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Products found: 53

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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
00569771	ACYCLOVIR	Zovirax (Off-Formulary Interchangeable) 5% Top Oint	VAL	N/A	N/A	YES	NO	NO
02089602	BECLOMETHASONE DIPROPIONATE	Propaderm 0.025% Cr	VAL	0.5969	0.5969	NO	NO	NO
02473623	BRODALUMAB	Siliq 210mg/1.5mL Inj Sol-Pref Syr	VAL	645.0000	645.0000	NO	YES	NO
02275090	BUPROPION HCL	Wellbutrin XL 150mg ER Tab	VAL	0.6211	0.2926	YES	YES	NO
02275104	BUPROPION HCL	Wellbutrin XL 300mg ER Tab	VAL	1.2425	0.5853	YES	YES	NO
02238441	BUPROPION HCL	Zyban 150mg SR Tab	VAL	1.3275	1.3275	NO	YES	NO
02237825	BUPROPION HCL	Wellbutrin SR (Not a Benefit) 150mg Tab	VAL	N/A	N/A	YES	NO	NO
02250535	CICLOPIROX	Penlac (Off-Formulary Interchangeable) 8% W/W Top Sol	VAL	N/A	N/A	YES	NO	YES
02248472	CLINDAMYCIN PHOSPHATE & BENZOYL PEROXIDE	BenzaClin Topical Gel 1% & 5% Top Gel	VAL	1.3169	0.7422	YES	NO	NO
02373955	COLESEVELAM HYDROCHLORIDE	Lodalis 625mg Tab	VAL	1.3906	0.5931	YES	NO	YES
02238162	DIAZEPAM	Diastat 5mg/mL Rect Gel-2x 5mg Pk	VAL	214.0310	214.0310	NO	NO	NO
09853340	DIAZEPAM	Diastat 5mg/mL Rect Gel-2x10mg Pk	VAL	214.0310	214.0310	NO	NO	NO
09853430	DIAZEPAM	Diastat 5mg/mL Rect Gel-2x15mg Pk	VAL	214.0310	214.0310	NO	NO	NO
02097257	DILTIAZEM HCL	Cardizem CD 180mg LA Cap	VAL	2.1565	0.4824	YES	NO	NO
02097265	DILTIAZEM HCL	Cardizem CD 240mg LA Cap	VAL	2.8604	0.6399	YES	NO	NO
02097273	DILTIAZEM HCL	Cardizem CD 300mg LA Cap	VAL	3.5755	0.7999	YES	NO	NO
02097249	DILTIAZEM HCL	Cardizem CD 120mg LA Cap	VAL	1.6244	0.3634	YES	NO	NO
02231151	DILTIAZEM HCL	Tiazac 180mg SR Cap	VAL	1.6062	0.2889	YES	NO	NO
02231152	DILTIAZEM HCL	Tiazac 240mg SR Cap	VAL	2.1304	0.3832	YES	NO	NO
02231154	DILTIAZEM HCL	Tiazac 300mg SR Cap	VAL	2.6682	0.4720	YES	NO	NO
02231155	DILTIAZEM HCL	Tiazac 360mg SR Cap	VAL	3.2124	0.5778	YES	NO	NO
02231150	DILTIAZEM HCL	Tiazac 120mg SR Cap	VAL	1.2023	0.2133	YES	NO	NO
00247960	ETHAMBUTOL HCL	Etibi 100mg Tab	VAL	0.2784	0.2784	YES	NO	NO
00247979	ETHAMBUTOL HCL	Etibi 400mg Tab	VAL	0.8355	0.8355	YES	NO	NO
00330582	FLUOROURACIL	Efudex 5% Cr	VAL	1.1341	1.1341	NO	NO	NO
00012718	FLURAZEPAM	Dalmane (Not a Benefit) 30mg Cap	VAL	N/A	N/A	YES	NO	NO
00012696	FLURAZEPAM	Dalmane (Not a Benefit) 15mg Cap	VAL	N/A	N/A	YES	NO	NO
09857622	IMIQUIMOD	Aldara P (Off-Formulary Interchangeable) 5% Top Cr	VAL	N/A	N/A	YES	NO	NO
00236683	LITHIUM CARBONATE	Carbolith 300mg Cap	VAL	0.1212	0.0657	YES	NO	NO
00461733	LITHIUM CARBONATE	Carbolith 150mg Cap	VAL	0.1560	0.0667	YES	NO	NO
02300451	METFORMIN HCL	Glumetza (Off-Formulary Interchangeable) 1000mg ER Tab	VAL	N/A	N/A	YES	NO	NO
02156091	METRONIDAZOLE	Noritate 1% Top Cr	VAL	0.7989	0.7989	NO	NO	NO
02312263	NABILONE	Cesamet (Off-Formulary Interchangeable) 0.25mg Cap	VAL	N/A	N/A	YES	NO	NO
02256193	NABILONE	Cesamet 0.5mg Cap	VAL	4.1793	1.8886	YES	NO	NO
00548375	NABILONE	Cesamet 1mg Cap	VAL	8.3582	3.6669	YES	NO	NO
00268593	NICOTINIC ACID	Niacin-ICN (Not a Benefit) 50mg Tab	VAL	N/A	N/A	YES	NO	YES
02247238	PIMECROLIMUS	Elidel 1% Cr	VAL	2.9720	2.9720	NO	YES	NO
00869953	PYRIDOSTIGMINE BROMIDE	Mestinon 180mg LA Tab	VAL	1.4239	1.4239	NO	NO	NO
00869961	PYRIDOSTIGMINE BROMIDE	Mestinon 60mg Tab	VAL	0.6384	0.2673	YES	NO	NO
00393444	RIFAMPIN	Rofact 150mg Cap	VAL	0.9001	0.9001	NO	NO	YES
00343617	RIFAMPIN	Rofact 300mg Cap	VAL	1.4169	1.4169	NO	NO	YES
00029246	TESTOSTERONE ENANTHATE	Delatestryl 1000mg/5mL Oily Inj Sol-5mL Pk	VAL	68.8536	35.5943	YES	YES	NO
02199270	TETRABENAZINE	Nitoman (Off-Formulary Interchangeable) 25mg Tab	VAL	N/A	N/A	YES	NO	NO
00268631	THIAMINE HCL	Vitamin B1-ICN (Not a Benefit) 50mg Tab	VAL	N/A	N/A	YES	NO	NO
01926462	TRETINOIN	Vitamin A Acid 0.01% Gel	VAL	0.4266	0.4266	NO	YES	NO
01926489	TRETINOIN	Vitamin A Acid 0.05% Gel	VAL	0.4266	0.4266	NO	YES	NO
02194058	TRIAMCINOLONE ACETONIDE	Aristocort R (Not a Benefit) 0.1% Cr	VAL	N/A	N/A	YES	NO	NO
00718149	TRYPTOPHAN	Tryptan (Off-Formulary Interchangeable) 500mg Cap	VAL	N/A	N/A	YES	NO	NO
02029456	TRYPTOPHAN	Tryptan (Off-Formulary Interchangeable) 500mg Tab	VAL	N/A	N/A	YES	NO	NO
02239327	TRYPTOPHAN	Tryptan (Off-Formulary Interchangeable) 750mg Tab	VAL	N/A	N/A	YES	NO	NO
00654531	TRYPTOPHAN	Tryptan (Off-Formulary Interchangeable) 1g Tab	VAL	N/A	N/A	YES	NO	NO
02370433	ZOLPIDEM TARTRATE	Sublinox (Off-Formulary Interchangeable) 10mg SL Tab	VAL	N/A	N/A	YES	NO	NO
02391678	ZOLPIDEM TARTRATE	Sublinox (Off-Formulary Interchangeable) 5mg SL Tab	VAL	N/A	N/A	YES	NO	NO

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