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Products found: 74New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
00548359ALPRAZOLAMXanax 0.25mg TabUJC0.30810.0633YESNONO
00723770ALPRAZOLAMXanax (Off-Formulary Interchangeable) 1mg TabUJCN/AN/AYESNONO
00548367ALPRAZOLAMXanax 0.5mg TabUJC0.36840.0757YESNONO
00813958ALPRAZOLAMXanax TS (Off-Formulary Interchangeable) 2mg TabUJCN/AN/AYESNONO
00878936AMLODIPINENorvasc 10mg TabUJC2.17240.1993YESNONO
00878928AMLODIPINENorvasc 5mg TabUJC1.48840.1343YESNONO
02273284AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 10mg & 10mg TabUJC2.52351.2250YESNOYES
02273276AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 5mg & 80mg TabUJC2.97930.7232YESNOYES
02273268AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 5mg & 40mg TabUJC2.97930.7232YESNOYES
02273233AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 5mg & 10mg TabUJC2.39021.1603YESNOYES
02273306AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 10mg & 40mg TabUJC3.29600.8000YESNOYES
02273314AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 10mg & 80mg TabUJC3.29600.8000YESNOYES
02273241AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 5mg & 20mg TabUJC2.81871.3683YESNOYES
02273292AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMCaduet 10mg & 20mg TabUJC3.14611.5272YESNOYES
02362821AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 10mg & 80mg TabUJC0.80000.8000YESNOYES
02362813AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 10mg & 40mg TabUJC0.80000.8000YESNOYES
02362791AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 10mg & 10mg TabUJC1.22501.2250YESNOYES
02362783AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 5mg & 80mg TabUJC0.72320.7232YESNOYES
02362775AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 5mg & 40mg TabUJC0.72320.7232YESNOYES
02362767AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 5mg & 20mg TabUJC1.36831.3683YESNOYES
02362759AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 5mg & 10mg TabUJC1.16031.1603YESNOYES
02362805AMLODIPINE BESYLATE & ATORVASTATIN CALCIUMGd-Amlodipine/Atorvastatin 10mg & 20mg TabUJC1.52721.5272YESNOYES
02243097ATORVASTATIN CALCIUMLipitor 80mg TabUJC2.46100.2342YESNONO
02230714ATORVASTATIN CALCIUMLipitor 40mg TabUJC2.46080.2342YESNONO
02230713ATORVASTATIN CALCIUMLipitor 20mg TabUJC2.28910.2179YESNONO
02230711ATORVASTATIN CALCIUMLipitor 10mg TabUJC1.83130.1743YESNONO
02239942CELECOXIBCelebrex 200mg CapUJC1.42110.2558YESYESYES
02239941CELECOXIBCelebrex 100mg CapUJC0.71050.1279YESYESYES
02342235ELETRIPTANGd-Eletriptan (Off-Formulary Interchangeable) 20mg TabUJC10.0850N/AYESNONO
02342243ELETRIPTANGd-Eletriptan (Off-Formulary Interchangeable) 40mg TabUJC10.0850N/AYESNONO
02256304ELETRIPTANRelpax (Off-Formulary Interchangeable) 40mg TabUJCN/AN/AYESNONO
02256290ELETRIPTANRelpax (Off-Formulary Interchangeable) 20mg TabUJCN/AN/AYESNONO
02323052EPLERENONEInspra 25mg TabUJC2.81192.0595YESYESNO
02323060EPLERENONEInspra 50mg TabUJC2.81192.0595YESYESNO
02084287GABAPENTINNeurontin 400mg CapUJC1.34060.1206YESNONO
02084260GABAPENTINNeurontin 100mg CapUJC0.47030.0416YESNONO
02084279GABAPENTINNeurontin 300mg CapUJC1.12490.1012YESNONO
02239718GABAPENTINNeurontin (Off-Formulary Interchangeable) 800mg TabUJCN/AN/AYESNONO
02239717GABAPENTINNeurontin (Off-Formulary Interchangeable) 600mg TabUJCN/AN/AYESNONO
02373041LATANOPROSTGd-Latanoprost 0.005% Oph Sol-2.5mL PkUJC9.58309.5830YESYESNO
02231493LATANOPROSTXalatan 0.005% Oph Sol-2.5mL PkUJC30.38209.5830YESYESNO
02373068LATANOPROST & TIMOLOL MALEATEGd-Latanoprost/Timolol 50mcg/mL & 5mg/mL Oph Sol-2.5mL PkUJC11.070011.0670YESYESNO
02246619LATANOPROST & TIMOLOL MALEATEXalacom 50mcg/mL & 5mg/mL Oph Sol-2.5mL PkUJC34.385911.0670YESYESNO
00037613NITROGLYCERINNitrostat 0.3mg SL TabUJC0.15810.1581NONONO
00037621NITROGLYCERINNitrostat 0.6mg SL TabUJC0.15810.1581NONONO
00023450PHENYTOIN (DIPHENYLHYDANTOIN)Dilantin-125 Suspension 25mg/mL O/LUJC0.05970.0428YESNONO
00023442PHENYTOIN (DIPHENYLHYDANTOIN)Dilantin-30 Suspension 6mg/mL O/LUJC0.05040.0504NONONO
00023698PHENYTOIN (DIPHENYLHYDANTOIN)Dilantin Infatabs 50mg TabUJC0.09150.0915NONONO
00022772PHENYTOIN (DIPHENYLHYDANTOIN) SODIUMDilantin 30mg CapUJC0.14290.1429NONONO
00022780PHENYTOIN (DIPHENYLHYDANTOIN) SODIUMDilantin 100mg CapUJC0.09270.0665YESNONO
02268418PREGABALINLyrica 25mg CapUJC0.85610.1481YESNONO
02268426PREGABALINLyrica 50mg CapUJC1.34300.2324YESNONO
02268434PREGABALINLyrica 75mg CapUJC1.73760.3007YESNONO
02268450PREGABALINLyrica 150mg CapUJC2.39540.4145YESNONO
02268477PREGABALINLyrica (Off-Formulary Interchangeable) 225mg CapUJCN/AN/AYESNONO
02268485PREGABALINLyrica 300mg CapUJC2.39540.4145YESNONO
02132702SERTRALINE HCLZoloft 25mg CapUJC0.87620.1516YESNOYES
01962817SERTRALINE HCLZoloft 50mg CapUJC1.75220.3032YESNOYES
01962779SERTRALINE HCLZoloft 100mg CapUJC1.90900.3303YESNOYES
02279401SILDENAFILRevatio (Off-Formulary Interchangeable) 20mg TabUJCN/AN/AYESNONO
02239768SILDENAFILViagra (Off-Formulary Interchangeable) 100mg TabUJCN/AN/AYESNONO
02239767SILDENAFILViagra (Off-Formulary Interchangeable) 50mg TabUJCN/AN/AYESNONO
02239766SILDENAFILViagra (Off-Formulary Interchangeable) 25mg TabUJCN/AN/AYESNONO
02244613TOLTERODINE L-TARTRATEDetrol LA 4mg SR CapUJC2.02130.4911YESYESNO
02244612TOLTERODINE L-TARTRATEDetrol LA 2mg SR CapUJC2.02130.4911YESYESNO
02239064TOLTERODINE L-TARTRATEDetrol 1mg TabUJC1.01050.2455YESYESNO
02239065TOLTERODINE L-TARTRATEDetrol 2mg TabUJC1.01050.2455YESYESNO
02237282VENLAFAXINE HCLEffexor XR 150mg ER CapUJC2.05500.1927YESNONO
02237280VENLAFAXINE HCLEffexor XR 75mg ER CapUJC1.94580.1825YESNONO
02237279VENLAFAXINE HCLEffexor XR 37.5mg ER CapUJC0.97320.0913YESNONO
02298600ZIPRASIDONE HCL MONOHYDRATEZeldox 40mg CapUJC2.14901.5786YESNONO
02298597ZIPRASIDONE HCL MONOHYDRATEZeldox 20mg CapUJC1.87611.3784YESNONO
02298619ZIPRASIDONE HCL MONOHYDRATEZeldox 60mg CapUJC2.14901.5786YESNONO
02298627ZIPRASIDONE HCL MONOHYDRATEZeldox 80mg CapUJC2.14901.5786YESNONO