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Products found: 24

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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
01981501	BOTULINUM TOXIN TYPE A	Botox 100U/Vial Pd Inj-100U Vial Pk	ABV	374.8500	374.8500	NO	YES	NO
02531585	BOTULINUM TOXIN TYPE A	Botox 200U/Vial Pd Inj-200U Vial Pk	ABV	749.7000	749.7000	NO	YES	NO
09857387	BOTULINUM TOXIN TYPE A	Botox 200U/Vial Pd Inj-200U Vial Pk	ABV	749.7000	749.7000	NO	YES	NO
02531577	BOTULINUM TOXIN TYPE A	Botox 50U/Vial Pd Inj-50U Vial Pk	ABV	187.4300	187.4300	NO	YES	NO
09857386	BOTULINUM TOXIN TYPE A	Botox 50U/Vial Pd Inj-50U Vial Pk	ABV	187.4300	187.4300	NO	YES	NO
00891738	CALCITRIOL	Calcijex (Off-Formulary Interchangeable) 1mcg/mL Inj Sol Amp-1mL Pk	ABV	N/A	N/A	YES	NO	NO
02526794	CARIPRAZINE	Vraylar 1.5mg Cap	ABV	4.9000	4.9000	NO	NO	NO
02526808	CARIPRAZINE	Vraylar 3mg Cap	ABV	4.9000	4.9000	NO	NO	NO
02526816	CARIPRAZINE	Vraylar 4.5mg Cap	ABV	4.9000	4.9000	NO	NO	NO
02526824	CARIPRAZINE	Vraylar 6mg Cap	ABV	4.9000	4.9000	NO	NO	NO
02467550	GLECAPREVIR & PIBRENTASVIR	Maviret 100mg & 40mg Tab	ABV	238.0952	238.0952	NO	YES	NO
02369362	KETOROLAC TROMETHAMINE	Acuvail 0.45% w/v Oph Sol-0.4mL Vial Pk (Preservative-Free)	ABV	0.2593	0.2593	NO	NO	YES
02243644	LOPINAVIR & RITONAVIR	Kaletra 80mg/mL & 20mg/mL O/L	ABV	2.3688	2.3688	NO	NO	NO
02285533	LOPINAVIR & RITONAVIR	Kaletra 200mg & 50mg Tab	ABV	5.8633	5.8633	NO	NO	NO
02312301	LOPINAVIR & RITONAVIR	Kaletra 100mg & 25mg Tab	ABV	2.9317	2.9317	NO	NO	NO
02487454	RISANKIZUMAB	Skyrizi 75mg/0.83mL Inj Sol-0.83mL Pref Syr (Preservative-Free)	ABV	2467.5000	2467.5000	NO	YES	NO
02519291	RISANKIZUMAB	Skyrizi 150mg/mL Inj Sol-Pref Pen (Preservative-Free)	ABV	4935.0000	4935.0000	NO	YES	NO
02519283	RISANKIZUMAB	Skyrizi 150mg/mL Inj Sol-Pref Syr (Preservative-Free)	ABV	4935.0000	4935.0000	NO	YES	NO
02520893	UPADACITINIB	Rinvoq 30mg ER Tab	ABV	76.9600	76.9600	NO	YES	NO
02495155	UPADACITINIB	Rinvoq 15mg ER Tab	ABV	51.6810	51.6810	NO	YES	NO
02539721	UPADACITINIB	Rinvoq 45mg ER Tab	ABV	101.8100	101.8100	NO	YES	NO
02443740	VILAZODONE HYDROCHLORIDE	Viibryd (Off-Formulary Interchangeable) 40mg Tab	ABV	N/A	N/A	YES	NO	NO
02443732	VILAZODONE HYDROCHLORIDE	Viibryd (Off-Formulary Interchangeable) 20mg Tab	ABV	N/A	N/A	YES	NO	NO
02443724	VILAZODONE HYDROCHLORIDE	Viibryd (Off-Formulary Interchangeable) 10mg Tab	ABV	N/A	N/A	YES	NO	NO

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