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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
02299712	ALENDRONATE	Alendronate 70mg Tab	SIV	1.7804	1.7804	YES	NO	NO
02447576	ALFUZOSIN HYDROCHLORIDE	Alfuzosin 10mg Prolong-Rel Tab	SIV	0.2601	0.2601	YES	YES	NO
02385465	AMIODARONE HCL	Amiodarone 200mg Tab	SIV	0.3706	0.3706	YES	NO	YES
02385805	AMLODIPINE	Amlodipine 10mg Tab	SIV	0.1993	0.1993	YES	NO	NO
02385791	AMLODIPINE	Amlodipine 5mg Tab	SIV	0.1343	0.1343	YES	NO	NO
02401509	AMOXICILLIN	Amoxicillin 500mg Cap	SIV	0.1308	0.1308	YES	NO	NO
02401541	AMOXICILLIN	Amoxicillin 50mg/mL O/L	SIV	0.0540	0.0540	YES	NO	NO
02529904	ANASTROZOLE	Anastrozole 1mg Tab	SIV	0.9522	0.9522	YES	NO	NO
02530716	APIXABAN	Apixaban 5mg Tab	SIV	0.4084	0.4084	YES	NO	NO
02530708	APIXABAN	Apixaban 2.5mg Tab	SIV	0.4084	0.4084	YES	NO	NO
02534371	ARIPIPRAZOLE	Aripiprazole 30mg Tab	SIV	1.0017	1.0017	YES	NO	YES
02534363	ARIPIPRAZOLE	Aripiprazole 20mg Tab	SIV	1.0017	1.0017	YES	NO	YES
02534355	ARIPIPRAZOLE	Aripiprazole 15mg Tab	SIV	1.2692	1.2692	YES	NO	YES
02534347	ARIPIPRAZOLE	Aripiprazole 10mg Tab	SIV	1.0754	1.0754	YES	NO	YES
02534320	ARIPIPRAZOLE	Aripiprazole 2mg Tab	SIV	0.8092	0.8092	YES	NO	YES
02534339	ARIPIPRAZOLE	Aripiprazole 5mg Tab	SIV	0.9046	0.9046	YES	NO	YES
02238316	ATENOLOL	Atenolol 50mg Tab	SIV	0.0938	0.0938	YES	NO	NO
02238318	ATENOLOL	Atenolol 100mg Tab	SIV	0.1543	0.1543	YES	NO	NO
02445913	ATOMOXETINE HCL	Atomoxetine 25mg Cap	SIV	0.6420	0.6420	YES	NO	NO
02445905	ATOMOXETINE HCL	Atomoxetine 18mg Cap	SIV	0.5748	0.5748	YES	NO	NO
02445948	ATOMOXETINE HCL	Atomoxetine 40mg Cap	SIV	0.7369	0.7369	YES	NO	NO
02445956	ATOMOXETINE HCL	Atomoxetine 60mg Cap	SIV	0.8092	0.8092	YES	NO	NO
02445883	ATOMOXETINE HCL	Atomoxetine 10mg Cap	SIV	0.5106	0.5106	YES	NO	NO
02411350	ATORVASTATIN CALCIUM	Atorvastatin-10 10mg Tab	SIV	0.1743	0.1743	YES	NO	NO
02411369	ATORVASTATIN CALCIUM	Atorvastatin-20 20mg Tab	SIV	0.2179	0.2179	YES	NO	NO
02411377	ATORVASTATIN CALCIUM	Atorvastatin-40 40mg Tab	SIV	0.2342	0.2342	YES	NO	NO
02411385	ATORVASTATIN CALCIUM	Atorvastatin-80 80mg Tab	SIV	0.2342	0.2342	YES	NO	NO
02442434	AZITHROMYCIN	Azithromycin 250mg Tab	SIV	0.9410	0.9410	YES	NO	YES
02495570	BISOPROLOL FUMARATE	Bisoprolol Tablets 10mg Tab	SIV	0.0885	0.0885	YES	NO	NO
02495562	BISOPROLOL FUMARATE	Bisoprolol Tablets 5mg Tab	SIV	0.0606	0.0606	YES	NO	NO
02388715	CANDESARTAN CILEXETIL	Candesartan 16mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02528258	CANDESARTAN CILEXETIL	Candesartan 4mg Tab	SIV	0.1700	0.1700	YES	NO	NO
02388707	CANDESARTAN CILEXETIL	Candesartan 8mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02528266	CANDESARTAN CILEXETIL	Candesartan 32mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02394812	CANDESARTAN CILEXETIL & HYDROCHLOROTHIAZIDE	Candesartan HCT 16mg & 12.5mg Tab	SIV	0.2156	0.2156	YES	NO	NO
02248755	CARVEDILOL	Carvedilol 25mg Tab	SIV	0.2060	0.2060	YES	YES	NO
02248753	CARVEDILOL	Carvedilol 6.25mg Tab	SIV	0.2060	0.2060	YES	YES	NO
02248754	CARVEDILOL	Carvedilol 12.5mg Tab	SIV	0.2060	0.2060	YES	YES	NO
02248752	CARVEDILOL	Carvedilol 3.125mg Tab	SIV	0.2060	0.2060	YES	YES	NO
02429675	CELECOXIB	Celecoxib 100mg Cap	SIV	0.1279	0.1279	YES	YES	YES
02429683	CELECOXIB	Celecoxib 200mg Cap	SIV	0.2558	0.2558	YES	YES	YES
02495651	CEPHALEXIN MONOHYDRATE	Cephalexin 500mg Tab	SIV	0.1731	0.1731	YES	NO	NO
02534126	CETIRIZINE HYDROCHLORIDE	Cetirizine (Off-Formulary Interchangeable) 20mg Tab	SIV	0.7535	N/A	YES	NO	NO
02386119	CIPROFLOXACIN	Ciprofloxacin 250mg Tab	SIV	0.4454	0.4454	YES	NO	YES
02386127	CIPROFLOXACIN	Ciprofloxacin 500mg Tab	SIV	0.5025	0.5025	YES	NO	YES
02387964	CITALOPRAM HYDROBROMIDE	Citalopram 40mg Tab	SIV	0.1332	0.1332	YES	NO	NO
02387956	CITALOPRAM HYDROBROMIDE	Citalopram 20mg Tab	SIV	0.1332	0.1332	YES	NO	NO
02442485	CLARITHROMYCIN	Clarithromycin (Off-Formulary Interchangeable) 500mg Tab	SIV	2.2009	N/A	YES	NO	YES
02442469	CLARITHROMYCIN	Clarithromycin 250mg Tab	SIV	0.4122	0.4122	YES	NO	YES
02538504	CLONIDINE HCL	Clonidine 0.2mg Tab	SIV	0.1212	0.1212	YES	NO	YES
02540061	CLONIDINE HCL	Clonidine (Off-Formulary Interchangeable) 0.025mg Tab	SIV	0.2713	N/A	YES	NO	YES
02538490	CLONIDINE HCL	Clonidine 0.1mg Tab	SIV	0.0679	0.0679	YES	NO	YES
02385813	CLOPIDOGREL BISULFATE	Clopidogrel 75mg Tab	SIV	0.2631	0.2631	YES	NO	NO
02424584	CYCLOBENZAPRINE HCL	Cyclobenzaprine (Not a Benefit) 10mg Tab	SIV	N/A	N/A	YES	NO	YES
02445999	DILTIAZEM HCL	Diltiazem CD 120mg LA Cap	SIV	0.3634	0.3634	YES	NO	NO
02446022	DILTIAZEM HCL	Diltiazem CD 300mg LA Cap	SIV	0.7999	0.7999	YES	NO	NO
02446014	DILTIAZEM HCL	Diltiazem CD 240mg LA Cap	SIV	0.6399	0.6399	YES	NO	NO
02446006	DILTIAZEM HCL	Diltiazem CD 180mg LA Cap	SIV	0.4824	0.4824	YES	NO	NO
02238341	DOMPERIDONE MALEATE	Domperidone 10mg Tab	SIV	0.0428	0.0428	YES	NO	NO
02420600	DONEPEZIL HCL	Donepezil 10mg Tab	SIV	0.4586	0.4586	YES	YES	NO
02420597	DONEPEZIL HCL	Donepezil 5mg Tab	SIV	0.4586	0.4586	YES	YES	NO
02453649	DULOXETINE	Duloxetine 60mg DR Cap	SIV	0.9769	0.7327	YES	NO	NO
02453630	DULOXETINE	Duloxetine 30mg DR Cap	SIV	0.4814	0.3611	YES	NO	NO
02429012	DUTASTERIDE	Dutasteride 0.5mg Cap	SIV	0.2565	0.2565	YES	YES	NO
02442957	ENALAPRIL MALEATE	Enalapril 2.5mg Tab	SIV	0.1863	0.1863	YES	NO	NO
02442973	ENALAPRIL MALEATE	Enalapril 10mg Tab	SIV	0.2647	0.2647	YES	NO	NO
02442965	ENALAPRIL MALEATE	Enalapril 5mg Tab	SIV	0.2203	0.2203	YES	NO	NO
02442981	ENALAPRIL MALEATE	Enalapril 20mg Tab	SIV	0.3195	0.3195	YES	NO	NO
02429047	ESCITALOPRAM	Escitalopram 20mg Tab	SIV	0.3310	0.3310	YES	NO	NO
02429039	ESCITALOPRAM	Escitalopram 10mg Tab	SIV	0.3109	0.3109	YES	NO	NO
02442507	ESOMEPRAZOLE	Esomeprazole DR Tab (Off-Formulary Interchangeable) 40mg	SIV	1.8690	N/A	YES	NO	NO
02442493	ESOMEPRAZOLE	Esomeprazole (Off-Formulary Interchangeable) 20mg DR Tab	SIV	1.8690	N/A	YES	NO	NO
02429659	EZETIMIBE	Ezetimibe 10mg Tab	SIV	0.1811	0.1811	YES	YES	NO
02447568	FINASTERIDE	Finasteride (Off-Formulary Interchangeable) 1mg Tab	SIV	1.1455	N/A	YES	NO	NO
02447541	FINASTERIDE	Finasteride 5mg Tab	SIV	0.3506	0.3506	YES	YES	NO
02534886	FLUCONAZOLE	Fluconazole 50mg Tab	SIV	1.2904	1.2904	YES	NO	NO
02534894	FLUCONAZOLE	Fluconazole 100mg Tab	SIV	2.2891	2.2891	YES	NO	NO
02374447	FLUOXETINE HCL	Fluoxetine (Off-Formulary Interchangeable) 10mg Cap	SIV	1.1773	N/A	YES	NO	YES
02374455	FLUOXETINE HCL	Fluoxetine 20mg Cap	SIV	0.3311	0.3311	YES	NO	YES
02246314	GABAPENTIN	Gabapentin 100mg Cap	SIV	0.0416	0.0416	YES	NO	NO
02246315	GABAPENTIN	Gabapentin 300mg Cap	SIV	0.1012	0.1012	YES	NO	NO
02246316	GABAPENTIN	Gabapentin 400mg Cap	SIV	0.1206	0.1206	YES	NO	NO
02388200	GABAPENTIN	Gabapentin (Off-Formulary Interchangeable) 600mg Tab	SIV	1.3045	N/A	YES	NO	NO
02388219	GABAPENTIN	Gabapentin (Off-Formulary Interchangeable) 800mg Tab	SIV	1.7393	N/A	YES	NO	NO
02521202	IMATINIB MESYLATE	Imatinib 100mg Tab	SIV	5.2079	5.2079	YES	NO	YES
02521210	IMATINIB MESYLATE	Imatinib 400mg Tab	SIV	20.8314	20.8314	YES	NO	YES
02385287	IRBESARTAN	Irbesartan 75mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02385295	IRBESARTAN	Irbesartan 150mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02385309	IRBESARTAN	Irbesartan 300mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02385317	IRBESARTAN & HYDROCHLOROTHIAZIDE	Irbesartan HCT 150mg & 12.5mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02385325	IRBESARTAN & HYDROCHLOROTHIAZIDE	Irbesartan HCT 300mg & 12.5mg Tab	SIV	0.2281	0.2281	YES	NO	NO
02385333	IRBESARTAN & HYDROCHLOROTHIAZIDE	Irbesartan HCT 300mg & 25mg Tab	SIV	0.2184	0.2184	YES	NO	NO
02428229	LAMOTRIGINE	Lamotrigine 150mg Tab	SIV	0.4107	0.4107	YES	NO	NO
02428210	LAMOTRIGINE	Lamotrigine 100mg Tab	SIV	0.2787	0.2787	YES	NO	NO
02428202	LAMOTRIGINE	Lamotrigine 25mg Tab	SIV	0.0698	0.0698	YES	NO	NO
02385767	LANSOPRAZOLE	Lansoprazole 15mg DR Cap	SIV	0.5000	0.5000	YES	YES	NO
02410389	LANSOPRAZOLE	Lansoprazole 30mg DR Cap	SIV	0.5000	0.5000	YES	YES	NO
02543575	LEFLUNOMIDE	Leflunomide 10mg Tab	SIV	2.6433	2.0000	YES	NO	NO
02543583	LEFLUNOMIDE	Leflunomide 20mg Tab	SIV	2.6433	2.0000	YES	NO	NO
02524244	LETROZOLE	Letrozole 2.5mg Tab	SIV	1.3780	1.3780	YES	NO	NO
02442566	LEVETIRACETAM	Levetiracetam 750mg Tab	SIV	0.5416	0.5416	YES	YES	NO
02442531	LEVETIRACETAM	Levetiracetam 250mg Tab	SIV	0.3210	0.3210	YES	YES	NO
02442558	LEVETIRACETAM	Levetiracetam 500mg Tab	SIV	0.3911	0.3911	YES	YES	NO
02386240	LISINOPRIL	Lisinopril 10mg Tab	SIV	0.1619	0.1619	YES	NO	NO
02386232	LISINOPRIL	Lisinopril 5mg Tab	SIV	0.1347	0.1347	YES	NO	NO
02386259	LISINOPRIL	Lisinopril 20mg Tab	SIV	0.1945	0.1945	YES	NO	NO
02388812	LOSARTAN POTASSIUM	Losartan 100mg Tab	SIV	0.3147	0.3147	YES	NO	NO
02388790	LOSARTAN POTASSIUM	Losartan 25mg Tab	SIV	0.3147	0.3147	YES	NO	NO
02388804	LOSARTAN POTASSIUM	Losartan 50mg Tab	SIV	0.3147	0.3147	YES	NO	NO
02388987	LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE	Losartan HCT 100mg & 25mg Tab	SIV	0.3147	0.3147	YES	NO	NO
02388960	LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE	Losartan HCT 50mg & 12.5mg Tab	SIV	0.3147	0.3147	YES	NO	NO
02388979	LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDE	Losartan HCT 100mg & 12.5mg Tab	SIV	0.3082	0.3082	YES	NO	NO
02446049	MEMANTINE HCL	Memantine (Off-Formulary Interchangeable) 10mg Tab	SIV	1.6357	N/A	YES	NO	NO
02385341	METFORMIN HCL	Metformin FC 500mg Tab	SIV	0.0247	0.0247	YES	NO	NO
02385368	METFORMIN HCL	Metformin FC (Off-Formulary Interchangeable) 850mg Tab	SIV	0.2090	N/A	YES	NO	NO
02442124	METOPROLOL TARTRATE	Metoprolol-L 50mg Tab	SIV	0.0624	0.0624	YES	NO	NO
02442132	METOPROLOL TARTRATE	Metoprolol-L 100mg Tab	SIV	0.1361	0.1361	YES	NO	NO
02496674	MIRTAZAPINE	Mirtazapine 30mg Tab	SIV	0.3100	0.3100	YES	NO	NO
02382466	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 5mg Chew Tab	SIV	1.2075	1.2075	YES	NO	NO
02382458	MONTELUKAST SODIUM	Montelukast 4mg Chew Tab	SIV	0.2758	0.2758	YES	YES	NO
02382474	MONTELUKAST SODIUM	Montelukast (Off-Formulary Interchangeable) 10mg Tab	SIV	1.7735	1.7735	YES	NO	NO
02343681	OLANZAPINE	Olanzapine ODT 15mg Rapid Dissolve Tab	SIV	1.0711	1.0711	YES	NO	NO
02343703	OLANZAPINE	Olanzapine ODT (Off-Formulary Interchangeable) 20mg Rapid Dissolve Tab	SIV	7.5977	N/A	YES	NO	NO
02343673	OLANZAPINE	Olanzapine ODT 10mg Rapid Dissolve Tab	SIV	0.7143	0.7143	YES	NO	NO
02343665	OLANZAPINE	Olanzapine ODT 5mg Rapid Dissolve Tab	SIV	0.3574	0.3574	YES	NO	NO
02385864	OLANZAPINE	Olanzapine 2.5mg Tab	SIV	0.1772	0.1772	YES	NO	NO
02385910	OLANZAPINE	Olanzapine (Off-Formulary Interchangeable) 20mg Tab	SIV	10.3093	N/A	YES	NO	NO
02385899	OLANZAPINE	Olanzapine 10mg Tab	SIV	0.7088	0.7088	YES	NO	NO
02385902	OLANZAPINE	Olanzapine 15mg Tab	SIV	1.0631	1.0631	YES	NO	NO
02385880	OLANZAPINE	Olanzapine 7.5mg Tab	SIV	0.5316	0.5316	YES	NO	NO
02385872	OLANZAPINE	Olanzapine 5mg Tab	SIV	0.3544	0.3544	YES	NO	NO
02411857	OMEPRAZOLE	Omeprazole-20 DR Cap 20mg	SIV	0.2287	0.2287	YES	YES	NO
09857640	OMEPRAZOLE MAGNESIUM	Omeprazole-20 DR Cap 20mg	SIV	0.2287	0.2287	YES	YES	NO
02541432	ONDANSETRON HYDROCHLORIDE	Ondansetron 8mg Tab	SIV	5.1110	3.8840	YES	YES	NO
02541424	ONDANSETRON HYDROCHLORIDE	Ondansetron 4mg Tab	SIV	3.3495	2.5450	YES	YES	NO
02519534	PANTOPRAZOLE MAGNESIUM	Pantoprazole T 40mg Ent Coated Tab	SIV	0.1875	0.1875	YES	NO	NO
02428172	PANTOPRAZOLE SODIUM	Pantoprazole-20 (Off-Formulary Interchangeable) 20mg Ent Tab	SIV	1.2750	N/A	YES	NO	NO
02428180	PANTOPRAZOLE SODIUM	Pantoprazole-40 40mg Ent Tab	SIV	0.2016	0.2016	YES	YES	NO
02388227	PAROXETINE HCL	Paroxetine (Off-Formulary Interchangeable) 10mg Tab	SIV	1.0430	N/A	YES	NO	NO
02388235	PAROXETINE HCL	Paroxetine 20mg Tab	SIV	0.3250	0.3250	YES	NO	NO
02388243	PAROXETINE HCL	Paroxetine 30mg Tab	SIV	0.3453	0.3453	YES	NO	NO
02479877	PERINDOPRIL ERBUMINE	Perindopril Erbumine 2mg Tab	SIV	0.1632	0.1632	YES	NO	NO
02479885	PERINDOPRIL ERBUMINE	Perindopril Erbumine 4mg Tab	SIV	0.2042	0.2042	YES	NO	NO
02479893	PERINDOPRIL ERBUMINE	Perindopril Erbumine 8mg Tab	SIV	0.2831	0.2831	YES	NO	NO
02479834	PERINDOPRIL ERBUMINE & INDAPAMIDE	Perindopril Erbumine/Indapamide 4mg & 1.25mg Tab	SIV	0.2556	0.2556	YES	NO	NO
02479842	PERINDOPRIL ERBUMINE & INDAPAMIDE	Perindopril Erbumine/Indapamide HD 8mg & 2.5mg Tab	SIV	0.2859	0.2859	YES	NO	NO
02309157	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole 1.5mg Tab	SIV	0.3901	0.3901	YES	NO	NO
02309149	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole 1mg Tab	SIV	0.3901	0.3901	YES	NO	NO
02309122	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole 0.25mg Tab	SIV	0.1950	0.1950	YES	NO	NO
02309130	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Pramipexole (Off-Formulary Interchangeable) 0.5mg Tab	SIV	1.3860	N/A	YES	NO	NO
02389738	PRAVASTATIN SODIUM	Pravastatin 20mg Tab	SIV	0.3440	0.3440	YES	NO	NO
02389703	PRAVASTATIN SODIUM	Pravastatin 10mg Tab	SIV	0.2916	0.2916	YES	NO	NO
02389746	PRAVASTATIN SODIUM	Pravastatin 40mg Tab	SIV	0.4143	0.4143	YES	NO	NO
02403730	PREGABALIN	Pregabalin 300mg Cap	SIV	0.4145	0.4145	YES	NO	NO
02403692	PREGABALIN	Pregabalin 25mg Cap	SIV	0.1481	0.1481	YES	NO	NO
02403706	PREGABALIN	Pregabalin 50mg Cap	SIV	0.2324	0.2324	YES	NO	NO
02403714	PREGABALIN	Pregabalin 75mg Cap	SIV	0.3007	0.3007	YES	NO	NO
02403722	PREGABALIN	Pregabalin 150mg Cap	SIV	0.4145	0.4145	YES	NO	NO
02417359	QUETIAPINE	Quetiapine XR 50mg ER Tab	SIV	0.2501	0.2501	YES	NO	NO
02417367	QUETIAPINE	Quetiapine XR 150mg ER Tab	SIV	0.4926	0.4926	YES	NO	NO
02417375	QUETIAPINE	Quetiapine XR 200mg ER Tab	SIV	0.6661	0.6661	YES	NO	NO
02417383	QUETIAPINE	Quetiapine XR 300mg ER Tab	SIV	0.9776	0.9776	YES	NO	NO
02417391	QUETIAPINE	Quetiapine XR 400mg ER Tab	SIV	1.3270	1.3270	YES	NO	NO
02317893	QUETIAPINE	Quetiapine 25mg Tab	SIV	0.0494	0.0494	YES	NO	NO
02317907	QUETIAPINE	Quetiapine 100mg Tab	SIV	0.1318	0.1318	YES	NO	NO
02317923	QUETIAPINE	Quetiapine 200mg Tab	SIV	0.2647	0.2647	YES	NO	NO
02317931	QUETIAPINE	Quetiapine 300mg Tab	SIV	0.3863	0.3863	YES	NO	NO
02385457	RABEPRAZOLE SODIUM	Rabeprazole 20mg Tab	SIV	0.1338	0.1338	YES	NO	NO
02385449	RABEPRAZOLE SODIUM	Rabeprazole 10mg Tab	SIV	0.0669	0.0669	YES	NO	NO
02308363	RAMIPRIL	Ramipril Cap 1.25mg	SIV	0.0708	0.0708	YES	NO	NO
02287927	RAMIPRIL	Ramipril Cap 2.5mg	SIV	0.0817	0.0817	YES	NO	NO
02287943	RAMIPRIL	Ramipril Cap 10mg	SIV	0.1034	0.1034	YES	NO	NO
02287935	RAMIPRIL	Ramipril Cap 5mg	SIV	0.0817	0.0817	YES	NO	NO
02411407	RISEDRONATE SODIUM	Risedronate-35 35mg Tab	SIV	1.6764	1.6764	YES	NO	NO
02533960	RISPERIDONE	Risperidone 4mg Tab	SIV	0.8111	0.8111	YES	NO	NO
02533952	RISPERIDONE	Risperidone 3mg Tab	SIV	0.6083	0.6083	YES	NO	NO
02533944	RISPERIDONE	Risperidone 2mg Tab	SIV	0.4062	0.4062	YES	NO	NO
02533936	RISPERIDONE	Risperidone 1mg Tab	SIV	0.2031	0.2031	YES	NO	NO
02533804	RISPERIDONE	Risperidone 0.25mg Tab	SIV	0.0878	0.0878	YES	NO	NO
02533928	RISPERIDONE	Risperidone 0.5mg Tab	SIV	0.1470	0.1470	YES	NO	NO
02541467	RIVAROXABAN	Rivaroxaban 2.5mg Tab	SIV	0.3550	0.3550	YES	NO	NO
02541491	RIVAROXABAN	Rivaroxaban 20mg Tab	SIV	0.7175	0.7175	YES	NO	NO
02541475	RIVAROXABAN	Rivaroxaban 10mg Tab	SIV	0.7175	0.7175	YES	NO	NO
02541483	RIVAROXABAN	Rivaroxaban 15mg Tab	SIV	0.7175	0.7175	YES	NO	NO
02446111	RIZATRIPTAN	Rizatriptan ODT (Off-Formulary Interchangeable) 5mg Orally Disintegrating Tab	SIV	11.1150	11.1150	YES	NO	NO
02446138	RIZATRIPTAN	Rizatriptan ODT (Off-Formulary Interchangeable) 10mg Orally Disintegrating Tab	SIV	11.1150	11.1150	YES	NO	NO
02411652	ROSUVASTATIN CALCIUM	Rosuvastatin 40mg Tab	SIV	0.1990	0.1990	YES	NO	NO
02411636	ROSUVASTATIN CALCIUM	Rosuvastatin 10mg Tab	SIV	0.1354	0.1354	YES	NO	NO
02411628	ROSUVASTATIN CALCIUM	Rosuvastatin 5mg Tab	SIV	0.1284	0.1284	YES	NO	NO
02411644	ROSUVASTATIN CALCIUM	Rosuvastatin 20mg Tab	SIV	0.1692	0.1692	YES	NO	NO
02386070	SERTRALINE HCL	Sertraline 25mg Cap	SIV	0.1516	0.1516	YES	NO	YES
02386089	SERTRALINE HCL	Sertraline 50mg Cap	SIV	0.3032	0.3032	YES	NO	YES
02386097	SERTRALINE HCL	Sertraline 100mg Cap	SIV	0.3303	0.3303	YES	NO	YES
02400715	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 100mg Tab	SIV	9.2006	9.2006	YES	NO	NO
02400707	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 50mg Tab	SIV	8.8481	8.8481	YES	NO	NO
02400693	SILDENAFIL	Sildenafil (Off-Formulary Interchangeable) 25mg Tab	SIV	8.2900	8.2894	YES	NO	NO
02386321	SIMVASTATIN	Simvastatin 40mg Tab	SIV	0.2501	0.2501	YES	NO	NO
02386348	SIMVASTATIN	Simvastatin 80mg Tab	SIV	0.2501	0.2501	YES	NO	NO
02386313	SIMVASTATIN	Simvastatin 20mg Tab	SIV	0.2501	0.2501	YES	NO	NO
02386305	SIMVASTATIN	Simvastatin 10mg Tab	SIV	0.2023	0.2023	YES	NO	NO
02386291	SIMVASTATIN	Simvastatin 5mg Tab	SIV	0.1023	0.1023	YES	NO	NO
02529068	SITAGLIPTIN	Sitagliptin 100mg Tab	SIV	0.8197	0.8197	YES	NO	YES
02529041	SITAGLIPTIN	Sitagliptin 50mg Tab	SIV	0.8197	0.8197	YES	NO	YES
02529033	SITAGLIPTIN	Sitagliptin 25mg Tab	SIV	0.8197	0.8197	YES	NO	YES
02546035	SUMATRIPTAN SUCCINATE	Sumatriptan (Off-Formulary Interchangeable) 50mg Tab	SIV	9.0650	9.0650	YES	NO	NO
02546043	SUMATRIPTAN SUCCINATE	Sumatriptan (Off-Formulary Interchangeable) 100mg Tab	SIV	9.9867	9.9867	YES	NO	NO
02385570	SUMATRIPTAN SUCCINATE	Sumatriptan DF (Off-Formulary Interchangeable) 50mg Tab	SIV	9.0650	9.0650	YES	NO	NO
02385589	SUMATRIPTAN SUCCINATE	Sumatriptan DF (Off-Formulary Interchangeable) 100mg Tab	SIV	9.9866	9.9866	YES	NO	NO
02429667	TAMSULOSIN HCL	Tamsulosin CR Tab 0.4mg	SIV	0.1500	0.1500	YES	NO	YES
02390353	TELMISARTAN	Telmisartan 80mg Tab	SIV	0.2161	0.2161	YES	NO	NO
02390345	TELMISARTAN	Telmisartan 40mg Tab	SIV	0.2161	0.2161	YES	NO	NO
02390302	TELMISARTAN & HYDROCHLOROTHIAZIDE	Telmisartan HCTZ 80mg & 12.5mg Tab	SIV	0.2098	0.2098	YES	NO	NO
02390310	TELMISARTAN & HYDROCHLOROTHIAZIDE	Telmisartan HCTZ 80mg & 25mg Tab	SIV	0.2098	0.2098	YES	NO	NO
02523922	TENOFOVIR DISOPROXIL	Tenofovir 300mg Tab	SIV	4.8884	4.8884	YES	YES	NO
02385279	TERBINAFINE HCL	Terbinafine 250mg Tab	SIV	0.7714	0.7714	YES	NO	NO
02389487	TOPIRAMATE	Topiramate 100mg Tab	SIV	0.4583	0.4583	YES	NO	NO
02389460	TOPIRAMATE	Topiramate 25mg Tab	SIV	0.2433	0.2433	YES	NO	NO
02526565	TRANDOLAPRIL	Trandolapril 1mg Cap	SIV	0.1762	0.1762	YES	NO	NO
02526573	TRANDOLAPRIL	Trandolapril 2mg Cap	SIV	0.2025	0.2025	YES	NO	NO
02526581	TRANDOLAPRIL	Trandolapril 4mg Cap	SIV	0.2498	0.2498	YES	NO	NO
02442000	VALACYCLOVIR	Valacyclovir 500mg Tab	SIV	0.6198	0.6198	YES	NO	NO
02384531	VALSARTAN	Valsartan 80mg Tab	SIV	0.2159	0.2159	YES	NO	NO
02384566	VALSARTAN	Valsartan 320mg Tab	SIV	0.2098	0.2098	YES	NO	NO
02384558	VALSARTAN	Valsartan 160mg Tab	SIV	0.2159	0.2159	YES	NO	NO
02384523	VALSARTAN	Valsartan (Off-Formulary Interchangeable) 40mg Tab	SIV	0.5823	N/A	YES	NO	NO
02384760	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 320mg & 12.5mg Tab	SIV	0.2235	0.2235	YES	NO	NO
02384744	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 160mg & 12.5mg Tab	SIV	0.2240	0.2240	YES	NO	NO
02384752	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 160mg & 25mg Tab	SIV	0.2238	0.2238	YES	NO	NO
02384736	VALSARTAN & HYDROCHLOROTHIAZIDE	Valsartan HCT 80mg & 12.5mg Tab	SIV	0.2213	0.2213	YES	NO	NO
02385929	VENLAFAXINE HCL	Venlafaxine XR 37.5mg ER Cap	SIV	0.0913	0.0913	YES	NO	NO
02385945	VENLAFAXINE HCL	Venlafaxine XR 150mg ER Cap	SIV	0.1927	0.1927	YES	NO	NO
02385937	VENLAFAXINE HCL	Venlafaxine XR 75mg ER Cap	SIV	0.1825	0.1825	YES	NO	NO
02385848	ZOPICLONE	Zopiclone (Off-Formulary Interchangeable) 7.5mg Tab	SIV	0.4685	0.4685	YES	NO	NO
02385821	ZOPICLONE	Zopiclone (Off-Formulary Interchangeable) 5mg Tab	SIV	0.2231	0.2231	YES	NO	NO

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