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Products found: 80

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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
01911635	ACYCLOVIR	Zovirax 800mg Tab	GSK	5.0692	1.2673	YES	NO	NO
01911627	ACYCLOVIR	Zovirax (Not a Benefit) 400mg Tab	GSK	N/A	N/A	YES	NO	NO
00634506	ACYCLOVIR	Zovirax (Not a Benefit) 200mg Tab	GSK	N/A	N/A	YES	NO	NO
02337630	ALITRETINOIN	Toctino (Not a Benefit) 10mg Cap	GSK	N/A	N/A	YES	NO	YES
02337649	ALITRETINOIN	Toctino (Not a Benefit) 30mg Cap	GSK	N/A	N/A	YES	NO	YES
02307073	AMBRISENTAN	Volibris (Off-Formulary Interchangeable) 10mg Tab	GSK	133.9247	106.3288	YES	NO	NO
02307065	AMBRISENTAN	Volibris (Off-Formulary Interchangeable) 5mg Tab	GSK	133.9247	106.3288	YES	NO	NO
01916882	AMOXICILLIN & CLAVULANIC ACID	Clavulin 25mg & 6.25mg/mL O/L	GSK	0.1241	0.1241	NO	NO	YES
01916874	AMOXICILLIN & CLAVULANIC ACID	Clavulin 50mg & 12.5mg/mL O/L	GSK	0.2702	0.1216	YES	NO	YES
02238830	AMOXICILLIN & CLAVULANIC ACID	Clavulin (BID) 400mg & 57mg/5mL Susp	GSK	0.3779	0.1591	YES	NO	YES
02238831	AMOXICILLIN & CLAVULANIC ACID	Clavulin (BID) 200mg & 28.5mg/5mL Susp	GSK	0.1937	0.1007	YES	NO	YES
01916866	AMOXICILLIN & CLAVULANIC ACID	Clavulin (Not a Benefit) 250mg & 125mg Tab	GSK	N/A	N/A	YES	NO	YES
01916858	AMOXICILLIN & CLAVULANIC ACID	Clavulin 500mg & 125mg Tab	GSK	1.8875	0.3778	YES	NO	YES
02238829	AMOXICILLIN & CLAVULANIC ACID	Clavulin (BID) 875mg & 125mg Tab	GSK	2.7515	0.5551	YES	NO	YES
02217422	ATOVAQUONE	Mepron 750mg/5mL O/L	GSK	3.7661	2.3785	YES	NO	NO
02238151	ATOVAQUONE & PROGUANIL HCL	Malarone (Off-Formulary Interchangeable) 250mg & 100mg Tab	GSK	6.3558	4.1308	YES	NO	NO
02229650	CARVEDILOL	Coreg (Not a Benefit) 3.125mg Tab	GSK	N/A	N/A	YES	NO	NO
02229651	CARVEDILOL	Coreg (Not a Benefit) 6.25mg Tab	GSK	N/A	N/A	YES	NO	NO
02229652	CARVEDILOL	Coreg (Not a Benefit) 12.5mg Tab	GSK	N/A	N/A	YES	NO	NO
02229653	CARVEDILOL	Coreg (Not a Benefit) 25mg Tab	GSK	N/A	N/A	YES	NO	NO
02212277	CEFUROXIME AXETIL	Ceftin (Not a Benefit) 250mg Tab	GSK	N/A	N/A	YES	NO	NO
02212285	CEFUROXIME AXETIL	Ceftin (Not a Benefit) 500mg Tab	GSK	N/A	N/A	YES	NO	NO
02247813	DUTASTERIDE	Avodart 0.5mg Cap	GSK	2.2293	0.2565	YES	YES	NO
02361825	ELTROMBOPAG OLAMINE	Revolade (Off-Formulary Interchangeable) 25mg Tab	GSK	65.0000	55.2500	YES	NO	NO
02361833	ELTROMBOPAG OLAMINE	Revolade (Off-Formulary Interchangeable) 50mg Tab	GSK	130.0000	110.5000	YES	NO	NO
01923420	FERROUS FUMARATE	Palafer (Not a Benefit) 300mg Cap	GSK	N/A	N/A	YES	NO	NO
01923439	FERROUS FUMARATE	Palafer 60mg/mL O/L	GSK	0.0981	0.0981	NO	NO	NO
02446588	FLUTICASONE FUROATE	Arnuity Ellipta 200mcg Blister Pd Inh-30 Dose Pk	GSK	101.5900	101.5900	NO	NO	NO
02446561	FLUTICASONE FUROATE	Arnuity Ellipta 100mcg Blister Pd Inh-30 Dose Pk	GSK	50.8100	50.8100	NO	NO	NO
02474522	FLUTICASONE FUROATE & UMECLIDINIUM BROMIDE & VILANTEROL TRIFENATATE	Trelegy Ellipta 100mcg & 62.5mcg & 25mcg Pd Inh-30 Dose Pk	GSK	137.6700	137.6700	NO	YES	YES
02444186	FLUTICASONE FUROATE & VILANTEROL	Breo Ellipta 200mcg & 25mcg Blister Pd Inh-30 Dose Pk	GSK	171.8900	171.8900	NO	YES	NO
02408872	FLUTICASONE FUROATE & VILANTEROL	Breo Ellipta 100mcg & 25mcg Blister Pd Inh-30 Dose Pk	GSK	110.5000	110.5000	NO	YES	NO
02244293	FLUTICASONE PROPIONATE	Flovent HFA 250mcg/Metered Dose Inh-120 Dose Pk	GSK	116.4200	45.0200	YES	NO	NO
02244291	FLUTICASONE PROPIONATE	Flovent HFA 50mcg/Metered Dose Inh-120 Dose Pk	GSK	33.7500	14.2080	YES	NO	NO
02244292	FLUTICASONE PROPIONATE	Flovent HFA 125mcg/Metered Dose Inh-120 Dose Pk	GSK	58.2100	23.4100	YES	NO	NO
02213672	FLUTICASONE PROPIONATE	Flonase (Off-Formulary Interchangeable) 50mcg/Actuation Nas Sp-120 Dose Pk	GSK	N/A	N/A	YES	NO	YES
02237246	FLUTICASONE PROPIONATE	Flovent Diskus 250mcg/Blister Pd Inh-60 Dose Pk	GSK	58.2100	58.2100	NO	NO	NO
02237247	FLUTICASONE PROPIONATE	Flovent Diskus 500mcg/Blister Pd Inh-60 Dose Pk	GSK	90.5500	90.5500	NO	NO	NO
02239193	LAMIVUDINE	Heptovir (Not a Benefit) 100mg Tab	GSK	N/A	N/A	YES	NO	NO
02142112	LAMOTRIGINE	Lamictal 150mg Tab	GSK	3.1803	0.4107	YES	NO	NO
02142104	LAMOTRIGINE	Lamictal 100mg Tab	GSK	2.1580	0.2787	YES	NO	NO
02142082	LAMOTRIGINE	Lamictal 25mg Tab	GSK	0.5402	0.0698	YES	NO	NO
02083531	NABUMETONE	Relafen (Off-Formulary Interchangeable) 500mg Tab	GSK	N/A	N/A	YES	NO	YES
02237821	NARATRIPTAN HYDROCHLORIDE	Amerge (Off-Formulary Interchangeable) 2.5mg Tab	GSK	N/A	N/A	YES	NO	NO
02237820	NARATRIPTAN HYDROCHLORIDE	Amerge (Off-Formulary Interchangeable) 1mg Tab	GSK	N/A	N/A	YES	NO	NO
01940473	PAROXETINE HCL	Paxil 30mg Tab	GSK	2.6577	0.3453	YES	NO	NO
01940481	PAROXETINE HCL	Paxil 20mg Tab	GSK	2.5021	0.3250	YES	NO	NO
02352303	PAZOPANIB	Votrient (Off-Formulary Interchangeable) 200mg Tab	GSK	41.3147	30.9655	YES	NO	NO
02212374	RANITIDINE HCL	Zantac (Not a Benefit) 15mg/mL Oral Sol	GSK	N/A	N/A	YES	NO	NO
02212331	RANITIDINE HCL	Zantac (Not a Benefit) 150mg Tab	GSK	N/A	N/A	YES	NO	NO
02212358	RANITIDINE HCL	Zantac (Not a Benefit) 300mg Tab	GSK	N/A	N/A	YES	NO	NO
02232567	ROPINIROLE	ReQuip (Not a Benefit) 1mg Tab	GSK	N/A	N/A	YES	NO	NO
02232565	ROPINIROLE	ReQuip (Not a Benefit) 0.25mg Tab	GSK	N/A	N/A	YES	NO	NO
02232568	ROPINIROLE	ReQuip (Not a Benefit) 2mg Tab	GSK	N/A	N/A	YES	NO	NO
02232569	ROPINIROLE	ReQuip (Not a Benefit) 5mg Tab	GSK	N/A	N/A	YES	NO	NO
02241114	ROSIGLITAZONE	Avandia (Off-Formulary Interchangeable) 8mg Tab	GSK	N/A	N/A	YES	NO	NO
02241112	ROSIGLITAZONE	Avandia (Off-Formulary Interchangeable) 2mg Tab	GSK	N/A	N/A	YES	NO	NO
02241113	ROSIGLITAZONE	Avandia (Off-Formulary Interchangeable) 4mg Tab	GSK	N/A	N/A	YES	NO	NO
02213427	SALBUTAMOL	Ventolin Nebules P.F. (Not a Benefit) 2mg/mL Inh Sol- 2.5mL Pk	GSK	N/A	N/A	YES	NO	NO
02213419	SALBUTAMOL	Ventolin Nebules P.F. (Not a Benefit) 1mg/mL Inh Sol- 2.5mL Pk	GSK	N/A	N/A	YES	NO	NO
02213486	SALBUTAMOL	Ventolin 5mg/mL Inh Sol-10mL Pk	GSK	3.1110	3.1110	NO	YES	NO
02241497	SALBUTAMOL	Ventolin HFA 100mcg/Metered Dose Inh-200 dose Pk	GSK	6.0000	5.0000	YES	NO	NO
02231129	SALMETEROL XINAFOATE	SereVent Diskus 50mcg Pd Inh-60 Dose Pk	GSK	79.5600	79.5600	NO	YES	NO
02245126	SALMETEROL XINAFOATE & FLUTICASONE PROPIONATE	Advair 125 25/125mcg/Metered Dose Inh-120 Dose Pk	GSK	135.8700	135.8700	NO	YES	NO
02245127	SALMETEROL XINAFOATE & FLUTICASONE PROPIONATE	Advair 250 25/250mcg/Metered Dose Inh-120 Dose Pk	GSK	192.8800	192.8800	NO	YES	NO
02240835	SALMETEROL XINAFOATE & FLUTICASONE PROPIONATE	Advair Diskus 50/100mcg Inh-60 Dose Pk	GSK	113.4900	42.4050	YES	YES	NO
02240837	SALMETEROL XINAFOATE & FLUTICASONE PROPIONATE	Advair Diskus 50/500mcg Inh-60 Dose Pk	GSK	192.8800	72.0600	YES	YES	NO
02240836	SALMETEROL XINAFOATE & FLUTICASONE PROPIONATE	Advair Diskus 50/250mcg Inh-60 Dose Pk	GSK	135.8700	50.7600	YES	YES	NO
09857299	SUMATRIPTAN SUCCINATE	Imitrex (Off-Formulary Interchangeable) 25mg Tab	GSK	N/A	N/A	YES	NO	NO
01950614	SUMATRIPTAN SUCCINATE	Imitrex (Off-Formulary Interchangeable) 100mg Tab	GSK	N/A	N/A	YES	NO	NO
02163764	SUMATRIPTAN SUCCINATE	Imitrex (Off-Formulary Interchangeable) 50mg Tab	GSK	N/A	N/A	YES	NO	NO
02239738	SUMATRIPTAN SUCCINATE	Imitrex DF (Off-Formulary Interchangeable) 25mg Tab	GSK	N/A	N/A	YES	NO	NO
02212153	SUMATRIPTAN SUCCINATE	Imitrex DF (Off-Formulary Interchangeable) 50mg Tab	GSK	19.7817	9.0650	YES	NO	NO
02212161	SUMATRIPTAN SUCCINATE	Imitrex DF (Off-Formulary Interchangeable) 100mg Tab	GSK	21.7933	9.9866	YES	NO	NO
01919598	TRANYLCYPROMINE SULFATE	Parnate 10mg Tab	GSK	0.5374	0.5374	NO	NO	YES
02423596	UMECLIDINIUM	Incruse Ellipta 62.5mcg Blister Pd Inh-30 Dose Pk	GSK	50.0000	50.0000	NO	NO	NO
02418401	UMECLIDINIUM & VILANTEROL	Anoro Ellipta 62.5mcg & 25mcg Blister Pd Inh-30 Dose Pk	GSK	88.5100	88.5100	NO	YES	NO
02246559	VALACYCLOVIR	Valtrex (Off-Formulary Interchangeable) 1000mg Tab	GSK	N/A	N/A	YES	NO	NO
02219492	VALACYCLOVIR	Valtrex 500mg Tab	GSK	4.5647	0.6198	YES	NO	NO
02240863	ZANAMIVIR	Relenza 5mg Pd Inh-5 Rotadisks Pk	GSK	49.2300	49.2300	NO	YES	NO

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