Attach7_Bulk Chemicals Used for Compounding Final Report 07 23 12.xlsx

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Draft RFP Elements for Comment - TRICARE Pharmacy Program, Fourth Generation (TPharm4) - AMENDMENT 1
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HT9402-13-R-0001
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Attach7_Bulk Chemicals Used for Compounding Final Report 07 23 12

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DRAFT_RFP_Section_X_Composite_-_Guarantee_(Oct_4 _2012).docx DOCX document
Attach1_Utilization Data.xls XLS spreadsheet
DRAFT RFP Section L —
DRAFT RFP Section F —
Attach4_MTF Sites.xls XLS spreadsheet
DRAFT RFP Section H —
Attach5_SRP Sites.doc DOC document
Attach3_MTF Workload.xls XLS spreadsheet
Attach6_Required Mailings.doc DOC document
Attach9_Specialty Clinical Services List.docx DOCX document
Attach8__ Enhanced IA Standards Checklist IAW H4.pdf PDF
DRAFT RFP Section B —
Attach2_Deployed Prescription Volume.xls XLS spreadsheet
DRAFT RFP Section C —
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Sheet1

Data collected from 7/1/2011 to 6/30/2012
NDCService Category (Claim)Drug/Strength/FormPIDTOLAS DescriptionGrams dispensedQty on Replenishment Report - # of bottles or packages *
38779070108Mail OrderVEHICLE BASE NO. 9 CREAM (G)CMPD-387790701*CMPD-HRT CREAM BASE114,838.7900229.6776
38779004305Mail OrderPROGESTERONE,MICRONIZED 100 % POWDERCMPD-387790043CMPD-PROGESTERONE USP (MICRON)9,026.408090.2641
38779007805Mail OrderKETOPROFEN 100 % POWDERCMPD-387790078CMPD-KETOPROFEN USP6,148.000061.4800
38779016305Mail OrderTESTOSTERONE POWDERCMPD-387790163CMPD-TESTOSTERONE POWDER3,763.669037.6367
51552090205Mail OrderGABAPENTIN 100 % POWDERCMPD-515520902CMPD-GABAPENTIN POWDER3,611.850036.1185
51552030705Mail OrderKETOPROFEN 100 % POWDERCMPD-515520307CMPD-KETOPROFEN 100% POWDER3,037.850030.3785
38779056708Mail OrderCELLULOSE POWDERCMPD-387790567CMPD-CELLULOSE NF POWDER2,834.36705.6687
38779175405Mail OrderKETAMINE HCL 100 % POWDERCMPD-387791754CMPD-KETAMINE HCL POWDER1,730.180017.3018
38779040908Mail OrderACETAMINOPHEN 100 % POWDERCMPD-387790409CMPD-ACETAMINOPOHEN POWDER1,450.00002.9000
38779008105Mail OrderLIDOCAINE POWDERCMPD-387790081CMPD-LIDOCAINE USP POWDER1,359.560013.5956
38779005705Mail OrderPROGESTERONE 100 % POWDERCMPD-387790057CMPD-PROGESTERONE (WET) POWDER995.60009.9560
00395262501Mail OrderSALICYLIC ACID POWDERCMPD-003952625CMPD-SALICYLIC ACID PWDR959.30002.1130
51552020105Mail OrderACETYLCYSTEINE POWDERCMPD-515520201CMPD-ACETYLCYSTEINE, USP828.00008.2800
38779010108Mail OrderUREA 100 % POWDERCMPD-387790101CMPD-UREA USP POWDER688.40001.3768
38779000905Mail OrderHYDROCORTISONE POWDERCMPD-387790009CMPD-HYDROCORTISONE USP549.30105.4930
51552014505Mail OrderLIDOCAINE POWDERCMPD-515520145CMPD-LIDOCAINE POWDER502.31005.0231
38779038805Mail OrderBACLOFEN 100 % POWDERCMPD-387790388CMPD-BACLOFEN POWDER377.11503.7712
38779005305Mail OrderTETRACYCLINE HCL POWDERCMPD-387790053CMPD-TETRACYCLINE HCL, USP PWD295.00402.9500
38779018905Mail OrderAMITRIPTYLINE HCL POWDERCMPD-387790189OPEN-AMITRIPTYLINE HCL POWDER289.10002.8910
38779198705Mail OrderURSODIOL 100 % POWDERCMPD-387791987CMPD-URSODIOL POWDER273.60002.7360
51552026204Mail OrderINDOMETHACIN POWDERCMPD-515520262CMPD-INDOMETHACIN USP POWDER242.00009.6800
38779039505Mail OrderCYCLOBENZAPRINE HCL 100 % POWDERCMPD-387790395CMPD-CYCLOBENZAPRINE HCL POWDR236.05002.3605
38779165405Mail OrderTHYROID,PORK 100 % POWDERCMPD-387791654CMPD-THYROID POWDER230.44202.3044
51552025506Mail OrderSULFAPYRIDINE POWDERCMPD-515520255CMPD-SULFAPYRIDINE USP225.00000.4956
38779169805Mail OrderDICLOFENAC SODIUM 100 % POWDERCMPD-387791698OPEN-DICLOFENAC SOD POWDER190.60001.9060
38779029905Mail OrderIBUPROFEN 100 % POWDERCMPD-387790299CMPD-IBUPROFEN POWDER188.20001.8820
38779048804Mail OrderCAPTOPRIL 100 % POWDERCMPD-387790488CMPD-CAPTOPRIL POWDER175.50007.0200
38779073305Mail OrderPRASTERONE (DHEA) POWDERCMPD-387790733CMPD-DEHYDRO (DHEA) POWDER145.11701.4512
51552035804Mail OrderQUINACRINE HCL POWDERCMPD-515520358CMPD-QUINACRINE HCL POWDER136.80005.4720
51552048305Mail OrderCYCLOBENZAPRINE HCL 100 % POWDERCMPD-515520483CMPD-CYCLOBENZAPRINE HCL 100%135.14001.3514
38779242709Mail OrderLACTOBACILLUS ACIDOPHILUS POWDERCMPD-387792427CMPD-ACIDOPHILUS LACTOBACILLUS135.00000.1350
38779169800Mail OrderDICLOFENAC SODIUM 100 % POWDERCMPD-387791698OPEN-DICLOFENAC SOD POWDER99.32000.9932
38779008100Mail OrderLIDOCAINE POWDERCMPD-387790081CMPD-LIDOCAINE USP POWDER92.47000.9247
51552081802Mail OrderFLURBIPROFEN POWDERCMPD-515520818CMPD-FLURBIPROFEN POWDER90.000018.0000
38779018900Mail OrderAMITRIPTYLINE HCL POWDERCMPD-387790189OPEN-AMITRIPTYLINE HCL POWDER86.75000.8675
38779001101Mail OrderTRIAMCINOLONE ACETONIDE 100 % POWDERCMPD-387790011CMPD-TRIMACINOLONE ACETONIDE86.13008.6130
38779027904Mail OrderKETOCONAZOLE POWDERCMPD-387790279CMPD-KETOCONAZOLE POWDER77.40003.0960
38779036204Mail OrderFLURBIPROFEN POWDERCMPD-387790362OPEN-FLURBIPROFEN, BP POWDER74.40002.9760
38779039500Mail OrderCYCLOBENZAPRINE HCL 100 % POWDERCMPD-387790395CMPD-CYCLOBENZAPRINE HCL POWDR68.64000.6864
38779028204Mail OrderDIPHENHYDRAMINE HCL POWDERCMPD-387790282CMPD-DIPHENHYDRAMINE HCL POWDR56.97502.2790
38779045405Mail OrderPAPAVERINE HCL POWDERCMPD-387790454CMPD-PAPAVERINE HCL POWDER54.00000.5400
38779025304Mail OrderPROMETHAZINE HCL POWDERCMPD-387790253CMPD-PROMETHAZINE HCL, USP51.10002.0440
51552038405Mail OrderESTRADIOL HEMIHYDRT,MICRONIZED 100 % POWDERCMPD-515520384CMPD-ESTRADIOL MICRO, USP PWD48.13900.4814
38779088704Mail OrderNALTREXONE HCL 100 % POWDERCMPD-387790887CMPD-NALTREXONE HYDROCHLORIDE43.33501.7334
51552082602Mail OrderBETAHISTINE HCL 100 % POWDERCMPD-515520826CMPD-BETAHISTINE DIHYDROCHLOR42.56008.5120
51552093904Mail OrderDALFAMPRIDINE POWDERCMPD-515520939CMPD-4 AMINOPYRIDINE REAGENT38.88001.5552
51552055305Mail OrderPHENYTOIN POWDERCMPD-515520553CMPD-PHENYTOIN USP36.00000.3600
38779017301Mail OrderACYCLOVIR 100 % POWDERCMPD-387790173CMPD-ACYCLOVIR POWDER30.25000.3025
51552048205Mail OrderDICLOFENAC SODIUM 100 % POWDERCMPD-515520482CMPD-DICLOFENAC SOD 100% PWD29.00000.2900
38779016505Mail OrderTESTOSTERONE PROPIONATE POWDERCMPD-387790165CMPD-TESTOSTERONE PROP POWDER28.45600.2846
38779044604Mail OrderLOPERAMIDE HCL POWDERCMPD-387790446CMPD-LOPERAMIDE HCL POWDER27.00001.0800
38779000505Mail OrderCLINDAMYCIN HCL POWDERCMPD-387790005CMPD-CLINDAMYCIN HCL USP23.33000.2333
51552104804Mail OrderLEVODOPA POWDERCMPD-515521048CMPD-LEVODOPA POWDER22.50000.9000
51552046405Mail OrderAMITRIPTYLINE HCL POWDERCMPD-515520464CMPD-AMITRIPTYLINE HCL POWDER22.15000.2215
38779056103Mail OrderCLONIDINE HCL POWDERCMPD-387790561CMPD-CLONIDINE HCL20.25204.0504
38779022701Mail OrderDILTIAZEM HCL POWDERCMPD-387790227CMPD-DILTIAZEM HCL POWDER17.90001.7900
38779063405Mail OrderASCORBIC ACID 100 % POWDERCMPD-387790634CMPD-ASCORBIC ACID POWDER17.54600.1755
38779028004Mail OrderNIFEDIPINE POWDERCMPD-387790280CMPD-NIFEDIPINE, USP16.53000.6612
38779018304Mail OrderPROPRANOLOL HCL POWDERCMPD-387790183CMPD-PROPRANOLOL HCL POWDER14.40000.5760
38779015505Mail OrderPRILOCAINE HCL POWDERCMPD-387790155CMPD-PRILOCAINE HCL POWDER12.60000.1260
38779017605Mail OrderSULFASALAZINE POWDERCMPD-387790176CMPD-SULFASALAZINE POWDER12.00000.1200
49452359003Mail OrderHYDROCORTISONE ACETATE POWDERCMPD-494523590CMPD-HYDROCORTI ACETA POWDER11.92700.1193
38779082205Mail OrderCHOLESTYRAMINE POWDERCMPD-387790822CMPD-CHOLESTYRAMINE RESIN11.88000.1188
38779035505Mail OrderDEXTROMETHORPHAN HBR POWDERCMPD-387790355CMPD-DEXTROMETHORPHAN HYDROBRO9.90000.0990
38779040505Mail OrderDEXAMETHASONE POWDERCMPD-387790405CMPD-DEXAMETHASONE POWDER, USP9.87500.0988
51552038408Mail OrderESTRADIOL HEMIHYDRT,MICRONIZED 100 % POWDERCMPD-515520384CMPD-ESTRADIOL MICRO, USP PWD9.73600.0974
51552102504Mail OrderDIAZEPAM 100 % POWDERCMPD-515521025CMPD-DIAZEPAM USP POWDER9.45000.3780
51552024405Mail OrderSULFACETAMIDE SODIUM POWDERCMPD-515520244CMPD-SULFACETAMIDE SODIUM USP8.50000.0850
38779010404Mail OrderMETHADONE HCL 100 % POWDERCMPD-387790104CMPD-METHADONE HCL USP POWDER7.80000.3120
51552100804Mail OrderTRIAMTERENE POWDERCMPD-515521008CMPD-TRIAMTERENE POWDER6.75000.2700
38779014604Mail OrderMETRONIDAZOLE POWDERCMPD-387790146CMPD-METRONIDAZOLE POWDER5.04000.2016
38779037201Mail OrderCLOBETASOL PROPIONATE POWDERCMPD-387790372CMPD-CLOBETASOL PROP POWDER4.74000.4740
38779244204Mail OrderFLUCONAZOLE 100 % POWDERCMPD-387792442CMPD-FLUCONAZOLE POWDER4.60000.1840
38779193505Mail OrderOMEPRAZOLE 100 % POWDERCMPD-387791935CMPD-OMEPRAZOLE POWDER4.24000.0424
38779014403Mail OrderMETHYLPREDNISOLONE ACETATE POWDERCMPD-387790144CMPD-METHYLPRED ACETATE POWDER4.00000.8000
38779009604Mail OrderSPIRONOLACTONE 100 % POWDERCMPD-387790096CMPD-SPIRONOLACTONE USP3.42000.1368
38779076404Mail OrderHYDROCODONE BITARTRATE 100 % POWDERCMPD-387790764CMPD-HYDROCODONE BIT POWDER2.80000.1120
38779007101Mail OrderDEXAMETHASONE SOD PHOSPHATE 100 % POWDERCMPD-387790071CMPD-DEXAMETHAS SOD PHOS PWDR2.40000.2400
38779007800Mail OrderKETOPROFEN 100 % POWDERCMPD-387790078CMPD-KETOPROFEN USP2.25000.0225
38779050305Mail OrderARGININE HCL 100 % POWDERCMPD-387790503CMPD-ARGININE HYDROCHLORIDE2.16000.0216
38779092706Mail OrderLORAZEPAM 100 % POWDERCMPD-387790927CMPD-LORAZEPAM POWDER1.87501.8750
38779008604Mail OrderMETHYLTESTOSTERONE POWDERCMPD-387790086CMPD-METHYLTESTOSTERONE, USP1.73400.0694
00574043101Mail OrderPROGESTERONE 100 % POWDERCMPD-005740431CMPD-PROGESTERONE (SOY)1.62500.0163
38779033006Mail OrderHALOPERIDOL POWDERCMPD-387790330CMPD-HALOPERIDOL POWDER1.49001.4900
38779155105Mail OrderPROPYLPARABEN CRYSTALSCMPD-387791551CMPD-PROPYLPARABEN, NF1.35300.0135
51552131604Mail OrderECONAZOLE NITRATE POWDERCMPD-515521316CMPD-ECONAZOLE NITRATE POWDER0.50000.0200
38779165706Mail OrderLEVOTHYROXINE SODIUM 100 % POWDERCMPD-387791657CMPD-LEVOTHYROXINE SOD POWDER0.48700.0974
38779089104Mail OrderESTRONE 100 % POWDERCMPD-387790891CMPD-ESTRONE POWDER0.32500.0130
38779040301Mail OrderMETOCLOPRAMIDE HCL POWDERCMPD-387790403CMPD-METOCLOPRAMIDE HCL POWDER0.22000.0220
51552035402Mail OrderLIOTHYRONINE SODIUM 100 % POWDERCMPD-515520354CMPD-LIOTHYRONINE SOD, USP PWD0.22000.0440
38779186506Mail OrderDIETHYLSTILBESTROL POWDERCMPD-387791865CMPD-DIETHYLSTILBESTROL POWDER0.18000.1800
38779001703Mail OrderBETAMETHASONE DIPROPIONATE POWDERCMPD-387790017CMPD-BETAMETH DIPROPIONATE PWD0.14100.0282
49452282502Mail OrderETHINYL ESTRADIOL POWDERCMPD-494522825CMPD-ETHINYL ESTRADIOL POWDER0.09500.0190
- 05.9146
* Quantity on the Replenishment report is reported as 0 if less than 1.

Sheet2

Sheet3

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