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Products found: 14New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02505355AFLIBERCEPTEylea 40mg/mL Inj Sol-0.05mL Pref Syr (Preservative-Free)BAH1418.00001418.0000NOYESNO
02415992AFLIBERCEPTEylea 40mg/mL Sol for Intravitreal Inj-0.05mL Vial PkBAH1418.00001418.0000NOYESNO
02374900DIENOGESTVisanne 2mg TabBAH2.11361.0231YESYESNO
02261723DROSPIRENONE & ETHINYL ESTRADIOLYasmin 21 3.0mg & 0.03mg Tab-21 PkBAH12.44006.2181YESNONO
02261731DROSPIRENONE & ETHINYL ESTRADIOLYasmin 28 3.0mg & 0.03mg Tab-28 PkBAH12.44006.2188YESNONO
02321157DROSPIRENONE & ETHINYL ESTRADIOLYaz 3.0mg & 0.02mg Tab-28 PkBAH16.52008.2600YESNONO
02155869NIFEDIPINEAdalat (Not a Benefit) 5mg CapBAHN/AN/AYESNONO
02155877NIFEDIPINEAdalat (Not a Benefit) 10mg CapBAHN/AN/AYESNOYES
02325926NIMODIPINENimotop 30mg TabBAH10.300610.3006NOYESNO
02378612RIVAROXABANXarelto 20mg TabBAH2.87002.8700NOYESNO
02378604RIVAROXABANXarelto 15mg TabBAH2.87002.8700NOYESNO
02316986RIVAROXABANXarelto 10mg TabBAH2.87002.8700NOYESNO
02480808RIVAROXABANXarelto 2.5mg TabBAH1.42001.4200NOYESNO
02372436VARDENAFIL HCLStaxyn (Off-Formulary Interchangeable) 10mg Orally Disintergrating TabBAHN/AN/AYESNONO