Figure: 25 TAC ยง230.1(c)(1)

Texas Department of Health
Bureau of Food and Drug Safety

Request for Actual Price Information from a Wholesale Distributor and Average Manufacturer Price Information from a Manufacturer

The Interagency Council on Pharmaceuticals Bulk Purchasing requests pricing information on the following drugs for the month and quarter of

______________________________________________:

National
Drug Code #
11 Char.

Name of
Drug
20 Char.

Name of
Manufacturer
15 Char.

Form
Size
10 Char.

Unit
Size
10 Char.

Unit Strength
10 Char.