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Products found: 5New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
00886157ACYCLOVIRZovirax 200mg/5mL Oral SuspGLW0.31420.3142NONONO
02213702BECLOMETHASONE DIPROPIONATEBeconase Aqueous (Not a Benefit) 50mcg Nas-Sp-200 Dose PkGLWN/AN/AYESNOYES
02213230LEVOTHYROXINE (SODIUM)Eltroxin (Not a Benefit) 0.3mg TabGLWN/AN/AYESNONO
02213478SALBUTAMOLVentolin (Not a Benefit) 100mcg/Metered Dose Inh-200 dose PkGLWN/AN/AYESNONO
02212188SUMATRIPTAN SUCCINATEImitrex (Off-Formulary Interchangeable) 6mg/0.5mL Inj Sol-Pref Syr 0.5mL PkGLW49.960036.5888YESNONO