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Products found: 25

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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
02518910	APREMILAST	GLN-Apremilast (Off-Formulary Interchangeable) 30mg Tab	GLP	18.7238	N/A	YES	NO	NO
02528495	ATOVAQUONE	GLN-Atovaquone 750mg/5mL O/L	GLP	2.3785	2.3785	YES	NO	NO
02466783	ATOVAQUONE & PROGUANIL HCL	Atovaquone and Proguanil Hydrochloride (Off-Formulary Interchangeable) 250mg & 100mg Tab	GLP	4.1308	4.1308	YES	NO	NO
09858334	COLESEVELAM HYDROCHLORIDE	Colesevelam (Temporary Benefit) 625mg Tab	GLP	0.5931	0.5931	NO	NO	YES
02519852	DAPAGLIFLOZIN	GLN-Dapagliflozin 5mg Tab	GLP	0.6825	0.6825	YES	NO	YES
02519860	DAPAGLIFLOZIN	GLN-Dapagliflozin 10mg Tab	GLP	0.6825	0.6825	YES	NO	YES
02494817	DIMETHYL FUMARATE	GLN-Dimethyl Fumarate (Off-Formulary Interchangeable) 240mg DR Cap	GLP	18.3867	18.3867	YES	NO	NO
02494809	DIMETHYL FUMARATE	GLN-Dimethyl Fumarate (Off-Formulary Interchangeable) 120mg DR Cap	GLP	9.1933	9.1933	YES	NO	NO
02421437	DROSPIRENONE & ETHINYL ESTRADIOL	Drospirenone&Ethinyl Estradiol USP 21 3.0mg & 0.03mg Tab-21 Pk	GLP	6.2181	6.2181	YES	NO	NO
02462060	DROSPIRENONE & ETHINYL ESTRADIOL	Drospirenone&Ethinyl Estradiol USP 3.0mg & 0.02mg Tab-28 Pk	GLP	8.2600	8.2600	YES	NO	NO
02421445	DROSPIRENONE & ETHINYL ESTRADIOL	Drospirenone&Ethinyl Estradiol USP 28 3.0mg & 0.03mg Tab-28 Pk	GLP	6.2188	6.2188	YES	NO	NO
02460750	EZETIMIBE	GLN-Ezetimibe 10mg Tab	GLP	0.1811	0.1811	YES	YES	NO
02410990	GABAPENTIN	GLN-Gabapentin (Off-Formulary Interchangeable) 600mg Tab	GLP	1.3045	N/A	YES	NO	NO
02411008	GABAPENTIN	GLN-Gabapentin (Off-Formulary Interchangeable) 800mg Tab	GLP	1.7393	N/A	YES	NO	NO
02483459	MUPIROCIN CALCIUM	Stramucin 2% w/w Cr	GLP	1.6000	1.6000	NO	NO	NO
02486296	NORGESTIMATE & ETHINYL ESTRADIOL	Tri-Jordyna 21 3 Phase Tab-21 Pk	GLP	14.3900	14.3900	YES	NO	NO
02486318	NORGESTIMATE & ETHINYL ESTRADIOL	Tri-Jordyna 28 3 Phase Tab-28 Pk	GLP	14.3900	14.3900	YES	NO	NO
02469820	OLMESARTAN MEDOXOMIL	GLN-Olmesartan 40mg Tab	GLP	0.3019	0.3019	YES	NO	NO
02469812	OLMESARTAN MEDOXOMIL	GLN-Olmesartan 20mg Tab	GLP	0.3019	0.3019	YES	NO	NO
02475707	OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE	GLN-Olmesartan HCTZ 20mg & 12.5mg Tab	GLP	0.3019	0.3019	YES	NO	NO
02475715	OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE	GLN-Olmesartan HCTZ 40mg & 12.5mg Tab	GLP	0.3019	0.3019	YES	NO	NO
02475723	OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDE	GLN-Olmesartan HCTZ 40mg & 25mg Tab	GLP	0.3019	0.3019	YES	NO	NO
02542021	POSACONAZOLE	GLN-Posaconazole (Off-Formulary Interchangeable) 100mg DR Tab	GLP	42.6030	42.6030	YES	NO	NO
02426900	URSODIOL	GLN-Ursodiol 250mg Tab	GLP	0.3818	0.3818	YES	YES	NO
02426919	URSODIOL	GLN-Ursodiol 500mg Tab	GLP	0.7242	0.7242	YES	YES	NO

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