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DIN/ PIN/ NPN	Generic Name	Brand Name, Strength & Dosage Form	MFR	Drug Benefit Price or Unit Price	Amount MOH Pays	Inter- change- able	Limited Use	Thera- peutic Notes
00545015	ACETAZOLAMIDE	Acetazolamide 250mg Tab	AAP	0.1414	0.1414	YES	NO	NO
02420333	ADEFOVIR DIPIVOXIL	AA-Adefovir (Off-Formulary Interchangeable) 10mg Tab	AAP	20.9130	N/A	YES	NO	NO
02249510	AMILORIDE HCL	Midamor 5mg Tab	AAP	0.3297	0.3297	NO	NO	NO
00784400	AMILORIDE HCL & HYDROCHLOROTHIAZIDE	AA-Amilzide 5mg & 50mg Tab	AAP	0.0881	0.0881	YES	NO	NO
00335088	AMITRIPTYLINE	Elavil 50mg Tab	AAP	0.2347	0.1540	YES	NO	NO
00335053	AMITRIPTYLINE	Elavil 10mg Tab	AAP	0.0664	0.0305	YES	NO	NO
00335061	AMITRIPTYLINE	Elavil 25mg Tab	AAP	0.1211	0.0829	YES	NO	NO
02248763	ATENOLOL & CHLORTHALIDONE	AA-Atenidone 50 & 25mg Tab	AAP	0.5342	0.5342	YES	NO	NO
02248764	ATENOLOL & CHLORTHALIDONE	AA-Atenidone 100 & 25mg Tab	AAP	0.8755	0.8755	YES	NO	NO
02290340	BENAZEPRIL	Benazepril 10mg Tab	AAP	0.9938	0.9938	YES	NO	NO
02273918	BENAZEPRIL	Benazepril 20mg Tab	AAP	1.2875	1.2875	YES	NO	NO
02290332	BENAZEPRIL	Benazepril 5mg Tab	AAP	0.9485	0.9485	YES	NO	NO
02301334	BRIMONIDINE	Brimonidine P 0.15% Oph Sol	AAP	2.0305	2.0305	YES	YES	NO
02230454	BROMOCRIPTINE	Bromocriptine 5mg Cap	AAP	1.7097	1.7097	YES	NO	NO
02087324	BROMOCRIPTINE	Bromocriptine 2.5mg Tab	AAP	1.0800	1.0800	YES	NO	NO
02242504	BUTORPHANOL TARTRATE	Butorphanol Nasal Spray (Off-Formulary Interchangeable) 10mg/mL Nas Sp-2.5mL Pk	AAP	64.0200	64.0200	YES	NO	NO
00522996	CHLORDIAZEPOXIDE	Chlordiazepoxide 25mg Cap	AAP	0.2014	0.2014	YES	NO	NO
00522724	CHLORDIAZEPOXIDE	Chlordiazepoxide 5mg Cap	AAP	0.0825	0.0825	YES	NO	NO
00522988	CHLORDIAZEPOXIDE	Chlordiazepoxide 10mg Cap	AAP	0.1115	0.1115	YES	NO	NO
00600067	CIMETIDINE	Cimetidine 600mg Tab	AAP	0.3405	0.3405	YES	NO	YES
00749494	CIMETIDINE	Cimetidine 800mg Tab	AAP	0.2530	0.2530	YES	NO	YES
00600059	CIMETIDINE	Cimetidine 400mg Tab	AAP	0.2930	0.2930	YES	NO	YES
00487872	CIMETIDINE	Cimetidine 300mg Tab	AAP	0.3423	0.3423	YES	NO	YES
00584215	CIMETIDINE	Cimetidine 200mg Tab	AAP	0.3557	0.3557	YES	NO	YES
00860697	CLORAZEPATE DIPOTASSIUM	Clorazepate 15mg Cap	AAP	0.4405	0.4405	YES	NO	NO
00860700	CLORAZEPATE DIPOTASSIUM	Clorazepate 7.5mg Cap	AAP	0.2337	0.2337	YES	NO	NO
00860689	CLORAZEPATE DIPOTASSIUM	Clorazepate 3.75mg Cap	AAP	0.1793	0.1793	YES	NO	NO
02458756	CLOZAPINE	AA-Clozapine (Off-Formulary Interchangeable) 200mg Tab	AAP	5.2892	N/A	YES	NO	NO
02248034	CLOZAPINE	AA-Clozapine (Off-Formulary Interchangeable) 25mg Tab	AAP	0.6594	N/A	YES	NO	NO
02248035	CLOZAPINE	AA-Clozapine (Off-Formulary Interchangeable) 100mg Tab	AAP	2.6446	N/A	YES	NO	NO
02458748	CLOZAPINE	AA-Clozapine (Off-Formulary Interchangeable) 50mg Tab	AAP	1.3206	N/A	YES	NO	NO
02245898	CYPROTERONE ACETATE	Cyproterone 50mg Tab	AAP	1.4085	1.4000	YES	NO	NO
02216256	DESIPRAMINE	Desipramine 25mg Tab	AAP	0.4345	0.4345	YES	NO	NO
02216264	DESIPRAMINE	Desipramine 50mg Tab	AAP	0.7659	0.7659	YES	NO	NO
02216272	DESIPRAMINE	Desipramine 75mg Tab	AAP	1.0184	1.0184	YES	NO	NO
02242465	DESMOPRESSIN ACETATE	Desmopressin Spray 10mcg/Metered Dose Nas Sp-2.5mL Pk	AAP	42.1661	42.1661	YES	NO	NO
02443236	DEXTROAMPHETAMINE SULFATE	Dextroamphetamine 5mg Tab	AAP	0.5081	0.5081	YES	NO	YES
00405329	DIAZEPAM	Diazepam 2mg Tab	AAP	0.0532	0.0532	YES	NO	NO
00405337	DIAZEPAM	Diazepam 10mg Tab	AAP	0.1204	0.1204	YES	NO	NO
00362158	DIAZEPAM	Diazepam 5mg Tab	AAP	0.1662	0.1662	YES	NO	NO
00771384	DILTIAZEM HCL	AA-Diltiaz 60mg Tab	AAP	0.3802	0.3802	YES	NO	NO
00771376	DILTIAZEM HCL	AA-Diltiaz 30mg Tab	AAP	0.2168	0.2168	YES	NO	NO
00326925	DOXEPIN HCL	Sinequan (Off-Formulary Interchangeable) 100mg Cap	AAP	N/A	N/A	YES	NO	NO
00024341	DOXEPIN HCL	Sinequan 50mg Cap	AAP	0.9274	0.5101	YES	NO	NO
00024333	DOXEPIN HCL	Sinequan 25mg Cap	AAP	0.5000	0.2750	YES	NO	NO
00024325	DOXEPIN HCL	Sinequan 10mg Cap	AAP	0.4075	0.2241	YES	NO	NO
00400750	DOXEPIN HCL	Sinequan (Off-Formulary Interchangeable) 75mg Cap	AAP	N/A	N/A	YES	NO	NO
02352923	ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE	Enalapril Maleate/HCTZ (Off-Formulary Interchangeable) 5mg & 12.5mg Tab	AAP	0.8762	N/A	YES	NO	NO
02352931	ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDE	Enalapril Maleate/HCTZ (Off-Formulary Interchangeable) 10mg & 25mg Tab	AAP	1.2284	N/A	YES	NO	NO
00682020	ERYTHROMYCIN BASE	Erythro-Base 250mg Tab	AAP	0.1865	0.1865	YES	NO	YES
02243180	FENOFIBRATE	AA-Feno-Micro (Off-Formulary Interchangeable) 67mg Cap	AAP	0.6025	N/A	YES	NO	NO
02239864	FENOFIBRATE	AA-Feno-Micro 200mg Cap	AAP	0.9257	0.9257	YES	NO	NO
02246860	FENOFIBRATE	AA-Feno-Super 160mg Tab	AAP	1.0022	1.0022	YES	NO	NO
02246859	FENOFIBRATE	AA-Feno-Super (Off-Formulary Interchangeable) 100mg Tab	AAP	0.9883	N/A	YES	NO	NO
00545031	FERROUS GLUCONATE	Ferrous Gluconate 300mg 300mg Tab	AAP	0.0424	0.0424	YES	NO	NO
02246082	FLUNARIZINE HCL	Flunarizine 5mg Cap	AAP	0.8320	0.8320	YES	YES	NO
00410632	FLUPHENAZINE HCL	Fluphenazine 2mg Tab	AAP	0.2252	0.2252	YES	NO	NO
00405345	FLUPHENAZINE HCL	Fluphenazine 1mg Tab	AAP	0.1739	0.1739	YES	NO	NO
00405361	FLUPHENAZINE HCL	Fluphenazine 5mg Tab	AAP	0.1720	0.1720	YES	NO	NO
00521698	FLURAZEPAM	Flurazepam 15mg Cap	AAP	0.1166	0.1166	YES	NO	NO
00521701	FLURAZEPAM	Flurazepam 30mg Cap	AAP	0.1364	0.1364	YES	NO	NO
01912046	FLURBIPROFEN	Flurbiprofen 50mg Tab	AAP	0.4530	0.4530	YES	NO	YES
01912038	FLURBIPROFEN	Flurbiprofen 100mg Tab	AAP	0.5930	0.5930	YES	NO	YES
02238560	FLUTAMIDE	Flutamide 250mg Tab	AAP	1.8255	1.8255	YES	NO	NO
00426849	FOLIC ACID	Folic Acid 5mg Tab	AAP	0.0404	0.0404	YES	NO	NO
00646059	HYDROXYZINE HCL	Hydroxyzine (Not a Benefit) 10mg Cap	AAP	N/A	N/A	YES	NO	NO
00646016	HYDROXYZINE HCL	Hydroxyzine (Not a Benefit) 50mg Cap	AAP	N/A	N/A	YES	NO	NO
00646024	HYDROXYZINE HCL	Hydroxyzine (Not a Benefit) 25mg Cap	AAP	N/A	N/A	YES	NO	NO
02126222	IPRATROPIUM BROMIDE	AA-Ipravent 250mcg/mL Inh Sol-20mL Pk	AAP	6.3140	6.3140	YES	YES	NO
02246084	IPRATROPIUM BROMIDE	Ipravent (Off-Formulary Interchangeable) 0.06% Nasal Spray	AAP	2.9700	N/A	YES	NO	NO
00670944	ISOSORBIDE DINITRATE	ISDN 5mg SL Tab	AAP	0.0633	0.0633	YES	NO	NO
00441686	ISOSORBIDE DINITRATE	ISDN 10mg Tab	AAP	0.0372	0.0372	YES	NO	NO
00441694	ISOSORBIDE DINITRATE	ISDN 30mg Tab	AAP	0.0874	0.0874	YES	NO	NO
00790427	KETOPROFEN	Ketoprofen 50mg Cap	AAP	0.3440	0.3440	YES	NO	YES
00790435	KETOPROFEN	Ketoprofen-E 50mg Ent Tab	AAP	0.3379	0.3379	YES	NO	YES
00842664	KETOPROFEN	Ketoprofen-E 100mg Ent Tab	AAP	0.6959	0.6959	YES	NO	YES
02172577	KETOPROFEN	Ketoprofen SR 200mg LA Tab	AAP	1.3925	1.3925	YES	NO	YES
02245821	KETOROLAC TROMETHAMINE	Ketorolac 0.5% Oph Sol	AAP	2.8997	2.8997	YES	NO	YES
02162660	KETOROLAC TROMETHAMINE	Toradol (Off-Formulary Interchangeable) 10mg Tab	AAP	N/A	N/A	YES	NO	YES
02470780	LANSOPRAZOLE & CLARITHROMYCIN & AMOXICILLIN	AA-LansoprazoleAmoxicillinClarithromycin 30mg & 500mg & 500mg Tab/Cap Pk	AAP	67.9100	67.9100	YES	YES	NO
02272873	LEVODOPA & CARBIDOPA	AA-Levocarb CR 100mg & 25mg CR Tab	AAP	0.7974	0.7974	YES	YES	NO
02245211	LEVODOPA & CARBIDOPA	AA-Levocarb CR 200mg & 50mg CR Tab	AAP	1.4282	1.4282	YES	YES	NO
02266695	LITHIUM CARBONATE	Lithmax (Off-Formulary Interchangeable) 300mg ER Tab	AAP	0.2880	0.2880	YES	NO	NO
02410745	LORAZEPAM	Lorazepam Sublingual (Off-Formulary Interchangeable) 0.5mg SL Tab	AAP	0.1099	N/A	YES	NO	NO
02410753	LORAZEPAM	Lorazepam Sublingual (Off-Formulary Interchangeable) 1mg SL Tab	AAP	0.1385	N/A	YES	NO	NO
02410761	LORAZEPAM	Lorazepam Sublingual (Off-Formulary Interchangeable) 2mg SL Tab	AAP	0.2152	N/A	YES	NO	NO
02220172	LOVASTATIN	Lovastatin 20mg Tab	AAP	1.1931	1.1931	YES	NO	NO
02220180	LOVASTATIN	Lovastatin 40mg Tab	AAP	2.1793	2.1793	YES	NO	NO
02277298	MEDROXYPROGESTERONE ACETATE	AA-Medroxy 10mg Tab	AAP	0.5649	0.5649	YES	NO	NO
02267640	MEDROXYPROGESTERONE ACETATE	AA-Medroxy 100mg Tab	AAP	1.2057	1.2057	YES	NO	NO
02244726	MEDROXYPROGESTERONE ACETATE	AA-Medroxy 2.5mg Tab	AAP	0.1183	0.1183	YES	NO	NO
02244727	MEDROXYPROGESTERONE ACETATE	AA-Medroxy 5mg Tab	AAP	0.2602	0.2602	YES	NO	NO
02229452	MEFENAMIC ACID	Mefenamic 250mg Cap	AAP	0.4988	0.4988	YES	NO	YES
00155225	MEFENAMIC ACID	Ponstan (Not a Benefit) 250mg Cap	AAP	N/A	N/A	YES	NO	YES
02244366	MEFLOQUINE HCL	Mefloquine (Off-Formulary Interchangeable) 250mg Tab	AAP	3.6950	3.6950	YES	NO	NO
02195917	MEGESTROL ACETATE	Megestrol 40mg Tab	AAP	1.3340	1.3340	YES	NO	NO
02195925	MEGESTROL ACETATE	Megestrol 160mg Tab	AAP	5.8151	5.8151	YES	NO	NO
02245882	METHAZOLAMIDE	Methazolamide 50mg Tab	AAP	0.4913	0.4913	YES	NO	NO
02238405	METHOTRIMEPRAZINE	Methoprazine 25mg Tab	AAP	0.2681	0.2681	YES	NO	NO
02238404	METHOTRIMEPRAZINE	Methoprazine 5mg Tab	AAP	0.1043	0.1043	YES	NO	NO
02238403	METHOTRIMEPRAZINE	Methoprazine 2mg Tab	AAP	0.0721	0.0721	YES	NO	NO
02238406	METHOTRIMEPRAZINE	Methoprazine 50mg Tab	AAP	0.4060	0.4060	YES	NO	NO
00426830	METHYLDOPA	Methyldopa 500mg Tab	AAP	0.2588	0.2588	YES	NO	NO
00360252	METHYLDOPA	Methyldopa 125mg Tab	AAP	0.1009	0.1009	YES	NO	NO
00360260	METHYLDOPA	Methyldopa 250mg Tab	AAP	0.1579	0.1579	YES	NO	NO
02285169	METOPROLOL TARTRATE	AA-Metoprolol SR 100mg LA Tab	AAP	0.1415	0.1415	YES	NO	NO
02285177	METOPROLOL TARTRATE	AA-Metoprolol SR 200mg LA Tab	AAP	0.2568	0.2568	YES	NO	NO
02084104	MINOCYCLINE HCL	Minocycline 100mg Cap	AAP	1.0836	1.0836	YES	NO	NO
02084090	MINOCYCLINE HCL	Minocycline 50mg Cap	AAP	0.5616	0.5616	YES	NO	NO
02244023	MISOPROSTOL	Misoprostol 200mcg Tab	AAP	0.4389	0.4389	YES	NO	NO
02244022	MISOPROSTOL	Misoprostol 100mcg Tab	AAP	0.2636	0.2636	YES	NO	NO
02232148	MOCLOBEMIDE	Moclobemide 100mg Tab	AAP	0.3400	0.3400	YES	NO	NO
02240456	MOCLOBEMIDE	Moclobemide 300mg Tab	AAP	1.0399	1.0399	YES	NO	NO
02232150	MOCLOBEMIDE	Moclobemide 150mg Tab	AAP	0.5295	0.5295	YES	NO	NO
02238639	NABUMETONE	Nabumetone (Off-Formulary Interchangeable) 500mg Tab	AAP	0.7363	N/A	YES	NO	YES
00755907	NIFEDIPINE	Nifedipine 10mg Cap	AAP	0.4877	0.4877	YES	NO	YES
00725110	NIFEDIPINE	Nifedipine 5mg Cap	AAP	0.3679	0.3679	YES	NO	NO
00511528	NITRAZEPAM	Mogadon 5mg Tab	AAP	0.1826	0.1826	NO	NO	NO
00511536	NITRAZEPAM	Mogadon 10mg Tab	AAP	0.2732	0.2732	NO	NO	NO
00319511	NITROFURANTOIN	Nitrofurantoin 50mg Tab	AAP	0.1703	0.1703	YES	NO	YES
00312738	NITROFURANTOIN	Nitrofurantoin 100mg Tab	AAP	0.2272	0.2272	YES	NO	YES
02229524	NORFLOXACIN	Norfloxacin 400mg Tab	AAP	1.8586	1.8586	YES	NO	NO
00015229	NORTRIPTYLINE	Aventyl 10mg Cap	AAP	0.2995	0.2995	NO	NO	NO
00015237	NORTRIPTYLINE	Aventyl 25mg Cap	AAP	0.6054	0.6054	NO	NO	NO
02236783	ORCIPRENALINE SULFATE	Orciprenaline 2mg/mL O/L	AAP	0.0574	0.0574	YES	NO	NO
00642215	PENICILLIN V (POTASSIUM)	PEN V-K 300mg Tab	AAP	0.1873	0.1873	YES	NO	NO
02230090	PENTOXIFYLLINE	Pentoxifylline SR 400mg SR Tab	AAP	0.7238	0.7238	YES	YES	NO
00335134	PERPHENAZINE	Perphenazine 2mg Tab	AAP	0.0668	0.0668	YES	NO	NO
00335126	PERPHENAZINE	Perphenazine 4mg Tab	AAP	0.0808	0.0808	YES	NO	NO
00335118	PERPHENAZINE	Perphenazine 8mg Tab	AAP	0.0888	0.0888	YES	NO	NO
00335096	PERPHENAZINE	Perphenazine 16mg Tab	AAP	0.1359	0.1359	YES	NO	NO
02460912	PHENYTOIN (DIPHENYLHYDANTOIN) SODIUM	Phenytoin Sodium 100mg Cap	AAP	0.0665	0.0665	YES	NO	NO
00313815	PIMOZIDE	Orap 2mg Tab	AAP	0.2279	0.2279	YES	NO	NO
00313823	PIMOZIDE	Orap 4mg Tab	AAP	0.4136	0.4136	YES	NO	NO
02245432	PIMOZIDE	Pimozide 2mg Tab	AAP	0.3093	0.2279	YES	NO	NO
02245433	PIMOZIDE	Pimozide 4mg Tab	AAP	0.4136	0.4136	YES	NO	NO
02469677	PINAVERIUM BROMIDE	Pinaverium (Off-Formulary Interchangeable) 50mg Tab	AAP	0.3100	0.3100	YES	NO	NO
02469685	PINAVERIUM BROMIDE	Pinaverium (Off-Formulary Interchangeable) 100mg Tab	AAP	0.5405	0.5405	YES	NO	NO
00271373	PREDNISONE	Winpred 1mg Tab	AAP	0.1276	0.1276	NO	NO	NO
00399310	PRIMIDONE	Primidone 125mg Tab	AAP	0.0564	0.0564	YES	NO	NO
00396761	PRIMIDONE	Primidone 250mg Tab	AAP	0.0887	0.0887	YES	NO	NO
00886440	PROCHLORPERAZINE	Prochlorazine 5mg Tab	AAP	0.1659	0.1659	YES	NO	NO
00886432	PROCHLORPERAZINE	Prochlorazine 10mg Tab	AAP	0.2025	0.2025	YES	NO	NO
02493268	RISEDRONATE SODIUM	AA-Risedronate DR 35mg DR Tab	AAP	2.9663	2.9663	YES	NO	NO
02403382	ROSIGLITAZONE	Rosiglitazone (Off-Formulary Interchangeable) 8mg Tab	AAP	2.7452	2.7452	YES	NO	NO
02403374	ROSIGLITAZONE	Rosiglitazone (Off-Formulary Interchangeable) 4mg Tab	AAP	1.9197	1.9197	YES	NO	NO
02403366	ROSIGLITAZONE	Rosiglitazone (Off-Formulary Interchangeable) 2mg Tab	AAP	1.2234	1.2234	YES	NO	NO
02230641	SELEGILINE HCL	Selegiline 5mg Tab	AAP	1.7072	1.7072	YES	NO	NO
00445274	SULFAMETHOXAZOLE & TRIMETHOPRIM	Sulfatrim 400mg & 80mg Tab	AAP	0.2184	0.2184	YES	NO	YES
00445282	SULFAMETHOXAZOLE & TRIMETHOPRIM	Sulfatrim-DS 800mg & 160mg Tab	AAP	0.2074	0.2074	YES	NO	YES
00604453	TEMAZEPAM	Restoril 15mg Cap	AAP	0.2461	0.2461	NO	NO	NO
00604461	TEMAZEPAM	Restoril 30mg Cap	AAP	0.2980	0.2980	NO	NO	NO
00580929	TETRACYCLINE	Tetracycline 250mg Cap	AAP	0.0670	0.0670	YES	NO	YES
02360128	THEOPHYLLINE ANHYDROUS	Theo ER 600mg SR Tab	AAP	0.4524	0.4524	YES	NO	NO
02360101	THEOPHYLLINE ANHYDROUS	Theo ER 400mg SR Tab	AAP	0.3735	0.3734	YES	NO	NO
02237701	TICLOPIDINE HCL	Ticlopidine 250mg Tab	AAP	1.0679	1.0679	YES	YES	NO
00755842	TIMOLOL MALEATE	Timolol 5mg Tab	AAP	0.2077	0.2077	YES	NO	NO
00755869	TIMOLOL MALEATE	Timolol 20mg Tab	AAP	0.6304	0.6304	YES	NO	NO
00755850	TIMOLOL MALEATE	Timolol 10mg Tab	AAP	0.3239	0.3239	YES	NO	NO
00808563	TRIAZOLAM	Triazolam 0.125mg Tab	AAP	0.1496	0.1496	YES	NO	NO
00808571	TRIAZOLAM	Triazolam 0.25mg Tab	AAP	0.2551	0.2551	YES	NO	NO
00312754	TRIFLUOPERAZINE	Trifluoperazine 2mg Tab	AAP	0.1793	0.1793	YES	NO	NO
00326836	TRIFLUOPERAZINE	Trifluoperazine 10mg Tab	AAP	0.2846	0.2846	YES	NO	NO
00312746	TRIFLUOPERAZINE	Trifluoperazine 5mg Tab	AAP	0.2375	0.2375	YES	NO	NO
00345539	TRIFLUOPERAZINE	Trifluoperazine 1mg Tab	AAP	0.1340	0.1340	YES	NO	NO
00545058	TRIHEXYPHENIDYL HCL	Trihexyphenidyl 2mg Tab	AAP	0.0376	0.0376	YES	NO	NO
00545074	TRIHEXYPHENIDYL HCL	Trihexyphenidyl 5mg Tab	AAP	0.0681	0.0681	YES	NO	NO
02243117	TRIMETHOPRIM	Trimethoprim 200mg Tab	AAP	0.5378	0.5378	YES	NO	NO
02243116	TRIMETHOPRIM	Trimethoprim 100mg Tab	AAP	0.2617	0.2617	YES	NO	NO
02070987	TRIMIPRAMINE	Trimipramine 75mg Cap	AAP	0.7800	0.7800	YES	NO	NO
00740799	TRIMIPRAMINE	Trimipramine 12.5mg Tab	AAP	0.2156	0.2156	YES	NO	NO
00740802	TRIMIPRAMINE	Trimipramine 25mg Tab	AAP	0.2960	0.2960	YES	NO	NO
00740829	TRIMIPRAMINE	Trimipramine 100mg Tab	AAP	0.9889	0.9889	YES	NO	NO
00740810	TRIMIPRAMINE	Trimipramine 50mg Tab	AAP	0.5795	0.5795	YES	NO	NO

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