Drug_Generic|Drug_HTW_Code|Drug_limit_fp|Drug_limit_ds|Drug_limit_ppg|Drug_limit_refill|Drug_NDC|Drug_Descr|Drug_Pkg|Drug_Unit|Drug_340B|Drug_med_Effdate|Drug_med_EndDate|Drug_Med_Code|Drug_CMP_V|Drug_Med_Comment|Drug_chip_EffDate|Drug_chip_EndDate|Drug_chip_code|Drug_CMP_P|Drug_cshcn_EffDate|Drug_cshcn_EndDate|Drug_cshcn_code|Drug_CMP_C|Drug_cshcn_comment|Drug_khc_EffDate|Drug_KHC_EndDate|Drug_khc_code|Drug_CMP_K|Drug_htw_EffDate|Drug_htw_EndDate|Drug_legend_status|Drug_PDL_pa_required|Drug_pdl_EffDate|Drug_MKID|Drug_Clinical_pa_required|Drug_Retail|Drug_Retail_EffDate|Drug_LTC|Drug_LTC_EffDate|Drug_SPC|Drug_SPC_EffDate|Drug_VAC|Drug_VAC_EffDate|Drug_MKID_Desc|ID|Drug_med_EndReason|Drug_chip_EndReason|Drug_cshcn_EndReason|Drug_khc_EndReason|Drug_limit_larc|Drug_limit_injection|Drug_admin_fee|Drug_manufacturer|Drug_HTWPLUS_code|Drug_htwplus_EffDate|Drug_htwplus_EndDate|Drug_chip_comment|Drug_khc_comment|Drug_medicare_B|Drug_medicare_D|Drug_sdl_code|Drug_sdl_Effdate|Drug_sdl_EndDate
dulaglutide|No|No|No|No|75%|00002143380|TRULICITY 0.75 MG/0.5 ML PEN|0.5|ML|210.1453|11/03/2014||Yes|No||11/03/2014||Yes|No|11/03/2014||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|471.64439||460.32492||463.62644||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|1|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
dulaglutide|No|No|No|No|75%|00002143480|TRULICITY 1.5 MG/0.5 ML PEN|0.5|ML|210.1453|11/03/2014||Yes|No||11/03/2014||Yes|No|11/03/2014||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|471.63676||460.31748||463.61894||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
galcanezumab-gnlm|No|No|No|No|75%|00002143611|EMGALITY 120 MG/ML PEN|1|ML|303.7391|02/12/2019||Yes|No||02/12/2019||Yes|No|02/12/2019||Yes|No||||No|No|||Prescription Required|No|07/25/2019|537|Yes|680.74802||664.41007||669.1753||||ANTIMIGRAINE AGENTS, OTHER|3|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
ixekizumab|No|No|No|No|75%|00002144509|TALTZ 80 MG/ML AUTOINJ (3-PK)|1|ML|2973.7596|06/04/2018||Yes|No||06/04/2018||Yes|No|06/04/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|071|Yes|6663.71067||6503.78161||6550.42759||||CYTOKINE AND CAM ANTAGONISTS|4|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
ixekizumab|No|No|No|No|75%|00002144511|TALTZ 80 MG/ML AUTOINJECTOR|1|ML|2973.7596|06/04/2018||Yes|No||06/04/2018||Yes|No|06/04/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|071|Yes|6671.73195||6511.61038||6558.31251||||CYTOKINE AND CAM ANTAGONISTS|5|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
ixekizumab|No|No|No|No|75%|00002144527|TALTZ 80 MG/ML AUTOINJ (2-PK)|1|ML|2973.7596|06/04/2018||Yes|No||06/04/2018||Yes|No|06/04/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|071|Yes|6673.463||6513.29989||6560.01413||||CYTOKINE AND CAM ANTAGONISTS|6|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002145701|MOUNJARO 15 MG/0.5 ML PEN|0.5|ML||02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|490.99808||490.99808||490.99808||490.99808|02/09/2023|HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|7|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002145780|MOUNJARO 15 MG/0.5 ML PEN|0.5|ML|229.8522|02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|515.37611||503.00708||506.61472||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|8|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002146001|MOUNJARO 12.5 MG/0.5 ML PEN|0.5|ML||02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|491.65476||491.65476||491.65476||491.65476|02/09/2023|HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|9|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002146080|MOUNJARO 12.5 MG/0.5 ML PEN|0.5|ML|229.8522|02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|515.55898||503.18556||506.79448||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|10|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002147101|MOUNJARO 10 MG/0.5 ML PEN|0.5|ML||02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|490.6332||490.6332||490.6332||490.6332|02/09/2023|HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|11|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002147180|MOUNJARO 10 MG/0.5 ML PEN|0.5|ML|229.8522|02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|515.74539||503.3675||506.97772||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|12|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002148401|MOUNJARO 7.5 MG/0.5 ML PEN|0.5|ML||02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|491.17982||491.17982||491.17982||491.17982|02/09/2023|HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|13|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002148480|MOUNJARO 7.5 MG/0.5 ML PEN|0.5|ML|229.8522|02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|515.86296||503.48225||507.09329||.|04/29/2024|HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|14|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002149501|MOUNJARO 5 MG/0.5 ML PEN|0.5|ML||02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|490.92721||490.92721||490.92721||490.92721|02/09/2023|HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|15|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002149580|MOUNJARO 5 MG/0.5 ML PEN|0.5|ML|229.8522|03/07/2023||Yes|No||03/07/2023||Yes|No|03/07/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|515.90193||503.52028||507.1316||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|16|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002150601|MOUNJARO 2.5 MG/0.5 ML PEN|0.5|ML||02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|490.72945||490.72945||490.72945||490.72945|02/09/2023|HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|17|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002150680|MOUNJARO 2.5 MG/0.5 ML PEN|0.5|ML|229.8522|02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|515.79692||503.41779||507.02837||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|18|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
dulaglutide|No|No|No|No|75%|00002223601|TRULICITY 3 MG/0.5 ML PEN|0.5|ML|190.6104|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|434.4144||428.20848||407.8176||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|19|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
dulaglutide|No|No|No|No|75%|00002223680|TRULICITY 3 MG/0.5 ML PEN|0.5|ML|210.1453|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|471.79876||460.47559||463.77818||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|20|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
galcanezumab-gnlm|No|No|No|No|75%|00002237711|EMGALITY 120 MG/ML SYRINGE|1|ML|303.7391|08/22/2019||Yes|No||08/22/2019||Yes|No|08/22/2019||Yes|No||||No|No|||Prescription Required|No|07/25/2019|537|Yes|680.71765||664.38043||669.14545||||ANTIMIGRAINE AGENTS, OTHER|21|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
selpercatinib|No|No|No|No|75%|00002298026|RETEVMO 80 MG CAPSULE|120|EA|80.97473|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|184.54706||181.91068||173.24826||||ONCOLOGY, ORAL - LUNG|22|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|09/29/2023|
selpercatinib|No|No|No|No|75%|00002298060|RETEVMO 80 MG CAPSULE|60|EA|80.97473|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|184.54706||181.91068||173.24826||||ONCOLOGY, ORAL - LUNG|23|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|09/29/2023|
galcanezumab-gnlm|No|No|No|No|75%|00002311509|EMGALITY 300 MG (100 MG X3SYR)|1|ML|253.1152|08/29/2019||Yes|No||08/29/2019||Yes|No|08/29/2019||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|537|Yes|568.47819||554.83471||558.81406||||ANTIMIGRAINE AGENTS, OTHER|24|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
dulaglutide|No|No|No|No|75%|00002318201|TRULICITY 4.5 MG/0.5 ML PEN|0.5|ML|190.6104|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|434.4144||428.20848||407.8176||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|25|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
dulaglutide|No|No|No|No|75%|00002318280|TRULICITY 4.5 MG/0.5 ML PEN|0.5|ML|210.1453|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|471.56282||460.24531||463.54625||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|26|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00002322730|STRATTERA 10 MG CAPSULE|30|EA|5.6674|01/02/2003||Yes|No||01/02/2003||Yes|No|01/02/2003||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|12.6873||12.3828||12.47162||||STIMULANTS AND RELATED AGENTS|27|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00002322830|STRATTERA 25 MG CAPSULE|30|EA|5.6674|01/02/2003||Yes|No||01/02/2003||Yes|No|01/02/2003||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|12.6221||12.31917||12.40752||||STIMULANTS AND RELATED AGENTS|28|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00002322930|STRATTERA 40 MG CAPSULE|30|EA|6.1576|01/02/2003||Yes|No||01/02/2003||Yes|No|01/02/2003||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|13.72093||13.39163||13.48767||||STIMULANTS AND RELATED AGENTS|29|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00002323130|SYMBYAX 6-25 MG CAPSULE|30|EA|5.7663|01/28/2004|01/19/2025|Yes|No||01/28/2004|01/19/2025|Yes|No|01/28/2004|01/19/2025|Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|13.1418||12.95406||12.3372||||ANTIPSYCHOTICS|30|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ELI LILLY & CO.|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00002323560|CYMBALTA 20 MG CAPSULE|60|EA|3.5862|08/26/2004||Yes|No||08/26/2004||Yes|No|08/26/2004||Yes|No||||No|No|||Prescription Required|Yes|12/12/2014|232|No|8.01177||7.81949||7.87557||||NEUROPATHIC PAIN|31|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00002323830|STRATTERA 18 MG CAPSULE|30|EA|5.6674|01/02/2003||Yes|No||01/02/2003||Yes|No|01/02/2003||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|12.60831||12.30571||12.39397||||STIMULANTS AND RELATED AGENTS|32|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00002323930|STRATTERA 60 MG CAPSULE|30|EA|6.1576|01/02/2003||Yes|No||01/02/2003||Yes|No|01/02/2003||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|13.70392||13.37503||13.47095||||STIMULANTS AND RELATED AGENTS|33|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00002324030|CYMBALTA 30 MG CAPSULE|30|EA|4.0205|08/26/2004||Yes|No||08/26/2004||Yes|No|08/26/2004||Yes|No||||No|No|||Prescription Required|Yes|12/12/2014|232|No|8.97136||8.75605||8.81885||||NEUROPATHIC PAIN|34|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00002324090|CYMBALTA 30 MG CAPSULE|90|EA|4.0205|07/19/2013||Yes|No||07/19/2013||Yes|No|07/19/2013||Yes|No||||No|No|||Prescription Required|Yes|12/12/2014|232|No|8.97136||8.75605||8.81885||||NEUROPATHIC PAIN|35|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00002325030|STRATTERA 80 MG CAPSULE|30|EA|6.6435|03/06/2006||Yes|No||03/06/2006||Yes|No|03/06/2006||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|14.75203||14.39798||14.50125||||STIMULANTS AND RELATED AGENTS|36|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00002325130|STRATTERA 100 MG CAPSULE|30|EA|6.6435|03/06/2006||Yes|No||03/06/2006||Yes|No|03/06/2006||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|14.7878||14.43289||14.53641||||STIMULANTS AND RELATED AGENTS|37|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00002327030|CYMBALTA 60 MG CAPSULE|30|EA|4.0205|06/28/2010||Yes|No||06/28/2010||Yes|No|06/28/2010||Yes|No||||No|No|||Prescription Required|Yes|12/12/2014|232|No|8.96961||8.75434||8.81713||||NEUROPATHIC PAIN|38|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
selpercatinib|No|No|No|No|75%|00002397760|RETEVMO 40 MG CAPSULE|60|EA|53.98313|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|123.03132||121.27373||115.49879||||ONCOLOGY, ORAL - LUNG|39|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|09/29/2023|
olanzapine|No|No|No|No|75%|00002411230|ZYPREXA 2.5 MG TABLET|30|EA|5.7405|10/20/2005||Yes|No||10/20/2005||Yes|No|10/20/2005||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|13.083||12.8961||12.282||||ANTIPSYCHOTICS|40|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002411530|ZYPREXA 5 MG TABLET|30|EA|6.7725|10/28/2005||Yes|No||10/28/2005||Yes|No|10/28/2005||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|15.17823||14.81395||14.9202||||ANTIPSYCHOTICS|41|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002411630|ZYPREXA 7.5 MG TABLET|30|EA|8.2388|10/20/2005||Yes|No||10/20/2005||Yes|No|10/20/2005||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|18.20593||17.76899||17.89643||||ANTIPSYCHOTICS|42|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002411730|ZYPREXA 10 MG TABLET|30|EA|10.2039|10/19/2005||Yes|No||10/19/2005||Yes|No|10/19/2005||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|22.82127||22.27356||22.43331||||ANTIPSYCHOTICS|43|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
baricitinib|No|No|No|No|75%|00002418230|OLUMIANT 2 MG TABLET|30|EA|39.27319|10/18/2018||Yes|No||10/18/2018||Yes|No|10/18/2018||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|071|Yes|88.75085||86.62083||87.24209||||CYTOKINE AND CAM ANTAGONISTS|44|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|03/31/2022|
raloxifene HCl|No|No|No|No|75%|00002418430|EVISTA 60 MG TABLET|30|EA|2.838|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription Required|No|01/27/2022|060|No|6.32854||6.17666||6.22095||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|45|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
lasmiditan succinate|No|No|No|No|75%|00002431208|REYVOW 50 MG TABLET|8|EA|39.8223|11/03/2020||Yes|No||11/03/2020||Yes|No|11/03/2020||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|537|No|88.62647||86.49943||87.11982||||ANTIMIGRAINE AGENTS, OTHER|46|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002441530|ZYPREXA 15 MG TABLET|30|EA|15.30585|10/18/2005||Yes|No||10/18/2005||Yes|No|10/18/2005||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|34.18426||33.36384||33.60313||||ANTIPSYCHOTICS|47|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002442030|ZYPREXA 20 MG TABLET|30|EA|20.4078|10/19/2005||Yes|No||10/19/2005||Yes|No|10/19/2005||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|49.79369||48.59864||48.9472||||ANTIPSYCHOTICS|48|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445385|ZYPREXA ZYDIS 5 MG TABLET|30|EA|7.1939|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|027|Yes|16.11767||15.73085||15.84367||||ANTIPSYCHOTICS|49|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445485|ZYPREXA ZYDIS 10 MG TABLET|30|EA|10.6253|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|027|Yes|24.2158||23.86986||22.7332||||ANTIPSYCHOTICS|50|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445585|ZYPREXA ZYDIS 15 MG TABLET|30|EA|15.72725|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|027|Yes|35.8435||35.33145||33.649||||ANTIPSYCHOTICS|51|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445685|ZYPREXA ZYDIS 20 MG TABLET|30|EA|20.8292|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|027|Yes|47.4712||46.79304||44.5648||||ANTIPSYCHOTICS|52|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
baricitinib|No|No|No|No|75%|00002447930|OLUMIANT 4 MG TABLET|30|EA|78.54638|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|071|No|177.48444||173.22481||174.4672||||CYTOKINE AND CAM ANTAGONISTS|53|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|10/16/2024|
abemaciclib|No|No|No|No|75%|00002448354|VERZENIO 50 MG TABLET|14|EA|118.29392|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|269.6001||265.74867||253.09397||||ONCOLOGY, ORAL - BREAST|54|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
lasmiditan succinate|No|No|No|No|75%|00002449108|REYVOW 100 MG TABLET|8|EA|39.8223|11/03/2020||Yes|No||11/03/2020||Yes|No|11/03/2020||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|537|No|88.81178||86.6803||87.30198||||ANTIMIGRAINE AGENTS, OTHER|55|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
baricitinib|No|No|No|No|75%|00002473230|OLUMIANT 1 MG TABLET|30|EA|39.27319|08/05/2020||Yes|No||08/05/2020||Yes|No|08/05/2020||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|071|Yes|89.50634||88.22768||84.02636||||CYTOKINE AND CAM ANTAGONISTS|56|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|03/31/2022|
abemaciclib|No|No|No|No|75%|00002481554|VERZENIO 100 MG TABLET|14|EA|118.29392|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|269.6001||265.74867||253.09397||||ONCOLOGY, ORAL - BREAST|57|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
abemaciclib|No|No|No|No|75%|00002533754|VERZENIO 150 MG TABLET|14|EA|118.29392|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|269.6001||265.74867||253.09397||||ONCOLOGY, ORAL - BREAST|58|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
glucagon|No|No|No|No|75%|00002614501|BAQSIMI 3 MG SPRAY|1|EA||02/06/2020||Yes|No||02/06/2020||Yes|No|02/06/2020||Yes|No||||No|No|||Prescription Required|No|07/30/2020|583|No|||||||||GLUCAGON AGENTS|59|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
glucagon|No|No|No|No|75%|00002614502|BAQSIMI 3 MG SPRAY|1|EA||02/06/2020||Yes|No||02/06/2020||Yes|No|02/06/2020||Yes|No||||No|No|||Prescription Required|No|07/30/2020|583|No|||||||||GLUCAGON AGENTS|60|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
glucagon|No|No|No|No|75%|00002614511|BAQSIMI 3 MG SPRAY ONE PACK|1|EA|120.744|02/06/2020||Yes|No||02/06/2020||Yes|No|02/06/2020||Yes|No||||No|No|||Prescription Required|No|07/30/2020|583|No|275.184||271.2528||258.336||||GLUCAGON AGENTS|61|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
glucagon|No|No|No|No|75%|00002614527|BAQSIMI 3 MG SPRAY TWO PACK|2|EA|120.744|02/06/2020||Yes|No||02/06/2020||Yes|No|02/06/2020||Yes|No||||No|No|||Prescription Required|No|07/30/2020|583|No|275.184||271.2528||258.336||||GLUCAGON AGENTS|62|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
abemaciclib|No|No|No|No|75%|00002621654|VERZENIO 200 MG TABLET|14|EA|118.29392|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|269.6001||265.74867||253.09397||||ONCOLOGY, ORAL - BREAST|63|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
pirtobrutinib|No|No|No|No|75%|00002690230|JAYPIRCA 50 MG TABLET|30|EA|105.35|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|239|No|240.1||236.67||225.4||||ONCOLOGY, ORAL - OTHER|64|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
pirtobrutinib|No|No|No|No|75%|00002702660|JAYPIRCA 100 MG TABLET|60|EA|158.025|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|239|No|360.15||355.005||338.1||||ONCOLOGY, ORAL - OTHER|65|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00002751001|HUMALOG 100 UNIT/ML VIAL|10|ML|2.8552|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|07/18/2006|029|No|6.37196||6.21903||6.26364||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|66|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00002751017|HUMALOG 100 UNIT/ML VIAL|3|ML|11.8121|11/14/2012|11/15/2024|Yes|No||11/14/2012|11/15/2024|Yes|No|11/14/2012|11/15/2024|Yes|No||||No|No|07/01/2016|11/15/2024|Prescription Required|No|02/02/2010|029|No|6.35355||6.20106||6.24554||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|67|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002751101|HUMALOG MIX 75-25 VIAL        |10|ML|3.67263|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|029|No|8.17894||7.98265||8.0399||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|68|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002751601|HUMALOG 100 UNIT/ML CARTRIDGE|3|ML|11.868|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|No|27.048||26.6616||25.392||32.91933|05/01/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|69|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002751659|HUMALOG 100 UNIT/ML CARTRIDGE|3|ML|4.39001|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/30/2020|029|No|9.79721||9.56208||9.63066||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|70|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002759701|ZYPREXA 10 MG VIAL|1|EA|21.6118|04/27/2004||Yes|No||04/27/2004||Yes|No|04/27/2004||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|027|Yes|49.2548||48.55116||46.2392||||ANTIPSYCHOTICS|71|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine pamoate|No|No|No|No|75%|00002763511|ZYPREXA RELPREVV 210 MG VL KIT|1|EA|253.5624|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|577.8864||569.63088||542.5056||||ANTIPSYCHOTICS|72|||||No|Yes|11.23000|ELI LILLY & CO.|No|||||No|No|No||
olanzapine pamoate|No|No|No|No|75%|00002763611|ZYPREXA RELPREVV 300 MG VL KIT|1|EA|362.232|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|825.552||813.7584||775.008||||ANTIPSYCHOTICS|73|||||No|Yes|11.23000|ELI LILLY & CO.|No|||||No|No|No||
olanzapine pamoate|No|No|No|No|75%|00002763711|ZYPREXA RELPREVV 405 MG VL KIT|1|EA|489.0132|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|1114.4952||1098.57384||1046.2608||||ANTIPSYCHOTICS|74|||||No|Yes|11.23000|ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002771201|HUMALOG 200 UNIT/ML KWIKPEN|3|ML|30.4096|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|029|No|69.3056||68.31552||65.0624||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|75|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00002771227|HUMALOG 200 UNIT/ML KWIKPEN|3|ML|30.4096|08/18/2015||Yes|No||08/18/2015||Yes|No|08/18/2015||Yes|No||||No|No|04/08/2020||Prescription Required|Yes|09/18/2020|029|No|67.84482||66.21654||66.69146||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|76|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002771401|HUMALOG JR 100 UNIT/ML KWIKPEN|3|ML||05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|Yes|32.592||32.592||32.592||32.592|05/01/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|77|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002771459|HUMALOG JR 100 UNIT/ML KWIKPEN|3|ML|4.56144|01/05/2018||Yes|No||01/05/2018||Yes|No|01/05/2018||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|Yes|10.17327||9.92911||10.00032||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|78|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00002771501|BASAGLAR 100 UNIT/ML KWIKPEN|3|ML|9.35536|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|029|No|21.32153||21.01693||20.01613||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|79|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine,hum.rec.anlog|Yes|No|No|No|75%|00002771559|BASAGLAR 100 UNIT/ML KWIKPEN|3|ML|9.35565|04/12/2017||Yes|No||04/12/2017||Yes|No|04/12/2017||Yes|No||||No|No|04/08/2020||Prescription Required|Yes|07/29/2021|029|Yes|20.93954||20.43699||20.58357||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|80|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
ixekizumab|No|No|No|No|75%|00002772401|TALTZ 80 MG/ML SYRINGE|1|ML|2973.7596|04/01/2019||Yes|No||04/01/2019||Yes|No|04/01/2019||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|071|Yes|6709.63143||6548.60028||6595.5677||.|07/01/2024|CYTOKINE AND CAM ANTAGONISTS|81|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
ixekizumab|No|No|No|No|75%|00002772411|TALTZ 80 MG/ML SYRINGE|1|ML|2973.7596|09/11/2020||Yes|No||09/11/2020||Yes|No|09/11/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|071|No|6709.63143||6548.60028||6595.5677||||CYTOKINE AND CAM ANTAGONISTS|82|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002772801|LYUMJEV 100 UNIT/ML VIAL|10|ML|11.8121|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|029|No|26.34353||25.71129||25.89569||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|83|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002773701|INSULIN LISPRO 100 UNIT/ML VL|10|ML|1.075|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|01/27/2022|029|No|2.40367||2.34598||2.36281||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|84|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002775201|INSULIN LISPRO JR 100 UNIT/ML |3|ML||08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|01/27/2022|029|Yes|10.04667||10.04667||10.04667||10.04667|08/01/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|85|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002775205|INSULIN LISPRO JR 100 UNIT/ML|3|ML|4.56144|10/08/2020||Yes|No||10/08/2020||Yes|No|10/08/2020||Yes|No||||No|No|||Prescription Required|No|01/27/2022|029|Yes|10.2079||9.96291||10.03437||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|86|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
somatropin|No|No|No|No|75%|00002814701|HUMATROPE 6 MG CARTRIDGE|1|EA|400.158|10/21/2005||Yes|No||10/21/2005||Yes|No|10/21/2005||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|Yes|07/29/2021|014|No|911.988||898.9596||856.152||618.576|06/08/2016|GROWTH HORMONE|87|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|10/23/2018|
somatropin|No|No|No|No|75%|00002814801|HUMATROPE 12 MG CARTRIDGE|1|EA|800.316|10/21/2005||Yes|No||10/21/2005||Yes|No|10/21/2005||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|Yes|07/29/2021|014|No|1797.846||1754.6977||1767.28262||.|04/22/2024|GROWTH HORMONE|88|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00002814901|HUMATROPE 24 MG CARTRIDGE|1|EA|1600.632|10/21/2005||Yes|No||10/21/2005||Yes|No|10/21/2005||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|Yes|07/29/2021|014|No|3647.952||3595.8384||3424.608||2474.304|06/08/2016|GROWTH HORMONE|89|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|10/23/2018|
insulin lispro-aabc|No|No|No|No|75%|00002820701|LYUMJEV 100 UNIT/ML KWIKPEN   |3|ML||06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|029|No|34.606||34.606||34.606||34.606|06/28/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|90|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002820705|LYUMJEV 100 UNIT/ML KWIKPEN|3|ML|15.2048|06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|029|No|33.91661||33.10261||33.34003||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|91|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002821301|HUMALOG TEMPO PEN 100 UNIT/ML|3|ML||04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|029|No|34.6528||34.6528||34.6528||34.6528|04/27/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|92|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002821305|HUMALOG TEMPO PEN 100 UNIT/ML|3|ML|4.56144|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|029|No|10.15846||9.91466||9.98577||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|93|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00002821401|BASAGLAR TEMPO PEN 100 UNIT/ML|3|ML||05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|029|No|20.90137||20.90137||20.90137||20.90137|05/01/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|94|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00002821405|BASAGLAR TEMPO PEN 100 UNIT/ML|3|ML|9.35565|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|029|No|20.95213||20.44928||20.59594||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|95|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin regular, human|Yes|No|No|No|75%|00002821501|HUMULIN R 100 UNIT/ML VIAL    |10|ML|1.91823|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Over The Counter|No|01/15/2014|029|No|4.27385||4.17128||4.20119||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|96|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin regular, human|Yes|No|No|No|75%|00002821517|HUMULIN R 100 UNIT/ML VIAL|3|ML|6.3941|10/08/2012|11/15/2024|Yes|No||10/08/2012|11/15/2024|Yes|No|10/08/2012|11/15/2024|Yes|No||||No|No|07/01/2016|11/15/2024|Over The Counter|No|01/15/2014|029|No|14.5726||14.36442||13.6804||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|97|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002822201|INSULIN LISPRO 100 UNIT/ML PEN|3|ML||08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|01/27/2022|029|No|9.974||9.974||9.974||9.974|08/01/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|98|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002822259|INSULIN LISPRO 100 UNIT/ML PEN|3|ML|4.56144|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|01/27/2022|029|No|10.20236||9.9575||10.02892||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|99|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002822801|LYUMJEV 200 UNIT/ML KWIKPEN   |3|ML||06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|029|No|69.25667||69.25667||69.25667||69.25667|06/28/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|100|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002822827|LYUMJEV 200 UNIT/ML KWIKPEN   |3|ML|30.4096|06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|029|No|67.94963||66.31884||66.79449||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|101|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002823305|INSULIN LISPRO MIX 75-25 KWKPN|3|ML|4.56144|10/08/2020||Yes|No||10/08/2020||Yes|No|10/08/2020||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|029|No|10.1866||9.94212||10.01343||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|102|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002823501|LYUMJEV TEMPO PEN 100 UNIT/ML|3|ML||06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|029|No|35.36||35.36||35.36||35.36|06/28/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|103|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002823505|LYUMJEV TEMPO PEN 100 UNIT/ML|3|ML|15.2048|06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|029|No|34.15608||33.33633||33.57543||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|104|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH human isophane|Yes|No|No|No|75%|00002831501|HUMULIN N 100 UNIT/ML VIAL|10|ML|1.91823|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Over The Counter|No|01/15/2014|029|No|4.28241||4.17963||4.20961||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|105|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
teriparatide|No|No|No|No|75%|00002840001|FORTEO 600 MCG/2.4 ML PEN INJ|2.4|ML|768.60529|10/15/2008||Yes|No||10/15/2008||Yes|No|10/15/2008||Yes|No||||No|No|||Prescription Required|No|01/27/2022|060|No|1728.04606||1686.57295||1698.66928||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|106|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin regular, human|No|No|No|No|75%|00002850101|HUMULIN R 500 UNIT/ML VIAL|20|ML|31.9705|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|029|No|71.2916||69.5806||70.07964||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|107|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH hum/reg insulin hm|Yes|No|No|No|75%|00002871501|HUMULIN 70-30 VIAL            |10|ML|1.91823|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Over The Counter|No|01/15/2014|029|No|4.27499||4.17239||4.20232||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|108|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002879701|HUMALOG MIX 75-25 KWIKPEN|3|ML|4.56086|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|No|10.39453||10.24603||9.75813||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|109|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002879759|HUMALOG MIX 75-25 KWIKPEN|3|ML|4.56144|03/04/2009||Yes|No||03/04/2009||Yes|No|03/04/2009||Yes|No||03/04/2009||Yes|No|||Prescription Required|No|01/30/2020|029|No|10.18063||9.93629||10.00756||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|110|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002879801|HUMALOG MIX 50-50 KWIKPEN     |3|ML|4.56086|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|No|10.39453||10.24603||9.75813||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|111|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002879859|HUMALOG MIX 50-50 KWIKPEN|3|ML|4.56144|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||01/14/2008||Yes|No|||Prescription Required|No|01/30/2020|029|No|10.16362||9.91969||9.99084||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|112|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002879901|HUMALOG 100 UNIT/ML KWIKPEN|3|ML|4.56086|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|No|10.39453||10.24603||9.75813||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|113|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002879959|HUMALOG 100 UNIT/ML KWIKPEN|3|ML|4.56144|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||01/14/2008||Yes|No|||Prescription Required|No|01/30/2020|029|No|10.18226||9.93789||10.00916||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|114|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH hum/reg insulin hm|No|No|No|No|75%|00002880301|HUMULIN 70/30 KWIKPEN         |3|ML|4.05346|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Over The Counter|No|01/30/2020|029|No|9.23813||9.10615||8.67253||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|115|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH hum/reg insulin hm|No|No|No|No|75%|00002880359|HUMULIN 70/30 KWIKPEN|3|ML|4.05318|04/02/2014||Yes|No||04/02/2014||Yes|No|04/02/2014||Yes|No||||No|No|||Over The Counter|No|01/30/2020|029|No|9.04574||8.82864||8.89196||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|116|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH human isophane|No|No|No|No|75%|00002880501|HUMULIN N 100 UNIT/ML KWIKPEN |3|ML|4.05346|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Over The Counter|Yes|01/28/2021|029|No|9.23813||9.10615||8.67253||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|117|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH human isophane|No|No|No|No|75%|00002880559|HUMULIN N 100 UNIT/ML KWIKPEN|3|ML|4.05318|04/02/2014||Yes|No||04/02/2014||Yes|No|04/02/2014||Yes|No||||No|No|||Over The Counter|Yes|01/28/2021|029|No|9.05512||8.8378||8.90118||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|118|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin regular, human|No|No|No|No|75%|00002882401|HUMULIN R 500 UNIT/ML KWIKPEN|3|ML||04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|No|92.72833||92.72833||92.72833||92.72833|04/27/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|119|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin regular, human|No|No|No|No|75%|00002882427|HUMULIN R 500 UNIT/ML KWIKPEN|3|ML|41.151|02/24/2017||Yes|No||02/24/2017||Yes|No|02/24/2017||Yes|No||||No|No|||Prescription Required|No|01/30/2020|029|No|91.7492||89.54722||90.18946||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|120|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine-aglr|No|No|No|No|75%|00002898001|REZVOGLAR 100 UNIT/ML KWIKPEN|3|ML||09/11/2023||Yes|No||09/11/2023||Yes|No|09/11/2023||Yes|No||||No|No|||Prescription Required|Yes|01/25/2024|029|No|6.01||6.01||6.01||6.01|09/11/2023|HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|121|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine-aglr|No|No|No|No|75%|00002898005|REZVOGLAR 100 UNIT/ML KWIKPEN|3|ML|2.63733|09/11/2023||Yes|No||09/11/2023||Yes|No|09/11/2023||Yes|No||||No|No|||Prescription Required|Yes|01/25/2024|029|No|5.92563||5.78341||5.82489||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|122|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00003029305|KENALOG-40 40 MG/ML VIAL|1|ML|4.0248|10/18/2006||Yes|No||10/18/2006||Yes|No|10/18/2006||Yes|No||||No|No|||Prescription Required|No|||No|9.005||8.78888||8.85192|||||123|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00003029328|KENALOG-40 400 MG/10 ML VIAL|10|ML|3.05128|10/18/2006||Yes|No||10/18/2006||Yes|No|10/18/2006||Yes|No||||No|No|||Prescription Required|No|||No|6.8313||6.66735||6.71517|||||124|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00003049420|KENALOG-10 50 MG/5 ML VIAL    |5|ML|1.03974|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|2.31885||2.2632||2.27943|||||125|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052411|SPRYCEL 70 MG TABLET|60|EA|145.10687|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|330.70867||325.98426||310.4612||||ONCOLOGY, ORAL - HEMATOLOGIC|126|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052711|SPRYCEL 20 MG TABLET|60|EA|72.55354|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|165.35458||162.99237||155.23083||||ONCOLOGY, ORAL - HEMATOLOGIC|127|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052811|SPRYCEL 50 MG TABLET|60|EA|145.10687|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|330.70867||325.98426||310.4612||||ONCOLOGY, ORAL - HEMATOLOGIC|128|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
hydroxyurea|No|No|No|No|75%|00003083050|HYDREA 500 MG CAPSULE|100|EA|.58699|11/04/2014|03/31/2025|Yes|No||11/04/2014|03/31/2025|Yes|No|11/04/2014|03/31/2025|Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|1.3378||1.31869||1.25589||||ONCOLOGY, ORAL - HEMATOLOGIC|129|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS/H2 PHARMA L|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003085222|SPRYCEL 100 MG TABLET|30|EA|261.53073|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|590.60336||576.42888||580.5631||||ONCOLOGY, ORAL - HEMATOLOGIC|130|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003085522|SPRYCEL 80 MG TABLET|30|EA|261.53073|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|596.04678||587.53183||559.55412||||ONCOLOGY, ORAL - HEMATOLOGIC|131|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003085722|SPRYCEL 140 MG TABLET|30|EA|261.53073|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|596.04678||587.53183||559.55412||||ONCOLOGY, ORAL - HEMATOLOGIC|132|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003089321|ELIQUIS 2.5 MG TABLET|60|EA|4.25986|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription Required|No|07/24/2013|068|Yes|9.50846||9.28026||9.34682||||ANTICOAGULANTS|133|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No||
apixaban|No|No|No|No|75%|00003089331|ELIQUIS 2.5 MG TABLET|100|EA|4.26023|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription Required|No|07/24/2013|068|Yes|9.50846||9.28026||9.34682||||ANTICOAGULANTS|134|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003089421|ELIQUIS 5 MG TABLET|60|EA|4.25986|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription Required|No|07/24/2013|068|Yes|9.51084||9.28258||9.34916||||ANTICOAGULANTS|135|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No||
apixaban|No|No|No|No|75%|00003089431|ELIQUIS 5 MG TABLET|100|EA|4.26023|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription Required|No|07/24/2013|068|Yes|9.51084||9.28258||9.34916||||ANTICOAGULANTS|136|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003089470|ELIQUIS 5 MG TABLET|74|EA|4.25996|07/09/2018||Yes|No||07/09/2018||Yes|No|07/09/2018||Yes|No||||No|No|||Prescription Required|No|07/21/2016|068|Yes|9.51084||9.28258||9.34916||||ANTICOAGULANTS|137|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No||
deucravacitinib|No|No|No|No|75%|00003089511|SOTYKTU 6 MG TABLET|30|EA|93.65744|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|071|Yes|213.45184||210.40253||200.38336||||CYTOKINE AND CAM ANTAGONISTS|138|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
entecavir|No|No|No|No|75%|00003161112|BARACLUDE 0.5 MG TABLET|30|EA|19.67221|07/12/2005||Yes|No||07/12/2005||Yes|No|07/12/2005||Yes|No||||No|No|||Prescription Required|No|||No|44.19933||43.13855||43.44794|||||139|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
entecavir|No|No|No|No|75%|00003161212|BARACLUDE 1 MG TABLET|30|EA|19.67221|07/12/2005||Yes|No||07/12/2005||Yes|No|07/12/2005||Yes|No||||No|No|||Prescription Required|No|||No|44.83434||44.19385||42.08938|||||140|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
entecavir|No|No|No|No|75%|00003161412|BARACLUDE 0.05 MG/ML SOLUTION |210|ML|1.96719|07/12/2005||Yes|No||07/12/2005||Yes|No|07/12/2005||Yes|No||||No|No|||Prescription Required|No|||No|4.48335||4.41931||4.20886|||||141|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003218811|ORENCIA 125 MG/ML SYRINGE|1|ML|612.24153|01/06/2014||Yes|No||01/06/2014||Yes|No|01/06/2014||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|071|Yes|1383.8398||1350.62764||1360.31452||||CYTOKINE AND CAM ANTAGONISTS|142|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003218851|ORENCIA CLICKJECT 125 MG/ML|1|ML|612.24153|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription Required|Yes|01/26/2017|071|Yes|1380.28902||1347.16208||1356.82411||||CYTOKINE AND CAM ANTAGONISTS|143|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003281411|ORENCIA 50 MG/0.4 ML SYRINGE|0.4|ML|1530.60381|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription Required|Yes|01/26/2017|071|Yes|3488.35288||3438.51926||3274.78025||||CYTOKINE AND CAM ANTAGONISTS|144|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003281811|ORENCIA 87.5 MG/0.7 ML SYRINGE|0.7|ML|874.63075|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription Required|Yes|01/26/2017|071|Yes|1993.3445||1964.86815||1871.303||||CYTOKINE AND CAM ANTAGONISTS|145|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00003362212|REYATAZ 300 MG CAPSULE|30|EA|28.9884|06/28/2007||Yes|No||06/28/2007||Yes|No|06/28/2007||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|47.34772||46.67132||44.44888||||HIV / AIDS|146|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00003363112|REYATAZ 200 MG CAPSULE        |60|EA|14.6326|07/01/2003||Yes|No||07/01/2003||Yes|No|07/01/2003||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|23.89991||23.55848||22.43665||||HIV / AIDS|147|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00003363810|REYATAZ 50 MG POWDER PACKET   |30|EA|4.5204|12/19/2014||Yes|No||12/19/2014||Yes|No|12/19/2014||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|7.38332||7.27784||6.93128||||HIV / AIDS|148|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
atazanavir sulfate/cobicistat|No|No|No|No|75%|00003364111|EVOTAZ 300 MG-150 MG TABLET|30|EA|32.1094|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|237|No|52.0325||50.78372||51.14795||||HIV / AIDS|149|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003376474|ELIQUIS DVT-PE TREAT START 5MG|74|EA|4.25996|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|01/31/2019|068|Yes|9.50461||9.2765||9.34303||||ANTICOAGULANTS|150|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No||
repotrectinib|No|No|No|No|75%|00003404012|AUGTYRO 40 MG CAPSULE|120|EA|55.07583|08/15/2024||Yes|No||08/15/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|08/08/2024|551|No|125.52166||123.7285||117.83666||||ONCOLOGY, ORAL - LUNG|151|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
repotrectinib|No|No|No|No|75%|00003404060|AUGTYRO 40 MG CAPSULE|60|EA|55.07583|10/17/2024||Yes|No||10/17/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|08/08/2024|551|No|125.52166||123.7285||117.83666||||ONCOLOGY, ORAL - LUNG|152|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
hydroxyurea|No|No|No|No|75%|00003633517|DROXIA 200 MG CAPSULE|60|EA|.32544|03/01/2002|03/31/2025|Yes|No||03/01/2002|03/31/2025|Yes|No|03/01/2002|03/31/2025|Yes|No||||No|No|||Prescription Required|No|07/30/2020|580|No|.72964||.71213||.71724||||SICKLE CELL ANEMIA TREATMENTS|153|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS/H2 PHARMA L|No|||||No|No|No||
hydroxyurea|No|No|No|No|75%|00003633617|DROXIA 300 MG CAPSULE|60|EA|.32544|03/01/2002|05/31/2025|Yes|No||03/01/2002|05/31/2025|Yes|No|03/01/2002|05/31/2025|Yes|No||||No|No|||Prescription Required|No|07/30/2020|580|No|.73145||.7139||.71902||||SICKLE CELL ANEMIA TREATMENTS|154|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS/H2 PHARMA L|No|||||No|No|No||
hydroxyurea|No|No|No|No|75%|00003633717|DROXIA 400 MG CAPSULE|60|EA|.34823|03/01/2002|05/31/2025|Yes|No||03/01/2002|05/31/2025|Yes|No|03/01/2002|05/31/2025|Yes|No||||No|No|||Prescription Required|No|07/30/2020|580|No|.77929||.76059||.76604||||SICKLE CELL ANEMIA TREATMENTS|155|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS/H2 PHARMA L|No|||||No|No|No||
valganciclovir HCl|No|No|No|No|75%|00004003822|VALCYTE 450 MG TABLET|60|EA|38.013|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|136|No|86.63428||85.39665||81.33014||||ANTIVIRALS, GENERAL|156|||||No|No||GENENTECH, INC.|No|||||No|No|No||
valganciclovir HCl|No|No|No|No|75%|00004003909|VALCYTE 50 MG/ML SOLUTION     |88|ML|5.22924|03/31/2010||Yes|No||03/31/2010||Yes|No|03/31/2010||Yes|No||||No|No|||Prescription Required|No|07/30/2020|136|No|11.9178||11.74755||11.18814||||ANTIVIRALS, GENERAL|157|||||No|No||GENENTECH, INC.|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00004005801|KLONOPIN 1 MG TABLET|100|EA|1.25177|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|Yes|2.85288||2.81212||2.67821||||ANTICONVULSANTS|158|||||No|No||ROCHE LABS.|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00004006801|KLONOPIN 0.5 MG TABLET|100|EA|1.09736|03/01/2002|02/01/2025|Yes|No||03/01/2002|02/01/2025|Yes|No|03/01/2002|02/01/2025|Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|Yes|2.50096||2.46523||2.34784||||ANTICONVULSANTS|159|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ROCHE LABS.|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004025901|CELLCEPT 250 MG CAPSULE|100|EA|3.86824|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|229|No|8.69869||8.48992||8.55081||||IMMUNOSUPPRESSIVES, ORAL|160|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004025943|CELLCEPT 250 MG CAPSULE|500|EA|3.86824|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|229|No|8.69869||8.48992||8.55081||||IMMUNOSUPPRESSIVES, ORAL|161|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004026001|CELLCEPT 500 MG TABLET|100|EA|7.73647|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|229|No|17.37357||16.9566||17.07822||||IMMUNOSUPPRESSIVES, ORAL|162|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004026043|CELLCEPT 500 MG TABLET|500|EA|7.73647|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|229|No|17.37357||16.9566||17.07822||||IMMUNOSUPPRESSIVES, ORAL|163|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004026129|CELLCEPT 200 MG/ML ORAL SUSP|160|ML|3.71108|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|229|No|8.32627||8.12644||8.18472||||IMMUNOSUPPRESSIVES, ORAL|164|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
peginterferon alfa-2a|No|No|No|No|75%|00004035009|PEGASYS 180 MCG/ML VIAL|1|ML|439.2407|11/06/2002||Yes|No||11/06/2002||Yes|No|11/06/2002||Yes|No||||No|No|||Prescription Required|Yes|04/08/2015|064|No|1070.904||1045.2023||1052.69863||||HEPATITIS C AGENTS|165|||||No|No||GENENTECH, INC.|No|||||No|No|No||
peginterferon alfa-2a|No|No|No|No|75%|00004035730|PEGASYS 180 MCG/0.5 ML SYRINGE|0.5|ML|878.4814|12/01/2011||Yes|No||12/01/2011||Yes|No|12/01/2011||Yes|No||||No|No|||Prescription Required|Yes|04/08/2015|064|No|2002.1204||1973.51868||1879.5416||||HEPATITIS C AGENTS|166|||||No|No||GENENTECH, INC.|No|||||No|No|No||
enfuvirtide|No|No|No|No|75%|00004038140|FUZEON 90 MG VIAL             |60|EA|35.8556|06/20/2012||Yes|No||06/20/2012||Yes|No|06/20/2012||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|58.56414||57.72751||54.97858||||HIV / AIDS|167|||||No|No||GENENTECH, INC.|No|||||No|No|No||
oseltamivir phosphate|No|No|No|No|75%|00004080085|TAMIFLU 75 MG CAPSULE|10|EA|6.53084|09/21/2009||Yes|No||09/21/2009||Yes|No|09/21/2009||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|025|No|14.61975||14.26888||14.37121||||ANTIVIRALS, ORAL|168|||||No|No||ROCHE LABS.|No|||||No|No|No||
oseltamivir phosphate|No|No|No|No|75%|00004080185|TAMIFLU 45 MG CAPSULE|10|EA|5.99162|04/28/2008||Yes|No||04/28/2008||Yes|No|04/28/2008||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|025|No|13.65532||13.46024||12.81928||||ANTIVIRALS, ORAL|169|||||No|No||ROCHE LABS.|No|||||No|No|No||
oseltamivir phosphate|No|No|No|No|75%|00004080285|TAMIFLU 30 MG CAPSULE|10|EA|5.99162|04/30/2009||Yes|No||04/30/2009||Yes|No|04/30/2009||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|025|No|13.65532||13.46024||12.81928||||ANTIVIRALS, ORAL|170|||||No|No||ROCHE LABS.|No|||||No|No|No||
oseltamivir phosphate|No|No|No|No|75%|00004082205|TAMIFLU 6 MG/ML SUSPENSION|60|ML|1.08847|08/14/2013||Yes|No||08/14/2013||Yes|No|08/14/2013||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|025|No|2.4807||2.44526||2.32882||||ANTIVIRALS, ORAL|171|||||No|No||GENENTECH, INC.|No|||||No|No|No||
capecitabine|No|No|No|No|75%|00004110020|XELODA 150 MG TABLET          |60|EA|5.82979|07/14/2004||Yes|No||07/14/2004||Yes|No|07/14/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|13.28651||13.0967||12.47305||||ONCOLOGY, ORAL - BREAST|172|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
capecitabine|No|No|No|No|75%|00004110150|XELODA 500 MG TABLET|120|EA|19.42994|07/14/2004||Yes|No||07/14/2004||Yes|No|07/14/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|44.28219||43.64959||41.57104||||ONCOLOGY, ORAL - BREAST|173|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
suvorexant|No|No|No|No|75%|00006000530|BELSOMRA 5 MG TABLET|30|EA|6.3683|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|054|No|14.18019||13.83987||13.93913||||SEDATIVE HYPNOTICS|174|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ivermectin|No|No|No|No|75%|00006003220|STROMECTOL 3 MG TABLET|20|EA|2.00058|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|4.55945||4.49432||4.2803|||||175|||||No|No||MERCK SHARP & D|No|||||No|No|No||
suvorexant|No|No|No|No|75%|00006003330|BELSOMRA 10 MG TABLET|30|EA|6.3683|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|054|No|14.19014||13.84958||13.94891||||SEDATIVE HYPNOTICS|176|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006007861|JANUMET XR 50-500 MG TABLET|60|EA|4.1065|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|9.18088||8.96054||9.02481||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|177|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006007862|JANUMET XR 50-500 MG TABLET|180|EA|4.1065|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|9.18088||8.96054||9.02481||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|178|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006007882|JANUMET XR 50-500 MG TABLET|1000|EA|4.1065|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|9.18088||8.96054||9.02481||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|179|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006008061|JANUMET XR 50-1,000 MG TABLET|60|EA|4.1065|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|9.16054||8.94069||9.00481||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|180|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006008062|JANUMET XR 50-1,000 MG TABLET|180|EA|4.1065|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|9.16054||8.94069||9.00481||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|181|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006008082|JANUMET XR 50-1,000 MG TABLET|1000|EA|4.1065|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|9.16054||8.94069||9.00481||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|182|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006008131|JANUMET XR 100-1,000 MG TABLET|30|EA|8.213|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|18.32823||17.88835||18.01665||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|183|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006008154|JANUMET XR 100-1,000 MG TABLET|90|EA|8.213|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|18.32823||17.88835||18.01665||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|184|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006008182|JANUMET XR 100-1,000 MG TABLET|1000|EA|8.213|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2024|111|Yes|18.32823||17.88835||18.01665||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|185|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006011231|JANUVIA 50 MG TABLET|30|EA|8.213|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.32801||17.88814||18.01643||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|186|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006011254|JANUVIA 50 MG TABLET|90|EA|8.213|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.32801||17.88814||18.01643||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|187|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006022131|JANUVIA 25 MG TABLET|30|EA|8.213|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.33151||17.89155||18.01987||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|188|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006022154|JANUVIA 25 MG TABLET|90|EA|8.213|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.33151||17.89155||18.01987||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|189|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006022761|ISENTRESS 400 MG TABLET|60|EA|19.968|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|32.30688||31.53151||31.75766||||HIV / AIDS|190|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027728|JANUVIA 100 MG TABLET|100|EA|8.213|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.33437||17.89435||18.02269||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|191|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027731|JANUVIA 100 MG TABLET|30|EA|8.213|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.33437||17.89435||18.02269||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|192|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027754|JANUVIA 100 MG TABLET|90|EA|8.213|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.33437||17.89435||18.02269||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|193|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027782|JANUVIA 100 MG TABLET|1000|EA|8.213|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|111|Yes|18.33437||17.89435||18.02269||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|194|||||No|No||MERCK SHARP & D|No|||||No|No|No||
suvorexant|No|No|No|No|75%|00006032530|BELSOMRA 15 MG TABLET|30|EA|6.3683|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|054|No|14.19465||13.85398||13.95334||||SEDATIVE HYPNOTICS|195|||||No|No||MERCK SHARP & D|No|||||No|No|No||
suvorexant|No|No|No|No|75%|00006033530|BELSOMRA 20 MG TABLET|30|EA|6.3683|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|054|No|14.20196||13.86111||13.96053||||SEDATIVE HYPNOTICS|196|||||No|No||MERCK SHARP & D|No|||||No|No|No||
aprepitant|No|No|No|No|75%|00006046102|EMEND 80 MG CAPSULE|2|EA|94.0711|02/19/2008||Yes|No||02/19/2008||Yes|No|02/19/2008||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|085|Yes|208.983||203.96741||205.43029||||ANTIEMETIC/ANTIVERTIGO AGENTS|197|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
raltegravir potassium|No|No|No|No|75%|00006047361|ISENTRESS 25 MG TABLET CHEW|60|EA|1.248|01/07/2015||Yes|No||01/07/2015||Yes|No|01/07/2015||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|2.0384||2.00928||1.9136||||HIV / AIDS|198|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006047761|ISENTRESS 100 MG TABLET CHEW|60|EA|4.992|01/07/2015||Yes|No||01/07/2015||Yes|No|01/07/2015||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|8.1536||8.03712||7.6544||||HIV / AIDS|199|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vorinostat|No|No|No|No|75%|00006056840|ZOLINZA 100 MG CAPSULE|120|EA|53.7844|10/19/2006||Yes|No||10/19/2006||Yes|No|10/19/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|122.5784||120.82728||115.0736||||ONCOLOGY, ORAL - HEMATOLOGIC|200|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006057561|JANUMET 50-500 MG TABLET|60|EA|4.1065|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|9.17268||8.95254||9.01674||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|201|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006057562|JANUMET 50-500 MG TABLET|180|EA|4.1065|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|9.17268||8.95254||9.01674||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|202|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006057582|JANUMET 50-500 MG TABLET|1000|EA|4.1065|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|9.17268||8.95254||9.01674||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|203|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006057761|JANUMET 50-1,000 MG TABLET|60|EA|4.1065|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|9.1698||8.94972||9.01391||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|204|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006057762|JANUMET 50-1,000 MG TABLET|180|EA|4.1065|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|9.1698||8.94972||9.01391||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|205|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|00006057782|JANUMET 50-1,000 MG TABLET|1000|EA|4.1065|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|No|07/29/2021|111|Yes|9.1698||8.94972||9.01391||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|206|||||No|No||MERCK SHARP & D|No|||||No|No|No||
losartan potassium|No|No|No|No|75%|00006095254|COZAAR 50 MG TABLET|90|EA|1.5953|09/03/2010||Yes|No||09/03/2010||Yes|No|09/03/2010||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|113|No|3.6358||3.58386||3.4132||||ANGIOTENSIN MODULATORS|207|||||No|No||MERCK SHARP & D|No|||||No|No|No||
aprepitant|No|No|No|No|75%|00006306603|EMEND 125 MG POWDER PACKET    |1|EA|146.9869|08/10/2016||Yes|No||08/10/2016||Yes|No|08/10/2016||Yes|No||||No|No|||Prescription Required|Yes|01/26/2017|085|Yes|324.69571||316.90301||319.17588||||ANTIEMETIC/ANTIVERTIGO AGENTS|208|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
doravirine|No|No|No|No|75%|00006306901|PIFELTRO 100 MG TABLET|30|EA|35.214|12/10/2018||Yes|No||12/10/2018||Yes|No|12/10/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|237|No|56.77018||55.4077||55.80509||||HIV / AIDS|209|||||No|No||MERCK SHARP & D|No|||||No|No|No||
elbasvir/grazoprevir|No|No|No|No|75%|00006307402|ZEPATIER 50-100 MG TABLET|14|EA|111.8|09/21/2016||Yes|No||01/25/2023||Yes|No|09/01/2021||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|064|No|254.8||251.16||239.2||663.|09/21/2016|HEPATITIS C AGENTS|210|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307502|PREVYMIS 240 MG TABLET|28|EA|112.3676|12/11/2019||Yes|No||12/11/2019||Yes|No|12/11/2019||Yes|No||||No|No|||Prescription Required|No|||No|256.0936||252.43512||240.4144|||||211|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307504|PREVYMIS 240 MG TABLET|14|EA|112.3676|05/23/2018||Yes|No||05/23/2018||Yes|No|05/23/2018||Yes|No||||No|No|||Prescription Required|No|||No|256.0936||252.43512||240.4144|||||212|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307602|PREVYMIS 480 MG TABLET|28|EA|112.3676|01/02/2020||Yes|No||01/02/2020||Yes|No|01/02/2020||Yes|No||||No|No|||Prescription Required|No|||No|256.0936||252.43512||240.4144|||||213|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307604|PREVYMIS 480 MG TABLET|14|EA|112.3676|08/08/2018||Yes|No||08/08/2018||Yes|No|08/08/2018||Yes|No||||No|No|||Prescription Required|No|||No|256.0936||252.43512||240.4144|||||214|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006308001|ISENTRESS HD 600 MG TABLET|60|EA|19.968|07/17/2017||Yes|No||07/17/2017||Yes|No|07/17/2017||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|32.31341||31.53789||31.76408||||HIV / AIDS|215|||||No|No||MERCK SHARP & D|No|||||No|No|No||
imipenem/cilastatin sodium|No|No|No|No|75%|00006351659|PRIMAXIN 500 MG VIAL          |1|EA|14.04002|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|31.99818||31.54106||30.0391|||||216|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006360361|ISENTRESS 100 MG POWDER PACKET|60|EA|4.992|07/22/2019||Yes|No||07/22/2019||Yes|No|07/22/2019||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|8.1536||8.03712||7.6544||||HIV / AIDS|217|||||No|No||MERCK SHARP & D|No|||||No|No|No||
caspofungin acetate|No|No|No|No|75%|00006382210|CANCIDAS IV 50 MG VIAL        |1|EA|145.2153|02/23/2006||Yes|No||02/23/2006||Yes|No|02/23/2006||Yes|No||||No|No|||Prescription Required|No|||No|330.9558||326.22786||310.6932|||||218|||||No|No||MERCK SHARP & D|No|||||No|No|No||
caspofungin acetate|No|No|No|No|75%|00006382310|CANCIDAS IV 70 MG VIAL        |1|EA|150.8784|02/23/2006||Yes|No||02/23/2006||Yes|No|02/23/2006||Yes|No||||No|No|||Prescription Required|No|||No|343.8624||338.95008||322.8096|||||219|||||No|No||MERCK SHARP & D|No|||||No|No|No||
aprepitant|No|No|No|No|75%|00006386203|EMEND TRIPACK                 |3|EA|110.9916|09/08/2007||Yes|No||09/08/2007||Yes|No|09/08/2007||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|085|Yes|252.9576||249.34392||237.4704||||ANTIEMETIC/ANTIVERTIGO AGENTS|220|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
doravirine/lamivu/tenofov diso|No|No|No|No|75%|00006500701|DELSTRIGO 100-300-300 MG TAB|30|EA|53.598|12/10/2018||Yes|No||12/10/2018||Yes|No|12/10/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|237|No|86.60706||84.52849||85.13474||||HIV / AIDS|221|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502801|VERQUVO 2.5 MG TABLET|14|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.55974||21.04231||21.19322|||||222|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502802|VERQUVO 2.5 MG TABLET|30|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.55974||21.04231||21.19322|||||223|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502804|VERQUVO 2.5 MG TABLET|100|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.55974||21.04231||21.19322|||||224|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502901|VERQUVO 5 MG TABLET|14|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.56355||21.04602||21.19697|||||225|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502902|VERQUVO 5 MG TABLET|30|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.56355||21.04602||21.19697|||||226|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502904|VERQUVO 5 MG TABLET|100|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.56355||21.04602||21.19697|||||227|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006503001|VERQUVO 10 MG TABLET|30|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.57319||21.05543||21.20645|||||228|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006503002|VERQUVO 10 MG TABLET|90|EA|9.6492|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.57319||21.05543||21.20645|||||229|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006503004|VERQUVO 10 MG TABLET|100|EA|9.6492|08/25/2021||Yes|No||08/25/2021||Yes|No|08/25/2021||Yes|No||||No|No|||Prescription Required|No|||No|21.57319||21.05543||21.20645|||||230|||||No|No||MERCK SHARP & D|No|||||No|No|No||
molnupiravir|No|No|No|No|75%|00006505506|LAGEVRIO 200 MG CAP (EUA)|40|EA|.0043|12/27/2021|10/11/2024|Yes|No||12/27/2021|10/11/2024|Yes|No|12/27/2021|10/11/2024|Yes|No||||No|No|||Prescription Required|No|||No|.0098||.00966||.0092||.0001|12/27/2021||231|No Longer Covered|No Longer Covered|No Longer Covered||No|No||MERCK SHARP & D|No|||||No|No|No||
sotatercept-csrk|No|No|No|No|75%|00006508701|WINREVAIR 45 MG TWO-VIAL KIT|1|EA|12040.|10/04/2024||Yes|No||10/04/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|27440.||27048.||25760.|||||232|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sotatercept-csrk|No|No|No|No|75%|00006508801|WINREVAIR 60 MG TWO-VIAL KIT|1|EA|12040.|09/25/2024||Yes|No||09/25/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|27440.||27048.||25760.|||||233|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sotatercept-csrk|No|No|No|No|75%|00006509001|WINREVAIR 45 MG ONE-VIAL KIT|1|EA|6020.|09/25/2024||Yes|No||09/25/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|13720.||13524.||12880.|||||234|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sotatercept-csrk|No|No|No|No|75%|00006509101|WINREVAIR 60 MG ONE-VIAL KIT|1|EA|6020.|09/25/2024||Yes|No||09/25/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|13720.||13524.||12880.|||||235|||||No|No||MERCK SHARP & D|No|||||No|No|No||
belzutifan|No|No|No|No|75%|00006533101|WELIREG 40 MG TABLET|90|EA|141.7151|02/22/2022||Yes|No||02/22/2022||Yes|No|02/22/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|322.9786||318.36462||303.2044||||ONCOLOGY, ORAL - RENAL CELL|236|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536303|STEGLATRO 5 MG TABLET|30|EA|5.117|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|535|Yes|11.44648||11.17176||11.25189||||HYPOGLYCEMICS, SGLT2|237|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536306|STEGLATRO 5 MG TABLET|90|EA|5.117|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|535|Yes|11.44648||11.17176||11.25189||||HYPOGLYCEMICS, SGLT2|238|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536403|STEGLATRO 15 MG TABLET|30|EA|5.117|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|535|Yes|11.4351||11.16066||11.2407||||HYPOGLYCEMICS, SGLT2|239|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536406|STEGLATRO 15 MG TABLET|90|EA|5.117|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|535|Yes|11.4351||11.16066||11.2407||||HYPOGLYCEMICS, SGLT2|240|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536703|STEGLUJAN 5-100 MG TABLET|30|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|111|Yes|17.55737||17.13599||17.25889||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|241|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536706|STEGLUJAN 5-100 MG TABLET|90|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|111|Yes|17.55737||17.13599||17.25889||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|242|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536803|STEGLUJAN 15-100 MG TABLET|30|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|111|Yes|17.70574||17.2808||17.40474||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|243|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536806|STEGLUJAN 15-100 MG TABLET|90|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|111|Yes|17.70574||17.2808||17.40474||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|244|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006536903|SEGLUROMET 2.5-500 MG TABLET|60|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.73883||5.6011||5.64127||||HYPOGLYCEMICS, SGLT2|245|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006536906|SEGLUROMET 2.5-500 MG TABLET|180|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.73883||5.6011||5.64127||||HYPOGLYCEMICS, SGLT2|246|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537003|SEGLUROMET 7.5-500 MG TABLET|60|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.74843||5.61047||5.65071||||HYPOGLYCEMICS, SGLT2|247|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537006|SEGLUROMET 7.5-500 MG TABLET|180|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.74843||5.61047||5.65071||||HYPOGLYCEMICS, SGLT2|248|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537303|SEGLUROMET 2.5-1,000 MG TABLET|60|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.73972||5.60197||5.64214||||HYPOGLYCEMICS, SGLT2|249|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537306|SEGLUROMET 2.5-1,000 MG TABLET|180|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.73972||5.60197||5.64214||||HYPOGLYCEMICS, SGLT2|250|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537403|SEGLUROMET 7.5-1,000 MG TABLET|60|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.73834||5.60062||5.64079||||HYPOGLYCEMICS, SGLT2|251|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537406|SEGLUROMET 7.5-1,000 MG TABLET|180|EA|2.5585|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|535|Yes|5.73834||5.60062||5.64079||||HYPOGLYCEMICS, SGLT2|252|||||No|No||MERCK SHARP & D|No|||||No|No|No||
montelukast sodium|No|No|No|No|75%|00006927531|SINGULAIR 5 MG TABLET CHEW|30|EA|3.2723|07/13/2012|01/12/2025|Yes|No||07/13/2012|01/12/2025|Yes|No|07/13/2012|01/12/2025|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|042|No|7.4578||7.35126||7.0012||||LEUKOTRIENE MODIFIERS|253|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MERCK SHARP & D|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083321|EFFEXOR XR 75 MG CAPSULE|30|EA|8.24052|02/24/2006||Yes|No||02/24/2006||Yes|No|02/24/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|031|No|18.39965||17.95806||18.08686||||ANTIDEPRESSANTS, OTHER|254|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083322|EFFEXOR XR 75 MG CAPSULE|90|EA|8.24123|02/24/2006||Yes|No||02/24/2006||Yes|No|02/24/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|031|No|18.39965||17.95806||18.08686||||ANTIDEPRESSANTS, OTHER|255|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083621|EFFEXOR XR 150 MG CAPSULE|30|EA|8.9761|02/23/2006||Yes|No||02/23/2006||Yes|No|02/23/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|031|No|20.01221||19.53192||19.672||||ANTIDEPRESSANTS, OTHER|256|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083622|EFFEXOR XR 150 MG CAPSULE|90|EA|8.97577|02/23/2006||Yes|No||02/23/2006||Yes|No|02/23/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|031|No|20.01221||19.53192||19.672||||ANTIDEPRESSANTS, OTHER|257|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083721|EFFEXOR XR 37.5 MG CAPSULE|30|EA|7.35457|03/03/2006||Yes|No||03/03/2006||Yes|No|03/03/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|031|No|16.45609||16.06114||16.17634||||ANTIDEPRESSANTS, OTHER|258|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083722|EFFEXOR XR 37.5 MG CAPSULE|90|EA|7.35443|03/03/2006||Yes|No||03/03/2006||Yes|No|03/03/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|031|No|16.45609||16.06114||16.17634||||ANTIDEPRESSANTS, OTHER|259|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00008084181|PROTONIX DR 40 MG TABLET|90|EA|6.22434|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|047|No|13.91888||13.58483||13.68226||||PROTON PUMP INHIBITORS|260|||||No|No||WYETH/PFIZER|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00008084381|PROTONIX DR 20 MG TABLET|90|EA|6.22434|09/01/2009||Yes|No||09/01/2009||Yes|No|09/01/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|047|No|14.18572||13.98306||13.3172||||PROTON PUMP INHIBITORS|261|||||No|No||WYETH/PFIZER|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00008084402|PROTONIX 40 MG SUSPENSION|30|EA|6.19572|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription Required|No|07/26/2012|047|No|13.75564||13.4255||13.52179||||PROTON PUMP INHIBITORS|262|||||No|No||WYETH/PFIZER|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00008092355|PROTONIX IV 40 MG VIAL|1|EA|2.18225|10/20/2004||Yes|No||10/20/2004||Yes|No|10/20/2004||Yes|No||||No|No|||Prescription Required|No|||No|4.9735||4.90245||4.669|||||263|||||No|No||WYETH/PFIZER|No|||||No|No|No||
sirolimus|No|No|No|No|75%|00008103006|RAPAMUNE 1 MG/ML ORAL SOLN|60|ML|14.07698|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|229|No|31.75346||30.99138||31.21365||||IMMUNOSUPPRESSIVES, ORAL|264|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
sirolimus|No|No|No|No|75%|00008104005|RAPAMUNE 0.5 MG TABLET|100|EA|7.39075|10/23/2012||Yes|No||10/23/2012||Yes|No|10/23/2012||Yes|No||10/23/2012||Yes|No|||Prescription Required|No|01/27/2022|229|No|16.84404||16.60341||15.81278||||IMMUNOSUPPRESSIVES, ORAL|265|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
sirolimus|No|No|No|No|75%|00008104105|RAPAMUNE 1 MG TABLET|100|EA|14.78061|03/24/2008||Yes|No||03/24/2008||Yes|No|03/24/2008||Yes|No||03/24/2008||Yes|No|||Prescription Required|No|01/27/2022|229|No|33.68603||33.2048||31.62362||||IMMUNOSUPPRESSIVES, ORAL|266|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
sirolimus|No|No|No|No|75%|00008104110|RAPAMUNE 1 MG TABLET|100|EA|14.78061|06/09/2006||Yes|No||06/09/2006||Yes|No|06/09/2006||Yes|No||06/09/2006||Yes|No|||Prescription Required|No|01/27/2022|229|No|33.68603||33.2048||31.62362||||IMMUNOSUPPRESSIVES, ORAL|267|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
sirolimus|No|No|No|No|75%|00008104205|RAPAMUNE 2 MG TABLET|100|EA|29.56104|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||03/08/2006||Yes|No|||Prescription Required|No|01/27/2022|229|No|67.37167||66.40922||63.24687||||IMMUNOSUPPRESSIVES, ORAL|268|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
estrogens,conj/bazedoxifene|No|No|No|No|75%|00008112312|DUAVEE 0.45-20 MG TABLET|30|EA|2.8228|03/17/2014||Yes|No||03/17/2014||Yes|No|03/17/2014||Yes|No||||No|No|||Prescription Required|No|||Yes|6.2926||6.14158||6.18563|||||269|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008121030|PRISTIQ ER 25 MG TABLET|30|EA|6.27757|02/10/2016||Yes|No||02/10/2016||Yes|No|02/10/2016||Yes|No||||No|No|||Prescription Required|No|07/28/2022|031|No|13.94126||13.60667||13.70426||||ANTIDEPRESSANTS, OTHER|270|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008121101|PRISTIQ ER 50 MG TABLET|90|EA|6.27733|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription Required|No|07/28/2022|031|No|13.9504||13.61559||13.71324||||ANTIDEPRESSANTS, OTHER|271|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008121114|PRISTIQ ER 50 MG TABLET|14|EA|6.27708|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription Required|No|07/28/2022|031|No|13.9504||13.61559||13.71324||||ANTIDEPRESSANTS, OTHER|272|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008121130|PRISTIQ ER 50 MG TABLET|30|EA|6.27757|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription Required|No|07/28/2022|031|No|13.9504||13.61559||13.71324||||ANTIDEPRESSANTS, OTHER|273|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008122201|PRISTIQ ER 100 MG TABLET|90|EA|6.27733|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription Required|No|07/28/2022|031|No|13.97408||13.6387||13.73652||||ANTIDEPRESSANTS, OTHER|274|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008122214|PRISTIQ ER 100 MG TABLET|14|EA|6.27708|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription Required|No|07/28/2022|031|No|13.97408||13.6387||13.73652||||ANTIDEPRESSANTS, OTHER|275|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008122230|PRISTIQ ER 100 MG TABLET|30|EA|6.27757|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription Required|No|07/28/2022|031|No|13.97408||13.6387||13.73652||||ANTIDEPRESSANTS, OTHER|276|||||No|No||WYETH/PFIZER|No|||||No|No|No||
tigecycline|No|No|No|No|75%|00008499020|TYGACIL 50 MG VIAL|1|EA|43.|06/20/2017||Yes|No||06/20/2017||Yes|No|06/20/2017||Yes|No||||No|No|||Prescription Required|No|||No|98.||96.6||92.|||||277|||||No|No||WYETH/PFIZER|No|||||No|No|No||
hydrocortisone sodium succ/PF|No|No|No|No|75%|00009001103|SOLU-CORTEF 100 MG ACT-O-VIAL|1|EA|9.2106|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription Required|No|||No|20.38303||19.89384||20.03652|||||278|||||No|No||PFIZER US PHARM|No|||||No|No|No||
hydrocortisone sodium succ/PF|No|No|No|No|75%|00009001104|SOLU-CORTEF 100 MG ACT-O-VIAL|1|EA|9.21421|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription Required|No|||No|20.89369||20.39224||20.5385|||||279|||||No|No||PFIZER US PHARM|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00009001201|CORTEF 5 MG TABLET|50|EA|.43224|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|.95967||.93664||.94336||||GLUCOCORTICOIDS, ORAL|280|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
hydrocortisone sodium succ/PF|No|No|No|No|75%|00009001305|SOLU-CORTEF 250 MG ACT-O-VIAL|1|EA|17.0452|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription Required|No|||No|37.916||37.00602||37.27143|||||281|||||No|No||PFIZER US PHARM|No|||||No|No|No||
hydrocortisone sodium succ/PF|No|No|No|No|75%|00009001306|SOLU-CORTEF 250 MG ACT-O-VIAL|1|EA|17.04331|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription Required|No|||No|37.916||37.00602||37.27143|||||282|||||No|No||PFIZER US PHARM|No|||||No|No|No||
methylprednisolone|No|No|No|No|75%|00009002201|MEDROL 8 MG TABLET|25|EA|.76815|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|1.75067||1.72566||1.64349||||GLUCOCORTICOIDS, ORAL|283|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009002901|XANAX 0.25 MG TABLET|100|EA|2.34255|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|5.23679||5.11111||5.14776||||ANXIOLYTICS|284|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009002902|XANAX 0.25 MG TABLET|500|EA|2.34256|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|5.23679||5.11111||5.14776||||ANXIOLYTICS|285|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00009003101|CORTEF 10 MG TABLET|100|EA|.73001|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|1.61512||1.57636||1.58766||||GLUCOCORTICOIDS, ORAL|286|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00009004401|CORTEF 20 MG TABLET|100|EA|1.38383|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|3.15384||3.10878||2.96074||||GLUCOCORTICOIDS, ORAL|287|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
medroxyprogesterone acetate|No|No|No|No|75%|00009005101|PROVERA 10 MG TABLET|100|EA|2.20784|03/22/2023||Yes|No||03/22/2023||Yes|No|03/22/2023||Yes|No||||No|No|||Prescription Required|No|||No|5.03181||4.95993||4.72374|||||288|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005501|XANAX 0.5 MG TABLET|100|EA|2.91845|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|6.51919||6.36273||6.40836||||ANXIOLYTICS|289|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005503|XANAX 0.5 MG TABLET|500|EA|2.91848|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|6.51919||6.36273||6.40836||||ANXIOLYTICS|290|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
methylprednisolone|No|No|No|No|75%|00009005602|MEDROL 4 MG TABLET|100|EA|.13098|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|.29851||.29424||.28023||||GLUCOCORTICOIDS, ORAL|291|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone|No|No|No|No|75%|00009005604|MEDROL 4 MG DOSEPAK|21|EA|.13084|07/06/2006||Yes|No||07/06/2006||Yes|No|07/06/2006||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|.26347||.25715||.25899||||GLUCOCORTICOIDS, ORAL|292|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005707|XANAX XR 0.5 MG TABLET|60|EA|4.51457|10/23/2006||Yes|No||10/23/2006||Yes|No|10/23/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|10.28902||10.14203||9.65908||||ANXIOLYTICS|293|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005907|XANAX XR 1 MG TABLET|60|EA|5.61759|10/23/2006||Yes|No||10/23/2006||Yes|No|10/23/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|12.80288||12.61998||12.01903||||ANXIOLYTICS|294|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
medroxyprogesterone acetate|No|No|No|No|75%|00009006501|PROVERA 2.5 MG TABLET|100|EA|1.12565|03/21/2023||Yes|No||03/21/2023||Yes|No|03/21/2023||Yes|No||||No|No|||Prescription Required|No|||No|2.56544||2.52879||2.40838|||||295|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009006607|XANAX XR 2 MG TABLET|60|EA|7.45591|05/10/2004||Yes|No||05/10/2004||Yes|No|05/10/2004||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|16.99254||16.74979||15.95218||||ANXIOLYTICS|296|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009006807|XANAX XR 3 MG TABLET|60|EA|11.18294|10/23/2006||Yes|No||10/23/2006||Yes|No|10/23/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|25.48669||25.1226||23.92628||||ANXIOLYTICS|297|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
methylprednisolone|No|No|No|No|75%|00009007301|MEDROL 16 MG TABLET|50|EA|1.23625|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|2.8175||2.77725||2.645||||GLUCOCORTICOIDS, ORAL|298|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009009001|XANAX 1 MG TABLET|100|EA|3.89425|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|8.69558||8.48689||8.54776||||ANXIOLYTICS|299|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009009004|XANAX 1 MG TABLET|500|EA|3.89421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|8.69558||8.48689||8.54776||||ANXIOLYTICS|300|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009009401|XANAX 2 MG TABLET|100|EA|6.62118|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|14.76705||14.41264||14.51601||||ANXIOLYTICS|301|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
clindamycin HCl|No|No|No|No|75%|00009022502|CLEOCIN HCL 150 MG CAPSULE|100|EA|.06261|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.14269||.14065||.13395||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|302|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009026002|COLESTID GRANULES|500|GM|.36665|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|055|No|.83563||.82369||.78447||||LIPOTROPICS, OTHER|303|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
estradiol cypionate|No|No|No|No|75%|00009027101|DEPO-ESTRADIOL 5 MG/ML VIAL|5|ML|17.46058|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|38.87746||37.9444||38.21654|||||304|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009027401|DEPO-MEDROL 100 MG/5 ML VIAL|5|ML|3.05816|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|6.96976||6.87019||6.54304|||||305|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009028002|DEPO-MEDROL 200 MG/5 ML VIAL|5|ML|4.23894|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|9.66084||9.52283||9.06936|||||306|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009028003|DEPO-MEDROL 400 MG/10 ML VIAL|10|ML|4.24367|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|9.0962||8.87789||8.94156|||||307|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009030602|DEPO-MEDROL 400 MG/5 ML VIAL|5|ML|8.48734|11/27/2002||Yes|No||11/27/2002||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|11.63567||11.35641||11.43786|||||308|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin HCl|No|No|No|No|75%|00009033102|CLEOCIN HCL 75 MG CAPSULE|100|EA|.09602|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.21883||.21571||.20544||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|309|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
glyburide,micronized|No|No|No|No|75%|00009034101|GLYNASE 1.5 MG PRESTAB|100|EA|.81167|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|1.84985||1.82342||1.73659|||||310|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00009034702|DEPO-TESTOSTERONE 1,000MG/10ML|10|ML|3.75906|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|6.11221||5.96552||6.0083|||||311|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
glyburide,micronized|No|No|No|No|75%|00009035201|GLYNASE 3 MG PRESTAB|100|EA|1.37256|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|3.12816||3.08347||2.93664|||||312|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin HCl|No|No|No|No|75%|00009039514|CLEOCIN HCL 300 MG CAPSULE|100|EA|.12221|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.27852||.27454||.26146||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|313|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00009041701|DEPO-TESTOSTERONE 200 MG/ML|1|ML|10.2297|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|No|||Yes|10.783||10.52421||10.59969|||||314|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00009041702|DEPO-TESTOSTERONE 200 MG/ML|10|ML|5.94131|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|7.34608||7.16977||7.2212|||||315|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009045003|COLESTID 1 GM TABLET|120|EA|.96621|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2022|055|No|2.14636||2.09485||2.10987||||LIPOTROPICS, OTHER|316|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone sod succ|No|No|No|No|75%|00009069801|SOLU-MEDROL 1 GRAM VIAL       |1|EA|18.9114|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|43.1004||42.48468||40.4616|||||317|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009072809|CLEOCIN PHOS 9 G/60 ML VIAL|60|ML|.16724|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.38115||.37571||.35782||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|318|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone sod succ|No|No|No|No|75%|00009075801|SOLU-MEDROL 500 MG VIAL|1|EA|10.4404|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|23.7944||23.45448||22.3376|||||319|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin palmitate HCl|No|No|No|No|75%|00009076004|CLEOCIN PEDIATRIC 75 MG/5 ML|100|ML|.13313|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.30341||.29907||.28483||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|320|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009077526|CLEOCIN PHOS 600 MG/4 ML VIAL|4|ML|.31644|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.72118||.71088||.67703||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|321|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
hydrocortisone sod succinate|No|No|No|No|75%|00009082501|SOLU-CORTEF 100 MG VIAL|1|EA|6.8198|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|15.08957||14.72742||14.83305|||||322|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009087026|CLEOCIN PHOS 150 MG/ML VIAL|2|ML|.53475|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|1.22784||1.19837||1.20697||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|323|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009090218|CLEOCIN PHOS 150 MG/ML VIAL|6|ML|.30556|11/27/2002||Yes|No||11/27/2002||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.69639||.68644||.65375||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|324|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009307301|DEPO-MEDROL 40 MG/ML VIAL     |1|ML|4.8848|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|6.89296||6.72753||6.77578|||||325|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009307322|DEPO-MEDROL 40 MG/ML VIAL     |1|ML|4.8848|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription Required|No|||No|6.89296||6.72753||6.77578|||||326|||||No|No||PFIZER-NOVAPLUS|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009307323|DEPO-MEDROL 40 MG/ML VIAL     |1|ML|4.88841|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription Required|No|||No|11.14103||10.98187||10.45893|||||327|||||No|No||PFIZER-NOVAPLUS|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009332901|CLEOCIN T 1% LOTION|60|ML|.83936|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|04/05/2008|104|No|.76406||.74572||.75107||||ACNE AGENTS, TOPICAL|328|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|Yes|No|No|No|75%|00009344801|CLEOCIN 2% VAGINAL CREAM|40|GM|.77819|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|11/01/2012||Prescription Required|Yes|02/10/2009|124|No|1.72383||1.68246||1.69452||||ANTIBIOTICS, VAGINAL|329|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
glyburide,micronized|No|No|No|No|75%|00009344901|GLYNASE 6 MG PRESTAB|100|EA|2.16423|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|4.93244||4.86197||4.63045|||||330|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009454102|DETROL 1 MG TABLET|60|EA|3.62762|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|No|8.2676||8.14949||7.76142||||BLADDER RELAXANT PREPARATIONS|331|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009454402|DETROL 2 MG TABLET|60|EA|3.72351|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|No|8.48614||8.36491||7.96658||||BLADDER RELAXANT PREPARATIONS|332|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513601|ZYVOX 100 MG/5 ML SUSPENSION|150|ML|.70371|06/02/2009||Yes|No||06/02/2009||Yes|No|06/02/2009||Yes|No||||No|No|||Prescription Required|No|07/28/2022|146|No|1.6038||1.58089||1.50561||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|333|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513604|ZYVOX 100 MG/5 ML SUSPENSION|150|ML|.70371|11/09/2023||Yes|No||11/09/2023||Yes|No|11/09/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|146|No|1.6038||1.58089||1.50561||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|334|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513802|ZYVOX 600 MG TABLET|20|EA|116.53516|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|146|No|265.59176||261.79759||249.33104||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|335|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513803|ZYVOX 600 MG TABLET|30|EA|2.70197|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|146|No|6.15799||6.07002||5.78097||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|336|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid in dextrose 5%|No|No|No|No|75%|00009514004|ZYVOX 600 MG/300 ML-D5W|300|ML|.0473|06/28/2017||Yes|No||06/28/2017||Yes|No|06/28/2017||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|146|No|.1078||.10626||.1012||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|337|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519001|DETROL LA 2 MG CAPSULE|30|EA|5.90734|03/01/2002|01/10/2025|Yes|No||03/01/2002|01/10/2025|Yes|No|03/01/2002|01/10/2025|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|No|13.46324||13.27091||12.63896||||BLADDER RELAXANT PREPARATIONS|338|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519002|DETROL LA 2 MG CAPSULE|90|EA|5.907|03/01/2002|01/10/2025|Yes|No||03/01/2002|01/10/2025|Yes|No|03/01/2002|01/10/2025|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|No|13.46248||13.27015||12.63824||||BLADDER RELAXANT PREPARATIONS|339|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519003|DETROL LA 2 MG CAPSULE|500|EA|5.62568|03/01/2002|12/22/2024|Yes|No||03/01/2002|12/22/2024|Yes|No|03/01/2002|12/22/2024|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|No|12.82132||12.63816||12.03634||||BLADDER RELAXANT PREPARATIONS|340|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519101|DETROL LA 4 MG CAPSULE|30|EA|5.90734|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|No|13.2561||12.93795||13.03075||||BLADDER RELAXANT PREPARATIONS|341|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519102|DETROL LA 4 MG CAPSULE|90|EA|5.907|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|Yes|13.2561||12.93795||13.03075||||BLADDER RELAXANT PREPARATIONS|342|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519103|DETROL LA 4 MG CAPSULE|500|EA|5.62568|03/01/2002|12/22/2024|Yes|No||03/01/2002|12/22/2024|Yes|No|03/01/2002|12/22/2024|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|006|Yes|12.82132||12.63816||12.03634||||BLADDER RELAXANT PREPARATIONS|343|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nicotine|No|No|No|No|75%|00009540001|NICOTROL CARTRIDGE INHALER|168|EA|1.29596|07/07/2016|01/31/2026|Yes|No||08/08/2024|01/31/2026|Yes|No|07/07/2016|01/31/2026|Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|040|No|2.88483||2.81559||2.83579||||SMOKING CESSATION|344|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
nicotine|No|No|No|No|75%|00009540101|NICOTROL NS 10 MG/ML SPRAY|10|ML|5.77243|07/07/2016||Yes|No||08/08/2024||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|040|No|12.86148||12.5528||12.64283||||SMOKING CESSATION|345|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
pegvisomant|No|No|No|No|75%|00009716801|SOMAVERT 15 MG VIAL|1|EA|172.7697|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription Required|No|||No|393.7542||388.12914||369.6468|||||346|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|03/31/2022|
pegvisomant|No|No|No|No|75%|00009718801|SOMAVERT 20 MG VIAL|1|EA|230.3424|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription Required|No|||No|524.9664||517.46688||492.8256|||||347|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|03/22/2019|
pegvisomant|No|No|No|No|75%|00009719901|SOMAVERT 25 MG VIAL|1|EA|287.928|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription Required|No|||No|656.208||646.8336||616.032|||||348|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|03/22/2019|
pegvisomant|No|No|No|No|75%|00009720001|SOMAVERT 30 MG VIAL|1|EA|345.5136|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription Required|No|||No|787.4496||776.20032||739.2384|||||349|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|06/17/2019|
medroxyprogesterone acetate|Yes|Yes|No|No|75%|00009737611|DEPO-PROVERA 150 MG/ML SYRINGE|1|ML|23.6285|02/25/2013||Yes|No||||No|No|01/01/2013||Yes|No|Refer to program requirements|||No|No|02/25/2013||Prescription Required|No|||No|52.91167||51.64179||52.01217|||||350|||||No|No||PFIZER US PHARM|No|||||No|No|No||
exemestane|No|No|No|No|75%|00009766304|AROMASIN 25 MG TABLET|30|EA|16.50024|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|36.6728||35.79265||36.04936||||ONCOLOGY, ORAL - BREAST|351|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009766701|CLEOCIN 100 MG VAGINAL OVULE|3|EA|26.3375|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2016|124|No|58.74794||57.33799||57.74923||||ANTIBIOTICS, VAGINAL|352|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009766705|CLEOCIN 100 MG VAGINAL OVULE|3|EA|26.3375|10/15/2024||Yes|No||10/15/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|01/25/2024|124|No|58.74794||57.33799||57.74923||||ANTIBIOTICS, VAGINAL|353|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
estramustine phosphate sodium|No|No|No|No|75%|00013013202|EMCYT 140 MG CAPSULE|100|EA|7.20585|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|550|No|16.42264||16.18803||15.41718||||ONCOLOGY, ORAL - PROSTATE|354|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
somatropin|No|No|No|No|75%|00013262681|GENOTROPIN 5 MG CARTRIDGE|1|EA|317.6711|12/21/2009||Yes|No||12/21/2009||Yes|No|12/21/2009||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|709.01364||691.99731||696.96041||||GROWTH HORMONE|355|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013264681|GENOTROPIN 12 MG CARTRIDGE|1|EA|762.4201|12/21/2009||Yes|No||12/21/2009||Yes|No|12/21/2009||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|1737.6086||1712.78562||1631.2244||1321.7652|01/27/2017|GROWTH HORMONE|356|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013264902|GENOTROPIN MINIQUICK 0.2 MG|7|EA|13.05357|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|29.05939||28.36196||28.56538||.|04/22/2024|GROWTH HORMONE|357|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265002|GENOTROPIN MINIQUICK 0.4 MG|7|EA|26.11083|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|58.73086||57.32132||57.73244||.|04/22/2024|GROWTH HORMONE|358|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265102|GENOTROPIN MINIQUICK 0.6 MG|7|EA|39.1644|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|88.12929||86.01419||86.63109||.|05/27/2024|GROWTH HORMONE|359|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265202|GENOTROPIN MINIQUICK 0.8 MG|7|EA|52.21981|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|119.01259||117.31241||111.72611||96.04279|01/26/2017|GROWTH HORMONE|360|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265302|GENOTROPIN MINIQUICK 1 MG|7|EA|65.27646|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|148.7696||146.64432||139.66125||111.16559|06/03/2016|GROWTH HORMONE|361|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265402|GENOTROPIN MINIQUICK 1.2 MG|7|EA|78.33126|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|178.5224||175.97208||167.59245||133.39619|06/03/2016|GROWTH HORMONE|362|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265502|GENOTROPIN MINIQUICK 1.4 MG|7|EA|91.38421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|208.27099||205.29569||195.51971||155.62539|06/03/2016|GROWTH HORMONE|363|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265602|GENOTROPIN MINIQUICK 1.6 MG|7|EA|104.43779|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|238.021||234.6207||223.44828||177.85459|06/03/2016|GROWTH HORMONE|364|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265702|GENOTROPIN MINIQUICK 1.8 MG|7|EA|117.49627|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|267.7822||263.95674||251.38737||200.09359|06/03/2016|GROWTH HORMONE|365|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265802|GENOTROPIN MINIQUICK 2 MG|7|EA|130.54923|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/23/2013|014|Yes|297.53079||293.28035||279.31462||222.3228|06/03/2016|GROWTH HORMONE|366|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
rifabutin|No|No|No|No|75%|00013530117|MYCOBUTIN 150 MG CAPSULE|100|EA|11.67264|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|19.06531||18.79295||17.89805|||||367|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
latanoprost|No|No|No|No|75%|00013830304|XALATAN 0.005% EYE DROPS|2.5|ML|45.45788|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|088|No|101.71021||99.26916||99.98114||||OPHTHALMICS, GLAUCOMA AGENTS|368|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
mineral oil/petrolatum,white|No|No|No|No|75%|00023031204|REFRESH LACRI-LUBE OINTMENT   |3.5|GM|1.20031|09/01/2012||Yes|No||||No|No|09/01/2012||Yes|No||||No|No|||Over The Counter|No|||No|2.7868||2.71992||2.73942|||||369|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
carboxymethylcellulose sodium|No|No|No|No|75%|00023040350|REFRESH PLUS 0.5% EYE DROPS   |50|EA|.11885|09/01/1999||Yes|No||||No|No|09/01/1999||Yes|No||||No|No|||Over The Counter|No|||No|.27638||.26975||.27168|||||370|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
ketorolac tromethamine|No|No|No|No|75%|00023218105|ACULAR 0.5% EYE DROPS         |5|ML|23.68698|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|10/23/2010|013|No|53.0952||51.82092||52.19258||||OPHTHALMICS, ANTI-INFLAMMATORIES|371|||||No|No||ALLERGAN INC.|No|||||No|No|No||
carboxymethylcell/glycerin/PF|No|No|No|No|75%|00023311010|REFRESH TEARS PF 0.5-0.9% DROP|10|ML|.42957|09/04/2024||Yes|No||||No|No|||No|No||||No|No|||Over The Counter|No|||No|1.30752||1.27614||1.28529|||||372|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
bimatoprost|No|No|No|No|75%|00023320503|LUMIGAN 0.01% EYE DROPS|2.5|ML|43.23908|10/11/2010||Yes|No||10/11/2010||Yes|No|10/11/2010||Yes|No||||No|No|||Prescription Required|Yes|07/22/2009|088|No|96.44183||94.12723||94.80232||||OPHTHALMICS, GLAUCOMA AGENTS|373|||||No|No||ALLERGAN INC.|No|||||No|No|No||
bimatoprost|No|No|No|No|75%|00023320505|LUMIGAN 0.01% EYE DROPS|5|ML|43.22102|10/11/2010||Yes|No||10/11/2010||Yes|No|10/11/2010||Yes|No||||No|No|||Prescription Required|Yes|07/22/2009|088|No|96.38051||94.06738||94.74204||||OPHTHALMICS, GLAUCOMA AGENTS|374|||||No|No||ALLERGAN INC.|No|||||No|No|No||
bimatoprost|No|No|No|No|75%|00023320508|LUMIGAN 0.01% EYE DROPS|7.5|ML|43.21958|10/11/2010||Yes|No||10/11/2010||Yes|No|10/11/2010||Yes|No||||No|No|||Prescription Required|Yes|07/22/2009|088|No|96.53368||94.21687||94.89261||||OPHTHALMICS, GLAUCOMA AGENTS|375|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ketorolac tromethamine/PF|No|No|No|No|75%|00023350731|ACUVAIL 0.45% OPHTH SOLUTION|30|EA|4.79063|12/21/2021||Yes|No||12/21/2021||Yes|No|12/21/2021||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|013|Yes|10.71694||10.45973||10.53475||||OPHTHALMICS, ANTI-INFLAMMATORIES|376|||||No|No||ALLERGAN INC.|No|||||No|No|No||
carboxymethylcell/glycerin/PF|No|No|No|No|75%|00023378210|REFRESH RELIEVA PF XTRA DROP|10|ML|.58437|09/04/2024||Yes|No||||No|No|||No|No||||No|No|||Over The Counter|No|||No|1.30752||1.27614||1.28529|||||377|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
alcaftadine|No|No|No|No|75%|00023429105|LASTACAFT ONCE DAILY 0.25% DRP|5|ML|1.22292|08/01/2022||Yes|No||||No|No|08/01/2022||Yes|No||||No|No|||Over The Counter|Yes|01/26/2023|002|No|2.83891||2.77078||2.79065||||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|378|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
alcaftadine|No|No|No|No|75%|00023429110|LASTACAFT ONCE DAILY 0.25% DRP|5|ML|.93482|08/01/2022||Yes|No||||No|No|08/01/2022||Yes|No||||No|No|||Over The Counter|Yes|01/26/2023|002|No|2.13052||2.10008||2.00008||||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|379|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
carboxymethylcellulose sodium|No|No|No|No|75%|00023455430|REFRESH CELLUVISC 1% EYE GEL|30|EA|.15766|11/27/2002||Yes|No||||No|No|||No|No||||No|No|||Over The Counter|No|||No|.36653||.35773||.3603|||||380|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
cyclosporine|No|No|No|No|75%|00023530105|RESTASIS MULTIDOSE 0.05% EYE|5.5|ML|50.47653|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|086|No|112.5807||109.87876||110.66683||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|381|||||No|No||ALLERGAN INC.|No|||||No|No|No||
carboxymethyl/gly/poly80/PF|No|No|No|No|75%|00023577330|REFRESH OPTIVE MEGA-3 DROPS|30|EA|.19436|11/08/2017||Yes|No||||No|No|11/08/2017||Yes|No||||No|No|||Over The Counter|No|||No|.45139||.44056||.44372|||||382|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
mesalamine|No|No|No|No|75%|00023585318|DELZICOL DR 400 MG CAPSULE|180|EA|1.66819|11/09/2016||Yes|No||11/09/2016||Yes|No|11/09/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2016|010|No|3.7324||3.64282||3.66895||||ULCERATIVE COLITIS AGENTS|383|||||No|No||ALLERGAN INC.|No|||||No|No|No||
oxybutynin chloride|No|No|No|No|75%|00023586110|GELNIQUE 10% GEL SACHET|1|GM|5.6674|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|006|No|12.9164||12.73188||12.1256||||BLADDER RELAXANT PREPARATIONS|384|||||No|No||ALLERGAN INC.|No|||||No|No|No||
oxybutynin chloride|No|No|No|No|75%|00023586111|GELNIQUE 10% GEL SACHET|1|GM|5.66926|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|006|No|12.92064||12.73606||12.12958||||BLADDER RELAXANT PREPARATIONS|385|||||No|No||ALLERGAN INC.|No|||||No|No|No||
norethindrone-e.estradiol-iron|Yes|Yes|No|No|75%|00023586230|TAYTULLA 1 MG-20 MCG CAPSULE|28|EA|3.66418|02/17/2017||Yes|No||02/17/2017||Yes|No|02/17/2017||Yes|No|Refer to program requirements|||No|No|02/17/2017||Prescription Required|No|||No|8.17365||7.97748||8.0347|||||386|||||No|No||ALLERGAN INC.|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
testosterone|No|No|No|No|90%|00023599002|ANDRODERM 2 MG/24HR PATCH|1|EA|4.4161|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|No|01/26/2023|084|Yes|10.0646||9.92082||9.4484||||ANDROGENIC AGENTS|387|||||No|No||ALLERGAN INC.|No|||||No|No|No||
testosterone|No|No|No|No|90%|00023599060|ANDRODERM 2 MG/24HR PATCH|60|EA|4.41395|02/20/2019|09/30/2024|Yes|No||02/20/2019|09/30/2024|Yes|No|02/20/2019|09/30/2024|Yes|No||||No|No|||Prescription Required|No|01/26/2023|084|Yes|10.0597||9.91599||9.4438||||ANDROGENIC AGENTS|388|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALLERGAN INC.|No|||||No|No|No||
testosterone|No|No|No|No|90%|00023599204|ANDRODERM 4 MG/24HR PATCH|1|EA|8.8279|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|No|01/26/2023|084|Yes|20.1194||19.83198||18.8876||||ANDROGENIC AGENTS|389|||||No|No||ALLERGAN INC.|No|||||No|No|No||
testosterone|No|No|No|No|90%|00023599230|ANDRODERM 4 MG/24HR PATCH|30|EA|8.8279|02/20/2019|09/30/2024|Yes|No||02/20/2019|09/30/2024|Yes|No|02/20/2019|09/30/2024|Yes|No||||No|No|||Prescription Required|No|01/26/2023|084|Yes|20.1194||19.83198||18.8876||||ANDROGENIC AGENTS|390|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALLERGAN INC.|No|||||No|No|No||
iron dextran complex|No|No|No|No|75%|00023608210|INFED 100 MG/2 ML VIAL|2|ML|7.63422|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|No|||No|17.22385||16.81048||16.93104|||||391|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
podofilox|No|No|No|No|75%|00023611803|CONDYLOX 0.5% GEL|3.5|GM|77.81034|05/31/2018||Yes|No||05/31/2018||Yes|No|05/31/2018||Yes|No||||No|No|||Prescription Required|No|||No|172.41048||168.27263||169.4795|||||392|||||No|No||ALLERGAN INC.|No|||||No|No|No||
silodosin|No|No|No|No|75%|00023614730|RAPAFLO 4 MG CAPSULE|30|EA|3.74788|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|003|No|8.54168||8.41966||8.01872||||BPH TREATMENTS|393|||||No|No||ALLERGAN INC.|No|||||No|No|No||
progesterone, micronized|No|No|No|No|75%|00023615108|CRINONE 8% GEL|1.125|GM|11.4208|01/04/2019||Yes|No||01/04/2019||Yes|No|01/04/2019||Yes|No||||No|No|||Prescription Required|No|||No|25.47363||24.86226||25.04058|||||394|||||No|No||ALLERGAN INC.|No|||||No|No|No||
progesterone, micronized|No|No|No|No|75%|00023615109|CRINONE 8% GEL|1.125|GM|11.4208|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|No|||No|26.0288||25.65696||24.4352|||||395|||||No|No||ALLERGAN INC.|No|||||No|No|No||
oxybutynin|No|No|No|No|75%|00023615301|OXYTROL 3.9 MG/24HR PATCH|1|EA|36.5414|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|006|No|81.20917||79.26015||79.82861||||BLADDER RELAXANT PREPARATIONS|396|||||No|No||ALLERGAN INC.|No|||||No|No|No||
oxybutynin|No|No|No|No|75%|00023615308|OXYTROL 3.9 MG/24HR PATCH|8|EA|36.54194|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|006|No|81.20917||79.26015||79.82861||||BLADDER RELAXANT PREPARATIONS|397|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ubrogepant|No|No|No|No|75%|00023649810|UBRELVY 50 MG TABLET|10|EA|44.42717|05/19/2020||Yes|No||05/19/2020||Yes|No|05/19/2020||Yes|No||||No|No|||Prescription Required|No|07/27/2023|537|Yes|99.13814||96.75882||97.45279||||ANTIMIGRAINE AGENTS, OTHER|398|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ubrogepant|No|No|No|No|75%|00023650110|UBRELVY 100 MG TABLET|10|EA|44.42717|05/19/2020||Yes|No||05/19/2020||Yes|No|05/19/2020||Yes|No||||No|No|||Prescription Required|No|07/27/2023|537|Yes|99.13635||96.75708||97.45103||||ANTIMIGRAINE AGENTS, OTHER|399|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ubrogepant|No|No|No|No|75%|00023650116|UBRELVY 100 MG TABLET|16|EA|44.42679|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||||No|No|||Prescription Required|No|07/27/2023|537|Yes|99.13635||96.75708||97.45103||||ANTIMIGRAINE AGENTS, OTHER|400|||||No|No||ALLERGAN INC.|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00023916330|RESTASIS 0.05% EYE EMULSION|30|EA|4.6268|06/26/2008||Yes|No||06/26/2008||Yes|No|06/26/2008||Yes|No||||No|No|||Prescription Required|No|07/27/2017|086|No|10.32169||10.07397||10.14622||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|401|||||No|No||ALLERGAN INC.|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00023916360|RESTASIS 0.05% EYE EMULSION|60|EA|4.62702|11/19/2012||Yes|No||11/19/2012||Yes|No|11/19/2012||Yes|No||||No|No|||Prescription Required|No|07/27/2017|086|No|10.33476||10.08673||10.15907||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|402|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate|No|No|No|No|75%|00023917705|ALPHAGAN P 0.15% EYE DROPS|5|ML|17.82694|12/06/2002||Yes|No||12/06/2002||Yes|No|12/06/2002||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|088|No|39.8457||38.8894||39.16832||||OPHTHALMICS, GLAUCOMA AGENTS|403|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate|No|No|No|No|75%|00023917710|ALPHAGAN P 0.15% EYE DROPS|10|ML|17.82264|12/06/2002||Yes|No||12/06/2002||Yes|No|12/06/2002||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|088|No|39.83774||38.88163||39.1605||||OPHTHALMICS, GLAUCOMA AGENTS|404|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate|No|No|No|No|75%|00023917715|ALPHAGAN P 0.15% EYE DROPS|15|ML|17.82436|04/27/2004||Yes|No||04/27/2004||Yes|No|04/27/2004||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|088|No|39.98449||39.02486||39.30475||||OPHTHALMICS, GLAUCOMA AGENTS|405|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate/timolol|No|No|No|No|75%|00023921105|COMBIGAN 0.2%-0.5% EYE DROPS|5|ML|17.55518|02/04/2008||Yes|No||02/04/2008||Yes|No|02/04/2008||Yes|No||||No|No|||Prescription Required|No|07/22/2008|088|No|39.17658||38.23634||38.51058||||OPHTHALMICS, GLAUCOMA AGENTS|406|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate/timolol|No|No|No|No|75%|00023921110|COMBIGAN 0.2%-0.5% EYE DROPS|10|ML|17.55561|02/04/2008||Yes|No||02/04/2008||Yes|No|02/04/2008||Yes|No||||No|No|||Prescription Required|No|07/22/2008|088|No|39.17763||38.23737||38.51161||||OPHTHALMICS, GLAUCOMA AGENTS|407|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate/timolol|No|No|No|No|75%|00023921115|COMBIGAN 0.2%-0.5% EYE DROPS|15|ML|17.55432|08/15/2016||Yes|No||08/15/2016||Yes|No|08/15/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2016|088|No|39.22257||38.28123||38.55579||||OPHTHALMICS, GLAUCOMA AGENTS|408|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ketorolac tromethamine|No|No|No|No|75%|00023927705|ACULAR LS 0.4% OPHTH SOL      |5|ML|24.3509|09/04/2003||Yes|No||09/04/2003||Yes|No|09/04/2003||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|013|No|55.4974||54.70458||52.0996||||OPHTHALMICS, ANTI-INFLAMMATORIES|409|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate|No|No|No|No|75%|00023932105|ALPHAGAN P 0.1% DROPS|5|ML|16.72184|09/19/2007||Yes|No||09/19/2007||Yes|No|09/19/2007||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|088|No|37.34019||36.44403||36.70541||||OPHTHALMICS, GLAUCOMA AGENTS|410|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate|No|No|No|No|75%|00023932110|ALPHAGAN P 0.1% DROPS|10|ML|16.7141|09/19/2007||Yes|No||09/19/2007||Yes|No|09/19/2007||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|088|No|37.31455||36.419||36.6802||||OPHTHALMICS, GLAUCOMA AGENTS|411|||||No|No||ALLERGAN INC.|No|||||No|No|No||
brimonidine tartrate|No|No|No|No|75%|00023932115|ALPHAGAN P 0.1% DROPS|15|ML|16.71668|09/19/2007||Yes|No||09/19/2007||Yes|No|09/19/2007||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|088|No|37.33658||36.4405||36.70186||||OPHTHALMICS, GLAUCOMA AGENTS|412|||||No|No||ALLERGAN INC.|No|||||No|No|No||
clopidogrel bisulfate|No|No|No|No|75%|00024117190|PLAVIX 75 MG TABLET|90|EA|3.53412|12/29/2020||Yes|No||12/29/2020||Yes|No|12/29/2020||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|004|Yes|7.87564||7.68662||7.74175||||PLATELET AGGREGATION INHIBITORS|413|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dronedarone HCl|No|No|No|No|75%|00024414260|MULTAQ 400 MG TABLET|60|EA|5.71907|07/22/2009||Yes|No||07/22/2009||Yes|No|07/22/2009||Yes|No||||No|No|||Prescription Required|No|||No|12.76062||12.45437||12.54369|||||414|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024540131|AMBIEN 5 MG TABLET|100|EA|9.23907|05/18/2007||Yes|No||05/18/2007||Yes|No|05/18/2007||Yes|No||||No|No|||Prescription Required|Yes|07/18/2006|054|Yes|20.65084||20.15522||20.29978||||SEDATIVE HYPNOTICS|415|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024542131|AMBIEN 10 MG TABLET|100|EA|9.23907|05/18/2007||Yes|No||05/18/2007||Yes|No|05/18/2007||Yes|No||||No|No|||Prescription Required|Yes|07/18/2006|054|Yes|20.57754||20.08368||20.22772||||SEDATIVE HYPNOTICS|416|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024550131|AMBIEN CR 6.25 MG TABLET|100|EA|9.23907|07/01/2009||Yes|No||07/01/2009||Yes|No|07/01/2009||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|054|Yes|20.67524||20.17903||20.32376||||SEDATIVE HYPNOTICS|417|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024552131|AMBIEN CR 12.5 MG TABLET|100|EA|9.23907|07/01/2009||Yes|No||07/01/2009||Yes|No|07/01/2009||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|054|Yes|20.64573||20.15023||20.29475||||SEDATIVE HYPNOTICS|418|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glargine/lixisenatide|No|No|No|No|75%|00024576105|SOLIQUA 100 UNIT-33 MCG/ML PEN|3|ML|25.53827|08/04/2017||Yes|No||08/04/2017||Yes|No|08/04/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|111|Yes|57.10871||55.7381||56.13786||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|419|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
tamsulosin HCl|No|No|No|No|75%|00024583701|FLOMAX 0.4 MG CAPSULE|100|EA|4.18235|09/26/2019||Yes|No||09/26/2019||Yes|No|09/26/2019||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|003|No|9.34522||9.12093||9.18635||||BPH TREATMENTS|420|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
irbesartan|No|No|No|No|75%|00024585090|AVAPRO 75 MG TABLET|90|EA|3.12767|12/09/2013||Yes|No||12/09/2013||Yes|No|12/09/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|113|Yes|7.12819||7.02636||6.69177||||ANGIOTENSIN MODULATORS|421|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
irbesartan|No|No|No|No|75%|00024585130|AVAPRO 150 MG TABLET|30|EA|3.2915|12/09/2013||Yes|No||12/09/2013||Yes|No|12/09/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|113|Yes|7.351||7.17458||7.22603||||ANGIOTENSIN MODULATORS|422|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
irbesartan|No|No|No|No|75%|00024585230|AVAPRO 300 MG TABLET|30|EA|3.95743|12/09/2013||Yes|No||12/09/2013||Yes|No|12/09/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|113|Yes|8.82928||8.61738||8.67918||||ANGIOTENSIN MODULATORS|423|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
irbesartan/hydrochlorothiazide|No|No|No|No|75%|00024585530|AVALIDE 150-12.5 MG TABLET|30|EA|3.98223|12/09/2013||Yes|No||12/09/2013||Yes|No|12/09/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|113|Yes|9.07578||8.94613||8.52012||||ANGIOTENSIN MODULATORS|424|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
irbesartan/hydrochlorothiazide|No|No|No|No|75%|00024585630|AVALIDE 300-12.5 MG TABLET|30|EA|4.33755|12/09/2013||Yes|No||12/09/2013||Yes|No|12/09/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|113|Yes|9.71247||9.47937||9.54736||||ANGIOTENSIN MODULATORS|425|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glargine,hum.rec.anlog|Yes|No|No|No|75%|00024586903|TOUJEO SOLOSTAR 300 UNIT/ML|1.5|ML|40.95224|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||05/12/2015||Yes|No|04/08/2020||Prescription Required|Yes|09/18/2020|029|No|91.43118||89.23683||89.87685||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|426|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glargine,hum.rec.anlog|Yes|No|No|No|75%|00024587102|TOUJEO MAX SOLOSTR 300 UNIT/ML|3|ML|40.95248|08/16/2018||Yes|No||08/16/2018||Yes|No|08/16/2018||Yes|No||08/16/2018||Yes|No|07/22/2019||Prescription Required|Yes|09/18/2020|029|No|91.407||89.21323||89.85308||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|427|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
sarilumab|No|No|No|No|75%|00024590801|KEVZARA 150 MG/1.14 ML SYRINGE|1.14|ML|819.09719|01/05/2018||Yes|No||01/05/2018||Yes|No|01/05/2018||Yes|No||||No|No|||Prescription Required|Yes|05/24/2017|071|Yes|1866.77965||1840.11137||1752.48701||||CYTOKINE AND CAM ANTAGONISTS|428|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
sarilumab|No|No|No|No|75%|00024591001|KEVZARA 200 MG/1.14 ML SYRINGE|1.14|ML|819.09719|01/05/2018||Yes|No||01/05/2018||Yes|No|01/05/2018||Yes|No||||No|No|||Prescription Required|Yes|05/24/2017|071|Yes|1866.77965||1840.11137||1752.48701||||CYTOKINE AND CAM ANTAGONISTS|429|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591102|DUPIXENT 100 MG/0.67 ML SYRING|0.67|ML|1151.34746|04/20/2022|10/23/2024|Yes|No||04/20/2022|10/23/2024|Yes|No|04/20/2022|10/23/2024|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|034|Yes|2624.00119||2586.51545||2463.34805||||IMMUNOMODULATORS, ATOPIC DERMATITIS|430|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591401|DUPIXENT 300 MG/2 ML SYRINGE|2|ML|408.844|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription Required|Yes|02/01/2018|034|Yes|916.59366||894.59541||901.01157||||IMMUNOMODULATORS, ATOPIC DERMATITIS|431|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591502|DUPIXENT 300 MG/2 ML PEN|2|ML|408.844|03/01/2021||Yes|No||03/01/2021||Yes|No|03/01/2021||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|034|Yes|916.54422||894.54716||900.96297||||IMMUNOMODULATORS, ATOPIC DERMATITIS|432|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591801|DUPIXENT 200 MG/1.14 ML SYRING|1.14|ML|717.27017|12/28/2018||Yes|No||12/28/2018||Yes|No|12/28/2018||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|034|Yes|1615.62649||1576.85145||1588.16084||||IMMUNOMODULATORS, ATOPIC DERMATITIS|433|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591900|DUPIXENT 200 MG/1.14 ML PEN|1.14|ML||11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|034|Yes|1514.26758||1514.26758||1514.26758||1514.26758|11/03/2022|IMMUNOMODULATORS, ATOPIC DERMATITIS|434|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591902|DUPIXENT 200 MG/1.14 ML PEN|1.14|ML|717.27017|02/23/2022||Yes|No||02/23/2022||Yes|No|02/23/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|034|Yes|1609.01173||1570.39545||1581.65853||||IMMUNOMODULATORS, ATOPIC DERMATITIS|435|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
sarilumab|No|No|No|No|75%|00024592001|KEVZARA 150 MG/1.14 ML PEN INJ|1.14|ML|819.09719|11/01/2018||Yes|No||11/01/2018||Yes|No|11/01/2018||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|071|Yes|1866.77965||1840.11137||1752.48701||||CYTOKINE AND CAM ANTAGONISTS|436|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
sarilumab|No|No|No|No|75%|00024592201|KEVZARA 200 MG/1.14 ML PEN INJ|1.14|ML|819.09719|11/01/2018||Yes|No||11/01/2018||Yes|No|11/01/2018||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|071|Yes|1852.54506||1808.08398||1821.05179||||CYTOKINE AND CAM ANTAGONISTS|437|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00024592410|ADMELOG 100 UNIT/ML VIAL|10|ML|4.21701|05/25/2018||Yes|No||05/25/2018||Yes|No|05/25/2018||Yes|No||05/25/2018||Yes|No|05/25/2018||Prescription Required|Yes|09/18/2020|029|No|9.4212||9.19509||9.26104||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|438|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00024592505|ADMELOG SOLOSTAR 100 UNIT/ML|3|ML|5.42803|05/25/2018||Yes|No||05/25/2018||Yes|No|05/25/2018||Yes|No||05/25/2018||Yes|No|04/08/2020||Prescription Required|Yes|09/18/2020|029|No|12.13366||11.84245||11.92739||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|439|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00024592605|ADMELOG 100 UNIT/ML VIAL|3|ML|5.62296|06/03/2019||Yes|No||06/03/2019||Yes|No|06/03/2019||Yes|No||06/03/2019||Yes|No|09/27/2019||Prescription Required|Yes|09/18/2020|029|No|12.53985||12.23889||12.32667||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|440|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
diphenoxylate HCl/atropine|No|No|No|No|75%|00025006131|LOMOTIL 2.5-0.025 MG TABLET|100|EA|1.29606|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|2.89494||2.82546||2.84573|||||441|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nafarelin acetate|No|No|No|No|75%|00025016608|SYNAREL 2 MG/ML NASAL SPRAY|8|ML|162.55774|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|370.48043||365.18785||347.79795|||||442|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00025100131|ALDACTONE 25 MG TABLET|100|EA|1.16474|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|2.65453||2.6166||2.492|||||443|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00025103131|ALDACTONE 100 MG TABLET|100|EA|3.42904|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|7.81501||7.70337||7.33654|||||444|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00025104131|ALDACTONE 50 MG TABLET|100|EA|2.04538|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|4.66157||4.59497||4.37616|||||445|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
oxaprozin|No|No|No|No|75%|00025138131|DAYPRO 600 MG CAPLET|100|EA|3.55945|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|059|Yes|8.11224||7.99635||7.61558||||NSAIDS|446|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
diclofenac sodium/misoprostol|No|No|No|No|75%|00025141160|ARTHROTEC 50 MG-200 MCG TAB|60|EA|3.76243|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|8.57483||8.45234||8.04984||||NSAIDS|447|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
diclofenac sodium/misoprostol|No|No|No|No|75%|00025141190|ARTHROTEC 50 MG-200 MCG TAB|90|EA|3.76221|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|8.57434||8.45185||8.04938||||NSAIDS|448|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
diclofenac sodium/misoprostol|No|No|No|No|75%|00025142160|ARTHROTEC 75 MG-200 MCG TAB|60|EA|3.76243|11/30/2009||Yes|No||11/30/2009||Yes|No|11/30/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|8.3941||8.19264||8.2514||||NSAIDS|449|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
misoprostol|No|No|No|No|75%|00025145160|CYTOTEC 100 MCG TABLET|60|EA|1.71785|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|3.9151||3.85917||3.6754|||||450|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
misoprostol|No|No|No|No|75%|00025146131|CYTOTEC 200 MCG TABLET|100|EA|2.50251|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|5.7034||5.62193||5.35422|||||451|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
misoprostol|No|No|No|No|75%|00025146160|CYTOTEC 200 MCG TABLET|60|EA|2.50267|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|5.70376||5.62227||5.35455|||||452|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025151501|CELEBREX 50 MG CAPSULE|60|EA|2.01133|09/19/2007||Yes|No||09/19/2007||Yes|No|09/19/2007||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|4.58395||4.51847||4.3033||||NSAIDS|453|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152031|CELEBREX 100 MG CAPSULE|100|EA|4.30391|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|9.56806||9.33843||9.4054||||NSAIDS|454|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152034|CELEBREX 100 MG CAPSULE|100|EA|4.30391|02/05/2010||Yes|No||02/05/2010||Yes|No|02/05/2010||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|9.56806||9.33843||9.4054||||NSAIDS|455|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152051|CELEBREX 100 MG CAPSULE|500|EA|4.30402|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|9.56806||9.33843||9.4054||||NSAIDS|456|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152531|CELEBREX 200 MG CAPSULE|100|EA|7.05961|03/01/2002|01/10/2025|Yes|No||03/01/2002|01/10/2025|Yes|No|03/01/2002|01/10/2025|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|15.73312||15.35553||15.46566||||NSAIDS|457|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152534|CELEBREX 200 MG CAPSULE|100|EA|7.05961|02/05/2010||Yes|No||02/05/2010||Yes|No|02/05/2010||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|No|15.73312||15.35553||15.46566||||NSAIDS|458|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152551|CELEBREX 200 MG CAPSULE|500|EA|7.05958|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|No|15.73312||15.35553||15.46566||||NSAIDS|459|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025153002|CELEBREX 400 MG CAPSULE|60|EA|10.58983|12/09/2002||Yes|No||12/09/2002||Yes|No|12/09/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|059|Yes|24.13495||23.79017||22.6573||||NSAIDS|460|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00025171001|INSPRA 25 MG TABLET|30|EA|6.35783|02/25/2005||Yes|No||02/25/2005||Yes|No|02/25/2005||Yes|No||||No|No|||Prescription Required|No|||No|14.1972||13.85647||13.95585|||||461|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00025172003|INSPRA 50 MG TABLET|30|EA|6.35783|02/25/2005||Yes|No||02/25/2005||Yes|No|02/25/2005||Yes|No||||No|No|||Prescription Required|No|||No|14.48995||14.28295||13.60281|||||462|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00025194250|FLAGYL 375 CAPSULE|50|EA|2.64527|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|115|No|6.02876||5.94264||5.65966||||ANTIBIOTICS, GI|463|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025273231|NORPACE CR 100 MG CAPSULE|100|EA|1.83851|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|4.19009||4.13023||3.93355|||||464|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025274231|NORPACE CR 150 MG CAPSULE|100|EA|2.17279|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|4.85762||4.74104||4.77504|||||465|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025275231|NORPACE 100 MG CAPSULE|100|EA|2.02977|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|4.62599||4.55991||4.34277|||||466|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025276231|NORPACE 150 MG CAPSULE|100|EA|2.39833|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|5.46595||5.38787||5.1313|||||467|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
antihemophil.FVIII,full length|No|No|No|No|75%|00026378225|KOGENATE FS 250 UNIT VIAL|1|EA|1.3736|11/08/2013||Yes|No||11/08/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|1.9796||1.95132||1.8584||||HEMOPHILIA TREATMENT|468|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|06/17/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026378335|KOGENATE FS 500 UNIT VIAL|1|EA|1.3736|11/08/2013||Yes|No||11/08/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|1.9796||1.95132||1.8584||||HEMOPHILIA TREATMENT|469|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|06/17/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026378555|KOGENATE FS 1,000 UNIT VIAL|1|EA|1.3736|11/08/2013||Yes|No||11/08/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|1.9796||1.95132||1.8584||||HEMOPHILIA TREATMENT|470|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|06/17/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026378665|KOGENATE FS 2,000 UNIT VIAL|1|EA|1.3736|11/08/2013||Yes|No||11/08/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|1.9796||1.95132||1.8584||||HEMOPHILIA TREATMENT|471|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|06/17/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026378775|KOGENATE FS 3,000 UNIT VIAL|1|EA|1.3736|11/08/2013||Yes|No||11/08/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|1.9796||1.95132||1.8584||||HEMOPHILIA TREATMENT|472|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|06/17/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026382125|KOVALTRY 250 UNIT KIT|1|EA|1.496|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.156||2.1252||2.024||||HEMOPHILIA TREATMENT|473|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|03/22/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026382225|KOVALTRY 500 UNIT KIT|1|EA|1.496|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.156||2.1252||2.024||||HEMOPHILIA TREATMENT|474|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|03/22/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026382425|KOVALTRY 1,000 UNIT KIT|1|EA|1.496|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.156||2.1252||2.024||||HEMOPHILIA TREATMENT|475|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|06/17/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026382650|KOVALTRY 2,000 UNIT KIT|1|EA|1.496|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.156||2.1252||2.024||||HEMOPHILIA TREATMENT|476|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|03/22/2019|
antihemophil.FVIII,full length|No|No|No|No|75%|00026382850|KOVALTRY 3,000 UNIT KIT|1|EA|1.496|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.156||2.1252||2.024||||HEMOPHILIA TREATMENT|477|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|03/22/2019|
FVIII rec,B-dom delet peg-aucl|No|No|No|No|75%|00026394225|JIVI 500 UNIT VIAL|1|EA|1.8768|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.7048||2.66616||2.5392||||HEMOPHILIA TREATMENT|478|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom delet peg-aucl|No|No|No|No|75%|00026394425|JIVI 1,000 UNIT VIAL|1|EA|1.8768|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.7048||2.66616||2.5392||||HEMOPHILIA TREATMENT|479|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom delet peg-aucl|No|No|No|No|75%|00026394625|JIVI 2,000 UNIT VIAL|1|EA|1.8768|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.7048||2.66616||2.5392||||HEMOPHILIA TREATMENT|480|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom delet peg-aucl|No|No|No|No|75%|00026394825|JIVI 3,000 UNIT VIAL|1|EA|1.8768|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.7048||2.66616||2.5392||||HEMOPHILIA TREATMENT|481|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|07/30/2021|
lipase/protease/amylase|No|No|No|No|75%|00032004670|CREON DR 6,000 UNIT CAPSULE|100|EA|1.59783|08/19/2024||Yes|No||08/19/2024||Yes|No|08/19/2024||Yes|No||||No|No|||Prescription Required|No|06/13/2024|108|No|1.99601||1.94811||1.96208||||PANCREATIC ENZYMES|482|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032004770|CREON DR 12,000 UNIT CAPSULE|100|EA|3.19396|08/19/2024||Yes|No||08/19/2024||Yes|No|08/19/2024||Yes|No||||No|No|||Prescription Required|No|06/13/2024|108|No|3.97825||3.88277||3.91062||||PANCREATIC ENZYMES|483|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032120370|CREON DR 3,000 UNIT CAPSULE|70|EA|.75465|08/16/2011||Yes|No||08/16/2011||Yes|No|08/16/2011||Yes|No||||No|No|||Prescription Required|No|07/27/2011|108|No|1.68165||1.64129||1.65306||.|05/27/2024|PANCREATIC ENZYMES|484|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032120601|CREON DR 6,000 UNIT CAPSULE|100|EA|.89345|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription Required|No|07/22/2009|108|No|1.99601||1.94811||1.96208||.|05/27/2024|PANCREATIC ENZYMES|485|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032121201|CREON DR 12,000 UNIT CAPSULE|100|EA|1.78596|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription Required|No|07/22/2009|108|No|3.97825||3.88277||3.91062||.|05/27/2024|PANCREATIC ENZYMES|486|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032121207|CREON DR 12,000 UNIT CAPSULE|250|EA|1.78591|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription Required|No|07/22/2009|108|No|4.07021||4.01207||3.82102||||PANCREATIC ENZYMES|487|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032122401|CREON DR 24,000 UNIT CAPSULE|100|EA|3.54006|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription Required|No|07/22/2009|108|No|7.89696||7.70743||7.76271||.|05/27/2024|PANCREATIC ENZYMES|488|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032122407|CREON DR 24,000 UNIT CAPSULE|250|EA|3.48303|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription Required|No|07/22/2009|108|No|7.89696||7.70743||7.76271||||PANCREATIC ENZYMES|489|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|Yes|No|No|No|75%|00032263601|CREON DR 24,000 UNIT CAPSULE|100|EA|3.54006|06/12/2024||Yes|No||06/12/2024||Yes|No|06/12/2024||Yes|No||07/18/2024||Yes|No|06/12/2024||Prescription Required|No|07/28/2022|108|No|7.89696||7.70743||7.76271||||PANCREATIC ENZYMES|490|||||No|No||ABBVIE US LLC|Yes|06/12/2024||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032301613|CREON DR 36,000 UNIT CAPSULE|100|EA|5.37517|07/30/2013||Yes|No||07/30/2013||Yes|No|07/30/2013||Yes|No||07/30/2013||Yes|No|||Prescription Required|No|01/23/2013|108|No|11.99702||11.70909||11.79307||.|05/27/2024|PANCREATIC ENZYMES|491|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032301628|CREON DR 36,000 UNIT CAPSULE|250|EA|5.3745|07/30/2013||Yes|No||07/30/2013||Yes|No|07/30/2013||Yes|No||07/30/2013||Yes|No|||Prescription Required|No|01/23/2013|108|No|12.24886||12.07388||11.49893||.|05/27/2024|PANCREATIC ENZYMES|492|||||No|No||ABBVIE US LLC|No|||||No|No|No||
azelastine/fluticasone|No|No|No|No|75%|00037024523|DYMISTA NASAL SPRAY|23|GM|3.91879|09/28/2012||Yes|No||09/28/2012||Yes|No|09/28/2012||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|019|No|8.72578||8.51636||8.57744||||INTRANASAL RHINITIS AGENTS|493|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
felbamate|No|No|No|No|75%|00037043001|FELBATOL 400 MG TABLET|100|EA|6.32074|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|14.02719||13.69054||13.78873||||ANTICONVULSANTS|494|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
felbamate|No|No|No|No|75%|00037043101|FELBATOL 600 MG TABLET|100|EA|7.24395|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|16.07376||15.68799||15.80051||||ANTICONVULSANTS|495|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
felbamate|No|No|No|No|75%|00037044217|FELBATOL 600 MG/5 ML SUSP|946|ML|3.16636|04/18/2008|11/01/2024|Yes|No||04/18/2008|11/01/2024|Yes|No|04/18/2008|11/01/2024|Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|7.21636||7.11327||6.77454||||ANTICONVULSANTS|496|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
felbamate|No|No|No|No|75%|00037044267|FELBATOL 600 MG/5 ML SUSP|237|ML|3.27778|03/01/2002|11/01/2024|Yes|No||03/01/2002|11/01/2024|Yes|No|03/01/2002|11/01/2024|Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|7.47029||7.36357||7.01292||||ANTICONVULSANTS|497|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
carisoprodol|No|No|No|No|90%|00037200101|SOMA 350 MG TABLET|100|EA|4.6056|09/24/2009||Yes|No||09/24/2009||Yes|No|09/24/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|116|No|10.36922||10.12036||10.19294||||SKELETAL MUSCLE RELAXANTS|498|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
carisoprodol|No|No|No|No|90%|00037225010|SOMA 250 MG TABLET|100|EA|3.15783|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|116|Yes|7.19692||7.09411||6.7563||||SKELETAL MUSCLE RELAXANTS|499|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
penicillamine|No|No|No|No|75%|00037440101|DEPEN 250 MG TITRATAB|100|EA|32.52047|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|74.11642||73.05761||69.57868|||||500|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
hydrocortisone/pramoxine|No|No|No|No|75%|00037682210|PROCTOFOAM-HC 1%-1% FOAM|10|GM|7.96016|04/08/2015||Yes|No||04/08/2015||Yes|No|04/08/2015||Yes|No||||No|No|||Prescription Required|No|||No|17.54741||17.12627||17.2491|||||501|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
hydrocortisone acetate|No|No|No|No|75%|00037683015|CORTIFOAM 10% AEROSOL|15|GM|12.5732|02/18/2016||Yes|No||02/18/2016||Yes|No|02/18/2016||Yes|No||||No|No|||Prescription Required|No|||No|28.07565||27.40183||27.59836|||||502|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
olsalazine sodium|No|No|No|No|75%|00037686010|DIPENTUM 250 MG CAPSULE|100|EA|6.41964|02/18/2016||Yes|No||02/18/2016||Yes|No|02/18/2016||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|010|No|14.23696||13.89527||13.99493||||ULCERATIVE COLITIS AGENTS|503|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046074905|PREMARIN 25 MG VIAL|1|EA|158.2615|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|360.689||355.5363||338.606|||||504|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046087221|PREMARIN VAGINAL CREAM-APPL|30|GM|6.45071|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription Required|No|||Yes|14.39682||14.0513||14.15207|||||505|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110081|PREMARIN 0.3 MG TABLET|100|EA|2.96941|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|6.61642||6.45763||6.50394|||||506|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110091|PREMARIN 0.3 MG TABLET|1000|EA|2.96932|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|6.61642||6.45763||6.50394|||||507|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110181|PREMARIN 0.45 MG TABLET|100|EA|2.96941|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|6.62434||6.46536||6.51173|||||508|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110281|PREMARIN 0.625 MG TABLET|100|EA|2.96941|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|6.61813||6.45929||6.50562|||||509|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110291|PREMARIN 0.625 MG TABLET|1000|EA|2.96932|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|6.61813||6.45929||6.50562|||||510|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110381|PREMARIN 0.9 MG TABLET|100|EA|2.96941|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|6.62379||6.46482||6.51119|||||511|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110481|PREMARIN 1.25 MG TABLET|100|EA|2.96941|05/31/2005||Yes|No||05/31/2005||Yes|No|05/31/2005||Yes|No||||No|No|||Prescription Required|No|||Yes|6.61502||6.45626||6.50256|||||512|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110491|PREMARIN 1.25 MG TABLET|1000|EA|2.96932|09/16/2004||Yes|No||09/16/2004||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|6.61502||6.45626||6.50256|||||513|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogen,con/m-progest acet|No|No|No|No|75%|00046110511|PREMPRO 0.3 MG-1.5 MG TABLET|28|EA|3.71351|11/13/2009||Yes|No||11/13/2009||Yes|No|11/13/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|8.28644||8.08757||8.14557|||||514|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogen,con/m-progest acet|No|No|No|No|75%|00046110611|PREMPRO 0.45-1.5 MG TABLET|28|EA|3.71351|03/18/2010||Yes|No||03/18/2010||Yes|No|03/18/2010||Yes|No||||No|No|||Prescription Required|No|||Yes|8.28746||8.08856||8.14657|||||515|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogen,con/m-progest acet|No|No|No|No|75%|00046110711|PREMPRO 0.625-2.5 MG TABLET|28|EA|3.71351|08/29/2011||Yes|No||08/29/2011||Yes|No|08/29/2011||Yes|No||||No|No|||Prescription Required|No|||Yes|8.28408||8.08526||8.14325|||||516|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogen,con/m-progest acet|No|No|No|No|75%|00046110811|PREMPRO 0.625-5 MG TABLET|28|EA|3.71351|01/27/2014||Yes|No||01/27/2014||Yes|No|01/27/2014||Yes|No||||No|No|||Prescription Required|No|||Yes|8.27337||8.07481||8.13272|||||517|||||No|No||WYETH/PFIZER|No|||||No|No|No||
ampicillin sod/sulbactam sod|No|No|No|No|75%|00049001383|UNASYN 1.5 GM VIAL|1|EA|3.31616|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|7.55776||7.44979||7.09504|||||518|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ampicillin sod/sulbactam sod|No|No|No|No|75%|00049001483|UNASYN 3 GM VIAL|1|EA|6.26166|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|14.27076||14.06689||13.39704|||||519|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ziprasidone HCl|No|No|No|No|75%|00049005460|GEODON 40 MG CAPSULE|60|EA|10.7262|06/17/2019||Yes|No||06/17/2019||Yes|No|06/17/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|027|Yes|24.44577||24.09654||22.94909||||ANTIPSYCHOTICS|520|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
glipizide|No|No|No|No|75%|00049017001|GLUCOTROL XL 2.5 MG TABLET|30|EA|.1677|10/11/2013||Yes|No||10/11/2013||Yes|No|10/11/2013||Yes|No||10/11/2013||Yes|No|||Prescription Required|No|||No|.3822||.37674||.3588|||||521|||||No|No||PFIZER US PHARM|No|||||No|No|No||
glipizide|No|No|No|No|75%|00049017807|GLUCOTROL XL 10 MG TABLET|100|EA|.3053|10/11/2013||Yes|No||10/11/2013||Yes|No|10/11/2013||Yes|No||10/11/2013||Yes|No|||Prescription Required|No|||No|.67892||.66263||.66738|||||522|||||No|No||PFIZER US PHARM|No|||||No|No|No||
glipizide|No|No|No|No|75%|00049017808|GLUCOTROL XL 10 MG TABLET|500|EA|.3053|10/11/2013||Yes|No||10/11/2013||Yes|No|10/11/2013||Yes|No||10/11/2013||Yes|No|||Prescription Required|No|||No|.67892||.66263||.66738|||||523|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ziprasidone HCl|No|No|No|No|75%|00049035460|GEODON 40 MG CAPSULE|60|EA|10.7262|10/20/2024||Yes|No||10/20/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|01/26/2023|027|Yes|24.44577||24.09654||22.94909||||ANTIPSYCHOTICS|524|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
penicillin G potassium|No|No|No|No|75%|00049052022|PFIZERPEN 5 MILLION UNIT VIAL|1|EA|5.47003|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription Required|No|||No|12.46658||12.28849||11.70332|||||525|||||No|No||PFIZER-NOVAPLUS|No|||||No|No|No||
penicillin G potassium|No|No|No|No|75%|00049052083|PFIZERPEN 5 MILLION UNIT VIAL|1|EA|5.47003|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|12.46658||12.28849||11.70332|||||526|||||No|No||PFIZER US PHARM|No|||||No|No|No||
penicillin G potassium|No|No|No|No|75%|00049053022|PFIZERPEN 20 MILLION UNIT VIAL|1|EA|21.8784|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription Required|No|||No|49.8624||49.15008||46.8096|||||527|||||No|No||PFIZER-NOVAPLUS|No|||||No|No|No||
penicillin G potassium|No|No|No|No|75%|00049053028|PFIZERPEN 20 MILLION UNIT VIAL|1|EA|21.8784|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|49.8624||49.15008||46.8096|||||528|||||No|No||PFIZER US PHARM|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00049233045|RELPAX 20 MG TABLET|6|EA|34.73038|02/08/2010||Yes|No||02/08/2010||Yes|No|02/08/2010||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|021|Yes|77.6113||75.74863||76.29191||||ANTIMIGRAINE AGENTS, TRIPTANS|529|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00049234005|RELPAX 40 MG TABLET|12|EA|34.73003|07/15/2007||Yes|No||07/15/2007||Yes|No|07/15/2007||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|021|Yes|76.75012||74.90812||75.44537||||ANTIMIGRAINE AGENTS, TRIPTANS|530|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00049234045|RELPAX 40 MG TABLET|6|EA|34.73038|02/08/2010||Yes|No||02/08/2010||Yes|No|02/08/2010||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|021|Yes|76.75012||74.90812||75.44537||||ANTIMIGRAINE AGENTS, TRIPTANS|531|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00049316044|VFEND 40 MG/ML SUSPENSION|75|ML|2.93896|05/10/2005||Yes|No||05/10/2005||Yes|No|05/10/2005||Yes|No||09/01/2021||Yes|No|||Prescription Required|No|01/26/2023|069|No|6.6981||6.60242||6.28802||||ANTIFUNGALS, ORAL|532|||||No|No||PFIZER US PHARM|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00049317030|VFEND 50 MG TABLET|30|EA|.64012|08/16/2002||Yes|No||08/16/2002||Yes|No|08/16/2002||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|03/29/2004|069|No|1.45889||1.43805||1.36957||||ANTIFUNGALS, ORAL|533|||||No|No||PFIZER US PHARM|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00049318030|VFEND 200 MG TABLET|30|EA|1.60117|10/09/2003||Yes|No||10/09/2003||Yes|No|10/09/2003||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|03/29/2004|069|No|3.64919||3.59706||3.42577||||ANTIFUNGALS, ORAL|534|||||No|No||PFIZER US PHARM|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00049319028|VFEND IV 200 MG VIAL          |1|EA|25.929|08/16/2002||Yes|No||08/16/2002||Yes|No|08/16/2002||Yes|No||||No|No|||Prescription Required|No|||No|59.094||58.2498||55.476|||||535|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fluconazole|No|No|No|No|75%|00049342030|DIFLUCAN 100 MG TABLET|30|EA|.4879|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|07/12/2005|069|No|1.09274||1.06651||1.07416||||ANTIFUNGALS, ORAL|536|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fluconazole|No|No|No|No|75%|00049343030|DIFLUCAN 200 MG TABLET|30|EA|26.9147|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|07/12/2005|069|No|61.34048||60.46419||57.58494||||ANTIFUNGALS, ORAL|537|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fluconazole|No|No|No|No|75%|00049345019|DIFLUCAN 40 MG/ML SUSPENSION|35|ML|.34535|08/22/2009||Yes|No||08/22/2009||Yes|No|08/22/2009||Yes|No||||No|No|||Prescription Required|Yes|07/12/2005|069|No|.78708||.77583||.73889||||ANTIFUNGALS, ORAL|538|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ziprasidone mesylate|No|No|No|No|75%|00049392083|GEODON 20 MG/ML VIAL|1|EA|27.70447|11/04/2010||Yes|No||11/04/2010||Yes|No|11/04/2010||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|027|Yes|63.14042||62.23841||59.27468||||ANTIPSYCHOTICS|539|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049490030|ZOLOFT 50 MG TABLET|30|EA|6.2188|11/28/2005||Yes|No||11/28/2005||Yes|No|11/28/2005||Yes|No||||No|No|||Prescription Required|Yes|01/23/2007|008|No|13.87865||13.54556||13.64271||||ANTIDEPRESSANTS, SSRIs|540|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049490041|ZOLOFT 50 MG TABLET|100|EA|6.21913|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2007|008|No|13.87865||13.54556||13.64271||||ANTIDEPRESSANTS, SSRIs|541|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049491030|ZOLOFT 100 MG TABLET|30|EA|6.2188|11/28/2005||Yes|No||11/28/2005||Yes|No|11/28/2005||Yes|No||||No|No|||Prescription Required|Yes|01/23/2007|008|No|13.86239||13.52969||13.62673||||ANTIDEPRESSANTS, SSRIs|542|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049491041|ZOLOFT 100 MG TABLET|100|EA|6.21913|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2007|008|No|13.86239||13.52969||13.62673||||ANTIDEPRESSANTS, SSRIs|543|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049496030|ZOLOFT 25 MG TABLET|30|EA|6.2188|11/28/2005||Yes|No||11/28/2005||Yes|No|11/28/2005||Yes|No||||No|No|||Prescription Required|Yes|01/23/2007|008|No|13.92533||13.59112||13.6886||||ANTIDEPRESSANTS, SSRIs|544|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
testosterone|No|No|No|No|90%|00051846233|ANDROGEL 1.62% GEL PUMP|75|GM|3.56074|05/23/2011||Yes|No||05/23/2011||Yes|No|05/23/2011||Yes|No||||No|No|||Prescription Required|No|01/20/2011|084|Yes|7.90527||7.71554||7.77088||||ANDROGENIC AGENTS|545|||||No|No||ABBVIE US LLC|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00052011030|REMERON 45 MG SOLTAB|30|EA|2.0038|06/22/2006|11/30/2024|Yes|No||06/22/2006|11/30/2024|Yes|No|06/22/2006|11/30/2024|Yes|No||||No|No|||Prescription Required|Yes|01/10/2005|031|No|4.5668||4.50156||4.2872||||ANTIDEPRESSANTS, OTHER|546|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MERCK SHARP & D|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00052436501|REMERON 30 MG TABLET|30|EA|2.365|06/09/2020||Yes|No||06/09/2020||Yes|No|06/09/2020||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|031|No|5.39||5.313||5.06||||ANTIDEPRESSANTS, OTHER|547|||||No|No||MERCK SHARP & D|No|||||No|No|No||
alpha-1-proteinase inhibitor|No|No|No|No|75%|00053720102|ZEMAIRA 1,000 MG VIAL|1|EA|.2537|12/02/2004||Yes|No||12/02/2004||Yes|No|12/02/2004||Yes|No||||No|No|||Prescription Required|No|||No|.5782||.56994||.5428|||||548|||||No|No||CSL BEHRING LLC|No|||||No|No|Yes|07/30/2021|
calcitriol|No|No|No|No|75%|00054000713|CALCITRIOL 0.25 MCG CAPSULE|30|EA|.44017|10/23/2007||Yes|No||10/23/2007||Yes|No|10/23/2007||Yes|No||10/23/2007||Yes|No|||Prescription Required|No|||No|.13574||.13248||.13343|||||549|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
calcitriol|No|No|No|No|75%|00054000725|CALCITRIOL 0.25 MCG CAPSULE|100|EA|.40674|10/23/2007||Yes|No||10/23/2007||Yes|No|10/23/2007||Yes|No||10/23/2007||Yes|No|||Prescription Required|No|||No|.13574||.13248||.13343|||||550|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001021|FLECAINIDE ACETATE 50 MG TAB|60|EA|.24682|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|||No|.08742||.08532||.08593|||||551|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001025|FLECAINIDE ACETATE 50 MG TAB|100|EA|.24682|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|||No|.08742||.08532||.08593|||||552|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001121|FLECAINIDE ACETATE 100 MG TAB|60|EA|.40334|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|||No|.14219||.13878||.13977|||||553|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001125|FLECAINIDE ACETATE 100 MG TAB|100|EA|.40334|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|||No|.14219||.13878||.13977|||||554|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001221|FLECAINIDE ACETATE 150 MG TAB|60|EA|.55406|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|||No|.17776||.17349||.17474|||||555|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001225|FLECAINIDE ACETATE 150 MG TAB|100|EA|.55406|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|||No|.17776||.17349||.17474|||||556|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
prednisone|No|No|No|No|75%|00054001720|PREDNISONE 10 MG TABLET|100|EA|.09185|12/30/2010||Yes|No||12/30/2010||Yes|No|12/30/2010||Yes|No||12/30/2010||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.04042||.03945||.03973||||GLUCOCORTICOIDS, ORAL|557|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054001820|PREDNISONE 20 MG TABLET|100|EA|.098|12/30/2010||Yes|No||12/30/2010||Yes|No|12/30/2010||Yes|No||12/30/2010||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.06386||.06233||.06277||||GLUCOCORTICOIDS, ORAL|558|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054001825|PREDNISONE 20 MG TABLET|100|EA|.0891|01/26/2005||Yes|No||01/26/2005||Yes|No|01/26/2005||Yes|No||01/26/2005||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.06386||.06233||.06277||||GLUCOCORTICOIDS, ORAL|559|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054001829|PREDNISONE 20 MG TABLET|500|EA|.0882|01/26/2005||Yes|No||01/26/2005||Yes|No|01/26/2005||Yes|No||01/26/2005||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.06386||.06233||.06277||||GLUCOCORTICOIDS, ORAL|560|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054001920|PREDNISONE 50 MG TABLET|100|EA|.14405|06/03/2020||Yes|No||06/03/2020||Yes|No|06/03/2020||Yes|No||06/03/2020||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.14844||.14488||.14592||||GLUCOCORTICOIDS, ORAL|561|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054001925|PREDNISONE 50 MG TABLET|100|EA|.14001|01/26/2005||Yes|No||01/26/2005||Yes|No|01/26/2005||Yes|No||01/26/2005||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.14844||.14488||.14592||||GLUCOCORTICOIDS, ORAL|562|||||No|No||ROXANE/WEST-WAR|Yes|09/01/2020||||Yes|No|No||
lithium carbonate|No|No|No|No|75%|00054002025|LITHIUM CARBONATE ER 450 MG TB|100|EA|.18473|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|||No|.16368||.15975||.1609|||||563|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054002125|LITHIUM CARBONATE ER 300 MG TB|100|EA|.14349|01/12/2005||Yes|No||01/12/2005||Yes|No|01/12/2005||Yes|No||||No|No|||Prescription Required|No|||No|.20806||.20307||.20452|||||564|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054002129|LITHIUM CARBONATE ER 300 MG TB|500|EA|.16003|01/12/2005||Yes|No||01/12/2005||Yes|No|01/12/2005||Yes|No||||No|No|||Prescription Required|No|||No|.20806||.20307||.20452|||||565|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
ipratropium bromide|No|No|No|No|75%|00054004544|IPRATROPIUM 0.03% SPRAY|30|ML|.516|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|08/08/2024|019|No|.44745||.43671||.43984||||INTRANASAL RHINITIS AGENTS|566|||||No|No||ROXANE/WEST-WAR|Yes|09/01/2020||||No|No|No||
ipratropium bromide|No|No|No|No|75%|00054004641|IPRATROPIUM 0.06% SPRAY|15|ML|1.032|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|08/08/2024|019|No|.8799||.85878||.86494||||INTRANASAL RHINITIS AGENTS|567|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
digoxin|No|No|No|No|75%|00054005746|DIGOXIN 0.05 MG/ML SOLUTION|60|ML|1.00333|02/09/2005||Yes|No||02/09/2005||Yes|No|02/09/2005||Yes|No||02/09/2005||Yes|No|||Prescription Required|No|||No|1.10733||1.08075||1.08851|||||568|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
citalopram hydrobromide|Yes|No|No|No|75%|00054006258|CITALOPRAM HBR 10 MG/5 ML SOLN|240|ML|.14333|05/16/2006||Yes|No||05/16/2006||Yes|No|05/16/2006||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|03/29/2004|008|No|.15442||.15071||.15179||||ANTIDEPRESSANTS, SSRIs|569|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
ondansetron HCl|No|No|No|No|75%|00054006447|ONDANSETRON 4 MG/5 ML SOLUTION|50|ML|.72188|05/23/2007||Yes|No||05/23/2007||Yes|No|05/23/2007||Yes|No||||No|No|||Prescription Required|No|01/23/2008|085|No|.30582||.29848||.30062||||ANTIEMETIC/ANTIVERTIGO AGENTS|570|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
torsemide|No|No|No|No|75%|00054007725|TORSEMIDE 20 MG TABLET|100|EA|.09193|10/04/2005||Yes|No||10/04/2005||Yes|No|10/04/2005||Yes|No||10/04/2005||Yes|No|||Prescription Required|No|||No|.05423||.05293||.05331|||||571|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
torsemide|No|No|No|No|75%|00054007729|TORSEMIDE 20 MG TABLET|500|EA|.26382|10/13/2006||Yes|No||10/13/2006||Yes|No|10/13/2006||Yes|No||10/13/2006||Yes|No|||Prescription Required|No|||No|.05423||.05293||.05331|||||572|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
balsalazide disodium|No|No|No|No|75%|00054007928|BALSALAZIDE DISODIUM 750 MG CP|280|EA|.32404|05/30/2008||Yes|No||05/30/2008||Yes|No|05/30/2008||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|010|No|.30374||.29645||.29858||||ULCERATIVE COLITIS AGENTS|573|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
exemestane|No|No|No|No|75%|00054008013|EXEMESTANE 25 MG TABLET|30|EA|4.66951|06/06/2011||Yes|No||06/06/2011||Yes|No|06/06/2011||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|.60665||.59209||.59634||||ONCOLOGY, ORAL - BREAST|574|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
zaleplon|No|No|No|No|90%|00054008425|ZALEPLON 5 MG CAPSULE|100|EA|.172|07/16/2008||Yes|No||07/16/2008||Yes|No|07/16/2008||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.12286||.11991||.12077||||SEDATIVE HYPNOTICS|575|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
zaleplon|No|No|No|No|90%|00054008525|ZALEPLON 10 MG CAPSULE|100|EA|.1806|07/16/2008||Yes|No||07/16/2008||Yes|No|07/16/2008||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.12923||.12613||.12703||||SEDATIVE HYPNOTICS|576|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
calcium acetate|No|No|No|No|75%|00054008813|CALCIUM ACETATE 667 MG CAPSULE|30|EA|.35217|05/23/2014||Yes|No||05/23/2014||Yes|No|05/23/2014||Yes|No||05/23/2014||Yes|No|||Prescription Required|No|07/24/2013|052|Yes|.13694||.13365||.13461||||PHOSPHATE BINDERS|577|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
calcium acetate|No|No|No|No|75%|00054008826|CALCIUM ACETATE 667 MG CAPSULE|200|EA|.24448|12/09/2008||Yes|No||12/09/2008||Yes|No|12/09/2008||Yes|No||12/09/2008||Yes|No|||Prescription Required|No|07/26/2012|052|Yes|.13694||.13365||.13461||||PHOSPHATE BINDERS|578|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
galantamine HBr|No|No|No|No|75%|00054013749|GALANTAMINE 4 MG/ML ORAL SOLN |100|ML|1.28845|08/26/2009||Yes|No||08/26/2009||Yes|No|08/26/2009||Yes|No||||No|No|||Prescription Required|Yes|07/22/2009|011|No|2.93647||2.89452||2.75669||||ALZHEIMER'S AGENTS|579|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
acarbose|No|No|No|No|75%|00054014025|ACARBOSE 25 MG TABLET|100|EA|.19995|01/13/2009||Yes|No||01/13/2009||Yes|No|01/13/2009||Yes|No||||No|No|||Prescription Required|No|||No|.1199||.11702||.11786|||||580|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
acarbose|No|No|No|No|75%|00054014125|ACARBOSE 50 MG TABLET|100|EA|.2193|01/13/2009||Yes|No||01/13/2009||Yes|No|01/13/2009||Yes|No||||No|No|||Prescription Required|No|||No|.1487||.14513||.14617|||||581|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
acarbose|No|No|No|No|75%|00054014225|ACARBOSE 100 MG TABLET|100|EA|.26015|01/13/2009||Yes|No||01/13/2009||Yes|No|01/13/2009||Yes|No||||No|No|||Prescription Required|No|||No|.17524||.17103||.17226|||||582|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00054016325|MYCOPHENOLATE 250 MG CAPSULE|100|EA|.23508|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.13723||.13394||.1349||||IMMUNOSUPPRESSIVES, ORAL|583|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00054016329|MYCOPHENOLATE 250 MG CAPSULE|500|EA|.22332|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.13723||.13394||.1349||||IMMUNOSUPPRESSIVES, ORAL|584|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00054016625|MYCOPHENOLATE 500 MG TABLET|100|EA|.47304|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.21368||.20855||.21005||||IMMUNOSUPPRESSIVES, ORAL|585|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00054016629|MYCOPHENOLATE 500 MG TABLET|500|EA|.4494|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.21368||.20855||.21005||||IMMUNOSUPPRESSIVES, ORAL|586|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
buprenorphine HCl|No|No|No|No|90%|00054017613|BUPRENORPHINE 2 MG TABLET SL|30|EA|.645|05/11/2010||Yes|No||05/11/2010||Yes|No|05/11/2010||Yes|No||||No|No|||Prescription Required|No|01/25/2012|145|Yes|.27394||.26737||.26928||||OPIATE DEPENDENCE TREATMENTS|587|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
buprenorphine HCl|No|No|No|No|90%|00054017713|BUPRENORPHINE 8 MG TABLET SL|30|EA|.78116|05/11/2010||Yes|No||05/11/2010||Yes|No|05/11/2010||Yes|No||||No|No|||Prescription Required|No|01/25/2012|145|Yes|.6003||.58589||.59009||||OPIATE DEPENDENCE TREATMENTS|588|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00054018813|BUPRENORPHINE-NALOX 2-0.5MG TB|30|EA|.39818|11/07/2014||Yes|No||11/07/2014||Yes|No|11/07/2014||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|.37404||.36506||.36768||||OPIATE DEPENDENCE TREATMENTS|589|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00054018913|BUPRENORPHINE-NALOX 8-2 MG TAB|30|EA|.5805|11/07/2014||Yes|No||11/07/2014||Yes|No|11/07/2014||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|.64498||.6295||.63402||||OPIATE DEPENDENCE TREATMENTS|590|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
protriptyline HCl|No|No|No|No|75%|00054021025|PROTRIPTYLINE HCL 5 MG TABLET|100|EA|2.05433|01/13/2009||Yes|No||01/13/2009||Yes|No|01/13/2009||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|3.67844||3.59016||3.61591||||ANTIDEPRESSANTS, TRICYCLIC|591|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
protriptyline HCl|No|No|No|No|75%|00054021125|PROTRIPTYLINE HCL 10 MG TABLET|100|EA|2.05433|01/13/2009||Yes|No||01/13/2009||Yes|No|01/13/2009||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|2.47793||2.41846||2.43581||||ANTIDEPRESSANTS, TRICYCLIC|592|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054023525|MORPHINE SULFATE IR 15 MG TAB|100|EA|.1858|08/04/2008||Yes|No||08/04/2008||Yes|No|08/04/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2008|109|Yes|.18514||.1807||.18199||||ANALGESICS, NARCOTICS SHORT|593|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054023625|MORPHINE SULFATE IR 30 MG TAB|100|EA|.31618|08/04/2008||Yes|No||08/04/2008||Yes|No|08/04/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2008|109|Yes|.27731||.27065||.2726||||ANALGESICS, NARCOTICS SHORT|594|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054023749|MORPHINE SULF 10 MG/5 ML SOLN|100|ML|.03917|06/26/2020||Yes|No||06/26/2020||Yes|No|06/26/2020||Yes|No||||No|No|||Prescription Required|No|01/23/2008|109|Yes|.09024||.08807||.08871||||ANALGESICS, NARCOTICS SHORT|595|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054023763|MORPHINE SULF 10 MG/5 ML SOLN|500|ML|.01981|08/04/2008||Yes|No||08/04/2008||Yes|No|08/04/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2008|109|Yes|.04393||.04288||.04318||||ANALGESICS, NARCOTICS SHORT|596|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054023849|MORPHINE SULF 20 MG/5 ML SOLN |100|ML|.05577|06/26/2020||Yes|No||06/26/2020||Yes|No|06/26/2020||Yes|No||||No|No|||Prescription Required|No|01/23/2008|109|Yes|.12724||.12419||.12508||||ANALGESICS, NARCOTICS SHORT|597|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054023863|MORPHINE SULF 20 MG/5 ML SOLN |500|ML|.0304|08/04/2008||Yes|No||08/04/2008||Yes|No|08/04/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2008|109|Yes|.06143||.05996||.06039||||ANALGESICS, NARCOTICS SHORT|598|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
codeine sulfate|No|No|No|No|90%|00054024324|CODEINE SULFATE 15 MG TABLET|100|EA|.30917|06/08/2020||Yes|No||06/08/2020||Yes|No|06/08/2020||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|109|Yes|.67536||.65915||.66388||||ANALGESICS, NARCOTICS SHORT|599|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
codeine sulfate|No|No|No|No|90%|00054024424|CODEINE SULFATE 30 MG TABLET|100|EA|.36946|06/08/2020||Yes|No||06/08/2020||Yes|No|06/08/2020||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|109|Yes|.63866||.62333||.6278||||ANALGESICS, NARCOTICS SHORT|600|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
codeine sulfate|No|No|No|No|90%|00054024425|CODEINE SULFATE 30 MG TABLET|100|EA|.33329|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|109|Yes|.63866||.62333||.6278||||ANALGESICS, NARCOTICS SHORT|601|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
codeine sulfate|No|No|No|No|90%|00054024525|CODEINE SULFATE 60 MG TABLET|100|EA|.61086|11/12/2009||Yes|No||11/12/2009||Yes|No|11/12/2009||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|109|Yes|1.07137||1.04566||1.05316||||ANALGESICS, NARCOTICS SHORT|602|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00054025413|IRBESARTAN-HCTZ 150-12.5 MG TB|30|EA|.172|05/16/2014||Yes|No||05/16/2014||Yes|No|05/16/2014||Yes|No||05/16/2014||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.392||.3864||.368||||ANGIOTENSIN MODULATORS|603|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00054025422|IRBESARTAN-HCTZ 150-12.5 MG TB|90|EA|.16244|05/16/2014||Yes|No||05/16/2014||Yes|No|05/16/2014||Yes|No||05/16/2014||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.37021||.36493||.34755||||ANGIOTENSIN MODULATORS|604|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00054025513|IRBESARTAN-HCTZ 300-12.5 MG TB|30|EA|.23621|12/11/2012||Yes|No||12/11/2012||Yes|No|12/11/2012||Yes|No||12/11/2012||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.53834||.53065||.50538||||ANGIOTENSIN MODULATORS|605|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00054025522|IRBESARTAN-HCTZ 300-12.5 MG TB|90|EA|.18155|12/11/2012||Yes|No||12/11/2012||Yes|No|12/11/2012||Yes|No||12/11/2012||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.41378||.40786||.38844||||ANGIOTENSIN MODULATORS|606|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
imipramine pamoate|No|No|No|No|75%|00054027313|IMIPRAMINE PAMOATE 75 MG CAP  |30|EA|5.07414|11/16/2010||Yes|No||11/16/2010||Yes|No|11/16/2010||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|3.42287||3.34072||3.36468||||ANTIDEPRESSANTS, TRICYCLIC|607|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
imipramine pamoate|No|No|No|No|75%|00054027413|IMIPRAMINE PAMOATE 100 MG CAP|30|EA|5.07414|11/16/2010||Yes|No||11/16/2010||Yes|No|11/16/2010||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|4.45145||4.34462||4.37578||||ANTIDEPRESSANTS, TRICYCLIC|608|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
imipramine pamoate|No|No|No|No|75%|00054027513|IMIPRAMINE PAMOATE 125 MG CAP |30|EA|5.07414|11/16/2010||Yes|No||11/16/2010||Yes|No|11/16/2010||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|11.56432||11.39912||10.8563||||ANTIDEPRESSANTS, TRICYCLIC|609|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
imipramine pamoate|No|No|No|No|75%|00054027613|IMIPRAMINE PAMOATE 150 MG CAP |30|EA|5.07414|11/16/2010||Yes|No||11/16/2010||Yes|No|11/16/2010||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|3.43953||3.35698||3.38106||||ANTIDEPRESSANTS, TRICYCLIC|610|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
naratriptan HCl|No|No|No|No|75%|00054027803|NARATRIPTAN HCL 1 MG TABLET|9|EA|4.70898|08/02/2010||Yes|No||08/02/2010||Yes|No|08/02/2010||Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|021|Yes|1.74439||1.70252||1.71474||||ANTIMIGRAINE AGENTS, TRIPTANS|611|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
naratriptan HCl|No|No|No|No|75%|00054027903|NARATRIPTAN HCL 2.5 MG TABLET|9|EA|4.70898|08/02/2010||Yes|No||08/02/2010||Yes|No|08/02/2010||Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|021|Yes|.87971||.8586||.86475||||ANTIMIGRAINE AGENTS, TRIPTANS|612|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
alendronate sodium|No|No|No|No|75%|00054028259|ALENDRONATE SOD 70 MG/75 ML|75|ML|.39557|04/01/2021||Yes|No||04/01/2021||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|060|No|.60895||.59434||.5986||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|613|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
oxymorphone HCl|No|No|No|No|90%|00054028325|OXYMORPHONE HCL 5 MG TABLET|100|EA|1.11478|12/07/2010||Yes|No||12/07/2010||Yes|No|12/07/2010||Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|2.54065||2.50436||2.3851||||ANALGESICS, NARCOTICS SHORT|614|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
oxymorphone HCl|No|No|No|No|90%|00054028425|OXYMORPHONE HCL 10 MG TABLET|100|EA|2.02423|12/07/2010||Yes|No||12/07/2010||Yes|No|12/07/2010||Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|1.44028||1.40571||1.4158||||ANALGESICS, NARCOTICS SHORT|615|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
linezolid|No|No|No|No|75%|00054031950|LINEZOLID 100 MG/5 ML SUSP    |150|ML|1.9258|12/17/2019||Yes|No||12/17/2019||Yes|No|12/17/2019||Yes|No||||No|No|||Prescription Required|No|||No|1.69693||1.6562||1.66808|||||616|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00054032656|FLUTICASONE-SALMETEROL 100-50|60|EA|.67159|08/23/2021||Yes|No||08/23/2021||Yes|No|08/23/2021||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|033|No|.91408||.89214||.89854||||GLUCOCORTICOIDS, INHALED|617|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00054032756|FLUTICASONE-SALMETEROL 250-50|60|EA|.83448|08/23/2021||Yes|No||08/23/2021||Yes|No|08/23/2021||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|033|No|1.13244||1.10526||1.11319||||GLUCOCORTICOIDS, INHALED|618|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00054032856|FLUTICASONE-SALMETEROL 500-50|60|EA|1.0975|10/04/2024||Yes|No||10/04/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/27/2023|033|No|1.56676||1.52916||1.54013||||GLUCOCORTICOIDS, INHALED|619|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
cevimeline HCl|No|No|No|No|75%|00054033425|CEVIMELINE HCL 30 MG CAPSULE|100|EA|1.11112|09/16/2013||Yes|No||09/16/2013||Yes|No|09/16/2013||Yes|No||||No|No|||Prescription Required|No|||No|.62675||.61171||.6161|||||620|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenoxybenzamine HCl|No|No|No|No|75%|00054034925|PHENOXYBENZAMINE HCL 10 MG CAP|100|EA|46.43613|06/30/2017||Yes|No||06/30/2017||Yes|No|06/30/2017||Yes|No||||No|No|||Prescription Required|No|||No|105.83118||104.31931||99.35172|||||621|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
disulfiram|No|No|No|No|75%|00054035613|DISULFIRAM 250 MG TABLET|30|EA|1.21618|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription Required|No|||No|2.77176||2.73217||2.60206|||||622|||||No|No||WEST-WARD/HIKMA|Yes|10/04/2021||||No|No|No||
disulfiram|No|No|No|No|75%|00054035625|DISULFIRAM 250 MG TABLET|100|EA|1.28312|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription Required|No|||No|2.92432||2.88254||2.74528|||||623|||||No|No||WEST-WARD/HIKMA|Yes|10/04/2021||||No|No|No||
disulfiram|No|No|No|No|75%|00054035725|DISULFIRAM 500 MG TABLET|100|EA|2.00079|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription Required|No|||No|4.55994||4.4948||4.28076|||||624|||||No|No||WEST-WARD/HIKMA|Yes|10/04/2021||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00054037025|LISDEXAMFETAMINE 20 MG CAPSULE|100|EA|4.52597|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.24516||5.11928||5.15599||||STIMULANTS AND RELATED AGENTS|625|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00054037125|LISDEXAMFETAMINE 30 MG CAPSULE|100|EA|4.52597|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.59503||5.46075||5.49991||||STIMULANTS AND RELATED AGENTS|626|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00054037225|LISDEXAMFETAMINE 40 MG CAPSULE|100|EA|4.52597|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|4.84006||4.7239||4.75778||||STIMULANTS AND RELATED AGENTS|627|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00054037325|LISDEXAMFETAMINE 50 MG CAPSULE|100|EA|4.52597|12/11/2023||Yes|No||12/11/2023||Yes|No|12/11/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.03501||4.91417||4.94941||||STIMULANTS AND RELATED AGENTS|628|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00054037425|LISDEXAMFETAMINE 60 MG CAPSULE|100|EA|4.52597|12/11/2023||Yes|No||12/11/2023||Yes|No|12/11/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.4397||5.30915||5.34723||||STIMULANTS AND RELATED AGENTS|629|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00054037525|LISDEXAMFETAMINE 70 MG CAPSULE|100|EA|4.52597|12/11/2023||Yes|No||12/11/2023||Yes|No|12/11/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.96445||5.8213||5.86305||||STIMULANTS AND RELATED AGENTS|630|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
cyclophosphamide|No|No|No|No|75%|00054038225|CYCLOPHOSPHAMIDE 25 MG CAPSULE|100|EA|3.22044|11/07/2014||Yes|No||11/07/2014||Yes|No|11/07/2014||Yes|No||11/07/2014||Yes|No|||Prescription Required|No|01/28/2021|502|No|2.40652||2.34876||2.36561||||ONCOLOGY, ORAL - BREAST|631|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
cyclophosphamide|No|No|No|No|75%|00054038325|CYCLOPHOSPHAMIDE 50 MG CAPSULE|100|EA|5.91035|11/07/2014||Yes|No||11/07/2014||Yes|No|11/07/2014||Yes|No||11/07/2014||Yes|No|||Prescription Required|No|01/28/2021|502|No|2.78553||2.71868||2.73818||||ONCOLOGY, ORAL - BREAST|632|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
hydromorphone HCl|No|No|No|No|90%|00054038663|HYDROMORPHONE 1 MG/ML SOLUTION|473|ML|.20631|05/17/2012||Yes|No||05/17/2012||Yes|No|05/17/2012||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|109|Yes|.28864||.28171||.28373||||ANALGESICS, NARCOTICS SHORT|633|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00054039041|OXYCODONE HCL 5 MG/5 ML SOLN  |15|ML|.30816|02/27/2015||Yes|No||02/27/2015||Yes|No|02/27/2015||Yes|No||||No|No|||Prescription Required|No|07/17/2014|109|Yes|.70233||.69229||.65933||||ANALGESICS, NARCOTICS SHORT|634|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00054039063|OXYCODONE HCL 5 MG/5 ML SOLN|500|ML|.09804|02/27/2015||Yes|No||02/27/2015||Yes|No|02/27/2015||Yes|No||||No|No|||Prescription Required|No|07/17/2014|109|Yes|.06324||.06172||.06216||||ANALGESICS, NARCOTICS SHORT|635|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054039168|METHADONE 10 MG/ML ORAL CONC|1000|ML|.02194|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.05||.04929||.04694||||ANALGESICS, NARCOTICS LONG|636|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054039268|METHADONE 10 MG/ML ORAL CONC  |1000|ML|.02194|12/07/2010||Yes|No||12/07/2010||Yes|No|12/07/2010||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.05||.04929||.04694||||ANALGESICS, NARCOTICS LONG|637|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
bexarotene|No|No|No|No|75%|00054039925|BEXAROTENE 75 MG CAPSULE      |100|EA|25.3055|04/14/2021||Yes|No||04/14/2021||Yes|No|04/14/2021||Yes|No||||No|No|||Prescription Required|No|||No|57.673||56.8491||54.142|||||638|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00054040013|DESVENLAFAXINE SUCCNT ER 50 MG|30|EA|.4568|05/08/2020||Yes|No||05/08/2020||Yes|No|05/08/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|031|No|.34459||.33632||.33873||||ANTIDEPRESSANTS, OTHER|639|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00054040022|DESVENLAFAXINE SUCCNT ER 50 MG|90|EA|.4568|05/08/2020||Yes|No||05/08/2020||Yes|No|05/08/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|031|Yes|.34459||.33632||.33873||||ANTIDEPRESSANTS, OTHER|640|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00054040113|DESVENLAFAXINE SUCCNT ER 100MG|30|EA|.4568|05/08/2020||Yes|No||05/08/2020||Yes|No|05/08/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|031|No|.35582||.34728||.34977||||ANTIDEPRESSANTS, OTHER|641|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00054040122|DESVENLAFAXINE SUCCNT ER 100MG|90|EA|.4568|05/08/2020||Yes|No||05/08/2020||Yes|No|05/08/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|031|Yes|.35582||.34728||.34977||||ANTIDEPRESSANTS, OTHER|642|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00054040713|RITONAVIR 100 MG TABLET|30|EA|3.2|06/04/2018||Yes|No||06/04/2018||Yes|No|06/04/2018||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|5.22666||5.152||4.90666||||HIV / AIDS|643|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
febuxostat|No|No|No|No|75%|00054041313|FEBUXOSTAT 40 MG TABLET|30|EA|2.15|04/24/2020||Yes|No||04/24/2020||Yes|No|04/24/2020||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|231|No|.34387||.33562||.33802||||ANTIHYPERURICEMICS|644|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
febuxostat|No|No|No|No|75%|00054041413|FEBUXOSTAT 80 MG TABLET|30|EA|2.15|04/24/2020||Yes|No||04/24/2020||Yes|No|04/24/2020||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|231|No|.45795||.44696||.45016||||ANTIHYPERURICEMICS|645|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
rufinamide|No|No|No|No|75%|00054042523|RUFINAMIDE 200 MG TABLET|120|EA|1.32053|08/26/2021||Yes|No||08/26/2021||Yes|No|08/26/2021||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|1.42717||1.39292||1.40291||||ANTICONVULSANTS|646|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
rufinamide|No|No|No|No|75%|00054042623|RUFINAMIDE 400 MG TABLET|120|EA|2.64106|08/26/2021||Yes|No||08/26/2021||Yes|No|08/26/2021||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|1.61894||1.58009||1.59142||||ANTICONVULSANTS|647|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00054044949|POSACONAZOLE 200 MG/5 ML SUSP|105|ML|5.37651|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|069|No|12.25345||12.0784||11.50324||||ANTIFUNGALS, ORAL|648|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054047021|EVEROLIMUS 0.25 MG TABLET     |60|EA|3.40926|06/12/2020||Yes|No||06/12/2020||Yes|No|06/12/2020||Yes|No||06/12/2020||Yes|No|||Prescription Required|Yes|01/30/2020|229|No|2.1282||2.07712||2.09202||||IMMUNOSUPPRESSIVES, ORAL|649|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00054047121|EVEROLIMUS 0.5 MG TABLET      |60|EA|6.81858|06/12/2020||Yes|No||06/12/2020||Yes|No|06/12/2020||Yes|No||06/12/2020||Yes|No|||Prescription Required|Yes|01/30/2020|229|No|4.02548||3.92887||3.95705||||IMMUNOSUPPRESSIVES, ORAL|650|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00054047221|EVEROLIMUS 0.75 MG TABLET     |60|EA|10.22777|06/12/2020||Yes|No||06/12/2020||Yes|No|06/12/2020||Yes|No||06/12/2020||Yes|No|||Prescription Required|Yes|01/30/2020|229|No|6.71867||6.55742||6.60445||||IMMUNOSUPPRESSIVES, ORAL|651|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00054048013|EVEROLIMUS 2.5 MG TABLET|30|EA|92.01183|06/08/2021||Yes|No||06/08/2021||Yes|No|06/08/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|209.70138||206.70565||196.86252||||ONCOLOGY, ORAL - RENAL CELL|652|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054048113|EVEROLIMUS 5 MG TABLET|30|EA|96.24288|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|23.31271||22.7532||22.91639||||ONCOLOGY, ORAL - RENAL CELL|653|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054048213|EVEROLIMUS 10 MG TABLET|30|EA|96.24288|03/29/2022||Yes|No||03/29/2022||Yes|No|03/29/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|28.82453||28.13274||28.33451||||ONCOLOGY, ORAL - RENAL CELL|654|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054049713|EVEROLIMUS 7.5 MG TABLET|30|EA|96.24288|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|219.34425||216.21076||205.91501||||ONCOLOGY, ORAL - RENAL CELL|655|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
icosapent ethyl|No|No|No|No|75%|00054050823|ICOSAPENT ETHYL 1 GRAM CAPSULE|120|EA|1.08167|04/14/2021||Yes|No||04/14/2021||Yes|No|04/14/2021||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|055|Yes|.59147||.57727||.58142||||LIPOTROPICS, OTHER|656|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054051741|MORPHINE SULF 100 MG/5 ML CONC|15|ML|.24624|08/27/2015||Yes|No||08/27/2015||Yes|No|08/27/2015||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|.49209||.48028||.48372||||ANALGESICS, NARCOTICS SHORT|657|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054051744|MORPHINE SULF 100 MG/5 ML CONC|30|ML|.24624|08/27/2015||Yes|No||08/27/2015||Yes|No|08/27/2015||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|.36644||.35765||.36021||||ANALGESICS, NARCOTICS SHORT|658|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00054051750|MORPHINE SULF 100 MG/5 ML CONC|120|ML|.24628|08/27/2015||Yes|No||08/27/2015||Yes|No|08/27/2015||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|.40858||.39877||.40163||||ANALGESICS, NARCOTICS SHORT|659|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
rufinamide|No|No|No|No|75%|00054052863|RUFINAMIDE 40 MG/ML SUSPENSION|460|ML|1.12396|04/14/2021||Yes|No||04/14/2021||Yes|No|04/14/2021||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|.41392||.40399||.40688||||ANTICONVULSANTS|660|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
deferiprone|No|No|No|No|75%|00054057625|DEFERIPRONE 500 MG TABLET|100|EA|26.43674|08/26/2021||Yes|No||08/26/2021||Yes|No|08/26/2021||Yes|No||||No|No|||Prescription Required|No|||No|60.25118||59.39045||56.56234|||||661|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00054060313|DESVENLAFAXINE SUCCNT ER 25 MG|30|EA|.41939|01/30/2020||Yes|No||01/30/2020||Yes|No|01/30/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|031|Yes|.35651||.34795||.35045||||ANTIDEPRESSANTS, OTHER|662|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054060421|EVEROLIMUS 1 MG TABLET|60|EA|13.63709|04/05/2022||Yes|No||04/05/2022||Yes|No|04/05/2022||Yes|No||04/05/2022||Yes|No|||Prescription Required|Yes|01/28/2021|229|No|13.38987||13.06851||13.16224||||IMMUNOSUPPRESSIVES, ORAL|663|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
icosapent ethyl|No|No|No|No|75%|00054062127|ICOSAPENT ETHYL 0.5 GM CAPSULE|240|EA|.64211|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|055|Yes|.63175||.61659||.62101||||LIPOTROPICS, OTHER|664|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00054062263|DICYCLOMINE 10 MG/5 ML SOLN|473|ML|.10333|09/30/2020||Yes|No||09/30/2020||Yes|No|09/30/2020||Yes|No||||No|No|||Prescription Required|No|||No|.1994||.19461||.19601|||||665|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methylergonovine maleate|No|No|No|No|75%|00054063905|METHYLERGONOVINE 0.2 MG TABLET|12|EA|23.12683|03/21/2019||Yes|No||03/21/2019||Yes|No|03/21/2019||Yes|No||||No|No|||Prescription Required|No|||No|8.44502||8.24234||8.30145|||||666|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methylergonovine maleate|No|No|No|No|75%|00054063913|METHYLERGONOVINE 0.2 MG TABLET|28|EA|23.11358|04/24/2020||Yes|No||04/24/2020||Yes|No|04/24/2020||Yes|No||||No|No|||Prescription Required|No|||No|8.44502||8.24234||8.30145|||||667|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
butalbit/acetamin/caff/codeine|No|No|No|No|90%|00054065025|BUTALB-ACETAMIN-CAF-COD 50-300|100|EA|2.61337|09/15/2022||Yes|No||09/15/2022||Yes|No|09/15/2022||Yes|No||09/15/2022||Yes|No|||Prescription Required|Yes|07/29/2021|109|Yes|4.6837||4.57129||4.60408||||ANALGESICS, NARCOTICS SHORT|668|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054070920|METHADONE HCL 5 MG TABLET|100|EA|.13223|06/08/2021||Yes|No||06/08/2021||Yes|No|06/08/2021||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|110|Yes|.15894||.15513||.15624||||ANALGESICS, NARCOTICS LONG|669|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054070925|METHADONE HCL 5 MG TABLET|100|EA|.09159|06/08/2021||Yes|No||06/08/2021||Yes|No|06/08/2021||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|110|Yes|.15894||.15513||.15624||||ANALGESICS, NARCOTICS LONG|670|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054071020|METHADONE HCL 10 MG TABLET|100|EA|.15046|06/08/2021||Yes|No||06/08/2021||Yes|No|06/08/2021||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|110|Yes|.194||.18934||.1907||||ANALGESICS, NARCOTICS LONG|671|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054071025|METHADONE HCL 10 MG TABLET|100|EA|.15209|06/08/2021||Yes|No||06/08/2021||Yes|No|06/08/2021||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|110|Yes|.194||.18934||.1907||||ANALGESICS, NARCOTICS LONG|672|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
deferiprone|No|No|No|No|75%|00054071119|DEFERIPRONE 1,000 MG TB(3X/DY)|50|EA|59.98999|06/28/2022||Yes|No||06/28/2022||Yes|No|06/28/2022||Yes|No||||No|No|||Prescription Required|No|||No|136.72137||134.76821||128.35067|||||673|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00054074287|ALBUTEROL HFA 90 MCG INHALER|6.7|GM|2.30916|03/30/2022||Yes|No||03/30/2022||Yes|No|03/30/2022||Yes|No||||No|No|||Prescription Required|Yes|05/23/2022|037|Yes|2.04805||1.9989||2.01323||||BRONCHODILATORS, BETA AGONIST|674|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00054074825|DICYCLOMINE 10 MG CAPSULE|100|EA|.08579|09/05/2023||Yes|No||09/05/2023||Yes|No|09/05/2023||Yes|No||||No|No|||Prescription Required|No|||No|.07257||.07083||.07134|||||675|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00054074831|DICYCLOMINE 10 MG CAPSULE|1000|EA|.07934|09/05/2023||Yes|No||09/05/2023||Yes|No|09/05/2023||Yes|No||||No|No|||Prescription Required|No|||No|.07257||.07083||.07134|||||676|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054252625|LITHIUM CARBONATE 150 MG CAP|100|EA|.05762|10/18/2006||Yes|No||10/18/2006||Yes|No|10/18/2006||Yes|No||||No|No|||Prescription Required|No|||No|.07826||.07638||.07693|||||677|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054252725|LITHIUM CARBONATE 300 MG CAP|100|EA|.0946|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.08126||.07931||.07988|||||678|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054252731|LITHIUM CARBONATE 300 MG CAP|1000|EA|.09194|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.08126||.07931||.07988|||||679|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054253125|LITHIUM CARBONATE 600 MG CAP|100|EA|.16147|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.23024||.22471||.22633|||||680|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
butalbit/acetamin/caff/codeine|No|No|No|No|90%|00054300001|BUTALB-ACETAMIN-CAF-COD 50-325|100|EA|.46763|09/14/2022||Yes|No||09/14/2022||Yes|No|09/14/2022||Yes|No||09/15/2022||Yes|No|||Prescription Required|Yes|07/29/2021|109|Yes|.58846||.57434||.57846||||ANALGESICS, NARCOTICS SHORT|681|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00054306844|ALPRAZOLAM INTENSOL 1 MG/ML   |30|ML|1.31322|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|2.99292||2.95016||2.80968||||ANXIOLYTICS|682|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
butorphanol tartrate|No|No|No|No|90%|00054309036|BUTORPHANOL 10 MG/ML SPRAY|2.5|ML|9.7008|09/15/2006||Yes|No||09/15/2006||Yes|No|09/15/2006||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|109|Yes|9.54349||9.31445||9.38125||||ANALGESICS, NARCOTICS SHORT|683|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
calcitriol|No|No|No|No|75%|00054312041|CALCITRIOL 1 MCG/ML SOLUTION|15|ML|4.10506|10/23/2007||Yes|No||10/23/2007||Yes|No|10/23/2007||Yes|No||10/23/2007||Yes|No|||Prescription Required|No|||No|8.0471||7.85397||7.9103|||||684|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054317644|DEXAMETHASONE INTENSOL 1 MG/ML|30|ML|.3417|10/18/2006||Yes|No||10/18/2006||Yes|No|10/18/2006||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|168|Yes|.||.||.||||GLUCOCORTICOIDS, ORAL|685|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054317757|DEXAMETHASONE 0.5 MG/5 ML LIQ|240|ML|.09128|12/30/2008||Yes|No||12/30/2008||Yes|No|12/30/2008||Yes|No||||No|No|||Prescription Required|No|01/15/2014|168|Yes|.1414||.13801||.139||||GLUCOCORTICOIDS, ORAL|686|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054317763|DEXAMETHASONE 0.5 MG/5 ML LIQ |500|ML|.01391|12/30/2008||Yes|No||12/30/2008||Yes|No|12/30/2008||Yes|No||||No|No|||Prescription Required|No|01/15/2014|168|Yes|.02987||.02915||.02936||||GLUCOCORTICOIDS, ORAL|687|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
diazepam|No|No|No|No|75%|00054318544|DIAZEPAM 5 MG/ML ORAL CONC|30|ML|.45608|10/23/2007||Yes|No||10/23/2007||Yes|No|10/23/2007||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|.9718||.94848||.95528||||ANXIOLYTICS|688|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
diazepam|No|No|No|No|75%|00054318863|DIAZEPAM 5 MG/5 ML SOLUTION|500|ML|.04967|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.09697||.09464||.09532||||ANXIOLYTICS|689|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
diphenoxylate HCl/atropine|No|No|No|No|75%|00054319446|DIPHENOXYLAT-ATROP 2.5-0.025/5|60|ML|.50166|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|1.14333||1.12699||1.07333|||||690|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00054327099|FLUTICASONE PROP 50 MCG SPRAY|16|GM|.36658|03/24/2006||Yes|No||03/24/2006||Yes|No|03/24/2006||Yes|No||||No|No|||Prescription Required|No|07/26/2012|019|No|.40191||.39226||.39508||||INTRANASAL RHINITIS AGENTS|691|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054329446|FUROSEMIDE 10 MG/ML SOLUTION|60|ML|.0483|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.09881||.09644||.09713|||||692|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054329450|FUROSEMIDE 10 MG/ML SOLUTION|120|ML|.0469|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.09881||.09644||.09713|||||693|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054329863|FUROSEMIDE 40 MG/5 ML SOLN|500|ML|.03332|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.07593||.07485||.07128|||||694|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
lidocaine HCl|No|No|No|No|75%|00054350049|LIDOCAINE 2% VISCOUS SOLN|100|ML|.0473|10/23/2002||Yes|No||10/23/2002||Yes|No|10/23/2002||Yes|No||||No|No|||Prescription Required|No|||No|.0848||.08276||.08336|||||695|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lidocaine HCl|No|No|No|No|75%|00054350547|LIDOCAINE HCL 4% SOLUTION|50|ML|.344|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.24656||.24064||.24237|||||696|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00054353244|LORAZEPAM INTENSOL 2 MG/ML|30|ML|.45221|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.||.||.||||ANXIOLYTICS|697|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
meperidine HCl|No|No|No|No|90%|00054354563|MEPERIDINE 50 MG/5 ML SOLUTION|500|ML|.07258|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|11/17/2006|109|Yes|.15854||.15474||.15584||||ANALGESICS, NARCOTICS SHORT|698|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054355344|METHADONE INTENSOL 10 MG/ML|30|ML|.29068|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.54357||.53052||.53433||||ANALGESICS, NARCOTICS LONG|699|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054355563|METHADONE 5 MG/5 ML SOLUTION|500|ML|.02743|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.05665||.05529||.05569||||ANALGESICS, NARCOTICS LONG|700|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054355663|METHADONE 10 MG/5 ML SOLUTION |500|ML|.04752|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.10831||.10676||.10168||||ANALGESICS, NARCOTICS LONG|701|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00054363063|NAPROXEN 125 MG/5 ML SUSPEN   |500|ML|.77094|06/08/2021||Yes|No||06/08/2021||Yes|No|06/08/2021||Yes|No||06/08/2021||Yes|No|||Prescription Required|Yes|01/15/2014|059|Yes|.37204||.36311||.36572||||NSAIDS|702|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
prednisone|No|No|No|No|75%|00054372144|PREDNISONE INTENSOL 5 MG/ML|30|ML|1.86333|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|168|Yes|.||.||.||||GLUCOCORTICOIDS, ORAL|703|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054372250|PREDNISONE 5 MG/5 ML SOLUTION|120|ML|.28666|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.3672||.35839||.36096||||GLUCOCORTICOIDS, ORAL|704|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054372263|PREDNISONE 5 MG/5 ML SOLUTION|500|ML|.2666|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.59424||.57998||.58414||||GLUCOCORTICOIDS, ORAL|705|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
propranolol HCl|No|No|No|No|75%|00054372763|PROPRANOLOL 20 MG/5 ML SOLN|500|ML|.04158|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.09551||.09322||.09389||||BETA-BLOCKERS|706|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00054373063|PROPRANOLOL 40 MG/5 ML SOLN   |500|ML|.05925|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.12488||.12188||.12276||||BETA-BLOCKERS|707|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
clotrimazole|No|No|No|No|75%|00054414622|CLOTRIMAZOLE 10 MG TROCHE|70|EA|.85091|10/03/2006||Yes|No||10/03/2006||Yes|No|10/03/2006||Yes|No||10/03/2006||Yes|No|||Prescription Required|No|07/12/2005|069|No|.35212||.34367||.34613||||ANTIFUNGALS, ORAL|708|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
clotrimazole|No|No|No|No|75%|00054414623|CLOTRIMAZOLE 10 MG TROCHE|140|EA|.74722|10/03/2006||Yes|No||10/03/2006||Yes|No|10/03/2006||Yes|No||10/03/2006||Yes|No|||Prescription Required|No|07/12/2005|069|No|.35212||.34367||.34613||||ANTIFUNGALS, ORAL|709|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054417925|DEXAMETHASONE 0.5 MG TABLET|100|EA|.04949|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.09507||.09279||.09345||||GLUCOCORTICOIDS, ORAL|710|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418025|DEXAMETHASONE 0.75 MG TABLET|100|EA|.08871|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.12734||.12428||.12518||||GLUCOCORTICOIDS, ORAL|711|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418125|DEXAMETHASONE 1 MG TABLET|100|EA|.10655|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.21813||.21289||.21442||||GLUCOCORTICOIDS, ORAL|712|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418225|DEXAMETHASONE 1.5 MG TABLET|100|EA|.17093|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.27409||.26751||.26943||||GLUCOCORTICOIDS, ORAL|713|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418325|DEXAMETHASONE 2 MG TABLET|100|EA|.21311|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.25707||.2509||.2527||||GLUCOCORTICOIDS, ORAL|714|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418425|DEXAMETHASONE 4 MG TABLET|100|EA|.42622|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.24359||.23774||.23945||||GLUCOCORTICOIDS, ORAL|715|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418625|DEXAMETHASONE 6 MG TABLET|100|EA|.63932|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.57422||.56044||.56446||||GLUCOCORTICOIDS, ORAL|716|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054429725|FUROSEMIDE 20 MG TABLET|100|EA|.02352|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.0194||.01893||.01907|||||717|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054429731|FUROSEMIDE 20 MG TABLET|1000|EA|.01552|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.0194||.01893||.01907|||||718|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054429925|FUROSEMIDE 40 MG TABLET|100|EA|.04941|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.02611||.02548||.02567|||||719|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054429931|FUROSEMIDE 40 MG TABLET|1000|EA|.02322|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.02611||.02548||.02567|||||720|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054430125|FUROSEMIDE 80 MG TABLET|100|EA|.05513|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.03891||.03798||.03825|||||721|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054430129|FUROSEMIDE 80 MG TABLET|500|EA|.03268|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.03891||.03798||.03825|||||722|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449613|LEUCOVORIN CALCIUM 5 MG TAB|30|EA|.48045|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.42675||.41651||.4195|||||723|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449625|LEUCOVORIN CALCIUM 5 MG TAB|100|EA|.46814|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.42675||.41651||.4195|||||724|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449705|LEUCOVORIN CALCIUM 10 MG TAB|12|EA|2.67926|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|2.834||2.76598||2.78582|||||725|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449710|LEUCOVORIN CALCIUM 10 MG TAB|24|EA|2.38184|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|2.834||2.76598||2.78582|||||726|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449810|LEUCOVORIN CALCIUM 15 MG TAB  |24|EA|2.27685|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|2.8859||2.81664||2.83684|||||727|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449911|LEUCOVORIN CALCIUM 25 MG TAB|25|EA|4.85814|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|3.22627||3.14884||3.17142|||||728|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054452725|LITHIUM CARBONATE 300 MG TAB|100|EA|.09142|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.1531||.14943||.1505|||||729|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054452731|LITHIUM CARBONATE 300 MG TAB|1000|EA|.08877|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.1531||.14943||.1505|||||730|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054453825|DISKETS 40 MG TABLET DISPR    |100|EA|.10991|05/31/2005||Yes|No||05/31/2005||Yes|No|05/31/2005||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|110|Yes|.25049||.24691||.23515||||ANALGESICS, NARCOTICS LONG|731|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methotrexate sodium|No|No|No|No|75%|00054455015|METHOTREXATE 2.5 MG TABLET|36|EA|.77639|07/27/2010|10/31/2024|Yes|No||07/27/2010|10/31/2024|Yes|No|07/27/2010|10/31/2024|Yes|No||||No|No|||Prescription Required|No|||No|1.76944||1.74416||1.66111|||||732|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
methotrexate sodium|No|No|No|No|75%|00054455025|METHOTREXATE 2.5 MG TABLET|100|EA|.75934|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.16189||.158||.15914|||||733|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
mercaptopurine|No|No|No|No|75%|00054458111|MERCAPTOPURINE 50 MG TABLET|25|EA|1.3631|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|1.48573||1.45007||1.46047||||ONCOLOGY, ORAL - HEMATOLOGIC|734|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
mercaptopurine|No|No|No|No|75%|00054458127|MERCAPTOPURINE 50 MG TABLET|250|EA|1.22679|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|1.48573||1.45007||1.46047||||ONCOLOGY, ORAL - HEMATOLOGIC|735|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
prednisone|No|No|No|No|75%|00054472825|PREDNISONE 5 MG TABLET|100|EA|.07779|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.17728||.17475||.16643||||GLUCOCORTICOIDS, ORAL|736|||||No|No||ROXANE/WEST-WAR|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054472831|PREDNISONE 5 MG TABLET|1000|EA|.07701|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.03916||.03822||.03849||||GLUCOCORTICOIDS, ORAL|737|||||No|No||ROXANE/WEST-WAR|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054474125|PREDNISONE 1 MG TABLET|100|EA|.08699|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.03996||.039||.03928||||GLUCOCORTICOIDS, ORAL|738|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054474131|PREDNISONE 1 MG TABLET|1000|EA|.08612|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.03996||.039||.03928||||GLUCOCORTICOIDS, ORAL|739|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054474225|PREDNISONE 2.5 MG TABLET|100|EA|.05667|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.05882||.05741||.05782||||GLUCOCORTICOIDS, ORAL|740|||||No|No||ROXANE/WEST-WAR|Yes|09/01/2020||||Yes|No|No||
triazolam|No|No|No|No|90%|00054485825|TRIAZOLAM 0.125 MG TABLET|100|EA|1.26141|03/07/2019||Yes|No||03/07/2019||Yes|No|03/07/2019||Yes|No||||No|No|||Prescription Required|No|07/26/2018|054|Yes|.24415||.23829||.24||||SEDATIVE HYPNOTICS|741|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
triazolam|No|No|No|No|90%|00054485925|TRIAZOLAM 0.25 MG TABLET|100|EA|1.26141|03/07/2019||Yes|No||03/07/2019||Yes|No|03/07/2019||Yes|No||||No|No|||Prescription Required|No|07/26/2018|054|Yes|.23798||.23227||.23393||||SEDATIVE HYPNOTICS|742|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
triazolam|No|No|No|No|90%|00054485929|TRIAZOLAM 0.25 MG TABLET|500|EA|.63072|07/01/2016||Yes|No||07/01/2016||Yes|No|07/01/2016||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.23798||.23227||.23393||||SEDATIVE HYPNOTICS|743|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
clotrimazole|No|No|No|No|75%|00054814622|CLOTRIMAZOLE 10 MG TROCHE|70|EA|1.18176|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|07/12/2005|069|No|.35212||.34367||.34613||||ANTIFUNGALS, ORAL|744|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054817425|DEXAMETHASONE 1 MG TABLET|100|EA|.13291|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.21813||.21289||.21442||||GLUCOCORTICOIDS, ORAL|745|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054817525|DEXAMETHASONE 4 MG TABLET|100|EA|.43163|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.24359||.23774||.23945||||GLUCOCORTICOIDS, ORAL|746|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054817625|DEXAMETHASONE 2 MG TABLET|100|EA|.26583|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.25707||.2509||.2527||||GLUCOCORTICOIDS, ORAL|747|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054817925|DEXAMETHASONE 0.5 MG TABLET|100|EA|.07409|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.09507||.09279||.09345||||GLUCOCORTICOIDS, ORAL|748|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054818025|DEXAMETHASONE 0.75 MG TABLET|100|EA|.0952|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.12734||.12428||.12518||||GLUCOCORTICOIDS, ORAL|749|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054818125|DEXAMETHASONE 1.5 MG TABLET|100|EA|.19634|01/20/2011||Yes|No||01/20/2011||Yes|No|02/16/2001||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.27409||.26751||.26943||||GLUCOCORTICOIDS, ORAL|750|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054818325|DEXAMETHASONE 6 MG TABLET|100|EA|.67914|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.57422||.56044||.56446||||GLUCOCORTICOIDS, ORAL|751|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054829725|FUROSEMIDE 20 MG TABLET|100|EA|.07237|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription Required|No|||No|.0194||.01893||.01907|||||752|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054829925|FUROSEMIDE 40 MG TABLET|100|EA|.08114|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription Required|No|||No|.02611||.02548||.02567|||||753|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054830125|FUROSEMIDE 80 MG TABLET|100|EA|.16757|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription Required|No|||No|.03891||.03798||.03825|||||754|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054849619|LEUCOVORIN CALCIUM 5 MG TAB|50|EA|.67716|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||||No|No|||Prescription Required|No|||No|.42675||.41651||.4195|||||755|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054852625|LITHIUM CARBONATE 150 MG CAP|100|EA|.06459|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription Required|No|||No|.07826||.07638||.07693|||||756|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054852725|LITHIUM CARBONATE 300 MG CAP|100|EA|.12612|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription Required|No|||No|.08126||.07931||.07988|||||757|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054852825|LITHIUM CARBONATE 300 MG TAB|100|EA|.11546|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription Required|No|||No|.1531||.14943||.1505|||||758|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methotrexate sodium|No|No|No|No|75%|00054855025|METHOTREXATE 2.5 MG TABLET|100|EA|1.31021|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription Required|No|||No|.16189||.158||.15914|||||759|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054872425|PREDNISONE 5 MG TABLET|100|EA|.08557|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.03916||.03822||.03849||||GLUCOCORTICOIDS, ORAL|760|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||Yes|No|No||
prednisone|No|No|No|No|75%|00054873925|PREDNISONE 1 MG TABLET|100|EA|.09568|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.21805||.21494||.2047||||GLUCOCORTICOIDS, ORAL|761|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054874025|PREDNISONE 2.5 MG TABLET|100|EA|.06239|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription Required|No|01/15/2014|168|Yes|.05882||.05741||.05782||||GLUCOCORTICOIDS, ORAL|762|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
sodium oxybate|No|No|No|No|75%|00054962857|SODIUM OXYBATE 0.5 G/ML SOLN|180|ML|13.84554|10/31/2023||Yes|No||10/31/2023||Yes|No|10/31/2023||Yes|No||||No|No|||Prescription Required|No|||Yes|31.55496||31.10418||29.62302|||||763|||||No|No||HIKMA PHARMACEU|No|||||No|No|Yes|10/16/2024|
prednisone|No|No|No|No|75%|00054981725|PREDNISONE 10 MG TABLET|100|EA|.08351|04/01/2021||Yes|No||04/01/2021||Yes|No|04/01/2021||Yes|No||04/01/2021||Yes|No|||Prescription Required|No|01/30/2020|168|Yes|.04042||.03945||.03973||||GLUCOCORTICOIDS, ORAL|764|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054981729|PREDNISONE 10 MG TABLET|500|EA|.08267|04/01/2021||Yes|No||04/01/2021||Yes|No|04/01/2021||Yes|No||04/01/2021||Yes|No|||Prescription Required|No|01/30/2020|168|Yes|.04042||.03945||.03973||||GLUCOCORTICOIDS, ORAL|765|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054982825|PREDNISONE 5 MG TABLET|100|EA|.07779|04/30/2021||Yes|No||04/30/2021||Yes|No|04/30/2021||Yes|No||04/30/2021||Yes|No|||Prescription Required|No|01/28/2021|168|Yes|.03916||.03822||.03849||||GLUCOCORTICOIDS, ORAL|766|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054982831|PREDNISONE 5 MG TABLET|1000|EA|.07701|04/30/2021||Yes|No||04/30/2021||Yes|No|04/30/2021||Yes|No||04/30/2021||Yes|No|||Prescription Required|No|01/28/2021|168|Yes|.03916||.03822||.03849||||GLUCOCORTICOIDS, ORAL|767|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
naltrexone HCl|No|No|No|No|75%|00056001176|NALTREXONE HCL|100|EA||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|||No|.7816||.7816||.7816||.7816|10/01/2020||768|||||No|No|||Yes|10/01/2020||||No|No|No||
cyclopentolate/phenylephrine|No|No|No|No|75%|00065035905|CYCLOMYDRIL EYE DROPS|5|ML|5.32684|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|12.14024||11.96681||11.39696|||||769|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039515|CYCLOGYL 0.5% EYE DROPS|15|ML|2.76404|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|6.29944||6.20945||5.91376|||||770|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039605|CYCLOGYL 1% EYE DROPS|5|ML|5.21762|01/02/2008||Yes|No||01/02/2008||Yes|No|01/02/2008||Yes|No||||No|No|||Prescription Required|No|||No|11.89132||11.72144||11.16328|||||771|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039705|CYCLOGYL 2% EYE DROPS|5|ML|6.278|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|14.308||14.1036||13.432|||||772|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039715|CYCLOGYL 2% EYE DROPS|15|ML|3.47583|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|7.92166||7.8085||7.43666|||||773|||||No|No||ALCON LABORATOR|No|||||No|No|No||
olopatadine HCl|No|No|No|No|75%|00065081604|PATADAY ONCE DAILY 0.7% DROPS|2.5|ML|2.6746|03/04/2021||Yes|No||||No|No|03/04/2021||Yes|No||||No|No|||Over The Counter|No|07/29/2021|002|No|6.20667||6.05771||6.10116||.|04/22/2024|OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|774|||||No|No||ALCON LABORATOR|No|||||No|Yes|No||
brinzolamide/brimonidine tart|No|No|No|No|75%|00065414727|SIMBRINZA 1%-0.2% EYE DROP|8|ML|11.13001|08/17/2022||Yes|No||08/17/2022||Yes|No|08/17/2022||Yes|No||||No|No|||Prescription Required|No|01/15/2014|088|No|24.84404||24.24778||24.42169||||OPHTHALMICS, GLAUCOMA AGENTS|775|||||No|No||ALCON LABORATOR|No|||||No|No|No||
olopatadine HCl|No|No|No|No|75%|00065815001|PATADAY ONCE DAILY 0.2% DROPS|2.5|ML|2.5542|03/04/2021||Yes|No||||No|No|03/04/2021||Yes|No||||No|No|||Over The Counter|Yes|01/28/2021|002|No|5.9326||5.79022||5.83175||||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|776|||||No|No||ALCON LABORATOR|No|||||No|Yes|No||
rifampin|No|No|No|No|75%|00068059701|RIFADIN IV 600 MG VIAL        |1|EA|76.7808|01/27/2010||Yes|No||01/27/2010||Yes|No|01/27/2010||Yes|No||||No|No|||Prescription Required|No|||No|174.9888||172.48896||164.2752|||||777|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
rifampin|No|No|No|No|75%|00068059901|RIFADIN IV 600 MG VIAL|1|EA|76.7808|01/05/2018||Yes|No||01/05/2018||Yes|No|01/05/2018||Yes|No||||No|No|||Prescription Required|No|||No|174.9888||172.48896||164.2752|||||778|||||No|No||SANOFI-AV-NOVAP|No|||||No|No|No||
taliglucerase alfa|No|No|No|No|75%|00069010601|ELELYSO 200 UNITS VIAL|1|EA|375.2481|01/08/2013||Yes|No||01/08/2013||Yes|No|01/08/2013||Yes|No||||No|No|||Prescription Required|No|||Yes|855.2166||842.99922||802.8564|||||779|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
bosutinib|No|No|No|No|75%|00069013501|BOSULIF 100 MG TABLET|120|EA|71.90703|11/22/2013||Yes|No||11/22/2013||Yes|No|11/22/2013||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|163.88115||161.53999||153.84761||||ONCOLOGY, ORAL - HEMATOLOGIC|780|||||No|No||PFIZER US PHARM|No|||||No|No|No||
bosutinib|No|No|No|No|75%|00069013601|BOSULIF 500 MG TABLET|30|EA|287.62814|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|655.52461||646.15997||615.39045||||ONCOLOGY, ORAL - HEMATOLOGIC|781|||||No|No||PFIZER US PHARM|No|||||No|No|No||
axitinib|No|No|No|No|75%|00069014501|INLYTA 1 MG TABLET|180|EA|49.08132|06/15/2012||Yes|No||06/15/2012||Yes|No|06/15/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|111.85976||110.26176||105.0112||||ONCOLOGY, ORAL - RENAL CELL|782|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
axitinib|No|No|No|No|75%|00069015111|INLYTA 5 MG TABLET|60|EA|147.24397|06/15/2012||Yes|No||06/15/2012||Yes|No|06/15/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|335.57927||330.78528||315.0336||||ONCOLOGY, ORAL - RENAL CELL|783|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
palbociclib|No|No|No|No|75%|00069018721|IBRANCE 75 MG CAPSULE|21|EA|327.25846|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|745.84487||735.18994||700.18089||||ONCOLOGY, ORAL - BREAST|784|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
palbociclib|No|No|No|No|75%|00069018821|IBRANCE 100 MG CAPSULE|21|EA|327.25846|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|745.84487||735.18994||700.18089||||ONCOLOGY, ORAL - BREAST|785|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
palbociclib|No|No|No|No|75%|00069018921|IBRANCE 125 MG CAPSULE|21|EA|327.25846|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|745.84487||735.18994||700.18089||||ONCOLOGY, ORAL - BREAST|786|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
bosutinib|No|No|No|No|75%|00069019301|BOSULIF 400 MG TABLET|30|EA|287.62814|08/23/2022||Yes|No||08/23/2022||Yes|No|08/23/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|655.52461||646.15997||615.39045||||ONCOLOGY, ORAL - HEMATOLOGIC|787|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069019502|FRAGMIN 2,500 UNIT/0.2 ML SYR|0.2|ML|80.02085|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|068|Yes|182.3731||179.76777||171.2074||||ANTICOAGULANTS|788|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069019602|FRAGMIN 5,000 UNIT/0.2 ML SYR|0.2|ML|129.82345|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|068|Yes|295.8767||291.64989||277.7618||||ANTICOAGULANTS|789|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dacomitinib|No|No|No|No|75%|00069019730|VIZIMPRO 15 MG TABLET|30|EA|229.75172|03/18/2019||Yes|No||03/18/2019||Yes|No|03/18/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|523.6202||516.13991||491.56182||||ONCOLOGY, ORAL - LUNG|790|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069020602|FRAGMIN 7,500 UNIT/0.3 ML SYR|0.3|ML|129.8385|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|068|Yes|295.911||291.6837||277.794||||ANTICOAGULANTS|791|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069021702|FRAGMIN 10,000 UNIT/ML SYRINGE|1|ML|51.92981|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|068|Yes|118.35166||116.66092||111.10564||||ANTICOAGULANTS|792|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069022002|FRAGMIN 12,500 UNIT/0.5 ML SYR|0.5|ML|129.8342|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|068|Yes|295.9012||291.67404||277.7848||||ANTICOAGULANTS|793|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069022302|FRAGMIN 15,000 UNIT/0.6 ML SYR|0.6|ML|129.8256|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|068|Yes|295.8816||291.65472||277.7664||||ANTICOAGULANTS|794|||||No|No||PFIZER US PHARM|No|||||No|No|No||
lorlatinib|No|No|No|No|75%|00069022701|LORBRENA 25 MG TABLET|30|EA|102.05104|11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|232.58144||229.25885||218.34176||||ONCOLOGY, ORAL - LUNG|795|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069022802|FRAGMIN 18,000 UNIT/0.72 ML|0.72|ML|129.82596|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|068|Yes|295.88241||291.65552||277.76716||||ANTICOAGULANTS|796|||||No|No||PFIZER US PHARM|No|||||No|No|No||
lorlatinib|No|No|No|No|75%|00069023101|LORBRENA 100 MG TABLET|30|EA|306.1524|11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|697.74268||687.77493||655.02374||||ONCOLOGY, ORAL - LUNG|797|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069023201|FRAGMIN 95,000 UNIT/3.8 ML VL|3.8|ML|117.46355|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|068|Yes|267.70763||263.88323||251.31737||||ANTICOAGULANTS|798|||||No|No||PFIZER US PHARM|No|||||No|No|No||
abrocitinib|No|No|No|No|75%|00069023530|CIBINQO 50 MG TABLET|30|EA|79.79825|03/29/2023||Yes|No||03/29/2023||Yes|No|03/29/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|071|Yes|181.86578||179.2677||170.73114||||CYTOKINE AND CAM ANTAGONISTS|799|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fesoterodine fumarate|No|No|No|No|75%|00069024230|TOVIAZ ER 4 MG TABLET|30|EA|4.1558|02/24/2009||Yes|No||02/24/2009||Yes|No|02/24/2009||Yes|No||||No|No|||Prescription Required|No|01/25/2012|006|No|9.26001||9.03777||9.10259||||BLADDER RELAXANT PREPARATIONS|800|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fesoterodine fumarate|No|No|No|No|75%|00069024430|TOVIAZ ER 8 MG TABLET|30|EA|4.1558|02/24/2009||Yes|No||02/24/2009||Yes|No|02/24/2009||Yes|No||||No|No|||Prescription Required|No|01/25/2012|006|No|9.27277||9.05022||9.11513||||BLADDER RELAXANT PREPARATIONS|801|||||No|No||PFIZER US PHARM|No|||||No|No|No||
crizotinib|No|No|No|No|75%|00069025160|XALKORI 20 MG PELLET|60|EA|16.07297|11/27/2024||Yes|No||11/27/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|08/08/2024|551|No|36.63142||36.10811||34.38868||||ONCOLOGY, ORAL - LUNG|802|||||No|No||PFIZER LABS.|No|||||No|No|No||
palbociclib|No|No|No|No|75%|00069028403|IBRANCE 75 MG TABLET|21|EA|327.25846|04/30/2020||Yes|No||04/30/2020||Yes|No|04/30/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|745.84487||735.18994||700.18089||||ONCOLOGY, ORAL - BREAST|803|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
filgrastim-aafi|No|No|No|No|75%|00069029101|NIVESTYM 300 MCG/0.5 ML SYRING|0.5|ML|188.34|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|148|No|429.24||423.108||402.96||||COLONY STIMULATING FACTORS|804|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029110|NIVESTYM 300 MCG/0.5 ML SYRING|0.5|ML|188.34|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|148|No|429.24||423.108||402.96||||COLONY STIMULATING FACTORS|805|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029201|NIVESTYM 480 MCG/0.8 ML SYRING|0.8|ML|188.34|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|148|No|429.24||423.108||402.96||||COLONY STIMULATING FACTORS|806|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029210|NIVESTYM 480 MCG/0.8 ML SYRING|0.8|ML|188.34|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|148|No|429.24||423.108||402.96||||COLONY STIMULATING FACTORS|807|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029301|NIVESTYM 300 MCG/ML VIAL|1|ML||02/06/2023||Yes|No||02/06/2023||Yes|No|02/06/2023||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|148|No|214.62||214.62||214.62||214.62|02/06/2023|COLONY STIMULATING FACTORS|808|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029310|NIVESTYM 300 MCG/ML VIAL|1|ML|94.17|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|148|No|214.62||211.554||201.48||||COLONY STIMULATING FACTORS|809|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029401|NIVESTYM 480 MCG/1.6 ML VIAL|1.6|ML||02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|148|No|214.62||214.62||214.62||214.62|02/16/2023|COLONY STIMULATING FACTORS|810|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029410|NIVESTYM 480 MCG/1.6 ML VIAL|1.6|ML|94.17|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|148|No|214.62||211.554||201.48||||COLONY STIMULATING FACTORS|811|||||No|No||PFIZER US PHARM|No|||||No|No|No||
talazoparib tosylate|No|No|No|No|75%|00069029630|TALZENNA 0.25 MG CAPSULE|30|EA|86.18877|02/27/2019||Yes|No||02/27/2019||Yes|No|02/27/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|196.43022||193.62407||184.40388||||ONCOLOGY, ORAL - BREAST|812|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/31/2022|
glasdegib maleate|No|No|No|No|75%|00069029860|DAURISMO 25 MG TABLET|60|EA|154.03525|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|351.05707||346.04197||329.56378||||ONCOLOGY, ORAL - HEMATOLOGIC|813|||||No|No||PFIZER US PHARM|No|||||No|No|No||
pegfilgrastim-apgf|No|No|No|No|75%|00069032401|NYVEPRIA 6 MG/0.6 ML SYRINGE|0.6|ML|2812.91666|02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription Required|No|01/26/2023|148|No|6410.83333||6319.24999||6018.33333||||COLONY STIMULATING FACTORS|814|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ritlecitinib tosylate|No|No|No|No|75%|00069033428|LITFULO 50 MG CAPSULE|28|EA|60.77881|11/27/2023||Yes|No||11/27/2023||Yes|No|11/27/2023||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|071|No|138.51915||136.5403||130.03838||||CYTOKINE AND CAM ANTAGONISTS|815|||||No|No||PFIZER US PHARM|No|||||No|No|No||
abrocitinib|No|No|No|No|75%|00069033530|CIBINQO 100 MG TABLET|30|EA|79.79825|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|071|Yes|180.09547||175.77318||177.03385||||CYTOKINE AND CAM ANTAGONISTS|816|||||No|No||PFIZER US PHARM|No|||||No|No|No||
sildenafil citrate|No|No|No|No|75%|00069033621|REVATIO 10 MG/ML ORAL SUSP|112|ML|39.05728|01/16/2015||Yes|No||01/16/2015||Yes|No|01/16/2015||Yes|No||||No|No|||Prescription Required|No|07/30/2020|171|Yes|88.22406||86.10668||86.72425||||PAH AGENTS, ORAL AND INHALED|817|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
abrocitinib|No|No|No|No|75%|00069043530|CIBINQO 200 MG TABLET|30|EA|79.79825|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|071|Yes|181.86578||179.2677||170.73114||||CYTOKINE AND CAM ANTAGONISTS|818|||||No|No||PFIZER US PHARM|No|||||No|No|No||
varenicline tartrate|No|No|No|No|75%|00069046956|CHANTIX 1 MG TABLET|56|EA|3.60371|09/17/2022||Yes|No||09/17/2022||Yes|No|09/17/2022||Yes|No||||No|No|||Prescription Required|No|07/17/2014|040|No|8.2131||8.09577||7.71025||||SMOKING CESSATION|819|||||No|No||PFIZER US PHARM|Yes|09/17/2022||||No|No|No||
varenicline tartrate|No|No|No|No|75%|00069047103|CHANTIX STARTING MONTH BOX|53|EA|3.80769|09/17/2022||Yes|No||09/17/2022||Yes|No|09/17/2022||Yes|No||||No|No|||Prescription Required|No|07/23/2015|040|No|8.67799||8.55402||8.14668||||SMOKING CESSATION|820|||||No|No||PFIZER US PHARM|Yes|09/17/2022||||No|No|No||
palbociclib|No|No|No|No|75%|00069048603|IBRANCE 100 MG TABLET|21|EA|327.25846|04/30/2020||Yes|No||04/30/2020||Yes|No|04/30/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|745.84487||735.18994||700.18089||||ONCOLOGY, ORAL - BREAST|821|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
tofacitinib citrate|No|No|No|No|75%|00069050130|XELJANZ XR 11 MG TABLET|30|EA|82.90314|07/17/2017||Yes|No||07/17/2017||Yes|No|07/17/2017||Yes|No||||No|No|||Prescription Required|Yes|01/26/2017|071|Yes|187.43198||182.93361||184.24564||||CYTOKINE AND CAM ANTAGONISTS|822|||||No|No||PFIZER US PHARM|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00069055038|SUTENT 12.5 MG CAPSULE|28|EA|99.15216|08/10/2006||Yes|No||08/10/2006||Yes|No|08/10/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|222.40627||217.06852||218.62536||||ONCOLOGY, ORAL - RENAL CELL|823|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|06/17/2019|
palbociclib|No|No|No|No|75%|00069068803|IBRANCE 125 MG TABLET|21|EA|327.25846|04/30/2020||Yes|No||04/30/2020||Yes|No|04/30/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|745.84487||735.18994||700.18089||||ONCOLOGY, ORAL - BREAST|824|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
sunitinib malate|No|No|No|No|75%|00069077038|SUTENT 25 MG CAPSULE|28|EA|198.30464|08/10/2006||Yes|No||08/10/2006||Yes|No|08/10/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|449.06387||438.28634||441.42978||||ONCOLOGY, ORAL - RENAL CELL|825|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/31/2022|
sunitinib malate|No|No|No|No|75%|00069083038|SUTENT 37.5 MG CAPSULE|28|EA|297.45695|03/05/2015||Yes|No||03/05/2015||Yes|No|03/05/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|677.92514||668.2405||636.41952||||ONCOLOGY, ORAL - RENAL CELL|826|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/31/2022|
doxycycline hyclate|Yes|No|No|No|75%|00069095050|VIBRAMYCIN 100 MG CAPSULE|50|EA|.39121|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|11/01/2012||Prescription Required|Yes|02/02/2010|213|No|.8916||.87887||.83702||||TETRACYCLINES|827|||||No|No||PFIZER US PHARM|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00069098038|SUTENT 50 MG CAPSULE|28|EA|345.22028|08/09/2006||Yes|No||08/09/2006||Yes|No|08/09/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|786.78109||775.54136||738.61082||||ONCOLOGY, ORAL - RENAL CELL|828|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/31/2022|
tofacitinib citrate|No|No|No|No|75%|00069100101|XELJANZ 5 MG TABLET|60|EA|41.45157|02/11/2013||Yes|No||02/11/2013||Yes|No|02/11/2013||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|071|Yes|93.57138||91.32567||91.98067||||CYTOKINE AND CAM ANTAGONISTS|829|||||No|No||PFIZER US PHARM|No|||||No|No|No||
tofacitinib citrate|No|No|No|No|75%|00069100201|XELJANZ 10 MG TABLET|60|EA|41.45157|11/29/2018||Yes|No||11/29/2018||Yes|No|11/29/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|071|Yes|93.80967||91.55824||92.21491||||CYTOKINE AND CAM ANTAGONISTS|830|||||No|No||PFIZER US PHARM|No|||||No|No|No||
tofacitinib citrate|No|No|No|No|75%|00069102902|XELJANZ 1 MG/ML SOLUTION|240|ML|8.29031|09/21/2021||Yes|No||09/21/2021||Yes|No|09/21/2021||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|071|Yes|18.89419||18.62428||17.73741||||CYTOKINE AND CAM ANTAGONISTS|831|||||No|No||PFIZER US PHARM|No|||||No|No|No||
talazoparib tosylate|No|No|No|No|75%|00069103130|TALZENNA 0.1 MG CAPSULE|30|EA|258.56602|09/17/2024||Yes|No||09/17/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|07/28/2022|502|No|589.29||580.87157||553.21102||||ONCOLOGY, ORAL - BREAST|832|||||No|No||PFIZER US PHARM|No|||||No|No|No||
immun glob G(IgG)-hipp/maltose|No|No|No|No|75%|00069106102|CUTAQUIG 16.5% (1 G/6 ML) VIAL|6|ML|14.70456|02/27/2023||Yes|No||02/27/2023||Yes|No|02/27/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|023|No|33.51273||33.03397||31.46093||||IMMUNE GLOBULINS|833|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
talazoparib tosylate|No|No|No|No|75%|00069119530|TALZENNA 1 MG CAPSULE|30|EA|258.56602|02/27/2019||Yes|No||02/27/2019||Yes|No|02/27/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|589.29||580.87157||553.21102||||ONCOLOGY, ORAL - BREAST|834|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/31/2022|
dacomitinib|No|No|No|No|75%|00069119830|VIZIMPRO 30 MG TABLET|30|EA|229.75172|03/18/2019||Yes|No||03/18/2019||Yes|No|03/18/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|523.6202||516.13991||491.56182||||ONCOLOGY, ORAL - LUNG|835|||||No|No||PFIZER US PHARM|No|||||No|No|No||
talazoparib tosylate|No|No|No|No|75%|00069123530|TALZENNA 0.35 MG CAPSULE|30|EA|258.56602|09/09/2024||Yes|No||09/09/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|07/28/2022|502|No|589.29||580.87157||553.21102||||ONCOLOGY, ORAL - BREAST|836|||||No|No||PFIZER US PHARM|No|||||No|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130501|RETACRIT 2,000 UNIT/ML VIAL|1|ML||10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|21.61||21.61||21.61||21.61|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|837|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130510|RETACRIT 2,000 UNIT/ML VIAL|1|ML|9.4858|10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|21.6188||21.30996||20.2952||||ERYTHROPOIESIS STIMULATING PROTEINS|838|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130601|RETACRIT 3,000 UNIT/ML VIAL|1|ML||10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|32.42||32.42||32.42||32.42|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|839|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130610|RETACRIT 3,000 UNIT/ML VIAL|1|ML|14.2287|10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|32.4282||31.96494||30.4428||||ERYTHROPOIESIS STIMULATING PROTEINS|840|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130701|RETACRIT 4,000 UNIT/ML VIAL|1|ML||10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|43.23||43.23||43.23||43.23|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|841|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130710|RETACRIT 4,000 UNIT/ML VIAL|1|ML|18.9716|10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|43.2376||42.61992||40.5904||||ERYTHROPOIESIS STIMULATING PROTEINS|842|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130801|RETACRIT 10,000 UNIT/ML VIAL|1|ML||10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|108.09||108.09||108.09||108.09|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|843|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130810|RETACRIT 10,000 UNIT/ML VIAL|1|ML|47.429|10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|107.7634||105.17708||105.93142||||ERYTHROPOIESIS STIMULATING PROTEINS|844|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130901|RETACRIT 40,000 UNIT/ML VIAL|1|ML||10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|432.37||432.37||432.37||432.37|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|845|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
epoetin alfa-epbx|No|No|No|No|75%|00069130904|RETACRIT 40,000 UNIT/ML VIAL|1|ML|189.716|10/07/2020||Yes|No||10/07/2020||Yes|No|10/07/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|038|Yes|432.376||426.1992||405.904||||ERYTHROPOIESIS STIMULATING PROTEINS|846|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
immun glob G(IgG)-hipp/maltose|No|No|No|No|75%|00069147602|CUTAQUIG 16.5% (2 G/12 ML) VL|12|ML|14.70456|02/27/2023||Yes|No||02/27/2023||Yes|No|02/27/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|023|No|33.51273||33.03397||31.46093||||IMMUNE GLOBULINS|847|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
talazoparib tosylate|No|No|No|No|75%|00069150130|TALZENNA 0.5 MG CAPSULE|30|EA|258.56602|09/09/2024||Yes|No||09/09/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|07/29/2021|502|No|589.29||580.87157||553.21102||||ONCOLOGY, ORAL - BREAST|848|||||No|No||PFIZER US PHARM|No|||||No|No|No||
immun glob G(IgG)-hipp/maltose|No|No|No|No|75%|00069150902|CUTAQUIG 16.5% (4 G/24 ML) VL|24|ML|14.70456|02/27/2023||Yes|No||02/27/2023||Yes|No|02/27/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|023|No|33.51273||33.03397||31.46093||||IMMUNE GLOBULINS|849|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
amlodipine besylate|No|No|No|No|75%|00069152068|NORVASC 2.5 MG TABLET|90|EA|3.64277|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/23/2008|045|No|8.07554||7.88173||7.93826||||CALCIUM CHANNEL BLOCKERS|850|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine besylate|No|No|No|No|75%|00069153068|NORVASC 5 MG TABLET|90|EA|3.64277|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/23/2008|045|No|8.37839||8.17731||8.23596||||CALCIUM CHANNEL BLOCKERS|851|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine besylate|No|No|No|No|75%|00069153072|NORVASC 5 MG TABLET|300|EA|3.64277|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/23/2008|045|No|8.37839||8.17731||8.23596||||CALCIUM CHANNEL BLOCKERS|852|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
glasdegib maleate|No|No|No|No|75%|00069153130|DAURISMO 100 MG TABLET|30|EA|308.07049|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|702.11414||692.08394||659.12756||||ONCOLOGY, ORAL - HEMATOLOGIC|853|||||No|No||PFIZER US PHARM|No|||||No|No|No||
amlodipine besylate|No|No|No|No|75%|00069154068|NORVASC 10 MG TABLET|90|EA|4.99421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/23/2008|045|No|11.13053||10.8634||10.94131||||CALCIUM CHANNEL BLOCKERS|854|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
talazoparib tosylate|No|No|No|No|75%|00069175130|TALZENNA 0.75 MG CAPSULE|30|EA|258.56602|09/09/2024||Yes|No||09/09/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|07/29/2021|502|No|589.29||580.87157||553.21102||||ONCOLOGY, ORAL - BREAST|855|||||No|No||PFIZER US PHARM|No|||||No|No|No||
immun glob G(IgG)-hipp/maltose|No|No|No|No|75%|00069196502|CUTAQUIG 16.5% (8 G/48 ML) VL|48|ML|14.70456|02/27/2023||Yes|No||02/27/2023||Yes|No|02/27/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|023|No|33.51273||33.03397||31.46093||||IMMUNE GLOBULINS|856|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
tafamidis meglumine|No|No|No|No|75%|00069197540|VYNDAQEL 20 MG CAPSULE|120|EA|80.02404|02/03/2020||Yes|No||02/03/2020||Yes|No|02/03/2020||Yes|No||||No|No|||Prescription Required|No|||No|182.38036||179.77493||171.21422|||||857|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dacomitinib|No|No|No|No|75%|00069229930|VIZIMPRO 45 MG TABLET|30|EA|229.75172|03/18/2019||Yes|No||03/18/2019||Yes|No|03/18/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|523.6202||516.13991||491.56182||||ONCOLOGY, ORAL - LUNG|858|||||No|No||PFIZER US PHARM|No|||||No|No|No||
COVID vac 24-25 (12up)(Pfi)/PF|Yes|No|No|No|75%|00069243201|COMIRNATY 2024-25(12Y UP) SYRG|0.3|ML||09/10/2024||Yes|No||09/10/2024||Yes|No|||No|No||||No|No|09/10/2024||Prescription Required|No|||No||||||||||859|||||No|No|30.00000|PFIZER US PHARM|No|||||Yes|Yes|No||
COVID vac 24-25 (12up)(Pfi)/PF|Yes|No|No|No|75%|00069243210|COMIRNATY 2024-25(12Y UP) SYRG|0.3|ML|350.53583|09/10/2024||Yes|No||09/10/2024||Yes|No|||No|No||||No|No|09/10/2024||Prescription Required|No|||No|446.71666||440.335||419.36666|||||860|||||No|No|30.00000|PFIZER US PHARM|No|||||Yes|Yes|No||
nifedipine|No|No|No|No|75%|00069265066|PROCARDIA XL 30 MG TABLET|100|EA|2.8411|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|02/23/2004|045|No|6.47506||6.38256||6.07862||||CALCIUM CHANNEL BLOCKERS|861|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069265072|PROCARDIA XL 30 MG TABLET|300|EA|2.84114|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|02/23/2004|045|No|6.47515||6.38265||6.07872||||CALCIUM CHANNEL BLOCKERS|862|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069266066|PROCARDIA XL 60 MG TABLET|100|EA|4.91649|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|02/23/2004|045|No|11.20503||11.04495||10.519||||CALCIUM CHANNEL BLOCKERS|863|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069266072|PROCARDIA XL 60 MG TABLET|300|EA|4.91652|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|02/23/2004|045|No|11.20508||11.04501||10.51906||||CALCIUM CHANNEL BLOCKERS|864|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069267066|PROCARDIA XL 90 MG TABLET|100|EA|5.67252|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|02/23/2004|045|No|12.92806||12.74338||12.13655||||CALCIUM CHANNEL BLOCKERS|865|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|Yes|No|No|No|75%|00069305107|ZITHROMAX 1 GM POWDER PACKET|10|EA|53.60767|10/28/2003||Yes|No||10/28/2003||Yes|No|10/28/2003||Yes|No||10/28/2003||Yes|No|11/01/2012||Prescription Required|Yes|05/25/2007|018|No|122.17562||120.43025||114.69548||||MACROLIDES/KETOLIDES|866|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|Yes|No|No|No|75%|00069305175|ZITHROMAX 1 GM POWDER PACKET|3|EA|10.621|10/23/2003||Yes|No||10/23/2003||Yes|No|10/23/2003||Yes|No||10/23/2003||Yes|No|11/01/2012||Prescription Required|Yes|05/25/2007|018|No|24.206||23.8602||22.724||||MACROLIDES/KETOLIDES|867|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|Yes|No|No|No|75%|00069306075|ZITHROMAX 250 MG Z-PAK TABLET|6|EA|.92904|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|11/01/2012||Prescription Required|Yes|07/18/2006|018|No|2.07324||2.02348||2.03799||||MACROLIDES/KETOLIDES|868|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|Yes|No|No|No|75%|00069307030|ZITHROMAX 500 MG TABLET|30|EA|1.28025|11/22/2005||Yes|No||11/22/2005||Yes|No|11/22/2005||Yes|No||11/22/2005||Yes|No|11/01/2012||Prescription Required|Yes|07/18/2006|018|No|2.91778||2.8761||2.73914||||MACROLIDES/KETOLIDES|869|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|Yes|No|No|No|75%|00069307075|ZITHROMAX TRI-PAK 500 MG TAB|3|EA|29.96526|04/16/2004||Yes|No||04/16/2004||Yes|No|04/16/2004||Yes|No||04/16/2004||Yes|No|11/01/2012||Prescription Required|Yes|07/18/2006|018|No|68.29293||67.31731||64.11173||||MACROLIDES/KETOLIDES|870|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00069311019|ZITHROMAX 100 MG/5 ML SUSP|15|ML|.7611|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|08/07/2010|018|No|1.7346||1.70982||1.6284||||MACROLIDES/KETOLIDES|871|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00069312019|ZITHROMAX 200 MG/5 ML SUSP|15|ML|1.45483|05/15/2008||Yes|No||05/15/2008||Yes|No|05/15/2008||Yes|No||05/15/2008||Yes|No|||Prescription Required|Yes|08/07/2010|018|No|3.31566||3.2683||3.11266||||MACROLIDES/KETOLIDES|872|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00069313019|ZITHROMAX 200 MG/5 ML SUSP|22.5|ML|.96989|05/15/2008||Yes|No||05/15/2008||Yes|No|05/15/2008||Yes|No||05/15/2008||Yes|No|||Prescription Required|Yes|08/07/2010|018|No|2.21044||2.17886||2.07511||||MACROLIDES/KETOLIDES|873|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00069314019|ZITHROMAX 200 MG/5 ML SUSP|30|ML|.38055|10/09/2003||Yes|No||10/09/2003||Yes|No|10/09/2003||Yes|No||10/09/2003||Yes|No|||Prescription Required|Yes|08/07/2010|018|No|.8673||.85491||.8142||||MACROLIDES/KETOLIDES|874|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00069315083|ZITHROMAX I.V. 500 MG VIAL|1|EA|2.6187|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|5.9682||5.88294||5.6028|||||875|||||No|No||PFIZER US PHARM|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00069322066|FELDENE 10 MG CAPSULE|100|EA|3.54109|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|059|Yes|8.0704||7.95511||7.57629||||NSAIDS|876|||||No|No||PFIZER US PHARM|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00069323066|FELDENE 20 MG CAPSULE|100|EA|6.06003|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|059|Yes|13.81124||13.61393||12.96565||||NSAIDS|877|||||No|No||PFIZER US PHARM|No|||||No|No|No||
zavegepant HCl|No|No|No|No|75%|00069350002|ZAVZPRET 10 MG NASAL SPRAY|6|EA|78.83333|12/15/2023||Yes|No||12/15/2023||Yes|No|||No|No||||No|No|||Prescription Required|Yes|01/25/2024|537|No|176.23293||172.00334||173.23697||||ANTIMIGRAINE AGENTS, OTHER|878|||||No|No||PFIZER US PHARM|No|||||No|No|No||
sildenafil citrate|No|No|No|No|75%|00069419068|REVATIO 20 MG TABLET|90|EA|26.5976|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No||||No|No|||Prescription Required|No|07/28/2022|171|Yes|60.61778||59.75181||56.90649||||PAH AGENTS, ORAL AND INHALED|879|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00069431071|MINIPRESS 1 MG CAPSULE|250|EA|.9955|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|2.26882||2.23641||2.12991|||||880|||||No|No||PFIZER US PHARM|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00069437071|MINIPRESS 2 MG CAPSULE|250|EA|1.38567|01/16/2004||Yes|No||01/16/2004||Yes|No|01/16/2004||Yes|No||01/16/2004||Yes|No|||Prescription Required|No|||No|3.15803||3.11292||2.96468|||||881|||||No|No||PFIZER US PHARM|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00069438071|MINIPRESS 5 MG CAPSULE|250|EA|2.36232|01/16/2004||Yes|No||01/16/2004||Yes|No|01/16/2004||Yes|No||01/16/2004||Yes|No|||Prescription Required|No|||No|5.38388||5.30697||5.05426|||||882|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069531720|PAXLOVID 150-100 MG DOSE PACK|20|EA|31.22983|01/04/2024||Yes|No||01/04/2024||Yes|No|01/04/2024||Yes|No||||No|No|||Prescription Required|No|||No|69.74186||68.06806||68.55625|||||883|||||No|No||PFIZER LABS.|No|||||No|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069532130|PAXLOVID 300-100 MG DOSE PACK|30|EA|20.81988|01/04/2024||Yes|No||01/04/2024||Yes|No|01/04/2024||Yes|No||||No|No|||Prescription Required|No|||No|46.52594||45.40932||45.735|||||884|||||No|No||PFIZER LABS.|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00069541066|VISTARIL 25 MG CAPSULE|100|EA|.07856|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|07/29/2021|574|No|.17905||.17649||.16808||||ANTIHISTAMINES, FIRST GENERATION|885|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069580043|TIKOSYN 125 MCG CAPSULE|40|EA|4.76494|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|10.85963||10.70449||10.19475|||||886|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069580060|TIKOSYN 125 MCG CAPSULE|60|EA|4.7649|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|10.85954||10.7044||10.19467|||||887|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069581043|TIKOSYN 250 MCG CAPSULE|40|EA|4.76494|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|10.85963||10.70449||10.19475|||||888|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069581060|TIKOSYN 250 MCG CAPSULE|60|EA|4.7649|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|10.85954||10.7044||10.19467|||||889|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069582043|TIKOSYN 500 MCG CAPSULE|40|EA|4.76494|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|10.6644||10.40845||10.48311|||||890|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069582060|TIKOSYN 500 MCG CAPSULE|60|EA|4.7649|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|10.6644||10.40845||10.48311|||||891|||||No|No||PFIZER US PHARM|No|||||No|No|No||
crizotinib|No|No|No|No|75%|00069814020|XALKORI 250 MG CAPSULE|60|EA|160.73006|12/06/2011||Yes|No||12/06/2011||Yes|No|12/06/2011||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|366.31501||361.08194||343.88756||||ONCOLOGY, ORAL - LUNG|892|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
crizotinib|No|No|No|No|75%|00069814120|XALKORI 200 MG CAPSULE|60|EA|160.73006|12/06/2011||Yes|No||12/06/2011||Yes|No|12/06/2011||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|366.31501||361.08194||343.88756||||ONCOLOGY, ORAL - LUNG|893|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|07/30/2021|
tafamidis|No|No|No|No|75%|00069873030|VYNDAMAX 61 MG CAPSULE|30|EA|320.09615|02/03/2020||Yes|No||02/03/2020||Yes|No|02/03/2020||Yes|No||||No|No|||Prescription Required|No|||No|729.52147||719.09973||684.85689|||||894|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/30/2023|
phenytoin|No|No|No|No|75%|00071000724|DILANTIN 50 MG INFATAB|100|EA|.6779|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/28/2021|056|No|1.51223||1.47594||1.48652||||ANTICONVULSANTS|895|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015523|LIPITOR 10 MG TABLET|90|EA|5.57117|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/28/2022|063|Yes|12.42522||12.12701||12.21399||||LIPOTROPICS, STATINS|896|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015623|LIPITOR 20 MG TABLET|90|EA|7.94716|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/28/2022|063|Yes|17.77277||17.34622||17.47063||||LIPOTROPICS, STATINS|897|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015723|LIPITOR 40 MG TABLET|90|EA|7.94716|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/28/2022|063|Yes|17.80281||17.37554||17.50016||||LIPOTROPICS, STATINS|898|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015823|LIPITOR 80 MG TABLET|90|EA|7.94716|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/28/2022|063|Yes|17.82491||17.39711||17.52189||||LIPOTROPICS, STATINS|899|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
quinapril/hydrochlorothiazide|No|No|No|No|75%|00071022323|ACCURETIC 20-25 MG TABLET|90|EA|2.15831|10/07/2002||Yes|No||10/07/2002||Yes|No|10/07/2002||Yes|No||10/07/2002||Yes|No|||Prescription Required|Yes|03/23/2007|113|Yes|4.91894||4.84867||4.61778||||ANGIOTENSIN MODULATORS|900|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ethosuximide|No|No|No|No|75%|00071023724|ZARONTIN 250 MG CAPSULE|100|EA|.57091|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|1.30115||1.28256||1.22148||||ANTICONVULSANTS|901|||||No|No||PFIZER US PHARM|No|||||No|No|No||
phenelzine sulfate|No|No|No|No|75%|00071035060|NARDIL 15 MG TABLET|60|EA|1.09721|01/30/2007||Yes|No||01/30/2007||Yes|No|01/30/2007||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|031|No|2.50063||2.4649||2.34753||||ANTIDEPRESSANTS, OTHER|902|||||No|No||PFIZER US PHARM|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00071036924|DILANTIN 100 MG CAPSULE|100|EA|.72348|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||02/08/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|.25508||.24896||.25074||||ANTICONVULSANTS|903|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00071036932|DILANTIN 100 MG CAPSULE|1000|EA|.72344|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||02/08/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|.25508||.24896||.25074||||ANTICONVULSANTS|904|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071040124|NEURONTIN 800 MG TABLET|100|EA|7.09246|03/08/2004||Yes|No||03/08/2004||Yes|No|03/08/2004||Yes|No||03/08/2004||Yes|No|||Prescription Required|Yes|07/29/2021|232|Yes|15.7938||15.41475||15.52531||||NEUROPATHIC PAIN|905|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041724|NITROSTAT 0.3 MG TABLET SL|100|EA|.31859|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.72608||.71571||.68163|||||906|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041813|NITROSTAT 0.4 MG TABLET SL|25|EA|.6951|10/01/2021||Yes|No||10/01/2021||Yes|No|10/01/2021||Yes|No||10/01/2021||Yes|No|||Prescription Required|No|||No|1.55055||1.51334||1.52419|||||907|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041824|NITROSTAT 0.4 MG TABLET SL|100|EA|.31859|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.72608||.71571||.68163|||||908|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041924|NITROSTAT 0.6 MG TABLET SL|100|EA|.31859|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.72608||.71571||.68163|||||909|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
methsuximide|No|No|No|No|75%|00071052524|CELONTIN 300 MG CAPSULE|100|EA|1.95444|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|4.35573||4.25119||4.28168||||ANTICONVULSANTS|910|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071052723|ACCUPRIL 5 MG TABLET|90|EA|2.22042|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|03/23/2007|113|No|5.06049||4.9882||4.75067||||ANGIOTENSIN MODULATORS|911|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071053023|ACCUPRIL 10 MG TABLET|90|EA|2.22042|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|03/23/2007|113|No|5.06049||4.9882||4.75067||||ANGIOTENSIN MODULATORS|912|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071053223|ACCUPRIL 20 MG TABLET|90|EA|2.22042|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|03/23/2007|113|No|5.06049||4.9882||4.75067||||ANGIOTENSIN MODULATORS|913|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071053523|ACCUPRIL 40 MG TABLET|90|EA|2.22042|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|03/23/2007|113|No|5.06049||4.9882||4.75067||||ANGIOTENSIN MODULATORS|914|||||No|No||PFIZER US PHARM|No|||||No|No|No||
gemfibrozil|No|No|No|No|75%|00071073720|LOPID 600 MG TABLET|60|EA|.56581|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|02/23/2004|055|No|1.28951||1.27109||1.21056||||LIPOTROPICS, OTHER|915|||||No|No||PFIZER US PHARM|No|||||No|No|No||
gemfibrozil|No|No|No|No|75%|00071073730|LOPID 600 MG TABLET|500|EA|.56585|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|02/23/2004|055|No|1.2896||1.27118||1.21065||||LIPOTROPICS, OTHER|916|||||No|No||PFIZER US PHARM|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071080324|NEURONTIN 100 MG CAPSULE|100|EA|1.24451|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|07/29/2021|232|Yes|2.78121||2.71446||2.73393||||NEUROPATHIC PAIN|917|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071080524|NEURONTIN 300 MG CAPSULE|100|EA|3.11178|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|07/29/2021|232|Yes|6.9199||6.75382||6.80226||||NEUROPATHIC PAIN|918|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071080624|NEURONTIN 400 MG CAPSULE|100|EA|3.73305|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|07/29/2021|232|Yes|8.30983||8.11039||8.16856||||NEUROPATHIC PAIN|919|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101268|LYRICA 25 MG CAPSULE|90|EA|4.3515|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No||09/13/2005||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.69607||9.46336||9.53124||||NEUROPATHIC PAIN|920|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101368|LYRICA 50 MG CAPSULE|90|EA|4.3515|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No||09/13/2005||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.70791||9.47492||9.54288||||NEUROPATHIC PAIN|921|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101468|LYRICA 75 MG CAPSULE|90|EA|4.3515|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No||09/13/2005||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.70501||9.47209||9.54002||||NEUROPATHIC PAIN|922|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101568|LYRICA 100 MG CAPSULE|90|EA|4.3515|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||05/29/2007||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.69416||9.4615||9.52936||||NEUROPATHIC PAIN|923|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101668|LYRICA 150 MG CAPSULE|90|EA|4.3515|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||05/29/2007||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.68547||9.45302||9.52082||||NEUROPATHIC PAIN|924|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101768|LYRICA 200 MG CAPSULE|90|EA|4.3515|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||05/29/2007||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.694||9.46134||9.5292||||NEUROPATHIC PAIN|925|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101868|LYRICA 300 MG CAPSULE|90|EA|4.3515|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||06/06/2023||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.70092||9.4681||9.536||||NEUROPATHIC PAIN|926|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101968|LYRICA 225 MG CAPSULE|90|EA|4.3515|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||05/29/2007||Yes|No|||Prescription Required|No|07/28/2022|232|No|9.69386||9.46121||9.52906||||NEUROPATHIC PAIN|927|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102001|LYRICA 20 MG/ML ORAL SOLUTION|473|ML|1.10398|09/14/2018||Yes|No||09/14/2018||Yes|No|09/14/2018||Yes|No||09/14/2018||Yes|No|||Prescription Required|Yes|07/26/2018|232|No|2.51604||2.4801||2.362||||NEUROPATHIC PAIN|928|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102601|LYRICA CR 82.5 MG TABLET|30|EA|7.47741|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||07/19/2018||Yes|No|||Prescription Required|Yes|07/26/2018|232|No|17.04154||16.79809||15.99818||||NEUROPATHIC PAIN|929|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102701|LYRICA CR 165 MG TABLET|30|EA|7.47741|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||07/19/2018||Yes|No|||Prescription Required|Yes|07/26/2018|232|No|17.04154||16.79809||15.99818||||NEUROPATHIC PAIN|930|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102901|LYRICA CR 330 MG TABLET|30|EA|7.47741|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||07/19/2018||Yes|No|||Prescription Required|Yes|07/26/2018|232|No|17.04154||16.79809||15.99818||||NEUROPATHIC PAIN|931|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071201247|NEURONTIN 250 MG/5 ML SOLUTION|470|ML|.4479|02/21/2023||Yes|No||02/21/2023||Yes|No|02/21/2023||Yes|No||02/21/2023||Yes|No|||Prescription Required|Yes|07/28/2022|232|Yes|1.0208||1.00621||.9583||||NEUROPATHIC PAIN|932|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
ethosuximide|No|No|No|No|75%|00071241819|ZARONTIN 250 MG/5 ML SOLUTION|474|ML|.12671|10/17/2022||Yes|No||10/17/2022||Yes|No|10/17/2022||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|.28879||.28466||.27111||||ANTICONVULSANTS|933|||||No|No||PFIZER US PHARM|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00071374066|DILANTIN 30 MG CAPSULE|100|EA|.6238|10/14/2009||Yes|No||10/14/2009||Yes|No|10/14/2009||Yes|No||10/14/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|.||.||.||||ANTICONVULSANTS|934|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
elagolix sodium|No|No|No|No|75%|00074003828|ORILISSA 150 MG TABLET|28|EA|17.72122|11/09/2018||Yes|No||11/09/2018||Yes|No|11/09/2018||Yes|No||||No|No|||Prescription Required|No|01/26/2023|577|No|39.7656||38.81123||39.08958||.|05/27/2024|UTERINE DISORDER TREATMENTS                       |935|||||No|No||ABBVIE US LLC|No|||||No|No|No||
elagolix sodium|No|No|No|No|75%|00074003956|ORILISSA 200 MG TABLET|56|EA|8.86061|11/09/2018||Yes|No||11/09/2018||Yes|No|11/09/2018||Yes|No||||No|No|||Prescription Required|No|01/26/2023|577|No|19.84583||19.36953||19.50845||||UTERINE DISORDER TREATMENTS                       |936|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074006702|HUMIRA(CF) PEDI CROHN 80-40 MG|2|EA|2232.5514|05/30/2018||Yes|No||05/30/2018||Yes|No|05/30/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|5088.1404||5015.45268||4776.6216||3580.9494|05/30/2018|CYTOKINE AND CAM ANTAGONISTS|937|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
adalimumab|No|No|No|No|75%|00074012402|HUMIRA(CF) PEN 80 MG/0.8 ML|2|EA|2976.73305|06/08/2021||Yes|No||06/08/2021||Yes|No|06/08/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|071|Yes|6726.58375||6565.14574||6612.23183||||CYTOKINE AND CAM ANTAGONISTS|938|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074012403|HUMIRA(CF) PEN CRHN-UC-HS 80MG|3|EA|2976.73806|08/24/2018||Yes|No||08/24/2018||Yes|No|08/24/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|6730.19722||6568.67249||6615.78387||||CYTOKINE AND CAM ANTAGONISTS|939|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074012404|HUMIRA(CF) PEN PEDI UC 80 MG|4|EA|2976.73305|05/17/2021||Yes|No||05/17/2021||Yes|No|05/17/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|071|Yes|6784.1823||6687.26541||6368.8242||||CYTOKINE AND CAM ANTAGONISTS|940|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074024302|HUMIRA(CF) 40 MG/0.4 ML SYRING|2|EA|1488.3633|05/30/2018||Yes|No||05/30/2018||Yes|No|05/30/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|3361.36598||3280.6932||3304.22276||.|04/22/2024|CYTOKINE AND CAM ANTAGONISTS|941|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lopinavir/ritonavir|No|No|No|No|75%|00074052260|KALETRA 100-25 MG TABLET|60|EA|2.5603|01/03/2008||Yes|No||01/03/2008||Yes|No|01/03/2008||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|4.18182||4.12208||3.92579||||HIV / AIDS|942|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074055402|HUMIRA(CF) PEN 40 MG/0.4 ML|2|EA|1488.3633|05/30/2018||Yes|No||05/30/2018||Yes|No|05/30/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|3362.47539||3281.77598||3305.31331||.|04/22/2024|CYTOKINE AND CAM ANTAGONISTS|943|||||No|No||ABBVIE US LLC|No|||||No|No|No||
venetoclax|No|No|No|No|75%|00074056111|VENCLEXTA 10 MG TAB (10MG X 2)|2|EA|5.52335|09/19/2016||Yes|No||09/19/2016||Yes|No|09/19/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|12.5881||12.40827||11.8174||||ONCOLOGY, ORAL - HEMATOLOGIC|944|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074056114|VENCLEXTA 10 MG TABLET|14|EA|5.52519|09/19/2016||Yes|No||09/19/2016||Yes|No|09/19/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|12.59229||12.4124||11.82134||||ONCOLOGY, ORAL - HEMATOLOGIC|945|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074056607|VENCLEXTA 50 MG TABLET|7|EA|27.62811|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|62.96639||62.06687||59.11131||||ONCOLOGY, ORAL - HEMATOLOGIC|946|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074056611|VENCLEXTA 50 MG TABLET|1|EA|27.6275|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|62.965||62.0655||59.11||||ONCOLOGY, ORAL - HEMATOLOGIC|947|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074057611|VENCLEXTA 100 MG TABLET|1|EA|55.2464|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|125.9104||124.11168||118.2016||||ONCOLOGY, ORAL - HEMATOLOGIC|948|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074057622|VENCLEXTA 100 MG TABLET|120|EA|55.25557|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|125.9313||124.13228||118.22122||||ONCOLOGY, ORAL - HEMATOLOGIC|949|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074057630|VENCLEXTA 100 MG TABLET|28|EA|55.25131|12/19/2022||Yes|No||12/19/2022||Yes|No|12/19/2022||Yes|No||||No|No|||Prescription Required|No|07/28/2022|173|No|125.92159||124.12271||118.21211||||ONCOLOGY, ORAL - HEMATOLOGIC|950|||||No|No||ABBVIE US LLC|No|||||No|No|No||
venetoclax|No|No|No|No|75%|00074057634|VENCLEXTA 100 MG TABLET|180|EA|55.25559|02/28/2019||Yes|No||02/28/2019||Yes|No|02/28/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|125.93135||124.13233||118.22127||||ONCOLOGY, ORAL - HEMATOLOGIC|951|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074057928|VENCLEXTA STARTING PACK|42|EA|34.07422|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|77.65753||76.54814||72.90299||||ONCOLOGY, ORAL - HEMATOLOGIC|952|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
adalimumab|No|No|No|No|75%|00074061602|HUMIRA(CF) 20 MG/0.2 ML SYRING|2|EA|1488.3633|05/30/2018||Yes|No||05/30/2018||Yes|No|05/30/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|3368.0255||3287.19289||3310.76907||.|04/22/2024|CYTOKINE AND CAM ANTAGONISTS|953|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074081702|HUMIRA(CF) 10 MG/0.1 ML SYRING|2|EA|1488.3633|05/30/2018||Yes|No||05/30/2018||Yes|No|05/30/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|3392.0838||3343.62546||3184.4052||2387.2|05/30/2018|CYTOKINE AND CAM ANTAGONISTS|954|||||No|No||ABBVIE US LLC|No|||||No|No|No||
elagolix/estradiol/norethindrn|No|No|No|No|75%|00074101756|ORIAHNN 300-1-0.5MG/300MG CAPS|56|EA|8.86061|09/28/2020||Yes|No||09/28/2020||Yes|No|09/28/2020||Yes|No||||No|No|||Prescription Required|No|01/26/2023|577|No|19.81341||19.33789||19.47658||||UTERINE DISORDER TREATMENTS                       |955|||||No|No||ABBVIE US LLC|No|||||No|No|No||
upadacitinib|No|No|No|No|75%|00074104328|RINVOQ ER 45 MG TABLET|28|EA|184.35943|05/23/2022||Yes|No||05/23/2022||Yes|No|05/23/2022||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|071|Yes|415.54656||405.57344||408.48227||||CYTOKINE AND CAM ANTAGONISTS|956|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074105001|SKYRIZI 150 MG/ML SYRINGE|1|ML|9037.4648|09/13/2021||Yes|No||09/13/2021||Yes|No|09/13/2021||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|071|Yes|20287.37882||19800.48173||19942.49338||||CYTOKINE AND CAM ANTAGONISTS|957|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074106501|SKYRIZI 180 MG/1.2 ML ON-BODY|1.2|ML|7531.22066|05/04/2023||Yes|No||05/04/2023||Yes|No|05/04/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|071|Yes|17164.17733||16918.97479||16113.30933||||CYTOKINE AND CAM ANTAGONISTS|958|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074107001|SKYRIZI 360 MG/2.4 ML ON-BODY|2.4|ML|3765.61033|12/15/2022||Yes|No||12/15/2022||Yes|No|12/15/2022||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|071|Yes|8515.535||8311.16216||8370.77091||||CYTOKINE AND CAM ANTAGONISTS|959|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074153903|HUMIRA(CF) PEN PS-UV-AHS 80-40|3|EA|1984.4887|08/24/2018||Yes|No||08/24/2018||Yes|No|08/24/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|4462.442||4355.34339||4386.58049||||CYTOKINE AND CAM ANTAGONISTS|960|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074210001|SKYRIZI 150 MG/ML PEN|1|ML|9037.4648|09/13/2021||Yes|No||09/13/2021||Yes|No|09/13/2021||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|071|Yes|20216.79444||19731.59137||19873.10893||||CYTOKINE AND CAM ANTAGONISTS|961|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074210803|LUPRON DEPOT-PED 7.5 MG KIT|1|EA|887.3351|08/25/2009||Yes|No||08/25/2009||Yes|No|08/25/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|2022.2986||1993.40862||1898.4844|||||962|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074228203|LUPRON DEPOT-PED 11.25 MG KIT|1|EA|1610.9348|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|3671.4328||3618.98376||3446.6512|||||963|||||No|No||ABBVIE US LLC|No|||||No|No|No||
upadacitinib|No|No|No|No|75%|00074230630|RINVOQ ER 15 MG TABLET|30|EA|92.18067|12/02/2019||Yes|No||12/02/2019||Yes|No|12/02/2019||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|071|Yes|207.83485||202.84681||204.30166||||CYTOKINE AND CAM ANTAGONISTS|964|||||No|No||ABBVIE US LLC|No|||||No|No|No||
upadacitinib|No|No|No|No|75%|00074231030|RINVOQ ER 30 MG TABLET|30|EA|92.18067|05/23/2022||Yes|No||05/23/2022||Yes|No|05/23/2022||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|071|Yes|207.18722||202.21473||203.66504||||CYTOKINE AND CAM ANTAGONISTS|965|||||No|No||ABBVIE US LLC|No|||||No|No|No||
upadacitinib|No|No|No|No|75%|00074232001|RINVOQ LQ 1 MG/ML SOLUTION|180|ML|13.18835|09/20/2024||Yes|No||09/20/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|16.807||16.5669||15.778|||||966|||||No|No||ABBVIE US LLC|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00074234030|NORVIR 100 MG TABLET|30|EA|5.1434|09/19/2023||Yes|No||09/19/2023||Yes|No|09/19/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/27/2022|237|No|8.34233||8.14211||8.20051||||HIV / AIDS|967|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074244003|LUPRON DEPOT-PED 15 MG KIT|1|EA|1774.2832|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|4043.7152||3985.94784||3796.1408|||||968|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074254003|HUMIRA(CF) PEDI CROHN 80MG/0.8|3|EA|2976.73806|05/30/2018||Yes|No||05/30/2018||Yes|No|05/30/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|071|Yes|6784.19373||6687.27667||6368.83493||4774.5992|05/30/2018|CYTOKINE AND CAM ANTAGONISTS|969|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|09/30/2022|
glecaprevir/pibrentasvir|No|No|No|No|75%|00074260028|MAVYRET 50-20 MG PELLET PACKET|28|EA|40.5447|12/07/2021||Yes|No||01/25/2023||Yes|No|12/07/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|064|No|92.4042||91.08414||86.7468||||HEPATITIS C AGENTS|970|||||No|No||ABBVIE US LLC|No|||||No|No|No||
glecaprevir/pibrentasvir|No|No|No|No|75%|00074262528|MAVYRET 100-40 MG TABLET|84|EA|67.57143|02/01/2018||Yes|No||01/25/2023||Yes|No|09/01/2021||Yes|No||||No|No|||Prescription Required|No|08/04/2017|064|No|152.86912||149.20026||150.27034||||HEPATITIS C AGENTS|971|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lopinavir/ritonavir|No|No|No|No|75%|00074300860|KALETRA 100-25 MG TABLET|60|EA|2.5603|08/19/2024||Yes|No||08/19/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|05/02/2024|237|No|4.18182||4.12208||3.92579||||HIV / AIDS|972|||||No|No||ABBVIE US LLC|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00074301207|DUOPA 4.63 MG-20 MG/ML SUSPENS|100|ML|.97156|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|015|No|2.21426||2.18263||2.07869||||ANTIPARKINSON'S AGENTS|973|||||No|No||ABBVIE US LLC|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00074302313|K-TAB ER 20 MEQ TABLET|100|EA|.35634|04/23/2014|02/15/2025|Yes|No||04/23/2014|02/15/2025|Yes|No|04/23/2014|02/15/2025|Yes|No||||No|No|||Prescription Required|No|||No|.81213||.80052||.7624|||||974|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ABBVIE US LLC|No|||||No|No|No||
cyclosporine, modified|No|No|No|No|75%|00074310832|GENGRAF 25 MG CAPSULE|30|EA|.75307|01/21/2016||Yes|No||01/21/2016||Yes|No|01/21/2016||Yes|No||01/21/2016||Yes|No|||Prescription Required|No|01/22/2015|229|No|.409||.39918||.40205||||IMMUNOSUPPRESSIVES, ORAL|975|||||No|No||ABBVIE US LLC|No|||||Yes|No|No||
cyclosporine, modified|No|No|No|No|75%|00074310932|GENGRAF 100 MG CAPSULE|30|EA|3.00842|02/19/2016||Yes|No||02/19/2016||Yes|No|02/19/2016||Yes|No||02/19/2016||Yes|No|||Prescription Required|No|01/22/2015|229|No|1.45579||1.42085||1.43104||||IMMUNOSUPPRESSIVES, ORAL|976|||||No|No||ABBVIE US LLC|No|||||Yes|No|No||
fenofibric acid (choline)|No|No|No|No|75%|00074316190|TRILIPIX DR 45 MG CAPSULE|90|EA|1.2932|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|2.94729||2.90519||2.76684||||LIPOTROPICS, OTHER|977|||||No|No||ABBVIE US LLC|No|||||No|No|No||
fenofibric acid (choline)|No|No|No|No|75%|00074316290|TRILIPIX DR 135 MG CAPSULE|90|EA|3.87979|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|8.63118||8.42403||8.48445||||LIPOTROPICS, OTHER|978|||||No|No||ABBVIE US LLC|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00074317390|TRICOR 48 MG TABLET|90|EA|.24347|11/21/2016||Yes|No||11/21/2016||Yes|No|11/21/2016||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|.5549||.54697||.52092||||LIPOTROPICS, OTHER|979|||||No|No||ABBVIE US LLC|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00074318990|TRICOR 145 MG TABLET|90|EA|.44462|11/21/2016||Yes|No||11/21/2016||Yes|No|11/21/2016||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|.99468||.97081||.97777||||LIPOTROPICS, OTHER|980|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074334603|LUPRON DEPOT 22.5 MG 3MO KIT|1|EA|2636.8761|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|5916.68667||5774.68619||5816.103|||||981|||||No|No||ABBVIE US LLC|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00074339930|NORVIR 100 MG POWDER PACKET|30|EA|5.1434|10/16/2018||Yes|No||10/16/2018||Yes|No|10/16/2018||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|8.40088||8.28087||7.88654||||HIV / AIDS|982|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074347303|LUPRON DEPOT 45 MG 6MO KIT|1|EA|5273.8425|07/08/2011||Yes|No||07/08/2011||Yes|No|07/08/2011||Yes|No||||No|No|||Prescription Required|No|||Yes|12019.455||11847.7485||11283.57|||||983|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074364103|LUPRON DEPOT 3.75 MG KIT|1|EA|737.5962|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|1656.22207||1616.47274||1628.06629|||||984|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074364203|LUPRON DEPOT 7.5 MG KIT|1|EA|878.963|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|1965.95364||1918.77075||1932.53243|||||985|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074366303|LUPRON DEPOT 11.25 MG 3MO KIT|1|EA|2212.8101|06/05/2009||Yes|No||06/05/2009||Yes|No|06/05/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|4964.88667||4845.72939||4880.4836|||||986|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074368303|LUPRON DEPOT-4 MONTH KIT|1|EA|3515.8434|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|8012.8524||7898.38308||7522.2696|||||987|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074372719|SYNTHROID 137 MCG TABLET|1000|EA|.67829|07/15/2015||Yes|No||07/15/2015||Yes|No|07/15/2015||Yes|No||||No|No|||Prescription Required|No|||No|1.51239||1.47609||1.48668|||||988|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074372790|SYNTHROID 137 MCG TABLET|90|EA|.67835|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51239||1.47609||1.48668|||||989|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074377903|LUPRON DEPOT-PED 11.25 MG 3MO|1|EA|4832.8216|09/01/2011||Yes|No||09/01/2011||Yes|No|09/01/2011||Yes|No||||No|No|||Prescription Required|No|||Yes|11014.3376||10856.98992||10339.9904|||||990|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074379902|HUMIRA 40 MG/0.8 ML SYRINGE|2|EA|1488.3633|10/14/2008||Yes|No||10/14/2008||Yes|No|10/14/2008||Yes|No||||No|No|||Prescription Required|No|06/09/2004|071|Yes|3361.4653||3280.79013||3304.32039||||CYTOKINE AND CAM ANTAGONISTS|991|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074382611|DEPAKOTE ER 250 MG TABLET|100|EA|1.59023|10/16/2007||Yes|No||10/16/2007||Yes|No|10/16/2007||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|3.35308||3.27261||3.29608||||ANTICONVULSANTS|992|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lopinavir/ritonavir|No|No|No|No|75%|00074395646|KALETRA 80 MG-20 MG/ML SOLN   |160|ML|1.92026|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|3.13642||3.09162||2.9444||||HIV / AIDS|993|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lopinavir/ritonavir|No|No|No|No|75%|00074401412|KALETRA 200-50 MG TABLET|120|EA|5.1207|10/02/2024||Yes|No||10/02/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|05/02/2024|237|No|8.3041||8.1048||8.16293||||HIV / AIDS|994|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074433902|HUMIRA PEN 40 MG/0.8 ML|2|EA|1488.3633|04/04/2007||Yes|No||04/04/2007||Yes|No|04/04/2007||Yes|No||||No|No|||Prescription Required|No|07/06/2006|071|Yes|3364.945||3284.18632||3307.74094||||CYTOKINE AND CAM ANTAGONISTS|995|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074433906|HUMIRA PEN CROHN-UC-HS 40 MG|6|EA|1488.36903|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||||No|No|||Prescription Required|No|07/18/2006|071|Yes|3392.09686||3343.63834||3184.41746||||CYTOKINE AND CAM ANTAGONISTS|996|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074434119|SYNTHROID 25 MCG TABLET|1000|EA|.67832|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51235||1.47605||1.48664|||||997|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074434190|SYNTHROID 25 MCG TABLET|90|EA|.67835|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51235||1.47605||1.48664|||||998|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074455219|SYNTHROID 50 MCG TABLET|1000|EA|.67804|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51212||1.47583||1.48641|||||999|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074455290|SYNTHROID 50 MCG TABLET|90|EA|.67806|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51212||1.47583||1.48641|||||1000|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074518219|SYNTHROID 75 MCG TABLET|1000|EA|.67833|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51284||1.47653||1.48712|||||1001|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074518290|SYNTHROID 75 MCG TABLET|90|EA|.67825|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51284||1.47653||1.48712|||||1002|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074611413|DEPAKOTE DR 125 MG SPRINKLE CP|100|EA|.80272|08/11/2009||Yes|No||08/11/2009||Yes|No|08/11/2009||Yes|No||08/11/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|1.79245||1.74943||1.76198||||ANTICONVULSANTS|1003|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074621413|DEPAKOTE DR 250 MG TABLET|100|EA|1.65387|09/11/2008||Yes|No||09/11/2008||Yes|No|09/11/2008||Yes|No||09/11/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|3.68393||3.59552||3.6213||||ANTICONVULSANTS|1004|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074621453|DEPAKOTE DR 250 MG TABLET|500|EA|1.65387|09/11/2008||Yes|No||09/11/2008||Yes|No|09/11/2008||Yes|No||09/11/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|3.68393||3.59552||3.6213||||ANTICONVULSANTS|1005|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074621553|DEPAKOTE DR 500 MG TABLET|500|EA|3.04978|09/11/2008||Yes|No||09/11/2008||Yes|No|09/11/2008||Yes|No||09/11/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|6.7802||6.61748||6.66494||||ANTICONVULSANTS|1006|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074659419|SYNTHROID 88 MCG TABLET|1000|EA|.67822|01/16/2003||Yes|No||01/16/2003||Yes|No|01/16/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51325||1.47693||1.48752|||||1007|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074659490|SYNTHROID 88 MCG TABLET|90|EA|.67825|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51325||1.47693||1.48752|||||1008|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074662419|SYNTHROID 100 MCG TABLET|1000|EA|.67805|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51241||1.47611||1.4867|||||1009|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074662490|SYNTHROID 100 MCG TABLET|90|EA|.67806|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51241||1.47611||1.4867|||||1010|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lopinavir/ritonavir|No|No|No|No|75%|00074679922|KALETRA 200-50 MG TABLET|120|EA|5.1207|11/08/2005||Yes|No||11/08/2005||Yes|No|11/08/2005||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|8.3041||8.1048||8.16293||||HIV / AIDS|1011|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706819|SYNTHROID 125 MCG TABLET|1000|EA|.67832|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51302||1.47671||1.4873|||||1012|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706890|SYNTHROID 125 MCG TABLET|90|EA|.67844|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51302||1.47671||1.4873|||||1013|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706919|SYNTHROID 150 MCG TABLET|1000|EA|.67836|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51244||1.47614||1.48673|||||1014|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706990|SYNTHROID 150 MCG TABLET|90|EA|.67844|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51244||1.47614||1.48673|||||1015|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074707019|SYNTHROID 175 MCG TABLET|1000|EA|.67743|01/22/2003||Yes|No||01/22/2003||Yes|No|01/22/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.50978||1.47355||1.48411|||||1016|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074707090|SYNTHROID 175 MCG TABLET|90|EA|.67744|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.50978||1.47355||1.48411|||||1017|||||No|No||ABBVIE US LLC|No|||||No|No|No||
atogepant|No|No|No|No|75%|00074709430|QULIPTA 60 MG TABLET|30|EA|15.66031|05/09/2022||Yes|No||05/09/2022||Yes|No|05/09/2022||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|537|Yes|34.96154||34.12246||34.36719||||ANTIMIGRAINE AGENTS, OTHER|1018|||||No|No||ABBVIE US LLC|No|||||No|No|No||
atogepant|No|No|No|No|75%|00074709530|QULIPTA 10 MG TABLET|30|EA|15.66031|05/09/2022||Yes|No||05/09/2022||Yes|No|05/09/2022||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|537|Yes|34.92091||34.08281||34.32725||||ANTIMIGRAINE AGENTS, OTHER|1019|||||No|No||ABBVIE US LLC|No|||||No|No|No||
atogepant|No|No|No|No|75%|00074709630|QULIPTA 30 MG TABLET|30|EA|15.66031|05/09/2022||Yes|No||05/09/2022||Yes|No|05/09/2022||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|537|Yes|34.95089||34.11207||34.35672||||ANTIMIGRAINE AGENTS, OTHER|1020|||||No|No||ABBVIE US LLC|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00074709804|VUITY 1.25% EYE DROP|2.5|ML|13.27152|05/23/2022||Yes|No||05/23/2022||Yes|No|05/23/2022||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|088|No|29.6598||28.94796||29.15558||||OPHTHALMICS, GLAUCOMA AGENTS|1021|||||No|No||ABBVIE US LLC|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00074709806|VUITY 1.25% EYE DROP|5|ML|10.08006|09/19/2023||Yes|No||09/19/2023||Yes|No|09/19/2023||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|088|No|22.57626||22.03443||22.19246||||OPHTHALMICS, GLAUCOMA AGENTS|1022|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714819|SYNTHROID 200 MCG TABLET|1000|EA|.67824|01/22/2003||Yes|No||01/22/2003||Yes|No|01/22/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51199||1.4757||1.48629|||||1023|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714890|SYNTHROID 200 MCG TABLET|90|EA|.67835|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51199||1.4757||1.48629|||||1024|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714919|SYNTHROID 300 MCG TABLET|1000|EA|.67786|01/22/2003||Yes|No||01/22/2003||Yes|No|01/22/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.50565||1.46951||1.48005|||||1025|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714990|SYNTHROID 300 MCG TABLET|90|EA|.67787|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.50565||1.46951||1.48005|||||1026|||||No|No||ABBVIE US LLC|No|||||No|No|No||
cyclosporine, modified|No|No|No|No|75%|00074726950|GENGRAF 100 MG/ML SOLUTION    |50|ML|3.39975|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||01/01/2011||Yes|No|||Prescription Required|No|01/15/2014|229|No|7.74827||7.63758||7.27389||||IMMUNOSUPPRESSIVES, ORAL|1027|||||No|No||ABBVIE US LLC|No|||||Yes|No|No||
divalproex sodium|No|No|No|No|75%|00074732513|DEPAKOTE DR 125 MG TABLET|100|EA|.84194|08/18/2022||Yes|No||08/18/2022||Yes|No|08/18/2022||Yes|No||08/18/2022||Yes|No|||Prescription Required|No|01/27/2022|056|No|1.88244||1.83726||1.85044||||ANTICONVULSANTS|1028|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074732613|DEPAKOTE DR 250 MG TABLET|100|EA|1.65387|12/05/2023||Yes|No||12/05/2023||Yes|No|12/05/2023||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|3.68393||3.59552||3.6213||||ANTICONVULSANTS|1029|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074732713|DEPAKOTE DR 500 MG TABLET|100|EA|3.04978|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||06/20/2022||Yes|No|||Prescription Required|No|01/27/2022|056|No|6.7802||6.61748||6.66494||||ANTICONVULSANTS|1030|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074740113|DEPAKOTE ER 250 MG TABLET|100|EA|1.50397|10/05/2022||Yes|No||10/05/2022||Yes|No|10/05/2022||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|3.35308||3.27261||3.29608||||ANTICONVULSANTS|1031|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074740213|DEPAKOTE ER 500 MG TABLET|100|EA|2.64549|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||06/20/2022||Yes|No|||Prescription Required|No|01/27/2022|056|No|5.9085||5.7667||5.80806||||ANTICONVULSANTS|1032|||||No|No||ABBVIE US LLC|No|||||No|No|No||
paricalcitol|No|No|No|No|75%|00074903630|ZEMPLAR 1 MCG CAPSULE|30|EA|5.59458|09/12/2019||Yes|No||09/12/2019||Yes|No|09/12/2019||Yes|No||||No|No|||Prescription Required|No|||No|12.75045||12.5683||11.96981|||||1033|||||No|No||ABBVIE US LLC|No|||||No|No|No||
paricalcitol|No|No|No|No|75%|00074903730|ZEMPLAR 2 MCG CAPSULE         |30|EA|11.18888|09/12/2019||Yes|No||09/12/2019||Yes|No|09/12/2019||Yes|No||||No|No|||Prescription Required|No|||No|25.50025||25.13596||23.93901|||||1034|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074929619|SYNTHROID 112 MCG TABLET|1000|EA|.67794|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription Required|No|||No|1.51206||1.47577||1.48635|||||1035|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074929690|SYNTHROID 112 MCG TABLET|90|EA|.67806|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|1.51206||1.47577||1.48635|||||1036|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074969403|LUPRON DEPOT-PED 30 MG 3MO KIT|1|EA|5322.8711|09/01/2011||Yes|No||09/01/2011||Yes|No|09/01/2011||Yes|No||||No|No|||Prescription Required|No|||Yes|12131.1946||11957.89182||11388.4684|||||1037|||||No|No||ABBVIE US LLC|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062040|LOVENOX 40 MG/0.4 ML SYRINGE|0.4|ML|10.66723|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|8.51143||8.30716||8.36674||||ANTICOAGULANTS|1038|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062160|LOVENOX 60 MG/0.6 ML SYRINGE|0.6|ML|10.67976|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|24.33993||23.99221||22.84973||||ANTICOAGULANTS|1039|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062280|LOVENOX 80 MG/0.8 ML SYRINGE|0.8|ML|10.67959|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|8.9735||8.75814||8.82095||||ANTICOAGULANTS|1040|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062300|LOVENOX 100 MG/ML SYRINGE|1|ML|10.67948|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|24.33928||23.99158||22.84912||||ANTICOAGULANTS|1041|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062430|LOVENOX 30 MG/0.3 ML SYRINGE|0.3|ML|10.66686|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|24.31053||23.96323||22.82213||||ANTICOAGULANTS|1042|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062603|LOVENOX 300 MG/3 ML VIAL|3|ML|10.66686|03/12/2003||Yes|No||03/12/2003||Yes|No|03/12/2003||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|24.31053||23.96323||22.82213||||ANTICOAGULANTS|1043|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075291201|LOVENOX 120 MG/0.8 ML SYRINGE|0.8|ML|16.02449|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|36.52093||35.9992||34.28495||||ANTICOAGULANTS|1044|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075291501|LOVENOX 150 MG/ML SYRINGE|1|ML|16.02481|01/26/2009||Yes|No||01/26/2009||Yes|No|01/26/2009||Yes|No||||No|No|||Prescription Required|Yes|09/17/2013|068|Yes|36.52166||35.99992||34.28564||||ANTICOAGULANTS|1045|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00078011022|SANDIMMUNE 100 MG/ML SOLN|50|ML|7.18547|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|16.37619||16.14225||15.37357||||IMMUNOSUPPRESSIVES, ORAL|1046|||||No|No||NOVARTIS|No|||||Yes|No|No||
octreotide acetate|No|No|No|No|75%|00078018001|SANDOSTATIN 0.05 MG/ML AMPUL  |1|ML|6.06988|11/30/2009||Yes|No||11/30/2009||Yes|No|11/30/2009||Yes|No||||No|No|||Prescription Required|No|||No|13.83368||13.63606||12.98672|||||1047|||||No|No||NOVARTIS|No|||||No|No|No||
octreotide acetate|No|No|No|No|75%|00078018101|SANDOSTATIN 0.1 MG/ML AMPUL   |1|ML|11.77426|11/30/2009||Yes|No||11/30/2009||Yes|No|11/30/2009||Yes|No||||No|No|||Prescription Required|No|||No|26.83436||26.45101||25.19144|||||1048|||||No|No||NOVARTIS|No|||||No|No|No||
octreotide acetate|No|No|No|No|75%|00078018201|SANDOSTATIN 0.5 MG/ML AMPUL   |1|ML|56.78924|11/30/2009||Yes|No||11/30/2009||Yes|No|11/30/2009||Yes|No||||No|No|||Prescription Required|No|||No|129.42664||127.57769||121.50256|||||1049|||||No|No||NOVARTIS|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00078024015|SANDIMMUNE 25 MG CAPSULE      |30|EA|1.89099|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|4.20731||4.10633||4.13579||||IMMUNOSUPPRESSIVES, ORAL|1050|||||No|No||NOVARTIS|No|||||Yes|No|No||
cyclosporine|No|No|No|No|75%|00078024115|SANDIMMUNE 100 MG CAPSULE     |30|EA|7.54707|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|17.2003||16.95458||16.14722||||IMMUNOSUPPRESSIVES, ORAL|1051|||||No|No||NOVARTIS|No|||||Yes|No|No||
cyclosporine, modified|No|No|No|No|75%|00078024615|NEORAL 25 MG GELATIN CAPSULE|30|EA|1.15139|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|229|No|2.57174||2.51002||2.52802||||IMMUNOSUPPRESSIVES, ORAL|1052|||||No|No||NOVARTIS|No|||||Yes|No|No||
cyclosporine, modified|No|No|No|No|75%|00078024815|NEORAL 100 MG GELATIN CAPSULE |30|EA|4.601|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|229|No|10.30521||10.05788||10.13002||||IMMUNOSUPPRESSIVES, ORAL|1053|||||No|No||NOVARTIS|No|||||Yes|No|No||
letrozole|No|No|No|No|75%|00078024915|FEMARA 2.5 MG TABLET|30|EA|11.39127|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|25.64129||25.0259||25.20539||||ONCOLOGY, ORAL - BREAST|1054|||||No|No||NOVARTIS|No|||||No|No|No||
cyclosporine, modified|No|No|No|No|75%|00078027422|NEORAL 100 MG/ML SOLUTION     |50|ML|5.01543|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|11.43052||11.26723||10.7307||||IMMUNOSUPPRESSIVES, ORAL|1055|||||No|No||NOVARTIS|No|||||Yes|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078031434|DIOVAN HCT 80-12.5 MG TABLET|90|EA|4.47033|04/12/2004||Yes|No||04/12/2004||Yes|No|04/12/2004||Yes|No||04/12/2004||Yes|No|||Prescription Required|Yes|07/17/2014|113|Yes|10.18819||10.04264||9.56442||||ANGIOTENSIN MODULATORS|1056|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078031534|DIOVAN HCT 160-12.5 MG TAB|90|EA|4.86373|04/12/2004||Yes|No||04/12/2004||Yes|No|04/12/2004||Yes|No||04/12/2004||Yes|No|||Prescription Required|Yes|07/17/2014|113|Yes|10.91256||10.65066||10.72705||||ANGIOTENSIN MODULATORS|1057|||||No|No||NOVARTIS|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078033705|TRILEPTAL 300 MG TABLET|100|EA|4.4603|04/16/2004||Yes|No||04/16/2004||Yes|No|04/16/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|9.9716||9.73228||9.80208||||ANTICONVULSANTS|1058|||||No|No||NOVARTIS|No|||||No|No|No||
estradiol|No|No|No|No|75%|00078034542|VIVELLE-DOT 0.075 MG PATCH|8|EA|8.28073|05/13/2016||Yes|No||05/13/2016||Yes|No|05/13/2016||Yes|No||||No|No|||Prescription Required|No|||Yes|18.38221||17.94104||18.06971|||||1059|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
estradiol|No|No|No|No|75%|00078034642|VIVELLE-DOT 0.1 MG PATCH|8|EA|8.28288|05/13/2016||Yes|No||05/13/2016||Yes|No|05/13/2016||Yes|No||||No|No|||Prescription Required|No|||Yes|18.49702||18.05309||18.18257|||||1060|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00078035415|LESCOL XL 80 MG TABLET|30|EA|5.87079|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|07/17/2014|063|Yes|13.10549||12.79096||12.8827||||LIPOTROPICS, STATINS|1061|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078035752|TRILEPTAL 300 MG/5 ML SUSP|250|ML|.82182|05/12/2004||Yes|No||05/12/2004||Yes|No|05/12/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|1.83819||1.79407||1.80694||||ANTICONVULSANTS|1062|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan|No|No|No|No|75%|00078035834|DIOVAN 80 MG TABLET|90|EA|3.97506|04/09/2004||Yes|No||04/09/2004||Yes|No|04/09/2004||Yes|No||04/09/2004||Yes|No|||Prescription Required|No|09/15/2007|113|Yes|8.91125||8.69738||8.75976||||ANGIOTENSIN MODULATORS|1063|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan|No|No|No|No|75%|00078035934|DIOVAN 160 MG TABLET|90|EA|4.27448|02/01/2004||Yes|No||02/01/2004||Yes|No|02/01/2004||Yes|No||02/01/2004||Yes|No|||Prescription Required|No|09/15/2007|113|Yes|9.53962||9.31067||9.37745||||ANGIOTENSIN MODULATORS|1064|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan|No|No|No|No|75%|00078036034|DIOVAN 320 MG TABLET|90|EA|5.40758|04/12/2004||Yes|No||04/12/2004||Yes|No|04/12/2004||Yes|No||04/12/2004||Yes|No|||Prescription Required|No|09/15/2007|113|Yes|12.10781||11.81722||11.90198||||ANGIOTENSIN MODULATORS|1065|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078036405|LOTREL 10-20 MG CAPSULE|100|EA|6.35153|10/08/2007||Yes|No||10/08/2007||Yes|No|10/08/2007||Yes|No||10/08/2007||Yes|No|||Prescription Required|Yes|07/26/2012|017|No|14.47558||14.26879||13.58932||||ANGIOTENSIN MODULATOR COMBINATIONS|1066|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078037005|RITALIN LA 20 MG CAPSULE|100|EA|5.4269|08/01/2002||Yes|No||08/01/2002||Yes|No|08/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|12.09316||11.80292||11.88758||||STIMULANTS AND RELATED AGENTS|1067|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078037105|RITALIN LA 30 MG CAPSULE|100|EA|5.55044|08/01/2002||Yes|No||08/01/2002||Yes|No|08/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|12.41831||12.12027||12.2072||||STIMULANTS AND RELATED AGENTS|1068|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078037205|RITALIN LA 40 MG CAPSULE|100|EA|5.70464|08/01/2002||Yes|No||08/01/2002||Yes|No|08/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|12.67723||12.37298||12.46172||||STIMULANTS AND RELATED AGENTS|1069|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078037905|LOTREL 10-40 MG CAPSULE|100|EA|6.99847|02/05/2008||Yes|No||02/05/2008||Yes|No|02/05/2008||Yes|No||02/05/2008||Yes|No|||Prescription Required|Yes|07/26/2012|017|No|15.65547||15.27974||15.38933||||ANGIOTENSIN MODULATOR COMBINATIONS|1070|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078038005|FOCALIN 2.5 MG TABLET|100|EA|.29137|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.64775||.6322||.63674||||STIMULANTS AND RELATED AGENTS|1071|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078038105|FOCALIN 5 MG TABLET|100|EA|.41534|04/27/2004||Yes|No||04/27/2004||Yes|No|04/27/2004||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.92491||.90271||.90919||||STIMULANTS AND RELATED AGENTS|1072|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078038205|FOCALIN 10 MG TABLET|100|EA|.59736|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.32954||1.29763||1.30694||||STIMULANTS AND RELATED AGENTS|1073|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078038334|DIOVAN HCT 160-25 MG TABLET|90|EA|5.51585|04/12/2004||Yes|No||04/12/2004||Yes|No|04/12/2004||Yes|No||04/12/2004||Yes|No|||Prescription Required|Yes|07/17/2014|113|Yes|12.35808||12.06149||12.14799||||ANGIOTENSIN MODULATORS|1074|||||No|No||NOVARTIS|No|||||No|No|No||
mycophenolate sodium|No|No|No|No|75%|00078038566|MYFORTIC 180 MG TABLET|120|EA|2.91798|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|6.56207||6.40458||6.45051||||IMMUNOSUPPRESSIVES, ORAL|1075|||||No|No||NOVARTIS|No|||||Yes|No|No||
mycophenolate sodium|No|No|No|No|75%|00078038666|MYFORTIC 360 MG TABLET|120|EA|5.83589|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|13.10783||12.79324||12.885||||IMMUNOSUPPRESSIVES, ORAL|1076|||||No|No||NOVARTIS|No|||||Yes|No|No||
imatinib mesylate|No|No|No|No|75%|00078040134|GLEEVEC 100 MG TABLET         |90|EA|40.26443|03/27/2008||Yes|No||03/27/2008||Yes|No|03/27/2008||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|91.76546||90.45452||86.14716||||ONCOLOGY, ORAL - HEMATOLOGIC|1077|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078040505|LOTREL 5-10 MG CAPSULE|100|EA|5.1769|07/12/2005||Yes|No||07/12/2005||Yes|No|07/12/2005||Yes|No||07/12/2005||Yes|No|||Prescription Required|Yes|07/26/2012|017|No|11.79851||11.62996||11.07616||||ANGIOTENSIN MODULATOR COMBINATIONS|1078|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078040605|LOTREL 5-20 MG CAPSULE|100|EA|5.46693|10/08/2007||Yes|No||10/08/2007||Yes|No|10/08/2007||Yes|No||10/08/2007||Yes|No|||Prescription Required|Yes|07/26/2012|017|No|12.22658||11.93314||12.01873||||ANGIOTENSIN MODULATOR COMBINATIONS|1079|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078041420|ZORTRESS 0.5 MG TABLET        |60|EA|9.0639|05/28/2010||Yes|No||05/28/2010||Yes|No|05/28/2010||Yes|No||07/01/2017||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|20.65725||20.36215||19.39252||||IMMUNOSUPPRESSIVES, ORAL|1080|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041461|ZORTRESS 0.5 MG TABLET        |1|EA|9.0816|03/11/2021||Yes|No||03/11/2021||Yes|No|03/11/2021||Yes|No||03/11/2021||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|20.6976||20.40192||19.4304||||IMMUNOSUPPRESSIVES, ORAL|1081|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041520|ZORTRESS 0.75 MG TABLET       |60|EA|13.59588|05/28/2010||Yes|No||05/28/2010||Yes|No|05/28/2010||Yes|No||07/01/2017||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|30.98596||30.54331||29.08886||||IMMUNOSUPPRESSIVES, ORAL|1082|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041561|ZORTRESS 0.75 MG TABLET       |1|EA|13.6095|03/11/2021||Yes|No||03/11/2021||Yes|No|03/11/2021||Yes|No||03/11/2021||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|31.017||30.5739||29.118||||IMMUNOSUPPRESSIVES, ORAL|1083|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041720|ZORTRESS 0.25 MG TABLET       |60|EA|4.53199|05/28/2010||Yes|No||05/28/2010||Yes|No|05/28/2010||Yes|No||07/01/2017||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|10.32871||10.18116||9.69634||||IMMUNOSUPPRESSIVES, ORAL|1084|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041761|ZORTRESS 0.25 MG TABLET       |1|EA|4.5322|03/11/2021||Yes|No||03/11/2021||Yes|No|03/11/2021||Yes|No||03/11/2021||Yes|No|||Prescription Required|Yes|01/15/2014|229|No|10.3292||10.18164||9.6968||||IMMUNOSUPPRESSIVES, ORAL|1085|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078042220|ZORTRESS 1 MG TABLET|60|EA|18.12794|03/11/2021||Yes|No||03/11/2021||Yes|No|03/11/2021||Yes|No||03/11/2021||Yes|No|||Prescription Required|Yes|01/25/2018|229|No|41.31484||40.72463||38.78536||||IMMUNOSUPPRESSIVES, ORAL|1086|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078042261|ZORTRESS 1 MG TABLET|1|EA|18.1245|03/11/2021||Yes|No||03/11/2021||Yes|No|03/11/2021||Yes|No||03/11/2021||Yes|No|||Prescription Required|Yes|01/25/2018|229|No|41.307||40.7169||38.778||||IMMUNOSUPPRESSIVES, ORAL|1087|||||No|No||NOVARTIS|No|||||Yes|No|No||
valsartan|No|No|No|No|75%|00078042315|DIOVAN 40 MG TABLET|30|EA|3.32547|09/08/2005||Yes|No||09/08/2005||Yes|No|09/08/2005||Yes|No||09/08/2005||Yes|No|||Prescription Required|No|09/15/2007|113|Yes|7.4368||7.25832||7.31037||||ANGIOTENSIN MODULATORS|1088|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078042405|RITALIN LA 10 MG CAPSULE|100|EA|5.4269|04/21/2004||Yes|No||04/21/2004||Yes|No|04/21/2004||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|12.11984||11.82896||11.9138||||STIMULANTS AND RELATED AGENTS|1089|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043005|FOCALIN XR 5 MG CAPSULE|100|EA|2.11461|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|4.7095||4.59647||4.62944||||STIMULANTS AND RELATED AGENTS|1090|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043105|FOCALIN XR 10 MG CAPSULE|100|EA|2.14592|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|4.78002||4.6653||4.69876||||STIMULANTS AND RELATED AGENTS|1091|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043205|FOCALIN XR 20 MG CAPSULE|100|EA|2.2068|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|4.90304||4.78537||4.81969||||STIMULANTS AND RELATED AGENTS|1092|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043305|FOCALIN XR 30 MG CAPSULE|100|EA|2.12588|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|4.72579||4.61237||4.64545||||STIMULANTS AND RELATED AGENTS|1093|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043405|FOCALIN XR 40 MG CAPSULE|100|EA|2.43316|09/30/2010||Yes|No||09/30/2010||Yes|No|09/30/2010||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|5.40171||5.27207||5.30988||||STIMULANTS AND RELATED AGENTS|1094|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078043905|RITALIN 5 MG TABLET|100|EA|.35819|10/24/2005||Yes|No||10/24/2005||Yes|No|10/24/2005||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.79952||.78033||.78593||||STIMULANTS AND RELATED AGENTS|1095|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078044005|RITALIN 10 MG TABLET|100|EA|.51067|10/24/2005||Yes|No||10/24/2005||Yes|No|10/24/2005||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.13724||1.10995||1.11791||||STIMULANTS AND RELATED AGENTS|1096|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078044105|RITALIN 20 MG TABLET|100|EA|.73431|10/24/2005||Yes|No||10/24/2005||Yes|No|10/24/2005||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.63796||1.59865||1.61011||||STIMULANTS AND RELATED AGENTS|1097|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078045605|TRILEPTAL 150 MG TABLET|100|EA|2.44214|02/28/2006||Yes|No||02/28/2006||Yes|No|02/28/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|5.45977||5.32874||5.36695||||ANTICONVULSANTS|1098|||||No|No||NOVARTIS|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078045705|TRILEPTAL 600 MG TABLET|100|EA|8.19765|02/28/2006||Yes|No||02/28/2006||Yes|No|02/28/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|18.33217||17.8922||18.02052||||ANTICONVULSANTS|1099|||||No|No||NOVARTIS|No|||||No|No|No||
deferoxamine mesylate|No|No|No|No|75%|00078046791|DESFERAL MESYLATE 500 MG VL   |1|EA|14.9296|05/17/2007||Yes|No||05/17/2007||Yes|No|05/17/2007||Yes|No||||No|No|||Prescription Required|No|||No|34.0256||33.53952||31.9424|||||1100|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078046815|EXJADE 125 MG TABLET          |30|EA|21.58227|07/20/2006||Yes|No||07/20/2006||Yes|No|07/20/2006||Yes|No||||No|No|||Prescription Required|No|||No|49.1875||48.48482||46.17602|||||1101|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078046915|EXJADE 250 MG TABLET          |30|EA|43.16354|07/20/2006||Yes|No||07/20/2006||Yes|No|07/20/2006||Yes|No||||No|No|||Prescription Required|No|||No|98.37272||96.9674||92.3499|||||1102|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078047015|EXJADE 500 MG TABLET          |30|EA|86.32565|07/11/2006||Yes|No||07/11/2006||Yes|No|07/11/2006||Yes|No||||No|No|||Prescription Required|No|||No|196.74218||193.93158||184.69674|||||1103|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078047134|DIOVAN HCT 320-12.5 MG TAB|90|EA|6.16228|06/27/2006||Yes|No||06/27/2006||Yes|No|06/27/2006||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|113|Yes|14.04426||13.84363||13.18441||||ANGIOTENSIN MODULATORS|1104|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078047234|DIOVAN HCT 320-25 MG TABLET|90|EA|6.99108|08/08/2006||Yes|No||08/08/2006||Yes|No|08/08/2006||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|113|Yes|15.61909||15.24423||15.35357||||ANGIOTENSIN MODULATORS|1105|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078048815|EXFORGE 5-160 MG TABLET|30|EA|4.53019|10/01/2009||Yes|No||10/01/2009||Yes|No|10/01/2009||Yes|No||10/01/2009||Yes|No|||Prescription Required|Yes|07/27/2017|017|Yes|8.5278||8.32313||8.38283||||ANGIOTENSIN MODULATOR COMBINATIONS|1106|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078048915|EXFORGE 10-160 MG TABLET|30|EA|5.13878|10/01/2009||Yes|No||10/01/2009||Yes|No|10/01/2009||Yes|No||10/01/2009||Yes|No|||Prescription Required|Yes|07/27/2017|017|Yes|11.49807||11.22212||11.3026||||ANGIOTENSIN MODULATOR COMBINATIONS|1107|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078049015|EXFORGE 5-320 MG TABLET|30|EA|5.74594|10/01/2009||Yes|No||10/01/2009||Yes|No|10/01/2009||Yes|No||10/01/2009||Yes|No|||Prescription Required|Yes|07/27/2017|017|Yes|13.09541||12.90833||12.29365||||ANGIOTENSIN MODULATOR COMBINATIONS|1108|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078049115|EXFORGE 10-320 MG TABLET|30|EA|6.52381|10/01/2009||Yes|No||10/01/2009||Yes|No|10/01/2009||Yes|No||10/01/2009||Yes|No|||Prescription Required|Yes|07/27/2017|017|Yes|14.58129||14.23134||14.33341||||ANGIOTENSIN MODULATOR COMBINATIONS|1109|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078049305|FOCALIN XR 15 MG CAPSULE|100|EA|2.2068|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|4.9136||4.79567||4.83007||||STIMULANTS AND RELATED AGENTS|1110|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00078050115|EXELON 4.6 MG/24HR PATCH|30|EA|9.83266|09/14/2007||Yes|No||09/14/2007||Yes|No|09/14/2007||Yes|No||||No|No|||Prescription Required|No|01/28/2021|011|No|21.93676||21.41028||21.56384||||ALZHEIMER'S AGENTS|1111|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00078050215|EXELON 9.5 MG/24HR PATCH|30|EA|9.83266|09/14/2007||Yes|No||09/14/2007||Yes|No|09/14/2007||Yes|No||||No|No|||Prescription Required|No|01/28/2021|011|No|21.94463||21.41796||21.57157||||ALZHEIMER'S AGENTS|1112|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00078050315|EXELON 13.3 MG/24HR PATCH|30|EA|9.83266|02/07/2013||Yes|No||02/07/2013||Yes|No|02/07/2013||Yes|No||||No|No|||Prescription Required|No|01/28/2021|011|No|21.96779||21.44056||21.59434||||ALZHEIMER'S AGENTS|1113|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078050883|TEGRETOL 100 MG/5 ML SUSP|450|ML|.18535|10/02/2008||Yes|No||10/02/2008||Yes|No|10/02/2008||Yes|No||10/02/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|.413||.40309||.40598||||ANTICONVULSANTS|1114|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078050905|TEGRETOL 200 MG TABLET|100|EA|1.29499|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|2.88957||2.82022||2.84045||||ANTICONVULSANTS|1115|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078051005|TEGRETOL XR 100 MG TABLET|100|EA|.6932|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|1.54798||1.51083||1.52166||||ANTICONVULSANTS|1116|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078051105|TEGRETOL XR 200 MG TABLET|100|EA|1.38353|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|3.08783||3.01372||3.03534||||ANTICONVULSANTS|1117|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078051205|TEGRETOL XR 400 MG TABLET|100|EA|2.76486|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription Required|No|01/28/2021|056|No|6.17027||6.02218||6.06538||||ANTICONVULSANTS|1118|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078052651|TASIGNA 200 MG CAPSULE|28|EA|76.94466|12/15/2015||Yes|No||12/15/2015||Yes|No|12/15/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|175.36225||172.85707||164.62578||||ONCOLOGY, ORAL - HEMATOLOGIC|1119|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078052687|TASIGNA 200 MG CAPSULE|28|EA|76.94512|08/19/2008||Yes|No||08/19/2008||Yes|No|08/19/2008||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|175.3633||172.85811||164.62677||||ONCOLOGY, ORAL - HEMATOLOGIC|1120|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078056651|AFINITOR 5 MG TABLET          |28|EA|286.69482|04/06/2009||Yes|No||04/06/2009||Yes|No|04/06/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|653.3975||644.06325||613.39357||||ONCOLOGY, ORAL - RENAL CELL|1121|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078056751|AFINITOR 10 MG TABLET|28|EA|286.69482|04/06/2009||Yes|No||04/06/2009||Yes|No|04/06/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|653.3975||644.06325||613.39357||||ONCOLOGY, ORAL - RENAL CELL|1122|||||No|No||NOVARTIS|No|||||No|No|No||
interferon beta-1b|No|No|No|No|75%|00078056912|EXTAVIA 0.3 MG KIT|15|EA|227.68356|01/11/2010||Yes|No||01/11/2010||Yes|No|01/11/2010||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|518.90673||511.49377||487.13693||||MULTIPLE SCLEROSIS AGENTS|1123|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078059251|TASIGNA 150 MG CAPSULE|28|EA|76.94466|12/15/2015||Yes|No||12/15/2015||Yes|No|12/15/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|175.36225||172.85707||164.62578||||ONCOLOGY, ORAL - HEMATOLOGIC|1124|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078059287|TASIGNA 150 MG CAPSULE|28|EA|76.94512|09/30/2010||Yes|No||09/30/2010||Yes|No|09/30/2010||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|175.3633||172.85811||164.62677||||ONCOLOGY, ORAL - HEMATOLOGIC|1125|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078059451|AFINITOR 2.5 MG TABLET        |28|EA|274.09137|01/03/2011||Yes|No||01/03/2011||Yes|No|01/03/2011||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|624.67334||615.74944||586.42804||||ONCOLOGY, ORAL - RENAL CELL|1126|||||No|No||NOVARTIS|No|||||No|No|No||
fingolimod HCl|No|No|No|No|75%|00078060715|GILENYA 0.5 MG CAPSULE|30|EA|152.38411|06/17/2015||Yes|No||06/17/2015||Yes|No|06/17/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|344.67549||336.40328||338.81601||||MULTIPLE SCLEROSIS AGENTS|1127|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078060805|FOCALIN XR 25 MG CAPSULE|100|EA|2.31723|10/03/2011||Yes|No||10/13/2011||Yes|No|10/03/2011||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|5.17358||5.04941||5.08563||||STIMULANTS AND RELATED AGENTS|1128|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078060905|FOCALIN XR 35 MG CAPSULE|100|EA|2.43316|10/03/2011||Yes|No||10/03/2011||Yes|No|10/03/2011||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|5.45224||5.32139||5.35955||||STIMULANTS AND RELATED AGENTS|1129|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062051|AFINITOR 7.5 MG TABLET        |28|EA|286.69482|10/08/2014||Yes|No||10/08/2014||Yes|No|10/08/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|653.3975||644.06325||613.39357||||ONCOLOGY, ORAL - RENAL CELL|1130|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062651|AFINITOR DISPERZ 2 MG TABLET|28|EA|272.72458|08/05/2013||Yes|No||08/05/2013||Yes|No|08/05/2013||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|621.55835||612.67894||583.50375||413.20035|09/14/2016|ONCOLOGY, ORAL - RENAL CELL|1131|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062751|AFINITOR DISPERZ 3 MG TABLET|28|EA|275.45646|08/05/2013||Yes|No||08/05/2013||Yes|No|08/05/2013||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|627.78449||618.81614||589.34871||||ONCOLOGY, ORAL - RENAL CELL|1132|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062851|AFINITOR DISPERZ 5 MG TABLET|28|EA|286.69482|08/05/2013||Yes|No||08/05/2013||Yes|No|08/05/2013||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|653.3975||644.06325||613.39357||||ONCOLOGY, ORAL - RENAL CELL|1133|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063941|COSENTYX SNRDY 300MG DOSE-2PEN|1|ML|1592.9264|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|071|Yes|3591.81951||3505.61584||3530.75858||||CYTOKINE AND CAM ANTAGONISTS|1134|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063968|COSENTYX SENSOREADY 150 MG PEN|1|ML|3185.8528|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|071|Yes|7204.33688||7031.43279||7081.86315||||CYTOKINE AND CAM ANTAGONISTS|1135|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063997|COSENTYX 150 MG/ML SYRINGE|1|ML|3185.8528|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|071|Yes|7204.26571||7031.36333||7081.79319||||CYTOKINE AND CAM ANTAGONISTS|1136|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063998|COSENTYX 300 MG DOSE-2 SYRINGE|1|ML|1592.9264|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|071|Yes|3599.85643||3513.45988||3538.65887||||CYTOKINE AND CAM ANTAGONISTS|1137|||||No|No||NOVARTIS|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00078064930|GLEEVEC 400 MG TABLET|30|EA|145.08816|03/09/2015||Yes|No||03/09/2015||Yes|No|03/09/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|328.03422||320.1614||322.45764||||ONCOLOGY, ORAL - HEMATOLOGIC|1138|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078065415|JADENU 90 MG TABLET           |30|EA|21.58227|06/02/2015||Yes|No||06/02/2015||Yes|No|06/02/2015||Yes|No||||No|No|||Prescription Required|No|||No|49.1875||48.48482||46.17602|||||1139|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078065515|JADENU 180 MG TABLET          |30|EA|43.16354|06/02/2015||Yes|No||06/02/2015||Yes|No|06/02/2015||Yes|No||||No|No|||Prescription Required|No|||No|98.37272||96.9674||92.3499|||||1140|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078065615|JADENU 360 MG TABLET|30|EA|86.32565|06/02/2015||Yes|No||06/02/2015||Yes|No|06/02/2015||Yes|No||||No|No|||Prescription Required|No|||No|196.74218||193.93158||184.69674|||||1141|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078065920|ENTRESTO 24 MG-26 MG TABLET|60|EA|4.93074|08/13/2015||Yes|No||08/13/2015||Yes|No|08/13/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|113|Yes|11.00435||10.74025||10.81728||||ANGIOTENSIN MODULATORS|1142|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078065967|ENTRESTO 24 MG-26 MG TABLET|180|EA|4.93081|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|No|07/23/2015|113|Yes|11.00435||10.74025||10.81728||||ANGIOTENSIN MODULATORS|1143|||||No|No||NOVARTIS|No|||||No|No|No||
indacaterol/glycopyrrolate|No|No|No|No|75%|00078066419|UTIBRON NEOHALER 27.5-15.6 MCG|60|EA|2.6316|04/03/2017||Yes|No||04/03/2017||Yes|No|04/03/2017||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|098|Yes|5.9976||5.91192||5.6304||||COPD AGENTS|1144|||||No|No||NOVARTIS/SUNOVI|No|||||No|No|No||
lapatinib ditosylate|No|No|No|No|75%|00078067119|TYKERB 250 MG TABLET          |150|EA|28.46167|09/19/2016||Yes|No||09/19/2016||Yes|No|09/19/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|64.86613||63.93947||60.89474||||ONCOLOGY, ORAL - BREAST|1145|||||No|No||NOVARTIS|No|||||No|No|No||
topotecan HCl|No|No|No|No|75%|00078067201|HYCAMTIN 0.25 MG CAPSULE|10|EA|52.19168|08/21/2023||Yes|No||08/21/2023||Yes|No|08/21/2023||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|118.94848||117.24922||111.66592||||ONCOLOGY, ORAL - LUNG|1146|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
topotecan HCl|No|No|No|No|75%|00078067301|HYCAMTIN 1 MG CAPSULE|10|EA|208.76242|05/16/2017||Yes|No||05/16/2017||Yes|No|05/16/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|475.78412||468.9872||446.65448||||ONCOLOGY, ORAL - LUNG|1147|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
dabrafenib mesylate|No|No|No|No|75%|00078068166|TAFINLAR 75 MG CAPSULE|120|EA|52.19938|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|563|No|118.96603||117.26652||111.6824||||ONCOLOGY, ORAL - SKIN|1148|||||No|No||NOVARTIS|No|||||No|No|No||
dabrafenib mesylate|No|No|No|No|75%|00078068266|TAFINLAR 50 MG CAPSULE|120|EA|40.50388|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|563|No|92.31118||90.99245||86.65947||||ONCOLOGY, ORAL - SKIN|1149|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068415|PROMACTA 12.5 MG TABLET|30|EA|103.8685|11/21/2016||Yes|No||11/21/2016||Yes|No|11/21/2016||Yes|No||||No|No|||Prescription Required|No|07/25/2019|235|No|236.72357||233.3418||222.23029||||THROMBOPOIESIS STIMULATING PROTEINS|1150|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068515|PROMACTA 25 MG TABLET|30|EA|103.8685|07/27/2016||Yes|No||07/27/2016||Yes|No|07/27/2016||Yes|No||||No|No|||Prescription Required|No|07/25/2019|235|No|236.72357||233.3418||222.23029||||THROMBOPOIESIS STIMULATING PROTEINS|1151|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068615|PROMACTA 50 MG TABLET|30|EA|187.96919|07/27/2016||Yes|No||07/27/2016||Yes|No|07/27/2016||Yes|No||||No|No|||Prescription Required|No|07/25/2019|235|No|428.39491||422.27498||402.16665||||THROMBOPOIESIS STIMULATING PROTEINS|1152|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068715|PROMACTA 75 MG TABLET|30|EA|281.95386|05/20/2016||Yes|No||05/20/2016||Yes|No|05/20/2016||Yes|No||||No|No|||Prescription Required|No|07/25/2019|235|No|642.59253||633.41263||603.25013||||THROMBOPOIESIS STIMULATING PROTEINS|1153|||||No|No||NOVARTIS|No|||||No|No|No||
ceritinib|No|No|No|No|75%|00078069484|ZYKADIA 150 MG TABLET|84|EA|64.20355|11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|146.32438||144.23403||137.36574||||ONCOLOGY, ORAL - LUNG|1154|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078069620|ENTRESTO 97 MG-103 MG TABLET|60|EA|4.93074|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|113|Yes|11.00245||10.73839||10.81541||||ANGIOTENSIN MODULATORS|1155|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078069667|ENTRESTO 97 MG-103 MG TABLET|180|EA|4.93081|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|No|07/23/2015|113|Yes|11.00245||10.73839||10.81541||||ANGIOTENSIN MODULATORS|1156|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078069761|PROMACTA 25 MG SUSPENSION PCKT|30|EA|103.87409|08/03/2021||Yes|No||08/03/2021||Yes|No|08/03/2021||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|235|No|236.73631||233.35436||222.24225||||THROMBOPOIESIS STIMULATING PROTEINS|1157|||||No|No||NOVARTIS|No|||||No|No|No||
midostaurin|No|No|No|No|75%|00078069802|RYDAPT 25 MG CAPSULE|2|EA|85.2647|07/17/2017||Yes|No||07/17/2017||Yes|No|07/17/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|194.3242||191.54814||182.4268||||ONCOLOGY, ORAL - HEMATOLOGIC|1158|||||No|No||NOVARTIS|No|||||No|No|No||
midostaurin|No|No|No|No|75%|00078069899|RYDAPT 25 MG CAPSULE|56|EA|85.26293|07/17/2017||Yes|No||07/17/2017||Yes|No|07/17/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|194.32017||191.54417||182.42302||||ONCOLOGY, ORAL - HEMATOLOGIC|1159|||||No|No||NOVARTIS|No|||||No|No|No||
alpelisib|No|No|No|No|75%|00078070184|PIQRAY 200 MG DAILY DOSE PACK|28|EA|338.46406|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|771.3832||760.36344||724.15565||||ONCOLOGY, ORAL - BREAST|1160|||||No|No||NOVARTIS|No|||||No|No|Yes|07/30/2021|
alpelisib|No|No|No|No|75%|00078070802|PIQRAY 300 MG DAILY DOSE PACK|56|EA|169.23203|04/13/2020||Yes|No||04/13/2020||Yes|No|04/13/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|385.69159||380.18171||362.07782||||ONCOLOGY, ORAL - BREAST|1161|||||No|No||NOVARTIS|No|||||No|No|Yes|03/31/2022|
capmatinib hydrochloride|No|No|No|No|75%|00078070956|TABRECTA 150 MG TABLET|56|EA|87.39689|11/10/2020||Yes|No||11/10/2020||Yes|No|11/10/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|199.1836||196.33812||186.98868||||ONCOLOGY, ORAL - LUNG|1162|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078071315|JADENU SPRINKLE 180 MG GRANULE|30|EA|43.16354|01/30/2018||Yes|No||01/30/2018||Yes|No|01/30/2018||Yes|No||||No|No|||Prescription Required|No|||No|98.37272||96.9674||92.3499|||||1163|||||No|No||NOVARTIS|No|||||No|No|No||
alpelisib|No|No|No|No|75%|00078071502|PIQRAY 250 MG DAILY DOSE PACK|56|EA|169.23203|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|385.69159||380.18171||362.07782||||ONCOLOGY, ORAL - BREAST|1164|||||No|No||NOVARTIS|No|||||No|No|Yes|03/31/2022|
capmatinib hydrochloride|No|No|No|No|75%|00078071656|TABRECTA 200 MG TABLET|56|EA|87.39689|11/10/2020||Yes|No||11/10/2020||Yes|No|11/10/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|199.1836||196.33812||186.98868||||ONCOLOGY, ORAL - LUNG|1165|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078072015|JADENU SPRINKLE 360 MG GRANULE|30|EA|86.32565|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription Required|No|||No|196.74218||193.93158||184.69674|||||1166|||||No|No||NOVARTIS|No|||||No|No|No||
brinzolamide|No|No|No|No|75%|00078072210|AZOPT 1% EYE DROPS|10|ML|15.8068|08/16/2022||Yes|No||08/16/2022||Yes|No|08/16/2022||Yes|No||||No|No|||Prescription Required|No|01/27/2022|088|No|35.14951||34.30592||34.55197||||OPHTHALMICS, GLAUCOMA AGENTS|1167|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078072715|JADENU SPRINKLE 90 MG GRANULE |30|EA|21.58227|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription Required|No|||No|49.1875||48.48482||46.17602|||||1168|||||No|No||NOVARTIS|No|||||No|No|No||
canakinumab/PF|No|No|No|No|75%|00078073461|ILARIS 150 MG/ML VIAL|1|ML|8360.8598|04/07/2017||Yes|No||04/07/2017||Yes|No|04/07/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|071|Yes|19054.9828||18782.76876||17888.3512||||CYTOKINE AND CAM ANTAGONISTS|1169|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078077720|ENTRESTO 49 MG-51 MG TABLET|60|EA|4.93074|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|113|Yes|11.00417||10.74007||10.8171||||ANGIOTENSIN MODULATORS|1170|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078077767|ENTRESTO 49 MG-51 MG TABLET|180|EA|4.93081|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|No|07/23/2015|113|Yes|11.00417||10.74007||10.8171||||ANGIOTENSIN MODULATORS|1171|||||No|No||NOVARTIS|No|||||No|No|No||
ciprofloxacin HCl/dexameth|No|No|No|No|75%|00078079975|CIPRODEX OTIC SUSPENSION|7.5|ML|14.28116|01/05/2021|09/15/2024|Yes|No||01/05/2021|09/15/2024|Yes|No|01/05/2021|09/15/2024|Yes|No||||No|No|||Prescription Required|No|01/30/2020|051|No|32.54776||32.08279||30.55504||||OTIC ANTIBIOTICS|1172|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||NOVARTIS|No|||||No|No|No||
tobramycin|No|No|No|No|75%|00078081301|TOBREX 0.3% EYE OINTMENT|3.5|GM|31.30154|12/07/2022||Yes|No||12/07/2022||Yes|No|12/07/2022||Yes|No||||No|No|||Prescription Required|No|01/27/2022|058|No|69.86516||68.1884||68.67745||||OPHTHALMIC ANTIBIOTICS|1173|||||No|No||NOVARTIS|No|||||No|No|No||
octreotide acetate,mi-spheres|No|No|No|No|75%|00078081881|SANDOSTATIN LAR DEPOT 20 MG KT|1|EA|1985.009|02/16/2017||Yes|No||02/16/2017||Yes|No|02/16/2017||Yes|No||||No|No|||Prescription Required|No|||No|4523.974||4459.3458||4246.996|||||1174|||||No|No||NOVARTIS|No|||||No|No|No||
octreotide acetate,mi-spheres|No|No|No|No|75%|00078082581|SANDOSTATIN LAR DEPOT 30 MG KT|1|EA|2972.4008|02/16/2017||Yes|No||02/16/2017||Yes|No|02/16/2017||Yes|No||||No|No|||Prescription Required|No|||No|6774.3088||6677.53296||6359.5552|||||1175|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate|No|No|No|No|75%|00078086001|KISQALI 200 MG DAILY DOSE|21|EA|144.85103|05/15/2017||Yes|No||05/15/2017||Yes|No|05/15/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|330.12559||325.40951||309.91382||||ONCOLOGY, ORAL - BREAST|1176|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate|No|No|No|No|75%|00078086742|KISQALI 400 MG DAILY DOSE|42|EA|144.85154|05/15/2017||Yes|No||05/15/2017||Yes|No|05/15/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|330.12676||325.41066||309.91492||||ONCOLOGY, ORAL - BREAST|1177|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate|No|No|No|No|75%|00078087463|KISQALI 600 MG DAILY DOSE|63|EA|120.70966|05/15/2017||Yes|No||05/15/2017||Yes|No|05/15/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|275.10575||271.17566||258.26254||||ONCOLOGY, ORAL - BREAST|1178|||||No|No||NOVARTIS|No|||||No|No|No||
tobramycin/dexamethasone|No|No|No|No|75%|00078087601|TOBRADEX EYE OINTMENT|3.5|GM|33.32377|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|036|No|74.409||72.62318||73.14405||||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|1179|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate/letrozole|No|No|No|No|75%|00078090961|KISQALI FEMARA 200 MG CO-PACK|49|EA|62.07901|07/10/2017||Yes|No||07/10/2017||Yes|No|07/10/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|141.48239||139.46122||132.82021||||ONCOLOGY, ORAL - BREAST|1180|||||No|No||NOVARTIS|No|||||No|No|No||
lifitegrast|No|No|No|No|75%|00078091112|XIIDRA 5% EYE DROPS|60|EA|5.02784|12/09/2020||Yes|No||12/09/2020||Yes|No|12/09/2020||Yes|No||||No|No|||Prescription Required|No|01/27/2022|086|No|11.23355||10.96394||11.04258||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|1181|||||No|No||NOVARTIS/BAUSCH|No|||||No|No|No||
ribociclib succinate/letrozole|No|No|No|No|75%|00078091661|KISQALI FEMARA 400 MG CO-PACK|70|EA|86.91092|07/10/2017||Yes|No||07/10/2017||Yes|No|07/10/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|198.07605||195.24639||185.94895||||ONCOLOGY, ORAL - BREAST|1182|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate/letrozole|No|No|No|No|75%|00078092361|KISQALI FEMARA 600 MG CO-PACK|91|EA|83.56823|07/10/2017||Yes|No||07/10/2017||Yes|No|07/10/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|190.45783||187.737||178.79714||||ONCOLOGY, ORAL - BREAST|1183|||||No|No||NOVARTIS|No|||||No|No|No||
travoprost|No|No|No|No|75%|00078094625|TRAVATAN Z 0.004% EYE DROP|5|ML|42.31114|10/13/2022||Yes|No||10/13/2022||Yes|No|10/13/2022||Yes|No||||No|No|||Prescription Required|No|01/30/2020|088|No|94.566||92.29642||92.95838||||OPHTHALMICS, GLAUCOMA AGENTS|1184|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
travoprost|No|No|No|No|75%|00078094640|TRAVATAN Z 0.004% EYE DROP|2.5|ML|42.312|10/13/2022||Yes|No||10/13/2022||Yes|No|10/13/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|088|No|94.31017||92.04673||92.7069||||OPHTHALMICS, GLAUCOMA AGENTS|1185|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078097261|PROMACTA 12.5 MG SUSPEN PACKET|30|EA|103.8685|04/02/2019||Yes|No||04/02/2019||Yes|No|04/02/2019||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|235|No|236.72357||233.3418||222.23029||||THROMBOPOIESIS STIMULATING PROTEINS|1186|||||No|No||NOVARTIS|No|||||No|No|No||
siponimod|No|No|No|No|75%|00078097912|MAYZENT 0.25MG START-2MG MAINT|12|EA|34.41183|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription Required|No|07/29/2021|043|No|78.42695||77.30657||73.6253||62.67134|04/10/2020|MULTIPLE SCLEROSIS AGENTS|1187|||||No|No||NOVARTIS|No|||||No|No|Yes|07/30/2021|
siponimod|No|No|No|No|75%|00078097950|MAYZENT 0.25 MG TABLET|28|EA|34.41167|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|78.4266||77.30622||73.62497||||MULTIPLE SCLEROSIS AGENTS|1188|||||No|No||NOVARTIS|No|||||No|No|Yes|07/30/2021|
siponimod|No|No|No|No|75%|00078098615|MAYZENT 2 MG TABLET|30|EA|137.64715|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|313.70747||309.22593||294.50089||||MULTIPLE SCLEROSIS AGENTS|1189|||||No|No||NOVARTIS|No|||||No|No|Yes|07/30/2021|
ofatumumab|No|No|No|No|75%|00078100768|KESIMPTA 20 MG/0.4 ML PEN|0.4|ML|9390.7485|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|21102.4675||20596.00828||20743.72555||||MULTIPLE SCLEROSIS AGENTS|1190|||||No|No||NOVARTIS|No|||||No|No|No||
siponimod|No|No|No|No|75%|00078101415|MAYZENT 1 MG TABLET|30|EA|137.64715|11/01/2022||Yes|No||11/01/2022||Yes|No|11/01/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|043|No|313.70747||309.22593||294.50089||||MULTIPLE SCLEROSIS AGENTS|1191|||||No|No||NOVARTIS|No|||||No|No|Yes|03/30/2023|
alpelisib|No|No|No|No|75%|00078102184|VIJOICE 50 MG TABLET|28|EA|499.10714|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription Required|No|||No|1137.49999||1121.24999||1067.85714|||||1192|||||No|No||NOVARTIS|No|||||No|No|No||
alpelisib|No|No|No|No|75%|00078102884|VIJOICE 125 MG TABLET|28|EA|499.10714|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription Required|No|||No|1137.49999||1121.24999||1067.85714|||||1193|||||No|No||NOVARTIS|No|||||No|No|No||
alpelisib|No|No|No|No|75%|00078103502|VIJOICE 250 MG DAILY DOSE PACK|56|EA|249.55357|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription Required|No|||No|568.75||560.625||533.92857|||||1194|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078105697|COSENTYX 75 MG/0.5 ML SYRINGE|0.5|ML|3185.8528|08/23/2022||Yes|No||08/23/2022||Yes|No|08/23/2022||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|071|Yes|7260.7808||7157.05536||6816.2432||||CYTOKINE AND CAM ANTAGONISTS|1195|||||No|No||NOVARTIS|No|||||No|No|No||
pazopanib HCl|No|No|No|No|75%|00078107766|VOTRIENT 200 MG TABLET|120|EA|62.29284|07/20/2022||Yes|No||07/20/2022||Yes|No|07/20/2022||Yes|No||||No|No|||Prescription Required|No|07/28/2022|548|No|141.96974||139.9416||133.27771||||ONCOLOGY, ORAL - RENAL CELL|1196|||||No|No||NOVARTIS|No|||||No|No|No||
asciminib hydrochloride|No|No|No|No|75%|00078109120|SCEMBLIX 20 MG TABLET|60|EA|155.61485|09/27/2022||Yes|No||09/27/2022||Yes|No|09/27/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|173|No|354.6571||349.59057||332.9434||||ONCOLOGY, ORAL - HEMATOLOGIC|1197|||||No|No||NOVARTIS|No|||||No|No|No||
asciminib hydrochloride|No|No|No|No|75%|00078109820|SCEMBLIX 40 MG TABLET|60|EA|155.61485|09/27/2022||Yes|No||09/27/2022||Yes|No|09/27/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|173|No|354.6571||349.59057||332.9434||||ONCOLOGY, ORAL - HEMATOLOGIC|1198|||||No|No||NOVARTIS|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078110515|MEKINIST 0.5 MG TABLET|30|EA|66.60671|11/15/2022||Yes|No||11/15/2022||Yes|No|11/15/2022||Yes|No||||No|No|||Prescription Required|No|07/28/2022|563|No|151.80134||149.63275||142.50738||||ONCOLOGY, ORAL - SKIN|1199|||||No|No||NOVARTIS|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078111215|MEKINIST 2 MG TABLET|30|EA|226.69671|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|563|No|516.65763||509.2768||485.02553||||ONCOLOGY, ORAL - SKIN|1200|||||No|No||NOVARTIS|No|||||No|No|No||
dabrafenib mesylate|No|No|No|No|75%|00078115421|TAFINLAR 10 MG TABLET FOR SUSP|210|EA|8.10105|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|563|No|18.46287||18.19911||17.33249||||ONCOLOGY, ORAL - SKIN|1201|||||No|No||NOVARTIS|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078116147|MEKINIST 0.05 MG/ML SOLUTION|90|ML|7.99274|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|563|No|18.21601||17.95579||17.10075||||ONCOLOGY, ORAL - SKIN|1202|||||No|No||NOVARTIS|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00085132801|NOXAFIL 40 MG/ML SUSPENSION|105|ML|5.8953|08/17/2009||Yes|No||08/17/2009||Yes|No|08/17/2009||Yes|No||||No|No|||Prescription Required|Yes|07/18/2006|069|No|13.4358||13.24386||12.6132||||ANTIFUNGALS, ORAL|1203|||||No|No||MERCK SHARP & D|No|||||No|No|No||
mometasone furoate|No|No|No|No|75%|00085134102|ASMANEX TWISTHALER 220 MCG #60|1|EA|96.6554|08/31/2005||Yes|No||08/31/2005||Yes|No|08/31/2005||Yes|No||||No|No|||Prescription Required|No|01/25/2006|033|Yes|220.2844||217.13748||206.7976||||GLUCOCORTICOIDS, INHALED|1204|||||No|No||MERCK SHARP & D|Yes|09/01/2020||||No|No|No||
temozolomide|No|No|No|No|75%|00085142504|TEMODAR 140 MG CAPSULE|14|EA|274.2712|01/25/2013||Yes|No||01/25/2013||Yes|No|01/25/2013||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|625.0832||616.15344||586.8128||||ONCOLOGY, ORAL - OTHER|1205|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
posaconazole|No|No|No|No|75%|00085222402|NOXAFIL 300 MG POWDERMIX SUSP|8|EA|88.4037|04/26/2023||Yes|No||04/26/2023||Yes|No|04/26/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|069|No|201.4782||198.59994||189.1428||||ANTIFUNGALS, ORAL|1206|||||No|No||MERCK SHARP & D|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00085432402|NOXAFIL DR 100 MG TABLET|60|EA|29.4679|12/09/2013||Yes|No||12/09/2013||Yes|No|12/09/2013||Yes|No||||No|No|||Prescription Required|Yes|01/25/2024|069|No|67.1594||66.19998||63.0476||||ANTIFUNGALS, ORAL|1207|||||No|No||MERCK SHARP & D|No|||||No|No|No||
pediatric multivitamin no.192|No|No|No|No|75%|00087040203|POLY-VI-SOL 250MCG-50MG/ML DRP|50|ML|.07052|04/10/2019||Yes|No||||No|No|04/10/2019||Yes|No||||No|No|||Over The Counter|No|||No|.16072||.15842||.15088|||||1208|||||No|No||MJ NUTRITIONAL|No|||||No|Yes|No||
pedi mv no.189/ferrous sulfate|No|No|No|No|75%|00087040501|POLY-VI-SOL WITH IRON DROPS   |50|ML|.07052|04/10/2019||Yes|No||||No|No|04/10/2019||Yes|No||||No|No|||Over The Counter|No|||No|.16072||.15842||.15088|||||1209|||||No|No||MJ NUTRITIONAL|No|||||No|Yes|No||
rifapentine|No|No|No|No|75%|00088210224|PRIFTIN 150 MG TABLET|24|EA|2.08299|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription Required|No|||No|4.65674||4.54498||4.57758|||||1210|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
leflunomide|No|No|No|No|75%|00088216030|ARAVA 10 MG TABLET|30|EA|21.42088|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|48.81968||48.12226||45.83072|||||1211|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
leflunomide|No|No|No|No|75%|00088216130|ARAVA 20 MG TABLET|30|EA|21.42088|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|48.81968||48.12226||45.83072|||||1212|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00088221905|LANTUS SOLOSTAR 100 UNIT/ML|3|ML|2.76289|09/30/2010||Yes|No||09/30/2010||Yes|No|09/30/2010||Yes|No||07/01/2013||Yes|No|||Prescription Required|No|01/22/2015|029|No|6.17267||6.02453||6.06773||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1213|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glargine,hum.rec.anlog|Yes|No|No|No|75%|00088222033|LANTUS 100 UNIT/ML VIAL|10|ML|2.76318|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|01/22/2015|029|No|6.16717||6.01916||6.06233||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1214|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glulisine|Yes|No|No|No|75%|00088250033|APIDRA 100 UNIT/ML VIAL       |10|ML|3.66317|02/01/2006||Yes|No||02/01/2006||Yes|No|02/01/2006||Yes|No||02/01/2006||Yes|No|04/08/2020||Prescription Required|Yes|09/18/2020|029|No|8.17057||7.97448||8.03167||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1215|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glulisine|Yes|No|No|No|75%|00088250205|APIDRA SOLOSTAR 100 UNIT/ML|3|ML|4.71738|04/08/2009||Yes|No||04/08/2009||Yes|No|04/08/2009||Yes|No||04/08/2009||Yes|No|04/08/2020||Prescription Required|Yes|09/18/2020|029|No|10.54384||10.29079||10.36459||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1216|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093001006|TOLTERODINE TARTRATE 1 MG TAB|60|EA|1.13835|05/13/2016||Yes|No||05/13/2016||Yes|No|05/13/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|006|No|.18035||.17602||.17728||||BLADDER RELAXANT PREPARATIONS|1217|||||No|No||TEVA USA|No|||||No|No|No||
moexipril HCl|No|No|No|No|75%|00093001701|MOEXIPRIL HCL 7.5 MG TABLET   |100|EA|.38829|05/02/2007||Yes|No||05/02/2007||Yes|No|05/02/2007||Yes|No||05/02/2007||Yes|No|||Prescription Required|Yes|03/23/2007|113|No|.9422||.91959||.92618||||ANGIOTENSIN MODULATORS|1218|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093001805|TOLTERODINE TARTRATE 2 MG TAB|500|EA|1.16839|11/21/2016||Yes|No||11/21/2016||Yes|No|11/21/2016||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|006|No|.20115||.19632||.19773||||BLADDER RELAXANT PREPARATIONS|1219|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093001806|TOLTERODINE TARTRATE 2 MG TAB|60|EA|1.16838|08/16/2016||Yes|No||08/16/2016||Yes|No|08/16/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|006|No|.20115||.19632||.19773||||BLADDER RELAXANT PREPARATIONS|1220|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093005101|CARVEDILOL 3.125 MG TABLET|100|EA|.0258|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|10/15/2007|070|No|.01328||.01296||.01305||||BETA-BLOCKERS|1221|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093005105|CARVEDILOL 3.125 MG TABLET|500|EA|.02516|11/15/2011||Yes|No||11/15/2011||Yes|No|11/15/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/17/2007|070|No|.01328||.01296||.01305||||BETA-BLOCKERS|1222|||||No|No||TEVA USA|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00093005301|BUSPIRONE HCL 5 MG TABLET|100|EA|.02215|01/28/2011||Yes|No||01/28/2011||Yes|No|01/28/2011||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.01735||.01693||.01706||||ANXIOLYTICS|1223|||||No|No||TEVA USA|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00093005401|BUSPIRONE HCL 10 MG TABLET|100|EA|.0304|01/28/2011||Yes|No||01/28/2011||Yes|No|01/28/2011||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.02582||.0252||.02538||||ANXIOLYTICS|1224|||||No|No||TEVA USA|No|||||No|No|No||
tramadol HCl|No|No|No|No|90%|00093005801|TRAMADOL HCL 50 MG TABLET|100|EA|.02021|06/24/2004||Yes|No||06/24/2004||Yes|No|06/24/2004||Yes|No||||No|No|||Prescription Required|No|11/17/2006|109|Yes|.02194||.02141||.02157||||ANALGESICS, NARCOTICS SHORT|1225|||||No|No||TEVA USA|No|||||No|No|No||
tramadol HCl|No|No|No|No|90%|00093005805|TRAMADOL HCL 50 MG TABLET|500|EA|.01978|06/21/2002||Yes|No||06/21/2002||Yes|No|06/21/2002||Yes|No||||No|No|||Prescription Required|No|11/17/2006|109|Yes|.02194||.02141||.02157||||ANALGESICS, NARCOTICS SHORT|1226|||||No|No||TEVA USA|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00093007301|ZOLPIDEM TARTRATE 5 MG TABLET|100|EA|.01982|05/02/2007||Yes|No||05/02/2007||Yes|No|05/02/2007||Yes|No||||No|No|||Prescription Required|No|07/17/2007|054|Yes|.02485||.02425||.02443||||SEDATIVE HYPNOTICS|1227|||||No|No||TEVA USA|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00093007401|ZOLPIDEM TARTRATE 10 MG TABLET|100|EA|.01982|05/02/2007||Yes|No||05/02/2007||Yes|No|05/02/2007||Yes|No||||No|No|||Prescription Required|No|07/17/2007|054|Yes|.0267||.02606||.02625||||SEDATIVE HYPNOTICS|1228|||||No|No||TEVA USA|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00093009001|EPITOL 200 MG TABLET|100|EA|.5501|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/28/2021|056|No|.19769||.19295||.19433||||ANTICONVULSANTS|1229|||||No|No||TEVA USA|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00093010901|CARBAMAZEPINE 200 MG TABLET|100|EA|.5501|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/28/2021|056|No|.19769||.19295||.19433||||ANTICONVULSANTS|1230|||||No|No||TEVA USA|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00093010910|CARBAMAZEPINE 200 MG TABLET|1000|EA|.53361|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/28/2021|056|No|.19769||.19295||.19433||||ANTICONVULSANTS|1231|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093013501|CARVEDILOL 6.25 MG TABLET|100|EA|.0258|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|10/15/2007|070|No|.01554||.01517||.01528||||BETA-BLOCKERS|1232|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093013505|CARVEDILOL 6.25 MG TABLET|500|EA|.02516|11/15/2011||Yes|No||11/15/2011||Yes|No|11/15/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/17/2007|070|No|.01554||.01517||.01528||||BETA-BLOCKERS|1233|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00093026215|FLUOCINONIDE 0.05% CREAM|15|GM|1.04461|01/03/2008||Yes|No||01/03/2008||Yes|No|01/03/2008||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|120|No|.38388||.37467||.37735||||STEROIDS, TOPICAL HIGH|1234|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00093026230|FLUOCINONIDE 0.05% CREAM|30|GM|1.04461|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|120|No|.36299||.35428||.35682||||STEROIDS, TOPICAL HIGH|1235|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00093026292|FLUOCINONIDE 0.05% CREAM|60|GM|1.04454|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|120|No|.28254||.27576||.27774||||STEROIDS, TOPICAL HIGH|1236|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide/emollient base|No|No|No|No|75%|00093026315|FLUOCINONIDE-E 0.05% CREAM|15|GM|1.10452|08/11/2008||Yes|No||08/11/2008||Yes|No|08/11/2008||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|120|No|.85828||.83768||.84369||||STEROIDS, TOPICAL HIGH|1237|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide/emollient base|No|No|No|No|75%|00093026330|FLUOCINONIDE-E 0.05% CREAM|30|GM|1.10452|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|120|No|.74997||.73197||.73722||||STEROIDS, TOPICAL HIGH|1238|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide/emollient base|No|No|No|No|75%|00093026392|FLUOCINONIDE-E 0.05% CREAM|60|GM|1.10452|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|120|No|.67814||.66186||.66661||||STEROIDS, TOPICAL HIGH|1239|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00093026415|FLUOCINONIDE 0.05% OINTMENT|15|GM|1.62253|01/03/2008||Yes|No||01/03/2008||Yes|No|01/03/2008||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|120|No|.43531||.42486||.42791||||STEROIDS, TOPICAL HIGH|1240|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00093026430|FLUOCINONIDE 0.05% OINTMENT|30|GM|1.62253|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|120|No|.25606||.24991||.25171||||STEROIDS, TOPICAL HIGH|1241|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00093026492|FLUOCINONIDE 0.05% OINTMENT|60|GM|1.62253|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|120|No|.27761||.27095||.27289||||STEROIDS, TOPICAL HIGH|1242|||||No|No||TEVA USA|No|||||No|No|No||
clemastine fumarate|No|No|No|No|75%|00093030801|CLEMASTINE FUM 2.68 MG TAB|100|EA|.29055|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription Required|Yes|01/31/2019|574|Yes|.51486||.5025||.50611||||ANTIHISTAMINES, FIRST GENERATION|1243|||||No|No||TEVA USA|No|||||No|No|No||
loperamide HCl|No|No|No|No|75%|00093031101|LOPERAMIDE 2 MG CAPSULE|100|EA|.15798|||No|No||||No|No|||No|No||09/01/1999||Yes|No|||Prescription Required|No|||No|.12668||.12364||.12453|||||1244|||||No|No||TEVA USA|No|||||No|No|No||
loperamide HCl|No|No|No|No|75%|00093031105|LOPERAMIDE 2 MG CAPSULE|500|EA|.15797|||No|No||||No|No|||No|No||09/01/1999||Yes|No|||Prescription Required|No|||No|.12668||.12364||.12453|||||1245|||||No|No||TEVA USA|No|||||No|No|No||
ketorolac tromethamine|No|No|No|No|75%|00093031401|KETOROLAC 10 MG TABLET|100|EA|.46371|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.28051||.27378||.27574||||NSAIDS|1246|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093031801|DILTIAZEM 30 MG TABLET|100|EA|.06446|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|045|No|.06732||.0657||.06618||||CALCIUM CHANNEL BLOCKERS|1247|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093031805|DILTIAZEM 30 MG TABLET|500|EA|.06332|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|045|No|.06732||.0657||.06618||||CALCIUM CHANNEL BLOCKERS|1248|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093031901|DILTIAZEM 60 MG TABLET|100|EA|.10105|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|045|No|.09725||.09492||.0956||||CALCIUM CHANNEL BLOCKERS|1249|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093031905|DILTIAZEM 60 MG TABLET|500|EA|.09928|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|045|No|.09725||.09492||.0956||||CALCIUM CHANNEL BLOCKERS|1250|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093032001|DILTIAZEM 90 MG TABLET|100|EA|.13816|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|045|No|.18967||.18512||.18645||||CALCIUM CHANNEL BLOCKERS|1251|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093032101|DILTIAZEM 120 MG TABLET|100|EA|.18602|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|045|No|.1974||.19266||.19404||||CALCIUM CHANNEL BLOCKERS|1252|||||No|No||TEVA USA|No|||||No|No|No||
lovastatin|Yes|No|No|No|75%|00093057610|LOVASTATIN 20 MG TABLET|1000|EA|.08798|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|07/01/2016||Prescription Required|No|07/23/2015|063|No|.03704||.03615||.03641||||LIPOTROPICS, STATINS|1253|||||No|No||TEVA USA|No|||||No|No|No||
flurbiprofen|No|No|No|No|75%|00093071101|FLURBIPROFEN 100 MG TABLET|100|EA|.20098|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|059|Yes|.34184||.33364||.33603||||NSAIDS|1254|||||No|No||TEVA USA|No|||||No|No|No||
flurbiprofen|No|No|No|No|75%|00093071105|FLURBIPROFEN 100 MG TABLET|500|EA|.19685|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|059|Yes|.34184||.33364||.33603||||NSAIDS|1255|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093075201|ATENOLOL 50 MG TABLET|100|EA|.01492|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.02063||.02013||.02028||||BETA-BLOCKERS|1256|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093075210|ATENOLOL 50 MG TABLET|1000|EA|.01418|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.02063||.02013||.02028||||BETA-BLOCKERS|1257|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093075301|ATENOLOL 100 MG TABLET|100|EA|.02623|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.03271||.03192||.03215||||BETA-BLOCKERS|1258|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093075305|ATENOLOL 100 MG TABLET|500|EA|.02558|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||02/08/2008||Yes|No|||Prescription Required|No|07/17/2007|070|No|.03271||.03192||.03215||||BETA-BLOCKERS|1259|||||No|No||TEVA USA|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00093075601|PIROXICAM 10 MG CAPSULE|100|EA|.48435|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|059|Yes|.15421||.15051||.15159||||NSAIDS|1260|||||No|No||TEVA USA|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00093075701|PIROXICAM 20 MG CAPSULE|100|EA|.90782|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|059|Yes|.17296||.16881||.17002||||NSAIDS|1261|||||No|No||TEVA USA|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00093075705|PIROXICAM 20 MG CAPSULE|500|EA|.88972|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|059|Yes|.17296||.16881||.17002||||NSAIDS|1262|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093077198|PRAVASTATIN SODIUM 10 MG TAB|90|EA|.11404|04/27/2006||Yes|No||04/27/2006||Yes|No|04/27/2006||Yes|No||04/27/2006||Yes|No|07/01/2016||Prescription Required|No|07/22/2009|063|Yes|.04614||.04503||.04536||||LIPOTROPICS, STATINS|1263|||||No|No||TEVA USA|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00093077801|CARBAMAZEPINE 100 MG TAB CHEW|100|EA|.22652|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/28/2021|056|No|.21042||.20537||.20684||||ANTICONVULSANTS|1264|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093078701|ATENOLOL 25 MG TABLET|100|EA|.01466|12/07/2004||Yes|No||12/07/2004||Yes|No|12/07/2004||Yes|No||12/07/2004||Yes|No|||Prescription Required|No|02/23/2004|070|No|.01865||.0182||.01833||||BETA-BLOCKERS|1265|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093078710|ATENOLOL 25 MG TABLET|1000|EA|.01393|12/07/2004||Yes|No||12/07/2004||Yes|No|12/07/2004||Yes|No||12/07/2004||Yes|No|||Prescription Required|No|02/23/2004|070|No|.01865||.0182||.01833||||BETA-BLOCKERS|1266|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081001|NORTRIPTYLINE HCL 10 MG CAP|100|EA|.08376|05/12/2011||Yes|No||05/12/2011||Yes|No|05/12/2011||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.08758||.08548||.08609||||ANTIDEPRESSANTS, TRICYCLIC|1267|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081101|NORTRIPTYLINE HCL 25 MG CAP|100|EA|.11438|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.11002||.10738||.10815||||ANTIDEPRESSANTS, TRICYCLIC|1268|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081105|NORTRIPTYLINE HCL 25 MG CAP|500|EA|.11152|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.11002||.10738||.10815||||ANTIDEPRESSANTS, TRICYCLIC|1269|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081201|NORTRIPTYLINE HCL 50 MG CAP|100|EA|.14014|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.14528||.14179||.14281||||ANTIDEPRESSANTS, TRICYCLIC|1270|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081205|NORTRIPTYLINE HCL 50 MG CAP|500|EA|.1366|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.14528||.14179||.14281||||ANTIDEPRESSANTS, TRICYCLIC|1271|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081301|NORTRIPTYLINE HCL 75 MG CAP|100|EA|.19406|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.1991||.19432||.19572||||ANTIDEPRESSANTS, TRICYCLIC|1272|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081305|NORTRIPTYLINE HCL 75 MG CAP|500|EA|.18922|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.1991||.19432||.19572||||ANTIDEPRESSANTS, TRICYCLIC|1273|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093083201|CLONAZEPAM 0.5 MG TABLET|100|EA|.0129|09/19/2023||Yes|No||09/19/2023||Yes|No|09/19/2023||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|Yes|.01744||.01702||.01714||||ANTICONVULSANTS|1274|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093083205|CLONAZEPAM 0.5 MG TABLET|500|EA|.0129|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||06/06/2023||Yes|No|||Prescription Required|No|01/28/2021|056|Yes|.01744||.01702||.01714||||ANTICONVULSANTS|1275|||||No|No||TEVA USA|No|||||No|No|No||
lovastatin|Yes|No|No|No|75%|00093092606|LOVASTATIN 10 MG TABLET|60|EA|.09001|02/16/2016||Yes|No||02/16/2016||Yes|No|02/16/2016||Yes|No||||No|No|07/01/2016||Prescription Required|No|07/23/2015|063|No|.03904||.0381||.03838||||LIPOTROPICS, STATINS|1276|||||No|No||TEVA USA|No|||||No|No|No||
lovastatin|Yes|No|No|No|75%|00093092610|LOVASTATIN 10 MG TABLET|1000|EA|.08562|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|07/01/2016||Prescription Required|No|07/23/2015|063|No|.03904||.0381||.03838||||LIPOTROPICS, STATINS|1277|||||No|No||TEVA USA|No|||||No|No|No||
lovastatin|Yes|No|No|No|75%|00093092810|LOVASTATIN 40 MG TABLET|1000|EA|.14144|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|07/01/2016||Prescription Required|No|07/23/2015|063|No|.04774||.04659||.04693||||LIPOTROPICS, STATINS|1278|||||No|No||TEVA USA|No|||||No|No|No||
diclofenac potassium|No|No|No|No|75%|00093094801|DICLOFENAC POT 50 MG TABLET|100|EA|.44969|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|059|Yes|.0931||.09087||.09152||||NSAIDS|1279|||||No|No||TEVA USA|No|||||No|No|No||
diclofenac potassium|No|No|No|No|75%|00093094805|DICLOFENAC POT 50 MG TABLET|500|EA|.44969|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|059|Yes|.0931||.09087||.09152||||NSAIDS|1280|||||No|No||TEVA USA|No|||||No|No|No||
nystatin|No|No|No|No|75%|00093098301|NYSTATIN 500,000 UNIT ORAL TAB|100|EA|.43129|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|03/29/2004|069|No|.29215||.28514||.28718||||ANTIFUNGALS, ORAL|1281|||||No|No||TEVA USA|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00093100301|BUSPIRONE HCL 15 MG TABLET|100|EA|.03771|12/14/2010||Yes|No||12/14/2010||Yes|No|12/14/2010||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.03594||.03508||.03533||||ANXIOLYTICS|1282|||||No|No||TEVA USA|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00093100305|BUSPIRONE HCL 15 MG TABLET|500|EA|.03713|12/14/2010||Yes|No||12/14/2010||Yes|No|12/14/2010||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.03594||.03508||.03533||||ANXIOLYTICS|1283|||||No|No||TEVA USA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00093100501|NAPROXEN DR 375 MG TABLET|100|EA|.29025|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/28/2021|059|Yes|.2261||.22067||.22226||||NSAIDS|1284|||||No|No||TEVA USA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00093100505|NAPROXEN DR 375 MG TABLET|500|EA|.27574|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/28/2021|059|Yes|.2261||.22067||.22226||||NSAIDS|1285|||||No|No||TEVA USA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00093100601|NAPROXEN DR 500 MG TABLET|100|EA|.37896|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/28/2021|059|Yes|.86367||.85134||.8108||||NSAIDS|1286|||||No|No||TEVA USA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00093100605|NAPROXEN DR 500 MG TABLET|500|EA|.35999|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/28/2021|059|Yes|.82044||.80872||.77021||||NSAIDS|1287|||||No|No||TEVA USA|No|||||No|No|No||
mupirocin|No|No|No|No|75%|00093101042|MUPIROCIN 2% OINTMENT|22|GM|.17786|11/14/2003||Yes|No||11/14/2003||Yes|No|11/14/2003||Yes|No||||No|No|||Prescription Required|No|01/23/2008|114|No|.14566||.14216||.14318||||ANTIBIOTICS, TOPICAL|1288|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093102406|NEFAZODONE HCL 100 MG TABLET|60|EA|.58946|09/22/2003||Yes|No||09/22/2003||Yes|No|09/22/2003||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|1.19844||1.16968||1.17807||||ANTIDEPRESSANTS, OTHER|1289|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093102506|NEFAZODONE HCL 200 MG TABLET|60|EA|.64851|09/22/2003||Yes|No||09/22/2003||Yes|No|09/22/2003||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|1.35087||1.31845||1.32791||||ANTIDEPRESSANTS, OTHER|1290|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093102606|NEFAZODONE HCL 250 MG TABLET|60|EA|.67775|09/22/2003||Yes|No||09/22/2003||Yes|No|09/22/2003||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|1.54464||1.52257||1.45007||||ANTIDEPRESSANTS, OTHER|1291|||||No|No||TEVA USA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00093106001|SOTALOL 120 MG TABLET|100|EA|.16125|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.07183||.07011||.07061||||BETA-BLOCKERS|1292|||||No|No||TEVA USA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00093106101|SOTALOL 80 MG TABLET|100|EA|.1204|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.05967||.05824||.05866||||BETA-BLOCKERS|1293|||||No|No||TEVA USA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00093106201|SOTALOL 160 MG TABLET|100|EA|.20425|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.14756||.14402||.14505||||BETA-BLOCKERS|1294|||||No|No||TEVA USA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00093106301|SOTALOL 240 MG TABLET         |100|EA|.28294|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|070|No|.2601||.25386||.25568||||BETA-BLOCKERS|1295|||||No|No||TEVA USA|No|||||No|No|No||
cefprozil|No|No|No|No|75%|00093107701|CEFPROZIL 250 MG TABLET|100|EA|.5833|05/17/2006||Yes|No||05/17/2006||Yes|No|05/17/2006||Yes|No||||No|No|||Prescription Required|No|01/30/2020|046|No|.59208||.57787||.58201||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1296|||||No|No||TEVA USA|No|||||No|No|No||
cefprozil|No|No|No|No|75%|00093107853|CEFPROZIL 500 MG TABLET|50|EA|1.20159|12/29/2005||Yes|No||12/29/2005||Yes|No|12/29/2005||Yes|No||||No|No|||Prescription Required|No|01/30/2020|046|No|.83839||.81827||.82414||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1297|||||No|No||TEVA USA|No|||||No|No|No||
cefaclor|No|No|No|No|75%|00093108701|CEFACLOR ER 500 MG TABLET     |100|EA|6.01768|09/10/2002||Yes|No||09/10/2002||Yes|No|09/10/2002||Yes|No||09/10/2002||Yes|No|||Prescription Required|Yes|01/25/2012|046|No|13.71471||13.51878||12.87503||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1298|||||No|No||TEVA USA|No|||||No|No|No||
etodolac|No|No|No|No|75%|00093111801|ETODOLAC ER 600 MG TABLET     |100|EA|1.1263|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|059|Yes|1.17317||1.14501||1.15323||||NSAIDS|1299|||||No|No||TEVA USA|No|||||No|No|No||
etodolac|No|No|No|No|75%|00093112201|ETODOLAC ER 400 MG TABLET|100|EA|.99803|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|059|Yes|1.07947||1.05356||1.06112||||NSAIDS|1300|||||No|No||TEVA USA|No|||||No|No|No||
abiraterone acetate|No|No|No|No|75%|00093112589|ABIRATERONE ACETATE 250 MG TAB|120|EA|12.53951|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|550|No|1.08623||1.06016||1.06776||||ONCOLOGY, ORAL - PROSTATE|1301|||||No|No||TEVA USA|No|||||No|No|No||
acitretin|No|No|No|No|75%|00093113556|ACITRETIN 10 MG CAPSULE|30|EA|5.36668|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|No|||No|3.9686||3.87335||3.90113|||||1302|||||No|No||TEVA USA|No|||||No|No|No||
acitretin|No|No|No|No|75%|00093113656|ACITRETIN 25 MG CAPSULE|30|EA|6.61497|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|No|||No|3.9502||3.8554||3.88305|||||1303|||||No|No||TEVA USA|No|||||No|No|No||
acitretin|No|No|No|No|75%|00093113856|ACITRETIN 17.5 MG CAPSULE|30|EA|8.26875|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|No|||No|13.21276||12.89565||12.98814|||||1304|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093117201|PENICILLIN VK 250 MG TABLET|100|EA|.08265|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.05543||.0541||.05449||||PENICILLINS|1305|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093117210|PENICILLIN VK 250 MG TABLET|1000|EA|.07851|12/08/2006||Yes|No||12/08/2006||Yes|No|12/08/2006||Yes|No||12/08/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.05543||.0541||.05449||||PENICILLINS|1306|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093117410|PENICILLIN VK 500 MG TABLET|1000|EA|.13343|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.06968||.06801||.0685||||PENICILLINS|1307|||||No|No||TEVA USA|No|||||No|No|No||
neomycin sulfate|No|No|No|No|75%|00093117701|NEOMYCIN 500 MG TABLET|100|EA|.47734|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/31/2019|115|No|.79328||.77424||.77979||||ANTIBIOTICS, GI|1308|||||No|No||TEVA USA|No|||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171201|WARFARIN SODIUM 1 MG TABLET|100|EA|.09374|02/18/2016||Yes|No||02/18/2016||Yes|No|02/18/2016||Yes|No||02/18/2016||Yes|No|||Prescription Required|No|07/23/2015|068|Yes|.0896||.08745||.08808||||ANTICOAGULANTS|1309|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171210|WARFARIN SODIUM 1 MG TABLET|1000|EA|.09094|02/18/2016||Yes|No||02/18/2016||Yes|No|02/18/2016||Yes|No||02/18/2016||Yes|No|||Prescription Required|No|07/23/2015|068|Yes|.0896||.08745||.08808||||ANTICOAGULANTS|1310|||||No|No||TEVA USA|No|||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171301|WARFARIN SODIUM 2 MG TABLET|100|EA|.09787|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/23/2015|068|Yes|.08437||.08235||.08294||||ANTICOAGULANTS|1311|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171310|WARFARIN SODIUM 2 MG TABLET|1000|EA|.09494|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/17/2014|068|Yes|.08437||.08235||.08294||||ANTICOAGULANTS|1312|||||No|No||TEVA USA|No|||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171401|WARFARIN SODIUM 2.5 MG TABLET|100|EA|.10096|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/17/2014|068|Yes|.08794||.08583||.08645||||ANTICOAGULANTS|1313|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171410|WARFARIN SODIUM 2.5 MG TABLET|1000|EA|.0979|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/17/2014|068|Yes|.08794||.08583||.08645||||ANTICOAGULANTS|1314|||||No|No||TEVA USA|No|||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171501|WARFARIN SODIUM 3 MG TABLET|100|EA|.10139|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/23/2015|068|Yes|.0946||.09233||.09299||||ANTICOAGULANTS|1315|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171601|WARFARIN SODIUM 4 MG TABLET|100|EA|.1017|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/17/2014|068|Yes|.08492||.08288||.08348||||ANTICOAGULANTS|1316|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171610|WARFARIN SODIUM 4 MG TABLET|1000|EA|.09861|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/23/2015|068|Yes|.08492||.08288||.08348||||ANTICOAGULANTS|1317|||||No|No||TEVA USA|No|||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171801|WARFARIN SODIUM 6 MG TABLET|100|EA|.14513|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/23/2015|068|Yes|.10604||.1035||.10424||||ANTICOAGULANTS|1318|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093172001|WARFARIN SODIUM 10 MG TABLET|100|EA|.15656|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/17/2014|068|Yes|.11126||.10859||.10937||||ANTICOAGULANTS|1319|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093172101|WARFARIN SODIUM 5 MG TABLET|100|EA|.1023|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/17/2014|068|Yes|.08932||.08718||.0878||||ANTICOAGULANTS|1320|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093172110|WARFARIN SODIUM 5 MG TABLET|1000|EA|.09924|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription Required|No|07/17/2014|068|Yes|.08932||.08718||.0878||||ANTICOAGULANTS|1321|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093172301|WARFARIN SODIUM 7.5 MG TABLET|100|EA|.1505|12/10/2018||Yes|No||12/10/2018||Yes|No|12/10/2018||Yes|No||12/10/2018||Yes|No|||Prescription Required|No|07/26/2018|068|Yes|.10583||.10329||.10403||||ANTICOAGULANTS|1322|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093192006|CYCLOBENZAPRINE ER 15 MG CAP  |60|EA|2.92035|06/29/2021||Yes|No||06/29/2021||Yes|No|06/29/2021||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|116|Yes|1.92533||1.87912||1.8926||||SKELETAL MUSCLE RELAXANTS|1323|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093192106|CYCLOBENZAPRINE ER 30 MG CAP  |60|EA|2.92035|06/29/2021||Yes|No||06/29/2021||Yes|No|06/29/2021||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|116|Yes|2.76133||2.69506||2.71439||||SKELETAL MUSCLE RELAXANTS|1324|||||No|No||TEVA USA|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00093201312|SUMATRIPTAN 4 MG/0.5 ML INJECT|0.5|ML|77.0904|06/14/2017||Yes|No||06/14/2017||Yes|No|06/14/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|021|Yes|175.6944||173.18448||164.9376||||ANTIMIGRAINE AGENTS, TRIPTANS|1325|||||No|No||TEVA USA|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00093201412|SUMATRIPTAN 6 MG/0.5ML AUTOINJ|0.5|ML|77.0904|06/14/2017||Yes|No||06/14/2017||Yes|No|06/14/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|021|Yes|175.6944||173.18448||164.9376||||ANTIMIGRAINE AGENTS, TRIPTANS|1326|||||No|No||TEVA USA|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00093202623|AZITHROMYCIN 200 MG/5 ML SUSP|15|ML|.74992|01/27/2011||Yes|No||01/27/2011||Yes|No|01/27/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|02/02/2010|018|No|.27215||.26562||.26752||||MACROLIDES/KETOLIDES|1327|||||No|No||TEVA USA|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00093202631|AZITHROMYCIN 200 MG/5 ML SUSP|30|ML|.37496|01/27/2011||Yes|No||01/27/2011||Yes|No|01/27/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/20/2011|018|No|.18019||.17587||.17713||||MACROLIDES/KETOLIDES|1328|||||No|No||TEVA USA|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00093202694|AZITHROMYCIN 200 MG/5 ML SUSP|22.5|ML|.49994|03/08/2011||Yes|No||03/08/2011||Yes|No|03/08/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/20/2011|018|No|.19878||.19401||.1954||||MACROLIDES/KETOLIDES|1329|||||No|No||TEVA USA|No|||||No|No|No||
azithromycin|No|No|No|No|75%|00093202723|AZITHROMYCIN 100 MG/5 ML SUSP|15|ML|.74992|01/27/2011||Yes|No||01/27/2011||Yes|No|01/27/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/20/2011|018|No|.31291||.3054||.30759||||MACROLIDES/KETOLIDES|1330|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093206301|QUETIAPINE FUMARATE 25 MG TAB|100|EA|.07998|04/28/2014||Yes|No||04/28/2014||Yes|No|04/28/2014||Yes|No||||No|No|||Prescription Required|No|01/15/2014|027|Yes|.02508||.02448||.02465||||ANTIPSYCHOTICS|1331|||||No|No||TEVA USA|No|||||No|No|No||
cilostazol|No|No|No|No|75%|00093206406|CILOSTAZOL 100 MG TABLET|60|EA|.15688|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||||No|No|||Prescription Required|No|||No|.10856||.10595||.10671|||||1332|||||No|No||TEVA USA|No|||||No|No|No||
cilostazol|No|No|No|No|75%|00093206506|CILOSTAZOL 50 MG TABLET|60|EA|.13688|06/06/2012||Yes|No||06/06/2012||Yes|No|06/06/2012||Yes|No||||No|No|||Prescription Required|No|||No|.11049||.10784||.10861|||||1333|||||No|No||TEVA USA|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00093206701|DOXAZOSIN MESYLATE 8 MG TAB|100|EA|.31958|02/18/2015||Yes|No||02/18/2015||Yes|No|02/18/2015||Yes|No||02/18/2015||Yes|No|||Prescription Required|No|07/17/2014|003|No|.07308||.07133||.07184||||BPH TREATMENTS|1334|||||No|No||TEVA USA|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00093206801|DOXAZOSIN MESYLATE 4 MG TAB|100|EA|.30431|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||10/28/2014||Yes|No|||Prescription Required|No|07/17/2014|003|No|.08438||.08235||.08295||||BPH TREATMENTS|1335|||||No|No||TEVA USA|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00093206901|DOXAZOSIN MESYLATE 2 MG TAB|100|EA|.28995|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||10/28/2014||Yes|No|||Prescription Required|No|07/17/2014|003|No|.05624||.05489||.05528||||BPH TREATMENTS|1336|||||No|No||TEVA USA|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00093207001|DOXAZOSIN MESYLATE 1 MG TAB|100|EA|.28995|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||10/28/2014||Yes|No|||Prescription Required|No|07/17/2014|003|No|.06555||.06398||.06444||||BPH TREATMENTS|1337|||||No|No||TEVA USA|No|||||No|No|No||
norgestimate-ethinyl estradiol|Yes|Yes|No|No|75%|00093214062|TRI-LO-SPRINTEC TABLET|28|EA|.18019|04/27/2016||Yes|No||04/27/2016||Yes|No|04/27/2016||Yes|No|Refer to program requirements|||No|No|04/27/2016||Prescription Required|No|||No|.09034||.08817||.0888|||||1338|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
naloxone HCl|No|No|No|No|75%|00093216519|NALOXONE HCL 4 MG NASAL SPRAY|1|EA||08/30/2024||Yes|No||08/30/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|01/27/2022|145|No|||||||||OPIATE DEPENDENCE TREATMENTS|1339|||||No|No||TEVA USA|No|||||No|No|No||
naloxone HCl|No|No|No|No|75%|00093216568|NALOXONE HCL 4 MG NASAL SPRAY|2|EA|23.22|03/29/2022||Yes|No||03/29/2022||Yes|No|03/29/2022||Yes|No||||No|No|||Prescription Required|No|01/27/2022|145|No|34.27||33.44752||33.68741||||OPIATE DEPENDENCE TREATMENTS|1340|||||No|No||TEVA USA|No|||||No|No|No||
liothyronine sodium|No|No|No|No|75%|00093217801|LIOTHYRONINE SOD 25 MCG TAB|100|EA|.3102|07/09/2021||Yes|No||07/09/2021||Yes|No|07/09/2021||Yes|No||||No|No|||Prescription Required|No|||No|.2458||.2399||.24162|||||1341|||||No|No||TEVA USA|No|||||No|No|No||
liothyronine sodium|No|No|No|No|75%|00093217901|LIOTHYRONINE SOD 5 MCG TAB|100|EA|.23616|07/09/2021||Yes|No||07/09/2021||Yes|No|07/09/2021||Yes|No||||No|No|||Prescription Required|No|||No|.1898||.18524||.18657|||||1342|||||No|No||TEVA USA|No|||||No|No|No||
liothyronine sodium|No|No|No|No|75%|00093218001|LIOTHYRONINE SOD 50 MCG TAB|100|EA|.4739|07/09/2021||Yes|No||07/09/2021||Yes|No|07/09/2021||Yes|No||||No|No|||Prescription Required|No|||No|.40449||.39478||.39761|||||1343|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220301|METOCLOPRAMIDE 10 MG TABLET|100|EA|.03139|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/27/2011|085|No|.0413||.04031||.0406||||ANTIEMETIC/ANTIVERTIGO AGENTS|1344|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220305|METOCLOPRAMIDE 10 MG TABLET|500|EA|.03|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/27/2011|085|No|.0413||.04031||.0406||||ANTIEMETIC/ANTIVERTIGO AGENTS|1345|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220310|METOCLOPRAMIDE 10 MG TABLET|1000|EA|.02864|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/27/2011|085|No|.0413||.04031||.0406||||ANTIEMETIC/ANTIVERTIGO AGENTS|1346|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220401|METOCLOPRAMIDE 5 MG TABLET|100|EA|.03096|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/27/2011|085|No|.0357||.03484||.03509||||ANTIEMETIC/ANTIVERTIGO AGENTS|1347|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220405|METOCLOPRAMIDE 5 MG TABLET|500|EA|.02718|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/27/2011|085|No|.0357||.03484||.03509||||ANTIEMETIC/ANTIVERTIGO AGENTS|1348|||||No|No||TEVA USA|No|||||No|No|No||
sucralfate|No|No|No|No|75%|00093221001|SUCRALFATE 1 GM TABLET|100|EA|.11627|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.15629||.15254||.15363|||||1349|||||No|No||TEVA USA|No|||||No|No|No||
sucralfate|No|No|No|No|75%|00093221005|SUCRALFATE 1 GM TABLET|500|EA|.1025|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.15629||.15254||.15363|||||1350|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093223801|CEPHALEXIN 250 MG TABLET|100|EA|.58226|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|046|No|.8741||.85312||.85924||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1351|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093224001|CEPHALEXIN 500 MG TABLET|100|EA|1.16431|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|Yes|01/15/2014|046|No|2.08561||2.03556||2.05015||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1352|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093226301|AMOXICILLIN 500 MG TABLET|100|EA|.16065|04/19/2006||Yes|No||04/19/2006||Yes|No|04/19/2006||Yes|No||04/19/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.09809||.09574||.09642||||PENICILLINS|1353|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093226401|AMOXICILLIN 875 MG TABLET|100|EA|.28126|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.12982||.1267||.12761||||PENICILLINS|1354|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093226701|AMOXICILLIN 125 MG TAB CHEW|100|EA|.0937|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.21354||.21049||.20047||||PENICILLINS|1355|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093226801|AMOXICILLIN 250 MG TAB CHEW|100|EA|.14052|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.2764||.26977||.2717||||PENICILLINS|1356|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093227034|AMOX-CLAV 200-28.5 MG TAB CHEW|20|EA|.99438|04/21/2005||Yes|No||04/21/2005||Yes|No|04/21/2005||Yes|No||04/21/2005||Yes|No|||Prescription Required|Yes|01/23/2013|046|No|2.26625||2.23388||2.1275||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1357|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093227234|AMOX-CLAV 400-57 MG TAB CHEW|20|EA|1.89501|02/15/2005||Yes|No||02/15/2005||Yes|No|02/15/2005||Yes|No||02/15/2005||Yes|No|||Prescription Required|Yes|01/23/2013|046|No|1.49723||1.4613||1.47178||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1358|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093227434|AMOX-CLAV 500-125 MG TABLET|20|EA|.60652|11/07/2002||Yes|No||11/07/2002||Yes|No|11/07/2002||Yes|No||11/07/2002||Yes|No|||Prescription Required|No|01/23/2008|046|No|.24183||.23603||.23772||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1359|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093227534|AMOX-CLAV 875-125 MG TABLET|20|EA|.72584|11/01/2002||Yes|No||11/01/2002||Yes|No|11/01/2002||Yes|No||11/01/2002||Yes|No|||Prescription Required|No|01/23/2008|046|No|.26312||.25681||.25865||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1360|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093227773|AMOX-CLAV 200-28.5 MG/5 ML SUS|100|ML|.05956|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05752||.05614||.05654||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1361|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093227973|AMOX-CLAV 400-57 MG/5 ML SUSP|100|ML|.22253|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05459||.05328||.05366||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1362|||||No|No||TEVA USA|No|||||No|No|No||
hydroxychloroquine sulfate|No|No|No|No|75%|00093240101|HYDROXYCHLOROQUINE 200 MG TAB|100|EA|1.4061|05/18/2021||Yes|No||05/18/2021||Yes|No|05/18/2021||Yes|No||||No|No|||Prescription Required|No|||No|.13986||.1365||.13748|||||1363|||||No|No||TEVA USA|No|||||No|No|No||
quinine sulfate|No|No|No|No|75%|00093300256|QUININE SULFATE 324 MG CAPSULE|30|EA|2.43294|10/22/2012||Yes|No||10/22/2012||Yes|No|10/22/2012||Yes|No||10/22/2012||Yes|No|||Prescription Required|No|||No|.70774||.69075||.69571|||||1364|||||No|No||TEVA USA|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00093300893|LANSOPRAZOLE DR 15 MG ODT|100|EA|5.14052|05/24/2018||Yes|No||05/24/2018||Yes|No|05/24/2018||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|03/22/2018|047|No|2.11115||2.06048||2.07526||||PROTON PUMP INHIBITORS|1365|||||No|No||TEVA USA|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00093300993|LANSOPRAZOLE DR 30 MG ODT|100|EA|5.14052|05/24/2018||Yes|No||05/24/2018||Yes|No|05/24/2018||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|03/22/2018|047|No|2.19636||2.14365||2.15902||||PROTON PUMP INHIBITORS|1366|||||No|No||TEVA USA|No|||||No|No|No||
rasagiline mesylate|No|No|No|No|75%|00093306056|RASAGILINE MESYLATE 0.5 MG TAB|30|EA|2.9561|05/16/2017||Yes|No||05/16/2017||Yes|No|05/16/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|015|No|1.07254||1.0468||1.05431||||ANTIPARKINSON'S AGENTS|1367|||||No|No||TEVA USA|No|||||No|No|No||
rasagiline mesylate|No|No|No|No|75%|00093306156|RASAGILINE MESYLATE 1 MG TAB|30|EA|2.9561|04/26/2017||Yes|No||04/26/2017||Yes|No|04/26/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|015|No|1.27886||1.24817||1.25712||||ANTIPARKINSON'S AGENTS|1368|||||No|No||TEVA USA|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00093309056|ARMODAFINIL 50 MG TABLET|30|EA|.18762|03/02/2017||Yes|No||03/02/2017||Yes|No|03/02/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.24165||.23585||.23754||||STIMULANTS AND RELATED AGENTS|1369|||||No|No||TEVA USA|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00093309256|ARMODAFINIL 150 MG TABLET|30|EA|.56473|03/02/2017||Yes|No||03/02/2017||Yes|No|03/02/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.53522||.52237||.52612||||STIMULANTS AND RELATED AGENTS|1370|||||No|No||TEVA USA|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00093309356|ARMODAFINIL 200 MG TABLET|30|EA|.56473|03/02/2017||Yes|No||03/02/2017||Yes|No|03/02/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.51721||.5048||.50842||||STIMULANTS AND RELATED AGENTS|1371|||||No|No||TEVA USA|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00093309456|ARMODAFINIL 250 MG TABLET|30|EA|.56473|03/02/2017||Yes|No||03/02/2017||Yes|No|03/02/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.63249||.61731||.62174||||STIMULANTS AND RELATED AGENTS|1372|||||No|No||TEVA USA|No|||||No|No|No||
risedronate sodium|No|No|No|No|75%|00093309829|RISEDRONATE SODIUM 35 MG TAB|12|EA|21.31116|07/31/2015||Yes|No||07/31/2015||Yes|No|07/31/2015||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|060|No|2.01354||1.96522||1.97931||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1373|||||No|No||TEVA USA|No|||||No|No|No||
risedronate sodium|No|No|No|No|75%|00093309844|RISEDRONATE SODIUM 35 MG TAB|4|EA|21.31188|07/31/2015||Yes|No||07/31/2015||Yes|No|07/31/2015||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|060|No|2.01354||1.96522||1.97931||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1374|||||No|No||TEVA USA|No|||||No|No|No||
risedronate sodium|No|No|No|No|75%|00093309956|RISEDRONATE SODIUM 5 MG TABLET|30|EA|3.0464|07/31/2015||Yes|No||07/31/2015||Yes|No|07/31/2015||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|060|No|1.35039||1.31798||1.32743||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1375|||||No|No||TEVA USA|No|||||No|No|No||
risedronate sodium|No|No|No|No|75%|00093310056|RISEDRONATE SODIUM 30 MG TAB  |30|EA|21.31108|07/31/2015||Yes|No||07/31/2015||Yes|No|07/31/2015||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|060|No|48.56945||47.8756||45.59581||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1376|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093310701|AMOXICILLIN 250 MG CAPSULE|100|EA|.05121|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.06473||.06318||.06363||||PENICILLINS|1377|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093310705|AMOXICILLIN 250 MG CAPSULE|500|EA|.04533|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.06473||.06318||.06363||||PENICILLINS|1378|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093310905|AMOXICILLIN 500 MG CAPSULE|500|EA|.0716|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.07085||.06915||.06965||||PENICILLINS|1379|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093310953|AMOXICILLIN 500 MG CAPSULE|50|EA|.07972|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.07085||.06915||.06965||||PENICILLINS|1380|||||No|No||TEVA USA|No|||||No|No|No||
norethindrone ac/eth estradiol|No|No|No|No|75%|00093312242|JINTELI 1 MG-5 MCG TABLET|28|EA|1.00758|03/04/2011||Yes|No||03/04/2011||Yes|No|03/04/2011||Yes|No||||No|No|||Prescription Required|No|||Yes|.70474||.68783||.69276|||||1381|||||No|No||TEVA USA|No|||||No|No|No||
norethindrone ac/eth estradiol|No|No|No|No|75%|00093312298|JINTELI 1 MG-5 MCG TABLET|90|EA|1.00739|03/04/2011||Yes|No||03/04/2011||Yes|No|03/04/2011||Yes|No||||No|No|||Prescription Required|No|||Yes|.70474||.68783||.69276|||||1382|||||No|No||TEVA USA|No|||||No|No|No||
dicloxacillin sodium|No|No|No|No|75%|00093312301|DICLOXACILLIN 250 MG CAPSULE|100|EA|.2936|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.44674||.43602||.43915||||PENICILLINS|1383|||||No|No||TEVA USA|No|||||No|No|No||
dicloxacillin sodium|No|No|No|No|75%|00093312501|DICLOXACILLIN 500 MG CAPSULE|100|EA|.58725|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.74958||.73159||.73684||||PENICILLINS|1384|||||No|No||TEVA USA|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00093312701|DISOPYRAMIDE 100 MG CAPSULE|100|EA|.85699|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.67064||.65454||.65924|||||1385|||||No|No||TEVA USA|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00093312901|DISOPYRAMIDE 150 MG CAPSULE|100|EA|.96617|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|1.06273||1.03722||1.04466|||||1386|||||No|No||TEVA USA|No|||||No|No|No||
imiquimod|No|No|No|No|75%|00093313331|IMIQUIMOD 3.75% CREAM PUMP    |7.5|GM|61.03592|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription Required|No|||Yes|139.10512||137.1179||130.58848|||||1387|||||No|No||TEVA USA|No|||||No|No|No||
L-norgest/e.estradiol-e.estrad|Yes|Yes|No|No|75%|00093313482|CAMRESE 0.15-0.03-0.01 MG TAB|91|EA|.8629|08/05/2011||Yes|No||08/05/2011||Yes|No|08/05/2011||Yes|No|Refer to program requirements|||No|No|09/04/2019||Prescription Required|No|||No|.||.||.|||||1388|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
cephalexin|No|No|No|No|75%|00093314501|CEPHALEXIN 250 MG CAPSULE|100|EA|.05676|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|04/28/2004|046|No|.07576||.07394||.07447||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1389|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093314505|CEPHALEXIN 250 MG CAPSULE|500|EA|.05418|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|04/28/2004|046|No|.07576||.07394||.07447||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1390|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093314701|CEPHALEXIN 500 MG CAPSULE|100|EA|.09374|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|04/28/2004|046|No|.08973||.08758||.0882||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1391|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093314705|CEPHALEXIN 500 MG CAPSULE|500|EA|.08858|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|04/28/2004|046|No|.08973||.08758||.0882||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1392|||||No|No||TEVA USA|No|||||No|No|No||
cefdinir|No|No|No|No|75%|00093316006|CEFDINIR 300 MG CAPSULE|60|EA|1.64933|05/14/2007||Yes|No||05/14/2007||Yes|No|05/14/2007||Yes|No||||No|No|||Prescription Required|No|01/23/2008|046|No|.35066||.34224||.3447||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1393|||||No|No||TEVA USA|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00093317431|ALBUTEROL HFA 90 MCG INHALER|8.5|GM|1.82016|04/17/2020||Yes|No||04/17/2020||Yes|No|04/17/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|037|Yes|2.02335||1.97479||1.98895||||BRONCHODILATORS, BETA AGONIST|1394|||||No|No||TEVA USA|No|||||No|No|No||
penciclovir|No|No|No|No|75%|00093318620|PENCICLOVIR 1% CREAM|5|GM|60.33416|06/07/2023||Yes|No||06/07/2023||Yes|No|06/07/2023||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|123|No|106.33038||103.77845||104.52276||||ANTIVIRALS, TOPICAL|1395|||||No|No||TEVA USA|No|||||No|No|No||
cefadroxil|No|No|No|No|75%|00093319601|CEFADROXIL 500 MG CAPSULE|100|EA|.2279|05/16/2007||Yes|No||05/16/2007||Yes|No|05/16/2007||Yes|No||05/16/2007||Yes|No|||Prescription Required|No|07/18/2006|046|No|.2356||.22995||.23159||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1396|||||No|No||TEVA USA|No|||||No|No|No||
cefadroxil|No|No|No|No|75%|00093319653|CEFADROXIL 500 MG CAPSULE|50|EA|.25585|11/01/2008||Yes|No||11/01/2008||Yes|No|11/01/2008||Yes|No||11/01/2008||Yes|No|||Prescription Required|No|07/06/2006|046|No|.2356||.22995||.23159||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1397|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093321201|CLONAZEPAM 1 MG TABLET|100|EA|.01806|01/30/2020||Yes|No||01/30/2020||Yes|No|01/30/2020||Yes|No||01/30/2020||Yes|No|||Prescription Required|No|01/28/2021|056|Yes|.02556||.02495||.02513||||ANTICONVULSANTS|1398|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093321205|CLONAZEPAM 1 MG TABLET|500|EA|.01806|09/06/2023||Yes|No||09/06/2023||Yes|No|09/06/2023||Yes|No||09/06/2023||Yes|No|||Prescription Required|No|01/28/2021|056|Yes|.02556||.02495||.02513||||ANTICONVULSANTS|1399|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093321301|CLONAZEPAM 2 MG TABLET|100|EA|.02666|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||02/02/2021||Yes|No|||Prescription Required|No|01/28/2021|056|Yes|.0316||.03084||.03106||||ANTICONVULSANTS|1400|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093321305|CLONAZEPAM 2 MG TABLET|500|EA|.02666|01/30/2020||Yes|No||01/30/2020||Yes|No|01/30/2020||Yes|No||01/30/2020||Yes|No|||Prescription Required|No|01/28/2021|056|Yes|.0316||.03084||.03106||||ANTICONVULSANTS|1401|||||No|No||TEVA USA|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00093321915|KETOCONAZOLE 2% CREAM|15|GM|.70864|02/01/2021||Yes|No||02/01/2021||Yes|No|02/01/2021||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|.24108||.23529||.23698||||ANTIFUNGALS, TOPICAL|1402|||||No|No||TEVA USA|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00093321930|KETOCONAZOLE 2% CREAM|30|GM|.59755|02/01/2021||Yes|No||02/01/2021||Yes|No|02/01/2021||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|.19484||.19016||.19153||||ANTIFUNGALS, TOPICAL|1403|||||No|No||TEVA USA|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00093321992|KETOCONAZOLE 2% CREAM|60|GM|.45365|02/01/2021||Yes|No||02/01/2021||Yes|No|02/01/2021||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|.13846||.13514||.13611||||ANTIFUNGALS, TOPICAL|1404|||||No|No||TEVA USA|No|||||No|No|No||
estradiol|No|No|No|No|75%|00093322308|ESTRADIOL 10 MCG VAGINAL INSRT|8|EA|8.34093|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription Required|No|||Yes|5.0022||4.88215||4.91716|||||1405|||||No|No||TEVA USA|No|||||No|No|No||
estradiol|No|No|No|No|75%|00093322397|ESTRADIOL 10 MCG VAGINAL INSRT|18|EA|8.34128|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription Required|No|||Yes|5.0022||4.88215||4.91716|||||1406|||||No|No||TEVA USA|No|||||No|No|No||
sulfasalazine|No|No|No|No|75%|00093323401|SULFASALAZINE 500 MG TABLET|100|EA|.0802|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription Required|No|01/26/2023|010|No|.17109||.16698||.16818||||ULCERATIVE COLITIS AGENTS|1407|||||No|No||TEVA USA|No|||||No|No|No||
sulfasalazine|No|No|No|No|75%|00093323405|SULFASALAZINE 500 MG TABLET|500|EA|.0802|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription Required|No|01/26/2023|010|No|.17109||.16698||.16818||||ULCERATIVE COLITIS AGENTS|1408|||||No|No||TEVA USA|No|||||No|No|No||
sulfasalazine|No|No|No|No|75%|00093323410|SULFASALAZINE 500 MG TABLET|1000|EA|.0802|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription Required|No|01/26/2023|010|No|.17109||.16698||.16818||||ULCERATIVE COLITIS AGENTS|1409|||||No|No||TEVA USA|No|||||No|No|No||
buprenorphine|No|No|No|No|90%|00093323940|BUPRENORPHINE 7.5 MCG/HR PATCH|4|EA|32.32095|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|110|Yes|25.34934||24.74096||24.9184||||ANALGESICS, NARCOTICS LONG|1410|||||No|No||TEVA USA|No|||||No|No|No||
bisoprolol/hydrochlorothiazide|No|No|No|No|75%|00093324101|BISOPROLOL-HCTZ 2.5-6.25 MG TB|100|EA|.28965|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||02/03/2021||Yes|No|||Prescription Required|No|07/26/2018|070|Yes|.17286||.16871||.16992||||BETA-BLOCKERS|1411|||||No|No||TEVA USA|No|||||No|No|No||
bisoprolol/hydrochlorothiazide|No|No|No|No|75%|00093324201|BISOPROLOL-HCTZ 5-6.25 MG TAB|100|EA|.28965|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||02/03/2021||Yes|No|||Prescription Required|No|07/26/2018|070|Yes|.14665||.14313||.14416||||BETA-BLOCKERS|1412|||||No|No||TEVA USA|No|||||No|No|No||
bisoprolol/hydrochlorothiazide|No|No|No|No|75%|00093324356|BISOPROLOL-HCTZ 10-6.25 MG TAB|30|EA|.28967|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||02/03/2021||Yes|No|||Prescription Required|No|07/26/2018|070|Yes|.12269||.11975||.1206||||BETA-BLOCKERS|1413|||||No|No||TEVA USA|No|||||No|No|No||
desogestrel-ethinyl estradiol|Yes|Yes|No|No|75%|00093330416|RECLIPSEN 28 DAY TABLET|28|EA|.3139|08/24/2017||Yes|No||08/24/2017||Yes|No|08/24/2017||Yes|No|Refer to program requirements|||No|No|08/24/2017||Prescription Required|No|||No|.11113||.10846||.10924|||||1414|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
tadalafil|No|No|No|No|75%|00093333406|ALYQ 20 MG TABLET|60|EA|.40528|08/07/2020||Yes|No||08/07/2020||Yes|No|08/07/2020||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|171|Yes|.28688||.27999||.282||||PAH AGENTS, ORAL AND INHALED|1415|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093342001|CYCLOBENZAPRINE 5 MG TABLET|100|EA|.07254|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|Yes|.01572||.01534||.01545||||SKELETAL MUSCLE RELAXANTS|1416|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093342101|CYCLOBENZAPRINE 7.5 MG TABLET|100|EA|1.65369|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|Yes|.35224||.34379||.34625||||SKELETAL MUSCLE RELAXANTS|1417|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093342201|CYCLOBENZAPRINE 10 MG TABLET|100|EA|.03053|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|Yes|.01441||.01406||.01417||||SKELETAL MUSCLE RELAXANTS|1418|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093342205|CYCLOBENZAPRINE 10 MG TABLET|500|EA|.02901|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|Yes|.01441||.01406||.01417||||SKELETAL MUSCLE RELAXANTS|1419|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093342210|CYCLOBENZAPRINE 10 MG TABLET|1000|EA|.02901|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|Yes|.01441||.01406||.01417||||SKELETAL MUSCLE RELAXANTS|1420|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342501|LORAZEPAM 0.5 MG TABLET|100|EA|.01875|06/13/2022||Yes|No||06/13/2022||Yes|No|06/13/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.03148||.03072||.03094||||ANXIOLYTICS|1421|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342505|LORAZEPAM 0.5 MG TABLET|500|EA|.01877|03/28/2022||Yes|No||03/28/2022||Yes|No|03/28/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.03148||.03072||.03094||||ANXIOLYTICS|1422|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342510|LORAZEPAM 0.5 MG TABLET|1000|EA|.0182|03/28/2022||Yes|No||03/28/2022||Yes|No|03/28/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.03148||.03072||.03094||||ANXIOLYTICS|1423|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342601|LORAZEPAM 1 MG TABLET|100|EA|.02129|03/28/2022||Yes|No||03/28/2022||Yes|No|03/28/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.03406||.03324||.03348||||ANXIOLYTICS|1424|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342605|LORAZEPAM 1 MG TABLET|500|EA|.0213|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.03406||.03324||.03348||||ANXIOLYTICS|1425|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342610|LORAZEPAM 1 MG TABLET|1000|EA|.02066|06/13/2022||Yes|No||06/13/2022||Yes|No|06/13/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.03406||.03324||.03348||||ANXIOLYTICS|1426|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342701|LORAZEPAM 2 MG TABLET|100|EA|.03311|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.05231||.05105||.05142||||ANXIOLYTICS|1427|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342705|LORAZEPAM 2 MG TABLET|500|EA|.03309|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.05231||.05105||.05142||||ANXIOLYTICS|1428|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342710|LORAZEPAM 2 MG TABLET|1000|EA|.0321|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|090|Yes|.05231||.05105||.05142||||ANXIOLYTICS|1429|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342810|TACROLIMUS 0.03% OINTMENT|100|GM|1.00336|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|2.28673||2.25406||2.14673||||IMMUNOMODULATORS, ATOPIC DERMATITIS|1430|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342830|TACROLIMUS 0.03% OINTMENT|30|GM|1.00333|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|2.28666||2.254||2.14666||||IMMUNOMODULATORS, ATOPIC DERMATITIS|1431|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342892|TACROLIMUS 0.03% OINTMENT|60|GM|1.00341|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|2.28683||2.25416||2.14682||||IMMUNOMODULATORS, ATOPIC DERMATITIS|1432|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342910|TACROLIMUS 0.1% OINTMENT|100|GM|1.43336|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|3.26673||3.22006||3.06673||||IMMUNOMODULATORS, ATOPIC DERMATITIS|1433|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342930|TACROLIMUS 0.1% OINTMENT|30|GM|1.43333|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|3.26666||3.22||3.06666||||IMMUNOMODULATORS, ATOPIC DERMATITIS|1434|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342992|TACROLIMUS 0.1% OINTMENT|60|GM|1.43341|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|3.26683||3.22016||3.06682||||IMMUNOMODULATORS, ATOPIC DERMATITIS|1435|||||No|No||TEVA USA|No|||||No|No|No||
estradiol|No|No|No|No|75%|00093354143|ESTRADIOL 0.01% CREAM|42.5|GM|1.101|05/21/2018||Yes|No||05/21/2018||Yes|No|05/21/2018||Yes|No||||No|No|||Prescription Required|No|||Yes|.36924||.36038||.36296|||||1436|||||No|No||TEVA USA|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00093354256|ATOMOXETINE HCL 10 MG CAPSULE|30|EA|1.59143|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.38337||.37417||.37685||||STIMULANTS AND RELATED AGENTS|1437|||||No|No||TEVA USA|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00093354356|ATOMOXETINE HCL 18 MG CAPSULE|30|EA|1.59143|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.42113||.41102||.41397||||STIMULANTS AND RELATED AGENTS|1438|||||No|No||TEVA USA|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00093354456|ATOMOXETINE HCL 25 MG CAPSULE|30|EA|1.59143|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.34441||.33614||.33856||||STIMULANTS AND RELATED AGENTS|1439|||||No|No||TEVA USA|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00093354556|ATOMOXETINE HCL 40 MG CAPSULE|30|EA|1.72903|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.59702||.58269||.58687||||STIMULANTS AND RELATED AGENTS|1440|||||No|No||TEVA USA|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00093354656|ATOMOXETINE HCL 60 MG CAPSULE|30|EA|1.72903|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.49054||.47877||.4822||||STIMULANTS AND RELATED AGENTS|1441|||||No|No||TEVA USA|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00093354756|ATOMOXETINE HCL 80 MG CAPSULE|30|EA|1.86548|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.48422||.4726||.47599||||STIMULANTS AND RELATED AGENTS|1442|||||No|No||TEVA USA|No|||||No|No|No||
atomoxetine HCl|No|No|No|No|75%|00093354856|ATOMOXETINE HCL 100 MG CAPSULE|30|EA|1.86548|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.5148||.50244||.50605||||STIMULANTS AND RELATED AGENTS|1443|||||No|No||TEVA USA|No|||||No|No|No||
peg3350/sod sul/NaCl/KCl/asb/C|No|No|No|No|75%|00093356026|PEG3350 100-7.5-2.691-1.01-5.9|1|EA|41.624|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||02/03/2021||Yes|No|||Prescription Required|No|||No|63.39167||61.87027||62.31401|||||1444|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360782|FLUTICASONE-SALMETEROL 55-14|1|EA|52.7739|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|033|Yes|108.241||105.64322||106.4009||||GLUCOCORTICOIDS, INHALED|1445|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360882|FLUTICASONE-SALMETEROL 113-14|1|EA|52.7739|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|033|Yes|103.78717||101.29628||102.02279||||GLUCOCORTICOIDS, INHALED|1446|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360982|FLUTICASONE-SALMETEROL 232-14|1|EA|52.7739|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|033|Yes|102.97519||100.50379||101.22461||||GLUCOCORTICOIDS, INHALED|1447|||||No|No||TEVA USA|No|||||No|No|No||
acyclovir|No|No|No|No|75%|00093363020|ACYCLOVIR 5% CREAM|5|GM|62.73442|08/31/2020||Yes|No||08/31/2020||Yes|No|08/31/2020||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|123|No|7.91889||7.72884||7.78427||||ANTIVIRALS, TOPICAL|1448|||||No|No||TEVA USA|No|||||No|No|No||
methylergonovine maleate|No|No|No|No|75%|00093365522|METHYLERGONOVINE 0.2 MG TABLET|12|EA|8.5441|06/06/2019||Yes|No||06/06/2019||Yes|No|06/06/2019||Yes|No||||No|No|||Prescription Required|No|||No|8.44502||8.24234||8.30145|||||1449|||||No|No||TEVA USA|No|||||No|No|No||
methylergonovine maleate|No|No|No|No|75%|00093365528|METHYLERGONOVINE 0.2 MG TABLET|28|EA|8.53934|06/06/2019||Yes|No||06/06/2019||Yes|No|06/06/2019||Yes|No||||No|No|||Prescription Required|No|||No|8.44502||8.24234||8.30145|||||1450|||||No|No||TEVA USA|No|||||No|No|No||
buprenorphine|No|No|No|No|90%|00093365640|BUPRENORPHINE 5 MCG/HR PATCH|4|EA|22.77065|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|110|Yes|21.61243||21.09373||21.24502||||ANALGESICS, NARCOTICS LONG|1451|||||No|No||TEVA USA|No|||||No|No|No||
buprenorphine|No|No|No|No|90%|00093365740|BUPRENORPHINE 10 MCG/HR PATCH|4|EA|34.15598|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|110|Yes|25.23439||24.62876||24.80541||||ANALGESICS, NARCOTICS LONG|1452|||||No|No||TEVA USA|No|||||No|No|No||
buprenorphine|No|No|No|No|90%|00093365840|BUPRENORPHINE 15 MCG/HR PATCH|4|EA|49.2694|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|110|Yes|40.56364||39.59011||39.87406||||ANALGESICS, NARCOTICS LONG|1453|||||No|No||TEVA USA|No|||||No|No|No||
buprenorphine|No|No|No|No|90%|00093365940|BUPRENORPHINE 20 MCG/HR PATCH|4|EA|60.46875|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|110|Yes|46.02211||44.91758||45.23973||||ANALGESICS, NARCOTICS LONG|1454|||||No|No||TEVA USA|No|||||No|No|No||
diclofenac epolamine|No|No|No|No|75%|00093372755|DICLOFENAC EPOLAMINE 1.3% PTCH|30|EA|4.61877|10/29/2020||Yes|No||10/29/2020||Yes|No|10/29/2020||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|059|Yes|4.89862||4.78105||4.81534||||NSAIDS|1455|||||No|No||TEVA USA|No|||||No|No|No||
tobramycin|No|No|No|No|75%|00093375028|TOBRAMYCIN 300 MG/4 ML AMPULE |4|ML|10.25937|01/27/2021||Yes|No||01/27/2021||Yes|No|01/27/2021||Yes|No|Submit HHS Form 1143|||No|No|||Prescription Required|Yes|07/27/2023|240|No|23.38183||23.0478||21.95029||||ANTIBIOTICS, INHALED|1456|||||No|No||TEVA USA|No|||||Yes|No|No||
tobramycin|No|No|No|No|75%|00093375063|TOBRAMYCIN 300 MG/4 ML AMPULE |4|ML|10.25937|01/27/2021||Yes|No||01/27/2021||Yes|No|01/27/2021||Yes|No|Submit HHS Form 1143|||No|No|||Prescription Required|Yes|07/27/2023|240|No|23.38183||23.0478||21.95029||||ANTIBIOTICS, INHALED|1457|||||No|No||TEVA USA|No|||||Yes|No|No||
ethinyl estradiol/drospirenone|No|Yes|No|No|75%|00093400062|VESTURA 3 MG-0.02 MG TABLET|28|EA|.86998|07/09/2021||Yes|No||07/09/2021||Yes|No|07/09/2021||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.1278||.12473||.12563|||||1458|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
cefadroxil|No|No|No|No|75%|00093405953|CEFADROXIL 1 GM TABLET        |50|EA|2.306|05/21/2007||Yes|No||05/21/2007||Yes|No|05/21/2007||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|046|No|2.93565||2.86519||2.88574||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1459|||||No|No||TEVA USA|No|||||No|No|No||
formoterol fumarate|No|No|No|No|75%|00093406106|FORMOTEROL 20 MCG/2 ML NEB VL|2|ML|3.45358|02/15/2022||Yes|No||02/15/2022||Yes|No|02/15/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|037|Yes|2.53139||2.47064||2.48836||||BRONCHODILATORS, BETA AGONIST|1460|||||No|No||TEVA USA|No|||||Yes|No|No||
formoterol fumarate|No|No|No|No|75%|00093406130|FORMOTEROL 20 MCG/2 ML NEB VL|2|ML|3.45361|02/10/2022||Yes|No||02/10/2022||Yes|No|02/10/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|037|Yes|2.95718||2.88621||2.90691||||BRONCHODILATORS, BETA AGONIST|1461|||||No|No||TEVA USA|No|||||Yes|No|No||
prazosin HCl|No|No|No|No|75%|00093406701|PRAZOSIN 1 MG CAPSULE|100|EA|.18481|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription Required|No|||No|.09805||.0957||.09638|||||1462|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406710|PRAZOSIN 1 MG CAPSULE|1000|EA|.18483|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription Required|No|||No|.09805||.0957||.09638|||||1463|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406801|PRAZOSIN 2 MG CAPSULE|100|EA|.27292|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription Required|No|||No|.10215||.0997||.10041|||||1464|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406810|PRAZOSIN 2 MG CAPSULE|1000|EA|.27291|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription Required|No|||No|.10215||.0997||.10041|||||1465|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406901|PRAZOSIN 5 MG CAPSULE|100|EA|.45055|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription Required|No|||No|.13572||.13246||.13341|||||1466|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406905|PRAZOSIN 5 MG CAPSULE|500|EA|.45054|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription Required|No|||No|.13572||.13246||.13341|||||1467|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406952|PRAZOSIN 5 MG CAPSULE|250|EA|.45052|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription Required|No|||No|.13572||.13246||.13341|||||1468|||||No|No||TEVA USA|No|||||No|No|No||
tobramycin in 0.225% sod chlor|No|No|No|No|75%|00093408563|TOBRAMYCIN 300 MG/5 ML AMPULE|5|ML|1.59472|12/13/2013||Yes|No||12/13/2013||Yes|No|12/13/2013||Yes|No|Submit HHS Form 1143|||No|No|||Prescription Required|Yes|07/29/2021|240|No|1.12973||1.10262||1.11052||||ANTIBIOTICS, INHALED|1469|||||No|No||TEVA USA|No|||||Yes|No|No||
penicillin V potassium|No|No|No|No|75%|00093412573|PENICILLIN VK 125 MG/5 ML SOLN|100|ML|.03419|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.07196||.07023||.07074||||PENICILLINS|1470|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093412574|PENICILLIN VK 125 MG/5 ML SOLN|200|ML|.02505|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04758||.04644||.04677||||PENICILLINS|1471|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093412773|PENICILLIN VK 250 MG/5 ML SOLN|100|ML|.03836|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04525||.04416||.04448||||PENICILLINS|1472|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093412774|PENICILLIN VK 250 MG/5 ML SOLN|200|ML|.02778|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.0499||.0487||.04905||||PENICILLINS|1473|||||No|No||TEVA USA|No|||||No|No|No||
cefdinir|No|No|No|No|75%|00093413664|CEFDINIR 125 MG/5 ML SUSP|60|ML|.27419|05/11/2007||Yes|No||05/11/2007||Yes|No|05/11/2007||Yes|No||||No|No|||Prescription Required|No|01/23/2008|046|No|.12139||.11848||.11933||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1474|||||No|No||TEVA USA|No|||||No|No|No||
cefdinir|No|No|No|No|75%|00093413673|CEFDINIR 125 MG/5 ML SUSP|100|ML|.26054|05/12/2008||Yes|No||05/12/2008||Yes|No|05/12/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2008|046|No|.09723||.0949||.09558||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1475|||||No|No||TEVA USA|No|||||No|No|No||
cefdinir|No|No|No|No|75%|00093413764|CEFDINIR 250 MG/5 ML SUSP|60|ML|.53471|05/12/2008||Yes|No||05/12/2008||Yes|No|05/12/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2008|046|No|.11481||.11205||.11286||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1476|||||No|No||TEVA USA|No|||||No|No|No||
cefdinir|No|No|No|No|75%|00093413773|CEFDINIR 250 MG/5 ML SUSP|100|ML|.50813|05/11/2007||Yes|No||05/11/2007||Yes|No|05/11/2007||Yes|No||||No|No|||Prescription Required|No|01/23/2008|046|No|.11267||.10997||.11075||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1477|||||No|No||TEVA USA|No|||||No|No|No||
levalbuterol HCl|No|No|No|No|75%|00093414556|LEVALBUTEROL 0.31 MG/3 ML SOL|3|ML|.22933|01/18/2019||Yes|No||01/18/2019||Yes|No|01/18/2019||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.27748||.27082||.27276||||BRONCHODILATORS, BETA AGONIST|1478|||||No|No||TEVA USA|No|||||Yes|No|No||
levalbuterol HCl|No|No|No|No|75%|00093414656|LEVALBUTEROL 0.63 MG/3 ML SOL|3|ML|.22933|03/07/2019||Yes|No||03/07/2019||Yes|No|03/07/2019||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.22097||.21567||.21721||||BRONCHODILATORS, BETA AGONIST|1479|||||No|No||TEVA USA|No|||||Yes|No|No||
levalbuterol HCl|No|No|No|No|75%|00093414756|LEVALBUTEROL CONC 1.25 MG/0.5|1|EA|2.3048|02/04/2015||Yes|No||02/04/2015||Yes|No|02/04/2015||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|5.2528||5.17776||4.9312||||BRONCHODILATORS, BETA AGONIST|1480|||||No|No||TEVA USA|No|||||Yes|No|No||
levalbuterol HCl|No|No|No|No|75%|00093414856|LEVALBUTEROL 1.25 MG/3 ML SOL|3|ML|.22933|01/18/2019||Yes|No||01/18/2019||Yes|No|01/18/2019||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.17734||.17308||.17433||||BRONCHODILATORS, BETA AGONIST|1481|||||No|No||TEVA USA|No|||||Yes|No|No||
amoxicillin|No|No|No|No|75%|00093415573|AMOXICILLIN 250 MG/5 ML SUSP|100|ML|.016|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02078||.02028||.02043||||PENICILLINS|1482|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093415579|AMOXICILLIN 250 MG/5 ML SUSP|80|ML|.01742|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02416||.02358||.02375||||PENICILLINS|1483|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093415580|AMOXICILLIN 250 MG/5 ML SUSP|150|ML|.01499|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/25/2012|209|No|.01892||.01847||.0186||||PENICILLINS|1484|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416073|AMOXICILLIN 200 MG/5 ML SUSP|100|ML|.03135|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04158||.04058||.04087||||PENICILLINS|1485|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416076|AMOXICILLIN 200 MG/5 ML SUSP|50|ML|.0313|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04322||.04218||.04249||||PENICILLINS|1486|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416078|AMOXICILLIN 200 MG/5 ML SUSP|75|ML|.0321|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.03851||.03759||.03786||||PENICILLINS|1487|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416173|AMOXICILLIN 400 MG/5 ML SUSP|100|ML|.03376|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02801||.02734||.02753||||PENICILLINS|1488|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416176|AMOXICILLIN 400 MG/5 ML SUSP|50|ML|.0338|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04008||.03912||.0394||||PENICILLINS|1489|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416178|AMOXICILLIN 400 MG/5 ML SUSP|75|ML|.03302|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.03455||.03372||.03396||||PENICILLINS|1490|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093417573|CEPHALEXIN 125 MG/5 ML SUSP|100|ML|.0817|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05257||.05131||.05168||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1491|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093417574|CEPHALEXIN 125 MG/5 ML SUSP|200|ML|.0688|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05495||.05363||.05402||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1492|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093417773|CEPHALEXIN 250 MG/5 ML SUSP|100|ML|.0989|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05802||.05663||.05703||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1493|||||No|No||TEVA USA|No|||||No|No|No||
cephalexin|No|No|No|No|75%|00093417774|CEPHALEXIN 250 MG/5 ML SUSP|200|ML|.08815|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.04229||.04128||.04157||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1494|||||No|No||TEVA USA|No|||||No|No|No||
olmesartan/amlodipin/hcthiazid|No|No|No|No|75%|00093500256|OLMSRTN-AMLDPN-HCTZ 40-10-25MG|30|EA|1.67843|02/17/2017||Yes|No||02/17/2017||Yes|No|02/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|017|Yes|1.28447||1.25364||1.26263||||ANGIOTENSIN MODULATOR COMBINATIONS|1495|||||No|No||TEVA USA|No|||||No|No|No||
olmesartan/amlodipin/hcthiazid|No|No|No|No|75%|00093500356|OLMSRTN-AMLDPN-HCTZ 40-10-12.5|30|EA|1.67843|02/17/2017||Yes|No||02/17/2017||Yes|No|02/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|017|Yes|1.21629||1.1871||1.19561||||ANGIOTENSIN MODULATOR COMBINATIONS|1496|||||No|No||TEVA USA|No|||||No|No|No||
olmesartan/amlodipin/hcthiazid|No|No|No|No|75%|00093500456|OLMSRTN-AMLDPN-HCTZ 40-5-25 MG|30|EA|1.67843|02/17/2017||Yes|No||02/17/2017||Yes|No|02/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|017|Yes|1.18874||1.16021||1.16853||||ANGIOTENSIN MODULATOR COMBINATIONS|1497|||||No|No||TEVA USA|No|||||No|No|No||
olmesartan/amlodipin/hcthiazid|No|No|No|No|75%|00093500556|OLMSRTN-AMLDPN-HCTZ 20-5-12.5|30|EA|1.3287|02/17/2017||Yes|No||02/17/2017||Yes|No|02/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|017|Yes|.95453||.93162||.9383||||ANGIOTENSIN MODULATOR COMBINATIONS|1498|||||No|No||TEVA USA|No|||||No|No|No||
olmesartan/amlodipin/hcthiazid|No|No|No|No|75%|00093500656|OLMSRTN-AMLDPN-HCTZ 40-5-12.5|30|EA|1.67843|02/17/2017||Yes|No||02/17/2017||Yes|No|02/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|017|Yes|1.16586||1.13788||1.14604||||ANGIOTENSIN MODULATOR COMBINATIONS|1499|||||No|No||TEVA USA|No|||||No|No|No||
tiagabine HCl|No|No|No|No|75%|00093503056|TIAGABINE HCL 2 MG TABLET     |30|EA|2.72949|08/16/2016||Yes|No||08/16/2016||Yes|No|08/16/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|2.02509||1.97649||1.99066||||ANTICONVULSANTS|1500|||||No|No||TEVA USA|No|||||No|No|No||
tiagabine HCl|No|No|No|No|75%|00093503156|TIAGABINE HCL 4 MG TABLET|30|EA|2.72949|11/06/2017||Yes|No||11/06/2017||Yes|No|11/06/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|2.2175||2.16428||2.1798||||ANTICONVULSANTS|1501|||||No|No||TEVA USA|No|||||No|No|No||
disulfiram|No|No|No|No|75%|00093503501|DISULFIRAM 250 MG TABLET|100|EA|1.40343|05/06/2011||Yes|No||05/06/2011||Yes|No|05/06/2011||Yes|No||||No|No|||Prescription Required|No|||No|3.19852||3.15283||3.0027|||||1502|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
disulfiram|No|No|No|No|75%|00093503601|DISULFIRAM 500 MG TABLET      |100|EA|2.24542|08/02/2011||Yes|No||08/02/2011||Yes|No|08/02/2011||Yes|No||||No|No|||Prescription Required|No|||No|5.11746||5.04436||4.80415|||||1503|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093504501|DEXMETHYLPHENIDATE ER 25 MG CP|100|EA|.91452|12/19/2017||Yes|No||12/19/2017||Yes|No|12/19/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.40165||1.36801||1.37782||||STIMULANTS AND RELATED AGENTS|1504|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093504601|DEXMETHYLPHENIDATE ER 35 MG CP|100|EA|.91452|12/19/2017||Yes|No||12/19/2017||Yes|No|12/19/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|2.6497||2.58611||2.60466||||STIMULANTS AND RELATED AGENTS|1505|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505610|ATORVASTATIN 10 MG TABLET|1000|EA|.0548|10/25/2022||Yes|No||10/25/2022||Yes|No|10/25/2022||Yes|No||10/25/2022||Yes|No|||Prescription Required|No|07/29/2021|063|Yes|.02244||.0219||.02206||||LIPOTROPICS, STATINS|1506|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505698|ATORVASTATIN 10 MG TABLET|90|EA|.0548|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription Required|No|07/21/2016|063|Yes|.02244||.0219||.02206||||LIPOTROPICS, STATINS|1507|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505705|ATORVASTATIN 80 MG TABLET|500|EA|.07821|10/25/2022||Yes|No||10/25/2022||Yes|No|10/25/2022||Yes|No||10/25/2022||Yes|No|||Prescription Required|No|07/29/2021|063|Yes|.06626||.06467||.06513||||LIPOTROPICS, STATINS|1508|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505798|ATORVASTATIN 80 MG TABLET|90|EA|.07821|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription Required|No|07/21/2016|063|Yes|.06626||.06467||.06513||||LIPOTROPICS, STATINS|1509|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505810|ATORVASTATIN 40 MG TABLET|1000|EA|.07821|10/25/2022||Yes|No||10/25/2022||Yes|No|10/25/2022||Yes|No||10/25/2022||Yes|No|||Prescription Required|No|07/29/2021|063|Yes|.04382||.04277||.04308||||LIPOTROPICS, STATINS|1510|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505898|ATORVASTATIN 40 MG TABLET|90|EA|.07821|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription Required|No|07/21/2016|063|Yes|.04382||.04277||.04308||||LIPOTROPICS, STATINS|1511|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505910|ATORVASTATIN 20 MG TABLET|1000|EA|.07821|10/25/2022||Yes|No||10/25/2022||Yes|No|10/25/2022||Yes|No||10/25/2022||Yes|No|||Prescription Required|No|07/29/2021|063|Yes|.02772||.02705||.02725||||LIPOTROPICS, STATINS|1512|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505998|ATORVASTATIN 20 MG TABLET|90|EA|.07821|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription Required|No|07/21/2016|063|Yes|.02772||.02705||.02725||||LIPOTROPICS, STATINS|1513|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506001|HYDROXYZINE HCL 10 MG TABLET|100|EA|.0258|10/14/2013||Yes|No||10/14/2013||Yes|No|10/14/2013||Yes|No||10/14/2013||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.02426||.02368||.02385||||ANTIHISTAMINES, FIRST GENERATION|1514|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506005|HYDROXYZINE HCL 10 MG TABLET|500|EA|.0258|05/24/2013||Yes|No||05/24/2013||Yes|No|05/24/2013||Yes|No||05/24/2013||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.02426||.02368||.02385||||ANTIHISTAMINES, FIRST GENERATION|1515|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506101|HYDROXYZINE HCL 25 MG TABLET|100|EA|.03195|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.03406||.03324||.03348||||ANTIHISTAMINES, FIRST GENERATION|1516|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506105|HYDROXYZINE HCL 25 MG TABLET|500|EA|.03193|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.03406||.03324||.03348||||ANTIHISTAMINES, FIRST GENERATION|1517|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506110|HYDROXYZINE HCL 25 MG TABLET|1000|EA|.03195|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.03406||.03324||.03348||||ANTIHISTAMINES, FIRST GENERATION|1518|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506201|HYDROXYZINE HCL 50 MG TABLET|100|EA|.04614|05/24/2013||Yes|No||05/24/2013||Yes|No|05/24/2013||Yes|No||05/24/2013||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.04886||.04769||.04803||||ANTIHISTAMINES, FIRST GENERATION|1519|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506205|HYDROXYZINE HCL 50 MG TABLET|500|EA|.04612|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.04886||.04769||.04803||||ANTIHISTAMINES, FIRST GENERATION|1520|||||No|No||TEVA USA|No|||||No|No|No||
moexipril HCl|No|No|No|No|75%|00093515001|MOEXIPRIL HCL 15 MG TABLET|100|EA|.40678|04/21/2009||Yes|No||04/21/2009||Yes|No|04/21/2009||Yes|No||04/21/2009||Yes|No|||Prescription Required|Yes|03/23/2007|113|No|.88441||.86318||.86938||||ANGIOTENSIN MODULATORS|1521|||||No|No||TEVA USA|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00093520005|BUSPIRONE HCL 30 MG TABLET|500|EA|.40632|03/30/2004||Yes|No||03/30/2004||Yes|No|03/30/2004||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.09876||.09639||.09708||||ANXIOLYTICS|1522|||||No|No||TEVA USA|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00093520006|BUSPIRONE HCL 30 MG TABLET|60|EA|.40635|03/30/2004||Yes|No||03/30/2004||Yes|No|03/30/2004||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.09876||.09639||.09708||||ANXIOLYTICS|1523|||||No|No||TEVA USA|No|||||No|No|No||
efavirenz/emtricit/tenofovr df|No|No|No|No|75%|00093523456|EFAVIR-EMTRI-TENOF 600-200-300|30|EA|4.8|05/18/2021||Yes|No||05/18/2021||Yes|No|05/18/2021||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|1.7007||1.65988||1.67179||||HIV / AIDS|1524|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00093524565|OLANZAPINE ODT 5 MG TABLET|30|EA|.76769|03/08/2012||Yes|No||03/08/2012||Yes|No|03/08/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.26972||.26325||.26513||||ANTIPSYCHOTICS|1525|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00093524665|OLANZAPINE ODT 10 MG TABLET|30|EA|1.12774|03/08/2012||Yes|No||03/08/2012||Yes|No|03/08/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.42712||.41687||.41986||||ANTIPSYCHOTICS|1526|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00093524765|OLANZAPINE ODT 15 MG TABLET|30|EA|1.66295|03/08/2012||Yes|No||03/08/2012||Yes|No|03/08/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.59589||.58159||.58576||||ANTIPSYCHOTICS|1527|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00093524865|OLANZAPINE ODT 20 MG TABLET|30|EA|2.19816|03/08/2012||Yes|No||03/08/2012||Yes|No|03/08/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.58199||.56802||.5721||||ANTIPSYCHOTICS|1528|||||No|No||TEVA USA|No|||||No|No|No||
almotriptan malate|No|No|No|No|75%|00093526018|ALMOTRIPTAN MALATE 6.25 MG TAB|6|EA|14.43366|08/17/2015||Yes|No||08/17/2015||Yes|No|08/17/2015||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|021|Yes|18.26397||17.82563||17.95348||||ANTIMIGRAINE AGENTS, TRIPTANS|1529|||||No|No||TEVA USA|No|||||No|No|No||
almotriptan malate|No|No|No|No|75%|00093526129|ALMOTRIPTAN MALATE 12.5 MG TAB|12|EA|14.43618|08/17/2015||Yes|No||08/17/2015||Yes|No|08/17/2015||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|021|Yes|15.98579||15.60213||15.71403||||ANTIMIGRAINE AGENTS, TRIPTANS|1530|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093529201|METHYLPHENIDATE CD 50 MG CAP|100|EA|1.6521|01/31/2017|10/31/2024|Yes|No||01/31/2017|10/31/2024|Yes|No|01/31/2017|10/31/2024|Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|3.76526||3.71147||3.53473||||STIMULANTS AND RELATED AGENTS|1531|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093529301|METHYLPHENIDATE CD 60 MG CAP|100|EA|1.6521|01/31/2017|10/31/2024|Yes|No||01/31/2017|10/31/2024|Yes|No|01/31/2017|10/31/2024|Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|3.76526||3.71147||3.53473||||STIMULANTS AND RELATED AGENTS|1532|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093529501|METHYLPHENIDATE CD 10 MG CAP|100|EA|1.2221|10/22/2012||Yes|No||10/22/2012||Yes|No|10/22/2012||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|.87151||.85059||.85669||||STIMULANTS AND RELATED AGENTS|1533|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093529601|METHYLPHENIDATE CD 20 MG CAP|100|EA|1.2221|10/22/2012||Yes|No||10/22/2012||Yes|No|10/22/2012||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|.77887||.76018||.76563||||STIMULANTS AND RELATED AGENTS|1534|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093529701|METHYLPHENIDATE CD 30 MG CAP|100|EA|1.2221|10/22/2012||Yes|No||10/22/2012||Yes|No|10/22/2012||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|1.14032||1.11295||1.12093||||STIMULANTS AND RELATED AGENTS|1535|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093529801|METHYLPHENIDATE CD 40 MG CAP|100|EA|1.6159|01/31/2017|10/31/2024|Yes|No||01/31/2017|10/31/2024|Yes|No|01/31/2017|10/31/2024|Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|3.68274||3.63013||3.45727||||STIMULANTS AND RELATED AGENTS|1536|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||TEVA USA|No|||||No|No|No||
norethindrone-e.estradiol-iron|Yes|Yes|No|No|75%|00093532862|JUNEL FE 24 TABLET|28|EA|.82504|02/10/2017||Yes|No||02/10/2017||Yes|No|02/10/2017||Yes|No|Refer to program requirements|||No|No|02/10/2017||Prescription Required|No|||No|.19432||.18966||.19102|||||1537|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093534601|METHYLPHENIDATE LA 20 MG CAP|100|EA|1.6988|07/27/2012||Yes|No||07/27/2012||Yes|No|07/27/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.72798||1.68651||1.6986||||STIMULANTS AND RELATED AGENTS|1538|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093534701|METHYLPHENIDATE LA 30 MG CAP|100|EA|1.73746|07/27/2012||Yes|No||07/27/2012||Yes|No|07/27/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.64334||1.6039||1.6154||||STIMULANTS AND RELATED AGENTS|1539|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093534801|METHYLPHENIDATE LA 40 MG CAP|100|EA|1.78575|07/27/2012||Yes|No||07/27/2012||Yes|No|07/27/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|2.25001||2.19601||2.21176||||STIMULANTS AND RELATED AGENTS|1540|||||No|No||TEVA USA|No|||||No|No|No||
acamprosate calcium|No|No|No|No|75%|00093535286|ACAMPROSATE CALC DR 333 MG TAB|180|EA|.60441|06/24/2016||Yes|No||06/24/2016||Yes|No|06/24/2016||Yes|No||||No|No|||Prescription Required|No|||No|1.3775||1.35782||1.29316|||||1541|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
clozapine|No|No|No|No|75%|00093537601|CLOZAPINE ODT 150 MG TABLET|100|EA|7.42318|02/09/2021||Yes|No||02/09/2021||Yes|No|02/09/2021||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|027|Yes|16.91794||16.67625||15.88214||||ANTIPSYCHOTICS|1542|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093537701|CLOZAPINE ODT 200 MG TABLET|100|EA|9.89761|02/09/2021||Yes|No||02/09/2021||Yes|No|02/09/2021||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|027|Yes|19.20171||18.74087||18.87528||||ANTIPSYCHOTICS|1543|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541601|CLOZAPINE ODT 12.5 MG TABLET|100|EA|.76626|11/09/2018||Yes|No||11/09/2018||Yes|No|11/09/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|027|Yes|1.74636||1.72141||1.63944||||ANTIPSYCHOTICS|1544|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541701|CLOZAPINE ODT 25 MG TABLET    |100|EA|1.03097|11/14/2017||Yes|No||11/14/2017||Yes|No|11/14/2017||Yes|No||||No|No|||Prescription Required|Yes|09/14/2017|027|Yes|1.99351||1.94567||1.95962||||ANTIPSYCHOTICS|1545|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541784|CLOZAPINE ODT 25 MG TABLET    |48|EA|1.03119|11/14/2017||Yes|No||11/14/2017||Yes|No|11/14/2017||Yes|No||||No|No|||Prescription Required|Yes|09/14/2017|027|Yes|1.99351||1.94567||1.95962||||ANTIPSYCHOTICS|1546|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541901|CLOZAPINE ODT 100 MG TABLET|100|EA|2.81207|11/14/2017||Yes|No||11/14/2017||Yes|No|11/14/2017||Yes|No||||No|No|||Prescription Required|Yes|09/14/2017|027|Yes|4.62881||4.51772||4.55012||||ANTIPSYCHOTICS|1547|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541984|CLOZAPINE ODT 100 MG TABLET|48|EA|2.8122|11/14/2017||Yes|No||11/14/2017||Yes|No|11/14/2017||Yes|No||||No|No|||Prescription Required|Yes|09/14/2017|027|Yes|4.62881||4.51772||4.55012||||ANTIPSYCHOTICS|1548|||||No|No||TEVA USA|No|||||No|No|No||
cabergoline|No|No|No|No|75%|00093542088|CABERGOLINE 0.5 MG TABLET|8|EA|6.9875|03/16/2007||Yes|No||03/16/2007||Yes|No|03/16/2007||Yes|No||||No|No|||Prescription Required|No|||No|1.0692||1.04354||1.05102|||||1549|||||No|No||TEVA USA|No|||||No|No|No||
estradiol/norethindrone acet|No|No|No|No|75%|00093545528|MIMVEY 1-0.5 MG TABLET|28|EA|1.75118|06/18/2010||Yes|No||06/18/2010||Yes|No|06/18/2010||Yes|No||||No|No|||Prescription Required|No|||Yes|.4012||.39157||.39438|||||1550|||||No|No||TEVA USA|No|||||No|No|No||
estradiol/norethindrone acet|No|No|No|No|75%|00093545542|MIMVEY 1-0.5 MG TABLET|28|EA|1.75118|06/18/2010||Yes|No||06/18/2010||Yes|No|06/18/2010||Yes|No||||No|No|||Prescription Required|No|||Yes|.4012||.39157||.39438|||||1551|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550356|OLANZAPINE-FLUOXETINE 3-25 MG|30|EA|3.41635|12/06/2013||Yes|No||12/06/2013||Yes|No|12/06/2013||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|027|Yes|3.74605||3.65614||3.68237||||ANTIPSYCHOTICS|1552|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550456|OLANZAPINE-FLUOXETINE 6-25 MG|30|EA|4.98198|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|027|Yes|4.96162||4.84254||4.87727||||ANTIPSYCHOTICS|1553|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550556|OLANZAPINE-FLUOXETINE 6-50 MG|30|EA|4.98198|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|027|Yes|5.10697||4.9844||5.02015||||ANTIPSYCHOTICS|1554|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550656|OLANZAPINE-FLUOXETINE 12-25 MG|30|EA|7.50837|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|027|Yes|7.99028||7.79851||7.85445||||ANTIPSYCHOTICS|1555|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550756|OLANZAPINE-FLUOXETINE 12-50 MG|30|EA|7.50837|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|027|Yes|8.35225||8.1518||8.21026||||ANTIPSYCHOTICS|1556|||||No|No||TEVA USA|No|||||No|No|No||
sildenafil citrate|No|No|No|No|75%|00093551798|SILDENAFIL 20 MG TABLET|90|EA|.09555|07/18/2013||Yes|No||07/18/2013||Yes|No|07/18/2013||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|171|Yes|.04413||.04307||.04338||||PAH AGENTS, ORAL AND INHALED|1557|||||No|No||TEVA USA|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00093552606|ATAZANAVIR SULFATE 150 MG CAP |60|EA|3.1606|03/22/2018||Yes|No||03/22/2018||Yes|No|03/22/2018||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|5.16231||5.08856||4.84625||||HIV / AIDS|1558|||||No|No||TEVA USA|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00093552706|ATAZANAVIR SULFATE 200 MG CAP |60|EA|3.1606|03/22/2018||Yes|No||03/22/2018||Yes|No|03/22/2018||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|1.62326||1.5843||1.59566||||HIV / AIDS|1559|||||No|No||TEVA USA|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00093552856|ATAZANAVIR SULFATE 300 MG CAP|30|EA|6.3212|03/22/2018||Yes|No||03/22/2018||Yes|No|03/22/2018||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|2.80339||2.73611||2.75573||||HIV / AIDS|1560|||||No|No||TEVA USA|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00093553756|ESZOPICLONE 1 MG TABLET|30|EA|.30243|05/05/2014||Yes|No||05/05/2014||Yes|No|05/05/2014||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.10879||.10618||.10694||||SEDATIVE HYPNOTICS|1561|||||No|No||TEVA USA|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00093553801|ESZOPICLONE 2 MG TABLET|100|EA|.30229|05/05/2014||Yes|No||05/05/2014||Yes|No|05/05/2014||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.08307||.08108||.08166||||SEDATIVE HYPNOTICS|1562|||||No|No||TEVA USA|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00093553901|ESZOPICLONE 3 MG TABLET|100|EA|.30229|05/05/2014||Yes|No||05/05/2014||Yes|No|05/05/2014||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.08536||.08331||.08391||||SEDATIVE HYPNOTICS|1563|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555001|DEXMETHYLPHENIDATE ER 5 MG CAP|100|EA|.55148|02/04/2015||Yes|No||02/04/2015||Yes|No|02/04/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.01437||.99003||.99713||||STIMULANTS AND RELATED AGENTS|1564|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555101|DEXMETHYLPHENIDATE ER 10 MG CP|100|EA|.55148|02/27/2015||Yes|No||02/27/2015||Yes|No|02/27/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.27387||1.2433||1.25221||||STIMULANTS AND RELATED AGENTS|1565|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555201|DEXMETHYLPHENIDATE ER 15 MG CP|100|EA|.55148|09/29/2014||Yes|No||09/29/2014||Yes|No|09/29/2014||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.71686||.69966||.70467||||STIMULANTS AND RELATED AGENTS|1566|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555301|DEXMETHYLPHENIDATE ER 20 MG CP|100|EA|.66439|07/31/2015||Yes|No||07/31/2015||Yes|No|07/31/2015||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.43141||1.39706||1.40708||||STIMULANTS AND RELATED AGENTS|1567|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555401|DEXMETHYLPHENIDATE ER 30 MG CP|100|EA|.91452|10/01/2014||Yes|No||10/01/2014||Yes|No|10/01/2014||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.1113||1.08463||1.09241||||STIMULANTS AND RELATED AGENTS|1568|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093556201|DEXMETHYLPHENIDATE ER 40 MG CP|100|EA|.91452|04/15/2014||Yes|No||04/15/2014||Yes|No|04/15/2014||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.27965||1.24894||1.2579||||STIMULANTS AND RELATED AGENTS|1569|||||No|No||TEVA USA|No|||||No|No|No||
erythromycin base|No|No|No|No|75%|00093557101|ERYTHROMYCIN 250 MG TABLET|100|EA|2.84424|08/30/2021||Yes|No||08/30/2021||Yes|No|08/30/2021||Yes|No||08/30/2021||Yes|No|||Prescription Required|Yes|01/28/2021|018|No|2.08818||2.03806||2.05268||||MACROLIDES/KETOLIDES|1570|||||No|No||TEVA USA|No|||||No|No|No||
erythromycin base|No|No|No|No|75%|00093557156|ERYTHROMYCIN 250 MG TABLET|30|EA|2.8443|08/30/2021||Yes|No||08/30/2021||Yes|No|08/30/2021||Yes|No||08/30/2021||Yes|No|||Prescription Required|Yes|01/28/2021|018|No|2.08818||2.03806||2.05268||||MACROLIDES/KETOLIDES|1571|||||No|No||TEVA USA|No|||||No|No|No||
erythromycin base|No|No|No|No|75%|00093557201|ERYTHROMYCIN 500 MG TABLET|100|EA|4.28753|08/30/2021||Yes|No||08/30/2021||Yes|No|08/30/2021||Yes|No||08/30/2021||Yes|No|||Prescription Required|Yes|01/28/2021|018|No|2.98659||2.91491||2.93582||||MACROLIDES/KETOLIDES|1572|||||No|No||TEVA USA|No|||||No|No|No||
erythromycin base|No|No|No|No|75%|00093557256|ERYTHROMYCIN 500 MG TABLET|30|EA|4.28753|08/30/2021||Yes|No||08/30/2021||Yes|No|08/30/2021||Yes|No||08/30/2021||Yes|No|||Prescription Required|Yes|01/28/2021|018|No|2.98659||2.91491||2.93582||||MACROLIDES/KETOLIDES|1573|||||No|No||TEVA USA|No|||||No|No|No||
mesalamine|No|No|No|No|75%|00093590786|MESALAMINE DR 400 MG CAPSULE|180|EA|1.44131|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|010|No|2.25055||2.19654||2.21229||||ULCERATIVE COLITIS AGENTS|1574|||||No|No||TEVA USA|No|||||No|No|No||
lanthanum carbonate|No|No|No|No|75%|00093593898|LANTHANUM CARB 500 MG TAB CHEW|90|EA|2.94287|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|052|Yes|4.63591||4.52465||4.5571||||PHOSPHATE BINDERS|1575|||||No|No||TEVA USA|No|||||No|No|No||
lanthanum carbonate|No|No|No|No|75%|00093593998|LANTHANUM CARB 750 MG TAB CHEW|90|EA|2.94287|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|052|Yes|3.62738||3.54032||3.56571||||PHOSPHATE BINDERS|1576|||||No|No||TEVA USA|No|||||No|No|No||
lanthanum carbonate|No|No|No|No|75%|00093594098|LANTHANUM CARB 1,000 MG TB CHW|90|EA|2.94287|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|052|Yes|3.71352||3.6244||3.65039||||PHOSPHATE BINDERS|1577|||||No|No||TEVA USA|No|||||No|No|No||
arformoterol tartrate|No|No|No|No|75%|00093595506|ARFORMOTEROL 15 MCG/2 ML SOLN|2|ML|1.37929|03/29/2022||Yes|No||03/29/2022||Yes|No|03/29/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|037|Yes|.71431||.69717||.70217||||BRONCHODILATORS, BETA AGONIST|1578|||||No|No||TEVA USA|No|||||Yes|No|No||
arformoterol tartrate|No|No|No|No|75%|00093595556|ARFORMOTEROL 15 MCG/2 ML SOLN|2|ML|1.37929|03/29/2022||Yes|No||03/29/2022||Yes|No|03/29/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|037|Yes|.56825||.55461||.55859||||BRONCHODILATORS, BETA AGONIST|1579|||||No|No||TEVA USA|No|||||Yes|No|No||
epinephrine|No|No|No|No|75%|00093598527|EPINEPHRINE 0.15 MG AUTO-INJCT|2|EA|64.5|12/16/2019||Yes|No||12/16/2019||Yes|No|12/16/2019||Yes|No||||No|No|||Prescription Required|Yes|11/01/2021|238|No|131.0461||127.90099||128.81832||||EPINEPHRINE, SELF-INJECTED|1580|||||No|No||TEVA USA|No|||||No|No|No||
epinephrine|No|No|No|No|75%|00093598627|EPINEPHRINE 0.3 MG AUTO-INJECT|2|EA|64.5|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|Yes|11/01/2021|238|No|127.57245||124.51071||125.40372||||EPINEPHRINE, SELF-INJECTED|1581|||||No|No||TEVA USA|No|||||No|No|No||
L-norgest/e.estradiol-e.estrad|Yes|Yes|No|No|75%|00093603182|RIVELSA TABLET                |91|EA|1.5708|06/05/2018||Yes|No||06/26/2018||Yes|No|06/05/2018||Yes|No|Refer to program requirements|||No|No|06/05/2018||Prescription Required|No|||No|.||.||.|||||1582|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
L-norgest/e.estradiol-e.estrad|Yes|Yes|No|No|75%|00093614882|CAMRESE LO TABLET|91|EA|1.01517|12/12/2011||Yes|No||12/12/2011||Yes|No|12/12/2011||Yes|No|Refer to program requirements|||No|No|09/04/2019||Prescription Required|No|||No|.||.||.|||||1583|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00093645056|ESOMEPRAZOLE MAG DR 20 MG CAP|30|EA|.21987|03/26/2015||Yes|No||03/26/2015||Yes|No|03/26/2015||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.5011||.49394||.47042||||PROTON PUMP INHIBITORS|1584|||||No|No||TEVA USA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00093645098|ESOMEPRAZOLE MAG DR 20 MG CAP|90|EA|.21987|03/26/2015||Yes|No||03/26/2015||Yes|No|03/26/2015||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.5011||.49394||.47042||||PROTON PUMP INHIBITORS|1585|||||No|No||TEVA USA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00093645156|ESOMEPRAZOLE MAG DR 40 MG CAP|30|EA|.21987|03/26/2015||Yes|No||03/26/2015||Yes|No|03/26/2015||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.11037||.10772||.10849||||PROTON PUMP INHIBITORS|1586|||||No|No||TEVA USA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00093645198|ESOMEPRAZOLE MAG DR 40 MG CAP|90|EA|.21987|03/26/2015||Yes|No||03/26/2015||Yes|No|03/26/2015||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.11037||.10772||.10849||||PROTON PUMP INHIBITORS|1587|||||No|No||TEVA USA|No|||||No|No|No||
budesonide|No|No|No|No|75%|00093681555|BUDESONIDE 0.25 MG/2 ML SUSP|2|ML|1.61923|02/01/2021||Yes|No||02/01/2021||Yes|No|02/01/2021||Yes|No||||No|No|||Prescription Required|No|07/29/2021|033|No|.85765||.83707||.84307||||GLUCOCORTICOIDS, INHALED|1588|||||No|No||TEVA USA|No|||||Yes|No|No||
budesonide|No|No|No|No|75%|00093681573|BUDESONIDE 0.25 MG/2 ML SUSP|2|ML|1.61923|11/24/2010||Yes|No||11/24/2010||Yes|No|11/24/2010||Yes|No||||No|No|||Prescription Required|No|07/29/2021|033|No|.85765||.83707||.84307||||GLUCOCORTICOIDS, INHALED|1589|||||No|No||TEVA USA|Yes|09/01/2020||||Yes|No|No||
budesonide|No|No|No|No|75%|00093681655|BUDESONIDE 0.5 MG/2 ML SUSP|2|ML|1.90561|02/01/2021||Yes|No||02/01/2021||Yes|No|02/01/2021||Yes|No||||No|No|||Prescription Required|No|07/29/2021|033|No|.72209||.70476||.70981||||GLUCOCORTICOIDS, INHALED|1590|||||No|No||TEVA USA|No|||||Yes|No|No||
budesonide|No|No|No|No|75%|00093681673|BUDESONIDE 0.5 MG/2 ML SUSP|2|ML|1.90561|05/12/2009||Yes|No||05/12/2009||Yes|No|05/12/2009||Yes|No||||No|No|||Prescription Required|No|07/29/2021|033|No|.72209||.70476||.70981||||GLUCOCORTICOIDS, INHALED|1591|||||No|No||TEVA USA|Yes|09/01/2020||||Yes|No|No||
budesonide|No|No|No|No|75%|00093681773|BUDESONIDE 1 MG/2 ML INH SUSP|2|ML|3.96976|06/13/2016||Yes|No||06/13/2016||Yes|No|06/13/2016||Yes|No||||No|No|||Prescription Required|No|07/29/2021|033|No|3.16316||3.08724||3.10939||||GLUCOCORTICOIDS, INHALED|1592|||||No|No||TEVA USA|No|||||Yes|No|No||
nefazodone HCl|No|No|No|No|75%|00093711306|NEFAZODONE HCL 150 MG TABLET|60|EA|.61877|09/22/2003||Yes|No||09/22/2003||Yes|No|09/22/2003||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|1.141||1.11362||1.1216||||ANTIDEPRESSANTS, OTHER|1593|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716305|TOLTERODINE TART ER 2 MG CAP|500|EA|2.76419|06/07/2017||Yes|No||06/07/2017||Yes|No|06/07/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|006|No|.32993||.32201||.32432||||BLADDER RELAXANT PREPARATIONS|1594|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716356|TOLTERODINE TART ER 2 MG CAP|30|EA|2.76432|06/06/2017||Yes|No||06/06/2017||Yes|No|06/06/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|006|No|.32993||.32201||.32432||||BLADDER RELAXANT PREPARATIONS|1595|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716398|TOLTERODINE TART ER 2 MG CAP|90|EA|2.76423|06/06/2017||Yes|No||06/06/2017||Yes|No|06/06/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|006|No|.32993||.32201||.32432||||BLADDER RELAXANT PREPARATIONS|1596|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716405|TOLTERODINE TART ER 4 MG CAP|500|EA|2.76419|06/07/2017||Yes|No||06/07/2017||Yes|No|06/07/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|006|No|.31729||.30968||.3119||||BLADDER RELAXANT PREPARATIONS|1597|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716456|TOLTERODINE TART ER 4 MG CAP|30|EA|2.76432|06/07/2017||Yes|No||06/07/2017||Yes|No|06/07/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|006|No|.31729||.30968||.3119||||BLADDER RELAXANT PREPARATIONS|1598|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716498|TOLTERODINE TART ER 4 MG CAP|90|EA|2.76423|06/07/2017||Yes|No||06/07/2017||Yes|No|06/07/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|006|No|.31729||.30968||.3119||||BLADDER RELAXANT PREPARATIONS|1599|||||No|No||TEVA USA|No|||||No|No|No||
etodolac|No|No|No|No|75%|00093717201|ETODOLAC ER 500 MG TABLET|100|EA|1.06021|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|059|Yes|1.02388||.99931||1.00647||||NSAIDS|1600|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093717801|NEFAZODONE HCL 50 MG TABLET|100|EA|.55995|09/22/2003||Yes|No||09/22/2003||Yes|No|09/22/2003||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|1.27616||1.25793||1.19802||||ANTIDEPRESSANTS, OTHER|1601|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|Yes|No|No|No|75%|00093719801|FLUOXETINE HCL 40 MG CAPSULE|100|EA|.33325|06/18/2009||Yes|No||06/18/2009||Yes|No|06/18/2009||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|07/22/2008|008|No|.04534||.04425||.04457||||ANTIDEPRESSANTS, SSRIs|1602|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|Yes|No|No|No|75%|00093719805|FLUOXETINE HCL 40 MG CAPSULE|500|EA|.2666|10/02/2008||Yes|No||10/02/2008||Yes|No|10/02/2008||Yes|No||||No|No|07/01/2016||Prescription Required|No|07/22/2008|008|No|.04534||.04425||.04457||||ANTIDEPRESSANTS, SSRIs|1603|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|Yes|No|No|No|75%|00093719856|FLUOXETINE HCL 40 MG CAPSULE|30|EA|.33325|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|03/29/2004|008|No|.04534||.04425||.04457||||ANTIDEPRESSANTS, SSRIs|1604|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093720110|PRAVASTATIN SODIUM 20 MG TAB|1000|EA|.11591|01/09/2007||Yes|No||01/09/2007||Yes|No|01/09/2007||Yes|No||01/09/2007||Yes|No|07/01/2016||Prescription Required|No|07/22/2009|063|Yes|.05049||.04928||.04963||||LIPOTROPICS, STATINS|1605|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093720198|PRAVASTATIN SODIUM 20 MG TAB|90|EA|.11591|01/09/2007||Yes|No||01/09/2007||Yes|No|01/09/2007||Yes|No||01/09/2007||Yes|No|07/01/2016||Prescription Required|No|07/22/2009|063|Yes|.05049||.04928||.04963||||LIPOTROPICS, STATINS|1606|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093720210|PRAVASTATIN SODIUM 40 MG TAB|1000|EA|.1701|01/09/2007||Yes|No||01/09/2007||Yes|No|01/09/2007||Yes|No||01/09/2007||Yes|No|07/01/2016||Prescription Required|No|07/22/2009|063|Yes|.06843||.06679||.06727||||LIPOTROPICS, STATINS|1607|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093720298|PRAVASTATIN SODIUM 40 MG TAB|90|EA|.17009|01/09/2007||Yes|No||01/09/2007||Yes|No|01/09/2007||Yes|No||01/09/2007||Yes|No|07/01/2016||Prescription Required|No|07/22/2009|063|Yes|.06843||.06679||.06727||||LIPOTROPICS, STATINS|1608|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727105|PIOGLITAZONE HCL 15 MG TABLET|500|EA|.1209|05/22/2015||Yes|No||05/22/2015||Yes|No|05/22/2015||Yes|No||05/22/2015||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.0587||.05729||.0577||||HYPOGLYCEMICS, TZD|1609|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727156|PIOGLITAZONE HCL 15 MG TABLET|30|EA|.12083|09/18/2015||Yes|No||09/18/2015||Yes|No|09/18/2015||Yes|No||09/18/2015||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.0587||.05729||.0577||||HYPOGLYCEMICS, TZD|1610|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727198|PIOGLITAZONE HCL 15 MG TABLET|90|EA|.12088|09/18/2015||Yes|No||09/18/2015||Yes|No|09/18/2015||Yes|No||09/18/2015||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.0587||.05729||.0577||||HYPOGLYCEMICS, TZD|1611|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727205|PIOGLITAZONE HCL 30 MG TABLET|500|EA|.18476|05/22/2015||Yes|No||05/22/2015||Yes|No|05/22/2015||Yes|No||05/22/2015||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.0828||.08081||.08139||||HYPOGLYCEMICS, TZD|1612|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727256|PIOGLITAZONE HCL 30 MG TABLET|30|EA|.18475|09/18/2015||Yes|No||09/18/2015||Yes|No|09/18/2015||Yes|No||09/18/2015||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.0828||.08081||.08139||||HYPOGLYCEMICS, TZD|1613|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727298|PIOGLITAZONE HCL 30 MG TABLET|90|EA|.18475|09/18/2015||Yes|No||09/18/2015||Yes|No|09/18/2015||Yes|No||09/18/2015||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.0828||.08081||.08139||||HYPOGLYCEMICS, TZD|1614|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727305|PIOGLITAZONE HCL 45 MG TABLET|500|EA|.20041|02/02/2018||Yes|No||02/02/2018||Yes|No|02/02/2018||Yes|No||02/02/2018||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.09644||.09413||.0948||||HYPOGLYCEMICS, TZD|1615|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727356|PIOGLITAZONE HCL 45 MG TABLET|30|EA|.20038|02/18/2016||Yes|No||02/18/2016||Yes|No|02/18/2016||Yes|No||02/18/2016||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.09644||.09413||.0948||||HYPOGLYCEMICS, TZD|1616|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727398|PIOGLITAZONE HCL 45 MG TABLET|90|EA|.20043|09/18/2015||Yes|No||09/18/2015||Yes|No|09/18/2015||Yes|No||09/18/2015||Yes|No|||Prescription Required|No|01/22/2015|009|Yes|.09644||.09413||.0948||||HYPOGLYCEMICS, TZD|1617|||||No|No||TEVA USA|No|||||No|No|No||
raloxifene HCl|No|No|No|No|75%|00093729001|RALOXIFENE HCL 60 MG TABLET|100|EA|1.66733|05/05/2014||Yes|No||05/05/2014||Yes|No|05/05/2014||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|060|Yes|.20539||.20046||.2019||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1618|||||No|No||TEVA USA|No|||||No|No|No||
raloxifene HCl|No|No|No|No|75%|00093729056|RALOXIFENE HCL 60 MG TABLET|30|EA|1.66266|05/05/2014||Yes|No||05/05/2014||Yes|No|05/05/2014||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|060|Yes|.20539||.20046||.2019||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1619|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093729501|CARVEDILOL 12.5 MG TABLET|100|EA|.0258|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|10/15/2007|070|No|.01836||.01792||.01805||||BETA-BLOCKERS|1620|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093729505|CARVEDILOL 12.5 MG TABLET|500|EA|.02516|11/15/2011||Yes|No||11/15/2011||Yes|No|11/15/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/17/2007|070|No|.01836||.01792||.01805||||BETA-BLOCKERS|1621|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093729601|CARVEDILOL 25 MG TABLET|100|EA|.0258|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||02/08/2008||Yes|No|||Prescription Required|No|10/15/2007|070|No|.02553||.02492||.0251||||BETA-BLOCKERS|1622|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093729605|CARVEDILOL 25 MG TABLET|500|EA|.02516|09/15/2010||Yes|No||09/15/2010||Yes|No|09/15/2010||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/17/2007|070|No|.02553||.02492||.0251||||BETA-BLOCKERS|1623|||||No|No||TEVA USA|No|||||No|No|No||
clopidogrel bisulfate|No|No|No|No|75%|00093731405|CLOPIDOGREL 75 MG TABLET|500|EA|.07164|06/05/2012||Yes|No||06/05/2012||Yes|No|06/05/2012||Yes|No||06/05/2012||Yes|No|||Prescription Required|No|06/24/2012|004|No|.05149||.05025||.05061||||PLATELET AGGREGATION INHIBITORS|1624|||||No|No||TEVA USA|No|||||No|No|No||
clopidogrel bisulfate|No|No|No|No|75%|00093731456|CLOPIDOGREL 75 MG TABLET|30|EA|.07166|06/05/2012||Yes|No||06/05/2012||Yes|No|06/05/2012||Yes|No||06/05/2012||Yes|No|||Prescription Required|No|06/24/2012|004|No|.05149||.05025||.05061||||PLATELET AGGREGATION INHIBITORS|1625|||||No|No||TEVA USA|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00093733401|MYCOPHENOLATE 250 MG CAPSULE|100|EA|.27628|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.13723||.13394||.1349||||IMMUNOSUPPRESSIVES, ORAL|1626|||||No|No||TEVA USA|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00093733405|MYCOPHENOLATE 250 MG CAPSULE|500|EA|.27628|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.13723||.13394||.1349||||IMMUNOSUPPRESSIVES, ORAL|1627|||||No|No||TEVA USA|No|||||Yes|No|No||
lansoprazole|No|No|No|No|75%|00093735056|LANSOPRAZOLE DR 15 MG CAPSULE|30|EA|.80983|07/02/2010||Yes|No||07/02/2010||Yes|No|07/02/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.12267||.11973||.12058||||PROTON PUMP INHIBITORS|1628|||||No|No||TEVA USA|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00093735156|LANSOPRAZOLE DR 30 MG CAPSULE|30|EA|.80983|07/02/2010||Yes|No||07/02/2010||Yes|No|07/02/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/29/2021|047|No|.07539||.07358||.07411||||PROTON PUMP INHIBITORS|1629|||||No|No||TEVA USA|No|||||No|No|No||
calcitriol|No|No|No|No|75%|00093735201|CALCITRIOL 0.25 MCG CAPSULE|100|EA|.41087|08/14/2018||Yes|No||08/14/2018||Yes|No|08/14/2018||Yes|No||08/14/2018||Yes|No|||Prescription Required|No|||No|.13574||.13248||.13343|||||1630|||||No|No||TEVA USA|No|||||No|No|No||
calcitriol|No|No|No|No|75%|00093735301|CALCITRIOL 0.5 MCG CAPSULE|100|EA|.65691|11/21/2016||Yes|No||11/21/2016||Yes|No|11/21/2016||Yes|No||11/21/2016||Yes|No|||Prescription Required|No|||No|.19835||.19359||.19498|||||1631|||||No|No||TEVA USA|No|||||No|No|No||
finasteride|No|No|No|No|75%|00093735505|FINASTERIDE 5 MG TABLET|500|EA|.23057|04/01/2008||Yes|No||04/01/2008||Yes|No|04/01/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2008|003|No|.05653||.05517||.05557||||BPH TREATMENTS|1632|||||No|No||TEVA USA|No|||||No|No|No||
finasteride|No|No|No|No|75%|00093735556|FINASTERIDE 5 MG TABLET|30|EA|.258|02/22/2007||Yes|No||02/22/2007||Yes|No|02/22/2007||Yes|No||||No|No|||Prescription Required|No|01/23/2008|003|No|.05653||.05517||.05557||||BPH TREATMENTS|1633|||||No|No||TEVA USA|No|||||No|No|No||
finasteride|No|No|No|No|75%|00093735598|FINASTERIDE 5 MG TABLET|90|EA|.2365|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||||No|No|||Prescription Required|No|01/23/2008|003|No|.05653||.05517||.05557||||BPH TREATMENTS|1634|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|Yes|No|No|No|75%|00093736710|LOSARTAN-HCTZ 50-12.5 MG TAB|1000|EA|.05918|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|113|Yes|.06268||.06118||.06161||||ANGIOTENSIN MODULATORS|1635|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|Yes|No|No|No|75%|00093736756|LOSARTAN-HCTZ 50-12.5 MG TAB|30|EA|.05948|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|113|Yes|.06268||.06118||.06161||||ANGIOTENSIN MODULATORS|1636|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|Yes|No|No|No|75%|00093736798|LOSARTAN-HCTZ 50-12.5 MG TAB|90|EA|.05929|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|113|Yes|.06268||.06118||.06161||||ANGIOTENSIN MODULATORS|1637|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|No|No|No|No|75%|00093736810|LOSARTAN-HCTZ 100-25 MG TAB|1000|EA|.0806|06/02/2010||Yes|No||06/02/2010||Yes|No|06/02/2010||Yes|No||06/02/2010||Yes|No|||Prescription Required|No|01/20/2011|113|Yes|.078||.07613||.07667||||ANGIOTENSIN MODULATORS|1638|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|No|No|No|No|75%|00093736856|LOSARTAN-HCTZ 100-25 MG TAB|30|EA|.08084|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|||Prescription Required|No|01/20/2011|113|Yes|.078||.07613||.07667||||ANGIOTENSIN MODULATORS|1639|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|No|No|No|No|75%|00093736898|LOSARTAN-HCTZ 100-25 MG TAB|90|EA|.08069|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|||Prescription Required|No|01/20/2011|113|Yes|.078||.07613||.07667||||ANGIOTENSIN MODULATORS|1640|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|Yes|No|No|No|75%|00093736910|LOSARTAN-HCTZ 100-12.5 MG TAB|1000|EA|.0806|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|113|Yes|.07463||.07284||.07336||||ANGIOTENSIN MODULATORS|1641|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|Yes|No|No|No|75%|00093736956|LOSARTAN-HCTZ 100-12.5 MG TAB|30|EA|.08084|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|113|Yes|.07463||.07284||.07336||||ANGIOTENSIN MODULATORS|1642|||||No|No||TEVA USA|No|||||No|No|No||
losartan/hydrochlorothiazide|Yes|No|No|No|75%|00093736998|LOSARTAN-HCTZ 100-12.5 MG TAB|90|EA|.08069|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||05/03/2010||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|113|Yes|.07463||.07284||.07336||||ANGIOTENSIN MODULATORS|1643|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093738456|VENLAFAXINE HCL ER 37.5 MG CAP|30|EA|.10965|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2012|031|No|.07117||.06946||.06996||||ANTIDEPRESSANTS, OTHER|1644|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093738498|VENLAFAXINE HCL ER 37.5 MG CAP|90|EA|.10052|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2012|031|No|.07117||.06946||.06996||||ANTIDEPRESSANTS, OTHER|1645|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093738556|VENLAFAXINE HCL ER 75 MG CAP|30|EA|.13272|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2012|031|No|.07585||.07403||.07456||||ANTIDEPRESSANTS, OTHER|1646|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093738598|VENLAFAXINE HCL ER 75 MG CAP|90|EA|.12264|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2012|031|No|.07585||.07403||.07456||||ANTIDEPRESSANTS, OTHER|1647|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093738656|VENLAFAXINE HCL ER 150 MG CAP|30|EA|.19235|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2012|031|No|.10567||.10313||.10387||||ANTIDEPRESSANTS, OTHER|1648|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093738698|VENLAFAXINE HCL ER 150 MG CAP|90|EA|.15843|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2012|031|No|.10567||.10313||.10387||||ANTIDEPRESSANTS, OTHER|1649|||||No|No||TEVA USA|No|||||No|No|No||
moxifloxacin HCl|No|No|No|No|75%|00093738756|MOXIFLOXACIN HCL 400 MG TABLET|30|EA|9.3654|03/25/2014||Yes|No||03/25/2014||Yes|No|03/25/2014||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|028|No|1.20366||1.17477||1.1832||||FLUOROQUINOLONES, ORAL|1650|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739286|NIACIN ER 500 MG TABLET|180|EA|1.45746|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|.13415||.13093||.13187||||LIPOTROPICS, OTHER|1651|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739386|NIACIN ER 750 MG TABLET|180|EA|2.07886|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|.35393||.34544||.34791||||LIPOTROPICS, OTHER|1652|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739398|NIACIN ER 750 MG TABLET|90|EA|2.07886|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|.35393||.34544||.34791||||LIPOTROPICS, OTHER|1653|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739486|NIACIN ER 1,000 MG TABLET|180|EA|2.5777|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|.16489||.16093||.16209||||LIPOTROPICS, OTHER|1654|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739498|NIACIN ER 1,000 MG TABLET|90|EA|2.5777|04/22/2014||Yes|No||04/22/2014||Yes|No|04/22/2014||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|.16489||.16093||.16209||||LIPOTROPICS, OTHER|1655|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744201|FLUVASTATIN SODIUM 20 MG CAP|100|EA|1.71871|07/25/2012||Yes|No||07/25/2012||Yes|No|07/25/2012||Yes|No||07/25/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|No|3.23963||3.16188||3.18456||||LIPOTROPICS, STATINS|1656|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744256|FLUVASTATIN SODIUM 20 MG CAP|30|EA|1.71871|07/25/2012||Yes|No||07/25/2012||Yes|No|07/25/2012||Yes|No||07/25/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|No|3.23963||3.16188||3.18456||||LIPOTROPICS, STATINS|1657|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744301|FLUVASTATIN SODIUM 40 MG CAP|100|EA|1.71871|07/25/2012||Yes|No||07/25/2012||Yes|No|07/25/2012||Yes|No||07/25/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|No|2.62452||2.56153||2.5799||||LIPOTROPICS, STATINS|1658|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744356|FLUVASTATIN SODIUM 40 MG CAP|30|EA|1.71871|07/25/2012||Yes|No||07/25/2012||Yes|No|07/25/2012||Yes|No||07/25/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|Yes|2.62452||2.56153||2.5799||||LIPOTROPICS, STATINS|1659|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744601|FLUVASTATIN ER 80 MG TABLET|100|EA|2.78266|10/05/2016||Yes|No||10/05/2016||Yes|No|10/05/2016||Yes|No||10/05/2016||Yes|No|||Prescription Required|Yes|07/23/2015|063|Yes|2.78806||2.72115||2.74066||||LIPOTROPICS, STATINS|1660|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744656|FLUVASTATIN ER 80 MG TABLET|30|EA|2.78253|10/05/2016||Yes|No||10/05/2016||Yes|No|10/05/2016||Yes|No||10/05/2016||Yes|No|||Prescription Required|Yes|07/23/2015|063|Yes|2.78806||2.72115||2.74066||||LIPOTROPICS, STATINS|1661|||||No|No||TEVA USA|No|||||No|No|No||
glipizide/metformin HCl|Yes|No|No|No|75%|00093745501|GLIPIZIDE-METFORMIN 2.5-250 MG|100|EA|.26733|10/31/2005||Yes|No||10/31/2005||Yes|No|10/31/2005||Yes|No||||No|No|07/01/2016||Prescription Required|Yes|01/26/2017|012|No|.24682||.2409||.24262||||HYPOGLYCEMICS, METFORMINS|1662|||||No|No||TEVA USA|No|||||No|No|No||
glipizide/metformin HCl|Yes|No|No|No|75%|00093745601|GLIPIZIDE-METFORMIN 2.5-500 MG|100|EA|.31893|10/31/2005||Yes|No||10/31/2005||Yes|No|10/31/2005||Yes|No||||No|No|07/01/2016||Prescription Required|Yes|01/26/2017|012|No|.23713||.23144||.2331||||HYPOGLYCEMICS, METFORMINS|1663|||||No|No||TEVA USA|No|||||No|No|No||
glipizide/metformin HCl|Yes|No|No|No|75%|00093745701|GLIPIZIDE-METFORMIN 5-500 MG|100|EA|.31893|10/31/2005||Yes|No||10/31/2005||Yes|No|||No|No||||No|No|07/01/2016||Prescription Required|Yes|01/26/2017|012|No|.19545||.19076||.19213||||HYPOGLYCEMICS, METFORMINS|1664|||||No|No||TEVA USA|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00093747119|RIZATRIPTAN 5 MG TABLET|1|EA|.645|04/15/2014||Yes|No||04/15/2014||Yes|No|04/15/2014||Yes|No||||No|No|||Prescription Required|No|07/26/2018|021|Yes|.37775||.36868||.37133||||ANTIMIGRAINE AGENTS, TRIPTANS|1665|||||No|No||TEVA USA|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00093747143|RIZATRIPTAN 5 MG TABLET|18|EA|.64333|04/15/2014||Yes|No||04/15/2014||Yes|No|04/15/2014||Yes|No||||No|No|||Prescription Required|No|07/26/2018|021|Yes|.37775||.36868||.37133||||ANTIMIGRAINE AGENTS, TRIPTANS|1666|||||No|No||TEVA USA|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00093747219|RIZATRIPTAN 10 MG TABLET|1|EA|.645|04/15/2014||Yes|No||04/15/2014||Yes|No|04/15/2014||Yes|No||||No|No|||Prescription Required|No|07/26/2018|021|Yes|.33156||.3236||.32592||||ANTIMIGRAINE AGENTS, TRIPTANS|1667|||||No|No||TEVA USA|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00093747243|RIZATRIPTAN 10 MG TABLET|18|EA|.64333|04/15/2014||Yes|No||04/15/2014||Yes|No|04/15/2014||Yes|No||||No|No|||Prescription Required|No|07/26/2018|021|Yes|.33156||.3236||.32592||||ANTIMIGRAINE AGENTS, TRIPTANS|1668|||||No|No||TEVA USA|No|||||No|No|No||
capecitabine|No|No|No|No|75%|00093747306|CAPECITABINE 150 MG TABLET    |60|EA|.5246|03/31/2014||Yes|No||03/31/2014||Yes|No|03/31/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|.26362||.25729||.25914||||ONCOLOGY, ORAL - BREAST|1669|||||No|No||TEVA USA|No|||||Yes|No|No||
capecitabine|No|No|No|No|75%|00093747489|CAPECITABINE 500 MG TABLET|120|EA|.73996|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|.43418||.42376||.4268||||ONCOLOGY, ORAL - BREAST|1670|||||No|No||TEVA USA|No|||||Yes|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093751631|FLUTICASONE-SALMETEROL 500-50|60|EA|1.0975|10/19/2022||Yes|No||10/19/2022||Yes|No|10/19/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|No|1.56676||1.52916||1.54013||||GLUCOCORTICOIDS, INHALED|1671|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093751731|FLUTICASONE-SALMETEROL 100-50|60|EA|.67159|10/19/2022||Yes|No||10/19/2022||Yes|No|10/19/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|No|.91408||.89214||.89854||||GLUCOCORTICOIDS, INHALED|1672|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093751831|FLUTICASONE-SALMETEROL 250-50|60|EA|.83448|10/19/2022||Yes|No||10/19/2022||Yes|No|10/19/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|No|1.13244||1.10526||1.11319||||GLUCOCORTICOIDS, INHALED|1673|||||No|No||TEVA USA|No|||||No|No|No||
anastrozole|No|No|No|No|75%|00093753656|ANASTROZOLE 1 MG TABLET|30|EA|.13932|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|.11102||.10836||.10913||||ONCOLOGY, ORAL - BREAST|1674|||||No|No||TEVA USA|No|||||No|No|No||
letrozole|No|No|No|No|75%|00093762056|LETROZOLE 2.5 MG TABLET|30|EA|.129|06/16/2011||Yes|No||06/16/2011||Yes|No|06/16/2011||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|.12776||.12469||.12559||||ONCOLOGY, ORAL - BREAST|1675|||||No|No||TEVA USA|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00093762998|IMATINIB MESYLATE 100 MG TAB  |90|EA|.52173|12/16/2016||Yes|No||12/16/2016||Yes|No|12/16/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|.64236||.62694||.63144||||ONCOLOGY, ORAL - HEMATOLOGIC|1676|||||No|No||TEVA USA|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00093763056|IMATINIB MESYLATE 400 MG TAB|30|EA|1.87996|12/16/2016||Yes|No||12/16/2016||Yes|No|12/16/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|2.5223||2.46176||2.47942||||ONCOLOGY, ORAL - HEMATOLOGIC|1677|||||No|No||TEVA USA|No|||||No|No|No||
erlotinib HCl|No|No|No|No|75%|00093766256|ERLOTINIB HCL 25 MG TABLET|30|EA|23.98941|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|551|No|54.67354||53.89249||51.32618||||ONCOLOGY, ORAL - LUNG|1678|||||No|No||TEVA USA|No|||||No|No|No||
erlotinib HCl|No|No|No|No|75%|00093766356|ERLOTINIB HCL 100 MG TABLET   |30|EA|92.53342|03/19/2021||Yes|No||03/19/2021||Yes|No|03/19/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|210.89012||207.8774||197.97848||||ONCOLOGY, ORAL - LUNG|1679|||||No|No||TEVA USA|No|||||No|No|No||
erlotinib HCl|No|No|No|No|75%|00093766456|ERLOTINIB HCL 150 MG TABLET   |30|EA|104.66214|03/19/2021||Yes|No||03/19/2021||Yes|No|03/19/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|238.53232||235.12472||223.9283||||ONCOLOGY, ORAL - LUNG|1680|||||No|No||TEVA USA|No|||||No|No|No||
etonogestrel/ethinyl estradiol|No|Yes|No|No|75%|00093767902|ETONOGESTREL-EE VAGINAL RING|1|EA|60.42216|06/07/2021||Yes|No||06/23/2021||Yes|No|06/07/2021||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|42.53705||41.51616||41.81392|||||1681|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
levocetirizine dihydrochloride|No|No|No|No|75%|00093770198|LEVOCETIRIZINE 5 MG TABLET|90|EA|.14333|09/16/2011||Yes|No||09/16/2011||Yes|No|09/16/2011||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|030|No|.05856||.05715||.05756||||ANTIHISTAMINES, MINIMALLY SEDATING|1682|||||No|No||TEVA USA|No|||||No|No|No||
emtricitabine/tenofovir (TDF)|No|No|No|No|75%|00093770456|EMTRICITABINE-TENOFV 200-300MG|30|EA|.6|05/26/2021||Yes|No||05/26/2021||Yes|No|05/26/2021||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|.44465||.43398||.43709||||HIV / AIDS|1683|||||No|No||TEVA USA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00093776624|EVEROLIMUS 2.5 MG TABLET      |28|EA|8.03685|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|18.31654||18.05488||17.19512||||ONCOLOGY, ORAL - RENAL CELL|1684|||||No|No||TEVA USA|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00093776724|EVEROLIMUS 5 MG TABLET        |28|EA|9.53295|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|23.31271||22.7532||22.91639||||ONCOLOGY, ORAL - RENAL CELL|1685|||||No|No||TEVA USA|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00093776824|EVEROLIMUS 7.5 MG TABLET      |28|EA|10.16904|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|23.17594||22.84486||21.75701||||ONCOLOGY, ORAL - RENAL CELL|1686|||||No|No||TEVA USA|No|||||No|No|Yes|09/30/2022|
risedronate sodium|No|No|No|No|75%|00093777113|RISEDRONATE SODIUM 150 MG TAB|3|EA|64.23196|03/01/2017||Yes|No||03/01/2017||Yes|No|03/01/2017||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|060|No|12.33554||12.03949||12.12584||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1687|||||No|No||TEVA USA|No|||||No|No|No||
risedronate sodium|No|No|No|No|75%|00093777179|RISEDRONATE SODIUM 150 MG TAB|1|EA|64.2334|03/16/2017||Yes|No||03/16/2017||Yes|No|03/16/2017||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|060|No|12.33554||12.03949||12.12584||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1688|||||No|No||TEVA USA|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00093786565|FENTANYL CITRATE OTFC 200 MCG|30|EA|5.23955|09/14/2016||Yes|No||09/14/2016||Yes|No|09/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|11.9413||11.77071||11.2102||||ANALGESICS, NARCOTICS SHORT|1689|||||No|No||TEVA USA|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00093786665|FENTANYL CITRATE OTFC 400 MCG|30|EA|6.63819|09/14/2016||Yes|No||09/14/2016||Yes|No|09/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|15.12891||14.91278||14.20265||||ANALGESICS, NARCOTICS SHORT|1690|||||No|No||TEVA USA|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00093786765|FENTANYL CITRATE OTFC 600 MCG|30|EA|8.13072|09/14/2016||Yes|No||09/14/2016||Yes|No|09/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|18.53049||18.26577||17.39597||18.90866|09/14/2016|ANALGESICS, NARCOTICS SHORT|1691|||||No|No||TEVA USA|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00093786865|FENTANYL CITRATE OTFC 800 MCG|30|EA|9.63372|09/14/2016||Yes|No||09/14/2016||Yes|No|09/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|21.95592||21.64226||20.61168||||ANALGESICS, NARCOTICS SHORT|1692|||||No|No||TEVA USA|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00093786965|FENTANYL CIT OTFC 1,200 MCG|30|EA|12.52489|09/14/2016||Yes|No||09/14/2016||Yes|No|09/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|28.54511||28.13732||26.79745||||ANALGESICS, NARCOTICS SHORT|1693|||||No|No||TEVA USA|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00093787065|FENTANYL CIT OTFC 1,600 MCG|30|EA|15.44732|09/14/2016||Yes|No||09/14/2016||Yes|No|09/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|109|Yes|35.20552||34.70258||33.05008||||ANALGESICS, NARCOTICS SHORT|1694|||||No|No||TEVA USA|No|||||No|No|No||
tiopronin|No|No|No|No|75%|00093790901|TIOPRONIN 100 MG TABLET|100|EA|10.48026|08/30/2021||Yes|No||08/30/2021||Yes|No|08/30/2021||Yes|No||||No|No|||Prescription Required|No|||No|23.88525||23.54403||22.42288|||||1695|||||No|No||TEVA USA|No|||||No|No|No||
glyburide,micronized|Yes|No|No|No|75%|00093803401|GLYBURIDE MICRO 1.5 MG TAB|100|EA|.07125|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.15996||.15612||.15724|||||1696|||||No|No||TEVA USA|No|||||No|No|No||
glyburide,micronized|Yes|No|No|No|75%|00093803501|GLYBURIDE MICRO 3 MG TABLET|100|EA|.09116|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.15795||.15416||.15526|||||1697|||||No|No||TEVA USA|No|||||No|No|No||
glyburide,micronized|Yes|No|No|No|75%|00093803505|GLYBURIDE MICRO 3 MG TABLET|500|EA|.08657|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.15795||.15416||.15526|||||1698|||||No|No||TEVA USA|No|||||No|No|No||
glyburide,micronized|Yes|No|No|No|75%|00093803601|GLYBURIDE MICRO 6 MG TABLET|100|EA|.25146|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.19012||.18556||.18689|||||1699|||||No|No||TEVA USA|No|||||No|No|No||
tiagabine HCl|No|No|No|No|75%|00093807256|TIAGABINE HCL 12 MG TABLET    |30|EA|3.75232|06/25/2018||Yes|No||06/25/2018||Yes|No|06/25/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|5.33856||5.21043||5.2478||||ANTICONVULSANTS|1700|||||No|No||TEVA USA|No|||||No|No|No||
ethynodiol d-ethinyl estradiol|Yes|Yes|No|No|75%|00093807316|KELNOR 1-50 TABLET|28|EA|.37988|06/04/2018||Yes|No||06/04/2018||Yes|No|06/04/2018||Yes|No|Refer to program requirements|||No|No|06/04/2018||Prescription Required|No|||No|.56358||.55005||.554|||||1701|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
tiagabine HCl|No|No|No|No|75%|00093807656|TIAGABINE HCL 16 MG TABLET    |30|EA|4.91404|06/25/2018||Yes|No||06/25/2018||Yes|No|06/25/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|6.48883||6.3331||6.37852||||ANTICONVULSANTS|1702|||||No|No||TEVA USA|No|||||No|No|No||
ibuprofen/famotidine|No|No|No|No|75%|00093810798|IBUPROFEN-FAMOTIDIN 800-26.6MG|90|EA|1.93022|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription Required|Yes|01/28/2021|059|Yes|4.3991||4.33626||4.12977||||NSAIDS|1703|||||No|No||TEVA USA|No|||||No|No|No||
famciclovir|No|No|No|No|75%|00093811756|FAMCICLOVIR 125 MG TABLET|30|EA|.63611|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2013|025|No|.20922||.2042||.20566||||ANTIVIRALS, ORAL|1704|||||No|No||TEVA USA|No|||||No|No|No||
famciclovir|Yes|No|No|No|75%|00093811856|FAMCICLOVIR 250 MG TABLET|30|EA|.69158|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||||No|No|11/01/2012||Prescription Required|No|01/23/2013|025|No|.30362||.29633||.29846||||ANTIVIRALS, ORAL|1705|||||No|No||TEVA USA|No|||||No|No|No||
famciclovir|No|No|No|No|75%|00093811956|FAMCICLOVIR 500 MG TABLET|30|EA|1.38875|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||||No|No|||Prescription Required|No|01/23/2013|025|No|.64365||.6282||.63271||||ANTIVIRALS, ORAL|1706|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093816201|QUETIAPINE FUMARATE 100 MG TAB|100|EA|.29485|04/17/2012||Yes|No||04/17/2012||Yes|No|04/17/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2012|027|Yes|.0394||.03845||.03873||||ANTIPSYCHOTICS|1707|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093816301|QUETIAPINE FUMARATE 200 MG TAB|100|EA|.55629|04/17/2012||Yes|No||04/17/2012||Yes|No|04/17/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2012|027|Yes|.07905||.07715||.07771||||ANTIPSYCHOTICS|1708|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093816401|QUETIAPINE FUMARATE 300 MG TAB|100|EA|.72937|04/17/2012||Yes|No||04/17/2012||Yes|No|04/17/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2012|027|Yes|.11359||.11086||.11166||||ANTIPSYCHOTICS|1709|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093816501|QUETIAPINE FUMARATE 400 MG TAB|100|EA|.85721|04/17/2012||Yes|No||04/17/2012||Yes|No|04/17/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2012|027|Yes|.14711||.14358||.14461||||ANTIPSYCHOTICS|1710|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093816601|QUETIAPINE FUMARATE 50 MG TAB|100|EA|.28238|04/17/2012||Yes|No||04/17/2012||Yes|No|04/17/2012||Yes|No||||No|No|||Prescription Required|No|01/25/2012|027|Yes|.02775||.02708||.02728||||ANTIPSYCHOTICS|1711|||||No|No||TEVA USA|No|||||No|No|No||
oseltamivir phosphate|No|No|No|No|75%|00093818064|OSELTAMIVIR 6 MG/ML SUSPENSION|60|ML|.301|11/20/2019||Yes|No||11/20/2019||Yes|No|11/20/2019||Yes|No||||No|No|||Prescription Required|No|03/09/2018|025|No|.12711||.12406||.12495||||ANTIVIRALS, ORAL|1712|||||No|No||TEVA USA|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00093819201|CIMETIDINE 300 MG TABLET|100|EA|.15889|02/02/2018||Yes|No||02/02/2018||Yes|No|02/02/2018||Yes|No||||No|No|||Prescription Required|No|||No|.22724||.22179||.22338|||||1713|||||No|No||TEVA USA|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00093819928|SUNITINIB MALATE 12.5 MG CAP|28|EA|75.08215|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|171.11745||168.67291||160.64087||||ONCOLOGY, ORAL - RENAL CELL|1714|||||No|No||TEVA USA|No|||||No|No|No||
norethindrone-e.estradiol-iron|No|Yes|No|No|75%|00093821062|FINZALA 1-0.02(24)-75 CHEW TAB|28|EA|1.64153|06/07/2023||Yes|No||06/07/2023||Yes|No|06/07/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.22701||.22156||.22315|||||1715|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
sunitinib malate|No|No|No|No|75%|00093822428|SUNITINIB MALATE 25 MG CAPSULE|28|EA|150.1646|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|342.2356||337.34652||321.2824||||ONCOLOGY, ORAL - RENAL CELL|1716|||||No|No||TEVA USA|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00093822928|SUNITINIB MALATE 37.5 MG CAP|28|EA|225.24705|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|513.35374||506.02012||481.92392||||ONCOLOGY, ORAL - RENAL CELL|1717|||||No|No||TEVA USA|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00093823128|SUNITINIB MALATE 50 MG CAPSULE|28|EA|261.41543|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|595.78399||587.27279||559.30742||||ONCOLOGY, ORAL - RENAL CELL|1718|||||No|No||TEVA USA|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00093823256|IRBESARTAN-HCTZ 300-12.5 MG TB|30|EA|.19192|03/18/2014||Yes|No||03/18/2014||Yes|No|03/18/2014||Yes|No||03/18/2014||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.17628||.17205||.17328||||ANGIOTENSIN MODULATORS|1719|||||No|No||TEVA USA|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00093823298|IRBESARTAN-HCTZ 300-12.5 MG TB|90|EA|.18561|03/18/2014||Yes|No||03/18/2014||Yes|No|03/18/2014||Yes|No||03/18/2014||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.17628||.17205||.17328||||ANGIOTENSIN MODULATORS|1720|||||No|No||TEVA USA|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00093823856|IRBESARTAN-HCTZ 150-12.5 MG TB|30|EA|.1548|05/24/2013||Yes|No||05/24/2013||Yes|No|05/24/2013||Yes|No||05/24/2013||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.13078||.12764||.12856||||ANGIOTENSIN MODULATORS|1721|||||No|No||TEVA USA|No|||||No|No|No||
irbesartan/hydrochlorothiazide|Yes|No|No|No|75%|00093823898|IRBESARTAN-HCTZ 150-12.5 MG TB|90|EA|.15064|05/24/2013||Yes|No||05/24/2013||Yes|No|05/24/2013||Yes|No||05/24/2013||Yes|No|07/01/2016||Prescription Required|No|07/27/2017|113|Yes|.13078||.12764||.12856||||ANGIOTENSIN MODULATORS|1722|||||No|No||TEVA USA|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00093830501|CIMETIDINE 800 MG TABLET|100|EA|.49618|03/08/2011||Yes|No||03/08/2011||Yes|No|03/08/2011||Yes|No||03/08/2011||Yes|No|||Prescription Required|No|||No|.78088||.76214||.76761|||||1723|||||No|No||TEVA USA|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00093831018|ELETRIPTAN HBR 20 MG TABLET|6|EA|7.92848|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|021|Yes|2.02414||1.97556||1.98973||||ANTIMIGRAINE AGENTS, TRIPTANS|1724|||||No|No||TEVA USA|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00093831118|ELETRIPTAN HBR 40 MG TABLET|6|EA|7.92848|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|021|Yes|2.12176||2.07084||2.08569||||ANTIMIGRAINE AGENTS, TRIPTANS|1725|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834201|GLYBURIDE 1.25 MG TABLET|100|EA|.05448|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.07066||.06896||.06946|||||1726|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834301|GLYBURIDE 2.5 MG TABLET|100|EA|.0688|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05724||.05587||.05627|||||1727|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834305|GLYBURIDE 2.5 MG TABLET|500|EA|.06708|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05724||.05587||.05627|||||1728|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834310|GLYBURIDE 2.5 MG TABLET|1000|EA|.06536|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05724||.05587||.05627|||||1729|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834401|GLYBURIDE 5 MG TABLET|100|EA|.1118|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05572||.05438||.05477|||||1730|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834405|GLYBURIDE 5 MG TABLET|500|EA|.11668|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05572||.05438||.05477|||||1731|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834410|GLYBURIDE 5 MG TABLET|1000|EA|.10375|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05572||.05438||.05477|||||1732|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093867574|AMOX-CLAV 600-42.9 MG/5 ML SUS|200|ML|.15564|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription Required|No|04/28/2004|046|No|.04711||.04598||.04631||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1733|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093867575|AMOX-CLAV 600-42.9 MG/5 ML SUS|125|ML|.15858|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05213||.05088||.05124||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1734|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00093867578|AMOX-CLAV 600-42.9 MG/5 ML SUS|75|ML|.16506|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription Required|No|04/28/2004|046|No|.07242||.07068||.07119||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1735|||||No|No||TEVA USA|No|||||No|No|No||
mexiletine HCl|No|No|No|No|75%|00093873901|MEXILETINE 150 MG CAPSULE|100|EA|.55612|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.22928||.22378||.22538|||||1736|||||No|No||TEVA USA|No|||||No|No|No||
mexiletine HCl|No|No|No|No|75%|00093874001|MEXILETINE 200 MG CAPSULE|100|EA|.6763|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.24719||.24126||.24299|||||1737|||||No|No||TEVA USA|No|||||No|No|No||
mexiletine HCl|No|No|No|No|75%|00093874101|MEXILETINE 250 MG CAPSULE|100|EA|.7921|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.45695||.44598||.44918|||||1738|||||No|No||TEVA USA|No|||||No|No|No||
cyclosporine, modified|No|No|No|No|75%|00093901865|CYCLOSPORINE MODIFIED 25 MG|30|EA|.47285|07/20/2021||Yes|No||07/20/2021||Yes|No|07/20/2021||Yes|No||07/20/2021||Yes|No|||Prescription Required|No|01/28/2021|229|No|.409||.39918||.40205||||IMMUNOSUPPRESSIVES, ORAL|1739|||||No|No||TEVA USA|No|||||Yes|No|No||
cyclosporine, modified|No|No|No|No|75%|00093901965|CYCLOSPORINE MODIFIED 50 MG|30|EA|.94528|07/20/2021||Yes|No||07/20/2021||Yes|No|07/20/2021||Yes|No||07/20/2021||Yes|No|||Prescription Required|Yes|01/28/2021|229|No|.71241||.69531||.7003||||IMMUNOSUPPRESSIVES, ORAL|1740|||||No|No||TEVA USA|No|||||Yes|No|No||
cyclosporine, modified|No|No|No|No|75%|00093902065|CYCLOSPORINE MODIFIED 100 MG|30|EA|1.89056|07/20/2021||Yes|No||07/20/2021||Yes|No|07/20/2021||Yes|No||07/20/2021||Yes|No|||Prescription Required|No|01/28/2021|229|No|1.45579||1.42085||1.43104||||IMMUNOSUPPRESSIVES, ORAL|1741|||||No|No||TEVA USA|No|||||Yes|No|No||
venlafaxine HCl|No|No|No|No|75%|00093914701|VENLAFAXINE HCL 25 MG TABLET|100|EA|.13373|06/24/2020||Yes|No||06/24/2020||Yes|No|06/24/2020||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/30/2020|031|No|.06904||.06738||.06787||||ANTIDEPRESSANTS, OTHER|1742|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093914801|VENLAFAXINE HCL 37.5 MG TABLET|100|EA|.13782|06/24/2020||Yes|No||06/24/2020||Yes|No|06/24/2020||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/30/2020|031|No|.06791||.06628||.06676||||ANTIDEPRESSANTS, OTHER|1743|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093914901|VENLAFAXINE HCL 50 MG TABLET|100|EA|.1419|06/24/2020||Yes|No||06/24/2020||Yes|No|06/24/2020||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/30/2020|031|No|.09108||.08889||.08953||||ANTIDEPRESSANTS, OTHER|1744|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093915701|VENLAFAXINE HCL 75 MG TABLET|100|EA|.1505|06/24/2020||Yes|No||06/24/2020||Yes|No|06/24/2020||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/30/2020|031|No|.05296||.05169||.05206||||ANTIDEPRESSANTS, OTHER|1745|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093916301|VENLAFAXINE HCL 100 MG TABLET|100|EA|.15953|06/24/2020||Yes|No||06/24/2020||Yes|No|06/24/2020||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/30/2020|031|No|.07113||.06942||.06992||||ANTIDEPRESSANTS, OTHER|1746|||||No|No||TEVA USA|No|||||No|No|No||
diflunisal|No|No|No|No|75%|00093922201|DIFLUNISAL 500 MG TABLET|100|EA|.71079|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||02/16/2022||Yes|No|||Prescription Required|Yes|01/28/2021|059|Yes|.85359||.8331||.83908||||NSAIDS|1747|||||No|No||TEVA USA|No|||||No|No|No||
diflunisal|No|No|No|No|75%|00093922205|DIFLUNISAL 500 MG TABLET|500|EA|.69302|06/07/2023||Yes|No||06/07/2023||Yes|No|06/07/2023||Yes|No||06/07/2023||Yes|No|||Prescription Required|Yes|01/27/2022|059|Yes|.85359||.8331||.83908||||NSAIDS|1748|||||No|No||TEVA USA|No|||||No|No|No||
diflunisal|No|No|No|No|75%|00093922206|DIFLUNISAL 500 MG TABLET|60|EA|.71079|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||02/16/2022||Yes|No|||Prescription Required|Yes|01/28/2021|059|Yes|.85359||.8331||.83908||||NSAIDS|1749|||||No|No||TEVA USA|No|||||No|No|No||
mesalamine|No|No|No|No|75%|00093922489|MESALAMINE ER 0.375 GRAM CAP|120|EA|1.355|05/27/2021||Yes|No||05/27/2021||Yes|No|05/27/2021||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|010|No|.49144||.47965||.48309||||ULCERATIVE COLITIS AGENTS|1750|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093929067|CLONAZEPAM 0.125 MG ODT|60|EA|.40212|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription Required|No|01/27/2022|056|Yes|.43197||.4216||.42463||||ANTICONVULSANTS|1751|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093929167|CLONAZEPAM 0.25 MG ODT|60|EA|.40212|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription Required|No|01/27/2022|056|Yes|.45406||.44316||.44634||||ANTICONVULSANTS|1752|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093929267|CLONAZEPAM 0.5 MG ODT|60|EA|.40147|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription Required|No|01/27/2022|056|Yes|.43||.41968||.42269||||ANTICONVULSANTS|1753|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093929367|CLONAZEPAM 1 MG ODT|60|EA|.45881|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription Required|No|01/27/2022|056|Yes|.49084||.47906||.4825||||ANTICONVULSANTS|1754|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093929467|CLONAZEPAM 2 MG ODT|60|EA|.63568|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription Required|No|01/27/2022|056|Yes|1.12274||1.09579||1.10365||||ANTICONVULSANTS|1755|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093936401|GLYBURIDE 5 MG TABLET|100|EA|.13739|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05572||.05438||.05477|||||1756|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093936405|GLYBURIDE 5 MG TABLET|500|EA|.13395|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05572||.05438||.05477|||||1757|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093936410|GLYBURIDE 5 MG TABLET|1000|EA|.13051|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05572||.05438||.05477|||||1758|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093943301|GLYBURIDE 2.5 MG TABLET|100|EA|.0888|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05724||.05587||.05627|||||1759|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093943305|GLYBURIDE 2.5 MG TABLET|500|EA|.08656|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.05724||.05587||.05627|||||1760|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093947753|GLYBURIDE 1.25 MG TABLET|50|EA|.08772|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||No|.07066||.06896||.06946|||||1761|||||No|No||TEVA USA|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00093960995|DOXEPIN 5% CREAM|45|GM|5.52158|02/29/2024||Yes|No||02/29/2024||Yes|No|02/29/2024||Yes|No||||No|No|||Prescription Required|No|||No|7.71347||7.52835||7.58234|||||1762|||||No|No||TEVA USA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00093970101|CARBIDOPA-LEVODOPA 10-100 TAB|100|EA|.09559|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|015|No|.07976||.07785||.0784||||ANTIPARKINSON'S AGENTS|1763|||||No|No||TEVA USA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00093970105|CARBIDOPA-LEVODOPA 10-100 TAB|500|EA|.09367|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription Required|No|07/28/2022|015|No|.07976||.07785||.0784||||ANTIPARKINSON'S AGENTS|1764|||||No|No||TEVA USA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00093970201|CARBIDOPA-LEVODOPA 25-100 TAB|100|EA|.10858|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|015|No|.06173||.06025||.06068||||ANTIPARKINSON'S AGENTS|1765|||||No|No||TEVA USA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00093970205|CARBIDOPA-LEVODOPA 25-100 TAB|500|EA|.10638|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|015|No|.06173||.06025||.06068||||ANTIPARKINSON'S AGENTS|1766|||||No|No||TEVA USA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00093970210|CARBIDOPA-LEVODOPA 25-100 TAB|1000|EA|.10638|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|015|No|.06173||.06025||.06068||||ANTIPARKINSON'S AGENTS|1767|||||No|No||TEVA USA|No|||||No|No|No||
butalbital/acetaminophen|No|No|No|No|75%|00095300001|BUPAP 50 MG-300 MG TABLET|100|EA|5.79941|08/23/2013||Yes|No||08/23/2013||Yes|No|08/23/2013||Yes|No||||No|No|||Prescription Required|No|||No|13.21726||13.02844||12.40804|||||1768|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
ibuprofen|No|No|No|No|75%|00113005705|GS INF IBUPROFEN 50 MG/1.25 ML|15|ML|.14992|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|03/20/2010|059|Yes|.2815||.27474||.27671||||NSAIDS|1769|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
famotidine|No|No|No|No|75%|00113014165|GS ACID REDUCER 10 MG TABLET|30|EA|.06206|05/06/2020||Yes|No||||No|No|05/06/2020||Yes|No||||No|No|||Over The Counter|No|||No|.09455||.09228||.09294|||||1770|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113016626|GS CHILD IBUPROFEN 100 MG/5 ML|120|ML|.01738|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.02925||.02855||.02875||||NSAIDS|1771|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
polyethylene glycol 3350|No|No|No|No|75%|00113030602|GS CLEARLAX POWDER|238|GM|.01068|03/29/2019||Yes|No||||No|No|03/29/2019||Yes|No||||No|No|||Over The Counter|No|||No|.02074||.02024||.02039|||||1772|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
polyethylene glycol 3350|No|No|No|No|75%|00113030603|GS CLEARLAX POWDER|510|GM|.00804|03/29/2019||Yes|No||||No|No|03/29/2019||Yes|No||||No|No|||Over The Counter|No|||No|.0208||.0203||.02045|||||1773|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
guaifenesin/dextromethorphan|No|No|No|No|75%|00113057826|GS TUSSIN DM LIQUID|118|ML|.00656|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|07/28/2010|184|Yes|.01495||.01473||.01403||||COUGH AND COLD, NON-NARCOTIC|1774|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113060471|GS IBUPROFEN 200 MG TABLET|50|EA|.01161|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.03534||.03449||.03474||||NSAIDS|1775|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113060478|GS IBUPROFEN 200 MG TABLET|100|EA|.0157|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.03534||.03449||.03474||||NSAIDS|1776|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113060490|GS IBUPROFEN 200 MG TABLET|500|EA|.01063|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.03534||.03449||.03474||||NSAIDS|1777|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
loratadine|No|No|No|No|75%|00113061239|GS ALLERGY RELIEF 10 MG TABLET|30|EA|.02795|06/20/2007||Yes|No||||No|No|06/20/2007||Yes|No||||No|No|||Over The Counter|No|07/18/2006|030|Yes|.04667||.04555||.04588||||ANTIHISTAMINES, MINIMALLY SEDATING|1778|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
loratadine|No|No|No|No|75%|00113061265|GS ALLERGY RELIEF 10 MG TABLET|30|EA|.02795|01/31/2005||Yes|No||||No|No|01/31/2005||Yes|No||||No|No|||Over The Counter|No|01/10/2005|030|Yes|.04667||.04555||.04588||||ANTIHISTAMINES, MINIMALLY SEDATING|1779|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113066026|GS CHILD IBUPROFEN 100 MG/5 ML|120|ML|.01164|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.02925||.02855||.02875||||NSAIDS|1780|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
nicotine polacrilex|No|No|No|No|75%|00113073402|GS NICOTINE 2 MG MINI LOZENGE|81|EA|.19292|01/05/2021||Yes|No||||No|No|01/05/2021||Yes|No||||No|No|||Over The Counter|No|07/25/2019|040|No|.34285||.33462||.33702||||SMOKING CESSATION|1781|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113089726|GS CHILD IBUPROFEN 100 MG/5 ML|120|ML|.01322|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.02925||.02855||.02875||||NSAIDS|1782|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113089734|GS CHILD IBUPROFEN 100 MG/5 ML|240|ML|.01094|06/23/2009||Yes|No||||No|No|06/23/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.02413||.02355||.02372||||NSAIDS|1783|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
omeprazole|No|No|No|No|75%|00113091555|GS OMEPRAZOLE DR 20 MG TABLET|42|EA|.13002|05/18/2009||Yes|No||||No|No|05/18/2009||Yes|No||||No|No|||Over The Counter|Yes|07/29/2021|047|Yes|.40714||.39737||.40022||||PROTON PUMP INHIBITORS|1784|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
norgestrel|No|Yes|No|No|75%|00113810101|OPILL 0.075 MG TABLET|28|EA|.38378|11/06/2024||Yes|No||||No|No|||No|No||||No|No|||Over The Counter|No|||No|.54687||.53375||.53757|||||1785|||||No|No||PERRIGO CO.|No|||||No|Yes|No||
baclofen|No|No|No|No|75%|00115101003|BACLOFEN 10 MG TABLET|1000|EA|.02817|12/15/2021|01/05/2025|Yes|No||12/15/2021|01/05/2025|Yes|No|12/15/2021|01/05/2025|Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|No|.06421||.06329||.06028||||SKELETAL MUSCLE RELAXANTS|1786|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
baclofen|No|No|No|No|75%|00115101101|BACLOFEN 5 MG TABLET|100|EA|.129|12/20/2021|01/05/2025|Yes|No||12/20/2021|01/05/2025|Yes|No|12/20/2021|01/05/2025|Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|No|.11956||.11669||.11753||||SKELETAL MUSCLE RELAXANTS|1787|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
baclofen|No|No|No|No|75%|00115101203|BACLOFEN 20 MG TABLET|1000|EA|.041|09/22/2021|01/05/2025|Yes|No||09/22/2021|01/05/2025|Yes|No|09/22/2021|01/05/2025|Yes|No||||No|No|||Prescription Required|No|01/28/2021|116|No|.09343||.0921||.08771||||SKELETAL MUSCLE RELAXANTS|1788|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dipyridamole|No|No|No|No|75%|00115107001|DIPYRIDAMOLE 25 MG TABLET|100|EA|.215|02/23/2022||Yes|No||02/23/2022||Yes|No|02/23/2022||Yes|No||||No|No|||Prescription Required|Yes|07/17/2007|004|No|.10241||.09995||.10067||||PLATELET AGGREGATION INHIBITORS|1789|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dipyridamole|No|No|No|No|75%|00115107101|DIPYRIDAMOLE 50 MG TABLET|100|EA|.34615|02/23/2022||Yes|No||02/23/2022||Yes|No|02/23/2022||Yes|No||||No|No|||Prescription Required|Yes|07/17/2007|004|No|.40386||.39417||.39699||||PLATELET AGGREGATION INHIBITORS|1790|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dipyridamole|No|No|No|No|75%|00115107201|DIPYRIDAMOLE 75 MG TABLET|100|EA|.46311|02/23/2022||Yes|No||02/23/2022||Yes|No|02/23/2022||Yes|No||||No|No|||Prescription Required|Yes|07/17/2007|004|No|.38484||.3756||.3783||||PLATELET AGGREGATION INHIBITORS|1791|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
carvedilol phosphate|No|No|No|No|75%|00115124808|CARVEDILOL ER 10 MG CAPSULE|30|EA|3.40875|08/15/2024||Yes|No||08/15/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/28/2022|070|No|4.89037||4.773||4.80723||||BETA-BLOCKERS|1792|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
carvedilol phosphate|No|No|No|No|75%|00115124908|CARVEDILOL ER 20 MG CAPSULE|30|EA|3.40875|08/15/2024||Yes|No||08/15/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/28/2022|070|No|3.94187||3.84727||3.87486||||BETA-BLOCKERS|1793|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
carvedilol phosphate|No|No|No|No|75%|00115125008|CARVEDILOL ER 40 MG CAPSULE|30|EA|3.40875|08/15/2024||Yes|No||08/15/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/28/2022|070|No|4.07228||3.97455||4.00305||||BETA-BLOCKERS|1794|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
carvedilol phosphate|No|No|No|No|75%|00115125108|CARVEDILOL ER 80 MG CAPSULE|30|EA|3.40875|08/22/2024||Yes|No||08/22/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/28/2022|070|No|5.01975||4.89928||4.93441||||BETA-BLOCKERS|1795|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colesevelam HCl|No|No|No|No|75%|00115132019|COLESEVELAM 625 MG TABLET|180|EA|.17916|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|055|No|.19503||.19035||.19171||||LIPOTROPICS, OTHER|1796|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
sevelamer carbonate|No|No|No|No|75%|00115136529|SEVELAMER 0.8 GM POWDER PACKET|90|EA|.83611|12/20/2021||Yes|No||12/20/2021||Yes|No|12/20/2021||Yes|No||12/20/2021||Yes|No|||Prescription Required|Yes|07/29/2021|052|Yes|1.4522||1.41735||1.42751||||PHOSPHATE BINDERS|1797|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
sevelamer carbonate|No|No|No|No|75%|00115136629|SEVELAMER 2.4 GM POWDER PACKET|90|EA|.83611|12/20/2021||Yes|No||12/20/2021||Yes|No|12/20/2021||Yes|No||12/20/2021||Yes|No|||Prescription Required|Yes|07/29/2021|052|Yes|1.40593||1.37219||1.38203||||PHOSPHATE BINDERS|1798|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00115140408|PYRIDOSTIGMINE ER 180 MG TAB|30|EA|6.93375|10/15/2015||Yes|No||10/15/2015||Yes|No|10/15/2015||Yes|No||||No|No|||Prescription Required|No|||No|5.70694||5.56997||5.60992|||||1799|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methyltestosterone|No|No|No|No|90%|00115140801|METHYLTESTOSTERONE 10 MG CAP|100|EA|26.71968|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription Required|No|||Yes|60.89602||60.02608||57.1677|||||1800|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00115143613|CYCLOBENZAPRINE ER 15 MG CAP  |60|EA|2.92035|06/05/2019||Yes|No||06/05/2019||Yes|No|06/05/2019||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|116|Yes|1.92533||1.87912||1.8926||||SKELETAL MUSCLE RELAXANTS|1801|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00115143713|CYCLOBENZAPRINE ER 30 MG CAP  |60|EA|2.92035|06/05/2019||Yes|No||06/05/2019||Yes|No|06/05/2019||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|116|Yes|2.76133||2.69506||2.71439||||SKELETAL MUSCLE RELAXANTS|1802|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148601|DEXTROAMP-AMPHET ER 5 MG CAP|100|EA|.3225|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.58063||.56669||.57076||||STIMULANTS AND RELATED AGENTS|1803|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148701|DEXTROAMP-AMPHET ER 10 MG CAP|100|EA|.3225|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.70399||.68709||.69202||||STIMULANTS AND RELATED AGENTS|1804|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148801|DEXTROAMP-AMPHET ER 15 MG CAP|100|EA|.3225|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.63267||.61749||.62191||||STIMULANTS AND RELATED AGENTS|1805|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148901|DEXTROAMP-AMPHET ER 20 MG CAP|100|EA|.3225|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.57443||.56064||.56466||||STIMULANTS AND RELATED AGENTS|1806|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115149001|DEXTROAMP-AMPHET ER 25 MG CAP|100|EA|.3225|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.52976||.51705||.52075||||STIMULANTS AND RELATED AGENTS|1807|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115149101|DEXTROAMP-AMPHET ER 30 MG CAP|100|EA|.3225|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.56014||.5467||.55062||||STIMULANTS AND RELATED AGENTS|1808|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115152210|FENOFIBRATE 40 MG TABLET      |90|EA|3.59413|06/13/2017||Yes|No||06/13/2017||Yes|No|06/13/2017||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|055|No|5.5954||5.46111||5.50028||||LIPOTROPICS, OTHER|1809|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115152310|FENOFIBRATE 120 MG TABLET|90|EA|10.78244|06/14/2017||Yes|No||06/14/2017||Yes|No|06/14/2017||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|055|No|19.08713||18.62904||18.76265||||LIPOTROPICS, OTHER|1810|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibric acid (choline)|No|No|No|No|75%|00115155410|FENOFIBRIC ACID DR 45 MG CAP|90|EA|.14333|05/29/2018||Yes|No||05/29/2018||Yes|No|05/29/2018||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|055|No|.10185||.09941||.10012||||LIPOTROPICS, OTHER|1811|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibric acid (choline)|No|No|No|No|75%|00115155510|FENOFIBRIC ACID DR 135 MG CAP|90|EA|.35833|11/17/2017||Yes|No||11/17/2017||Yes|No|11/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|055|No|.28214||.27537||.27734||||LIPOTROPICS, OTHER|1812|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
nitrofurantoin macrocrystal|No|No|No|No|75%|00115164301|NITROFURANTOIN MCR 50 MG CAP|100|EA|.3225|05/25/2017||Yes|No||05/25/2017||Yes|No|05/25/2017||Yes|No||||No|No|||Prescription Required|No|||No|.1825||.17812||.1794|||||1813|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
nitrofurantoin macrocrystal|No|No|No|No|75%|00115164501|NITROFURANTOIN MCR 100 MG CAP|100|EA|.5332|05/16/2017||Yes|No||05/16/2017||Yes|No|05/16/2017||Yes|No||05/16/2017||Yes|No|||Prescription Required|No|||No|.30858||.30117||.30333|||||1814|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115165901|PROPRANOLOL 10 MG TABLET|100|EA|.06889|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.05353||.05225||.05262||||BETA-BLOCKERS|1815|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115165903|PROPRANOLOL 10 MG TABLET|1000|EA|.06889|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.05353||.05225||.05262||||BETA-BLOCKERS|1816|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115166001|PROPRANOLOL 20 MG TABLET|100|EA|.08591|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.05737||.05599||.05639||||BETA-BLOCKERS|1817|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115166003|PROPRANOLOL 20 MG TABLET|1000|EA|.08591|03/03/2017||Yes|No||03/03/2017||Yes|No|03/03/2017||Yes|No||03/03/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.05737||.05599||.05639||||BETA-BLOCKERS|1818|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115166101|PROPRANOLOL 40 MG TABLET|100|EA|.10913|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.09062||.08845||.08908||||BETA-BLOCKERS|1819|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115166103|PROPRANOLOL 40 MG TABLET|1000|EA|.10913|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.09062||.08845||.08908||||BETA-BLOCKERS|1820|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115166201|PROPRANOLOL 80 MG TABLET|100|EA|.1637|05/24/2017||Yes|No||05/24/2017||Yes|No|05/24/2017||Yes|No||05/24/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.19368||.18903||.19039||||BETA-BLOCKERS|1821|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115166202|PROPRANOLOL 80 MG TABLET|500|EA|.1637|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.19368||.18903||.19039||||BETA-BLOCKERS|1822|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115169301|PROPRANOLOL 60 MG TABLET|100|EA|.30302|05/23/2017||Yes|No||05/23/2017||Yes|No|05/23/2017||Yes|No||05/23/2017||Yes|No|||Prescription Required|No|07/21/2016|070|No|.13241||.12923||.13016||||BETA-BLOCKERS|1823|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
epinephrine|No|No|No|No|75%|00115169449|EPINEPHRINE 0.3 MG AUTO-INJECT|2|EA|64.5|06/01/2017||Yes|No||06/01/2017||Yes|No|06/01/2017||Yes|No||||No|No|||Prescription Required|Yes|11/01/2021|238|No|87.70104||85.59622||86.21012||||EPINEPHRINE, SELF-INJECTED|1824|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
epinephrine|No|No|No|No|75%|00115169549|EPINEPHRINE 0.15 MG AUTO-INJCT|2|EA|64.5|06/01/2017||Yes|No||06/01/2017||Yes|No|06/01/2017||Yes|No||||No|No|||Prescription Required|Yes|11/01/2021|238|No|91.14245||88.95503||89.59303||||EPINEPHRINE, SELF-INJECTED|1825|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00115169606|HYDROCORTISONE 5 MG TABLET|50|EA|.12152|03/29/2021||Yes|No||03/29/2021||Yes|No|03/29/2021||Yes|No||||No|No|||Prescription Required|No|01/26/2017|168|Yes|.169||.16494||.16613||||GLUCOCORTICOIDS, ORAL|1826|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00115169701|HYDROCORTISONE 10 MG TABLET|100|EA|.20533|04/08/2021||Yes|No||04/08/2021||Yes|No|03/29/2021||Yes|No||||No|No|||Prescription Required|No|11/16/2017|168|Yes|.18731||.18281||.18413||||GLUCOCORTICOIDS, ORAL|1827|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00115170001|HYDROCORTISONE 20 MG TABLET|100|EA|.38949|06/24/2021||Yes|No||06/24/2021||Yes|No|06/24/2021||Yes|No||||No|No|||Prescription Required|No|09/14/2017|168|Yes|.34088||.3327||.33509||||GLUCOCORTICOIDS, ORAL|1828|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115170901|DEXMETHYLPHENIDATE ER 25 MG CP|100|EA|1.39956|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.40165||1.36801||1.37782||||STIMULANTS AND RELATED AGENTS|1829|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115171001|DEXMETHYLPHENIDATE ER 35 MG CP|100|EA|1.61456|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|2.6497||2.58611||2.60466||||STIMULANTS AND RELATED AGENTS|1830|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
griseofulvin ultramicrosize|No|No|No|No|75%|00115172401|GRISEOFULVIN ULTRA 125 MG TAB |100|EA|1.71527|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|069|No|2.57912||2.51722||2.53527||||ANTIFUNGALS, ORAL|1831|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
griseofulvin ultramicrosize|No|No|No|No|75%|00115172501|GRISEOFULVIN ULTRA 250 MG TAB|100|EA|2.19257|11/27/2018||Yes|No||11/27/2018||Yes|No|11/27/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|069|No|3.26362||3.18529||3.20814||||ANTIFUNGALS, ORAL|1832|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115173601|METHYLPHENIDATE ER(CD) 10MG CP|100|EA|.73328|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|.87151||.85059||.85669||||STIMULANTS AND RELATED AGENTS|1833|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115173701|METHYLPHENIDATE ER(CD) 20MG CP|100|EA|.73328|11/27/2018||Yes|No||11/27/2018||Yes|No|11/27/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|.77887||.76018||.76563||||STIMULANTS AND RELATED AGENTS|1834|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115173801|METHYLPHENIDATE ER(CD) 30MG CP|100|EA|.73328|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|1.14032||1.11295||1.12093||||STIMULANTS AND RELATED AGENTS|1835|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115173901|METHYLPHENIDATE ER(CD) 40MG CP|100|EA|.96952|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|1.19476||1.16609||1.17445||||STIMULANTS AND RELATED AGENTS|1836|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115174001|METHYLPHENIDATE ER(CD) 50MG CP|100|EA|.99124|09/13/2019||Yes|No||09/13/2019||Yes|No|09/13/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|1.20485||1.17593||1.18437||||STIMULANTS AND RELATED AGENTS|1837|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115174101|METHYLPHENIDATE ER(CD) 60MG CP|100|EA|.99124|11/27/2018||Yes|No||11/27/2018||Yes|No|11/27/2018||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|007|Yes|1.70493||1.66401||1.67595||||STIMULANTS AND RELATED AGENTS|1838|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
metaxalone|No|No|No|No|75%|00115174501|METAXALONE 400 MG TABLET      |100|EA|2.20293|09/24/2018||Yes|No||09/24/2018||Yes|No|09/24/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|116|No|2.57977||2.51786||2.53591||||SKELETAL MUSCLE RELAXANTS|1839|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
acitretin|No|No|No|No|75%|00115175008|ACITRETIN 10 MG CAPSULE|30|EA|5.36668|11/17/2017||Yes|No||11/17/2017||Yes|No|11/17/2017||Yes|No||||No|No|||Prescription Required|No|||No|3.9686||3.87335||3.90113|||||1840|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
acitretin|No|No|No|No|75%|00115175108|ACITRETIN 17.5 MG CAPSULE     |30|EA|8.26875|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|||No|13.21276||12.89565||12.98814|||||1841|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
acitretin|No|No|No|No|75%|00115175308|ACITRETIN 25 MG CAPSULE|30|EA|6.61497|05/29/2018||Yes|No||05/29/2018||Yes|No|05/29/2018||Yes|No||||No|No|||Prescription Required|No|||No|3.9502||3.8554||3.88305|||||1842|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
cyproheptadine HCl|No|No|No|No|75%|00115175701|CYPROHEPTADINE 4 MG TABLET|100|EA|.0387|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|574|Yes|.06461||.06306||.06351||||ANTIHISTAMINES, FIRST GENERATION|1843|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115180001|METHYLPHENIDATE 5 MG TABLET|100|EA|.04322|12/06/2018||Yes|No||12/06/2018||Yes|No|12/06/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.10713||.10456||.10531||||STIMULANTS AND RELATED AGENTS|1844|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115180101|METHYLPHENIDATE 10 MG TABLET|100|EA|.05762|12/06/2018||Yes|No||12/06/2018||Yes|No|12/06/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.14244||.13902||.14002||||STIMULANTS AND RELATED AGENTS|1845|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115180201|METHYLPHENIDATE 20 MG TABLET|100|EA|.06626|12/06/2018||Yes|No||12/06/2018||Yes|No|12/06/2018||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.19971||.19492||.19631||||STIMULANTS AND RELATED AGENTS|1846|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00115180301|HYDROXYZINE PAM 25 MG CAP|100|EA|.05676|11/27/2018||Yes|No||11/27/2018||Yes|No|11/27/2018||Yes|No||11/27/2018||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.05412||.05282||.0532||||ANTIHISTAMINES, FIRST GENERATION|1847|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00115180302|HYDROXYZINE PAM 25 MG CAP|500|EA|.05392|05/25/2018||Yes|No||05/25/2018||Yes|No|05/25/2018||Yes|No||05/25/2018||Yes|No|||Prescription Required|No|03/29/2018|574|Yes|.05412||.05282||.0532||||ANTIHISTAMINES, FIRST GENERATION|1848|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00115180401|HYDROXYZINE PAM 50 MG CAP|100|EA|.07009|06/06/2018||Yes|No||06/06/2018||Yes|No|06/06/2018||Yes|No||06/06/2018||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.06972||.06805||.06853||||ANTIHISTAMINES, FIRST GENERATION|1849|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00115180402|HYDROXYZINE PAM 50 MG CAP|500|EA|.06659|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.06972||.06805||.06853||||ANTIHISTAMINES, FIRST GENERATION|1850|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colesevelam HCl|No|No|No|No|75%|00115186418|COLESEVELAM HCL 3.75 G PACKET|30|EA|3.225|09/18/2023||Yes|No||09/18/2023||Yes|No|09/18/2023||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|055|No|3.14812||3.07257||3.0946||||LIPOTROPICS, OTHER|1851|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
rimantadine HCl|No|No|No|No|75%|00115191101|RIMANTADINE HCL 100 MG TABLET |100|EA|.97786|12/29/2004||Yes|No||12/29/2004||Yes|No|12/29/2004||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|025|No|2.22862||2.19678||2.09217||||ANTIVIRALS, ORAL|1852|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
terbutaline sulfate|No|No|No|No|75%|00115262201|TERBUTALINE SULFATE 5 MG TAB  |100|EA|1.462|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|037|No|1.54345||1.50641||1.51721||||BRONCHODILATORS, BETA AGONIST|1853|||||No|No||AMNEAL PHARMACE|Yes|09/01/2020||||No|No|No||
chloroquine phosphate|No|No|No|No|75%|00115279006|CHLOROQUINE PH 250 MG TABLET|50|EA|1.33197|08/10/2023||Yes|No||08/10/2023||Yes|No|08/10/2023||Yes|No||||No|No|||Prescription Required|No|||No|2.12067||2.06977||2.08462|||||1854|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00115351101|PYRIDOSTIGMINE BR 60 MG TABLET|100|EA|.35088|12/21/2007||Yes|No||12/21/2007||Yes|No|12/21/2007||Yes|No||||No|No|||Prescription Required|No|||No|.18665||.18217||.18348|||||1855|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dantrolene sodium|No|No|No|No|75%|00115441101|DANTROLENE SODIUM 25 MG CAP|100|EA|.34817|05/05/2006||Yes|No||05/05/2006||Yes|No|05/05/2006||Yes|No||||No|No|||Prescription Required|Yes|02/10/2009|116|No|.35654||.34798||.35048||||SKELETAL MUSCLE RELAXANTS|1856|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dantrolene sodium|No|No|No|No|75%|00115442201|DANTROLENE SODIUM 50 MG CAP|100|EA|.5627|05/05/2006||Yes|No||05/05/2006||Yes|No|05/05/2006||Yes|No||||No|No|||Prescription Required|Yes|02/10/2009|116|No|.64224||.62683||.63132||||SKELETAL MUSCLE RELAXANTS|1857|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dantrolene sodium|No|No|No|No|75%|00115443301|DANTROLENE SODIUM 100 MG CAP|100|EA|.70563|05/05/2006||Yes|No||05/05/2006||Yes|No|05/05/2006||Yes|No||||No|No|||Prescription Required|Yes|02/10/2009|116|No|.88898||.86764||.87387||||SKELETAL MUSCLE RELAXANTS|1858|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00115521116|COLESTIPOL HCL 1 GM TABLET|120|EA|.44355|05/04/2007||Yes|No||05/04/2007||Yes|No|05/04/2007||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|055|No|.5635||.54998||.55392||||LIPOTROPICS, OTHER|1859|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115551110|FENOFIBRATE 54 MG TABLET|90|EA|.09149|09/03/2008||Yes|No||09/03/2008||Yes|No|09/03/2008||Yes|No||||No|No|||Prescription Required|No|07/23/2015|055|No|.06398||.06244||.06289||||LIPOTROPICS, OTHER|1860|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115552202|FENOFIBRATE 160 MG TABLET|500|EA|.16723|05/19/2011||Yes|No||05/19/2011||Yes|No|05/19/2011||Yes|No||||No|No|||Prescription Required|No|07/23/2015|055|No|.10985||.10721||.10798||||LIPOTROPICS, OTHER|1861|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115552210|FENOFIBRATE 160 MG TABLET|90|EA|.16722|09/03/2008||Yes|No||09/03/2008||Yes|No|09/03/2008||Yes|No||||No|No|||Prescription Required|No|07/23/2015|055|No|.10985||.10721||.10798||||LIPOTROPICS, OTHER|1862|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00115592201|PILOCARPINE HCL 5 MG TABLET|100|EA|.258|05/22/2009||Yes|No||05/22/2009||Yes|No|05/22/2009||Yes|No||||No|No|||Prescription Required|No|||No|.19978||.19499||.19638|||||1863|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
chloroquine phosphate|No|No|No|No|75%|00115701009|CHLOROQUINE PH 500 MG TABLET|25|EA|3.45582|08/10/2023||Yes|No||08/10/2023||Yes|No|08/10/2023||Yes|No||||No|No|||Prescription Required|No|||No|6.10136||5.95493||5.99764|||||1864|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fludrocortisone acetate|No|No|No|No|75%|00115703301|FLUDROCORTISONE 0.1 MG TABLET|100|EA|.25357|06/12/2002||Yes|No||06/12/2002||Yes|No|06/12/2002||Yes|No||||No|No|||Prescription Required|No|||No|.33226||.32429||.32661|||||1865|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fludrocortisone acetate|No|No|No|No|75%|00115703302|FLUDROCORTISONE 0.1 MG TABLET|500|EA|.25342|05/22/2009||Yes|No||05/22/2009||Yes|No|05/22/2009||Yes|No||||No|No|||Prescription Required|No|||No|.33226||.32429||.32661|||||1866|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methyltestosterone|No|No|No|No|90%|00115703701|METHITEST 10 MG TABLET        |100|EA|26.71968|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|60.89602||60.02608||57.1677|||||1867|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115991801|DEXMETHYLPHENIDATE ER 5 MG CAP|100|EA|.96956|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.01437||.99003||.99713||||STIMULANTS AND RELATED AGENTS|1868|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115991901|DEXMETHYLPHENIDATE ER 10 MG CP|100|EA|1.07706|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.27387||1.2433||1.25221||||STIMULANTS AND RELATED AGENTS|1869|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115992001|DEXMETHYLPHENIDATE ER 15 MG CP|100|EA|1.18456|05/25/2018||Yes|No||05/25/2018||Yes|No|05/25/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.71686||.69966||.70467||||STIMULANTS AND RELATED AGENTS|1870|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115992101|DEXMETHYLPHENIDATE ER 20 MG CP|100|EA|1.29206|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.43141||1.39706||1.40708||||STIMULANTS AND RELATED AGENTS|1871|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115992201|DEXMETHYLPHENIDATE ER 30 MG CP|100|EA|1.50706|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|1.1113||1.08463||1.09241||||STIMULANTS AND RELATED AGENTS|1872|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
levalbuterol HCl|No|No|No|No|75%|00115993078|LEVALBUTEROL 0.31 MG/3 ML SOL |3|ML|.172|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.28031||.27358||.27554||||BRONCHODILATORS, BETA AGONIST|1873|||||No|No||AMNEAL PHARMACE|No|||||Yes|No|No||
levalbuterol HCl|No|No|No|No|75%|00115993178|LEVALBUTEROL 0.63 MG/3 ML SOL|3|ML|.172|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.27613||.2695||.27144||||BRONCHODILATORS, BETA AGONIST|1874|||||No|No||AMNEAL PHARMACE|No|||||Yes|No|No||
levalbuterol HCl|No|No|No|No|75%|00115993278|LEVALBUTEROL 1.25 MG/3 ML SOL|3|ML|.172|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.28014||.27342||.27538||||BRONCHODILATORS, BETA AGONIST|1875|||||No|No||AMNEAL PHARMACE|Yes|09/01/2020||||Yes|No|No||
chlorhexidine gluconate|No|No|No|No|75%|00116200104|CHLORHEXIDINE 0.12% RINSE|118|ML|.0113|02/01/2024||Yes|No||02/01/2024||Yes|No|02/01/2024||Yes|No||||No|No|||Prescription Required|No|||No|.01592||.01554||.01565|||||1876|||||No|No||XTTRIUM LABS.|No|||||No|No|No||
chlorhexidine gluconate|No|No|No|No|75%|00116200115|CHLORHEXIDINE 0.12% RINSE|15|ML|.05016|02/01/2024||Yes|No||02/01/2024||Yes|No|02/01/2024||Yes|No||||No|No|||Prescription Required|No|||No|.11433||.11269||.10733|||||1877|||||No|No||XTTRIUM LABS.|No|||||No|No|No||
chlorhexidine gluconate|No|No|No|No|75%|00116200116|CHLORHEXIDINE 0.12% RINSE|473|ML|.00464|09/27/2007||Yes|No||09/27/2007||Yes|No|09/27/2007||Yes|No||||No|No|||Prescription Required|No|||No|.00626||.00611||.00615|||||1878|||||No|No||XTTRIUM LABS.|No|||||No|No|No||
lactulose|No|No|No|No|75%|00116400508|LACTULOSE 10 GM/15 ML SOLUTION|237|ML|.01361|03/11/2024||Yes|No||03/11/2024||Yes|No|03/11/2024||Yes|No||||No|No|||Prescription Required|No|||No|.01581||.01543||.01554|||||1879|||||No|No||XTTRIUM LABS.|No|||||No|No|No||
lactulose|No|No|No|No|75%|00116400516|LACTULOSE 10 GM/15 ML SOLUTION|473|ML|.01268|10/03/2024||Yes|No||10/03/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.02404||.02346||.02363|||||1880|||||No|No||XTTRIUM LABS.|No|||||No|No|No||
lactulose|No|No|No|No|75%|00116400532|LACTULOSE 10 GM/15 ML SOLUTION|946|ML|.01268|03/11/2024||Yes|No||03/11/2024||Yes|No|03/11/2024||Yes|No||||No|No|||Prescription Required|No|||No|.0114||.01113||.01121|||||1881|||||No|No||XTTRIUM LABS.|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00121050404|ACETAMINOP-CODEINE 120-12 MG/5|118|ML|.0102|03/01/2002|09/01/2024|Yes|No||03/01/2002|09/01/2024|Yes|No|03/01/2002|09/01/2024|Yes|No||03/01/2002|09/01/2024|Yes|No|||Prescription Required|No|11/17/2006|109|Yes|.02325||.02291||.02182||||ANALGESICS, NARCOTICS SHORT|1882|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PHARM ASSOC INC|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00121057616|METOCLOPRAMIDE 5 MG/5 ML SOLN|473|ML|.02681|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|07/27/2011|085|No|.0304||.02967||.02988||||ANTIEMETIC/ANTIVERTIGO AGENTS|1883|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
haloperidol lactate|No|No|No|No|75%|00121058104|HALOPERIDOL LAC 2 MG/ML CONC|120|ML|.0989|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.1908||.18622||.18756||||ANTIPSYCHOTICS|1884|||||No|No||PHARM ASSOC INC|Yes|09/01/2020||||No|No|No||
citric acid/sodium citrate|No|No|No|No|75%|00121059516|SOD CITRATE-CITRIC ACID SOLN|473|ML|.01272|09/07/2015||Yes|No||||No|No|09/07/2015||Yes|No||||No|No|||Over The Counter|No|||No|.02107||.02056||.02071|||||1885|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
amantadine HCl|No|No|No|No|75%|00121064616|AMANTADINE 50 MG/5 ML SOLUTION|473|ML|.02454|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|02/14/2015|015|No|.05997||.05853||.05895||||ANTIPARKINSON'S AGENTS|1886|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
fluphenazine HCl|No|No|No|No|75%|00121065304|FLUPHENAZINE 5 MG/ML CONC|120|ML|1.1243|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|2.56237||2.52576||2.40549||||ANTIPSYCHOTICS|1887|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
fluphenazine HCl|No|No|No|No|75%|00121065402|FLUPHENAZINE 2.5 MG/5 ML ELIX|60|ML|.22926|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.5225||.51503||.49051||||ANTIPSYCHOTICS|1888|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
fluphenazine HCl|No|No|No|No|75%|00121065416|FLUPHENAZINE 2.5 MG/5 ML ELIX|473|ML|.23269|08/16/2022||Yes|No||08/16/2022||Yes|No|08/16/2022||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.53032||.52274||.49785||||ANTIPSYCHOTICS|1889|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
trihexyphenidyl HCl|No|No|No|No|75%|00121065816|TRIHEXYPHENIDYL 2 MG/5 ML SOLN|473|ML|.03877|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|06/09/2004|015|No|.07174||.07002||.07052||||ANTIPARKINSON'S AGENTS|1890|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
ethosuximide|No|No|No|No|75%|00121067016|ETHOSUXIMIDE 250 MG/5 ML SOLN|473|ML|.05121|12/11/2020||Yes|No||12/11/2020||Yes|No|12/11/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.07573||.07391||.07444||||ANTICONVULSANTS|1891|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
valproic acid (as sodium salt)|No|No|No|No|75%|00121067516|VALPROIC ACID 250 MG/5 ML SOLN|473|ML|.01136|03/10/2006||Yes|No||03/10/2006||Yes|No|03/10/2006||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.03444||.03361||.03385||||ANTICONVULSANTS|1892|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
valproic acid (as sodium salt)|No|No|No|No|75%|00121067585|VALPROIC ACID 250 MG/5 ML SOLN|473|ML|.01705|04/19/2022||Yes|No||04/19/2022||Yes|No|04/19/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.03444||.03361||.03385||||ANTICONVULSANTS|1893|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
potassium citrate/citric acid|No|No|No|No|75%|00121067616|POTASSIUM CIT-CITRIC ACID SOLN|473|ML|.03236|02/11/2014||Yes|No||||No|No|02/11/2014||Yes|No||||No|No|||Over The Counter|No|||No|.05222||.05097||.05133|||||1894|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
sod/pot/K cit/sod cit/cit acid|No|No|No|No|75%|00121067716|TRICITRATES ORAL SOLUTION|473|ML|.01805|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Over The Counter|No|||No|.0323||.03152||.03175|||||1895|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
nortriptyline HCl|No|No|No|No|75%|00121067816|NORTRIPTYLINE 10 MG/5 ML SOLN|473|ML|.1726|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|.30273||.29546||.29758||||ANTIDEPRESSANTS, TRICYCLIC|1896|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
prednisolone sodium phosphate|No|No|No|No|75%|00121075908|PREDNISOLONE 15 MG/5 ML SOLN|237|ML|.09425|12/15/2006||Yes|No||12/15/2006||Yes|No|12/15/2006||Yes|No||||No|No|||Prescription Required|No|01/15/2014|168|Yes|.09721||.09488||.09556||||GLUCOCORTICOIDS, ORAL|1897|||||No|No||PHARM ASSOC INC|No|||||Yes|No|No||
calcium carbonate|No|No|No|No|75%|00121076616|CALCIUM CARB 1,250 MG/5 ML SUS|473|ML|.00886|10/10/2014||Yes|No||||No|No|10/10/2014||Yes|No||||No|No|||Over The Counter|No|||No|.0158||.01542||.01553|||||1898|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
lorazepam|No|No|No|No|90%|00121077001|LORAZEPAM 2 MG/ML ORAL CONCENT|30|ML|.21528|12/19/2022||Yes|No||12/19/2022||Yes|No|12/19/2022||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.64468||.62921||.63372||||ANXIOLYTICS|1899|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00121077216|HYDROCODONE-ACETAMN 7.5-325/15|473|ML|.0275|09/02/2014|09/07/2024|Yes|No||09/02/2014|09/07/2024|Yes|No|09/02/2014|09/07/2024|Yes|No||||No|No|||Prescription Required|No|07/24/2013|109|Yes|.06267||.06178||.05883||||ANALGESICS, NARCOTICS SHORT|1900|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARM ASSOC INC|No|||||No|No|No||
prednisolone sodium phosphate|No|No|No|No|75%|00121077308|PREDNISOLONE 10 MG/5 ML SOLN  |237|ML|1.07019|10/03/2017||Yes|No||10/03/2017||Yes|No|10/03/2017||Yes|No||||No|No|||Prescription Required|Yes|01/26/2017|168|Yes|2.03006||1.98134||1.99555||||GLUCOCORTICOIDS, ORAL|1901|||||No|No||PHARM ASSOC INC|No|||||Yes|No|No||
codeine phosphate/guaifenesin|No|No|No|No|90%|00121077504|GUAIFEN-CODEINE 100-10 MG/5 ML|118|ML|.02365|11/06/2006||Yes|No||04/15/2011||Yes|No|11/06/2006||Yes|No||||No|No|||Over The Counter|No|07/22/2009|183|Yes|.04445||.04338||.04369||||COUGH AND COLD, NARCOTIC|1902|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
codeine phosphate/guaifenesin|No|No|No|No|90%|00121077516|GUAIFEN-CODEINE 100-10 MG/5 ML|473|ML|.01419|11/06/2006||Yes|No||04/15/2011||Yes|No|11/06/2006||Yes|No||||No|No|||Over The Counter|No|07/22/2009|183|Yes|.03128||.03053||.03075||||COUGH AND COLD, NARCOTIC|1903|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
prednisolone sodium phosphate|No|No|No|No|75%|00121077708|PREDNISOLONE 20 MG/5 ML SOLN  |237|ML|1.52076|10/03/2017||Yes|No||10/03/2017||Yes|No|10/03/2017||Yes|No||||No|No|||Prescription Required|Yes|01/26/2017|168|Yes|2.44955||2.39076||2.40791||||GLUCOCORTICOIDS, ORAL|1904|||||No|No||PHARM ASSOC INC|No|||||Yes|No|No||
morphine sulfate|No|No|No|No|90%|00121082508|MORPHINE SULF 100 MG/5 ML CONC|240|ML|.17585|09/14/2022|01/30/2025|Yes|No||09/14/2022|01/30/2025|Yes|No|09/14/2022|01/30/2025|Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|109|Yes|.40077||.39505||.37623||||ANALGESICS, NARCOTICS SHORT|1905|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARM ASSOC INC|No|||||No|No|No||
sulfamethoxazole/trimethoprim|No|No|No|No|75%|00121085416|SULFATRIM PEDIATRIC SUSPENSION|473|ML|.03422|12/04/2018||Yes|No||12/04/2018||Yes|No|12/04/2018||Yes|No||||No|No|||Prescription Required|No|||No|.||.||.|||||1906|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
nystatin|No|No|No|No|75%|00121086802|NYSTATIN 100,000 UNIT/ML SUSP|60|ML|.09453|02/04/2021||Yes|No||02/04/2021||Yes|No|02/04/2021||Yes|No||||No|No|||Prescription Required|No|01/30/2020|069|No|.13618||.13291||.13386||||ANTIFUNGALS, ORAL|1907|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
nystatin|No|No|No|No|75%|00121086816|NYSTATIN 100,000 UNIT/ML SUSP|473|ML|.03173|02/04/2021||Yes|No||02/04/2021||Yes|No|02/04/2021||Yes|No||||No|No|||Prescription Required|No|01/30/2020|069|No|.05126||.05003||.05039||||ANTIFUNGALS, ORAL|1908|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
lactulose|No|No|No|No|75%|00121087316|LACTULOSE 10 GM/15 ML SOLUTION|473|ML|.01268|06/01/2020||Yes|No||06/01/2020||Yes|No|06/01/2020||Yes|No||||No|No|||Prescription Required|No|||No|.02404||.02346||.02363|||||1909|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
lactulose|No|No|No|No|75%|00121087332|LACTULOSE 10 GM/15 ML SOLUTION|946|ML|.01268|06/01/2020||Yes|No||06/01/2020||Yes|No|06/01/2020||Yes|No||||No|No|||Prescription Required|No|||No|.0114||.01113||.01121|||||1910|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
cetirizine HCl|No|No|No|No|75%|00121087416|CETIRIZINE HCL 1 MG/ML SOLN|480|ML|.07122|10/07/2024||Yes|No||||No|No|||No|No||||No|No|||Prescription Required|No|01/25/2024|030|Yes|.13172||.12856||.12948||||ANTIHISTAMINES, MINIMALLY SEDATING|1911|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
prednisolone|No|No|No|No|75%|00121088508|PREDNISOLONE 15 MG/5 ML SOLN|240|ML|.31354|10/07/2024||Yes|No||10/07/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|01/26/2023|168|Yes|.57276||.55901||.56302||||GLUCOCORTICOIDS, ORAL|1912|||||No|No||PHARM ASSOC INC|No|||||Yes|No|No||
prednisolone|No|No|No|No|75%|00121088516|PREDNISOLONE 15 MG/5 ML SOLN|480|ML|.29786|10/04/2024||Yes|No||10/04/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|01/26/2023|168|Yes|.58586||.5718||.5759||||GLUCOCORTICOIDS, ORAL|1913|||||No|No||PHARM ASSOC INC|No|||||Yes|No|No||
chlorhexidine gluconate|No|No|No|No|75%|00121089316|CHLORHEXIDINE 0.12% RINSE|473|ML|.00464|04/15/2021|12/15/2024|Yes|No||04/15/2021|12/15/2024|Yes|No|04/15/2021|12/15/2024|Yes|No||||No|No|||Prescription Required|No|||No|.00626||.00611||.00615|||||1914|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARM ASSOC INC|No|||||No|No|No||
brompheniramine/pseudoephed/DM|No|No|No|No|75%|00121093304|BROMPHEN-PSE-DM 2-30-10 MG/5ML|118|ML|.03626|11/15/2022||Yes|No||11/15/2022||Yes|No|11/15/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|184|Yes|.09737||.09503||.09571||||COUGH AND COLD, NON-NARCOTIC|1915|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
brompheniramine/pseudoephed/DM|No|No|No|No|75%|00121093316|BROMPHEN-PSE-DM 2-30-10 MG/5ML|473|ML|.01813|09/25/2024||Yes|No||09/25/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|07/29/2021|184|Yes|.10527||.10274||.10348||||COUGH AND COLD, NON-NARCOTIC|1916|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
phenobarbital|No|No|No|No|75%|00121094216|PHENOBARBITAL 20 MG/5 ML SOLN|473|ML|.03251|04/19/2022||Yes|No||04/19/2022||Yes|No|04/19/2022||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.04239||.04137||.04167||||ANTICONVULSANTS|1917|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
lidocaine HCl|No|No|No|No|75%|00121095003|LIDOCAINE 2% VISCOUS SOLN|100|ML|.1961|10/07/2024||Yes|No||10/07/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.0848||.08276||.08336|||||1918|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00121101830|BUPRENORPHINE-NALOX 2-0.5MG TB|30|EA|.39775|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription Required|No|01/27/2022|145|Yes|.37404||.36506||.36768||||OPIATE DEPENDENCE TREATMENTS|1919|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
buprenorphine HCl|No|No|No|No|90%|00121101930|BUPRENORPHINE 2 MG TABLET SL|30|EA|.5805|06/26/2024||Yes|No||06/26/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|01/27/2022|145|Yes|.27394||.26737||.26928||||OPIATE DEPENDENCE TREATMENTS|1920|||||No|No||PHARM ASSOC INC|Yes|06/26/2024||||No|No|No||
nystatin|No|No|No|No|75%|00121104516|NYSTATIN 100,000 UNIT/ML SUSP|473|ML|.14549|10/15/2024||Yes|No||10/15/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|06/20/2024|069|No|.05126||.05003||.05039||||ANTIFUNGALS, ORAL|1921|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00121203630|BUPRENORPHINE-NALOX 8-2 MG TAB|30|EA|.57333|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription Required|No|01/27/2022|145|Yes|.64498||.6295||.63402||||OPIATE DEPENDENCE TREATMENTS|1922|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
buprenorphine HCl|No|No|No|No|90%|00121203830|BUPRENORPHINE 8 MG TABLET SL|30|EA|.774|06/26/2024||Yes|No||06/26/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|01/27/2022|145|Yes|.6003||.58589||.59009||||OPIATE DEPENDENCE TREATMENTS|1923|||||No|No||PHARM ASSOC INC|Yes|06/26/2024||||No|No|No||
lacosamide|No|No|No|No|75%|00131247735|VIMPAT 50 MG TABLET|60|EA|5.06433|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|11.28733||11.01643||11.09545||||ANTICONVULSANTS|1924|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247760|VIMPAT 50 MG TABLET|60|EA|5.57136|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|11.28733||11.01643||11.09545||||ANTICONVULSANTS|1925|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247835|VIMPAT 100 MG TABLET|60|EA|7.91759|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|17.62853||17.20545||17.32884||||ANTICONVULSANTS|1926|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247860|VIMPAT 100 MG TABLET|60|EA|8.71008|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|17.62853||17.20545||17.32884||||ANTICONVULSANTS|1927|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247935|VIMPAT 150 MG TABLET|60|EA|8.38536|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|18.70662||18.25766||18.38861||||ANTICONVULSANTS|1928|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247960|VIMPAT 150 MG TABLET|60|EA|9.22443|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|18.70662||18.25766||18.38861||||ANTICONVULSANTS|1929|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131248035|VIMPAT 200 MG TABLET|60|EA|8.38772|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|18.68606||18.23759||18.3684||||ANTICONVULSANTS|1930|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131248060|VIMPAT 200 MG TABLET|60|EA|9.22737|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|18.68606||18.23759||18.3684||||ANTICONVULSANTS|1931|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131541072|VIMPAT 10 MG/ML SOLUTION|200|ML|.98268|09/16/2020||Yes|No||09/16/2020||Yes|No|09/16/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|2.18845||2.13593||2.15125||||ANTICONVULSANTS|1932|||||No|No||UCB PHARMA|No|||||No|No|No||
sodium phosphate,mono-dibasic|No|No|No|No|75%|00132020220|FLEET PEDIA-LAX ENEMA|66|ML|.00892|09/07/2015||Yes|No||||No|No|09/07/2015||Yes|No||||No|No|||Over The Counter|No|||No|.02006||.01958||.01972|||||1933|||||No|No||FLEET,C.B. CO.|No|||||No|Yes|No||
captopril|Yes|No|No|No|75%|00143117101|CAPTOPRIL 12.5 MG TABLET|100|EA|.4355|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|07/01/2016||Prescription Required|Yes|07/26/2018|113|No|.39621||.3867||.38947||||ANGIOTENSIN MODULATORS|1934|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117110|CAPTOPRIL 12.5 MG TABLET|1000|EA|.43554|10/29/2003||Yes|No||10/29/2003||Yes|No|10/29/2003||Yes|No||10/29/2003||Yes|No|07/01/2016||Prescription Required|Yes|07/26/2018|113|No|.39621||.3867||.38947||||ANGIOTENSIN MODULATORS|1935|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117201|CAPTOPRIL 25 MG TABLET|100|EA|.46664|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|07/01/2016||Prescription Required|Yes|07/26/2018|113|No|.25356||.24747||.24925||||ANGIOTENSIN MODULATORS|1936|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117210|CAPTOPRIL 25 MG TABLET|1000|EA|.4666|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|07/01/2016||Prescription Required|Yes|07/26/2018|113|No|.25356||.24747||.24925||||ANGIOTENSIN MODULATORS|1937|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117301|CAPTOPRIL 50 MG TABLET|100|EA|.81021|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|07/01/2016||Prescription Required|Yes|07/26/2018|113|No|.34948||.34109||.34354||||ANGIOTENSIN MODULATORS|1938|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117310|CAPTOPRIL 50 MG TABLET|1000|EA|.81019|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|07/01/2016||Prescription Required|Yes|07/26/2018|113|No|.34948||.34109||.34354||||ANGIOTENSIN MODULATORS|1939|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117401|CAPTOPRIL 100 MG TABLET|100|EA|1.06386|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|07/01/2016||Prescription Required|Yes|07/26/2018|113|No|.86072||.84006||.84609||||ANGIOTENSIN MODULATORS|1940|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143122701|DICYCLOMINE 20 MG TABLET|100|EA|.11933|11/28/2015||Yes|No||11/28/2015||Yes|No|11/28/2015||Yes|No||||No|No|||Prescription Required|No|||No|.08225||.08028||.08085|||||1941|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143122710|DICYCLOMINE 20 MG TABLET|1000|EA|.10965|11/28/2015||Yes|No||11/28/2015||Yes|No|11/28/2015||Yes|No||||No|No|||Prescription Required|No|||No|.08225||.08028||.08085|||||1942|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
digoxin|No|No|No|No|75%|00143124001|DIGOXIN 125 MCG TABLET|100|EA|.129|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription Required|No|||No|.14686||.14334||.14436|||||1943|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
digoxin|No|No|No|No|75%|00143124010|DIGOXIN 125 MCG TABLET|1000|EA|.129|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription Required|No|||No|.14686||.14334||.14436|||||1944|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
digoxin|No|No|No|No|75%|00143124101|DIGOXIN 250 MCG TABLET|100|EA|.129|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription Required|No|||No|.12341||.12045||.12131|||||1945|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
digoxin|No|No|No|No|75%|00143124110|DIGOXIN 250 MCG TABLET|1000|EA|.129|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription Required|No|||No|.12341||.12045||.12131|||||1946|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||No|No|No||
phenobarbital|No|No|No|No|75%|00143144510|PHENOBARBITAL 15 MG TABLET|1000|EA|.02061|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||09/07/2015||Yes|No|||Prescription Required|No|||No|.04696||.04629||.04409|||||1947|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143145501|PHENOBARBITAL 60 MG TABLET|100|EA|.1892|02/15/2022||Yes|No||02/15/2022||Yes|No|02/15/2022||Yes|No||02/15/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.12825||.12517||.12607||||ANTICONVULSANTS|1948|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143145505|PHENOBARBITAL 60 MG TABLET|500|EA|.0946|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||09/07/2015||Yes|No|||Prescription Required|No|01/28/2021|056|No|.12825||.12517||.12607||||ANTICONVULSANTS|1949|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143145510|PHENOBARBITAL 60 MG TABLET|1000|EA|.03219|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||09/07/2015||Yes|No|||Prescription Required|No|||No|.07337||.07232||.06888|||||1950|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143145801|PHENOBARBITAL 100 MG TABLET|100|EA|.2666|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||09/07/2015||Yes|No|||Prescription Required|No|01/28/2021|056|No|.18324||.17884||.18012||||ANTICONVULSANTS|1951|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143145805|PHENOBARBITAL 100 MG TABLET|500|EA|.1333|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||09/07/2015||Yes|No|||Prescription Required|No|01/28/2021|056|No|.18324||.17884||.18012||||ANTICONVULSANTS|1952|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143145810|PHENOBARBITAL 100 MG TABLET|1000|EA|.04507|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||09/07/2015||Yes|No|||Prescription Required|No|||No|.10272||.10126||.09643|||||1953|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143149501|PHENOBARBITAL 15 MG TABLET|100|EA|.1204|02/15/2022||Yes|No||02/15/2022||Yes|No|02/15/2022||Yes|No||02/15/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.09355||.0913||.09196||||ANTICONVULSANTS|1954|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143149505|PHENOBARBITAL 15 MG TABLET|500|EA|.0602|02/15/2022||Yes|No||02/15/2022||Yes|No|02/15/2022||Yes|No||02/15/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.09355||.0913||.09196||||ANTICONVULSANTS|1955|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143150001|PHENOBARBITAL 30 MG TABLET|100|EA|.15136|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||10/01/2020||Yes|No|||Prescription Required|No|01/28/2021|056|No|.09134||.08915||.08979||||ANTICONVULSANTS|1956|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
phenobarbital|No|No|No|No|75%|00143150005|PHENOBARBITAL 30 MG TABLET|500|EA|.07568|02/15/2022||Yes|No||02/15/2022||Yes|No|02/15/2022||Yes|No||02/15/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.09134||.08915||.08979||||ANTICONVULSANTS|1957|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
isosorbide dinitrate|No|No|No|No|75%|00143176901|ISOSORBIDE DINITRATE 5 MG TAB|100|EA|.22588|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.18259||.17821||.17949|||||1958|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
isosorbide dinitrate|No|No|No|No|75%|00143177101|ISOSORBIDE DINITRATE 10 MG TAB|100|EA|.2485|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.20286||.19799||.19941|||||1959|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
isosorbide dinitrate|No|No|No|No|75%|00143177201|ISOSORBIDE DINITRATE 20 MG TAB|100|EA|.27335|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.21543||.21026||.21177|||||1960|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
doxycycline hyclate|Yes|No|No|No|75%|00143211205|DOXYCYCLINE HYCLATE 100 MG TAB|500|EA|.1204|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|11/01/2012||Prescription Required|Yes|01/22/2015|213|No|.09502||.09274||.0934||||TETRACYCLINES|1961|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
doxycycline hyclate|Yes|No|No|No|75%|00143211250|DOXYCYCLINE HYCLATE 100 MG TAB|50|EA|.1204|09/08/2003||Yes|No||09/08/2003||Yes|No|09/08/2003||Yes|No||09/08/2003||Yes|No|11/01/2012||Prescription Required|Yes|01/22/2015|213|No|.09502||.09274||.0934||||TETRACYCLINES|1962|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301801|COLCHICINE 0.6 MG CAPSULE|100|EA|2.57888|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||05/12/2015||Yes|No|||Prescription Required|Yes|01/22/2015|231|No|1.73034||1.68881||1.70092||||ANTIHYPERURICEMICS|1963|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301810|COLCHICINE 0.6 MG CAPSULE|1000|EA|2.57889|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||05/12/2015||Yes|No|||Prescription Required|Yes|01/22/2015|231|No|1.73034||1.68881||1.70092||||ANTIHYPERURICEMICS|1964|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301830|COLCHICINE 0.6 MG CAPSULE|30|EA|2.57885|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription Required|Yes|07/26/2018|231|No|1.73034||1.68881||1.70092||||ANTIHYPERURICEMICS|1965|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143312601|DICYCLOMINE 10 MG CAPSULE|100|EA|.08579|09/09/2016|02/28/2025|Yes|No||09/09/2016|02/28/2025|Yes|No|09/09/2016|02/28/2025|Yes|No||||No|No|||Prescription Required|No|||No|.07257||.07083||.07134|||||1966|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143312610|DICYCLOMINE 10 MG CAPSULE|1000|EA|.07934|09/09/2016|01/31/2025|Yes|No||09/09/2016|01/31/2025|Yes|No|09/09/2016|01/31/2025|Yes|No||||No|No|||Prescription Required|No|||No|.07257||.07083||.07134|||||1967|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
doxycycline hyclate|Yes|No|No|No|75%|00143314250|DOXYCYCLINE HYCLATE 100 MG CAP|50|EA|.516|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|11/01/2012||Prescription Required|No|01/28/2021|213|No|.08932||.08718||.0878||||TETRACYCLINES|1968|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
gentamicin sulfate|No|No|No|No|75%|00143912825|GENTAMICIN 80 MG/2 ML VIAL|2|ML|.7611|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|||No|1.50596||1.46982||1.48036|||||1969|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
mitomycin|No|No|No|No|75%|00143913501|MITOMYCIN 20 MG VIAL|1|EA|47.3|10/26/2023||Yes|No||10/26/2023||Yes|No|10/26/2023||Yes|No||||No|No|||Prescription Required|No|||No|107.8||106.26||101.2|||||1970|||||No|No||WEST-WARD/HI-NO|No|||||No|No|No||
cefazolin sodium|No|No|No|No|75%|00143913925|CEFAZOLIN 2 GM VIAL|1|EA|2.5155|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|||No|5.733||5.6511||5.382|||||1971|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
vancomycin HCl|No|No|No|No|75%|00143915210|VANCOMYCIN HCL 1.25 GRAM VIAL|1|EA|8.643|02/13/2024||Yes|No||02/13/2024||Yes|No|02/13/2024||Yes|No||||No|No|||Prescription Required|No|||No|19.698||19.4166||18.492|||||1972|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143924920|AMOX-CLAV 875-125 MG TABLET|20|EA|.5074|04/24/2020||Yes|No||04/24/2020||Yes|No|04/24/2020||Yes|No||04/24/2020||Yes|No|||Prescription Required|No|01/26/2017|046|No|.26312||.25681||.25865||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1973|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dihydroergotamine mesylate|No|No|No|No|75%|00143927301|DIHYDROERGOTAMINE 1 MG/ML AMP|1|ML||08/16/2022||Yes|No||08/16/2022||Yes|No|08/16/2022||Yes|No||||No|No|||Prescription Required|Yes|12/07/2017|537|Yes|152.49||152.49||152.49||152.49|08/16/2022|ANTIMIGRAINE AGENTS, OTHER|1974|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dihydroergotamine mesylate|No|No|No|No|75%|00143927310|DIHYDROERGOTAMINE 1 MG/ML AMP|1|ML|64.285|08/16/2022||Yes|No||08/16/2022||Yes|No|08/16/2022||Yes|No||||No|No|||Prescription Required|Yes|12/07/2017|537|Yes|68.0082||66.376||66.85206||||ANTIMIGRAINE AGENTS, OTHER|1975|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143928501|AMOXICILLIN 875 MG TABLET|100|EA|.18748|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||12/03/2018||Yes|No|||Prescription Required|No|03/09/2018|209|No|.12982||.1267||.12761||||PENICILLINS|1976|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143928520|AMOXICILLIN 875 MG TABLET|20|EA|.20425|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||12/03/2018||Yes|No|||Prescription Required|No|03/09/2018|209|No|.12982||.1267||.12761||||PENICILLINS|1977|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
estradiol valerate|No|No|No|No|75%|00143928901|ESTRADIOL VALERATE 50 MG/5 ML|5|ML|10.26152|10/26/2023||Yes|No||10/26/2023||Yes|No|10/26/2023||Yes|No||||No|No|||Prescription Required|No|||Yes|16.81367||16.41014||16.52784|||||1978|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
linezolid in dextrose 5%|No|No|No|No|75%|00143953410|LINEZOLID 600 MG/300 ML-D5W|300|ML|.02006|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|146|No|.04573||.04507||.04293||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|1979|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
abiraterone acetate|No|No|No|No|75%|00143959721|ABIRATERONE ACETATE 250 MG TAB|120|EA|2.15|03/04/2019||Yes|No||03/04/2019||Yes|No|03/04/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|550|No|1.08623||1.06016||1.06776||||ONCOLOGY, ORAL - PROSTATE|1980|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cyanocobalamin (vitamin B-12)|No|No|No|No|75%|00143961901|CYANOCOBALAMIN 30,000 MCG/30ML|30|ML|1.51833|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||No|.72692||.70947||.71456|||||1981|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
cyanocobalamin (vitamin B-12)|No|No|No|No|75%|00143961910|CYANOCOBALAMIN 30,000 MCG/30ML|30|ML|1.51833|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||No|3.46038||3.41095||3.24852|||||1982|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
cyanocobalamin (vitamin B-12)|No|No|No|No|75%|00143962001|CYANOCOBALAMIN 10,000 MCG/10ML|10|ML||08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||No|3.20115||3.12432||3.14673|||||1983|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
cyanocobalamin (vitamin B-12)|No|No|No|No|75%|00143962010|CYANOCOBALAMIN 10,000 MCG/10ML|10|ML|1.8518|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||No|.97219||.94886||.95566|||||1984|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
cyanocobalamin (vitamin B-12)|No|No|No|No|75%|00143962101|CYANOCOBALAMIN 1,000 MCG/ML VL|1|ML||08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||No|7.0584||7.0584||7.0584||7.0584|08/11/2022||1985|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
cyanocobalamin (vitamin B-12)|No|No|No|No|75%|00143962125|CYANOCOBALAMIN 1,000 MCG/ML VL|1|ML|2.9756|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||No|1.54621||1.5091||1.51992|||||1986|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
testosterone cypionate|No|No|No|No|90%|00143965901|TESTOSTERONE CYP 200 MG/ML|1|ML|7.74|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||Yes|10.77328||10.51472||10.59013|||||1987|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
glycopyrrolate|No|No|No|No|75%|00143967910|GLYCOPYRROLATE 4 MG/20 ML VIAL|20|ML|.86|05/23/2014||Yes|No||05/23/2014||Yes|No|05/23/2014||Yes|No||||No|No|||Prescription Required|No|||No|1.96||1.932||1.84|||||1988|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
glycopyrrolate|No|No|No|No|75%|00143968025|GLYCOPYRROLATE 1 MG/5 ML VIAL|5|ML|.86|05/23/2014||Yes|No||05/23/2014||Yes|No|05/23/2014||Yes|No||||No|No|||Prescription Required|No|||No|1.96||1.932||1.84|||||1989|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
glycopyrrolate|No|No|No|No|75%|00143968125|GLYCOPYRROLATE 0.4 MG/2 ML VL|2|ML|1.118|05/23/2014||Yes|No||05/23/2014||Yes|No|05/23/2014||Yes|No||||No|No|||Prescription Required|No|||No|2.548||2.5116||2.392|||||1990|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
glycopyrrolate|No|No|No|No|75%|00143968225|GLYCOPYRROLATE 0.2 MG/ML VIAL|1|ML|1.118|05/23/2014||Yes|No||05/23/2014||Yes|No|05/23/2014||Yes|No||||No|No|||Prescription Required|No|||No|2.548||2.5116||2.392|||||1991|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
milrinone lactate|No|No|No|No|75%|00143970801|MILRINONE LACT 50 MG/50 ML VL|50|ML|.344|07/24/2012||Yes|No||07/24/2012||Yes|No|07/24/2012||Yes|No||||No|No|||Prescription Required|No|||No|.784||.7728||.736|||||1992|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
milrinone lactate|No|No|No|No|75%|00143970910|MILRINONE LACT 20 MG/20 ML VL|20|ML|.19737|08/06/2012||Yes|No||08/06/2012||Yes|No|08/06/2012||Yes|No||||No|No|||Prescription Required|No|||No|.44982||.44339||.42228|||||1993|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
milrinone lactate|No|No|No|No|75%|00143971010|MILRINONE LACT 10 MG/10 ML VL|10|ML|.26875|08/03/2012||Yes|No||08/03/2012||Yes|No|08/03/2012||Yes|No||||No|No|||Prescription Required|No|||No|.6125||.60375||.575|||||1994|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
milrinone lactate/D5W|No|No|No|No|75%|00143971810|MILRINONE-D5W 40 MG/200 ML|200|ML|.06859|08/06/2012||Yes|No||08/06/2012||Yes|No|08/06/2012||Yes|No||||No|No|||Prescription Required|No|||No|.15631||.15408||.14674|||||1995|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
milrinone lactate/D5W|No|No|No|No|75%|00143971910|MILRINONE-D5W 20 MG/100 ML|100|ML|.06536|08/06/2012||Yes|No||08/06/2012||Yes|No|08/06/2012||Yes|No||||No|No|||Prescription Required|No|||No|.14896||.14683||.13984|||||1996|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
levofloxacin in dextrose 5 %|No|No|No|No|75%|00143972001|LEVOFLOXACIN 750 MG/150 ML-D5W|150|ML|.03761|03/14/2012||Yes|No||03/14/2012||Yes|No|03/14/2012||Yes|No||||No|No|||Prescription Required|No|||No|.08571||.08449||.08046||.04244|06/01/2016||1997|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
levofloxacin in dextrose 5 %|No|No|No|No|75%|00143972101|LEVOFLOXACIN 500 MG/100 ML-D5W|100|ML|.05925|03/14/2012||Yes|No||03/14/2012||Yes|No|03/14/2012||Yes|No||||No|No|||Prescription Required|No|||No|.13504||.13311||.12678||.06239|06/01/2016||1998|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
levofloxacin in dextrose 5 %|No|No|No|No|75%|00143972201|LEVOFLOXACIN 250 MG/50 ML-D5W |50|ML|.06209|03/14/2012||Yes|No||03/14/2012||Yes|No|03/14/2012||Yes|No||||No|No|||Prescription Required|No|||No|.14151||.13949||.13285||.1224|06/01/2016||1999|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
progesterone|No|No|No|No|75%|00143972501|PROGESTERONE 500 MG/10 ML VIAL|10|ML|1.46329|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|||No|2.10048||2.05007||2.06477|||||2000|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00143972601|TESTOSTERONE CYP 2,000 MG/10ML|10|ML|3.397|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||Yes|3.40055||3.31894||3.34274|||||2001|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
benztropine mesylate|No|No|No|No|75%|00143972905|BENZTROPINE 2 MG/2 ML AMPULE|2|ML|12.9|11/15/2009||Yes|No||11/15/2009||Yes|No|11/15/2009||Yes|No||||No|No|||Prescription Required|No|||No|29.4||28.98||27.6|||||2002|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
testosterone enanthate|No|No|No|No|90%|00143975001|TESTOSTERON ENAN 1,000 MG/5 ML|5|ML|7.05888|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|||Yes|11.98079||11.69325||11.77712|||||2003|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methylprednisolone sod succ|No|No|No|No|75%|00143975325|METHYLPREDNISOLONE SS 40 MG VL|1|EA|1.7544|11/27/2023||Yes|No||11/27/2023||Yes|No|11/27/2023||Yes|No||||No|No|||Prescription Required|No|||No|3.9984||3.94128||3.7536|||||2004|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
methylprednisolone sod succ|No|No|No|No|75%|00143975425|METHYLPREDNISOLONE SS 125 MG|1|EA|2.7778|11/27/2023||Yes|No||11/27/2023||Yes|No|11/27/2023||Yes|No||||No|No|||Prescription Required|No|||No|6.3308||6.24036||5.9432|||||2005|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
valproic acid (as sodium salt)|No|No|No|No|75%|00143978510|VALPROATE SOD 500 MG/5 ML VL|5|ML|1.48668|09/18/2020||Yes|No||09/18/2020||Yes|No|09/18/2020||Yes|No||||No|No|||Prescription Required|No|||No|3.38825||3.33985||3.18081|||||2006|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
doxycycline hyclate|No|No|No|No|75%|00143980250|DOXYCYCLINE HYCLATE 50 MG CAP|50|EA|.1204|04/01/2021||Yes|No||04/01/2021||Yes|No|04/01/2021||Yes|No||04/01/2021||Yes|No|||Prescription Required|No|01/28/2021|213|No|.11191||.10922||.11001||||TETRACYCLINES|2007|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
doxycycline hyclate|Yes|No|No|No|75%|00143980305|DOXYCYCLINE HYCLATE 100 MG CAP|500|EA|.1204|06/25/2020||Yes|No||06/25/2020||Yes|No|06/25/2020||Yes|No||06/25/2020||Yes|No|09/21/2020||Prescription Required|No|01/28/2021|213|No|.08932||.08718||.0878||||TETRACYCLINES|2008|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
doxycycline hyclate|Yes|No|No|No|75%|00143980350|DOXYCYCLINE HYCLATE 100 MG CAP|50|EA|.1204|06/25/2020||Yes|No||06/25/2020||Yes|No|06/25/2020||Yes|No||06/25/2020||Yes|No|09/21/2020||Prescription Required|No|01/28/2021|213|No|.08932||.08718||.0878||||TETRACYCLINES|2009|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00143983601|PENICILLIN VK 500 MG TABLET|100|EA|.08587|04/20/2020||Yes|No||04/20/2020||Yes|No|04/20/2020||Yes|No||04/20/2020||Yes|No|||Prescription Required|No|01/26/2017|209|No|.06968||.06801||.0685||||PENICILLINS|2010|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00143983610|PENICILLIN VK 500 MG TABLET|1000|EA|.04762|04/20/2020||Yes|No||04/20/2020||Yes|No|04/20/2020||Yes|No||04/20/2020||Yes|No|||Prescription Required|No|01/26/2017|209|No|.06968||.06801||.0685||||PENICILLINS|2011|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00143983701|PENICILLIN VK 250 MG TABLET|100|EA|.03483|04/20/2020||Yes|No||04/20/2020||Yes|No|04/20/2020||Yes|No||04/20/2020||Yes|No|||Prescription Required|No|01/26/2017|209|No|.05543||.0541||.05449||||PENICILLINS|2012|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00143983710|PENICILLIN VK 250 MG TABLET|1000|EA|.03483|04/20/2020||Yes|No||04/20/2020||Yes|No|04/20/2020||Yes|No||04/20/2020||Yes|No|||Prescription Required|No|01/26/2017|209|No|.05543||.0541||.05449||||PENICILLINS|2013|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143985316|AMOX-CLAV 600-42.9 MG/5 ML SUS|125|ML|.0602|04/01/2008||Yes|No||04/01/2008||Yes|No|04/01/2008||Yes|No||04/01/2008||Yes|No|||Prescription Required|No|01/23/2008|046|No|.05213||.05088||.05124||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2014|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143985324|AMOX-CLAV 600-42.9 MG/5 ML SUS|200|ML|.086|02/21/2020||Yes|No||02/21/2020||Yes|No|02/21/2020||Yes|No||02/21/2020||Yes|No|||Prescription Required|No|07/27/2011|046|No|.04711||.04598||.04631||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2015|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143985375|AMOX-CLAV 600-42.9 MG/5 ML SUS|75|ML|.0817|04/01/2008||Yes|No||04/01/2008||Yes|No|04/01/2008||Yes|No||04/01/2008||Yes|No|||Prescription Required|No|01/23/2008|046|No|.07242||.07068||.07119||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2016|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988601|AMOXICILLIN 200 MG/5 ML SUSP|100|ML|.02619|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04158||.04058||.04087||||PENICILLINS|2017|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988650|AMOXICILLIN 200 MG/5 ML SUSP|50|ML|.02632|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04322||.04218||.04249||||PENICILLINS|2018|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988675|AMOXICILLIN 200 MG/5 ML SUSP|75|ML|.02614|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.03851||.03759||.03786||||PENICILLINS|2019|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988701|AMOXICILLIN 400 MG/5 ML SUSP|100|ML|.02812|05/06/2009||Yes|No||05/06/2009||Yes|No|05/06/2009||Yes|No||05/06/2009||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02801||.02734||.02753||||PENICILLINS|2020|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988750|AMOXICILLIN 400 MG/5 ML SUSP|50|ML|.02812|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.04008||.03912||.0394||||PENICILLINS|2021|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988775|AMOXICILLIN 400 MG/5 ML SUSP|75|ML|.02804|10/27/2009||Yes|No||10/27/2009||Yes|No|10/27/2009||Yes|No||10/27/2009||Yes|No|||Prescription Required|No|01/25/2012|209|No|.03455||.03372||.03396||||PENICILLINS|2022|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988801|AMOXICILLIN 125 MG/5 ML SUSP|100|ML|.01011|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02117||.02066||.02081||||PENICILLINS|2023|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988815|AMOXICILLIN 125 MG/5 ML SUSP|150|ML|.00874|01/13/2012||Yes|No||01/13/2012||Yes|No|01/13/2012||Yes|No||01/13/2012||Yes|No|||Prescription Required|No|01/25/2012|209|No|.01746||.01704||.01716||||PENICILLINS|2024|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988880|AMOXICILLIN 125 MG/5 ML SUSP|80|ML|.01021|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02175||.02123||.02138||||PENICILLINS|2025|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988901|AMOXICILLIN 250 MG/5 ML SUSP|100|ML|.01269|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02078||.02028||.02043||||PENICILLINS|2026|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988915|AMOXICILLIN 250 MG/5 ML SUSP|150|ML|.01333|10/06/2009||Yes|No||10/06/2009||Yes|No|10/06/2009||Yes|No||10/06/2009||Yes|No|||Prescription Required|No|01/25/2012|209|No|.01892||.01847||.0186||||PENICILLINS|2027|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988980|AMOXICILLIN 250 MG/5 ML SUSP|80|ML|.01398|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription Required|No|01/25/2012|209|No|.02416||.02358||.02375||||PENICILLINS|2028|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefazolin sodium|No|No|No|No|75%|00143992390|CEFAZOLIN 500 MG VIAL|1|EA|.86086|08/20/2007||Yes|No||08/20/2007||Yes|No|08/20/2007||Yes|No||||No|No|||Prescription Required|No|||No|1.96196||1.93393||1.84184|||||2029|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefazolin sodium|No|No|No|No|75%|00143992490|CEFAZOLIN 1 GM VIAL|1|EA|.58807|08/20/2007||Yes|No||08/20/2007||Yes|No|08/20/2007||Yes|No||||No|No|||Prescription Required|No|||No|1.00185||.97781||.98482|||||2030|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
ciprofloxacin HCl|Yes|No|No|No|75%|00143992701|CIPROFLOXACIN HCL 250 MG TAB|100|EA|.06235|07/27/2004||Yes|No||07/27/2004||Yes|No|07/27/2004||Yes|No||07/27/2004||Yes|No|07/01/2016||Prescription Required|No|01/10/2005|028|No|.08113||.07918||.07975||||FLUOROQUINOLONES, ORAL|2031|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
ciprofloxacin HCl|No|No|No|No|75%|00143992801|CIPROFLOXACIN HCL 500 MG TAB|100|EA|.0903|07/27/2004||Yes|No||07/27/2004||Yes|No|07/27/2004||Yes|No||07/27/2004||Yes|No|||Prescription Required|No|01/10/2005|028|No|.10843||.10583||.10659||||FLUOROQUINOLONES, ORAL|2032|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
ciprofloxacin HCl|No|No|No|No|75%|00143992950|CIPROFLOXACIN HCL 750 MG TAB|50|EA|.1376|07/27/2004||Yes|No||07/27/2004||Yes|No|07/27/2004||Yes|No||07/27/2004||Yes|No|||Prescription Required|No|01/10/2005|028|No|.20711||.20214||.20359||||FLUOROQUINOLONES, ORAL|2033|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143993905|AMOXICILLIN 500 MG CAPSULE|500|EA|.06476|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||05/21/2007||Yes|No|||Prescription Required|No|01/25/2012|209|No|.07085||.06915||.06965||||PENICILLINS|2034|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefuroxime sodium|No|No|No|No|75%|00143997790|CEFUROXIME SOD 1.5 GM VIAL|1|EA|2.623|04/18/2005||Yes|No||04/18/2005||Yes|No|04/18/2005||Yes|No||||No|No|||Prescription Required|No|||No|5.978||5.8926||5.612||4.41|06/01/2016||2035|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefuroxime sodium|No|No|No|No|75%|00143997922|CEFUROXIME SOD 750 MG VIAL|1|EA|1.2568|09/10/2008||Yes|No||09/10/2008||Yes|No|09/10/2008||Yes|No||||No|No|||Prescription Required|No|||No|2.86434||2.82342||2.68898|||||2036|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefuroxime sodium|No|No|No|No|75%|00143997990|CEFUROXIME SOD 750 MG VIAL|1|EA|1.763|04/18/2005||Yes|No||04/18/2005||Yes|No|04/18/2005||Yes|No||||No|No|||Prescription Required|No|||No|4.018||3.9606||3.772||2.205|06/01/2016||2037|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143998101|AMOX-CLAV 200-28.5 MG/5 ML SUS|100|ML|.04644|08/01/2006||Yes|No||08/01/2006||Yes|No|08/01/2006||Yes|No||08/01/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05752||.05614||.05654||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2038|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143998150|AMOX-CLAV 200-28.5 MG/5 ML SUS|50|ML|.0743|08/01/2006||Yes|No||08/01/2006||Yes|No|08/01/2006||Yes|No||08/01/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.0622||.06071||.06114||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2039|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143998175|AMOX-CLAV 200-28.5 MG/5 ML SUS|75|ML|.05274|08/01/2006||Yes|No||08/01/2006||Yes|No|08/01/2006||Yes|No||08/01/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05658||.05522||.05562||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2040|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143998201|AMOX-CLAV 400-57 MG/5 ML SUSP|100|ML|.06278|08/01/2006||Yes|No||08/01/2006||Yes|No|08/01/2006||Yes|No||08/01/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.05459||.05328||.05366||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2041|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143998250|AMOX-CLAV 400-57 MG/5 ML SUSP|50|ML|.09288|08/01/2006||Yes|No||08/01/2006||Yes|No|08/01/2006||Yes|No||08/01/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.0767||.07486||.0754||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2042|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143998275|AMOX-CLAV 400-57 MG/5 ML SUSP|75|ML|.06593|08/01/2006||Yes|No||08/01/2006||Yes|No|08/01/2006||Yes|No||08/01/2006||Yes|No|||Prescription Required|No|04/28/2004|046|No|.0524||.05114||.05151||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2043|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefazolin sodium|No|No|No|No|75%|00143998391|CEFAZOLIN 10 GM VIAL|1|EA|6.45|01/26/2005||Yes|No||01/26/2005||Yes|No|01/26/2005||Yes|No||||No|No|||Prescription Required|No|||No|14.7||14.49||13.8||16.8|06/01/2016||2044|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000215|TRIAMCINOLONE 0.5% CREAM|15|GM|.26516|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.19056||.18599||.18732||||STEROIDS, TOPICAL HIGH|2045|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000315|TRIAMCINOLONE 0.025% CREAM|15|GM|.10664|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.11566||.11288||.11369||||STEROIDS, TOPICAL HIGH|2046|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000380|TRIAMCINOLONE 0.025% CREAM|80|GM|.04993|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.04256||.04154||.04184||||STEROIDS, TOPICAL HIGH|2047|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000415|TRIAMCINOLONE 0.1% CREAM|15|GM|.086|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.10663||.10407||.10482||||STEROIDS, TOPICAL HIGH|2048|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000416|TRIAMCINOLONE 0.1% CREAM|453.6|GM|.01896|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.02293||.02238||.02254||||STEROIDS, TOPICAL HIGH|2049|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000480|TRIAMCINOLONE 0.1% CREAM|80|GM|.03763|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.04476||.04369||.044||||STEROIDS, TOPICAL HIGH|2050|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000580|TRIAMCINOLONE 0.025% OINT|80|GM|.04993|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.06247||.06097||.06141||||STEROIDS, TOPICAL HIGH|2051|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000615|TRIAMCINOLONE 0.1% OINTMENT|15|GM|.1333|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.09573||.09343||.0941||||STEROIDS, TOPICAL HIGH|2052|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000616|TRIAMCINOLONE 0.1% OINTMENT|453.6|GM|.0237|04/24/2009||Yes|No||04/24/2009||Yes|No|04/24/2009||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.03791||.037||.03727||||STEROIDS, TOPICAL HIGH|2053|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000680|TRIAMCINOLONE 0.1% OINTMENT|80|GM|.06246|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.05112||.04989||.05025||||STEROIDS, TOPICAL HIGH|2054|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168001516|HYDROCORTISONE 1% CREAM       |453.6|GM|.05688|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.11442||.11167||.11247||||STEROIDS, TOPICAL LOW|2055|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168001531|HYDROCORTISONE 1% CREAM|28.35|GM|.09101|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.10167||.09923||.09994||||STEROIDS, TOPICAL LOW|2056|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168002016|HYDROCORTISONE 1% OINTMENT    |453.6|GM|.06251|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.12105||.11814||.11899||||STEROIDS, TOPICAL LOW|2057|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168002031|HYDROCORTISONE 1% OINTMENT|28.35|GM|.09995|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.12218||.11925||.1201||||STEROIDS, TOPICAL LOW|2058|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168003315|BETAMETHASONE VALER 0.1% OINTM|15|GM|.4664|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|01/30/2020|120|No|.61951||.60464||.60898||||STEROIDS, TOPICAL HIGH|2059|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168003346|BETAMETHASONE VALER 0.1% OINTM|45|GM|.31743|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|01/30/2020|120|No|.44647||.43575||.43888||||STEROIDS, TOPICAL HIGH|2060|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168004015|BETAMETHASONE VA 0.1% CREAM|15|GM|.64156|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.48274||.47115||.47453||||STEROIDS, TOPICAL HIGH|2061|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168004046|BETAMETHASONE VA 0.1% CREAM|45|GM|.4365|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|120|No|.35046||.34205||.3445||||STEROIDS, TOPICAL HIGH|2062|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168004160|BETAMETHASONE VA 0.1% LOTION|60|ML|.43|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|120|No|.35945||.35082||.35334||||STEROIDS, TOPICAL HIGH|2063|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone dipropionate|No|No|No|No|75%|00168005515|BETAMETHASONE DP 0.05% CRM|15|GM|1.21145|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.41251||.40261||.4055||||STEROIDS, TOPICAL HIGH|2064|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone dipropionate|No|No|No|No|75%|00168005546|BETAMETHASONE DP 0.05% CRM|45|GM|.80763|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.45379||.4429||.44608||||STEROIDS, TOPICAL HIGH|2065|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone dipropionate|No|No|No|No|75%|00168005615|BETAMETHASONE DP 0.05% OINT|15|GM|1.41011|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.73035||.71282||.71793||||STEROIDS, TOPICAL HIGH|2066|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone dipropionate|No|No|No|No|75%|00168005646|BETAMETHASONE DP 0.05% OINT|45|GM|.94007|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.54634||.53323||.53705||||STEROIDS, TOPICAL HIGH|2067|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone dipropionate|No|No|No|No|75%|00168005760|BETAMETHASONE DP 0.05% LOT|60|ML|.2866|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|01/15/2014|120|No|.28058||.27385||.27581||||STEROIDS, TOPICAL HIGH|2068|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluocinolone acetonide|No|No|No|No|75%|00168005960|FLUOCINOLONE 0.01% SOLUTION|60|ML|.23936|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|119|No|.20525||.20032||.20176||||STEROIDS, TOPICAL MEDIUM|2069|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluocinolone acetonide|No|No|No|No|75%|00168006415|FLUOCINOLONE 0.025% OINTMENT|15|GM|.80668|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|119|No|1.2239||1.19453||1.20309||||STEROIDS, TOPICAL MEDIUM|2070|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluocinolone acetonide|No|No|No|No|75%|00168006460|FLUOCINOLONE 0.025% OINTMENT|60|GM|.6048|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|119|No|.6874||.6709||.67571||||STEROIDS, TOPICAL MEDIUM|2071|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168008016|HYDROCORTISONE 2.5% CREAM|453.6|GM|.05688|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.09655||.09423||.09491||||STEROIDS, TOPICAL LOW|2072|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168008031|HYDROCORTISONE 2.5% CREAM|30|GM|.0473|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.06237||.06087||.06131||||STEROIDS, TOPICAL LOW|2073|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00168009915|KETOCONAZOLE 2% CREAM|15|GM|.43|06/18/2004||Yes|No||06/18/2004||Yes|No|06/18/2004||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|.24108||.23529||.23698||||ANTIFUNGALS, TOPICAL|2074|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00168009930|KETOCONAZOLE 2% CREAM|30|GM|.35833|06/18/2004||Yes|No||06/18/2004||Yes|No|06/18/2004||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|.19484||.19016||.19153||||ANTIFUNGALS, TOPICAL|2075|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00168009960|KETOCONAZOLE 2% CREAM|60|GM|.26875|06/18/2004||Yes|No||06/18/2004||Yes|No|06/18/2004||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|.13846||.13514||.13611||||ANTIFUNGALS, TOPICAL|2076|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00168013460|FLUOCINONIDE 0.05% SOLUTION|60|ML|.28666|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|120|No|.15076||.14714||.1482||||STEROIDS, TOPICAL HIGH|2077|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168014616|HYDROCORTISONE 2.5% OINTMENT  |453.6|GM|.05688|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.08615||.08408||.08469||||STEROIDS, TOPICAL LOW|2078|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168014630|HYDROCORTISONE 2.5% OINTMENT|28.35|GM|.05005|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|118|No|.0617||.06022||.06065||||STEROIDS, TOPICAL LOW|2079|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016315|CLOBETASOL 0.05% CREAM|15|GM|.46325|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.14857||.145||.14604||||STEROIDS, TOPICAL VERY HIGH|2080|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016330|CLOBETASOL 0.05% CREAM|30|GM|.46311|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.11283||.11012||.11091||||STEROIDS, TOPICAL VERY HIGH|2081|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016346|CLOBETASOL 0.05% CREAM|45|GM|.46316|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.08078||.07884||.07941||||STEROIDS, TOPICAL VERY HIGH|2082|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016360|CLOBETASOL 0.05% CREAM|60|GM|.41445|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.10865||.10604||.1068||||STEROIDS, TOPICAL VERY HIGH|2083|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00168020130|CLINDAMYCIN PH 1% SOLUTION|30|ML|.26516|08/25/2017||Yes|No||08/25/2017||Yes|No|08/25/2017||Yes|No||||No|No|||Prescription Required|No|07/18/2006|104|No|.21471||.20956||.21106||||ACNE AGENTS, TOPICAL|2084|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00168020160|CLINDAMYCIN PH 1% SOLUTION|60|ML|.258|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|07/18/2006|104|No|.12602||.123||.12388||||ACNE AGENTS, TOPICAL|2085|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00168020230|CLINDAMYCIN PH 1% GEL|30|GM|1.18852|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|07/18/2006|104|No|.1504||.14679||.14784||||ACNE AGENTS, TOPICAL|2086|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00168020260|CLINDAMYCIN PH 1% GEL|60|GM|1.07041|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|07/18/2006|104|No|.12586||.12284||.12372||||ACNE AGENTS, TOPICAL|2087|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00168020360|CLINDAMYCIN PHOSP 1% LOTION|60|ML|.82689|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|104|No|.24834||.24238||.24412||||ACNE AGENTS, TOPICAL|2088|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
lidocaine|No|No|No|No|75%|00168020437|LIDOCAINE 5% OINTMENT|35.44|GM|2.91196|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||12/01/2023||Yes|No|||Prescription Required|No|||No|.16344||.15952||.16066|||||2089|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clotrimazole/betamethasone dip|No|No|No|No|75%|00168025815|CLOTRIMAZOLE-BETAMETHASONE CRM|15|GM|.48332|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2016|061|No|.31484||.30728||.30949||||ANTIFUNGALS, TOPICAL|2090|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clotrimazole/betamethasone dip|No|No|No|No|75%|00168025846|CLOTRIMAZOLE-BETAMETHASONE CRM|45|GM|.34686|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2016|061|No|.23715||.23146||.23312||||ANTIFUNGALS, TOPICAL|2091|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026315|ALCLOMETASONE DIPRO 0.05% CRM|15|GM|1.10252|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|118|No|1.11067||1.08401||1.09179||||STEROIDS, TOPICAL LOW|2092|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026345|ALCLOMETASONE DIPRO 0.05% CRM|45|GM|.74543|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|118|No|.686||.66954||.67434||||STEROIDS, TOPICAL LOW|2093|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026360|ALCLOMETASONE DIPRO 0.05% CRM|60|GM|.64829|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|118|No|.60712||.59255||.5968||||STEROIDS, TOPICAL LOW|2094|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026415|ALCLOMETASONE DIPR 0.05% OINT|15|GM|.47787|04/21/2008|09/30/2024|Yes|No||04/21/2008|09/30/2024|Yes|No|04/21/2008|09/30/2024|Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|118|No|1.0891||1.07354||1.02242||||STEROIDS, TOPICAL LOW|2095|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026460|ALCLOMETASONE DIPR 0.05% OINT|60|GM|.22554|04/21/2008|12/31/2024|Yes|No||04/21/2008|12/31/2024|Yes|No|04/21/2008|12/31/2024|Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|118|No|.43771||.4272||.43027||||STEROIDS, TOPICAL LOW|2096|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026515|BETAMETHASONE DP AUG 0.05% CRM|15|GM|.60888|01/04/2008||Yes|No||01/04/2008||Yes|No|01/04/2008||Yes|No||||No|No|||Prescription Required|No|01/15/2014|120|No|1.38768||1.36786||1.30272||||STEROIDS, TOPICAL HIGH|2097|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026730|BETAMETHASONE DP AUG 0.05% LOT|30|ML|.65675|08/10/2009||Yes|No||08/10/2009||Yes|No|08/10/2009||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.56435||.55081||.55476||||STEROIDS, TOPICAL HIGH|2098|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026760|BETAMETHASONE DP AUG 0.05% LOT|60|ML|.64722|08/10/2009||Yes|No||08/10/2009||Yes|No|08/10/2009||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.43001||.41969||.4227||||STEROIDS, TOPICAL HIGH|2099|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026815|BETAMETHASONE DP AUG 0.05% OIN|15|GM|1.14466|04/28/2006||Yes|No||04/28/2006||Yes|No|04/28/2006||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.61598||.6012||.60551||||STEROIDS, TOPICAL HIGH|2100|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026850|BETAMETHASONE DP AUG 0.05% OIN|50|GM|.76918|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|120|No|.84415||.82389||.8298||||STEROIDS, TOPICAL HIGH|2101|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168026950|CLOBETASOL 0.05% SOLUTION|50|ML|.4128|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.18132||.17697||.17824||||STEROIDS, TOPICAL VERY HIGH|2102|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|Yes|No|No|No|75%|00168027740|CLINDAMYCIN 2% VAGINAL CREAM|40|GM|1.1208|04/15/2010||Yes|No||04/15/2010||Yes|No|04/15/2010||Yes|No||||No|No|11/01/2012||Prescription Required|Yes|01/30/2020|124|No|1.1725||1.14436||1.15257||||ANTIBIOTICS, VAGINAL|2103|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168029315|CLOBETASOL 0.05% GEL|15|GM|1.02684|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.51617||.50378||.5074||||STEROIDS, TOPICAL VERY HIGH|2104|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168029330|CLOBETASOL 0.05% GEL|30|GM|.93009|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.42404||.41386||.41683||||STEROIDS, TOPICAL VERY HIGH|2105|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168029360|CLOBETASOL 0.05% GEL|60|GM|.89075|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.2481||.24215||.24388||||STEROIDS, TOPICAL VERY HIGH|2106|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate/emoll|No|No|No|No|75%|00168030115|CLOBETASOL EMOLLIENT 0.05% CRM|15|GM|.7095|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.7649||.74654||.7519||||STEROIDS, TOPICAL VERY HIGH|2107|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate/emoll|No|No|No|No|75%|00168030130|CLOBETASOL EMOLLIENT 0.05% CRM|30|GM|.7095|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.75618||.73803||.74332||||STEROIDS, TOPICAL VERY HIGH|2108|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate/emoll|No|No|No|No|75%|00168030160|CLOBETASOL EMOLLIENT 0.05% CRM|60|GM|.7095|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||||No|No|||Prescription Required|No|02/10/2009|121|No|.67197||.65584||.66055||||STEROIDS, TOPICAL VERY HIGH|2109|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00168032346|METRONIDAZOLE 0.75% CREAM|45|GM|.68179|12/02/2005||Yes|No||12/02/2005||Yes|No|12/02/2005||Yes|No||||No|No|||Prescription Required|No|01/28/2021|221|No|.21836||.21312||.21465||||ROSACEA AGENTS, TOPICAL|2110|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00168033215|FLUTICASONE PROP 0.05% CREAM|15|GM|.45465|01/04/2008||Yes|No||01/04/2008||Yes|No|01/04/2008||Yes|No||||No|No|||Prescription Required|No|07/26/2012|119|No|.30111||.29388||.29599||||STEROIDS, TOPICAL MEDIUM|2111|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00168033230|FLUTICASONE PROP 0.05% CREAM|30|GM|.3503|06/18/2004||Yes|No||06/18/2004||Yes|No|06/18/2004||Yes|No||||No|No|||Prescription Required|No|07/26/2012|119|No|.18379||.17938||.18067||||STEROIDS, TOPICAL MEDIUM|2112|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00168033260|FLUTICASONE PROP 0.05% CREAM|60|GM|.27613|06/18/2004||Yes|No||06/18/2004||Yes|No|06/18/2004||Yes|No||||No|No|||Prescription Required|No|07/26/2012|119|No|.20491||.19999||.20143||||STEROIDS, TOPICAL MEDIUM|2113|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
terconazole|No|No|No|No|75%|00168034720|TERCONAZOLE 0.8% CREAM|20|GM|.84345|04/21/2021||Yes|No||04/21/2021||Yes|No|04/21/2021||Yes|No||||No|No|||Prescription Required|No|||No|.98499||.96135||.96825|||||2114|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
halobetasol propionate|No|No|No|No|75%|00168035550|HALOBETASOL PROP 0.05% CREAM|50|GM|.78991|06/23/2005||Yes|No||06/23/2005||Yes|No|06/23/2005||Yes|No||||No|No|||Prescription Required|No|01/26/2017|121|No|.37938||.37027||.37293||||STEROIDS, TOPICAL VERY HIGH|2115|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
lidocaine/prilocaine|No|No|No|No|75%|00168035730|LIDOCAINE-PRILOCAINE CREAM|30|GM|.21614|01/26/2004||Yes|No||01/26/2004||Yes|No|01/26/2004||Yes|No||12/01/2023||Yes|No|||Prescription Required|No|||No|.2434||.23756||.23926|||||2116|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
lidocaine/prilocaine|No|No|No|No|75%|00168035755|LIDOCAINE-PRILOCAINE CREAM|5|GM|.7107|03/30/2022||Yes|No||03/30/2022||Yes|No|03/30/2022||Yes|No||12/01/2023||Yes|No|||Prescription Required|No|||No|1.61974||1.5966||1.52058|||||2117|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
oxiconazole nitrate|No|No|No|No|75%|00168035830|OXICONAZOLE NITRATE 1% CREAM  |30|GM|7.04899|06/29/2016||Yes|No||06/29/2016||Yes|No|06/29/2016||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|061|No|4.44387||4.33722||4.36832||||ANTIFUNGALS, TOPICAL|2118|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
oxiconazole nitrate|No|No|No|No|75%|00168035860|OXICONAZOLE NITRATE 1% CREAM|60|GM|3.57616|06/29/2016||Yes|No||06/29/2016||Yes|No|06/29/2016||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|061|No|3.03942||2.96647||2.98775||||ANTIFUNGALS, TOPICAL|2119|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
oxiconazole nitrate|No|No|No|No|75%|00168035890|OXICONAZOLE NITRATE 1% CREAM  |90|GM|3.57449|06/29/2016||Yes|No||06/29/2016||Yes|No|06/29/2016||Yes|No||||No|No|||Prescription Required|Yes|01/28/2016|061|No|3.32506||3.24526||3.26853||||ANTIFUNGALS, TOPICAL|2120|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00168038360|METRONIDAZOLE 0.75% LOTION|59|ML|1.50099|03/19/2009||Yes|No||03/19/2009||Yes|No|03/19/2009||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|221|No|1.2872||1.25631||1.26532||||ROSACEA AGENTS, TOPICAL|2121|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
prednicarbate|No|No|No|No|75%|00168041060|PREDNICARBATE 0.1% OINTMENT|60|GM|.44068|03/19/2009||Yes|No||03/19/2009||Yes|No|03/19/2009||Yes|No||||No|No|||Prescription Required|Yes|01/20/2011|119|No|1.00433||.98999||.94284||||STEROIDS, TOPICAL MEDIUM|2122|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041630|TACROLIMUS 0.1% OINTMENT|30|GM|1.94116|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|.71426||.69712||.70212||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2123|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041660|TACROLIMUS 0.1% OINTMENT|60|GM|1.94124|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|.73991||.72215||.72733||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2124|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041699|TACROLIMUS 0.1% OINTMENT|100|GM|1.94119|02/19/2015||Yes|No||02/19/2015||Yes|No|02/19/2015||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|.63218||.61701||.62143||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2125|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041730|TACROLIMUS 0.03% OINTMENT|30|GM|1.00333|05/21/2015||Yes|No||05/21/2015||Yes|No|05/21/2015||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|.90511||.88339||.88972||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2126|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041760|TACROLIMUS 0.03% OINTMENT|60|GM|1.00341|02/19/2015||Yes|No||02/19/2015||Yes|No|02/19/2015||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|.7882||.76928||.7748||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2127|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041799|TACROLIMUS 0.03% OINTMENT|100|GM|1.00336|02/19/2015||Yes|No||02/19/2015||Yes|No|02/19/2015||Yes|No||||No|No|||Prescription Required|No|07/27/2023|034|Yes|.81338||.79386||.79955||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2128|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
adapalene|No|No|No|No|75%|00168042446|ADAPALENE 0.1% CREAM|45|GM|2.25387|08/02/2010||Yes|No||08/02/2010||Yes|No|08/02/2010||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|Yes|2.49682||2.4369||2.45437||||ACNE AGENTS, TOPICAL|2129|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
insulin regular, human|Yes|No|No|No|75%|00169183311|NOVOLIN R 100 UNIT/ML VIAL|10|ML|2.0726|03/01/2002||Yes|No||12/17/2014||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Over The Counter|No|01/30/2020|029|No|4.62694||4.51589||4.54828||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2130|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin NPH human isophane|Yes|No|No|No|75%|00169183411|NOVOLIN N 100 UNIT/ML VIAL|10|ML|2.0726|10/01/2002||Yes|No||12/17/2014||Yes|No|10/01/2002||Yes|No||10/01/2002||Yes|No|07/01/2016||Over The Counter|No|01/30/2020|029|No|4.63572||4.52446||4.55691||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2131|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin NPH hum/reg insulin hm|Yes|No|No|No|75%|00169183711|NOVOLIN 70-30 100 UNIT/ML VIAL|10|ML|2.0726|03/01/2002||Yes|No||12/17/2014||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Over The Counter|Yes|09/18/2020|029|No|4.6292||4.5181||4.5505||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2132|||||No|No||NOVO NORDISK|No|||||No|No|No||
dasiglucagon HCl|No|No|No|No|75%|00169191201|ZEGALOGUE 0.6 MG/0.6ML AUTOINJ|0.6|ML|221.45|12/07/2023||Yes|No||12/07/2023||Yes|No|12/07/2023||Yes|No||||No|No|||Prescription Required|No|08/08/2024|583|No|494.55||482.6808||486.14265||||GLUCAGON AGENTS|2133|||||No|No||NOVO NORDISK|No|||||No|No|No||
dasiglucagon HCl|No|No|No|No|75%|00169191202|ZEGALOGUE 0.6 MG/0.6ML AUTOINJ|0.6|ML|221.45|01/29/2024||Yes|No||01/29/2024||Yes|No|01/29/2024||Yes|No||||No|No|||Prescription Required|No|08/08/2024|583|No|504.7||497.49||473.8||||GLUCAGON AGENTS|2134|||||No|No||NOVO NORDISK|No|||||No|No|No||
dasiglucagon HCl|No|No|No|No|75%|00169191301|ZEGALOGUE 0.6 MG/0.6 ML SYRING|0.6|ML|221.45|12/07/2023||Yes|No||12/07/2023||Yes|No|12/07/2023||Yes|No||||No|No|||Prescription Required|No|08/08/2024|583|No|504.7||497.49||473.8||||GLUCAGON AGENTS|2135|||||No|No||NOVO NORDISK|No|||||No|No|No||
dasiglucagon HCl|No|No|No|No|75%|00169191302|ZEGALOGUE 0.6 MG/0.6 ML SYRING|0.6|ML|221.45|12/07/2023||Yes|No||12/07/2023||Yes|No|12/07/2023||Yes|No||||No|No|||Prescription Required|No|08/08/2024|583|No|504.7||497.49||473.8||||GLUCAGON AGENTS|2136|||||No|No||NOVO NORDISK|No|||||No|No|No||
somapacitan-beco|No|No|No|No|75%|00169203011|SOGROYA 10 MG/1.5 ML PEN|1.5|ML|800.17266|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|Yes|01/25/2024|014|No|1823.64933||1797.59719||1711.99733||||GROWTH HORMONE|2137|||||No|No||NOVO NORDISK|No|||||No|No|No||
somapacitan-beco|No|No|No|No|75%|00169203511|SOGROYA 5 MG/1.5 ML PEN|1.5|ML|400.08633|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|Yes|01/25/2024|014|No|911.82466||898.7986||855.99866||||GROWTH HORMONE|2138|||||No|No||NOVO NORDISK|No|||||No|No|No||
somapacitan-beco|No|No|No|No|75%|00169203711|SOGROYA 15 MG/1.5 ML PEN|1.5|ML|1200.259|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|Yes|01/25/2024|014|No|2735.474||2696.3958||2567.996||||GROWTH HORMONE|2139|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169210011|RELION NOVOLOG 100 UNIT/ML VL|10|ML|3.11062|09/30/2021||Yes|No||09/30/2021||Yes|No|09/30/2021||Yes|No||09/30/2021||Yes|No|||Prescription Required|No|01/28/2021|029|No|7.08932||6.98804||6.65528||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2140|||||No|No||NOVO NORDISK-WA|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169210125|RELION NOVOLOG U-100 FLEXPEN|3|ML|4.00502|09/30/2021||Yes|No||09/30/2021||Yes|No|09/30/2021||Yes|No||09/30/2021||Yes|No|||Prescription Required|No|01/28/2021|029|No|9.12772||8.99732||8.56888||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2141|||||No|No||NOVO NORDISK-WA|No|||||No|No|No||
insulin aspart prot/insuln asp|No|No|No|No|75%|00169220011|RELION NOVOLOG MIX 70-30 VIAL|10|ML|3.11062|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||02/02/2022||Yes|No|||Prescription Required|No|01/28/2021|029|No|7.08932||6.98804||6.65528||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2142|||||No|No||NOVO NORDISK-WA|No|||||No|No|No||
insulin aspart prot/insuln asp|No|No|No|No|75%|00169220125|RELION NOVOLOG MIX 70-30 FLXPN|3|ML|4.00502|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||02/02/2022||Yes|No|||Prescription Required|No|01/28/2021|029|No|9.12772||8.99732||8.56888||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2143|||||No|No||NOVO NORDISK-WA|No|||||No|No|No||
insulin degludec|Yes|No|No|No|75%|00169255013|TRESIBA FLEXTOUCH 200 UNIT/ML|3|ML|29.1497|10/23/2015||Yes|No||10/23/2015||Yes|No|10/23/2015||Yes|No||10/23/2015||Yes|No|04/08/2020||Prescription Required|Yes|09/18/2020|029|No|65.09634||63.53403||63.9897||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2144|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin degludec|Yes|No|No|No|75%|00169266015|TRESIBA FLEXTOUCH 100 UNIT/ML|3|ML|14.57499|10/23/2015||Yes|No||10/23/2015||Yes|No|10/23/2015||Yes|No||10/23/2015||Yes|No|04/08/2020||Prescription Required|Yes|09/18/2020|029|No|32.5479||31.76675||31.99459||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2145|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin degludec|Yes|No|No|No|75%|00169266211|TRESIBA 100 UNIT/ML VIAL|10|ML|14.57485|02/05/2019||Yes|No||02/05/2019||Yes|No|02/05/2019||Yes|No||02/05/2019||Yes|No|07/22/2019||Prescription Required|Yes|09/18/2020|029|No|32.51793||31.7375||31.96513||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2146|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin degludec/liraglutide|No|No|No|No|75%|00169291115|XULTOPHY 100 UNIT-3.6MG/ML PEN|3|ML|37.1434|08/15/2017||Yes|No||08/15/2017||Yes|No|08/15/2017||Yes|No||08/15/2017||Yes|No|||Prescription Required|Yes|07/27/2017|111|Yes|82.98878||80.99705||81.57797||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2147|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin regular, human|Yes|No|No|No|75%|00169300315|NOVOLIN R 100 UNIT/ML FLEXPEN|3|ML|2.61124|03/17/2020||Yes|No||03/17/2020||Yes|No|03/17/2020||Yes|No||03/17/2020||Yes|No|06/19/2020||Over The Counter|Yes|07/25/2019|029|No|5.83329||5.69329||5.73412||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2148|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin NPH human isophane|Yes|No|No|No|75%|00169300415|NOVOLIN N 100 UNIT/ML FLEXPEN|3|ML|2.61124|03/17/2020||Yes|No||03/17/2020||Yes|No|03/17/2020||Yes|No||03/17/2020||Yes|No|06/19/2020||Over The Counter|Yes|07/25/2019|029|No|5.82731||5.68745||5.72825||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2149|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin NPH hum/reg insulin hm|Yes|No|No|No|75%|00169300715|NOVOLIN 70-30 FLEXPEN|3|ML|2.61124|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||02/25/2019||Yes|No|07/22/2019||Over The Counter|Yes|09/18/2020|029|No|5.83486||5.69482||5.73567||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2150|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart (niacinamide)|Yes|No|No|No|75%|00169320111|FIASP 100 UNIT/ML VIAL|10|ML|12.44248|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||07/06/2018||Yes|No|07/22/2019||Prescription Required|Yes|09/18/2020|029|No|27.76436||27.09802||27.29237||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2151|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart (niacinamide)|Yes|No|No|No|75%|00169320415|FIASP 100 UNIT/ML FLEXTOUCH|3|ML|16.01979|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||07/06/2018||Yes|No|07/22/2019||Prescription Required|Yes|09/18/2020|029|No|35.7542||34.8961||35.14638||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2152|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart (niacinamide)|Yes|No|No|No|75%|00169320515|FIASP PENFILL 100 UNIT/ML CART|3|ML|15.40747|02/27/2020||Yes|No||02/27/2020||Yes|No|02/27/2020||Yes|No||02/27/2020||Yes|No|03/20/2020||Prescription Required|Yes|07/30/2020|029|No|34.41398||33.58804||33.82894||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2153|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart/B3/pump cart|No|No|No|No|75%|00169320615|FIASP PUMPCART 100 UNIT/ML|1.6|ML|15.40744|09/05/2024||Yes|No||09/05/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|01/25/2024|029|No|34.47927||33.65177||33.89312||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2154|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169330312|NOVOLOG PENFILL 100 UNIT/ML|3|ML|3.85194|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|029|No|8.58434||8.37832||8.43841||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2155|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart prot/insuln asp|Yes|No|No|No|75%|00169368512|NOVOLOG MIX 70-30 VIAL|10|ML|3.11062|01/01/2004||Yes|No||01/01/2004||Yes|No|01/01/2004||Yes|No||01/01/2004||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|029|No|6.94585||6.77915||6.82777||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2156|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin detemir|No|No|No|No|75%|00169368712|LEVEMIR 100 UNIT/ML VIAL|10|ML|4.63755|03/15/2007||Yes|No||03/15/2007||Yes|No|03/15/2007||Yes|No||03/15/2007||Yes|No|||Prescription Required|No|01/15/2014|029|No|10.3637||10.11497||10.18752||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2157|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart prot/insuln asp|No|No|No|No|75%|00169369619|NOVOLOG MIX 70-30 FLEXPEN|3|ML|4.00502|09/02/2004||Yes|No||09/02/2004||Yes|No|09/02/2004||Yes|No||09/02/2004||Yes|No|||Prescription Required|No|01/20/2011|029|No|8.94684||8.73212||8.79474||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2158|||||No|No||NOVO NORDISK|No|||||No|No|No||
liraglutide|No|No|No|No|75%|00169406012|VICTOZA 2-PAK 18 MG/3 ML PEN|3|ML|38.95155|02/23/2010||Yes|No||02/23/2010||Yes|No|02/23/2010||Yes|No||11/01/2016||Yes|No|||Prescription Required|No|01/22/2015|111|Yes|87.41821||85.32017||85.9321||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2159|||||No|No||NOVO NORDISK|No|||||No|No|No||
liraglutide|No|No|No|No|75%|00169406013|VICTOZA 3-PAK 18 MG/3 ML PEN|3|ML|38.95179|02/23/2010||Yes|No||02/23/2010||Yes|No|02/23/2010||Yes|No||11/01/2016||Yes|No|||Prescription Required|No|01/22/2015|111|Yes|87.44901||85.35023||85.96238||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2160|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169413013|OZEMPIC 1 MG/DOSE (4 MG/3 ML)|3|ML|138.8212|05/11/2021||Yes|No||05/11/2021||Yes|No|05/11/2021||Yes|No||05/11/2021||Yes|No|||Prescription Required|No|01/26/2023|111|Yes|311.80217||304.31892||306.50153||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2161|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169418113|OZEMPIC 0.25-0.5 MG/DOSE PEN|3|ML|138.8212|04/13/2023||Yes|No||04/13/2023||Yes|No|04/13/2023||Yes|No||04/13/2023||Yes|No|||Prescription Required|No|01/26/2023|111|Yes|311.81111||304.32764||306.51032||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2162|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169430330|RYBELSUS 3 MG TABLET|30|EA|13.88212|02/07/2022||Yes|No||02/07/2022||Yes|No|02/07/2022||Yes|No||02/07/2022||Yes|No|||Prescription Required|Yes|07/29/2021|111|Yes|31.14246||30.39504||30.61304||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2163|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169430713|RYBELSUS 7 MG TABLET|30|EA|13.88212|03/30/2020||Yes|No||03/30/2020||Yes|No|03/30/2020||Yes|No||03/30/2020||Yes|No|||Prescription Required|Yes|07/30/2020|111|Yes|31.15834||30.41054||30.62865||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2164|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169430730|RYBELSUS 7 MG TABLET|30|EA|13.88212|02/07/2022||Yes|No||02/07/2022||Yes|No|02/07/2022||Yes|No||02/07/2022||Yes|No|||Prescription Required|Yes|07/29/2021|111|Yes|31.15834||30.41054||30.62865||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2165|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169431430|RYBELSUS 14 MG TABLET|30|EA|13.88212|02/07/2022||Yes|No||02/07/2022||Yes|No|02/07/2022||Yes|No||02/07/2022||Yes|No|||Prescription Required|Yes|07/29/2021|111|Yes|31.15327||30.40559||30.62366||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2166|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169477212|OZEMPIC 2 MG/DOSE (8 MG/3 ML)|3|ML|138.8212|11/15/2022||Yes|No||11/15/2022||Yes|No|11/15/2022||Yes|No||11/15/2022||Yes|No|||Prescription Required|No|01/26/2023|111|Yes|311.75422||304.27212||306.4544||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2167|||||No|No||NOVO NORDISK|No|||||No|No|No||
estradiol|No|No|No|No|75%|00169517603|VAGIFEM 10 MCG VAGINAL TAB|8|EA|9.1461|02/22/2010||Yes|No||02/22/2010||Yes|No|02/22/2010||Yes|No||||No|No|||Prescription Required|No|||Yes|20.41365||19.92372||20.06662|||||2168|||||No|No||NOVO NORDISK|No|||||No|No|No||
estradiol|No|No|No|No|75%|00169517604|VAGIFEM 10 MCG VAGINAL TAB|18|EA|9.1461|02/22/2010||Yes|No||02/22/2010||Yes|No|02/22/2010||Yes|No||||No|No|||Prescription Required|No|||Yes|20.41365||19.92372||20.06662|||||2169|||||No|No||NOVO NORDISK|No|||||No|No|No||
nedosiran sodium|No|No|No|No|75%|00169530610|RIVFLOZA 160 MG/ML SYRINGE|1|ML|27038.4|11/25/2024||Yes|No||11/25/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|61622.4||60742.08||57849.6|||||2170|||||No|No||NOVO NORDISK|No|||||No|No|No||
nedosiran sodium|No|No|No|No|75%|00169530708|RIVFLOZA 128 MG/0.8 ML SYRINGE|0.8|ML|27038.4|11/25/2024||Yes|No||11/25/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|61622.4||60742.08||57849.6|||||2171|||||No|No||NOVO NORDISK|No|||||No|No|No||
nedosiran sodium|No|No|No|No|75%|00169530801|RIVFLOZA 80 MG/0.5 ML VIAL|0.5|ML|27038.4|11/25/2024||Yes|No||11/25/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|61622.4||60742.08||57849.6|||||2172|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169633910|NOVOLOG 100 UNIT/ML FLEXPEN|3|ML|4.00502|05/05/2004||Yes|No||05/05/2004||Yes|No|05/05/2004||Yes|No||05/05/2004||Yes|No|||Prescription Required|No|01/20/2011|029|No|8.94572||8.73102||8.79364||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2173|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin detemir|No|No|No|No|75%|00169643210|LEVEMIR FLEXPEN 100 UNIT/ML|3|ML|4.6374|04/04/2023||Yes|No||04/04/2023||Yes|No|04/04/2023||Yes|No||04/04/2023||Yes|No|||Prescription Required|No|01/26/2023|029|No|10.35873||10.11012||10.18263||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2174|||||No|No||NOVO NORDISK|No|||||No|No|No||
factor XIII A-subunit,recomb|No|No|No|No|75%|00169701301|TRETTEN 2,500 UNIT VIAL|1|EA|12.274|03/25/2014||Yes|No||03/25/2014||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|17.689||17.4363||16.606||||HEMOPHILIA TREATMENT|2175|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
glucagon|No|No|No|No|75%|00169706515|GLUCAGEN 1 MG HYPOKIT|1|EA|132.311|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||||No|No|||Prescription Required|No|07/30/2020|583|No|295.08516||288.00312||290.06871||||GLUCAGON AGENTS|2176|||||No|No||NOVO NORDISK|No|||||No|No|No||
coagulation factor VIIa,recomb|No|No|No|No|75%|00169720101|NOVOSEVEN RT 1 MG VIAL|1|EA|1.8224|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.6264||2.58888||2.4656||||HEMOPHILIA TREATMENT|2177|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|10/23/2018|
coagulation factor VIIa,recomb|No|No|No|No|75%|00169720201|NOVOSEVEN RT 2 MG VIAL|1|EA|1.8224|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.6264||2.58888||2.4656||||HEMOPHILIA TREATMENT|2178|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|03/22/2019|
coagulation factor VIIa,recomb|No|No|No|No|75%|00169720501|NOVOSEVEN RT 5 MG VIAL|1|EA|1.8224|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.6264||2.58888||2.4656||||HEMOPHILIA TREATMENT|2179|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
coagulation factor VIIa,recomb|No|No|No|No|75%|00169720801|NOVOSEVEN RT 8 MG VIAL|1|EA|1.8224|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.6264||2.58888||2.4656||||HEMOPHILIA TREATMENT|2180|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|10/23/2018|
insulin aspart|Yes|No|No|No|75%|00169750111|NOVOLOG 100 UNIT/ML VIAL|10|ML|3.11062|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|029|No|6.946||6.7793||6.82792||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2181|||||No|No||NOVO NORDISK|No|||||No|No|No||
somatropin|No|No|No|No|75%|00169770321|NORDITROPIN FLEXPRO 30 MG/3 ML|3|ML|692.687|05/20/2015||Yes|No||05/20/2015||Yes|No|05/20/2015||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|01/22/2015|014|Yes|1578.682||1556.1294||1482.028||1008.224|06/07/2016|GROWTH HORMONE|2182|||||No|No||NOVO NORDISK|No|||||No|No|Yes|06/17/2019|
somatropin|No|No|No|No|75%|00169770421|NORDITROPIN FLEXPRO 5 MG/1.5|1.5|ML|230.89566|04/15/2010||Yes|No||04/15/2010||Yes|No|04/15/2010||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|07/24/2013|014|Yes|515.08445||502.72242||506.32801||.|09/23/2024|GROWTH HORMONE|2183|||||No|No||NOVO NORDISK|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00169770521|NORDITROPIN FLEXPRO 10 MG/1.5|1.5|ML|461.79133|04/15/2010||Yes|No||04/15/2010||Yes|No|04/15/2010||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|07/24/2013|014|Yes|1039.25298||1014.31091||1021.58568||||GROWTH HORMONE|2184|||||No|No||NOVO NORDISK|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00169770821|NORDITROPIN FLEXPRO 15 MG/1.5|1.5|ML|692.687|04/15/2010||Yes|No||04/15/2010||Yes|No|04/15/2010||Yes|No|Submit HHS Form 1312|||No|No|||Prescription Required|No|07/24/2013|014|Yes|1563.40571||1525.88397||1536.82781||||GROWTH HORMONE|2185|||||No|No||NOVO NORDISK|No|||||No|No|Yes|06/17/2019|
antihemoph.FVIII,B-dom truncat|No|No|No|No|75%|00169781001|NOVOEIGHT 1,000 UNIT VIAL|1|EA|1.4688|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.1168||2.08656||1.9872||||HEMOPHILIA TREATMENT|2186|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
antihemoph.FVIII,B-dom truncat|No|No|No|No|75%|00169781501|NOVOEIGHT 1,500 UNIT VIAL|1|EA|1.4688|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.1168||2.08656||1.9872||||HEMOPHILIA TREATMENT|2187|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
antihemoph.FVIII,B-dom truncat|No|No|No|No|75%|00169782001|NOVOEIGHT 2,000 UNIT VIAL|1|EA|1.4688|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.1168||2.08656||1.9872||||HEMOPHILIA TREATMENT|2188|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
antihemoph.FVIII,B-dom truncat|No|No|No|No|75%|00169782501|NOVOEIGHT 250 UNIT VIAL|1|EA|1.4688|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.1168||2.08656||1.9872||||HEMOPHILIA TREATMENT|2189|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|03/22/2019|
antihemoph.FVIII,B-dom truncat|No|No|No|No|75%|00169783001|NOVOEIGHT 3,000 UNIT VIAL|1|EA|1.4688|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.1168||2.08656||1.9872||||HEMOPHILIA TREATMENT|2190|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|03/22/2019|
antihemoph.FVIII,B-dom truncat|No|No|No|No|75%|00169785001|NOVOEIGHT 500 UNIT VIAL|1|EA|1.4688|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.1168||2.08656||1.9872||||HEMOPHILIA TREATMENT|2191|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
factor IX human rec,pegylated|No|No|No|No|75%|00169790101|REBINYN 1,000 UNIT VIAL|1|EA|3.2912|06/22/2018||Yes|No||06/22/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|4.7432||4.67544||4.4528||||HEMOPHILIA TREATMENT|2192|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
factor IX human rec,pegylated|No|No|No|No|75%|00169790201|REBINYN 2,000 UNIT VIAL|1|EA|3.2912|06/22/2018||Yes|No||06/22/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|4.7432||4.67544||4.4528||||HEMOPHILIA TREATMENT|2193|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
factor IX human rec,pegylated|No|No|No|No|75%|00169790301|REBINYN 3,000 UNIT VIAL|1|EA|3.2912|08/21/2023||Yes|No||08/21/2023||Yes|No|08/21/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|105|No|4.7432||4.67544||4.4528||||HEMOPHILIA TREATMENT|2194|||||No|No||NOVO NORDISK|No|||||Yes|No|No||
factor IX human rec,pegylated|No|No|No|No|75%|00169790501|REBINYN 500 UNIT VIAL|1|EA|3.2912|06/22/2018||Yes|No||06/22/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|4.7432||4.67544||4.4528||||HEMOPHILIA TREATMENT|2195|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom trunc peg-exei|No|No|No|No|75%|00169810001|ESPEROCT 1,000 UNIT VIAL|1|EA|1.734|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.499||2.4633||2.346||||HEMOPHILIA TREATMENT|2196|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom trunc peg-exei|No|No|No|No|75%|00169815001|ESPEROCT 1,500 UNIT VIAL|1|EA|1.734|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.499||2.4633||2.346||||HEMOPHILIA TREATMENT|2197|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom trunc peg-exei|No|No|No|No|75%|00169820001|ESPEROCT 2,000 UNIT VIAL|1|EA|1.734|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.499||2.4633||2.346||||HEMOPHILIA TREATMENT|2198|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom trunc peg-exei|No|No|No|No|75%|00169830001|ESPEROCT 3,000 UNIT VIAL|1|EA|1.734|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.499||2.4633||2.346||||HEMOPHILIA TREATMENT|2199|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
FVIII rec,B-dom trunc peg-exei|No|No|No|No|75%|00169850001|ESPEROCT 500 UNIT VIAL|1|EA|1.734|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|105|No|2.499||2.4633||2.346||||HEMOPHILIA TREATMENT|2200|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
hydrochlorothiazide|Yes|No|No|No|75%|00172208360|HYDROCHLOROTHIAZIDE 25 MG TAB|100|EA|.01823|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||Yes|.00955||.00932||.00939|||||2201|||||No|No||TEVA USA|No|||||No|No|No||
hydrochlorothiazide|Yes|No|No|No|75%|00172208380|HYDROCHLOROTHIAZIDE 25 MG TAB|1000|EA|.01768|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||Yes|.00955||.00932||.00939|||||2202|||||No|No||TEVA USA|No|||||No|No|No||
hydrochlorothiazide|Yes|No|No|No|75%|00172208960|HYDROCHLOROTHIAZIDE 50 MG TAB|100|EA|.03505|08/15/2002||Yes|No||08/15/2002||Yes|No|08/15/2002||Yes|No||08/15/2002||Yes|No|07/01/2016||Prescription Required|No|||Yes|.03229||.03152||.03174|||||2203|||||No|No||TEVA USA|No|||||No|No|No||
hydrochlorothiazide|Yes|No|No|No|75%|00172208980|HYDROCHLOROTHIAZIDE 50 MG TAB|1000|EA|.03374|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|07/01/2016||Prescription Required|No|||Yes|.03229||.03152||.03174|||||2204|||||No|No||TEVA USA|No|||||No|No|No||
lisinopril|Yes|No|No|No|75%|00172376170|LISINOPRIL 40 MG TABLET|500|EA|.05241|07/24/2002||Yes|No||07/24/2002||Yes|No|07/24/2002||Yes|No||07/24/2002||Yes|No|07/01/2016||Prescription Required|No|03/23/2007|113|No|.03918||.03824||.03851||||ANGIOTENSIN MODULATORS|2205|||||No|No||TEVA USA|No|||||No|No|No||
lisinopril|Yes|No|No|No|75%|00172376260|LISINOPRIL 30 MG TABLET|100|EA|.0501|07/24/2002||Yes|No||07/24/2002||Yes|No|07/24/2002||Yes|No||07/24/2002||Yes|No|07/01/2016||Prescription Required|No|03/23/2007|113|No|.04188||.04087||.04117||||ANGIOTENSIN MODULATORS|2206|||||No|No||TEVA USA|No|||||No|No|No||
diazepam|No|No|No|No|75%|00172392560|DIAZEPAM 2 MG TABLET|100|EA|.01286|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02079||.02029||.02044||||ANXIOLYTICS|2207|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392570|DIAZEPAM 2 MG TABLET|500|EA|.01203|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02079||.02029||.02044||||ANXIOLYTICS|2208|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392660|DIAZEPAM 5 MG TABLET|100|EA|.0206|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.0216||.02108||.02123||||ANXIOLYTICS|2209|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392670|DIAZEPAM 5 MG TABLET|500|EA|.01896|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.0216||.02108||.02123||||ANXIOLYTICS|2210|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392680|DIAZEPAM 5 MG TABLET|1000|EA|.01201|04/28/2011||Yes|No||04/28/2011||Yes|No|04/28/2011||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.0216||.02108||.02123||||ANXIOLYTICS|2211|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392760|DIAZEPAM 10 MG TABLET|100|EA|.03978|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02583||.02521||.02539||||ANXIOLYTICS|2212|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392770|DIAZEPAM 10 MG TABLET|500|EA|.03878|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02583||.02521||.02539||||ANXIOLYTICS|2213|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392780|DIAZEPAM 10 MG TABLET|1000|EA|.01562|04/01/2011||Yes|No||04/01/2011||Yes|No|04/01/2011||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02583||.02521||.02539||||ANXIOLYTICS|2214|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
baclofen|No|No|No|No|75%|00172409660|BACLOFEN 10 MG TABLET|100|EA|.09396|07/13/2010||Yes|No||07/13/2010||Yes|No|07/13/2010||Yes|No||||No|No|||Prescription Required|No|02/10/2009|116|No|.03184||.03108||.0313||||SKELETAL MUSCLE RELAXANTS|2215|||||No|No||TEVA USA|No|||||No|No|No||
baclofen|No|No|No|No|75%|00172409680|BACLOFEN 10 MG TABLET|1000|EA|.09393|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|02/10/2009|116|No|.03184||.03108||.0313||||SKELETAL MUSCLE RELAXANTS|2216|||||No|No||TEVA USA|No|||||No|No|No||
baclofen|No|No|No|No|75%|00172409760|BACLOFEN 20 MG TABLET|100|EA|.15506|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|02/10/2009|116|No|.04628||.04517||.04549||||SKELETAL MUSCLE RELAXANTS|2217|||||No|No||TEVA USA|No|||||No|No|No||
baclofen|No|No|No|No|75%|00172409780|BACLOFEN 20 MG TABLET|1000|EA|.15507|05/09/2012||Yes|No||09/01/2020||Yes|No|09/01/2020||Yes|No||||No|No|||Prescription Required|No|02/10/2009|116|No|.04628||.04517||.04549||||SKELETAL MUSCLE RELAXANTS|2218|||||No|No||TEVA USA|No|||||No|No|No||
anagrelide HCl|No|No|No|No|75%|00172524060|ANAGRELIDE HCL 1 MG CAPSULE|100|EA|.77013|06/28/2010|02/05/2025|Yes|No||06/28/2010|02/05/2025|Yes|No|06/28/2010|02/05/2025|Yes|No||||No|No|||Prescription Required|No|||No|1.58513||1.54709||1.55818|||||2219|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||TEVA USA|No|||||No|No|No||
anagrelide HCl|No|No|No|No|75%|00172524160|ANAGRELIDE HCL 0.5 MG CAPSULE|100|EA|.35815|06/28/2010|02/05/2025|Yes|No||06/28/2010|02/05/2025|Yes|No|06/28/2010|02/05/2025|Yes|No||||No|No|||Prescription Required|No|||No|.72451||.70712||.71219|||||2220|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||TEVA USA|No|||||No|No|No||
famotidine|No|No|No|No|75%|00172572860|FAMOTIDINE 20 MG TABLET|100|EA|.0602|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.02541||.0248||.02498|||||2221|||||No|No||TEVA USA|No|||||No|No|No||
famotidine|No|No|No|No|75%|00172572870|FAMOTIDINE 20 MG TABLET|500|EA|.0602|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.02541||.0248||.02498|||||2222|||||No|No||TEVA USA|No|||||No|No|No||
famotidine|No|No|No|No|75%|00172572880|FAMOTIDINE 20 MG TABLET|1000|EA|.0602|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.02541||.0248||.02498|||||2223|||||No|No||TEVA USA|No|||||No|No|No||
famotidine|No|No|No|No|75%|00172572960|FAMOTIDINE 40 MG TABLET|100|EA|.1204|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.04746||.04632||.04665|||||2224|||||No|No||TEVA USA|No|||||No|No|No||
famotidine|No|No|No|No|75%|00172572970|FAMOTIDINE 40 MG TABLET|500|EA|.1204|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.04746||.04632||.04665|||||2225|||||No|No||TEVA USA|No|||||No|No|No||
cyclosporine, modified|No|No|No|No|75%|00172731320|CYCLOSPORINE MODIFIED 100MG/ML|50|ML|2.02779|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||03/08/2006||Yes|No|||Prescription Required|No|01/15/2014|229|No|1.95172||1.90488||1.91854||||IMMUNOSUPPRESSIVES, ORAL|2226|||||No|No||TEVA USA|No|||||Yes|No|No||
bupropion HCl|No|No|No|No|75%|00173013555|WELLBUTRIN SR 150 MG TABLET|60|EA|3.38546|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|7.54015||7.35919||7.41197||||ANTIDEPRESSANTS, OTHER|2227|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
beclomethasone dipropionate|No|No|No|No|75%|00173038879|BECONASE AQ 0.042% SPRAY|25|GM|5.04579|03/01/2002|11/27/2024|Yes|No||03/01/2002|11/27/2024|Yes|No|03/01/2002|11/27/2024|Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|019|No|11.16891||10.90086||10.97904||||INTRANASAL RHINITIS AGENTS|2228|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173047800|IMITREX 6 MG/0.5 ML CARTRIDGES|1|ML|196.5057|06/22/2009||Yes|No||06/22/2009||Yes|No|06/22/2009||Yes|No||||No|No|||Prescription Required|No|07/27/2023|021|Yes|438.25333||427.73525||430.80302||||ANTIMIGRAINE AGENTS, TRIPTANS|2229|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173047900|IMITREX 6 MG/0.5 ML PEN INJECT|1|ML|207.4793|06/26/2009||Yes|No||06/26/2009||Yes|No|06/26/2009||Yes|No||||No|No|||Prescription Required|No|07/27/2023|021|Yes|462.21462||451.12147||454.35697||||ANTIMIGRAINE AGENTS, TRIPTANS|2230|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
epoprostenol sodium (glycine)|No|No|No|No|75%|00173051700|FLOLAN 0.5 MG VIAL|1|EA|8.0367|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|18.3162||18.05454||17.1948|||||2231|||||No|No||GLAXOSMITHKLINE|No|||||Yes|No|Yes|10/23/2018|
epoprostenol sodium (glycine)|No|No|No|No|75%|00173051900|FLOLAN 1.5 MG VIAL|1|EA|19.4102|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|44.2372||43.60524||41.5288|||||2232|||||No|No||GLAXOSMITHKLINE|No|||||No|No|Yes|10/23/2018|
salmeterol xinafoate|No|No|No|No|75%|00173052100|SEREVENT DISKUS 50 MCG|60|EA|3.03479|10/10/2003||Yes|No||10/10/2003||Yes|No|10/10/2003||Yes|No||||No|No|||Prescription Required|No|07/27/2023|037|Yes|6.76348||6.60116||6.6485||||BRONCHODILATORS, BETA AGONIST|2233|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan|No|No|No|No|75%|00173052300|IMITREX 20 MG NASAL SPRAY|6|EA|40.21933|03/25/2009|01/18/2025|Yes|No||03/25/2009|01/18/2025|Yes|No|03/25/2009|01/18/2025|Yes|No||||No|No|||Prescription Required|No|07/29/2021|021|Yes|91.66266||90.3532||86.05066||||ANTIMIGRAINE AGENTS, TRIPTANS|2234|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan|No|No|No|No|75%|00173052400|IMITREX 5 MG NASAL SPRAY|6|EA|40.21933|08/13/2007|01/18/2025|Yes|No||08/13/2007|01/18/2025|Yes|No|08/13/2007|01/18/2025|Yes|No||||No|No|||Prescription Required|No|07/29/2021|021|Yes|91.66266||90.3532||86.05066||||ANTIMIGRAINE AGENTS, TRIPTANS|2235|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173052600|LAMICTAL 5 MG DISPER TABLET|100|EA|3.97376|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|9.05647||8.9271||8.502||||ANTICONVULSANTS|2236|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173052700|LAMICTAL 25 MG DISPER TABLET|100|EA|4.90578|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|10.97043||10.70714||10.78393||||ANTICONVULSANTS|2237|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
atovaquone|No|No|No|No|75%|00173054700|MEPRON 750 MG/5 ML SUSPENSION|5|ML|3.97865|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|6.49847||6.40563||6.1006|||||2238|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00173056504|VALTREX 1 GM CAPLET|30|EA|9.09335|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|11/01/2012||Prescription Required|Yes|05/02/2016|025|No|20.32358||19.83581||19.97808||||ANTIVIRALS, ORAL|2239|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00173056510|VALTREX 1 GM CAPLET|90|EA|9.09349|02/22/2007||Yes|No||02/22/2007||Yes|No|02/22/2007||Yes|No||||No|No|11/01/2012||Prescription Required|Yes|05/02/2016|025|No|20.32358||19.83581||19.97808||||ANTIVIRALS, ORAL|2240|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173059402|LAMICTAL TB START KIT (ORANGE)|49|EA|3.84113|01/11/2005||Yes|No||01/11/2005||Yes|No|01/11/2005||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|8.75419||8.62913||8.21822||||ANTICONVULSANTS|2241|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173060002|FLOVENT 50 MCG DISKUS|60|EA|1.3899|07/02/2007|12/18/2024|Yes|No||07/02/2007|12/18/2024|Yes|No|07/02/2007|12/18/2024|Yes|No||||No|No|||Prescription Required|No|07/27/2023|033|Yes|3.09631||3.022||3.04367||||GLUCOCORTICOIDS, INHALED|2242|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|Yes|09/01/2020|12/18/2024|||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173060102|FLOVENT 250 MCG DISKUS|60|EA|1.96245|07/29/2009|12/18/2024|Yes|No||07/29/2009|12/18/2024|Yes|No|07/29/2009|12/18/2024|Yes|No||||No|No|||Prescription Required|No|07/27/2023|033|Yes|4.37162||4.2667||4.2973||||GLUCOCORTICOIDS, INHALED|2243|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173060202|FLOVENT 100 MCG DISKUS|60|EA|1.46587|07/29/2009|12/18/2024|Yes|No||07/29/2009|12/18/2024|Yes|No|07/29/2009|12/18/2024|Yes|No||||No|No|||Prescription Required|No|07/27/2023|033|Yes|3.26664||3.18824||3.21111||||GLUCOCORTICOIDS, INHALED|2244|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|Yes|09/01/2020|12/18/2024|||No|No|No||
lamotrigine|No|No|No|No|75%|00173063302|LAMICTAL 25 MG TABLET|100|EA|4.48327|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|10.00795||9.76776||9.83781||||ANTICONVULSANTS|2245|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173063310|LAMICTAL TAB START KIT (BLUE)|35|EA|3.97001|06/14/2009||Yes|No||06/14/2009||Yes|No|06/14/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|9.04792||8.91866||8.49396||||ANTICONVULSANTS|2246|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173064255|LAMICTAL 100 MG TABLET|100|EA|4.76917|05/12/2004||Yes|No||05/12/2004||Yes|No|05/12/2004||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|10.62317||10.36821||10.44258||||ANTICONVULSANTS|2247|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173064360|LAMICTAL 150 MG TABLET|60|EA|5.01294|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|11.17163||10.90351||10.98171||||ANTICONVULSANTS|2248|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173064460|LAMICTAL 200 MG TABLET|60|EA|5.27051|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|11.75622||11.47407||11.55636||||ANTICONVULSANTS|2249|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
atovaquone|No|No|No|No|75%|00173066518|MEPRON 750 MG/5 ML SUSPENSION|210|ML|4.30285|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|7.02799||6.92759||6.59771|||||2250|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
atovaquone/proguanil HCl|No|No|No|No|75%|00173067501|MALARONE 250-100 MG TABLET|100|EA|2.89381|04/29/2009||Yes|No||04/29/2009||Yes|No|04/29/2009||Yes|No||||No|No|||Prescription Required|No|||No|6.6105||6.45185||6.49812|||||2251|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
atovaquone/proguanil HCl|No|No|No|No|75%|00173067502|MALARONE 250-100 MG TABLET|24|EA|2.95266|04/29/2009||Yes|No||04/29/2009||Yes|No|04/29/2009||Yes|No||||No|No|||Prescription Required|No|||No|6.6105||6.45185||6.49812|||||2252|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
atovaquone/proguanil HCl|No|No|No|No|75%|00173067601|MALARONE 62.5-25 MG PED TAB   |100|EA|1.07036|04/29/2009||Yes|No||04/29/2009||Yes|No|04/29/2009||Yes|No||||No|No|||Prescription Required|No|||No|2.43942||2.40457||2.29006|||||2253|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
zanamivir|No|No|No|No|75%|00173068101|RELENZA 5 MG DISKHALER        |20|EA|1.2685|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|025|No|2.8319||2.76393||2.78376||||ANTIVIRALS, ORAL|2254|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00173068220|VENTOLIN HFA 90 MCG INHALER|18|GM|1.36214|07/14/2006||Yes|No||07/14/2006||Yes|No|07/14/2006||Yes|No||||No|No|||Prescription Required|No|07/29/2021|037|No|3.03947||2.96652||2.9878||||BRONCHODILATORS, BETA AGONIST|2255|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00173068224|VENTOLIN HFA 90 MCG INHALER|8|GM|1.2212|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription Required|No|07/29/2021|037|No|2.72174||2.65642||2.67547||||BRONCHODILATORS, BETA AGONIST|2256|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173069500|ADVAIR 100-50 DISKUS|60|EA|1.11793|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|02/23/2004|033|Yes|2.49405||2.43419||2.45165||||GLUCOCORTICOIDS, INHALED|2257|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173069600|ADVAIR 250-50 DISKUS|60|EA|1.40309|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|02/23/2004|033|Yes|3.13045||3.05532||3.07723||||GLUCOCORTICOIDS, INHALED|2258|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173069700|ADVAIR 500-50 DISKUS|60|EA|1.9011|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|02/23/2004|033|Yes|4.23964||4.13789||4.16757||||GLUCOCORTICOIDS, INHALED|2259|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173071520|ADVAIR HFA 45-21 MCG INHALER|12|GM|8.987|12/18/2008||Yes|No||12/18/2008||Yes|No|12/18/2008||Yes|No||||No|No|||Prescription Required|No|07/22/2008|033|Yes|20.0317||19.55094||19.69116||||GLUCOCORTICOIDS, INHALED|2260|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173071522|ADVAIR HFA 45-21 MCG INHALER|8|GM|9.05741|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription Required|No|07/22/2009|033|Yes|20.64248||20.34758||19.37865||||GLUCOCORTICOIDS, INHALED|2261|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173071620|ADVAIR HFA 115-21 MCG INHALER|12|GM|11.42796|12/18/2008||Yes|No||12/18/2008||Yes|No|12/18/2008||Yes|No||||No|No|||Prescription Required|No|07/22/2008|033|Yes|25.49626||24.88435||25.06282||||GLUCOCORTICOIDS, INHALED|2262|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173071622|ADVAIR HFA 115-21 MCG INHALER|8|GM|8.41026|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription Required|No|07/22/2009|033|Yes|18.74162||18.29182||18.42301||||GLUCOCORTICOIDS, INHALED|2263|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173071720|ADVAIR HFA 230-21 MCG INHALER|12|GM|15.75663|08/27/2010||Yes|No||08/27/2010||Yes|No|08/27/2010||Yes|No||||No|No|||Prescription Required|No|07/22/2008|033|Yes|35.1375||34.2942||34.54016||||GLUCOCORTICOIDS, INHALED|2264|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173071722|ADVAIR HFA 230-21 MCG INHALER|8|GM|13.74656|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription Required|No|07/22/2009|033|Yes|30.61788||29.88305||30.09738||||GLUCOCORTICOIDS, INHALED|2265|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173071820|FLOVENT HFA 44 MCG INHALER|10.6|GM|8.29737|05/04/2007|12/18/2024|Yes|No||05/04/2007|12/18/2024|Yes|No|05/04/2007|12/18/2024|Yes|No||||No|No|||Prescription Required|No|10/03/2014|033|Yes|18.49857||18.0546||18.18409||||GLUCOCORTICOIDS, INHALED|2266|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|Yes|09/01/2020|12/18/2024|||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173071920|FLOVENT HFA 110 MCG INHALER|12|GM|9.81224|03/13/2007|12/18/2024|Yes|No||03/13/2007|12/18/2024|Yes|No|03/13/2007|12/18/2024|Yes|No||||No|No|||Prescription Required|No|10/03/2014|033|Yes|21.87607||21.35104||21.50418||||GLUCOCORTICOIDS, INHALED|2267|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|Yes|09/01/2020|12/18/2024|||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173072020|FLOVENT HFA 220 MCG INHALER|12|GM|15.24099|05/16/2007|12/18/2024|Yes|No||05/16/2007|12/18/2024|Yes|No|05/16/2007|12/18/2024|Yes|No||||No|No|||Prescription Required|No|10/03/2014|033|Yes|33.96662||33.15142||33.38919||||GLUCOCORTICOIDS, INHALED|2268|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GLAXOSMITHKLINE|Yes|09/01/2020|12/18/2024|||No|No|No||
bupropion HCl|No|No|No|No|75%|00173072200|WELLBUTRIN SR 200 MG TABLET|60|EA|6.28667|06/25/2002||Yes|No||06/25/2002||Yes|No|06/25/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|14.03472||13.69789||13.79613||||ANTIDEPRESSANTS, OTHER|2269|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073500|IMITREX 25 MG TABLET|9|EA|14.93676|01/05/2004||Yes|No||01/05/2004||Yes|No|01/05/2004||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|021|No|34.04193||33.55561||31.95773||||ANTIMIGRAINE AGENTS, TRIPTANS|2270|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073601|IMITREX 50 MG TABLET|9|EA|32.55912|01/05/2004||Yes|No||01/05/2004||Yes|No|01/05/2004||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|021|No|73.06816||71.31452||71.826||||ANTIMIGRAINE AGENTS, TRIPTANS|2271|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073701|IMITREX 100 MG TABLET|9|EA|32.55912|07/23/2009||Yes|No||07/23/2009||Yes|No|07/23/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|021|No|72.78022||71.03349||71.54296||||ANTIMIGRAINE AGENTS, TRIPTANS|2272|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073900|IMITREX 4 MG/0.5 ML PEN INJECT|1|ML|207.4793|06/22/2010||Yes|No||06/22/2010||Yes|No|06/22/2010||Yes|No||||No|No|||Prescription Required|No|07/27/2023|021|Yes|472.8598||466.10466||443.9092||||ANTIMIGRAINE AGENTS, TRIPTANS|2273|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073902|IMITREX 4 MG/0.5 ML CARTRIDGES|1|ML|196.5057|09/28/2010||Yes|No||09/28/2010||Yes|No|09/28/2010||Yes|No||||No|No|||Prescription Required|No|07/27/2023|021|Yes|447.8502||441.45234||420.4308||||ANTIMIGRAINE AGENTS, TRIPTANS|2274|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173075400|LAMICTAL XR 25 MG TABLET|30|EA|6.02014|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|13.4205||13.09841||13.19235||||ANTICONVULSANTS|2275|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173075500|LAMICTAL XR 50 MG TABLET|30|EA|12.03885|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|26.85062||26.20621||26.39416||||ANTICONVULSANTS|2276|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173075600|LAMICTAL XR 100 MG TABLET|30|EA|12.89555|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|28.69799||28.00924||28.21012||||ANTICONVULSANTS|2277|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173075700|LAMICTAL XR 200 MG TABLET|30|EA|13.7514|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|30.65001||29.91441||30.12896||||ANTICONVULSANTS|2278|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173075800|LAMICTAL XR START KIT (BLUE)|28|EA|7.52485|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|17.14965||16.90465||16.09967||||ANTICONVULSANTS|2279|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173075900|LAMICTAL XR START KIT (GREEN)|35|EA|17.19717|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|39.19355||38.63364||36.79395||||ANTICONVULSANTS|2280|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173076000|LAMICTAL XR START KIT (ORANGE)|35|EA|8.59902|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|19.59776||19.31779||18.39789||||ANTICONVULSANTS|2281|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173076100|LAMICTAL XR 300 MG TABLET|30|EA|20.62767|04/14/2011||Yes|No||04/14/2011||Yes|No|04/14/2011||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|46.10631||44.99976||45.3225||||ANTICONVULSANTS|2282|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173077202|LAMICTAL ODT 25 MG TABLET|30|EA|5.75813|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|12.75291||12.44684||12.53611||||ANTICONVULSANTS|2283|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173077402|LAMICTAL ODT 50 MG TABLET|30|EA|6.16763|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|13.74833||13.41837||13.51461||||ANTICONVULSANTS|2284|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173077602|LAMICTAL ODT 100 MG TABLET|30|EA|6.57627|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|14.65516||14.30344||14.40602||||ANTICONVULSANTS|2285|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173077702|LAMICTAL ODT 200 MG TABLET|30|EA|7.84764|06/18/2009||Yes|No||06/18/2009||Yes|No|06/18/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|17.46607||17.04688||17.16915||||ANTICONVULSANTS|2286|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173077800|LAMICTAL ODT START KT (ORANGE)|35|EA|8.22479|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|18.74487||18.47709||17.59723||||ANTICONVULSANTS|2287|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173077900|LAMICTAL ODT START KIT (BLUE)|28|EA|7.19728|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|16.40309||16.16876||15.39882||||ANTICONVULSANTS|2288|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173078000|LAMICTAL ODT START KIT (GREEN)|56|EA|10.28069|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|23.4304||23.09568||21.99588||||ANTICONVULSANTS|2289|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173078100|LAMICTAL XR 250 MG TABLET|30|EA|18.75258|03/08/2012||Yes|No||03/08/2012||Yes|No|03/08/2012||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|41.78836||40.78544||41.07796||||ANTICONVULSANTS|2290|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173081728|LAMICTAL TAB START KIT (GREEN)|98|EA|3.63148|05/05/2011||Yes|No||05/05/2011||Yes|No|05/05/2011||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|8.27639||8.15816||7.76968||||ANTICONVULSANTS|2291|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173085910|BREO ELLIPTA 100-25 MCG INHALR|60|EA|2.91841|10/25/2013||Yes|No||10/25/2013||Yes|No|10/25/2013||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|033|Yes|6.51258||6.35628||6.40187||||GLUCOCORTICOIDS, INHALED|2292|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173085914|BREO ELLIPTA 100-25 MCG INHALR|28|EA|2.40923|10/25/2013||Yes|No||10/25/2013||Yes|No|10/25/2013||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|033|Yes|5.35327||5.22479||5.26226||||GLUCOCORTICOIDS, INHALED|2293|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
umeclidinium brm/vilanterol tr|No|No|No|No|75%|00173086910|ANORO ELLIPTA 62.5-25 MCG INH|60|EA|3.40302|06/30/2014||Yes|No||06/30/2014||Yes|No|06/30/2014||Yes|No||||No|No|||Prescription Required|No|07/29/2021|098|Yes|7.59321||7.41097||7.46413||||COPD AGENTS|2294|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
umeclidinium bromide|No|No|No|No|75%|00173087310|INCRUSE ELLIPTA 62.5 MCG INH|30|EA|5.07543|03/18/2015||Yes|No||03/18/2015||Yes|No|03/18/2015||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|098|No|11.32387||11.0521||11.13136||||COPD AGENTS|2295|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone furoate|No|No|No|No|75%|00173087410|ARNUITY ELLIPTA 100 MCG INH|30|EA|2.98835|03/18/2015||Yes|No||03/18/2015||Yes|No|03/18/2015||Yes|No||||No|No|||Prescription Required|Yes|09/18/2020|033|Yes|6.66811||6.50808||6.55475||||GLUCOCORTICOIDS, INHALED|2296|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone furoate|No|No|No|No|75%|00173087610|ARNUITY ELLIPTA 200 MCG INH|30|EA|4.001|03/18/2015||Yes|No||03/18/2015||Yes|No|03/18/2015||Yes|No||||No|No|||Prescription Required|Yes|09/18/2020|033|Yes|8.92528||8.71107||8.77355||||GLUCOCORTICOIDS, INHALED|2297|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173088210|BREO ELLIPTA 200-25 MCG INHALR|60|EA|2.91841|07/16/2015||Yes|No||07/16/2015||Yes|No|07/16/2015||Yes|No||||No|No|||Prescription Required|Yes|07/23/2015|033|Yes|6.51198||6.35569||6.40128||||GLUCOCORTICOIDS, INHALED|2298|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/umeclidin/vilanter|No|No|No|No|75%|00173088710|TRELEGY ELLIPTA 100-62.5-25|60|EA|4.71337|01/30/2018||Yes|No||01/30/2018||Yes|No|01/30/2018||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|033|Yes|10.53262||10.27984||10.35357||||GLUCOCORTICOIDS, INHALED|2299|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/umeclidin/vilanter|No|No|No|No|75%|00173088714|TRELEGY ELLIPTA 100-62.5-25|28|EA|4.70696|01/30/2018||Yes|No||01/30/2018||Yes|No|01/30/2018||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|033|Yes|10.49591||10.24401||10.31748||||GLUCOCORTICOIDS, INHALED|2300|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone furoate|No|No|No|No|75%|00173088810|ARNUITY ELLIPTA 50 MCG INH|30|EA|2.98835|11/07/2018||Yes|No||11/07/2018||Yes|No|11/07/2018||Yes|No||||No|No|||Prescription Required|Yes|09/18/2020|033|Yes|6.66972||6.50965||6.55633||||GLUCOCORTICOIDS, INHALED|2301|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
tafenoquine succinate|No|No|No|No|75%|00173088939|KRINTAFEL 150 MG TABLET       |2|EA|6.88|06/03/2019||Yes|No||06/03/2019||Yes|No|06/03/2019||Yes|No||||No|No|||Prescription Required|No|||No|15.68||15.456||14.72|||||2302|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
mepolizumab|No|No|No|No|75%|00173089201|NUCALA 100 MG/ML AUTO-INJECTOR|1|ML|1586.1969|02/04/2020||Yes|No||02/04/2020||Yes|No|02/04/2020||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|206|Yes|3615.0534||3563.40978||3393.7236||||IMMUNOMODULATORS, ASTHMA|2303|||||No|No||GLAXOSMITHKLINE|No|||||No|No|Yes|09/30/2022|
mepolizumab|No|No|No|No|75%|00173089242|NUCALA 100 MG/ML SYRINGE|1|ML|1586.1969|02/04/2020||Yes|No||02/04/2020||Yes|No|02/04/2020||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|206|Yes|3615.0534||3563.40978||3393.7236||||IMMUNOMODULATORS, ASTHMA|2304|||||No|No||GLAXOSMITHKLINE|No|||||No|No|Yes|07/30/2021|
fluticasone/umeclidin/vilanter|No|No|No|No|75%|00173089310|TRELEGY ELLIPTA 200-62.5-25|60|EA|4.71337|04/26/2021||Yes|No||04/26/2021||Yes|No|04/26/2021||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|033|Yes|10.53059||10.27786||10.35157||||GLUCOCORTICOIDS, INHALED|2305|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/umeclidin/vilanter|No|No|No|No|75%|00173089314|TRELEGY ELLIPTA 200-62.5-25|28|EA|4.70696|04/26/2021||Yes|No||04/26/2021||Yes|No|04/26/2021||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|033|Yes|10.53303||10.28024||10.35397||||GLUCOCORTICOIDS, INHALED|2306|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
daprodustat|No|No|No|No|75%|00173089713|JESDUVROQ 1 MG TABLET|30|EA|1.6813|05/10/2024||Yes|No||05/10/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|08/08/2024|038|No|3.8318||3.77706||3.5972||||ERYTHROPOIESIS STIMULATING PROTEINS|2307|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
daprodustat|No|No|No|No|75%|00173090313|JESDUVROQ 2 MG TABLET|30|EA|3.3626|05/10/2024||Yes|No||05/10/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|08/08/2024|038|No|7.6636||7.55412||7.1944||||ERYTHROPOIESIS STIMULATING PROTEINS|2308|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
mepolizumab|No|No|No|No|75%|00173090442|NUCALA 40 MG/0.4 ML SYRINGE|0.4|ML|1586.2055|05/08/2024||Yes|No||05/08/2024||Yes|No|07/01/2024||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|206|Yes|3615.073||3563.4291||3393.742||||IMMUNOMODULATORS, ASTHMA|2309|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
daprodustat|No|No|No|No|75%|00173090613|JESDUVROQ 4 MG TABLET|30|EA|6.7252|05/16/2024||Yes|No||05/16/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|08/08/2024|038|No|15.3272||15.10824||14.3888||||ERYTHROPOIESIS STIMULATING PROTEINS|2310|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
niraparib tosylate|No|No|No|No|75%|00173090913|ZEJULA 100 MG TABLET|30|EA|262.68212|08/28/2023||Yes|No||08/28/2023||Yes|No|08/28/2023||Yes|No||||No|No|||Prescription Required|No|08/08/2024|239|No|598.67089||590.11845||562.01757||||ONCOLOGY, ORAL - OTHER|2311|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
daprodustat|No|No|No|No|75%|00173091113|JESDUVROQ 6 MG TABLET|30|EA|10.0878|05/10/2024||Yes|No||05/10/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|08/08/2024|038|No|22.9908||22.66236||21.5832||||ERYTHROPOIESIS STIMULATING PROTEINS|2312|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
niraparib tosylate|No|No|No|No|75%|00173091213|ZEJULA 200 MG TABLET|30|EA|262.68212|08/28/2023||Yes|No||08/28/2023||Yes|No|08/28/2023||Yes|No||||No|No|||Prescription Required|No|08/08/2024|239|No|598.67089||590.11845||562.01757||||ONCOLOGY, ORAL - OTHER|2313|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
daprodustat|No|No|No|No|75%|00173091413|JESDUVROQ 8 MG TABLET|30|EA|13.4504|05/10/2024||Yes|No||05/10/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|08/08/2024|038|No|30.6544||30.21648||28.7776||||ERYTHROPOIESIS STIMULATING PROTEINS|2314|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
niraparib tosylate|No|No|No|No|75%|00173091513|ZEJULA 300 MG TABLET|30|EA|262.68212|08/28/2023||Yes|No||08/28/2023||Yes|No|08/28/2023||Yes|No||||No|No|||Prescription Required|No|08/08/2024|239|No|598.67089||590.11845||562.01757||||ONCOLOGY, ORAL - OTHER|2315|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173091610|BREO ELLIPTA 50-25 MCG INHALER|60|EA|2.91841|02/12/2024||Yes|No||02/12/2024||Yes|No|02/12/2024||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|033|No|6.50558||6.34945||6.39499||||GLUCOCORTICOIDS, INHALED|2316|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
valacyclovir HCl|No|No|No|No|75%|00173093308|VALTREX 500 MG CAPLET|30|EA|5.77346|02/21/2003||Yes|No||02/21/2003||Yes|No|02/21/2003||Yes|No||||No|No|||Prescription Required|Yes|05/02/2016|025|No|12.90005||12.59045||12.68075||||ANTIVIRALS, ORAL|2317|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
valacyclovir HCl|No|No|No|No|75%|00173093310|VALTREX 500 MG CAPLET|90|EA|5.77299|02/22/2007||Yes|No||02/22/2007||Yes|No|02/22/2007||Yes|No||||No|No|||Prescription Required|Yes|05/02/2016|025|No|12.90005||12.59045||12.68075||||ANTIVIRALS, ORAL|2318|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00173094755|WELLBUTRIN SR 100 MG TABLET|60|EA|3.15878|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|031|No|7.03427||6.86545||6.91469||||ANTIDEPRESSANTS, OTHER|2319|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
iron carb,gl/FA/B12/C/docusate|No|No|No|No|75%|00178008990|FERRALET 90 TABLET            |90|EA|.97505|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Over The Counter|No|08/27/2011|506|No|.||.||.||||IRON, ORAL|2320|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
zinc oxide|No|No|No|No|75%|00178033002|DR. SMITH'S DIAPER 10% OINTMNT|56.7|GM|.02169|03/24/2010||Yes|No||||No|No|03/24/2010||Yes|No||||No|No|||Over The Counter|No|||No|.04943||.04873||.0464|||||2321|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
zinc oxide|No|No|No|No|75%|00178033003|DR. SMITH'S DIAPER 10% OINTMNT|85|GM|.02403|11/02/2010||Yes|No||||No|No|11/02/2010||Yes|No||||No|No|||Over The Counter|No|||No|.05476||.05398||.05141|||||2322|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
hydrocortisone|No|No|No|No|75%|00178045501|TEXACORT 2.5% SOLUTION        |30|ML|2.92729|06/06/2012||Yes|No||06/06/2012||Yes|No|06/06/2012||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|118|No|6.35367||6.20118||6.24566||||STEROIDS, TOPICAL LOW|2323|||||No|No||MISSION PHARM.|No|||||No|No|No||
acetohydroxamic acid|No|No|No|No|75%|00178050001|LITHOSTAT 250 MG TABLET|100|EA|2.9885|01/04/2005||Yes|No||01/04/2005||Yes|No|01/04/2005||Yes|No||||No|No|||Prescription Required|No|||No|6.67294||6.51279||6.5595|||||2324|||||No|No||MISSION PHARM.|No|||||No|No|No||
potassium citrate|No|No|No|No|75%|00178060001|UROCIT-K SR 5 MEQ TABLET|100|EA|.65627|01/04/2005||Yes|No||01/04/2005||Yes|No|01/04/2005||Yes|No||||No|No|||Prescription Required|No|||No|1.49568||1.47431||1.4041|||||2325|||||No|No||MISSION PHARM.|No|||||No|No|No||
potassium citrate|No|No|No|No|75%|00178061001|UROCIT-K SR 10 MEQ TABLET|100|EA|.91981|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|2.09632||2.06637||1.96797|||||2326|||||No|No||MISSION PHARM.|No|||||No|No|No||
potassium citrate|No|No|No|No|75%|00178061501|UROCIT-K ER 15 MEQ TABLET|100|EA|1.56607|02/24/2010||Yes|No||02/24/2010||Yes|No|02/24/2010||Yes|No||||No|No|||Prescription Required|No|||No|3.56919||3.5182||3.35067|||||2327|||||No|No||MISSION PHARM.|No|||||No|No|No||
PNV59/iron,carb,fum/FA/dss/dha|No|No|No|No|75%|00178079630|CITRANATAL HARMONY CAPSULE    |30|EA|1.73863|05/15/2014||Yes|No||05/15/2014||Yes|No|05/15/2014||Yes|No||||No|No|||Prescription Required|Yes|09/07/2023|243|No|3.8871||3.79381||3.82102||||PRENATAL VITAMINS|2328|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
iron carb,gl/FA/B12/C/docusate|No|No|No|No|75%|00178081330|CITRANATAL BLOOM TABLET       |30|EA|1.78679|02/27/2018||Yes|No||02/27/2018||Yes|No|02/27/2018||Yes|No||||No|No|||Prescription Required|Yes|04/26/2020|506|No|3.96789||3.87266||3.90044||||IRON, ORAL|2329|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
PNV72/iron,gluc/folic/dss/dha|No|No|No|No|75%|00178082130|CITRANATAL 90 DHA COMBO PACK  |60|EA|.89763|05/15/2014||Yes|No||05/15/2014||Yes|No|05/15/2014||Yes|No||||No|No|||Prescription Required|Yes|09/07/2023|243|No|2.00336||1.95528||1.9693||||PRENATAL VITAMINS|2330|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
prenatal 48/iron/folic acid/B6|No|No|No|No|75%|00178083230|CITRANATAL B-CALM COMBO PACK  |90|EA|.52336|12/21/2012||Yes|No||12/21/2012||Yes|No|12/21/2012||Yes|No||||No|No|||Over The Counter|Yes|07/29/2021|243|Yes|1.16334||1.13542||1.14356||||PRENATAL VITAMINS|2331|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
PNV73/iron,gluc/folic/dss/dha|No|No|No|No|75%|00178089130|CITRANATAL ASSURE COMBO PACK  |60|EA|.86652|05/29/2014||Yes|No||05/29/2014||Yes|No|05/29/2014||Yes|No||||No|No|||Prescription Required|Yes|09/07/2023|243|No|1.94141||1.89482||1.90841||||PRENATAL VITAMINS|2332|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
mv-min102/iron carb,fum/FA/dha|No|No|No|No|75%|00178089630|CITRANATAL MEDLEY SOFTGEL|30|EA|1.79166|08/01/2023||Yes|No||||No|No|08/01/2023||Yes|No||||No|No|||Over The Counter|No|||No|3.94917||3.85439||3.88203|||||2333|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
tiopronin|No|No|No|No|75%|00178090001|THIOLA 100 MG TABLET          |100|EA|12.12996|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|27.64502||27.25009||25.95246|||||2334|||||No|No||TRAVERE THERAPE|No|||||No|No|Yes|06/17/2019|
tiopronin|No|No|No|No|75%|00178090190|THIOLA EC 300 MG TABLET|90|EA|36.38985|11/20/2019||Yes|No||11/20/2019||Yes|No|11/20/2019||Yes|No||||No|No|||Prescription Required|No|||No|82.935||81.75021||77.85735|||||2335|||||No|No||TRAVERE THERAPE|No|||||No|No|Yes|07/30/2021|
tiopronin|No|No|No|No|75%|00178090201|THIOLA EC 100 MG TABLET|300|EA|12.12996|11/20/2019||Yes|No||11/20/2019||Yes|No|11/20/2019||Yes|No||||No|No|||Prescription Required|No|||No|27.64502||27.25009||25.95246|||||2336|||||No|No||TRAVERE THERAPE|No|||||No|No|Yes|07/30/2021|
orphenadrine citrate|No|No|No|No|75%|00185002201|ORPHENADRINE ER 100 MG TABLET|100|EA|.40227|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|116|Yes|.40327||.39359||.39641||||SKELETAL MUSCLE RELAXANTS|2337|||||No|No||SANDOZ|No|||||No|No|No||
naltrexone HCl|No|No|No|No|75%|00185003901|NALTREXONE 50 MG TABLET|100|EA|1.10299|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|145|No|2.5138||2.47789||2.35989||||OPIATE DEPENDENCE TREATMENTS|2338|||||No|No||SANDOZ|Yes|09/01/2020||||No|No|No||
metolazone|No|No|No|No|75%|00185005501|METOLAZONE 5 MG TABLET|100|EA|.29025|08/24/2004||Yes|No||08/24/2004||Yes|No|08/24/2004||Yes|No||08/24/2004||Yes|No|||Prescription Required|No|||No|.22109||.21578||.21733|||||2339|||||No|No||SANDOZ|No|||||No|No|No||
nitrofurantoin monohyd/m-cryst|No|No|No|No|75%|00185012201|NITROFURANTOIN MONO-MCR 100 MG|100|EA|.215|06/02/2005||Yes|No||06/02/2005||Yes|No|06/02/2005||Yes|No||06/02/2005||Yes|No|||Prescription Required|No|||No|.25614||.24999||.25179|||||2340|||||No|No||SANDOZ|No|||||No|No|No||
nitrofurantoin monohyd/m-cryst|No|No|No|No|75%|00185012210|NITROFURANTOIN MONO-MCR 100 MG|1000|EA|.215|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||10/07/2016||Yes|No|||Prescription Required|No|||No|.25614||.24999||.25179|||||2341|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185012801|BUMETANIDE 0.5 MG TABLET|100|EA|.1935|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.13466||.13143||.13237|||||2342|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185012805|BUMETANIDE 0.5 MG TABLET|500|EA|.1935|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.13466||.13143||.13237|||||2343|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185012901|BUMETANIDE 1 MG TABLET|100|EA|.19505|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.1247||.12171||.12258|||||2344|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185012905|BUMETANIDE 1 MG TABLET|500|EA|.19505|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.1247||.12171||.12258|||||2345|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185013001|BUMETANIDE 2 MG TABLET|100|EA|.36185|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.2091||.20408||.20555|||||2346|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185013005|BUMETANIDE 2 MG TABLET|500|EA|.36185|05/11/2003||Yes|No||05/11/2003||Yes|No|05/11/2003||Yes|No||05/11/2003||Yes|No|||Prescription Required|No|||No|.2091||.20408||.20555|||||2347|||||No|No||SANDOZ|No|||||No|No|No||
oxaprozin|No|No|No|No|75%|00185014101|OXAPROZIN 600 MG TABLET|100|EA|.63021|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|059|Yes|.42276||.41261||.41557||||NSAIDS|2348|||||No|No||SANDOZ|No|||||No|No|No||
benazepril/hydrochlorothiazide|No|No|No|No|75%|00185021101|BENAZEPRIL-HCTZ 20-12.5 MG TAB|100|EA|.38472|05/20/2004||Yes|No||05/20/2004||Yes|No|05/20/2004||Yes|No||05/20/2004||Yes|No|||Prescription Required|Yes|07/27/2017|113|Yes|.15033||.14672||.14777||||ANGIOTENSIN MODULATORS|2349|||||No|No||SANDOZ|No|||||No|No|No||
benazepril/hydrochlorothiazide|No|No|No|No|75%|00185023601|BENAZEPRIL-HCTZ 5-6.25 MG TAB|100|EA|.38472|06/04/2015||Yes|No||06/04/2015||Yes|No|06/04/2015||Yes|No||06/04/2015||Yes|No|||Prescription Required|Yes|07/27/2017|113|Yes|.45128||.44045||.44361||||ANGIOTENSIN MODULATORS|2350|||||No|No||SANDOZ|No|||||No|No|No||
benazepril/hydrochlorothiazide|No|No|No|No|75%|00185027701|BENAZEPRIL-HCTZ 20-25 MG TAB|100|EA|.38472|05/20/2004||Yes|No||05/20/2004||Yes|No|05/20/2004||Yes|No||05/20/2004||Yes|No|||Prescription Required|Yes|07/27/2017|113|Yes|.2044||.19949||.20093||||ANGIOTENSIN MODULATORS|2351|||||No|No||SANDOZ|No|||||No|No|No||
benazepril/hydrochlorothiazide|No|No|No|No|75%|00185032501|BENAZEPRIL-HCTZ 10-12.5 MG TAB|100|EA|.38472|12/03/2014||Yes|No||12/03/2014||Yes|No|12/03/2014||Yes|No||12/03/2014||Yes|No|||Prescription Required|Yes|07/27/2017|113|Yes|.13985||.13649||.13747||||ANGIOTENSIN MODULATORS|2352|||||No|No||SANDOZ|No|||||No|No|No||
metaxalone|No|No|No|No|75%|00185044801|METAXALONE 800 MG TABLET|100|EA|1.75259|02/26/2016||Yes|No||02/26/2016||Yes|No|02/26/2016||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|116|No|.44348||.43284||.43594||||SKELETAL MUSCLE RELAXANTS|2353|||||No|No||SANDOZ|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00185067401|HYDROXYZINE PAM 25 MG CAP|100|EA|.03298|10/23/2014||Yes|No||10/23/2014||Yes|No|10/23/2014||Yes|No||10/23/2014||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.05412||.05282||.0532||||ANTIHISTAMINES, FIRST GENERATION|2354|||||No|No||SANDOZ|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00185067405|HYDROXYZINE PAM 25 MG CAP|500|EA|.03199|10/23/2014||Yes|No||10/23/2014||Yes|No|10/23/2014||Yes|No||10/23/2014||Yes|No|||Prescription Required|No|03/09/2018|574|Yes|.05412||.05282||.0532||||ANTIHISTAMINES, FIRST GENERATION|2355|||||No|No||SANDOZ|No|||||No|No|No||
etodolac|No|No|No|No|75%|00185067501|ETODOLAC 400 MG TABLET|100|EA|.45537|10/07/2016|07/31/2025|Yes|No||10/07/2016|07/31/2025|Yes|No|10/07/2016|07/31/2025|Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|059|Yes|.22211||.21678||.21833||||NSAIDS|2356|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||SANDOZ|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00185067601|HYDROXYZINE PAM 50 MG CAP|100|EA|.04506|02/01/2022||Yes|No||02/01/2022||Yes|No|02/01/2022||Yes|No||02/01/2022||Yes|No|||Prescription Required|No|01/28/2021|574|Yes|.06972||.06805||.06853||||ANTIHISTAMINES, FIRST GENERATION|2357|||||No|No||SANDOZ|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00185067605|HYDROXYZINE PAM 50 MG CAP|500|EA|.04371|02/01/2022||Yes|No||02/01/2022||Yes|No|02/01/2022||Yes|No||02/01/2022||Yes|No|||Prescription Required|No|01/28/2021|574|Yes|.06972||.06805||.06853||||ANTIHISTAMINES, FIRST GENERATION|2358|||||No|No||SANDOZ|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00185084201|DEXTROAMP-AMPHETAMIN 10 MG TAB|100|EA|.1603|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||||No|No|||Prescription Required|No|07/23/2015|007|Yes|.19746||.19272||.1941||||STIMULANTS AND RELATED AGENTS|2359|||||No|No||SANDOZ|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00185085301|DEXTROAMP-AMPHETAMIN 20 MG TAB|100|EA|.1603|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||||No|No|||Prescription Required|No|07/23/2015|007|Yes|.34197||.33376||.33616||||STIMULANTS AND RELATED AGENTS|2360|||||No|No||SANDOZ|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00185209801|DEXTROAMP-AMPHETAMINE 5 MG TAB|100|EA|.1603|03/30/2022||Yes|No||03/30/2022||Yes|No|03/30/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|.23184||.22628||.2279||||STIMULANTS AND RELATED AGENTS|2361|||||No|No||SANDOZ|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00185209901|DEXTROAMP-AMPHETAMIN 30 MG TAB|100|EA|.1603|03/30/2022||Yes|No||03/30/2022||Yes|No|03/30/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|007|Yes|.25597||.24983||.25162||||STIMULANTS AND RELATED AGENTS|2362|||||No|No||SANDOZ|No|||||No|No|No||
metolazone|No|No|No|No|75%|00185505001|METOLAZONE 2.5 MG TABLET|100|EA|.25155|08/24/2004||Yes|No||08/24/2004||Yes|No|08/24/2004||Yes|No||08/24/2004||Yes|No|||Prescription Required|No|||No|.18326||.17886||.18014|||||2363|||||No|No||SANDOZ|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00185536830|EPLERENONE 25 MG TABLET|30|EA|1.49267|04/06/2010||Yes|No||04/06/2010||Yes|No|04/06/2010||Yes|No||||No|No|||Prescription Required|No|||No|3.4019||3.3533||3.19362|||||2364|||||No|No||SANDOZ|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00185536930|EPLERENONE 50 MG TABLET|30|EA|1.49281|04/06/2010||Yes|No||04/06/2010||Yes|No|04/06/2010||Yes|No||||No|No|||Prescription Required|No|||No|3.40223||3.35362||3.19393|||||2365|||||No|No||SANDOZ|No|||||No|No|No||
metolazone|No|No|No|No|75%|00185560001|METOLAZONE 10 MG TABLET|100|EA|.387|08/24/2004||Yes|No||08/24/2004||Yes|No|08/24/2004||Yes|No||08/24/2004||Yes|No|||Prescription Required|No|||No|.42215||.41202||.41497|||||2366|||||No|No||SANDOZ|No|||||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00186037020|SYMBICORT 160-4.5 MCG INHALER|10.2|GM|9.87651|06/25/2007||Yes|No||06/25/2007||Yes|No|06/25/2007||Yes|No||||No|No|||Prescription Required|No|08/01/2016|033|Yes|22.04934||21.52016||21.6745||||GLUCOCORTICOIDS, INHALED|2367|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00186037220|SYMBICORT 80-4.5 MCG INHALER|10.2|GM|8.64089|06/25/2007||Yes|No||06/25/2007||Yes|No|06/25/2007||Yes|No||||No|No|||Prescription Required|No|08/01/2016|033|Yes|19.29162||18.82862||18.96366||||GLUCOCORTICOIDS, INHALED|2368|||||No|No||ASTRAZENECA|No|||||No|No|No||
ticagrelor|No|No|No|No|75%|00186077660|BRILINTA 60 MG TABLET|60|EA|3.23367|07/13/2016||Yes|No||07/13/2016||Yes|No|07/13/2016||Yes|No||||No|No|||Prescription Required|No|07/23/2015|004|No|7.2142||7.04106||7.09156||||PLATELET AGGREGATION INHIBITORS|2369|||||No|No||ASTRAZENECA|No|||||No|No|No||
ticagrelor|No|No|No|No|75%|00186077760|BRILINTA 90 MG TABLET|60|EA|3.23367|09/05/2011||Yes|No||09/05/2011||Yes|No|09/05/2011||Yes|No||||No|No|||Prescription Required|No|07/24/2013|004|No|7.21287||7.03976||7.09025||||PLATELET AGGREGATION INHIBITORS|2370|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide|No|No|No|No|75%|00186091612|PULMICORT 180 MCG FLEXHALER|1|EA|113.778|06/07/2007||Yes|No||06/07/2007||Yes|No|06/07/2007||Yes|No||||No|No|||Prescription Required|No|07/28/2022|033|No|253.29118||247.21219||248.98523||||GLUCOCORTICOIDS, INHALED|2371|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide|No|No|No|No|75%|00186091706|PULMICORT 90 MCG FLEXHALER|1|EA|84.968|05/02/2007||Yes|No||05/02/2007||Yes|No|05/02/2007||Yes|No||||No|No|||Prescription Required|No|07/28/2022|033|No|189.65345||185.10177||186.42934||||GLUCOCORTICOIDS, INHALED|2372|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide|No|No|No|No|75%|00186198804|PULMICORT 0.25 MG/2 ML RESPUL|2|ML|1.87379|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|Yes|4.18512||4.08468||4.11397||||GLUCOCORTICOIDS, INHALED|2373|||||No|No||ASTRAZENECA|No|||||Yes|No|No||
budesonide|No|No|No|No|75%|00186198904|PULMICORT 0.5 MG/2 ML RESPULE|2|ML|2.20532|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|Yes|4.91827||4.80023||4.83466||||GLUCOCORTICOIDS, INHALED|2374|||||No|No||ASTRAZENECA|No|||||Yes|No|No||
budesonide|No|No|No|No|75%|00186199004|PULMICORT 1 MG/2 ML RESPULE|2|ML|4.41094|10/25/2007||Yes|No||10/25/2007||Yes|No|10/25/2007||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|Yes|9.86075||9.62409||9.69312||||GLUCOCORTICOIDS, INHALED|2375|||||No|No||ASTRAZENECA|No|||||Yes|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186401001|NEXIUM DR 10 MG PACKET|30|EA|4.11768|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|No|08/04/2012|047|No|9.1904||8.96983||9.03416||||PROTON PUMP INHIBITORS|2376|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186402001|NEXIUM DR 20 MG PACKET|30|EA|4.11768|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|No|08/04/2012|047|No|9.18108||8.96073||9.025||||PROTON PUMP INHIBITORS|2377|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186402501|NEXIUM DR 2.5 MG PACKET|30|EA|4.11768|08/06/2014||Yes|No||08/06/2014||Yes|No|08/06/2014||Yes|No||||No|No|||Prescription Required|No|07/26/2012|047|No|9.20289||8.98202||9.04644||||PROTON PUMP INHIBITORS|2378|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186404001|NEXIUM DR 40 MG PACKET|30|EA|4.11768|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|No|08/04/2012|047|No|9.17312||8.95297||9.01718||||PROTON PUMP INHIBITORS|2379|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186405001|NEXIUM DR 5 MG PACKET|30|EA|4.11768|08/06/2014||Yes|No||08/06/2014||Yes|No|08/06/2014||Yes|No||||No|No|||Prescription Required|No|07/26/2012|047|No|9.18869||8.96816||9.03248||||PROTON PUMP INHIBITORS|2380|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186502031|NEXIUM DR 20 MG CAPSULE|30|EA|3.94611|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|047|Yes|8.82343||8.61167||8.67343||||PROTON PUMP INHIBITORS|2381|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186502054|NEXIUM DR 20 MG CAPSULE|90|EA|3.94592|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|047|Yes|8.82343||8.61167||8.67343||||PROTON PUMP INHIBITORS|2382|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186504031|NEXIUM DR 40 MG CAPSULE|30|EA|3.94611|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|047|Yes|8.81004||8.5986||8.66027||||PROTON PUMP INHIBITORS|2383|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186504054|NEXIUM DR 40 MG CAPSULE|90|EA|3.94592|08/31/2009||Yes|No||08/31/2009||Yes|No|08/31/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|047|Yes|8.81004||8.5986||8.66027||||PROTON PUMP INHIBITORS|2384|||||No|No||ASTRAZENECA|No|||||No|No|No||
halobetasol propionate|No|No|No|No|75%|00187000201|BRYHALI 0.01% LOTION|100|GM|2.2999|03/04/2019||Yes|No||03/04/2019||Yes|No|03/04/2019||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|121|No|5.1097||4.98707||5.02284||||STEROIDS, TOPICAL VERY HIGH|2385|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
halobetasol propionate|No|No|No|No|75%|00187000260|BRYHALI 0.01% LOTION|60|GM|2.29992|03/04/2019||Yes|No||03/04/2019||Yes|No|03/04/2019||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|121|No|5.16226||5.03837||5.0745||||STEROIDS, TOPICAL VERY HIGH|2386|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
brodalumab|No|No|No|No|75%|00187000402|SILIQ 210 MG/1.5 ML SYRINGE|1.5|ML|748.2043|07/09/2018||Yes|No||07/09/2018||Yes|No|07/09/2018||Yes|No||||No|No|||Prescription Required|Yes|02/01/2018|071|Yes|1705.2098||1680.84966||1600.8092||||CYTOKINE AND CAM ANTAGONISTS|2387|||||No|No||BAUSCH HEALTH U|No|||||No|No|Yes|07/30/2021|
tretinoin|No|No|No|No|75%|00187000520|ALTRENO 0.05% LOTION          |20|GM|1.075|03/03/2020||Yes|No||03/03/2020||Yes|No|03/03/2020||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|104|No|2.39853||2.34097||2.35775||||ACNE AGENTS, TOPICAL|2388|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00187000545|ALTRENO 0.05% LOTION|45|GM|1.09889|05/16/2019||Yes|No||05/16/2019||Yes|No|05/16/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|104|No|2.44804||2.38929||2.40642||||ACNE AGENTS, TOPICAL|2389|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
adapalene/benzoyl/clindamycin|No|No|No|No|75%|00187000625|CABTREO 1.2%-0.15%-3.15% GEL|50|GM|8.17|09/09/2024||Yes|No||09/09/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|08/08/2024|104|No|18.16403||17.72809||17.85524||||ACNE AGENTS, TOPICAL|2390|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
enalapril maleate|No|No|No|No|75%|00187014090|VASOTEC 2.5 MG TABLET|90|EA|7.56494|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/26/2012|113|No|17.24102||16.99472||16.18545||||ANGIOTENSIN MODULATORS|2391|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
enalapril/hydrochlorothiazide|No|No|No|No|75%|00187014601|VASERETIC 10-25 MG TABLET     |100|EA|5.60505|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|113|Yes|12.7743||12.59181||11.9922||||ANGIOTENSIN MODULATORS|2392|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
isosorbide dinitrate|No|No|No|No|75%|00187015201|ISORDIL TITRADOSE 5 MG TAB|100|EA|3.94301|12/19/2022||Yes|No||12/19/2022||Yes|No|12/19/2022||Yes|No||||No|No|||Prescription Required|No|||No|8.9864||8.85803||8.43622|||||2393|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
isosorbide dinitrate|No|No|No|No|75%|00187019201|ISORDIL 40 MG TABLET          |100|EA|8.68002|12/19/2022||Yes|No||12/19/2022||Yes|No|12/19/2022||Yes|No||||No|No|||Prescription Required|No|||No|19.78238||19.49977||18.57121|||||2394|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
dihydroergotamine mesylate|No|No|No|No|75%|00187024503|MIGRANAL NASAL SPRAY|1|ML|205.48249|03/30/2009||Yes|No||03/30/2009||Yes|No|03/30/2009||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|537|Yes|468.30893||461.6188||439.63695||||ANTIMIGRAINE AGENTS, OTHER|2395|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
selegiline HCl|No|No|No|No|75%|00187045302|ZELAPAR 1.25 MG ODT TABLET|60|EA|41.04974|09/21/2006||Yes|No||09/21/2006||Yes|No|09/21/2006||Yes|No||||No|No|||Prescription Required|Yes|07/17/2007|015|No|93.55521||92.21871||87.82734||||ANTIPARKINSON'S AGENTS|2396|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
halobetasol propion/tazarotene|No|No|No|No|75%|00187065301|DUOBRII 0.01%-0.045% LOTION|100|GM|4.46684|09/06/2019||Yes|No||09/06/2019||Yes|No|09/06/2019||Yes|No||||No|No|||Prescription Required|No|||No|9.91729||9.67928||9.7487|||||2397|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00187073030|WELLBUTRIN XL 150 MG TABLET|30|EA|28.6261|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|031|No|63.82825||62.29637||62.74317||||ANTIDEPRESSANTS, OTHER|2398|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00187073090|WELLBUTRIN XL 150 MG TABLET|90|EA|28.62782|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|031|No|63.82825||62.29637||62.74317||||ANTIDEPRESSANTS, OTHER|2399|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00187073130|WELLBUTRIN XL 300 MG TABLET|30|EA|37.78768|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||||No|No|||Prescription Required|Yes|07/26/2012|031|No|84.3114||82.28793||82.87811||||ANTIDEPRESSANTS, OTHER|2400|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187077247|CARDIZEM 60 MG TABLET|100|EA|4.31703|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|9.83881||9.69825||9.23643||||CALCIUM CHANNEL BLOCKERS|2401|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079247|CARDIZEM 120 MG TABLET|100|EA|7.9467|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||||No|No|||Prescription Required|Yes|07/27/2011|045|No|18.11109||17.85236||17.00224||||CALCIUM CHANNEL BLOCKERS|2402|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079530|CARDIZEM CD 120 MG CAPSULE|30|EA|12.23493|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|27.88426||27.48592||26.17706||||CALCIUM CHANNEL BLOCKERS|2403|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079630|CARDIZEM CD 180 MG CAPSULE|30|EA|15.43327|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|35.1735||34.67102||33.02002||||CALCIUM CHANNEL BLOCKERS|2404|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079642|CARDIZEM CD 180 MG CAPSULE|90|EA|14.73151|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|33.57414||33.09451||31.51858||||CALCIUM CHANNEL BLOCKERS|2405|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079730|CARDIZEM CD 240 MG CAPSULE|30|EA|20.92294|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|46.64545||45.52596||45.85248||||CALCIUM CHANNEL BLOCKERS|2406|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079742|CARDIZEM CD 240 MG CAPSULE|90|EA|20.89824|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|46.64545||45.52596||45.85248||||CALCIUM CHANNEL BLOCKERS|2407|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079830|CARDIZEM CD 300 MG CAPSULE|30|EA|27.40633|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||07/13/2012||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|62.46095||61.56865||58.63681||||CALCIUM CHANNEL BLOCKERS|2408|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079942|CARDIZEM CD 360 MG CAPSULE|90|EA|39.98613|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||01/15/2013||Yes|No|||Prescription Required|Yes|07/27/2011|045|No|91.13118||89.82931||85.55172||||CALCIUM CHANNEL BLOCKERS|2409|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
tolcapone|No|No|No|No|75%|00187093801|TASMAR 100 MG TABLET          |90|EA|50.97158|03/01/2005||Yes|No||03/01/2005||Yes|No|||No|No||||No|No|||Prescription Required|Yes|06/09/2004|015|No|116.16778||114.50824||109.05547||||ANTIPARKINSON'S AGENTS|2410|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
acyclovir|No|No|No|No|75%|00187099395|ZOVIRAX 5% OINTMENT           |30|GM|2.15|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription Required|No|01/27/2022|123|No|4.79677||4.68165||4.71522||||ANTIVIRALS, TOPICAL|2411|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
acyclovir|No|No|No|No|75%|00187099445|ZOVIRAX 5% CREAM|5|GM|17.2|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription Required|No|01/27/2022|123|No|38.29123||37.37224||37.64028||||ANTIVIRALS, TOPICAL|2412|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187204690|CARDIZEM LA 180 MG TABLET     |90|EA|1.72817|11/30/2015||Yes|No||11/30/2015||Yes|No|11/30/2015||Yes|No||11/30/2015||Yes|No|||Prescription Required|Yes|01/22/2015|045|No|3.8314||3.73945||3.76627||||CALCIUM CHANNEL BLOCKERS|2413|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
tazarotene|No|No|No|No|75%|00187209845|ARAZLO 0.045% LOTION|45|GM|5.1126|10/26/2020||Yes|No||10/26/2020||Yes|No|10/26/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|No|11.40462||11.13091||11.21074||||ACNE AGENTS, TOPICAL|2414|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
trientine HCl|No|No|No|No|75%|00187212010|SYPRINE 250 MG CAPSULE|100|EA|91.44724|11/30/2015||Yes|No||11/30/2015||Yes|No|11/30/2015||Yes|No||||No|No|||Prescription Required|No|||No|208.41464||205.43729||195.65456|||||2415|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00187301030|MESTINON 60 MG TABLET|100|EA|8.68931|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|19.80355||19.52064||18.59108|||||2416|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00187301220|MESTINON 60 MG/5 ML SOLUTION|473|ML|1.49215|07/10/2002||Yes|No||07/10/2002||Yes|No|07/10/2002||Yes|No||||No|No|||Prescription Required|No|||No|3.40072||3.35214||3.19251|||||2417|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00187301330|MESTINON 180 MG TIMESPAN|30|EA|16.48104|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|36.79113||35.90814||36.16568|||||2418|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
fluorouracil|No|No|No|No|75%|00187320447|EFUDEX 5% CREAM|40|GM|.645|04/13/2009||Yes|No||04/13/2009||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|1.44331||1.40867||1.41877|||||2419|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
flucytosine|No|No|No|No|75%|00187355410|ANCOBON 250 MG CAPSULE        |100|EA|33.04279|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|069|No|75.30683||74.23101||70.6962||||ANTIFUNGALS, ORAL|2420|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
flucytosine|No|No|No|No|75%|00187355510|ANCOBON 500 MG CAPSULE        |100|EA|63.93833|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|03/29/2004|069|No|145.71992||143.63821||136.7983||||ANTIFUNGALS, ORAL|2421|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pimecrolimus|No|No|No|No|75%|00187510001|ELIDEL 1% CREAM|30|GM|4.28638|01/12/2012||Yes|No||01/12/2012||Yes|No|01/12/2012||Yes|No||||No|No|||Prescription Required|No|07/28/2022|034|Yes|9.61029||9.37964||9.44692||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2422|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pimecrolimus|No|No|No|No|75%|00187510102|ELIDEL 1% CREAM|60|GM|4.28646|01/12/2012||Yes|No||01/12/2012||Yes|No|01/12/2012||Yes|No||||No|No|||Prescription Required|No|07/28/2022|034|Yes|9.57441||9.34462||9.41165||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2423|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pimecrolimus|No|No|No|No|75%|00187510203|ELIDEL 1% CREAM|100|GM|4.28637|01/12/2012||Yes|No||01/12/2012||Yes|No|01/12/2012||Yes|No||||No|No|||Prescription Required|No|07/28/2022|034|Yes|9.54463||9.31556||9.38237||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2424|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
acyclovir/hydrocortisone|No|No|No|No|75%|00187510401|XERESE 5%-1% CREAM            |5|GM|105.67594|01/15/2013||Yes|No||01/15/2013||Yes|No|01/15/2013||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|123|Yes|236.48867||230.81294||232.46836||||ANTIVIRALS, TOPICAL|2425|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
tretinoin microspheres|No|No|No|No|75%|00187514650|RETIN-A MICRO PUMP 0.06% GEL|50|GM|7.83744|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|104|No|17.42421||17.00603||17.128||||ACNE AGENTS, TOPICAL|2426|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00187520260|NORITATE 1% CREAM             |60|GM|14.02158|09/26/2024||Yes|No||09/26/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|01/28/2021|221|No|31.30253||30.55127||30.77039||||ROSACEA AGENTS, TOPICAL|2427|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
efinaconazole|No|No|No|No|75%|00187540004|JUBLIA 10% TOPICAL SOLUTION|4|ML|81.7645|12/16/2016||Yes|No||12/16/2016||Yes|No|12/16/2016||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|061|No|182.53745||178.15655||179.43431||||ANTIFUNGALS, TOPICAL|2428|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bexarotene|No|No|No|No|75%|00187552675|TARGRETIN 75 MG CAPSULE       |100|EA|106.96074|04/25/2014||Yes|No||04/25/2014||Yes|No|04/25/2014||Yes|No||||No|No|||Prescription Required|No|||No|243.77098||240.28854||228.84623|||||2429|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HBr|No|No|No|No|75%|00187581030|APLENZIN ER 174 MG TABLET|30|EA|28.99404|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|031|No|64.57372||63.02395||63.47597||||ANTIDEPRESSANTS, OTHER|2430|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HBr|No|No|No|No|75%|00187581130|APLENZIN ER 348 MG TABLET|30|EA|38.22141|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|031|No|85.20619||83.16124||83.75768||||ANTIDEPRESSANTS, OTHER|2431|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HBr|No|No|No|No|75%|00187581230|APLENZIN ER 522 MG TABLET|30|EA|86.98054|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|031|No|194.30358||189.64029||191.00042||||ANTIDEPRESSANTS, OTHER|2432|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00228141003|LAMOTRIGINE ER 25 MG TABLET|30|EA|2.08564|06/28/2016||Yes|No||06/28/2016||Yes|No|06/28/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.22243||.21709||.21865||||ANTICONVULSANTS|2433|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00228142203|LAMOTRIGINE ER 100 MG TABLET|30|EA|4.4677|06/28/2016||Yes|No||06/28/2016||Yes|No|06/28/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.54181||.52881||.5326||||ANTICONVULSANTS|2434|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00228143503|LAMOTRIGINE ER 50 MG TABLET|30|EA|4.17085|06/28/2016||Yes|No||06/28/2016||Yes|No|06/28/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.47304||.46169||.465||||ANTICONVULSANTS|2435|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00228145303|LAMOTRIGINE ER 200 MG TABLET|30|EA|4.76425|06/28/2016||Yes|No||06/28/2016||Yes|No|06/28/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.48766||.47596||.47937||||ANTICONVULSANTS|2436|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00228158003|LAMOTRIGINE ER 300 MG TABLET|30|EA|7.1466|06/28/2016||Yes|No||06/28/2016||Yes|No|06/28/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|.98671||.96303||.96994||||ANTICONVULSANTS|2437|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00228163803|LAMOTRIGINE ER 250 MG TABLET|30|EA|5.23654|05/16/2017||Yes|No||05/16/2017||Yes|No|05/16/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|1.25944||1.22921||1.23803||||ANTICONVULSANTS|2438|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202710|ALPRAZOLAM 0.25 MG TABLET|100|EA|.02064|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.01801||.01758||.0177||||ANXIOLYTICS|2439|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202750|ALPRAZOLAM 0.25 MG TABLET|500|EA|.02064|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.01801||.01758||.0177||||ANXIOLYTICS|2440|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202796|ALPRAZOLAM 0.25 MG TABLET|1000|EA|.02064|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.01801||.01758||.0177||||ANXIOLYTICS|2441|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202910|ALPRAZOLAM 0.5 MG TABLET|100|EA|.02107|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.01867||.01822||.01835||||ANXIOLYTICS|2442|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202950|ALPRAZOLAM 0.5 MG TABLET|500|EA|.0212|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.01867||.01822||.01835||||ANXIOLYTICS|2443|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202996|ALPRAZOLAM 0.5 MG TABLET|1000|EA|.0212|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.01867||.01822||.01835||||ANXIOLYTICS|2444|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228203110|ALPRAZOLAM 1 MG TABLET|100|EA|.02623|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02224||.02171||.02186||||ANXIOLYTICS|2445|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228203150|ALPRAZOLAM 1 MG TABLET|500|EA|.0258|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02224||.02171||.02186||||ANXIOLYTICS|2446|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228203196|ALPRAZOLAM 1 MG TABLET|1000|EA|.0258|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02224||.02171||.02186||||ANXIOLYTICS|2447|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228203910|ALPRAZOLAM 2 MG TABLET|100|EA|.06708|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.04002||.03906||.03934||||ANXIOLYTICS|2448|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
oxazepam|No|No|No|No|90%|00228206710|OXAZEPAM 10 MG CAPSULE|100|EA|.4128|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|.61337||.59865||.60294||||ANXIOLYTICS|2449|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
oxazepam|No|No|No|No|90%|00228206910|OXAZEPAM 15 MG CAPSULE|100|EA|.5212|11/29/2016||Yes|No||11/29/2016||Yes|No|11/29/2016||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|090|Yes|1.06339||1.03787||1.04531||||ANXIOLYTICS|2450|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
oxazepam|No|No|No|No|90%|00228207310|OXAZEPAM 30 MG CAPSULE|100|EA|.75388|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|1.36941||1.33654||1.34613||||ANXIOLYTICS|2451|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
temazepam|No|No|No|No|90%|00228207610|TEMAZEPAM 15 MG CAPSULE|100|EA|.03913|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|06/09/2004|054|Yes|.05478||.05347||.05385||||SEDATIVE HYPNOTICS|2452|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
temazepam|No|No|No|No|90%|00228207650|TEMAZEPAM 15 MG CAPSULE|500|EA|.03754|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|06/09/2004|054|Yes|.05478||.05347||.05385||||SEDATIVE HYPNOTICS|2453|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
temazepam|No|No|No|No|90%|00228207710|TEMAZEPAM 30 MG CAPSULE|100|EA|.0501|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|06/09/2004|054|Yes|.07255||.07081||.07132||||SEDATIVE HYPNOTICS|2454|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
temazepam|No|No|No|No|90%|00228207750|TEMAZEPAM 30 MG CAPSULE|500|EA|.04807|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|06/09/2004|054|Yes|.07255||.07081||.07132||||SEDATIVE HYPNOTICS|2455|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
clonidine HCl|No|No|No|No|75%|00228212710|CLONIDINE HCL 0.1 MG TABLET|100|EA|.01823|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|166|No|.02022||.01973||.01988||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2456|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
clonidine HCl|No|No|No|No|75%|00228212750|CLONIDINE HCL 0.1 MG TABLET|500|EA|.01823|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|166|No|.02022||.01973||.01988||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2457|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
clonidine HCl|No|No|No|No|75%|00228212810|CLONIDINE HCL 0.2 MG TABLET|100|EA|.02494|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|166|No|.0287||.02801||.02821||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2458|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
clonidine HCl|No|No|No|No|75%|00228212850|CLONIDINE HCL 0.2 MG TABLET|500|EA|.02494|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|166|No|.0287||.02801||.02821||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2459|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
clonidine HCl|No|No|No|No|75%|00228212910|CLONIDINE HCL 0.3 MG TABLET|100|EA|.02778|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/15/2014|166|No|.03206||.03129||.03151||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2460|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
propylthiouracil|No|No|No|No|75%|00228234810|PROPYLTHIOURACIL 50 MG TABLET|100|EA|.3225|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|.24328||.23744||.23914|||||2461|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00228249710|NIFEDIPINE 10 MG CAPSULE|100|EA|.36748|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|045|No|.83751||.82554||.78623||||CALCIUM CHANNEL BLOCKERS|2462|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00228253010|NIFEDIPINE 20 MG CAPSULE|100|EA|.79215|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|Yes|01/15/2014|045|No|1.80536||1.77957||1.69482||||CALCIUM CHANNEL BLOCKERS|2463|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228254010|CARBIDOPA-LEVODOPA 25-250 TAB|100|EA|.12539|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|06/09/2004|015|No|.09682||.0945||.09517||||ANTIPARKINSON'S AGENTS|2464|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228254050|CARBIDOPA-LEVODOPA 25-250 TAB|500|EA|.1191|03/01/2002|12/15/2024|Yes|No||03/01/2002|12/15/2024|Yes|No|03/01/2002|12/15/2024|Yes|No||||No|No|||Prescription Required|No|06/09/2004|015|No|.09682||.0945||.09517||||ANTIPARKINSON'S AGENTS|2465|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228254096|CARBIDOPA-LEVODOPA 25-250 TAB|1000|EA|.1191|03/01/2002|02/08/2025|Yes|No||03/01/2002|02/08/2025|Yes|No|03/01/2002|02/08/2025|Yes|No||||No|No|||Prescription Required|No|06/09/2004|015|No|.09682||.0945||.09517||||ANTIPARKINSON'S AGENTS|2466|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255006|DICLOFENAC SOD EC 50 MG TAB|60|EA|.1361|04/17/2007||Yes|No||04/17/2007||Yes|No|04/17/2007||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.07047||.06878||.06927||||NSAIDS|2467|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255011|DICLOFENAC SOD EC 50 MG TAB|100|EA|.1361|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.07047||.06878||.06927||||NSAIDS|2468|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255096|DICLOFENAC SOD EC 50 MG TAB|1000|EA|.13201|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.07047||.06878||.06927||||NSAIDS|2469|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255106|DICLOFENAC SOD EC 75 MG TAB|60|EA|.1677|07/01/2009||Yes|No||07/01/2009||Yes|No|07/01/2009||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.07204||.07031||.07082||||NSAIDS|2470|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255111|DICLOFENAC SOD EC 75 MG TAB|100|EA|.1677|03/03/2004||Yes|No||03/03/2004||Yes|No|03/03/2004||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.07204||.07031||.07082||||NSAIDS|2471|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255196|DICLOFENAC SOD EC 75 MG TAB|1000|EA|.16267|07/01/2009||Yes|No||07/01/2009||Yes|No|07/01/2009||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.07204||.07031||.07082||||NSAIDS|2472|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
indapamide|No|No|No|No|75%|00228257111|INDAPAMIDE 2.5 MG TABLET|100|EA|.1806|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.08987||.08771||.08834|||||2473|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
indapamide|No|No|No|No|75%|00228257196|INDAPAMIDE 2.5 MG TABLET|1000|EA|.17028|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.08987||.08771||.08834|||||2474|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
indapamide|No|No|No|No|75%|00228259711|INDAPAMIDE 1.25 MG TABLET|100|EA|.13691|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.08366||.08165||.08224|||||2475|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
indapamide|No|No|No|No|75%|00228259796|INDAPAMIDE 1.25 MG TABLET|1000|EA|.13418|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.08366||.08165||.08224|||||2476|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
isosorbide mononitrate|No|No|No|No|75%|00228262011|ISOSORBIDE MONONIT 20 MG TAB|100|EA|.21887|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.18467||.18024||.18153|||||2477|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
isosorbide mononitrate|No|No|No|No|75%|00228263111|ISOSORBIDE MONONIT 10 MG TAB|100|EA|.21018|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.22604||.22062||.2222|||||2478|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00228263611|GABAPENTIN 600 MG TABLET|100|EA|.27916|12/15/2004||Yes|No||12/15/2004||Yes|No|12/15/2004||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/29/2021|232|Yes|.06016||.05872||.05914||||NEUROPATHIC PAIN|2479|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00228263650|GABAPENTIN 600 MG TABLET|500|EA|.27916|12/15/2004||Yes|No||12/15/2004||Yes|No|12/15/2004||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/29/2021|232|Yes|.06016||.05872||.05914||||NEUROPATHIC PAIN|2480|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00228263711|GABAPENTIN 800 MG TABLET|100|EA|.33699|12/15/2004||Yes|No||12/15/2004||Yes|No|12/15/2004||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/29/2021|232|Yes|.07994||.07802||.07858||||NEUROPATHIC PAIN|2481|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00228263750|GABAPENTIN 800 MG TABLET|500|EA|.33699|12/15/2004||Yes|No||12/15/2004||Yes|No|12/15/2004||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/29/2021|232|Yes|.07994||.07802||.07858||||NEUROPATHIC PAIN|2482|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00228277811|PROPRANOLOL ER 60 MG CAPSULE|100|EA|.72322|09/26/2007||Yes|No||09/26/2007||Yes|No|09/26/2007||Yes|No||09/26/2007||Yes|No|||Prescription Required|Yes|07/28/2010|070|No|.15186||.14822||.14928||||BETA-BLOCKERS|2483|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00228277911|PROPRANOLOL ER 80 MG CAPSULE|100|EA|.84469|09/26/2007||Yes|No||09/26/2007||Yes|No|09/26/2007||Yes|No||09/26/2007||Yes|No|||Prescription Required|Yes|07/28/2010|070|No|.15892||.15511||.15622||||BETA-BLOCKERS|2484|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00228278011|PROPRANOLOL ER 120 MG CAPSULE|100|EA|1.04782|09/26/2007||Yes|No||09/26/2007||Yes|No|09/26/2007||Yes|No||09/26/2007||Yes|No|||Prescription Required|Yes|07/28/2010|070|No|.1811||.17675||.17802||||BETA-BLOCKERS|2485|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00228278111|PROPRANOLOL ER 160 MG CAPSULE|100|EA|1.37183|09/26/2007||Yes|No||09/26/2007||Yes|No|09/26/2007||Yes|No||09/26/2007||Yes|No|||Prescription Required|Yes|07/28/2010|070|No|.27867||.27198||.27393||||BETA-BLOCKERS|2486|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00228280111|PILOCARPINE HCL 5 MG TABLET|100|EA|.17553|01/07/2005||Yes|No||01/07/2005||Yes|No|01/07/2005||Yes|No||||No|No|||Prescription Required|No|||No|.19978||.19499||.19638|||||2487|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
hydrochlorothiazide|No|No|No|No|75%|00228282011|HYDROCHLOROTHIAZIDE 12.5 MG TB|100|EA|.1204|03/02/2007||Yes|No||03/02/2007||Yes|No|03/02/2007||Yes|No||01/01/2012||Yes|No|||Prescription Required|No|||Yes|.03452||.03369||.03393|||||2488|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
hydrochlorothiazide|No|No|No|No|75%|00228282096|HYDROCHLOROTHIAZIDE 12.5 MG TB|1000|EA|.04584|08/23/2024||Yes|No||08/23/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|.03452||.03369||.03393|||||2489|||||No|No||TEVA USA|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00228283711|PILOCARPINE HCL 7.5 MG TABLET|100|EA|.2798|09/08/2006||Yes|No||09/08/2006||Yes|No|09/08/2006||Yes|No||||No|No|||Prescription Required|No|||No|.34838||.34002||.34246|||||2490|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
fluvoxamine maleate|No|No|No|No|75%|00228284803|FLUVOXAMINE ER 100 MG CAPSULE|30|EA|3.24392|12/16/2014||Yes|No||12/16/2014||Yes|No|12/16/2014||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|008|Yes|4.2469||4.14497||4.1747||||ANTIDEPRESSANTS, SSRIs|2491|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
fluvoxamine maleate|No|No|No|No|75%|00228284903|FLUVOXAMINE ER 150 MG CAPSULE|30|EA|3.48128|12/16/2014||Yes|No||12/16/2014||Yes|No|12/16/2014||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|008|No|4.43941||4.33286||4.36394||||ANTIDEPRESSANTS, SSRIs|2492|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
guanfacine HCl|No|No|No|No|75%|00228285011|GUANFACINE HCL ER 1 MG TABLET|100|EA|.31579|01/13/2015||Yes|No||01/13/2015||Yes|No|01/13/2015||Yes|No||01/13/2015||Yes|No|||Prescription Required|No|10/01/2015|007|Yes|.15264||.14898||.15005||||STIMULANTS AND RELATED AGENTS|2493|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
guanfacine HCl|No|No|No|No|75%|00228285111|GUANFACINE HCL ER 2 MG TABLET|100|EA|.31579|01/13/2015||Yes|No||01/13/2015||Yes|No|01/13/2015||Yes|No||01/13/2015||Yes|No|||Prescription Required|No|10/01/2015|007|Yes|.17048||.16639||.16758||||STIMULANTS AND RELATED AGENTS|2494|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
guanfacine HCl|No|No|No|No|75%|00228285311|GUANFACINE HCL ER 3 MG TABLET|100|EA|.31579|01/13/2015||Yes|No||01/13/2015||Yes|No|01/13/2015||Yes|No||01/13/2015||Yes|No|||Prescription Required|No|10/01/2015|007|Yes|.15202||.14837||.14944||||STIMULANTS AND RELATED AGENTS|2495|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
guanfacine HCl|No|No|No|No|75%|00228285511|GUANFACINE HCL ER 4 MG TABLET|100|EA|.31579|01/13/2015||Yes|No||01/13/2015||Yes|No|01/13/2015||Yes|No||01/13/2015||Yes|No|||Prescription Required|No|10/01/2015|007|Yes|.16612||.16213||.1633||||STIMULANTS AND RELATED AGENTS|2496|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00228289006|DULOXETINE HCL DR 20 MG CAP|60|EA|.54825|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||||No|No|||Prescription Required|No|12/12/2014|232|No|.08451||.08248||.08307||||NEUROPATHIC PAIN|2497|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00228289103|DULOXETINE HCL DR 30 MG CAP|30|EA|.5848|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||||No|No|||Prescription Required|No|12/12/2014|232|No|.06996||.06828||.06877||||NEUROPATHIC PAIN|2498|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00228289150|DULOXETINE HCL DR 30 MG CAP|500|EA|.5848|02/05/2015||Yes|No||02/05/2015||Yes|No|02/05/2015||Yes|No||||No|No|||Prescription Required|No|12/12/2014|232|No|.06996||.06828||.06877||||NEUROPATHIC PAIN|2499|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00228289203|DULOXETINE HCL DR 60 MG CAP|30|EA|.5848|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||||No|No|||Prescription Required|No|12/12/2014|232|No|.08403||.08201||.0826||||NEUROPATHIC PAIN|2500|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
duloxetine HCl|No|No|No|No|75%|00228289296|DULOXETINE HCL DR 60 MG CAP|1000|EA|.5848|02/05/2015||Yes|No||02/05/2015||Yes|No|02/05/2015||Yes|No||02/05/2015||Yes|No|||Prescription Required|No|12/12/2014|232|No|.08403||.08201||.0826||||NEUROPATHIC PAIN|2501|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
doxycycline hyclate|No|No|No|No|75%|00228289506|DOXYCYCLINE HYC DR 75 MG TAB  |60|EA|3.51711|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||02/18/2014||Yes|No|||Prescription Required|Yes|01/25/2012|213|No|8.01574||7.90123||7.52498||||TETRACYCLINES|2502|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
doxycycline hyclate|Yes|No|No|No|75%|00228289611|DOXYCYCLINE HYC DR 100 MG TAB |100|EA|4.52304|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Prescription Required|Yes|01/25/2012|213|No|1.84959||1.8052||1.81815||||TETRACYCLINES|2503|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00228291809|DILTIAZEM 24H ER(CD) 360 MG CP|90|EA|2.1124|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||02/18/2014||Yes|No|||Prescription Required|No|01/23/2013|045|No|.3019||.29465||.29677||||CALCIUM CHANNEL BLOCKERS|2504|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
tamsulosin HCl|No|No|No|No|75%|00228299611|TAMSULOSIN HCL 0.4 MG CAPSULE|100|EA|.215|01/23/2012||Yes|No||01/23/2012||Yes|No|01/23/2012||Yes|No||||No|No|||Prescription Required|No|10/29/2012|003|No|.49||.483||.46||||BPH TREATMENTS|2505|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
tamsulosin HCl|No|No|No|No|75%|00228299650|TAMSULOSIN HCL 0.4 MG CAPSULE|500|EA|.215|01/23/2012||Yes|No||01/23/2012||Yes|No|01/23/2012||Yes|No||||No|No|||Prescription Required|No|10/29/2012|003|No|.49||.483||.46||||BPH TREATMENTS|2506|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00228305911|DEXTROAMP-AMPHET ER 10 MG CAP|100|EA|.50142|07/24/2012||Yes|No||07/24/2012||Yes|No|07/24/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.70399||.68709||.69202||||STIMULANTS AND RELATED AGENTS|2507|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00228306011|DEXTROAMP-AMPHET ER 20 MG CAP|100|EA|.50142|07/24/2012||Yes|No||07/24/2012||Yes|No|07/24/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.57443||.56064||.56466||||STIMULANTS AND RELATED AGENTS|2508|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00228306111|DEXTROAMP-AMPHET ER 30 MG CAP|100|EA|.50142|07/24/2012||Yes|No||07/24/2012||Yes|No|07/24/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.56014||.5467||.55062||||STIMULANTS AND RELATED AGENTS|2509|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00228306211|DEXTROAMP-AMPHET ER 5 MG CAP|100|EA|.50142|07/24/2012||Yes|No||07/24/2012||Yes|No|07/24/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.58063||.56669||.57076||||STIMULANTS AND RELATED AGENTS|2510|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00228306311|DEXTROAMP-AMPHET ER 15 MG CAP|100|EA|.50142|07/24/2012||Yes|No||07/24/2012||Yes|No|07/24/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.63267||.61749||.62191||||STIMULANTS AND RELATED AGENTS|2511|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00228306411|DEXTROAMP-AMPHET ER 25 MG CAP|100|EA|.50142|07/24/2012||Yes|No||07/24/2012||Yes|No|07/24/2012||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.52976||.51705||.52075||||STIMULANTS AND RELATED AGENTS|2512|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228308306|ALPRAZOLAM ER 0.5 MG TABLET|60|EA|.30939|02/21/2007||Yes|No||02/21/2007||Yes|No|02/21/2007||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|.14033||.13696||.13794||||ANXIOLYTICS|2513|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228308406|ALPRAZOLAM ER 1 MG TABLET|60|EA|.41345|02/21/2007||Yes|No||02/21/2007||Yes|No|02/21/2007||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|.1287||.12561||.12651||||ANXIOLYTICS|2514|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228308606|ALPRAZOLAM ER 3 MG TABLET|60|EA|.79658|02/21/2007||Yes|No||02/21/2007||Yes|No|02/21/2007||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|.20232||.19746||.19888||||ANXIOLYTICS|2515|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228308706|ALPRAZOLAM ER 2 MG TABLET|60|EA|.49722|02/21/2007||Yes|No||02/21/2007||Yes|No|02/21/2007||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|.15867||.15486||.15597||||ANXIOLYTICS|2516|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228309011|MORPHINE SULFATE ER 30 MG CAP |100|EA|1.97099|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|4.49203||4.42785||4.217||||ANALGESICS, NARCOTICS LONG|2517|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228309111|MORPHINE SULFATE ER 60 MG CAP |100|EA|3.82743|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|8.72298||8.59837||8.18892||||ANALGESICS, NARCOTICS LONG|2518|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228309211|MORPHINE SULFATE ER 90 MG CAP |100|EA|5.75486|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|13.11573||12.92836||12.31273||||ANALGESICS, NARCOTICS LONG|2519|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228309311|MORPHINE SULFATE ER 120 MG CAP|100|EA|6.79013|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|15.47518||15.25411||14.52772||||ANALGESICS, NARCOTICS LONG|2520|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228311611|MORPHINE SULFATE ER 45 MG CAP |100|EA|2.92245|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|6.66047||6.56532||6.25269||||ANALGESICS, NARCOTICS LONG|2521|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228311711|MORPHINE SULFATE ER 75 MG CAP |100|EA|4.8707|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|11.10066||10.94208||10.42102||||ANALGESICS, NARCOTICS LONG|2522|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
buprenorphine HCl|No|No|No|No|90%|00228315303|BUPRENORPHINE 8 MG TABLET SL|30|EA|1.09836|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|145|Yes|.6003||.58589||.59009||||OPIATE DEPENDENCE TREATMENTS|2523|||||No|No||ACTAVIS/TEVA|Yes|09/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00228315403|BUPRENORPHINE-NALOX 2-0.5MG TB|30|EA|1.09836|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|.37404||.36506||.36768||||OPIATE DEPENDENCE TREATMENTS|2524|||||No|No||ACTAVIS/TEVA|Yes|10/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00228315503|BUPRENORPHINE-NALOX 8-2 MG TAB|30|EA|3.58892|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|.64498||.6295||.63402||||OPIATE DEPENDENCE TREATMENTS|2525|||||No|No||ACTAVIS/TEVA|Yes|10/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00228315567|BUPRENORPHINE-NALOX 8-2 MG TAB|15|EA||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|||||||||OPIATE DEPENDENCE TREATMENTS|2526|||||No|No||ACTAVIS/TEVA|Yes|10/01/2020||||No|No|No||
buprenorphine HCl|No|No|No|No|90%|00228315603|BUPRENORPHINE 2 MG TABLET SL|30|EA|.58752|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|145|Yes|.27394||.26737||.26928||||OPIATE DEPENDENCE TREATMENTS|2527|||||No|No||ACTAVIS/TEVA|Yes|09/01/2020||||No|No|No||
doxepin HCl|No|No|No|No|75%|00228331503|DOXEPIN HCL 3 MG TABLET|30|EA|5.6221|05/20/2020||Yes|No||05/20/2020||Yes|No|05/20/2020||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|054|No|2.8046||2.73729||2.75692||||SEDATIVE HYPNOTICS|2528|||||No|No||TEVA USA|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00228331603|DOXEPIN HCL 6 MG TABLET|30|EA|5.6221|05/20/2020||Yes|No||05/20/2020||Yes|No|05/20/2020||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|054|No|3.05319||2.97991||3.00129||||SEDATIVE HYPNOTICS|2529|||||No|No||TEVA USA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228364003|ROPINIROLE HCL ER 6 MG TABLET|30|EA|2.77995|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|1.20583||1.17689||1.18533||||ANTIPARKINSON'S AGENTS|2530|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228365803|ROPINIROLE HCL ER 2 MG TABLET|30|EA|.92665|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|.36471||.35596||.35851||||ANTIPARKINSON'S AGENTS|2531|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228365809|ROPINIROLE HCL ER 2 MG TABLET|90|EA|.92665|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|.36471||.35596||.35851||||ANTIPARKINSON'S AGENTS|2532|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228365903|ROPINIROLE HCL ER 4 MG TABLET|30|EA|1.8533|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|.48193||.47036||.47374||||ANTIPARKINSON'S AGENTS|2533|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228365909|ROPINIROLE HCL ER 4 MG TABLET|90|EA|1.85335|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|.48193||.47036||.47374||||ANTIPARKINSON'S AGENTS|2534|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228366003|ROPINIROLE HCL ER 8 MG TABLET|30|EA|2.77995|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|1.80183||1.75859||1.7712||||ANTIPARKINSON'S AGENTS|2535|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228366009|ROPINIROLE HCL ER 8 MG TABLET|90|EA|2.78|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|1.80183||1.75859||1.7712||||ANTIPARKINSON'S AGENTS|2536|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228366103|ROPINIROLE HCL ER 12 MG TABLET|30|EA|4.63339|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|015|No|2.71149||2.64641||2.66539||||ANTIPARKINSON'S AGENTS|2537|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228401911|ALPRAZOLAM ODT 0.25 MG TAB|100|EA|.46397|06/13/2016||Yes|No||06/13/2016||Yes|No|06/13/2016||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|.92468||.90249||.90896||||ANXIOLYTICS|2538|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228402211|ALPRAZOLAM ODT 0.5 MG TAB|100|EA|.57809|06/14/2016||Yes|No||06/14/2016||Yes|No|06/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|1.15182||1.12418||1.13224||||ANXIOLYTICS|2539|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228402411|ALPRAZOLAM ODT 1 MG TAB|100|EA|.77129|06/14/2016||Yes|No||06/14/2016||Yes|No|06/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|1.65187||1.61223||1.62379||||ANXIOLYTICS|2540|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228402511|ALPRAZOLAM ODT 2 MG TAB|100|EA|1.31141|06/14/2016||Yes|No||06/14/2016||Yes|No|06/14/2016||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|090|Yes|2.9888||2.94611||2.80582||||ANXIOLYTICS|2541|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
clonidine HCl|No|No|No|No|75%|00228424106|CLONIDINE HCL ER 0.1 MG TABLET|60|EA|1.43333|06/17/2015||Yes|No||06/17/2015||Yes|No|06/17/2015||Yes|No||06/17/2015||Yes|No|||Prescription Required|Yes|07/29/2021|007|No|.20052||.19571||.19711||||STIMULANTS AND RELATED AGENTS|2542|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228427011|MORPHINE SULF ER 15 MG TABLET|100|EA|.28823|11/12/2015||Yes|No||11/12/2015||Yes|No|11/12/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|110|Yes|.23044||.22491||.22652||||ANALGESICS, NARCOTICS LONG|2543|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228427111|MORPHINE SULF ER 30 MG TABLET|100|EA|.54769|11/12/2015||Yes|No||11/12/2015||Yes|No|11/12/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|110|Yes|.37178||.36286||.36546||||ANALGESICS, NARCOTICS LONG|2544|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228431111|MORPHINE SULF ER 60 MG TABLET|100|EA|1.06872|11/12/2015||Yes|No||11/12/2015||Yes|No|11/12/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|110|Yes|.5361||.52323||.52699||||ANALGESICS, NARCOTICS LONG|2545|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228432311|MORPHINE SULF ER 100 MG TABLET|100|EA|1.58231|11/12/2015||Yes|No||11/12/2015||Yes|No|11/12/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|110|Yes|.87381||.85284||.85896||||ANALGESICS, NARCOTICS LONG|2546|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228434711|MORPHINE SULF ER 200 MG TABLET|100|EA|2.89777|11/12/2015||Yes|No||11/12/2015||Yes|No|11/12/2015||Yes|No||||No|No|||Prescription Required|No|07/23/2015|110|Yes|2.04448||1.99541||2.00972||||ANALGESICS, NARCOTICS LONG|2547|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00245003623|PREVALITE POWDER|231|GM|.11867|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|055|No|.13431||.13109||.13203||||LIPOTROPICS, OTHER|2548|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00245003642|PREVALITE PACKET|42|EA|.88355|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|055|No|.76253||.74423||.74957||||LIPOTROPICS, OTHER|2549|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00245003660|PREVALITE PACKET|60|EA|.88172|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|02/23/2004|055|No|.76253||.74423||.74957||||LIPOTROPICS, OTHER|2550|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium citrate|No|No|No|No|75%|00245007011|POTASSIUM CITRATE ER 5 MEQ TAB|100|EA|.43396|07/11/2008||Yes|No||07/11/2008||Yes|No|07/11/2008||Yes|No||07/11/2008||Yes|No|||Prescription Required|No|||No|.10889||.10628||.10704|||||2551|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium citrate|No|No|No|No|75%|00245007111|POTASSIUM CITRATE ER 10 MEQ TB|100|EA|.60824|07/11/2008||Yes|No||07/11/2008||Yes|No|07/11/2008||Yes|No||07/11/2008||Yes|No|||Prescription Required|No|||No|.17051||.16642||.16761|||||2552|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014401|PACERONE 100 MG TABLET|100|EA|1.19841|07/15/2004||Yes|No||07/15/2004||Yes|No|07/15/2004||Yes|No||||No|No|||Prescription Required|No|||No|.99993||.97593||.98293|||||2553|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014430|PACERONE 100 MG TABLET|30|EA|1.19841|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription Required|No|||No|.99993||.97593||.98293|||||2554|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014701|PACERONE 200 MG TABLET|100|EA|.16035|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.36544||.36022||.34307|||||2555|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014715|PACERONE 200 MG TABLET|500|EA|.11654|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.2656||.26181||.24934|||||2556|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014760|PACERONE 200 MG TABLET|60|EA|.11896|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.27113||.26725||.25453|||||2557|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014790|PACERONE 200 MG TABLET|90|EA|.11892|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription Required|No|||No|.27102||.26715||.25443|||||2558|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00245021111|MIDODRINE HCL 2.5 MG TABLET|100|EA|.1032|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||05/21/2008||Yes|No|||Prescription Required|No|||No|.0668||.0652||.06566|||||2559|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00245021201|MIDODRINE HCL 5 MG TABLET|100|EA|.37247|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||09/06/2016||Yes|No|||Prescription Required|No|||No|.11336||.11064||.11143|||||2560|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00245021211|MIDODRINE HCL 5 MG TABLET|100|EA|.1548|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||05/21/2008||Yes|No|||Prescription Required|No|||No|.11336||.11064||.11143|||||2561|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00245021311|MIDODRINE HCL 10 MG TABLET|100|EA|.258|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||05/21/2008||Yes|No|||Prescription Required|No|||No|.20527||.20034||.20178|||||2562|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245036001|KLOR-CON 20 MEQ PACKET|100|EA|.6536|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||07/19/2018||Yes|No|||Prescription Required|No|||No|1.01212||.98783||.99491|||||2563|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245036030|KLOR-CON 20 MEQ PACKET|30|EA|.645|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||07/19/2018||Yes|No|||Prescription Required|No|||No|1.01212||.98783||.99491|||||2564|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine (with sugar)|No|No|No|No|75%|00245053660|CHOLESTYRAMINE PACKET|60|EA|.88172|04/04/2014||Yes|No||04/04/2014||Yes|No|04/04/2014||Yes|No||04/04/2014||Yes|No|||Prescription Required|No|07/27/2011|055|No|.58937||.57523||.57935||||LIPOTROPICS, OTHER|2565|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
vigabatrin|No|No|No|No|75%|00245055650|VIGADRONE 500 MG POWDER PACKET|50|EA|46.39657|12/07/2018||Yes|No||12/07/2018||Yes|No|||No|No||||No|No|||Prescription Required|No|01/28/2021|056|No|105.74102||104.23043||99.26708||||ANTICONVULSANTS|2566|||||No|No||UPSHER-SMITH LA|No|||||No|No|Yes|10/01/2019|
isotretinoin|No|No|No|No|75%|00245057001|ISOTRETINOIN 10 MG CAPSULE|30|EA|10.9445|08/04/2022||Yes|No||08/04/2022||Yes|No|08/04/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|144|No|11.90787||11.62208||11.70544||||ACNE AGENTS, ORAL|2567|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
isotretinoin|No|No|No|No|75%|00245057101|ISOTRETINOIN 20 MG CAPSULE|30|EA|10.9445|08/04/2022||Yes|No||08/04/2022||Yes|No|08/04/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|144|No|13.01485||12.70249||12.7936||||ACNE AGENTS, ORAL|2568|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
isotretinoin|No|No|No|No|75%|00245057301|ISOTRETINOIN 30 MG CAPSULE|30|EA|11.77569|08/04/2022||Yes|No||08/04/2022||Yes|No|08/04/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|144|No|15.65001||15.27441||15.38396||||ACNE AGENTS, ORAL|2569|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
isotretinoin|No|No|No|No|75%|00245057501|ISOTRETINOIN 40 MG CAPSULE|30|EA|11.77569|08/04/2022||Yes|No||08/04/2022||Yes|No|08/04/2022||Yes|No||||No|No|||Prescription Required|No|07/30/2020|144|No|16.70926||16.30824||16.4252||||ACNE AGENTS, ORAL|2570|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00245080938|ZEMBRACE SYMTOUCH 3 MG/0.5 ML|0.5|ML|172.344|04/12/2022||Yes|No||04/12/2022||Yes|No|04/12/2022||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|021|Yes|382.3235||373.14774||375.824||||ANTIMIGRAINE AGENTS, TRIPTANS|2571|||||No|No||UP-SM/TONIX PHA|No|||||No|No|No||
sumatriptan|No|No|No|No|75%|00245081261|TOSYMRA 10 MG NASAL SPRAY|6|EA|48.6201|02/23/2022||Yes|No||02/23/2022||Yes|No|02/23/2022||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|021|Yes|108.77167||106.16115||106.92255||||ANTIMIGRAINE AGENTS, TRIPTANS|2572|||||No|No||UP-SM/TONIX PHA|No|||||No|No|No||
metronidazole|Yes|No|No|No|75%|00245086070|VANDAZOLE VAGINAL 0.75% GEL|70|GM|.75109|11/13/2008||Yes|No||11/13/2008||Yes|No|11/13/2008||Yes|No||||No|No|11/01/2012||Prescription Required|Yes|02/10/2009|124|No|.68307||.66668||.67146||||ANTIBIOTICS, VAGINAL|2573|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
testosterone|No|No|No|No|90%|00245087105|VOGELXO 50 MG/5 GRAM GEL      |5|GM|1.2775|06/18/2015||Yes|No||06/18/2015||Yes|No|06/18/2015||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|084|Yes|3.78412||3.6933||3.71979||||ANDROGENIC AGENTS|2574|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
testosterone|No|No|No|No|90%|00245087135|VOGELXO 50 MG/5 GRAM GEL PACKT|5|GM|1.27578|06/18/2015||Yes|No||06/18/2015||Yes|No|06/18/2015||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|084|Yes|2.90759||2.86605||2.72958||||ANDROGENIC AGENTS|2575|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
testosterone|No|No|No|No|90%|00245087242|VOGELXO 12.5 MG/1.25 GRAM PUMP|75|GM|1.27578|06/18/2015||Yes|No||06/18/2015||Yes|No|06/18/2015||Yes|No||||No|No|||Prescription Required|Yes|01/22/2015|084|Yes|2.90759||2.86605||2.72958||||ANDROGENIC AGENTS|2576|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
topiramate|No|No|No|No|75%|00245107130|QUDEXY XR 25 MG CAPSULE       |30|EA|4.20138|11/13/2014||Yes|No||11/13/2014||Yes|No|11/13/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|9.57525||9.43846||8.98901||||ANTICONVULSANTS|2577|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
topiramate|No|No|No|No|75%|00245107230|QUDEXY XR 50 MG CAPSULE|30|EA|5.47289|11/13/2014||Yes|No||11/13/2014||Yes|No|11/13/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|12.47311||12.29492||11.70945||||ANTICONVULSANTS|2578|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
topiramate|No|No|No|No|75%|00245107330|QUDEXY XR 200 MG CAPSULE      |30|EA|14.83299|11/13/2014||Yes|No||11/13/2014||Yes|No|11/13/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|32.69441||31.90974||32.13861||||ANTICONVULSANTS|2579|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
topiramate|No|No|No|No|75%|00245107430|QUDEXY XR 100 MG CAPSULE|30|EA|10.84316|11/13/2014||Yes|No||11/13/2014||Yes|No|11/13/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|24.25428||23.67218||23.84196||||ANTICONVULSANTS|2580|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
topiramate|No|No|No|No|75%|00245107530|QUDEXY XR 150 MG CAPSULE      |30|EA|13.33759|11/13/2014||Yes|No||11/13/2014||Yes|No|11/13/2014||Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|No|29.5792||28.8693||29.07635||||ANTICONVULSANTS|2581|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245164501|PACERONE 400 MG TABLET|100|EA|1.72|09/30/2021||Yes|No||09/30/2021||Yes|No|09/30/2021||Yes|No||||No|No|||Prescription Required|No|||No|1.05908||1.03366||1.04108|||||2582|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245164530|PACERONE 400 MG TABLET|30|EA|1.43333|09/30/2021||Yes|No||09/30/2021||Yes|No|09/30/2021||Yes|No||||No|No|||Prescription Required|No|||No|1.05908||1.03366||1.04108|||||2583|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531501|KLOR-CON 8 MEQ TABLET|100|EA|.20885|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.25254||.24648||.24825|||||2584|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531511|KLOR-CON 8 MEQ TABLET|100|EA|.18451|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.25254||.24648||.24825|||||2585|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531515|KLOR-CON 8 MEQ TABLET|500|EA|.18451|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.25254||.24648||.24825|||||2586|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531601|KLOR-CON 10 MEQ TABLET|100|EA|.21689|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.13196||.12879||.12972|||||2587|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531611|KLOR-CON 10 MEQ TABLET|100|EA|.19423|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.13196||.12879||.12972|||||2588|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531615|KLOR-CON 10 MEQ TABLET|500|EA|.19423|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.13196||.12879||.12972|||||2589|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531701|KLOR-CON M10 TABLET|100|EA|.21255|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.09507||.09279||.09345|||||2590|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531710|KLOR-CON M10 TABLET|1000|EA|.20501|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.09507||.09279||.09345|||||2591|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531711|KLOR-CON M10 TABLET|100|EA|.20502|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.09507||.09279||.09345|||||2592|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531790|KLOR-CON M10 TABLET|90|EA|.20501|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription Required|No|||No|.09507||.09279||.09345|||||2593|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531801|KLOR-CON M15 TABLET           |100|EA|.36533|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|||No|.36702||.35821||.36078|||||2594|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531811|KLOR-CON M15 TABLET           |100|EA|.34142|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|||No|.36702||.35821||.36078|||||2595|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531901|KLOR-CON M20 TABLET|100|EA|.23388|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|||No|.16035||.1565||.15762|||||2596|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531910|KLOR-CON M20 TABLET|1000|EA|.21582|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|||No|.16035||.1565||.15762|||||2597|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531911|KLOR-CON M20 TABLET|100|EA|.21582|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|||No|.16035||.1565||.15762|||||2598|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531915|KLOR-CON M20 TABLET|500|EA|.21583|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|||No|.16035||.1565||.15762|||||2599|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531990|KLOR-CON M20 TABLET|90|EA|.21581|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription Required|No|||No|.16035||.1565||.15762|||||2600|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium bicarbonate/cit ac|No|No|No|No|75%|00245532601|KLOR-CON-EF 25 MEQ TAB EFF|100|EA|.54012|10/12/2020||Yes|No||10/12/2020||Yes|No|10/12/2020||Yes|No||10/12/2020||Yes|No|||Prescription Required|No|||No|.||.||.|||||2601|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium bicarbonate/cit ac|No|No|No|No|75%|00245532630|KLOR-CON-EF 25 MEQ TAB EFF|30|EA|.54051|10/12/2020||Yes|No||10/12/2020||Yes|No|10/12/2020||Yes|No||10/12/2020||Yes|No|||Prescription Required|No|||No|.||.||.|||||2602|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
vigabatrin|No|No|No|No|75%|00245600111|VIGADRONE 500 MG TABLET|100|EA|64.1947|02/08/2024||Yes|No||02/08/2024||Yes|No|02/08/2024||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|146.3042||144.21414||137.3468||||ANTICONVULSANTS|2603|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
colchicine|No|No|No|No|75%|00254046001|COLCHICINE 0.6 MG CAPSULE|100|EA|2.17172|09/18/2024||Yes|No||09/18/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/28/2022|231|No|1.73034||1.68881||1.70092||||ANTIHYPERURICEMICS|2604|||||No|No||PAR PHARM.|No|||||No|No|No||
diazoxide|No|No|No|No|75%|00254101019|DIAZOXIDE 50 MG/ML ORAL SUSP|30|ML|3.94912|12/11/2020||Yes|No||12/11/2020||Yes|No|12/11/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|583|No|6.88592||6.72066||6.76886||||GLUCAGON AGENTS|2605|||||No|No||PAR PHARM.|No|||||No|No|No||
sucralfate|No|No|No|No|75%|00254101196|SUCRALFATE 1 GM/10 ML SUSP|420|ML|.17997|06/30/2020||Yes|No||06/30/2020||Yes|No|06/30/2020||Yes|No||||No|No|||Prescription Required|No|||No|.2543||.2482||.24998|||||2606|||||No|No||PAR PHARM.|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00254101636|POSACONAZOLE 200 MG/5 ML SUSP|105|ML|4.71624|09/12/2023||Yes|No||09/12/2023||Yes|No|09/12/2023||Yes|No||||No|No|||Prescription Required|No|01/25/2024|069|No|10.74864||10.59509||10.09056||||ANTIFUNGALS, ORAL|2607|||||No|No||PAR PHARM.|No|||||No|No|No||
penicillamine|No|No|No|No|75%|00254200001|PENICILLAMINE 250 MG TABLET   |100|EA|20.00756|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||||No|No|||Prescription Required|No|||No|45.59862||44.94721||42.80686|||||2608|||||No|No||PAR PHARM.|No|||||No|No|No||
chlorzoxazone|No|No|No|No|75%|00254200501|CHLORZOXAZONE 750 MG TABLET   |100|EA|1.7845|08/03/2023||Yes|No||08/03/2023||Yes|No|08/03/2023||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|116|Yes|1.87487||1.82987||1.843||||SKELETAL MUSCLE RELAXANTS|2609|||||No|No||PAR PHARM.|No|||||No|No|No||
colchicine|No|No|No|No|75%|00254200801|COLCHICINE 0.6 MG TABLET|100|EA|2.41385|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|231|No|.18453||.1801||.18139||||ANTIHYPERURICEMICS|2610|||||No|No||PAR PHARM.|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00254204502|POSACONAZOLE DR 100 MG TABLET|60|EA|6.95166|12/20/2019||Yes|No||12/20/2019||Yes|No|12/20/2019||Yes|No||||No|No|||Prescription Required|No|01/25/2024|069|No|4.79889||4.68372||4.71731||||ANTIFUNGALS, ORAL|2611|||||No|No||PAR PHARM.|No|||||No|No|No||
chlorzoxazone|No|No|No|No|75%|00254205301|CHLORZOXAZONE 375 MG TABLET|100|EA|1.591|08/03/2023||Yes|No||08/03/2023||Yes|No|08/03/2023||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|116|Yes|2.17662||2.12438||2.13962||||SKELETAL MUSCLE RELAXANTS|2612|||||No|No||PAR PHARM.|No|||||No|No|No||
nitisinone|No|No|No|No|75%|00254302002|NITISINONE 2 MG CAPSULE       |60|EA|31.24316|05/11/2020||Yes|No||05/11/2020||Yes|No|05/11/2020||Yes|No||||No|No|||Prescription Required|No|||Yes|71.20533||70.18811||66.84582|||||2613|||||No|No||PAR PHARM.|No|||||No|No|Yes|07/30/2021|
nitisinone|No|No|No|No|75%|00254302102|NITISINONE 5 MG CAPSULE       |60|EA|78.10742|05/11/2020||Yes|No||05/11/2020||Yes|No|05/11/2020||Yes|No||||No|No|||Prescription Required|No|||Yes|178.01226||175.46922||167.11355|||||2614|||||No|No||PAR PHARM.|No|||||No|No|Yes|07/30/2021|
nitisinone|No|No|No|No|75%|00254302202|NITISINONE 10 MG CAPSULE      |60|EA|156.21506|05/11/2020||Yes|No||05/11/2020||Yes|No|05/11/2020||Yes|No||||No|No|||Prescription Required|No|||Yes|356.02501||350.93894||334.22756|||||2615|||||No|No||PAR PHARM.|No|||||No|No|Yes|07/30/2021|
lubiprostone|No|No|No|No|75%|00254302802|LUBIPROSTONE 8 MCG CAPSULE|60|EA|.43|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription Required|No|01/25/2024|534|Yes|.54472||.53165||.53546||||GI MOTILITY, CHRONIC|2616|||||No|No||PAR PHARM.|No|||||No|No|No||
lubiprostone|No|No|No|No|75%|00254302902|LUBIPROSTONE 24 MCG CAPSULE|60|EA|.43|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription Required|No|01/25/2024|534|Yes|.58677||.57269||.57679||||GI MOTILITY, CHRONIC|2617|||||No|No||PAR PHARM.|No|||||No|No|No||
glycopyrrolate|No|No|No|No|75%|00259050116|CUVPOSA 1 MG/5 ML SOLUTION|473|ML|.45409|04/16/2013||Yes|No||04/16/2013||Yes|No|04/16/2013||Yes|No||||No|No|||Prescription Required|No|||No|1.009||.98478||.99185|||||2618|||||No|No||MERZ|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00264151032|DEXTROSE 5%-WATER IV SOLN     |100|ML|.01062|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.02421||.02386||.02272|||||2619|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264180031|SODIUM CHLORIDE 0.9% SOLUTION |50|ML|.02322|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.05292||.05216||.04968|||||2620|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264180032|SODIUM CHLORIDE 0.9% SOLUTION |100|ML|.0117|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.02666||.02628||.02502|||||2621|||||No|No||B.BRAUN|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00264210100|STERILE WATER FOR IRRIGATION  |1000|ML|.00171|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00389||.00384||.00365|||||2622|||||No|No||B.BRAUN|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00264210110|STERILE WATER FOR IRRIGATION  |500|ML|.00303|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00691||.00681||.00649|||||2623|||||No|No||B.BRAUN|No|||||No|No|No||
sodium chloride irrig solution|No|No|No|No|75%|00264220100|SODIUM CHLORIDE 0.9% IRRIG.   |1000|ML|.00186|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00424||.00418||.00398|||||2624|||||No|No||B.BRAUN|No|||||No|No|No||
sodium chloride irrig solution|No|No|No|No|75%|00264220110|SODIUM CHLORIDE 0.9% IRRIG.   |500|ML|.00319|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00726||.00716||.00682|||||2625|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264220300|LACTATED RINGERS IRRIGATION   |1000|ML|.00256|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00583||.00575||.00547|||||2626|||||No|No||B.BRAUN|No|||||No|No|No||
physiological irrig soln no.1|No|No|No|No|75%|00264220500|PHYSIOLYTE IRRIGATION SOLN    |1000|ML|.00347|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00791||.0078||.00742|||||2627|||||No|No||B.BRAUN|No|||||No|No|No||
acetic acid|No|No|No|No|75%|00264230400|ACETIC ACID 0.25% IRRIG SOLN  |1000|ML|.00362|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00825||.00813||.00775|||||2628|||||No|No||B.BRAUN|No|||||No|No|No||
acetic acid|No|No|No|No|75%|00264230410|ACETIC ACID 0.25% IRRIG SOLN  |500|ML|.00644|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.01468||.01447||.01378|||||2629|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00264751000|DEXTROSE 5%-WATER IV SOLN     |1000|ML|.00173|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00394||.00388||.0037|||||2630|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00264751010|DEXTROSE 5%-WATER IV SOLN     |500|ML|.00347|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.0079||.00779||.00742|||||2631|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00264751020|DEXTROSE 5%-WATER IV SOLN     |250|ML|.00636|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.01449||.01429||.01361|||||2632|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 10 % in water|No|No|No|No|75%|00264752000|DEXTROSE 10%-WATER IV SOLUTION|1000|ML|.00259|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00591||.00582||.00555|||||2633|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 10 % in water|No|No|No|No|75%|00264752010|DEXTROSE 10%-WATER IV SOLUTION|500|ML|.0038|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00866||.00854||.00813|||||2634|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 10 % in water|No|No|No|No|75%|00264752020|DEXTROSE 10%-WATER IV SOLUTION|250|ML|.00749|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.01708||.01684||.01604|||||2635|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 % and 0.9 % NaCl|No|No|No|No|75%|00264761000|DEXTROSE 5%-0.9% NACL IV SOLN |1000|ML|.00163|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00371||.00366||.00349|||||2636|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 % and 0.9 % NaCl|No|No|No|No|75%|00264761010|DEXTROSE 5%-0.9% NACL IV SOLN |500|ML|.00344|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00784||.00773||.00736|||||2637|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 %-0.45 % sod chlord|No|No|No|No|75%|00264761200|DEXTROSE 5%-0.45% NACL IV SOLN|1000|ML|.00132|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.003||.00296||.00282|||||2638|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 %-0.45 % sod chlord|No|No|No|No|75%|00264761210|DEXTROSE 5%-0.45% NACL IV SOLN|500|ML|.00336|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00766||.00755||.00719|||||2639|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 %-0.2 % sod chlorid|No|No|No|No|75%|00264761600|DEXTROSE 5%-0.2% NACL IV SOLN |1000|ML|.00224|03/01/2002||Yes|No||03/01/2002||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.00512||.00504||.0048|||||2640|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 %-0.2 % sod chlorid|No|No|No|No|75%|00264761610|DEXTROSE 5%-0.2% NACL IV SOLN |500|ML|.00367|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00837||.00825||.00786|||||2641|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 %-0.2 % sod chlorid|No|No|No|No|75%|00264761620|DEXTROSE 5%-0.2% NACL IV SOLN |250|ML|.00768|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.0175||.01725||.01643|||||2642|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 10 % and 0.45 % NaCl|No|No|No|No|75%|00264762200|DEXTROSE 10%-0.45% NACL IV SOL|1000|ML|.00406|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00925||.00912||.00868|||||2643|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 10 % and 0.2 % NaCl|No|No|No|No|75%|00264762320|DEXTROSE 10%-0.2% NACL IV SOLN|250|ML|.00697|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.0159||.01567||.01492|||||2644|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride in D5W|No|No|No|No|75%|00264762500|KCL 20 MEQ/L IN D5W SOLUTION|1000|ML|.00432|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00984||.0097||.00924|||||2645|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763400|KCL 10 MEQ/L-D5W-0.45% NACL|1000|ML|.00421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00958||.00945||.009|||||2646|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763500|KCL 20 MEQ/L-D5W-0.45% NACL|1000|ML|.0021|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00479||.00472||.0045|||||2647|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763600|KCL 30 MEQ/L-D5W-0.45% NACL|1000|ML|.00403|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00918||.00905||.00862|||||2648|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763800|KCL 40 MEQ/L-D5W-0.45% NACL|1000|ML|.00421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00958||.00945||.009|||||2649|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.2%NaCl|No|No|No|No|75%|00264764500|KCL 20 MEQ/L-D5W-0.2% NACL|1000|ML|.00374|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00852||.00839||.00799|||||2650|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.9%NaCl|No|No|No|No|75%|00264765200|KCL 20 MEQ/L-D5W-0.9% NACL|1000|ML|.00238|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00543||.00535||.0051|||||2651|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775000|LACTATED RINGERS INJECTION    |1000|ML|.00131|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00291||.00284||.00286|||||2652|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775010|LACTATED RINGERS INJECTION    |500|ML|.00317|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00291||.00284||.00286|||||2653|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775020|LACTATED RINGERS INJECTION    |250|ML|.00738|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.01682||.01658||.01579|||||2654|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5%-lactated ringers|No|No|No|No|75%|00264775100|DEXTROSE 5%-LR IV SOLUTION    |1000|ML|.00135|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00308||.00303||.00289|||||2655|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5%-lactated ringers|No|No|No|No|75%|00264775110|DEXTROSE 5%-LR IV SOLUTION    |500|ML|.0043|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.0098||.00966||.0092|||||2656|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264780000|SODIUM CHLORIDE 0.9% SOL-EXCEL|1000|ML|.00117|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00268||.00264||.00251|||||2657|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264780009|SODIUM CHLORIDE 0.9% SOLUTION|1000|ML|.00117|04/03/2018||Yes|No||||No|No|04/03/2018||Yes|No||||No|No|||Prescription Required|No|||No|.00268||.00264||.00251|||||2658|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264780010|SODIUM CHLORIDE 0.9% SOL-EXCEL|500|ML|.00291|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00662||.00653||.00622|||||2659|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264780020|SODIUM CHLORIDE 0.9% SOL-EXCEL|250|ML|.00494|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.01125||.01109||.01056|||||2660|||||No|No||B.BRAUN|No|||||No|No|No||
sodium chloride 0.45 %|No|No|No|No|75%|00264780200|SALINE 0.45% SOLN-EXCEL CON   |1000|ML|.00168|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00382||.00377||.00359|||||2661|||||No|No||B.BRAUN|No|||||No|No|No||
sodium chloride 0.45 %|No|No|No|No|75%|00264780210|SALINE 0.45% SOLN-EXCEL CON   |500|ML|.00329|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00749||.00738||.00703|||||2662|||||No|No||B.BRAUN|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00264785000|STERILE WATER FOR INJECTION   |1000|ML|.00201|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00459||.00452||.00431|||||2663|||||No|No||B.BRAUN|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00264785020|STERILE WATER FOR INJECTION   |250|ML|.00694|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.01581||.01558||.01484|||||2664|||||No|No||B.BRAUN|No|||||No|No|No||
heparin sodium,porcine/D5W|No|No|No|No|75%|00264957710|HEPARIN 25,000 UNIT/500 ML-D5W|500|ML|.01412|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.03218||.03172||.03021|||||2665|||||No|No||B.BRAUN|No|||||No|No|No||
lidocaine HCl/dextrose 5 %/PF|No|No|No|No|75%|00264959410|LIDOCAINE 0.4% IN D5W SOLN    |500|ML|.00765|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.01744||.01719||.01638|||||2666|||||No|No||B.BRAUN|No|||||No|No|No||
lidocaine HCl/dextrose 5 %/PF|No|No|No|No|75%|00264959820|LIDOCAINE 0.8% IN D5W SOLN    |250|ML|.01465|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.0334||.03292||.03135|||||2667|||||No|No||B.BRAUN|No|||||No|No|No||
heparin sodium,porcine/NS/PF|No|No|No|No|75%|00264987210|HEPARIN 1,000 UNIT/500 ML-NS  |500|ML|.00383|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00872||.0086||.00819|||||2668|||||No|No||B.BRAUN|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00281032608|NITRO-BID 2% OINTMENT         |1|GM|1.04149|12/11/2015||Yes|No||12/11/2015||Yes|No|12/11/2015||Yes|No||||No|No|||Prescription Required|No|||No|2.35451||2.298||2.31448|||||2669|||||No|No||SANDOZ|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00281032630|NITRO-BID 2% OINTMENT|30|GM|.53664|10/12/2016||Yes|No||10/12/2016||Yes|No|10/12/2016||Yes|No||||No|No|||Prescription Required|No|||No|1.21963||1.19036||1.1989|||||2670|||||No|No||SANDOZ|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00281032660|NITRO-BID 2% OINTMENT|60|GM|.53671|10/12/2016||Yes|No||10/12/2016||Yes|No|10/12/2016||Yes|No||||No|No|||Prescription Required|No|||No|1.22685||1.19741||1.20599|||||2671|||||No|No||SANDOZ|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310008828|DALIRESP 250 MCG TABLET|28|EA|6.36124|09/24/2018||Yes|No||09/24/2018||Yes|No|09/24/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|098|No|14.09273||13.7545||13.85315||||COPD AGENTS|2672|||||No|No||ASTRAZENECA|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310008839|DALIRESP 250 MCG TABLET|20|EA|6.35992|09/24/2018||Yes|No||09/24/2018||Yes|No|09/24/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|098|No|14.09273||13.7545||13.85315||||COPD AGENTS|2673|||||No|No||ASTRAZENECA|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310009530|DALIRESP 500 MCG TABLET|30|EA|6.36142|09/03/2015||Yes|No||09/03/2015||Yes|No|09/03/2015||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|098|No|14.17258||13.83244||13.93165||||COPD AGENTS|2674|||||No|No||ASTRAZENECA|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310009590|DALIRESP 500 MCG TABLET|90|EA|6.36147|09/03/2015||Yes|No||09/03/2015||Yes|No|09/03/2015||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|098|No|14.17258||13.83244||13.93165||||COPD AGENTS|2675|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027110|SEROQUEL 100 MG TABLET|100|EA|2.86681|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|6.41998||6.2659||6.31084||||ANTIPSYCHOTICS|2676|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027210|SEROQUEL 200 MG TABLET|100|EA|5.40833|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|11.98132||11.69377||11.77764||||ANTIPSYCHOTICS|2677|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027460|SEROQUEL 300 MG TABLET|60|EA|7.09127|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|15.74346||15.36562||15.47582||||ANTIPSYCHOTICS|2678|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027510|SEROQUEL 25 MG TABLET|100|EA|1.67059|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|3.72534||3.63593||3.66201||||ANTIPSYCHOTICS|2679|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027810|SEROQUEL 50 MG TABLET|100|EA|2.74521|07/13/2006||Yes|No||07/13/2006||Yes|No|07/13/2006||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|6.13797||5.99066||6.03362||||ANTIPSYCHOTICS|2680|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027910|SEROQUEL 400 MG TABLET|100|EA|8.33383|07/13/2006||Yes|No||07/13/2006||Yes|No|07/13/2006||Yes|No||||No|No|||Prescription Required|Yes|05/10/2022|027|Yes|18.53934||18.0944||18.22417||||ANTIPSYCHOTICS|2681|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310028060|SEROQUEL XR 50 MG TABLET|60|EA|3.53116|02/18/2009||Yes|No||02/18/2009||Yes|No|02/18/2009||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|7.87859||7.6895||7.74465||||ANTIPSYCHOTICS|2682|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310028160|SEROQUEL XR 150 MG TABLET|60|EA|6.34078|02/19/2009||Yes|No||02/19/2009||Yes|No|02/19/2009||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|14.20268||13.86182||13.96123||||ANTIPSYCHOTICS|2683|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310028260|SEROQUEL XR 200 MG TABLET|60|EA|6.9789|07/24/2007||Yes|No||07/24/2007||Yes|No|07/24/2007||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|15.52177||15.14925||15.2579||||ANTIPSYCHOTICS|2684|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310028360|SEROQUEL XR 300 MG TABLET|60|EA|9.15025|07/24/2007||Yes|No||07/24/2007||Yes|No|07/24/2007||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|20.46388||19.97275||20.11599||||ANTIPSYCHOTICS|2685|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310028460|SEROQUEL XR 400 MG TABLET|60|EA|10.75387|07/24/2007||Yes|No||07/24/2007||Yes|No|07/24/2007||Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|24.01545||23.43908||23.60719||||ANTIPSYCHOTICS|2686|||||No|No||ASTRAZENECA|No|||||No|No|No||
gefitinib|No|No|No|No|75%|00310048230|IRESSA 250 MG TABLET|30|EA|111.64061|06/13/2003||Yes|No||06/13/2003||Yes|No|06/13/2003||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|254.43674||250.80193||238.85898||||ONCOLOGY, ORAL - LUNG|2687|||||No|No||ASTRAZENECA|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310061028|KOSELUGO 10 MG CAPSULE|28|EA|40.35105|09/22/2021||Yes|No||09/22/2021||Yes|No|09/22/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|91.96285||90.64909||86.33247||||ONCOLOGY, ORAL - OTHER|2688|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310061060|KOSELUGO 10 MG CAPSULE|60|EA|40.35005|06/12/2020||Yes|No||06/12/2020||Yes|No|06/12/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|91.96058||90.64686||86.33034||||ONCOLOGY, ORAL - OTHER|2689|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310062528|KOSELUGO 25 MG CAPSULE|28|EA|100.87508|09/22/2021||Yes|No||09/22/2021||Yes|No|09/22/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|229.90135||226.61704||215.82575||||ONCOLOGY, ORAL - OTHER|2690|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310062560|KOSELUGO 25 MG CAPSULE|60|EA|100.87513|06/15/2020||Yes|No||06/15/2020||Yes|No|06/15/2020||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|229.90146||226.61716||215.82586||||ONCOLOGY, ORAL - OTHER|2691|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
olaparib|No|No|No|No|75%|00310066812|LYNPARZA 100 MG TABLET|120|EA|60.39504|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|137.64451||135.67816||129.21729||||ONCOLOGY, ORAL - OTHER|2692|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
olaparib|No|No|No|No|75%|00310066860|LYNPARZA 100 MG TABLET|60|EA|60.39501|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|137.64443||135.67808||129.21722||||ONCOLOGY, ORAL - OTHER|2693|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
olaparib|No|No|No|No|75%|00310067912|LYNPARZA 150 MG TABLET|120|EA|60.39504|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|137.64451||135.67816||129.21729||||ONCOLOGY, ORAL - OTHER|2694|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
olaparib|No|No|No|No|75%|00310067960|LYNPARZA 150 MG TABLET|60|EA|60.39501|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription Required|No|01/28/2021|239|No|137.64443||135.67808||129.21722||||ONCOLOGY, ORAL - OTHER|2695|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
sodium zirconium cyclosilicate|No|No|No|No|75%|00310110530|LOKELMA 5 GRAM POWDER PACKET|30|EA|11.7605|05/16/2019||Yes|No||05/16/2019||Yes|No|05/16/2019||Yes|No||||No|No|||Prescription Required|No|07/28/2022|578|No|26.19167||25.56307||25.74641||||POTASSIUM BINDERS|2696|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310110539|LOKELMA 5 GRAM POWDER PACKET|11|EA|11.7605|05/23/2019||Yes|No||05/23/2019||Yes|No|05/23/2019||Yes|No||||No|No|||Prescription Required|No|07/28/2022|578|No|26.19167||25.56307||25.74641||||POTASSIUM BINDERS|2697|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310111030|LOKELMA 10 GRAM POWDER PACKET|30|EA|11.7605|05/16/2019||Yes|No||05/16/2019||Yes|No|05/16/2019||Yes|No||||No|No|||Prescription Required|No|07/28/2022|578|No|26.19521||25.56652||25.74989||||POTASSIUM BINDERS|2698|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310111039|LOKELMA 10 GRAM POWDER PACKET|11|EA|11.7605|05/23/2019||Yes|No||05/23/2019||Yes|No|05/23/2019||Yes|No||||No|No|||Prescription Required|No|07/28/2022|578|No|26.19521||25.56652||25.74989||||POTASSIUM BINDERS|2699|||||No|No||ASTRAZENECA|No|||||No|No|No||
osimertinib mesylate|No|No|No|No|75%|00310134930|TAGRISSO 40 MG TABLET|30|EA|245.34753|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|559.16415||551.17609||524.92961||||ONCOLOGY, ORAL - LUNG|2700|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
osimertinib mesylate|No|No|No|No|75%|00310135030|TAGRISSO 80 MG TABLET|30|EA|245.34753|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription Required|No|01/28/2021|551|No|559.16415||551.17609||524.92961||||ONCOLOGY, ORAL - LUNG|2701|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
benralizumab|No|No|No|No|75%|00310173030|FASENRA 30 MG/ML SYRINGE|1|ML|2441.0025|09/03/2024|09/30/2024|Yes|No||09/03/2024|09/30/2024|Yes|No|||No|No||||No|No|||Prescription Required|No|03/30/2024|206|Yes|5563.215||5483.7405||5222.61||||IMMUNOMODULATORS, ASTHMA|2702|No Longer Covered|No Longer Covered|||No|No||ASTRAZENECA|No|||||No|No|No||
benralizumab|No|No|No|No|75%|00310183030|FASENRA PEN 30 MG/ML|1|ML|2441.0025|02/27/2020||Yes|No||02/27/2020||Yes|No|02/27/2020||Yes|No||||No|No|||Prescription Required|No|07/30/2020|206|Yes|5563.215||5483.7405||5222.61||||IMMUNOMODULATORS, ASTHMA|2703|||||No|No||ASTRAZENECA|No|||||No|No|No||
acalabrutinib maleate|No|No|No|No|75%|00310351260|CALQUENCE 100 MG TABLET|60|EA|110.13812|11/21/2022||Yes|No||11/21/2022||Yes|No|11/21/2022||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|251.01246||247.42656||235.64435||||ONCOLOGY, ORAL - HEMATOLOGIC|2704|||||No|No||ASTRAZENECA|No|||||No|No|No||
glycopyrrolate/formoterol fum|No|No|No|No|75%|00310460012|BEVESPI AEROSPHERE INHALER|10.7|GM|17.3507|04/12/2017||Yes|No||04/12/2017||Yes|No|04/12/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|098|Yes|38.73445||37.80482||38.07596||||COPD AGENTS|2705|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide/glycopyr/formoterol|No|No|No|No|75%|00310461612|BREZTRI AEROSPHERE INHALER|10.7|GM|25.92618|02/24/2021||Yes|No||02/24/2021||Yes|No|02/24/2021||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|Yes|57.82374||56.43597||56.84074||||GLUCOCORTICOIDS, INHALED|2706|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide/glycopyr/formoterol|No|No|No|No|75%|00310461639|BREZTRI AEROSPHERE INHALER|5.9|GM|25.92754|02/24/2021||Yes|No||02/24/2021||Yes|No|02/24/2021||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|Yes|57.76179||56.37551||56.77984||||GLUCOCORTICOIDS, INHALED|2707|||||No|No||ASTRAZENECA|No|||||No|No|No||
saxagliptin HCl|No|No|No|No|75%|00310610030|ONGLYZA 2.5 MG TABLET|30|EA|6.95281|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/15/2014|111|Yes|15.84594||15.61957||14.87578||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2708|||||No|No||ASTRAZENECA|No|||||No|No|No||
saxagliptin HCl|No|No|No|No|75%|00310610090|ONGLYZA 2.5 MG TABLET|90|EA|6.95257|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|15.84539||15.61903||14.87527||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2709|||||No|No||ASTRAZENECA|No|||||No|No|No||
saxagliptin HCl|No|No|No|No|75%|00310610530|ONGLYZA 5 MG TABLET|30|EA|6.95281|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|15.51491||15.14255||15.25116||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2710|||||No|No||ASTRAZENECA|No|||||No|No|No||
saxagliptin HCl|No|No|No|No|75%|00310610590|ONGLYZA 5 MG TABLET|90|EA|6.95257|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|15.51491||15.14255||15.25116||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2711|||||No|No||ASTRAZENECA|No|||||No|No|No||
saxagliptin HCl/metformin HCl|No|No|No|No|75%|00310612560|KOMBIGLYZE XR 2.5-1,000 MG TAB|60|EA|3.4764|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/15/2014|111|Yes|7.92297||7.80978||7.43789||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2712|||||No|No||ASTRAZENECA|No|||||No|No|No||
saxagliptin HCl/metformin HCl|No|No|No|No|75%|00310613530|KOMBIGLYZE XR 5-500 MG TABLET|30|EA|6.95281|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|15.84594||15.61957||14.87578||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2713|||||No|No||ASTRAZENECA|No|||||No|No|No||
saxagliptin HCl/metformin HCl|No|No|No|No|75%|00310614530|KOMBIGLYZE XR 5-1,000 MG TAB|30|EA|6.95281|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|15.84594||15.61957||14.87578||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2714|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin propanediol|No|No|No|No|75%|00310620530|FARXIGA 5 MG TABLET|30|EA|8.34558|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|02/01/2018|535|Yes|18.61825||18.17141||18.30174||||HYPOGLYCEMICS, SGLT2|2715|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin propanediol|No|No|No|No|75%|00310621030|FARXIGA 10 MG TABLET|30|EA|8.34558|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|02/01/2018|535|Yes|18.62952||18.18241||18.31282||||HYPOGLYCEMICS, SGLT2|2716|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310625030|XIGDUO XR 5 MG-500 MG TABLET|30|EA|8.34558|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription Required|No|01/31/2019|535|Yes|18.64629||18.19878||18.3293||||HYPOGLYCEMICS, SGLT2|2717|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310626060|XIGDUO XR 5 MG-1,000 MG TABLET|60|EA|4.17279|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription Required|No|01/31/2019|535|Yes|9.3122||9.08871||9.15389||||HYPOGLYCEMICS, SGLT2|2718|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310627030|XIGDUO XR 10 MG-500 MG TABLET|30|EA|8.34558|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription Required|No|01/31/2019|535|Yes|18.67483||18.22663||18.35736||||HYPOGLYCEMICS, SGLT2|2719|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310628030|XIGDUO XR 10 MG-1,000 MG TAB|30|EA|8.34558|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription Required|No|01/31/2019|535|Yes|18.60629||18.15974||18.28998||||HYPOGLYCEMICS, SGLT2|2720|||||No|No||ASTRAZENECA|No|||||No|No|No||
exenatide|No|No|No|No|75%|00310651201|BYETTA 5 MCG DOSE PEN INJ|1.2|ML|304.56541|02/10/2015||Yes|No||02/10/2015||Yes|No|02/10/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|680.23247||663.90689||668.66852||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2721|||||No|No||ASTRAZENECA|No|||||No|No|No||
exenatide|No|No|No|No|75%|00310652401|BYETTA 10 MCG DOSE PEN INJ|2.4|ML|152.28271|02/10/2015||Yes|No||02/10/2015||Yes|No|02/10/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|340.10783||331.94524||334.326||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2722|||||No|No||ASTRAZENECA|No|||||No|No|No||
exenatide microspheres|No|No|No|No|75%|00310654004|BYDUREON BCISE 2 MG AUTOINJECT|0.85|ML|104.64809|07/10/2018||Yes|No||07/10/2018||Yes|No|07/10/2018||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|111|Yes|234.17857||228.55828||230.19753||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2723|||||No|No||ASTRAZENECA|No|||||No|No|No||
pramlintide acetate|No|No|No|No|75%|00310661502|SYMLINPEN 60 PEN INJECTOR|1.5|ML|148.48043|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|111|Yes|331.09||323.14384||325.46147||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2724|||||No|No||ASTRAZENECA|No|||||No|No|No||
pramlintide acetate|No|No|No|No|75%|00310662702|SYMLINPEN 120 PEN INJECTOR|2.7|ML|97.95718|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/15/2014|111|Yes|217.79333||212.56629||214.09084||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2725|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin/saxagliptin HCl|No|No|No|No|75%|00310678030|QTERN 10 MG-5 MG TABLET|30|EA|8.10249|07/09/2018||Yes|No||07/09/2018||Yes|No|07/09/2018||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|111|Yes|18.04886||17.61569||17.74203||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2726|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00310737020|BUDESONIDE-FORMOTEROL 160-4.5|10.2|GM|10.54174|03/06/2020||Yes|No||03/06/2020||Yes|No|03/06/2020||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|033|No|17.54808||17.12693||17.24976||||GLUCOCORTICOIDS, INHALED|2727|||||No|No||ASTRAZENECA/PRA|No|||||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00310737220|BUDESONIDE-FORMOTEROL 80-4.5|10.2|GM|9.22265|03/06/2020||Yes|No||03/06/2020||Yes|No|03/06/2020||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|033|No|14.74679||14.39287||14.49609||||GLUCOCORTICOIDS, INHALED|2728|||||No|No||ASTRAZENECA/PRA|No|||||No|No|No||
albuterol sulfate/budesonide|No|No|No|No|75%|00310908012|AIRSUPRA 90-80 MCG INHALER|10.7|GM|19.08878|08/12/2024||Yes|No||08/12/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|08/08/2024|033|No|42.65639||41.63264||41.93123||||GLUCOCORTICOIDS, INHALED|2729|||||No|No||ASTRAZENECA|No|||||No|No|No||
eplontersen sodium|No|No|No|No|75%|00310940001|WAINUA 45 MG/0.8 ML AUTOINJECT|0.8|ML|22351.03988|08/13/2024||Yes|No||08/13/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|50939.57925||50211.87098||47820.8295|||||2730|||||No|No||ASTRAZENECA|No|||||No|No|No||
capivasertib|No|No|No|No|75%|00310950001|TRUQAP 160 MG TABLET|64|EA|154.00719|02/28/2024||Yes|No||02/28/2024||Yes|No|02/28/2024||Yes|No||||No|No|||Prescription Required|No|08/08/2024|502|No|350.99313||345.97894||329.50375||||ONCOLOGY, ORAL - BREAST|2731|||||No|No||ASTRAZENECA|No|||||No|No|No||
capivasertib|No|No|No|No|75%|00310950101|TRUQAP 200 MG TABLET|64|EA|154.00719|02/28/2024||Yes|No||02/28/2024||Yes|No|02/28/2024||Yes|No||||No|No|||Prescription Required|No|08/08/2024|502|No|350.99313||345.97894||329.50375||||ONCOLOGY, ORAL - BREAST|2732|||||No|No||ASTRAZENECA|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00338000344|STERILE WATER FOR IRRIGATION|1000|ML|.00333|03/11/2004||Yes|No||03/11/2004||Yes|No|03/11/2004||Yes|No||||No|No|||Prescription Required|No|||No|.0076||.00749||.00713|||||2733|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00338000346|STERILE WATER FOR IRRIGATION|2000|ML|.00239|03/11/2004||Yes|No||03/11/2004||Yes|No|03/11/2004||Yes|No||||No|No|||Prescription Required|No|||No|.00544||.00536||.00511|||||2734|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00338000347|STERILE WATER FOR IRRIGATION|3000|ML|.00231|03/07/2005||Yes|No||03/07/2005||Yes|No|03/07/2005||Yes|No||||No|No|||Prescription Required|No|||No|.00526||.00519||.00494|||||2735|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00338000404|STERILE WATER FOR IRRIGATION|1000|ML|.00174|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00396||.0039||.00372|||||2736|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00338001304|STERILE WATER FOR INJECTION|1000|ML|.00415|03/07/2005||Yes|No||03/07/2005||Yes|No|03/07/2005||Yes|No||||No|No|||Prescription Required|No|||No|.00945||.00931||.00887|||||2737|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00338001329|STERILE WATER FOR INJECTION|5000|ML|.00174|03/07/2005||Yes|No||03/07/2005||Yes|No|03/07/2005||Yes|No||||No|No|||Prescription Required|No|||No|.00397||.00391||.00373|||||2738|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00338001704|DEXTROSE 5%-WATER IV SOLN|1000|ML|.00238|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00542||.00534||.00509|||||2739|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00338001711|DEXTROSE 5%-WATER IV SOLN|50|ML|.02185|||No|No||||No|No|03/08/2005||Yes|No||||No|No|||Prescription Required|No|||No|.0498||.04909||.04675|||||2740|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00338001718|DEXTROSE 5%-WATER IV SOLN|100|ML|.01088|03/20/2007||Yes|No||03/20/2007||Yes|No|03/20/2007||Yes|No||||No|No|||Prescription Required|No|||No|.0248||.02445||.02329|||||2741|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00338001731|DEXTROSE 5%-WATER IV SOLN|50|ML|.02025|08/24/2006||Yes|No||08/24/2006||Yes|No|08/24/2006||Yes|No||||No|No|||Prescription Required|No|||No|.04615||.04549||.04332|||||2742|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00338001738|DEXTROSE 5%-WATER IV SOLN|100|ML|.01012|03/20/2007||Yes|No||03/20/2007||Yes|No|03/20/2007||Yes|No||||No|No|||Prescription Required|No|||No|.02307||.02274||.02166|||||2743|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00338001741|DEXTROSE 5%-WATER IV SOLN|50|ML|.02345|03/20/2007||Yes|No||03/20/2007||Yes|No|03/20/2007||Yes|No||||No|No|||Prescription Required|No|||No|.05345||.05269||.05018|||||2744|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00338001748|DEXTROSE 5%-WATER IV SOLN|100|ML|.01161|||No|No||||No|No|09/01/1999||Yes|No||||No|No|||Prescription Required|No|||No|.02647||.02609||.02485|||||2745|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
sodium chloride 0.45 %|No|No|No|No|75%|00338004303|SODIUM CHLORIDE 0.45% SOLN|500|ML|.00405|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||||No|No|||Prescription Required|No|||No|.00923||.0091||.00867|||||2746|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
sodium chloride 0.45 %|No|No|No|No|75%|00338004304|SODIUM CHLORIDE 0.45% SOLN|1000|ML|.00269|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||||No|No|||Prescription Required|No|||No|.00613||.00604||.00575|||||2747|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
sodium chloride irrig solution|No|No|No|No|75%|00338004804|SODIUM CHLORIDE 0.9% IRRIG.|1000|ML|.00197|12/05/2005||Yes|No||12/05/2005||Yes|No|12/05/2005||Yes|No||||No|No|||Prescription Required|No|||No|.00449||.00442||.00421|||||2748|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00338004902|SODIUM CHLORIDE 0.9% SOLUTION|250|ML|.00737|02/29/2008||Yes|No||02/29/2008||Yes|No|02/29/2008||Yes|No||||No|No|||Prescription Required|No|||No|.0168||.01656||.01577|||||2749|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00338004903|SODIUM CHLORIDE 0.9% SOLUTION|500|ML|.00362|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00826||.00814||.00776|||||2750|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00338004904|SODIUM CHLORIDE 0.9% SOLUTION|1000|ML|.00212|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00179||.00175||.00176|||||2751|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00338004911|SODIUM CHLORIDE 0.9% SOLUTION|50|ML|.02268|02/29/2008||Yes|No||02/29/2008||Yes|No|02/29/2008||Yes|No||||No|No|||Prescription Required|No|||No|.0517||.05096||.04853|||||2752|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00338004938|SODIUM CHLORIDE 0.9% SOLUTION|100|ML|.01103|02/29/2008||Yes|No||02/29/2008||Yes|No|02/29/2008||Yes|No||||No|No|||Prescription Required|No|||No|.02515||.02479||.02361|||||2753|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 %-0.45 % sod chlord|No|No|No|No|75%|00338008504|DEXTROSE 5%-0.45% NACL IV SOLN|1000|ML|.00267|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00609||.006||.00571|||||2754|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 5 % and 0.9 % NaCl|No|No|No|No|75%|00338008904|DEXTROSE 5%-0.9% NACL IV SOLN|1000|ML|.00254|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00578||.0057||.00543|||||2755|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00338011704|LACTATED RINGERS INJECTION|1000|ML|.00221|03/31/2005||Yes|No||03/31/2005||Yes|No|03/31/2005||Yes|No||||No|No|||Prescription Required|No|||No|.00299||.00292||.00294|||||2756|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
lidocaine HCl/dextrose 5 %/PF|No|No|No|No|75%|00338040903|LIDOCAINE 0.4% IN D5W SOLN|500|ML|.00584|03/31/2005||Yes|No||03/31/2005||Yes|No|03/31/2005||Yes|No||||No|No|||Prescription Required|No|||No|.01332||.01313||.0125|||||2757|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
gentamicin in NaCl, iso-osm|No|No|No|No|75%|00338050348|ISOTON GENTAMICIN 80 MG/100 ML|100|ML|.01715|12/09/2003||Yes|No||12/09/2003||Yes|No|12/09/2003||Yes|No||||No|No|||Prescription Required|No|||No|.03909||.03853||.0367|||||2758|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
gentamicin in NaCl, iso-osm|No|No|No|No|75%|00338050548|ISO GENTAMICIN 100 MG/100 ML|100|ML|.01837|12/10/2003||Yes|No||12/10/2003||Yes|No|12/10/2003||Yes|No||||No|No|||Prescription Required|No|||No|.04188||.04128||.03931|||||2759|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
gentamicin in NaCl, iso-osm|No|No|No|No|75%|00338050741|ISOTON GENTAMICIN 60 MG/50 ML|50|ML|.03291|12/10/2003||Yes|No||12/10/2003||Yes|No|12/10/2003||Yes|No||||No|No|||Prescription Required|No|||No|.075||.07393||.07041|||||2760|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
gentamicin in NaCl, iso-osm|No|No|No|No|75%|00338050748|ISO GENTAMICIN 120 MG/100 ML|100|ML|.0179|12/10/2003||Yes|No||12/10/2003||Yes|No|12/10/2003||Yes|No||||No|No|||Prescription Required|No|||No|.0408||.04021||.0383|||||2761|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
gentamicin in NaCl, iso-osm|No|No|No|No|75%|00338050941|ISOTON GENTAMICIN 80 MG/50 ML|50|ML|.03499|12/10/2003||Yes|No||12/10/2003||Yes|No|12/10/2003||Yes|No||||No|No|||Prescription Required|No|||No|.07975||.07861||.07487|||||2762|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
gentamicin in NaCl, iso-osm|No|No|No|No|75%|00338051141|ISOTON GENTAMICIN 100 MG/50 ML|50|ML|.03569|12/10/2003||Yes|No||12/10/2003||Yes|No|12/10/2003||Yes|No||||No|No|||Prescription Required|No|||No|.08134||.08018||.07636|||||2763|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00338055311|SODIUM CHLORIDE 0.9% SOLUTION|50|ML|.05733|08/24/2006||Yes|No||08/24/2006||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.13065||.12879||.12265|||||2764|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00338055318|SODIUM CHLORIDE 0.9% SOLUTION|100|ML|.02866|09/15/2010||Yes|No||09/15/2010||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.06533||.06439||.06133|||||2765|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
potassium chloride-0.45% NaCl|No|No|No|No|75%|00338070434|POTASSIUM CL 20 MEQ-0.45% NACL|1000|ML|.0031|06/15/2005||Yes|No||06/15/2005||Yes|No|06/15/2005||Yes|No||||No|No|||Prescription Required|No|||No|.00708||.00697||.00664|||||2766|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dextrose 70 % in water|No|No|No|No|75%|00338071906|DEXTROSE 70%-WATER IV SOLN|2000|ML|.00422|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.00961||.00948||.00903|||||2767|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
oxacillin in dextrose(iso-osm)|No|No|No|No|75%|00338101541|OXACILLIN 2 GM/ 50 ML INJ     |50|ML|.2101|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription Required|No|||No|.47883||.47199||.44951|||||2768|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
nafcillin in dextrose,iso-osm|No|No|No|No|75%|00338101741|NAFCILLIN 1 GM/ 50 ML INJ|50|ML|.14599|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription Required|No|||No|.33273||.32798||.31236|||||2769|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
nafcillin in dextrose,iso-osm|No|No|No|No|75%|00338101948|NAFCILLIN 2 GM/ 100 ML INJ    |100|ML|.10505|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription Required|No|||No|.23941||.23599||.22476|||||2770|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
pen G pot/dextrose-water|No|No|No|No|75%|00338102341|PEN G K 2 MILLION UNIT/50 ML  |50|ML|.08884|03/31/2005||Yes|No||03/31/2005||Yes|No|03/31/2005||Yes|No||||No|No|||Prescription Required|No|||No|.20247||.19958||.19007|||||2771|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
pen G pot/dextrose-water|No|No|No|No|75%|00338102541|PEN G K 3 MILLION UNIT/50 ML  |50|ML|.09224|03/31/2005||Yes|No||03/31/2005||Yes|No|03/31/2005||Yes|No||||No|No|||Prescription Required|No|||No|.21021||.20721||.19734|||||2772|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
metronidazole/sodium chloride|No|No|No|No|75%|00338105548|METRONIDAZOLE 500 MG/100 ML   |100|ML|.00985|11/18/2003||Yes|No||11/18/2003||Yes|No|11/18/2003||Yes|No||||No|No|||Prescription Required|No|||No|.02245||.02213||.02108|||||2773|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dobutamine HCl in dextrose 5 %|No|No|No|No|75%|00338107302|DOBUTAMINE 250 MG/250 ML-D5W|250|ML|.03861|08/09/2013||Yes|No||08/09/2013||Yes|No|08/09/2013||Yes|No||||No|No|||Prescription Required|No|||No|.08799||.08674||.08261|||||2774|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dobutamine HCl in dextrose 5 %|No|No|No|No|75%|00338107502|DOBUTAMINE 500 MG/250 ML D5W|250|ML|.06871|08/09/2013||Yes|No||08/09/2013||Yes|No|08/09/2013||Yes|No||||No|No|||Prescription Required|No|||No|.15658||.15435||.147|||||2775|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
dobutamine HCl in dextrose 5 %|No|No|No|No|75%|00338107702|DOBUTAMINE 1,000 MG/250 ML D5W|250|ML|.05027|08/09/2013||Yes|No||08/09/2013||Yes|No|08/09/2013||Yes|No||||No|No|||Prescription Required|No|||No|.11456||.11293||.10755|||||2776|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
cefepime in iso-osm dextrose|No|No|No|No|75%|00338130141|CEFEPIME 1 GM INJECTION|50|ML|.232|10/15/2008||Yes|No||10/15/2008||Yes|No|10/15/2008||Yes|No||||No|No|||Prescription Required|No|||No|.52874||.52119||.49637|||||2777|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
cefepime in iso-osm dextrose|No|No|No|No|75%|00338130148|CEFEPIME 2 GM INJECTION       |100|ML|.18309|10/15/2008||Yes|No||10/15/2008||Yes|No|10/15/2008||Yes|No||||No|No|||Prescription Required|No|||No|.41728||.41132||.39174|||||2778|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
cefazolin sodium/dextrose,iso|No|No|No|No|75%|00338350341|CEFAZOLIN 1 G/50 ML-DEXTROSE|50|ML|.04527|07/07/2008||Yes|No||07/07/2008||Yes|No|07/07/2008||Yes|No||||No|No|||Prescription Required|No|||No|.10317||.1017||.09686|||||2779|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
vancomycin HCl in 5 % dextrose|No|No|No|No|75%|00338355148|VANCOMYCIN-D5W 500 MG/100 ML  |100|ML|.03335|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription Required|No|||No|.076||.07491||.07135|||||2780|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
vancomycin HCl in 5 % dextrose|No|No|No|No|75%|00338355248|VANCOMYCIN HCL 1G/200 ML BAG  |200|ML|.0582|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription Required|No|||No|.13264||.13075||.12452|||||2781|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
vancomycin HCl in 5 % dextrose|No|No|No|No|75%|00338358048|VANCOMYCIN 750 MG/150 ML BAG  |150|ML|.03463|05/15/2011||Yes|No||05/15/2011||Yes|No|05/15/2011||Yes|No||||No|No|||Prescription Required|No|||No|.07892||.07779||.07409|||||2782|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
ceftriaxone in is-osm dextrose|No|No|No|No|75%|00338500241|CEFTRIAXONE 1 GM PIGGYBACK|50|ML|.12203|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription Required|No|||No|.27812||.27415||.2611|||||2783|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
ceftriaxone in is-osm dextrose|No|No|No|No|75%|00338500341|CEFTRIAXONE 2 GM PIGGYBACK|50|ML|.28905|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription Required|No|||No|.65876||.64935||.61842|||||2784|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
famotidine in NaCl,iso-osm/PF|No|No|No|No|75%|00338519741|FAMOTIDINE 20 MG PIGGYBACK|50|ML|.04813|11/18/2003||Yes|No||11/18/2003||Yes|No|11/18/2003||Yes|No||||No|No|||Prescription Required|No|||No|.10968||.10811||.10297|||||2785|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
milrinone lactate/D5W|No|No|No|No|75%|00338601048|MILRINONE-D5W 20 MG/100 ML|100|ML|.14486|11/18/2003||Yes|No||11/18/2003||Yes|No|11/18/2003||Yes|No||||No|No|||Prescription Required|No|||No|.33015||.32544||.30994|||||2786|||||No|No||BAXTER HEALTHCA|No|||||Yes|No|No||
milrinone lactate/D5W|No|No|No|No|75%|00338601137|MILRINONE-D5W 40 MG/200 ML|200|ML|.14715|11/18/2003||Yes|No||11/18/2003||Yes|No|11/18/2003||Yes|No||||No|No|||Prescription Required|No|||No|.33538||.33058||.31484|||||2787|||||No|No||BAXTER HEALTHCA|No|||||Yes|No|No||
fluconazole in NaCL,iso-osm|No|No|No|No|75%|00338604537|FLUCONAZOLE-NACL 400 MG/200 ML|200|ML|.04475|03/04/2005||Yes|No||03/04/2005||Yes|No|03/04/2005||Yes|No||||No|No|||Prescription Required|No|||No|.10198||.10052||.09574|||||2788|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
fluconazole in NaCL,iso-osm|No|No|No|No|75%|00338604648|FLUCONAZOLE-NACL 200 MG/100 ML|100|ML|.08024|03/04/2005||Yes|No||03/04/2005||Yes|No|03/04/2005||Yes|No||||No|No|||Prescription Required|No|||No|.18288||.18027||.17168|||||2789|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00378000585|EVEROLIMUS 2 MG TAB FOR SUSP|28|EA|198.03005|05/17/2022||Yes|No||05/17/2022||Yes|No|05/17/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|451.3243||444.87681||423.6922||||ONCOLOGY, ORAL - RENAL CELL|2790|||||No|No||MYLAN|No|||||No|No|No||
everolimus|No|No|No|No|75%|00378000685|EVEROLIMUS 3 MG TAB FOR SUSP|28|EA|200.01358|05/17/2022||Yes|No||05/17/2022||Yes|No|05/17/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|455.84489||449.33282||427.93602||||ONCOLOGY, ORAL - RENAL CELL|2791|||||No|No||MYLAN|No|||||No|No|No||
everolimus|No|No|No|No|75%|00378000785|EVEROLIMUS 5 MG TAB FOR SUSP|28|EA|208.17406|05/17/2022||Yes|No||05/17/2022||Yes|No|05/17/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|474.4432||467.66544||445.39565||||ONCOLOGY, ORAL - RENAL CELL|2792|||||No|No||MYLAN|No|||||No|No|No||
methotrexate sodium|No|No|No|No|75%|00378001401|METHOTREXATE 2.5 MG TABLET|100|EA|1.01244|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.16189||.158||.15914|||||2793|||||No|No||MYLAN|No|||||Yes|No|No||
metoprolol tartrate|No|No|No|No|75%|00378001801|METOPROLOL TARTRATE 25 MG TAB|100|EA|.02064|01/18/2005||Yes|No||01/18/2005||Yes|No|01/18/2005||Yes|No||01/18/2005||Yes|No|||Prescription Required|No|01/20/2011|070|No|.01421||.01387||.01397||||BETA-BLOCKERS|2794|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378001805|METOPROLOL TARTRATE 25 MG TAB|500|EA|.01961|06/25/2008||Yes|No||06/25/2008||Yes|No|06/25/2008||Yes|No||06/25/2008||Yes|No|||Prescription Required|No|01/20/2011|070|No|.01421||.01387||.01397||||BETA-BLOCKERS|2795|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378003201|METOPROLOL TARTRATE 50 MG TAB|100|EA|.02107|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.01546||.01509||.0152||||BETA-BLOCKERS|2796|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378003210|METOPROLOL TARTRATE 50 MG TAB|1000|EA|.01828|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.01546||.01509||.0152||||BETA-BLOCKERS|2797|||||No|No||MYLAN|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378004201|PERPHEN-AMITRIP 4 MG-10 MG TAB|100|EA|.55406|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|1.26273||1.24469||1.18542||||ANTIPSYCHOTICS|2798|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378004701|METOPROLOL TARTRATE 100 MG TAB|100|EA|.03118|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.02127||.02076||.02091||||BETA-BLOCKERS|2799|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378004710|METOPROLOL TARTRATE 100 MG TAB|1000|EA|.02688|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.02127||.02076||.02091||||BETA-BLOCKERS|2800|||||No|No||MYLAN|No|||||No|No|No||
pindolol|No|No|No|No|75%|00378005201|PINDOLOL 5 MG TABLET|100|EA|.45399|03/01/2002|04/30/2025|Yes|No||03/01/2002|04/30/2025|Yes|No|03/01/2002|04/30/2025|Yes|No||03/01/2002|04/30/2025|Yes|No|||Prescription Required|Yes|07/26/2012|070|No|.56371||.55018||.55413||||BETA-BLOCKERS|2801|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00378005301|CIMETIDINE 200 MG TABLET|100|EA|.15287|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.27834||.27166||.27361|||||2802|||||No|No||MYLAN|No|||||No|No|No||
timolol maleate|No|No|No|No|75%|00378005501|TIMOLOL MALEATE 5 MG TABLET|100|EA|.47356|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|070|No|1.07927||1.06386||1.0132||||BETA-BLOCKERS|2803|||||No|No||MYLAN|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378007301|PERPHEN-AMITRIP 4 MG-50 MG TAB|100|EA|1.13365|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|2.58367||2.54676||2.42549||||ANTIPSYCHOTICS|2804|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378007801|CARBIDOPA-LEVODOPA 10-100 TAB|100|EA|.11245|06/25/2020||Yes|No||06/25/2020||Yes|No|06/25/2020||Yes|No||||No|No|||Prescription Required|No|01/20/2011|015|No|.07976||.07785||.0784||||ANTIPARKINSON'S AGENTS|2805|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378008501|CARBIDOPA-LEVODOPA 25-100 TAB|100|EA|.12771|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription Required|No|01/20/2011|015|No|.06173||.06025||.06068||||ANTIPARKINSON'S AGENTS|2806|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378008801|CARBIDOPA-LEVO ER 25-100 TAB|100|EA|.29709|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/20/2011|015|No|.10483||.10231||.10305||||ANTIPARKINSON'S AGENTS|2807|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378009401|CARBIDOPA-LEVO ER 50-200 TAB|100|EA|.60424|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/20/2011|015|No|.16373||.1598||.16095||||ANTIPARKINSON'S AGENTS|2808|||||No|No||MYLAN|No|||||No|No|No||
pindolol|No|No|No|No|75%|00378012701|PINDOLOL 10 MG TABLET|100|EA|.6186|03/01/2002|04/30/2025|Yes|No||03/01/2002|04/30/2025|Yes|No|03/01/2002|04/30/2025|Yes|No||03/01/2002|04/30/2025|Yes|No|||Prescription Required|Yes|07/26/2012|070|No|.83158||.81162||.81744||||BETA-BLOCKERS|2809|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
allopurinol|No|No|No|No|75%|00378013701|ALLOPURINOL 100 MG TABLET|100|EA|.12199|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|231|No|.03406||.03324||.03348||||ANTIHYPERURICEMICS|2810|||||No|No||MYLAN|No|||||No|No|No||
allopurinol|No|No|No|No|75%|00378013710|ALLOPURINOL 100 MG TABLET|1000|EA|.12199|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|231|No|.03406||.03324||.03348||||ANTIHYPERURICEMICS|2811|||||No|No||MYLAN|No|||||No|No|No||
tamoxifen citrate|No|No|No|No|75%|00378014491|TAMOXIFEN 10 MG TABLET|60|EA|.16376|03/04/2003||Yes|No||03/04/2003||Yes|No|03/04/2003||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|.11309||.11038||.11117||||ONCOLOGY, ORAL - BREAST|2812|||||No|No||MYLAN|No|||||No|No|No||
allopurinol|No|No|No|No|75%|00378018101|ALLOPURINOL 300 MG TABLET|100|EA|.24514|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|231|No|.05678||.05542||.05581||||ANTIHYPERURICEMICS|2813|||||No|No||MYLAN|No|||||No|No|No||
allopurinol|No|No|No|No|75%|00378018105|ALLOPURINOL 300 MG TABLET|500|EA|.24513|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|231|No|.05678||.05542||.05581||||ANTIHYPERURICEMICS|2814|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018201|PROPRANOLOL 10 MG TABLET|100|EA|.12268|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.05353||.05225||.05262||||BETA-BLOCKERS|2815|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018210|PROPRANOLOL 10 MG TABLET|1000|EA|.12269|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.05353||.05225||.05262||||BETA-BLOCKERS|2816|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018301|PROPRANOLOL 20 MG TABLET|100|EA|.15338|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.05737||.05599||.05639||||BETA-BLOCKERS|2817|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018310|PROPRANOLOL 20 MG TABLET|1000|EA|.15336|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.05737||.05599||.05639||||BETA-BLOCKERS|2818|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018401|PROPRANOLOL 40 MG TABLET|100|EA|.21547|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.09062||.08845||.08908||||BETA-BLOCKERS|2819|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018410|PROPRANOLOL 40 MG TABLET|1000|EA|.21549|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.09062||.08845||.08908||||BETA-BLOCKERS|2820|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018501|PROPRANOLOL 80 MG TABLET|100|EA|.29154|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.19368||.18903||.19039||||BETA-BLOCKERS|2821|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018505|PROPRANOLOL 80 MG TABLET|500|EA|.29152|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.19368||.18903||.19039||||BETA-BLOCKERS|2822|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018701|PROPRANOLOL 60 MG TABLET|100|EA|.38296|05/17/2011||Yes|No||05/17/2011||Yes|No|05/17/2011||Yes|No||||No|No|||Prescription Required|No|07/28/2010|070|No|.13241||.12923||.13016||||BETA-BLOCKERS|2823|||||No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378020810|FUROSEMIDE 20 MG TABLET|1000|EA|.01937|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.04414||.04351||.04144|||||2824|||||No|No||MYLAN|No|||||No|No|No||
amitriptyline/chlordiazepoxide|No|No|No|No|75%|00378021101|CHLORDIAZEPO-AMITRIPTYL 5-12.5|100|EA|.52731|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|1.21892||1.18967||1.1982|||||2825|||||No|No||MYLAN|No|||||No|No|No||
amitriptyline/chlordiazepoxide|No|No|No|No|75%|00378021105|CHLORDIAZEPO-AMITRIPTYL 5-12.5|500|EA|.52729|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|1.21892||1.18967||1.1982|||||2826|||||No|No||MYLAN|No|||||No|No|No||
chlorthalidone|No|No|No|No|75%|00378021301|CHLORTHALIDONE 50 MG TABLET|100|EA|.512|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.11215||.10946||.11024|||||2827|||||No|No||MYLAN|No|||||No|No|No||
chlorthalidone|No|No|No|No|75%|00378021310|CHLORTHALIDONE 50 MG TABLET|1000|EA|.51193|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.11215||.10946||.11024|||||2828|||||No|No||MYLAN|No|||||No|No|No||
haloperidol|No|No|No|No|75%|00378021401|HALOPERIDOL 2 MG TABLET|100|EA|.21741|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.20267||.19781||.19922||||ANTIPSYCHOTICS|2829|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378021410|HALOPERIDOL 2 MG TABLET|1000|EA|.2174|08/23/2009||Yes|No||08/23/2009||Yes|No|08/23/2009||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.20267||.19781||.19922||||ANTIPSYCHOTICS|2830|||||No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378021601|FUROSEMIDE 40 MG TABLET|100|EA|.02223|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.05067||.04994||.04756|||||2831|||||No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378021610|FUROSEMIDE 40 MG TABLET|1000|EA|.02|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.04558||.04493||.04279|||||2832|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378021801|ATENOLOL 25 MG TABLET|100|EA|.02795|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.01865||.0182||.01833||||BETA-BLOCKERS|2833|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378021810|ATENOLOL 25 MG TABLET|1000|EA|.02655|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.01865||.0182||.01833||||BETA-BLOCKERS|2834|||||No|No||MYLAN|No|||||No|No|No||
timolol maleate|No|No|No|No|75%|00378022101|TIMOLOL MALEATE 10 MG TABLET|100|EA|.58583|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|070|No|1.33515||1.31608||1.25341||||BETA-BLOCKERS|2835|||||No|No||MYLAN|No|||||No|No|No||
chlorthalidone|No|No|No|No|75%|00378022201|CHLORTHALIDONE 25 MG TABLET|100|EA|.41517|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.07302||.07127||.07178|||||2836|||||No|No||MYLAN|No|||||No|No|No||
chlorthalidone|No|No|No|No|75%|00378022210|CHLORTHALIDONE 25 MG TABLET|1000|EA|.41513|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.07302||.07127||.07178|||||2837|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378023101|ATENOLOL 50 MG TABLET|100|EA|.03032|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.02063||.02013||.02028||||BETA-BLOCKERS|2838|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378023110|ATENOLOL 50 MG TABLET|1000|EA|.02881|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.02063||.02013||.02028||||BETA-BLOCKERS|2839|||||No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378023201|FUROSEMIDE 80 MG TABLET|100|EA|.03251|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.07409||.07303||.06955|||||2840|||||No|No||MYLAN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00378024301|SPIRONOLACTONE 50 MG TABLET|100|EA|.18331|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.0766||.07476||.0753|||||2841|||||No|No||MYLAN|No|||||No|No|No||
haloperidol|No|No|No|No|75%|00378025701|HALOPERIDOL 1 MG TABLET|100|EA|.15871|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.13457||.13134||.13228||||ANTIPSYCHOTICS|2842|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378025710|HALOPERIDOL 1 MG TABLET|1000|EA|.1587|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.13457||.13134||.13228||||ANTIPSYCHOTICS|2843|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378027101|DIAZEPAM 2 MG TABLET|100|EA|.01376|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02079||.02029||.02044||||ANXIOLYTICS|2844|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378027105|DIAZEPAM 2 MG TABLET|500|EA|.01226|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02079||.02029||.02044||||ANXIOLYTICS|2845|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
tamoxifen citrate|No|No|No|No|75%|00378027493|TAMOXIFEN 20 MG TABLET|30|EA|.32751|03/04/2003||Yes|No||03/04/2003||Yes|No|03/04/2003||Yes|No||||No|No|||Prescription Required|No|01/28/2021|502|No|.20788||.20289||.20435||||ONCOLOGY, ORAL - BREAST|2846|||||No|No||MYLAN|No|||||No|No|No||
amitriptyline/chlordiazepoxide|No|No|No|No|75%|00378027701|CHLORDIAZEPOX-AMITRIPTYL 10-25|100|EA|.74399|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|1.6956||1.67137||1.59178|||||2847|||||No|No||MYLAN|No|||||No|No|No||
amitriptyline/chlordiazepoxide|No|No|No|No|75%|00378027705|CHLORDIAZEPOX-AMITRIPTYL 10-25|500|EA|.74399|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|1.6956||1.67137||1.59178|||||2848|||||No|No||MYLAN|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00378031701|CIMETIDINE 300 MG TABLET|100|EA|.15889|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.22724||.22179||.22338|||||2849|||||No|No||MYLAN|No|||||No|No|No||
haloperidol|No|No|No|No|75%|00378032701|HALOPERIDOL 5 MG TABLET|100|EA|.35217|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.26296||.25665||.25849||||ANTIPSYCHOTICS|2850|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378032710|HALOPERIDOL 5 MG TABLET|1000|EA|.35217|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.26296||.25665||.25849||||ANTIPSYCHOTICS|2851|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378033001|PERPHEN-AMITRIP 2 MG-10 MG TAB|100|EA|.4951|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|1.12837||1.11225||1.05929||||ANTIPSYCHOTICS|2852|||||No|No||MYLAN|No|||||No|No|No||
haloperidol|No|No|No|No|75%|00378033401|HALOPERIDOL 10 MG TABLET|100|EA|.64767|03/26/2010||Yes|No||03/26/2010||Yes|No|03/26/2010||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.30088||.29366||.29577||||ANTIPSYCHOTICS|2853|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378033501|HALOPERIDOL 20 MG TABLET|100|EA|1.24481|03/26/2010||Yes|No||03/26/2010||Yes|No|03/26/2010||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.55862||.54521||.54912||||ANTIPSYCHOTICS|2854|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00378034501|DIAZEPAM 5 MG TABLET|100|EA|.0215|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.0216||.02108||.02123||||ANXIOLYTICS|2855|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378034505|DIAZEPAM 5 MG TABLET|500|EA|.01931|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.0216||.02108||.02123||||ANXIOLYTICS|2856|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378035101|HALOPERIDOL 0.5 MG TABLET|100|EA|.11197|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.14371||.14026||.14127||||ANTIPSYCHOTICS|2857|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378035110|HALOPERIDOL 0.5 MG TABLET|1000|EA|.11197|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.14371||.14026||.14127||||ANTIPSYCHOTICS|2858|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
cimetidine|No|No|No|No|75%|00378037201|CIMETIDINE 400 MG TABLET|100|EA|.2583|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.3166||.309||.31122|||||2859|||||No|No||MYLAN|No|||||No|No|No||
dimethyl fumarate|No|No|No|No|75%|00378039614|DIMETHYL FUMARATE DR 120 MG CP|14|EA|2.39571|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|5.45999||5.38199||5.12571||||MULTIPLE SCLEROSIS AGENTS|2860|||||No|No||MYLAN|No|||||No|No|No||
dimethyl fumarate|No|No|No|No|75%|00378039991|DIMETHYL FUMARATE DR 240 MG CP|60|EA|1.68416|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|1.04859||1.02342||1.03076||||MULTIPLE SCLEROSIS AGENTS|2861|||||No|No||MYLAN|No|||||No|No|No||
spironolact/hydrochlorothiazid|No|No|No|No|75%|00378040301|SPIRONOLACTONE-HCTZ 25-25 TAB|100|EA|.52847|05/04/2020||Yes|No||05/04/2020||Yes|No|05/04/2020||Yes|No||||No|No|||Prescription Required|No|||Yes|.39056||.38119||.38392|||||2862|||||No|No||MYLAN|No|||||No|No|No||
metoprolol/hydrochlorothiazide|No|No|No|No|75%|00378042401|METOPROLOL-HCTZ 50-25 MG TAB|100|EA|.48216|03/15/2007||Yes|No||03/15/2007||Yes|No|03/15/2007||Yes|No||03/15/2007||Yes|No|||Prescription Required|Yes|07/24/2013|070|Yes|.67058||.65449||.65918||||BETA-BLOCKERS|2863|||||No|No||MYLAN|No|||||No|No|No||
metoprolol/hydrochlorothiazide|No|No|No|No|75%|00378043401|METOPROLOL-HCTZ 100-25 MG TAB|100|EA|.75362|03/15/2007||Yes|No||03/15/2007||Yes|No|03/15/2007||Yes|No||03/15/2007||Yes|No|||Prescription Required|Yes|07/24/2013|070|Yes|1.31654||1.28494||1.29416||||BETA-BLOCKERS|2864|||||No|No||MYLAN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00378043701|SPIRONOLACTONE 100 MG TABLET|100|EA|.33003|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.13586||.1326||.13355|||||2865|||||No|No||MYLAN|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378044201|PERPHEN-AMITRIP 2 MG-25 MG TAB|100|EA|.63042|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|1.43678||1.41625||1.34881||||ANTIPSYCHOTICS|2866|||||No|No||MYLAN|No|||||No|No|No||
metoprolol/hydrochlorothiazide|No|No|No|No|75%|00378044501|METOPROLOL-HCTZ 100-50 MG TAB |100|EA|.79911|03/15/2007||Yes|No||03/15/2007||Yes|No|03/15/2007||Yes|No||03/15/2007||Yes|No|||Prescription Required|Yes|07/24/2013|070|Yes|1.82123||1.79521||1.70973||||BETA-BLOCKERS|2867|||||No|No||MYLAN|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00378047201|DIVALPROEX SOD ER 250 MG TAB|100|EA|.215|03/12/2009||Yes|No||03/12/2009||Yes|No|03/12/2009||Yes|No||03/12/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|.11588||.1131||.11391||||ANTICONVULSANTS|2868|||||No|No||MYLAN|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00378047205|DIVALPROEX SOD ER 250 MG TAB|500|EA|.215|03/12/2009||Yes|No||03/12/2009||Yes|No|03/12/2009||Yes|No||03/12/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|.11588||.1131||.11391||||ANTICONVULSANTS|2869|||||No|No||MYLAN|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00378047301|DIVALPROEX SOD ER 500 MG TAB|100|EA|.43|03/12/2009||Yes|No||03/12/2009||Yes|No|03/12/2009||Yes|No||03/12/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|.15077||.14715||.14821||||ANTICONVULSANTS|2870|||||No|No||MYLAN|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00378047305|DIVALPROEX SOD ER 500 MG TAB|500|EA|.43|03/12/2009||Yes|No||03/12/2009||Yes|No|03/12/2009||Yes|No||03/12/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|.15077||.14715||.14821||||ANTICONVULSANTS|2871|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378047701|DIAZEPAM 10 MG TABLET|100|EA|.04107|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02583||.02521||.02539||||ANXIOLYTICS|2872|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378047705|DIAZEPAM 10 MG TABLET|500|EA|.03904|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|Yes|.02583||.02521||.02539||||ANXIOLYTICS|2873|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
bisoprolol/hydrochlorothiazide|No|No|No|No|75%|00378050101|BISOPROLOL-HCTZ 2.5-6.25 MG TB|100|EA|.15897|09/01/2019||Yes|No||09/01/2019||Yes|No|09/01/2019||Yes|No||||No|No|||Prescription Required|No|01/20/2011|070|Yes|.17286||.16871||.16992||||BETA-BLOCKERS|2874|||||No|No||MYLAN|No|||||No|No|No||
bisoprolol/hydrochlorothiazide|No|No|No|No|75%|00378050301|BISOPROLOL-HCTZ 5-6.25 MG TAB|100|EA|.15897|09/01/2019||Yes|No||09/01/2019||Yes|No|09/01/2019||Yes|No||||No|No|||Prescription Required|No|01/20/2011|070|Yes|.14665||.14313||.14416||||BETA-BLOCKERS|2875|||||No|No||MYLAN|No|||||No|No|No||
bisoprolol/hydrochlorothiazide|No|No|No|No|75%|00378050501|BISOPROLOL-HCTZ 10-6.25 MG TAB|100|EA|.15897|10/01/2019||Yes|No||10/01/2019||Yes|No|10/01/2019||Yes|No||||No|No|||Prescription Required|No|01/20/2011|070|Yes|.12269||.11975||.1206||||BETA-BLOCKERS|2876|||||No|No||MYLAN|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00378054101|CIMETIDINE 800 MG TABLET|100|EA|.49618|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.78088||.76214||.76761|||||2877|||||No|No||MYLAN|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378057401|PERPHEN-AMITRIP 4 MG-25 MG TAB|100|EA|.68662|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|1.56486||1.54251||1.46906||||ANTIPSYCHOTICS|2878|||||No|No||MYLAN|No|||||No|No|No||
thioridazine HCl|No|No|No|No|75%|00378061201|THIORIDAZINE 10 MG TABLET     |100|EA|.20485|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.45513||.44421||.44739||||ANTIPSYCHOTICS|2879|||||No|No||MYLAN|No|||||No|No|No||
thioridazine HCl|No|No|No|No|75%|00378061401|THIORIDAZINE 25 MG TABLET|100|EA|.28819|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.5023||.49024||.49376||||ANTIPSYCHOTICS|2880|||||No|No||MYLAN|No|||||No|No|No||
thioridazine HCl|No|No|No|No|75%|00378061601|THIORIDAZINE 50 MG TABLET     |100|EA|.36038|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.67534||.65913||.66386||||ANTIPSYCHOTICS|2881|||||No|No||MYLAN|No|||||No|No|No||
thioridazine HCl|No|No|No|No|75%|00378061801|THIORIDAZINE 100 MG TABLET    |100|EA|.41039|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.93531||.92195||.87805||||ANTIPSYCHOTICS|2882|||||No|No||MYLAN|No|||||No|No|No||
prednisone|No|No|No|No|75%|00378064001|PREDNISONE 5 MG TABLET|100|EA|.07|06/04/2019||Yes|No||06/04/2019||Yes|No|06/04/2019||Yes|No||06/04/2019||Yes|No|||Prescription Required|No|01/25/2018|168|Yes|.03916||.03822||.03849||||GLUCOCORTICOIDS, ORAL|2883|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064010|PREDNISONE 5 MG TABLET|1000|EA|.06931|06/04/2019||Yes|No||06/04/2019||Yes|No|06/04/2019||Yes|No||06/04/2019||Yes|No|||Prescription Required|No|01/25/2018|168|Yes|.03916||.03822||.03849||||GLUCOCORTICOIDS, ORAL|2884|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064101|PREDNISONE 10 MG TABLET|100|EA|.07516|01/03/2020||Yes|No||01/03/2020||Yes|No|01/03/2020||Yes|No||01/03/2020||Yes|No|||Prescription Required|No|01/25/2018|168|Yes|.04042||.03945||.03973||||GLUCOCORTICOIDS, ORAL|2885|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064110|PREDNISONE 10 MG TABLET|1000|EA|.0744|01/03/2020||Yes|No||01/03/2020||Yes|No|01/03/2020||Yes|No||01/03/2020||Yes|No|||Prescription Required|No|01/25/2018|168|Yes|.04042||.03945||.03973||||GLUCOCORTICOIDS, ORAL|2886|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064201|PREDNISONE 20 MG TABLET|100|EA|.0802|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||12/30/2020||Yes|No|||Prescription Required|No|01/30/2020|168|Yes|.06386||.06233||.06277||||GLUCOCORTICOIDS, ORAL|2887|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064205|PREDNISONE 20 MG TABLET|500|EA|.07938|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||12/30/2020||Yes|No|||Prescription Required|No|01/30/2020|168|Yes|.06386||.06233||.06277||||GLUCOCORTICOIDS, ORAL|2888|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064210|PREDNISONE 20 MG TABLET|1000|EA|.07541|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||12/30/2020||Yes|No|||Prescription Required|No|01/30/2020|168|Yes|.06386||.06233||.06277||||GLUCOCORTICOIDS, ORAL|2889|||||No|No||MYLAN|No|||||Yes|No|No||
timolol maleate|No|No|No|No|75%|00378071501|TIMOLOL MALEATE 20 MG TABLET|100|EA|1.08085|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|070|No|2.46333||2.42814||2.31251||||BETA-BLOCKERS|2890|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378075701|ATENOLOL 100 MG TABLET|100|EA|.05569|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|070|No|.03271||.03192||.03215||||BETA-BLOCKERS|2891|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378075710|ATENOLOL 100 MG TABLET|1000|EA|.05291|06/02/2005||Yes|No||06/02/2005||Yes|No|06/02/2005||Yes|No||06/02/2005||Yes|No|||Prescription Required|No|01/20/2011|070|No|.03271||.03192||.03215||||BETA-BLOCKERS|2892|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378082501|CLOZAPINE 25 MG TABLET|100|EA|.36176|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.25169||.24565||.24741||||ANTIPSYCHOTICS|2893|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378086001|CLOZAPINE 100 MG TABLET|100|EA|.93843|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.53374||.52093||.52467||||ANTIPSYCHOTICS|2894|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378086005|CLOZAPINE 100 MG TABLET|500|EA|.89443|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.53374||.52093||.52467||||ANTIPSYCHOTICS|2895|||||No|No||MYLAN|No|||||No|No|No||
clonidine|No|No|No|No|75%|00378087199|CLONIDINE 0.1 MG/DAY PATCH|4|EA|11.39393|07/20/2010||Yes|No||07/20/2010||Yes|No|07/20/2010||Yes|No||01/01/2012||Yes|No|||Prescription Required|No|07/27/2023|166|No|5.25716||5.13099||5.16779||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2896|||||No|No||MYLAN|No|||||No|No|No||
clonidine|No|No|No|No|75%|00378087299|CLONIDINE 0.2 MG/DAY PATCH|4|EA|19.18338|07/20/2010||Yes|No||07/20/2010||Yes|No|07/20/2010||Yes|No||01/01/2012||Yes|No|||Prescription Required|No|07/27/2023|166|No|8.91855||8.7045||8.76693||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2897|||||No|No||MYLAN|No|||||No|No|No||
clonidine|No|No|No|No|75%|00378087399|CLONIDINE 0.3 MG/DAY PATCH|4|EA|26.6127|07/20/2010||Yes|No||07/20/2010||Yes|No|07/20/2010||Yes|No||01/01/2012||Yes|No|||Prescription Required|No|07/27/2023|166|No|11.42837||11.15409||11.23409||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2898|||||No|No||MYLAN|No|||||No|No|No||
penciclovir|No|No|No|No|75%|00378089655|PENCICLOVIR 1% CREAM|5|GM|60.26708|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|123|No|106.33038||103.77845||104.52276||||ANTIVIRALS, TOPICAL|2899|||||No|No||MYLAN|No|||||No|No|No||
buprenorphine HCl|No|No|No|No|90%|00378092393|BUPRENORPHINE 2 MG TABLET SL  |30|EA|.22933|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/22/2015|145|Yes|.52266||.5152||.49066||||OPIATE DEPENDENCE TREATMENTS|2900|||||No|No||MYLAN|Yes|10/01/2020||||No|No|No||
buprenorphine HCl|No|No|No|No|90%|00378092493|BUPRENORPHINE 8 MG TABLET SL  |30|EA|.71666|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/22/2015|145|Yes|1.63333||1.60999||1.53333||||OPIATE DEPENDENCE TREATMENTS|2901|||||No|No||MYLAN|Yes|10/01/2020||||No|No|No||
clozapine|No|No|No|No|75%|00378097201|CLOZAPINE 50 MG TABLET|100|EA|.5676|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|.45731||.44633||.44954||||ANTIPSYCHOTICS|2902|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378097301|CLOZAPINE 200 MG TABLET|100|EA|1.88718|05/03/2010||Yes|No||05/03/2010||Yes|No|05/03/2010||Yes|No||||No|No|||Prescription Required|No|01/23/2013|027|Yes|1.13599||1.10873||1.11668||||ANTIPSYCHOTICS|2903|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378104901|DOXEPIN 10 MG CAPSULE|100|EA|.20141|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.06254||.06104||.06148||||ANTIDEPRESSANTS, TRICYCLIC|2904|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378104910|DOXEPIN 10 MG CAPSULE|1000|EA|.2014|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.06254||.06104||.06148||||ANTIDEPRESSANTS, TRICYCLIC|2905|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107593|TELMISARTAN-AMLODIPINE 40-5 MG|30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription Required|Yes|07/17/2014|017|Yes|2.3569||2.30033||2.31683||||ANGIOTENSIN MODULATOR COMBINATIONS|2906|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107693|TELMISARTAN-AMLODIPINE 40-10  |30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription Required|Yes|07/17/2014|017|Yes|2.31222||2.25673||2.27291||||ANGIOTENSIN MODULATOR COMBINATIONS|2907|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107793|TELMISARTAN-AMLODIPINE 80-5 MG|30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription Required|Yes|07/17/2014|017|Yes|2.60023||2.53782||2.55603||||ANGIOTENSIN MODULATOR COMBINATIONS|2908|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107893|TELMISARTAN-AMLODIPINE 80-10  |30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription Required|Yes|07/17/2014|017|Yes|2.7592||2.69298||2.71229||||ANGIOTENSIN MODULATOR COMBINATIONS|2909|||||No|No||MYLAN|No|||||No|No|No||
colchicine|No|No|No|No|75%|00378108601|COLCHICINE 0.6 MG TABLET|100|EA|.86903|07/21/2020|12/31/2024|Yes|No||07/21/2020|12/31/2024|Yes|No|07/21/2020|12/31/2024|Yes|No||07/21/2020|12/31/2024|Yes|No|||Prescription Required|Yes|07/27/2023|231|No|.18453||.1801||.18139||||ANTIHYPERURICEMICS|2910|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378110101|PRAZOSIN 1 MG CAPSULE|100|EA|.23104|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.09805||.0957||.09638|||||2911|||||No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378110110|PRAZOSIN 1 MG CAPSULE|1000|EA|.23103|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.09805||.0957||.09638|||||2912|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378113301|CARBIDOPA-LEVODOPA 25-250 TAB|100|EA|.14749|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription Required|No|01/20/2011|015|No|.09682||.0945||.09517||||ANTIPARKINSON'S AGENTS|2913|||||No|No||MYLAN|No|||||No|No|No||
ketorolac tromethamine|No|No|No|No|75%|00378113401|KETOROLAC 10 MG TABLET|100|EA|.77916|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|01/26/2023|059|Yes|.28051||.27378||.27574||||NSAIDS|2914|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378114001|BUSPIRONE HCL 5 MG TABLET|100|EA|.03419|03/26/2002||Yes|No||03/26/2002||Yes|No|03/26/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.01735||.01693||.01706||||ANXIOLYTICS|2915|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378114005|BUSPIRONE HCL 5 MG TABLET|500|EA|.03419|03/26/2002||Yes|No||03/26/2002||Yes|No|03/26/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.01735||.01693||.01706||||ANXIOLYTICS|2916|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378114501|BUSPIRONE HCL 7.5 MG TABLET|100|EA|.19544|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.07973||.07782||.07837||||ANXIOLYTICS|2917|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378115001|BUSPIRONE HCL 10 MG TABLET|100|EA|.04687|03/26/2002||Yes|No||03/26/2002||Yes|No|03/26/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.02582||.0252||.02538||||ANXIOLYTICS|2918|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378115005|BUSPIRONE HCL 10 MG TABLET|500|EA|.04687|03/26/2002||Yes|No||03/26/2002||Yes|No|03/26/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.02582||.0252||.02538||||ANXIOLYTICS|2919|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378116580|BUSPIRONE HCL 15 MG TABLET|180|EA|.05733|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.03594||.03508||.03533||||ANXIOLYTICS|2920|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378116591|BUSPIRONE HCL 15 MG TABLET|60|EA|.05733|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.03594||.03508||.03533||||ANXIOLYTICS|2921|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378117591|BUSPIRONE HCL 30 MG TABLET|60|EA|.62515|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|090|No|.09876||.09639||.09708||||ANXIOLYTICS|2922|||||No|No||MYLAN|No|||||No|No|No||
sorafenib tosylate|No|No|No|No|75%|00378120178|SORAFENIB 200 MG TABLET|120|EA|43.03583|09/14/2022||Yes|No||09/14/2022||Yes|No|09/14/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|98.08166||96.6805||92.07666||||ONCOLOGY, ORAL - RENAL CELL|2923|||||No|No||MYLAN|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00378130001|LITHIUM CARBONATE ER 300 MG TB|100|EA|.14349|07/19/2012||Yes|No||07/19/2012||Yes|No|07/19/2012||Yes|No||||No|No|||Prescription Required|No|||No|.20806||.20307||.20452|||||2924|||||No|No||MYLAN|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00378130005|LITHIUM CARBONATE ER 300 MG TB|500|EA|.14349|07/19/2012||Yes|No||07/19/2012||Yes|No|07/19/2012||Yes|No||||No|No|||Prescription Required|No|||No|.20806||.20307||.20452|||||2925|||||No|No||MYLAN|No|||||No|No|No||
mesalamine|No|No|No|No|75%|00378137578|MESALAMINE ER 0.375 GRAM CAP|120|EA|1.57817|03/02/2020||Yes|No||03/02/2020||Yes|No|03/02/2020||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|010|No|.49144||.47965||.48309||||ULCERATIVE COLITIS AGENTS|2926|||||No|No||MYLAN|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00378140496|RIZATRIPTAN 10 MG TABLET|12|EA|1.34841|06/29/2018||Yes|No||06/29/2018||Yes|No|06/29/2018||Yes|No||||No|No|||Prescription Required|No|07/26/2018|021|Yes|.33156||.3236||.32592||||ANTIMIGRAINE AGENTS, TRIPTANS|2927|||||No|No||MYLAN|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00378145001|LITHIUM CARBONATE ER 450 MG TB|100|EA|.16615|08/30/2012||Yes|No||08/30/2012||Yes|No|08/30/2012||Yes|No||||No|No|||Prescription Required|No|||No|.16368||.15975||.1609|||||2928|||||No|No||MYLAN|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00378162693|VORICONAZOLE 50 MG TABLET|30|EA|4.03383|12/12/2011|12/31/2024|Yes|No||12/12/2011|12/31/2024|Yes|No|12/12/2011|12/31/2024|Yes|No||09/01/2021|12/31/2024|Yes|No|||Prescription Required|Yes|01/20/2011|069|No|.77158||.75306||.75846||||ANTIFUNGALS, ORAL|2929|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00378164093|VORICONAZOLE 200 MG TABLET|30|EA|16.1356|12/12/2011|12/31/2024|Yes|No||12/12/2011|12/31/2024|Yes|No|12/12/2011|12/31/2024|Yes|No||09/01/2021|12/31/2024|Yes|No|||Prescription Required|Yes|01/20/2011|069|No|1.44781||1.41306||1.4232||||ANTIFUNGALS, ORAL|2930|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00378172193|AMLODIPINE-VALSARTAN 5-160 MG|30|EA|.25456|07/17/2015||Yes|No||07/17/2015||Yes|No|07/17/2015||Yes|No||07/17/2015||Yes|No|||Prescription Required|No|07/27/2017|017|Yes|.384||.37478||.37747||||ANGIOTENSIN MODULATOR COMBINATIONS|2931|||||No|No||MYLAN|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00378172293|AMLODIPINE-VALSARTAN 10-160 MG|30|EA|.28867|07/17/2015||Yes|No||07/17/2015||Yes|No|07/17/2015||Yes|No||07/17/2015||Yes|No|||Prescription Required|No|07/27/2017|017|Yes|.41248||.40258||.40547||||ANGIOTENSIN MODULATOR COMBINATIONS|2932|||||No|No||MYLAN|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00378172393|AMLODIPINE-VALSARTAN 5-320 MG|30|EA|.32278|07/17/2015||Yes|No||07/17/2015||Yes|No|07/17/2015||Yes|No||07/17/2015||Yes|No|||Prescription Required|No|07/27/2017|017|Yes|.45346||.44258||.44575||||ANGIOTENSIN MODULATOR COMBINATIONS|2933|||||No|No||MYLAN|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00378172493|AMLODIPINE-VALSARTAN 10-320 MG|30|EA|.3665|07/17/2015||Yes|No||07/17/2015||Yes|No|07/17/2015||Yes|No||07/17/2015||Yes|No|||Prescription Required|No|07/27/2017|017|Yes|.52831||.51563||.51933||||ANGIOTENSIN MODULATOR COMBINATIONS|2934|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180010|LEVOTHYROXINE 25 MCG TABLET|1000|EA|.14185|12/20/2007||Yes|No||12/20/2007||Yes|No|12/20/2007||Yes|No||||No|No|||Prescription Required|No|||No|.04351||.04247||.04277|||||2935|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180310|LEVOTHYROXINE 50 MCG TABLET|1000|EA|.16103|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription Required|No|||No|.04701||.04588||.04621|||||2936|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180377|LEVOTHYROXINE 50 MCG TABLET|90|EA|.16101|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription Required|No|||No|.04701||.04588||.04621|||||2937|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180510|LEVOTHYROXINE 75 MCG TABLET|1000|EA|.17794|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription Required|No|||No|.04574||.04464||.04496|||||2938|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180577|LEVOTHYROXINE 75 MCG TABLET|90|EA|.17797|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription Required|No|||No|.04574||.04464||.04496|||||2939|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180710|LEVOTHYROXINE 88 MCG TABLET|1000|EA|.18101|10/18/2007||Yes|No||10/18/2007||Yes|No|10/18/2007||Yes|No||||No|No|||Prescription Required|No|||No|.05266||.0514||.05176|||||2940|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180777|LEVOTHYROXINE 88 MCG TABLET|90|EA|.18098|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription Required|No|||No|.05266||.0514||.05176|||||2941|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180910|LEVOTHYROXINE 100 MCG TABLET|1000|EA|.18241|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription Required|No|||No|.05406||.05276||.05314|||||2942|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180977|LEVOTHYROXINE 100 MCG TABLET|90|EA|.18241|06/07/2018||Yes|No||06/07/2018||Yes|No|06/07/2018||Yes|No||||No|No|||Prescription Required|No|||No|.05406||.05276||.05314|||||2943|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181110|LEVOTHYROXINE 112 MCG TABLET|1000|EA|.21093|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||||No|No|||Prescription Required|No|||No|.06343||.06191||.06235|||||2944|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181177|LEVOTHYROXINE 112 MCG TABLET|90|EA|.21094|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription Required|No|||No|.06343||.06191||.06235|||||2945|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181310|LEVOTHYROXINE 125 MCG TABLET|1000|EA|.21385|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription Required|No|||No|.0691||.06744||.06793|||||2946|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181377|LEVOTHYROXINE 125 MCG TABLET|90|EA|.21385|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription Required|No|||No|.0691||.06744||.06793|||||2947|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181510|LEVOTHYROXINE 150 MCG TABLET|1000|EA|.22009|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription Required|No|||No|.05947||.05804||.05846|||||2948|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181577|LEVOTHYROXINE 150 MCG TABLET|90|EA|.22011|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription Required|No|||No|.05947||.05804||.05846|||||2949|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181710|LEVOTHYROXINE 175 MCG TABLET|1000|EA|.2616|08/23/2007||Yes|No||08/23/2007||Yes|No|08/23/2007||Yes|No||||No|No|||Prescription Required|No|||No|.07319||.07143||.07195|||||2950|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181777|LEVOTHYROXINE 175 MCG TABLET|90|EA|.26163|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription Required|No|||No|.07319||.07143||.07195|||||2951|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181910|LEVOTHYROXINE 200 MCG TABLET|1000|EA|.26212|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription Required|No|||No|.07779||.07592||.07647|||||2952|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181977|LEVOTHYROXINE 200 MCG TABLET|90|EA|.26211|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription Required|No|||No|.07779||.07592||.07647|||||2953|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182177|LEVOTHYROXINE 300 MCG TABLET|90|EA|.33836|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription Required|No|||No|.09416||.0919||.09256|||||2954|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182310|LEVOTHYROXINE 137 MCG TABLET|1000|EA|.21682|02/26/2008||Yes|No||02/26/2008||Yes|No|02/26/2008||Yes|No||||No|No|||Prescription Required|No|||No|.06675||.06515||.06562|||||2955|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182377|LEVOTHYROXINE 137 MCG TABLET|90|EA|.21681|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription Required|No|||No|.06675||.06515||.06562|||||2956|||||No|No||MYLAN|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00378190101|MIDODRINE HCL 2.5 MG TABLET|100|EA|.34873|07/26/2004||Yes|No||07/26/2004||Yes|No|07/26/2004||Yes|No||07/26/2004||Yes|No|||Prescription Required|No|||No|.0668||.0652||.06566|||||2957|||||No|No||MYLAN|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00378190201|MIDODRINE HCL 5 MG TABLET|100|EA|.70176|07/26/2004||Yes|No||07/26/2004||Yes|No|07/26/2004||Yes|No||07/26/2004||Yes|No|||Prescription Required|No|||No|.11336||.11064||.11143|||||2958|||||No|No||MYLAN|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00378190301|MIDODRINE HCL 10 MG TABLET|100|EA|1.40374|03/09/2004||Yes|No||03/09/2004||Yes|No|03/09/2004||Yes|No||03/09/2004||Yes|No|||Prescription Required|No|||No|.20527||.20034||.20178|||||2959|||||No|No||MYLAN|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00378190577|ROFLUMILAST 500 MCG TABLET|90|EA|1.82286|04/26/2023||Yes|No||04/26/2023||Yes|No|04/26/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|098|No|.25629||.25014||.25193||||COPD AGENTS|2960|||||No|No||MYLAN|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00378190593|ROFLUMILAST 500 MCG TABLET|30|EA|1.82291|04/26/2023||Yes|No||04/26/2023||Yes|No|04/26/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|098|No|.25629||.25014||.25193||||COPD AGENTS|2961|||||No|No||MYLAN|No|||||No|No|No||
emtricitabine/tenofovir (TDF)|No|No|No|No|75%|00378193093|EMTRICITABINE-TENOFV 200-300MG|30|EA|1.4554|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|.44465||.43398||.43709||||HIV / AIDS|2962|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193601|LENALIDOMIDE 5 MG CAPSULE|100|EA|309.55967|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.50808||695.42939||662.3137||||ONCOLOGY, ORAL - HEMATOLOGIC|2963|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193628|LENALIDOMIDE 5 MG CAPSULE|28|EA|309.55946|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.5076||695.42892||662.31325||||ONCOLOGY, ORAL - HEMATOLOGIC|2964|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193701|LENALIDOMIDE 10 MG CAPSULE|100|EA|309.55967|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.50808||695.42939||662.3137||||ONCOLOGY, ORAL - HEMATOLOGIC|2965|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193728|LENALIDOMIDE 10 MG CAPSULE|28|EA|309.55946|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.5076||695.42892||662.31325||||ONCOLOGY, ORAL - HEMATOLOGIC|2966|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378194001|LENALIDOMIDE 25 MG CAPSULE|100|EA|309.55967|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.50808||695.42939||662.3137||||ONCOLOGY, ORAL - HEMATOLOGIC|2967|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378194021|LENALIDOMIDE 25 MG CAPSULE|21|EA|309.55986|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.50853||695.42983||662.31413||||ONCOLOGY, ORAL - HEMATOLOGIC|2968|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378194101|LENALIDOMIDE 15 MG CAPSULE|100|EA|309.55967|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.50808||695.42939||662.3137||||ONCOLOGY, ORAL - HEMATOLOGIC|2969|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378194121|LENALIDOMIDE 15 MG CAPSULE|21|EA|309.55986|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|07/27/2023|173|No|705.50853||695.42983||662.31413||||ONCOLOGY, ORAL - HEMATOLOGIC|2970|||||No|No||MYLAN|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00378204501|TACROLIMUS 0.5 MG CAPSULE (IR)|100|EA|.20141|04/01/2011||Yes|No||04/01/2011||Yes|No|04/01/2011||Yes|No||01/01/2011||Yes|No|||Prescription Required|No|01/28/2016|229|No|.10913||.10651||.10727||||IMMUNOSUPPRESSIVES, ORAL|2971|||||No|No||MYLAN|No|||||Yes|No|No||
tacrolimus|No|No|No|No|75%|00378204601|TACROLIMUS 1 MG CAPSULE (IR)|100|EA|.40282|04/04/2011||Yes|No||04/04/2011||Yes|No|04/04/2011||Yes|No||01/01/2011||Yes|No|||Prescription Required|No|01/28/2016|229|No|.15718||.15341||.15451||||IMMUNOSUPPRESSIVES, ORAL|2972|||||No|No||MYLAN|No|||||Yes|No|No||
tacrolimus|No|No|No|No|75%|00378204701|TACROLIMUS 5 MG CAPSULE (IR)|100|EA|2.01421|04/04/2011||Yes|No||04/04/2011||Yes|No|04/04/2011||Yes|No||01/01/2011||Yes|No|||Prescription Required|No|01/28/2016|229|No|.96428||.94114||.94789||||IMMUNOSUPPRESSIVES, ORAL|2973|||||No|No||MYLAN|No|||||Yes|No|No||
dexlansoprazole|No|No|No|No|75%|00378208593|DEXLANSOPRAZOLE DR 30 MG CAP|30|EA|3.75719|08/21/2024||Yes|No||08/21/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/27/2023|047|No|4.57621||4.46638||4.49841||||PROTON PUMP INHIBITORS|2974|||||No|No||MYLAN|No|||||No|No|No||
dexlansoprazole|No|No|No|No|75%|00378208677|DEXLANSOPRAZOLE DR 60 MG CAP|90|EA|3.75724|08/21/2024||Yes|No||08/21/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/27/2023|047|No|4.4609||4.35384||4.38506||||PROTON PUMP INHIBITORS|2975|||||No|No||MYLAN|No|||||No|No|No||
dexlansoprazole|No|No|No|No|75%|00378208693|DEXLANSOPRAZOLE DR 60 MG CAP|30|EA|3.75719|08/21/2024||Yes|No||08/21/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/27/2023|047|No|4.4609||4.35384||4.38506||||PROTON PUMP INHIBITORS|2976|||||No|No||MYLAN|No|||||No|No|No||
nisoldipine|No|No|No|No|75%|00378209601|NISOLDIPINE ER 8.5 MG TABLET|100|EA|1.98071|03/10/2011||Yes|No||03/10/2011||Yes|No|03/10/2011||Yes|No||03/10/2011||Yes|No|||Prescription Required|Yes|07/29/2021|045|No|2.7972||2.73007||2.74965||||CALCIUM CHANNEL BLOCKERS|2977|||||No|No||MYLAN|No|||||No|No|No||
nisoldipine|No|No|No|No|75%|00378209701|NISOLDIPINE ER 17 MG TABLET|100|EA|2.48248|03/10/2011||Yes|No||03/10/2011||Yes|No|03/10/2011||Yes|No||03/10/2011||Yes|No|||Prescription Required|Yes|07/29/2021|045|No|3.83394||3.74193||3.76876||||CALCIUM CHANNEL BLOCKERS|2978|||||No|No||MYLAN|No|||||No|No|No||
nisoldipine|No|No|No|No|75%|00378209801|NISOLDIPINE ER 25.5 MG TABLET |100|EA|2.70732|03/10/2011||Yes|No||03/10/2011||Yes|No|03/10/2011||Yes|No||03/10/2011||Yes|No|||Prescription Required|Yes|07/29/2021|045|Yes|6.17018||6.08203||5.79241||||CALCIUM CHANNEL BLOCKERS|2979|||||No|No||MYLAN|No|||||No|No|No||
nisoldipine|No|No|No|No|75%|00378209901|NISOLDIPINE ER 34 MG TABLET|100|EA|2.70732|03/10/2011||Yes|No||03/10/2011||Yes|No|03/10/2011||Yes|No||03/10/2011||Yes|No|||Prescription Required|Yes|07/29/2021|045|Yes|4.00235||3.90629||3.93431||||CALCIUM CHANNEL BLOCKERS|2980|||||No|No||MYLAN|No|||||No|No|No||
loperamide HCl|No|No|No|No|75%|00378210001|LOPERAMIDE 2 MG CAPSULE|100|EA|.15798|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.12668||.12364||.12453|||||2981|||||No|No||MYLAN|No|||||No|No|No||
loperamide HCl|No|No|No|No|75%|00378210005|LOPERAMIDE 2 MG CAPSULE|500|EA|.15797|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.12668||.12364||.12453|||||2982|||||No|No||MYLAN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00378214601|SPIRONOLACTONE 25 MG TABLET|100|EA|.06884|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.04096||.03998||.04026|||||2983|||||No|No||MYLAN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00378214605|SPIRONOLACTONE 25 MG TABLET|500|EA|.06884|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.04096||.03998||.04026|||||2984|||||No|No||MYLAN|No|||||No|No|No||
meclofenamate sodium|No|No|No|No|75%|00378215001|MECLOFENAMATE 50 MG CAPSULE   |100|EA|1.43388|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|059|Yes|3.26791||3.22122||3.06783||||NSAIDS|2985|||||No|No||MYLAN|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00378224577|IMATINIB MESYLATE 100 MG TAB  |90|EA|1.27566|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|.64236||.62694||.63144||||ONCOLOGY, ORAL - HEMATOLOGIC|2986|||||No|No||MYLAN|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00378224693|IMATINIB MESYLATE 400 MG TAB|30|EA|5.031|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|2.5223||2.46176||2.47942||||ONCOLOGY, ORAL - HEMATOLOGIC|2987|||||No|No||MYLAN|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00378225001|MYCOPHENOLATE 250 MG CAPSULE|100|EA|.18894|08/01/2009||Yes|No||08/01/2009||Yes|No|08/01/2009||Yes|No||08/01/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.13723||.13394||.1349||||IMMUNOSUPPRESSIVES, ORAL|2988|||||No|No||MYLAN|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00378225005|MYCOPHENOLATE 250 MG CAPSULE|500|EA|.18923|08/01/2009||Yes|No||08/01/2009||Yes|No|08/01/2009||Yes|No||08/01/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.13723||.13394||.1349||||IMMUNOSUPPRESSIVES, ORAL|2989|||||No|No||MYLAN|No|||||Yes|No|No||
prazosin HCl|No|No|No|No|75%|00378230201|PRAZOSIN 2 MG CAPSULE|100|EA|.34116|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.10215||.0997||.10041|||||2990|||||No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378230210|PRAZOSIN 2 MG CAPSULE|1000|EA|.34114|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.10215||.0997||.10041|||||2991|||||No|No||MYLAN|No|||||No|No|No||
rufinamide|No|No|No|No|75%|00378233078|RUFINAMIDE 200 MG TABLET|120|EA|1.32053|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|1.42717||1.39292||1.40291||||ANTICONVULSANTS|2992|||||No|No||MYLAN|No|||||No|No|No||
rufinamide|No|No|No|No|75%|00378233178|RUFINAMIDE 400 MG TABLET|120|EA|2.64106|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription Required|No|01/27/2022|056|No|1.61894||1.58009||1.59142||||ANTICONVULSANTS|2993|||||No|No||MYLAN|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00378235093|ESOMEPRAZOLE MAG DR 20 MG CAP|30|EA|.36277|09/21/2015||Yes|No||09/21/2015||Yes|No|09/21/2015||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.13071||.12757||.12849||||PROTON PUMP INHIBITORS|2994|||||No|No||MYLAN|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00378235193|ESOMEPRAZOLE MAG DR 40 MG CAP|30|EA|.36277|09/21/2015||Yes|No||09/21/2015||Yes|No|09/21/2015||Yes|No||09/01/2021||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.11037||.10772||.10849||||PROTON PUMP INHIBITORS|2995|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378240101|TRIFLUOPERAZINE 1 MG TABLET   |100|EA|.2632|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.47003||.45875||.46204||||ANTIPSYCHOTICS|2996|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378240201|TRIFLUOPERAZINE 2 MG TABLET   |100|EA|.38786|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.70087||.68405||.68896||||ANTIPSYCHOTICS|2997|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378240501|TRIFLUOPERAZINE 5 MG TABLET|100|EA|.48852|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|.74036||.72259||.72777||||ANTIPSYCHOTICS|2998|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378241001|TRIFLUOPERAZINE 10 MG TABLET  |100|EA|.73638|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/28/2010|027|Yes|1.41349||1.37957||1.38946||||ANTIPSYCHOTICS|2999|||||No|No||MYLAN|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00378267001|PHENYTEK 200 MG CAPSULE       |100|EA|.62677|08/24/2009||Yes|No||08/24/2009||Yes|No|08/24/2009||Yes|No||08/24/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|1.39788||1.36433||1.37412||||ANTICONVULSANTS|3000|||||No|No||MYLAN|No|||||No|No|No||
telmisartan|Yes|No|No|No|75%|00378292093|TELMISARTAN 20 MG TABLET|30|EA|.46096|10/09/2014||Yes|No||10/09/2014||Yes|No|10/09/2014||Yes|No||10/09/2014||Yes|No|07/01/2016||Prescription Required|Yes|07/17/2014|113|Yes|.1256||.12259||.12346||||ANGIOTENSIN MODULATORS|3001|||||No|No||MYLAN|No|||||No|No|No||
meclofenamate sodium|No|No|No|No|75%|00378300001|MECLOFENAMATE 100 MG CAPSULE  |100|EA|2.66179|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|059|Yes|6.0664||5.97973||5.69498||||NSAIDS|3002|||||No|No||MYLAN|No|||||No|No|No||
candesartan/hydrochlorothiazid|No|No|No|No|75%|00378300177|CANDESARTAN-HCTZ 16-12.5 MG TB|90|EA|1.62373|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||11/04/2013||Yes|No|||Prescription Required|Yes|07/29/2021|113|Yes|.65024||.63463||.63919||||ANGIOTENSIN MODULATORS|3003|||||No|No||MYLAN|No|||||No|No|No||
candesartan/hydrochlorothiazid|No|No|No|No|75%|00378300277|CANDESARTAN-HCTZ 32-12.5 MG TB|90|EA|1.65602|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||11/04/2013||Yes|No|||Prescription Required|Yes|07/29/2021|113|Yes|.7888||.76987||.77539||||ANGIOTENSIN MODULATORS|3004|||||No|No||MYLAN|No|||||No|No|No||
candesartan/hydrochlorothiazid|No|No|No|No|75%|00378300377|CANDESARTAN-HCTZ 32-25 MG TAB|90|EA|1.79257|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||11/04/2013||Yes|No|||Prescription Required|Yes|07/29/2021|113|Yes|.9857||.96204||.96894||||ANGIOTENSIN MODULATORS|3005|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00378306577|FENOFIBRATE 48 MG TABLET|90|EA|.15332|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription Required|No|12/12/2014|055|No|.0892||.08706||.08768||||LIPOTROPICS, OTHER|3006|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00378306605|FENOFIBRATE 145 MG TABLET|500|EA|.28008|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription Required|No|12/12/2014|055|No|.10881||.1062||.10696||||LIPOTROPICS, OTHER|3007|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00378306677|FENOFIBRATE 145 MG TABLET|90|EA|.28007|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription Required|No|12/12/2014|055|No|.10881||.1062||.10696||||LIPOTROPICS, OTHER|3008|||||No|No||MYLAN|No|||||No|No|No||
everolimus|No|No|No|No|75%|00378309685|EVEROLIMUS 2.5 MG TABLET      |28|EA|98.5841|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|224.68004||221.47033||210.92412||||ONCOLOGY, ORAL - RENAL CELL|3009|||||No|No||MYLAN|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00378309785|EVEROLIMUS 5 MG TABLET        |28|EA|103.11738|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|23.31271||22.7532||22.91639||||ONCOLOGY, ORAL - RENAL CELL|3010|||||No|No||MYLAN|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00378309885|EVEROLIMUS 7.5 MG TABLET      |28|EA|103.11738|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|548|No|235.01169||231.65438||220.62322||||ONCOLOGY, ORAL - RENAL CELL|3011|||||No|No||MYLAN|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00378309985|EVEROLIMUS 10 MG TABLET|28|EA|25.77942|08/31/2023||Yes|No||08/31/2023||Yes|No|08/31/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|548|No|28.82453||28.13274||28.33451||||ONCOLOGY, ORAL - RENAL CELL|3012|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378312501|DOXEPIN 25 MG CAPSULE|100|EA|.26501|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.1216||.11868||.11953||||ANTIDEPRESSANTS, TRICYCLIC|3013|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378312510|DOXEPIN 25 MG CAPSULE|1000|EA|.26509|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.1216||.11868||.11953||||ANTIDEPRESSANTS, TRICYCLIC|3014|||||No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378320501|PRAZOSIN 5 MG CAPSULE|100|EA|.56317|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.13572||.13246||.13341|||||3015|||||No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378320525|PRAZOSIN 5 MG CAPSULE|250|EA|.56315|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|||No|.13572||.13246||.13341|||||3016|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322477|CANDESARTAN CILEXETIL 4 MG TAB|90|EA|.54466|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.47238||.46104||.46435||||ANGIOTENSIN MODULATORS|3017|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322493|CANDESARTAN CILEXETIL 4 MG TAB|30|EA|.54466|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.47238||.46104||.46435||||ANGIOTENSIN MODULATORS|3018|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322577|CANDESARTAN CILEXETIL 8 MG TAB|90|EA|.57333|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.54966||.53647||.54032||||ANGIOTENSIN MODULATORS|3019|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322593|CANDESARTAN CILEXETIL 8 MG TAB|30|EA|.57333|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.54966||.53647||.54032||||ANGIOTENSIN MODULATORS|3020|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323177|CANDESARTAN CILEXETIL 16 MG TB|90|EA|.44433|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.44278||.43215||.43525||||ANGIOTENSIN MODULATORS|3021|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323193|CANDESARTAN CILEXETIL 16 MG TB|30|EA|.44433|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.44278||.43215||.43525||||ANGIOTENSIN MODULATORS|3022|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323277|CANDESARTAN CILEXETIL 32 MG TB|90|EA|.731|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.57233||.55859||.5626||||ANGIOTENSIN MODULATORS|3023|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323293|CANDESARTAN CILEXETIL 32 MG TB|30|EA|.731|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription Required|Yes|07/29/2021|113|Yes|.57233||.55859||.5626||||ANGIOTENSIN MODULATORS|3024|||||No|No||MYLAN|No|||||No|No|No||
etoposide|No|No|No|No|75%|00378326694|ETOPOSIDE 50 MG CAPSULE|20|EA|32.39147|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|73.82242||72.76781||69.30268|||||3025|||||No|No||MYLAN|No|||||Yes|No|No||
norelgestromin/ethin.estradiol|Yes|Yes|No|No|75%|00378334053|XULANE 150-35 MCG/DAY PATCH   |3|EA|17.50816|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No|Refer to program requirements|||No|No|09/10/2014||Prescription Required|No|||No|36.45025||35.57544||35.8306|||||3026|||||No|No||MYLAN|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
estradiol|No|No|No|No|75%|00378334999|ESTRADIOL 0.025 MG PATCH(1/WK)|4|EA|7.98295|04/11/2005||Yes|No||04/11/2005||Yes|No|04/11/2005||Yes|No||||No|No|||Prescription Required|No|||Yes|9.17832||8.95804||9.02229|||||3027|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378335099|ESTRADIOL 0.05 MG PATCH (1/WK)|4|EA|7.98295|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|9.18628||8.96581||9.03011|||||3028|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378335199|ESTRADIOL 0.075 MG PATCH(1/WK)|4|EA|7.98295|04/11/2005||Yes|No||04/11/2005||Yes|No|04/11/2005||Yes|No||||No|No|||Prescription Required|No|||Yes|9.81375||9.57822||9.64692|||||3029|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378335299|ESTRADIOL 0.1 MG PATCH (1/WK)|4|EA|7.98295|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||Yes|9.89478||9.65731||9.72657|||||3030|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378336099|ESTRADIOL 0.0375MG PATCH(1/WK)|4|EA|7.98295|09/28/2006||Yes|No||09/28/2006||Yes|No|09/28/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|9.93134||9.69299||9.76251|||||3031|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378336199|ESTRADIOL 0.06 MG PATCH (1/WK)|4|EA|7.98295|09/28/2006||Yes|No||09/28/2006||Yes|No|09/28/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|9.925||9.6868||9.75628|||||3032|||||No|No||MYLAN|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00378343193|ARMODAFINIL 50 MG TABLET|30|EA|2.49873|06/21/2017||Yes|No||06/21/2017||Yes|No|06/21/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.24165||.23585||.23754||||STIMULANTS AND RELATED AGENTS|3033|||||No|No||MYLAN|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00378343293|ARMODAFINIL 150 MG TABLET|30|EA|7.52113|06/21/2017||Yes|No||06/21/2017||Yes|No|06/21/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.53522||.52237||.52612||||STIMULANTS AND RELATED AGENTS|3034|||||No|No||MYLAN|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00378343393|ARMODAFINIL 250 MG TABLET|30|EA|7.52113|06/21/2017||Yes|No||06/21/2017||Yes|No|06/21/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.63249||.61731||.62174||||STIMULANTS AND RELATED AGENTS|3035|||||No|No||MYLAN|No|||||No|No|No||
azelastine/fluticasone|No|No|No|No|75%|00378345823|AZELASTIN-FLUTIC 137-50MCG SPR|23|GM|3.19396|09/22/2020||Yes|No||09/22/2020||Yes|No|09/22/2020||Yes|No||||No|No|||Prescription Required|Yes|04/26/2020|019|No|3.06933||2.99567||3.01715||||INTRANASAL RHINITIS AGENTS|3036|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378351501|MIRTAZAPINE 15 MG TABLET|100|EA|.08682|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription Required|No|07/23/2015|031|No|.05459||.05328||.05366||||ANTIDEPRESSANTS, OTHER|3037|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378351593|MIRTAZAPINE 15 MG TABLET|30|EA|.12756|07/14/2003||Yes|No||07/14/2003||Yes|No|07/14/2003||Yes|No||||No|No|||Prescription Required|No|01/20/2011|031|No|.05459||.05328||.05366||||ANTIDEPRESSANTS, OTHER|3038|||||No|No||MYLAN|No|||||No|No|No||
fosamprenavir calcium|No|No|No|No|75%|00378352091|FOSAMPRENAVIR 700 MG TABLET   |60|EA|9.9989|02/28/2018||Yes|No||02/28/2018||Yes|No|02/28/2018||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|16.33153||16.09823||15.33164||||HIV / AIDS|3039|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378353001|MIRTAZAPINE 30 MG TABLET|100|EA|.12117|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription Required|No|07/23/2015|031|No|.07159||.06987||.07037||||ANTIDEPRESSANTS, OTHER|3040|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378353093|MIRTAZAPINE 30 MG TABLET|30|EA|.16125|07/14/2003||Yes|No||07/14/2003||Yes|No|07/14/2003||Yes|No||||No|No|||Prescription Required|No|01/20/2011|031|No|.07159||.06987||.07037||||ANTIDEPRESSANTS, OTHER|3041|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378354501|MIRTAZAPINE 45 MG TABLET|100|EA|.15321|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription Required|No|07/21/2016|031|No|.09392||.09167||.09232||||ANTIDEPRESSANTS, OTHER|3042|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378354593|MIRTAZAPINE 45 MG TABLET|30|EA|.18275|07/14/2003||Yes|No||07/14/2003||Yes|No|07/14/2003||Yes|No||||No|No|||Prescription Required|No|01/20/2011|031|No|.09392||.09167||.09232||||ANTIDEPRESSANTS, OTHER|3043|||||No|No||MYLAN|No|||||No|No|No||
mercaptopurine|No|No|No|No|75%|00378354725|MERCAPTOPURINE 50 MG TABLET|250|EA|1.22679|07/13/2005||Yes|No||07/13/2005||Yes|No|07/13/2005||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|1.48573||1.45007||1.46047||||ONCOLOGY, ORAL - HEMATOLOGIC|3044|||||No|No||MYLAN|No|||||No|No|No||
mercaptopurine|No|No|No|No|75%|00378354752|MERCAPTOPURINE 50 MG TABLET|25|EA|1.3631|07/13/2005||Yes|No||07/13/2005||Yes|No|07/13/2005||Yes|No||||No|No|||Prescription Required|No|01/28/2021|173|No|1.48573||1.45007||1.46047||||ONCOLOGY, ORAL - HEMATOLOGIC|3045|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363201|CARVEDILOL 6.25 MG TABLET|100|EA|.03414|09/07/2007|02/28/2025|Yes|No||09/07/2007|02/28/2025|Yes|No|09/07/2007|02/28/2025|Yes|No||07/01/2012|02/28/2025|Yes|No|||Prescription Required|No|01/20/2011|070|No|.01554||.01517||.01528||||BETA-BLOCKERS|3046|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363205|CARVEDILOL 6.25 MG TABLET|500|EA|.03414|09/07/2007|01/31/2025|Yes|No||09/07/2007|01/31/2025|Yes|No|09/07/2007|01/31/2025|Yes|No||07/01/2012|01/31/2025|Yes|No|||Prescription Required|No|01/20/2011|070|No|.01554||.01517||.01528||||BETA-BLOCKERS|3047|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363305|CARVEDILOL 12.5 MG TABLET|500|EA|.03414|09/07/2007|03/31/2025|Yes|No||09/07/2007|03/31/2025|Yes|No|09/07/2007|03/31/2025|Yes|No||07/01/2012|03/31/2025|Yes|No|||Prescription Required|No|01/20/2011|070|No|.01836||.01792||.01805||||BETA-BLOCKERS|3048|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363401|CARVEDILOL 25 MG TABLET|100|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|01/20/2011|070|No|.02553||.02492||.0251||||BETA-BLOCKERS|3049|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363405|CARVEDILOL 25 MG TABLET|500|EA|.03414|09/07/2007|03/31/2025|Yes|No||09/07/2007|03/31/2025|Yes|No|09/07/2007|03/31/2025|Yes|No||07/01/2012|03/31/2025|Yes|No|||Prescription Required|No|01/20/2011|070|No|.02553||.02492||.0251||||BETA-BLOCKERS|3050|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
cetirizine HCl|No|No|No|No|75%|00378363501|CETIRIZINE HCL 5 MG TABLET|100|EA|.05719|02/14/2008||Yes|No||||No|No|02/14/2008||Yes|No||||No|No|||Over The Counter|No|01/20/2011|030|Yes|.03815||.03723||.0375||||ANTIHISTAMINES, MINIMALLY SEDATING|3051|||||No|No||MYLAN|No|||||No|Yes|No||
cetirizine HCl|No|No|No|No|75%|00378363701|CETIRIZINE HCL 10 MG TABLET|100|EA|.05719|02/13/2008||Yes|No||||No|No|02/13/2008||Yes|No||||No|No|||Over The Counter|No|01/20/2011|030|Yes|.06069||.05923||.05966||||ANTIHISTAMINES, MINIMALLY SEDATING|3052|||||No|No||MYLAN|No|||||No|Yes|No||
cetirizine HCl|No|No|No|No|75%|00378363705|CETIRIZINE HCL 10 MG TABLET|500|EA|.05431|02/13/2008||Yes|No||||No|No|02/13/2008||Yes|No||||No|No|||Over The Counter|No|01/20/2011|030|Yes|.06069||.05923||.05966||||ANTIHISTAMINES, MINIMALLY SEDATING|3053|||||No|No||MYLAN|No|||||No|Yes|No||
phenytoin sodium extended|No|No|No|No|75%|00378375001|PHENYTEK 300 MG CAPSULE       |100|EA|.93916|08/26/2009||Yes|No||08/26/2009||Yes|No|08/26/2009||Yes|No||08/26/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|2.08781||2.0377||2.05232||||ANTICONVULSANTS|3054|||||No|No||MYLAN|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00378375093|PHENYTEK 300 MG CAPSULE       |30|EA|.93912|08/24/2009||Yes|No||08/24/2009||Yes|No|08/24/2009||Yes|No||08/24/2009||Yes|No|||Prescription Required|No|01/28/2021|056|No|2.08781||2.0377||2.05232||||ANTICONVULSANTS|3055|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378381601|CLOZAPINE ODT 150 MG TABLET|100|EA|7.42318|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|027|Yes|16.91794||16.67625||15.88214||||ANTIPSYCHOTICS|3056|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378381701|CLOZAPINE ODT 200 MG TABLET|100|EA|9.89761|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|027|Yes|19.20171||18.74087||18.87528||||ANTIPSYCHOTICS|3057|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00378395005|ATORVASTATIN 10 MG TABLET|500|EA|.04666|07/05/2017||Yes|No||07/05/2017||Yes|No|07/05/2017||Yes|No||07/05/2017||Yes|No|||Prescription Required|No|07/24/2013|063|Yes|.02244||.0219||.02206||||LIPOTROPICS, STATINS|3058|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395077|ATORVASTATIN 10 MG TABLET|90|EA|.04668|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription Required|No|07/24/2013|063|Yes|.02244||.0219||.02206||||LIPOTROPICS, STATINS|3059|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395105|ATORVASTATIN 20 MG TABLET|500|EA|.06641|02/21/2019||Yes|No||02/21/2019||Yes|No|02/21/2019||Yes|No||02/21/2019||Yes|No|07/22/2019||Prescription Required|No|07/24/2013|063|Yes|.02772||.02705||.02725||||LIPOTROPICS, STATINS|3060|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395177|ATORVASTATIN 20 MG TABLET|90|EA|.06641|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription Required|No|07/24/2013|063|Yes|.02772||.02705||.02725||||LIPOTROPICS, STATINS|3061|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00378395205|ATORVASTATIN 40 MG TABLET|500|EA|.06641|07/05/2017||Yes|No||07/05/2017||Yes|No|07/05/2017||Yes|No||07/05/2017||Yes|No|||Prescription Required|No|07/24/2013|063|Yes|.04382||.04277||.04308||||LIPOTROPICS, STATINS|3062|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395277|ATORVASTATIN 40 MG TABLET|90|EA|.06641|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription Required|No|07/24/2013|063|Yes|.04382||.04277||.04308||||LIPOTROPICS, STATINS|3063|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395305|ATORVASTATIN 80 MG TABLET|500|EA|.06641|02/21/2019||Yes|No||02/21/2019||Yes|No|02/21/2019||Yes|No||02/21/2019||Yes|No|07/22/2019||Prescription Required|No|07/24/2013|063|Yes|.06626||.06467||.06513||||LIPOTROPICS, STATINS|3064|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395377|ATORVASTATIN 80 MG TABLET|90|EA|.06641|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription Required|No|07/24/2013|063|Yes|.06626||.06467||.06513||||LIPOTROPICS, STATINS|3065|||||No|No||MYLAN|No|||||No|No|No||
nevirapine|No|No|No|No|75%|00378405091|NEVIRAPINE 200 MG TABLET      |60|EA|.1022|07/02/2012||Yes|No||07/20/2012||Yes|No|07/02/2012||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|.12538||.12237||.12325||||HIV / AIDS|3066|||||No|No||MYLAN|No|||||No|No|No||
abacavir sulfate|No|No|No|No|75%|00378410591|ABACAVIR 300 MG TABLET|60|EA|4.8213|07/19/2012||Yes|No||07/19/2012||Yes|No|07/19/2012||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|.59275||.57852||.58267||||HIV / AIDS|3067|||||No|No||MYLAN|No|||||No|No|No||
riluzole|No|No|No|No|75%|00378414591|RILUZOLE 50 MG TABLET|60|EA|1.21073|10/09/2014||Yes|No||10/09/2014||Yes|No|10/09/2014||Yes|No||||No|No|||Prescription Required|No|||No|.30036||.29315||.29525|||||3068|||||No|No||MYLAN|No|||||No|No|No||
atovaquone/proguanil HCl|No|No|No|No|75%|00378416201|ATOVAQUONE-PROGUANIL 250-100|100|EA|2.45973|10/09/2014||Yes|No||10/09/2014||Yes|No|10/09/2014||Yes|No||||No|No|||Prescription Required|No|||No|1.25342||1.22334||1.23211|||||3069|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378425001|DOXEPIN 50 MG CAPSULE|100|EA|.37969|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.11647||.11367||.11449||||ANTIDEPRESSANTS, TRICYCLIC|3070|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378425010|DOXEPIN 50 MG CAPSULE|1000|EA|.3797|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.11647||.11367||.11449||||ANTIDEPRESSANTS, TRICYCLIC|3071|||||No|No||MYLAN|No|||||No|No|No||
ambrisentan|No|No|No|No|75%|00378427093|AMBRISENTAN 5 MG TABLET       |30|EA|16.51257|09/11/2019||Yes|No||09/11/2019||Yes|No|09/11/2019||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|171|Yes|37.6333||37.09568||35.32922||||PAH AGENTS, ORAL AND INHALED|3072|||||No|No||MYLAN|No|||||No|No|Yes|07/30/2021|
ambrisentan|No|No|No|No|75%|00378427193|AMBRISENTAN 10 MG TABLET      |30|EA|16.51257|09/11/2019||Yes|No||09/11/2019||Yes|No|09/11/2019||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|171|Yes|37.6333||37.09568||35.32922||||PAH AGENTS, ORAL AND INHALED|3073|||||No|No||MYLAN|No|||||No|No|Yes|07/30/2021|
valacyclovir HCl|Yes|No|No|No|75%|00378427577|VALACYCLOVIR HCL 500 MG TABLET|90|EA|.16722|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|07/05/2024||Prescription Required|No|05/02/2016|025|No|.20426||.19936||.20079||||ANTIVIRALS, ORAL|3074|||||No|No||MYLAN|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00378427593|VALACYCLOVIR HCL 500 MG TABLET|30|EA|.172|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|07/05/2024||Prescription Required|No|05/02/2016|025|No|.20426||.19936||.20079||||ANTIVIRALS, ORAL|3075|||||No|No||MYLAN|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00378427677|VALACYCLOVIR HCL 1 GRAM TABLET|90|EA|.26278|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|11/01/2012||Prescription Required|No|05/02/2016|025|No|.37188||.36295||.36556||||ANTIVIRALS, ORAL|3076|||||No|No||MYLAN|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00378427693|VALACYCLOVIR HCL 1 GRAM TABLET|30|EA|.27233|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|11/01/2012||Prescription Required|No|05/02/2016|025|No|.37188||.36295||.36556||||ANTIVIRALS, ORAL|3077|||||No|No||MYLAN|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00378428785|ELETRIPTAN HBR 20 MG TABLET|6|EA|5.1385|06/08/2018||Yes|No||06/08/2018||Yes|No|06/08/2018||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|021|Yes|2.02414||1.97556||1.98973||||ANTIMIGRAINE AGENTS, TRIPTANS|3078|||||No|No||MYLAN|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00378428808|ELETRIPTAN HBR 40 MG TABLET|12|EA|5.1385|06/08/2018||Yes|No||06/08/2018||Yes|No|06/08/2018||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|021|Yes|2.12176||2.07084||2.08569||||ANTIMIGRAINE AGENTS, TRIPTANS|3079|||||No|No||MYLAN|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00378428885|ELETRIPTAN HBR 40 MG TABLET|6|EA|5.1385|06/08/2018||Yes|No||06/08/2018||Yes|No|06/08/2018||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|021|Yes|2.12176||2.07084||2.08569||||ANTIMIGRAINE AGENTS, TRIPTANS|3080|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00378439077|FENOFIBRATE 40 MG TABLET      |90|EA|3.59413|07/03/2017||Yes|No||07/03/2017||Yes|No|07/03/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|5.5954||5.46111||5.50028||||LIPOTROPICS, OTHER|3081|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00378439177|FENOFIBRATE 120 MG TABLET|90|EA|10.78244|07/03/2017||Yes|No||07/03/2017||Yes|No|07/03/2017||Yes|No||||No|No|||Prescription Required|Yes|07/21/2016|055|No|19.08713||18.62904||18.76265||||LIPOTROPICS, OTHER|3082|||||No|No||MYLAN|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00378447201|MYCOPHENOLATE 500 MG TABLET|100|EA|.38984|08/01/2009||Yes|No||08/01/2009||Yes|No|08/01/2009||Yes|No||08/01/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.21368||.20855||.21005||||IMMUNOSUPPRESSIVES, ORAL|3083|||||No|No||MYLAN|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00378447205|MYCOPHENOLATE 500 MG TABLET|500|EA|.38985|08/01/2009||Yes|No||08/01/2009||Yes|No|08/01/2009||Yes|No||08/01/2009||Yes|No|||Prescription Required|No|01/15/2014|229|No|.21368||.20855||.21005||||IMMUNOSUPPRESSIVES, ORAL|3084|||||No|No||MYLAN|No|||||Yes|No|No||
budesonide|No|No|No|No|75%|00378450093|BUDESONIDE ER 9 MG TABLET|30|EA|22.20262|04/15/2021||Yes|No||04/15/2021||Yes|No|04/15/2021||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|010|No|17.70692||17.28195||17.4059||||ULCERATIVE COLITIS AGENTS|3085|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451493|AMLODIPINE-ATORVAST 5-20 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription Required|Yes|07/24/2013|063|Yes|.83849||.81837||.82424||||LIPOTROPICS, STATINS|3086|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451593|AMLODIPINE-ATORVAST 5-40 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription Required|Yes|07/17/2014|063|Yes|1.6089||1.57029||1.58155||||LIPOTROPICS, STATINS|3087|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451793|AMLODIPINE-ATORVAST 10-10 MG|30|EA|2.35625|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription Required|Yes|07/17/2014|063|Yes|1.24341||1.21357||1.22227||||LIPOTROPICS, STATINS|3088|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451893|AMLODIPINE-ATORVAST 10-20 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription Required|Yes|07/24/2013|063|Yes|1.09517||1.06889||1.07655||||LIPOTROPICS, STATINS|3089|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451993|AMLODIPINE-ATORVAST 10-40 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription Required|Yes|07/24/2013|063|Yes|1.19189||1.16328||1.17163||||LIPOTROPICS, STATINS|3090|||||No|No||MYLAN|No|||||No|No|No||
fingolimod HCl|No|No|No|No|75%|00378452593|FINGOLIMOD 0.5 MG CAPSULE|30|EA|4.58666|02/21/2023||Yes|No||02/21/2023||Yes|No|02/21/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|043|No|9.44005||9.21349||9.27957||||MULTIPLE SCLEROSIS AGENTS|3091|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456005|POTASSIUM CL ER 8 MEQ TABLET|500|EA|.1845|08/01/2017||Yes|No||08/01/2017||Yes|No|08/01/2017||Yes|No||08/01/2017||Yes|No|||Prescription Required|No|||No|.10819||.10559||.10635|||||3092|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456077|POTASSIUM CL ER 8 MEQ TABLET|90|EA|.18452|07/25/2017||Yes|No||07/25/2017||Yes|No|07/25/2017||Yes|No||07/25/2017||Yes|No|||Prescription Required|No|||No|.10819||.10559||.10635|||||3093|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456105|POTASSIUM CL ER 10 MEQ TABLET|500|EA|.19422|10/01/2017||Yes|No||10/01/2017||Yes|No|10/01/2017||Yes|No||10/01/2017||Yes|No|||Prescription Required|No|||No|.0894||.08725||.08788|||||3094|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456177|POTASSIUM CL ER 10 MEQ TABLET|90|EA|.19421|10/01/2017||Yes|No||10/01/2017||Yes|No|10/01/2017||Yes|No||10/01/2017||Yes|No|||Prescription Required|No|||No|.0894||.08725||.08788|||||3095|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459510|METOPROLOL SUCC ER 25 MG TAB|1000|EA|.32226|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.0508||.04958||.04994||||BETA-BLOCKERS|3096|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459577|METOPROLOL SUCC ER 25 MG TAB|90|EA|.32226|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.0508||.04958||.04994||||BETA-BLOCKERS|3097|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459610|METOPROLOL SUCC ER 50 MG TAB|1000|EA|.32226|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.06035||.0589||.05932||||BETA-BLOCKERS|3098|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459677|METOPROLOL SUCC ER 50 MG TAB|90|EA|.32226|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.06035||.0589||.05932||||BETA-BLOCKERS|3099|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459710|METOPROLOL SUCC ER 100 MG TAB|1000|EA|.53807|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.1039||.10141||.10213||||BETA-BLOCKERS|3100|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459777|METOPROLOL SUCC ER 100 MG TAB|90|EA|.53807|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.1039||.10141||.10213||||BETA-BLOCKERS|3101|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459805|METOPROLOL SUCC ER 200 MG TAB|500|EA|.85608|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.12843||.12535||.12625||||BETA-BLOCKERS|3102|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459877|METOPROLOL SUCC ER 200 MG TAB|90|EA|.85608|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription Required|No|07/23/2015|070|No|.12843||.12535||.12625||||BETA-BLOCKERS|3103|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378461926|ESTRADIOL 0.025 MG PATCH(2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|||Yes|4.9692||4.84994||4.88472|||||3104|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462026|ESTRADIOL 0.0375MG PATCH(2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|||Yes|5.32362||5.19585||5.23312|||||3105|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462126|ESTRADIOL 0.05 MG PATCH (2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|||Yes|4.99138||4.87159||4.90653|||||3106|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462226|ESTRADIOL 0.075 MG PATCH(2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|||Yes|5.37438||5.24539||5.28302|||||3107|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462326|ESTRADIOL 0.1 MG PATCH (2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|||Yes|5.01515||4.89479||4.92989|||||3108|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464026|ESTRADIOL 0.1 MG PATCH (2/WK)|8|EA|3.90548|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription Required|No|||Yes|5.01515||4.89479||4.92989|||||3109|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464126|ESTRADIOL 0.075 MG PATCH(2/WK)|8|EA|3.90386|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription Required|No|||Yes|5.37438||5.24539||5.28302|||||3110|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464226|ESTRADIOL 0.05 MG PATCH (2/WK)|8|EA|3.89956|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription Required|No|||Yes|4.99138||4.87159||4.90653|||||3111|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464326|ESTRADIOL 0.0375MG PATCH(2/WK)|8|EA|3.89688|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription Required|No|||Yes|5.32362||5.19585||5.23312|||||3112|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464426|ESTRADIOL 0.025 MG PATCH(2/WK)|8|EA|3.89688|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription Required|No|||Yes|4.9692||4.84994||4.88472|||||3113|||||No|No||MYLAN|No|||||No|No|No||
saxagliptin HCl|No|No|No|No|75%|00378470593|SAXAGLIPTIN HCL 2.5 MG TABLET|30|EA|6.00065|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|4.04579||3.94869||3.97701||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3114|||||No|No||MYLAN|No|||||No|No|No||
saxagliptin HCl|No|No|No|No|75%|00378470677|SAXAGLIPTIN HCL 5 MG TABLET|90|EA|6.00036|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|4.80835||4.69295||4.72661||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3115|||||No|No||MYLAN|No|||||No|No|No||
saxagliptin HCl|No|No|No|No|75%|00378470693|SAXAGLIPTIN HCL 5 MG TABLET|30|EA|6.00065|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|4.80835||4.69295||4.72661||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3116|||||No|No||MYLAN|No|||||No|No|No||
dapsone|No|No|No|No|75%|00378483060|DAPSONE 7.5% GEL PUMP|60|GM|3.09399|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|No|.88456||.86333||.86952||||ACNE AGENTS, TOPICAL|3117|||||No|No||MYLAN|No|||||No|No|No||
dapsone|No|No|No|No|75%|00378483090|DAPSONE 7.5% GEL PUMP|90|GM|2.70556|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|No|1.41188||1.37799||1.38788||||ACNE AGENTS, TOPICAL|3118|||||No|No||MYLAN|No|||||No|No|No||
nevirapine|No|No|No|No|75%|00378489093|NEVIRAPINE ER 400 MG TABLET|30|EA|4.92|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|01/28/2021|237|No|1.80619||1.76284||1.77548||||HIV / AIDS|3119|||||No|No||MYLAN|No|||||No|No|No||
pitavastatin calcium|No|No|No|No|75%|00378505577|PITAVASTATIN 1 MG TABLET|90|EA|2.47197|03/18/2024||Yes|No||03/18/2024||Yes|No|03/18/2024||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|063|Yes|1.54369||1.50664||1.51745||||LIPOTROPICS, STATINS|3120|||||No|No||MYLAN|No|||||No|No|No||
pitavastatin calcium|No|No|No|No|75%|00378505677|PITAVASTATIN 2 MG TABLET|90|EA|2.47197|03/18/2024||Yes|No||03/18/2024||Yes|No|03/18/2024||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|063|Yes|1.15442||1.12671||1.13479||||LIPOTROPICS, STATINS|3121|||||No|No||MYLAN|No|||||No|No|No||
pitavastatin calcium|No|No|No|No|75%|00378505777|PITAVASTATIN 4 MG TABLET|90|EA|2.47197|03/18/2024||Yes|No||03/18/2024||Yes|No|03/18/2024||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|063|Yes|1.60236||1.5639||1.57512||||LIPOTROPICS, STATINS|3122|||||No|No||MYLAN|No|||||No|No|No||
prasugrel HCl|No|No|No|No|75%|00378518593|PRASUGREL 5 MG TABLET|30|EA|.43|06/05/2018||Yes|No||06/05/2018||Yes|No|06/05/2018||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2018|004|No|.26975||.26328||.26516||||PLATELET AGGREGATION INHIBITORS|3123|||||No|No||MYLAN|No|||||No|No|No||
prasugrel HCl|No|No|No|No|75%|00378518693|PRASUGREL 10 MG TABLET|30|EA|.43|06/05/2018||Yes|No||06/05/2018||Yes|No|06/05/2018||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|07/26/2018|004|No|.23119||.22564||.22726||||PLATELET AGGREGATION INHIBITORS|3124|||||No|No||MYLAN|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00378527001|ESZOPICLONE 1 MG TABLET|100|EA|.30229|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.10879||.10618||.10694||||SEDATIVE HYPNOTICS|3125|||||No|No||MYLAN|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00378527101|ESZOPICLONE 2 MG TABLET|100|EA|.30229|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.08307||.08108||.08166||||SEDATIVE HYPNOTICS|3126|||||No|No||MYLAN|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00378527201|ESZOPICLONE 3 MG TABLET|100|EA|.30229|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No||||No|No|||Prescription Required|No|07/30/2020|054|Yes|.08536||.08331||.08391||||SEDATIVE HYPNOTICS|3127|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378537501|DOXEPIN 75 MG CAPSULE|100|EA|.58377|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.17637||.17214||.17337||||ANTIDEPRESSANTS, TRICYCLIC|3128|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378537510|DOXEPIN 75 MG CAPSULE|1000|EA|.58377|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.17637||.17214||.17337||||ANTIDEPRESSANTS, TRICYCLIC|3129|||||No|No||MYLAN|No|||||No|No|No||
moxifloxacin HCl|No|No|No|No|75%|00378543035|MOXIFLOXACIN 0.5% EYE DROPS|3|ML|4.87333|02/03/2021|10/31/2024|Yes|No||02/03/2021|10/31/2024|Yes|No|02/03/2021|10/31/2024|Yes|No||||No|No|||Prescription Required|No|01/25/2024|058|No|11.10666||10.948||10.42666||||OPHTHALMIC ANTIBIOTICS|3130|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551093|OLANZAPINE ODT 5 MG TABLET|30|EA|.36793|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.26972||.26325||.26513||||ANTIPSYCHOTICS|3131|||||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551193|OLANZAPINE ODT 10 MG TABLET|30|EA|.54051|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.42712||.41687||.41986||||ANTIPSYCHOTICS|3132|||||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551293|OLANZAPINE ODT 15 MG TABLET|30|EA|.79707|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.59589||.58159||.58576||||ANTIPSYCHOTICS|3133|||||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551393|OLANZAPINE ODT 20 MG TABLET|30|EA|1.05378|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription Required|No|01/28/2016|027|Yes|.58199||.56802||.5721||||ANTIPSYCHOTICS|3134|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561505|LEVETIRACETAM 500 MG TABLET|500|EA|.20267|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.06077||.05931||.05974||||ANTICONVULSANTS|3135|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561578|LEVETIRACETAM 500 MG TABLET|120|EA|.21335|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.06077||.05931||.05974||||ANTICONVULSANTS|3136|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561705|LEVETIRACETAM 750 MG TABLET|500|EA|.27145|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.09537||.09308||.09375||||ANTICONVULSANTS|3137|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561778|LEVETIRACETAM 750 MG TABLET|120|EA|.28574|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/28/2021|056|No|.09537||.09308||.09375||||ANTICONVULSANTS|3138|||||No|No||MYLAN|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00378563059|SUMATRIPTAN SUCC 25 MG TABLET|9|EA|.44672|09/02/2009||Yes|No||09/02/2009||Yes|No|09/02/2009||Yes|No||||No|No|||Prescription Required|No|01/25/2012|021|Yes|.2655||.25913||.26099||||ANTIMIGRAINE AGENTS, TRIPTANS|3139|||||No|No||MYLAN|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00378563159|SUMATRIPTAN SUCC 50 MG TABLET|9|EA|.44672|09/02/2009||Yes|No||09/02/2009||Yes|No|09/02/2009||Yes|No||||No|No|||Prescription Required|No|01/25/2012|021|Yes|.30289||.29562||.29774||||ANTIMIGRAINE AGENTS, TRIPTANS|3140|||||No|No||MYLAN|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00378563259|SUMATRIPTAN SUCC 100 MG TABLET|9|EA|.44672|09/02/2009||Yes|No||09/02/2009||Yes|No|09/02/2009||Yes|No||||No|No|||Prescription Required|No|01/25/2012|021|Yes|.37205||.36312||.36573||||ANTIMIGRAINE AGENTS, TRIPTANS|3141|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378580793|VALSARTAN 40 MG TABLET|30|EA|.11466|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription Required|Yes|07/29/2021|113|Yes|.10521||.10268||.10342||||ANGIOTENSIN MODULATORS|3142|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378581377|VALSARTAN 80 MG TABLET|90|EA|.14333|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription Required|Yes|07/29/2021|113|Yes|.11135||.10868||.10946||||ANGIOTENSIN MODULATORS|3143|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378581477|VALSARTAN 160 MG TABLET|90|EA|.19111|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription Required|Yes|07/29/2021|113|No|.13499||.13175||.1327||||ANGIOTENSIN MODULATORS|3144|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378581577|VALSARTAN 320 MG TABLET|90|EA|.23889|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription Required|Yes|07/29/2021|113|Yes|.17764||.17338||.17462||||ANGIOTENSIN MODULATORS|3145|||||No|No||MYLAN|No|||||No|No|No||
metformin HCl|No|No|No|No|75%|00378600191|METFORMIN ER 1,000 MG OSM-TAB|60|EA|6.967|07/03/2017||Yes|No||07/03/2017||Yes|No|07/03/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|012|Yes|.33509||.32705||.32939||||HYPOGLYCEMICS, METFORMINS|3146|||||No|No||MYLAN|No|||||No|No|No||
metformin HCl|No|No|No|No|75%|00378600291|METFORMIN ER 500 MG OSMOTIC TB|60|EA|3.82607|07/03/2017||Yes|No||07/03/2017||Yes|No|07/03/2017||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|012|Yes|.14245||.13903||.14003||||HYPOGLYCEMICS, METFORMINS|3147|||||No|No||MYLAN|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00378606001|DILTIAZEM 12HR ER 60 MG CAP|100|EA|1.09125|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|045|No|1.92378||1.87761||1.89108||||CALCIUM CHANNEL BLOCKERS|3148|||||No|No||MYLAN|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00378609001|DILTIAZEM 12HR ER 90 MG CAP|100|EA|1.24683|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|045|No|1.90033||1.85472||1.86802||||CALCIUM CHANNEL BLOCKERS|3149|||||No|No||MYLAN|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00378612001|DILTIAZEM 12HR ER 120 MG CAP|100|EA|1.6254|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|045|No|1.64472||1.60525||1.61676||||CALCIUM CHANNEL BLOCKERS|3150|||||No|No||MYLAN|No|||||No|No|No||
metolazone|No|No|No|No|75%|00378617201|METOLAZONE 2.5 MG TABLET|100|EA|.77589|01/18/2005||Yes|No||01/18/2005||Yes|No|01/18/2005||Yes|No||01/18/2005||Yes|No|||Prescription Required|No|||No|.18326||.17886||.18014|||||3151|||||No|No||MYLAN|No|||||No|No|No||
metolazone|No|No|No|No|75%|00378617301|METOLAZONE 5 MG TABLET|100|EA|.88163|12/07/2004||Yes|No||12/07/2004||Yes|No|12/07/2004||Yes|No||12/07/2004||Yes|No|||Prescription Required|No|||No|.22109||.21578||.21733|||||3152|||||No|No||MYLAN|No|||||No|No|No||
metolazone|No|No|No|No|75%|00378617401|METOLAZONE 10 MG TABLET|100|EA|1.05587|12/07/2004||Yes|No||12/07/2004||Yes|No|12/07/2004||Yes|No||12/07/2004||Yes|No|||Prescription Required|No|||No|.42215||.41202||.41497|||||3153|||||No|No||MYLAN|No|||||No|No|No||
citalopram hydrobromide|Yes|No|No|No|75%|00378623101|CITALOPRAM HBR 10 MG TABLET|100|EA|.03126|09/28/2011||Yes|No||09/28/2011||Yes|No|09/28/2011||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|008|No|.02135||.02084||.02099||||ANTIDEPRESSANTS, SSRIs|3154|||||No|No||MYLAN|No|||||No|No|No||
citalopram hydrobromide|Yes|No|No|No|75%|00378623105|CITALOPRAM HBR 10 MG TABLET|500|EA|.03125|09/28/2011||Yes|No||09/28/2011||Yes|No|09/28/2011||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|008|No|.02135||.02084||.02099||||ANTIDEPRESSANTS, SSRIs|3155|||||No|No||MYLAN|No|||||No|No|No||
citalopram hydrobromide|Yes|No|No|No|75%|00378623201|CITALOPRAM HBR 20 MG TABLET|100|EA|.03492|09/28/2011||Yes|No||09/28/2011||Yes|No|09/28/2011||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|008|No|.02445||.02386||.02403||||ANTIDEPRESSANTS, SSRIs|3156|||||No|No||MYLAN|No|||||No|No|No||
citalopram hydrobromide|Yes|No|No|No|75%|00378623205|CITALOPRAM HBR 20 MG TABLET|500|EA|.03492|09/28/2011||Yes|No||09/28/2011||Yes|No|09/28/2011||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|008|No|.02445||.02386||.02403||||ANTIDEPRESSANTS, SSRIs|3157|||||No|No||MYLAN|No|||||No|No|No||
citalopram hydrobromide|Yes|No|No|No|75%|00378623301|CITALOPRAM HBR 40 MG TABLET|100|EA|.04322|09/28/2011||Yes|No||09/28/2011||Yes|No|09/28/2011||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|008|No|.03552||.03467||.03492||||ANTIDEPRESSANTS, SSRIs|3158|||||No|No||MYLAN|No|||||No|No|No||
citalopram hydrobromide|Yes|No|No|No|75%|00378623305|CITALOPRAM HBR 40 MG TABLET|500|EA|.04322|09/28/2011||Yes|No||09/28/2011||Yes|No|09/28/2011||Yes|No||09/01/2022||Yes|No|07/01/2016||Prescription Required|No|01/20/2011|008|No|.03552||.03467||.03492||||ANTIDEPRESSANTS, SSRIs|3159|||||No|No||MYLAN|No|||||No|No|No||
verapamil HCl|No|No|No|No|75%|00378632001|VERAPAMIL ER 120 MG CAPSULE|100|EA|.62544|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|045|No|.66106||.64519||.64982||||CALCIUM CHANNEL BLOCKERS|3160|||||No|No||MYLAN|No|||||No|No|No||
valsartan/hydrochlorothiazide|Yes|No|No|No|75%|00378632177|VALSARTAN-HCTZ 80-12.5 MG TAB|90|EA|.08523|09/27/2012||Yes|No||09/27/2012||Yes|No|09/27/2012||Yes|No||09/27/2012||Yes|No|07/01/2016||Prescription Required|Yes|07/29/2021|113|Yes|.11433||.11159||.11239||||ANGIOTENSIN MODULATORS|3161|||||No|No||MYLAN|No|||||No|No|No||
valsartan/hydrochlorothiazide|Yes|No|No|No|75%|00378632277|VALSARTAN-HCTZ 160-12.5 MG TAB|90|EA|.09269|09/27/2012||Yes|No||09/27/2012||Yes|No|09/27/2012||Yes|No||09/27/2012||Yes|No|07/01/2016||Prescription Required|Yes|07/29/2021|113|No|.13066||.12752||.12844||||ANGIOTENSIN MODULATORS|3162|||||No|No||MYLAN|No|||||No|No|No||
valsartan/hydrochlorothiazide|Yes|No|No|No|75%|00378632377|VALSARTAN-HCTZ 160-25 MG TAB|90|EA|.1052|09/27/2012||Yes|No||09/27/2012||Yes|No|09/27/2012||Yes|No||09/27/2012||Yes|No|07/01/2016||Prescription Required|Yes|07/29/2021|113|No|.14429||.14083||.14184||||ANGIOTENSIN MODULATORS|3163|||||No|No||MYLAN|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00378632477|VALSARTAN-HCTZ 320-12.5 MG TAB|90|EA|.11753|09/27/2012||Yes|No||09/27/2012||Yes|No|09/27/2012||Yes|No||09/27/2012||Yes|No|||Prescription Required|Yes|07/29/2021|113|No|.18803||.18352||.18483||||ANGIOTENSIN MODULATORS|3164|||||No|No||MYLAN|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00378632577|VALSARTAN-HCTZ 320-25 MG TAB|90|EA|.13325|09/27/2012||Yes|No||09/27/2012||Yes|No|09/27/2012||Yes|No||09/27/2012||Yes|No|||Prescription Required|Yes|07/29/2021|113|No|.19049||.18592||.18725||||ANGIOTENSIN MODULATORS|3165|||||No|No||MYLAN|No|||||No|No|No||
acamprosate calcium|No|No|No|No|75%|00378633380|ACAMPROSATE CALC DR 333 MG TAB|180|EA|.35319|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||||No|No|||Prescription Required|No|||No|.29706||.28993||.29201|||||3166|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
verapamil HCl|No|No|No|No|75%|00378638001|VERAPAMIL ER 180 MG CAPSULE|100|EA|.65502|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|045|No|1.17579||1.14757||1.1558||||CALCIUM CHANNEL BLOCKERS|3167|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378641001|DOXEPIN 100 MG CAPSULE|100|EA|.63597|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.23465||.22902||.23066||||ANTIDEPRESSANTS, TRICYCLIC|3168|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378641010|DOXEPIN 100 MG CAPSULE|1000|EA|.63595|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|07/27/2017|215|No|.23465||.22902||.23066||||ANTIDEPRESSANTS, TRICYCLIC|3169|||||No|No||MYLAN|No|||||No|No|No||
verapamil HCl|No|No|No|No|75%|00378644001|VERAPAMIL ER 240 MG CAPSULE|100|EA|.73921|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|01/20/2011|045|No|1.17444||1.14625||1.15447||||CALCIUM CHANNEL BLOCKERS|3170|||||No|No||MYLAN|No|||||No|No|No||
scopolamine|No|No|No|No|75%|00378647044|SCOPOLAMINE 1 MG/3 DAY PATCH|24|EA|7.90322|09/17/2019||Yes|No||09/17/2019||Yes|No|09/17/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|085|No|4.68559||4.57314||4.60593||||ANTIEMETIC/ANTIVERTIGO AGENTS|3171|||||No|No||MYLAN|No|||||No|No|No||
scopolamine|No|No|No|No|75%|00378647097|SCOPOLAMINE 1 MG/3 DAY PATCH|10|EA|7.90297|09/17/2019||Yes|No||09/17/2019||Yes|No|09/17/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|085|No|4.68559||4.57314||4.60593||||ANTIEMETIC/ANTIVERTIGO AGENTS|3172|||||No|No||MYLAN|No|||||No|No|No||
scopolamine|No|No|No|No|75%|00378647099|SCOPOLAMINE 1 MG/3 DAY PATCH|4|EA|6.9488|09/17/2019||Yes|No||09/17/2019||Yes|No|09/17/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|085|No|4.68559||4.57314||4.60593||||ANTIEMETIC/ANTIVERTIGO AGENTS|3173|||||No|No||MYLAN|No|||||No|No|No||
levonorgestrel/ethin.estradiol|Yes|Yes|No|No|75%|00378655053|LEVONOR-ETH ESTRAD 0.15-0.03|28|EA|.07883|12/02/2016||Yes|No||12/02/2016||Yes|No|12/02/2016||Yes|No|Refer to program requirements|||No|No|12/02/2016||Prescription Required|No|||No|.07997||.07805||.07861|||||3174|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
isotretinoin|No|No|No|No|75%|00378661193|AMNESTEEM 10 MG CAPSULE|30|EA|2.15716|12/01/2016||Yes|No||12/01/2016||Yes|No|12/01/2016||Yes|No||||No|No|||Prescription Required|No|07/23/2015|144|No|1.7375||1.6958||1.70796||||ACNE AGENTS, ORAL|3175|||||No|No||MYLAN|No|||||No|No|No||
isotretinoin|No|No|No|No|75%|00378661293|AMNESTEEM 20 MG CAPSULE|30|EA|2.5585|06/01/2017||Yes|No||06/01/2017||Yes|No|06/01/2017||Yes|No||||No|No|||Prescription Required|No|07/23/2015|144|No|1.84555||1.80126||1.81418||||ACNE AGENTS, ORAL|3176|||||No|No||MYLAN|No|||||No|No|No||
isotretinoin|No|No|No|No|75%|00378661493|AMNESTEEM 40 MG CAPSULE|30|EA|2.97244|05/01/2017||Yes|No||05/01/2017||Yes|No|05/01/2017||Yes|No||||No|No|||Prescription Required|No|07/23/2015|144|No|1.94559||1.8989||1.91251||||ACNE AGENTS, ORAL|3177|||||No|No||MYLAN|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00378667828|SUNITINIB MALATE 12.5 MG CAP|28|EA|63.74888|08/02/2022||Yes|No||08/02/2022||Yes|No|08/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|145.28815||143.2126||136.39295||||ONCOLOGY, ORAL - RENAL CELL|3178|||||No|No||MYLAN|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00378667928|SUNITINIB MALATE 25 MG CAPSULE|28|EA|127.49823|08/02/2022||Yes|No||08/02/2022||Yes|No|08/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|290.57735||286.42625||272.7869||||ONCOLOGY, ORAL - RENAL CELL|3179|||||No|No||MYLAN|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00378668028|SUNITINIB MALATE 50 MG CAPSULE|28|EA|221.95617|08/02/2022||Yes|No||08/02/2022||Yes|No|08/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|505.8536||498.62712||474.88297||||ONCOLOGY, ORAL - RENAL CELL|3180|||||No|No||MYLAN|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00378668128|SUNITINIB MALATE 37.5 MG CAP|28|EA|191.24726|08/02/2022||Yes|No||08/02/2022||Yes|No|08/02/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|548|No|435.86585||429.63919||409.18018||||ONCOLOGY, ORAL - RENAL CELL|3181|||||No|No||MYLAN|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00378668877|PANTOPRAZOLE SOD DR 20 MG TAB|90|EA|.04816|01/27/2011||Yes|No||01/27/2011||Yes|No|01/27/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/26/2012|047|No|.03666||.03578||.03604||||PROTON PUMP INHIBITORS|3182|||||No|No||MYLAN|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00378668910|PANTOPRAZOLE SOD DR 40 MG TAB|1000|EA|.04575|01/27/2011||Yes|No||01/27/2011||Yes|No|01/27/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/26/2012|047|No|.0331||.03231||.03254||||PROTON PUMP INHIBITORS|3183|||||No|No||MYLAN|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00378668977|PANTOPRAZOLE SOD DR 40 MG TAB|90|EA|.04816|01/27/2011||Yes|No||01/27/2011||Yes|No|01/27/2011||Yes|No||07/01/2012||Yes|No|||Prescription Required|No|07/26/2012|047|No|.0331||.03231||.03254||||PROTON PUMP INHIBITORS|3184|||||No|No||MYLAN|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00378685477|LISDEXAMFETAMINE 10 MG CAPSULE|90|EA|2.22166|12/04/2023||Yes|No||12/04/2023||Yes|No|12/04/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.48509||5.35345||5.39184||||STIMULANTS AND RELATED AGENTS|3185|||||No|No||MYLAN|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00378685577|LISDEXAMFETAMINE 20 MG CAPSULE|90|EA|2.22166|11/22/2023||Yes|No||11/22/2023||Yes|No|11/22/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.24516||5.11928||5.15599||||STIMULANTS AND RELATED AGENTS|3186|||||No|No||MYLAN|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00378685677|LISDEXAMFETAMINE 30 MG CAPSULE|90|EA|2.22166|11/22/2023||Yes|No||11/22/2023||Yes|No|11/22/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.59503||5.46075||5.49991||||STIMULANTS AND RELATED AGENTS|3187|||||No|No||MYLAN|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00378685777|LISDEXAMFETAMINE 40 MG CAPSULE|90|EA|2.22166|11/22/2023||Yes|No||11/22/2023||Yes|No|11/22/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|4.84006||4.7239||4.75778||||STIMULANTS AND RELATED AGENTS|3188|||||No|No||MYLAN|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00378685877|LISDEXAMFETAMINE 50 MG CAPSULE|90|EA|2.22166|11/22/2023||Yes|No||11/22/2023||Yes|No|11/22/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.03501||4.91417||4.94941||||STIMULANTS AND RELATED AGENTS|3189|||||No|No||MYLAN|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00378685977|LISDEXAMFETAMINE 60 MG CAPSULE|90|EA|2.22166|11/27/2023||Yes|No||11/27/2023||Yes|No|11/27/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.4397||5.30915||5.34723||||STIMULANTS AND RELATED AGENTS|3190|||||No|No||MYLAN|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00378686077|LISDEXAMFETAMINE 70 MG CAPSULE|90|EA|2.22166|11/22/2023||Yes|No||11/22/2023||Yes|No|11/22/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.96445||5.8213||5.86305||||STIMULANTS AND RELATED AGENTS|3191|||||No|No||MYLAN|No|||||No|No|No||
abiraterone acetate|No|No|No|No|75%|00378692078|ABIRATERONE ACETATE 250 MG TAB|120|EA|6.09166|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|01/28/2021|550|No|1.08623||1.06016||1.06776||||ONCOLOGY, ORAL - PROSTATE|3192|||||No|No||MYLAN|No|||||No|No|No||
abiraterone acetate|No|No|No|No|75%|00378692191|ABIRATERONE ACETATE 500 MG TAB|60|EA|67.3375|04/14/2021||Yes|No||04/14/2021||Yes|No|04/14/2021||Yes|No||||No|No|||Prescription Required|No|01/28/2021|550|No|13.60423||13.27773||13.37296||||ONCOLOGY, ORAL - PROSTATE|3193|||||No|No||MYLAN|No|||||No|No|No||
bexarotene|No|No|No|No|75%|00378695501|BEXAROTENE 75 MG CAPSULE      |100|EA|25.3055|11/15/2016||Yes|No||11/15/2016||Yes|No|11/15/2016||Yes|No||||No|No|||Prescription Required|No|||No|5.60218||5.46773||5.50694|||||3194|||||No|No||MYLAN|No|||||No|No|No||
glatiramer acetate|No|No|No|No|75%|00378696093|GLATIRAMER 20 MG/ML SYRINGE|1|ML|27.95|02/05/2018||Yes|No||02/05/2018||Yes|No|02/05/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|49.91876||48.72071||49.07014||||MULTIPLE SCLEROSIS AGENTS|3195|||||No|No||MYLAN|No|||||No|No|No||
glatiramer acetate|No|No|No|No|75%|00378696112|GLATIRAMER 40 MG/ML SYRINGE|1|ML|69.875|02/06/2018||Yes|No||02/06/2018||Yes|No|02/06/2018||Yes|No||||No|No|||Prescription Required|No|01/28/2021|043|No|103.01933||100.54687||101.268||||MULTIPLE SCLEROSIS AGENTS|3196|||||No|No||MYLAN|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00378698188|LANSOPRAZOLE DR 15 MG ODT|100|EA|3.87968|02/01/2019||Yes|No||02/01/2019||Yes|No|02/01/2019||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/26/2018|047|No|2.11115||2.06048||2.07526||||PROTON PUMP INHIBITORS|3197|||||No|No||MYLAN|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00378698288|LANSOPRAZOLE DR 30 MG ODT|100|EA|3.87968|02/01/2019||Yes|No||02/01/2019||Yes|No|02/01/2019||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/26/2018|047|No|2.19636||2.14365||2.15902||||PROTON PUMP INHIBITORS|3198|||||No|No||MYLAN|No|||||No|No|No||
levalbuterol HCl|No|No|No|No|75%|00378699393|LEVALBUTEROL CONC 1.25 MG/0.5|1|EA|2.30451|09/02/2009||Yes|No||09/02/2009||Yes|No|09/02/2009||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|4.13722||4.03793||4.06689||||BRONCHODILATORS, BETA AGONIST|3199|||||No|No||MYLAN|No|||||Yes|No|No||
paroxetine HCl|No|No|No|No|75%|00378700110|PAROXETINE HCL 10 MG TABLET|1000|EA|.04902|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.05294||.05167||.05204||||ANTIDEPRESSANTS, SSRIs|3200|||||No|No||MYLAN|No|||||No|No|No||
paroxetine HCl|No|No|No|No|75%|00378700193|PAROXETINE HCL 10 MG TABLET|30|EA|.04902|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.05294||.05167||.05204||||ANTIDEPRESSANTS, SSRIs|3201|||||No|No||MYLAN|No|||||No|No|No||
paroxetine HCl|No|No|No|No|75%|00378700210|PAROXETINE HCL 20 MG TABLET|1000|EA|.05963|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.05972||.05829||.0587||||ANTIDEPRESSANTS, SSRIs|3202|||||No|No||MYLAN|No|||||No|No|No||
paroxetine HCl|No|No|No|No|75%|00378700293|PAROXETINE HCL 20 MG TABLET|30|EA|.05962|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.05972||.05829||.0587||||ANTIDEPRESSANTS, SSRIs|3203|||||No|No||MYLAN|No|||||No|No|No||
paroxetine HCl|No|No|No|No|75%|00378700310|PAROXETINE HCL 30 MG TABLET|1000|EA|.08285|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.07352||.07176||.07227||||ANTIDEPRESSANTS, SSRIs|3204|||||No|No||MYLAN|No|||||No|No|No||
paroxetine HCl|No|No|No|No|75%|00378700393|PAROXETINE HCL 30 MG TABLET|30|EA|.08284|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.07352||.07176||.07227||||ANTIDEPRESSANTS, SSRIs|3205|||||No|No||MYLAN|No|||||No|No|No||
paroxetine HCl|No|No|No|No|75%|00378700410|PAROXETINE HCL 40 MG TABLET|1000|EA|.08625|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.08636||.08429||.08489||||ANTIDEPRESSANTS, SSRIs|3206|||||No|No||MYLAN|No|||||No|No|No||
paroxetine HCl|No|No|No|No|75%|00378700493|PAROXETINE HCL 40 MG TABLET|30|EA|.08772|08/26/2008||Yes|No||08/26/2008||Yes|No|08/26/2008||Yes|No||09/01/2022||Yes|No|||Prescription Required|No|01/20/2011|008|No|.08636||.08429||.08489||||ANTIDEPRESSANTS, SSRIs|3207|||||No|No||MYLAN|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00378700701|KETOCONAZOLE 2% FOAM|100|GM|2.97053|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|6.77004||6.67332||6.35554||||ANTIFUNGALS, TOPICAL|3208|||||No|No||MYLAN|No|||||No|No|No||
ketoconazole|No|No|No|No|75%|00378700750|KETOCONAZOLE 2% FOAM|50|GM|5.07658|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|11.56988||11.4046||10.86152||||ANTIFUNGALS, TOPICAL|3209|||||No|No||MYLAN|No|||||No|No|No||
acitretin|No|No|No|No|75%|00378702093|ACITRETIN 10 MG CAPSULE|30|EA|5.36668|09/15/2016||Yes|No||09/15/2016||Yes|No|09/15/2016||Yes|No||||No|No|||Prescription Required|No|||No|3.9686||3.87335||3.90113|||||3210|||||No|No||MYLAN|No|||||No|No|No||
acitretin|No|No|No|No|75%|00378702393|ACITRETIN 25 MG CAPSULE|30|EA|6.61497|09/15/2016||Yes|No||09/15/2016||Yes|No|09/15/2016||Yes|No||||No|No|||Prescription Required|No|||No|3.9502||3.8554||3.88305|||||3211|||||No|No||MYLAN|No|||||No|No|No||
bepotastine besilate|No|No|No|No|75%|00378705535|BEPOTASTINE 1.5% EYE DROP|5|ML|17.93272|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|002|No|23.3947||22.83323||22.99699||||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|3212|||||No|No||MYLAN|No|||||No|No|No||
bepotastine besilate|No|No|No|No|75%|00378705567|BEPOTASTINE 1.5% EYE DROP|10|ML|17.14883|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|002|No|17.07393||16.66416||16.78367||||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|3213|||||No|No||MYLAN|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00378705752|ALBUTEROL SUL 0.63 MG/3 ML SOL|3|ML|.19063|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|037|Yes|.15782||.15403||.15514||||BRONCHODILATORS, BETA AGONIST|3214|||||No|No||MYLAN|No|||||Yes|No|No||
albuterol sulfate|No|No|No|No|75%|00378705852|ALBUTEROL SUL 1.25 MG/3 ML SOL|3|ML|.19063|02/27/2023||Yes|No||02/27/2023||Yes|No|02/27/2023||Yes|No||||No|No|||Prescription Required|No|07/28/2022|037|Yes|.1629||.15899||.16013||||BRONCHODILATORS, BETA AGONIST|3215|||||No|No||MYLAN|No|||||Yes|No|No||
bromocriptine mesylate|No|No|No|No|75%|00378709601|BROMOCRIPTINE 5 MG CAPSULE|100|EA|3.20277|09/15/2009||Yes|No||09/15/2009||Yes|No|09/15/2009||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|015|No|3.32692||3.24707||3.27036||||ANTIPARKINSON'S AGENTS|3216|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
bromocriptine mesylate|No|No|No|No|75%|00378709693|BROMOCRIPTINE 5 MG CAPSULE|30|EA|3.20278|04/14/2005||Yes|No||04/14/2005||Yes|No|04/14/2005||Yes|No||||No|No|||Prescription Required|Yes|07/30/2020|015|No|3.32692||3.24707||3.27036||||ANTIPARKINSON'S AGENTS|3217|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
fenofibrate|No|No|No|No|75%|00378710077|FENOFIBRATE 54 MG TABLET|90|EA|.27247|01/11/2010||Yes|No||01/11/2010||Yes|No|01/11/2010||Yes|No||||No|No|||Prescription Required|No|07/23/2015|055|No|.06398||.06244||.06289||||LIPOTROPICS, OTHER|3218|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00378710177|FENOFIBRATE 160 MG TABLET|90|EA|.81748|01/11/2010||Yes|No||01/11/2010||Yes|No|01/11/2010||Yes|No||||No|No|||Prescription Required|No|07/23/2015|055|No|.10985||.10721||.10798||||LIPOTROPICS, OTHER|3219|||||No|No||MYLAN|No|||||No|No|No||
metformin HCl|Yes|No|No|No|75%|00378718505|METFORMIN HCL 500 MG TABLET|500|EA|.01256|06/15/2010||Yes|No||06/15/2010||Yes|No|06/15/2010||Yes|No||||No|No|07/01/2016||Prescription Required|No|01/26/2017|012|No|.01225||.01196||.01204||||HYPOGLYCEMICS, METFORMINS|3220|||||No|No||MYLAN|No|||||No|No|No||
metformin HCl|Yes|No|No|No|75%|00378718605|METFORMIN HCL 850 MG TABLET|500|EA|.01742|06/15/2010||Yes|No||06/15/2010||Yes|No|06/15/2010||Yes|No||||No|No|07/01/2016||Prescription Required|No|01/26/2017|012|No|.02021||.01972||.01987||||HYPOGLYCEMICS, METFORMINS|3221|||||No|No||MYLAN|No|||||No|No|No||
metformin HCl|Yes|No|No|No|75%|00378718705|METFORMIN HCL 1,000 MG TABLET|500|EA|.01985|06/15/2010||Yes|No||06/15/2010||Yes|No|06/15/2010||Yes|No||||No|No|07/01/2016||Prescription Required|No|01/26/2017|012|No|.02057||.02008||.02022||||HYPOGLYCEMICS, METFORMINS|3222|||||No|No||MYLAN|No|||||No|No|No||
norethindrone|Yes|Yes|No|No|75%|00378727253|NORETHINDRONE 0.35 MG TABLET|28|EA|.05738|01/04/2017||Yes|No||01/04/2017||Yes|No|01/04/2017||Yes|No|Refer to program requirements|||No|No|01/04/2017||Prescription Required|No|||No|.06909||.06743||.06792|||||3223|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
norethindrone ac/eth estradiol|No|Yes|No|No|75%|00378727453|NORETHIN-EE 1.5-0.03 MG(21) TB|21|EA|.43996|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.32562||.31781||.32008|||||3224|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
norethindrone ac/eth estradiol|Yes|Yes|No|No|75%|00378728053|NORETHIND-ETH ESTRAD 1-0.02 MG|21|EA|.14244|02/09/2015||Yes|No||02/09/2015||Yes|No|02/09/2015||Yes|No|Refer to program requirements|||No|No|02/09/2015||Prescription Required|No|||No|.16192||.15803||.15917|||||3225|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
levonorgestrel/ethin.estradiol|Yes|Yes|No|No|75%|00378728153|LEVONOR-ETH ESTRAD 0.15-0.03|91|EA|.25963|11/09/2015||Yes|No||11/09/2015||Yes|No|11/09/2015||Yes|No|Refer to program requirements|||No|No|11/09/2015||Prescription Required|No|||No|.10576||.10322||.10396|||||3226|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
norethindrone-e.estradiol-iron|Yes|Yes|No|No|75%|00378728353|NORETH-EE-FE 1-0.02(21)-75 TAB|28|EA|.10683|02/09/2015||Yes|No||02/09/2015||Yes|No|02/09/2015||Yes|No|Refer to program requirements|||No|No|02/09/2015||Prescription Required|No|||No|.12217||.11924||.12009|||||3227|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
L-norgest/e.estradiol-e.estrad|Yes|Yes|No|No|75%|00378728490|LEVONOR-E ESTRAD 0.1-0.02-0.01|91|EA|.18008|05/05/2020||Yes|No||05/05/2020||Yes|No|05/05/2020||Yes|No|Refer to program requirements|||No|No|06/19/2020||Prescription Required|No|||No|.18242||.17804||.17932|||||3228|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
L-norgest/e.estradiol-e.estrad|No|Yes|No|No|75%|00378728590|LEVONO-E ESTRAD 0.15-0.03-0.01|91|EA|.44937|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.22042||.21513||.21667|||||3229|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
levonorgestrel/ethin.estradiol|Yes|Yes|No|No|75%|00378728753|LEVONOR-ETH ESTRAD 0.1-0.02 MG|28|EA|.1311|02/09/2015||Yes|No||02/09/2015||Yes|No|02/09/2015||Yes|No|Refer to program requirements|||No|No|02/09/2015||Prescription Required|No|||No|.12769||.12463||.12552|||||3230|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
norethindrone-e.estradiol-iron|No|Yes|No|No|75%|00378728853|NORETH-EE-FE 1.5-0.03MG(21)-75|28|EA|.11773|12/15/2023||Yes|No||||No|No|12/15/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.1354||.13215||.1331|||||3231|||||No|No||MYL-VIA/XIROMED|No|||||No|No|No||
norethindrone acetate|No|No|No|No|75%|00378729189|NORETHINDRONE 5 MG TABLET|50|EA|.79722|12/17/2019||Yes|No||12/17/2019||Yes|No|12/17/2019||Yes|No||||No|No|||Prescription Required|No|||No|.21352||.2084||.20989|||||3232|||||No|No||MYL-VIA/XIROMED|No|||||No|No|No||
norethindrone|Yes|Yes|No|No|75%|00378729253|NORETHINDRONE 0.35 MG TABLET|28|EA|.05738|10/09/2014||Yes|No||10/09/2014||Yes|No|10/09/2014||Yes|No|Refer to program requirements|||No|No|10/09/2014||Prescription Required|No|||No|.06909||.06743||.06792|||||3233|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
estradiol/norethindrone acet|No|No|No|No|75%|00378729453|ESTRADIOL-NORETH 0.5-0.1 MG TB|28|EA|.24827|11/29/2018||Yes|No||11/29/2018||Yes|No|11/29/2018||Yes|No||||No|No|||Prescription Required|No|||Yes|.40484||.39512||.39796|||||3234|||||No|No||MYL-VIA/XIROMED|No|||||No|No|No||
estradiol/norethindrone acet|No|No|No|No|75%|00378729553|ESTRADIOL-NORETH 1-0.5 MG TAB|28|EA|.2258|11/29/2018||Yes|No||11/29/2018||Yes|No|11/29/2018||Yes|No||||No|No|||Prescription Required|No|||Yes|.4012||.39157||.39438|||||3235|||||No|No||MYL-VIA/XIROMED|No|||||No|No|No||
desog-e.estradiol/e.estradiol|Yes|Yes|No|No|75%|00378729653|DESOGESTR-ETH ESTRAD ETH ESTRA|28|EA|.25349|02/09/2015||Yes|No||02/09/2015||Yes|No|02/09/2015||Yes|No|Refer to program requirements|||No|No|02/09/2015||Prescription Required|No|||No|.15631||.15256||.15365|||||3236|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
noreth-ethinyl estradiol/iron|Yes|Yes|No|No|75%|00378729753|NORET-ESTR-FE 0.4-0.035(21)-75|28|EA|.36954|10/16/2017||Yes|No||10/16/2017||Yes|No|10/16/2017||Yes|No|Refer to program requirements|||No|No|10/16/2017||Prescription Required|No|||No|.4685||.45726||.46054|||||3237|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
ethinyl estradiol/drospirenone|Yes|Yes|No|No|75%|00378729953|DROSPIRENONE-EE 3-0.02 MG TAB|28|EA|.28999|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No|Refer to program requirements|||No|No|07/22/2019||Prescription Required|No|||No|.1278||.12473||.12563|||||3238|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
ethinyl estradiol/drospirenone|Yes|Yes|No|No|75%|00378730053|DROSPIRENONE-EE 3-0.03 MG TAB|28|EA|.26276|11/10/2015||Yes|No||11/10/2015||Yes|No|11/10/2015||Yes|No|Refer to program requirements|||No|No|11/10/2015||Prescription Required|No|||No|.15775||.15396||.15507|||||3239|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
norethindrone-e.estradiol-iron|No|Yes|No|No|75%|00378730353|NORETH-EE-FE 1 MG/20-30-35 MCG|28|EA|.63195|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.98071||.95717||.96404|||||3240|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
ethynodiol d-ethinyl estradiol|No|Yes|No|No|75%|00378730653|ETHYNODIOL-ETH ESTRA 1MG-50MCG|28|EA|.3677|12/15/2023||Yes|No||||No|No|12/15/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.56358||.55005||.554|||||3241|||||No|No||MYL-VIA/XIROMED|No|||||No|No|No||
ethynodiol d-ethinyl estradiol|No|Yes|No|No|75%|00378730753|ETHYNODIOL-ETH ESTRA 1MG-35MCG|28|EA|.34057|12/15/2023||Yes|No||||No|No|12/15/2023||Yes|No|Refer to program requirements|||No|No|||Prescription Required|No|||No|.22526||.21985||.22143|||||3242|||||No|No||MYL-VIA/XIROMED|No|||||No|No|No||
noreth-ethinyl estradiol/iron|Yes|Yes|No|No|75%|00378730853|NORETHIN-ESTRA-FE 0.8-0.025 MG|28|EA|1.4988|07/17/2015||Yes|No||07/17/2015||Yes|No|07/17/2015||Yes|No|Refer to program requirements|||No|No|07/17/2015||Prescription Required|No|||No|1.53572||1.49886||1.50961|||||3243|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
L-norgest/e.estradiol-e.estrad|Yes|Yes|No|No|75%|00378731685|LEVONORG 0.15MG-EE 20-25-30MCG|91|EA|1.57077|06/26/2018||Yes|No||06/26/2018||Yes|No|06/26/2018||Yes|No|Refer to program requirements|||No|No|09/04/2019||Prescription Required|No|||No|1.93323||1.88683||1.90037|||||3244|||||No|No||MYL-VIA/XIROMED|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00378750232|BREYNA 80-4.5 MCG INHALER|10.3|GM|9.13311|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|033|Yes|20.58045||20.08652||20.23058||||GLUCOCORTICOIDS, INHALED|3245|||||No|No||MYLAN|No|||||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00378750332|BREYNA 160-4.5 MCG INHALER|10.3|GM|10.43939|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|033|Yes|23.30965||22.75022||22.91339||||GLUCOCORTICOIDS, INHALED|3246|||||No|No||MYLAN|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00378801593|LANSOPRAZOLE DR 15 MG CAPSULE|30|EA|.43|12/18/2009||Yes|No||12/18/2009||Yes|No|12/18/2009||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/29/2021|047|No|.12267||.11973||.12058||||PROTON PUMP INHIBITORS|3247|||||No|No||MYLAN|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00378802077|FLUVASTATIN SODIUM 20 MG CAP|90|EA|1.71928|05/14/2012||Yes|No||05/14/2012||Yes|No|05/14/2012||Yes|No||05/14/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|No|3.23963||3.16188||3.18456||||LIPOTROPICS, STATINS|3248|||||No|No||MYLAN|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00378802093|FLUVASTATIN SODIUM 20 MG CAP|30|EA|1.72215|05/14/2012||Yes|No||05/14/2012||Yes|No|05/14/2012||Yes|No||05/14/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|No|3.23963||3.16188||3.18456||||LIPOTROPICS, STATINS|3249|||||No|No||MYLAN|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00378802177|FLUVASTATIN SODIUM 40 MG CAP|90|EA|1.71928|05/14/2012||Yes|No||05/14/2012||Yes|No|05/14/2012||Yes|No||05/14/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|No|2.62452||2.56153||2.5799||||LIPOTROPICS, STATINS|3250|||||No|No||MYLAN|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00378802193|FLUVASTATIN SODIUM 40 MG CAP|30|EA|1.72215|05/14/2012||Yes|No||05/14/2012||Yes|No|05/14/2012||Yes|No||05/14/2012||Yes|No|||Prescription Required|Yes|07/29/2021|063|No|2.62452||2.56153||2.5799||||LIPOTROPICS, STATINS|3251|||||No|No||MYLAN|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00378803005|LANSOPRAZOLE DR 30 MG CAPSULE|500|EA|.43|11/16/2009||Yes|No||11/16/2009||Yes|No|11/16/2009||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/29/2021|047|No|.07539||.07358||.07411||||PROTON PUMP INHIBITORS|3252|||||No|No||MYLAN|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00378803077|LANSOPRAZOLE DR 30 MG CAPSULE|90|EA|.43|11/16/2009||Yes|No||11/16/2009||Yes|No|11/16/2009||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/29/2021|047|No|.07539||.07358||.07411||||PROTON PUMP INHIBITORS|3253|||||No|No||MYLAN|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00378803093|LANSOPRAZOLE DR 30 MG CAPSULE|30|EA|.43|10/29/2010||Yes|No||10/29/2010||Yes|No|10/29/2010||Yes|No||09/01/2022||Yes|No|||Prescription Required|Yes|07/29/2021|047|Yes|.07539||.07358||.07411||||PROTON PUMP INHIBITORS|3254|||||No|No||MYLAN|No|||||No|No|No||
halcinonide|No|No|No|No|75%|00378805649|HALCINONIDE 0.1% CREAM        |30|GM|5.60161|12/17/2019||Yes|No||12/17/2019||Yes|No|12/17/2019||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|120|No|12.76646||12.58408||11.98484||||STEROIDS, TOPICAL HIGH|3255|||||No|No||MYLAN|No|||||No|No|No||
halcinonide|No|No|No|No|75%|00378805660|HALCINONIDE 0.1% CREAM        |60|GM|4.7629|12/17/2019||Yes|No||12/17/2019||Yes|No|12/17/2019||Yes|No||||No|No|||Prescription Required|Yes|01/25/2018|120|No|10.85497||10.6999||10.19038||||STEROIDS, TOPICAL HIGH|3256|||||No|No||MYLAN|No|||||No|No|No||
erythromycin base in ethanol|No|No|No|No|75%|00378807560|ERYGEL 2% GEL                 |60|GM|1.79639|09/05/2019||Yes|No||09/05/2019||Yes|No|09/05/2019||Yes|No||||No|No|||Prescription Required|No|07/25/2019|104|No|4.09411||4.03562||3.84345||||ACNE AGENTS, TOPICAL|3257|||||No|No||MYLAN|No|||||No|No|No||
erythromycin base in ethanol|No|No|No|No|75%|00378807593|ERYGEL 2% GEL                 |30|GM|2.50489|01/03/2020||Yes|No||01/03/2020||Yes|No|01/03/2020||Yes|No||||No|No|||Prescription Required|No|07/25/2019|104|No|5.70882||5.62727||5.3593||||ACNE AGENTS, TOPICAL|3258|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808220|TRETINOIN 0.025% CREAM|20|GM|1.79977|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|.82117||.80146||.80721||||ACNE AGENTS, TOPICAL|3259|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808245|TRETINOIN 0.025% CREAM|45|GM|1.51455|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|.82669||.80685||.81264||||ACNE AGENTS, TOPICAL|3260|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808320|TRETINOIN 0.05% CREAM|20|GM|2.01842|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|1.17661||1.14837||1.15661||||ACNE AGENTS, TOPICAL|3261|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808345|TRETINOIN 0.05% CREAM|45|GM|1.68244|12/19/2022||Yes|No||12/19/2022||Yes|No|12/19/2022||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|1.00011||.97611||.98311||||ACNE AGENTS, TOPICAL|3262|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808420|TRETINOIN 0.1% CREAM|20|GM|2.35576|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|1.09396||1.0677||1.07536||||ACNE AGENTS, TOPICAL|3263|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808445|TRETINOIN 0.1% CREAM|45|GM|1.96061|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|.87876||.85767||.86382||||ACNE AGENTS, TOPICAL|3264|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808515|TRETINOIN 0.01% GEL|15|GM|1.90576|01/03/2020||Yes|No||01/03/2020||Yes|No|01/03/2020||Yes|No||||No|No|||Prescription Required|No|07/30/2020|104|No|2.49452||2.43465||2.45211||||ACNE AGENTS, TOPICAL|3265|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808545|TRETINOIN 0.01% GEL|45|GM|1.49965|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/30/2020|104|No|1.49215||1.45634||1.46678||||ACNE AGENTS, TOPICAL|3266|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808615|TRETINOIN 0.025% GEL|15|GM|1.92267|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|2.49288||2.43305||2.4505||||ACNE AGENTS, TOPICAL|3267|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378808645|TRETINOIN 0.025% GEL|45|GM|1.51178|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|No|07/26/2018|104|No|1.76169||1.71941||1.73174||||ACNE AGENTS, TOPICAL|3268|||||No|No||MYLAN|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00378809045|TRETINOIN 0.05% GEL|45|GM|2.68702|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|104|No|3.2879||3.20899||3.23201||||ACNE AGENTS, TOPICAL|3269|||||No|No||MYLAN|No|||||No|No|No||
tretinoin microspheres|No|No|No|No|75%|00378809220|TRETINOIN GEL MICRO 0.04% TUBE|20|GM|5.37565|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|Yes|7.64346||7.46002||7.51352||||ACNE AGENTS, TOPICAL|3270|||||No|No||MYLAN|No|||||No|No|No||
tretinoin microspheres|No|No|No|No|75%|00378809245|TRETINOIN GEL MICRO 0.04% TUBE|45|GM|4.31662|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|Yes|6.11569||5.96891||6.01172||||ACNE AGENTS, TOPICAL|3271|||||No|No||MYLAN|No|||||No|No|No||
tretinoin microspheres|No|No|No|No|75%|00378809250|TRETINOIN GEL MICRO 0.04% PUMP|50|GM|4.51466|01/29/2020||Yes|No||01/29/2020||Yes|No|01/29/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|Yes|7.83424||7.64622||7.70106||||ACNE AGENTS, TOPICAL|3272|||||No|No||MYLAN|No|||||No|No|No||
tretinoin microspheres|No|No|No|No|75%|00378809345|TRETINOIN GEL MICRO 0.1% TUBE|45|GM|4.31662|05/04/2020||Yes|No||05/04/2020||Yes|No|05/04/2020||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|Yes|6.80487||6.64155||6.68919||||ACNE AGENTS, TOPICAL|3273|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378811745|DOXEPIN 5% CREAM|45|GM|5.75177|05/22/2019||Yes|No||05/22/2019||Yes|No|05/22/2019||Yes|No||||No|No|||Prescription Required|No|||No|7.71347||7.52835||7.58234|||||3274|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378812330|ZONALON 5% CREAM|30|GM|8.49565|02/27/2019||Yes|No||02/27/2019||Yes|No|02/27/2019||Yes|No||||No|No|||Prescription Required|No|||No|19.36218||19.08558||18.17674|||||3275|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378812345|ZONALON 5% CREAM|45|GM|6.39075|02/27/2019||Yes|No||02/27/2019||Yes|No|02/27/2019||Yes|No||||No|No|||Prescription Required|No|||No|14.56498||14.3569||13.67324|||||3276|||||No|No||MYLAN|No|||||No|No|No||
saxagliptin HCl/metformin HCl|No|No|No|No|75%|00378817593|SAXAGLIPTIN-METFORMIN ER 5-500|30|EA|6.00065|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|13.6759||13.48053||12.8386||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3277|||||No|No||MYLAN|No|||||No|No|No||
saxagliptin HCl/metformin HCl|No|No|No|No|75%|00378817691|SAXAGLIPTN-METFORM ER 2.5-1000|60|EA|3.00033|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|4.24045||4.13868||4.16836||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3278|||||No|No||MYLAN|No|||||No|No|No||
saxagliptin HCl/metformin HCl|No|No|No|No|75%|00378817793|SAXAGLIPTIN-METFORMN ER 5-1000|30|EA|6.00065|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|01/26/2023|111|Yes|9.79445||9.55938||9.62794||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3279|||||No|No||MYLAN|No|||||No|No|No||
ketoprofen|No|No|No|No|75%|00378820001|KETOPROFEN ER 200 MG CAPSULE  |100|EA|3.72053|09/17/2003||Yes|No||09/17/2003||Yes|No|09/17/2003||Yes|No||||No|No|||Prescription Required|Yes|01/23/2013|059|Yes|8.47935||8.35822||7.96021||||NSAIDS|3280|||||No|No||MYLAN|No|||||No|No|No||
erythromycin base in ethanol|No|No|No|No|75%|00378821260|ERYTHROMYCIN 2% GEL|60|GM|1.40939|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|07/25/2019|104|No|.68046||.66413||.66889||||ACNE AGENTS, TOPICAL|3281|||||No|No||MYLAN|No|||||No|No|No||
erythromycin base in ethanol|No|No|No|No|75%|00378821293|ERYTHROMYCIN 2% GEL|30|GM|1.96524|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|No|07/25/2019|104|No|.56049||.54704||.55096||||ACNE AGENTS, TOPICAL|3282|||||No|No||MYLAN|No|||||No|No|No||
miconazole nitrate/zinc ox/pet|No|No|No|No|75%|00378822250|MICONAZOLE-ZINC-PETRO 0.25-15%|50|GM|4.32924|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription Required|Yes|03/09/2018|061|No|9.86664||9.72569||9.26256||||ANTIFUNGALS, TOPICAL|3283|||||No|No||MYLAN|No|||||No|No|No||
methylphenidate|No|No|No|No|75%|00378826093|METHYLPHENIDATE 10 MG/9HR PTCH|30|EA|5.76429|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|007|Yes|9.27788||9.05521||9.12016||||STIMULANTS AND RELATED AGENTS|3284|||||No|No||MYLAN|No|||||No|No|No||
methylphenidate|No|No|No|No|75%|00378826193|METHYLPHENIDATE 15 MG/9HR PTCH|30|EA|5.76429|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|007|Yes|8.5267||8.32206||8.38175||||STIMULANTS AND RELATED AGENTS|3285|||||No|No||MYLAN|No|||||No|No|No||
methylphenidate|No|No|No|No|75%|00378826293|METHYLPHENIDATE 20 MG/9HR PTCH|30|EA|5.76429|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|007|Yes|8.63467||8.42744||8.48788||||STIMULANTS AND RELATED AGENTS|3286|||||No|No||MYLAN|No|||||No|No|No||
methylphenidate|No|No|No|No|75%|00378826393|METHYLPHENIDATE 30 MG/9HR PTCH|30|EA|5.76429|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|Yes|07/28/2022|007|Yes|9.54535||9.31626||9.38308||||STIMULANTS AND RELATED AGENTS|3287|||||No|No||MYLAN|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00378827052|ALBUTEROL SUL 2.5 MG/3 ML SOLN|3|ML|.02935|04/03/2013||Yes|No||04/03/2013||Yes|No|04/03/2013||Yes|No||||No|No|||Prescription Required|No|07/26/2012|037|Yes|.0568||.05544||.05583||||BRONCHODILATORS, BETA AGONIST|3288|||||No|No||MYLAN|Yes|09/01/2020||||Yes|No|No||
albuterol sulfate|No|No|No|No|75%|00378827091|ALBUTEROL SUL 2.5 MG/3 ML SOLN|3|ML|.02936|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription Required|No|07/29/2021|037|No|.05488||.05356||.05395||||BRONCHODILATORS, BETA AGONIST|3289|||||No|No||MYLAN|No|||||Yes|No|No||
clindamycin phos/benzoyl perox|No|No|No|No|75%|00378868854|CLINDAMYCIN-BENZOYL PEROX 1-5%|50|GM|1.29|09/01/2009||Yes|No||09/01/2009||Yes|No|09/01/2009||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|104|Yes|.42116||.41105||.414||||ACNE AGENTS, TOPICAL|3290|||||No|No||MYLAN|No|||||No|No|No||
acyclovir|No|No|No|No|75%|00378870006|ACYCLOVIR 5% OINTMENT|15|GM|2.15|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|123|No|.42686||.41662||.4196||||ANTIVIRALS, TOPICAL|3291|||||No|No||MYLAN|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00378876058|CYCLOSPORINE 0.05% EYE EMULS|30|EA|1.64833|08/02/2022||Yes|No||08/02/2022||Yes|No|08/02/2022||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|086|No|2.21608||2.16289||2.17841||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|3292|||||No|No||MYLAN|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00378876091|CYCLOSPORINE 0.05% EYE EMULS|60|EA|1.64833|08/02/2022||Yes|No||08/02/2022||Yes|No|08/02/2022||Yes|No||||No|No|||Prescription Required|Yes|01/27/2022|086|No|1.76187||1.71959||1.73192||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|3293|||||No|No||MYLAN|No|||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876516|BUPRENORPHINE-NALOX 2-0.5MG FM|1|EA||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|1.24181||1.21201||1.2207||.|04/22/2024|OPIATE DEPENDENCE TREATMENTS|3294|||||No|No||MYLAN|Yes|10/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876593|BUPRENORPHINE-NALOX 2-0.5MG FM|30|EA|.95718|09/22/2020||Yes|No||09/22/2020||Yes|No|09/22/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|1.24181||1.21201||1.2207||||OPIATE DEPENDENCE TREATMENTS|3295|||||No|No||MYLAN|Yes|09/22/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876616|BUPRENORPHINE-NALOX 4-1MG FILM|1|EA||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|2.20927||2.15625||2.17171||.|04/22/2024|OPIATE DEPENDENCE TREATMENTS|3296|||||No|No||MYLAN|Yes|10/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876693|BUPRENORPHINE-NALOX 4-1MG FILM|30|EA|1.71484|09/22/2020||Yes|No||09/22/2020||Yes|No|09/22/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|2.20927||2.15625||2.17171||||OPIATE DEPENDENCE TREATMENTS|3297|||||No|No||MYLAN|Yes|09/22/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876716|BUPRENORPHINE-NALOX 8-2MG FILM|1|EA||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|1.61125||1.57258||1.58386||.|04/22/2024|OPIATE DEPENDENCE TREATMENTS|3298|||||No|No||MYLAN|Yes|10/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876793|BUPRENORPHINE-NALOX 8-2MG FILM|30|EA|1.71484|06/04/2019||Yes|No||06/04/2019||Yes|No|06/04/2019||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|1.61125||1.57258||1.58386||||OPIATE DEPENDENCE TREATMENTS|3299|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876816|BUPRENORPHINE-NALOX 12-3MG FLM|1|EA||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|4.4264||4.32017||4.35115||.|04/22/2024|OPIATE DEPENDENCE TREATMENTS|3300|||||No|No||MYLAN|Yes|10/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00378876893|BUPRENORPHINE-NALOX 12-3MG FLM|30|EA|3.42953|06/04/2019||Yes|No||06/04/2019||Yes|No|06/04/2019||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|4.4264||4.32017||4.35115||||OPIATE DEPENDENCE TREATMENTS|3301|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
estradiol|No|No|No|No|75%|00378877035|ESTRADIOL 0.01% CREAM|42.5|GM|1.59828|02/28/2018||Yes|No||02/28/2018||Yes|No|02/28/2018||Yes|No||||No|No|||Prescription Required|No|||Yes|.36924||.36038||.36296|||||3302|||||No|No||MYLAN|No|||||No|No|No||
cysteamine bitartrate|No|No|No|No|75%|00378904005|CYSTAGON 50 MG CAPSULE        |500|EA|.11438|06/26/2002||Yes|No||06/26/2002||Yes|No|06/26/2002||Yes|No||||No|No|||Prescription Required|No|||No|.26068||.25696||.24472|||||3303|||||No|No||MYLAN|No|||||No|No|Yes|10/23/2018|
cysteamine bitartrate|No|No|No|No|75%|00378904505|CYSTAGON 150 MG CAPSULE       |500|EA|.33334|06/26/2002||Yes|No||06/26/2002||Yes|No|06/26/2002||Yes|No||||No|No|||Prescription Required|No|||No|.7597||.74884||.71318|||||3304|||||No|No||MYLAN|No|||||No|No|Yes|10/23/2018|
lidocaine|No|No|No|No|75%|00378905593|LIDOCAINE 5% PATCH|30|EA|3.53474|10/05/2016||Yes|No||10/05/2016||Yes|No|10/05/2016||Yes|No||||No|No|||Prescription Required|No|08/08/2024|232|No|1.83539||1.79134||1.80419||||NEUROPATHIC PAIN|3305|||||No|No||MYLAN|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00378907093|RIVASTIGMINE 4.6 MG/24HR PATCH|30|EA|.71666|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|011|No|1.46822||1.43298||1.44326||||ALZHEIMER'S AGENTS|3306|||||No|No||MYLAN|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00378907193|RIVASTIGMINE 9.5 MG/24HR PATCH|30|EA|.71666|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|011|No|1.29256||1.26154||1.27059||||ALZHEIMER'S AGENTS|3307|||||No|No||MYLAN|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00378907293|RIVASTIGMINE 13.3 MG/24HR PTCH|30|EA|.71666|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription Required|Yes|01/28/2021|011|No|1.6518||1.61216||1.62372||||ALZHEIMER'S AGENTS|3308|||||No|No||MYLAN|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00378910293|NITROGLYCERIN 0.1 MG/HR PATCH|30|EA|.26273|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.4601||.44906||.45228|||||3309|||||No|No||MYLAN|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00378910493|NITROGLYCERIN 0.2 MG/HR PATCH|30|EA|.30372|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.5191||.50664||.51028|||||3310|||||No|No||MYLAN|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00378911293|NITROGLYCERIN 0.4 MG/HR PATCH|30|EA|.35102|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.62105||.60614||.61049|||||3311|||||No|No||MYLAN|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00378911693|NITROGLYCERIN 0.6 MG/HR PATCH|30|EA|.44576|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|||No|.80623||.78688||.79252|||||3312|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378911998|FENTANYL 12 MCG/HR PATCH|5|EA|6.98406|07/29/2010||Yes|No||07/29/2010||Yes|No|07/29/2010||Yes|No||||No|No|||Prescription Required|No|07/24/2013|110|Yes|9.27315||9.05059||9.11551||||ANALGESICS, NARCOTICS LONG|3313|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378912198|FENTANYL 25 MCG/HR PATCH|5|EA|3.0659|07/29/2010||Yes|No||07/29/2010||Yes|No|07/29/2010||Yes|No||||No|No|||Prescription Required|No|07/24/2013|110|Yes|4.65244||4.54078||4.57335||||ANALGESICS, NARCOTICS LONG|3314|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378912298|FENTANYL 50 MCG/HR PATCH|5|EA|5.44638|07/29/2010||Yes|No||07/29/2010||Yes|No|07/29/2010||Yes|No||||No|No|||Prescription Required|No|07/24/2013|110|Yes|8.44767||8.24493||8.30406||||ANALGESICS, NARCOTICS LONG|3315|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378912398|FENTANYL 75 MCG/HR PATCH|5|EA|8.6086|07/29/2010||Yes|No||07/29/2010||Yes|No|07/29/2010||Yes|No||||No|No|||Prescription Required|No|07/24/2013|110|Yes|11.50368||11.22759||11.30812||||ANALGESICS, NARCOTICS LONG|3316|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378912498|FENTANYL 100 MCG/HR PATCH|5|EA|11.84994|09/28/2009||Yes|No||09/28/2009||Yes|No|09/28/2009||Yes|No||||No|No|||Prescription Required|No|07/24/2013|110|Yes|16.19469||15.80602||15.91938||||ANALGESICS, NARCOTICS LONG|3317|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378912598|FENTANYL 37.5 MCG/HR PATCH|5|EA|18.25522|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|39.8188||38.86315||39.14188||||ANALGESICS, NARCOTICS LONG|3318|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378912698|FENTANYL 62.5 MCG/HR PATCH    |5|EA|26.52584|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|60.45424||59.59061||56.75296||||ANALGESICS, NARCOTICS LONG|3319|||||No|No||MYLAN|No|||||No|No|No||
fentanyl|No|No|No|No|90%|00378912798|FENTANYL 87.5 MCG/HR PATCH|5|EA|36.1157|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription Required|Yes|07/24/2013|110|Yes|82.3102||81.13434||77.2708||||ANALGESICS, NARCOTICS LONG|3320|||||No|No||MYLAN|No|||||No|No|No||
sucralfate|No|No|No|No|75%|00378920535|SUCRALFATE 1 GM/10 ML SUSP|420|ML|.17997|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription Required|No|||No|.2543||.2482||.24998|||||3321|||||No|No||MYLAN|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00378932032|WIXELA 100-50 INHUB|60|EA|.67159|05/29/2019||Yes|No||05/29/2019||Yes|No|05/29/2019||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|033|Yes|.91408||.89214||.89854||||GLUCOCORTICOIDS, INHALED|3322|||||No|No||MYLAN|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00378932132|WIXELA 250-50 INHUB|60|EA|.83448|05/29/2019||Yes|No||05/29/2019||Yes|No|05/29/2019||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|033|Yes|1.13244||1.10526||1.11319||||GLUCOCORTICOIDS, INHALED|3323|||||No|No||MYLAN|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00378932232|WIXELA 500-50 INHUB|60|EA|1.0975|05/29/2019||Yes|No||05/29/2019||Yes|No|05/29/2019||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|033|Yes|1.56676||1.52916||1.54013||||GLUCOCORTICOIDS, INHALED|3324|||||No|No||MYLAN|No|||||No|No|No||
travoprost|No|No|No|No|75%|00378965132|TRAVOPROST 0.004% EYE DROP|2.5|ML|27.29296|03/03/2020||Yes|No||03/03/2020||Yes|No|03/03/2020||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|088|No|14.21188||13.87079||13.97028||||OPHTHALMICS, GLAUCOMA AGENTS|3325|||||No|No||MYLAN|No|||||No|No|No||
travoprost|No|No|No|No|75%|00378965150|TRAVOPROST 0.004% EYE DROP|5|ML|27.2921|03/03/2020||Yes|No||03/03/2020||Yes|No|03/03/2020||Yes|No||||No|No|||Prescription Required|Yes|07/25/2019|088|No|15.13021||14.76708||14.873||||OPHTHALMICS, GLAUCOMA AGENTS|3326|||||No|No||MYLAN|No|||||No|No|No||
levalbuterol HCl|No|No|No|No|75%|00378969052|LEVALBUTEROL 0.31 MG/3 ML SOL |3|ML|.40013|11/29/2018||Yes|No||11/29/2018||Yes|No|11/29/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.28031||.27358||.27554||||BRONCHODILATORS, BETA AGONIST|3327|||||No|No||MYLAN|No|||||Yes|No|No||
levalbuterol HCl|No|No|No|No|75%|00378969152|LEVALBUTEROL 0.63 MG/3 ML SOL|3|ML|.40013|11/29/2018||Yes|No||11/29/2018||Yes|No|11/29/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.27613||.2695||.27144||||BRONCHODILATORS, BETA AGONIST|3328|||||No|No||MYLAN|No|||||Yes|No|No||
levalbuterol HCl|No|No|No|No|75%|00378969252|LEVALBUTEROL 1.25 MG/3 ML SOL|3|ML|.40013|11/29/2018||Yes|No||11/29/2018||Yes|No|11/29/2018||Yes|No||||No|No|||Prescription Required|Yes|08/08/2024|037|Yes|.28014||.27342||.27538||||BRONCHODILATORS, BETA AGONIST|3329|||||No|No||MYLAN|Yes|09/01/2020||||Yes|No|No||
miconazole nitrate/zinc ox/pet|No|No|No|No|75%|00378973050|VUSION OINTMENT               |50|GM|5.01629|06/12/2020||Yes|No||06/12/2020||Yes|No|06/12/2020||Yes|No||||No|No|||Prescription Required|Yes|01/30/2020|061|No|11.43248||11.26916||10.73254||||ANTIFUNGALS, TOPICAL|3330|||||No|No||MYLAN|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012301|HYDROCODONE-ACETAMIN 5-325 MG|100|EA|.086|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.12498||.12198||.12286||||ANALGESICS, NARCOTICS SHORT|3331|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012305|HYDROCODONE-ACETAMIN 5-325 MG|500|EA|.086|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.12498||.12198||.12286||||ANALGESICS, NARCOTICS SHORT|3332|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012310|HYDROCODONE-ACETAMIN 5-325 MG|1000|EA|.086|11/18/2016||Yes|No||11/18/2016||Yes|No|11/18/2016||Yes|No||11/18/2016||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.12498||.12198||.12286||||ANALGESICS, NARCOTICS SHORT|3333|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012362|HYDROCODONE-ACETAMIN 5-325 MG|100|EA|.18933|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.12498||.12198||.12286||||ANALGESICS, NARCOTICS SHORT|3334|||||No|No||SPECGX LLC|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012401|HYDROCODONE-ACETAMIN 7.5-325|100|EA|.0903|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15186||.14822||.14928||||ANALGESICS, NARCOTICS SHORT|3335|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012405|HYDROCODONE-ACETAMIN 7.5-325|500|EA|.0903|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15186||.14822||.14928||||ANALGESICS, NARCOTICS SHORT|3336|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012410|HYDROCODONE-ACETAMIN 7.5-325|1000|EA|.0903|11/18/2016||Yes|No||11/18/2016||Yes|No|11/18/2016||Yes|No||11/18/2016||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15186||.14822||.14928||||ANALGESICS, NARCOTICS SHORT|3337|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012462|HYDROCODONE-ACETAMIN 7.5-325|100|EA|.20881|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15186||.14822||.14928||||ANALGESICS, NARCOTICS SHORT|3338|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012501|HYDROCODONE-ACETAMIN 10-325 MG|100|EA|.0946|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15319||.14951||.15059||||ANALGESICS, NARCOTICS SHORT|3339|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012505|HYDROCODONE-ACETAMIN 10-325 MG|500|EA|.0946|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15319||.14951||.15059||||ANALGESICS, NARCOTICS SHORT|3340|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012510|HYDROCODONE-ACETAMIN 10-325 MG|1000|EA|.0946|11/18/2016||Yes|No||11/18/2016||Yes|No|11/18/2016||Yes|No||11/18/2016||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15319||.14951||.15059||||ANALGESICS, NARCOTICS SHORT|3341|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406012562|HYDROCODONE-ACETAMIN 10-325 MG|100|EA|.21242|09/22/2014||Yes|No||09/22/2014||Yes|No|09/22/2014||Yes|No||09/22/2014||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.15319||.14951||.15059||||ANALGESICS, NARCOTICS SHORT|3342|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406012701|METHYLPHENIDATE ER 27 MG TAB|100|EA|1.72|05/03/2013||Yes|No||05/03/2013||Yes|No|05/03/2013||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.61843||.60359||.60792||||STIMULANTS AND RELATED AGENTS|3343|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406013601|METHYLPHENIDATE ER 36 MG TAB|100|EA|1.7845|05/03/2013||Yes|No||05/03/2013||Yes|No|05/03/2013||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.63374||.61853||.62297||||STIMULANTS AND RELATED AGENTS|3344|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406015401|METHYLPHENIDATE ER 54 MG TAB|100|EA|1.935|05/03/2013||Yes|No||05/03/2013||Yes|No|05/03/2013||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.70036||.68355||.68845||||STIMULANTS AND RELATED AGENTS|3345|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406037601|HYDROCODONE-ACETAMIN 5-300 MG|100|EA|.21242|09/05/2017||Yes|No||09/05/2017||Yes|No|09/05/2017||Yes|No||09/05/2017||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.12442||.12143||.1223||||ANALGESICS, NARCOTICS SHORT|3346|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406037605|HYDROCODONE-ACETAMIN 5-300 MG|500|EA|.21242|09/05/2017||Yes|No||09/05/2017||Yes|No|09/05/2017||Yes|No||09/05/2017||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.12442||.12143||.1223||||ANALGESICS, NARCOTICS SHORT|3347|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406037701|HYDROCODONE-ACETAMIN 7.5-300|100|EA|.21242|09/05/2017||Yes|No||09/05/2017||Yes|No|09/05/2017||Yes|No||09/05/2017||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.1899||.18534||.18667||||ANALGESICS, NARCOTICS SHORT|3348|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406037705|HYDROCODONE-ACETAMIN 7.5-300|500|EA|.21242|09/05/2017||Yes|No||09/05/2017||Yes|No|09/05/2017||Yes|No||09/05/2017||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.1899||.18534||.18667||||ANALGESICS, NARCOTICS SHORT|3349|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406037801|HYDROCODONE-ACETAMIN 10-300 MG|100|EA|.21242|09/05/2017||Yes|No||09/05/2017||Yes|No|09/05/2017||Yes|No||09/05/2017||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.17035||.16626||.16745||||ANALGESICS, NARCOTICS SHORT|3350|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydrocodone/acetaminophen|No|No|No|No|90%|00406037805|HYDROCODONE-ACETAMIN 10-300 MG|500|EA|.21242|09/05/2017||Yes|No||09/05/2017||Yes|No|09/05/2017||Yes|No||09/05/2017||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.17035||.16626||.16745||||ANALGESICS, NARCOTICS SHORT|3351|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00406048301|ACETAMINOPHEN-COD #2 TABLET|100|EA|.17944|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.27593||.26931||.27124||||ANALGESICS, NARCOTICS SHORT|3352|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00406048401|ACETAMINOPHEN-COD #3 TABLET|100|EA|.18705|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.21587||.21069||.2122||||ANALGESICS, NARCOTICS SHORT|3353|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00406048410|ACETAMINOPHEN-COD #3 TABLET|1000|EA|.15395|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.21587||.21069||.2122||||ANALGESICS, NARCOTICS SHORT|3354|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00406048462|ACETAMINOPHEN-COD #3 TABLET|100|EA|.17363|03/27/2002||Yes|No||03/27/2002||Yes|No|03/27/2002||Yes|No||03/27/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.21587||.21069||.2122||||ANALGESICS, NARCOTICS SHORT|3355|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00406048501|ACETAMINOPHEN-COD #4 TABLET|100|EA|.24837|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.34724||.33891||.34134||||ANALGESICS, NARCOTICS SHORT|3356|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00406048505|ACETAMINOPHEN-COD #4 TABLET|500|EA|.23597|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.34724||.33891||.34134||||ANALGESICS, NARCOTICS SHORT|3357|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl/acetaminophen|No|No|No|No|90%|00406051201|OXYCODONE-ACETAMINOPHEN 5-325|100|EA|.07671|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.1216||.11868||.11953||||ANALGESICS, NARCOTICS SHORT|3358|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl/acetaminophen|No|No|No|No|90%|00406051205|OXYCODONE-ACETAMINOPHEN 5-325|500|EA|.07673|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.1216||.11868||.11953||||ANALGESICS, NARCOTICS SHORT|3359|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl/acetaminophen|No|No|No|No|90%|00406052201|OXYCODONE-ACETAMINOPHN 7.5-325|100|EA|.21242|11/12/2004||Yes|No||11/12/2004||Yes|No|11/12/2004||Yes|No||11/12/2004||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.17958||.17527||.17653||||ANALGESICS, NARCOTICS SHORT|3360|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl/acetaminophen|No|No|No|No|90%|00406052205|OXYCODONE-ACETAMINOPHN 7.5-325|500|EA|.21242|06/06/2016||Yes|No||06/06/2016||Yes|No|06/06/2016||Yes|No||06/06/2016||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.17958||.17527||.17653||||ANALGESICS, NARCOTICS SHORT|3361|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl/acetaminophen|No|No|No|No|90%|00406052301|OXYCODONE-ACETAMINOPHEN 10-325|100|EA|.21242|11/12/2004||Yes|No||11/12/2004||Yes|No|11/12/2004||Yes|No||11/12/2004||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.19788||.19313||.19452||||ANALGESICS, NARCOTICS SHORT|3362|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl/acetaminophen|No|No|No|No|90%|00406052305|OXYCODONE-ACETAMINOPHEN 10-325|500|EA|.21242|06/06/2016||Yes|No||06/06/2016||Yes|No|06/06/2016||Yes|No||06/16/2016||Yes|No|||Prescription Required|No|12/05/2017|109|Yes|.19788||.19313||.19452||||ANALGESICS, NARCOTICS SHORT|3363|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00406052710|METHADOSE 10 MG/ML ORAL CONC|1000|ML|.03363|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.07666||.07556||.07196||||ANALGESICS, NARCOTICS LONG|3364|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00406054034|METHADOSE 40 MG TABLET DISPR  |100|EA|.11051|04/02/2002||Yes|No||04/02/2002||Yes|No|04/02/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.25186||.24826||.23644||||ANALGESICS, NARCOTICS LONG|3365|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00406055201|OXYCODONE HCL (IR) 5 MG TABLET|100|EA|.08587|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.08144||.07949||.08006||||ANALGESICS, NARCOTICS SHORT|3366|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406080301|DEXTROAMPH-AMPHET ER 25 MG CAP|100|EA|4.19598|08/23/2024||Yes|No||08/23/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|8.40281||8.20114||8.25996||||STIMULANTS AND RELATED AGENTS|3367|||||No|No||SPECGX LLC|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406080401|DEXTROAMPH-AMPHET ER 50 MG CAP|100|EA|4.19598|09/17/2024||Yes|No||09/17/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|8.37778||8.17671||8.23536||||STIMULANTS AND RELATED AGENTS|3368|||||No|No||SPECGX LLC|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406080701|DEXTROAMPH-AMPHET ER 37.5MG CP|100|EA|4.19598|09/17/2024||Yes|No||09/17/2024||Yes|No|||No|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|8.4309||8.22856||8.28757||||STIMULANTS AND RELATED AGENTS|3369|||||No|No||SPECGX LLC|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406114201|METHYLPHENIDATE 5 MG TABLET|100|EA|.08471|08/11/2011||Yes|No||08/11/2011||Yes|No|08/11/2011||Yes|No||||No|No|||Prescription Required|No|12/05/2017|007|Yes|.10713||.10456||.10531||||STIMULANTS AND RELATED AGENTS|3370|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406114401|METHYLPHENIDATE 10 MG TABLET|100|EA|.12074|08/24/2011||Yes|No||08/24/2011||Yes|No|08/24/2011||Yes|No||||No|No|||Prescription Required|No|12/05/2017|007|Yes|.14244||.13902||.14002||||STIMULANTS AND RELATED AGENTS|3371|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406114601|METHYLPHENIDATE 20 MG TABLET|100|EA|.17342|08/24/2011||Yes|No||08/24/2011||Yes|No|08/24/2011||Yes|No||||No|No|||Prescription Required|No|12/05/2017|007|Yes|.19971||.19492||.19631||||STIMULANTS AND RELATED AGENTS|3372|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
naltrexone HCl|No|No|No|No|75%|00406117001|NALTREXONE 50 MG TABLET|100|EA|.645|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|12/05/2017|145|No|1.02137||.99686||1.00401||||OPIATE DEPENDENCE TREATMENTS|3373|||||No|No||SPECGX LLC|Yes|09/01/2020||||No|No|No||
naltrexone HCl|No|No|No|No|75%|00406117003|NALTREXONE 50 MG TABLET|30|EA|.645|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|12/05/2017|145|No|1.02137||.99686||1.00401||||OPIATE DEPENDENCE TREATMENTS|3374|||||No|No||SPECGX LLC|Yes|09/01/2020||||No|No|No||
diphenoxylate HCl/atropine|No|No|No|No|75%|00406123601|DIPHENOXYLATE-ATROP 2.5-0.025|100|EA|.0817|02/27/2023||Yes|No||02/27/2023||Yes|No|02/27/2023||Yes|No||02/27/2023||Yes|No|||Prescription Required|No|||No|.12979||.12668||.12758|||||3375|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406144501|METHYLPHENIDATE ER 10 MG TAB|100|EA|.4515|08/24/2011||Yes|No||08/24/2011||Yes|No|08/24/2011||Yes|No||||No|No|||Prescription Required|Yes|02/08/2018|007|Yes|.40748||.3977||.40055||||STIMULANTS AND RELATED AGENTS|3376|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406147301|METHYLPHENIDATE ER 20 MG TAB|100|EA|.4945|08/24/2011||Yes|No||08/24/2011||Yes|No|08/24/2011||Yes|No||||No|No|||Prescription Required|Yes|02/08/2018|007|Yes|.51318||.50086||.50446||||STIMULANTS AND RELATED AGENTS|3377|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406181001|METHYLPHENIDATE ER(CD) 10MG CP|100|EA|1.2255|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|.87151||.85059||.85669||||STIMULANTS AND RELATED AGENTS|3378|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406182001|METHYLPHENIDATE ER(CD) 20MG CP|100|EA|1.2255|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|.77887||.76018||.76563||||STIMULANTS AND RELATED AGENTS|3379|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406183001|METHYLPHENIDATE ER(CD) 30MG CP|100|EA|1.2255|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|1.14032||1.11295||1.12093||||STIMULANTS AND RELATED AGENTS|3380|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406184001|METHYLPHENIDATE ER(CD) 40MG CP|100|EA|1.29|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|1.19476||1.16609||1.17445||||STIMULANTS AND RELATED AGENTS|3381|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406185001|METHYLPHENIDATE ER(CD) 50MG CP|100|EA|1.548|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|1.20485||1.17593||1.18437||||STIMULANTS AND RELATED AGENTS|3382|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00406186001|METHYLPHENIDATE ER(CD) 60MG CP|100|EA|1.548|05/17/2017||Yes|No||05/17/2017||Yes|No|05/17/2017||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|007|Yes|1.70493||1.66401||1.67595||||STIMULANTS AND RELATED AGENTS|3383|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00406192303|BUPRENORPHINE-NALOX 2-0.5MG TB|30|EA|2.00394|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|4.56712||4.50188||4.2875||||OPIATE DEPENDENCE TREATMENTS|3384|||||No|No||MALLINCKRODT PH|Yes|10/01/2020||||No|No|No||
methadone HCl|No|No|No|No|90%|00406254001|METHADONE 40 MG TABLET DISPR  |100|EA|.11352|08/31/2005||Yes|No||08/31/2005||Yes|No|08/31/2005||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.25872||.25502||.24288||||ANALGESICS, NARCOTICS LONG|3385|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydromorphone HCl|No|No|No|No|90%|00406324301|HYDROMORPHONE 2 MG TABLET|100|EA|.06261|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.14028||.13691||.1379||||ANALGESICS, NARCOTICS SHORT|3386|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydromorphone HCl|No|No|No|No|90%|00406324401|HYDROMORPHONE 4 MG TABLET|100|EA|.07327|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.16669||.16269||.16386||||ANALGESICS, NARCOTICS SHORT|3387|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
hydromorphone HCl|No|No|No|No|90%|00406324901|HYDROMORPHONE 8 MG TABLET|100|EA|.21242|06/26/2006||Yes|No||06/26/2006||Yes|No|06/26/2006||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.47452||.46313||.46645||||ANALGESICS, NARCOTICS SHORT|3388|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00406511101|LISDEXAMFETAMINE 10 MG CAPSULE|100|EA|3.96998|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.48509||5.35345||5.39184||||STIMULANTS AND RELATED AGENTS|3389|||||No|No||SPECGX LLC|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00406511201|LISDEXAMFETAMINE 20 MG CAPSULE|100|EA|3.96998|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.24516||5.11928||5.15599||||STIMULANTS AND RELATED AGENTS|3390|||||No|No||SPECGX LLC|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00406511301|LISDEXAMFETAMINE 30 MG CAPSULE|100|EA|3.96998|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.59503||5.46075||5.49991||||STIMULANTS AND RELATED AGENTS|3391|||||No|No||SPECGX LLC|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00406511401|LISDEXAMFETAMINE 40 MG CAPSULE|100|EA|3.96998|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|4.84006||4.7239||4.75778||||STIMULANTS AND RELATED AGENTS|3392|||||No|No||SPECGX LLC|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00406511501|LISDEXAMFETAMINE 50 MG CAPSULE|100|EA|3.96998|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.03501||4.91417||4.94941||||STIMULANTS AND RELATED AGENTS|3393|||||No|No||SPECGX LLC|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00406511601|LISDEXAMFETAMINE 60 MG CAPSULE|100|EA|3.96998|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.4397||5.30915||5.34723||||STIMULANTS AND RELATED AGENTS|3394|||||No|No||SPECGX LLC|No|||||No|No|No||
lisdexamfetamine dimesylate|No|No|No|No|75%|00406511701|LISDEXAMFETAMINE 70 MG CAPSULE|100|EA|3.96998|12/15/2023||Yes|No||12/15/2023||Yes|No|12/15/2023||Yes|No||||No|No|||Prescription Required|Yes|07/27/2023|007|Yes|5.96445||5.8213||5.86305||||STIMULANTS AND RELATED AGENTS|3395|||||No|No||SPECGX LLC|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406511801|MORPHINE SULFATE IR 15 MG TAB|100|EA|.1858|03/18/2024||Yes|No||03/18/2024||Yes|No|03/18/2024||Yes|No||||No|No|||Prescription Required|No|07/28/2022|109|Yes|.18514||.1807||.18199||||ANALGESICS, NARCOTICS SHORT|3396|||||No|No||SPECGX LLC|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406511862|MORPHINE SULFATE IR 15 MG TAB|100|EA|.32585|03/18/2024||Yes|No||03/18/2024||Yes|No|03/18/2024||Yes|No||||No|No|||Prescription Required|No|07/28/2022|109|Yes|.18514||.1807||.18199||||ANALGESICS, NARCOTICS SHORT|3397|||||No|No||SPECGX LLC|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406511901|MORPHINE SULFATE IR 30 MG TAB|100|EA|.31618|03/18/2024||Yes|No||03/18/2024||Yes|No|03/18/2024||Yes|No||||No|No|||Prescription Required|No|07/28/2022|109|Yes|.27731||.27065||.2726||||ANALGESICS, NARCOTICS SHORT|3398|||||No|No||SPECGX LLC|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406511962|MORPHINE SULFATE IR 30 MG TAB|100|EA|.55324|03/18/2024||Yes|No||03/18/2024||Yes|No|03/18/2024||Yes|No||||No|No|||Prescription Required|No|07/28/2022|109|Yes|.27731||.27065||.2726||||ANALGESICS, NARCOTICS SHORT|3399|||||No|No||SPECGX LLC|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00406575501|METHADONE HCL 5 MG TABLET|100|EA|.09159|02/28/2005||Yes|No||02/28/2005||Yes|No|02/28/2005||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.15894||.15513||.15624||||ANALGESICS, NARCOTICS LONG|3400|||||No|No||MALLINCKRODT PH|Yes|09/01/2020||||No|No|No||
methadone HCl|No|No|No|No|90%|00406577101|METHADONE HCL 10 MG TABLET|100|EA|.15209|02/28/2005||Yes|No||02/28/2005||Yes|No|02/28/2005||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.194||.18934||.1907||||ANALGESICS, NARCOTICS LONG|3401|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406800312|MORPHINE SULF 100 MG/5 ML CONC|120|ML|.2408|06/25/2009||Yes|No||06/25/2009||Yes|No|06/25/2009||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|109|Yes|.40858||.39877||.40163||||ANALGESICS, NARCOTICS SHORT|3402|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406800315|MORPHINE SULF 100 MG/5 ML CONC|15|ML|.258|06/25/2009||Yes|No||06/25/2009||Yes|No|06/25/2009||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|109|Yes|.49209||.48028||.48372||||ANALGESICS, NARCOTICS SHORT|3403|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406800324|MORPHINE SULF 100 MG/5 ML CONC|240|ML|.17943|06/25/2009||Yes|No||06/25/2009||Yes|No|06/25/2009||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|109|Yes|.40894||.4031||.38391||||ANALGESICS, NARCOTICS SHORT|3404|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406800330|MORPHINE SULF 100 MG/5 ML CONC|30|ML|.2365|06/25/2009||Yes|No||06/25/2009||Yes|No|06/25/2009||Yes|No||||No|No|||Prescription Required|Yes|07/17/2014|109|Yes|.36644||.35765||.36021||||ANALGESICS, NARCOTICS SHORT|3405|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00406800503|BUPRENORPHINE-NALOX 2-0.5MG TB|30|EA|.57333|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|.37404||.36506||.36768||||OPIATE DEPENDENCE TREATMENTS|3406|||||No|No||MALLINCKRODT PH|Yes|10/01/2020||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00406802003|BUPRENORPHINE-NALOX 8-2 MG TAB|30|EA|.688|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|Yes|.64498||.6295||.63402||||OPIATE DEPENDENCE TREATMENTS|3407|||||No|No||MALLINCKRODT PH|Yes|10/01/2020||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406831501|MORPHINE SULF ER 15 MG TABLET|100|EA|.28823|08/13/2003||Yes|No||08/13/2003||Yes|No|08/13/2003||Yes|No||||No|No|||Prescription Required|No|12/05/2017|110|Yes|.23044||.22491||.22652||||ANALGESICS, NARCOTICS LONG|3408|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406832001|MORPHINE SULF ER 200 MG TABLET|100|EA|2.89777|08/13/2003||Yes|No||08/13/2003||Yes|No|08/13/2003||Yes|No||||No|No|||Prescription Required|No|12/05/2017|110|Yes|2.04448||1.99541||2.00972||||ANALGESICS, NARCOTICS LONG|3409|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406833001|MORPHINE SULF ER 30 MG TABLET|100|EA|.54769|08/13/2003||Yes|No||08/13/2003||Yes|No|08/13/2003||Yes|No||||No|No|||Prescription Required|No|12/05/2017|110|Yes|.37178||.36286||.36546||||ANALGESICS, NARCOTICS LONG|3410|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406838001|MORPHINE SULF ER 60 MG TABLET|100|EA|1.06872|08/13/2003||Yes|No||08/13/2003||Yes|No|08/13/2003||Yes|No||||No|No|||Prescription Required|No|12/05/2017|110|Yes|.5361||.52323||.52699||||ANALGESICS, NARCOTICS LONG|3411|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00406839001|MORPHINE SULF ER 100 MG TABLET|100|EA|1.58231|08/13/2003||Yes|No||08/13/2003||Yes|No|08/13/2003||Yes|No||||No|No|||Prescription Required|No|12/05/2017|110|Yes|.87381||.85284||.85896||||ANALGESICS, NARCOTICS LONG|3412|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00406851501|OXYCODONE HCL (IR) 15 MG TAB|100|EA|.13696|08/16/2004||Yes|No||08/16/2004||Yes|No|08/16/2004||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.17192||.16779||.169||||ANALGESICS, NARCOTICS SHORT|3413|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00406851562|OXYCODONE HCL (IR) 15 MG TAB|100|EA|.42549|07/22/2015||Yes|No||07/22/2015||Yes|No|07/22/2015||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.17192||.16779||.169||||ANALGESICS, NARCOTICS SHORT|3414|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00406853001|OXYCODONE HCL (IR) 30 MG TAB|100|EA|.21242|08/16/2004||Yes|No||08/16/2004||Yes|No|08/16/2004||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.30575||.29841||.30055||||ANALGESICS, NARCOTICS SHORT|3415|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00406853062|OXYCODONE HCL (IR) 30 MG TAB|100|EA|.66435|07/22/2015||Yes|No||07/22/2015||Yes|No|07/22/2015||Yes|No||||No|No|||Prescription Required|No|12/05/2017|109|Yes|.30575||.29841||.30055||||ANALGESICS, NARCOTICS SHORT|3416|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00406855605|OXYCODONE HCL 5 MG/5 ML SOLN|500|ML|.05332|08/13/2019||Yes|No||08/13/2019||Yes|No|08/13/2019||Yes|No||||No|No|||Prescription Required|No|07/26/2018|109|Yes|.06324||.06172||.06216||||ANALGESICS, NARCOTICS SHORT|3417|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00406855730|OXYCODONE HCL 100 MG/5 ML CONC|30|ML|1.57666|08/13/2019||Yes|No||08/13/2019||Yes|No|08/13/2019||Yes|No||||No|No|||Prescription Required|Yes|07/26/2018|109|Yes|2.65752||2.59374||2.61234||||ANALGESICS, NARCOTICS SHORT|3418|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00406872510|METHADOSE 10 MG/ML ORAL CONC|1000|ML|.03363|05/28/2002||Yes|No||05/28/2002||Yes|No|05/28/2002||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|110|Yes|.07666||.07556||.07196||||ANALGESICS, NARCOTICS LONG|3419|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00406880601|CLOMIPRAMINE 25 MG CAPSULE|100|EA|.645|08/06/2015||Yes|No||08/06/2015||Yes|No|08/06/2015||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|.19127||.18668||.18802||||ANTIDEPRESSANTS, TRICYCLIC|3420|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00406880701|CLOMIPRAMINE 50 MG CAPSULE|100|EA|.645|08/06/2015||Yes|No||08/06/2015||Yes|No|08/06/2015||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|.32571||.31789||.32017||||ANTIDEPRESSANTS, TRICYCLIC|3421|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00406880801|CLOMIPRAMINE 75 MG CAPSULE|100|EA|.645|08/06/2015||Yes|No||08/06/2015||Yes|No|08/06/2015||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|.30499||.29767||.29981||||ANTIDEPRESSANTS, TRICYCLIC|3422|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406888401|DEXTROAMP-AMPHETAM 7.5 MG TAB|100|EA|.21715|02/23/2023||Yes|No||02/23/2023||Yes|No|02/23/2023||Yes|No||||No|No|||Prescription Required|No|03/09/2018|007|Yes|.18574||.18128||.18258||||STIMULANTS AND RELATED AGENTS|3423|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406889301|DEXTROAMP-AMPHETAMIN 20 MG TAB|100|EA|.21715|10/07/2022||Yes|No||10/07/2022||Yes|No|10/07/2022||Yes|No||||No|No|||Prescription Required|No|07/30/2020|007|Yes|.34197||.33376||.33616||||STIMULANTS AND RELATED AGENTS|3424|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406889401|DEXTROAMP-AMPHETAMIN 30 MG TAB|100|EA|.21715|11/08/2022||Yes|No||11/08/2022||Yes|No|11/08/2022||Yes|No||||No|No|||Prescription Required|No|07/30/2020|007|Yes|.25597||.24983||.25162||||STIMULANTS AND RELATED AGENTS|3425|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406895101|DEXTROAMP-AMPHET ER 5 MG CAP|100|EA|.473|07/31/2023||Yes|No||07/31/2023||Yes|No|07/31/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.58063||.56669||.57076||||STIMULANTS AND RELATED AGENTS|3426|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406895201|DEXTROAMP-AMPHET ER 10 MG CAP|100|EA|.473|08/07/2023||Yes|No||08/07/2023||Yes|No|08/07/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.70399||.68709||.69202||||STIMULANTS AND RELATED AGENTS|3427|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406895301|DEXTROAMP-AMPHET ER 15 MG CAP|100|EA|.473|08/07/2023||Yes|No||08/07/2023||Yes|No|08/07/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.63267||.61749||.62191||||STIMULANTS AND RELATED AGENTS|3428|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406895401|DEXTROAMP-AMPHET ER 20 MG CAP|100|EA|.473|08/07/2023||Yes|No||08/07/2023||Yes|No|08/07/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|Yes|.57443||.56064||.56466||||STIMULANTS AND RELATED AGENTS|3429|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406895501|DEXTROAMP-AMPHET ER 25 MG CAP|100|EA|.473|08/07/2023||Yes|No||08/07/2023||Yes|No|08/07/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.52976||.51705||.52075||||STIMULANTS AND RELATED AGENTS|3430|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00406895601|DEXTROAMP-AMPHET ER 30 MG CAP|100|EA|.473|08/07/2023||Yes|No||08/07/2023||Yes|No|08/07/2023||Yes|No||||No|No|||Prescription Required|Yes|07/29/2021|007|No|.56014||.5467||.55062||||STIMULANTS AND RELATED AGENTS|3431|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine sulfate|No|No|No|No|75%|00406895801|DEXTROAMPHETAMINE 5 MG TAB|100|EA|.5934|02/16/2016||Yes|No||02/16/2016||Yes|No|02/16/2016||Yes|No||||No|No|||Prescription Required|No|12/05/2017|007|Yes|.42465||.41446||.41743||||STIMULANTS AND RELATED AGENTS|3432|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine sulfate|No|No|No|No|75%|00406895901|DEXTROAMPHETAMINE 10 MG TAB|100|EA|.6106|02/16/2016||Yes|No||02/16/2016||Yes|No|02/16/2016||Yes|No||||No|No|||Prescription Required|No|12/05/2017|007|Yes|.31812||.31049||.31271||||STIMULANTS AND RELATED AGENTS|3433|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine sulfate|No|No|No|No|75%|00406896001|DEXTROAMPHETAMINE ER 5 MG CAP|100|EA|1.25397|02/10/2016||Yes|No||02/10/2016||Yes|No|02/10/2016||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|007|No|.82808||.80821||.814||||STIMULANTS AND RELATED AGENTS|3434|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine sulfate|No|No|No|No|75%|00406896101|DEXTROAMPHETAMINE ER 10 MG CAP|100|EA|1.5664|02/10/2016||Yes|No||02/10/2016||Yes|No|02/10/2016||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|007|Yes|.98412||.9605||.96739||||STIMULANTS AND RELATED AGENTS|3435|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
dextroamphetamine sulfate|No|No|No|No|75%|00406896201|DEXTROAMPHETAMINE ER 15 MG CAP|100|EA|1.99731|02/10/2016||Yes|No||02/10/2016||Yes|No|02/10/2016||Yes|No||||No|No|||Prescription Required|Yes|12/01/2021|007|Yes|1.35278||1.32031||1.32978||||STIMULANTS AND RELATED AGENTS|3436|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00406920230|FENTANYL CITRATE OTFC 200 MCG|30|EA|5.23955|03/26/2010|01/31/2025|Yes|No||03/26/2010|01/31/2025|Yes|No|03/26/2010|01/31/2025|Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|11.9413||11.77071||11.2102||||ANALGESICS, NARCOTICS SHORT|3437|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MALLINCKRODT PH|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00406920430|FENTANYL CITRATE OTFC 400 MCG|30|EA|6.63819|03/26/2010|09/30/2024|Yes|No||03/26/2010|09/30/2024|Yes|No|03/26/2010|09/30/2024|Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|15.12891||14.91278||14.20265||||ANALGESICS, NARCOTICS SHORT|3438|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MALLINCKRODT PH|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00406920630|FENTANYL CITRATE OTFC 600 MCG|30|EA|8.13072|03/26/2010|12/31/2024|Yes|No||03/26/2010|12/31/2024|Yes|No|03/26/2010|12/31/2024|Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|18.53049||18.26577||17.39597||||ANALGESICS, NARCOTICS SHORT|3439|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MALLINCKRODT PH|No|||||No|No|No||
fentanyl citrate|No|No|No|No|90%|00406921230|FENTANYL CIT OTFC 1,200 MCG|30|EA|12.52489|03/26/2010|10/31/2024|Yes|No||03/26/2010|10/31/2024|Yes|No|03/26/2010|10/31/2024|Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|28.54511||28.13732||26.79745||||ANALGESICS, NARCOTICS SHORT|3440|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MALLINCKRODT PH|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00406990603|ANAFRANIL 25 MG CAPSULE|30|EA|16.68185|09/07/2006||Yes|No||09/07/2006||Yes|No|09/07/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|38.0191||37.47597||35.6914||||ANTIDEPRESSANTS, TRICYCLIC|3441|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00406990703|ANAFRANIL 50 MG CAPSULE|30|EA|16.99661|09/07/2006||Yes|No||09/07/2006||Yes|No|09/07/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|38.73646||38.18308||36.36484||||ANTIDEPRESSANTS, TRICYCLIC|3442|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00406990803|ANAFRANIL 75 MG CAPSULE|30|EA|17.31122|09/07/2006||Yes|No||09/07/2006||Yes|No|09/07/2006||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|39.45349||38.88987||37.03797||||ANTIDEPRESSANTS, TRICYCLIC|3443|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00406991003|PAMELOR 10 MG CAPSULE|30|EA|18.56998|02/11/2008||Yes|No||02/11/2008||Yes|No|02/11/2008||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|42.32228||41.71768||39.73112||||ANTIDEPRESSANTS, TRICYCLIC|3444|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00406991103|PAMELOR 25 MG CAPSULE|30|EA|18.94121|02/11/2008||Yes|No||02/11/2008||Yes|No|02/11/2008||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|43.16834||42.55165||40.52538||||ANTIDEPRESSANTS, TRICYCLIC|3445|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00406991203|PAMELOR 50 MG CAPSULE|30|EA|19.31287|02/11/2008||Yes|No||02/11/2008||Yes|No|02/11/2008||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|44.01539||43.3866||41.32057||||ANTIDEPRESSANTS, TRICYCLIC|3446|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00406991303|PAMELOR 75 MG CAPSULE|30|EA|19.68425|10/21/2008||Yes|No||10/21/2008||Yes|No|10/21/2008||Yes|No||||No|No|||Prescription Required|Yes|07/27/2017|215|No|44.86178||44.2209||42.11514||||ANTIDEPRESSANTS, TRICYCLIC|3447|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
temazepam|No|No|No|No|90%|00406991403|RESTORIL 22.5 MG CAPSULE|30|EA|15.17169|01/20/2005||Yes|No||01/20/2005||Yes|No|01/20/2005||Yes|No||||No|No|||Prescription Required|Yes|06/09/2004|054|Yes|34.57734||34.08338||32.46036||||SEDATIVE HYPNOTICS|3448|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
temazepam|No|No|No|No|90%|00406991501|RESTORIL 7.5 MG CAPSULE|100|EA|13.94232|08/02/2002||Yes|No||08/02/2002||Yes|No|08/02/2002||Yes|No||||No|No|||Prescription Required|Yes|06/09/2004|054|Yes|31.77552||31.32158||29.83008||||SEDATIVE HYPNOTICS|3449|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
temazepam|No|No|No|No|90%|00406991503|RESTORIL 7.5 MG CAPSULE|30|EA|13.94217|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||||No|No|||Prescription Required|Yes|02/10/2009|054|Yes|31.77519||31.32126||29.82977||||SEDATIVE HYPNOTICS|3450|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
temazepam|No|No|No|No|90%|00406991601|RESTORIL 15 MG CAPSULE|100|EA|14.75433|12/18/2002||Yes|No||12/18/2002||Yes|No|12/18/2002||Yes|No||||No|No|||Prescription Required|Yes|06/09/2004|054|Yes|33.62615||33.14578||31.56741||||SEDATIVE HYPNOTICS|3451|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
temazepam|No|No|No|No|90%|00406991701|RESTORIL 30 MG CAPSULE|100|EA|15.59722|04/23/2002||Yes|No||04/23/2002||Yes|No|04/23/2002||Yes|No||||No|No|||Prescription Required|Yes|06/09/2004|054|Yes|35.54715||35.03933||33.37079||||SEDATIVE HYPNOTICS|3452|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
temazepam|No|No|No|No|90%|00406995903|TEMAZEPAM 22.5 MG CAPSULE|30|EA|.93166|07/09/2008||Yes|No||07/09/2008||Yes|No|07/09/2008||Yes|No||||No|No|||Prescription Required|Yes|07/28/2010|054|Yes|1.15718||1.12941||1.13751||||SEDATIVE HYPNOTICS|3453|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
temazepam|No|No|No|No|90%|00406996001|TEMAZEPAM 7.5 MG CAPSULE|100|EA|1.1438|03/11/2009||Yes|No||03/11/2009||Yes|No|03/11/2009||Yes|No||||No|No|||Prescription Required|Yes|07/28/2010|054|Yes|.73935||.72161||.72678||||SEDATIVE HYPNOTICS|3454|||||No|No||MALLINCKRODT PH|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00409113403|MORPHINE SULFATE 50 MG/ML VIAL|20|ML|.33476|09/07/2015|12/11/2024|Yes|No||09/07/2015|12/11/2024|Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|.76293||.75203||.71622|||||3455|Discontinued by Manufacturer|Discontinued by Manufacturer|||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00409113405|MORPHINE SULFATE 50 MG/ML VIAL|50|ML|.28414|09/07/2015||Yes|No||09/07/2015||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|.64758||.63833||.60794|||||3456|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
meperidine HCl|No|No|No|No|90%|00409118130|DEMEROL 50 MG/ML VIAL|30|ML|1.79052|09/25/2006||Yes|No||09/25/2006||Yes|No|09/25/2006||Yes|No||||No|No|||Prescription Required|No|||Yes|4.08072||4.02242||3.83088|||||3457|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
gentamicin sulfate|No|No|No|No|75%|00409120703|GENTAMICIN 80 MG/2 ML VIAL|2|ML|.73917|10/07/2005||Yes|No||10/07/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|1.50596||1.46982||1.48036|||||3458|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409121501|NALOXONE 0.4 MG/ML VIAL|1|ML|6.8069|03/26/2015||Yes|No||03/26/2015||Yes|No|03/26/2015||Yes|No||||No|No|||Prescription Required|No|04/30/2015|145|No|6.3197||6.16803||6.21227||||OPIATE DEPENDENCE TREATMENTS|3459|||||No|Yes|11.23000|HOSPIRA/PFIZER|Yes|09/01/2020||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409121521|NALOXONE 0.4 MG/ML VIAL       |1|ML||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|No|15.5134||15.5134||15.5134||15.5134|10/01/2020|OPIATE DEPENDENCE TREATMENTS|3460|||||No|Yes|11.23000|HOSPIRA/PFIZER|Yes|10/01/2020||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409121525|NALOXONE 0.4 MG/ML VIAL|1|ML|6.7037|03/26/2015||Yes|No||03/26/2015||Yes|No|03/26/2015||Yes|No||||No|No|||Prescription Required|No|04/30/2015|145|No|15.2782||15.05994||14.3428||||OPIATE DEPENDENCE TREATMENTS|3461|||||No|Yes|11.23000|HOSPIRA-NOVAPLU|Yes|09/01/2020||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409121901|NALOXONE 4 MG/10 ML VIAL|10|ML|5.10582|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|04/30/2015|145|No|11.63652||11.47028||10.92408||||OPIATE DEPENDENCE TREATMENTS|3462|||||No|Yes|11.23000|HOSPIRA/PFIZER|Yes|10/01/2020||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409121925|NALOXONE 4 MG/10 ML VIAL|10|ML|5.02928|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|04/30/2015|145|No|11.46208||11.29834||10.76032||||OPIATE DEPENDENCE TREATMENTS|3463|||||No|Yes|11.23000|HOSPIRA-NOVAPLU|Yes|10/01/2020||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409121930|NALOXONE 4 MG/10 ML VIAL|10|ML||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|No|11.27||11.27||11.27||11.27|10/01/2020|OPIATE DEPENDENCE TREATMENTS|3464|||||No|Yes|11.23000|HOSPIRA-NOVAPLU|Yes|10/01/2020||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409121941|NALOXONE 4 MG/10 ML VIAL|10|ML||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/30/2020|145|No|6.3197||6.16803||6.21227||.|04/22/2024|OPIATE DEPENDENCE TREATMENTS|3465|||||No|Yes|11.23000|HOSPIRA/PFIZER|Yes|10/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00409127303|DIAZEPAM 10 MG/2 ML CARPUJECT|2|ML||05/24/2022||Yes|No||05/24/2022||Yes|No|05/24/2022||Yes|No||||No|No|||Prescription Required|No|||Yes|13.63131||13.63131||13.63131||13.63131|05/24/2022||3466|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
diazepam|No|No|No|No|75%|00409127332|DIAZEPAM 10 MG/2 ML CARPUJECT|2|ML|7.23712|05/24/2022||Yes|No||05/24/2022||Yes|No|05/24/2022||Yes|No||||No|No|||Prescription Required|No|||Yes|16.49389||16.25826||15.48406|||||3467|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
nalbuphine HCl|No|No|No|No|90%|00409146301|NALBUPHINE 10 MG/ML AMPUL|1|ML|1.91694|05/10/2005||Yes|No||05/10/2005||Yes|No|05/10/2005||Yes|No||||No|No|||Prescription Required|No|||Yes|4.36884||4.30643||4.10136|||||3468|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
nalbuphine HCl|No|No|No|No|90%|00409146701|NALBUPHINE 200 MG/10 ML VIAL|10|ML|2.5053|10/11/2005||Yes|No||10/11/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||Yes|5.70975||5.62819||5.36018|||||3469|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409178203|NALOXONE 0.4 MG/ML CARPUJECT|1|ML||10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription Required|No|01/26/2017|145|No|15.1312||15.1312||15.1312||15.1312|10/01/2020|OPIATE DEPENDENCE TREATMENTS|3470|||||No|Yes|11.23000|HOSPIRA/PFIZER|Yes|10/01/2020||||No|No|No||
naloxone HCl|No|No|No|No|75%|00409178269|NALOXONE 0.4 MG/ML CARPUJECT|1|ML|6.6392|03/26/2015||Yes|No||03/26/2015||Yes|No|03/26/2015||Yes|No||||No|No|||Prescription Required|No|01/22/2015|145|No|15.1312||14.91504||14.2048||||OPIATE DEPENDENCE TREATMENTS|3471|||||No|Yes|11.23000|HOSPIRA/PFIZER|Yes|09/01/2020||||No|No|No||
levetiracetam|No|No|No|No|75%|00409188602|LEVETIRACETAM 500 MG/5 ML VIAL|5|ML|.33433|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription Required|No|||No|.76197||.75108||.71532|||||3472|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00409189001|MORPHINE 2 MG/ML CARPUJECT|1|ML|.91547|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription Required|No|||Yes|1.834||1.78998||1.80282|||||3473|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00409189101|MORPHINE 4 MG/ML CARPUJECT|1|ML|.83678|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription Required|No|||Yes|1.90708||1.87984||1.79032|||||3474|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00409189201|MORPHINE 8 MG/ML CARPUJECT|1|ML|.99287|03/06/2013||Yes|No||03/05/2013||Yes|No|03/05/2013||Yes|No||||No|No|||Prescription Required|No|||Yes|2.26282||2.23049||2.12428|||||3475|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00409189301|MORPHINE 10 MG/ML CARPUJECT|1|ML|.99287|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription Required|No|||Yes|2.26282||2.23049||2.12428|||||3476|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
bacteriostatic sodium chloride|No|No|No|No|75%|00409196607|BACTERIOSTATIC SALINE VIAL|30|ML|.01748|05/04/2005||Yes|Yes||05/04/2005||Yes|Yes|05/04/2005||Yes|Yes||||No|Yes|||Prescription Required|No|||No|.03984||.03927||.0374|||||3477|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
deferoxamine mesylate|No|No|No|No|75%|00409233725|DEFEROXAMINE 2 GRAM VIAL|1|EA|15.1618|10/12/2005||Yes|No||10/12/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|34.5548||34.06116||32.4392|||||3478|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
dobutamine HCl|No|No|No|No|75%|00409234401|DOBUTAMINE 250 MG/20 ML VIAL|20|ML|.15824|08/31/2010||Yes|No||08/31/2010||Yes|No|08/31/2010||Yes|No||||No|No|||Prescription Required|No|||No|.36064||.35549||.33856|||||3479|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
dobutamine HCl|No|No|No|No|75%|00409234402|DOBUTAMINE 250 MG/20 ML VIAL|20|ML|.14902|08/31/2010||Yes|No||08/31/2010||Yes|No|08/31/2010||Yes|No||||No|No|||Prescription Required|No|||No|.33962||.33477||.31883|||||3480|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
diazepam|No|No|No|No|75%|00409321311|DIAZEPAM 50 MG/10 ML VIAL     |10|ML||05/23/2022||Yes|No||05/23/2022||Yes|No|05/23/2022||Yes|No||||No|No|||Prescription Required|No|||Yes|4.132||4.132||4.132||4.132|05/23/2022||3481|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
diazepam|No|No|No|No|75%|00409321312|DIAZEPAM 50 MG/10 ML VIAL|10|ML|2.15456|06/06/2013||Yes|No||06/06/2013||Yes|No|06/06/2013||Yes|No||||No|No|||Prescription Required|No|||Yes|4.91039||4.84024||4.60975|||||3482|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
acetylcysteine|No|No|No|No|75%|00409330703|ACETYLCYSTEINE 10% VIAL|30|ML|.20473|08/23/2011||Yes|No||08/23/2011||Yes|No|08/23/2011||Yes|No||||No|No|||Prescription Required|No|||No|.57667||.56283||.56687|||||3483|||||No|No||HOSPIRA/PFIZER|No|||||Yes|No|No||
acetylcysteine|No|No|No|No|75%|00409330803|ACETYLCYSTEINE 20% VIAL|30|ML|.20109|08/23/2011||Yes|No||08/23/2011||Yes|No|08/23/2011||Yes|No||||No|No|||Prescription Required|No|||No|.63874||.62341||.62788|||||3484|||||No|No||HOSPIRA/PFIZER|No|||||Yes|No|No||
piperacillin sodium/tazobactam|No|No|No|No|75%|00409338302|PIPERACIL-TAZOBACT 2.25 GM VL|1|EA|2.9971|08/25/2011||Yes|No||08/25/2011||Yes|No|08/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|6.8306||6.73302||6.4124|||||3485|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
piperacillin sodium/tazobactam|No|No|No|No|75%|00409338513|PIPERACIL-TAZOBACT 3.375 GM VL|1|EA|4.49651|08/25/2011||Yes|No||08/25/2011||Yes|No|08/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|3.71257||3.62347||3.64946|||||3486|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
piperacillin sodium/tazobactam|No|No|No|No|75%|00409339004|PIPERACIL-TAZOBACT 4.5 GM VIAL|1|EA|5.99463|08/25/2011||Yes|No||08/25/2011||Yes|No|08/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|13.66218||13.46701||12.82572|||||3487|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
tobramycin sulfate|No|No|No|No|75%|00409357801|TOBRAMYCIN 80 MG/2 ML VIAL|2|ML|.64165|10/06/2005||Yes|No||10/06/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.73015||.71263||.71774|||||3488|||||No|No||HOSPIRA/PFIZER|No|||||Yes|No|No||
ketorolac tromethamine|No|No|No|No|75%|00409379601|KETOROLAC 60 MG/2 ML VIAL|2|ML|.70314|10/21/2009||Yes|No||10/21/2009||Yes|No|10/21/2009||Yes|No||||No|No|||Prescription Required|No|||Yes|.69819||.68143||.68632|||||3489|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
water for inj.,bacteriostatic|No|No|No|No|75%|00409397703|BACTERIOSTATIC WATER VIAL|30|ML|.02721|10/12/2005||Yes|No||10/12/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.05704||.05567||.05607|||||3490|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
lidocaine HCl|No|No|No|No|75%|00409427601|LIDOCAINE HCL 1% VIAL|20|ML|.03409|10/11/2005||Yes|No||10/11/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.07018||.0685||.06899|||||3491|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
lidocaine HCl/PF|No|No|No|No|75%|00409427902|LIDOCAINE HCL 1% 300 MG/30 ML|30|ML|.04693|10/11/2005||Yes|No||10/11/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.10696||.10543||.10041|||||3492|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
vancomycin HCl|No|No|No|No|75%|00409433201|VANCOMYCIN 500 MG VIAL|1|EA|3.50923|05/21/2014||Yes|No||05/21/2014||Yes|No|05/21/2014||Yes|No||||No|No|||Prescription Required|No|||No|2.63267||2.56949||2.58791|||||3493|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00409488720|WATER FOR INJECTION VIAL|20|ML|.03154|10/23/2006||Yes|No||10/23/2006||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.06516||.0636||.06405|||||3494|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00409488750|WATER FOR INJECTION VIAL|50|ML|.02297|10/06/2005||Yes|No||10/06/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.05236||.05161||.04916|||||3495|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00409488810|SODIUM CHLORIDE 0.9% VIAL|10|ML|.04051|03/28/2008||Yes|No||03/28/2008||Yes|No|03/28/2008||Yes|No||||No|No|||Prescription Required|No|||No|.0883||.08618||.0868|||||3496|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00409488820|SODIUM CHLORIDE 0.9% VIAL|20|ML|.02805|03/28/2008||Yes|No||03/28/2008||Yes|No|03/28/2008||Yes|No||||No|No|||Prescription Required|No|||No|.0584||.057||.05741|||||3497|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftazidime|No|No|No|No|75%|00409508216|TAZICEF 1 GRAM VIAL|1|EA|1.83335|10/23/2006||Yes|No||10/23/2006||Yes|No|10/23/2006||Yes|No||||No|No|||Prescription Required|No|||No|4.17833||4.11864||3.92251|||||3498|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftazidime|No|No|No|No|75%|00409508411|TAZICEF 2 GRAM VIAL|1|EA|4.10736|10/23/2006||Yes|No||10/23/2006||Yes|No|10/23/2006||Yes|No||||No|No|||Prescription Required|No|||No|9.36096||9.22723||8.78784|||||3499|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftazidime|No|No|No|No|75%|00409508611|TAZICEF 6 GRAM VIAL|1|EA|13.13822|10/23/2006||Yes|No||10/23/2006||Yes|No|10/23/2006||Yes|No||||No|No|||Prescription Required|No|||No|29.94292||29.51516||28.10968|||||3500|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
aminophylline|No|No|No|No|75%|00409592201|AMINOPHYLLINE 500 MG/20 ML VL|20|ML|.22865|10/12/2005||Yes|No||10/12/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.52111||.51366||.4892|||||3501|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
furosemide|No|No|No|No|75%|00409610204|FUROSEMIDE 40 MG/4 ML VIAL|4|ML|.31536|10/24/2006||Yes|No||10/24/2006||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.30266||.2954||.29751|||||3502|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
erythromycin lactobionate|No|No|No|No|75%|00409647644|ERYTHROCIN 500 MG ADDVAN VIAL|1|EA|36.35005|10/24/2006||Yes|No||10/24/2006||Yes|No|10/24/2006||Yes|No||||No|No|||Prescription Required|No|||No|82.8443||81.66081||77.7722|||||3503|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
erythromycin lactobionate|No|No|No|No|75%|00409648201|ERYTHROCIN LACT 500 MG VIAL|1|EA|39.08012|10/06/2005||Yes|No||10/06/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|89.06632||87.79394||83.61328|||||3504|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
vancomycin HCl|No|No|No|No|75%|00409650901|VANCOMYCIN HCL 5 GM VIAL|1|EA|38.8118|10/24/2008||Yes|No||10/24/2008||Yes|No|10/24/2008||Yes|No||||No|No|||Prescription Required|No|||No|39.316||38.37242||38.64763|||||3505|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
vancomycin HCl|No|No|No|No|75%|00409653101|VANCOMYCIN 750 MG ADD-VAN VIAL|1|EA|2.87283|05/21/2014||Yes|No||05/21/2014||Yes|No|05/21/2014||Yes|No||||No|No|||Prescription Required|No|||No|6.54738||6.45385||6.14652|||||3506|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
vancomycin HCl|No|No|No|No|75%|00409653102|VANCOMYCIN HCL 750 MG VIAL|1|EA|4.22905|08/25/2011||Yes|No||08/25/2011||Yes|No|08/25/2011||Yes|No||||No|No|||Prescription Required|No|||No|9.6383||9.50061||9.0482|||||3507|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
vancomycin HCl|No|No|No|No|75%|00409653401|VANCOMYCIN 500 MG ADD-VAN VIAL|1|EA|2.33275|10/06/2005||Yes|No||10/06/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|5.3165||5.24055||4.991|||||3508|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
vancomycin HCl|No|No|No|No|75%|00409653501|VANCOMYCIN 1 GM ADD-VAN VIAL|1|EA|3.60512|10/12/2005||Yes|No||10/12/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|8.21632||8.09894||7.71328|||||3509|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00409656201|TESTOSTERONE CYP 200 MG/ML|1|ML|9.4557|03/22/2023||Yes|No||03/22/2023||Yes|No|03/22/2023||Yes|No||||No|No|||Prescription Required|No|||Yes|10.77328||10.51472||10.59013|||||3510|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00409656220|TESTOSTERONE CYP 2,000 MG/10ML|10|ML|4.03899|03/22/2023||Yes|No||03/22/2023||Yes|No|03/22/2023||Yes|No||||No|No|||Prescription Required|No|||Yes|3.40055||3.31894||3.34274|||||3511|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
sodium bicarbonate|No|No|No|No|75%|00409662514|SODIUM BICARBONATE 8.4% VIAL|50|ML|.08459|06/15/2021||Yes|No||06/15/2021||Yes|No|06/15/2021||Yes|No||||No|No|||Prescription Required|No|||No|.15429||.15059||.15167|||||3512|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00409665106|POTASSIUM CL 20 MEQ/10 ML CONC|10|ML|.16383|10/24/2006||Yes|No||10/24/2006||Yes|No|10/24/2006||Yes|No||||No|No|||Prescription Required|No|||No|.37338||.36805||.35052|||||3513|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00409665305|POTASSIUM CL 40 MEQ/20 ML CONC|20|ML|.10871|04/21/2010||Yes|No||04/21/2010||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.24776||.24422||.23259|||||3514|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00409710002|DEXTROSE 5%-WATER IV SOLN|250|ML|.01001|10/12/2005||Yes|No||10/12/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.02282||.0225||.02143|||||3515|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00409710067|DEXTROSE 5%-WATER IV SOLN|100|ML|.01887|10/12/2005||Yes|No||10/12/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.04301||.0424||.04038|||||3516|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00409710102|SODIUM CHLORIDE 0.9% SOLN|250|ML|.01008|10/12/2005||Yes|No||10/12/2005||Yes|No|||No|No||||No|No|||Prescription Required|No|||No|.02297||.02264||.02156|||||3517|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftriaxone sodium|No|No|No|No|75%|00409733201|CEFTRIAXONE 1 GM VIAL|1|EA|.65489|03/31/2009||Yes|No||03/31/2009||Yes|No|03/31/2009||Yes|No||||No|No|||Prescription Required|No|||No|1.72375||1.68238||1.69445|||||3518|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftriaxone sodium|No|No|No|No|75%|00409733410|CEFTRIAXONE 10 GM VIAL|1|EA|7.4476|09/22/2005||Yes|No||09/22/2005||Yes|No|09/22/2005||Yes|No||||No|No|||Prescription Required|No|||No|16.9736||16.73112||15.9344|||||3519|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftriaxone sodium|No|No|No|No|75%|00409733503|CEFTRIAXONE 2 GM VIAL|1|EA|1.24399|03/31/2009||Yes|No||03/31/2009||Yes|No|03/31/2009||Yes|No||||No|No|||Prescription Required|No|||No|2.958||2.88701||2.90771|||||3520|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftriaxone sodium|Yes|No|No|No|75%|00409733701|CEFTRIAXONE 250 MG VIAL|1|EA|.32766|10/13/2005||Yes|No||10/13/2005||Yes|No|10/13/2005||Yes|No||||No|No|11/01/2012||Prescription Required|No|||No|.795||.77592||.78149|||||3521|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No||
ceftriaxone sodium|