00886157 | ACYCLOVIR | Zovirax 200mg/5mL Oral Susp | GLW | 0.3142 | 0.3142 | NO | NO | NO |
02213702 | BECLOMETHASONE DIPROPIONATE | Beconase Aqueous (Not a Benefit) 50mcg Nas-Sp-200 Dose Pk | GLW | N/A | N/A | YES | NO | YES |
02213230 | LEVOTHYROXINE (SODIUM) | Eltroxin (Not a Benefit) 0.3mg Tab | GLW | N/A | N/A | YES | NO | NO |
02213478 | SALBUTAMOL | Ventolin (Not a Benefit) 100mcg/Metered Dose Inh-200 dose Pk | GLW | N/A | N/A | YES | NO | NO |
02212188 | SUMATRIPTAN SUCCINATE | Imitrex (Off-Formulary Interchangeable) 6mg/0.5mL Inj Sol-Pref Syr 0.5mL Pk | GLW | 49.9600 | 36.5888 | YES | NO | NO |