Verifying Cash Pricing Worksheet - The ICD
Verifying Cash Pricing Worksheet DRUG DESCRIPTION NDC QTY ACQUISITION COST ($) CASH PRICE ($) 1. Accupril 10 mg tablets 00071-0530-23 30 ________ ________ 2. Lorazepam 0.5 mg tablets 00378-0321-05 120 ________ ________ 60 ________ ________ 3. Cephalexin 500 mg capsules 00093-3147-05 40 ________ ________ 4. Alprazolam 2 mg tablets 00781-1089-05 120 ________ ________ 5. Ciprofloxacin ER 500 mg tablets 00378-1743-89 28 ________ ________ 14 ________ ________ 20 ________ ________ 10 ________ ________ 10 ________ ________ 5 ________ ________ 6. Humalog 100 units/mL vial 7. Zolpidem Tartrate 10 mg tablets 00002-7510-01 00054-0087-29 8. Phenobarbital 64.8 mg tablets 00603-5167-32 90 ________ ________ 9. Propoxy-N/APAP 100-650 tablets 00172-4980-80 40 ________ ________ 10. Amoxil 250 mg per 5mL suspension 00029-6009-22 150 ________ ________ 75 ________ ________ 11. Gentamicin 00168-0178-03 10 ________ ________ 12. Zyprexa 15 mg tablets 00002-4415-30 30 ________ ________ 13. Prednisone 2.5 mg tablets 00054-8740-25 32 ________ ________ 20 ________ ________ 14. Fluoxetine HCL 20 mg capsules 00406-0663-01 30 ________ ________ 15. Methylphenidate 00781-5754-01 60 ________ ________ 30 ________ ________ Career Step, LLC www.careerstep.com © 2010. All Rights Reserved.
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