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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
02238072	ACETAZOLAMIDE	Diamox (Not a Benefit) 250mg Tab	WAY	N/A	N/A	YES	NO	NO
02041308	AMOXICILLIN	Amoxil (Not a Benefit) 500mg Cap	WAY	N/A	N/A	YES	NO	NO
02041294	AMOXICILLIN	Amoxil (Not a Benefit) 250mg Cap	WAY	N/A	N/A	YES	NO	NO
02042592	AMOXICILLIN	Amoxil (Not a Benefit) 50mg/mL O/L	WAY	N/A	N/A	YES	NO	NO
02041316	AMOXICILLIN	Amoxil (Not a Benefit) 25mg/mL O/L	WAY	N/A	N/A	YES	NO	NO
02042975	CLOXACILLIN	Orbenin (Not a Benefit) 25mg/mL O/L	WAY	N/A	N/A	YES	NO	NO
02170078	ETHAMBUTOL HCL	Myambutol (Not a Benefit) 400mg Tab	WAY	N/A	N/A	YES	NO	NO
02042606	ISOSORBIDE DINITRATE	Isordil (Not a Benefit) 5mg SL Tab	WAY	N/A	N/A	YES	NO	NO
02042622	ISOSORBIDE DINITRATE	Isordil (Not a Benefit) 10mg Tab	WAY	N/A	N/A	YES	NO	NO
02042614	ISOSORBIDE DINITRATE	Isordil (Not a Benefit) 30mg Tab	WAY	N/A	N/A	YES	NO	NO
02170493	LEUCOVORIN CALCIUM	Leucovorin Calcium 5mg Tab	WAY	7.3552	3.6776	YES	NO	NO
02041405	LORAZEPAM	Ativan (Not a Benefit) 4mg/mL Inj Sol (with preservative)	WAY	N/A	N/A	YES	NO	NO
02170019	LOXAPINE SUCCINATE	Loxapac (Not a Benefit) 5mg Tab	WAY	N/A	N/A	YES	NO	NO
02170027	LOXAPINE SUCCINATE	Loxapac (Not a Benefit) 10mg Tab	WAY	N/A	N/A	YES	NO	NO
02170132	LOXAPINE SUCCINATE	Loxapac (Not a Benefit) 25mg Tab	WAY	N/A	N/A	YES	NO	NO
02170035	LOXAPINE SUCCINATE	Loxapac (Not a Benefit) 50mg Tab	WAY	N/A	N/A	YES	NO	NO
02238071	METHAZOLAMIDE	Neptazane (Not a Benefit) 50mg Tab	WAY	N/A	N/A	YES	NO	NO
02170671	METHOTREXATE	Methotrexate (Not a Benefit) 50mg/2mL Inj Sol-2mL Pk	WAY	N/A	N/A	YES	NO	NO
02043653	OXAZEPAM	Serax (Not a Benefit) 10mg Tab	WAY	N/A	N/A	YES	NO	NO
02043688	OXAZEPAM	Serax (Not a Benefit) 30mg Tab	WAY	N/A	N/A	YES	NO	NO
02043661	OXAZEPAM	Serax (Not a Benefit) 15mg Tab	WAY	N/A	N/A	YES	NO	NO
02042363	PRIMIDONE	Mysoline (Not a Benefit) 125mg Tab	WAY	N/A	N/A	YES	NO	NO
02042355	PRIMIDONE	Mysoline (Not a Benefit) 250mg Tab	WAY	N/A	N/A	YES	NO	NO
02042258	PROPRANOLOL	Inderal-LA (Off-Formulary Interchangeable) 80mg LA Cap	WAY	N/A	N/A	YES	NO	NO
02042274	PROPRANOLOL	Inderal-LA (Off-Formulary Interchangeable) 160mg LA Cap	WAY	N/A	N/A	YES	NO	NO
02042231	PROPRANOLOL	Inderal-LA (Off-Formulary Interchangeable) 60mg LA Cap	WAY	N/A	N/A	YES	NO	NO
02042215	PROPRANOLOL	Inderal (Not a Benefit) 80mg Tab	WAY	N/A	N/A	YES	NO	NO
02042193	PROPRANOLOL	Inderal (Not a Benefit) 20mg Tab	WAY	N/A	N/A	YES	NO	NO
02042177	PROPRANOLOL	Inderal (Not a Benefit) 10mg Tab	WAY	N/A	N/A	YES	NO	NO
02243237	SIROLIMUS	Rapamune 1mg/mL O/L	WAY	9.1200	9.1200	NO	YES	NO
02247111	SIROLIMUS	Rapamune 1mg Tab	WAY	9.1200	9.1200	NO	YES	NO

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