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Products found: 32New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02230434ACETAMINOPHENACET 120 120mg SupPEN0.53670.5367YESNONO
02230436ACETAMINOPHENACET 325 325mg SupPEN0.66250.6625YESNONO
02230437ACETAMINOPHENACET 650 650mg SupPEN0.76080.7608YESNONO
01919385ACETAMINOPHENAbenol (Not a Benefit) 120mg SupPENN/AN/AYESNONO
01919393ACETAMINOPHENAbenol (Not a Benefit) 325mg SupPENN/AN/AYESNONO
01919407ACETAMINOPHENAbenol (Not a Benefit) 650mg SupPENN/AN/AYESNONO
01990403AMANTADINE HCLPDP-Amantadine Hydrochloride Capsules 100mg CapPEN0.56620.5662YESNOYES
02022826AMANTADINE HCLPDP-Amantadine Hydrochloride Syrup 10mg/mL O/LPEN0.09880.0988YESNOYES
02484706AMLODIPINEPDP-Amlodipine 1mg/mL Oral SolPEN1.16671.1667NOYESNO
00706531BENZTROPINE MESYLATEPDP-Benztropine 1mg TabPEN0.05630.0563NONONO
02229777BENZYDAMINE HCLPharixia (Not a Benefit) 0.15% Oral RinsePENN/AN/AYESNONO
02240433CHLORHEXIDINE GLUCONATEPerichlor (Off-Formulary Interchangeable) 0.12% Oral RinsePEN0.0253N/AYESNONO
02493160CHLORHEXIDINE GLUCONATEPerichlor Without Alcohol (Off-Formulary Interchangeable) 0.12% Oral RinsePEN0.0253N/AYESNONO
02229315DESONIDEPDP-Desonide 0.05% CrPEN0.28570.2857YESNONO
02229323DESONIDEPDP-Desonide 0.05% OintPEN0.28530.2853YESNONO
02490447LEVETIRACETAMPDP-Levetiracetam 100mg/mL Oral SolPEN0.81420.8142NOYESNO
02230840LOXAPINE SUCCINATEXylac 50mg TabPEN0.61970.6197YESNONO
02230837LOXAPINE SUCCINATEXylac 5mg TabPEN0.18010.1801YESNONO
02230838LOXAPINE SUCCINATEXylac 10mg TabPEN0.32330.3233YESNONO
02230839LOXAPINE SUCCINATEXylac 25mg TabPEN0.50120.5012YESNONO
00778338NIZATIDINEAxid 150mg CapPEN0.90470.9047NONOYES
00677442PEG-ELECTROLYTESColyte (Not a Benefit) Pd-4L PkPENN/AN/AYESNONO
00777838PEG-ELECTROLYTESPegLyte Powder Pd-4L PkPEN17.733117.7331YESNONO
00645575PHENOBARBITALPhenobarb Elixir 5mg/mL Oral ElixirPEN0.15350.1535NONONO
00178829PHENOBARBITALPhenobarb 100mg TabPEN0.33290.3329NONONO
00178802PHENOBARBITALPhenobarb 30mg TabPEN0.17950.1795NONONO
00178810PHENOBARBITALPhenobarb 60mg TabPEN0.24330.2433NONONO
00178799PHENOBARBITALPhenobarb 15mg TabPEN0.15080.1508NONONO
00769541POLYSTYRENE SODIUM SULFONATESolystat (Off-Formulary Interchangeable) 250mg/mL O/LPENN/AN/AYESNONO
00755338POLYSTYRENE SODIUM SULFONATESolystat 1mEq/g Oral Pd-454g PkPEN29.417529.4175YESNONO
00649392PROCYCLIDINE HCLPdp-Procyclidine 2.5mg TabPEN0.05770.0577NONONO
02009277SODIUM CROMOGLYCATECromolyn Eye Drops 2% Oph SolPEN0.95000.9500YESNONO