Figure: 25 TAC §230.1(c)(2)(A)
Texas Department of Health
Bureau of Food and Drug Safety
Report of Actual Price Information from a Wholesale Drug Distributor
Actual price - The weighted median invoice price at which a wholesale distributor sells a prescription drug to Texas retail pharmacies from the first day of the month through the last day of the calendar month prior to the date of the request.
_________________________________________________________________________________________________________
(Name of licensee - identifying number)
Submits the following pricing information on the following drugs for the month and quarter of
______________________________________________:
National |
Name of |
Name of Manufacturer |
Form |
Unit |
Unit Strength |
Wholesale |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|