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Products found: 26New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
01947923BETHANECHOL CHLORIDEDuvoid 50mg TabPAL0.99210.9921NONONO
01947931BETHANECHOL CHLORIDEDuvoid 25mg TabPAL0.75340.7534NONONO
01947958BETHANECHOL CHLORIDEDuvoid 10mg TabPAL0.46530.4653NONONO
02290308CYPROTERONE ACETATE & ETHINYL ESTRADIOLCyestra-35 (Off-Formulary Interchangeable) 2mg & 0.035mg Tab-21 PkPAL23.3394N/AYESNONO
01924559DEXTROAMPHETAMINE SULFATEDexedrine Spansules 10mg SR CapPAL1.18510.8096YESNOYES
01924567DEXTROAMPHETAMINE SULFATEDexedrine Spansules 15mg SR CapPAL1.44890.9898YESNOYES
01924516DEXTROAMPHETAMINE SULFATEDexedrine 5mg TabPAL0.80260.5081YESNOYES
02247265DICLOFENAC SODIUMPennsaid (Off-Formulary Interchangeable) 1.5% W/W Top SolPALN/AN/AYESNONO
00728179FLAVOXATE HCLUrispas (Not a Benefit) 200mg TabPALN/AN/AYESNONO
02086026FLUDROCORTISONE ACETATEFlorinef 0.1mg TabPAL0.55260.5526NONONO
00074454FLUMETHASONE PIVALATE & IODOCHLORHYDROXYQUINLocacorten-Vioform 0.02% & 1% Ot SolPAL2.50272.5027NONOYES
02240335FOSFOMYCIN TROMETHAMINEMonurol Sachet-3g PkPAL21.670014.0250YESNOYES
02106280LABETALOL HCLTrandate 200mg TabPAL0.71480.3504YESNONO
02106272LABETALOL HCLTrandate 100mg TabPAL0.40440.1983YESNONO
02244290METHADONE HCLMetadol-D 10mg/mL Oral ConcentratePAL0.15530.1553NONOYES
02296039METHIMAZOLETapazole (Off-Formulary Interchangeable) 10mg TabPALN/AN/AYESNONO
00015741METHIMAZOLETapazole 5mg TabPAL0.36960.1531YESNONO
00594644MORPHINE SULFATEStatex 10mg TabPAL0.19920.1992NONOYES
00594652MORPHINE SULFATEStatex 5mg TabPAL0.12890.1289NONOYES
02230734NITROGLYCERINTrinipatch 0.6mg/Hr/21 Sq Cm PatchPAL0.85170.8517NONONO
02230733NITROGLYCERINTrinipatch 0.4mg/Hr/14 Sq Cm PatchPAL0.85170.8517NONONO
00511552PIZOTYLINESandomigran DS 1mg TabPAL1.13571.1357NONONO
02280248TESTOSTERONETestim 1% Top Gel-5g PkPAL4.31804.3180NOYESNO
02296403TRAMADOL HCLTridural (Off-Formulary Interchangeable) 200mg ER TabPALN/AN/AYESNOYES
02296381TRAMADOL HCLTridural (Off-Formulary Interchangeable) 100mg ER TabPALN/AN/AYESNOYES
02296411TRAMADOL HCLTridural (Off-Formulary Interchangeable) 300mg ER TabPALN/AN/AYESNOYES