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Products found: 31

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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
02413647	BACLOFEN	Baclofen Intrathecal (Off-Formulary Interchangeable) 2mg/mL Inj Sol (Preservative-Free)	STE	35.4500	35.4500	YES	NO	YES
02413620	BACLOFEN	Baclofen Injection (Off-Formulary Interchangeable) 0.05mg/mL Inj Sol-1mL Pk (Preservative-Free)	STE	11.2500	11.2500	YES	NO	YES
02413639	BACLOFEN	Baclofen Intrathecal (Off-Formulary Interchangeable) 0.5mg/mL Inj Sol-20mL Pk (Preservative-Free)	STE	177.2500	177.2500	YES	NO	YES
02399334	CALCITRIOL	Calcitriol Injection USP (Off-Formulary Interchangeable) 1mcg/mL Inj Sol Amp-1mL Pk	STE	9.5132	9.5132	YES	NO	NO
02437104	CEFAZOLIN SODIUM	Cefazolin for Injection (Off-Formulary Interchangeable) 500mg/Vial Inj Pd-Vial Pk	STE	4.0000	4.0000	YES	NO	NO
02437120	CEFAZOLIN SODIUM	Cefazolin for Injection (Off-Formulary Interchangeable) 10g/Vial Inj Pd-Vial Pk	STE	56.0000	56.0000	YES	NO	NO
02437112	CEFAZOLIN SODIUM	Cefazolin for Injection (Off-Formulary Interchangeable) 1g/Vial Inj Pd-Vial Pk	STE	6.0000	6.0000	YES	NO	NO
02325616	CEFTRIAXONE DISODIUM	Ceftriaxone Sodium For Injection BP 1g/Vial Inj Pd-1 Vial Pk	STE	12.4950	12.4950	YES	NO	NO
02325632	CEFTRIAXONE DISODIUM	Ceftriaxone Sodium For Injection BP (Off-Formulary Interchangeable) 10g/Vial Inj Pd-1 Vial Pk	STE	214.2000	214.2000	YES	NO	NO
02325624	CEFTRIAXONE DISODIUM	Ceftriaxone Sodium For Injection BP 2g/Vial Inj Pd-1 Vial Pk	STE	24.1395	24.1395	YES	NO	NO
02325594	CEFTRIAXONE DISODIUM	Ceftriaxone Sodium For Injection BP 0.25g/Vial Inj Pd-1 Vial Pk	STE	3.9501	3.9501	YES	NO	NO
01987003	CYANOCOBALAMIN	Cyanocobalamin 1mg/mL Inj Sol-10mL Pk	STE	3.0600	3.0600	YES	NO	NO
01977547	DEXAMETHASONE 21-PHOSPHATE	Dexamethasone Sodium 4mg/mL Inj Sol	STE	1.6900	1.6900	YES	NO	NO
02434571	DICLOFENAC SODIUM	Diclofenac Topical Solution (Off-Formulary Interchangeable) 1.5% W/W Top Sol	STE	0.6226	N/A	YES	NO	NO
02473879	GLYCOPYRROLATE	Glycopyrrolate Injection USP 0.2mg/mL Inj Sol (Preservative Free)	STE	2.7825	2.7825	YES	YES	NO
02473895	GLYCOPYRROLATE	Glycopyrrolate Injection USP 0.4mg/2mL Inj Sol (Preservative Free)	STE	2.7825	2.7825	YES	YES	NO
02473887	GLYCOPYRROLATE	Glycopyrrolate Injection USP 4mg/20mL Inj Sol (With Preservative)	STE	2.7825	2.7825	YES	YES	NO
00723754	HYDRALAZINE HCL	Apresoline 20mg/mL Inj Sol-1mL Pk	STE	11.6500	11.6500	NO	NO	NO
00005533	HYDRALAZINE HCL	Apresoline (Not a Benefit) 25mg Tab	STE	N/A	N/A	YES	NO	NO
02400871	KETOTIFEN	Ketotifen Ophthalmic Solution (Off-Formulary Interchangeable) 0.25mg/mL Oph Sol-5mL Pk	STE	21.1700	N/A	YES	NO	NO
02415275	MERCAPTOPURINE	Mercaptopurine Tablets USP 50mg Tab	STE	2.8610	2.8610	YES	NO	YES
02493349	MEROPENEM	Meropenem for Injection (Off-Formulary Interchangeable) 1g/Vial Pd for Inj Sol	STE	47.9900	47.9900	YES	NO	NO
02493330	MEROPENEM	Meropenem for Injection (Off-Formulary Interchangeable) 500mg/Vial Pd for Inj Sol	STE	23.9950	23.9950	YES	NO	NO
02464578	ONDANSETRON HCL DIHYDRATE	Ondansetron Injection USP (Off-Formulary Interchangeable) 2mg/mL Inj Sol-2mL Pk	STE	13.2180	N/A	YES	NO	NO
09857602	ONDANSETRON HCL DIHYDRATE	Ondansetron Injection USP (Off-Formulary Interchangeable) 2mg/mL Inj Sol-4mL Pk	STE	26.4360	N/A	YES	NO	NO
02362619	PIPERACILLIN SODIUM & TAZOBACTAM SODIUM	Piperacillin & Tazobactam for Injection (Off-Formulary Interchangeable) 2g & 250mg Inj Pd-2.25g Vial Pk	STE	10.1300	10.1300	YES	NO	NO
02362627	PIPERACILLIN SODIUM & TAZOBACTAM SODIUM	Piperacillin & Tazobactam for Injection (Off-Formulary Interchangeable) 3g & 375mg Inj Pd-3.375g Vial Pk	STE	15.2000	15.2000	YES	NO	NO
02362635	PIPERACILLIN SODIUM & TAZOBACTAM SODIUM	Piperacillin & Tazobactam for Injection (Off-Formulary Interchangeable) 4g & 500mg Inj Pd-4.5g Vial Pk	STE	20.2700	20.2700	YES	NO	NO
02410338	TETRABENAZINE	Tetrabenazine Tablets (Off-Formulary Interchangeable) 25mg Tab	STE	4.8551	4.8551	YES	NO	NO
02502372	TOBRAMYCIN SULFATE	Tobramycin Injection USP 80mg/2mL Inj Sol-2mL Pk	STE	3.1500	3.1500	YES	NO	YES
02401231	TRANEXAMIC ACID	Tranexamic Acid Tablets (Off-Formulary Interchangeable) 500mg Tab	STE	0.8071	0.8071	YES	NO	NO

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