| Document Date: 2009-01-05 16:14:00
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Currency USD / / Facility Pharmacy Supply Fees Effective / Pharmacy Dispensing Fees / / MedicalCondition FOR ESRD / / Product METHYLPREDNISOLONE / General Electric J1250 Digital Camera / FENTANYL CITRATE / MG J7641KQ J7638KO / MORPHINE SULFATE / ETOPOSIDE / PREDNISOLONE / HYDROXYZINE PAMOATE / DIPHENHYDRAMINE HYDROCHLORIDE / AMPHOTERICIN B / GLYCOPYRROLATE / DEXAMETHASONE / FOSCARNET SODIUM / ACETYLCYSTEINE / CLADRIBINE / CYCLOSPORINE / DOBUTAMINE HYDROCHLORIDE / ACYCLOVIR / FLOXURIDINE / IPRATROPIUM BROMIDE / GRANISETRON HYDROCHLORIDE / CYTARABINE / MG 5MG / VINBLASTINE SULFATE / CROMOLYN SODIUM / CYCLOPHOSPHAMIDE / FLUNISOLIDE / BLEOMYCIN SULFATE / MILRINONE LACTATE / TRIMETHOBENZAMIDE HYDROCHLORIDE / MG 7 / METAPROTERENOL SULFATE / TRIAMCINOLONE / DEFEROXAMINE MESYLATE / GANCICLOVIR SODIUM / ATROPINE / PERPHENAZINE / BENEFICIARY INJECTION / PREDNISONE / TERBUTALINE SULFATE / AZATHIOPRINE / VINCRISTINE SULFATE / PROCHLORPERAZINE MALEATE / FLUOROURACIL / ALBUTEROL / MG J7638KP J7638KQ / PROMETHAZINE HYDROCHLORIDE / HEPARIN SODIUM / ONDANSETRON HYDROCHLORIDE / METHYLPREDNISOLONE SODIUM SUCCINATE / LIPOSOME INJECTION / CHLORPROMAZINE HYDROCHLORIDE / TOBRAMYCIN / / ProgrammingLanguage C / ML / / Technology ALPHA / DIALYSIS / /
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Rev 3rd Quarter 2006 Drug Fees Bulletin (CR5852 -jan 08).xls