Skip Navigation LinksOA_ADAP_PrEP_AP_Clinically_Administered_Medications

office of aids

PrEP-AP Clinically Administered Medications

The California Department of Public Health, Office of AIDS (OA), PrEP Assistance Program (PrEP-AP) assists with medical out-of-pocket costs for clients for the PrEP-related services identified below. For reimbursement, all claims must include: 1) National Drug Codes (NDC) on claims for medication, 2) the corresponding Healthcare Common Procedure Coding System (HCPCS) codes or Current Procedural Terminology (CPT) code, and 3) the units administered for each code.

Please Note: Most contracted providers are required to be participants in the 340B Drug Pricing Program. All contracted providers are required to bill PAI at the discounted 340B rate if they wish to bill for clinically administered medications. Claims submitted in excess of this amount will only be paid up to the 340B amount. Uninsured clients, minor clients, and clients with confidentiality concerns must receive services at approved locations within the PrEP-AP Provider Network. Unless the client is a minor or is a client with confidentiality concerns, insured clients must receive services from a provider within their health plan network.  PrEP-AP will pay for the actual portion of their co-payment obligation charged by the insurance plan.

Approved Clinically Administered Medications

Medications approved by PrEP-AP for direct dispense by a clinician are limited to single dose medications on the PrEP-AP Formulary. A prescription must be provided for all other medications on the PrEP-AP Formulary that require multiple doses or ongoing treatment. PrEP-AP will cover vaccination and therapeutic injection series that require more than a single dose of medication; however, each dose must be billed separately at the time of each individual injection administration.

The following are the only medications currently approved by PrEP-AP for administration in a clinical setting. A more detailed list of allowable permutations including NDCs and reimbursement amounts begins on page 5 of this document.


HCPCS/CPT CodeMedicationStrengthDosage FormDate Added
90651
Human Papillomavirus (HPV)

9-valent recombinant vaccine (Gardasil 9 ™)

0.5 mL
Syringe, Vial
03/06/2019

90632

(CPT codes covered if selection criteria are met: 90633 or 90634 adolescent dosages)

Hepatitis A vaccine (Havrix™ or Vaqta™)

Havrix: 0.5 mL (720 EIU), 1.0 mL (1440 EIU)

Vaqta: 0.5 mL (25 U), 1.0 mL (50 U)

Syringe, Vial04/15/2020
G0010Hepatitis B vaccine (Heplisav-B™)20 mcg / 0.5 mLSyringe, Vial01/30/2019
G0010
Hepatitis B vaccine (Engerix-B™ or Recombivax HB™)

Engerix-B: 0.5 mL (10 mcg), 20 mcg / mL

Recombivax HB: 5 mcg / 0.5 mL, 10 mcg / mL

Syringe, Vial04/09/2018
90636Hepatitis A/Hepatitis B combined vaccine (Twinrix™)20 mcg / mLSyringe, Vial04/09/2018
Q0144Azithromycin250 mg / 500 mg / 600 mgTablet04/09/2018
J0561Penicillin G Benzathine1.2 million unit / 2 mL,
2.4 million unit / 4 mL,
600,000 unit / mL
Syringe04/09/2018

J0715 / 500mg

J0696 / 250mg

Ceftriaxone Sodium250 mg-10 gVial04/09/2018
G8711
Gemifloxacin320 mgTablet04/09/2018
J1580
Gentamicin Sulfate

40 mg / mL, 20mg / 2mL

Vial04/09/2018
J3490
Metronidazole250-500mgTablet04/09/2018
J3490
Cefixime400 mgCapsule04/09/2018

90620

Bexsero
50-50/.5mLSyringe10/08/2021
90734
Menactra, Menveo4mcg/5.mL, 10-5/.5mLVial10/08/2021
90621Trumenba120mcg/.5mLSyringe10/08/2021


Billing for Administration

Billing for injection administration must be supported by corresponding CPT and/or HCPCS codes for the injections listed on the chart above. If more than one injection is administered, billing for administration must be displayed as separate line items.

The CPT codes below may be used when billing for injection administration:

CPT Code
DescriptionReimbursement Rate
90471
Immunization Administration
$16.94
96372, 96373Therapeutic, Prophylactic, & Diagnostic Injections and Infusions$16.94


Billing for Clinically Administered Medications

Approved medications that are administered in a clinical setting must be billed through the PrEP-AP's Medical Benefits Manager, Pool Administrators Inc. (PAI) either electronically through the established medical claims clearinghouse or directly to PAI via a Centers for Medicare & Medicaid Services (CMS) Form 1500. As with all medical claims, PrEP-AP requires that claims be submitted within 180 days of the provider visit.

Reporting NDCs

NDCs are a universal product identifier for drugs by which drug products are identified and reported. NDCs consist of a unique, three-segment number with 11 digits in a 5-4-2 format. The first 5 digits identify the manufacturer of the drug and are assigned by the Food and Drug Administration. The remaining digits are assigned by the manufacturer and identify the specific product and package size.

Some packages may display less than 11 digits, but leading zeroes can be assumed and must be used. Additionally, NDCs must be reported with hyphens displayed. 

For example:

NCD Package Display
11-Digit NDC Format
XXXX-XXXX-XX0XXXX-XXXX-XX
XXXXX-XXX-XXXXXXX-0XXX-XX
XXXXX-XXXX-XXXXXX-XXXX-0X


Claim Submission Checklist:

  • File the claim within 180 days

  • Ensure an approved International Classification of Diseases (ICD-10) code(s) is provided to substantiate the provider visit as being PrEP-related

  • Bill only for medications approved by PrEP-AP for direct dispense by a clinician. 

  • Ensure the correct 11-digit NDC with hyphens and corresponding HCPC/CPT is provided

  • Ensure claims billed for medication do not exceed the 340B drug price


Detailed List of Allowable Clinically Administered Medications


NDC CodeCPT CodeStart DateBrand Name
Generic Name
Per Unit PriceStrengthDosage FormPackage SizeBilling UnitMulti Source Single Source Ind
Clinical Formulation ID (GSN)
00006-4119-03906513/6/2019GARDASIL 9HUMAN PAPILLOMAVIRUS (HPV) 9-VALENT RECOMBINANT VACCINE$216.360.5 mLVIAL (mL)0.50MILLILITERSSingle Source73199
00006-4121-02906513/6/2019GARDASIL 9HUMAN PAPILLOMAVIRUS (HPV) 9-VALENT RECOMBINANT VACCINE$216.360.5 mLSYRINGE (mL)0.50MILLILITERSSingle Source73200
43528-0002-01G00101/30/2019HEPLISAV - BHEPATITIS B VACCINE RECOMBINANT/VACCINE ADJUVANT CpG$96.6020 mcg/0.5 mLVIAL (mL)0.50MILLILITERSSingle Source77946
43528-0002-05
G00101/30/2019HEPLISAV - B
HEPATITIS B VACCINE RECOMBINANT/VACCINE ADJUVANT CpG$96.6020 mcg/0.5 mLVIAL (mL)0.50MILLILITERSSingle Source077976
43528-0003-01G00101/30/2019HEPLISAV - BHEPATITIS B VACCINE RECOMBINANT/VACCINE ADJUVANT CpG$96.6020 mcg/0.5 mLSYRINGE (mL)0.50MILLILITERSSingle Source078645
43528-0003-05G00101/30/2019HEPLISAV - BHEPATITIS B VACCINE RECOMBINANT/VACCINE ADJUVANT CpG$96.6020 mcg/0.5 mLSYRINGE (mL)0.50MILLILITERSSingle Source078645
58160-0821-01G00104/9/2018ENGERIX-B ADULTHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$47.4620 mcg/mLVIAL (ML)1.00MILLILITERSSingle Source62668
58160-0821-11G00104/9/2018ENGERIX-B ADULTHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$47.4620 mcg/mLVIAL (ML)1.00MILLILITERSSingle Source62668
58160-0821-43G00104/9/2018ENGERIX-B ADULTHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$47.4620 mcg/mLSYRINGE (mL)1.00MILLILITERSSingle Source62514
58160-0821-52G00104/9/2018ENGERIX-B ADULTHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$47.4620 mcg/mLSYRINGE (mL)1.00MILLILITERSSingle Source62514
58160-0820-43G00104/9/2018ENGERIX-B PEDIATRIC-ADOLESCENTHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$37.4610 mcg/0.5 mLSYRINGE (mL)0.50MILLILITERSSingle Source62664
58160-0820-52G00104/9/2018ENGERIX-B PEDIATRIC-ADOLESCENTHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$37.4610 mcg/0.5 mLSYRINGE (mL)0.50MILLILITERSSingle Source62664
00006-4093-01G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$38.985 mcg/0.5 mLSYRINGE (mL)0.50MILLILITERSSingle Source62709
00006-4093-02G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$38.985 mcg/0.5 mLSYRINGE (mL)0.50MILLILITERSSingle Source62709
00006-4094-01G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$50.7910 mcg/mLSYRINGE (mL)1.00MILLILITERSSingle Source62708
00006-4094-02G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$50.7910 mcg/mLSYRINGE (mL)1.00MILLILITERSSingle Source62708
00006-4981-00G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$38.985 mcg/0.5 mLVIAL (mL)0.50MILLILITERSSingle Source62710
00006-4981-01G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$38.985 mcg/0.5 mLVIAL (mL)0.50MILLILITERSSingle Source62710
00006-4995-00G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$51.6910 mcg/mLVIAL (mL)1.00MILLILITERSSingle Source62678
00006-4995-01G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$51.6910 mcg/mLVIAL (mL)1.00MILLILITERSSingle Source62678
00006-4995-41G00104/9/2018RECOMBIVAX HBHEPATITIS B VIRUS VACCINE RECOMBINANT/PF$50.7910 mcg/mLVIAL (mL)1.00MILLILITERSSingle Source62678
58160-0815-43906364/9/2018TWINRIXHEPATITIS A VIRUS AND HEPATITIS B VIRUS VACCINE/PF$83.58720 Elisa unit-20 mcg/mLSYRINGE (mL)1.00MILLILITERSSingle Source62816
58160-0815-52906364/9/2018TWINRIXHEPATITIS A VIRUS AND HEPATITIS B VIRUS VACCINE/PF$83.58720 Elisa unit-20 mcg/mLSYRINGE (mL)1.00MILLILITERSSingle Source62816
68180-0161-06Q01445/1/2019AZITHROMYCINAZITHROMYCIN$4.83500 mgTABLET30.00EACHMultiple Source26624
60505-2581-02Q01444/9/2018AZITHROMYCINAZITHROMYCIN$1.18250 mgTABLET6.00EACHMultiple Source26721
68084-0278-01Q01444/9/2018AZITHROMYCINAZITHROMYCIN$1.46250 mgTABLET100.00EACHMultiple Source26721
63739-0575-10Q01444/9/2018AZITHROMYCINAZITHROMYCIN$1.87250 mgTABLET100.00EACHMultiple Source26721
60505-2582-02Q01444/9/2018AZITHROMYCINAZITHROMYCIN$2.36500 mgTABLET3.00EACHMultiple Source22624
59762-3060-03Q01444/9/2018AZITHROMYCINAZITHROMYCIN$2.86250 mgTABLET50.00EACHMultiple Source26721
60687-0314-25Q01444/9/2018AZITHROMYCINAZITHROMYCIN$3.18600 mgTABLET30.00EACHMultiple Source27252
50111-0788-52Q01444/9/2018AZITHROMYCINAZITHROMYCIN$8.49500 mgTABLET50.00EACHMultiple Source22624
00069-3060-86Q01444/9/2018ZITHROMAXAZITHROMYCIN$28.83250 mgTABLET50.00EACHMultiple Source26721
00069-3070-86Q01444/9/2018ZITHROMAXAZITHROMYCIN$57.67500 mgTABLET50.00EACHMultiple Source22624
60793-0701-10J05614/9/2018BICILLIN L-APENICILLIN G BENZATHINE$66.091.2 million unit/2 mLSYRINGE (mL)2.00MILLILITERSSingle Source43349
60793-0701-10J05614/9/2018BICILLIN L-APENICILLIN G BENZATHINE$66.091.2 million unit/2 mLSYRINGE (mL)2.00MILLILITERSSingle Source43349
60793-0702-10J05614/9/2018BICILLIN L-APENICILLIN G BENZATHINE$67.722.4 million unit/4 mLSYRINGE (mL)4.00MILLILITERSSingle Source43350
60793-0702-10J05614/9/2018BICILLIN L-APENICILLIN G BENZATHINE$67.722.4 million unit/4 mLSYRINGE (mL)4.00MILLILITERSSingle Source43350
60793-0700-10J05614/9/2018BICILLIN L-APENICILLIN G BENZATHINE$76.32600,000 unit/mLSYRINGE (mL)1.00MILLILITERSSingle Source8873
60793-0700-10J05614/9/2018BICILLIN L-APENICILLIN G BENZATHINE$76.32600,000 unit/mLSYRINGE (mL)1.00MILLILITERSSingle Source8873
00409-7337-01J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$0.63250 mgVIAL (EA)1.00EACHMultiple Source9165
00409-7338-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$0.80500 mgVIAL (EA)1.00EACHMultiple Source9166
00143-9859-25J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.01250 mgVIAL (EA)1.00EACHMultiple Source9165
55390-0310-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.05500 mgVIAL (EA)1.00EACHMultiple Source9166
55390-0309-10J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.05250 mgVIAL (EA)1.00EACHMultiple Source9165
00143-9858-25J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.26500 mgVIAL (EA)1.00EACHMultiple Source9166
00409-7332-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.261 gramVIAL (EA)1.00EACHMultiple Source9162
63323-0344-10J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.33250 mgVIAL (EA)1.00EACHMultiple Source9165
00781-3206-95J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.49250 mgVIAL (EA)1.00EACHMultiple Source9165
25021-0105-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.51500 mgVIAL (EA)1.00EACHMultiple Source9166
25021-0105-66J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.51500 mgVIAL (EA)1.00EACHMultiple Source9166
60505-0750-01J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.56250 mgVIAL (EA)1.00EACHMultiple Source9165
60505-0750-04J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.56250 mgVIAL (EA)1.00EACHMultiple Source9165
60505-6151-01J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.56250 mgVIAL (EA)1.00EACHMultiple Source9165
64679-0701-02J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.76250 mgVIAL (EA)1.00EACHMultiple Source9165
55390-0311-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.851 gramVIAL (EA)1.00EACHMultiple Source9162
60505-0750-00J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.89250 mgVIAL (EA)1.00EACHMultiple Source9165
60505-6151-04J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.89250 mgVIAL (EA)1.00EACHMultiple Source9165
68180-0611-01J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.89250 mgVIAL (EA)1.00EACHMultiple Source9165
68180-0611-10J06964/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$1.89250 mgVIAL (EA)1.00EACHMultiple Source9165
25021-0106-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.021 gramVIAL (EA)1.00EACHMultiple Source9162
25021-0106-67J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.021 gramVIAL (EA)1.00EACHMultiple Source9162
00143-9857-25J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.101 gramVIAL (EA)1.00EACHMultiple Source9162
60505-6102-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.352 gramVIAL (EA)1.00EACHMultiple Source9164
60505-6102-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.352 gramVIAL (EA)1.00EACHMultiple Source9164
00781-3207-95J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.39500 mgVIAL (EA)1.00EACHMultiple Source9166
00409-7335-03J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.392 gramVIAL (EA)1.00EACHMultiple Source9164
60505-0751-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.52500 mgVIAL (EA)1.00EACHMultiple Source9166
60505-0751-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.52500 mgVIAL (EA)1.00EACHMultiple Source9166
60505-6152-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.52500 mgVIAL (EA)1.00EACHMultiple Source9166
44567-0701-25J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.521 gramVIAL (EA)1.00EACHMultiple Source9162
63323-0345-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.70500 mgVIAL (EA)1.00EACHMultiple Source9166
64679-0702-02J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.90500 mgVIAL (EA)1.00EACHMultiple Source9166
60505-0752-03J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.941 gramVIAL (EA)1.00EACHMultiple Source9162
60505-0752-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.941 gramVIAL (EA)1.00EACHMultiple Source9162
60505-6148-00J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.941 gramVIAL (EA)1.00EACHMultiple Source9162
60505-6148-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$2.941 gramVIAL (EA)1.00EACHMultiple Source9162
60505-0751-00J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.07500 mgVIAL (EA)1.00EACHMultiple Source9166
60505-6152-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.07500 mgVIAL (EA)1.00EACHMultiple Source9166
68180-0622-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.07500 mgVIAL (EA)1.00EACHMultiple Source9166
68180-0622-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.07500 mgVIAL (EA)1.00EACHMultiple Source9166
00409-7333-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.131 gramVIAL WITH THREADED PORT (EA)1.00EACHSingle Source59869
63323-0346-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.281 gramVIAL (EA)1.00EACHMultiple Source9162
00409-7333-49J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.281 gramVIAL WITH THREADED PORT (EA)1.00EACHSingle Source59869
10019-0098-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.361 gramVIAL (EA)1.00EACHMultiple Source9162
10019-0098-71J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.361 gramVIAL (EA)1.00EACHMultiple Source9162
25021-0107-20J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.702 gramVIAL (EA)1.00EACHMultiple Source9164
25021-0107-68J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.702 gramVIAL (EA)1.00EACHMultiple Source9164
55390-0312-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.702 gramVIAL (EA)1.00EACHMultiple Source9164
00143-9856-25J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.782 gramVIAL (EA)1.00EACHMultiple Source9164
00781-3208-95J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.921 gramVIAL (EA)1.00EACHMultiple Source9162
00781-9328-95J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$3.921 gramVIAL (EA)1.00EACHMultiple Source9162
68180-0633-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$4.641 gramVIAL (EA)1.00EACHMultiple Source9162
68180-0633-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$4.641 gramVIAL (EA)1.00EACHMultiple Source9162
44567-0702-25J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$5.042 gramVIAL (EA)1.00EACHMultiple Source9164
60505-0753-03J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$5.042 gramVIAL (EA)1.00EACHMultiple Source9164
60505-0753-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$5.042 gramVIAL (EA)1.00EACHMultiple Source9164
60505-6149-00J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$5.042 gramVIAL (EA)1.00EACHMultiple Source9164
60505-6149-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$5.042 gramVIAL (EA)1.00EACHMultiple Source9164
64679-0983-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$5.881 gramVIAL (EA)1.00EACHMultiple Source9162
64679-0983-02J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$5.881 gramVIAL (EA)1.00EACHMultiple Source9162
00409-7336-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$6.032 gramVIAL WITH THREADED PORT (EA)1.00EACHSingle Source59870
10019-0688-04J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$6.272 gramVIAL (EA)1.00EACHMultiple Source9164
10019-0688-27J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$6.272 gramVIAL (EA)1.00EACHMultiple Source9164
63323-0347-20J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$6.552 gramVIAL (EA)1.00EACHMultiple Source9164
00781-3209-95J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$7.492 gramVIAL (EA)1.00EACHMultiple Source9164
64679-0703-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$9.242 gramVIAL (EA)1.00EACHMultiple Source9164
64679-0703-02J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$9.242 gramVIAL (EA)1.00EACHMultiple Source9164
68180-0644-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$9.272 gramVIAL (EA)1.00EACHMultiple Source9164
68180-0644-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$9.272 gramVIAL (EA)1.00EACHMultiple Source9164
00409-7334-10J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$14.3310 gramVIAL (EA)1.00EACHMultiple Source9163
55390-0316-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$22.4310 gramVIAL (EA)1.00EACHMultiple Source9163
25021-0108-69J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$23.5210 gramVIAL (EA)1.00EACHMultiple Source9163
44567-0703-01J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$23.5210 gramVIAL (EA)1.00EACHMultiple Source9163
10019-0689-05J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$29.2210 gramVIAL (EA)1.00EACHMultiple Source9163
10019-0689-11J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$29.2210 gramVIAL (EA)1.00EACHMultiple Source9163
60505-0679-05J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$33.9110 gramVIAL (EA)1.00EACHMultiple Source9163
00781-3210-46J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$37.4710 gramVIAL (EA)1.00EACHMultiple Source9163
63323-0348-61J07154/9/2018CEFTRIAXONECEFTRIAXONE SODIUM$38.2210 gramVIAL (EA)1.00EACHMultiple Source9163
44001-0321-05G87114/9/2018FACTIVEGEMIFLOXACIN MESYLATE$39.87320 mgTABLET5.00EACHSingle Source53835
44001-0321-07G87114/9/2018FACTIVEGEMIFLOXACIN MESYLATE$39.87320 mgTABLET7.00EACHSingle Source53835
63323-0010-94J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$0.3540 mg/mLVIAL (mL)2.00MILLILITERSMultiple Source9299
00409-1207-25J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$0.3740 mg/mLVIAL (mL)2.00MILLILITERSMultiple Source9299
00409-1207-03J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$0.4740 mg/mLVIAL (mL)2.00MILLILITERSMultiple Source9299
63323-0010-95J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$0.7640 mg/mLVIAL (mL)20.00MILLILITERSMultiple Source9299
63323-0010-96J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$0.7640 mg/mLVIAL (mL)20.00MILLILITERSMultiple Source9299
63323-0010-20J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$0.8540 mg/mLVIAL (mL)20.00MILLILITERSMultiple Source9299
63323-0010-02J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$1.3640 mg/mLVIAL (mL)2.00MILLILITERSMultiple Source9299
63323-0513-02J15804/9/2018GENTAMICIN SULFATEGENTAMICIN SULFATE$1.6820 mg/2 mLVIAL (mL)2.00MILLILITERSSingle Source9298
51079-0216-20J34904/9/2018METRONIDAZOLEMETRONIDAZOLE$0.33250 mgTABLET100.00EACHMultiple Source9591
50268-0538-15J34904/9/2018METRONIDAZOLEMETRONIDAZOLE$0.33250 mgTABLET50.00EACHMultiple Source9591
00904-1453-61J34904/9/2018METRONIDAZOLEMETRONIDAZOLE$0.34250 mgTABLET100.00EACHMultiple Source9591
68084-0216-01J34904/9/2018METRONIDAZOLEMETRONIDAZOLE$0.35250 mgTABLET100.00EACHMultiple Source9591
42292-0001-20J34904/9/2018METRONIDAZOLEMETRONIDAZOLE$0.56500 mgTABLET100.00EACHMultiple Source9592
68084-0966-01J34904/9/2018METRONIDAZOLEMETRONIDAZOLE$0.63500 mgTABLET100.00EACHMultiple Source9592
00904-6568-61J34904/9/2018METRONIDAZOLEMETRONIDAZOLE$0.65500 mgTABLET100.00EACHMultiple Source9592
27437-0208-11J34904/9/2018SUPRAXCEFIXIME$19.37400 mgCAPSULE1.00EACHSingle Source28142
58160-0976-029062010/8/2021BEXSEROMENINGITIS VACCINE$459.8950-50/0.5mlSYRINGE (mL)0.5EACHSingle Source71917
49281-0589-589073410/8/2021MENACTRAMENINGITIS VACCINE$323.144 mcg/0.5 mlVial (mL)0.5EACHSingle Source63830
58160-0955-099073410/8/2021MENVEOMENINGITIS VACCINE$167.8510-5/0.5mlVial (mL)5EACHSingle Source66091
00005-0100-059062110/8/2021TRUMENBAMENINGITIS VACCINE$377.34120 mcg/0.5 mlSYRINGE (mL)0.5MILLILITERSSingle Source73089
00005-0100-109062110/8/2021TRUMENBAMENINGITIS VACCINE$377.34120 mcg/0.5 mlSYRINGE (mL)0.5MILLILITERSSingle Source73089

Page Last Updated :