SOUTH DAKOTA MEDICAID MAC LIST
DRUGS THAT START WITH LETTER S


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GENERIC NAME GPI MAC
SALICYLIC ACID CREAM 6% 90750030003712 $0.18500
SALICYLIC ACID LOTION 6% 90750030004140 $0.18000
SALINE INJECTION BACTERIOSTATIC 98401040002010 $0.00000
SALINE INJECTION W/ BENZYL ALCOHOL 98401040102010 $0.00000
SALINE INJECTION W/ PARABENS 98401040202010 $0.00000
SALINE NASAL SPRAY 0.65% 42500010002010 $0.05290
SALSALATE TAB 500 MG 64100075000305 $0.07000
SALSALATE TAB 750 MG 64100075000310 $0.10000
SELEGILINE HCL CAP 5 MG 73300030100120 $1.36430
SELEGILINE HCL TAB 5 MG 73300030100320 $0.00000
SELENIUM SULFIDE LOTION 2.5% 90300050004120 $0.06500
SELENIUM SULFIDE SHAMPOO 1% 90300050004505 $0.00000
SELENIUM SULFIDE SHAMPOO 2.5% 90300050004510 $0.00000
SENNOSIDES TAB 15 MG 46200060200315 $0.19900
SENNOSIDES TAB 25 MG 46200060200325 $0.17700
SENNOSIDES TAB 8.6 MG 46200060200303 $0.06500
SERTRALINE HCL ORAL CONC 20 MG/ML 58160070101320 $0.75000
SERTRALINE HCL TAB 100 MG 58160070100320 $0.23000
SERTRALINE HCL TAB 25 MG 58160070100305 $0.28000
SERTRALINE HCL TAB 50 MG 58160070100310 $0.23000
SILVER SULFADIAZINE CREAM 1% 90450030003710 $0.11500
SIMETHICONE SUSP 40 MG/0.6ML 52200020001810 $0.13800
SIMVASTATIN TAB 10 MG 39400075000320 $0.21000
SIMVASTATIN TAB 20 MG 39400075000330 $0.38750
SIMVASTATIN TAB 40 MG 39400075000340 $0.40900
SIMVASTATIN TAB 5 MG 39400075000310 $0.18000
SIMVASTATIN TAB 80 MG 39400075000360 $0.42300
SODIUM BICARBONATE INJ 4% 79050020002005 $0.00000
SODIUM BICARBONATE INJ 4.2% 79050020002010 $0.00000
SODIUM BICARBONATE INJ 5% 79050020002015 $0.00000
SODIUM BICARBONATE INJ 7.5% 79050020002020 $0.08000
SODIUM BICARBONATE INJ 8.4% 79050020002025 $0.04000
SODIUM CHLORIDE INJ 0.45% 79750010002010 $0.01500
SODIUM CHLORIDE INJ 0.9% 79750010002020 $0.00000
SODIUM CHLORIDE INJ 2.5 MEQ/ML 79750010002050 $0.00000
SODIUM CHLORIDE INJ 23.4% 79750010002045 $0.00000
SODIUM CHLORIDE INJ KIT 0.9% 79750010006420 $0.00000
SODIUM CHLORIDE IRRIGATION SOLN 0.9% 56700060002010 $0.00520
SODIUM CHLORIDE IV SOLN 0.9% ************** $0.02400
SODIUM CHLORIDE IV SOLN 0.9% ************** $0.02400
SODIUM CHLORIDE IV SOLN 0.9% 79750010002021 $0.03500
SODIUM CHLORIDE SOLN NEBU 0.9% 43400010002520 $0.00000
SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML 56202020002010 $0.01500
SODIUM FLUORIDE CHEW TAB 1.1 MG (0.5MG F) 79300020000510 $0.00000
SODIUM FLUORIDE CHEW TAB 2.2 MG 79300020000515 $0.00000
SODIUM FLUORIDE CREAM 1.1% 88402020003721 $0.09040
SODIUM FLUORIDE RINSE 0.044% 88401020002008 $0.00000
SODIUM FLUORIDE RINSE 0.2% 88401020002020 $0.00000
SODIUM FLUORIDE SOLN 1.1 MG/ML (0.5 MG/ML F) 79300020002050 $0.11000
SODIUM SULFACETAMIDE OPHTH OINT 10% 86102010104205 $0.00000
SODIUM SULFACETAMIDE OPHTH SOLN 10% 86102010102010 $0.13500
SODIUM SULFACETAMIDE OPHTH SOLN 30% 86102010102020 $0.00000
SOTALOL HCL (AFIB/AFL) TAB 120 MG 33100045120315 $0.72000
SOTALOL HCL (AFIB/AFL) TAB 160 MG 33100045120320 $1.12500
SOTALOL HCL (AFIB/AFL) TAB 80 MG 33100045120310 $0.69000
SOTALOL HCL TAB 120 MG 33100045100315 $0.30000
SOTALOL HCL TAB 160 MG 33100045100320 $0.60000
SOTALOL HCL TAB 240 MG 33100045100330 $0.48000
SOTALOL HCL TAB 80 MG 33100045100310 $0.26000
SPIRONOLACTONE & HYDROCHLOROTHIAZIDE TAB 25-25 MG 37990002200310 $0.22000
SPIRONOLACTONE TAB 100 MG 37500020000315 $0.85000
SPIRONOLACTONE TAB 25 MG 37500020000305 $0.17210
SPIRONOLACTONE TAB 50 MG 37500020000310 $0.48000
STAVUDINE CAP 20 MG 12108070000120 $1.70500
STAVUDINE CAP 30 MG 12108070000130 $1.81000
STAVUDINE CAP 40 MG 12108070000140 $1.88500
STREPTOKINASE FOR INJ 250000 IU 85600010002105 $0.00000
STREPTOKINASE FOR INJ 750000 IU 85600010002115 $0.00000
SUCRALFATE TAB 1 GM 49300010000305 $0.29740
SULFACETAMIDE SODIUM LIQUID 10% 90300060000920 $0.00000
SULFACETAMIDE SODIUM LOTION 10% (ACNE) 90051036104120 $0.63500
SULFACETAMIDE SODIUM W/ SULFUR CLEANSING CLOTH 10-5% 90059903204320 $2.60000
SULFACETAMIDE SODIUM W/ SULFUR EMULSION 10-5% 90059903201620 $0.17710
SULFACETAMIDE SODIUM W/ SULFUR LOTION 10-5% 90059903204110 $1.42850
SULFACETAMIDE SODIUM W/ SULFUR LOTION 10-5% 90059903204110 $1.68870
SULFACETAMIDE SODIUM-PREDNISOLONE OPHTH SOLN 10-0.25% 86309902722015 $2.26560
SULFACETAMIDE SODIUM-UREA PAD 10-10% 90309902604320 $1.79590
SULFASALAZINE EC TAB 500 MG 52500060000610 $0.29000
SULFASALAZINE TAB 500 MG 52500060000310 $0.12500
SULFINPYRAZONE TAB 100 MG 68100020000305 $0.00000
SULFISOXAZOLE TAB 500 MG 08000070000305 $0.00000
SULINDAC TAB 150 MG 66100080000305 $0.21000
SULINDAC TAB 200 MG 66100080000310 $0.33000
SUMATRIPTAN SUCCINATE INJ 12 MG/ML 67406070102010 $93.43760
SUMATRIPTAN SUCCINATE TAB 100 MG 67406070100320 $3.47990
SUMATRIPTAN SUCCINATE TAB 25 MG 67406070100305 $3.98500
SUMATRIPTAN SUCCINATE TAB 50 MG 67406070100310 $3.75290

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