Pennsylvania Bulletin

PA Bulletin, Doc. No. 02-1897

NOTICES

Update of List of Citations to ACIP Recommendations Prescribing Child Immunization Practices and Immunizing Agents and Doses

[32 Pa.B. 5352]

   In accordance with 31 Pa. Code §§ 89.806(a) and 89.807(b) (relating to coverage of child immunizations; and immunizing agents, doses and AWPs), the Department of Health (Department), Bureau of Communicable Diseases, Division of Immunization is updating 31 Pa. Code §§ 89.801--89.809, Appendix G (relating to ACIP recommendations prescribing child immunization practices) and Appendix H (relating to immunizing agents and doses). The Department has primary responsibility for the interpretation and the implementation of 31 Pa. Code §§ 89.806 and 89.807. See 31 Pa. Code § 89.801(b) (relating to authority and purpose; implementation).

   Health insurance policies are required by the Childhood Immunization Insurance Act (act) (40 P. S. §§ 3501--3508) and regulations promulgated thereunder (see 31 Pa. Code §§ 89.801--89.809 (relating to childhood immunization insurance)) to include coverage for certain childhood immunizations, unless the policies are exempted by the act and 31 Pa. Code § 89.809 (relating to exempt policies). The childhood immunizations covered are those that meet Advisory Committee on Immunization Practices (ACIP) standards in effect on May 21, 1992 (see 31 Pa. Code § 89.806(a)). A list of the Centers for Disease Control Morbidity and Mortality Weekly Report (MMWR) publications containing ACIP recommendations issued under the ACIP standards in effect on May 21, 1992, appears in 31 Pa. Code §§ 89.801--89.809, Appendix G.

   The Department is required to update the list of these MMWR publications appearing in 31 Pa. Code §§ 89.801--89.809, Appendix G. See 31 Pa. Code § 89.806(a). The additions to the list are as follows, the remainder of the list at 31 Pa. Code §§ 89.801--89.809, Appendix G remains in full force and effect:

   ''Notice to Readers: FDA Approval for a Combined Hepatitis A and B Vaccine,'' MMWR, September 21, 2001 /Vol. 50 / No.37.

   ''Simultaneous Administration of Varicella Vaccine and Other Recommended Childhood Vaccines--United States, 1995-1999,'' MMWR, November 30, 2001 / Vol. 50 / No.47.

   ''General Recommendations on Immunization,'' MMWR, February 8, 2002 / Vol. 51 / No. RR-2.

   ''Prevention and Control of Influenza,'' MMWR, April 12, 2002 / Vol. 51 / No.RR-3.

   The Department is also required to update information relating to immunizing agents and doses that the Department has extracted from ACIP recommendations issued under the standards in 31 Pa. Code § 89.806(a). See 31 Pa. Code § 89.807(b). The Department is also to periodically list the average wholesale price (AWP) for immunizing agents. This information currently appears in 31 Pa. Code §§ 89.801--89.809, Appendix H. The updated information is as follows:

List of Immunizing Agents and Average Wholesale Prices for 2002

Product Name, Company Brand/Product Name NDC Number Unit Dose AWP/Dose

Diphtheria Tetanus acellular Pertussis Vaccine (DTaP):

Aventis Pasteur Tripedia 49281-0298-10 10 x 1 0.5 ml $23.81

GlaxoSmithKline Infanrix 58160-0840-11 10 x 1 0.5 ml $24.01

Diphtheria Tetanus pediatric Vaccine (DT pediatric):

Aventis Pasteur DT Pediatric 49281-0275-10 5.0 ml 0.5 ml $9.89

Diphtheria Tetanus acellular Pertussis/Haemophilus Influenzae B (DTaP-HIB):

Aventis Pasteur TriHIBit 49281-0597-05 5 x 1 0.5 ml $23.89

Tetanus Diphtheria adult Vaccine (Td adult):

Aventis Pasteur Td Adult syringe 49281-0271-10 10 x 1 0.5 ml $11.50

Aventis Pasteur Td Adult 49281-0271-83 5.0 ml 0.5 ml $9.89

Haemophilus Influenzae B Vaccine (HIB):

Wyeth-Lederle HibTITER 0005-0104-32 5 x 0.5 0.5 ml $28.38

Aventis Pasteur ActHIB 49281-0545-05 5 x 1 0.5 ml $27.04

Merck & Co. Pedvax HIB 0006-4897-00 10 x 0.5 0.5 ml $25.60

Injectable Polio Vaccine Inactivated (Salk Enhanced IPV):

Aventis Pasteur IPOL 49281-0860-10 5.0 ml 0.5 ml $25.07

Aventis Pasteur IPOL 49281-0860-52 10 x 1 0.5 ml $28.95

Measles Mumps Rubella Vaccine (MMR):

Merck & Co. MMR II 0006-4749-00 0.5 ml 0.5 ml $43.76

Merck & Co. MMR II 0006-4681-00 10 x 0.5 0.5 ml $37.93

Measles Vaccine (Rubeola):

Merck & Co. Atenuvax 0006-4709-00 0.5 ml 0.5 ml $18.11

Merck & Co. Atenuvax 0006-4589-00 10 x 0.5 0.5 ml $14.55

Mumps Vaccine (Mumps):

Merck & Co. Mumpsvax 0006-4753-00 0.5 ml 0.5 ml $20.89

Merck & Co. Mumpsvax 0006-4584-00 10 x 0.5 0.5 ml $18.79

Rubella (German Measles):

Merck & Co. Meruvax II 0006-4747-00 0.5 ml 0.5 ml $18.98

Merck & Co. Meruvax II 0006-4673-00 10 x 0.5 0.5 ml $16.20

Hepatitis A Vaccine Pediatric (HEP-A):

Merck & Co. VAQTA 0006-4831-00 0.5 ml 0.5 ml $35.93

Merck & Co. VAQTA 0006-4831-38 5 x 0.5 0.5 ml $33.91

Merck & Co. VAQTA syringe 0006-4845-00 0.5 ml 0.5 ml $35.93

Merck & Co. VAQTA syringe 0006-4845-38 5 x 0.5 0.5 ml $33.91

GlaxoSmithKline Havrix 58160-0837-01 0.5 ml 0.5 ml $34.16

GlaxoSmithKline Havrix 58160-0837-11 10 x 0.5 0.5 ml $32.67

GlaxoSmithKline Havrix syringe 58160-0837-50 25 x 0.5 0.5 ml $36.67

GlaxoSmithKline Havrix syringe 58160-0837-46 5 x 0.5 0.5 ml $36.67

GlaxoSmithKline Havrix syringe 58160-0837-50 25 x 0.5 0.5 ml $36.67

GlaxoSmithKline Havrix syringe 58160-0837-58 25 x 0.5 0.5 ml $32.67

Hepatitis A Vaccine Adult (HEP-A):

Merck & Co. VAQTA 0006-4841-00 1.0 ml 1.0 ml $71.85

Merck & Co. VAQTA 0006-4841-38 5 x 1.0 1.0 ml $67.81

Merck & Co. VAQTA syringe 0006-4844-00 1.0 ml 1.0 ml $71.85

Merck & Co. VAQTA syringe 0006-4844-38 5 x 1.0 1.0 ml $67.81

GlaxoSmithKline Havrix 58160-0835-01 0.5 ml 0.5 ml $66.94

GlaxoSmithKline Havrix syringe 58160-0835-41 1 x 0.5 0.5 ml $65.50

GlaxoSmithKline Havrix syringe 58160-0835-46 5 x 0.5 0.5 ml $65.50

Hepatitis B Vaccine (HEP-B):

Merck & Co. (1) Recombivax HB 00006-4980-00 0.5 ml 0.5 ml $30.48

Merck & Co. (1) Recombivax HB 00006-4981-00 10 x 0.5 0.5 ml $29.01

Merck & Co. (2) Recombivax HB 00006-4769-00 0.5 ml 0.5 ml $30.48

Merck & Co. (2) Recombivax HB 00006-4876-00 10 x 0.5 0.5 ml $28.66

Merck & Co. (2) Recombivax HB 00006-4849-00 5 x 0.5 0.5 ml $30.50

Merck & Co. (2) Recombivax HB 00006-4969-00 5 x 0.5 0.5 ml $30.50

Merck & Co. (3) Recombivax HB 00006-4773-00 3.0 ml 0.5 ml $74.56

Merck & Co. (3) Recombivax HB 00006-4775-00 1.0 ml 1.0 ml $74.63

Merck & Co. (3) Recombivax HB 00006-4872-00 10 x 1.0 1.0 ml $73.87

Merck & Co. (3) Recombivax HB 00006-4873-00 10 x 3.0 0.5 ml $73.89

Merck & Co. (3) Recombivax HB 00006-4848-00 5 x 1.0 1.0 ml $74.64

GlaxoSmithKline (4) Engerix-B 58160-0856-01 0.5 ml 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B 58160-0856-11 10 x 0.5 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B syringe 58160-0856-46 5 x 0.5 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B syringe 58160-0856-50 25 x 0.5 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B syringe 58160-0856-46 5 x 0.5 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B syringe 58160-0856-50 25 x 0.5 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B syringe 58160-0856-50 25 x 0.5 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B syringe 58160-0856-58 25 x 0.5 0.5 ml $26.52

GlaxoSmithKline (4) Engerix-B syringe 58160-0856-57 25 x 0.5 0.5 ml $26.52

GlaxoSmithKline (5) Engerix-B 58160-0857-01 1.0 ml 1.0 ml $62.20

GlaxoSmithKline (5) Engerix-B 58160-0857-16 25 x 1.0 1.0 ml $60.63

GlaxoSmithKline (5) Engerix-B syringe 58160-0857-46 5 x 1.0 1.0 ml $60.95

GlaxoSmithKline (5) Engerix-B syringe 58160-0857-50 25 x 1.0 1.0 ml $60.95

      (1)  Pediatric low risk formulation @ 5 mcg/ml
      (2)  Adolescent/infant high risk formulation @ 10 mcg/ml
      (3)  Adult formulation @ 10 mcg/0.5 ml
      (4)  Pediatric formulation @ 10 mcg/0.5 ml
Adult formulation @ 20 mcg/ml

Hepatitis B/HIB:

Merck & Co. COMVAX 0006-4898-00 10 x 0.5 0.5 ml $53.32

Hepatitis A and Hepatitis B Vaccine:

GlaxoSmithKline Twinrix 58160-0850-01 1.0 ml 1.0 ml $98.15

GlaxoSmithKline Twinrix 58160-0850-11 10 x 1.0 1.0 ml $96.58

GlaxoSmithKline Twinrix syringe 58160-0850-46 5 x 1.0 1.0 ml $96.90

Influenza (split virus) Vaccine:

Evans Fluvirin 19650-0103-10 5.0 ml 0.5 ml $4.49

Evans Fluvirin/syringe 19650-0103-01 10 x 0.5 0.5 ml $5.60

Wyeth-Lederle Flu-Shield 0008-0986-01 5.0 ml 0.5 ml $6.62

Rabies Vaccine:

Aventis Pasteur Imovax Rabies 49281-0250-10 1.0 ml 1.0 ml $155.91

Pneumococcal Vaccine:

Wyeth-Lederle Prevnar 0005-1970-67 5 x 0.5 0.5 ml $72.50

Wyeth-Lederle Pnu-Immune 23 0005-2309-31 5 x 0.5 0.5 ml $16.58

Wyeth-Lederle Pnu-Immune 23 syringe 0005-2309-33 5 x 0.5 0.5 ml $18.60

Merck & Co. Pneumovax 23 0006-4739-00 2.5 ml 0.5 ml $15.16

Merck & Co. Pneumovax 23 0006-4943-00 10 x 0.5 0.5 ml $17.01

Merck & Co. Pneumovax 23 syringe 0006-4894-00 5 x 0.5 0.5 ml $21.46

Meningococcal Vaccine:

Aventis Pasteur Menomune 49281-0489-05 5 x 0.5 0.5 ml $73.11

Aventis Pasteur Menomune 49281-0489-91 5.0 ml 0.5 ml $80.34

Varicella Virus Vaccine Live (Chickenpox):

Merck & Co. Varivax* 00006-4827-00 10 x 0.5 0.5 ml $64.42

Merck & Co. Varivax* 00006-4826-00 0.5 ml 0.5 ml $68.55

*Comes with a box of 10 vials of diluent (package B: 00006-4309-00)

Gamma Globulin/Immune Globulin (GG/IG):

Bayer Gamimune N 10% 0026-0648-12 1 g 2.0 ml $90.00/g

Bayer Gamimune N 10% 0026-0648-15 2.5 g 2.0 ml $90.00/g

Bayer Gamimune N 10% 0026-0648-20 5 g 2.0 ml $90.00/g

Bayer Gamimune N 10% 0026-0648-71 10 g 2.0 ml $90.00/g

Bayer Gamimune N 10% 0026-0648-24 20 g 2.0 ml $90.00/g

*Dosage will vary depending upon the weight of the child and the disease for which the child is being immunized. 150 Pct AWP/Dose is to be calculated based upon the dosage used.

Hepatitis B Immune Globulin (HBIG):

NABI NABI-HB 59730-4402-01 1.0 ml 1.0 ml $175.00

NABI NABI-HB 59730-4403-01 5.0 ml 5.0 ml $140.00

Varicella-Zoster Immune Globulin (VZIG):

Mass. PHBL VZIG 52769-0574-66 625 u 250 u* $560.00

*Dosage will vary depending upon the weight of the child. If any portion of a vial is used to immunize a child, and the remainder cannot be used to immunize another individual, the entire vial shall be considered as part of the dosage used. 150 Pct LST/Dose is to be calculated based upon the dosage used.

**LST (list price) is used instead of AWP. This product has no AWP. LST may fluctuate slightly, depending on where the product is purchased.

Rabies Immune Globulin (RIG):

Aventis Pasteur Imogam Rabies-HT 49281-0190-10 10.0 ml 1.0ml* $79.83

Aventis Pasteur Imogam Rabies-HT 49281-0190-20 2 ml 1.0ml* $79.83

*Dosage will vary depending upon the weight of the child. Each 1.0 ml contains 150 IU units. If any portion of the vial is used to immunize a child, and the remainder cannot be used to immunize another individual, the entire vial shall be considered as part of the dosage used. 150 Pct AWP/Dose is to be calculated based upon the dosage used.

Tetanus Immune Globulin (TIG):

Bayer Baytet syringe 00026-0634-02 250.0 unit/in 1.0 ml $120.00

   Persons with a disability who require an alternative format of this notice (for example, large print, audiotape or Braille), should contact Alice Gray, Director, Division of Immunization, Department of Health, P. O. Box 90, Harrisburg, PA 17108-0090, (717) 787-5681 or for speech and/or hearing impaired persons, V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).

ROBERT S. ZIMMERMAN, Jr.,
Secretary

[Pa.B. Doc. No. 02-1897. Filed for public inspection October 25, 2002, 9:00 a.m.]

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Product Name, Company	Brand/Product Name	NDC Number	Unit	Dose	AWP/Dose
Diphtheria Tetanus acellular Pertussis Vaccine (DTaP):
Aventis Pasteur	Tripedia	49281-0298-10	10 x 1	0.5 ml	$23.81
GlaxoSmithKline	Infanrix	58160-0840-11	10 x 1	0.5 ml	$24.01
Diphtheria Tetanus pediatric Vaccine (DT pediatric):
Aventis Pasteur	DT Pediatric	49281-0275-10	5.0 ml	0.5 ml	$9.89
Diphtheria Tetanus acellular Pertussis/Haemophilus Influenzae B (DTaP-HIB):
Aventis Pasteur	TriHIBit	49281-0597-05	5 x 1	0.5 ml	$23.89
Tetanus Diphtheria adult Vaccine (Td adult):
Aventis Pasteur	Td Adult syringe	49281-0271-10	10 x 1	0.5 ml	$11.50
Aventis Pasteur	Td Adult	49281-0271-83	5.0 ml	0.5 ml	$9.89
Haemophilus Influenzae B Vaccine (HIB):
Wyeth-Lederle	HibTITER	0005-0104-32	5 x 0.5	0.5 ml	$28.38
Aventis Pasteur	ActHIB	49281-0545-05	5 x 1	0.5 ml	$27.04
Merck & Co.	Pedvax HIB	0006-4897-00	10 x 0.5	0.5 ml	$25.60
Injectable Polio Vaccine Inactivated (Salk Enhanced IPV):
Aventis Pasteur	IPOL	49281-0860-10	5.0 ml	0.5 ml	$25.07
Aventis Pasteur	IPOL	49281-0860-52	10 x 1	0.5 ml	$28.95
Measles Mumps Rubella Vaccine (MMR):
Merck & Co.	MMR II	0006-4749-00	0.5 ml	0.5 ml	$43.76
Merck & Co.	MMR II	0006-4681-00	10 x 0.5	0.5 ml	$37.93
Measles Vaccine (Rubeola):
Merck & Co.	Atenuvax	0006-4709-00	0.5 ml	0.5 ml	$18.11
Merck & Co.	Atenuvax	0006-4589-00	10 x 0.5	0.5 ml	$14.55
Mumps Vaccine (Mumps):
Merck & Co.	Mumpsvax	0006-4753-00	0.5 ml	0.5 ml	$20.89
Merck & Co.	Mumpsvax	0006-4584-00	10 x 0.5	0.5 ml	$18.79
Rubella (German Measles):
Merck & Co.	Meruvax II	0006-4747-00	0.5 ml	0.5 ml	$18.98
Merck & Co.	Meruvax II	0006-4673-00	10 x 0.5	0.5 ml	$16.20
Hepatitis A Vaccine Pediatric (HEP-A):
Merck & Co.	VAQTA	0006-4831-00	0.5 ml	0.5 ml	$35.93
Merck & Co.	VAQTA	0006-4831-38	5 x 0.5	0.5 ml	$33.91
Merck & Co.	VAQTA syringe	0006-4845-00	0.5 ml	0.5 ml	$35.93
Merck & Co.	VAQTA syringe	0006-4845-38	5 x 0.5	0.5 ml	$33.91
GlaxoSmithKline	Havrix	58160-0837-01	0.5 ml	0.5 ml	$34.16
GlaxoSmithKline	Havrix	58160-0837-11	10 x 0.5	0.5 ml	$32.67
GlaxoSmithKline	Havrix syringe	58160-0837-50	25 x 0.5	0.5 ml	$36.67
GlaxoSmithKline	Havrix syringe	58160-0837-46	5 x 0.5	0.5 ml	$36.67
GlaxoSmithKline	Havrix syringe	58160-0837-50	25 x 0.5	0.5 ml	$36.67
GlaxoSmithKline	Havrix syringe	58160-0837-58	25 x 0.5	0.5 ml	$32.67
Hepatitis A Vaccine Adult (HEP-A):
Merck & Co.	VAQTA	0006-4841-00	1.0 ml	1.0 ml	$71.85
Merck & Co.	VAQTA	0006-4841-38	5 x 1.0	1.0 ml	$67.81
Merck & Co.	VAQTA syringe	0006-4844-00	1.0 ml	1.0 ml	$71.85
Merck & Co.	VAQTA syringe	0006-4844-38	5 x 1.0	1.0 ml	$67.81
GlaxoSmithKline	Havrix	58160-0835-01	0.5 ml	0.5 ml	$66.94
GlaxoSmithKline	Havrix syringe	58160-0835-41	1 x 0.5	0.5 ml	$65.50
GlaxoSmithKline	Havrix syringe	58160-0835-46	5 x 0.5	0.5 ml	$65.50
Hepatitis B Vaccine (HEP-B):
Merck & Co.	(1) Recombivax HB	00006-4980-00	0.5 ml	0.5 ml	$30.48
Merck & Co.	(1) Recombivax HB	00006-4981-00	10 x 0.5	0.5 ml	$29.01
Merck & Co.	(2) Recombivax HB	00006-4769-00	0.5 ml	0.5 ml	$30.48
Merck & Co.	(2) Recombivax HB	00006-4876-00	10 x 0.5	0.5 ml	$28.66
Merck & Co.	(2) Recombivax HB	00006-4849-00	5 x 0.5	0.5 ml	$30.50
Merck & Co.	(2) Recombivax HB	00006-4969-00	5 x 0.5	0.5 ml	$30.50
Merck & Co.	(3) Recombivax HB	00006-4773-00	3.0 ml	0.5 ml	$74.56
Merck & Co.	(3) Recombivax HB	00006-4775-00	1.0 ml	1.0 ml	$74.63
Merck & Co.	(3) Recombivax HB	00006-4872-00	10 x 1.0	1.0 ml	$73.87
Merck & Co.	(3) Recombivax HB	00006-4873-00	10 x 3.0	0.5 ml	$73.89
Merck & Co.	(3) Recombivax HB	00006-4848-00	5 x 1.0	1.0 ml	$74.64
GlaxoSmithKline	(4) Engerix-B	58160-0856-01	0.5 ml	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B	58160-0856-11	10 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B syringe	58160-0856-46	5 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B syringe	58160-0856-50	25 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B syringe	58160-0856-46	5 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B syringe	58160-0856-50	25 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B syringe	58160-0856-50	25 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B syringe	58160-0856-58	25 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(4) Engerix-B syringe	58160-0856-57	25 x 0.5	0.5 ml	$26.52
GlaxoSmithKline	(5) Engerix-B	58160-0857-01	1.0 ml	1.0 ml	$62.20
GlaxoSmithKline	(5) Engerix-B	58160-0857-16	25 x 1.0	1.0 ml	$60.63
GlaxoSmithKline	(5) Engerix-B syringe	58160-0857-46	5 x 1.0	1.0 ml	$60.95
GlaxoSmithKline	(5) Engerix-B syringe	58160-0857-50	25 x 1.0	1.0 ml	$60.95
(1) Pediatric low risk formulation @ 5 mcg/ml (2) Adolescent/infant high risk formulation @ 10 mcg/ml (3) Adult formulation @ 10 mcg/0.5 ml (4) Pediatric formulation @ 10 mcg/0.5 ml Adult formulation @ 20 mcg/ml
Hepatitis B/HIB:
Merck & Co.	COMVAX	0006-4898-00	10 x 0.5	0.5 ml	$53.32
Hepatitis A and Hepatitis B Vaccine:
GlaxoSmithKline	Twinrix	58160-0850-01	1.0 ml	1.0 ml	$98.15
GlaxoSmithKline	Twinrix	58160-0850-11	10 x 1.0	1.0 ml	$96.58
GlaxoSmithKline	Twinrix syringe	58160-0850-46	5 x 1.0	1.0 ml	$96.90
Influenza (split virus) Vaccine:
Evans	Fluvirin	19650-0103-10	5.0 ml	0.5 ml	$4.49
Evans	Fluvirin/syringe	19650-0103-01	10 x 0.5	0.5 ml	$5.60
Wyeth-Lederle	Flu-Shield	0008-0986-01	5.0 ml	0.5 ml	$6.62
Rabies Vaccine:
Aventis Pasteur	Imovax Rabies	49281-0250-10	1.0 ml	1.0 ml	$155.91
Pneumococcal Vaccine:
Wyeth-Lederle	Prevnar	0005-1970-67	5 x 0.5	0.5 ml	$72.50
Wyeth-Lederle	Pnu-Immune 23	0005-2309-31	5 x 0.5	0.5 ml	$16.58
Wyeth-Lederle	Pnu-Immune 23 syringe	0005-2309-33	5 x 0.5	0.5 ml	$18.60
Merck & Co.	Pneumovax 23	0006-4739-00	2.5 ml	0.5 ml	$15.16
Merck & Co.	Pneumovax 23	0006-4943-00	10 x 0.5	0.5 ml	$17.01
Merck & Co.	Pneumovax 23 syringe	0006-4894-00	5 x 0.5	0.5 ml	$21.46
Meningococcal Vaccine:
Aventis Pasteur	Menomune	49281-0489-05	5 x 0.5	0.5 ml	$73.11
Aventis Pasteur	Menomune	49281-0489-91	5.0 ml	0.5 ml	$80.34
Varicella Virus Vaccine Live (Chickenpox):
Merck & Co.	Varivax*	00006-4827-00	10 x 0.5	0.5 ml	$64.42
Merck & Co.	Varivax*	00006-4826-00	0.5 ml	0.5 ml	$68.55
*Comes with a box of 10 vials of diluent (package B: 00006-4309-00)
Gamma Globulin/Immune Globulin (GG/IG):
Bayer	Gamimune N 10%	0026-0648-12	1 g	2.0 ml	$90.00/g
Bayer	Gamimune N 10%	0026-0648-15	2.5 g	2.0 ml	$90.00/g
Bayer	Gamimune N 10%	0026-0648-20	5 g	2.0 ml	$90.00/g
Bayer	Gamimune N 10%	0026-0648-71	10 g	2.0 ml	$90.00/g
Bayer	Gamimune N 10%	0026-0648-24	20 g	2.0 ml	$90.00/g
*Dosage will vary depending upon the weight of the child and the disease for which the child is being immunized. 150 Pct AWP/Dose is to be calculated based upon the dosage used.
Hepatitis B Immune Globulin (HBIG):
NABI	NABI-HB	59730-4402-01	1.0 ml	1.0 ml	$175.00
NABI	NABI-HB	59730-4403-01	5.0 ml	5.0 ml	$140.00
Varicella-Zoster Immune Globulin (VZIG):
Mass. PHBL	VZIG	52769-0574-66	625 u	250 u*	$560.00
*Dosage will vary depending upon the weight of the child. If any portion of a vial is used to immunize a child, and the remainder cannot be used to immunize another individual, the entire vial shall be considered as part of the dosage used. 150 Pct LST/Dose is to be calculated based upon the dosage used.
**LST (list price) is used instead of AWP. This product has no AWP. LST may fluctuate slightly, depending on where the product is purchased.
Rabies Immune Globulin (RIG):
Aventis Pasteur	Imogam Rabies-HT	49281-0190-10	10.0 ml	1.0ml*	$79.83
Aventis Pasteur	Imogam Rabies-HT	49281-0190-20	2 ml	1.0ml*	$79.83
*Dosage will vary depending upon the weight of the child. Each 1.0 ml contains 150 IU units. If any portion of the vial is used to immunize a child, and the remainder cannot be used to immunize another individual, the entire vial shall be considered as part of the dosage used. 150 Pct AWP/Dose is to be calculated based upon the dosage used.
Tetanus Immune Globulin (TIG):
Bayer	Baytet syringe	00026-0634-02	250.0 unit/in	1.0 ml	$120.00