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Products found: 31New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02238072ACETAZOLAMIDEDiamox (Not a Benefit) 250mg TabWAYN/AN/AYESNONO
02041308AMOXICILLINAmoxil (Not a Benefit) 500mg CapWAYN/AN/AYESNONO
02041294AMOXICILLINAmoxil (Not a Benefit) 250mg CapWAYN/AN/AYESNONO
02042592AMOXICILLINAmoxil (Not a Benefit) 50mg/mL O/LWAYN/AN/AYESNONO
02041316AMOXICILLINAmoxil (Not a Benefit) 25mg/mL O/LWAYN/AN/AYESNONO
02042975CLOXACILLINOrbenin (Not a Benefit) 25mg/mL O/LWAYN/AN/AYESNONO
02170078ETHAMBUTOL HCLMyambutol (Not a Benefit) 400mg TabWAYN/AN/AYESNONO
02042606ISOSORBIDE DINITRATEIsordil (Not a Benefit) 5mg SL TabWAYN/AN/AYESNONO
02042622ISOSORBIDE DINITRATEIsordil (Not a Benefit) 10mg TabWAYN/AN/AYESNONO
02042614ISOSORBIDE DINITRATEIsordil (Not a Benefit) 30mg TabWAYN/AN/AYESNONO
02170493LEUCOVORIN CALCIUMLeucovorin Calcium 5mg TabWAY7.35523.6776YESNONO
02041405LORAZEPAMAtivan (Not a Benefit) 4mg/mL Inj Sol (with preservative)WAYN/AN/AYESNONO
02170027LOXAPINE SUCCINATELoxapac (Not a Benefit) 10mg TabWAYN/AN/AYESNONO
02170035LOXAPINE SUCCINATELoxapac (Not a Benefit) 50mg TabWAYN/AN/AYESNONO
02170019LOXAPINE SUCCINATELoxapac (Not a Benefit) 5mg TabWAYN/AN/AYESNONO
02170132LOXAPINE SUCCINATELoxapac (Not a Benefit) 25mg TabWAYN/AN/AYESNONO
02238071METHAZOLAMIDENeptazane (Not a Benefit) 50mg TabWAYN/AN/AYESNONO
02170671METHOTREXATEMethotrexate (Not a Benefit) 50mg/2mL Inj Sol-2mL PkWAYN/AN/AYESNONO
02043653OXAZEPAMSerax (Not a Benefit) 10mg TabWAYN/AN/AYESNONO
02043688OXAZEPAMSerax (Not a Benefit) 30mg TabWAYN/AN/AYESNONO
02043661OXAZEPAMSerax (Not a Benefit) 15mg TabWAYN/AN/AYESNONO
02042355PRIMIDONEMysoline (Not a Benefit) 250mg TabWAYN/AN/AYESNONO
02042363PRIMIDONEMysoline (Not a Benefit) 125mg TabWAYN/AN/AYESNONO
02042274PROPRANOLOLInderal-LA (Off-Formulary Interchangeable) 160mg LA CapWAYN/AN/AYESNONO
02042258PROPRANOLOLInderal-LA (Off-Formulary Interchangeable) 80mg LA CapWAYN/AN/AYESNONO
02042231PROPRANOLOLInderal-LA (Off-Formulary Interchangeable) 60mg LA CapWAYN/AN/AYESNONO
02042193PROPRANOLOLInderal (Not a Benefit) 20mg TabWAYN/AN/AYESNONO
02042177PROPRANOLOLInderal (Not a Benefit) 10mg TabWAYN/AN/AYESNONO
02042215PROPRANOLOLInderal (Not a Benefit) 80mg TabWAYN/AN/AYESNONO
02243237SIROLIMUSRapamune 1mg/mL O/LWAY9.44009.4400NOYESNO
02247111SIROLIMUSRapamune 1mg TabWAY9.44009.4400NOYESNO