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Products found: 35

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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
02453908	BUPRENORPHINE & NALOXONE	Act Buprenorphine/Naloxone 2mg & 0.5mg SL Tab	ACV	1.3350	1.3350	YES	NO	NO
02453916	BUPRENORPHINE & NALOXONE	Act Buprenorphine/Naloxone 8mg & 2mg SL Tab	ACV	2.3650	2.3650	YES	NO	NO
02439662	BUPROPION HCL	Act Bupropion XL 300mg ER Tab	ACV	0.5853	0.5853	YES	YES	NO
02439654	BUPROPION HCL	Act Bupropion XL 150mg ER Tab	ACV	0.2926	0.2926	YES	YES	NO
02420155	CELECOXIB	Act Celecoxib 100mg Cap	ACV	0.1279	0.1279	YES	YES	YES
02420163	CELECOXIB	Act Celecoxib 200mg Cap	ACV	0.2558	0.2558	YES	YES	YES
02403196	CLARITHROMYCIN	Act Clarithromycin XL 500mg ER Tab	ACV	1.2572	1.2572	YES	NO	YES
02420813	DESOGESTREL & ETHINYL ESTRADIOL	Reclipsen 21 (Not a Benefit) 0.15mg & 0.03mg Tab-21 Pk	ACV	N/A	N/A	YES	NO	NO
02417464	DESOGESTREL & ETHINYL ESTRADIOL	Reclipsen 28 (Not a Benefit) 0.15mg & 0.03mg Tab-28 Pk	ACV	N/A	N/A	YES	NO	NO
02448319	DEXTROAMPHETAMINE SULFATE	Act Dextroamphetamine SR 10mg SR Cap	ACV	0.8096	0.8096	YES	NO	YES
02448327	DEXTROAMPHETAMINE SULFATE	Act Dextroamphetamine SR 15mg SR Cap	ACV	0.9898	0.9898	YES	NO	YES
02454297	ESCITALOPRAM	Act Escitalopram ODT 10mg Orally Disintegrating Tab	ACV	1.3199	1.3199	YES	NO	NO
02454300	ESCITALOPRAM	Act Escitalopram ODT 20mg Orally Disintegrating Tablet	ACV	1.4052	1.4052	YES	NO	NO
02414716	EZETIMIBE	Act Ezetimibe 10mg Tab	ACV	0.1811	0.1811	YES	YES	NO
02281279	FLUCONAZOLE	Act Fluconazole 100mg Tab	ACV	2.2891	2.2891	YES	NO	NO
02281260	FLUCONAZOLE	Act Fluconazole 50mg Tab	ACV	1.2904	1.2904	YES	NO	NO
02429764	GLICLAZIDE	Act Gliclazide MR 30mg SR Tab	ACV	0.0931	0.0931	YES	NO	NO
02436256	LATANOPROST & TIMOLOL MALEATE	Act Latanoprost/Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk	ACV	11.0700	11.0670	YES	YES	NO
02274191	LEVETIRACETAM	Act Levetiracetam 500mg Tab	ACV	0.3911	0.3911	YES	YES	NO
02274183	LEVETIRACETAM	Act Levetiracetam 250mg Tab	ACV	0.3210	0.3210	YES	YES	NO
02274205	LEVETIRACETAM	Act Levetiracetam 750mg Tab	ACV	0.5416	0.5416	YES	YES	NO
02439271	MIXED SALT AMPHETAMINE	Act Amphetamine XR 25mg ER Cap	ACV	0.8305	0.8305	YES	NO	YES
02439263	MIXED SALT AMPHETAMINE	Act Amphetamine XR 20mg ER Cap	ACV	0.7572	0.7572	YES	NO	YES
02439239	MIXED SALT AMPHETAMINE	Act Amphetamine XR 5mg ER Cap	ACV	0.5372	0.5372	YES	NO	YES
02439298	MIXED SALT AMPHETAMINE	Act Amphetamine XR 30mg ER Cap	ACV	0.9038	0.9038	YES	NO	YES
02439247	MIXED SALT AMPHETAMINE	Act Amphetamine XR 10mg ER Cap	ACV	0.6105	0.6105	YES	NO	YES
02439255	MIXED SALT AMPHETAMINE	Act Amphetamine XR 15mg ER Cap	ACV	0.6838	0.6838	YES	NO	YES
02404656	MOXIFLOXACIN HYDROCHLORIDE	Act Moxifloxacin (Off-Formulary Interchangeable) 0.5% Oph Sol-3mL Pk (Preservative-Free)	ACV	11.2700	N/A	YES	NO	NO
02404095	OLOPATADINE HCL	Act Olopatadine 0.2% (Off-Formulary Interchangeable) 0.2% Oph Sol-2.5mL Pk	ACV	26.1300	N/A	YES	NO	NO
02422247	SOLIFENACIN SUCCINATE	Act Solifenacin 10mg Tab	ACV	0.3041	0.3041	YES	YES	NO
02422239	SOLIFENACIN SUCCINATE	Act Solifenacin 5mg Tab	ACV	0.3041	0.3041	YES	YES	NO
02428628	TADALAFIL	Act Tadalafil (Off-Formulary Interchangeable) 2.5mg Tab	ACV	3.6471	3.6471	YES	NO	NO
02428636	TADALAFIL	Act Tadalafil (Off-Formulary Interchangeable) 5mg Tab	ACV	3.6471	3.6471	YES	NO	NO
02428652	TADALAFIL	Act Tadalafil (Off-Formulary Interchangeable) 20mg Tab	ACV	12.3569	12.3569	YES	NO	NO
02428644	TADALAFIL	Act Tadalafil (Off-Formulary Interchangeable) 10mg Tab	ACV	11.9255	11.9255	YES	NO	NO

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