $0.0219/EACH
CHOLECALCIFEROL (VITAMIN D3) 2000 UNIT CAPSULE $0.0375/EACH
CHOLESTYRAMINE LITE 4 gm PACKET $1.8606/EACH
CHOLESTYRAMINE LITE 4 gm PWDR $0.3000/GRAM
CHOLESTYRAMINE/SUCROSE 4 gm PACKET $1.2183/EACH
CHOLESTYRAMINE 4 gm PWDR $0.2176/GRAM
CHOLINE MAGNESIUM TRISALICYLATE 1000 mg TABLET $0.0000
CHOLINE MAGNESIUM TRISALICYLATE 500 mg TABLET $0.0000
CHOLINE MAGNESIUM TRISALICYLATE 750 mg TABLET $0.0000
CICLOPIROX 0.0077 GEL $1.5450/GRAM
CICLOPIROX 0.01 SHAMPOO $0.4581/MILLILITER
CICLOPIROX 0.08 SOLN $1.8720/MILLILITER
CICLOPIROX 0.77% CRM $0.3048/GRAM
CICLOPIROX 0.77% SUSP $1.0320/MILLILITER
CILOSTAZOL 100 mg TABLET $0.1257/EACH
CILOSTAZOL 50 mg TABLET $0.0845/EACH
CIMETIDINE 200 mg TABLET $0.2520/EACH
CIMETIDINE 300 mg TABLET $0.3670/EACH
CIMETIDINE 400 mg TABLET $0.6032/EACH
CIMETIDINE 800 mg TABLET $0.5656/EACH
CIPROFLOXACIN LACTATE/D5W 400 mg/200 ml SOLN $0.0210/MILLILITER
CIPROFLOXACIN/CIPROFLOXA HCL 1000 mg TABLET $11.1165/EACH Reactivate
CIPROFLOXACIN/CIPROFLOXA HCL 500 mg TABLET $9.3741/EACH Reactivate
CIPROFLOXACIN 0.003 DROPS $0.9450/MILLILITER
CIPROFLOXACIN 250 mg TABLET $0.1721/EACH
CIPROFLOXACIN 500 mg TABLET $0.1661/EACH
CIPROFLOXACIN 750 mg TABLET $0.6360/EACH
CITALOPRAM 10 mg/5 ml SOLN $0.2563/MILLILITER
CITALOPRAM 10 mg TABLET $0.0348/EACH
CITALOPRAM 20 mg TABLET $0.0373/EACH
CITALOPRAM 40 mg TABLET $0.0476/EACH
CLADRIBINE 10 mg/10 ml VIAL $28.3030/MILLILITER
CLARITHROMYCIN 500 mg TABLET $3.1582/EACH
CLARITHROMYCIN 125 mg/5 ml SUSP, RECON $0.8157/MILLILITER
CLARITHROMYCIN 250 mg/5 ml SUSP, RECON $1.0364/MILLILITER
CLARITHROMYCIN 250 mg TABLET $1.3052/EACH
CLARITHROMYCIN 500 mg TABLET $0.7600/EACH
CLIDINIUM/CHLORDIAZEPOXIDE 2.5 mg/5 mg CAPSULE $0.0000
CLINDAMYCIN HCL 150 mg CAPSULE $0.1313/EACH
CLINDAMYCIN HCL 300 mg CAPSULE $0.2129/EACH
CLINDAMYCIN PALMITATE HCL 75 mg/5 ml SOLN $0.2175/MILLILITER
CLINDAMYCIN PHOS/BENZOYL PEROX 1 %-5 % GEL $0.0000
CLINDAMYCIN PHOSPHATE 1% 0.01 FOAM $4.4640/GRAM
CLINDAMYCIN PHOSPHATE 1% 1% SWAB $0.3725/EACH
CLINDAMYCIN PHOSPHATE 1% 1% GEL $1.4475/GRAM
CLINDAMYCIN PHOSPHATE 1% 1% LOTION $1.1111/MILLILITER
CLINDAMYCIN PHOSPHATE 1% 1% SOLN $0.5892/MILLILITER
CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE 1% - 5% GEL $4.5094/GRAM
CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE 1.2(1)%-5% GEL $3.3873/GRAM Reactivate
CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER 300MG/50ML SOLN $0.1722/MILLILITER
CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER 600MG/50ML SOLN $0.2597/MILLILITER
CLINDAMYCIN PHOSPHATE/DEXTROSE 5 % IN WATER 900MG/50ML SOLN $0.3172/MILLILITER
CLINDAMYCIN PHOSPHATE 0.02 CRM $1.7010/GRAM
CLINDAMYCIN PHOSPHATE 150 mg/ml VIAL $0.9231/MILLILITER
CLOBETASOL PROPIONATE/EMOLLIENT 0.05 % FOAM $3.8100/GRAM
CLOBETASOL PROPIONATE/EMOLLIENT 0.05% CRM $2.9640/GRAM
CLOBETASOL PROPIONATE 0.0005 FOAM $4.1030/GRAM
CLOBETASOL PROPIONATE 0.0005 SHAMPOO $1.6775/MILLILITER
CLOBETASOL PROPIONATE 0.05 % LOTION $3.2980/MILLILITER
CLOBETASOL PROPIONATE 0.05 % SPRAY $2.8840/MILLILITER
CLOBETASOL PROPIONATE 0.05% CRM $2.1516/GRAM Decrease
CLOBETASOL PROPIONATE 0.05% GEL $4.2000/GRAM
CLOBETASOL PROPIONATE 0.05% OINT $3.5604/GRAM
CLOBETASOL PROPIONATE 0.05% SOLN $1.2742/MILLILITER Decrease
CLOMIPHENE CITRATE 50 mg TABLET $0.0000
CLOMIPRAMINE HCL 25 mg CAPSULE $5.2800/EACH Decrease
CLOMIPRAMINE HCL 50 mg CAPSULE $6.2160/EACH Decrease
CLOMIPRAMINE HCL 75 mg CAPSULE $5.6437/EACH
CLONAZEPAM ODT 0.125 mg TABLET $0.5499/EACH
CLONAZEPAM ODT 0.25 mg TABLET $1.0743/EACH
CLONAZEPAM ODT 0.5 mg TABLET $0.7392/EACH
CLONAZEPAM ODT 1 mg TABLET $0.8441/EACH
CLONAZEPAM ODT 2 mg TABLET $1.6845/EACH
CLONAZEPAM 0.5 mg TABLET $0.0150/EACH
Page 6 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
CLONAZEPAM 1 mg TABLET $0.0281/EACH
CLONAZEPAM 2 mg TABLET $0.0417/EACH
CLONIDINE HCL 0.1 MG TABLET $2.4119/EACH
CLONIDINE HCL 0.1 mg TABLET $0.0246/EACH
CLONIDINE HCL 0.2 mg TABLET $0.0375/EACH
CLONIDINE HCL 0.3 mg TABLET $0.0450/EACH
CLONIDINE 0.1 mg/24 hr PATCH $0.0000
CLONIDINE 0.2 mg/24 hr PATCH $0.0000
CLONIDINE 0.3 mg/24 hr PATCH $0.0000
CLOPIDOGREL 75 MG TABLET $0.0792/EACH Decrease
CLORAZEPATE DIPOTASSIUM 15 mg CAPSULE $0.0000
CLORAZEPATE DIPOTASSIUM 15 mg TABLET $1.6143/EACH
CLORAZEPATE DIPOTASSIUM 3.75 mg CAPSULE $0.0000
CLORAZEPATE DIPOTASSIUM 3.75 mg TABLET $1.0746/EACH
CLORAZEPATE DIPOTASSIUM 7.5 mg CAPSULE $0.0000
CLORAZEPATE DIPOTASSIUM 7.5 mg TABLET $0.0000
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 1-0.05%, 15 gm CRM $0.5780/GRAM
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 1-0.05%, 45 gm CRM $0.5020/GRAM
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 1-0.05% LOTION $3.9203/MILLILITER
CLOTRIMAZOLE 0.01 CRM $0.0000 Delete
CLOTRIMAZOLE 0.01 CRM $0.0739/GRAM
CLOTRIMAZOLE 0.01 SOLN $1.4404/MILLILITER
CLOTRIMAZOLE 10 mg TROCHE $0.3631/EACH
CLOZAPINE 100 mg TABLET $0.9196/EACH Decrease
CLOZAPINE 200 mg TABLET $2.2500/EACH Decrease
CLOZAPINE 25 mg TABLET $0.4015/EACH Decrease
CLOZAPINE 50 mg TABLET $0.7260/EACH
CODEINE SULFATE 15 MG TAB $0.4374/TABLET Add
CODEINE SULFATE 30 MG TAB $0.4657/TABLET Add
CODEINE SULFATE 60 MG TAB $0.7832/TABLET Add
COLCHICINE 0.6 mg TABLET $5.4036/EACH
COLESTIPOL HCL 1 gm TABLET $0.8783/EACH
COLISTIMETHATE SODIUM 150 mg VIAL $23.4410/EACH
CROMOLYN SODIUM 0.04 DROPS $0.9000/MILLILITER
CROMOLYN SODIUM 10 mg/ml AMPUL $0.0000
CROMOLYN SODIUM 20 MG/ML CONC $0.9394/MILLILITER Decrease
CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG TABLET $0.0693/EACH
CYCLOBENZAPRINE HCL 5 mg TABLET $0.0360/EACH
CYCLOBENZAPRINE HCL 10 mg TABLET $0.0240/EACH
CYCLOPENTOLATE HCL 1%, 2 ml DROPS $2.4840/MILLILITER
CYCLOPHOSPHAMIDE 50 mg TABLET $0.0000
CYCLOSPORINE, MODIFIED 100 mg/ml SOLN $2.4000/MILLILITER
CYCLOSPORINE, MODIFIED 100 mg CAPSULE $2.7720/EACH
CYCLOSPORINE, MODIFIED 25 mg CAPSULE $0.6540/EACH
CYCLOSPORINE, MODIFIED 50 MG CAPSULE $1.2960/EACH
CYCLOSPORINE 100 MG CAPSULE $8.2800/EACH
CYCLOSPORINE 25 MG CAPSULE $1.7640/EACH
CYPROHEPTADINE HCL 2 mg/5 ml SYRUP $0.1282/MILLILITER
CYPROHEPTADINE HCL 4 mg TABLET $0.3883/EACH
CYTARABINE/PF 2 g/20 ml VIAL $0.9720/MILLILITER
DACARBAZINE 200 mg VIAL $14.2010/EACH
DANAZOL 200 mg CAPSULE $4.0501/EACH
DANTROLENE SODIUM 100 mg CAPSULE $1.4500/EACH Reactivate
DANTROLENE SODIUM 25 mg CAPSULE $0.8400/EACH
DANTROLENE SODIUM 50 mg CAPSULE $1.2600/EACH Reactivate
DAPSONE 100 MG TABLET $2.1840/EACH
DAPSONE 25 MG TABLET $1.7880/EACH
DAUNORUBICIN HCL 5 mg/ml VIAL $18.2247/MILLILITER
DEFEROXAMINE MESYLATE 2 gm VIAL $39.6550/EACH
DEFEROXAMINE MESYLATE 500 mg VIAL $12.4643/EACH
DEMECLOCYCLINE 150 mg TABLET $4.4500/EACH
DEMECLOCYCLINE 300 mg TABLET $8.4000/EACH
DESIPRAMINE HCL 10 mg TABLET $0.6292/EACH
DESIPRAMINE HCL 100 mg TABLET $0.0000
DESIPRAMINE HCL 150 mg TABLET $0.0000
DESIPRAMINE HCL 25 mg TABLET $0.9300/EACH
DESIPRAMINE HCL 50 mg TABLET $2.1473/EACH
DESIPRAMINE HCL 75 mg TABLET $2.9153/EACH
DESLORATADINE 5 mg TABLET $0.4581/EACH
DESMOPRESSIN ACETATE 0.1 mg TABLET $0.7229/EACH
DESMOPRESSIN ACETATE 0.2 mg TABLET $0.9000/EACH Decrease
DESMOPRESSIN ACETATE 4 mcg/ml AMPUL $0.0000
DESMOPRESSIN ACETATE 4 mcg/ml VIAL $0.0000
DESMOPRESSIN 0.1 mg/ml AERO (ML) $17.5316/MILLILITER
DESOGESTREL/ETHINY ESTRADIOL (DESOGEN, ORTHO-CEPT, APRI) 0.15 mg/30 mcg TABLET $0.4216/EACH
DESOGESTREL/ETHINY ESTRADIOL (KARIVA, MIRCETTE) 0.15 mg/20 mcg TABLET $0.8194/EACH
DESOGESTREL/ETHINY ESTRADIOL 7-7-7 (CYCLESSA, VELIVET) 0.1-25/0.125-25/0.15-25 mg-mcg TABLET $0.4920/EACH
DESONIDE 0.0005 LOTION $2.1720/MILLILITER
DESONIDE 0.05%; 15 gm CRM $2.9705/GRAM Decrease
DESONIDE 0.05%; 15 gm OINT $1.7304/GRAM Reactivate
DESONIDE 0.05%; 60 gm CRM $3.6294/GRAM
DESONIDE 0.05%; 60 gm OINT $1.1242/GRAM Reactivate
DESOXIMETASONE 0.0025 CRM $0.6880/GRAM Reactivate
DESOXIMETASONE 0.05%; 15 gm CRM $2.7872/GRAM
DESOXIMETASONE 0.05%; 15 gm GEL $4.6920/GRAM
DESOXIMETASONE 0.05%; 60 gm CRM $5.8788/GRAM
DESOXIMETASONE 0.05%; 60 gm GEL $2.5030/GRAM
DESOXIMETASONE 0.25%; 15 gm CRM $2.5490/GRAM
DESOXIMETASONE 0.25%; 15 gm OINT $5.9088/GRAM
DESOXIMETASONE 0.25%; 60 gm CRM $1.3940/GRAM
DESOXIMETASONE 0.25%; 60 gm OINT $5.6442/GRAM
DESVENLAFAXINE SUCCINATE 100 MG TAB, ER 24 HR $0.9595/TABLET Add
Page 7 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
DESVENLAFAXINE SUCCINATE 50 MG TAB, ER 24 HR $0.9595/TABLET Add
DEXAMETHASONE 0.5 mg/5 ml ELIXIR $0.0000
DEXAMETHASONE 0.5 mg TABLET $0.0674/EACH Reactivate
DEXAMETHASONE 4 mg TABLET $0.0000
DEXMETHYLPHENIDATE HCL 10 mg CAPSULE $4.3666/EACH Decrease
DEXMETHYLPHENIDATE HCL 10 mg TABLET $0.9070/EACH Decrease
DEXMETHYLPHENIDATE HCL 15 MG CAPSULE $4.5588/EACH
DEXMETHYLPHENIDATE HCL 2.5 mg TABLET $0.5537/EACH
DEXMETHYLPHENIDATE HCL 20 mg CAPSULE $5.6320/EACH
DEXMETHYLPHENIDATE HCL 30 MG CAPSULE $4.5812/EACH
DEXMETHYLPHENIDATE HCL 40 MG CAPSULE $5.7992/EACH
DEXMETHYLPHENIDATE HCL 5 mg CAPSULE $5.4160/EACH
DEXMETHYLPHENIDATE HCL 5 mg TABLET $0.6865/EACH Decrease
DEXTROAMPHETAMINE SULFATE 10 mg CAPSULE $1.7550/EACH
DEXTROAMPHETAMINE SULFATE 10 mg TABLET $1.0937/EACH
DEXTROAMPHETAMINE SULFATE 15 mg CAPSULE $1.8749/EACH
DEXTROAMPHETAMINE SULFATE 5 mg CAPSULE $2.8351/EACH
DEXTROAMPHETAMINE SULFATE 5 mg TABLET $1.1431/EACH
DEXTROMETHORPHAN HBR/PHENYLEPHRINE HCL/CHLORPHENIRAMINE 15-12.5-4 SYRUP $0.0198/MILLILITER
DHCODEINE BT/ACETAMINOPHN/CAFF 32-713-60 TABLET $0.0000
DIAZEPAM 10 mg TABLET $0.0271/EACH
DIAZEPAM 2 mg TABLET $0.0240/EACH
DIAZEPAM 5 mg TABLET $0.0297/EACH
DICLOFENAC POTASSIUM 50 mg TABLET $0.6000/EACH
DICLOFENAC SODIUM XR 100 mg TABLET $0.2698/EACH
DICLOFENAC SODIUM/MISOPROSTOL 50 MG-200 TABLET $2.4720/EACH
DICLOFENAC SODIUM/MISOPROSTOL 75 MG-200 TABLET $2.5545/EACH
DICLOFENAC SODIUM 0.001 DROPS $1.5173/MILLILITER
DICLOFENAC SODIUM 1 % GEL $0.4038/GRAM
DICLOFENAC SODIUM 25 mg TABLET $0.8100/EACH Reactivate
DICLOFENAC SODIUM 3 % GEL $2.4360/GRAM Decrease
DICLOFENAC SODIUM 50 mg TABLET $0.2054/EACH
DICLOFENAC SODIUM 75 mg TABLET $0.1580/EACH
DICLOXACILLIN SODIUM 250 mg CAPSULE $0.2990/EACH
DICLOXACILLIN SODIUM 500 mg CAPSULE $0.5700/EACH
DICYCLOMINE HCL 10 mg CAPSULE $0.0438/EACH
DICYCLOMINE HCL 20 mg TABLET $0.0567/EACH
DIDANOSINE 125 mg CAPSULE $1.5960/EACH
DIDANOSINE 200 mg CAPSULE $6.4841/EACH
DIDANOSINE 250 mg CAPSULE $5.8440/EACH
DIDANOSINE 400 mg CAPSULE $4.3500/EACH
DIFLORASONE DIACETATE 0.05% CRM $0.0000
DIFLORASONE DIACETATE 0.05% OINT $2.8476/GRAM
DIFLUNISAL 250 mg TABLET $0.0000
DIFLUNISAL 500 mg TABLET $1.2720/EACH
DIGOXIN .125 mg TABLET $0.5535/EACH
DIGOXIN .250 mg TABLET $0.6776/EACH
DILTIAZEM HCL 420 mg CAPSULE $1.2360/EACH
DILTIAZEM HCL 120 mg CAPSULE $0.5600/EACH
DILTIAZEM HCL 120 mg CAPSULE $0.2250/EACH
DILTIAZEM HCL 120 mg CAPSULE $3.1996/EACH
DILTIAZEM HCL 120 mg CAPSULE $0.3122/EACH
DILTIAZEM HCL 120 mg TABLET $0.3000/EACH
DILTIAZEM HCL 180 mg CAPSULE $0.5640/EACH
DILTIAZEM HCL 180 mg CAPSULE $0.4560/EACH
DILTIAZEM HCL 180 mg CAPSULE $0.3460/EACH
DILTIAZEM HCL 180 MG TABLET $2.0880/EACH
DILTIAZEM HCL 240 mg CAPSULE $0.8520/EACH
DILTIAZEM HCL 240 mg CAPSULE $0.3750/EACH
DILTIAZEM HCL 240 mg CAPSULE $0.3840/EACH
DILTIAZEM HCL 240 MG TABLET $2.3400/EACH
DILTIAZEM HCL 30 mg TABLET $0.2494/EACH
DILTIAZEM HCL 300 mg CAPSULE $0.8280/EACH
DILTIAZEM HCL 300 mg CAPSULE $0.4151/EACH
DILTIAZEM HCL 300 MG TABLET $3.0360/EACH
DILTIAZEM HCL 360 mg CAPSULE $4.8388/EACH
DILTIAZEM HCL 360 mg CAPSULE $0.5498/EACH
DILTIAZEM HCL 360 MG TABLET $3.2710/EACH
DILTIAZEM HCL 420 MG TABLET $3.5520/EACH
DILTIAZEM HCL 60 mg CAPSULE $2.1480/EACH
DILTIAZEM HCL 60 mg TABLET $0.1699/EACH
DILTIAZEM HCL 90 mg CAPSULE $2.4600/EACH
DILTIAZEM HCL 90 mg TABLET $0.3480/EACH
DIPHENHYDRAMINE 25 mg CAPSULE $0.0240/EACH
DIPHENHYDRAMINE 50 mg CAPSULE $0.0235/EACH
DIPHENOXYLATE HCL; ATROPINE SULFATE 2.5 mg; 0.025 mg/5 ml LIQ $0.0000
DIPHENOXYLATE HCL; ATROPINE SULFATE 2.5 mg; 0.025 mg TABLET $0.3750/EACH
DIPYRIDAMOLE 25 mg TABLET $0.0630/EACH
DIPYRIDAMOLE 50 mg TABLET $0.0834/EACH
DIPYRIDAMOLE 75 mg TABLET $0.1200/EACH
DISOPYRAMIDE CR 150 mg CAPSULE $0.0000
DISOPYRAMIDE 100 mg CAPSULE $0.5520/EACH
DISOPYRAMIDE 150 mg CAPSULE $0.0000
DISULFIRAM 250 mg TABLET $1.9800/EACH
DIVALPROEX SODIUM 125 mg CAPSULE $0.5150/EACH Decrease
DIVALPROEX SODIUM 125 mg TABLET $0.0450/EACH
DIVALPROEX SODIUM 250 mg TABLET $0.0692/EACH
DIVALPROEX SODIUM 250 mg TABLET $0.8280/EACH Decrease
DIVALPROEX SODIUM 500 mg TABLET $0.1296/EACH
DIVALPROEX SODIUM 500 mg TABLET $0.6437/EACH
D-METHORP TAN/P-EPD TAN/D-CP 25 mg; 75 mg; 2.5 mg/5 ml SUSP $0.0000
D-METHORPHAN HB/PE/CHLORPHENIR 15 mg; 6 mg; 2 mg/5 ml SYRUP $0.0000
Page 8 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
D-METHORPHAN HB/P-EPD HCL/BPM 3 mg; 12.5 mg;1 mg/ml DROPS $0.0000
D-METHORPHAN HB/P-EPD HCL/BPM 10 mg; 30 mg; 2 mg/5 ml SYRUP $0.0000
D-METHORPHAN HB/P-EPD HCL/BPM 15 mg; 45 mg; 4 mg/5 ml SYRUP $0.0000
D-METHORPHAN HB/P-EPD HCL/BPM 30 mg; 60 mg; 4 mg/5 ml SYRUP $0.0000
D-METHORPHAN HB/P-EPD HCL/BPM 4 mg; 15 mg; 1 mg/ml DROPS $0.0000
DOCUSATE CALCIUM 240 mg CAPSULE $0.0600/EACH
DOCUSATE SODIUM/CASANTHRANOL 100 mg/30 mg CAPSULE $0.0000
DOCUSATE SODIUM/CASANTHRANOL 60 mg/30 mg per 15 ml SYRUP $0.0000
DOCUSATE SODIUM/SENNA 50 mg/8.6 mg TABLET $0.0000
DOCUSATE SODIUM 100 mg CAPSULE $0.0204/EACH Decrease
DOCUSATE SODIUM 150 mg/15 ml LIQ $0.0109/MILLILITER
DOCUSATE SODIUM 283 mg ENEMA $2.0647/EACH
DOCUSATE SODIUM 50 mg CAPSULE $0.2760/EACH
DOFETILIDE 125 MCG CAPSULE $4.7280/EACH
DOFETILIDE 250 MCG CAPSULE $4.8343/EACH
DOFETILIDE 500 MCG CAPSULE $4.9616/EACH
DONEPEZIL HCL 10 mg TABLET $0.3500/EACH
DONEPEZIL HCL 10 mg TABLET $0.0367/EACH
DONEPEZIL HCL 23 mg TABLET $1.8343/EACH
DONEPEZIL HCL 5 mg TABLET $0.1680/EACH
DONEPEZIL HCL 5 mg TABLET $0.0367/EACH
DORZOLAMIDE HCL 0.02 DROPS $1.3296/MILLILITER
DOXAZOSIN MESYLATE 1 mg TABLET $0.5540/EACH
DOXAZOSIN MESYLATE 2 mg TABLET $0.3423/EACH Decrease
DOXAZOSIN MESYLATE 4 mg TABLET $0.4734/EACH
DOXAZOSIN MESYLATE 8 mg TABLET $0.3646/EACH
DOXEPIN HCL 10 MG/ML CONC $0.0600/MILLILITER
DOXEPIN HCL 10 mg CAPSULE $0.4412/EACH
DOXEPIN HCL 100 mg CAPSULE $1.3848/EACH
DOXEPIN HCL 150 mg CAPSULE $0.0000
DOXEPIN HCL 25 mg CAPSULE $0.6000/EACH
DOXEPIN HCL 50 mg CAPSULE $0.8232/EACH
DOXEPIN HCL 75 mg CAPSULE $1.2046/EACH
DOXERCALCIFEROL 0.5 MCG CAPSULE $10.2700/EACH
DOXERCALCIFEROL 1 MCG CAPSULE $17.3800/EACH
DOXERCALCIFEROL 2.5 MCG CAPSULE $23.6340/EACH
DOXORUBICIN HCL 10 mg/5 ml VIAL $2.2680/MILLILITER
DOXORUBICIN HCL 2 mg/ ml VIAL $1.6797/MILLILITER
DOXORUBICIN HCL 20 mg/10 ml VIAL $2.6250/MILLILITER
DOXORUBICIN HCL 50 mg/25 ml VIAL $2.8200/MILLILITER
DOXYCYCLINE HYCLATE 100 mg CAPSULE $0.2689/EACH
DOXYCYCLINE HYCLATE 100 mg TABLET $0.7635/EACH Decrease
DOXYCYCLINE HYCLATE 100 MG TABLET $9.4050/EACH
DOXYCYCLINE HYCLATE 150 MG TABLET $13.2000/EACH
DOXYCYCLINE HYCLATE 20 mg TABLET $0.4440/EACH
DOXYCYCLINE HYCLATE 50 mg CAPSULE $0.6840/EACH
DOXYCYCLINE MONOHYDRATE 100 mg TABLET $0.5941/EACH
DOXYCYCLINE MONOHYDRATE 50 mg TABLET $0.4099/EACH
DOXYCYCLINE MONOHYDRATE 100 mg CAPSULE $0.4318/EACH
DOXYCYCLINE MONOHYDRATE 150 mg CAPSULE $10.5710/EACH
DOXYCYCLINE MONOHYDRATE 150 mg TABLET $6.1440/EACH
DOXYCYCLINE MONOHYDRATE 50 mg CAPSULE $0.3047/EACH
DRONABINOL 5 mg CAPSULE $5.0272/EACH Decrease
DRONABINOL 10 mg CAPSULE $8.4627/EACH
DRONABINOL 2.5 mg CAPSULE $2.9095/EACH Decrease
DULOXETINE HCL 20 mg CAPSULE $0.3173/EACH
DULOXETINE HCL 30 mg CAPSULE $0.2635/EACH Decrease
DULOXETINE HCL 60 mg CAPSULE $0.2265/EACH Decrease
DUTASTERIDE/TAMSULOSIN HCL 0.5-0.4 MG CAPSULE $3.8760/EACH
ECONAZOLE NITRATE 1% CRM $0.0000
ECONAZOLE NITRATE 1% CRM $1.8900/GRAM Decrease
ECONAZOLE NITRATE 1% CRM $2.5086/GRAM Decrease
ECONAZOLE NITRATE 1% CRM $2.3465/GRAM
ELECTROLYTE ORAL SOLUTION 1000 ml SOLN $0.0000
ELECTROLYTE ORAL SOLUTION 540 ml SOLN $0.0000
ENALAPRIL MALEATE/HCTZ 10 mg/25 mg TABLET $0.1890/EACH
ENALAPRIL MALEATE/HCTZ 5 mg/12.5 mg TABLET $0.2040/EACH
ENALAPRIL MALEATE 10 mg TABLET $0.3053/EACH
ENALAPRIL MALEATE 2.5 mg TABLET $0.1645/EACH
ENALAPRIL MALEATE 20 mg TABLET $0.2700/EACH
ENALAPRIL MALEATE 5 mg TABLET $0.3000/EACH
ENALAPRILAT DIHYDRATE 1.25 mg/ml VIAL $3.0240/MILLILITER
ENOXAPARIN SODIUM 100 mg/ml SYRINGE $0.0000
ENOXAPARIN SODIUM 120 mg/0.8 ml SYRINGE $0.0000
ENOXAPARIN SODIUM 150 mg/ml SYRINGE $0.0000
ENOXAPARIN SODIUM 30 mg/0.3 ml SYRINGE $0.0000
ENOXAPARIN SODIUM 300MG/3ML VIAL $0.0000
ENOXAPARIN SODIUM 40 mg/0.4 ml SYRINGE $0.0000
ENOXAPARIN SODIUM 60 mg/0.6 ml SYRINGE $0.0000
ENOXAPARIN SODIUM 80 mg/0.8 ml SYRINGE $0.0000
ENTACAPONE 200 MG TABLET $2.3700/EACH
ENTECAVIR 0.5 MG TABLET $6.3030/EACH Decrease
ENTECAVIR 1 mg TABLET $6.3030/EACH Decrease
EPINASTINE HCL 0.05 % DROPS $5.8200/MILLILITER
EPIRUBICIN HCL 200 mg/0.1 l VIAL $1.9688/MILLILITER
EPIRUBICIN HCL 50 mg/25 ml VIAL $2.1175/MILLILITER
EPLERENONE 25 mg TABLET $2.2200/EACH
EPLERENONE 50 mg TABLET $1.9459/EACH
EPOPROSTENOL NA 0.5 mg VIAL $0.0000
EPOPROSTENOL NA 1.5 mg VIAL $0.0000
ERGOCALCIFEROL (VITAMIN D2) 50000 unit CAPSULE $0.1793/EACH
ERGOCALCIFEROL (VITAMIN D2) 8000/ML DROPS $0.5400/MILLILITER
Page 9 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
ERYTHROMYCIN BASE/BENZOYL PEROXIDE 3%; 5% GEL $5.9800/GRAM
ERYTHROMYCIN BASE/ETHANOL 2% GEL $3.3360/GRAM
ERYTHROMYCIN BASE 250 mg TABLET $0.0000
ERYTHROMYCIN BASE 333 mg TABLET $0.0000
ERYTHROMYCIN BASE 500 mg TABLET $0.0000
ERYTHROMYCIN ETHYLSUCCINATE (EES) 400 mg TABLET $0.0000
ERYTHROMYCIN/SULFISOXAZOLE 200 mg/600 mg per 5 ml SUSP, RECON $0.0000
ERYTHROMYCIN 0.005 OINT $1.4160/GRAM
ERYTHROMYCIN 2% SOLN $0.7712/MILLILITER
ESCITALOPRAM OXALATE 10 MG TABLET $0.0955/EACH
ESCITALOPRAM OXALATE 20 MG TABLET $0.1078/EACH
ESCITALOPRAM OXALATE 5 MG/5 ML SOLN $0.7050/MILLILITER
ESCITALOPRAM OXALATE 5 MG TABLET $0.0931/EACH
ESOMEPRAZOLE MAGNESIUM 20 mg CAPSULE $0.0000
ESOMEPRAZOLE MAGNESIUM 40 mg CAPSULE $0.0000
ESTAZOLAM 1 mg TABLET $0.5160/EACH
ESTAZOLAM 2 mg TABLET $0.8520/EACH
ESTERIFIED ESTROGENS/METHYLTESTOSTERONE (H.S.) 0.625-1.25 mg TABLET $0.0000
ESTERIFIED ESTROGENS/METHYLTESTOSTERONE (H.S.) 1.25-2.5 mg TABLET $0.0000
ESTRADIOL VALERATE/DIENOGEST 3-2-1(28) TABLET $0.0000
ESTRADIOL .025 mg/24hr PATCH $8.6050/EACH
ESTRADIOL .025 mg PATCH $15.0920/EACH
ESTRADIOL .0375 mg/24hr PATCH $7.3495/EACH
ESTRADIOL .0375mg/24 PATCH $13.7200/EACH
ESTRADIOL .05 mg PATCH $16.0762/EACH
ESTRADIOL .075 mg/24hr PATCH $9.4848/EACH Decrease
ESTRADIOL .075 mg PATCH $15.0920/EACH
ESTRADIOL .1 mg PATCH $15.0920/EACH
ESTRADIOL/NORETHINDRONE ACETATE (ACTIVELLA) 1-0.5 mg TABLET $3.3000/EACH
ESTRADIOL/NORETHINDRONE ACETATE 0.5-0.1mg TABLET $3.7791/EACH
ESTRADIOL 0.05 mg/24hr PATCH $9.0854/EACH
ESTRADIOL 0.06mg/24h PATCH $13.7200/EACH
ESTRADIOL 0.1 mg/24 hr PATCH $8.9870/EACH
ESTRADIOL 0.5 mg TABLET $0.0850/EACH
ESTRADIOL 1 mg TABLET $0.1086/EACH
ESTRADIOL 2 mg TABLET $0.1320/EACH
ESTROPIPATE 0.75 mg TABLET $0.3397/EACH
ESTROPIPATE 1.5 mg TABLET $0.4800/EACH
ESTROPIPATE 3 mg TABLET $0.0000
ESZOPICLONE 1 mg TABLET $0.6017/EACH
ESZOPICLONE 2 mg TABLET $0.3789/EACH
ESZOPICLONE 3 mg TABLET $0.3159/EACH
ETHACRYNIC ACID 25 MG TABLET $17.1270/EACH
ETHAMBUTOL HCL 100 MG TABLET $0.9858/EACH
ETHAMBUTOL HCL 400 mg TABLET $0.7320/EACH
ETHINYL ESTRADIOL/DROSPIRENONE (YASMIN, OCELLA) 0.03-3 mg TABLET $0.7200/EACH
ETHINYL ESTRADIOL/DROSPIRENONE 0.02-3(24) TABLET $1.3000/EACH Decrease
ETHOSUXIMIDE 250 mg/5 ml SOLN $0.2333/MILLILITER
ETHOSUXIMIDE 250 mg CAPSULE $0.9884/EACH
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (DEMULEN 1/35, ZOVIA 1/35E) 1 mg/35 mcg TABLET $0.6565/EACH
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (DEMULEN 1/50, ZOVIA 1/50E) 1 mg/50 mcg TABLET $0.8520/EACH
ETODOLAC 500 mg TABLET $2.0520/EACH
ETODOLAC 200 mg CAPSULE $1.2484/EACH
ETODOLAC 300 mg CAPSULE $1.2480/EACH Reactivate
ETODOLAC 400 mg TABLET $1.9320/EACH
ETODOLAC 400 mg TABLET $0.6253/EACH
ETODOLAC 500 mg TABLET $0.9720/EACH
ETODOLAC 600 mg TABLET $2.2398/EACH
ETOPOSIDE 20 mg/ml VIAL $1.8300/MILLILITER
ETOPOSIDE 50 mg CAPSULE $67.2980/EACH
EXEMESTANE 25 mg TABLET $6.2707/EACH
EZETIMIBE/SIMVASTATIN 10 MG-10MG TAB $3.6240/TABLET Add
EZETIMIBE/SIMVASTATIN 10 MG-20MG TAB $3.6240/TABLET Add
EZETIMIBE/SIMVASTATIN 10 MG-40MG TAB $3.6240/TABLET Add
EZETIMIBE/SIMVASTATIN 10 MG-80MG TAB $3.6240/TABLET Add
EZETIMIBE 10 MG TAB $0.2466/TABLET Add
FAMCICLOVIR 125 mg TABLET $0.4050/EACH
FAMCICLOVIR 250 mg TABLET $0.5240/EACH
FAMCICLOVIR 500 mg TABLET $0.9735/EACH
FAMOTIDINE/CALCIUM CARBONATE/MAGNESIUM 10-800-165 TABLET $0.3360/EACH
FAMOTIDINE 10 mg TABLET $0.0842/EACH
FAMOTIDINE 20 mg TABLET $0.0347/EACH
FAMOTIDINE 40 mg/5 ml SUSP $0.6396/MILLILITER
FAMOTIDINE 40 mg TABLET $0.0480/EACH
FELBAMATE 400 mg TABLET $3.3450/EACH
FELBAMATE 600 mg/5 ml SUSP $1.8960/MILLILITER
FELBAMATE 600 mg TABLET $3.3300/EACH Decrease
FELODIPINE 10 mg TABLET $0.2154/EACH
FELODIPINE 2.5 mg TABLET $0.5050/EACH
FELODIPINE 5 mg TABLET $0.2167/EACH
FENOFIBRATE NANOCRYSTALLIZED 145MG TABLET $0.6129/EACH Reactivate
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET $0.4933/EACH Reactivate
FENOFIBRATE,MICRONIZED 130 mg CAPSULE $1.8240/EACH
FENOFIBRATE,MICRONIZED 134 mg CAPSULE $1.3713/EACH
FENOFIBRATE,MICRONIZED 200 mg CAPSULE $2.2055/EACH
FENOFIBRATE,MICRONIZED 43 mg CAPSULE $0.6480/EACH
FENOFIBRATE,MICRONIZED 67 mg CAPSULE $0.7395/EACH
FENOFIBRATE 120 MG TABLET $23.9479/EACH
FENOFIBRATE 160 mg TABLET $0.5040/EACH Decrease
FENOFIBRATE 54 mg TABLET $0.8640/EACH
FENOFIBRIC ACID (CHOLINE) 135 MG CAPSULE $1.5465/EACH Decrease
FENOFIBRIC ACID (CHOLINE) 45 MG CAPSULE $0.9900/EACH
Page 10 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
Delete
Increase
Decrease
Reactivate
FENOPROFEN CALCIUM 600 mg TABLET $0.0000
FENTANYL CITRATE 1,200 mcg LOZENGE $15.1382/EACH
FENTANYL CITRATE 1,600 mcg LOZENGE $25.5566/EACH
FENTANYL CITRATE 200 mcg LOZENGE $17.1116/EACH
FENTANYL CITRATE 400 mcg LOZENGE $21.6796/EACH
FENTANYL CITRATE 600 mcg LOZENGE $24.5112/EACH
FENTANYL CITRATE 800 mcg LOZENGE $14.5211/EACH Decrease
FENTANYL 100 mcg PATCH $9.0900/EACH
FENTANYL 12 mcg/hr PATCH $11.5000/EACH Decrease
FENTANYL 25 mcg PATCH $3.3531/EACH
FENTANYL 50 mcg PATCH $5.6412/EACH
FENTANYL 75 mcg PATCH $8.2169/EACH
FERROUS FUMARATE/DOCUSATE SODIUM/FOLIC ACID 106-50-1mg TABLET $0.2000/EACH
FERROUS FUMARATE/FOLIC ACID 106 mg; 1 mg TABLET $0.0000
FERROUS SULFATE 220 mg/5 ml ELIXIR $0.0000
FERROUS SULFATE 325 mg TABLET $0.0150/EACH
FERROUS SULFATE 75 mg/0.6 ml; 50 ml DROPS $0.0000
FEXOFENADINE HCL/PSEUDOEPHEDRINE HCL 60mg-120mg TABLET $0.7680/EACH
FEXOFENADINE HCL 180 mg TABLET $0.3960/EACH
FEXOFENADINE HCL 30 mg TABLET $0.3390/EACH
FEXOFENADINE HCL 60 mg TABLET $0.3360/EACH
FINASTERIDE 5 mg TABLET $0.1126/EACH Decrease
FINASTERIDE 1 MG TABLET $0.0000
FLAVOXATE HCL 100 mg TABLET $0.7245/EACH
FLECAINIDE ACETATE 100 mg TABLET $0.4200/EACH
FLECAINIDE ACETATE 150 mg TABLET $0.6225/EACH Decrease
FLECAINIDE ACETATE 50 mg TABLET $0.4080/EACH
FLUCONAZOLE IN SALINE, ISO-OSMOTIC 400 mg/200 ml SOLN $0.0580/MILLILITER
FLUCONAZOLE 10 mg/ml SUSP, RECON $0.3442/MILLILITER
FLUCONAZOLE 100 mg TABLET $0.9955/EACH
FLUCONAZOLE 150 mg TABLET $1.1890/EACH
FLUCONAZOLE 200 mg TABLET $1.8584/EACH
FLUCONAZOLE 40 mg/ml SUSP, RECON $0.5643/MILLILITER
FLUCONAZOLE 50 mg TABLET $1.0350/EACH
FLUDARABINE PHOSPHATE 50 mg/2 ml VIAL $125.6101/MILLILITER
FLUDARABINE PHOSPHATE 50 mg VIAL $95.2560/EACH
FLUDROCORTISONE ACETATE 0.1 mg TABLET $0.4873/EACH
FLUNISOLIDE 0.00025 AERO (ML) $2.0429/MILLILITER Reactivate
FLUNISOLIDE 0.00025 AERO (ML) $1.7606/MILLILITER
FLUOCINOLONE ACETONIDE 0.01 % OIL $0.8858/MILLILITER
FLUOCINOLONE 0.01%, 60 mL SOLN $0.0000
FLUOCINOLONE 0.01% CRM $0.0000
FLUOCINOLONE 0.025% CRM $0.0000
FLUOCINOLONE 0.025% OINT $0.0000
FLUOCINONIDE/EMOLLIENT 0.05% CRM $1.7048/GRAM
FLUOCINONIDE 0.05% CRM $1.0624/GRAM
FLUOCINONIDE 0.05% GEL $2.2208/GRAM
FLUOCINONIDE 0.05% OINT $1.5120/GRAM
FLUOCINONIDE 0.05% SOLN $1.3436/MILLILITER
FLUOCINONIDE 0.1 % CRM $6.9000/GRAM
FLUOROMETHOLONE 0.1% DROPS $0.0000
FLUOROURACIL 0.05 CRM $3.3680/GRAM
FLUOROURACIL 0.05 SOLN $6.6742/MILLILITER Reactivate
FLUOROURACIL 50 mg/ml; 10 ml VIAL $0.3282/MILLILITER
FLUOROURACIL 50 mg/ml; 100 ml VIAL $0.3356/MILLILITER
FLUOROURACIL 50 mg/ml; 20 ml VIAL $0.0000
FLUOROURACIL 50 mg/ml; 50 ml VIAL $0.3911/MILLILITER
FLUOROURACIL 50 mg/ml VIAL $0.0000
FLUOXETINE HCL 10 mg CAPSULE $0.0389/EACH
FLUOXETINE HCL 10 mg TABLET $0.0389/EACH
FLUOXETINE HCL 20 mg/5 ml SOLN $0.0450/MILLILITER
FLUOXETINE HCL 20 mg CAPSULE $0.0360/EACH
FLUOXETINE HCL 20 mg TABLET $0.0360/EACH
FLUOXETINE HCL 40 mg CAPSULE $0.1535/EACH Decrease
FLUOXETINE HCL 90 mg CAPSULE $30.8688/EACH
FLUPHENAZINE DECANOATE 25 mg/ml VIAL $15.5156/MILLILITER
FLUPHENAZINE 1 mg TABLET $0.0000
FLUPHENAZINE 10 mg TABLET $0.0000
FLUPHENAZINE 2.5 mg TABLET $0.0000
FLUPHENAZINE 5 mg TABLET $0.0000
FLURAZEPAM HCL 15 mg CAPSULE $0.3442/EACH
FLURAZEPAM HCL 30 mg CAPSULE $0.4148/EACH
FLURBIPROFEN SODIUM 0.03 % DROPS $1.1580/MILLILITER
FLURBIPROFEN 100 mg TABLET $0.3900/EACH
FLURBIPROFEN 50 mg TABLET $0.2160/EACH
FLUTICASONE PROPIONATE 0.005% OINT $0.4240/GRAM
FLUTICASONE PROPIONATE 0.05% CRM $0.4200/GRAM
FLUTICASONE PROPIONATE 50 mcg SUSP $0.2701/GRAM
FLUVASTATIN SODIUM 20 MG CAP $3.7175/CAPSULE Add
FLUVASTATIN SODIUM 40 MG CAP $3.7175/CAPSULE Add
FLUVASTATIN SODIUM 80 mg TABLET $5.2137/EACH
FLUVOXAMINE MALEATE 100 mg CAPSULE $6.8860/EACH
FLUVOXAMINE MALEATE 150 mg CAPSULE $7.0730/EACH
FLUVOXAMINE 100 mg TABLET $0.2791/EACH
FLUVOXAMINE 25 mg TABLET $0.1200/EACH
FLUVOXAMINE 50 mg TABLET $0.1992/EACH
FOLIC ACID/VITAMIN B COMP W-C 1 mg CAPSULE $0.1500/EACH
FOLIC ACID 1 mg TABLET $0.0138/EACH
FONDAPARINUX SODIUM 10mg/0.8ml SYRINGE $73.1940/MILLILITER
FONDAPARINUX SODIUM 2.5 mg/0.5 SYRINGE $33.6480/MILLILITER
FONDAPARINUX SODIUM 5mg/0.4ml SYRINGE $190.1400/MILLILITER
FONDAPARINUX SODIUM 7.5mg/0.6 SYRINGE $97.5920/MILLILITER
Page 11 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
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Delete
Increase
Decrease
Reactivate
FOSINOPRIL SODIUM/HCTZ 10-12.5 mg TABLET $0.7440/EACH Decrease
FOSINOPRIL SODIUM/HCTZ 20-12.5 mg TABLET $0.7440/EACH Decrease
FOSINOPRIL SODIUM 10 mg TABLET $0.1193/EACH
FOSINOPRIL SODIUM 20 mg TABLET $0.1237/EACH
FOSINOPRIL SODIUM 40 mg TABLET $0.2097/EACH
FROVATRIPTAN SUCCINATE 2.5 MG TABLET $37.0598/EACH
FUROSEMIDE 10 mg/ml SOLN $0.1080/MILLILITER
FUROSEMIDE 20 mg TABLET $0.0135/EACH
FUROSEMIDE 40 mg TABLET $0.0120/EACH
FUROSEMIDE 80 mg TABLET $0.0340/EACH
GABAPENTIN 100 mg CAPSULE $0.0360/EACH
GABAPENTIN 250 mg/5 ml SOLN $0.1257/MILLILITER
GABAPENTIN 300 mg CAPSULE $0.0473/EACH
GABAPENTIN 400 mg CAPSULE $0.0666/EACH Decrease
GABAPENTIN 600 mg TABLET $0.1300/EACH Decrease
GABAPENTIN 800 mg TABLET $0.1661/EACH
GALANTAMINE HYDROBROMIDE 12 mg TABLET $1.6264/EACH
GALANTAMINE HYDROBROMIDE 16 mg CAPSULE $2.3167/EACH
GALANTAMINE HYDROBROMIDE 24 mg CAPSULE $1.6800/EACH
GALANTAMINE HYDROBROMIDE 4 mg TABLET $2.2000/EACH
GALANTAMINE HYDROBROMIDE 8 mg CAPSULE $1.6800/EACH
GALANTAMINE HYDROBROMIDE 8 mg TABLET $1.6264/EACH
GEMCITABINE HCL 1 g VIAL $41.5800/EACH
GEMCITABINE HCL 2 g VIAL $123.8743/EACH
GEMCITABINE HCL 200 mg VIAL $10.1617/EACH
GEMFIBROZIL 600 mg TABLET $0.1062/EACH
GENTAMICIN SULFATE 0.1% CRM $1.8872/GRAM
GENTAMICIN SULFATE 0.1% OINT $1.8840/GRAM
GENTAMICIN SULFATE 0.3 % OINT $2.8457/GRAM
GENTAMICIN SULFATE 0.3%, 15 ml DROPS $0.0000
GENTAMICIN SULFATE 0.3% DROPS $1.6944/MILLILITER
GENTAMICIN SULFATE 40 mg/ml VIAL $0.6000/MILLILITER Decrease
GLIMEPIRIDE 1 mg TABLET $0.0743/EACH
GLIMEPIRIDE 2 mg TABLET $0.1286/EACH
GLIMEPIRIDE 4 mg TABLET $0.1594/EACH
GLIPIZIDE/METFORMIN HCL 2.5-250 mg TABLET $0.8132/EACH
GLIPIZIDE/METFORMIN HCL 2.5-500 mg TABLET $0.3370/EACH
GLIPIZIDE/METFORMIN HCL 5 mg; 500 mg TABLET $0.3713/EACH
GLIPIZIDE 10 mg TABLET $0.3130/EACH
GLIPIZIDE 10 mg TABLET $0.0300/EACH
GLIPIZIDE 2.5 mg TABLET $0.2804/EACH
GLIPIZIDE 5 mg TABLET $0.1670/EACH
GLIPIZIDE 5 mg TABLET $0.0251/EACH
GLYBURIDE, Micronized 1.5 mg TABLET $0.0345/EACH
GLYBURIDE, Micronized 3 mg TABLET $0.0323/EACH
GLYBURIDE, Micronized 6 mg TABLET $0.1524/EACH
GLYBURIDE/METFORMIN HCL 1.25/250 mg TABLET $0.0450/EACH
GLYBURIDE/METFORMIN HCL 2.5/500 mg TABLET $0.0506/EACH
GLYBURIDE/METFORMIN HCL 5/500 mg TABLET $0.0540/EACH
GLYBURIDE 1.25 mg TABLET $0.1200/EACH
GLYBURIDE 2.5 mg TABLET $0.1680/EACH
GLYBURIDE 5 mg TABLET $0.1418/EACH Decrease
GLYCERIN pediatric SUPP $0.0668/EACH
GLYCOPYRROLATE 1 mg TABLET $0.4399/EACH
GLYCOPYRROLATE 2 mg TABLET $0.6518/EACH
GRANISETRON HCL 1 mg/ml; MDV VIAL $7.1094/MILLILITER
GRANISETRON HCL 1 mg/ml; SDV VIAL $6.6000/MILLILITER
GRANISETRON HCL 1 mg TABLET $1.8900/EACH
GRISEOFULVIN ULTRAMICROSIZE 250 MG TABLET $5.2190/EACH
GRISEOFULVIN, MICROSIZE 500 MG TABLET $6.4130/EACH
GRISEOFULVIN,MICROSIZE 125 mg/5 ml SUSP $0.2378/MILLILITER
GUAIFEN/DM HB/P-EPHEDRINE 100 mg; 15 mg; 40 mg/5 ml SYRUP $0.0000
GUAIFENESIN; CODEINE PHOSPHATE (Sugar-Free) 100 mg; 10 mg LIQ $0.0000 Delete
GUAIFENESIN; CODEINE PHOSPHATE 100 mg; 10 mg SYRUP $0.0000
GUAIFENESIN; DEXTROMETHORPHAN HBr 100 mg; 10 mg LIQ $0.0000 Delete
GUAIFENESIN; DEXTROMETHORPHAN HBr 100 mg; 10 mg SYRUP $0.0000
GUAIFENESIN; HYDROCODONE BITARTRATE 100 mg; 5 mg SYRUP $0.0000
GUAIFENESIN; PHENYLEPHRINE HCL 600 mg; 40 mg TABLET $0.0000
GUAIFENESIN; PSEUDOEPHEDRINE HCL; CODEINE 100 mg; 30 mg; 10 mg SYRUP $0.0000
GUAIFENESIN; PSEUDOEPHEDRINE HCL 100 mg; 30 mg SYRUP $0.0000
GUAIFENESIN; PSEUDOEPHEDRINE HCL 600 mg; 120 mg TABLET $0.0000
GUAIFENESIN 100 mg/5 ml LIQ $0.0000 Delete
GUAIFENESIN 100 mg/5 ml SYRUP $0.0000
GUAIFENESIN 1200 mg TABLET $0.0000
GUAIFENESIN 200 mg TABLET $0.0000
GUAIFENESIN 600 mg TABLET $0.0000
GUANFACINE HCL 1 mg TABLET $0.5284/EACH
GUANFACINE HCL 2 mg TABLET $0.5284/EACH
GUANFACINE HCL 3 mg TABLET $0.5284/EACH
GUANFACINE HCL 4 mg TABLET $0.5284/EACH
GUANFACINE 1 mg TABLET $0.0702/EACH Decrease
GUANFACINE 2 mg TABLET $0.0900/EACH
HALOBETASOL PROPIONATE 0.05% CRM $3.2772/GRAM
HALOBETASOL PROPIONATE 0.05% OINT $3.1056/GRAM
HALOPERIDOL DECANOATE 100 mg/ml VIAL $0.0000
HALOPERIDOL DECANOATE 100 mg/ml VIAL $0.0000
HALOPERIDOL DECANOATE 50 mg/ml VIAL $0.0000
HALOPERIDOL LACTATE 2 mg/ml; 120 ml CONC $0.0449/MILLILITER
HALOPERIDOL LACTATE 2 mg/ml; 15 ml CONC $0.0000
HALOPERIDOL 0.5 mg TABLET $0.2477/EACH
HALOPERIDOL 1 mg TABLET $0.4950/EACH
HALOPERIDOL 10 mg TABLET $0.6051/EACH
Page 12 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
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Delete
Increase
Decrease
Reactivate
HALOPERIDOL 2 mg TABLET $0.4445/EACH Decrease
HALOPERIDOL 20 mg TABLET $1.3329/EACH Decrease
HALOPERIDOL 5 mg TABLET $0.4600/EACH
HC ACETATE/LIDOCAINE HCL 0.5%; 3% CRM $0.8252/GRAM
HYDRALAZINE HCL 10 mg TABLET $0.0448/EACH Decrease
HYDRALAZINE HCL 100 mg TABLET $0.0900/EACH
HYDRALAZINE HCL 25 mg TABLET $0.0542/EACH
HYDRALAZINE HCL 50 mg TABLET $0.0607/EACH
HYDROCHLOROTHIAZIDE 12.5 mg CAPSULE $0.0374/EACH
HYDROCHLOROTHIAZIDE 12.5 MG TABLET $0.0720/EACH
HYDROCHLOROTHIAZIDE 25 mg TABLET $0.0150/EACH
HYDROCHLOROTHIAZIDE 50 mg TABLET $0.0177/EACH
HYDROCODONE BIT/ACETAMINOPHEN 10MG-300MG TABLET $1.8240/EACH
HYDROCODONE BIT/ACETAMINOPHEN 7.5-325/15 SOLN $0.2163/MILLILITER Decrease
HYDROCODONE BIT/HOMATROPINE 5-1.5 mg/5 SYRUP $0.1080/MILLILITER
HYDROCODONE/ACETAMINOPHEN 5MG-300MG TABLET $1.0800/EACH Decrease
HYDROCODONE/ACETAMINOPHEN 7.5-300MG TABLET $1.6800/EACH
HYDROCODONE/APAP 10 mg; 325 mg TABLET $0.1866/EACH
HYDROCODONE/APAP 10 mg; 500 mg TABLET $0.0000
HYDROCODONE/APAP 10 mg; 650 mg TABLET $0.0000
HYDROCODONE/APAP 10 mg; 660 mg TABLET $0.0000
HYDROCODONE/APAP 10 mg; 750 mg TABLET $0.0000
HYDROCODONE/APAP 2.5 mg; 500 mg TABLET $0.0000
HYDROCODONE/APAP 5 mg; 325 mg TABLET $0.1275/EACH
HYDROCODONE/APAP 5 mg; 500 mg TABLET $0.0000
HYDROCODONE/APAP 7.5 mg; 325 mg TABLET $0.1800/EACH
HYDROCODONE/APAP 7.5 mg; 500 mg TABLET $0.0000
HYDROCODONE/APAP 7.5 mg; 650 mg TABLET $0.0000
HYDROCODONE/APAP 7.5 mg; 750 mg TABLET $0.0000
HYDROCODONE/APAP 7.5/500 mg SOLN $0.0000
HYDROCODONE/CPM/PSEUDOEPHED 5-4-60MG/5 SOLN $0.5729/MILLILITER
HYDROCODONE/IBUPROFEN 7.5 mg; 200 mg TABLET $0.3751/EACH
HYDROCORTISONE ACETATE 1 % CRM $0.0000 Delete
HYDROCORTISONE ACETATE 25 mg SUPP $0.0000
HYDROCORTISONE BUTYRATE/EMOLL 0.1 % CRM $6.0720/GRAM
HYDROCORTISONE BUTYRATE 0.001 CRM $4.9410/GRAM Reactivate
HYDROCORTISONE BUTYRATE 0.1 % OINT $1.2224/GRAM
HYDROCORTISONE BUTYRATE 0.1 % SOLN $1.2224/MILLILITER
HYDROCORTISONE POWDER NA PWDR $0.0000
HYDROCORTISONE VALERATE 0.2% CRM $3.8900/GRAM
HYDROCORTISONE VALERATE 0.2% OINT $4.8150/GRAM Reactivate
HYDROCORTISONE 0.5% CRM $0.0000
HYDROCORTISONE 0.5% OINT $0.0000
HYDROCORTISONE 1% CRM $0.0000
HYDROCORTISONE 1% OINT $0.0000 Delete
HYDROCORTISONE 1% LOTION $0.0662/MILLILITER
HYDROCORTISONE 10 MG TABLET $0.1680/EACH
HYDROCORTISONE 2.5 % CRM $0.0000 Delete
HYDROCORTISONE 2.5% CRM $0.0000
HYDROCORTISONE 2.5% CRM $3.9652/GRAM
HYDROCORTISONE 2.5% OINT $0.1339/GRAM
HYDROCORTISONE 2.5% LOTION $0.7741/MILLILITER
HYDROCORTISONE 20 mg TABLET $0.4443/EACH
HYDROCORTISONE 5 MG TABLET $0.1128/EACH
HYDROMORPHONE HCL 12 MG TABLET $10.7745/EACH
HYDROMORPHONE HCL 16 MG TABLET $19.9450/EACH
HYDROMORPHONE HCL 2 mg TABLET $0.0806/EACH
HYDROMORPHONE HCL 4 mg TABLET $0.1173/EACH
HYDROMORPHONE HCL 8 MG TABLET $9.0761/EACH
HYDROMORPHONE HCL 8 mg TABLET $0.6720/EACH
HYDROQUINONE 4% 0.04 CRM $1.9018/GRAM
HYDROQUINONE 4% 4% GEL $0.0000
HYDROQUINONE 4% w/ SUNSCREEN 0.04 CRM $0.0000
HYDROXYCHLOROQUINE SULFATE 200 mg TABLET $0.6013/EACH
HYDROXYUREA 500 mg CAPSULE $0.3658/EACH
HYDROXYZINE HCL 10 mg TABLET $0.0000
HYDROXYZINE HCL 25 mg TABLET $0.0806/EACH
HYDROXYZINE HCL 50 mg TABLET $0.1085/EACH Decrease
HYDROXYZINE PAM 25 mg CAPSULE $0.0723/EACH
HYDROXYZINE PAM 50 mg CAPSULE $0.0750/EACH
HYDROXYZINE 10 mg/5 ml SOLN $0.0444/MILLILITER
HYOSCYAMINE SULFATE 0.125 mg/ml DROPS $1.2861/MILLILITER
HYOSCYAMINE SULFATE 0.125 mg TABLET $0.0918/EACH
HYOSCYAMINE SULFATE 0.125 mg TABLET $0.2153/EACH
HYOSCYAMINE SULFATE 0.125 mg TABLET $0.1200/EACH
HYOSCYAMINE SULFATE 0.375 mg CAPSULE $0.0000
HYOSCYAMINE SULFATE 0.375 mg TABLET $0.1666/EACH
IBANDRONATE SODIUM 150 MG TABLET $8.7550/EACH
IBANDRONATE SODIUM 3 mg/3 ml SYRINGE $72.8090/MILLILITER
IBUPROFEN/OXYCODONE HCL 400 mg; 5 mg TABLET $1.2370/EACH
IBUPROFEN 100 mg/5 ml SUSP $0.0000 Delete
IBUPROFEN 200 mg CAPSULE $0.0000 Delete
IBUPROFEN 200 mg TABLET $0.0000 Delete
IBUPROFEN 400 mg TABLET $0.0600/EACH
IBUPROFEN 50 mg/1.25 DROPS $0.0000 Delete
IBUPROFEN 600 mg TABLET $0.0600/EACH
IBUPROFEN 800 mg TABLET $0.0500/EACH
IDARUBICIN HCL 1 mg/ml VIAL $16.8714/MILLILITER
IFOSFAMIDE 1 g VIAL $35.5152/EACH
IFOSFAMIDE 3 g VIAL $110.2046/EACH
IMATINIB MESYLATE 100 MG TABLET $48.4500/EACH Decrease
IMATINIB MESYLATE 400 MG TABLET $158.3400/EACH Decrease
Page 13 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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Delete
Increase
Decrease
Reactivate
IMIPENEM/CILASTATIN SODIUM 250 mg VIAL $5.9063/EACH
IMIPENEM/CILASTATIN SODIUM 500 mg VIAL $9.1000/EACH
IMIPRAMINE HCL 10 mg TABLET $0.1410/EACH
IMIPRAMINE HCL 25 mg TABLET $0.2075/EACH
IMIPRAMINE HCL 50 mg TABLET $0.3096/EACH
IMIPRAMINE PAMOATE 100 mg CAPSULE $7.6670/EACH Decrease
IMIPRAMINE PAMOATE 125 mg CAPSULE $14.3818/EACH
IMIPRAMINE PAMOATE 150 mg CAPSULE $6.4800/EACH
IMIPRAMINE PAMOATE 75 mg CAPSULE $4.9800/EACH
IMIQUIMOD 5 % PACKET $1.3915/EACH
INDAPAMIDE 1.25 mg TABLET $0.2080/EACH
INDAPAMIDE 2.5 mg TABLET $0.3431/EACH
INDOMETHACIN SR 75 mg CAPSULE $0.9241/EACH
INDOMETHACIN 25 mg CAPSULE $0.1440/EACH
INDOMETHACIN 50 mg CAPSULE $0.1398/EACH
IPRATROPIUM BROMIDE 0.0003 AERO (ML) $1.0356/MILLILITER
IPRATROPIUM BROMIDE 0.0006 AERO (ML) $1.3708/MILLILITER
IPRATROPIUM BROMIDE 0.2 mg/ml SOLN $0.0720/MILLILITER
IPRATROPIUM/ALBUTEROL SULFATE 0.5-2.5 mg/3 ml AMPUL $0.0727/MILLILITER
IRBESARTAN/HYDROCHLOROTHIAZIDE 150-12.5MG TABLET $0.0960/EACH
IRBESARTAN/HYDROCHLOROTHIAZIDE 300-12.5MG TABLET $0.2964/EACH
IRBESARTAN 150 MG TABLET $0.1223/EACH
IRBESARTAN 300 MG TABLET $0.1539/EACH
IRBESARTAN 75 MG TABLET $0.0668/EACH
IRINOTECAN HCL 100 mg/5 ml VIAL $3.1440/MILLILITER
IRINOTECAN HCL 40 mg/2 ml VIAL $6.4793/MILLILITER
IRINOTECAN HCL 500 mg/25 ml VIAL $0.0000
IRON POLYSACCHARIDES COMPLEX 150 mg CAPSULE $0.1427/EACH
IRON,CARBONYL/ASCORBIC ACID/CYANOCOBALAMIN/FOLIC ACID 100-250-1 TABLET $1.2480/EACH
IRON,CARBONYL/ASCORBIC ACID/CYANOCOBALAMIN/FOLIC ACID 100-320-1 CAPSULE $0.2000/EACH
IRON,CARBONYL/FOLIC ACID/MULTIVITAMINS W-MINERALS 50-1.25mg TABLET $0.0000
ISONIAZID 300 mg TABLET $0.1215/EACH
ISOSORBIDE DINITRATE 10 mg TABLET $0.6480/EACH
ISOSORBIDE DINITRATE 2.5 mg TABLET $0.0000
ISOSORBIDE DINITRATE 20 mg TABLET $0.7127/EACH
ISOSORBIDE DINITRATE 30 mg TABLET $0.7800/EACH
ISOSORBIDE DINITRATE 40 mg TABLET $1.2120/EACH
ISOSORBIDE DINITRATE 5 mg TABLET $0.0000
ISOSORBIDE DINITRATE 5 mg TABLET $0.6755/EACH
ISOSORBIDE MONONITRATE 10 mg TABLET $0.1920/EACH
ISOSORBIDE MONONITRATE 120 mg TABLET $0.4200/EACH
ISOSORBIDE MONONITRATE 20 mg TABLET $0.1560/EACH
ISOSORBIDE MONONITRATE 30 mg TABLET $0.1582/EACH Decrease
ISOSORBIDE MONONITRATE 60 mg TABLET $0.2340/EACH
ISOTRETINOIN 10 mg CAPSULE $3.0509/EACH
ISOTRETINOIN 20 mg CAPSULE $5.3540/EACH Decrease
ISOTRETINOIN 40 mg CAPSULE $5.1027/EACH Decrease
ITRACONAZOLE 200 mg CAPSULE $4.6950/EACH
KETOCONAZOLE 2% SHAMPOO $0.0734/MILLILITER
KETOCONAZOLE 2 % FOAM $3.2959/GRAM
KETOCONAZOLE 2% CRM $0.8450/GRAM
KETOCONAZOLE 200 mg TABLET $1.7848/EACH
KETOPROFEN 200 mg CAPSULE $6.1160/EACH
KETOPROFEN 50 mg CAPSULE $0.3840/EACH
KETOPROFEN 75 mg CAPSULE $0.4560/EACH
KETOROLAC TROMETHAMINE 0.4% DROPS $6.5885/MILLILITER
KETOROLAC TROMETHAMINE 0.5% DROPS $1.6800/MILLILITER
KETOROLAC TROMETHAMINE 10 mg TABLET $0.8280/EACH
KETOROLAC TROMETHAMINE 15 mg/ml CARTRIDGE $0.0000
KETOROLAC TROMETHAMINE 30 mg/ml CARTRIDGE $0.0000
KETOROLAC TROMETHAMINE 60 mg/2 ml VIAL $1.2199/MILLILITER
LABETALOL HCL 100 mg TABLET $0.2863/EACH
LABETALOL HCL 200 mg TABLET $0.2596/EACH
LABETALOL HCL 300 mg TABLET $0.2342/EACH Decrease
LACTULOSE 10 gm/15 ml SOLN $0.0150/MILLILITER
LACTULOSE 10 gm/15 ml SOLN $0.0120/MILLILITER
LACTULOSE 10 gm/15 ml SYRUP $0.0000
LAMIVUDINE/ZIDOVUDINE 150 - 300 mg TABLET $1.6800/EACH Decrease
LAMIVUDINE 100 mg TABLET $5.6718/EACH
LAMIVUDINE 150 MG TAB $1.4784/TABLET Add
LAMIVUDINE 300 MG TABLET $4.4400/EACH
LAMOTRIGINE 100 mg TABLET $6.8640/EACH
LAMOTRIGINE 100 MG TABLET $6.0700/EACH Decrease
LAMOTRIGINE 100 mg TABLET $0.0600/EACH
LAMOTRIGINE 150 mg TABLET $0.0755/EACH
LAMOTRIGINE 200 mg TABLET $8.5900/EACH Decrease
LAMOTRIGINE 200 MG TABLET $6.5040/EACH
LAMOTRIGINE 200 mg TABLET $0.1092/EACH
LAMOTRIGINE 25 mg TABLET $0.0000
LAMOTRIGINE 25 mg TABLET $0.2738/EACH
LAMOTRIGINE 25 MG TABLET $2.9800/EACH
LAMOTRIGINE 25 mg TABLET $0.0532/EACH
LAMOTRIGINE 250 MG TABLET $11.7600/EACH Decrease
LAMOTRIGINE 300 MG TABLET $9.4268/EACH
LAMOTRIGINE 5 mg TABLET $0.3516/EACH
LAMOTRIGINE 50 mg TABLET $6.4320/EACH
LAMOTRIGINE 50 MG TABLET $5.9600/EACH
LANSOPRAZOLE/AMOXICILLIN/CLARITHROMYCIN 30-500-500 COMBINATION PACKAGE $3.7186/EACH
LANSOPRAZOLE 15 mg CAPSULE $0.5100/EACH
LANSOPRAZOLE 15 mg TABLET $4.8342/EACH Reactivate
LANSOPRAZOLE 30 mg CAPSULE $0.2600/EACH Decrease
LANSOPRAZOLE 30 mg TABLET $4.8342/EACH Reactivate
Page 14 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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Decrease
Reactivate
LATANOPROST 0.00005 DROPS $1.8288/MILLILITER
LEFLUNOMIDE 10 mg TABLET $3.9626/EACH
LEFLUNOMIDE 20 mg TABLET $3.1700/EACH Decrease
LETROZOLE 2.5 mg TABLET $0.1396/EACH
LEUCOVORIN CALCIUM 25 mg TABLET $5.9607/EACH
LEUCOVORIN CALCIUM 5 mg TABLET $0.6000/EACH
LEUPROLIDE ACETATE 1 mg/0.2 ml KIT $183.0000/EACH
LEVALBUTEROL HCL 0.31MG/3ML VIAL $0.5400/MILLILITER
LEVALBUTEROL HCL 0.63MG/3ML VIAL $0.5332/MILLILITER
LEVALBUTEROL HCL 1.25MG/3ML VIAL $0.5382/MILLILITER Decrease
LEVETIRACETAM 100 mg/ml SOLN $0.0475/MILLILITER Decrease
LEVETIRACETAM 1000 mg TABLET $0.3000/EACH
LEVETIRACETAM 250 mg TABLET $0.0900/EACH
LEVETIRACETAM 500 mg/5 ml VIAL $1.3126/MILLILITER
LEVETIRACETAM 500 mg TABLET $0.3450/EACH
LEVETIRACETAM 500 mg TABLET $0.0901/EACH
LEVETIRACETAM 750 mg TABLET $0.4956/EACH
LEVETIRACETAM 750 mg TABLET $0.2170/EACH
LEVOBUNOLOL HCL 0.25% DROPS $0.0000
LEVOBUNOLOL HCL 0.50% DROPS $2.2904/MILLILITER
LEVOCARNITINE 100 mg/ml SOLN $0.0000
LEVOCARNITINE 200 mg/ml VIAL $2.1370/MILLILITER
LEVOCARNITINE 330 mg TABLET $0.6338/EACH Increase
LEVOCETIRIZINE DIHYDROCHLORIDE 2.5 mg/5 ml SOLN $0.5640/MILLILITER
LEVOCETIRIZINE DIHYDROCHLORIDE 5 mg TABLET $0.1700/EACH
LEVOFLOXACIN 250 mg TABLET $0.1406/EACH
LEVOFLOXACIN 250MG/10ML SOLN $1.1112/MILLILITER
LEVOFLOXACIN 500 mg TABLET $0.1939/EACH Decrease
LEVOFLOXACIN 750 mg TABLET $0.5664/EACH
LEVONORGESTREL/ETHINYL ESTRADIOL (ALESSE, LEVLITE, AVIANE) 0.1 mg/20 mcg TABLET $0.4097/EACH
LEVONORGESTREL/ETHINYL ESTRADIOL (LEVLEN, NORDETTE, LEVORA 0.15/30)0.15 mg/30 mcg TABLET $0.3360/EACH
LEVONORGESTREL/ETHINYL ESTRADIOL (SEASONALE, JOLESSA, QUASENSE) 0.15 mg/30 mcg TABLET $0.6600/EACH
LEVONORGESTREL/ETHINYL ESTRADIOL TRIPHASIC (TRI-LEVLEN, TRIPHASIL, TRIVORA-28)0.05 mg/30 mcg; 0.075 mg/40 mcg; 0.125 mg/30 mcg TABLET $0.5550/EACH
LEVONORGESTREL 0.75 mg TABLET $0.0000
LEVONORGESTREL 1.5 mg TABLET $21.9375/EACH
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL 100-20(84) TABLET $1.7836/EACH
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL 150-30 (84) TABLET $1.2480/EACH
LEVONORGESTREL-ETH ESTRA 90-20mcg TABLET $0.8640/EACH
LEVOTHYROXINE 100 mcg TABLET $0.4180/EACH
LEVOTHYROXINE 112 mcg TABLET $0.4782/EACH
LEVOTHYROXINE 125 mcg TABLET $0.4848/EACH
LEVOTHYROXINE 137 mcg TABLET $0.4915/EACH
LEVOTHYROXINE 150 mcg TABLET $0.4990/EACH
LEVOTHYROXINE 175 mcg TABLET $0.5930/EACH
LEVOTHYROXINE 200 mcg TABLET $0.4291/EACH
LEVOTHYROXINE 25 mcg TABLET $0.3146/EACH
LEVOTHYROXINE 300 mcg TABLET $0.7800/EACH
LEVOTHYROXINE 50 mcg TABLET $0.3250/EACH Decrease
LEVOTHYROXINE 75 mcg TABLET $0.3990/EACH
LEVOTHYROXINE 88 mcg TABLET $0.4104/EACH
LIDOCAINE HCL 2% SOLN $0.0409/MILLILITER
LIDOCAINE HCL 3 % CRM $1.3500/GRAM
LIDOCAINE/PRILOCAINE 2.5-2.5% CRM $0.6224/GRAM
LIDOCAINE 2% JEL $0.3750/MILLILITER
LIDOCAINE 5 % OINT $1.3120/GRAM Decrease
LINDANE 1% LOTION $0.0000
LINDANE 1% SHAMPOO $0.0000
LINEZOLID 600 mg TABLET $5.0686/EACH
LIOTHYRONINE SODIUM 25 mcg TABLET $0.7619/EACH
LIOTHYRONINE SODIUM 5 mcg TABLET $0.4762/EACH
LIOTHYRONINE SODIUM 50 mcg TABLET $1.3560/EACH
LISINOPRIL/HCTZ 10 mg/12.5 mg TABLET $0.0296/EACH
LISINOPRIL/HCTZ 20 mg/12.5 mg TABLET $0.0479/EACH
LISINOPRIL/HCTZ 20 mg/25 mg TABLET $0.0534/EACH
LISINOPRIL 10 mg TABLET $0.0180/EACH
LISINOPRIL 2.5 mg TABLET $0.0141/EACH
LISINOPRIL 20 mg TABLET $0.0360/EACH
LISINOPRIL 30 mg TABLET $0.0450/EACH
LISINOPRIL 40 mg TABLET $0.0500/EACH Decrease
LISINOPRIL 5 mg TABLET $0.0232/EACH
LITHIUM CARBONATE 150 mg CAPSULE $0.0552/EACH
LITHIUM CARBONATE 300 mg CAPSULE $0.0360/EACH
LITHIUM CARBONATE 300 mg TABLET $0.1922/EACH
LITHIUM CARBONATE 300 mg TABLET $0.1666/EACH
LITHIUM CARBONATE 450 mg TABLET $0.2329/EACH
LITHIUM CARBONATE 600 MG CAPSULE $0.1080/EACH
LITHIUM CITRATE 8 mEq/5 ml SOLN $0.0480/MILLILITER
LOPERAMIDE HCL 1 mg/5 ml LIQ $0.0362/MILLILITER
LOPERAMIDE HCL 2 mg CAPSULE $0.2520/EACH
LOPERAMIDE HCL 2 mg TABLET $0.1030/EACH
LORATADINE 10 mg TABLET $0.0000 Delete
LORATADINE 10 mg TABLET $0.0000 Delete
LORATADINE 5 mg/5 ml SOLN $0.0000 Delete
LORAZEPAM 0.5 mg TABLET $0.0240/EACH
LORAZEPAM 1 mg TABLET $0.0274/EACH
LORAZEPAM 2 mg/ml CONC $0.4808/MILLILITER
LORAZEPAM 2 mg/ml SYRINGE $0.0000
LORAZEPAM 2 mg/ml VIAL $0.8898/MILLILITER
LORAZEPAM 2 mg TABLET $0.0450/EACH
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 100 mg-25 mg TABLET $0.0968/EACH
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 100-12.5 mg TABLET $0.1048/EACH
LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE 50-12.5 mg TABLET $0.0750/EACH
Page 15 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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LOSARTAN POTASSIUM 100 mg TABLET $0.0625/EACH
LOSARTAN POTASSIUM 25 mg TABLET $0.0413/EACH
LOSARTAN POTASSIUM 50 mg TABLET $0.0483/EACH
LOVASTATIN 10 mg TABLET $0.0804/EACH
LOVASTATIN 20 mg TABLET $0.0747/EACH Decrease
LOVASTATIN 40 mg TABLET $0.0960/EACH
LOXAPINE SUCCINATE 10 mg CAPSULE $0.4800/EACH
LOXAPINE SUCCINATE 25 mg CAPSULE $0.7080/EACH
LOXAPINE SUCCINATE 5 mg CAPSULE $0.3480/EACH
LOXAPINE SUCCINATE 50 mg CAPSULE $1.2720/EACH
MAGNESIUM HYDROXIDE/ALUMINUM HYDROXIDE/SIMETHICONE 200-200-20 SUSP $0.0074/MILLILITER
MAGNESIUM OXIDE 400 mg TABLET $0.0240/EACH
MALATHION 0.005 LOTION $3.7098/MILLILITER
MAPROTILINE HCL 25 mg TABLET $0.0000
MAPROTILINE HCL 50 mg TABLET $0.0000
MAPROTILINE HCL 75 mg TABLET $0.0000
MECLIZINE HCL 12.5 mg TABLET $0.0720/EACH
MECLIZINE HCL 25 mg TABLET $0.1500/EACH
MECLOFENAMATE SODIUM 100 mg CAPSULE $0.0000
MECLOFENAMATE SODIUM 50 mg CAPSULE $0.0000
MEDROXYPROGESTERONE ACET 150 mg/ml SYRINGE $85.9305/MILLILITER Decrease
MEDROXYPROGESTERONE ACET 150 mg/ml VIAL $0.0000
MEDROXYPROGESTERONE ACETATE 10 mg TABLET $0.1680/EACH
MEDROXYPROGESTERONE ACETATE 2.5 mg TABLET $0.1360/EACH
MEDROXYPROGESTERONE ACETATE 5 mg TABLET $0.1560/EACH
MEFENAMIC ACID 250 mg CAPSULE $7.6208/EACH
MEFLOQUINE HCL 250 MG TABLET $5.6472/EACH
MEGESTROL ACETATE 20 mg TABLET $0.2753/EACH
MEGESTROL ACETATE 40 mg/ml SUSP $0.0981/MILLILITER
MEGESTROL ACETATE 40 mg TABLET $0.2076/EACH
MEGESTROL ACETATE 625mg/5ml SUSP $4.0325/MILLILITER
MELOXICAM 15 mg TABLET $0.0300/EACH
MELOXICAM 7.5 mg TABLET $0.0251/EACH
MEMANTINE HCL 10 mg TABLET $0.2183/EACH
MEMANTINE HCL 5 mg TABLET $0.2508/EACH Decrease
MEPERIDINE HCL 100 mg TABLET $1.1760/EACH
MEPERIDINE HCL 50 mg TABLET $0.7680/EACH
MEPROBAMATE 200 mg TABLET $0.0000
MEPROBAMATE 400 mg TABLET $0.0000
MERCAPTOPURINE 50 mg TABLET $1.6180/EACH
MEROPENEM 1 G VIAL $10.9200/EACH
MEROPENEM 500 mg VIAL $6.1688/EACH
MESALAMINE 4g/60ml ENEMA $0.1317/MILLILITER
MESALAMINE 800 MG TAB, EC $6.3800/TABLET Add
METAXALONE 800 mg TABLET $2.4863/EACH Reactivate
METFORMIN HCL 1000 MG TABLET $9.5260/EACH
METFORMIN HCL 500 mg TABLET $0.0393/EACH
METFORMIN HCL 500 MG TABLET $7.4750/EACH
METFORMIN HCL 750 mg TABLET $0.1096/EACH Decrease
METFORMIN 1000 mg TABLET $0.0237/EACH Decrease
METFORMIN 500 mg TABLET $0.0200/EACH
METFORMIN 850 mg TABLET $0.0404/EACH
METHADONE HCL 10 mg/ml CONC $0.0494/MILLILITER
METHADONE HCL 10 mg TABLET $0.1324/EACH
METHADONE HCL 40 mg TABLET $0.3125/EACH
METHADONE HCL 5 mg TABLET $0.2171/EACH
METHAMPHETAMINE HYDROCHLORIDE 5 mg TABLET $0.0000
METHENAMINE HIPPURATE 1 g TABLET $1.8800/EACH
METHIMAZOLE 10 mg TABLET $0.1320/EACH
METHIMAZOLE 5 mg TABLET $0.1260/EACH
METHOCARBAMOL 500 mg TABLET $0.0717/EACH
METHOCARBAMOL 750 mg TABLET $0.0996/EACH
METHOTREXATE SODIUM/PF 25 mg/ml VIAL $1.4160/MILLILITER
METHOTREXATE SODIUM 25 mg/ml VIAL $1.8840/MILLILITER
METHOTREXATE 2.5 mg TABLET $1.1375/EACH
METHSCOPOLAMINE BROMIDE 2.5 MG TABLET $0.3595/EACH
METHSCOPOLAMINE BROMIDE 5 mg TABLET $2.1360/EACH
METHYLDOPA 250 mg TABLET $0.1300/EACH
METHYLDOPA 500 mg TABLET $0.2880/EACH
METHYLERGONOVINE MALEATE 0.2 MG TABLET $22.5240/EACH
METHYLPHENIDATE HCL 10 MG CAPSULE $2.6028/EACH
METHYLPHENIDATE HCL 10 MG TABLET $4.9100/EACH
METHYLPHENIDATE HCL 10 mg TABLET $0.5988/EACH
METHYLPHENIDATE HCL 18 MG TABLET $6.1422/EACH
METHYLPHENIDATE HCL 20 MG CAPSULE $3.2625/EACH
METHYLPHENIDATE HCL 20 MG CAPSULE $0.0000
METHYLPHENIDATE HCL 20 mg TABLET $0.0000
METHYLPHENIDATE HCL 20 mg TABLET $0.7013/EACH
METHYLPHENIDATE HCL 27 mg TABLET $6.8740/EACH
METHYLPHENIDATE HCL 30 MG CAPSULE $3.1950/EACH
METHYLPHENIDATE HCL 30 MG CAPSULE $4.9080/EACH
METHYLPHENIDATE HCL 36 MG TABLET $7.0848/EACH
METHYLPHENIDATE HCL 40 MG CAPSULE $0.0000
METHYLPHENIDATE HCL 40 MG CAPSULE $3.5160/EACH
METHYLPHENIDATE HCL 5 mg TABLET $0.5040/EACH
METHYLPHENIDATE HCL 50 MG CAPSULE $5.6478/EACH
METHYLPHENIDATE HCL 54 MG TABLET $7.7040/EACH
METHYLPHENIDATE HCL 60 MG CAPSULE $4.3200/EACH
METHYLPREDNISOLONE DOSEPAK 4 mg TABLET $0.5133/EACH Decrease
METHYLPREDNISOLONE 4 mg TABLET $0.6282/EACH
METIPRANOLOL 0.3 % DROPS $3.7800/MILLILITER
METOCLOPRAMIDE HCL 10 mg TABLET $0.0240/EACH
Page 16 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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METOCLOPRAMIDE HCL 5 mg/5 ml SOLN $0.0150/MILLILITER
METOCLOPRAMIDE HCL 5 mg TABLET $0.0274/EACH
METOLAZONE 10 mg TABLET $2.1966/EACH
METOLAZONE 2.5 mg TABLET $1.0285/EACH
METOLAZONE 5 mg TABLET $1.3578/EACH
METOPROLOL SUCCINATE 25 mg TABLET $0.2100/EACH
METOPROLOL SUCCINATE 100 mg TABLET $0.3524/EACH
METOPROLOL SUCCINATE 200 mg TABLET $0.9840/EACH
METOPROLOL SUCCINATE 50 mg TABLET $0.2363/EACH
METOPROLOL TARTRATE 100 mg TABLET $0.0510/EACH
METOPROLOL TARTRATE 25 mg TABLET $0.0168/EACH
METOPROLOL TARTRATE 50 mg TABLET $0.0240/EACH
METOPROLOL/HYDROCHLOROTHIAZIDE 50 MG-25MG TABLET $0.9600/EACH
METRONIDAZOLE 0.75% GEL $0.0000 Delete
METRONIDAZOLE 0.0075 CRM $1.8014/GRAM
METRONIDAZOLE 0.0075 GEL $1.8890/GRAM
METRONIDAZOLE 0.75 % LOTION $2.7375/MILLILITER
METRONIDAZOLE 1 % GEL $2.5044/GRAM
METRONIDAZOLE 1 % GEL $3.4324/GRAM
METRONIDAZOLE 250 mg TABLET $0.2502/EACH
METRONIDAZOLE 375 mg CAPSULE $3.1080/EACH
METRONIDAZOLE 500 mg TABLET $0.3487/EACH
METRONIDAZOLE 750 mg TABLET $0.0000
MEXILETINE HCL 150 mg CAPSULE $0.0000
MEXILETINE HCL 200 mg CAPSULE $0.0000
MEXILETINE HCL 250 mg CAPSULE $0.0000
MICONAZOLE NITRATE 2 % CRM $0.1050/GRAM
MICONAZOLE NITRATE 2 % CRM $0.0000 Delete
MIDODRINE HCL 10 mg TABLET $0.9360/EACH
MIDODRINE HCL 2.5 mg TABLET $1.0511/EACH
MIDODRINE HCL 5 mg TABLET $0.4715/EACH
MILRINONE LACTATE/D5W 20MG/100ML SOLN $0.1596/MILLILITER
MILRINONE LACTATE/D5W 40MG/200ML SOLN $0.1675/MILLILITER
MILRINONE LACTATE 1 mg/ml VIAL $0.8204/MILLILITER
MINERAL OIL/PETROLATUM,HYDROPHILIC OINT $0.0263/GRAM
MINOCYCLINE HCL 100 mg CAPSULE $0.3300/EACH
MINOCYCLINE HCL 100 mg TABLET $3.2858/EACH
MINOCYCLINE HCL 135MG TABLET $3.0280/EACH
MINOCYCLINE HCL 45 MG TABLET $3.0280/EACH
MINOCYCLINE HCL 50 mg CAPSULE $0.1919/EACH
MINOCYCLINE HCL 75 mg CAPSULE $0.4200/EACH
MINOCYCLINE HCL 90 MG TABLET $5.9832/EACH
MINOXIDIL 10 mg TABLET $0.2400/EACH
MINOXIDIL 2.5 mg TABLET $0.1300/EACH
MIRTAZAPINE SOLTAB 15 mg TABLET $0.9450/EACH
MIRTAZAPINE SOLTAB 30 mg TABLET $0.8440/EACH
MIRTAZAPINE SOLTAB 45 mg TABLET $0.8280/EACH
MIRTAZAPINE 15 mg TABLET $0.0930/EACH
MIRTAZAPINE 30 mg TABLET $0.1532/EACH Decrease
MIRTAZAPINE 45 mg TABLET $0.3453/EACH
MIRTAZAPINE 7.5 mg TABLET $1.6616/EACH
MISOPROSTOL 100 mcg TABLET $0.4863/EACH
MISOPROSTOL 200 mcg TABLET $0.9260/EACH
MITOMYCIN 20 mg VIAL $410.0200/EACH
MITOMYCIN 40 MG VIAL $772.4200/EACH
MITOMYCIN 5 mg VIAL $102.5000/EACH
MITOXANTRONE HCL 2 mg/ml VIAL $23.3718/MILLILITER
MODAFINIL 100 mg TABLET $0.9402/EACH
MODAFINIL 200 mg TABLET $1.6680/EACH
MOEXIPRIL HCL/HCTZ 15-12.5 mg TABLET $0.7500/EACH
MOEXIPRIL HCL/HCTZ 15-25 mg TABLET $0.9600/EACH
MOEXIPRIL HCL/HCTZ 7.5-12.5 mg TABLET $0.6750/EACH
MOEXIPRIL HCL 15 mg TABLET $0.7186/EACH
MOEXIPRIL HCL 7.5 mg TABLET $1.0800/EACH
MOMETASONE FUROATE 0.1% CRM $0.3050/GRAM
MOMETASONE FUROATE 0.1% OINT $0.2700/GRAM
MOMETASONE FUROATE 0.1 % SOLN $0.2620/MILLILITER
MONTELUKAST SODIUM 10 mg TABLET $0.0900/EACH Decrease
MONTELUKAST SODIUM 4 MG PACKET $4.1000/EACH
MONTELUKAST SODIUM 4 mg TABLET $0.1740/EACH Decrease
MONTELUKAST SODIUM 5 mg TABLET $0.1502/EACH Decrease
MORPHINE SULFATE 10 MG/5 ML SOLN $0.0690/MILLILITER
MORPHINE SULFATE 10 MG CAPSULE $2.7480/EACH
MORPHINE SULFATE 100 MG CAPSULE $12.2100/EACH Decrease
MORPHINE SULFATE 100 mg TABLET $1.5321/EACH
MORPHINE SULFATE 15 mg TABLET $0.3099/EACH
MORPHINE SULFATE 15 mg TABLET $0.1980/EACH
MORPHINE SULFATE 20 mg/ml SOLN $0.4100/MILLILITER
MORPHINE SULFATE 20 MG CAPSULE $3.8224/EACH
MORPHINE SULFATE 200 mg TABLET $2.3020/EACH
MORPHINE SULFATE 30 MG CAPSULE $2.9813/EACH
MORPHINE SULFATE 30 mg TABLET $0.4489/EACH Decrease
MORPHINE SULFATE 30 mg TABLET $0.2315/EACH
MORPHINE SULFATE 50 MG CAPSULE $6.3900/EACH
MORPHINE SULFATE 60 MG CAPSULE $7.6349/EACH
MORPHINE SULFATE 60 mg TABLET $0.8550/EACH Decrease
MORPHINE SULFATE 80 MG CAPSULE $8.2773/EACH Decrease
MOXIFLOXACIN HCL 400 MG TABLET $5.8208/EACH Reactivate
MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET $0.0367/EACH
MULTIVITAMIN WITH MINERALS TABLET $0.0568/EACH
MULTIVITAMIN W-MINERALS/LUTEIN TABLET $0.0665/EACH
MULTIVITAMIN TABLET $0.0240/EACH
Page 17 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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MULTIVITAMIN TABLET $0.0272/EACH
MULTIVITAMINS WITH IRON TABLET $0.0342/EACH
MUPIROCIN CALCIUM 2 % CRM $0.0000
MUPIROCIN 2% OINT $0.2416/GRAM
MYCOPHENOLATE MOFETIL 200 MG/ML SUSP, RECON $5.8712/MILLILITER Increase
MYCOPHENOLATE MOFETIL 250 mg CAPSULE $0.3016/EACH
MYCOPHENOLATE MOFETIL 500 mg TABLET $0.2780/EACH Decrease
MYCOPHENOLATE SODIUM 180 MG TABLET $2.7371/EACH
MYCOPHENOLATE SODIUM 360 MG TABLET $5.2450/EACH
NABUMETONE 500 mg TABLET $0.2214/EACH
NABUMETONE 750 mg TABLET $0.2690/EACH
NADOLOL 120 mg TABLET $0.0000
NADOLOL 160 mg TABLET $0.0000
NADOLOL 20 mg TABLET $1.6300/EACH
NADOLOL 40 mg TABLET $1.7760/EACH
NADOLOL 80 mg TABLET $2.4300/EACH
NALTREXONE HCL 50 mg TABLET $0.8181/EACH
NAPROXEN EC 375 mg TABLET $0.3240/EACH
NAPROXEN EC 500 mg TABLET $0.1913/EACH
NAPROXEN SODIUM 220 mg TABLET $0.0000 Delete
NAPROXEN SODIUM 275 mg TABLET $1.1160/EACH
NAPROXEN SODIUM 375 MG TABLET $11.5280/EACH
NAPROXEN SODIUM 500 mg TABLET $0.0000
NAPROXEN SODIUM 550 mg TABLET $1.8038/EACH
NAPROXEN 250 mg TABLET $0.0488/EACH
NAPROXEN 375 mg TABLET $0.0604/EACH
NAPROXEN 500 mg TABLET $0.0750/EACH
NARATRIPTAN HCL 1 MG TABLET $1.0200/EACH
NARATRIPTAN HCL 2.5 MG TABLET $3.1892/EACH
NATEGLINIDE 120 mg TABLET $0.6750/EACH
NATEGLINIDE 60 mg TABLET $0.6900/EACH
NEFAZODONE HCL 100 mg TABLET $0.0000
NEFAZODONE HCL 150 mg TABLET $0.0000
NEFAZODONE HCL 200 mg TABLET $0.0000
NEFAZODONE HCL 250 mg TABLET $0.0000
NEFAZODONE HCL 50 mg TABLET $0.0000
NEOMY SULF/POLYMYX B SULF/HC 3.5-10,000-10 DROPS $0.0000
NEOMYCIN SULFATE/POLYMYXIN B SULFATE/GRAMICIDIN D 1.75 mg-10k DROPS $0.0000
NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 0.1% OINT $3.7436/GRAM Decrease
NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 3.5 mg/10,000 units/0.1% per gm OINT $0.0000
NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 3.5 mg/10,000 units/0.1% per ml DROPS $3.6540/MILLILITER
NEOMYCIN/POLYMYXIN B/HC 0.01 SOLN $5.0470/MILLILITER
NEOMYCIN/POLYMYXIN B/HC 3.5 mg/10,000 units/10 mg per ml DROPS $4.3297/MILLILITER
NEVIRAPINE 200 mg TABLET $0.1950/EACH
NEVIRAPINE 400 mg TABLET $11.1600/EACH
NIACIN 1000 mg TABLET $1.5298/EACH Reactivate
NIACIN 250 mg CAPSULE $0.0000
NIACIN 500 mg TABLET $1.0050/EACH Reactivate
NIACIN 500 mg TABLET $0.0000
NIACIN 750 mg TABLET $1.5298/EACH Reactivate
NICARDIPINE HCL 20 mg CAPSULE $0.0000
NICARDIPINE HCL 30 mg CAPSULE $0.0000
NICOTINE 14 mg/24 hr PATCH $1.7134/EACH
NICOTINE 21 mg/24 hr PATCH $1.0613/EACH
NICOTINE 7 mg/24 hr PATCH $2.3803/EACH
NIFEDIPINE CC 30 mg TABLET $0.3208/EACH
NIFEDIPINE CC 60 mg TABLET $0.4650/EACH
NIFEDIPINE CC 90 mg TABLET $0.7600/EACH
NIFEDIPINE ER 30 mg TABLET $0.0000 Delete
NIFEDIPINE ER 60 mg TABLET $0.0000 Delete
NIFEDIPINE ER 90 mg TABLET $0.4800/EACH
NIFEDIPINE 10 mg CAPSULE $0.7875/EACH
NIFEDIPINE 20 mg CAPSULE $0.0000
NIMODIPINE 30 mg CAPSULE $7.9750/EACH
NISOLDIPINE 17 mg TABLET $5.1920/EACH
NISOLDIPINE 25.5 mg TABLET $5.8925/EACH
NISOLDIPINE 34 mg TABLET $5.7310/EACH
NISOLDIPINE 8.5mg TABLET $3.5860/EACH
NITROFURANTOIN MACROCRYSTALS 100 mg CAPSULE $0.9812/EACH
NITROFURANTOIN MACROCRYSTALS 50 mg CAPSULE $0.6305/EACH
NITROFURANTOIN 100 mg CAPSULE $0.8276/EACH Decrease
NITROFURANTOIN 25 MG/5 ML SUSP $1.8282/MILLILITER
NITROGLYCERIN 0.2 mg/HR PATCH $0.5825/EACH
NITROGLYCERIN 0.3 mg TABLET $0.0000
NITROGLYCERIN 0.4 mg/HR PATCH $0.5640/EACH
NITROGLYCERIN 0.4 mg TABLET $0.0000
NITROGLYCERIN 0.6 mg/HR PATCH $1.0300/EACH
NITROGLYCERIN 0.6 mg TABLET $0.0000
NITROGLYCERIN 2.5 mg CAPSULE $0.0000
NITROGLYCERIN 6.5 mg CAPSULE $0.0000
NITROGLYCERIN 9 mg CAPSULE $0.0000
NIZATIDINE 150 mg/10 ml SOLN $0.5520/MILLILITER
NIZATIDINE 150 mg CAPSULE $0.3480/EACH
NIZATIDINE 300 mg CAPSULE $0.9450/EACH
NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE)1.5-0.03 mg TABLET $0.3056/EACH
NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE) 1-0.02mg TABLET $0.3056/EACH
NORETH-ETHINYL ESTRADIOL/IRON 0.8-25(24) TABLET $2.6175/EACH
NORETHINDRONE (ERRIN, CAMILA, JOLIVETTE, ORTHO MICRONOR) 0.35 mg TABLET $0.3834/EACH
NORETHINDRONE ACETATE/ETHINYL ESTRADIOL BIPHASIC (ORTHO-NOVUM 10/11, NECON 10/11)0.5 mg/35 mcg; 1 mg/35 mcg TABLET $0.0000
NORETHINDRONE ACETATE 5 mg TABLET $1.0957/EACH
NORETHINDRONE AC-ETH ESTRADIOL 0.5MG-2.5 TABLET $2.5105/EACH
NORETHINDRONE AC-ETH ESTRADIOL 1MG-5MCG TABLET $1.7160/EACH
Page 18 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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NORETHINDRONE A-E ESTRADIOL (JUNEL, MICROGESTIN, LOESTRIN) 1.5-0.030 mg TABLET $0.6000/EACH
NORETHINDRONE A-E ESTRADIOL (JUNEL, MICROGESTIN, LOESTRIN) 1-0.02mg TABLET $0.4952/EACH
NORETHINDRONE A-E ESTRADIOL/FERROUS FUMARATE (ESTROSTEP FE, TRI-LEGEST FE, TILIA FE)5-7-9-7 TABLET $0.9983/EACH
NORETHINDRONE/ETHINYL ESTRADIOL (BALZIVA, OVCON-35, ZENCHENT) 0.4 mg/35 mcg TABLET $0.8625/EACH
NORETHINDRONE/ETHINYL ESTRADIOL (BREVICON, MODICON, NECON 0.5/35) 0.5 mg/35 mcg TABLET $0.5160/EACH
NORETHINDRONE/ETHINYL ESTRADIOL (NECON 1/35, NORINYL 1+35, ORTHO-NOVUM 1/35)1 mg/35 mcg TABLET $0.3156/EACH
NORETHINDRONE/ETHINYL ESTRADIOL (NECON 7/7/7, NORTREL 7/7/7, ORTHO-NOVUM 7/7/7).5-35/0.75-35/1-35 mg-mcg TABLET $0.5348/EACH
NORETHINDRONE/MESTRANOL (NECON 1/50, NORINYL 1+50, ORTHO-NOVUM 1/501 mg/50 mcg TABLET $0.0000
NORETHINDRONE-E.ESTRADIOL-IRON 1 mg-20(24) TABLET $1.1760/EACH
NORETHINDRONE-E.ESTRADIOL-IRON 1MG-20(24) TABLET $4.0545/EACH
NORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE 0.4-35(21) TABLET $1.3320/EACH
NORETHINDRONE-ETHINYL ESTRADIOL 7-9-5 TABLET $0.6480/EACH
NORGESTIMATE-ETHINYL ESTRADIOL (ORTHO-CYCLEN, SPRINTEC, MONONESSA)0.25 mg/35 mcg TABLET $0.2664/EACH
NORGESTIMATE-ETHINYL ESTRADIOL (TRI-SPRINTEC, ORTHO TRI-CYCLEN, TRINESSA)7-7-7 TABLET $0.2690/EACH
NORGESTIMATE-ETHINYL ESTRADIOL 7 days X 3 LO TABLET $0.3068/EACH
NORGESTREL/ETHINYL ESTRADIOL (LO/OVRAL, LOW-OGESTREL) 0.3 mg/30 mcg TABLET $0.4682/EACH
NORGESTREL/ETHINYL ESTRADIOL (OGESTREL) 0.5 mg/50 mcg TABLET $0.0000
NORTRIPTYLINE HCL 10 mg/5 ml SOLN $0.3556/MILLILITER
NORTRIPTYLINE HCL 10 mg CAPSULE $0.1205/EACH
NORTRIPTYLINE HCL 25 mg CAPSULE $0.1321/EACH Decrease
NORTRIPTYLINE HCL 50 mg CAPSULE $0.1619/EACH
NORTRIPTYLINE HCL 75 mg CAPSULE $0.2804/EACH
NYSTATIN/TRIAMCINOLONE 100,000 units/gm; 0.1% CRM $0.0000
NYSTATIN/TRIAMCINOLONE 100,000 units/gm; 0.1% OINT $3.7855/GRAM
NYSTATIN 100,000 units/gm CRM $0.3888/GRAM
NYSTATIN 100,000 units/gm OINT $0.4584/GRAM
NYSTATIN 100,000 units/gm PWDR $0.0000
NYSTATIN 100,000 units/ml SUSP $0.1200/MILLILITER
NYSTATIN 500,000 units TABLET $0.5508/EACH
OCTREOTIDE ACETATE 100 mcg/ml VIAL $4.9440/MILLILITER
OCTREOTIDE ACETATE 1000 mcg/ml VIAL $30.8000/MILLILITER
OCTREOTIDE ACETATE 200 mcg/ml VIAL $8.0600/MILLILITER
OCTREOTIDE ACETATE 500 mcg/ml VIAL $0.0000
OFLOXACIN 0.003 DROPS $10.6345/MILLILITER
OFLOXACIN 0.3% DROPS $3.8832/MILLILITER
OFLOXACIN 200 mg TABLET $4.0186/EACH
OFLOXACIN 300 mg TABLET $0.0000
OFLOXACIN 400 mg TABLET $5.2532/EACH
OLANZAPINE/FLUOXETINE HCL 3 mg-25 mg CAPSULE $8.8100/EACH
OLANZAPINE/FLUOXETINE HCL 6MG-25MG CAPSULE $8.2940/EACH
OLANZAPINE/FLUOXETINE HCL 6MG-50MG CAPSULE $9.0516/EACH
OLANZAPINE 10 mg TABLET $0.7440/EACH
OLANZAPINE 10 mg TABLET $0.2085/EACH Decrease
OLANZAPINE 10 MG VIAL $36.0938/EACH
OLANZAPINE 15 mg TABLET $1.9800/EACH
OLANZAPINE 15 mg TABLET $0.3454/EACH
OLANZAPINE 2.5 mg TABLET $0.1680/EACH
OLANZAPINE 20 mg TABLET $2.6760/EACH
OLANZAPINE 20 mg TABLET $0.3743/EACH Decrease
OLANZAPINE 5 mg TABLET $0.9360/EACH
OLANZAPINE 5 mg TABLET $0.1325/EACH Decrease
OLANZAPINE 7.5 mg TABLET $0.1680/EACH
OLMESARTAN/HYDROCHLOROTHIAZIDE 20-12.5 MG TAB $0.1401/TABLET Add
OLOPATADINE HCL 0.1 % DROPS $5.8938/MILLILITER
OLOPATADINE HCL 0.6 % AERO (GM) $0.0000
OMEGA-3 ACID ETHYL ESTERS 1 G CAPSULE $0.5008/EACH Decrease
OMEPRAZOLE MAGNESIUM 20 mg TABLET $0.0000
OMEPRAZOLE/SODIUM BICARBONATE 20MG-1.1G CAPSULE $7.9736/EACH
OMEPRAZOLE/SODIUM BICARBONATE 40-1680MG PACKET $68.1340/EACH
OMEPRAZOLE/SODIUM BICARBONATE 40MG-1.1G CAPSULE $11.3259/EACH Decrease
OMEPRAZOLE 10 mg CAPSULE $0.2568/EACH
OMEPRAZOLE 20 mg CAPSULE $0.0528/EACH
OMEPRAZOLE 20 mg TABLET $0.6836/EACH
OMEPRAZOLE 40 mg CAPSULE $0.1107/EACH
ONDANSETRON HCL 4 mg/5 ml SOLN $0.2100/MILLILITER Decrease
ONDANSETRON HCL/D5W/PF 32 mg/50 ml SOLN $0.5167/MILLILITER
ONDANSETRON HCL 2 mg/ml; MDV VIAL $0.0000
ONDANSETRON HCL 4 mg/2 ml; SDV VIAL $0.2280/MILLILITER Reactivate
ONDANSETRON HCL 4 mg TABLET $0.1360/EACH
ONDANSETRON HCL 8 mg TABLET $0.1575/EACH
ONDANSETRON 4 mg TABLET $0.3641/EACH
ONDANSETRON 8 mg TABLET $0.0384/EACH
ORPHENADRINE CITRATE 100 mg TABLET $0.6150/EACH
ORPHENADRINE WITH ASPIRIN AND CAFFEINE 25 mg; 385 mg; 30 mg TABLET $0.0000
ORPHENADRINE WITH ASPIRIN AND CAFFEINE 50 mg; 770 mg; 60 mg TABLET $0.0000
OSELTAMIVIR PHOSPHATE 30 MG CAPSULE $8.3272/EACH
OSELTAMIVIR PHOSPHATE 45 MG CAPSULE $8.3030/EACH
OSELTAMIVIR PHOSPHATE 75 MG CAPSULE $9.0506/EACH
OXALIPLATIN 100 mg/20 ml VIAL $8.7318/MILLILITER
OXALIPLATIN 50 mg/10 ml VIAL $8.7326/MILLILITER
OXANDROLONE 10 mg TABLET $13.3980/EACH
OXANDROLONE 2.5 mg TABLET $2.7960/EACH
OXAPROZIN 600 mg TABLET $1.9308/EACH
OXAZEPAM 10 mg CAPSULE $0.7251/EACH
OXAZEPAM 15 mg CAPSULE $0.4406/EACH
OXAZEPAM 30 mg CAPSULE $1.7640/EACH
OXCARBAZEPINE 150 mg TABLET $0.1146/EACH
OXCARBAZEPINE 300 mg/5 ml SUSP $0.4429/MILLILITER
OXCARBAZEPINE 300 mg TABLET $0.1818/EACH
OXCARBAZEPINE 600 mg TABLET $0.3511/EACH
OXICONAZOLE NITRATE 1 % CRM $15.1560/GRAM
OXYBUTYNIN CHLORIDE 10 mg TABLET $0.6440/EACH Decrease
Page 19 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
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Reactivate
OXYBUTYNIN CHLORIDE 15 mg TABLET $0.5294/EACH
OXYBUTYNIN CHLORIDE 5 mg TABLET $0.7881/EACH
OXYBUTYNIN 5 mg/5 ml SYRUP $0.0198/MILLILITER
OXYBUTYNIN 5 mg TABLET $0.3728/EACH
OXYCODONE / APAP 10 mg; 650 mg TABLET $0.0000
OXYCODONE / APAP 10/325 mg TABLET $0.4924/EACH
OXYCODONE / APAP 5 mg; 325 mg TABLET $0.1359/EACH
OXYCODONE / APAP 5 mg; 500 mg CAPSULE $0.0000
OXYCODONE / APAP 7.5 mg; 325 mg TABLET $0.4356/EACH
OXYCODONE / APAP 7.5 mg; 500 mg TABLET $0.0000
OXYCODONE HCL 15 mg TABLET $0.2000/EACH
OXYCODONE HCL 20 mg/ml CONC $5.1042/MILLILITER
OXYCODONE HCL 5 mg CAPSULE $0.0000
OXYCODONE HCL/ASPIRIN 4.8355-325 TABLET $0.3341/EACH
OXYCODONE HCL 10 MG TABLET $0.1650/EACH
OXYCODONE HCL 10 mg TABLET $0.0000
OXYCODONE HCL 20 MG TABLET $0.3120/EACH
OXYCODONE HCL 20 mg TABLET $0.0000
OXYCODONE HCL 30 mg TABLET $0.3165/EACH Decrease
OXYCODONE HCL 40 mg TABLET $0.0000
OXYCODONE HCL 5 MG/5 ML SOLN $0.3563/MILLILITER
OXYCODONE HCL 5 mg TABLET $0.1016/EACH Decrease
OXYCODONE HCL 80 mg TABLET $0.0000
OXYCODONE/ASPIRIN 4.88-325 mg TABLET $0.8110/EACH
OXYMORPHONE HCL 10 mg TABLET $2.9640/EACH
OXYMORPHONE HCL 10 mg TABLET $2.1699/EACH
OXYMORPHONE HCL 20 mg TABLET $5.2560/EACH
OXYMORPHONE HCL 30 mg TABLET $7.1268/EACH
OXYMORPHONE HCL 40 mg TABLET $9.0640/EACH
OXYMORPHONE HCL 5 mg TABLET $1.9826/EACH
OXYMORPHONE HCL 5 mg TABLET $1.4160/EACH
PACLITAXEL 6 mg/ml VIAL $2.1416/MILLILITER
PALIPERIDONE 1.5 mg TABLET $15.4546/EACH
PALIPERIDONE 3 mg TABLET $14.2205/EACH Decrease
PALIPERIDONE 6 mg TABLET $14.1015/EACH Decrease
PALIPERIDONE 9 mg TABLET $22.1025/EACH
PAMIDRONATE DISODIUM 3 mg/ml VIAL $1.7399/MILLILITER
PAMIDRONATE DISODIUM 30 mg VIAL $0.0000
PAMIDRONATE DISODIUM 9 mg/ml VIAL $8.2031/MILLILITER
PAMIDRONATE DISODIUM 90 mg VIAL $0.0000
PANTOPRAZOLE SODIUM 20 mg TABLET $0.1055/EACH Decrease
PANTOPRAZOLE SODIUM 40 mg TABLET $0.0751/EACH
PARICALCITOL 1 MCG CAPSULE $3.4680/EACH
PARICALCITOL 2 MCG CAPSULE $8.6160/EACH
PARICALCITOL 4MCG CAPSULE $17.2320/EACH
PAROXETINE HCL 10 mg/5 ml SUSP $0.0000
PAROXETINE HCL 10 mg TABLET $0.0750/EACH
PAROXETINE HCL 12.5 mg TABLET $3.8300/EACH
PAROXETINE HCL 20 mg TABLET $0.0750/EACH
PAROXETINE HCL 25 mg TABLET $4.2220/EACH
PAROXETINE HCL 30 mg TABLET $0.1587/EACH
PAROXETINE HCL 37.5 mg TABLET $3.7500/EACH
PAROXETINE HCL 40 mg TABLET $0.1372/EACH
PEG 3350/SOD SULF ANHYD/SODIUM BICARBONATE/SOD CHLORIDE/KCL 236 - 22.74 g SOLN $0.0046/MILLILITER
PEMOLINE 18.75 mg TABLET $0.0000
PEMOLINE 37.5 mg TABLET $0.0000
PEMOLINE 75 mg TABLET $0.0000
PENICILLIN V POTASSIUM 125 mg/5 ml, 100 ml SOLN $0.0613/MILLILITER
PENICILLIN V POTASSIUM 250 mg/5 ml SOLN $0.0507/MILLILITER
PENICILLIN V POTASSIUM 250 mg TABLET $0.1050/EACH Decrease
PENICILLIN V POTASSIUM 500 mg TABLET $0.1639/EACH Decrease
PENTAZOCINE/NALOXONE HCL 50 mg/0.5 mg TABLET $2.2680/EACH
PENTOXIFYLLINE 400 mg TABLET $0.1800/EACH
P-EPHED HCL/BROMPHENIRAMIN 45 mg; 4 mg/5 ml SYRUP $0.0000
P-EPHED HCL/CARBINOX MAL 15-1 mg/ml DROPS $0.0000
PERINDOPRIL ERBUMINE 2 mg TABLET $0.6720/EACH
PERINDOPRIL ERBUMINE 4 mg TABLET $0.3210/EACH
PERINDOPRIL ERBUMINE 8 mg TABLET $0.7151/EACH
PERMETHRIN 5% CRM $0.8872/GRAM
PERPHENAZINE 16 mg TABLET $0.0000
PERPHENAZINE 2 mg TABLET $1.1640/EACH
PERPHENAZINE 4 mg TABLET $0.8577/EACH
PERPHENAZINE 8 mg TABLET $1.5456/EACH
PHENAZOPYRIDINE HCL 100 mg TABLET $1.1880/EACH
PHENAZOPYRIDINE HCL 200 mg TABLET $1.5925/EACH
PHENELZINE SULFATE 15 MG TABLET $0.8040/EACH
PHENOBARBITAL 100 mg TABLET $0.0000
PHENOBARBITAL 15 mg TABLET $0.0302/EACH
PHENOBARBITAL 16.2 mg TABLET $0.4488/EACH
PHENOBARBITAL 20 mg/5 ml ELIXIR $0.2100/MILLILITER
PHENOBARBITAL 30 mg TABLET $0.0000
PHENOBARBITAL 60 mg TABLET $0.0000
PHENTERMINE HCL 30 mg CAPSULE $0.0000
PHENTERMINE HCL 37.5 mg TABLET $0.0000
PHENYLEPHRINE HCL/CHLOR-MAL 12.5-4 mg/5 SYRUP $0.0194/MILLILITER
PHENYLEPHRINE HCL/COD/PROMETH 5-10-6.25 SYRUP $0.0000
PHENYLEPHRINE/CHLORPHENIRAMINE 5-4.5 mg/5 ml SUSP $0.4092/MILLILITER
PHENYLEPHRINE/HYDROCODONE/CHLORPHENIRAMINE 5-2.5-2 mg/5 ml SYRUP $0.0000
PHENYLEPHRINE/PYRIL TAN/CP 5 mg; 12.5 mg; 2 mg/5 ml SUSP $0.0000
PHENYTOIN SODIUM EXTENDED 300 MG CAPSULE $1.0140/EACH
PHENYTOIN SODIUM 100 mg CAPSULE $0.2874/EACH
PHENYTOIN SODIUM 125 mg/5 ml SUSP $0.1332/MILLILITER
Page 20 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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Decrease
Reactivate
PHENYTOIN 50 MG TABLET $0.5684/EACH
PILOCARPINE HCL 5 mg TABLET $1.2100/EACH
PILOCARPINE HCL 0.5% DROPS $0.0000
PILOCARPINE HCL 1% DROPS $3.6176/MILLILITER
PILOCARPINE HCL 2% DROPS $0.0000
PILOCARPINE HCL 4% DROPS $5.2000/MILLILITER
PILOCARPINE HCL 6% DROPS $0.0000
PILOCARPINE HCL 7.5 mg TABLET $1.2566/EACH Decrease
PINDOLOL 10 mg TABLET $0.0000
PINDOLOL 5 mg TABLET $0.0000
PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg-2 mg TABLET $11.5170/EACH
PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg-4 mg TABLET $11.5170/EACH
PIOGLITAZONE HCL/METFORMIN HCL 15MG-500MG TABLET $0.4500/EACH
PIOGLITAZONE HCL/METFORMIN HCL 15MG-850MG TABLET $0.4500/EACH
PIOGLITAZONE HCL 15 MG TABLET $0.0888/EACH
PIOGLITAZONE HCL 30 MG TABLET $0.0600/EACH
PIOGLITAZONE HCL 45 MG TABLET $0.0840/EACH
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 2.25 gm VIAL $5.7750/EACH
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 3.375 gm VIAL $0.0000
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 4.5 gm VIAL $13.9563/EACH
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 40.5 gm VIAL $128.9178/EACH
PIROXICAM 10 mg CAPSULE $1.1489/EACH
PIROXICAM 20 mg CAPSULE $1.1790/EACH Decrease
PNV #116/IRON FUMARATE/FA/DHA 28-800-200 KIT $0.2000/EACH
PNV #78/IRON ASP GLY/FA#1/DHA 18-1-300MG CAPSULE $0.2000/EACH
PNV #86/IRON POLY/FA/DHA/EPA 32-1-120MG KIT $0.2000/EACH
PNV 112/IRON/FA/OM-3S/DHA/EPA 3.33-.33MG TABLET $0.2000/EACH
PNV CMB#82/IRON PS CMPLX/FOLIC ACID/OMEGA 3/DHA/EPA/FISH OIL 13.5-0.5mg TABLET $0.2000/EACH
PNV CMB#95/FERROUS FUMARATE/FA 28mg-0.8mg TABLET $0.2000/EACH
PNV COMB.12/IRON,CARBONYL/FA CMB #1/DOCUSATE SODIUM/DHA 90-0.4-250 KIT $0.2000/EACH
PNV COMB.NO26/IRON ASP GLY/FA/DOCUSATE SODIUM/FAT COMBO NO.7 30-1-50mg TAB & CAP $0.2000/EACH
PNV COMB.NO5/FE ASP GLY/DOCUSATE/FOLIC ACID/FAT COMBO NO.4 30-50-1mg TAB & CAP $0.2000/EACH
PNV COMB.NO58/IRON BISGLY/FA 10MG-0.4MG CAPSULE $0.2000/EACH
PNV NO.100/IRON/FA/DHA/EPA 27 MG-1 MG CAPSULE $0.2000/EACH
PNV NO.106/IRON/FOLATE #6/DHA 27.5MG-1MG CAPSULE $0.2000/EACH
PNV NO.111/IRON/FOLATE/DHA 38-1-225MG CAP $0.2000/CAPSULE Add
PNV NO.115/IRON FUMARATE/FA 29 MG-1 MG TABLET $0.2000/EACH
PNV NO.118/IRON FUMARATE/FA 29 MG-1 MG TABLET $0.2000/EACH
PNV NO.121/IRON/FOLIC ACID 28MG-0.8MG TAB $0.2000/TABLET Add
PNV NO.122/IRON/FOLIC ACID 27MG-0.8MG TABLET $0.2000/EACH
PNV NO.20/IRON FUMARATE/FA/DOCUSATE NA/FISH OIL CONC/DHA/EPA 27-1-500mg CAPSULE $0.2000/EACH
PNV NO.35/IRON FUMARATE/FOLATE COMB. #6/DHA 29-1-300mg CAPSULE $0.2000/EACH
PNV NO.63/IRON,CARBONYL/FA/DHA 27-800-200 CAPSULE $0.2000/EACH
PNV NO.66/IRON,CARBONYL/FA/DHA 20-1-320MG CAPSULE $0.2000/EACH
PNV NO.74/IRON FUM/FA/COQ10 18-1-125MG KIT $0.2000/EACH
PNV NO.74/IRON FUM/FA/DHA 27-1-300MG KIT $0.2000/EACH
PNV NO.80/IRON/MFOLATE/DSS/DHA 38-1-25 MG CAPSULE $0.2000/EACH
PNV NO.81/IRON CBN&GLUC/FA/DSS 27-1-50 MG TABLET $0.2000/EACH
PNV NO.86/IRON/MFOLATE/DSS/DHA 38-1-50 MG KIT $0.2000/EACH
PNV NO.88/IRON PS,HEME/FA/DHA 28-6-1 MG KIT $0.2000/EACH
PNV NO.90/IRON FUM & PS/FA/DHA 32-1.25 MG CAPSULE $0.2000/EACH
PNV NO17/IRON,CARB/IRON BISGLY/FA/FISH OIL/DHA/OMEGA 3,6 #1 35-5-1.2mg CAPSULE $0.2000/EACH
PNV NO18/IRON,CARBONYL/FOLIC ACID/DOCUSATE NA/UBIDECAR/DHA 15-0.5-25 TABLET $0.2000/EACH
PNV WITH CA #37/IRON CARB, ASP, & GLY/FA/OMEGA-3 FATTY ACIDS 27-1-330mg CAPSULE $0.2000/EACH
PNV WITH CA NO.37/IRON CARB & ASP GLY/FA/OMEGA-3 FATTY ACIDS 27-1-330mg CAPSULE $0.2000/EACH
PNV WITH CA,NO.72/IRON,CARB/FA 29 MG-1 MG TABLET $0.2000/EACH
PNV#102/IRON/FA/DHA/LUTEIN 27-800-200 KIT $0.2000/EACH
PNV#102/IRON/FOLATE #1/DSS/DHA 90-1-200mg CAPSULE $0.2000/EACH
PNV#31/IRON,EL.&GLU/FA/DSS/DHA 35-1-50 MG KIT $0.2000/EACH
PNV#64/IRON/LMFOLATE/ALGAL/SOY 27-1.13 MG CAPSULE $0.2000/EACH
PNV#64/IRON/LMFOLATE/ALGAL/SOY 27-1.13 MG CAPSULE $0.2000/EACH
PNV#67/IRON PS/FA CMB#1/DHA 29-1-200MG CAPSULE $0.2000/EACH
PNV#71/IRON/FOLIC ACID/DHA 30-1.4-200 CAPSULE $0.2000/EACH
PNV#75/IRON FUM/FA/OM3/DHA/EPA 28-800-223 KIT $0.2000/EACH
PNV#85/IRON CARB./IRON ASP.GLYCINATE/FOLIC ACID/DHA/FISH OIL 40-10-1 mg CAPSULE $0.2000/EACH
PNV,CA,NO.35/IRON,CARBONYL & ASP GLY/FA/DSS/OMEGA-3 27-1-50mg CAPSULE $0.2000/EACH
PNV/FA/B6/CALCIUM CARB/GINGER 1.2-42 MG TABLET $0.2000/EACH
PNV/FA/B6/CALCIUM PHOS/GINGER 1.2-40-100 TABLET $0.2000/EACH
PNV/FA/B6/CALCIUM PHOS/GINGER 1.2-42 MG TABLET $0.2000/EACH
PNV/FE BISGLY/OMEGA-3/FA 29-250-1MG KIT $0.2000/EACH
PNV/FE SULF/FA/MIN AA CHEL 14-0.25MG TABLET $0.2000/EACH
PNV/FERROUS FUMARATE/DOSS/FA 65 MG-1 MG TABLET $0.2000/EACH
PNV/FERROUS SULFATE/FOLIC ACID 27-<0.5MG TABLET $0.2000/EACH
PNV/FERROUS SULFATE/FOLIC ACID 27MG-0.8MG TABLET $0.2000/EACH
PNV/FERROUS SULFATE/FOLIC ACID 40-1MG/15 LIQ $0.2000/MILLILITER
PNV/IRON,CARBONYL/DOCUSATE/FA 100-1MG TABLET $0.2000/EACH
PNV/IRON,CARBONYL/DOCUSATE/FA 95-50-1MG CAPSULE $0.2000/EACH
PNV/IRON,CARBONYL/FOLIC ACID 65 MG-1 MG TABLET $0.2000/EACH
PNV/IRON/DHA/EPA/OMEGA-3/FA 60 MG-1 MG KIT $0.2000/EACH
PNV/IRON/DOCUSATE/FA/LMEFOLATE 90-50-1MG TABLET $0.2000/EACH
PNV/IRON/FOLIC ACID 40-1MG TABLET $0.2000/EACH
PNV100/IRON EDTA&PS/FA/OMEGA3 27-1-374MG KIT $0.2000/EACH
PNV103/FA/OMEGA3/DHA/FISH OIL 0.4-32.5mg TABLET $0.2000/EACH
PNV103/FE/FA/DHA/EPA/OTHER OM3 27 MG-1 MG KIT $0.2000/EACH
PNV105/IRON/FA/OMEGA 3/DHA/EPA 27-1-380MG KIT $0.2000/EACH
PNV106/IRON/FA/OM3/DHA/EPA 25-1-400MG KIT $0.2000/EACH
PNV106/IRON/FA/OM3/DHA/EPA 25-1-430MG KIT $0.2000/EACH
PNV107/IRON/FA/OM3/DHA/EPA 25-1-400MG KIT $0.2000/EACH
PNV107/IRON/FA/OM3/DHA/EPA 25-1-430MG KIT $0.2000/EACH
PNV110/IRON/FA/OMEGA 3/DHA/EPA 26-1-278 mg KIT $0.2000/EACH
PNV113/FE/L-MEF/OM3/DHA/EPA/FS 4.5-1-150 COMBINATION PACKAGE $0.2000/EACH
PNV113/IRON/FA/OMEGA-3/DHA/EPA 24-1-272MG KIT $0.2000/EACH
Page 21 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
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Delete
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Reactivate
PNV115/IRON FUMARATE/FA/DSS 29-1-25 MG TABLET $0.2000/EACH
PNV117/IRON/FA/OM3/DHA/EPA 25 MG-1 MG KIT $0.2000/EACH
PNV119/IRON FUMARATE/FA/DSS 29-1-25 MG TABLET $0.2000/EACH
PNV120/LEVOMEFOLATE/OMEGA3/DHA 267MCG-321 TABLET $0.2000/EACH
PNV123/IRON CAR/FA/OM3/DHA/EPA 28-800-235 CAPSULE $0.2000/EACH
PNV133/FERROUS FUMARATE/FA 28MG-0.8MG TABLET $0.2000/EACH
PNV135/IRON/L-MEFOL/OMEGA3/DHA 18-800-290 COMBINATION PACKAGE $0.2000/EACH
PNV14/FE FUM/FA#1/DHA/DOSS CA 27-1-50 MG CAPSULE $0.2000/EACH
PNV2/IRON B-G SUC-P/FA/OMEGA-3 29-1-300MG KIT $0.2000/EACH
PNV2/IRON B-G SUC-P/FA/OMEGA-3 29-1-300MG KIT $0.2000/EACH
PNV34/IRON,CARB&FUM/FA/DSS/DHA 27-1-50 MG CAPSULE $0.2000/EACH
PNV34/IRON,CARBONYL/FA/DSS/DHA 29-1-50 MG CAPSULE $0.2000/EACH
PNV50/IRON FUM&BISGLYCINATE/FA 25 MG-1 MG TABLET $0.2000/EACH
PNV51/IRON FUM/FA/OM-3/DHA/EPA 27-800-228 CAPSULE $0.2000/EACH
PNV53/IRON FUM/FA/DOCUSATE/DHA 29-1.25-55 CAPSULE $0.2000/EACH
PNV59/IRON,CARB&FUM/FA/DSS/DHA 27-1-50MG CAPSULE $0.2000/EACH
PNV59/IRON,CARBONYL/FA/DSS/DHA 29-1-50 MG CAPSULE $0.2000/EACH
PNV62/FA/OM3/DHA/EPA/FISH OIL 400-35-25 TABLET $0.2000/EACH
PNV72/IRON,CARB&GLU/FA/DSS/DHA 90-1-300MG KIT $0.2000/EACH
PNV73/IRON,CARB&GLU/FA/DSS/DHA 35-1-50 MG KIT $0.2000/EACH
PNV76/IRON,CARB&GLU/FA/DSS/DHA 27-1-50 MG KIT $0.2000/EACH
PODOFILOX 0.5 % SOLN $14.1900/MILLILITER
POLYETHYLENE GLYCOL 17 gm PACKET $1.1640/EACH
POLYETHYLENE GLYCOL NA PWDR $0.0290/GRAM
POTASSIUM BICARB/CITRATE 25 mEq TABLET $0.2160/EACH
POTASSIUM CHLORIDE 40 mEq/15 ml LIQ $0.9157/MILLILITER
POTASSIUM CHLORIDE/BICARB 25 mEq TABLET $0.0000
POTASSIUM CHLORIDE 10 mEq CAPSULE $0.2850/EACH Decrease
POTASSIUM CHLORIDE 10 mEq TABLET $0.2400/EACH
POTASSIUM CHLORIDE 10 mEq TABLET $0.2904/EACH
POTASSIUM CHLORIDE 20 mEq/15 ml LIQ $0.5517/MILLILITER
POTASSIUM CHLORIDE 20 mEq PACKET $1.0605/EACH
POTASSIUM CHLORIDE 20 MEQ TABLET $0.3687/EACH
POTASSIUM CHLORIDE 20 mEq TABLET $0.2233/EACH
POTASSIUM CHLORIDE 8 MEQ CAPSULE $0.3360/EACH
POTASSIUM CHLORIDE 8 mEq TABLET $0.4920/EACH
POTASSIUM CITRATE 10 MEQ TABLET $1.1880/EACH
POTASSIUM CITRATE 15 MEQ TABLET $1.9146/EACH
POVIDONE IODINE 0.1 SOLN $0.0177/MILLILITER
POVIDONE IODINE 0.1 OINT $0.0000
PRAMIPEXOLE DI-HCL 0.375 mg TABLET $11.6610/EACH
PRAMIPEXOLE DI-HCL 0.75 mg TABLET $9.8670/EACH
PRAMIPEXOLE DI-HCL 0.75 mg TABLET $0.1217/EACH
PRAMIPEXOLE DI-HCL 1.5 mg TABLET $12.2430/EACH
PRAMIPEXOLE DI-HCL 3 mg TABLET $10.8832/EACH
PRAMIPEXOLE DIHYDROCHLORIDE 0.125 mg TABLET $0.0450/EACH
PRAMIPEXOLE DIHYDROCHLORIDE 0.25 mg TABLET $0.0515/EACH
PRAMIPEXOLE DIHYDROCHLORIDE 0.5 mg TABLET $0.0515/EACH
PRAMIPEXOLE DIHYDROCHLORIDE 1 mg TABLET $0.0683/EACH
PRAMIPEXOLE DIHYDROCHLORIDE 1.5 mg TABLET $0.1200/EACH
PRAVASTATIN SODIUM 10 mg TABLET $0.1762/EACH
PRAVASTATIN SODIUM 20 mg TABLET $0.1583/EACH
PRAVASTATIN SODIUM 40 mg TABLET $0.2050/EACH Decrease
PRAVASTATIN SODIUM 80 mg TABLET $0.3294/EACH
PRAZOSIN HCL 1 mg CAPSULE $0.3921/EACH
PRAZOSIN HCL 2 mg CAPSULE $0.4693/EACH
PRAZOSIN HCL 5 mg CAPSULE $1.1550/EACH
PREDNISOLONE ACETATE 1% DROPS $5.3046/MILLILITER
PREDNISOLONE SODIUM PHOSPHATE 15 mg/5 ml SOLN $0.0902/MILLILITER
PREDNISOLONE 15 mg/5 ml SOLN $0.0340/MILLILITER
PREDNISONE 1 mg TABLET $0.1596/EACH
PREDNISONE 10 mg TABLET $0.6880/EACH
PREDNISONE 10 mg TABLET $0.1249/EACH
PREDNISONE 2.5 mg TABLET $0.1368/EACH
PREDNISONE 20 mg TABLET $0.1211/EACH
PREDNISONE 5 mg TABLET $0.1440/EACH
PRENATAL #103/IRON FUMARATE/FA 27 MG-1 MG TABLET $0.2000/EACH
PRENATAL #108/IRON,CARBONYL/FA 30 MG-1 MG TABLET $0.2000/EACH
PRENATAL #48/IRON CB&GLU/FA/B6 20-1-25 MG TABLET $0.2000/EACH
PRENATAL #57/IRON/FA/DSS/DHA 29-1.25-55 CAPSULE $0.2000/EACH
PRENATAL #58/IRON/FA/DSS/DHA 29-1.25-55 CAPSULE $0.2000/EACH
PRENATAL #79/IRON ASP GLY/FA#1 20 MG-1 MG TABLET $0.2000/EACH
PRENATAL #92/IRON/FA #8/PS-DHA 1.5-8.73MG CAPSULE $0.2000/EACH
PRENATAL CMB#95/IRON/FA/DHA 28-800-200 KIT $0.2000/EACH
PRENATAL COMB NO.42/FOLIC ACID 1.4 MG TABLET $0.2000/EACH
PRENATAL NO.123/IRON/FOLIC AC 50-1.25 MG TABLET $0.2000/EACH
PRENATAL NO.13/IRON PS/FA CB#1 29 MG-1 MG TABLET $0.2000/EACH
PRENATAL NO.25/IRON/FA #6/DHA 30-1-200MG CAPSULE $0.2000/EACH
PRENATAL NO.29/IRON CARB & ASP.GLYCINATE/FA/DHA/FISH OIL 40-10-1 mg CAPSULE $0.2000/EACH
PRENATAL NO.30/IRON CARBONLY & ASPARTO GLYCINATE/FA/OMEGA3 30-10-1 mg CAPSULE $0.2000/EACH
PRENATAL NO.40/IRON/FA/DHA 27-0.8-250 CAPSULE $0.2000/EACH
PRENATAL NO.52/IRON/FA/DHA 28-1-200MG CAPSULE $0.2000/EACH
PRENATAL NO.56/IRON CARBONYL & ASPARTO GLYCINATE/FA/DHA 35-5-1 mg CAPSULE $0.2000/EACH
PRENATAL NO.75/IRON/FOLATE #1 18 MG-1 MG TABLET $0.2000/EACH
PRENATAL NO.77/IRON ASP GLY/FA 20 MG-1 MG TABLET $0.2000/EACH
PRENATAL NO.82/IRON/FOLATE #2 27 MG-1 MG TABLET $0.2000/EACH
PRENATAL NO.93/IRON/FA #9/DHA 31-1-200 mg CAPSULE $0.2000/EACH
PRENATAL VIT #105/IRON/FA/DHA 30-1.4-300 COMBINATION PACKAGE $0.2000/EACH
PRENATAL VIT #108/IRON/FA 30-0.8MG TABLET $0.2000/EACH
PRENATAL VIT #113/IRON/FOLATE 4.5 MG-1MG TABLET $0.2000/EACH
PRENATAL VIT #116/IRON/FA/DHA 28-800-200 CAPSULE $0.2000/EACH
PRENATAL VIT #16/IRON FUM & PS COMPLEX/FOLIC ACID/OMEGA-3 35-1-200mg CAPSULE $0.2000/EACH
Page 22 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
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Increase
Decrease
Reactivate
PRENATAL VIT #49/IRON FUM/FA 6.75-0.2MG TABLET $0.2000/EACH
PRENATAL VIT #60/IRON FUM/FA 27 MG-1 MG TABLET $0.2000/EACH
PRENATAL VIT #68/IRON/FA#6/DHA 28-1-400MG CAPSULE $0.2000/EACH
PRENATAL VIT #69/IRON/FA#6/DHA 27-1-400MG CAPSULE $0.2000/EACH
PRENATAL VIT #83/IRON/FA#6/DHA 29-1-150MG CAPSULE $0.2000/EACH
PRENATAL VIT #91/FE FUM/FA/DHA 28-975-200 KIT $0.2000/EACH
PRENATAL VIT COMB NO.4/IRON CARBONYL-IRON GLUCONATE/FA/DOSS 27-1-50mg TABLET $0.2000/EACH
PRENATAL VIT NO.109/IRON/FA 40-1MG TABLET $0.2000/EACH
PRENATAL VIT NO.112/FOLIC ACID 1 MG TABLET $0.2000/EACH
PRENATAL VIT NO.114/FA/GINGER 1MG-500MG TABLET $0.2000/EACH
PRENATAL VIT NO.124/IRON/FA 27MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT NO.126/IRON/FA 28MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT NO.128/IRON/FA 28MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT NO.129/IRON/FA 27MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT NO.130/IRON/FA 27MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT NO.131/IRON/FA 28MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT NO.44/IRON/FA/DHA 29-1-350MG CAPSULE $0.2000/EACH
PRENATAL VIT NO.87/IRON/FA/DHA 18-1-350MG CAPSULE $0.2000/EACH
PRENATAL VIT W/O CALC NO.10/IRON FUM&POLYSAC COMP/FA/OMEGA-3 30-1-310.1 CAPSULE $0.2000/EACH
PRENATAL VIT W-CA,FE,FA(<1 MG) CAPSULE $0.2000/EACH
PRENATAL VIT W-CA,FE,FA(<1 MG) KIT $0.2000/EACH
PRENATAL VIT WITH CA #75/IRON FUM/FOLIC ACID/OMEGA-3/DHA/EPA 28-800-440 KIT $0.2000/EACH
PRENATAL VIT WITH CA NO.64/IRON CARB&GLUC/FOLIC ACID/DSS/DHA 90-1-300mg KIT $0.2000/EACH
PRENATAL VIT WITH CA NO.68/IRON FUMARATE/FOLIC ACID #1/DHA 28-1-300mg CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM #32/IRON/FA/FISH OIL 27-1-880mg CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM #34/IRON/FOLIC ACID/DHA 28-1-250mg KIT $0.2000/EACH
PRENATAL VIT WITH CALCIUM #34/IRON/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH
PRENATAL VIT WITH CALCIUM #60/IRON/FOLIC ACID/DHA 27-1-250mg KIT $0.2000/EACH
PRENATAL VIT WITH CALCIUM #69/IRON,CARBON/FOLIC ACID/DSS/DHA 27-1-50mg CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM #69/IRON,CARBON/FOLIC ACID/DSS/DHA 28-1-50 mg CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM CMB 11/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg TABLET $0.2000/EACH
PRENATAL VIT WITH CALCIUM COMB NO.63/IRON,CARBONYL/FA/B6 20-1-25 mg TABLET $0.2000/EACH
PRENATAL VIT WITH CALCIUM COMB NO.65/IRON POLYSACCH CMPLX/FA 60 mg-1 mg CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO. 40/IRON FUMARATE/FA CMB NO.1 27 mg-1 mg TABLET $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO.39/IRON FUM/FOLIC ACID/DSS/DHA 30-1.24-55 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO.39/IRON FUM/FOLIC ACID/DSS/DHA 30-1.2-55 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO.61/IRON FUMARATE/FOLIC ACID/DHA 28-975-200 KIT $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO.66/IRON FUM/FOLIC ACID/DSS/DHA 26-1.2-55 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO.66/IRON FUM/FOLIC ACID/DSS/DHA 27-1.25-55 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO.80/IRON FUM/FOLIC ACID/DSS/DHA 27-1.25-55 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO.80/IRON FUM/FOLIC ACID/DSS/DHA 29-1.25-55 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO42/IRON FUM/FA/L-MEFOLATE CA/DHA 27-1.13 mg CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO42/IRON FUM/FA/L-MEFOLATE CA/DHA 27-400-1 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO42/IRON FUM/FA/L-MEFOLATE CA/DHA 27mg-400 CAPSULE $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO8-IRON PS CMPLX,FA& LEVOMEFOLATE 29-400-1 TABLET $0.2000/EACH
PRENATAL VIT WITH CALCIUM NO8-IRON PS CMPLX,FA,L-MEFOLATE CA 29-1.13 mg TABLET $0.2000/EACH
PRENATAL VIT#101/IRON/FA/DHA 27-800-200 KIT $0.2000/EACH
PRENATAL VIT#118/IRON/FA#6/DHA 30-1-300MG CAPSULE $0.2000/EACH
PRENATAL VIT#42/FA CMB#6 1 mg TABLET $0.2000/EACH
PRENATAL VIT#65/IRON FUM&PS/FA 40-1.25 MG CAPSULE $0.2000/EACH
PRENATAL VIT#84/IRON/FA#1/DHA 18-1-300MG CAPSULE $0.2000/EACH
PRENATAL VIT#85/IRON/FA#1/DHA 10-1-200MG CAPSULE $0.2000/EACH
PRENATAL VIT#96/FERROUS FUM/FA 27MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT#98/FERROUS FUM/FA 9MG-267MCG TABLET $0.2000/EACH
PRENATAL VIT/FE FUMARATE/FA 27 mg; 1 mg TABLET $0.2000/EACH
PRENATAL VIT/FE FUMARATE/FA 28-1 mg TABLET $0.2000/EACH
PRENATAL VIT/IRON FUMARATE/FA 108.9-0.4 TABLET $0.2000/EACH
PRENATAL VIT/IRON FUMARATE/FA 29 MG-1 MG TABLET $0.2000/EACH
PRENATAL VIT/IRON FUMARATE/FA 29MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT/IRON FUMARATE/FA 45-1MG TABLET $0.2000/EACH
PRENATAL VIT/IRON FUMARATE/FA 45MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT/IRON FUMARATE/FA 60MG-0.8MG TABLET $0.2000/EACH
PRENATAL VIT/IRON,CARB/DOSS/FA 90 mg; 50 mg; 1 mg TABLET $0.2000/EACH
PRENATAL VIT/IRON,CARBONYL/FA 60 MG-1 MG TABLET $0.2000/EACH
PRENATAL VIT28&CALCIUM/IRON/FA 60 MG-1 MG TABLET $0.2000/EACH
PRENATAL VITAMIN #55/IRON FUMARATE & BISGLYCINATE/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMIN 27 WITH CALCIUM/FERROUS FUMARATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMIN COMB NO.42/IRON FUMARAT/FA/LEVOMEFOLATE/DHA 27-400-1 CAPSULE $0.2000/EACH
PRENATAL VITAMIN COMB NO.79/IRON FUMARAT/FA/LMEFOLATE CA/DHA 27-1.13 mg CAPSULE $0.2000/EACH
PRENATAL VITAMIN COMBINATION NO.19/IRON/FOLIC ACID/DHA 22-6-1-200 CAPSULE $0.2000/EACH
PRENATAL VITAMIN COMBINATION NO.8/IRON/FOLIC ACID/DHA 22-6-1-200 KIT $0.2000/EACH
PRENATAL VITAMIN COMBO NO.22/IRON/FOLIC ACID/OMEGA-3/DHA 28-6-1-203 KIT $0.2000/EACH
PRENATAL VITAMIN COMBO NO.8/IRON PS CMPLX & ASPGL/FA/DHA 22-6-1-200 KIT $0.2000/EACH
PRENATAL VITAMIN NO.15/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH
PRENATAL VITAMIN NO.16/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH
PRENATAL VITAMIN NO.17/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH
PRENATAL VITAMIN NO.18/IRON,CARBONYL/FOLIC ACID/DOCUSATE SOD 90-1-50 mg TABLET $0.2000/EACH
PRENATAL VITAMIN NO.67/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 27-1-300mg KIT $0.2000/EACH
PRENATAL VITAMIN NO.77/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 27-1-430mg KIT $0.2000/EACH
PRENATAL VITAMIN NO.81/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 27-1-430mg KIT $0.2000/EACH
PRENATAL VITAMIN NO.86/IRON BIS-GLYCINATE/FOLIC ACID 32 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMIN NO.88/IRON PS COMPLEX/FA/L-MEFOLATE CA/DHA 29-0.5-1.4 KIT $0.2000/EACH
PRENATAL VITAMIN NO.94/SODIUM FEREDETATE-IRON POLY/FA/OMEGA3 26-1-374mg KIT $0.2000/EACH
PRENATAL VITAMIN W-O CALCIUM/FE BISGLY/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O CALCIUM/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O CALCIUM/FERROUS GLUCONATE/FOLIC ACID 30-0.8mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O CALCIUM/IRON POLYSACCHARIDES COMPLEX/FA 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O CALCIUM/IRON,CARBONYL/DOCUSATE/FA 29-50-1mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O CALCIUM/IRON,CARBONYL/DOCUSATE/FA 29-50-1mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O VIT A/FE CARBONYL-FE FUMARATE/FA 30mg-1mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O VIT A/FE CARBONYL-FE FUMARATE/FA 40-1mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/DOCUSATE/FA/ZINC 28-1-66mg CAPSULE $0.2000/EACH
Page 23 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
Update
Add
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Increase
Decrease
Reactivate
PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/DOCUSATE/FA 28 mg-1 mg CAPSULE $0.2000/EACH
PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/FOLIC ACID 40-1mg TABLET $0.2000/EACH
PRENATAL VITAMIN W-O VIT A/FERROUS FUMARATE/FOLIC ACID 40-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS #39/IRON AMINO ACID CHELATE/FA COMBO#6/DHA 30-1-300 mg KIT $0.2000/EACH
PRENATAL VITAMINS #45/IRON/FA 28 MG-1 MG TABLET $0.2000/EACH
PRENATAL VITAMINS COMB #83/IRON,CARBONYL/IRON ASPARTO GLY/FA 30-20-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB 10/FERROUS FUMARATE/FOLIC ACID/DHA 65-1-250mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB 10/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.1/IRON,CARBONYL/DOCUSATE/FA 90-50-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.19/IRON BG HCL SUC-PROT/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.19/IRON BG HCL&SUCC-P2/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.19/IRON B-G SUC CHE-PR/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.2/IRON B-G SUC-P/FA/OMEGA-3 29-1-250mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.20/IRON BISGLY/FOLIC ACID/DHA 26-1-200mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.21/IRON/FOLIC ACID 14mg-0.4mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.25/IRON BISGLY/FOLIC ACID 25mg-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.3/FE FUMARATE-FE GLUCONATE/FA 20mg-0.8mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.43/IRON,CARBONYL/FA/DOCUSATE SOD 29-1-50mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.44/IRON,CARBONYL/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.47/FERROUS FUMARATE/FA CMB #1/DHA 27-1-300mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS COMB NO.48/IRON NA FEREDETATE/FA/OMEGA-3 30-1-440mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.52/IRON B-G SUC-P/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.53/IRON B-G HCL SUC-P/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.53/IRON B-G SUC-P/FA/OMEGA-3 29-1-400mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.54/IRON B-G HCL SUC-P/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.54/IRON B-G SUC-P/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.55/IRON BG HCL SUC-PROT/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.55/IRON BG HCL&SUCC-P2/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.55/IRON B-G SUC CHE-PR/FA/OMEGA-3 29-1-430mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.59/FERROUS SULFATE/FOLIC ACID/DHA 28-975-200 PACKET $0.2000/EACH
PRENATAL VITAMINS COMB NO.62/FERROUS FUMARATE/FOLIC ACID/DHA 27-1-250mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS COMB NO.7/FE ASP GLY/DOCUSATE/FOLIC ACID 30-50-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.70/FERROUS FUMARATE/FOLIC ACID/DHA 28-1-250mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS COMB NO.71/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.0000
PRENATAL VITAMINS COMB NO.72/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.73/FERROUS FUMARATE/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.74/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.76/IRON,CARBONYL/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.78/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.84/IRON,CARBONYL/FOLIC ACID/DHA 20-1-100mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.87/IRON BISGLY/FOLIC ACID/DHA 32-1-230mg KIT $0.2000/EACH
PRENATAL VITAMINS COMB NO.89/FERROUS FUMARATE/FOLIC ACID 25mg-0.8mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB NO.90/FERROUS FUMARATE/FOLIC ACID 9 mg-0.5mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMB. NO.21 WITH IRON & FOLIC ACID 28-6-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMBO #36/FERROUS FUMARATE/FOLATE COMBO #6 26 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMBO NO.14/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMBO NO.23/IRON PS COMPLEX/FOLIC ACID 155 mg-1mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS COMBO NO.25/FERROUS FUMARATE/FA/DHA 30-975-200 CAPSULE $0.2000/EACH
PRENATAL VITAMINS COMBO NO.28/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMBO NO.33/IRON PS CMPLX/FOLIC ACID/DHA 29-1-250mg KIT $0.2000/EACH
PRENATAL VITAMINS COMBO NO.34/IRON,CARB/FOLIC ACID/DSS/DHA 30-1-50 mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS COMBO NO.37/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS COMBO NO.8/IRON PS CMPLX & ASPGLY/FA 22-6-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS NO.11/FERROUS FUMARATE/FOLIC ACID/OMEGA-3 28-1-200mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS NO.12/IRON,CARBONYL/FA/DOCUSATE NA/OMEGA-3 29-1-50mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.13/IRON POLYSACCHARIDES COMPLEX/FA/DHA 29-1-250mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.13/IRON,CARBONYL/FA/DOCUSATE NA/DHA 90-1-250mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.15/IRON FUMARATE & POLYSAC COMP/FA 85 mg-1 mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS NO.18/IRON,CARBONYL/FA/UBIDECARENONE/DHA 15-0.5-50 TABLET $0.2000/EACH
PRENATAL VITAMINS NO.22/IRON CBN & GLUC/FOLIC ACID/DSS 27-1-50mg TABLET $0.2000/EACH
PRENATAL VITAMINS NO.22/IRON CBN&GLUCON/FOLIC ACID/DSS/DHA 27-1-50mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.22/IRON,CARBONYL/FA/DOCUSATE NA/DHA 90-1-250mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.24/IRON AMINO ACID CHELATE/FA/DHA 30-975-300 KIT $0.2000/EACH
PRENATAL VITAMINS NO.24/IRON AMINO ACID CHELATE/FOLIC ACID 30 mg-975 TABLET $0.2000/EACH
PRENATAL VITAMINS NO.24/IRON CBN&GLUCON/FOLIC ACID/DOSS/DHA 30-1-75mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.26/IRON POLYSACCHARIDES/FA/DHA 29-1-200 mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS NO.27/IRON CARBONYL & FUMARATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS NO.38/IRON CBN&GLUCON/FOLIC ACID/DSS/DHA 35-1-50mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.38/IRON FUMARATE/FOLATE COMB NO.6/DHA 28-1-300mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS NO.4/FERROUS FUMARATE/FOLIC ACID 106 mg-1mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS NO.4/IRON CBN&GLUCONAT/FOLIC ACID/DOSS/DHA 27-1-50mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.45/IRON,CARBONYL/FA/DOCUSATE SOD/DHA 90-1-250mg KIT $0.2000/EACH
PRENATAL VITAMINS NO.46/IRON,CARBONYL/FOLIC ACID/DHA 7-400-100 TABLET $0.2000/EACH
PRENATAL VITAMINS WITHOUT CALCIUM NO.9/IRON/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS W-O CA COMB. NO. 8 WITH IRON & FOLIC ACID 22-6-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FE CARBONYL-FE SULFATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS BIS-GLYCINATE CHELATE/FOLIC ACID 27 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS BIS-GLYCINATE CHELATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/DOCUSATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/DOCUSATE/FOLIC ACID 40-25-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/DOCUSATE/FOLIC ACID 90-50-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID/FATTY ACIDS 30mg-1mg KIT $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID/SELENIUM 27 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 15-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 17mg-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 27 mg-1 mg BAR $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 27-0.5mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 27mg-0.8mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 28 mg-1 mg BAR $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 28mg-0.8mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 35-1mg TABLET $0.2000/EACH
Page 24 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 40-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 65 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 66-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/FOLIC ACID 75-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS FUMARATE/OMEGA-3/FA/FAT COMBO NO.1 30-300-1mg KIT $0.2000/EACH
PRENATAL VITAMINS/FERROUS GLUCONATE/FOLIC ACID 2.2-.1-455 PWDR $0.2000/GRAM
PRENATAL VITAMINS/FERROUS GLUCONATE/FOLIC ACID 30-0.4mg TABLET $0.2000/EACH
PRENATAL VITAMINS/FERROUS GLUCONATE/FOLIC ACID 30-0.8mg TABLET $0.2000/EACH
PRENATAL VITAMINS/IRON FUMARATE & BIS-GLYCINAT/FA/ASPARTAME 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/IRON FUMARATE & BIS-GLYCINAT/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/IRON POLYSACCHARIDES COMPLEX/FOLIC ACID 60 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/IRON,CARBONYL/DOCUSATE/CALCIUM/FOLIC ACID 90-1-600mg KIT $0.2000/EACH
PRENATAL VITAMINS/IRON,CARBONYL/FOLIC ACID 29 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITAMINS/IRON,CARBONYL/FOLIC ACID 50-1mg TABLET $0.2000/EACH
PRENATAL VITAMINS/IRON,CARBONYL/OMEGA-3/FA/FAT COMBO NO.1 27-300-1mg CAPSULE $0.2000/EACH
PRENATAL VITAMINS/IRON,CARBONYL/OMEGA-3/FA/MIN AA CHEL 29-600-1mg KIT $0.2000/EACH
PRENATAL VITS #32/IRON/FA/DHA 27-1-150MG KIT $0.2000/EACH
PRENATAL VITS #4/IRON FUMARATE & POLYSACC COMPLEX/FOLIC ACID 106 mg-1mg CAPSULE $0.2000/EACH
PRENATAL VITS #43/IRON/FA/DHA 27-1-200mg CAPSULE $0.2000/EACH
PRENATAL VITS #92/IRON/FA/DHA 28MG-0.8MG KIT $0.2000/EACH
PRENATAL VITS #93/IRON FUM/FA 9MG-267MCG TABLET $0.2000/EACH
PRENATAL VITS CMB W-O CA NO.1/FE BISGLY/FOLIC ACID 28 mg-1 mg TABLET $0.2000/EACH
PRENATAL VITS CMB W-O CA NO.2 106 mg-1mg CAPSULE $0.2000/EACH
PRENATAL VITS W-CA,FE,FA(<1MG) TABLET $0.2000/EACH
PRENATAL VITS W-CA,FE,FA(1MG)/SELENIUM TABLET $0.2000/EACH
PRENATAL VITS W-CA,FE,FA(1MG) CAPSULE $0.2000/EACH
PRENATAL VITS W-CA,FE,FA(1MG) TABLET $0.2000/EACH
PRENATAL VITS WITH CALCIUM #36/FERROUS FUMARATE/FOLIC ACID 13.5-0.4mg CAPSULE $0.2000/EACH
PRENATAL VITS WITHOUT CALC NO3/FERROUS FUMARATE/FOLIC ACID 106 mg-1mg CAPSULE $0.2000/EACH
PRENATAL VITS WITHOUT CALC NO4/FERROUS FUMARATE/FOLIC ACID 106.5-1mg CAPSULE $0.2000/EACH
PRENATAL VITS WITHOUT CALC NO5/FERROUS FUMARATE/FOLIC ACID 106.5-1mg CAPSULE $0.2000/EACH
PRENATAL VITS W-O CA COMB. NO. 7 W/ IRON & FOLIC ACID & DHA 28-1.25mg CAPSULE $0.2000/EACH
PRENATAL72/IRON FUM/FA/OM3/DHA 27-1-250MG COMBINATION PACKAGE $0.2000/EACH
PRENATL VIT6/IRON/FA/B12/CA/D3 35 MG-5 MG TABLET $0.2000/EACH
PRENATL VIT6/IRON/FA/B12/CA/D3 35MG-1.1MG TABLET $0.2000/EACH
PRIMIDONE 50 mg TABLET $0.0621/EACH
PRIMIDONE 250 mg TABLET $0.1340/EACH
PROBENECID W/COLCHICINE 0.5 gm/0.5 mg TABLET $0.0000
PROBENECID 0.5 gm TABLET $0.7800/EACH
PROCHLORPERAZINE MALEATE 10 mg TABLET $0.0584/EACH
PROCHLORPERAZINE MALEATE 25 mg SUPP $7.5110/EACH
PROCHLORPERAZINE MALEATE 5 mg TABLET $0.0421/EACH
PROGESTERONE,MICRONIZED 100 MG CAPSULE $0.9123/EACH
PROGESTERONE,MICRONIZED 200 MG CAPSULE $1.5264/EACH Decrease
PROMETHAZINE HCL 12.5 mg SUPP $9.4500/EACH
PROMETHAZINE HCL 12.5 mg TABLET $0.1314/EACH
PROMETHAZINE HCL 25 mg/ml AMPUL $1.1025/MILLILITER
PROMETHAZINE HCL 25 mg/ml VIAL $1.0315/MILLILITER
PROMETHAZINE HCL 25 mg SUPP $7.4375/EACH
PROMETHAZINE HCL 25 mg TABLET $0.0408/EACH
PROMETHAZINE HCL 50 mg/ml AMPUL $2.3310/MILLILITER
PROMETHAZINE HCL 50 mg/ml VIAL $2.4192/MILLILITER
PROMETHAZINE HCL 50 mg SUPP $29.0400/EACH
PROMETHAZINE HCL 50 mg TABLET $0.0750/EACH
PROMETHAZINE HCL 6.25 mg/5 ml SYRUP $0.0120/MILLILITER
PROMETHAZINE VC W/CODEINE 6.25 mg/5 mg/10 mg per 5 ml SYRUP $0.0000
PROMETHAZINE VC 6.25 mg/5 mg per 5 ml SYRUP $0.0000
PROMETHAZINE W/DM 6.25-15/5 SYRUP $0.0122/MILLILITER
PROMETHAZINE/CODEINE 10-6.25/5 ml SYRUP $0.0205/MILLILITER
PROPAFENONE HCL 150 mg TABLET $0.1920/EACH
PROPAFENONE HCL 225 mg CAPSULE $4.9313/EACH
PROPAFENONE HCL 225 mg TABLET $0.2700/EACH
PROPAFENONE HCL 300 mg TABLET $1.1640/EACH
PROPAFENONE HCL 325 mg CAPSULE $6.2477/EACH
PROPAFENONE HCL 425 mg CAPSULE $6.2477/EACH
PROPOXYPHENE HCL 65 mg CAPSULE $0.0000
PROPOXYPHENE NAPSYLATE; APAP 100 mg; 650 mg TABLET $0.0000
PROPOXYPHENE; APAP 65/650 mg TABLET $0.0000
PROPRANOLOL HCL 10 mg TABLET $0.0746/EACH
PROPRANOLOL HCL 120 mg CAPSULE $1.4639/EACH
PROPRANOLOL HCL 160 mg CAPSULE $2.2034/EACH
PROPRANOLOL HCL 20 mg TABLET $0.2295/EACH Decrease
PROPRANOLOL HCL 40 mg TABLET $0.3045/EACH Decrease
PROPRANOLOL HCL 60 mg CAPSULE $1.2608/EACH Decrease
PROPRANOLOL HCL 60 mg TABLET $0.8400/EACH
PROPRANOLOL HCL 80 mg CAPSULE $1.4961/EACH Decrease
PROPRANOLOL HCL 80 mg TABLET $0.4920/EACH
PROPRANOLOL/HCTZ 40 mg; 25 mg TABLET $0.0000
PROPRANOLOL/HCTZ 80 mg; 25 mg TABLET $0.0000
PROPYLTHIOURACIL 50 mg TABLET $0.6360/EACH
PROTRIPTYLINE HCL 10 mg TABLET $2.2500/EACH
PROTRIPTYLINE HCL 5 mg TABLET $1.3800/EACH
PSEUDOEPHEDRINE HCL/CETIRIZINE HCL 120 mg; 5 mg TABLET $0.0000 Delete
PSEUDOEPHEDRINE HCL; CHLORPHENIRAMINE MALEATE 120 mg; 8 mg CAPSULE $0.0000
PSEUDOEPHEDRINE HCL; CHLORPHENIRAMINE MALEATE 30 mg; 2 mg per 5 ml SOLN $0.0000
PSEUDOEPHEDRINE HCL 30 mg TABLET $0.0361/EACH
PSEUDOEPHEDRINE HCL 60 mg TABLET $0.0329/EACH
PSEUDOEPHEDRINE SULFATE/LORATADINE 240-10 mg TABLET $0.0000 Delete
PSYLLIUM SEED (WITH DEXTROSE) PWDR $0.0137/GRAM
PSYLLIUM SEED/SUCROSE ORAL POWDER NA PWDR $0.0122/GRAM
Page 25 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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PSYLLIUM/SUCROSE ORAL PACKET NA PACKET $0.0000
PSYLLIUM NA PWDR $0.0346/GRAM
PV W-O VIT A/FE FUMARATE/FA 106 MG-1MG CAPSULE $0.2000/EACH
PV W-O VIT A/IRON,CARBONYL/FA 29 MG-1 MG TABLET $0.2000/EACH
PYRIDOSTIGMINE BROMIDE 60 mg TABLET $0.6718/EACH
PYRIDOSTIGMINE BROMIDE 180 mg TABLET $12.5760/EACH
QUETIAPINE FUMARATE 100 mg TABLET $0.0768/EACH
QUETIAPINE FUMARATE 150 MG TAB, ER 24 HR $0.9666/TABLET Add
QUETIAPINE FUMARATE 200 mg TABLET $0.1653/EACH
QUETIAPINE FUMARATE 200 MG TAB, ER 24 HR $1.2359/TABLET Add
QUETIAPINE FUMARATE 25 mg TABLET $0.0683/EACH
QUETIAPINE FUMARATE 300 mg TABLET $0.1582/EACH
QUETIAPINE FUMARATE 300 MG TAB, ER 24 HR $1.4227/TABLET Add
QUETIAPINE FUMARATE 400 mg TABLET $0.2475/EACH Decrease
QUETIAPINE FUMARATE 400 MG TAB, ER 24 HR $1.6214/TABLET Add
QUETIAPINE FUMARATE 50 mg TABLET $0.1065/EACH Decrease
QUINAPRIL HCL/HCTZ 10-12.5 mg TABLET $0.5400/EACH Decrease
QUINAPRIL HCL/HCTZ 20-12.5 mg TABLET $0.2760/EACH
QUINAPRIL HCL/HCTZ 20-25 mg TABLET $0.6760/EACH
QUINAPRIL HCL 10 mg TABLET $0.2160/EACH
QUINAPRIL HCL 20 mg TABLET $0.1508/EACH
QUINAPRIL HCL 40 mg TABLET $0.1588/EACH
QUINAPRIL HCL 5 mg TABLET $0.1588/EACH
QUINIDINE GLUCONATE 324 mg TABLET $0.0000
QUINIDINE SULFATE 200 mg TABLET $0.0000
QUININE SULFATE 260 mg TABLET $0.0000
QUININE SULFATE 324 MG CAPSULE $3.3450/EACH
QUININE SULFATE 325 mg CAPSULE $0.0000
RABEPRAZOLE SODIUM 20 MG TABLET $0.4800/EACH
RALOXIFENE HCL 60 MG TABLET $1.2140/EACH Decrease
RAMIPRIL 1.25 mg CAPSULE $0.1787/EACH
RAMIPRIL 10 mg CAPSULE $0.0750/EACH
RAMIPRIL 2.5 mg CAPSULE $0.0598/EACH
RAMIPRIL 5 mg CAPSULE $0.1560/EACH
RANITIDINE HCL 150 mg/10 ml SYRUP $0.0225/MILLILITER
RANITIDINE HCL 150 mg CAPSULE $0.6480/EACH
RANITIDINE HCL 150 mg TABLET $0.0673/EACH
RANITIDINE HCL 300 mg CAPSULE $1.1760/EACH
RANITIDINE HCL 300 mg TABLET $0.1283/EACH
REPAGLINIDE 0.5 MG TABLET $0.3600/EACH
REPAGLINIDE 1 MG TABLET $0.2586/EACH
REPAGLINIDE 2 MG TABLET $0.2635/EACH
RIBAVIRIN 200 mg CAPSULE $0.3515/EACH
RIBAVIRIN 200 mg TABLET $1.0500/EACH
RIFABUTIN 150 mg CAPSULE $14.1680/EACH
RIFAMPIN 300 mg CAPSULE $0.8894/EACH
RIFAMPIN 150 MG CAPSULE $1.1258/EACH
RILUZOLE 50 MG TABLET $2.5100/EACH
RIMANTADINE HCL 100 mg TABLET $2.6040/EACH
RISEDRONATE SODIUM 150 mg TABLET $85.3050/EACH Reactivate
RISEDRONATE SODIUM 35 mg TABLET $30.1000/EACH Reactivate
RISEDRONATE SODIUM 35 mg TABLET $6.2361/EACH Reactivate
RISPERIDONE 0.25 MG TABLET $2.4750/EACH
RISPERIDONE 0.25 mg TABLET $0.0763/EACH
RISPERIDONE 0.5 mg TABLET $0.9302/EACH
RISPERIDONE 0.5 mg TABLET $0.0708/EACH
RISPERIDONE 1 mg/ml SOLN $0.4400/MILLILITER
RISPERIDONE 1 mg TABLET $2.2080/EACH
RISPERIDONE 1 mg TABLET $0.1035/EACH Decrease
RISPERIDONE 2 mg TABLET $1.3600/EACH
RISPERIDONE 2 mg TABLET $0.0720/EACH
RISPERIDONE 3 mg TABLET $4.7421/EACH
RISPERIDONE 3 mg TABLET $0.0993/EACH Decrease
RISPERIDONE 4 mg TABLET $5.8000/EACH
RISPERIDONE 4 mg TABLET $0.1469/EACH Decrease
RIVASTIGMINE TARTRATE 1.5 MG CAPSULE $0.7800/EACH
RIVASTIGMINE TARTRATE 3 MG CAPSULE $0.5902/EACH Decrease
RIVASTIGMINE TARTRATE 4.5 MG CAPSULE $2.4840/EACH
RIVASTIGMINE TARTRATE 6 MG CAPSULE $0.7800/EACH
RIZATRIPTAN BENZOATE 10 MG TABLET $1.2513/EACH
RIZATRIPTAN BENZOATE 10 MG TABLET $1.1583/EACH Decrease
RIZATRIPTAN BENZOATE 5 MG TABLET $1.6320/EACH
RIZATRIPTAN BENZOATE 5 MG TABLET $1.7640/EACH
ROPINIROLE HCL 0.25 mg TABLET $0.0840/EACH
ROPINIROLE HCL 0.5 mg TABLET $0.0780/EACH
ROPINIROLE HCL 1 mg TABLET $0.0930/EACH
ROPINIROLE HCL 12 MG TABLET $6.3840/EACH
ROPINIROLE HCL 2 MG TABLET $1.1280/EACH
ROPINIROLE HCL 2 mg TABLET $0.1248/EACH
ROPINIROLE HCL 3 mg TABLET $0.0960/EACH
ROPINIROLE HCL 4 MG TABLET $1.7160/EACH
ROPINIROLE HCL 4 mg TABLET $0.0960/EACH
ROPINIROLE HCL 5 mg TABLET $0.0966/EACH
ROPINIROLE HCL 6 MG TABLET $3.8550/EACH
ROPINIROLE HCL 8 MG TABLET $3.3840/EACH
ROSUVASTATIN CALCIUM 10 MG TABLET $0.1874/EACH Decrease
ROSUVASTATIN CALCIUM 20 MG TABLET $0.1785/EACH Decrease
ROSUVASTATIN CALCIUM 40 MG TABLET $0.1981/EACH Decrease
ROSUVASTATIN CALCIUM 5 MG TABLET $0.2270/EACH Decrease
SALICYLIC ACID 6 % SHAMPOO $0.1320/MILLILITER
SALSALATE 500 mg TABLET $0.8400/EACH
SALSALATE 750 mg TABLET $1.0080/EACH
Page 26 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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Reactivate
SANCTURA 20 MG TABLET $1.2386/EACH
SELEGILINE HCL 5 mg CAPSULE $0.0000
SELEGILINE HCL 5 mg TABLET $1.3114/EACH
SELENIUM SULFIDE 2.5% SUSP $0.1133/MILLILITER
SENNOSIDES/DOCUSATE SODIUM 8.6mg-50mg TABLET $0.0282/EACH
SENNOSIDES 8.6 mg TABLET $0.0197/EACH Decrease
SERTRALINE HCL 100 mg TABLET $0.0600/EACH
SERTRALINE HCL 20 mg/ml CONC $1.0532/MILLILITER
SERTRALINE HCL 25 mg TABLET $0.0450/EACH
SERTRALINE HCL 50 mg TABLET $0.0639/EACH
SILDENAFIL CITRATE 20 MG TABLET $0.3706/EACH
SILVER SULFADIAZINE 1% CRM $0.2397/GRAM
SIMETHICONE 40mg/0.6ml DROPS $0.0720/MILLILITER
SIMETHICONE 80 mg TABLET $0.0260/EACH
SIMVASTATIN 10 mg TABLET $0.0360/EACH
SIMVASTATIN 20 mg TABLET $0.0212/EACH
SIMVASTATIN 40 mg TABLET $0.0371/EACH
SIMVASTATIN 5 mg TABLET $0.0600/EACH
SIMVASTATIN 80 mg TABLET $0.0903/EACH
SIROLIMUS 0.5 mg TABLET $6.3830/EACH
SIROLIMUS 1 mg TABLET $9.1390/EACH
SIROLIMUS 2 mg TABLET $20.3720/EACH
SODIUM CHLORIDE/SODIUM BICARBONATE 420 g SOLN $0.0041/MILLILITER
SODIUM CHLORIDE 0.65 % AERO (ML) $0.0240/MILLILITER
SODIUM CHLORIDE 0.9%; 10 ml VIAL $0.0000
SODIUM CHLORIDE 0.9%; 100 ml SOLN $0.0155/MILLILITER
SODIUM CHLORIDE 0.9%; 1000 ml SOLN $0.0024/MILLILITER
SODIUM CHLORIDE 0.9%; 150 ml SOLN $0.0134/MILLILITER
SODIUM CHLORIDE 0.9%; 25 ml SOLN $0.0641/MILLILITER
SODIUM CHLORIDE 0.9%; 250 ml SOLN $0.0120/MILLILITER
SODIUM CHLORIDE 0.9%; 3 ml VIAL $0.1207/MILLILITER
SODIUM CHLORIDE 0.9%; 50 ml SOLN $0.0360/MILLILITER
SODIUM CHLORIDE 0.9%; 500 ml SOLN $0.0066/MILLILITER
SODIUM CHLORIDE 5 % OINT $2.1943/GRAM
SODIUM FLUORIDE .5 mg TABLET $0.0300/EACH
SODIUM FLUORIDE 0.25(0.55) TABLET $0.0450/EACH
SODIUM FLUORIDE 0.5 mg/ml DROPS $0.1950/MILLILITER
SODIUM FLUORIDE 1 mg TABLET $0.0450/EACH
SODIUM FLUORIDE 1.1% CRM $0.0720/GRAM Decrease
SODIUM PHOSPHATE,MONOBASIC/SODIUM PHOSPHATE,DIBASIC 19g-7g/118 ENEMA $0.0065/MILLILITER
SODIUM POLYSTYRENE SULFONATE PWDR $0.2040/GRAM
SODIUM SULFATE/SODIUM CHLORIDE/SODIUM BICARBONATE/POTASSIUM CHLORIDE/POLYETHYLENE GLYCOLN/A SOLN $0.0035/MILLILITER
SOTALOL HCL 120 mg TABLET $0.2147/EACH
SOTALOL HCL 160 mg TABLET $0.2400/EACH
SOTALOL HCL 240 mg TABLET $0.1500/EACH
SOTALOL HCL 80 mg TABLET $0.0756/EACH
SPIRONOLACTONE/HCTZ 25 mg/25 mg TABLET $1.1520/EACH
SPIRONOLACTONE 100 mg TABLET $0.1856/EACH
SPIRONOLACTONE 25 mg TABLET $0.0613/EACH Decrease
SPIRONOLACTONE 50 mg TABLET $0.1151/EACH
STAVUDINE 15 mg CAPSULE $6.3890/EACH
STAVUDINE 20 mg CAPSULE $0.8880/EACH
STAVUDINE 30 mg CAPSULE $2.4514/EACH
STAVUDINE 40 mg CAPSULE $0.8160/EACH
SUCRALFATE 1 gm TABLET $0.2114/EACH Increase
SULFACETAMIDE SODIUM/SULFUR 10 %-2 % CRM $5.9160/GRAM
SULFACETAMIDE SODIUM/SULFUR 10%-5% PAD $7.6612/EACH
SULFACETAMIDE SODIUM/SULFUR 10-5%(w/w) CLEANSER $0.2835/GRAM
SULFACETAMIDE SODIUM/SULFUR 10-5%(w/w) CRM $0.0000
SULFACETAMIDE SODIUM 10 % SUSP $1.2544/MILLILITER
SULFACETAMIDE SODIUM 10% DROPS $3.7632/MILLILITER
SULFASALAZINE 500 mg TABLET $0.3202/EACH
SULFASALAZINE 500 mg TABLET $0.0000 Delete
SULINDAC 150 mg TABLET $0.2100/EACH
SULINDAC 200 mg TABLET $0.2550/EACH
SUMATRIPTAN SUCCINATE 100 mg TABLET $0.6572/EACH
SUMATRIPTAN SUCCINATE 25 mg TABLET $0.8100/EACH
SUMATRIPTAN SUCCINATE 4 mg/0.5 ml CARTRIDGE $161.0620/MILLILITER Reactivate
SUMATRIPTAN SUCCINATE 4 mg/0.5 ml PEN INJECTOR $185.5080/MILLILITER Reactivate
SUMATRIPTAN SUCCINATE 50 mg TABLET $0.6453/EACH
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml CARTRIDGE $131.8900/MILLILITER Reactivate
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml PEN INJECTOR $125.9880/MILLILITER Reactivate
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml VIAL $52.6478/MILLILITER Reactivate
SUMATRIPTAN 20 mg AERO (ML) $44.3370/EACH Reactivate
SUMATRIPTAN 5 mg AERO (ML) $43.9114/EACH Reactivate
TACROLIMUS ANHYDROUS 0.5 mg CAPSULE $0.2111/EACH Decrease
TACROLIMUS ANHYDROUS 1 mg CAPSULE $0.2880/EACH
TACROLIMUS ANHYDROUS 5 mg CAPSULE $1.8150/EACH
TACROLIMUS 0.03 % OINT $6.1160/GRAM
TACROLIMUS 0.1 % OINT $5.8648/GRAM
TAMOXIFEN CITRATE 10 mg TABLET $0.2700/EACH
TAMOXIFEN CITRATE 20 mg TABLET $0.5440/EACH
TAMSULOSIN HCL 0.4 mg CAPSULE $0.1500/EACH Decrease
TELMISARTAN/AMLODIPINE 40 MG-10MG TABLET $3.8804/EACH
TELMISARTAN/AMLODIPINE 40 MG-5 MG TABLET $3.8804/EACH
TELMISARTAN/AMLODIPINE 80 MG-10MG TABLET $4.5840/EACH
TELMISARTAN/AMLODIPINE 80 MG-5 MG TABLET $3.5072/EACH
TELMISARTAN/HYDROCHLOROTHIAZID 80-12.5 mg TABLET $0.0000
TELMISARTAN 20 mg TABLET $0.0000
TELMISARTAN 40 MG TABLET $0.0000
TELMISARTAN 80 MG TABLET $0.0000
TEMAZEPAM 15 mg CAPSULE $0.0471/EACH
Page 27 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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TEMAZEPAM 22.5 mg CAPSULE $4.0680/EACH
TEMAZEPAM 30 mg CAPSULE $0.0644/EACH
TEMAZEPAM 7.5 mg CAPSULE $3.2526/EACH
TEMOZOLOMIDE 100 MG CAPSULE $81.0647/EACH
TEMOZOLOMIDE 140 MG CAPSULE $136.0080/EACH
TEMOZOLOMIDE 180 MG CAPSULE $219.3620/EACH
TEMOZOLOMIDE 20 MG CAPSULE $9.7500/EACH Decrease
TEMOZOLOMIDE 250 MG CAPSULE $90.2500/EACH Decrease
TEMOZOLOMIDE 5 MG CAPSULE $5.8080/EACH
TERAZOSIN 1 mg CAPSULE $0.1038/EACH
TERAZOSIN 10 mg CAPSULE $0.0845/EACH
TERAZOSIN 2 mg CAPSULE $0.1012/EACH
TERAZOSIN 5 mg CAPSULE $0.0915/EACH
TERBINAFINE HCL 250 mg TABLET $0.1940/EACH
TERBUTALINE SULFATE 2.5 MG TABLET $0.0000
TERBUTALINE SULFATE 5 MG TABLET $1.4154/EACH
TERCONAZOLE 0.4% CRM $0.4488/GRAM
TERCONAZOLE 0.8% CRM $0.0000
TERCONAZOLE 80 mg SUPP $24.3200/EACH
TESTOSTERONE 1.25g (1%) GEL $0.0000
TESTOSTERONE 25mg(1%) GEL $0.0000
TESTOSTERONE 50 mg (1%) GEL $0.0000
TESTOSTERONE 50 mg (1%) GEL $2.0137/GRAM
TETRABENAZINE 12.5 MG TABLET $69.3440/EACH
TETRABENAZINE 25 MG TABLET $138.6990/EACH
TETRACYCLINE HCL 250 mg CAPSULE $6.0480/EACH
TETRACYCLINE HCL 500 mg CAPSULE $7.3800/EACH Decrease
THEOPHYLLINE ANHYDROUS 100 MG TABLET $0.3603/EACH
THEOPHYLLINE ANHYDROUS 400 MG TABLET $0.5100/EACH
THEOPHYLLINE ANHYDROUS 600 MG TABLET $0.8100/EACH
THEOPHYLLINE 200 mg TABLET $0.4446/EACH
THEOPHYLLINE 300 mg CAPSULE $0.0000
THEOPHYLLINE 300 mg TABLET $2.4324/EACH
THIORIDAZINE HCL 10 mg TABLET $0.3720/EACH
THIORIDAZINE HCL 100 mg/ml CONC $0.0000
THIORIDAZINE HCL 100 mg TABLET $0.7320/EACH
THIORIDAZINE HCL 15 mg TABLET $0.0000
THIORIDAZINE HCL 200 mg TABLET $0.0000
THIORIDAZINE HCL 25 mg TABLET $0.5111/EACH
THIORIDAZINE HCL 30 mg/ml CONC $0.0000
THIORIDAZINE HCL 50 mg TABLET $0.3720/EACH
THIOTHIXENE 1 mg CAPSULE $0.6120/EACH
THIOTHIXENE 10 mg CAPSULE $1.7400/EACH
THIOTHIXENE 2 mg CAPSULE $1.1346/EACH
THIOTHIXENE 5 mg CAPSULE $1.2360/EACH
TIAGABINE HCL 2 mg TABLET $5.5550/EACH
TIAGABINE HCL 4 mg TABLET $5.2432/EACH
TICLOPIDINE HCL 250 mg TABLET $0.0000
TIMOLOL MALEATE/DORZOLAMIDE HCL 0.5%-2% DROPS $0.8970/MILLILITER
TIMOLOL MALEATE 0.0025 DROPS $0.7560/MILLILITER
TIMOLOL MALEATE 0.0025 SOLN $22.6700/MILLILITER
TIMOLOL MALEATE 0.005 DROPS $0.7950/MILLILITER
TIMOLOL MALEATE 0.005 SOLN $15.5100/MILLILITER
TIMOLOL MALEATE 10 mg TABLET $0.0000
TIZANIDINE HCL 2 MG CAPSULE $1.7160/EACH
TIZANIDINE HCL 2 mg TABLET $0.1175/EACH Decrease
TIZANIDINE HCL 4 MG CAPSULE $1.7040/EACH
TIZANIDINE HCL 4 mg TABLET $0.1315/EACH Decrease
TIZANIDINE HCL 6 MG CAPSULE $3.2520/EACH
TOBRAMYCIN IN 0.225% NACL 300 MG/5ML AMPUL $12.0560/MILLILITER Reactivate
TOBRAMYCIN SULFATE/DEXAMETHASONE 0.3 - 0.1% DROPS $13.1040/MILLILITER
TOBRAMYCIN SULFATE 1.2 gm VIAL $101.9813/EACH
TOBRAMYCIN SULFATE 40 mg/ml VIAL $0.0000
TOBRAMYCIN 0.003 DROPS $2.4461/MILLILITER
TOLBUTAMIDE 500 mg TABLET $0.0000
TOLCAPONE 100 MG TABLET $94.2004/EACH
TOLMETIN SODIUM 200 mg TABLET $0.0000
TOLMETIN SODIUM 400 mg CAPSULE $0.0000
TOLMETIN SODIUM 600 mg TABLET $0.0000
TOLNAFTATE 1 % CRM $0.0000 Delete
TOLTERODINE TARTRATE 1 MG TABLET $0.7920/EACH
TOLTERODINE TARTRATE 2 MG CAPSULE $4.4532/EACH
TOLTERODINE TARTRATE 2 MG TABLET $1.0650/EACH
TOLTERODINE TARTRATE 4 MG CAPSULE $3.1950/EACH Decrease
TOPIRAMATE 100 mg TABLET $0.1214/EACH
TOPIRAMATE 15 mg CAPSULE $0.4500/EACH
TOPIRAMATE 200 mg TABLET $0.1327/EACH Decrease
TOPIRAMATE 25 mg CAPSULE $0.4440/EACH
TOPIRAMATE 25 mg TABLET $0.0400/EACH
TOPIRAMATE 50 mg TABLET $0.0587/EACH
TOPOTECAN HCL 4 mg VIAL $126.0000/EACH
TORSEMIDE 10 mg TABLET $0.0960/EACH
TORSEMIDE 100 mg TABLET $0.2400/EACH
TORSEMIDE 20 mg TABLET $0.0969/EACH
TORSEMIDE 5 mg TABLET $0.1264/EACH
TRAMADOL HCL/APAP 37.5/325 mg TABLET $0.3761/EACH
TRAMADOL HCL 100 mg TABLET $0.7745/EACH
TRAMADOL HCL 100 mg TABLET $1.8344/EACH
TRAMADOL HCL 200 mg TABLET $1.3200/EACH
TRAMADOL HCL 200 MG TAB, ER 24 HR $3.1553/TABLET Add
TRAMADOL HCL 300 MG TABLET $2.5410/EACH
TRAMADOL HCL 300 mg TABLET $4.4600/EACH
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NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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TRAMADOL 50 mg TABLET $0.0176/EACH
TRANDOLAPRIL 1 mg TABLET $0.1910/EACH
TRANDOLAPRIL 2 mg TABLET $0.3163/EACH
TRANDOLAPRIL 4 mg TABLET $0.1910/EACH
TRANEXAMIC ACID 650 MG TABLET $2.3433/EACH
TRANYLCYPROMINE SULFATE 10 mg TABLET $1.7694/EACH
TRAZODONE HCL 100 mg TABLET $0.0700/EACH
TRAZODONE HCL 150 mg TABLET $0.2113/EACH
TRAZODONE HCL 300 mg TABLET $3.0300/EACH
TRAZODONE HCL 50 mg TABLET $0.0631/EACH
TRETINOIN MICROSPHERES 0.04 % GEL $8.8330/GRAM
TRETINOIN MICROSPHERES 0.04 % GEL $10.4990/GRAM
TRETINOIN MICROSPHERES 0.1 % GEL $8.8330/GRAM
TRETINOIN MICROSPHERES 0.1 % GEL $9.2391/GRAM
TRETINOIN 0.0001 GEL $0.0000
TRETINOIN 0.00025 CRM $0.0000
TRETINOIN 0.00025 GEL $0.0000
TRETINOIN 0.0005 CRM $0.0000
TRETINOIN 0.0005 LIQ $0.0000
TRETINOIN 0.001 CRM $0.0000
TRETINOIN 10 mg CAPSULE $0.0000
TRIAMCINOLONE ACETONIDE 0.00025 LOTION $0.4656/MILLILITER
TRIAMCINOLONE ACETONIDE 0.001 CRM $0.0951/GRAM
TRIAMCINOLONE ACETONIDE 0.001 OINT $0.1780/GRAM Decrease
TRIAMCINOLONE ACETONIDE 0.001 PASTE $8.7900/GRAM
TRIAMCINOLONE ACETONIDE 0.001 LOTION $0.4800/MILLILITER
TRIAMCINOLONE ACETONIDE 0.005 CRM $0.7380/GRAM
TRIAMCINOLONE ACETONIDE 0.025%, 15gm CRM $0.2928/GRAM
TRIAMCINOLONE ACETONIDE 0.025%, 80gm CRM $0.1251/GRAM
TRIAMCINOLONE ACETONIDE 0.025%, 80gm OINT $0.1050/GRAM
TRIAMTERENE & HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg CAPSULE $0.1643/EACH
TRIAMTERENE & HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg TABLET $0.1505/EACH Decrease
TRIAMTERENE & HYDROCHLOROTHIAZIDE 50 mg; 25 mg CAPSULE $0.0000
TRIAMTERENE & HYDROCHLOROTHIAZIDE 75 mg; 50 mg TABLET $0.0840/EACH
TRIAZOLAM 0.125 mg TABLET $0.8412/EACH
TRIAZOLAM 0.25 mg TABLET $1.0253/EACH
TRIFLUOPERAZINE HCL 1 mg TABLET $0.6611/EACH
TRIFLUOPERAZINE HCL 10 mg TABLET $1.8480/EACH
TRIFLUOPERAZINE HCL 2 mg TABLET $0.9720/EACH
TRIFLUOPERAZINE HCL 5 mg TABLET $1.2240/EACH
TRIHEXYPHENIDYL HCL 2 mg TABLET $0.0660/EACH
TRIHEXYPHENIDYL HCL 5 mg TABLET $0.1080/EACH
TRIMETHOBENZAMIDE HCL 300 mg CAPSULE $0.9628/EACH
TRIMETHOBENZAMIDE 100 mg SUPP $0.0000
TRIMETHOBENZAMIDE 200 mg SUPP $0.0000
TRIMETHOPRIM AND SULFAMETHOXAZOLE DS 160 mg; 800 mg TABLET $0.0480/EACH
TRIMETHOPRIM AND SULFAMETHOXAZOLE SS 80 mg; 400 mg TABLET $0.0832/EACH
TRIMETHOPRIM AND SULFAMETHOXAZOLE 40 mg; 200 mg per 5 ml SUSP $0.1945/MILLILITER Decrease
TRIMETHOPRIM/POLYMYXIN B 1 mg/10,000 units/ml DROPS $0.3828/MILLILITER
TRIMETHOPRIM 100 mg TABLET $0.0000
TROPICAMIDE 0.5 % DROPS $0.0000
TROPICAMIDE 1 % DROPS $0.0000
UREA 10 % CRM $0.0969/GRAM
UREA 40 % CRM $0.0000
UREA 40 % FOAM $2.0615/GRAM
UREA 50 % CRM $0.0600/GRAM
UREA 50 % OINT $1.2557/GRAM
URSODIOL 250 mg TABLET $1.5200/EACH
URSODIOL 300 mg CAPSULE $3.4284/EACH
URSODIOL 500 mg TABLET $1.8000/EACH
VALACYCLOVIR HCL 1000 mg TABLET $0.5516/EACH Reactivate
VALACYCLOVIR HCL 500 mg TABLET $0.3300/EACH Reactivate
VALGANCICLOVIR HCL 450 mg TABLET $17.3832/EACH
VALPROIC ACID 250 mg/5 ml SOLN $0.0150/MILLILITER
VALPROIC ACID 250 mg CAPSULE $0.1548/EACH
VALSARTAN/HYDROCHLOROTHIAZIDE 160-12.5MG TABLET $0.1956/EACH Reactivate
VALSARTAN/HYDROCHLOROTHIAZIDE 160-25MG TABLET $0.2640/EACH Reactivate
VALSARTAN/HYDROCHLOROTHIAZIDE 320-12.5MG TABLET $0.2880/EACH Reactivate
VALSARTAN/HYDROCHLOROTHIAZIDE 320MG-25MG TABLET $0.3240/EACH Reactivate
VALSARTAN/HYDROCHLOROTHIAZIDE 80-12.5MG TABLET $0.2085/EACH Reactivate
VALSARTAN 160 MG TABLET $0.1590/EACH Reactivate
VANCOMYCIN HCL 1 gm VIAL $14.2538/EACH
VANCOMYCIN HCL 125 MG CAPSULE $5.9153/EACH
VANCOMYCIN HCL 250 MG CAPSULE $10.9200/EACH
VANCOMYCIN HCL 5 gm VIAL $28.9713/EACH
VANCOMYCIN HCL 500 mg VIAL $0.0000
VANCOMYCIN HCL 500 mg VIAL $3.8536/EACH
VENLAFAXINE HCL 37.5 mg TABLET $0.2700/EACH
VENLAFAXINE HCL 75 mg TABLET $0.2420/EACH
VENLAFAXINE HCL 100 mg TABLET $0.4080/EACH
VENLAFAXINE HCL 150 MG CAPSULE $0.2093/EACH
VENLAFAXINE HCL 150 MG TABLET $4.5720/EACH
VENLAFAXINE HCL 225 MG TAB, ER 24 HR $8.9600/TABLET Add
VENLAFAXINE HCL 25 mg TABLET $0.2640/EACH
VENLAFAXINE HCL 37.5 MG CAPSULE $0.1440/EACH
VENLAFAXINE HCL 37.5 MG TABLET $2.9636/EACH
VENLAFAXINE HCL 50 mg TABLET $0.2160/EACH
VENLAFAXINE HCL 75 MG CAPSULE $0.1457/EACH
VENLAFAXINE HCL 75 MG TABLET $2.5360/EACH
VERAPAMIL HCL 100 mg CAPSULE $1.0680/EACH
VERAPAMIL HCL 120 mg CAPSULE $0.8213/EACH
VERAPAMIL HCL 120 mg TABLET $0.1891/EACH
Page 29 of 30
NAME OF GENERIC DRUG STRENGTH FORM
October 1, 2017 Price
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Reactivate
VERAPAMIL HCL 120 mg TABLET $0.0923/EACH
VERAPAMIL HCL 180 mg CAPSULE $1.0650/EACH
VERAPAMIL HCL 180 mg TABLET $0.2742/EACH
VERAPAMIL HCL 200 mg CAPSULE $1.9542/EACH
VERAPAMIL HCL 240 mg CAPSULE $0.9672/EACH
VERAPAMIL HCL 240 mg TABLET $0.0826/EACH
VERAPAMIL HCL 300 mg CAPSULE $1.8600/EACH
VERAPAMIL HCL 360 mg CAPSULE $4.2588/EACH
VERAPAMIL HCL 80 mg TABLET $0.1080/EACH
VINCRISTINE SULFATE 1 mg/ ml VIAL $5.9400/MILLILITER
VINCRISTINE SULFATE 2 mg/2 ml VIAL $7.0274/MILLILITER
VINORELBINE TARTRATE 10 mg/ml VIAL $20.4750/MILLILITER
VINORELBINE TARTRATE 50 mg/5 ml VIAL $17.3250/MILLILITER
VORICONAZOLE 200 mg TABLET $5.8200/EACH
VORICONAZOLE 50 mg TABLET $11.0044/EACH
WARFARIN SODIUM 1 mg TABLET $0.1274/EACH
WARFARIN SODIUM 10 mg TABLET $0.1500/EACH
WARFARIN SODIUM 2 mg TABLET $0.1585/EACH
WARFARIN SODIUM 2.5 mg TABLET $0.1320/EACH
WARFARIN SODIUM 3 mg TABLET $0.1500/EACH
WARFARIN SODIUM 4 mg TABLET $0.1261/EACH
WARFARIN SODIUM 5 mg TABLET $0.1842/EACH
WARFARIN SODIUM 6 mg TABLET $0.1262/EACH
WARFARIN SODIUM 7.5 mg TABLET $0.1127/EACH
WATER FOR INJECTION, BACTERIOSTATIC VIAL NA VIAL $0.0000
WATER FOR INJECTION, STERILE IV SOLUTION NA SOLN $0.0000
WATER FOR IRRIGATION, STERILE SOLUTION NA SOLN $0.0000
ZAFIRLUKAST 10 mg TABLET $1.3542/EACH Reactivate
ZAFIRLUKAST 20 mg TABLET $1.4550/EACH Reactivate
ZALEPLON 10 mg CAPSULE $0.1728/EACH
ZALEPLON 5 mg CAPSULE $0.1724/EACH
ZIDOVUDINE 100 mg CAPSULE $1.3950/EACH
ZIDOVUDINE 300 mg TABLET $0.3600/EACH
ZIDOVUDINE 50 mg/5 ml SYRUP $0.1750/MILLILITER
ZIPRASIDONE HCL 20 mg CAPSULE $0.6100/EACH
ZIPRASIDONE HCL 40 mg CAPSULE $0.5956/EACH
ZIPRASIDONE HCL 60 mg CAPSULE $0.7800/EACH
ZIPRASIDONE HCL 80 mg CAPSULE $0.7100/EACH
ZOLMITRIPTAN 2.5 MG TABLET $8.1730/EACH
ZOLMITRIPTAN 2.5 MG TABLET $7.6050/EACH
ZOLMITRIPTAN 5 MG TABLET $8.7120/EACH
ZOLMITRIPTAN 5 MG TABLET $8.7120/EACH
ZOLPIDEM TARTRATE 10 mg TABLET $0.0318/EACH
ZOLPIDEM TARTRATE 12.5 mg TABLET $1.0284/EACH
ZOLPIDEM TARTRATE 5 mg TABLET $0.0318/EACH
ZOLPIDEM TARTRATE 6.25 mg TABLET $1.2810/EACH
ZONISAMIDE 100 mg CAPSULE $0.2034/EACH
ZONISAMIDE 25 mg CAPSULE $0.0845/EACH
ZONISAMIDE 50 mg CAPSULE $0.1350/EACH
Page 30 of 30