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Products found: 59

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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
00518131	BROMAZEPAM	Lectopam (Not a Benefit) 6mg Tab	HLR	N/A	N/A	YES	NO	NO
00518123	BROMAZEPAM	Lectopam (Not a Benefit) 3mg Tab	HLR	N/A	N/A	YES	NO	NO
00682314	BROMAZEPAM	Lectopam (Not a Benefit) 1.5mg Tab	HLR	N/A	N/A	YES	NO	NO
00481815	CALCITRIOL	Rocaltrol 0.5mcg Cap	HLR	1.1246	0.3723	YES	NO	NO
00481823	CALCITRIOL	Rocaltrol 0.25mcg Cap	HLR	0.7071	0.2341	YES	NO	NO
02238453	CAPECITABINE	Xeloda 150mg Tab	HLR	1.9478	0.4575	YES	NO	NO
02238454	CAPECITABINE	Xeloda 500mg Tab	HLR	6.4933	1.5250	YES	NO	NO
00657417	CEFTRIAXONE DISODIUM	Rocephin (Not a Benefit) 1g/Vial Inj Pd-1 Vial Pk	HLR	N/A	N/A	YES	NO	NO
00657387	CEFTRIAXONE DISODIUM	Rocephin (Not a Benefit) 0.25g/Vial Inj Pd-1 Vial Pk	HLR	N/A	N/A	YES	NO	NO
00657409	CEFTRIAXONE DISODIUM	Rocephin (Not a Benefit) 2g/Vial Inj Pd-1 Vial Pk	HLR	N/A	N/A	YES	NO	NO
00851957	CEFTRIAXONE DISODIUM	Rocephin (Off-Formulary Interchangeable) 10g/Vial Inj Pd-1 Vial Pk	HLR	N/A	N/A	YES	NO	NO
00012629	CHLORDIAZEPOXIDE	Librium (Not a Benefit) 5mg Cap	HLR	N/A	N/A	YES	NO	NO
00012645	CHLORDIAZEPOXIDE	Librium (Not a Benefit) 25mg Cap	HLR	N/A	N/A	YES	NO	NO
00012637	CHLORDIAZEPOXIDE	Librium (Not a Benefit) 10mg Cap	HLR	N/A	N/A	YES	NO	NO
01911473	CILAZAPRIL	Inhibace (Not a Benefit) 2.5mg Tab	HLR	N/A	N/A	YES	NO	NO
01911465	CILAZAPRIL	Inhibace (Not a Benefit) 1mg Tab	HLR	N/A	N/A	YES	NO	NO
01927078	CLODRONATE DISODIUM	Ostac (Not a Benefit) 400mg Cap	HLR	N/A	N/A	YES	NO	NO
00382825	CLONAZEPAM	Rivotril 0.5mg Tab	HLR	0.2782	0.0418	YES	NO	NO
00382841	CLONAZEPAM	Rivotril 2mg Tab	HLR	0.4797	0.0721	YES	NO	NO
00013293	DIAZEPAM	Valium (Not a Benefit) 10mg Tab	HLR	N/A	N/A	YES	NO	NO
00013285	DIAZEPAM	Valium (Not a Benefit) 5mg Tab	HLR	N/A	N/A	YES	NO	NO
00013277	DIAZEPAM	Valium (Not a Benefit) 2mg Tab	HLR	N/A	N/A	YES	NO	NO
02269015	ERLOTINIB	Tarceva (Off-Formulary Interchangeable) 100mg Tab	HLR	N/A	N/A	YES	NO	NO
02269023	ERLOTINIB	Tarceva (Off-Formulary Interchangeable) 150mg Tab	HLR	N/A	N/A	YES	NO	NO
02269007	ERLOTINIB	Tarceva (Off-Formulary Interchangeable) 25mg Tab	HLR	N/A	N/A	YES	NO	NO
02527618	FARICIMAB	Vabysmo 6mg/0.05mL Inj Sol-0.24mL Vial Pk (Preservative-Free)	HLR	1350.0000	1350.0000	NO	YES	NO
02185881	GRANISETRON HCL	Kytril (Not a Benefit) 1mg Tab	HLR	N/A	N/A	YES	NO	NO
00582352	ISOTRETINOIN	Accutane 40mg Cap	HLR	1.9480	1.9003	YES	NO	YES
00582344	ISOTRETINOIN	Accutane 10mg Cap	HLR	0.9547	0.9313	YES	NO	YES
00386464	LEVODOPA & BENSERAZIDE	Prolopa 100-25 100mg & 25mg Cap	HLR	0.5528	0.5528	NO	NO	NO
00386472	LEVODOPA & BENSERAZIDE	Prolopa 200-50 200mg & 50mg Cap	HLR	0.9281	0.9281	NO	NO	NO
00522597	LEVODOPA & BENSERAZIDE	Prolopa 50-12.5 50mg & 12.5mg Cap	HLR	0.3357	0.3357	NO	NO	NO
02018055	MEFLOQUINE HCL	Lariam (Off-Formulary Interchangeable) 250mg Tab	HLR	N/A	N/A	YES	NO	NO
00766011	MIDAZOLAM	Versed (Not a Benefit) 5mg/mL Inj Sol (with Preservative)	HLR	N/A	N/A	YES	NO	NO
00899348	MOCLOBEMIDE	Manerix (Not a Benefit) 100mg Tab	HLR	N/A	N/A	YES	NO	NO
02192748	MYCOPHENOLATE MOFETIL	CellCept 250mg Cap	HLR	2.1846	0.3712	YES	NO	NO
02242145	MYCOPHENOLATE MOFETIL	CellCept 200mg/mL Pd for Oral Susp-175mL Pk	HLR	342.5800	244.7025	YES	YES	NO
02237484	MYCOPHENOLATE MOFETIL	CellCept 500mg Tab	HLR	4.3692	0.7423	YES	NO	NO
02162415	NAPROXEN	Naprosyn E (Off-Formulary Interchangeable) 375mg Ent Tab	HLR	N/A	N/A	YES	NO	YES
02162423	NAPROXEN	Naprosyn E (Off-Formulary Interchangeable) 500mg Ent Tab	HLR	N/A	N/A	YES	NO	YES
02162792	NAPROXEN	Naprosyn E (Off-Formulary Interchangeable) 250mg Ent Tab	HLR	N/A	N/A	YES	NO	YES
02162458	NAPROXEN	Naprosyn (Not a Benefit) 500mg Sup	HLR	N/A	N/A	YES	NO	YES
02162490	NAPROXEN	Naprosyn (Not a Benefit) 500mg Tab	HLR	N/A	N/A	YES	NO	YES
02162474	NAPROXEN	Naprosyn (Not a Benefit) 250mg Tab	HLR	N/A	N/A	YES	NO	YES
02162482	NAPROXEN	Naprosyn (Not a Benefit) 375mg Tab	HLR	N/A	N/A	YES	NO	YES
02162725	NAPROXEN SODIUM	Anaprox (Off-Formulary Interchangeable) 275mg Tab	HLR	N/A	N/A	YES	NO	YES
02162717	NAPROXEN SODIUM	Anaprox DS (Off-Formulary Interchangeable) 550mg Tab	HLR	N/A	N/A	YES	NO	YES
02304848	OSELTAMIVIR PHOSPHATE	Tamiflu 30mg Cap	HLR	2.1150	0.5243	YES	YES	NO
02304856	OSELTAMIVIR PHOSPHATE	Tamiflu 45mg Cap	HLR	3.2540	1.6135	YES	YES	NO
02241472	OSELTAMIVIR PHOSPHATE	Tamiflu 75mg Cap	HLR	4.1940	1.0393	YES	YES	NO
02381842	OSELTAMIVIR PHOSPHATE	Tamiflu (Off-Formulary Interchangeable) 6mg/mL O/L	HLR	N/A	N/A	YES	NO	NO
02027860	OXAPROZIN.	Daypro (Off-Formulary Interchangeable) 600mg Tab	HLR	N/A	N/A	YES	NO	YES
02464500	PIRFENIDONE	Esbriet (Off-Formulary Interchangeable) 801mg Tab	HLR	40.2720	20.1361	YES	NO	NO
02464489	PIRFENIDONE	Esbriet (Off-Formulary Interchangeable) 267mg Tab	HLR	13.4240	6.7120	YES	NO	NO
00272485	SULFAMETHOXAZOLE & TRIMETHOPRIM	Bactrim Sugar Free (Not a Benefit) 40mg & 8mg/mL O/L	HLR	N/A	N/A	YES	NO	YES
00272469	SULFAMETHOXAZOLE & TRIMETHOPRIM	Bactrim (Not a Benefit) 400mg & 80mg Tab	HLR	N/A	N/A	YES	NO	YES
00371823	SULFAMETHOXAZOLE & TRIMETHOPRIM	Bactrim-DS (Not a Benefit) 800mg & 160mg Tab	HLR	N/A	N/A	YES	NO	YES
02162776	TICLOPIDINE HCL	Ticlid (Not a Benefit) 250mg Tab	HLR	N/A	N/A	YES	NO	NO
02145839	TRETINOIN	Vesanoid (Off-Formulary Interchangeable) 10mg Cap	HLR	N/A	N/A	YES	NO	NO

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