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4/23/2019 NDC/Ref. No. ITEM DESCRIPTION SIZE AWP 62991

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4/23/2019 NDC/Ref. No. ITEM DESCRIPTION SIZE AWP 62991 current as of: 4/23/2019 NDC/Ref. No. ITEM DESCRIPTION SIZE AWP 62991-4021-01 690329 #000 CLEAR CAPSULES 1000 $ 246.00 62991-4021-05 690330 #000 CLEAR CAPSULES 5000 $ 1,230.00 62991-4142-01 693487 #00 BLACK/RED CAPSULES 1000 $ 97.50 62991-4142-02 693494 #00 BLACK/RED CAPSULES 5000 $ 487.50 62991-4119-01 690325 #00 BLUE CAPSULES 1000 $ 97.50 62991-4119-05 690326 #00 BLUE CAPSULES 5000 $ 487.50 62991-4143-01 693488 #00 BLUE/WHITE CAPSULES 1000 $ 97.50 62991-4143-02 693495 #00 BLUE/WHITE CAPSULE 5000 $ 487.50 62991-4120-01 684615 #00 CLEAR CAPSULES 1000 $ 97.50 62991-4120-05 690574 #00 CLEAR CAPSULES 5000 $ 487.50 62991-4120-07 690943 #00 CLEAR CAPSULES 25000 $ 2,437.50 62991-4121-01 690363 #00 DARK GREEN CAPSULES 1000 $ 97.50 62991-4121-05 690364 #00 DARK GREEN CAPSULES 5000 $ 487.50 62991-4017-01 690366 #00 ORANGE CAPSULES 1000 $ 97.50 62991-4017-05 690367 #00 ORANGE CAPSULES 5000 $ 487.50 62991-4144-01 693489 #00 PINK/PINK CAPSULES 1000 $ 97.50 62991-4144-02 693496 #00 PINK/PINK CAPSULES 5000 $ 487.50 62991-4145-01 693490 #00 PURPLE/PURPLE CAPSULES 1000 $ 97.50 62991-4145-02 693497 #00 PURPLE/PURPLE CAPSULES 5000 $ 487.50 62991-4146-01 693491 #00 PURPLE/WHITE CAPSULES 1000 $ 97.50 62991-4146-02 693498 #00 PURPLE/WHITE CAPSULES 5000 $ 487.50 62991-4019-01 690357 #00 RED CAPSULES 1000 $ 97.50 62991-4019-05 690358 #00 RED CAPSULES 5000 $ 487.50 62991-4147-01 693492 #00 RED/WHITE CAPSULES 1000 $ 97.50 62991-4147-02 693499 #00 RED/WHITE CAPSULES 5000 $ 487.50 62991-4122-01 684640 #00 VEGETABLE CLEAR CAPSULES 1000 $ 150.00 62991-4122-05 690591 #00 VEGETABLE CLEAR CAPSULES 5000 $ 750.00 62991-4122-04 692582 #00 VEGETABLE CLEAR CAPSULES 70000 $ 10,500.00 62991-4156-01 693550 #00 VEGETABLE WHITE CAPSULES 1000 $ 150.00 62991-4156-02 693551 #00 VEGETABLE WHITE CAPSULES 5000 $ 750.00 62991-4020-01 684616 #00 WHITE CAPSULES 1000 $ 97.50 62991-4020-05 690575 #00 WHITE CAPSULES 5000 $ 487.50 62991-4148-01 693493 #00 YELLOW/YELLOW CAPSULES 1000 $ 97.50 62991-4148-02 693500 #00 YELLOW/YELLOW CAPSULES 5000 $ 487.50 62991-4001-01 690318 #0 BLUE CAPSULES 1000 $ 97.50 62991-4001-05 690319 #0 BLUE CAPSULES 5000 $ 487.50 62991-4002-01 684639 #0 BLUE/WHITE CAPSULES 1000 $ 97.50 62991-4002-05 690590 #0 BLUE/WHITE CAPSULES 5000 $ 487.50 62991-4004-01 684625 #0 CLEAR CAPSULES 1000 $ 97.50 62991-4004-05 690594 #0 CLEAR CAPSULES 5000 $ 487.50 62991-4004-09 691186 #0 CLEAR CAPSULES 100000 $ 9,750.00 62991-4005-01 690332 #0 GREEN TRANS/CLEAR CAPSULES 1000 $ 97.50 62991-4005-05 690333 #0 GREEN TRANS/CLEAR CAPSULES 5000 $ 487.50 62991-4008-01 690343 #0 ORANGE CAPSULES 1000 $ 97.50 62991-4008-05 690344 #0 ORANGE CAPSULES 5000 $ 487.50 62991-4114-01 690711 #0 PINK CAPSULES 1000 $ 97.50 62991-4114-05 690712 #0 PINK CAPSULES 5000 $ 487.50 62991-4117-01 690346 #0 PURPLE CAPSULES 1000 $ 97.50 62991-4117-05 690347 #0 PURPLE CAPSULES 5000 $ 487.50 LETCO MEDICAL 1 OF 43 current as of: 4/23/2019 NDC/Ref. No. ITEM DESCRIPTION SIZE AWP 62991-4118-01 690354 #0 PURPLE/WHITE CAPSULE 1000 $ 97.50 62991-4118-05 690355 #0 PURPLE/WHITE CAPSULE 5000 $ 487.50 62991-4010-01 690322 #0 RED CAPSULES 1000 $ 97.50 62991-4010-05 690323 #0 RED CAPSULES 5000 $ 487.50 62991-4149-01 693509 #0 RED TRANS/WHITE CAPSULES 1000 $ 97.50 62991-4149-02 693510 #0 RED TRANS/WHITE CAPSULES 5000 $ 487.50 62991-4009-01 690360 #0 RED/CLEAR CAPSULES 1000 $ 97.50 62991-4009-05 690361 #0 RED/CLEAR CAPSULES 5000 $ 487.50 62991-4011-01 684610 #0 RED/WHITE CAPSULES 1000 $ 97.50 62991-4011-05 690573 #0 RED/WHITE CAPSULES 5000 $ 487.50 62991-4013-01 684638 #0 VEGETABLE CLEAR CAPSULES 1000 $ 150.00 62991-4013-05 690589 #0 VEGETABLE CLEAR CAPSULES 5000 $ 750.00 62991-4150-01 693511 #0 VEGETABLE GREEN CAPSULES 1000 $ 150.00 62991-4150-02 693517 #0 VEGETABLE GREEN CAPSULES 5000 $ 750.00 62991-4151-01 693512 #0 VEGETABLE WHITE CAPSULES 1000 $ 150.00 62991-4151-02 693518 #0 VEGETABLE WHITE CAPSULES 5000 $ 750.00 62991-4015-01 684628 #0 WHITE CAPSULES 1000 $ 97.50 62991-4015-05 690583 #0 WHITE CAPSULES 5000 $ 487.50 62991-4014-01 684631 #0 WHITE/CLEAR CAPSULES 1000 $ 97.50 62991-4014-05 690585 #0 WHITE/CLEAR CAPSULES 5000 $ 487.50 62991-4016-01 684630 #0 YELLOW CAPSULES 1000 $ 97.50 62991-4016-05 690584 #0 YELLOW CAPSULES 5000 $ 487.50 62991-4022-01 690379 #1 AQUA BLUE TRANS CAPSULES 1000 $ 97.50 62991-4022-05 690380 #1 AQUA BLUE TRANS CAPSULES 5000 $ 487.50 62991-4025-01 690385 #1 BLUE CAPSULES 1000 $ 97.50 62991-4025-05 690386 #1 BLUE CAPSULES 5000 $ 487.50 62991-4024-01 691272 #1 BLUE TRANS/PINK TRANS CAPSULES 1000 $ 97.50 62991-4024-05 691273 #1 BLUE TRANS/PINK TRANS CAPSULES 5000 $ 487.50 62991-4124-01 690388 #1 BLUE/CLEAR CAPSULES 1000 $ 97.50 62991-4124-05 690389 #1 BLUE/CLEAR CAPSULES 5000 $ 487.50 62991-4023-01 690392 #1 BLUE/PINK TRANS CAPSULES 1000 $ 97.50 62991-4023-05 690393 #1 BLUE/PINK TRANS CAPSULES 5000 $ 487.50 62991-4026-01 690395 #1 BLUE/POWDER BLUE CAPSULES 1000 $ 97.50 62991-4026-05 690396 #1 BLUE/POWDER BLUE CAPSULES 5000 $ 487.50 62991-4027-01 690398 #1 BLUE/WHITE CAPSULES 1000 $ 97.50 62991-4027-05 690399 #1 BLUE/WHITE CAPSULES 5000 $ 487.50 62991-4027-02 691265 #1 BLUE/WHITE CAPSULES 125000 $ 12,187.50 62991-4030-01 690401 #1 BROWN/IVORY CAPSULES 1000 $ 97.50 62991-4030-05 690402 #1 BROWN/IVORY CAPSULES 5000 $ 487.50 62991-4031-01 684618 #1 CLEAR CAP/WHITE CAPSULES 1000 $ 97.50 62991-4031-05 690576 #1 CLEAR CAP/WHITE CAPSULES 5000 $ 487.50 62991-4033-01 684617 #1 CLEAR CAPSULES 1000 $ 97.50 62991-4033-05 690227 #1 CLEAR CAPSULES 5000 $ 487.50 62991-4033-07 690946 #1 CLEAR CAPSULES 25000 $ 2,437.50 62991-4033-08 695146 #1 CLEAR CAPSULES *SO 125000 $ 12,187.50 62991-4034-01 690407 #1 DARK GREEN CAPSULES 1000 $ 97.50 62991-4034-05 690408 #1 DARK GREEN CAPSULES 5000 $ 487.50 62991-4035-01 691236 #1 GREEN TRANS/YELLOW CAPSULES 1000 $ 97.50 62991-4035-05 691237 #1 GREEN TRANS/YELLOW CAPSULES 5000 $ 487.50 LETCO MEDICAL 2 OF 43 current as of: 4/23/2019 NDC/Ref. No. ITEM DESCRIPTION SIZE AWP 62991-4037-01 684634 #1 GREEN/ORANGE CAPSULE 1000 $ 97.50 62991-4037-05 690305 #1 GREEN/ORANGE CAPSULE 5000 $ 487.50 62991-4038-01 690410 #1 GREEN/WHITE CAPSULES 1000 $ 97.50 62991-4038-05 690411 #1 GREEN/WHITE CAPSULES 5000 $ 487.50 62991-4039-01 684632 #1 GREEN/YELLOW CAPSULES 1000 $ 97.50 62991-4039-05 690451 #1 GREEN/YELLOW CAPSULES 5000 $ 487.50 62991-4040-01 690413 #1 GREY/PINK CAPSULES 1000 $ 97.50 62991-4040-05 690414 #1 GREY/PINK CAPSULES 5000 $ 487.50 62991-4041-01 690416 #1 IVORY CAPSULES 1000 $ 97.50 62991-4041-05 690417 #1 IVORY CAPSULES 5000 $ 487.50 62991-4043-01 691015 #1 MAROON TRANS/CLEAR CAPSULES 1000 $ 97.50 62991-4043-05 691016 #1 MAROON TRANS/CLEAR CAPSULES 5000 $ 487.50 62991-4044-01 691195 #1 MINT GREEN CAPSULES 1000 $ 97.50 62991-4044-05 691196 #1 MINT GREEN CAPSULES 5000 $ 487.50 62991-4044-02 695885 #1 MINT GREEN CAPSULES 125000 $ 12,187.50 62991-4046-01 690419 #1 ORANGE CAPSULES 1000 $ 97.50 62991-4046-05 690420 #1 ORANGE CAPSULES 5000 $ 487.50 62991-4045-01 684633 #1 ORANGE/CLEAR CAPSULES 1000 $ 97.50 62991-4045-05 690452 #1 ORANGE/CLEAR CAPSULES 5000 $ 487.50 62991-4047-01 690443 #1 ORANGE/YELLOW CAPSULES 1000 $ 97.50 62991-4047-05 690444 #1 ORANGE/YELLOW CAPSULES 5000 $ 487.50 62991-4050-01 690446 #1 PINK CAPSULES 1000 $ 97.50 62991-4050-05 690447 #1 PINK CAPSULES 5000 $ 487.50 62991-4049-01 690449 #1 PINK/CLEAR CAPSULES 1000 $ 97.50 62991-4049-05 690450 #1 PINK/CLEAR CAPSULES 5000 $ 487.50 62991-4125-01 690527 #1 PINK/POWDER BLUE CAPSULES 1000 $ 97.50 62991-4125-05 690528 #1 PINK/POWDER BLUE CAPSULES 5000 $ 487.50 62991-4051-01 690530 #1 PINK/WHITE CAPSULES 1000 $ 97.50 62991-4051-05 690531 #1 PINK/WHITE CAPSULES 5000 $ 487.50 62991-4052-01 690533 #1 PINK/YELLOW CAPSULES 1000 $ 97.50 62991-4052-05 690534 #1 PINK/YELLOW CAPSULES 5000 $ 487.50 62991-4053-01 690422 #1 POWDER BLUE CAPSULES 1000 $ 97.50 62991-4053-05 690423 #1 POWDER BLUE CAPSULES 5000 $ 487.50 62991-4055-01 690425 #1 PURPLE CAPSULES 1000 $ 97.50 62991-4055-05 690426 #1 PURPLE CAPSULES 5000 $ 487.50 62991-4055-02 692713 #1 PURPLE CAPSULES 125000 $ 12,187.50 62991-4057-01 690434 #1 RED CAPSULES 1000 $ 97.50 62991-4057-05 690435 #1 RED CAPSULES 5000 $ 487.50 62991-4056-01 690428 #1 RED/BLUE CAPSULES 1000 $ 97.50 62991-4056-05 690429 #1 RED/BLUE CAPSULES 5000 $ 487.50 62991-4058-01 690431 #1 RED/WHITE CAPSULES 1000 $ 97.50 62991-4058-05 690432 #1 RED/WHITE CAPSULES 5000 $ 487.50 62991-4059-01 684636 #1 VEGETABLE CLEAR CAPSULES 1000 $ 150.00 62991-4059-05 690587 #1 VEGETABLE CLEAR CAPSULES 5000 $ 750.00 62991-4152-01 693513 #1 VEGETABLE WHITE CAPSULES 1000 $ 150.00 62991-4152-02 693519 #1 VEGETABLE WHITE CAPSULES 5000 $ 750.00 62991-4061-01 684620 #1 WHITE CAPSULES 1000 $ 97.50 62991-4061-05 690578 #1 WHITE CAPSULES 5000 $ 487.50 62991-4061-02 691389 #1 WHITE CAPSULES 125000 $ 12,187.50 LETCO MEDICAL 3 OF 43 current as of: 4/23/2019 NDC/Ref.
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