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Products found: 33

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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
02230434	ACETAMINOPHEN	ACET 120 120mg Sup	PEN	0.5367	0.5367	YES	NO	NO
02230436	ACETAMINOPHEN	ACET 325 325mg Sup	PEN	0.6625	0.6625	YES	NO	NO
02230437	ACETAMINOPHEN	ACET 650 650mg Sup	PEN	0.7608	0.7608	YES	NO	NO
01919385	ACETAMINOPHEN	Abenol (Not a Benefit) 120mg Sup	PEN	N/A	N/A	YES	NO	NO
01919393	ACETAMINOPHEN	Abenol (Not a Benefit) 325mg Sup	PEN	N/A	N/A	YES	NO	NO
01919407	ACETAMINOPHEN	Abenol (Not a Benefit) 650mg Sup	PEN	N/A	N/A	YES	NO	NO
01990403	AMANTADINE HCL	PDP-Amantadine Hydrochloride Capsules 100mg Cap	PEN	0.5662	0.5662	YES	NO	YES
02022826	AMANTADINE HCL	PDP-Amantadine Hydrochloride Syrup 10mg/mL O/L	PEN	0.0988	0.0988	YES	NO	YES
02484706	AMLODIPINE	PDP-Amlodipine 1mg/mL Oral Sol	PEN	1.1667	1.1667	NO	YES	NO
00706531	BENZTROPINE MESYLATE	PDP-Benztropine 1mg Tab	PEN	0.0563	0.0563	NO	NO	NO
02229777	BENZYDAMINE HCL	Pharixia (Not a Benefit) 0.15% Oral Rinse	PEN	N/A	N/A	YES	NO	NO
02240433	CHLORHEXIDINE GLUCONATE	Perichlor (Off-Formulary Interchangeable) 0.12% Oral Rinse	PEN	0.0253	N/A	YES	NO	NO
02493160	CHLORHEXIDINE GLUCONATE	Perichlor Without Alcohol (Off-Formulary Interchangeable) 0.12% Oral Rinse	PEN	0.0253	N/A	YES	NO	NO
02229315	DESONIDE	PDP-Desonide 0.05% Cr	PEN	0.2857	0.2857	YES	NO	NO
02229323	DESONIDE	PDP-Desonide 0.05% Oint	PEN	0.2853	0.2853	YES	NO	NO
02247104	DOXYCYCLINE HYCLATE	Periostat (Off-Formulary Interchangeable) 20mg Cap	PEN	N/A	N/A	YES	NO	NO
02490447	LEVETIRACETAM	PDP-Levetiracetam 100mg/mL Oral Sol	PEN	0.8142	0.8142	NO	YES	NO
02230840	LOXAPINE SUCCINATE	Xylac 50mg Tab	PEN	0.6197	0.6197	YES	NO	NO
02230839	LOXAPINE SUCCINATE	Xylac 25mg Tab	PEN	0.5012	0.5012	YES	NO	NO
02230838	LOXAPINE SUCCINATE	Xylac 10mg Tab	PEN	0.3233	0.3233	YES	NO	NO
02230837	LOXAPINE SUCCINATE	Xylac 5mg Tab	PEN	0.1801	0.1801	YES	NO	NO
00778338	NIZATIDINE	Axid 150mg Cap	PEN	0.9047	0.9047	NO	NO	YES
00677442	PEG-ELECTROLYTES	Colyte (Not a Benefit) Pd-4L Pk	PEN	N/A	N/A	YES	NO	NO
00777838	PEG-ELECTROLYTES	PegLyte Powder Pd-4L Pk	PEN	17.7331	17.7331	YES	NO	NO
00645575	PHENOBARBITAL	Phenobarb Elixir 5mg/mL Oral Elixir	PEN	0.1535	0.1535	NO	NO	NO
00178810	PHENOBARBITAL	Phenobarb 60mg Tab	PEN	0.2433	0.2433	NO	NO	NO
00178829	PHENOBARBITAL	Phenobarb 100mg Tab	PEN	0.3329	0.3329	NO	NO	NO
00178802	PHENOBARBITAL	Phenobarb 30mg Tab	PEN	0.1795	0.1795	NO	NO	NO
00178799	PHENOBARBITAL	Phenobarb 15mg Tab	PEN	0.1508	0.1508	NO	NO	NO
00769541	POLYSTYRENE SODIUM SULFONATE	Solystat (Off-Formulary Interchangeable) 250mg/mL O/L	PEN	N/A	N/A	YES	NO	NO
00755338	POLYSTYRENE SODIUM SULFONATE	Solystat 1mEq/g Oral Pd-454g Pk	PEN	29.4175	29.4175	YES	NO	NO
00649392	PROCYCLIDINE HCL	Pdp-Procyclidine 2.5mg Tab	PEN	0.0577	0.0577	NO	NO	NO
02009277	SODIUM CROMOGLYCATE	Cromolyn Eye Drops 2% Oph Sol	PEN	0.9500	0.9500	YES	NO	NO

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