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Products found: 5

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
00886157	ACYCLOVIR	Zovirax 200mg/5mL Oral Susp	GLW	0.2992	0.2992	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	47.5800	36.5888	YES	NO	NO