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|471.6033||460.28482||463.58604||||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|471.63655||460.31727||463.61873||||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|680.96312||664.62001||669.38675||||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|6640.92324||6481.54108||6528.02754||||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|6655.08438||6495.36235||6541.94795||||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||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|515.32659||502.95875||506.56604||||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||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|515.53437||503.16155||506.77029||||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||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|515.72771||503.35024||506.96034||||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||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|515.87126||503.49035||507.10145||.||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||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|515.93113||503.54878||507.1603||||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||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|515.8586||503.47799||507.089||||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|471.82527||460.50146||463.80424||||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|680.86942||664.52855||669.29464||||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|568.50523||554.8611||558.84064||||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|471.5786||460.26071||463.56176||||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|12.62339||12.32043||12.40879||||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|13.70968||13.38065||13.47662||||STIMULANTS AND RELATED AGENTS|29|||||No|No||ELI LILLY & CO.|No|||||No|No|No|| olanzapine/fluoxetine HCl|No|No|No|No|75%|00002323030|SYMBYAX 3-25 MG CAPSULE|30|EA|4.2183|07/19/2007|07/31/2024|Yes|No||07/19/2007|07/31/2024|Yes|No|07/19/2007|07/31/2024|Yes|No||||No|No|||Prescription Required|Yes|01/15/2014|027|Yes|9.6138||9.47646||9.0252||||ANTIPSYCHOTICS|30|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|31|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|8.01283||7.82052||7.87661||||NEUROPATHIC PAIN|32|||||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|12.5985||12.29614||12.38433||||STIMULANTS AND RELATED AGENTS|33|||||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|13.64558||13.31809||13.41361||||STIMULANTS AND RELATED AGENTS|34|||||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|8.95905||8.74403||8.80675||||NEUROPATHIC PAIN|35|||||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|8.95905||8.74403||8.80675||||NEUROPATHIC PAIN|36|||||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|14.75875||14.40454||14.50785||||STIMULANTS AND RELATED AGENTS|37|||||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|38|||||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|8.96582||8.75064||8.8134||||NEUROPATHIC PAIN|39|||||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|40|||||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|41|||||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|15.24447||14.8786||14.98531||||ANTIPSYCHOTICS|42|||||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|18.26917||17.83071||17.95859||||ANTIPSYCHOTICS|43|||||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|22.79125||22.24426||22.4038||||ANTIPSYCHOTICS|44|||||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|88.61017||86.48353||87.1038||||CYTOKINE AND CAM ANTAGONISTS|45|||||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|6.32656||6.17472||6.21901||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|46|||||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|88.66408||86.53614||87.15679||||ANTIMIGRAINE AGENTS, OTHER|47|||||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|34.16517||33.34521||33.58436||||ANTIPSYCHOTICS|48|||||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|49|||||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|50|||||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|51|||||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|52|||||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|53|||||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|179.01268||176.45536||168.05272||||CYTOKINE AND CAM ANTAGONISTS|54|||||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|55|||||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|88.77369||86.64312||87.26454||||ANTIMIGRAINE AGENTS, OTHER|56|||||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|57|||||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|58|||||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|59|||||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|60|||||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|61|||||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|62|||||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|63|||||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|64|||||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|65|||||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|66|||||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|6.3751||6.2221||6.26672||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|67|||||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|6.35667||6.20411||6.24861||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|68|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|8.18903||7.99249||8.04982||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|69|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|70|||||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|9.80118||9.56595||9.63456||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|71|||||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|72|||||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|73|||||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|74|||||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|75|||||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|76|||||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|67.83884||66.21071||66.68558||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|77|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|78|||||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|10.18135||9.937||10.00827||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|79|||||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|80|||||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|20.93925||20.43671||20.58328||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|81|||||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||.||CYTOKINE AND CAM ANTAGONISTS|82|||||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|83|||||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|26.34909||25.71671||25.90116||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|84|||||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|2.40085||2.34323||2.36004||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|85|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|86|||||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|10.17701||9.93276||10.004||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|87|||||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||GROWTH HORMONE|88|||||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|1803.43||1760.14768||1772.77169||.||GROWTH HORMONE|89|||||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||GROWTH HORMONE|90|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|91|||||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|33.92473||33.11054||33.34801||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|92|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|93|||||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|10.14547||9.90198||9.973||||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%|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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|95|||||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|20.93902||20.43648||20.58306||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|96|||||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|4.27534||4.17273||4.20266||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|97|||||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|98|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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|99|||||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|10.19438||9.94971||10.02108||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|100|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|101|||||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|67.88075||66.25161||66.72678||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|102|||||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|10.18157||9.93721||10.00848||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|103|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|104|||||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|33.95867||33.14366||33.38137||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|105|||||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|4.28335||4.18055||4.21053||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|106|||||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|1727.66728||1686.20327||1698.29694||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|107|||||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|71.29486||69.58378||70.08285||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|108|||||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|4.27661||4.17397||4.20391||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|109|||||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|110|||||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|10.18419||9.93977||10.01106||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|111|||||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|112|||||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|10.1708||9.9267||9.9979||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|113|||||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|114|||||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|10.18392||9.93951||10.01079||||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%|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|116|||||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|9.04734||8.8302||8.89354||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|117|||||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|118|||||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|9.05761||8.84023||8.90363||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|119|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|120|||||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|91.79143||89.58844||90.23098||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|121|||||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||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|122|||||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|5.9256||5.78339||5.82486||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|123|||||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|8.992||8.77619||8.83914|||||124|||||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|6.82495||6.66115||6.70893|||||125|||||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|2.31557||2.26||2.27621|||||126|||||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|127|||||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|128|||||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|129|||||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|130|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|131|||||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|132|||||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|133|||||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|9.50939||9.28116||9.34773||||ANTICOAGULANTS|134|||||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|9.50939||9.28116||9.34773||||ANTICOAGULANTS|135|||||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|9.51193||9.28364||9.35023||||ANTICOAGULANTS|136|||||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|9.51193||9.28364||9.35023||||ANTICOAGULANTS|137|||||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|9.51193||9.28364||9.35023||||ANTICOAGULANTS|138|||||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|139|||||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|44.29072||43.22774||43.53778|||||140|||||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|||||141|||||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|||||142|||||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|1383.2712||1350.07269||1359.75559||||CYTOKINE AND CAM ANTAGONISTS|143|||||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|1383.04193||1349.84892||1359.53022||||CYTOKINE AND CAM ANTAGONISTS|144|||||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|145|||||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|146|||||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|147|||||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|148|||||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|149|||||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|51.98231||50.73473||51.09861||||HIV / AIDS|150|||||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|9.50615||9.278||9.34455||||ANTICOAGULANTS|151|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No|| repotrectinib|No|No|No|No|75%|00003404012|AUGTYRO 40 MG CAPSULE|120|EA|51.95833|08/15/2024||Yes|No||08/15/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|08/08/2024|551|No|118.41666||116.725||111.16666||||ONCOLOGY, ORAL - LUNG|152|||||No|No||BMS PRIMARYCARE|No|||||No|No|No|| repotrectinib|No|No|No|No|75%|00003404060|AUGTYRO 40 MG CAPSULE|60|EA|51.95833|10/17/2024||Yes|No||10/17/2024||Yes|No|||No|No||||No|No|||Prescription Required|No|08/08/2024|551|No|118.41666||116.725||111.16666||||ONCOLOGY, ORAL - LUNG|153|||||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|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%|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|.73151||.71395||.71907||||SICKLE CELL ANEMIA TREATMENTS|155|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|.78033||.7616||.76706||||SICKLE CELL ANEMIA TREATMENTS|156|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|157|||||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|158|||||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|159|||||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|160|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|8.68746||8.47896||8.53977||||IMMUNOSUPPRESSIVES, ORAL|161|||||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|8.68746||8.47896||8.53977||||IMMUNOSUPPRESSIVES, ORAL|162|||||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|17.41941||17.00134||17.12328||||IMMUNOSUPPRESSIVES, ORAL|163|||||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|17.41941||17.00134||17.12328||||IMMUNOSUPPRESSIVES, ORAL|164|||||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|8.32969||8.12978||8.18809||||IMMUNOSUPPRESSIVES, ORAL|165|||||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|1001.0602||986.75934||939.7708||||HEPATITIS C AGENTS|166|||||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|167|||||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|168|||||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|14.62292||14.27197||14.37433||||ANTIVIRALS, ORAL|169|||||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|170|||||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|171|||||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|172|||||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|173|||||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|174|||||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|14.1744||13.83421||13.93344||||SEDATIVE HYPNOTICS|175|||||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|||||176|||||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|14.19016||13.8496||13.94893||||SEDATIVE HYPNOTICS|177|||||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|9.17333||8.95317||9.01738||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|178|||||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|9.17333||8.95317||9.01738||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|179|||||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|9.17333||8.95317||9.01738||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|180|||||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|9.16092||8.94106||9.00518||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|181|||||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|9.16092||8.94106||9.00518||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|182|||||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|9.16092||8.94106||9.00518||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|183|||||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|18.32587||17.88605||18.01433||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|184|||||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|18.32587||17.88605||18.01433||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|185|||||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|18.32587||17.88605||18.01433||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|186|||||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|18.32945||17.88954||18.01785||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|187|||||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|18.32945||17.88954||18.01785||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|188|||||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|18.33643||17.89636||18.02471||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|189|||||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|18.33643||17.89636||18.02471||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|190|||||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|32.30606||31.53071||31.75686||||HIV / AIDS|191|||||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|18.33627||17.8962||18.02455||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|192|||||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|18.33627||17.8962||18.02455||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|193|||||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|18.33627||17.8962||18.02455||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|194|||||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|18.33627||17.8962||18.02455||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|195|||||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|14.20019||13.85939||13.95879||||SEDATIVE HYPNOTICS|196|||||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|14.2119||13.87081||13.9703||||SEDATIVE HYPNOTICS|197|||||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|214.3946||211.33182||201.2684||||ANTIEMETIC/ANTIVERTIGO AGENTS|198|||||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|199|||||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|200|||||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|201|||||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|9.1732||8.95304||9.01726||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|202|||||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|9.1732||8.95304||9.01726||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|203|||||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|9.1732||8.95304||9.01726||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|204|||||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|9.17078||8.95068||9.01488||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|205|||||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|9.17078||8.95068||9.01488||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|206|||||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|9.17078||8.95068||9.01488||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|207|||||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|208|||||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|209|||||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|56.8792||55.5141||55.91225||||HIV / AIDS|210|||||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.||HEPATITIS C AGENTS|211|||||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|||||212|||||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|||||213|||||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|||||214|||||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|||||215|||||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|32.29761||31.52247||31.74855||||HIV / AIDS|216|||||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|||||217|||||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|218|||||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|||||219|||||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|||||220|||||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|221|||||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|86.62168||84.54276||85.14911||||HIV / AIDS|222|||||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|21.59787||21.07952||21.23071|||||223|||||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|21.59787||21.07952||21.23071|||||224|||||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|21.59787||21.07952||21.23071|||||225|||||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|21.58051||21.06258||21.21364|||||226|||||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|21.58051||21.06258||21.21364|||||227|||||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|21.58051||21.06258||21.21364|||||228|||||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|21.57471||21.05692||21.20794|||||229|||||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|21.57471||21.05692||21.20794|||||230|||||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|21.57471||21.05692||21.20794|||||231|||||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|||232|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.|||||233|||||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.|||||234|||||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.|||||235|||||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.|||||236|||||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|237|||||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|11.44358||11.16893||11.24904||||HYPOGLYCEMICS, SGLT2|238|||||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|11.44358||11.16893||11.24904||||HYPOGLYCEMICS, SGLT2|239|||||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|11.44418||11.16952||11.24963||||HYPOGLYCEMICS, SGLT2|240|||||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|11.44418||11.16952||11.24963||||HYPOGLYCEMICS, SGLT2|241|||||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|17.55094||17.12972||17.25257||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|242|||||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|17.55094||17.12972||17.25257||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|243|||||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|17.70528||17.28035||17.40429||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|244|||||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|17.70528||17.28035||17.40429||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|245|||||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|5.74962||5.61163||5.65188||||HYPOGLYCEMICS, SGLT2|246|||||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|5.74962||5.61163||5.65188||||HYPOGLYCEMICS, SGLT2|247|||||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|5.74409||5.60623||5.64644||||HYPOGLYCEMICS, SGLT2|248|||||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|5.74409||5.60623||5.64644||||HYPOGLYCEMICS, SGLT2|249|||||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|5.73656||5.59888||5.63904||||HYPOGLYCEMICS, SGLT2|250|||||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|5.73656||5.59888||5.63904||||HYPOGLYCEMICS, SGLT2|251|||||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|5.73872||5.60099||5.64116||||HYPOGLYCEMICS, SGLT2|252|||||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|5.73872||5.60099||5.64116||||HYPOGLYCEMICS, SGLT2|253|||||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|254|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|18.39483||17.95335||18.08212||||ANTIDEPRESSANTS, OTHER|255|||||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|18.39483||17.95335||18.08212||||ANTIDEPRESSANTS, OTHER|256|||||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|20.01006||19.52982||19.66989||||ANTIDEPRESSANTS, OTHER|257|||||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|20.01006||19.52982||19.66989||||ANTIDEPRESSANTS, OTHER|258|||||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|259|||||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|260|||||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|13.91869||13.58464||13.68207||||PROTON PUMP INHIBITORS|261|||||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|262|||||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|13.74762||13.41768||13.51391||||PROTON PUMP INHIBITORS|263|||||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|||||264|||||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|265|||||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|266|||||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|267|||||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|268|||||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|269|||||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|6.28858||6.13765||6.18167|||||270|||||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|13.92751||13.59325||13.69074||||ANTIDEPRESSANTS, OTHER|271|||||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|13.95008||13.61528||13.71293||||ANTIDEPRESSANTS, OTHER|272|||||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|13.95008||13.61528||13.71293||||ANTIDEPRESSANTS, OTHER|273|||||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|13.95008||13.61528||13.71293||||ANTIDEPRESSANTS, OTHER|274|||||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|13.97321||13.63785||13.73567||||ANTIDEPRESSANTS, OTHER|275|||||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|13.97321||13.63785||13.73567||||ANTIDEPRESSANTS, OTHER|276|||||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|13.97321||13.63785||13.73567||||ANTIDEPRESSANTS, OTHER|277|||||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.|||||278|||||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|20.54751||20.05437||20.1982|||||279|||||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|20.67114||20.17503||20.31973|||||280|||||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|.95871||.9357||.94241||||GLUCOCORTICOIDS, ORAL|281|||||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|38.8472||38.29224||36.4688|||||282|||||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|38.84289||38.28799||36.46475|||||283|||||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|284|||||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|5.25164||5.1256||5.16236||||ANXIOLYTICS|285|||||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|5.25164||5.1256||5.16236||||ANXIOLYTICS|286|||||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|1.6123||1.5736||1.58489||||GLUCOCORTICOIDS, ORAL|287|||||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|288|||||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|||||289|||||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|6.52283||6.36628||6.41194||||ANXIOLYTICS|290|||||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|6.52283||6.36628||6.41194||||ANXIOLYTICS|291|||||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|292|||||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|.26247||.25617||.25801||||GLUCOCORTICOIDS, ORAL|293|||||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|294|||||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|295|||||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|||||296|||||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|297|||||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|298|||||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|299|||||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|8.70938||8.50035||8.56132||||ANXIOLYTICS|300|||||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|8.70938||8.50035||8.56132||||ANXIOLYTICS|301|||||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|14.75721||14.40304||14.50634||||ANXIOLYTICS|302|||||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|303|||||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|304|||||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|||||305|||||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|||||306|||||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|||||307|||||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|||||308|||||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|11.722||11.44067||11.52273|||||309|||||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|310|||||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|||||311|||||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|||||312|||||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|||||313|||||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|314|||||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|12.04691||11.75778||11.84211|||||315|||||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|||||316|||||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|317|||||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|||||318|||||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|319|||||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|||||320|||||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|321|||||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|322|||||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|15.15101||14.78739||14.89344|||||323|||||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|1.21873||1.20132||1.14411||||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|324|||||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|325|||||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|7.1896||7.01705||7.06738|||||326|||||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|7.1896||7.01705||7.06738|||||327|||||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|||||328|||||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|329|||||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|330|||||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|||||331|||||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|332|||||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|333|||||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|334|||||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|335|||||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|336|||||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|337|||||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|338|||||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|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%|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|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%|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|341|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|13.46324||13.27091||12.63896||||BLADDER RELAXANT PREPARATIONS|342|||||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|13.46248||13.27015||12.63824||||BLADDER RELAXANT PREPARATIONS|343|||||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|344|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|345|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|12.87503||12.56603||12.65615||||SMOKING CESSATION|346|||||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|||||347|||||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|||||348|||||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|||||349|||||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|||||350|||||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|52.77625||51.50962||51.87905|||||351|||||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|352|||||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|58.77394||57.36337||57.77478||||ANTIBIOTICS, VAGINAL|353|||||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|58.77394||57.36337||57.77478||||ANTIBIOTICS, VAGINAL|354|||||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|355|||||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|709.709||692.67598||697.64395||||GROWTH HORMONE|356|||||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||GROWTH HORMONE|357|||||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|29.05768||28.3603||28.5637||.||GROWTH HORMONE|358|||||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|58.83429||57.42227||57.83411||.||GROWTH HORMONE|359|||||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||.||GROWTH HORMONE|360|||||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||GROWTH HORMONE|361|||||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||GROWTH HORMONE|362|||||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||GROWTH HORMONE|363|||||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||GROWTH HORMONE|364|||||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||GROWTH HORMONE|365|||||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||GROWTH HORMONE|366|||||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||GROWTH HORMONE|367|||||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|||||368|||||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|101.75108||99.30905||100.02131||||OPHTHALMICS, GLAUCOMA AGENTS|369|||||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|||||370|||||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|||||371|||||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|52.908||51.63821||52.00856||||OPHTHALMICS, ANTI-INFLAMMATORIES|372|||||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|1.237||1.20731||1.21597|||||373|||||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|96.49546||94.17957||94.85504||||OPHTHALMICS, GLAUCOMA AGENTS|374|||||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|96.42423||94.11005||94.78502||||OPHTHALMICS, GLAUCOMA AGENTS|375|||||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|96.58624||94.26817||94.94427||||OPHTHALMICS, GLAUCOMA AGENTS|376|||||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|377|||||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|1.237||1.20731||1.21597|||||378|||||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|379|||||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|380|||||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|||||381|||||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|112.5737||109.87193||110.65995||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|382|||||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|.45027||.43946||.44262|||||383|||||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|3.71971||3.63044||3.65647||||ULCERATIVE COLITIS AGENTS|384|||||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|385|||||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|12.56474||12.26319||12.35114||||BLADDER RELAXANT PREPARATIONS|386|||||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|||||387|||||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|388|||||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|389|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|390|||||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|391|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|17.20156||16.78872||16.90913|||||392|||||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|177.33519||174.80183||166.47794|||||393|||||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|394|||||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|25.48089||24.86935||25.04771|||||395|||||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|||||396|||||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|81.37414||79.42116||79.99078||||BLADDER RELAXANT PREPARATIONS|397|||||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|81.37414||79.42116||79.99078||||BLADDER RELAXANT PREPARATIONS|398|||||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|99.19753||96.81679||97.51117||||ANTIMIGRAINE AGENTS, OTHER|399|||||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|99.16495||96.78499||97.47915||||ANTIMIGRAINE AGENTS, OTHER|400|||||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|99.16495||96.78499||97.47915||||ANTIMIGRAINE AGENTS, OTHER|401|||||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|10.32199||10.07426||10.14652||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|402|||||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|10.33615||10.08808||10.16044||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|403|||||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|39.83548||38.87943||39.15828||||OPHTHALMICS, GLAUCOMA AGENTS|404|||||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|39.8676||38.91078||39.18985||||OPHTHALMICS, GLAUCOMA AGENTS|405|||||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|39.96321||39.00409||39.28384||||OPHTHALMICS, GLAUCOMA AGENTS|406|||||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|39.17326||38.2331||38.50731||||OPHTHALMICS, GLAUCOMA AGENTS|407|||||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|39.18188||38.24151||38.51579||||OPHTHALMICS, GLAUCOMA AGENTS|408|||||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|39.23238||38.2908||38.56543||||OPHTHALMICS, GLAUCOMA AGENTS|409|||||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|410|||||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|37.3355||36.43945||36.7008||||OPHTHALMICS, GLAUCOMA AGENTS|411|||||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|37.29948||36.40429||36.66539||||OPHTHALMICS, GLAUCOMA AGENTS|412|||||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|37.35576||36.45922||36.72071||||OPHTHALMICS, GLAUCOMA AGENTS|413|||||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|7.88413||7.69491||7.7501||||PLATELET AGGREGATION INHIBITORS|414|||||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|12.76758||12.46116||12.55053|||||415|||||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|416|||||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|20.58516||20.09112||20.23521||||SEDATIVE HYPNOTICS|417|||||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|21.05648||20.75567||19.7673||||SEDATIVE HYPNOTICS|418|||||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|20.6551||20.15938||20.30396||||SEDATIVE HYPNOTICS|419|||||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|57.11238||55.74168||56.14147||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|420|||||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|9.32325||9.09949||9.16475||||BPH TREATMENTS|421|||||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|422|||||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|7.33148||7.15552||7.20684||||ANGIOTENSIN MODULATORS|423|||||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|8.82273||8.61098||8.67274||||ANGIOTENSIN MODULATORS|424|||||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|425|||||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|426|||||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|91.44102||89.24644||89.88652||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|427|||||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|91.41496||89.221||89.86091||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|428|||||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|429|||||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|430|||||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|431|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|917.01023||895.00198||901.42106||||IMMUNOMODULATORS, ATOPIC DERMATITIS|432|||||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|917.4377||895.4192||901.84126||||IMMUNOMODULATORS, ATOPIC DERMATITIS|433|||||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|1617.82664||1578.9988||1590.32359||||IMMUNOMODULATORS, ATOPIC DERMATITIS|434|||||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||IMMUNOMODULATORS, ATOPIC DERMATITIS|435|||||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|1608.76195||1570.15166||1581.413||||IMMUNOMODULATORS, ATOPIC DERMATITIS|436|||||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|437|||||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|1852.20724||1807.75427||1820.71972||||CYTOKINE AND CAM ANTAGONISTS|438|||||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|9.41044||9.18459||9.25046||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|439|||||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|12.13277||11.84158||11.92651||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|440|||||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|12.53203||12.23126||12.31899||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|441|||||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|2.89406||2.8246||2.84486|||||442|||||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|||||443|||||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|||||444|||||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|||||445|||||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|||||446|||||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|447|||||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|448|||||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|449|||||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|8.57483||8.45234||8.04984||||NSAIDS|450|||||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|||||451|||||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|||||452|||||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|||||453|||||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|454|||||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|455|||||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|456|||||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|457|||||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|15.71609||15.3389||15.44892||||NSAIDS|458|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|15.71609||15.3389||15.44892||||NSAIDS|459|||||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|15.71609||15.3389||15.44892||||NSAIDS|460|||||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|461|||||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|14.48995||14.28295||13.60281|||||462|||||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|||||463|||||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|464|||||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|||||465|||||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|4.95194||4.8812||4.64876|||||466|||||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|||||467|||||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|||||468|||||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|469|||||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|470|||||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|471|||||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|472|||||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|473|||||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|474|||||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|475|||||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|476|||||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|477|||||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|478|||||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|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%|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|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%|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|481|||||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|482|||||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|1.99267||1.94485||1.95879||||PANCREATIC ENZYMES|483|||||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|3.98532||3.88967||3.91757||||PANCREATIC ENZYMES|484|||||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||.||PANCREATIC ENZYMES|485|||||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|1.99267||1.94485||1.95879||.||PANCREATIC ENZYMES|486|||||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|3.98532||3.88967||3.91757||.||PANCREATIC ENZYMES|487|||||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|488|||||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|7.90078||7.71116||7.76647||.||PANCREATIC ENZYMES|489|||||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|7.90078||7.71116||7.76647||||PANCREATIC ENZYMES|490|||||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|7.90078||7.71116||7.76647||||PANCREATIC ENZYMES|491|||||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|11.99838||11.71042||11.79441||.||PANCREATIC ENZYMES|492|||||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|11.99838||11.71042||11.79441||.||PANCREATIC ENZYMES|493|||||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|8.71717||8.50796||8.56898||||INTRANASAL RHINITIS AGENTS|494|||||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|14.09612||13.75781||13.85649||||ANTICONVULSANTS|495|||||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|16.06596||15.68038||15.79284||||ANTICONVULSANTS|496|||||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|497|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|498|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|499|||||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|500|||||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|||||501|||||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|17.59676||17.17444||17.29762|||||502|||||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|27.948||27.27725||27.47288|||||503|||||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|14.63081||14.4218||13.73505||||ULCERATIVE COLITIS AGENTS|504|||||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|||||505|||||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|14.40039||14.05478||14.15558|||||506|||||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|6.61811||6.45928||6.5056|||||507|||||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|6.61811||6.45928||6.5056|||||508|||||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|6.62806||6.46899||6.51538|||||509|||||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|6.62409||6.46511||6.51148|||||510|||||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|6.62409||6.46511||6.51148|||||511|||||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|6.62702||6.46797||6.51436|||||512|||||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|6.62029||6.4614||6.50775|||||513|||||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|6.62029||6.4614||6.50775|||||514|||||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|8.29111||8.09212||8.15016|||||515|||||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|8.2903||8.09133||8.14936|||||516|||||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|8.28643||8.08756||8.14556|||||517|||||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|8.27555||8.07694||8.13487|||||518|||||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|||||519|||||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|||||520|||||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|521|||||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|||||522|||||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|||||523|||||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|||||524|||||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|525|||||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|||||526|||||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|||||527|||||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|||||528|||||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|||||529|||||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|77.62111||75.7582||76.30155||||ANTIMIGRAINE AGENTS, TRIPTANS|530|||||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|77.52398||75.6634||76.20607||||ANTIMIGRAINE AGENTS, TRIPTANS|531|||||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|77.52398||75.6634||76.20607||||ANTIMIGRAINE AGENTS, TRIPTANS|532|||||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|533|||||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|534|||||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|535|||||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|||||536|||||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|537|||||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|538|||||No|No||PFIZER US PHARM|No|||||No|No|No|| fluconazole|No|No|No|No|75%|00049344019|DIFLUCAN 10 MG/ML SUSPENSION|35|ML|.20923|03/01/2002|07/31/2024|Yes|No||03/01/2002|07/31/2024|Yes|No|03/01/2002|07/31/2024|Yes|No||||No|No|||Prescription Required|Yes|07/12/2005|069|No|.47684||.47003||.44764||||ANTIFUNGALS, ORAL|539|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|540|||||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|541|||||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|13.86258||13.52988||13.62692||||ANTIDEPRESSANTS, SSRIs|542|||||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|13.86258||13.52988||13.62692||||ANTIDEPRESSANTS, SSRIs|543|||||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|13.86471||13.53196||13.62901||||ANTIDEPRESSANTS, SSRIs|544|||||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|13.86471||13.53196||13.62901||||ANTIDEPRESSANTS, SSRIs|545|||||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|13.94489||13.61021||13.70783||||ANTIDEPRESSANTS, SSRIs|546|||||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|547|||||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|548|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|549|||||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|||||550|||||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|.18158||.17722||.17849|||||551|||||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|.18158||.17722||.17849|||||552|||||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|.11685||.11405||.11486|||||553|||||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|.11685||.11405||.11486|||||554|||||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|.18553||.18108||.18238|||||555|||||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|.18553||.18108||.18238|||||556|||||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|.30034||.29313||.29523|||||557|||||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|.30034||.29313||.29523|||||558|||||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|.06166||.06018||.06061||||GLUCOCORTICOIDS, ORAL|559|||||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|.08552||.08347||.08407||||GLUCOCORTICOIDS, ORAL|560|||||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|.08552||.08347||.08407||||GLUCOCORTICOIDS, ORAL|561|||||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|.08552||.08347||.08407||||GLUCOCORTICOIDS, ORAL|562|||||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|.22793||.22246||.22406||||GLUCOCORTICOIDS, ORAL|563|||||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|.22793||.22246||.22406||||GLUCOCORTICOIDS, ORAL|564|||||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|.26225||.25596||.25779|||||565|||||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|.21776||.21253||.21406|||||566|||||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|.21776||.21253||.21406|||||567|||||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|.62534||.61033||.61471||||INTRANASAL RHINITIS AGENTS|568|||||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|1.13755||1.11025||1.11821||||INTRANASAL RHINITIS AGENTS|569|||||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|1.17625||1.14802||1.15625|||||570|||||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|.1787||.17441||.17566||||ANTIDEPRESSANTS, SSRIs|571|||||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|.30923||.30181||.30397||||ANTIEMETIC/ANTIVERTIGO AGENTS|572|||||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|.07664||.0748||.07534|||||573|||||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|.07664||.0748||.07534|||||574|||||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|.4876||.4759||.47931||||ULCERATIVE COLITIS AGENTS|575|||||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|.85697||.8364||.8424||||ONCOLOGY, ORAL - BREAST|576|||||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|.1851||.18066||.18195||||SEDATIVE HYPNOTICS|577|||||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|.20156||.19672||.19813||||SEDATIVE HYPNOTICS|578|||||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|.20792||.20293||.20439||||PHOSPHATE BINDERS|579|||||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|.20792||.20293||.20439||||PHOSPHATE BINDERS|580|||||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|581|||||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|.15465||.15094||.15202|||||582|||||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|.15801||.15422||.15532|||||583|||||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|.27251||.26597||.26788|||||584|||||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|.19573||.19103||.1924||||IMMUNOSUPPRESSIVES, ORAL|585|||||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|.19573||.19103||.1924||||IMMUNOSUPPRESSIVES, ORAL|586|||||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|.28413||.27731||.2793||||IMMUNOSUPPRESSIVES, ORAL|587|||||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|.28413||.27731||.2793||||IMMUNOSUPPRESSIVES, ORAL|588|||||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|.56866||.55501||.55899||||OPIATE DEPENDENCE TREATMENTS|589|||||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|.87432||.85334||.85946||||OPIATE DEPENDENCE TREATMENTS|590|||||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|.59147||.57727||.58142||||OPIATE DEPENDENCE TREATMENTS|591|||||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|.92797||.9057||.91219||||OPIATE DEPENDENCE TREATMENTS|592|||||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|3.14333||3.06789||3.08989||||ANTIDEPRESSANTS, TRICYCLIC|593|||||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|2.2488||2.19483||2.21057||||ANTIDEPRESSANTS, TRICYCLIC|594|||||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|.23843||.23271||.23438||||ANALGESICS, NARCOTICS SHORT|595|||||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|.39907||.38949||.39229||||ANALGESICS, NARCOTICS SHORT|596|||||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|.0886||.08647||.08709||||ANALGESICS, NARCOTICS SHORT|597|||||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|.03885||.03792||.03819||||ANALGESICS, NARCOTICS SHORT|598|||||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|599|||||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|.05364||.05235||.05273||||ANALGESICS, NARCOTICS SHORT|600|||||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|.65897||.64315||.64777||||ANALGESICS, NARCOTICS SHORT|601|||||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|.52476||.51217||.51584||||ANALGESICS, NARCOTICS SHORT|602|||||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|.52476||.51217||.51584||||ANALGESICS, NARCOTICS SHORT|603|||||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|.96108||.93801||.94474||||ANALGESICS, NARCOTICS SHORT|604|||||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|605|||||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|606|||||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|607|||||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|608|||||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|3.74163||3.65183||3.67802||||ANTIDEPRESSANTS, TRICYCLIC|609|||||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|5.38624||5.25697||5.29467||||ANTIDEPRESSANTS, TRICYCLIC|610|||||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|611|||||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|3.3905||3.30913||3.33286||||ANTIDEPRESSANTS, TRICYCLIC|612|||||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|2.16255||2.11065||2.12579||||ANTIMIGRAINE AGENTS, TRIPTANS|613|||||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|1.52922||1.49252||1.50322||||ANTIMIGRAINE AGENTS, TRIPTANS|614|||||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|.64442||.62895||.63346||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|615|||||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|616|||||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|1.67582||1.6356||1.64733||||ANALGESICS, NARCOTICS SHORT|617|||||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|1.86166||1.81698||1.83001|||||618|||||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|1.22747||1.19801||1.2066||||GLUCOCORTICOIDS, INHALED|619|||||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|1.43829||1.40377||1.41384||||GLUCOCORTICOIDS, INHALED|620|||||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|2.03023||1.9815||1.99572||||GLUCOCORTICOIDS, INHALED|621|||||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|.96531||.94214||.9489|||||622|||||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|||||623|||||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|||||624|||||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|||||625|||||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|||||626|||||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|4.41791||4.31188||4.34281||||STIMULANTS AND RELATED AGENTS|627|||||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|3.94657||3.85185||3.87948||||STIMULANTS AND RELATED AGENTS|628|||||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|4.1178||4.01897||4.0478||||STIMULANTS AND RELATED AGENTS|629|||||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|5.43974||5.30919||5.34726||||STIMULANTS AND RELATED AGENTS|630|||||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|5.79148||5.65248||5.69302||||STIMULANTS AND RELATED AGENTS|631|||||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|4.62673||4.51569||4.54808||||STIMULANTS AND RELATED AGENTS|632|||||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|2.09752||2.04718||2.06186||||ONCOLOGY, ORAL - BREAST|633|||||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|3.54159||3.45659||3.48138||||ONCOLOGY, ORAL - BREAST|634|||||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|.28418||.27736||.27935||||ANALGESICS, NARCOTICS SHORT|635|||||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|636|||||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|.08591||.08385||.08445||||ANALGESICS, NARCOTICS SHORT|637|||||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|638|||||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|639|||||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|||||640|||||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|.48618||.47451||.47791||||ANTIDEPRESSANTS, OTHER|641|||||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|.48618||.47451||.47791||||ANTIDEPRESSANTS, OTHER|642|||||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|.47716||.46571||.46905||||ANTIDEPRESSANTS, OTHER|643|||||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|.47716||.46571||.46905||||ANTIDEPRESSANTS, OTHER|644|||||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|645|||||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|.36093||.35227||.35479||||ANTIHYPERURICEMICS|646|||||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|.52316||.5106||.51427||||ANTIHYPERURICEMICS|647|||||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|1.51856||1.48211||1.49274||||ANTICONVULSANTS|648|||||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|2.64965||2.58606||2.60461||||ANTICONVULSANTS|649|||||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|650|||||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|2.16755||2.11553||2.1307||||IMMUNOSUPPRESSIVES, ORAL|651|||||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|5.82691||5.68706||5.72785||||IMMUNOSUPPRESSIVES, ORAL|652|||||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|6.14955||6.00196||6.04501||||IMMUNOSUPPRESSIVES, ORAL|653|||||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|654|||||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|20.37932||19.89022||20.03287||||ONCOLOGY, ORAL - RENAL CELL|655|||||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|656|||||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|657|||||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|.82861||.80872||.81452||||LIPOTROPICS, OTHER|658|||||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|.465||.45384||.4571||||ANALGESICS, NARCOTICS SHORT|659|||||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|.38603||.37677||.37947||||ANALGESICS, NARCOTICS SHORT|660|||||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|.34922||.34084||.34328||||ANALGESICS, NARCOTICS SHORT|661|||||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|.49805||.4861||.48958||||ANTICONVULSANTS|662|||||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|||||663|||||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|.50137||.48934||.49285||||ANTIDEPRESSANTS, OTHER|664|||||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|10.68585||10.42939||10.50419||||IMMUNOSUPPRESSIVES, ORAL|665|||||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|.79162||.77262||.77816||||LIPOTROPICS, OTHER|666|||||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|.18975||.1852||.18652|||||667|||||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|6.44875||6.29398||6.33912|||||668|||||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|6.44875||6.29398||6.33912|||||669|||||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|4.78099||4.66625||4.69971||||ANALGESICS, NARCOTICS SHORT|670|||||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|.18703||.18254||.18385||||ANALGESICS, NARCOTICS LONG|671|||||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|.18703||.18254||.18385||||ANALGESICS, NARCOTICS LONG|672|||||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|.18152||.17716||.17843||||ANALGESICS, NARCOTICS LONG|673|||||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|.18152||.17716||.17843||||ANALGESICS, NARCOTICS LONG|674|||||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|||||675|||||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|2.78457||2.71774||2.73723||||BRONCHODILATORS, BETA AGONIST|676|||||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|.09755||.09521||.09589|||||677|||||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|.09755||.09521||.09589|||||678|||||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|.10042||.09801||.09871|||||679|||||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|.09966||.09727||.09797|||||680|||||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|.09966||.09727||.09797|||||681|||||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|.24915||.24317||.24491|||||682|||||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|.80686||.7875||.79314||||ANALGESICS, NARCOTICS SHORT|683|||||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|684|||||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|13.248||12.93005||13.02278||||ANALGESICS, NARCOTICS SHORT|685|||||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|6.74173||6.57993||6.62712|||||686|||||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|.77877||.76764||.73109||||GLUCOCORTICOIDS, ORAL|687|||||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|.12705||.124||.12489||||GLUCOCORTICOIDS, ORAL|688|||||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|.02924||.02854||.02874||||GLUCOCORTICOIDS, ORAL|689|||||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|.95391||.93102||.93769||||ANXIOLYTICS|690|||||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|.09811||.09576||.09644||||ANXIOLYTICS|691|||||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|||||692|||||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|.41661||.40661||.40953||||INTRANASAL RHINITIS AGENTS|693|||||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|.09946||.09707||.09777|||||694|||||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|.09946||.09707||.09777|||||695|||||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|||||696|||||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|.0871||.08501||.08562|||||697|||||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|.26933||.26287||.26475|||||698|||||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|1.03063||1.0159||.96753||||ANXIOLYTICS|699|||||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|.15583||.15209||.15318||||ANALGESICS, NARCOTICS SHORT|700|||||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|.48821||.47649||.47991||||ANALGESICS, NARCOTICS LONG|701|||||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|.05571||.05437||.05476||||ANALGESICS, NARCOTICS LONG|702|||||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|703|||||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|.45498||.44406||.44725||||NSAIDS|704|||||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|4.24666||4.186||3.98666||||GLUCOCORTICOIDS, ORAL|705|||||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|.35747||.34889||.35139||||GLUCOCORTICOIDS, ORAL|706|||||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|.55342||.54014||.54401||||GLUCOCORTICOIDS, ORAL|707|||||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|.08765||.08555||.08616||||BETA-BLOCKERS|708|||||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|709|||||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|.39222||.38281||.38555||||ANTIFUNGALS, ORAL|710|||||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|.39222||.38281||.38555||||ANTIFUNGALS, ORAL|711|||||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|.07559||.07378||.0743||||GLUCOCORTICOIDS, ORAL|712|||||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|.13733||.13403||.135||||GLUCOCORTICOIDS, ORAL|713|||||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|.22251||.21717||.21873||||GLUCOCORTICOIDS, ORAL|714|||||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|.25577||.24963||.25142||||GLUCOCORTICOIDS, ORAL|715|||||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|.37087||.36197||.36457||||GLUCOCORTICOIDS, ORAL|716|||||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|.3285||.32062||.32292||||GLUCOCORTICOIDS, ORAL|717|||||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|.71543||.69826||.70327||||GLUCOCORTICOIDS, ORAL|718|||||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|.02725||.0266||.02679|||||719|||||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|.02725||.0266||.02679|||||720|||||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|.0333||.0325||.03273|||||721|||||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|.0333||.0325||.03273|||||722|||||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|.05655||.05519||.05559|||||723|||||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|.05655||.05519||.05559|||||724|||||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|.47091||.45961||.4629|||||725|||||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|.47091||.45961||.4629|||||726|||||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|3.08029||3.00636||3.02793|||||727|||||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|3.08029||3.00636||3.02793|||||728|||||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|2.63503||2.57179||2.59023|||||729|||||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|2.86408||2.79534||2.81539|||||730|||||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|.18805||.18354||.18485|||||731|||||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|.18805||.18354||.18485|||||732|||||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|733|||||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|.17536||.17115||.17238|||||734|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|.17536||.17115||.17238|||||735|||||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|.92704||.90479||.91128||||ONCOLOGY, ORAL - HEMATOLOGIC|736|||||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|.92704||.90479||.91128||||ONCOLOGY, ORAL - HEMATOLOGIC|737|||||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|738|||||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|.04955||.04836||.04871||||GLUCOCORTICOIDS, ORAL|739|||||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|.05072||.0495||.04986||||GLUCOCORTICOIDS, ORAL|740|||||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|.05072||.0495||.04986||||GLUCOCORTICOIDS, ORAL|741|||||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|.06593||.06435||.06481||||GLUCOCORTICOIDS, ORAL|742|||||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|.38294||.37375||.37643||||SEDATIVE HYPNOTICS|743|||||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|.46552||.45435||.45761||||SEDATIVE HYPNOTICS|744|||||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|.46552||.45435||.45761||||SEDATIVE HYPNOTICS|745|||||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|.39222||.38281||.38555||||ANTIFUNGALS, ORAL|746|||||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|.22251||.21717||.21873||||GLUCOCORTICOIDS, ORAL|747|||||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|.3285||.32062||.32292||||GLUCOCORTICOIDS, ORAL|748|||||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|.37087||.36197||.36457||||GLUCOCORTICOIDS, ORAL|749|||||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|.07559||.07378||.0743||||GLUCOCORTICOIDS, ORAL|750|||||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|.13733||.13403||.135||||GLUCOCORTICOIDS, ORAL|751|||||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|.25577||.24963||.25142||||GLUCOCORTICOIDS, ORAL|752|||||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|.71543||.69826||.70327||||GLUCOCORTICOIDS, ORAL|753|||||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|.02725||.0266||.02679|||||754|||||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|.0333||.0325||.03273|||||755|||||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|.05655||.05519||.05559|||||756|||||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|.47091||.45961||.4629|||||757|||||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|.10042||.09801||.09871|||||758|||||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|.09966||.09727||.09797|||||759|||||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|.18805||.18354||.18485|||||760|||||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|.17536||.17115||.17238|||||761|||||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|.04955||.04836||.04871||||GLUCOCORTICOIDS, ORAL|762|||||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|763|||||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|.06593||.06435||.06481||||GLUCOCORTICOIDS, ORAL|764|||||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|||||765|||||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|.06166||.06018||.06061||||GLUCOCORTICOIDS, ORAL|766|||||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|.06166||.06018||.06061||||GLUCOCORTICOIDS, ORAL|767|||||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|.04955||.04836||.04871||||GLUCOCORTICOIDS, ORAL|768|||||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|.04955||.04836||.04871||||GLUCOCORTICOIDS, ORAL|769|||||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|||770|||||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|||||771|||||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|||||772|||||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|||||773|||||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|||||774|||||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|||||775|||||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||.||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|776|||||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|24.85518||24.25866||24.43264||||OPHTHALMICS, GLAUCOMA AGENTS|777|||||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|778|||||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|||||779|||||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|||||780|||||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|||||781|||||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|782|||||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|783|||||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|784|||||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|785|||||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|786|||||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|787|||||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|788|||||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|789|||||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|790|||||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|791|||||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|792|||||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|793|||||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|794|||||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|795|||||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|796|||||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|797|||||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|798|||||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|799|||||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|800|||||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|801|||||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|9.2563||9.03415||9.09894||||BLADDER RELAXANT PREPARATIONS|802|||||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|9.26292||9.04061||9.10545||||BLADDER RELAXANT PREPARATIONS|803|||||No|No||PFIZER US PHARM|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|804|||||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|805|||||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|806|||||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|807|||||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|808|||||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||COLONY STIMULATING FACTORS|809|||||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|810|||||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||COLONY STIMULATING FACTORS|811|||||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|812|||||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|813|||||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|814|||||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|815|||||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|816|||||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|181.86578||179.2677||170.73114||||CYTOKINE AND CAM ANTAGONISTS|817|||||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|818|||||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|819|||||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|820|||||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|821|||||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|822|||||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|187.38529||182.88804||184.19974||||CYTOKINE AND CAM ANTAGONISTS|823|||||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|824|||||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|825|||||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|826|||||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|827|||||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|828|||||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|829|||||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|93.55021||91.305||91.95986||||CYTOKINE AND CAM ANTAGONISTS|830|||||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|93.84515||91.59287||92.24978||||CYTOKINE AND CAM ANTAGONISTS|831|||||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|832|||||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|833|||||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|834|||||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|835|||||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|836|||||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|837|||||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||ERYTHROPOIESIS STIMULATING PROTEINS|838|||||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|839|||||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||ERYTHROPOIESIS STIMULATING PROTEINS|840|||||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|841|||||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||ERYTHROPOIESIS STIMULATING PROTEINS|842|||||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|843|||||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||ERYTHROPOIESIS STIMULATING PROTEINS|844|||||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|107.68067||105.09633||105.8501||||ERYTHROPOIESIS STIMULATING PROTEINS|845|||||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||ERYTHROPOIESIS STIMULATING PROTEINS|846|||||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|847|||||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|848|||||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|849|||||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|850|||||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|8.08053||7.8866||7.94316||||CALCIUM CHANNEL BLOCKERS|851|||||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|852|||||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|853|||||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|854|||||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|11.14613||10.87862||10.95665||||CALCIUM CHANNEL BLOCKERS|855|||||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|856|||||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|857|||||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|||||858|||||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|859|||||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||||||||||860|||||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|||||861|||||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|862|||||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|863|||||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|864|||||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|865|||||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|866|||||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|867|||||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|868|||||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|2.07792||2.02805||2.0426||||MACROLIDES/KETOLIDES|869|||||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|870|||||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|871|||||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|872|||||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|873|||||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|874|||||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|875|||||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|||||876|||||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|877|||||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|878|||||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|176.1732||171.94504||173.17826||||ANTIMIGRAINE AGENTS, OTHER|879|||||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|880|||||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|||||881|||||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|||||882|||||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|||||883|||||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|70.01386||68.33353||68.82362|||||884|||||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|46.58616||45.46809||45.7942|||||885|||||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|886|||||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|||||887|||||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|||||888|||||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|||||889|||||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|||||890|||||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|||||891|||||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|||||892|||||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|893|||||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|894|||||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|||||895|||||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|1.51735||1.48093||1.49156||||ANTICONVULSANTS|896|||||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|12.41207||12.11418||12.20106||||LIPOTROPICS, STATINS|897|||||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|17.79707||17.36994||17.49452||||LIPOTROPICS, STATINS|898|||||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|17.80833||17.38093||17.50559||||LIPOTROPICS, STATINS|899|||||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|900|||||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|901|||||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|902|||||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|903|||||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|.13893||.1356||.13657||||ANTICONVULSANTS|904|||||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|.13893||.1356||.13657||||ANTICONVULSANTS|905|||||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|15.80319||15.42391||15.53454||||NEUROPATHIC PAIN|906|||||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|||||907|||||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|||||908|||||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|||||909|||||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|||||910|||||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|4.4543||4.39066||4.18158||||ANTICONVULSANTS|911|||||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|912|||||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|913|||||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|914|||||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|915|||||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|916|||||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|917|||||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|2.78942||2.72247||2.742||||NEUROPATHIC PAIN|918|||||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|6.9208||6.7547||6.80315||||NEUROPATHIC PAIN|919|||||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|8.50787||8.38633||7.98698||||NEUROPATHIC PAIN|920|||||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|9.7289||9.49541||9.56351||||NEUROPATHIC PAIN|921|||||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|9.7195||9.48623||9.55427||||NEUROPATHIC PAIN|922|||||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|9.71029||9.47724||9.54522||||NEUROPATHIC PAIN|923|||||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|9.68112||9.44877||9.51654||||NEUROPATHIC PAIN|924|||||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|9.69296||9.46033||9.52818||||NEUROPATHIC PAIN|925|||||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|9.6958||9.4631||9.53097||||NEUROPATHIC PAIN|926|||||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|9.69676||9.46404||9.53192||||NEUROPATHIC PAIN|927|||||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|9.69422||9.46156||9.52942||||NEUROPATHIC PAIN|928|||||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|929|||||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|930|||||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|931|||||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|932|||||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|933|||||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|934|||||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|1.42169||1.40138||1.33464||||ANTICONVULSANTS|935|||||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|39.77307||38.81852||39.09693||.||UTERINE DISORDER TREATMENTS |936|||||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|19.82965||19.35374||19.49255||||UTERINE DISORDER TREATMENTS |937|||||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||CYTOKINE AND CAM ANTAGONISTS|938|||||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|6727.5786||6566.11671||6613.20976||||CYTOKINE AND CAM ANTAGONISTS|939|||||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|940|||||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|941|||||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|3363.34455||3282.62428||3306.16769||.||CYTOKINE AND CAM ANTAGONISTS|942|||||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|943|||||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|3363.4365||3282.71402||3306.25808||.||CYTOKINE AND CAM ANTAGONISTS|944|||||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|945|||||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|946|||||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|947|||||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|948|||||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|949|||||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|950|||||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|951|||||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|952|||||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|953|||||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|3367.27556||3286.46095||3310.03188||.||CYTOKINE AND CAM ANTAGONISTS|954|||||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||CYTOKINE AND CAM ANTAGONISTS|955|||||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|19.82172||19.346||19.48475||||UTERINE DISORDER TREATMENTS |956|||||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|415.8101||405.83066||408.74133||||CYTOKINE AND CAM ANTAGONISTS|957|||||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|20284.61909||19797.78823||19939.78057||||CYTOKINE AND CAM ANTAGONISTS|958|||||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|959|||||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|960|||||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|961|||||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|20254.98421||19768.86459||19910.64948||||CYTOKINE AND CAM ANTAGONISTS|962|||||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|||||963|||||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|||||964|||||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|207.9726||202.98126||204.43707||||CYTOKINE AND CAM ANTAGONISTS|965|||||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|207.21455||202.2414||203.6919||||CYTOKINE AND CAM ANTAGONISTS|966|||||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|||||967|||||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|8.34345||8.14321||8.20161||||HIV / AIDS|968|||||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|||||969|||||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||CYTOKINE AND CAM ANTAGONISTS|970|||||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|971|||||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|152.89372||149.22427||150.29453||||HEPATITIS C AGENTS|972|||||No|No||ABBVIE US LLC|No|||||No|No|No|| lopinavir/ritonavir|No|No|No|No|75%|00074300860|KALETRA 100-25 MG TABLET|60|EA|3.28145|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|973|||||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|974|||||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|||||975|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|.51331||.50099||.50458||||IMMUNOSUPPRESSIVES, ORAL|976|||||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|1.60339||1.56491||1.57613||||IMMUNOSUPPRESSIVES, ORAL|977|||||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|978|||||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|8.63511||8.42787||8.48831||||LIPOTROPICS, OTHER|979|||||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|980|||||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|.99292||.96909||.97604||||LIPOTROPICS, OTHER|981|||||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|5951.675||5808.8348||5850.49653|||||982|||||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|983|||||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|||||984|||||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|1658.30286||1618.50359||1630.11171|||||985|||||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|||||986|||||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|4966.32714||4847.13529||4881.89958|||||987|||||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|||||988|||||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|1.5132||1.47688||1.48748|||||989|||||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|1.5132||1.47688||1.48748|||||990|||||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|||||991|||||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|3362.92792||3282.21765||3305.75815||||CYTOKINE AND CAM ANTAGONISTS|992|||||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|3.34863||3.26826||3.2917||||ANTICONVULSANTS|993|||||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|994|||||No|No||ABBVIE US LLC|No|||||No|No|No|| lopinavir/ritonavir|No|No|No|No|75%|00074401412|KALETRA 200-50 MG TABLET|120|EA|6.56303|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|995|||||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|3364.52102||3283.77252||3307.32416||||CYTOKINE AND CAM ANTAGONISTS|996|||||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|997|||||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|1.51258||1.47628||1.48687|||||998|||||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|1.51258||1.47628||1.48687|||||999|||||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|1.5123||1.476||1.48659|||||1000|||||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|1.5123||1.476||1.48659|||||1001|||||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|1.51374||1.47741||1.48801|||||1002|||||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|1.51374||1.47741||1.48801|||||1003|||||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|1.79295||1.74992||1.76247||||ANTICONVULSANTS|1004|||||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|3.687||3.59851||3.62432||||ANTICONVULSANTS|1005|||||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|3.687||3.59851||3.62432||||ANTICONVULSANTS|1006|||||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|6.78067||6.61793||6.6654||||ANTICONVULSANTS|1007|||||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|1.51363||1.4773||1.4879|||||1008|||||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|1.51363||1.4773||1.4879|||||1009|||||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|1.51256||1.47626||1.48685|||||1010|||||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|1.51256||1.47626||1.48685|||||1011|||||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|1012|||||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|1.51379||1.47746||1.48806|||||1013|||||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|1.51379||1.47746||1.48806|||||1014|||||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|1.51255||1.47625||1.48684|||||1015|||||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|1.51255||1.47625||1.48684|||||1016|||||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|1.51038||1.47413||1.4847|||||1017|||||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|1.51038||1.47413||1.4847|||||1018|||||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|34.97231||34.13297||34.37778||||ANTIMIGRAINE AGENTS, OTHER|1019|||||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|34.94065||34.10207||34.34666||||ANTIMIGRAINE AGENTS, OTHER|1020|||||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|34.98202||34.14245||34.38733||||ANTIMIGRAINE AGENTS, OTHER|1021|||||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|29.65832||28.94652||29.15413||||OPHTHALMICS, GLAUCOMA AGENTS|1022|||||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|22.63056||22.08743||22.24584||||OPHTHALMICS, GLAUCOMA AGENTS|1023|||||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|1.51259||1.47629||1.48688|||||1024|||||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|1.51259||1.47629||1.48688|||||1025|||||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|1.50633||1.47018||1.48072|||||1026|||||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|1.50633||1.47018||1.48072|||||1027|||||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|1028|||||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|1.87545||1.83044||1.84357||||ANTICONVULSANTS|1029|||||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|3.687||3.59851||3.62432||||ANTICONVULSANTS|1030|||||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|6.78067||6.61793||6.6654||||ANTICONVULSANTS|1031|||||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|3.34863||3.26826||3.2917||||ANTICONVULSANTS|1032|||||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|5.90408||5.76238||5.80371||||ANTICONVULSANTS|1033|||||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|||||1034|||||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|||||1035|||||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|1.51279||1.47648||1.48707|||||1036|||||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|1.51279||1.47648||1.48707|||||1037|||||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|||||1038|||||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|8.35125||8.15082||8.20928||||ANTICOAGULANTS|1039|||||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|1040|||||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|1041|||||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|1042|||||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|1043|||||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|1044|||||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|1045|||||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|1046|||||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|1047|||||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|||||1048|||||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|||||1049|||||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|||||1050|||||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|1051|||||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|1052|||||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|2.57013||2.50845||2.52644||||IMMUNOSUPPRESSIVES, ORAL|1053|||||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|10.31178||10.0643||10.13648||||IMMUNOSUPPRESSIVES, ORAL|1054|||||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|25.6388||25.02347||25.20294||||ONCOLOGY, ORAL - BREAST|1055|||||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|1056|||||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|1057|||||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|1058|||||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|9.95621||9.71726||9.78695||||ANTICONVULSANTS|1059|||||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|||||1060|||||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|||||1061|||||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|1062|||||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|1.83825||1.79413||1.807||||ANTICONVULSANTS|1063|||||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|8.90602||8.69228||8.75462||||ANGIOTENSIN MODULATORS|1064|||||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|9.54976||9.32057||9.38741||||ANGIOTENSIN MODULATORS|1065|||||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|12.09462||11.80435||11.88901||||ANGIOTENSIN MODULATORS|1066|||||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|1067|||||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|12.10621||11.81566||11.9004||||STIMULANTS AND RELATED AGENTS|1068|||||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|12.39381||12.09636||12.18312||||STIMULANTS AND RELATED AGENTS|1069|||||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|12.72293||12.41758||12.50664||||STIMULANTS AND RELATED AGENTS|1070|||||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|1071|||||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|.64797||.63242||.63695||||STIMULANTS AND RELATED AGENTS|1072|||||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|.92465||.90246||.90893||||STIMULANTS AND RELATED AGENTS|1073|||||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|1074|||||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|12.36085||12.06419||12.15072||||ANGIOTENSIN MODULATORS|1075|||||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|6.55947||6.40204||6.44796||||IMMUNOSUPPRESSIVES, ORAL|1076|||||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|13.08781||12.7737||12.86532||||IMMUNOSUPPRESSIVES, ORAL|1077|||||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|1078|||||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|1079|||||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|12.12971||11.8386||11.9235||||ANGIOTENSIN MODULATOR COMBINATIONS|1080|||||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|1081|||||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|1082|||||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|1083|||||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|1084|||||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|1085|||||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|1086|||||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|1087|||||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|1088|||||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|7.43786||7.25935||7.31142||||ANGIOTENSIN MODULATORS|1089|||||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|12.15138||11.85975||11.94481||||STIMULANTS AND RELATED AGENTS|1090|||||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|4.70829||4.59529||4.62825||||STIMULANTS AND RELATED AGENTS|1091|||||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|4.7808||4.66606||4.69953||||STIMULANTS AND RELATED AGENTS|1092|||||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|4.89893||4.78136||4.81565||||STIMULANTS AND RELATED AGENTS|1093|||||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|4.72249||4.60915||4.64221||||STIMULANTS AND RELATED AGENTS|1094|||||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|5.40086||5.27124||5.30905||||STIMULANTS AND RELATED AGENTS|1095|||||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|.79997||.78077||.78637||||STIMULANTS AND RELATED AGENTS|1096|||||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|1097|||||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|1.63538||1.59613||1.60758||||STIMULANTS AND RELATED AGENTS|1098|||||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|5.46273||5.33162||5.36986||||ANTICONVULSANTS|1099|||||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|18.32347||17.88371||18.01197||||ANTICONVULSANTS|1100|||||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|||||1101|||||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|||||1102|||||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|||||1103|||||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|||||1104|||||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|1105|||||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|15.93316||15.70555||14.95766||||ANGIOTENSIN MODULATORS|1106|||||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|1107|||||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|11.71165||11.54434||10.99461||||ANGIOTENSIN MODULATOR COMBINATIONS|1108|||||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|1109|||||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|14.57062||14.22093||14.32292||||ANGIOTENSIN MODULATOR COMBINATIONS|1110|||||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|4.91457||4.79662||4.83102||||STIMULANTS AND RELATED AGENTS|1111|||||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|21.94739||21.42065||21.57428||||ALZHEIMER'S AGENTS|1112|||||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|21.90897||21.38315||21.53652||||ALZHEIMER'S AGENTS|1113|||||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|21.94669||21.41997||21.5736||||ALZHEIMER'S AGENTS|1114|||||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|.41265||.40275||.40563||||ANTICONVULSANTS|1115|||||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|2.88743||2.81813||2.83834||||ANTICONVULSANTS|1116|||||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|1.54772||1.51057||1.52141||||ANTICONVULSANTS|1117|||||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|3.08826||3.01414||3.03576||||ANTICONVULSANTS|1118|||||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|6.16715||6.01914||6.06231||||ANTICONVULSANTS|1119|||||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|1120|||||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|1121|||||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|1122|||||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|1123|||||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|1124|||||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|1125|||||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|1126|||||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|1127|||||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|1128|||||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|5.17122||5.04711||5.08331||||STIMULANTS AND RELATED AGENTS|1129|||||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|5.45076||5.31994||5.3581||||STIMULANTS AND RELATED AGENTS|1130|||||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|1131|||||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||ONCOLOGY, ORAL - RENAL CELL|1132|||||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|1133|||||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|1134|||||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|3587.07464||3500.98485||3526.09437||||CYTOKINE AND CAM ANTAGONISTS|1135|||||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|7203.73417||7030.84455||7081.27069||||CYTOKINE AND CAM ANTAGONISTS|1136|||||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|7260.7808||7157.05536||6816.2432||||CYTOKINE AND CAM ANTAGONISTS|1137|||||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|3597.85417||3511.50567||3536.69065||||CYTOKINE AND CAM ANTAGONISTS|1138|||||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|1139|||||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|||||1140|||||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|||||1141|||||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|||||1142|||||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|11.00645||10.7423||10.81934||||ANGIOTENSIN MODULATORS|1143|||||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|11.00645||10.7423||10.81934||||ANGIOTENSIN MODULATORS|1144|||||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|1145|||||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|1146|||||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|1147|||||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|1148|||||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|1149|||||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|1150|||||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|1151|||||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|1152|||||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|1153|||||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|1154|||||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|1155|||||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|11.006||10.74186||10.8189||||ANGIOTENSIN MODULATORS|1156|||||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|11.006||10.74186||10.8189||||ANGIOTENSIN MODULATORS|1157|||||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|1158|||||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|1159|||||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|1160|||||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|1161|||||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|1162|||||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|1163|||||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|||||1164|||||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|1165|||||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|1166|||||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|||||1167|||||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|35.16592||34.32194||34.5681||||OPHTHALMICS, GLAUCOMA AGENTS|1168|||||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|||||1169|||||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|1170|||||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|11.00714||10.74297||10.82002||||ANGIOTENSIN MODULATORS|1171|||||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|11.00714||10.74297||10.82002||||ANGIOTENSIN MODULATORS|1172|||||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|1173|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|69.87536||68.19835||68.68748||||OPHTHALMIC ANTIBIOTICS|1174|||||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|||||1175|||||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|||||1176|||||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|1177|||||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|1178|||||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|1179|||||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|74.44241||72.65579||73.17689||||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|1180|||||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|1181|||||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|11.23637||10.9667||11.04535||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|1182|||||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|1183|||||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|1184|||||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|1185|||||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|1186|||||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|1187|||||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||MULTIPLE SCLEROSIS AGENTS|1188|||||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|1189|||||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|1190|||||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|21076.64861||20570.80904||20718.34558||||MULTIPLE SCLEROSIS AGENTS|1191|||||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|1192|||||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|||||1193|||||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|||||1194|||||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|||||1195|||||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|1196|||||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|1197|||||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|1198|||||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|1199|||||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|1200|||||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|1201|||||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|1202|||||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|1203|||||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|1204|||||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|1205|||||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|1206|||||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|1207|||||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|1208|||||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|||||1209|||||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|||||1210|||||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|4.66052||4.54867||4.58129|||||1211|||||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|||||1212|||||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|||||1213|||||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|6.17439||6.0262||6.06943||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1214|||||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|6.1691||6.02104||6.06423||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1215|||||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|8.1744||7.97821||8.03544||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1216|||||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|10.55581||10.30247||10.37636||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|1217|||||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|.35634||.34779||.35028||||BLADDER RELAXANT PREPARATIONS|1218|||||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|.92123||.89912||.90557||||ANGIOTENSIN MODULATORS|1219|||||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|.27052||.26403||.26592||||BLADDER RELAXANT PREPARATIONS|1220|||||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|.27052||.26403||.26592||||BLADDER RELAXANT PREPARATIONS|1221|||||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|.01698||.01657||.01669||||BETA-BLOCKERS|1222|||||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|.01698||.01657||.01669||||BETA-BLOCKERS|1223|||||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|.02423||.02365||.02382||||ANXIOLYTICS|1224|||||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|.03491||.03407||.03432||||ANXIOLYTICS|1225|||||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|.03044||.02971||.02992||||ANALGESICS, NARCOTICS SHORT|1226|||||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|.03044||.02971||.02992||||ANALGESICS, NARCOTICS SHORT|1227|||||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|.03696||.03607||.03633||||SEDATIVE HYPNOTICS|1228|||||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|.03918||.03824||.03851||||SEDATIVE HYPNOTICS|1229|||||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|1230|||||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|1231|||||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|1232|||||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|.01929||.01883||.01896||||BETA-BLOCKERS|1233|||||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|.01929||.01883||.01896||||BETA-BLOCKERS|1234|||||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|.34787||.33952||.34196||||STEROIDS, TOPICAL HIGH|1235|||||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|.3949||.38542||.38819||||STEROIDS, TOPICAL HIGH|1236|||||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|.2968||.28968||.29175||||STEROIDS, TOPICAL HIGH|1237|||||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|.97733||.95387||.96072||||STEROIDS, TOPICAL HIGH|1238|||||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|.71164||.69456||.69954||||STEROIDS, TOPICAL HIGH|1239|||||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|.7118||.69472||.6997||||STEROIDS, TOPICAL HIGH|1240|||||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|.31303||.30552||.30771||||STEROIDS, TOPICAL HIGH|1241|||||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|.30852||.30112||.30328||||STEROIDS, TOPICAL HIGH|1242|||||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|.28715||.28026||.28227||||STEROIDS, TOPICAL HIGH|1243|||||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|.51627||.50388||.50749||||ANTIHISTAMINES, FIRST GENERATION|1244|||||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|.17435||.17017||.17139|||||1245|||||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|.17435||.17017||.17139|||||1246|||||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|.40372||.39403||.39686||||NSAIDS|1247|||||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|.07897||.07707||.07763||||CALCIUM CHANNEL BLOCKERS|1248|||||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|.07897||.07707||.07763||||CALCIUM CHANNEL BLOCKERS|1249|||||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|.14441||.14094||.14196||||CALCIUM CHANNEL BLOCKERS|1250|||||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|.14441||.14094||.14196||||CALCIUM CHANNEL BLOCKERS|1251|||||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|.17733||.17307||.17432||||CALCIUM CHANNEL BLOCKERS|1252|||||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|.26926||.2628||.26468||||CALCIUM CHANNEL BLOCKERS|1253|||||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|.04699||.04586||.04619||||LIPOTROPICS, STATINS|1254|||||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|.36705||.35824||.36081||||NSAIDS|1255|||||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|.36705||.35824||.36081||||NSAIDS|1256|||||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|.02708||.02643||.02662||||BETA-BLOCKERS|1257|||||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|.02708||.02643||.02662||||BETA-BLOCKERS|1258|||||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|.04191||.0409||.0412||||BETA-BLOCKERS|1259|||||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|.04191||.0409||.0412||||BETA-BLOCKERS|1260|||||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|.19658||.19186||.19324||||NSAIDS|1261|||||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|.25006||.24406||.24581||||NSAIDS|1262|||||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|.25006||.24406||.24581||||NSAIDS|1263|||||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|.06511||.06355||.064||||LIPOTROPICS, STATINS|1264|||||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|.26393||.2576||.25944||||ANTICONVULSANTS|1265|||||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|.02334||.02278||.02294||||BETA-BLOCKERS|1266|||||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|.02334||.02278||.02294||||BETA-BLOCKERS|1267|||||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|.09822||.09586||.09655||||ANTIDEPRESSANTS, TRICYCLIC|1268|||||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|.10071||.09829||.099||||ANTIDEPRESSANTS, TRICYCLIC|1269|||||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|.10071||.09829||.099||||ANTIDEPRESSANTS, TRICYCLIC|1270|||||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|.14496||.14148||.1425||||ANTIDEPRESSANTS, TRICYCLIC|1271|||||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|.14496||.14148||.1425||||ANTIDEPRESSANTS, TRICYCLIC|1272|||||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|.18537||.18092||.18222||||ANTIDEPRESSANTS, TRICYCLIC|1273|||||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|.18537||.18092||.18222||||ANTIDEPRESSANTS, TRICYCLIC|1274|||||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|.02836||.02768||.02788||||ANTICONVULSANTS|1275|||||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|.02836||.02768||.02788||||ANTICONVULSANTS|1276|||||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|.04369||.04264||.04295||||LIPOTROPICS, STATINS|1277|||||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|.04369||.04264||.04295||||LIPOTROPICS, STATINS|1278|||||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|.05833||.05693||.05734||||LIPOTROPICS, STATINS|1279|||||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|.17637||.17214||.17337||||NSAIDS|1280|||||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|.17637||.17214||.17337||||NSAIDS|1281|||||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|.3479||.33955||.34199||||ANTIFUNGALS, ORAL|1282|||||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|.05068||.04946||.04982||||ANXIOLYTICS|1283|||||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|.05068||.04946||.04982||||ANXIOLYTICS|1284|||||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|1285|||||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|1286|||||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|2.07206||2.02233||2.03683||||NSAIDS|1287|||||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|2.07206||2.02233||2.03683||||NSAIDS|1288|||||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|.16996||.16588||.16707||||ANTIBIOTICS, TOPICAL|1289|||||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|1.14419||1.11673||1.12474||||ANTIDEPRESSANTS, OTHER|1290|||||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|1.3115||1.28002||1.2892||||ANTIDEPRESSANTS, OTHER|1291|||||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|1292|||||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|.0975||.09516||.09584||||BETA-BLOCKERS|1293|||||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|.07458||.07279||.07331||||BETA-BLOCKERS|1294|||||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|.17096||.16686||.16805||||BETA-BLOCKERS|1295|||||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|.34383||.33558||.33798||||BETA-BLOCKERS|1296|||||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|.57702||.56317||.56721||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1297|||||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|1.03033||1.0056||1.01281||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1298|||||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|1299|||||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|1.13735||1.11005||1.11802||||NSAIDS|1300|||||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|.88679||.86551||.87171||||NSAIDS|1301|||||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|.85771||.83712||.84313||||ONCOLOGY, ORAL - PROSTATE|1302|||||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|4.78889||4.67396||4.70748|||||1303|||||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|5.7987||5.65953||5.70012|||||1304|||||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|18.84507||18.57585||17.69129|||||1305|||||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|.07201||.07028||.07079||||PENICILLINS|1306|||||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|.07201||.07028||.07079||||PENICILLINS|1307|||||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|.10658||.10402||.10477||||PENICILLINS|1308|||||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|.83084||.8109||.81672||||ANTIBIOTICS, GI|1309|||||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|.09147||.08927||.08992||||ANTICOAGULANTS|1310|||||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|.09147||.08927||.08992||||ANTICOAGULANTS|1311|||||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|.09366||.09141||.09207||||ANTICOAGULANTS|1312|||||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|.09366||.09141||.09207||||ANTICOAGULANTS|1313|||||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|.10072||.0983||.09901||||ANTICOAGULANTS|1314|||||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|.10072||.0983||.09901||||ANTICOAGULANTS|1315|||||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|.09927||.09689||.09758||||ANTICOAGULANTS|1316|||||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|.09272||.09049||.09114||||ANTICOAGULANTS|1317|||||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|.09272||.09049||.09114||||ANTICOAGULANTS|1318|||||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|.11259||.10989||.11068||||ANTICOAGULANTS|1319|||||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|.10752||.10494||.10569||||ANTICOAGULANTS|1320|||||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|.10067||.09825||.09896||||ANTICOAGULANTS|1321|||||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|.10067||.09825||.09896||||ANTICOAGULANTS|1322|||||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|.11219||.1095||.11028||||ANTICOAGULANTS|1323|||||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|2.37382||2.31685||2.33347||||SKELETAL MUSCLE RELAXANTS|1324|||||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|1.6982||1.65744||1.66933||||SKELETAL MUSCLE RELAXANTS|1325|||||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|133.27462||130.07603||131.00895||||ANTIMIGRAINE AGENTS, TRIPTANS|1326|||||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|88.48829||86.36457||86.98399||||ANTIMIGRAINE AGENTS, TRIPTANS|1327|||||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|.3853||.37605||.37875||||MACROLIDES/KETOLIDES|1328|||||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|.2533||.24722||.24899||||MACROLIDES/KETOLIDES|1329|||||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|.27715||.2705||.27244||||MACROLIDES/KETOLIDES|1330|||||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|.41739||.40737||.41029||||MACROLIDES/KETOLIDES|1331|||||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|.03315||.03235||.03259||||ANTIPSYCHOTICS|1332|||||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|.12884||.12575||.12665|||||1333|||||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|.13427||.13105||.13199|||||1334|||||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|.10058||.09817||.09887||||BPH TREATMENTS|1335|||||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|.1027||.10024||.10095||||BPH TREATMENTS|1336|||||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|.07589||.07407||.0746||||BPH TREATMENTS|1337|||||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|.07787||.076||.07655||||BPH TREATMENTS|1338|||||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|.12834||.12526||.12616|||||1339|||||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|1340|||||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|37.72796||36.82249||37.08658||||OPIATE DEPENDENCE TREATMENTS|1341|||||No|Yes|11.23000|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|.38852||.3792||.38192|||||1342|||||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|.26737||.26095||.26282|||||1343|||||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|.39788||.38833||.39112|||||1344|||||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|.04889||.04772||.04806||||ANTIEMETIC/ANTIVERTIGO AGENTS|1345|||||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|.04889||.04772||.04806||||ANTIEMETIC/ANTIVERTIGO AGENTS|1346|||||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|.04889||.04772||.04806||||ANTIEMETIC/ANTIVERTIGO AGENTS|1347|||||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|.04373||.04268||.04299||||ANTIEMETIC/ANTIVERTIGO AGENTS|1348|||||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|.04373||.04268||.04299||||ANTIEMETIC/ANTIVERTIGO AGENTS|1349|||||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|.18517||.18073||.18202|||||1350|||||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|.18517||.18073||.18202|||||1351|||||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|.92005||.89797||.90441||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1352|||||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|1.71739||1.67617||1.68819||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1353|||||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|.14868||.14511||.14615||||PENICILLINS|1354|||||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|.18595||.18149||.18279||||PENICILLINS|1355|||||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|1356|||||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|.28715||.28026||.28227||||PENICILLINS|1357|||||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|1358|||||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|1359|||||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|.32486||.31706||.31934||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1360|||||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|.28945||.2825||.28453||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1361|||||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|.04853||.04737||.0477||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1362|||||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|.06559||.06402||.06447||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1363|||||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|.17945||.17514||.1764|||||1364|||||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|.86424||.8435||.84955|||||1365|||||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|2.92777||2.8575||2.878||||PROTON PUMP INHIBITORS|1366|||||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|2.28058||2.22585||2.24181||||PROTON PUMP INHIBITORS|1367|||||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|.828||.80813||.81392||||ANTIPARKINSON'S AGENTS|1368|||||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|1.15953||1.1317||1.13982||||ANTIPARKINSON'S AGENTS|1369|||||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|.2384||.23268||.23435||||STIMULANTS AND RELATED AGENTS|1370|||||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|.70696||.68999||.69494||||STIMULANTS AND RELATED AGENTS|1371|||||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|.74996||.73196||.73721||||STIMULANTS AND RELATED AGENTS|1372|||||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|.82515||.80535||.81112||||STIMULANTS AND RELATED AGENTS|1373|||||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|2.21746||2.16424||2.17976||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1374|||||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|2.21746||2.16424||2.17976||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1375|||||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|1.52244||1.4859||1.49656||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1376|||||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|1377|||||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|.0869||.08481||.08542||||PENICILLINS|1378|||||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|.0869||.08481||.08542||||PENICILLINS|1379|||||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|.09954||.09715||.09785||||PENICILLINS|1380|||||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|.09954||.09715||.09785||||PENICILLINS|1381|||||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|1.40537||1.37164||1.38148|||||1382|||||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|1.40537||1.37164||1.38148|||||1383|||||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|.46599||.45481||.45807||||PENICILLINS|1384|||||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|1.05301||1.02774||1.03511||||PENICILLINS|1385|||||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|.95003||.92723||.93388|||||1386|||||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|1.35823||1.32563||1.33514|||||1387|||||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|||||1388|||||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|1.96662||1.93852||1.84621|||||1389|||||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|.08993||.08777||.0884||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1390|||||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|.08993||.08777||.0884||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1391|||||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|.13137||.12822||.12914||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1392|||||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|.13137||.12822||.12914||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1393|||||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|.48292||.47133||.47471||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1394|||||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|2.62873||2.56564||2.58404||||BRONCHODILATORS, BETA AGONIST|1395|||||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|87.1725||85.08036||85.69057||||ANTIVIRALS, TOPICAL|1396|||||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|.29325||.28621||.28826||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1397|||||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|.29325||.28621||.28826||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1398|||||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|.03246||.03168||.03191||||ANTICONVULSANTS|1399|||||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|.03246||.03168||.03191||||ANTICONVULSANTS|1400|||||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|.04259||.04157||.04187||||ANTICONVULSANTS|1401|||||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|.04259||.04157||.04187||||ANTICONVULSANTS|1402|||||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|.269||.26254||.26443||||ANTIFUNGALS, TOPICAL|1403|||||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|.24405||.23819||.2399||||ANTIFUNGALS, TOPICAL|1404|||||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|.19631||.1916||.19297||||ANTIFUNGALS, TOPICAL|1405|||||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|7.5352||7.35436||7.4071|||||1406|||||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|7.5352||7.35436||7.4071|||||1407|||||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|.18894||.18441||.18573||||ULCERATIVE COLITIS AGENTS|1408|||||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|.18894||.18441||.18573||||ULCERATIVE COLITIS AGENTS|1409|||||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|.18894||.18441||.18573||||ULCERATIVE COLITIS AGENTS|1410|||||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|39.37811||38.43304||38.70868||||ANALGESICS, NARCOTICS LONG|1411|||||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|.25113||.2451||.24686||||BETA-BLOCKERS|1412|||||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|.22943||.22392||.22553||||BETA-BLOCKERS|1413|||||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|.22511||.21971||.22128||||BETA-BLOCKERS|1414|||||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|.14367||.14022||.14123|||||1415|||||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|.29039||.28342||.28545||||PAH AGENTS, ORAL AND INHALED|1416|||||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|.02306||.02251||.02267||||SKELETAL MUSCLE RELAXANTS|1417|||||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|.53592||.52306||.52681||||SKELETAL MUSCLE RELAXANTS|1418|||||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|.01984||.01936||.0195||||SKELETAL MUSCLE RELAXANTS|1419|||||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|.01984||.01936||.0195||||SKELETAL MUSCLE RELAXANTS|1420|||||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|.01984||.01936||.0195||||SKELETAL MUSCLE RELAXANTS|1421|||||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|.04364||.04259||.0429||||ANXIOLYTICS|1422|||||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|.04364||.04259||.0429||||ANXIOLYTICS|1423|||||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|.04364||.04259||.0429||||ANXIOLYTICS|1424|||||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|.05249||.05123||.0516||||ANXIOLYTICS|1425|||||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|.05249||.05123||.0516||||ANXIOLYTICS|1426|||||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|.05249||.05123||.0516||||ANXIOLYTICS|1427|||||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|.0708||.0691||.0696||||ANXIOLYTICS|1428|||||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|.0708||.0691||.0696||||ANXIOLYTICS|1429|||||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|.0708||.0691||.0696||||ANXIOLYTICS|1430|||||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|1431|||||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|1432|||||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|1433|||||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|1434|||||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|1435|||||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|1436|||||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|.49266||.48084||.48428|||||1437|||||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|.37444||.36545||.36807||||STIMULANTS AND RELATED AGENTS|1438|||||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|.50608||.49393||.49748||||STIMULANTS AND RELATED AGENTS|1439|||||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|.46155||.45047||.4537||||STIMULANTS AND RELATED AGENTS|1440|||||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|.55842||.54502||.54893||||STIMULANTS AND RELATED AGENTS|1441|||||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|.57178||.55806||.56206||||STIMULANTS AND RELATED AGENTS|1442|||||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|.63662||.62134||.6258||||STIMULANTS AND RELATED AGENTS|1443|||||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|.62541||.6104||.61478||||STIMULANTS AND RELATED AGENTS|1444|||||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|77.52||75.65952||76.20216|||||1445|||||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|102.1505||99.69889||100.41394||||GLUCOCORTICOIDS, INHALED|1446|||||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|98.93773||96.56322||97.25579||||GLUCOCORTICOIDS, INHALED|1447|||||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|108.31852||105.71888||106.47711||||GLUCOCORTICOIDS, INHALED|1448|||||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|17.90162||17.47198||17.59729||||ANTIVIRALS, TOPICAL|1449|||||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|6.44875||6.29398||6.33912|||||1450|||||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|6.44875||6.29398||6.33912|||||1451|||||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|23.32385||22.76408||22.92734||||ANALGESICS, NARCOTICS LONG|1452|||||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|36.92315||36.03699||36.29546||||ANALGESICS, NARCOTICS LONG|1453|||||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|54.49821||53.19025||53.57174||||ANALGESICS, NARCOTICS LONG|1454|||||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|68.74741||67.09747||67.5787||||ANALGESICS, NARCOTICS LONG|1455|||||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|5.62849||5.49341||5.53281||||NSAIDS|1456|||||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|1457|||||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|1458|||||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|.209||.20398||.20545|||||1459|||||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|3.09454||3.02027||3.04193||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1460|||||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|4.23499||4.13335||4.163||||BRONCHODILATORS, BETA AGONIST|1461|||||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|4.30907||4.20565||4.23582||||BRONCHODILATORS, BETA AGONIST|1462|||||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|.14449||.14102||.14203|||||1463|||||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|.14449||.14102||.14203|||||1464|||||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|.14726||.14373||.14476|||||1465|||||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|.14726||.14373||.14476|||||1466|||||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|.24843||.24247||.24421|||||1467|||||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|.24843||.24247||.24421|||||1468|||||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|.24843||.24247||.24421|||||1469|||||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|1.74711||1.70518||1.71741||||ANTIBIOTICS, INHALED|1470|||||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|.06988||.0682||.06869||||PENICILLINS|1471|||||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|.04841||.04725||.04759||||PENICILLINS|1472|||||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|.07312||.07137||.07188||||PENICILLINS|1473|||||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|.04832||.04716||.0475||||PENICILLINS|1474|||||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|.16425||.16031||.16146||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1475|||||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|.11686||.11406||.11487||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1476|||||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|.16754||.16352||.16469||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1477|||||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|.15649||.15273||.15383||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1478|||||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|.30712||.29975||.3019||||BRONCHODILATORS, BETA AGONIST|1479|||||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|.35477||.34626||.34874||||BRONCHODILATORS, BETA AGONIST|1480|||||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|3.84996||3.75756||3.78451||||BRONCHODILATORS, BETA AGONIST|1481|||||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|.39742||.38788||.39066||||BRONCHODILATORS, BETA AGONIST|1482|||||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|.02737||.02671||.0269||||PENICILLINS|1483|||||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|.028||.02733||.02752||||PENICILLINS|1484|||||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|.02637||.02574||.02592||||PENICILLINS|1485|||||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|.03767||.03677||.03703||||PENICILLINS|1486|||||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|.0423||.04128||.04158||||PENICILLINS|1487|||||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|.03613||.03526||.03552||||PENICILLINS|1488|||||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|.03164||.03088||.0311||||PENICILLINS|1489|||||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|.04769||.04655||.04688||||PENICILLINS|1490|||||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|.03552||.03467||.03492||||PENICILLINS|1491|||||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|.06983||.06815||.06864||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1492|||||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|.05496||.05364||.05403||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1493|||||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|.09187||.08967||.09031||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1494|||||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|.06981||.06813||.06862||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1495|||||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|1.54526||1.50817||1.51899||||ANGIOTENSIN MODULATOR COMBINATIONS|1496|||||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|1.59478||1.55651||1.56767||||ANGIOTENSIN MODULATOR COMBINATIONS|1497|||||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|1.46946||1.43419||1.44448||||ANGIOTENSIN MODULATOR COMBINATIONS|1498|||||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|1.16659||1.13859||1.14676||||ANGIOTENSIN MODULATOR COMBINATIONS|1499|||||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|1.92378||1.87761||1.89108||||ANGIOTENSIN MODULATOR COMBINATIONS|1500|||||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|1.94737||1.90063||1.91426||||ANTICONVULSANTS|1501|||||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|3.06223||2.98874||3.01017||||ANTICONVULSANTS|1502|||||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|||||1503|||||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|||||1504|||||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|1.95864||1.91163||1.92534||||STIMULANTS AND RELATED AGENTS|1505|||||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|2.89558||2.82609||2.84636||||STIMULANTS AND RELATED AGENTS|1506|||||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|.03016||.02944||.02965||||LIPOTROPICS, STATINS|1507|||||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|.03016||.02944||.02965||||LIPOTROPICS, STATINS|1508|||||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|.08427||.08225||.08284||||LIPOTROPICS, STATINS|1509|||||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|.08427||.08225||.08284||||LIPOTROPICS, STATINS|1510|||||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|.05122||.04999||.05035||||LIPOTROPICS, STATINS|1511|||||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|.05122||.04999||.05035||||LIPOTROPICS, STATINS|1512|||||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|.03661||.03573||.03599||||LIPOTROPICS, STATINS|1513|||||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|.03661||.03573||.03599||||LIPOTROPICS, STATINS|1514|||||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|.03328||.03248||.03271||||ANTIHISTAMINES, FIRST GENERATION|1515|||||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|.03328||.03248||.03271||||ANTIHISTAMINES, FIRST GENERATION|1516|||||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|.04472||.04365||.04396||||ANTIHISTAMINES, FIRST GENERATION|1517|||||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|.04472||.04365||.04396||||ANTIHISTAMINES, FIRST GENERATION|1518|||||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|.04472||.04365||.04396||||ANTIHISTAMINES, FIRST GENERATION|1519|||||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|.072||.07027||.07078||||ANTIHISTAMINES, FIRST GENERATION|1520|||||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|.072||.07027||.07078||||ANTIHISTAMINES, FIRST GENERATION|1521|||||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|.88641||.86514||.87134||||ANGIOTENSIN MODULATORS|1522|||||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|.1396||.13625||.13723||||ANXIOLYTICS|1523|||||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|.1396||.13625||.13723||||ANXIOLYTICS|1524|||||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|1.28982||1.25886||1.26789||||HIV / AIDS|1525|||||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|.40113||.3915||.39431||||ANTIPSYCHOTICS|1526|||||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|.49112||.47933||.48277||||ANTIPSYCHOTICS|1527|||||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|.71154||.69446||.69944||||ANTIPSYCHOTICS|1528|||||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|.81358||.79405||.79975||||ANTIPSYCHOTICS|1529|||||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|15.95956||15.57653||15.68825||||ANTIMIGRAINE AGENTS, TRIPTANS|1530|||||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|17.9775||17.54604||17.67188||||ANTIMIGRAINE AGENTS, TRIPTANS|1531|||||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|1.5562||1.51885||1.52974||||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%|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|1.68257||1.64219||1.65397||||STIMULANTS AND RELATED AGENTS|1533|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|1.37115||1.33824||1.34784||||STIMULANTS AND RELATED AGENTS|1534|||||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|1.59163||1.55343||1.56457||||STIMULANTS AND RELATED AGENTS|1535|||||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|1.28044||1.24971||1.25867||||STIMULANTS AND RELATED AGENTS|1536|||||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|1.7424||1.70058||1.71278||||STIMULANTS AND RELATED AGENTS|1537|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|.25585||.24971||.2515|||||1538|||||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|3.15794||3.08215||3.10426||||STIMULANTS AND RELATED AGENTS|1539|||||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|2.80926||2.74184||2.7615||||STIMULANTS AND RELATED AGENTS|1540|||||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|2.92359||2.85342||2.87389||||STIMULANTS AND RELATED AGENTS|1541|||||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|||||1542|||||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|1543|||||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|18.76788||18.31745||18.44883||||ANTIPSYCHOTICS|1544|||||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|1545|||||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|1.8184||1.77476||1.78749||||ANTIPSYCHOTICS|1546|||||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|1.8184||1.77476||1.78749||||ANTIPSYCHOTICS|1547|||||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|3.66503||3.57707||3.60272||||ANTIPSYCHOTICS|1548|||||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|3.66503||3.57707||3.60272||||ANTIPSYCHOTICS|1549|||||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|1.7744||1.73181||1.74424|||||1550|||||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|.75875||.74054||.74585|||||1551|||||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|.75875||.74054||.74585|||||1552|||||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|3.3876||3.3063||3.33001||||ANTIPSYCHOTICS|1553|||||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|5.30157||5.17433||5.21144||||ANTIPSYCHOTICS|1554|||||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|5.30159||5.17435||5.21146||||ANTIPSYCHOTICS|1555|||||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|17.1121||16.86764||16.06442||||ANTIPSYCHOTICS|1556|||||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|7.059||6.88958||6.939||||ANTIPSYCHOTICS|1557|||||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|.08738||.08528||.08589||||PAH AGENTS, ORAL AND INHALED|1558|||||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|1559|||||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|5.16231||5.08856||4.84625||||HIV / AIDS|1560|||||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|1.79595||1.75285||1.76542||||HIV / AIDS|1561|||||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|.15723||.15346||.15456||||SEDATIVE HYPNOTICS|1562|||||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|.11002||.10738||.10815||||SEDATIVE HYPNOTICS|1563|||||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|.11487||.11211||.11292||||SEDATIVE HYPNOTICS|1564|||||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|.87773||.85666||.86281||||STIMULANTS AND RELATED AGENTS|1565|||||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|1.31162||1.28014||1.28932||||STIMULANTS AND RELATED AGENTS|1566|||||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|1.50588||1.46974||1.48028||||STIMULANTS AND RELATED AGENTS|1567|||||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|1.41488||1.38092||1.39083||||STIMULANTS AND RELATED AGENTS|1568|||||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|2.08681||2.03673||2.05133||||STIMULANTS AND RELATED AGENTS|1569|||||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|1.1267||1.09966||1.10755||||STIMULANTS AND RELATED AGENTS|1570|||||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|1.62122||1.58231||1.59366||||MACROLIDES/KETOLIDES|1571|||||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|1.62122||1.58231||1.59366||||MACROLIDES/KETOLIDES|1572|||||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|2.144||2.09254||2.10755||||MACROLIDES/KETOLIDES|1573|||||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|2.144||2.09254||2.10755||||MACROLIDES/KETOLIDES|1574|||||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|2.06508||2.01552||2.02997||||ULCERATIVE COLITIS AGENTS|1575|||||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|4.24779||4.14584||4.17558||||PHOSPHATE BINDERS|1576|||||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|3.66218||3.57429||3.59992||||PHOSPHATE BINDERS|1577|||||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|3.45691||3.37394||3.39814||||PHOSPHATE BINDERS|1578|||||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|1.27554||1.24493||1.25386||||BRONCHODILATORS, BETA AGONIST|1579|||||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|1.04319||1.01815||1.02546||||BRONCHODILATORS, BETA AGONIST|1580|||||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|140.29947||136.93228||137.91438||||EPINEPHRINE, SELF-INJECTED|1581|||||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|136.48871||133.21298||134.1684||||EPINEPHRINE, SELF-INJECTED|1582|||||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|3.57996||3.52882||3.36078|||||1583|||||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|2.31365||2.2806||2.172|||||1584|||||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|.18797||.18346||.18477||||PROTON PUMP INHIBITORS|1585|||||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|.18797||.18346||.18477||||PROTON PUMP INHIBITORS|1586|||||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|.16104||.15718||.1583||||PROTON PUMP INHIBITORS|1587|||||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|.16104||.15718||.1583||||PROTON PUMP INHIBITORS|1588|||||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|.95132||.92849||.93515||||GLUCOCORTICOIDS, INHALED|1589|||||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|.95132||.92849||.93515||||GLUCOCORTICOIDS, INHALED|1590|||||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|.67709||.66084||.66558||||GLUCOCORTICOIDS, INHALED|1591|||||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|.67709||.66084||.66558||||GLUCOCORTICOIDS, INHALED|1592|||||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|3.75346||3.66338||3.68965||||GLUCOCORTICOIDS, INHALED|1593|||||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|1.22402||1.19464||1.20321||||ANTIDEPRESSANTS, OTHER|1594|||||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|.37319||.36423||.36685||||BLADDER RELAXANT PREPARATIONS|1595|||||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|.37319||.36423||.36685||||BLADDER RELAXANT PREPARATIONS|1596|||||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|.37319||.36423||.36685||||BLADDER RELAXANT PREPARATIONS|1597|||||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|.40299||.39332||.39614||||BLADDER RELAXANT PREPARATIONS|1598|||||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|.40299||.39332||.39614||||BLADDER RELAXANT PREPARATIONS|1599|||||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|.40299||.39332||.39614||||BLADDER RELAXANT PREPARATIONS|1600|||||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|.93789||.91538||.92195||||NSAIDS|1601|||||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|1602|||||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|.06911||.06745||.06794||||ANTIDEPRESSANTS, SSRIs|1603|||||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|.06911||.06745||.06794||||ANTIDEPRESSANTS, SSRIs|1604|||||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|.06911||.06745||.06794||||ANTIDEPRESSANTS, SSRIs|1605|||||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|.0609||.05944||.05986||||LIPOTROPICS, STATINS|1606|||||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|.0609||.05944||.05986||||LIPOTROPICS, STATINS|1607|||||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|.08703||.08494||.08555||||LIPOTROPICS, STATINS|1608|||||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|.08703||.08494||.08555||||LIPOTROPICS, STATINS|1609|||||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|.07858||.07669||.07724||||HYPOGLYCEMICS, TZD|1610|||||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|.07858||.07669||.07724||||HYPOGLYCEMICS, TZD|1611|||||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|.07858||.07669||.07724||||HYPOGLYCEMICS, TZD|1612|||||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|.10703||.10446||.10521||||HYPOGLYCEMICS, TZD|1613|||||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|.10703||.10446||.10521||||HYPOGLYCEMICS, TZD|1614|||||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|.10703||.10446||.10521||||HYPOGLYCEMICS, TZD|1615|||||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|.12916||.12606||.12696||||HYPOGLYCEMICS, TZD|1616|||||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|.12916||.12606||.12696||||HYPOGLYCEMICS, TZD|1617|||||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|.12916||.12606||.12696||||HYPOGLYCEMICS, TZD|1618|||||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|.26671||.26031||.26218||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1619|||||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|.26671||.26031||.26218||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1620|||||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|.02288||.02233||.02249||||BETA-BLOCKERS|1621|||||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|.02288||.02233||.02249||||BETA-BLOCKERS|1622|||||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|.02984||.02912||.02933||||BETA-BLOCKERS|1623|||||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|.02984||.02912||.02933||||BETA-BLOCKERS|1624|||||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|.0626||.0611||.06154||||PLATELET AGGREGATION INHIBITORS|1625|||||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|.0626||.0611||.06154||||PLATELET AGGREGATION INHIBITORS|1626|||||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|.19573||.19103||.1924||||IMMUNOSUPPRESSIVES, ORAL|1627|||||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|.19573||.19103||.1924||||IMMUNOSUPPRESSIVES, ORAL|1628|||||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|.17662||.17238||.17362||||PROTON PUMP INHIBITORS|1629|||||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|.10807||.10548||.10623||||PROTON PUMP INHIBITORS|1630|||||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|.18158||.17722||.17849|||||1631|||||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|.24833||.24237||.24411|||||1632|||||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|.07118||.06947||.06997||||BPH TREATMENTS|1633|||||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|.07118||.06947||.06997||||BPH TREATMENTS|1634|||||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|.07118||.06947||.06997||||BPH TREATMENTS|1635|||||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|.08845||.08633||.08695||||ANGIOTENSIN MODULATORS|1636|||||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|.08845||.08633||.08695||||ANGIOTENSIN MODULATORS|1637|||||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|.08845||.08633||.08695||||ANGIOTENSIN MODULATORS|1638|||||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|.1095||.10687||.10764||||ANGIOTENSIN MODULATORS|1639|||||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|.1095||.10687||.10764||||ANGIOTENSIN MODULATORS|1640|||||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|.1095||.10687||.10764||||ANGIOTENSIN MODULATORS|1641|||||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|.10245||.09999||.10071||||ANGIOTENSIN MODULATORS|1642|||||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|.10245||.09999||.10071||||ANGIOTENSIN MODULATORS|1643|||||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|.10245||.09999||.10071||||ANGIOTENSIN MODULATORS|1644|||||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|.09542||.09313||.0938||||ANTIDEPRESSANTS, OTHER|1645|||||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|.09542||.09313||.0938||||ANTIDEPRESSANTS, OTHER|1646|||||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|.09975||.09736||.09805||||ANTIDEPRESSANTS, OTHER|1647|||||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|.09975||.09736||.09805||||ANTIDEPRESSANTS, OTHER|1648|||||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|.14127||.13788||.13887||||ANTIDEPRESSANTS, OTHER|1649|||||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|.14127||.13788||.13887||||ANTIDEPRESSANTS, OTHER|1650|||||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|1.57939||1.54148||1.55254||||FLUOROQUINOLONES, ORAL|1651|||||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|.19113||.18654||.18788||||LIPOTROPICS, OTHER|1652|||||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|.26886||.26241||.26429||||LIPOTROPICS, OTHER|1653|||||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|.26886||.26241||.26429||||LIPOTROPICS, OTHER|1654|||||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|.33103||.32309||.3254||||LIPOTROPICS, OTHER|1655|||||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|.33103||.32309||.3254||||LIPOTROPICS, OTHER|1656|||||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|3.27838||3.1997||3.22265||||LIPOTROPICS, STATINS|1657|||||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|3.27838||3.1997||3.22265||||LIPOTROPICS, STATINS|1658|||||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|2.32057||2.26488||2.28112||||LIPOTROPICS, STATINS|1659|||||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|2.32057||2.26488||2.28112||||LIPOTROPICS, STATINS|1660|||||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|2.84302||2.77479||2.79469||||LIPOTROPICS, STATINS|1661|||||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|2.84302||2.77479||2.79469||||LIPOTROPICS, STATINS|1662|||||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|.21246||.20736||.20885||||HYPOGLYCEMICS, METFORMINS|1663|||||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|.27403||.26745||.26937||||HYPOGLYCEMICS, METFORMINS|1664|||||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|.2414||.23561||.2373||||HYPOGLYCEMICS, METFORMINS|1665|||||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|.41845||.40841||.41134||||ANTIMIGRAINE AGENTS, TRIPTANS|1666|||||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|.41845||.40841||.41134||||ANTIMIGRAINE AGENTS, TRIPTANS|1667|||||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|.38826||.37894||.38166||||ANTIMIGRAINE AGENTS, TRIPTANS|1668|||||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|.38826||.37894||.38166||||ANTIMIGRAINE AGENTS, TRIPTANS|1669|||||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|.41943||.40936||.4123||||ONCOLOGY, ORAL - BREAST|1670|||||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|.45611||.44516||.44836||||ONCOLOGY, ORAL - BREAST|1671|||||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|2.03023||1.9815||1.99572||||GLUCOCORTICOIDS, INHALED|1672|||||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|1.22747||1.19801||1.2066||||GLUCOCORTICOIDS, INHALED|1673|||||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|1.43829||1.40377||1.41384||||GLUCOCORTICOIDS, INHALED|1674|||||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|.16529||.16132||.16248||||ONCOLOGY, ORAL - BREAST|1675|||||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|.14837||.14481||.14585||||ONCOLOGY, ORAL - BREAST|1676|||||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|.50016||.48816||.49166||||ONCOLOGY, ORAL - HEMATOLOGIC|1677|||||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|2.07293||2.02318||2.03769||||ONCOLOGY, ORAL - HEMATOLOGIC|1678|||||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|1679|||||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|1680|||||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|1681|||||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|62.57472||61.07293||61.51095|||||1682|||||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|.0678||.06617||.06665||||ANTIHISTAMINES, MINIMALLY SEDATING|1683|||||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|.55946||.54603||.54995||||HIV / AIDS|1684|||||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|1685|||||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|20.37932||19.89022||20.03287||||ONCOLOGY, ORAL - RENAL CELL|1686|||||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|1687|||||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|13.3675||13.04668||13.14025||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1688|||||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|13.3675||13.04668||13.14025||||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1689|||||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|1690|||||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|1691|||||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||ANALGESICS, NARCOTICS SHORT|1692|||||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|1693|||||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|1694|||||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|1695|||||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|||||1696|||||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|.161||.15714||.15826|||||1697|||||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|.16494||.16098||.16214|||||1698|||||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|.16494||.16098||.16214|||||1699|||||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|.20846||.20346||.20492|||||1700|||||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|5.91567||5.77369||5.8151||||ANTICONVULSANTS|1701|||||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|.5828||.56881||.57289|||||1702|||||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|11.19944||11.03945||10.51376||||ANTICONVULSANTS|1703|||||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|1.44791||1.41316||1.4233||||NSAIDS|1704|||||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|.21102||.20596||.20743||||ANTIVIRALS, ORAL|1705|||||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|.36825||.35941||.36199||||ANTIVIRALS, ORAL|1706|||||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|.80026||.78105||.78666||||ANTIVIRALS, ORAL|1707|||||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|.05787||.05648||.05689||||ANTIPSYCHOTICS|1708|||||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|.11098||.10832||.10909||||ANTIPSYCHOTICS|1709|||||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|.15649||.15273||.15383||||ANTIPSYCHOTICS|1710|||||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|.19331||.18867||.19002||||ANTIPSYCHOTICS|1711|||||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|.04457||.0435||.04381||||ANTIPSYCHOTICS|1712|||||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|.22081||.21551||.21706||||ANTIVIRALS, ORAL|1713|||||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|.25025||.24424||.246|||||1714|||||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|1715|||||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|.29916||.29198||.29407|||||1716|||||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|1717|||||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|1718|||||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|1719|||||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|.22084||.21554||.21709||||ANGIOTENSIN MODULATORS|1720|||||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|.22084||.21554||.21709||||ANGIOTENSIN MODULATORS|1721|||||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|.17381||.16964||.17086||||ANGIOTENSIN MODULATORS|1722|||||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|.17381||.16964||.17086||||ANGIOTENSIN MODULATORS|1723|||||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|.98937||.96563||.97255|||||1724|||||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|2.49633||2.43642||2.45389||||ANTIMIGRAINE AGENTS, TRIPTANS|1725|||||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|2.36558||2.30881||2.32537||||ANTIMIGRAINE AGENTS, TRIPTANS|1726|||||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|.08016||.07824||.0788|||||1727|||||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|.07753||.07567||.07621|||||1728|||||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|.07753||.07567||.07621|||||1729|||||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|.07753||.07567||.07621|||||1730|||||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|.06058||.05913||.05955|||||1731|||||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|.06058||.05913||.05955|||||1732|||||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|.06058||.05913||.05955|||||1733|||||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|.06529||.06372||.06418||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1734|||||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|.07579||.07397||.0745||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1735|||||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|.08511||.08307||.08366||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1736|||||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|.34564||.33734||.33976|||||1737|||||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|.36708||.35827||.36084|||||1738|||||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|.47676||.46532||.46866|||||1739|||||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|.51331||.50099||.50458||||IMMUNOSUPPRESSIVES, ORAL|1740|||||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|1.1985||1.16974||1.17813||||IMMUNOSUPPRESSIVES, ORAL|1741|||||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|1.60339||1.56491||1.57613||||IMMUNOSUPPRESSIVES, ORAL|1742|||||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|.07461||.07282||.07334||||ANTIDEPRESSANTS, OTHER|1743|||||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|.08739||.08529||.0859||||ANTIDEPRESSANTS, OTHER|1744|||||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|.12009||.11721||.11805||||ANTIDEPRESSANTS, OTHER|1745|||||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|.08452||.08249||.08308||||ANTIDEPRESSANTS, OTHER|1746|||||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|.13767||.13437||.13533||||ANTIDEPRESSANTS, OTHER|1747|||||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|1.10856||1.08195||1.08971||||NSAIDS|1748|||||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|1.10856||1.08195||1.08971||||NSAIDS|1749|||||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|1.10856||1.08195||1.08971||||NSAIDS|1750|||||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|.5962||.58189||.58606||||ULCERATIVE COLITIS AGENTS|1751|||||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|.43766||.42716||.43022||||ANTICONVULSANTS|1752|||||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|.54596||.53286||.53668||||ANTICONVULSANTS|1753|||||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|.59499||.58071||.58488||||ANTICONVULSANTS|1754|||||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|.66737||.65135||.65602||||ANTICONVULSANTS|1755|||||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|.92203||.8999||.90636||||ANTICONVULSANTS|1756|||||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|.06058||.05913||.05955|||||1757|||||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|.06058||.05913||.05955|||||1758|||||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|.06058||.05913||.05955|||||1759|||||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|.07753||.07567||.07621|||||1760|||||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|.07753||.07567||.07621|||||1761|||||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|.08016||.07824||.0788|||||1762|||||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|8.3536||8.15311||8.21159|||||1763|||||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|.09496||.09268||.09335||||ANTIPARKINSON'S AGENTS|1764|||||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|.09496||.09268||.09335||||ANTIPARKINSON'S AGENTS|1765|||||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|.09028||.08811||.08875||||ANTIPARKINSON'S AGENTS|1766|||||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|.09028||.08811||.08875||||ANTIPARKINSON'S AGENTS|1767|||||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|.09028||.08811||.08875||||ANTIPARKINSON'S AGENTS|1768|||||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|||||1769|||||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|.2805||.27377||.27573||||NSAIDS|1770|||||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|.10063||.09821||.09892|||||1771|||||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|.02827||.02759||.02779||||NSAIDS|1772|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No|| polyethylene glycol 3350|No|No|No|No|75%|00113030602|GS CLEARLAX POWDER|238|GM|.00981|03/29/2019||Yes|No||||No|No|03/29/2019||Yes|No||||No|No|||Over The Counter|No|||No|.02768||.02702||.02721|||||1773|||||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|.02047||.01998||.02012|||||1774|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No|| guaifenesin/dextromethorphan|No|No|No|No|75%|00113057826|GS TUSSIN DM LIQUID|118|ML|.00714|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|07/28/2010|184|Yes|.01628||.01605||.01528||||COUGH AND COLD, NON-NARCOTIC|1775|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No|| ibuprofen|No|No|No|No|75%|00113060471|GS IBUPROFEN 200 MG TABLET|50|EA|.01066|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.03689||.036||.03626||||NSAIDS|1776|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No|| ibuprofen|No|No|No|No|75%|00113060478|GS IBUPROFEN 200 MG TABLET|100|EA|.01054|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.03689||.036||.03626||||NSAIDS|1777|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No|| ibuprofen|No|No|No|No|75%|00113060490|GS IBUPROFEN 200 MG TABLET|500|EA|.00777|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over The Counter|No|02/02/2010|059|Yes|.03689||.036||.03626||||NSAIDS|1778|||||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|.05832||.05692||.05733||||ANTIHISTAMINES, MINIMALLY SEDATING|1779|||||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|.05832||.05692||.05733||||ANTIHISTAMINES, MINIMALLY SEDATING|1780|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No|| ibuprofen|No|No|No|No|75%|00113066026|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|.02827||.02759||.02779||||NSAIDS|1781|||||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|.37758||.36852||.37116||||SMOKING CESSATION|1782|||||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|.02827||.02759||.02779||||NSAIDS|1783|||||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|.02389||.02332||.02348||||NSAIDS|1784|||||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|.43047||.42014||.42315||||PROTON PUMP INHIBITORS|1785|||||No|No||PERRIGO/GOODSEN|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|.0405||.03953||.03981||||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|.11972||.11685||.11768||||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|.06126||.05979||.06022||||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|.20381||.19892||.20035||||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|.25945||.25322||.25504||||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|.51937||.50691||.51054||||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|5.83037||5.69044||5.73125||||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|6.16275||6.01484||6.05798||||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|6.12718||5.98013||6.02302||||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|5.27172||5.1452||5.1821||||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|.24115||.23536||.23705||||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|1.51326||1.47694||1.48753||||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|1.65626||1.61651||1.6281||||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|5.36919||5.24033||5.27791|||||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|2.37382||2.31685||2.33347||||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|1.6982||1.65744||1.66933||||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|.55116||.53793||.54179||||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|.50232||.49026||.49378||||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|.56507||.55151||.55546||||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|.5342||.52138||.52512||||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|.61942||.60455||.60889||||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|.64541||.62992||.63444||||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|5.40163||5.27199||5.3098||||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|17.12432||16.71334||16.83321||||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|.15879||.15498||.15609||||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|.46105||.44998||.45321||||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|.21297||.20786||.20935|||||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|.46429||.45315||.4564|||||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|.05812||.05673||.05713||||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|.05812||.05673||.05713||||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|.06207||.06058||.06101||||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|.06207||.06058||.06101||||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|.09634||.09403||.0947||||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|.09634||.09403||.0947||||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|.18529||.18084||.18214||||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|.18529||.18084||.18214||||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|.21467||.20952||.21102||||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|109.83746||107.20136||107.97022||||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|111.80222||109.11897||109.90158||||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|.17499||.17079||.17202||||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|.25571||.24957||.25136||||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|.45581||.44487||.44806||||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|1.95864||1.91163||1.92534||||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|2.89558||2.82609||2.84636||||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|2.443||2.38437||2.40147||||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|3.60907||3.52245||3.54772||||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|1.37115||1.33824||1.34784||||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|1.59163||1.55343||1.56457||||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|1.28044||1.24971||1.25867||||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|1.7424||1.70058||1.71278||||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|1.5562||1.51885||1.52974||||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|1.68257||1.64219||1.65397||||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|3.01378||2.94145||2.96255||||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|4.78889||4.67396||4.70748|||||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|18.84507||18.57585||17.69129|||||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|5.7987||5.65953||5.70012|||||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|.08295||.08096||.08154||||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|.13559||.13234||.13328||||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|.17854||.17426||.1755||||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|.25321||.24713||.24891||||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|.06306||.06155||.06199||||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|.06306||.06155||.06199||||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|.07656||.07472||.07526||||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|.07656||.07472||.07526||||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|3.14144||3.06605||3.08804||||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|1.68032||1.63999||1.65175||||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|2.12182||2.0709||2.08575|||||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|.26457||.25822||.26007|||||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|.43544||.42499||.42804||||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|.74149||.72369||.72888||||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|.93944||.91689||.92347||||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|.74946||.73147||.73672||||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|.08093||.07899||.07955||||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|.10481||.10229||.10303||||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|.10481||.10229||.10303||||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|.27045||.26396||.26585|||||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|5.08333||4.96133||4.99691|||||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|.42273||.41258||.41554|||||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|.42273||.41258||.41554|||||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|||No|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|.87773||.85666||.86281||||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|1.31162||1.28014||1.28932||||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|1.50588||1.46974||1.48028||||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|1.41488||1.38092||1.39083||||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|2.08681||2.03673||2.05133||||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|.25154||.2455||.24726||||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|.3196||.31193||.31417||||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|.27075||.26425||.26615||||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|.01467||.01432||.01442|||||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|.00742||.00724||.00729|||||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|.01336||.01304||.01313|||||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|.02335||.02279||.02295|||||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|.01514||.01478||.01488|||||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|| acetaminophen with codeine|No|No|No|No|90%|00121050416|ACETAMINOP-CODEINE 120-12 MG/5|473|ML|.00722|03/01/2002|08/01/2024|Yes|No||03/01/2002|08/01/2024|Yes|No|03/01/2002|08/01/2024|Yes|No||03/01/2002|08/01/2024|Yes|No|||Prescription Required|No|11/17/2006|109|Yes|.39099||.38161||.38434||||ANALGESICS, NARCOTICS SHORT|1883|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|.03991||.03895||.03923||||ANTIEMETIC/ANTIVERTIGO AGENTS|1884|||||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|1885|||||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|.02253||.02199||.02215|||||1886|||||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|.0506||.04939||.04974||||ANTIPARKINSON'S AGENTS|1887|||||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|1888|||||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|1889|||||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|1890|||||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|.06879||.06714||.06762||||ANTIPARKINSON'S AGENTS|1891|||||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|.08633||.08426||.08486||||ANTICONVULSANTS|1892|||||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|.03335||.03255||.03278||||ANTICONVULSANTS|1893|||||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|.03335||.03255||.03278||||ANTICONVULSANTS|1894|||||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|.05813||.05673||.05714|||||1895|||||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|.03106||.03031||.03053|||||1896|||||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|.32279||.31504||.3173||||ANTIDEPRESSANTS, TRICYCLIC|1897|||||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|.12174||.11882||.11967||||GLUCOCORTICOIDS, ORAL|1898|||||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|.01659||.01619||.01631|||||1899|||||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|.59414||.57988||.58404||||ANXIOLYTICS|1900|||||No|No||PHARM ASSOC INC|No|||||No|No|No|| hydrocodone/acetaminophen|No|No|No|No|90%|00121077204|HYDROCODONE-ACETAMN 7.5-325/15|118|ML|.0583|09/02/2014|07/31/2024|Yes|No||09/02/2014|07/31/2024|Yes|No|09/02/2014|07/31/2024|Yes|No||||No|No|||Prescription Required|No|07/24/2013|109|Yes|.13288||.13098||.12474||||ANALGESICS, NARCOTICS SHORT|1901|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.3425||.33428||.33668||||ANALGESICS, NARCOTICS SHORT|1902|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|1.81305||1.76954||1.78223||||GLUCOCORTICOIDS, ORAL|1903|||||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|.06311||.0616||.06204||||COUGH AND COLD, NARCOTIC|1904|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No|| codeine phosphate/guaifenesin|No|No|No|No|90%|00121077508|GUAIFEN-CODEINE 100-10 MG/5 ML|237|ML|.02126|11/19/2018|08/01/2024|Yes|No||||No|No|11/19/2018|08/01/2024|Yes|No||||No|No|||Over The Counter|No|02/08/2018|183|Yes|.04846||.04777||.04549||||COUGH AND COLD, NARCOTIC|1905|Discontinued by Manufacturer||Discontinued by Manufacturer||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|.03436||.03354||.03378||||COUGH AND COLD, NARCOTIC|1906|||||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|1907|||||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|1908|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|.078||.07688||.07322|||||1909|||||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|.14831||.14475||.14579||||ANTIFUNGALS, ORAL|1910|||||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|.07388||.07211||.07262||||ANTIFUNGALS, ORAL|1911|||||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|.02335||.02279||.02295|||||1912|||||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|.01514||.01478||.01488|||||1913|||||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|.11421||.11147||.11227||||ANTIHISTAMINES, MINIMALLY SEDATING|1914|||||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|.55628||.54293||.54682||||GLUCOCORTICOIDS, ORAL|1915|||||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|.66252||.64662||.65126||||GLUCOCORTICOIDS, ORAL|1916|||||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|.00742||.00724||.00729|||||1917|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARM ASSOC INC|No|||||No|No|No|| promethazine HCl|No|No|No|No|75%|00121092716|PROMETHAZINE 6.25 MG/5 ML SOLN|473|ML|.01227|02/13/2023|08/01/2024|Yes|No||02/13/2023|08/01/2024|Yes|No|02/13/2023|08/01/2024|Yes|No||||No|No|||Prescription Required|No|01/30/2020|085|Yes|.03244||.03166||.03189||||ANTIEMETIC/ANTIVERTIGO AGENTS|1918|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|.09385||.0916||.09225||||COUGH AND COLD, NON-NARCOTIC|1919|||||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|.09582||.09352||.09419||||COUGH AND COLD, NON-NARCOTIC|1920|||||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|.06309||.06158||.06202||||ANTICONVULSANTS|1921|||||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|.59147||.57727||.58142||||OPIATE DEPENDENCE TREATMENTS|1922|||||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|.56866||.55501||.55899||||OPIATE DEPENDENCE TREATMENTS|1923|||||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|.07388||.07211||.07262||||ANTIFUNGALS, ORAL|1924|||||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|.92797||.9057||.91219||||OPIATE DEPENDENCE TREATMENTS|1925|||||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|.87432||.85334||.85946||||OPIATE DEPENDENCE TREATMENTS|1926|||||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|11.28435||11.01353||11.09252||||ANTICONVULSANTS|1927|||||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|11.28435||11.01353||11.09252||||ANTICONVULSANTS|1928|||||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|17.62772||17.20465||17.32805||||ANTICONVULSANTS|1929|||||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|17.62772||17.20465||17.32805||||ANTICONVULSANTS|1930|||||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|18.73293||18.28334||18.41447||||ANTICONVULSANTS|1931|||||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|18.73293||18.28334||18.41447||||ANTICONVULSANTS|1932|||||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|18.69268||18.24406||18.3749||||ANTICONVULSANTS|1933|||||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|18.69268||18.24406||18.3749||||ANTICONVULSANTS|1934|||||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|2.1884||2.13588||2.1512||||ANTICONVULSANTS|1935|||||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|||||1936|||||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|.36997||.36109||.36368||||ANGIOTENSIN MODULATORS|1937|||||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|.36997||.36109||.36368||||ANGIOTENSIN MODULATORS|1938|||||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|.30564||.2983||.30044||||ANGIOTENSIN MODULATORS|1939|||||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|.30564||.2983||.30044||||ANGIOTENSIN MODULATORS|1940|||||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|.31433||.30679||.30899||||ANGIOTENSIN MODULATORS|1941|||||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|.31433||.30679||.30899||||ANGIOTENSIN MODULATORS|1942|||||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|.86638||.84559||.85165||||ANGIOTENSIN MODULATORS|1943|||||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|.10186||.09942||.10013|||||1944|||||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|.10186||.09942||.10013|||||1945|||||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|.18653||.18205||.18336|||||1946|||||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|.18653||.18205||.18336|||||1947|||||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|.17483||.17063||.17186|||||1948|||||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|.17483||.17063||.17186|||||1949|||||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|||||1950|||||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|.24282||.23699||.23869||||ANTICONVULSANTS|1951|||||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|.24282||.23699||.23869||||ANTICONVULSANTS|1952|||||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|||||1953|||||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|.33245||.32447||.3268||||ANTICONVULSANTS|1954|||||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|.33245||.32447||.3268||||ANTICONVULSANTS|1955|||||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|||||1956|||||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|.09907||.09669||.09739||||ANTICONVULSANTS|1957|||||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|.09907||.09669||.09739||||ANTICONVULSANTS|1958|||||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|.17565||.17143||.17266||||ANTICONVULSANTS|1959|||||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|.17565||.17143||.17266||||ANTICONVULSANTS|1960|||||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|.28662||.27974||.28175|||||1961|||||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|.22737||.22191||.2235|||||1962|||||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|.28023||.2735||.27547|||||1963|||||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|.12909||.12599||.1269||||TETRACYCLINES|1964|||||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|.12909||.12599||.1269||||TETRACYCLINES|1965|||||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|4.11719||4.01838||4.0472||||ANTIHYPERURICEMICS|1966|||||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|4.11719||4.01838||4.0472||||ANTIHYPERURICEMICS|1967|||||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|4.11719||4.01838||4.0472||||ANTIHYPERURICEMICS|1968|||||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|.09755||.09521||.09589|||||1969|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|.09755||.09521||.09589|||||1970|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|.13173||.12857||.12949||||TETRACYCLINES|1971|||||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|1.79342||1.75038||1.76293|||||1972|||||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|||||1973|||||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|||||1974|||||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|||||1975|||||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|.28945||.2825||.28453||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1976|||||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||ANTIMIGRAINE AGENTS, OTHER|1977|||||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|1978|||||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|.18595||.18149||.18279||||PENICILLINS|1979|||||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|.18595||.18149||.18279||||PENICILLINS|1980|||||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|16.25291||15.86284||15.97661|||||1981|||||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|1982|||||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|.85771||.83712||.84313||||ONCOLOGY, ORAL - PROSTATE|1983|||||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|.7448||.72692||.73214|||||1984|||||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|||||1985|||||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|3.68495||3.59651||3.62231|||||1986|||||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|.991||.96722||.97415|||||1987|||||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|||1988|||||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|1.84176||1.79756||1.81045|||||1989|||||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|13.49281||13.16898||13.26343|||||1990|||||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|||||1991|||||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|||||1992|||||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|||||1993|||||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|||||1994|||||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|||||1995|||||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|||||1996|||||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|||||1997|||||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|||||1998|||||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|||||1999|||||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|||2000|||||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|||2001|||||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|||2002|||||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|1.45075||1.41593||1.42609|||||2003|||||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|3.72117||3.63186||3.65791|||||2004|||||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|||||2005|||||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|13.7602||13.42996||13.52628|||||2006|||||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|||||2007|||||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|||||2008|||||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|||||2009|||||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|.16935||.16529||.16647||||TETRACYCLINES|2010|||||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|.13173||.12857||.12949||||TETRACYCLINES|2011|||||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|.13173||.12857||.12949||||TETRACYCLINES|2012|||||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|.10658||.10402||.10477||||PENICILLINS|2013|||||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|.10658||.10402||.10477||||PENICILLINS|2014|||||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|.07201||.07028||.07079||||PENICILLINS|2015|||||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|.07201||.07028||.07079||||PENICILLINS|2016|||||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|.07579||.07397||.0745||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2017|||||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|.06529||.06372||.06418||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2018|||||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|.08511||.08307||.08366||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2019|||||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|.03767||.03677||.03703||||PENICILLINS|2020|||||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|.0423||.04128||.04158||||PENICILLINS|2021|||||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|.03613||.03526||.03552||||PENICILLINS|2022|||||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|.03164||.03088||.0311||||PENICILLINS|2023|||||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|.04769||.04655||.04688||||PENICILLINS|2024|||||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|.03552||.03467||.03492||||PENICILLINS|2025|||||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|.01957||.0191||.01924||||PENICILLINS|2026|||||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|.01501||.01465||.01475||||PENICILLINS|2027|||||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|.02043||.01994||.02008||||PENICILLINS|2028|||||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|.02737||.02671||.0269||||PENICILLINS|2029|||||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|.02637||.02574||.02592||||PENICILLINS|2030|||||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|.028||.02733||.02752||||PENICILLINS|2031|||||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|||||2032|||||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|.98657||.96289||.9698|||||2033|||||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|.10237||.09991||.10063||||FLUOROQUINOLONES, ORAL|2034|||||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|.15001||.14641||.14746||||FLUOROQUINOLONES, ORAL|2035|||||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|.26813||.26169||.26357||||FLUOROQUINOLONES, ORAL|2036|||||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|.09954||.09715||.09785||||PENICILLINS|2037|||||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|||2038|||||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|||||2039|||||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|||2040|||||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|.04853||.04737||.0477||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2041|||||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|.06424||.0627||.06315||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2042|||||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|.0636||.06207||.06252||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2043|||||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|.06559||.06402||.06447||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2044|||||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|.08732||.08522||.08584||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2045|||||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|.07358||.07181||.07233||||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2046|||||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|||2047|||||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|.22718||.22173||.22332||||STEROIDS, TOPICAL HIGH|2048|||||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|.15365||.14996||.15104||||STEROIDS, TOPICAL HIGH|2049|||||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|.07054||.06885||.06934||||STEROIDS, TOPICAL HIGH|2050|||||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|.12516||.12216||.12303||||STEROIDS, TOPICAL HIGH|2051|||||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|.02718||.02653||.02672||||STEROIDS, TOPICAL HIGH|2052|||||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|.05491||.05359||.05398||||STEROIDS, TOPICAL HIGH|2053|||||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|.07077||.06907||.06957||||STEROIDS, TOPICAL HIGH|2054|||||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|.13467||.13144||.13238||||STEROIDS, TOPICAL HIGH|2055|||||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|.03839||.03747||.03774||||STEROIDS, TOPICAL HIGH|2056|||||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|.0713||.06959||.07009||||STEROIDS, TOPICAL HIGH|2057|||||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|.12962||.12777||.12169||||STEROIDS, TOPICAL LOW|2058|||||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|.09324||.091||.09165||||STEROIDS, TOPICAL LOW|2059|||||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|.11798||.11515||.11597||||STEROIDS, TOPICAL LOW|2060|||||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|.17656||.17232||.17356||||STEROIDS, TOPICAL LOW|2061|||||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|.7691||.75064||.75603||||STEROIDS, TOPICAL HIGH|2062|||||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|.5359||.52304||.52679||||STEROIDS, TOPICAL HIGH|2063|||||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|.48038||.46885||.47221||||STEROIDS, TOPICAL HIGH|2064|||||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|.41872||.40867||.4116||||STEROIDS, TOPICAL HIGH|2065|||||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|.55013||.53693||.54078||||STEROIDS, TOPICAL HIGH|2066|||||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|.73102||.71348||.71859||||STEROIDS, TOPICAL HIGH|2067|||||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|.5511||.53787||.54173||||STEROIDS, TOPICAL HIGH|2068|||||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|.5953||.58101||.58518||||STEROIDS, TOPICAL HIGH|2069|||||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|.61253||.59783||.60212||||STEROIDS, TOPICAL HIGH|2070|||||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|.35904||.35042||.35294||||STEROIDS, TOPICAL HIGH|2071|||||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|.23544||.22979||.23144||||STEROIDS, TOPICAL MEDIUM|2072|||||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|1.10943||1.0828||1.09057||||STEROIDS, TOPICAL MEDIUM|2073|||||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|.88578||.86452||.87072||||STEROIDS, TOPICAL MEDIUM|2074|||||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|.10906||.10644||.10721||||STEROIDS, TOPICAL LOW|2075|||||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|.08004||.07812||.07868||||STEROIDS, TOPICAL LOW|2076|||||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|.269||.26254||.26443||||ANTIFUNGALS, TOPICAL|2077|||||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|.24405||.23819||.2399||||ANTIFUNGALS, TOPICAL|2078|||||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|.19631||.1916||.19297||||ANTIFUNGALS, TOPICAL|2079|||||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|.18989||.18533||.18666||||STEROIDS, TOPICAL HIGH|2080|||||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|.12508||.12208||.12295||||STEROIDS, TOPICAL LOW|2081|||||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|.09802||.09567||.09635||||STEROIDS, TOPICAL LOW|2082|||||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|.20264||.19778||.1992||||STEROIDS, TOPICAL VERY HIGH|2083|||||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|.16874||.16469||.16587||||STEROIDS, TOPICAL VERY HIGH|2084|||||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|.15152||.14788||.14894||||STEROIDS, TOPICAL VERY HIGH|2085|||||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|.15877||.15496||.15607||||STEROIDS, TOPICAL VERY HIGH|2086|||||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|.23343||.22783||.22946||||ACNE AGENTS, TOPICAL|2087|||||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|.18668||.1822||.18351||||ACNE AGENTS, TOPICAL|2088|||||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|.25541||.24928||.25107||||ACNE AGENTS, TOPICAL|2089|||||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|.23042||.22489||.2265||||ACNE AGENTS, TOPICAL|2090|||||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|.35376||.34527||.34775||||ACNE AGENTS, TOPICAL|2091|||||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|.18033||.176||.17726|||||2092|||||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|.24978||.24379||.24553||||ANTIFUNGALS, TOPICAL|2093|||||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|.18189||.17752||.1788||||ANTIFUNGALS, TOPICAL|2094|||||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|1.05642||1.03107||1.03846||||STEROIDS, TOPICAL LOW|2095|||||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|.60958||.59495||.59922||||STEROIDS, TOPICAL LOW|2096|||||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|.55405||.54075||.54463||||STEROIDS, TOPICAL LOW|2097|||||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|2098|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||FOUGERA/SANDOZ|No|||||No|No|No|| alclometasone dipropionate|No|No|No|No|75%|00168026445|ALCLOMETASONE DIPR 0.05% OINT|45|GM|.23745|04/21/2008|07/31/2024|Yes|No||04/21/2008|07/31/2024|Yes|No|04/21/2008|07/31/2024|Yes|No||||No|No|||Prescription Required|Yes|01/25/2012|118|No|.54118||.53344||.50804||||STEROIDS, TOPICAL LOW|2099|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|.33047||.32254||.32485||||STEROIDS, TOPICAL LOW|2100|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|2101|||||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|.68138||.66503||.6698||||STEROIDS, TOPICAL HIGH|2102|||||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|.53822||.5253||.52907||||STEROIDS, TOPICAL HIGH|2103|||||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|.84299||.82276||.82866||||STEROIDS, TOPICAL HIGH|2104|||||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|.69938||.68259||.68749||||STEROIDS, TOPICAL HIGH|2105|||||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|.25059||.24458||.24633||||STEROIDS, TOPICAL VERY HIGH|2106|||||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|1.59593||1.55763||1.5688||||ANTIBIOTICS, VAGINAL|2107|||||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|.8335||.8135||.81933||||STEROIDS, TOPICAL VERY HIGH|2108|||||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|.52134||.50883||.51248||||STEROIDS, TOPICAL VERY HIGH|2109|||||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|.34027||.3321||.33449||||STEROIDS, TOPICAL VERY HIGH|2110|||||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|.76623||.74784||.7532||||STEROIDS, TOPICAL VERY HIGH|2111|||||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|.80389||.7846||.79022||||STEROIDS, TOPICAL VERY HIGH|2112|||||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|.39765||.38811||.39089||||STEROIDS, TOPICAL VERY HIGH|2113|||||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|.34887||.3405||.34294||||ROSACEA AGENTS, TOPICAL|2114|||||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|.3445||.33623||.33864||||STEROIDS, TOPICAL MEDIUM|2115|||||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|.23839||.23267||.23434||||STEROIDS, TOPICAL MEDIUM|2116|||||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|.22046||.21517||.21671||||STEROIDS, TOPICAL MEDIUM|2117|||||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|1.17405||1.14587||1.15409|||||2118|||||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|.44408||.43342||.43653||||STEROIDS, TOPICAL VERY HIGH|2119|||||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|.2919||.28489||.28694|||||2120|||||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|||||2121|||||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|6.28704||6.13615||6.18016||||ANTIFUNGALS, TOPICAL|2122|||||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|2.98465||2.91302||2.93391||||ANTIFUNGALS, TOPICAL|2123|||||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|3.31504||3.23548||3.25868||||ANTIFUNGALS, TOPICAL|2124|||||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|1.73844||1.69672||1.70889||||ROSACEA AGENTS, TOPICAL|2125|||||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|2126|||||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|1.25441||1.2243||1.23309||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2127|||||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|1.06489||1.03933||1.04679||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2128|||||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|1.10777||1.08118||1.08894||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2129|||||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|.93125||.9089||.91542||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2130|||||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|.81677||.79717||.80288||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2131|||||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|.86133||.84066||.84669||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2132|||||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|2.40614||2.34839||2.36524||||ACNE AGENTS, TOPICAL|2133|||||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|4.62645||4.51542||4.5478||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2134|||||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|4.63772||4.52641||4.55888||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2135|||||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|4.62764||4.51658||4.54897||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2136|||||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|494.46389||482.59676||486.058||||GLUCAGON AGENTS|2137|||||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|2138|||||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|2139|||||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|2140|||||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|2141|||||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|2142|||||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|2143|||||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|2144|||||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|2145|||||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|2146|||||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|2147|||||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|65.09068||63.5285||63.98414||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2148|||||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|32.54583||31.76473||31.99255||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2149|||||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|32.51315||31.73283||31.96043||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2150|||||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|82.98779||80.99608||81.577||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2151|||||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|5.83342||5.69342||5.73425||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2152|||||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|5.82898||5.68908||5.72989||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2153|||||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|5.83594||5.69588||5.73673||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2154|||||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|27.77102||27.10452||27.29891||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2155|||||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|35.75357||34.89548||35.14576||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2156|||||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|34.40585||33.58011||33.82095||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2157|||||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|35.11463||34.61299||32.96475||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2158|||||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|8.58605||8.37998||8.44009||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2159|||||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|6.94953||6.78274||6.83139||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2160|||||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|10.36754||10.11872||10.19129||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2161|||||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|8.94756||8.73282||8.79545||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2162|||||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|87.44523||85.34654||85.95866||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2163|||||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|87.46969||85.37042||85.98271||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2164|||||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|311.78839||304.30547||306.48799||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2165|||||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|311.80659||304.32323||306.50588||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2166|||||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|31.15054||30.40293||30.62098||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2167|||||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|31.16194||30.41405||30.63219||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2168|||||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|31.16194||30.41405||30.63219||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2169|||||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|31.16068||30.41282||30.63095||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2170|||||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|311.73405||304.25243||306.43457||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2171|||||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|20.4149||19.92494||20.06785|||||2172|||||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|20.4149||19.92494||20.06785|||||2173|||||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|8.94772||8.73297||8.79561||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2174|||||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|10.36039||10.11174||10.18426||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2175|||||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|2176|||||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|2177|||||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|2178|||||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|2179|||||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|2180|||||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|2181|||||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|6.94777||6.78102||6.82966||||HYPOGLYCEMICS, INSULIN AND RELATED AGENTS|2182|||||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||GROWTH HORMONE|2183|||||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|512.856||500.54746||504.13745||.||GROWTH HORMONE|2184|||||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|1036.66923||1011.78917||1019.04585||||GROWTH HORMONE|2185|||||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|1562.20222||1524.70937||1535.64478||||GROWTH HORMONE|2186|||||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|2187|||||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|2188|||||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|2189|||||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|2190|||||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|2191|||||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|2192|||||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|2193|||||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|2194|||||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|2195|||||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|2196|||||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|2197|||||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|2198|||||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|2199|||||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|2200|||||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|2201|||||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|.01297||.01266||.01275|||||2202|||||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|.01297||.01266||.01275|||||2203|||||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|.03754||.03664||.0369|||||2204|||||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|.03754||.03664||.0369|||||2205|||||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|.0451||.04402||.04433||||ANGIOTENSIN MODULATORS|2206|||||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|.05521||.05388||.05427||||ANGIOTENSIN MODULATORS|2207|||||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|.02209||.02156||.02171||||ANXIOLYTICS|2208|||||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|.02209||.02156||.02171||||ANXIOLYTICS|2209|||||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|.02811||.02744||.02763||||ANXIOLYTICS|2210|||||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|.02811||.02744||.02763||||ANXIOLYTICS|2211|||||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|.02811||.02744||.02763||||ANXIOLYTICS|2212|||||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|.03014||.02942||.02963||||ANXIOLYTICS|2213|||||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|.03014||.02942||.02963||||ANXIOLYTICS|2214|||||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|.03014||.02942||.02963||||ANXIOLYTICS|2215|||||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|.0405||.03953||.03981||||SKELETAL MUSCLE RELAXANTS|2216|||||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|.0405||.03953||.03981||||SKELETAL MUSCLE RELAXANTS|2217|||||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|.06126||.05979||.06022||||SKELETAL MUSCLE RELAXANTS|2218|||||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|.06126||.05979||.06022||||SKELETAL MUSCLE RELAXANTS|2219|||||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|1.52689||1.49024||1.50093|||||2220|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|.60169||.58725||.59146|||||2221|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|.03493||.03409||.03434|||||2222|||||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|.03493||.03409||.03434|||||2223|||||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|.03493||.03409||.03434|||||2224|||||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|.05768||.0563||.0567|||||2225|||||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|.05768||.0563||.0567|||||2226|||||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|1.77441||1.73182||1.74425||||IMMUNOSUPPRESSIVES, ORAL|2227|||||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|7.53022||7.34949||7.40221||||ANTIDEPRESSANTS, OTHER|2228|||||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|2229|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|2230|||||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|462.31818||451.22254||454.45877||||ANTIMIGRAINE AGENTS, TRIPTANS|2231|||||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|||||2232|||||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|||||2233|||||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|6.76243||6.60013||6.64747||||BRONCHODILATORS, BETA AGONIST|2234|||||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|2235|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|2236|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|2237|||||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|10.93784||10.67533||10.7519||||ANTICONVULSANTS|2238|||||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|||||2239|||||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|20.29131||19.80432||19.94636||||ANTIVIRALS, ORAL|2240|||||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|20.29131||19.80432||19.94636||||ANTIVIRALS, ORAL|2241|||||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|2242|||||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|2243|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|2244|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|2245|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|10.01268||9.77238||9.84246||||ANTICONVULSANTS|2246|||||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|2247|||||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|10.63221||10.37704||10.45146||||ANTICONVULSANTS|2248|||||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|11.17702||10.90877||10.98701||||ANTICONVULSANTS|2249|||||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|11.75983||11.47759||11.55991||||ANTICONVULSANTS|2250|||||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|||||2251|||||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|||||2252|||||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|||||2253|||||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|||||2254|||||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|2255|||||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|3.0401||2.96714||2.98842||||BRONCHODILATORS, BETA AGONIST|2256|||||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|2.71912||2.65386||2.67289||||BRONCHODILATORS, BETA AGONIST|2257|||||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|2.4955||2.43561||2.45308||||GLUCOCORTICOIDS, INHALED|2258|||||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|3.13127||3.05612||3.07804||||GLUCOCORTICOIDS, INHALED|2259|||||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|4.24044||4.13867||4.16835||||GLUCOCORTICOIDS, INHALED|2260|||||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|20.03962||19.55867||19.69895||||GLUCOCORTICOIDS, INHALED|2261|||||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|2262|||||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|25.50098||24.88896||25.06746||||GLUCOCORTICOIDS, INHALED|2263|||||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|18.73962||18.28987||18.42105||||GLUCOCORTICOIDS, INHALED|2264|||||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|35.14701||34.30348||34.54951||||GLUCOCORTICOIDS, INHALED|2265|||||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|2266|||||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|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%|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|2268|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|2269|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|14.046||13.7089||13.80722||||ANTIDEPRESSANTS, OTHER|2270|||||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|2271|||||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|2272|||||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|72.82531||71.0775||71.58728||||ANTIMIGRAINE AGENTS, TRIPTANS|2273|||||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|2274|||||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|2275|||||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|13.43297||13.11058||13.20461||||ANTICONVULSANTS|2276|||||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|26.85672||26.21216||26.40016||||ANTICONVULSANTS|2277|||||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|28.6839||27.99549||28.19627||||ANTICONVULSANTS|2278|||||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|30.64217||29.90676||30.12125||||ANTICONVULSANTS|2279|||||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|2280|||||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|2281|||||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|2282|||||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|46.10587||44.99933||45.32207||||ANTICONVULSANTS|2283|||||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|12.751||12.44498||12.53423||||ANTICONVULSANTS|2284|||||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|13.7675||13.43708||13.53345||||ANTICONVULSANTS|2285|||||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|14.68533||14.33288||14.43568||||ANTICONVULSANTS|2286|||||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|17.4455||17.02681||17.14893||||ANTICONVULSANTS|2287|||||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|2288|||||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|2289|||||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|2290|||||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|41.84317||40.83893||41.13184||||ANTICONVULSANTS|2291|||||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|2292|||||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|6.51395||6.35762||6.40321||||GLUCOCORTICOIDS, INHALED|2293|||||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|5.34989||5.22149||5.25894||||GLUCOCORTICOIDS, INHALED|2294|||||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|7.59524||7.41295||7.46612||||COPD AGENTS|2295|||||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|11.32595||11.05413||11.13341||||COPD AGENTS|2296|||||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|6.66867||6.50862||6.5553||||GLUCOCORTICOIDS, INHALED|2297|||||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|8.92757||8.71331||8.7758||||GLUCOCORTICOIDS, INHALED|2298|||||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|6.5141||6.35776||6.40336||||GLUCOCORTICOIDS, INHALED|2299|||||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|10.53481||10.28197||10.35572||||GLUCOCORTICOIDS, INHALED|2300|||||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|10.49507||10.24319||10.31665||||GLUCOCORTICOIDS, INHALED|2301|||||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|6.67437||6.51419||6.56091||||GLUCOCORTICOIDS, INHALED|2302|||||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|||||2303|||||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|2304|||||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|2305|||||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|10.53282||10.28003||10.35376||||GLUCOCORTICOIDS, INHALED|2306|||||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|10.54515||10.29207||10.36588||||GLUCOCORTICOIDS, INHALED|2307|||||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|2308|||||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|2309|||||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|2310|||||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|2311|||||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|2312|||||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|2313|||||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|2314|||||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|2315|||||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|2316|||||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|6.51009||6.35385||6.39942||||GLUCOCORTICOIDS, INHALED|2317|||||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|12.92367||12.6135||12.70397||||ANTIVIRALS, ORAL|2318|||||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|12.92367||12.6135||12.70397||||ANTIVIRALS, ORAL|2319|||||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|7.02883||6.86014||6.90934||||ANTIDEPRESSANTS, OTHER|2320|||||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|2.2222||2.19045||2.08615||||IRON, ORAL|2321|||||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|||||2322|||||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|||||2323|||||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|6.22958||6.08007||6.12368||||STEROIDS, TOPICAL LOW|2324|||||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|||||2325|||||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|||||2326|||||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|||||2327|||||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|||||2328|||||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|2329|||||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|2330|||||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|2331|||||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|1.16255||1.13465||1.14279||||PRENATAL VITAMINS|2332|||||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|2333|||||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|3.93478||3.84035||3.86789|||||2334|||||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|||||2335|||||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|||||2336|||||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|||||2337|||||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|.43486||.42442||.42747||||SKELETAL MUSCLE RELAXANTS|2338|||||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|2339|||||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|.29642||.28931||.29138|||||2340|||||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|.456||.44506||.44825|||||2341|||||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|.456||.44506||.44825|||||2342|||||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|.16949||.16542||.16661|||||2343|||||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|.16949||.16542||.16661|||||2344|||||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|.19817||.19341||.1948|||||2345|||||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|.19817||.19341||.1948|||||2346|||||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|.28929||.28235||.28437|||||2347|||||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|.28929||.28235||.28437|||||2348|||||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|.61621||.60142||.60573||||NSAIDS|2349|||||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|.24916||.24318||.24492||||ANGIOTENSIN MODULATORS|2350|||||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|.4277||.41744||.42043||||ANGIOTENSIN MODULATORS|2351|||||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|.28918||.28224||.28426||||ANGIOTENSIN MODULATORS|2352|||||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|.25966||.25343||.25525||||ANGIOTENSIN MODULATORS|2353|||||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|.63473||.6195||.62394||||SKELETAL MUSCLE RELAXANTS|2354|||||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|.06306||.06155||.06199||||ANTIHISTAMINES, FIRST GENERATION|2355|||||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|.06306||.06155||.06199||||ANTIHISTAMINES, FIRST GENERATION|2356|||||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|.33111||.32316||.32548||||NSAIDS|2357|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|.07656||.07472||.07526||||ANTIHISTAMINES, FIRST GENERATION|2358|||||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|.07656||.07472||.07526||||ANTIHISTAMINES, FIRST GENERATION|2359|||||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|.26317||.25685||.2587||||STIMULANTS AND RELATED AGENTS|2360|||||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|.32728||.31943||.32172||||STIMULANTS AND RELATED AGENTS|2361|||||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|.24799||.24204||.24377||||STIMULANTS AND RELATED AGENTS|2362|||||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|.32517||.31737||.31964||||STIMULANTS AND RELATED AGENTS|2363|||||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|.27225||.26572||.26762|||||2364|||||No|No||SANDOZ|No|||||No|No|No|| eplerenone|No|No|No|No|75%|00185536809|EPLERENONE 25 MG TABLET|90|EA|1.49281|04/06/2010|07/31/2024|Yes|No||04/06/2010|07/31/2024|Yes|No|04/06/2010|07/31/2024|Yes|No||||No|No|||Prescription Required|No|||No|3.40223||3.35362||3.19393|||||2365|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.46074||.44968||.45291|||||2366|||||No|No||SANDOZ|No|||||No|No|No|| eplerenone|No|No|No|No|75%|00185536909|EPLERENONE 50 MG TABLET|90|EA|1.49281|04/06/2010|07/31/2024|Yes|No||04/06/2010|07/31/2024|Yes|No|04/06/2010|07/31/2024|Yes|No||||No|No|||Prescription Required|No|||No|3.40223||3.35362||3.19393|||||2367|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|||||2368|||||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|.38377||.37456||.37725|||||2369|||||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|22.05019||21.52099||21.67534||||GLUCOCORTICOIDS, INHALED|2370|||||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|19.29464||18.83157||18.96663||||GLUCOCORTICOIDS, INHALED|2371|||||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|7.21578||7.0426||7.09311||||PLATELET AGGREGATION INHIBITORS|2372|||||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|7.21492||7.04176||7.09227||||PLATELET AGGREGATION INHIBITORS|2373|||||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|253.34215||247.26194||249.03533||||GLUCOCORTICOIDS, INHALED|2374|||||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|189.65668||185.10492||186.43252||||GLUCOCORTICOIDS, INHALED|2375|||||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|4.18242||4.08204||4.11132||||GLUCOCORTICOIDS, INHALED|2376|||||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|4.91115||4.79328||4.82766||||GLUCOCORTICOIDS, INHALED|2377|||||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|9.88872||9.65139||9.72061||||GLUCOCORTICOIDS, INHALED|2378|||||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|9.19414||8.97348||9.03784||||PROTON PUMP INHIBITORS|2379|||||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|9.17807||8.9578||9.02204||||PROTON PUMP INHIBITORS|2380|||||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|9.21018||8.98914||9.05361||||PROTON PUMP INHIBITORS|2381|||||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|9.18112||8.96077||9.02504||||PROTON PUMP INHIBITORS|2382|||||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|9.19466||8.97399||9.03835||||PROTON PUMP INHIBITORS|2383|||||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|8.82354||8.61178||8.67354||||PROTON PUMP INHIBITORS|2384|||||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|8.82354||8.61178||8.67354||||PROTON PUMP INHIBITORS|2385|||||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|8.81049||8.59904||8.66071||||PROTON PUMP INHIBITORS|2386|||||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|8.81049||8.59904||8.66071||||PROTON PUMP INHIBITORS|2387|||||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|2388|||||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|2389|||||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|2390|||||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|2.39855||2.34098||2.35777||||ACNE AGENTS, TOPICAL|2391|||||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|2.4471||2.38837||2.4055||||ACNE AGENTS, TOPICAL|2392|||||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|18.13587||17.70061||17.82756||||ACNE AGENTS, TOPICAL|2393|||||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|2394|||||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|2395|||||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|||||2396|||||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|||||2397|||||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|2398|||||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|2399|||||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|9.92462||9.68643||9.7559|||||2400|||||No|No||BAUSCH HEALTH U|No|||||No|No|No|| diazepam|No|No|No|No|75%|00187065820|DIASTAT ACUDIAL 5-7.5-10 MG KT|1|EA|150.8225|10/17/2005|08/31/2024|Yes|No||10/17/2005|08/31/2024|Yes|No|10/17/2005|08/31/2024|Yes|No||||No|No|||Prescription Required|No|01/28/2021|056|Yes|343.735||338.8245||322.69||||ANTICONVULSANTS|2401|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|63.81333||62.28181||62.7285||||ANTIDEPRESSANTS, OTHER|2402|||||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|63.81333||62.28181||62.7285||||ANTIDEPRESSANTS, OTHER|2403|||||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|84.3356||82.31155||82.90189||||ANTIDEPRESSANTS, OTHER|2404|||||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|2405|||||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|2406|||||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|2407|||||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|2408|||||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|2409|||||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|2410|||||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|2411|||||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|2412|||||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|2413|||||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|2414|||||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|4.79487||4.67979||4.71336||||ANTIVIRALS, TOPICAL|2415|||||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|38.30033||37.38112||37.64922||||ANTIVIRALS, TOPICAL|2416|||||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|2417|||||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|11.40581||11.13207||11.21191||||ACNE AGENTS, TOPICAL|2418|||||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|||||2419|||||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|||||2420|||||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|||||2421|||||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|37.56144||37.02485||35.26176|||||2422|||||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|1.44231||1.40769||1.41779|||||2423|||||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|2424|||||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|2425|||||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|9.57695||9.3471||9.41414||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2426|||||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|9.58452||9.35449||9.42158||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2427|||||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|9.55398||9.32468||9.39156||||IMMUNOMODULATORS, ATOPIC DERMATITIS|2428|||||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|236.8468||231.16248||232.8204||||ANTIVIRALS, TOPICAL|2429|||||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|17.43126||17.01291||17.13493||||ACNE AGENTS, TOPICAL|2430|||||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|31.30958||30.55815||30.77732||||ROSACEA AGENTS, TOPICAL|2431|||||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|182.59087||178.20869||179.48683||||ANTIFUNGALS, TOPICAL|2432|||||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|||||2433|||||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|64.63948||63.08813||63.54061||||ANTIDEPRESSANTS, OTHER|2434|||||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|85.15978||83.11595||83.71206||||ANTIDEPRESSANTS, OTHER|2435|||||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|194.55129||189.88206||191.24392||||ANTIDEPRESSANTS, OTHER|2436|||||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|.55227||.53902||.54288||||ANTICONVULSANTS|2437|||||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|.79281||.77378||.77933||||ANTICONVULSANTS|2438|||||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|.84218||.82197||.82786||||ANTICONVULSANTS|2439|||||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|.84636||.82605||.83197||||ANTICONVULSANTS|2440|||||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|1.99688||1.94895||1.96293||||ANTICONVULSANTS|2441|||||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|2.48505||2.42541||2.4428||||ANTICONVULSANTS|2442|||||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|.02342||.02286||.02302||||ANXIOLYTICS|2443|||||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|.02342||.02286||.02302||||ANXIOLYTICS|2444|||||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|.02342||.02286||.02302||||ANXIOLYTICS|2445|||||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|.02477||.02418||.02435||||ANXIOLYTICS|2446|||||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|.02477||.02418||.02435||||ANXIOLYTICS|2447|||||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|.02477||.02418||.02435||||ANXIOLYTICS|2448|||||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|.02913||.02843||.02863||||ANXIOLYTICS|2449|||||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|.02913||.02843||.02863||||ANXIOLYTICS|2450|||||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|.02913||.02843||.02863||||ANXIOLYTICS|2451|||||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|.04987||.04867||.04902||||ANXIOLYTICS|2452|||||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|.71117||.6941||.69908||||ANXIOLYTICS|2453|||||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|.95242||.92956||.93623||||ANXIOLYTICS|2454|||||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|1.35516||1.32264||1.33212||||ANXIOLYTICS|2455|||||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|.07905||.07715||.07771||||SEDATIVE HYPNOTICS|2456|||||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|.07905||.07715||.07771||||SEDATIVE HYPNOTICS|2457|||||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|.09652||.0942||.09488||||SEDATIVE HYPNOTICS|2458|||||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|.09652||.0942||.09488||||SEDATIVE HYPNOTICS|2459|||||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|.02647||.02583||.02602||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2460|||||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|.02647||.02583||.02602||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2461|||||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|.03613||.03526||.03552||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2462|||||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|.03613||.03526||.03552||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2463|||||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|.04157||.04057||.04086||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2464|||||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|.30653||.29917||.30132|||||2465|||||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|2466|||||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|2467|||||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|.14236||.13894||.13994||||ANTIPARKINSON'S AGENTS|2468|||||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|.14236||.13894||.13994||||ANTIPARKINSON'S AGENTS|2469|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|.14236||.13894||.13994||||ANTIPARKINSON'S AGENTS|2470|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|.1014||.09897||.09968||||NSAIDS|2471|||||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|.1014||.09897||.09968||||NSAIDS|2472|||||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|.1014||.09897||.09968||||NSAIDS|2473|||||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|.09778||.09543||.09612||||NSAIDS|2474|||||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|.09778||.09543||.09612||||NSAIDS|2475|||||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|.09778||.09543||.09612||||NSAIDS|2476|||||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|.13442||.13119||.13213|||||2477|||||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|.13442||.13119||.13213|||||2478|||||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|.12301||.12006||.12092|||||2479|||||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|.12301||.12006||.12092|||||2480|||||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|.15019||.14659||.14764|||||2481|||||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|.204||.1991||.20053|||||2482|||||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|.09645||.09414||.09481||||NEUROPATHIC PAIN|2483|||||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|.09645||.09414||.09481||||NEUROPATHIC PAIN|2484|||||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|.11004||.1074||.10817||||NEUROPATHIC PAIN|2485|||||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|.11004||.1074||.10817||||NEUROPATHIC PAIN|2486|||||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|.1882||.18368||.185||||BETA-BLOCKERS|2487|||||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|.20779||.2028||.20426||||BETA-BLOCKERS|2488|||||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|.21539||.21022||.21173||||BETA-BLOCKERS|2489|||||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|.30371||.29642||.29855||||BETA-BLOCKERS|2490|||||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|.27045||.26396||.26585|||||2491|||||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|.04755||.04641||.04674|||||2492|||||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|.04755||.04641||.04674|||||2493|||||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|.39118||.38179||.38453|||||2494|||||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|5.82978||5.68987||5.73067||||ANTIDEPRESSANTS, SSRIs|2495|||||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|5.69046||5.55389||5.59372||||ANTIDEPRESSANTS, SSRIs|2496|||||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|.19405||.18939||.19075||||STIMULANTS AND RELATED AGENTS|2497|||||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|.21719||.21198||.2135||||STIMULANTS AND RELATED AGENTS|2498|||||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|.20591||.20097||.20241||||STIMULANTS AND RELATED AGENTS|2499|||||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|.22032||.21503||.21657||||STIMULANTS AND RELATED AGENTS|2500|||||No|No||ACTAVIS/TEVA|No|||||No|No|No|| pregabalin|No|No|No|No|90%|00228286309|PREGABALIN 300 MG CAPSULE|90|EA|.08122|05/25/2021|08/28/2024|Yes|No||05/25/2021|08/28/2024|Yes|No|05/25/2021|08/28/2024|Yes|No||09/01/2022|08/28/2024|Yes|No|||Prescription Required|Yes|07/27/2023|232|Yes|.09061||.08844||.08907||||NEUROPATHIC PAIN|2501|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||TEVA USA|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|.10801||.10542||.10617||||NEUROPATHIC PAIN|2502|||||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|.0884||.08628||.0869||||NEUROPATHIC PAIN|2503|||||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|.0884||.08628||.0869||||NEUROPATHIC PAIN|2504|||||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|.10997||.10733||.1081||||NEUROPATHIC PAIN|2505|||||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|.10997||.10733||.1081||||NEUROPATHIC PAIN|2506|||||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|2507|||||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|1.65018||1.61058||1.62213||||TETRACYCLINES|2508|||||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|.33522||.32717||.32952||||CALCIUM CHANNEL BLOCKERS|2509|||||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|2510|||||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|2511|||||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|.50232||.49026||.49378||||STIMULANTS AND RELATED AGENTS|2512|||||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|.5342||.52138||.52512||||STIMULANTS AND RELATED AGENTS|2513|||||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|.64541||.62992||.63444||||STIMULANTS AND RELATED AGENTS|2514|||||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|.55116||.53793||.54179||||STIMULANTS AND RELATED AGENTS|2515|||||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|.56507||.55151||.55546||||STIMULANTS AND RELATED AGENTS|2516|||||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|.61942||.60455||.60889||||STIMULANTS AND RELATED AGENTS|2517|||||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|.14911||.14553||.14658||||ANXIOLYTICS|2518|||||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|.19879||.19402||.19541||||ANXIOLYTICS|2519|||||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|.25729||.25112||.25292||||ANXIOLYTICS|2520|||||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|.17915||.17485||.1761||||ANXIOLYTICS|2521|||||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|2522|||||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|2523|||||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|2524|||||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|2525|||||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|2526|||||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|2527|||||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|.87432||.85334||.85946||||OPIATE DEPENDENCE TREATMENTS|2528|||||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|.59147||.57727||.58142||||OPIATE DEPENDENCE TREATMENTS|2529|||||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|.92797||.9057||.91219||||OPIATE DEPENDENCE TREATMENTS|2530|||||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|2531|||||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|.56866||.55501||.55899||||OPIATE DEPENDENCE TREATMENTS|2532|||||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|3.65591||3.56817||3.59376||||SEDATIVE HYPNOTICS|2533|||||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|3.76686||3.67646||3.70282||||SEDATIVE HYPNOTICS|2534|||||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|1.12387||1.0969||1.10476||||ANTIPARKINSON'S AGENTS|2535|||||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|.55313||.53985||.54373||||ANTIPARKINSON'S AGENTS|2536|||||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|.55313||.53985||.54373||||ANTIPARKINSON'S AGENTS|2537|||||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|.81039||.79094||.79661||||ANTIPARKINSON'S AGENTS|2538|||||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|.81039||.79094||.79661||||ANTIPARKINSON'S AGENTS|2539|||||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|1.37142||1.33851||1.34811||||ANTIPARKINSON'S AGENTS|2540|||||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|1.37142||1.33851||1.34811||||ANTIPARKINSON'S AGENTS|2541|||||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|2.2818||2.22704||2.24301||||ANTIPARKINSON'S AGENTS|2542|||||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|.75771||.73952||.74483||||ANXIOLYTICS|2543|||||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|.98962||.96587||.9728||||ANXIOLYTICS|2544|||||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|1.63404||1.59482||1.60626||||ANXIOLYTICS|2545|||||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|2546|||||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|.29335||.28631||.28836||||STIMULANTS AND RELATED AGENTS|2547|||||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|.23592||.23026||.23191||||ANALGESICS, NARCOTICS LONG|2548|||||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|.37145||.36254||.36514||||ANALGESICS, NARCOTICS LONG|2549|||||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|.58585||.57179||.57589||||ANALGESICS, NARCOTICS LONG|2550|||||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|.94858||.92581||.93245||||ANALGESICS, NARCOTICS LONG|2551|||||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|1.80368||1.76039||1.77302||||ANALGESICS, NARCOTICS LONG|2552|||||No|No||ACTAVIS/TEVA|No|||||No|No|No|| sotalol HCl|No|No|No|No|75%|00245001201|SORINE 80 MG TABLET|100|EA|.68607|01/04/2017|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription Required|No|02/23/2004|070|No|.07458||.07279||.07331||||BETA-BLOCKERS|2553|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|No|||||No|No|No|| sotalol HCl|No|No|No|No|75%|00245001301|SORINE 120 MG TABLET|100|EA|.91091|01/04/2017|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription Required|No|02/23/2004|070|No|.0975||.09516||.09584||||BETA-BLOCKERS|2554|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|No|||||No|No|No|| sotalol HCl|No|No|No|No|75%|00245001401|SORINE 160 MG TABLET|100|EA|1.13593|01/04/2017|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription Required|No|02/23/2004|070|No|.17096||.16686||.16805||||BETA-BLOCKERS|2555|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|No|||||No|No|No|| sotalol HCl|No|No|No|No|75%|00245001501|SORINE 240 MG TABLET|100|EA|1.59607|01/04/2017|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription Required|No|02/23/2004|070|No|.34383||.33558||.33798||||BETA-BLOCKERS|2556|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|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|.1768||.17256||.17379||||LIPOTROPICS, OTHER|2557|||||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|.91175||.88987||.89625||||LIPOTROPICS, OTHER|2558|||||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|.91175||.88987||.89625||||LIPOTROPICS, OTHER|2559|||||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|.1709||.1668||.16799|||||2560|||||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|.24474||.23887||.24058|||||2561|||||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|.8622||.84151||.84754|||||2562|||||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|.8622||.84151||.84754|||||2563|||||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|||||2564|||||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|||||2565|||||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|||||2566|||||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|||||2567|||||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|.11046||.10781||.10858|||||2568|||||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|.16099||.15713||.15825|||||2569|||||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|.16099||.15713||.15825|||||2570|||||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|.23129||.22574||.22736|||||2571|||||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|1.25545||1.22532||1.23411|||||2572|||||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|1.25545||1.22532||1.23411|||||2573|||||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|.92853||.90625||.91274||||LIPOTROPICS, OTHER|2574|||||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|2575|||||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|14.07774||13.73987||13.83842||||ACNE AGENTS, ORAL|2576|||||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|15.54182||15.16882||15.27761||||ACNE AGENTS, ORAL|2577|||||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|14.30836||13.96496||14.06512||||ACNE AGENTS, ORAL|2578|||||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|17.60478||17.18227||17.3055||||ACNE AGENTS, ORAL|2579|||||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|383.35419||374.15369||376.83717||||ANTIMIGRAINE AGENTS, TRIPTANS|2580|||||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|108.12614||105.53111||106.288||||ANTIMIGRAINE AGENTS, TRIPTANS|2581|||||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|.76752||.7491||.75447||||ANTIBIOTICS, VAGINAL|2582|||||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|3.78375||3.69294||3.71943||||ANDROGENIC AGENTS|2583|||||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|2584|||||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|2585|||||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|2586|||||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|2587|||||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|32.74922||31.96324||32.19248||||ANTICONVULSANTS|2588|||||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|23.12284||22.56789||22.72975||||ANTICONVULSANTS|2589|||||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|30.39731||29.96306||28.53625||||ANTICONVULSANTS|2590|||||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|1.40879||1.37498||1.38484|||||2591|||||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|1.40879||1.37498||1.38484|||||2592|||||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|.26606||.25967||.26154|||||2593|||||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|.26606||.25967||.26154|||||2594|||||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|.26606||.25967||.26154|||||2595|||||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|.10815||.10555||.10631|||||2596|||||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|.10815||.10555||.10631|||||2597|||||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|.10815||.10555||.10631|||||2598|||||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|.13467||.13144||.13238|||||2599|||||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|.13467||.13144||.13238|||||2600|||||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|.13467||.13144||.13238|||||2601|||||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|.13467||.13144||.13238|||||2602|||||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|.35188||.34343||.3459|||||2603|||||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|.35188||.34343||.3459|||||2604|||||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|.14828||.14472||.14576|||||2605|||||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|.14828||.14472||.14576|||||2606|||||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|.14828||.14472||.14576|||||2607|||||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|.14828||.14472||.14576|||||2608|||||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|.14828||.14472||.14576|||||2609|||||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|1.23098||1.21339||1.15561|||||2610|||||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|1.23186||1.21426||1.15644|||||2611|||||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|2612|||||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|4.11719||4.01838||4.0472||||ANTIHYPERURICEMICS|2613|||||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|7.20049||7.02768||7.07808||||GLUCAGON AGENTS|2614|||||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|.2598||.25356||.25538|||||2615|||||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|2616|||||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|||||2617|||||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|1.72378||1.68241||1.69448||||SKELETAL MUSCLE RELAXANTS|2618|||||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|.19706||.19233||.19371||||ANTIHYPERURICEMICS|2619|||||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|4.99306||4.87323||4.90818||||ANTIFUNGALS, ORAL|2620|||||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|2621|||||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|||||2622|||||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|||||2623|||||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|||||2624|||||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|.86863||.84778||.85386||||GI MOTILITY, CHRONIC|2625|||||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|.85784||.83725||.84326||||GI MOTILITY, CHRONIC|2626|||||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|1.00841||.98421||.99127|||||2627|||||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|||||2628|||||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|||||2629|||||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|||||2630|||||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|||||2631|||||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|||||2632|||||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|||||2633|||||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|||||2634|||||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|||||2635|||||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|||||2636|||||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|||||2637|||||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|||||2638|||||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|||||2639|||||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|||||2640|||||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|||||2641|||||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|||||2642|||||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|||||2643|||||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|||||2644|||||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|||||2645|||||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|||||2646|||||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|||||2647|||||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|||||2648|||||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|||||2649|||||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|||||2650|||||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|||||2651|||||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|||||2652|||||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|||||2653|||||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|||||2654|||||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|||||2655|||||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|||||2656|||||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|||||2657|||||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|||||2658|||||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|||||2659|||||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|||||2660|||||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|.0046||.00449||.00452|||||2661|||||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|.0046||.00449||.00452|||||2662|||||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|||||2663|||||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|||||2664|||||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|||||2665|||||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|||||2666|||||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|||||2667|||||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|||||2668|||||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|||||2669|||||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|||||2670|||||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|||||2671|||||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|||||2672|||||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|||||2673|||||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|||||2674|||||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|||||2675|||||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|||||2676|||||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|||||2677|||||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|||||2678|||||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|1.21678||1.18758||1.19609|||||2679|||||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|1.21693||1.18772||1.19624|||||2680|||||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|14.10145||13.76302||13.86173||||COPD AGENTS|2681|||||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|14.10145||13.76302||13.86173||||COPD AGENTS|2682|||||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|14.17974||13.83943||13.93868||||COPD AGENTS|2683|||||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|14.17974||13.83943||13.93868||||COPD AGENTS|2684|||||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|6.412||6.25811||6.303||||ANTIPSYCHOTICS|2685|||||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|2686|||||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|15.74591||15.36801||15.47823||||ANTIPSYCHOTICS|2687|||||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|3.73421||3.64459||3.67073||||ANTIPSYCHOTICS|2688|||||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|6.1047||5.95819||6.00092||||ANTIPSYCHOTICS|2689|||||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|18.52052||18.07603||18.20567||||ANTIPSYCHOTICS|2690|||||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|2691|||||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|14.19174||13.85114||13.95048||||ANTIPSYCHOTICS|2692|||||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|15.53313||15.16033||15.26907||||ANTIPSYCHOTICS|2693|||||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|20.4601||19.96906||20.11228||||ANTIPSYCHOTICS|2694|||||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|24.00084||23.42482||23.59283||||ANTIPSYCHOTICS|2695|||||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|2696|||||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|2697|||||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|2698|||||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|2699|||||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|2700|||||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|2701|||||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|2702|||||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|2703|||||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|2704|||||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|26.27855||25.64786||25.83181||||POTASSIUM BINDERS|2705|||||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|26.27855||25.64786||25.83181||||POTASSIUM BINDERS|2706|||||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|26.2125||25.5834||25.76689||||POTASSIUM BINDERS|2707|||||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|26.2125||25.5834||25.76689||||POTASSIUM BINDERS|2708|||||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|2709|||||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|2710|||||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|2711|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|2712|||||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|2713|||||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|38.73487||37.80523||38.07638||||COPD AGENTS|2714|||||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|57.84924||56.46086||56.8658||||GLUCOCORTICOIDS, INHALED|2715|||||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|57.94915||56.55837||56.96401||||GLUCOCORTICOIDS, INHALED|2716|||||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|2717|||||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|2718|||||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|15.51325||15.14093||15.24952||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2719|||||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|15.51325||15.14093||15.24952||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2720|||||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|7.78654||7.59966||7.65417||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2721|||||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|2722|||||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|15.5404||15.16743||15.27621||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2723|||||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|18.62146||18.17454||18.3049||||HYPOGLYCEMICS, SGLT2|2724|||||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|18.63029||18.18316||18.31358||||HYPOGLYCEMICS, SGLT2|2725|||||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|18.67767||18.22941||18.36015||||HYPOGLYCEMICS, SGLT2|2726|||||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|9.31568||9.0921||9.15731||||HYPOGLYCEMICS, SGLT2|2727|||||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|18.66903||18.22097||18.35166||||HYPOGLYCEMICS, SGLT2|2728|||||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|18.60684||18.16028||18.29052||||HYPOGLYCEMICS, SGLT2|2729|||||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|681.3386||664.98647||669.75584||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2730|||||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|340.08377||331.92176||334.30235||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2731|||||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|234.16046||228.54061||230.17973||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2732|||||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|331.0725||323.12676||325.44427||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2733|||||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|223.25125||220.06195||209.58281||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2734|||||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|18.08108||17.64713||17.7737||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|2735|||||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|19.68724||19.21475||19.35256||||GLUCOCORTICOIDS, INHALED|2736|||||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|17.38152||16.96436||17.08603||||GLUCOCORTICOIDS, INHALED|2737|||||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|42.70703||41.68206||41.98101||||GLUCOCORTICOIDS, INHALED|2738|||||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|||||2739|||||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|2740|||||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|2741|||||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|||||2742|||||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|||||2743|||||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|||||2744|||||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|||||2745|||||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|||||2746|||||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|||||2747|||||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|||||2748|||||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|||||2749|||||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|||||2750|||||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|||||2751|||||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|||||2752|||||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|||||2753|||||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|||||2754|||||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|||||2755|||||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|||||2756|||||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|||||2757|||||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|||||2758|||||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|||||2759|||||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|.00182||.00178||.00179|||||2760|||||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|||||2761|||||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|||||2762|||||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|||||2763|||||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|||||2764|||||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|.00505||.00497||.00474|||||2765|||||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|||||2766|||||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|||||2767|||||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|||||2768|||||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|||||2769|||||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|||||2770|||||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|||||2771|||||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|||||2772|||||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|||||2773|||||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|||||2774|||||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|||||2775|||||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|||||2776|||||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|||||2777|||||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|||||2778|||||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|||||2779|||||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|||||2780|||||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|||||2781|||||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|||||2782|||||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|||||2783|||||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|||||2784|||||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|||||2785|||||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|||||2786|||||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|||||2787|||||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|||||2788|||||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|||||2789|||||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|||||2790|||||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|||||2791|||||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|||||2792|||||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|||||2793|||||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|||||2794|||||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|||||2795|||||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|||||2796|||||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|||||2797|||||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|||||2798|||||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|2799|||||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|2800|||||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|2801|||||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|.17536||.17115||.17238|||||2802|||||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|.01808||.01765||.01777||||BETA-BLOCKERS|2803|||||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|.01808||.01765||.01777||||BETA-BLOCKERS|2804|||||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|.02199||.02146||.02162||||BETA-BLOCKERS|2805|||||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|.02199||.02146||.02162||||BETA-BLOCKERS|2806|||||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|2807|||||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|.02792||.02725||.02745||||BETA-BLOCKERS|2808|||||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|.02792||.02725||.02745||||BETA-BLOCKERS|2809|||||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|.65364||.63795||.64253||||BETA-BLOCKERS|2810|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|.30302||.29575||.29787|||||2811|||||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|2812|||||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|2813|||||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|.09496||.09268||.09335||||ANTIPARKINSON'S AGENTS|2814|||||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|.09028||.08811||.08875||||ANTIPARKINSON'S AGENTS|2815|||||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|.13734||.13404||.13501||||ANTIPARKINSON'S AGENTS|2816|||||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|.2236||.21823||.2198||||ANTIPARKINSON'S AGENTS|2817|||||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|.71117||.6941||.69908||||BETA-BLOCKERS|2818|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|.04624||.04513||.04545||||ANTIHYPERURICEMICS|2819|||||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|.04624||.04513||.04545||||ANTIHYPERURICEMICS|2820|||||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|.13846||.13514||.13611||||ONCOLOGY, ORAL - BREAST|2821|||||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|.07149||.06977||.07027||||ANTIHYPERURICEMICS|2822|||||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|.07149||.06977||.07027||||ANTIHYPERURICEMICS|2823|||||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|.05812||.05673||.05713||||BETA-BLOCKERS|2824|||||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|.05812||.05673||.05713||||BETA-BLOCKERS|2825|||||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|.06207||.06058||.06101||||BETA-BLOCKERS|2826|||||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|.06207||.06058||.06101||||BETA-BLOCKERS|2827|||||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|.09634||.09403||.0947||||BETA-BLOCKERS|2828|||||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|.09634||.09403||.0947||||BETA-BLOCKERS|2829|||||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|.18529||.18084||.18214||||BETA-BLOCKERS|2830|||||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|.18529||.18084||.18214||||BETA-BLOCKERS|2831|||||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|.21467||.20952||.21102||||BETA-BLOCKERS|2832|||||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|||||2833|||||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|||||2834|||||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|||||2835|||||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|.15337||.14969||.15076|||||2836|||||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|.15337||.14969||.15076|||||2837|||||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|.25046||.24445||.2462||||ANTIPSYCHOTICS|2838|||||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|.25046||.24445||.2462||||ANTIPSYCHOTICS|2839|||||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|||||2840|||||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|||||2841|||||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|.02334||.02278||.02294||||BETA-BLOCKERS|2842|||||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|.02334||.02278||.02294||||BETA-BLOCKERS|2843|||||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|2844|||||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|.09323||.09099||.09165|||||2845|||||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|.09323||.09099||.09165|||||2846|||||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|.02708||.02643||.02662||||BETA-BLOCKERS|2847|||||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|.02708||.02643||.02662||||BETA-BLOCKERS|2848|||||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|||||2849|||||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|.10335||.10087||.10159|||||2850|||||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|.188||.18349||.1848||||ANTIPSYCHOTICS|2851|||||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|.188||.18349||.1848||||ANTIPSYCHOTICS|2852|||||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|.02209||.02156||.02171||||ANXIOLYTICS|2853|||||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|.02209||.02156||.02171||||ANXIOLYTICS|2854|||||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|.29418||.28712||.28918||||ONCOLOGY, ORAL - BREAST|2855|||||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|||||2856|||||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|||||2857|||||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|.25025||.24424||.246|||||2858|||||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|.29969||.2925||.2946||||ANTIPSYCHOTICS|2859|||||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|.29969||.2925||.2946||||ANTIPSYCHOTICS|2860|||||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|2861|||||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|.33439||.32636||.32871||||ANTIPSYCHOTICS|2862|||||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|.54482||.53174||.53556||||ANTIPSYCHOTICS|2863|||||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|.02811||.02744||.02763||||ANXIOLYTICS|2864|||||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|.02811||.02744||.02763||||ANXIOLYTICS|2865|||||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|.14924||.14566||.1467||||ANTIPSYCHOTICS|2866|||||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|.14924||.14566||.1467||||ANTIPSYCHOTICS|2867|||||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|.39657||.38705||.38983|||||2868|||||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|2869|||||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|1.10754||1.08096||1.08871||||MULTIPLE SCLEROSIS AGENTS|2870|||||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|.57324||.55948||.56349|||||2871|||||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|.79556||.77647||.78204||||BETA-BLOCKERS|2872|||||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|1.31735||1.28573||1.29496||||BETA-BLOCKERS|2873|||||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|.20132||.19649||.1979|||||2874|||||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|2875|||||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|2876|||||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|.15846||.15466||.15577||||ANTICONVULSANTS|2877|||||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|.15846||.15466||.15577||||ANTICONVULSANTS|2878|||||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|.19604||.19134||.19271||||ANTICONVULSANTS|2879|||||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|.19604||.19134||.19271||||ANTICONVULSANTS|2880|||||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|.03014||.02942||.02963||||ANXIOLYTICS|2881|||||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|.03014||.02942||.02963||||ANXIOLYTICS|2882|||||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|.25113||.2451||.24686||||BETA-BLOCKERS|2883|||||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|.22943||.22392||.22553||||BETA-BLOCKERS|2884|||||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|.22511||.21971||.22128||||BETA-BLOCKERS|2885|||||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|.98937||.96563||.97255|||||2886|||||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|2887|||||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|.4195||.40943||.41237||||ANTIPSYCHOTICS|2888|||||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|.49997||.48797||.49147||||ANTIPSYCHOTICS|2889|||||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|.6616||.64572||.65035||||ANTIPSYCHOTICS|2890|||||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|2891|||||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|.04955||.04836||.04871||||GLUCOCORTICOIDS, ORAL|2892|||||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|.04955||.04836||.04871||||GLUCOCORTICOIDS, ORAL|2893|||||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|.06166||.06018||.06061||||GLUCOCORTICOIDS, ORAL|2894|||||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|.06166||.06018||.06061||||GLUCOCORTICOIDS, ORAL|2895|||||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|.08552||.08347||.08407||||GLUCOCORTICOIDS, ORAL|2896|||||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|.08552||.08347||.08407||||GLUCOCORTICOIDS, ORAL|2897|||||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|.08552||.08347||.08407||||GLUCOCORTICOIDS, ORAL|2898|||||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|2899|||||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|.04191||.0409||.0412||||BETA-BLOCKERS|2900|||||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|.04191||.0409||.0412||||BETA-BLOCKERS|2901|||||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|.26149||.25521||.25704||||ANTIPSYCHOTICS|2902|||||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|.65416||.63846||.64304||||ANTIPSYCHOTICS|2903|||||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|.65416||.63846||.64304||||ANTIPSYCHOTICS|2904|||||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|6.77783||6.61516||6.66261||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2905|||||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|10.51964||10.26717||10.34081||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2906|||||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|14.15201||13.81236||13.91143||||ANTIHYPERTENSIVES, SYMPATHOLYTICS|2907|||||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|87.1725||85.08036||85.69057||||ANTIVIRALS, TOPICAL|2908|||||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|2909|||||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|2910|||||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|.5187||.50625||.50988||||ANTIPSYCHOTICS|2911|||||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|1.30082||1.2696||1.27871||||ANTIPSYCHOTICS|2912|||||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|.09481||.09253||.0932||||ANTIDEPRESSANTS, TRICYCLIC|2913|||||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|.09481||.09253||.0932||||ANTIDEPRESSANTS, TRICYCLIC|2914|||||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|2.41556||2.35759||2.3745||||ANGIOTENSIN MODULATOR COMBINATIONS|2915|||||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|2.0593||2.00988||2.02429||||ANGIOTENSIN MODULATOR COMBINATIONS|2916|||||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|2.82192||2.75419||2.77395||||ANGIOTENSIN MODULATOR COMBINATIONS|2917|||||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|2.7328||2.66721||2.68634||||ANGIOTENSIN MODULATOR COMBINATIONS|2918|||||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|.19706||.19233||.19371||||ANTIHYPERURICEMICS|2919|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|.14449||.14102||.14203|||||2920|||||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|.14449||.14102||.14203|||||2921|||||No|No||MYLAN|No|||||No|No|No|| glipizide|Yes|No|No|No|75%|00378111001|GLIPIZIDE 10 MG TABLET|100|EA|.03999|03/01/2002|08/31/2024|Yes|No||03/01/2002|08/31/2024|Yes|No|03/01/2002|08/31/2024|Yes|No||03/01/2002|08/31/2024|Yes|No|07/01/2016|08/31/2024|Prescription Required|No|||No|.09114||.08984||.08556|||||2922|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No|| glipizide|Yes|No|No|No|75%|00378111005|GLIPIZIDE 10 MG TABLET|500|EA|.03784|03/01/2002|08/31/2024|Yes|No||03/01/2002|08/31/2024|Yes|No|03/01/2002|08/31/2024|Yes|No||03/01/2002|08/31/2024|Yes|No|07/01/2016|08/31/2024|Prescription Required|No|||No|.08624||.08501||.08096|||||2923|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|.14236||.13894||.13994||||ANTIPARKINSON'S AGENTS|2924|||||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|.40372||.39403||.39686||||NSAIDS|2925|||||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|.02423||.02365||.02382||||ANXIOLYTICS|2926|||||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|.02423||.02365||.02382||||ANXIOLYTICS|2927|||||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|.12783||.12476||.12566||||ANXIOLYTICS|2928|||||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|.03491||.03407||.03432||||ANXIOLYTICS|2929|||||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|.03491||.03407||.03432||||ANXIOLYTICS|2930|||||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|.05068||.04946||.04982||||ANXIOLYTICS|2931|||||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|.05068||.04946||.04982||||ANXIOLYTICS|2932|||||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|.1396||.13625||.13723||||ANXIOLYTICS|2933|||||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|2934|||||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|.21776||.21253||.21406|||||2935|||||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|.21776||.21253||.21406|||||2936|||||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|.5962||.58189||.58606||||ULCERATIVE COLITIS AGENTS|2937|||||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|.38826||.37894||.38166||||ANTIMIGRAINE AGENTS, TRIPTANS|2938|||||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|.26225||.25596||.25779|||||2939|||||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|.39742||.38788||.39066||||ANTIFUNGALS, ORAL|2940|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|1.86086||1.8162||1.82923||||ANTIFUNGALS, ORAL|2941|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|.43235||.42197||.425||||ANGIOTENSIN MODULATOR COMBINATIONS|2942|||||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|.53949||.52654||.53032||||ANGIOTENSIN MODULATOR COMBINATIONS|2943|||||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|.61757||.60275||.60707||||ANGIOTENSIN MODULATOR COMBINATIONS|2944|||||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|.6333||.6181||.62253||||ANGIOTENSIN MODULATOR COMBINATIONS|2945|||||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|.0489||.04773||.04807|||||2946|||||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|.05924||.05782||.05823|||||2947|||||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|.05924||.05782||.05823|||||2948|||||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|.06556||.06399||.06445|||||2949|||||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|.06556||.06399||.06445|||||2950|||||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|.0628||.06129||.06173|||||2951|||||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|.0628||.06129||.06173|||||2952|||||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|.0627||.0612||.06163|||||2953|||||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|.0627||.0612||.06163|||||2954|||||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|.07652||.07468||.07522|||||2955|||||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|.07652||.07468||.07522|||||2956|||||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|.09546||.09317||.09384|||||2957|||||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|.09546||.09317||.09384|||||2958|||||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|.08214||.08017||.08074|||||2959|||||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|.08214||.08017||.08074|||||2960|||||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|.11444||.11169||.11249|||||2961|||||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|.11444||.11169||.11249|||||2962|||||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|.10161||.09917||.09988|||||2963|||||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|.10161||.09917||.09988|||||2964|||||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|.13136||.12821||.12913|||||2965|||||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|.0822||.08023||.0808|||||2966|||||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|.0822||.08023||.0808|||||2967|||||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|.11046||.10781||.10858|||||2968|||||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|.16099||.15713||.15825|||||2969|||||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|.23129||.22574||.22736|||||2970|||||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|.39942||.38983||.39263||||COPD AGENTS|2971|||||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|.39942||.38983||.39263||||COPD AGENTS|2972|||||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|.55946||.54603||.54995||||HIV / AIDS|2973|||||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|2974|||||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|2975|||||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|2976|||||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|2977|||||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|2978|||||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|2979|||||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|2980|||||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|2981|||||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|.17237||.16823||.16944||||IMMUNOSUPPRESSIVES, ORAL|2982|||||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|.18077||.17643||.1777||||IMMUNOSUPPRESSIVES, ORAL|2983|||||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|.94148||.91888||.92547||||IMMUNOSUPPRESSIVES, ORAL|2984|||||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|5.54356||5.41051||5.44932||||PROTON PUMP INHIBITORS|2985|||||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|5.46252||5.33142||5.36966||||PROTON PUMP INHIBITORS|2986|||||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|5.46252||5.33142||5.36966||||PROTON PUMP INHIBITORS|2987|||||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|3.35201||3.27156||3.29503||||CALCIUM CHANNEL BLOCKERS|2988|||||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|3.72616||3.63673||3.66282||||CALCIUM CHANNEL BLOCKERS|2989|||||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|2990|||||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|3.78981||3.69885||3.72538||||CALCIUM CHANNEL BLOCKERS|2991|||||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|.17435||.17017||.17139|||||2992|||||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|.17435||.17017||.17139|||||2993|||||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|.0539||.05261||.05298|||||2994|||||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|.0539||.05261||.05298|||||2995|||||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|2996|||||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|.50016||.48816||.49166||||ONCOLOGY, ORAL - HEMATOLOGIC|2997|||||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|2.07293||2.02318||2.03769||||ONCOLOGY, ORAL - HEMATOLOGIC|2998|||||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|.19573||.19103||.1924||||IMMUNOSUPPRESSIVES, ORAL|2999|||||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|.19573||.19103||.1924||||IMMUNOSUPPRESSIVES, ORAL|3000|||||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|.14726||.14373||.14476|||||3001|||||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|.14726||.14373||.14476|||||3002|||||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|1.51856||1.48211||1.49274||||ANTICONVULSANTS|3003|||||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|2.64965||2.58606||2.60461||||ANTICONVULSANTS|3004|||||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|.18797||.18346||.18477||||PROTON PUMP INHIBITORS|3005|||||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|.16104||.15718||.1583||||PROTON PUMP INHIBITORS|3006|||||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|.49946||.48747||.49097||||ANTIPSYCHOTICS|3007|||||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|.67942||.66311||.66787||||ANTIPSYCHOTICS|3008|||||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|.70692||.68995||.6949||||ANTIPSYCHOTICS|3009|||||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|1.27724||1.24659||1.25553||||ANTIPSYCHOTICS|3010|||||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|3011|||||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|.15122||.14759||.14865||||ANGIOTENSIN MODULATORS|3012|||||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|3013|||||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|1.34666||1.31434||1.32377||||ANGIOTENSIN MODULATORS|3014|||||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|1.39891||1.36534||1.37513||||ANGIOTENSIN MODULATORS|3015|||||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|1.39349||1.36005||1.3698||||ANGIOTENSIN MODULATORS|3016|||||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|.09921||.09683||.09752||||LIPOTROPICS, OTHER|3017|||||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|.13807||.13476||.13572||||LIPOTROPICS, OTHER|3018|||||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|.13807||.13476||.13572||||LIPOTROPICS, OTHER|3019|||||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|3020|||||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|20.37932||19.89022||20.03287||||ONCOLOGY, ORAL - RENAL CELL|3021|||||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|3022|||||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|3023|||||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|.148||.14445||.14548||||ANTIDEPRESSANTS, TRICYCLIC|3024|||||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|.148||.14445||.14548||||ANTIDEPRESSANTS, TRICYCLIC|3025|||||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|.24843||.24247||.24421|||||3026|||||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|.24843||.24247||.24421|||||3027|||||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|.62661||.61157||.61596||||ANGIOTENSIN MODULATORS|3028|||||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|.62661||.61157||.61596||||ANGIOTENSIN MODULATORS|3029|||||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|.6144||.59965||.60396||||ANGIOTENSIN MODULATORS|3030|||||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|.6144||.59965||.60396||||ANGIOTENSIN MODULATORS|3031|||||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|.52823||.51555||.51925||||ANGIOTENSIN MODULATORS|3032|||||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|.52823||.51555||.51925||||ANGIOTENSIN MODULATORS|3033|||||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|.91841||.89637||.9028||||ANGIOTENSIN MODULATORS|3034|||||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|.91841||.89637||.9028||||ANGIOTENSIN MODULATORS|3035|||||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|||||3036|||||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|39.10623||38.16768||38.44142|||||3037|||||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|13.13324||12.81804||12.90997|||||3038|||||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|11.65608||11.37633||11.45793|||||3039|||||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|13.51606||13.19167||13.28629|||||3040|||||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|11.97798||11.69051||11.77435|||||3041|||||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|11.8466||11.56228||11.64521|||||3042|||||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|11.10763||10.84105||10.9188|||||3043|||||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|.2384||.23268||.23435||||STIMULANTS AND RELATED AGENTS|3044|||||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|.70696||.68999||.69494||||STIMULANTS AND RELATED AGENTS|3045|||||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|.82515||.80535||.81112||||STIMULANTS AND RELATED AGENTS|3046|||||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|3.29244||3.21342||3.23647||||INTRANASAL RHINITIS AGENTS|3047|||||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|.07188||.07015||.07066||||ANTIDEPRESSANTS, OTHER|3048|||||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|.07188||.07015||.07066||||ANTIDEPRESSANTS, OTHER|3049|||||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|3050|||||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|.08607||.084||.08461||||ANTIDEPRESSANTS, OTHER|3051|||||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|.08607||.084||.08461||||ANTIDEPRESSANTS, OTHER|3052|||||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|.12661||.12357||.12446||||ANTIDEPRESSANTS, OTHER|3053|||||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|.12661||.12357||.12446||||ANTIDEPRESSANTS, OTHER|3054|||||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|.92704||.90479||.91128||||ONCOLOGY, ORAL - HEMATOLOGIC|3055|||||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|.92704||.90479||.91128||||ONCOLOGY, ORAL - HEMATOLOGIC|3056|||||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|.01929||.01883||.01896||||BETA-BLOCKERS|3057|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|.01929||.01883||.01896||||BETA-BLOCKERS|3058|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|.02288||.02233||.02249||||BETA-BLOCKERS|3059|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|.02984||.02912||.02933||||BETA-BLOCKERS|3060|||||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|.02984||.02912||.02933||||BETA-BLOCKERS|3061|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|.053||.05173||.0521||||ANTIHISTAMINES, MINIMALLY SEDATING|3062|||||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|.06437||.06283||.06328||||ANTIHISTAMINES, MINIMALLY SEDATING|3063|||||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|.06437||.06283||.06328||||ANTIHISTAMINES, MINIMALLY SEDATING|3064|||||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|2.0883||2.03818||2.0528||||ANTICONVULSANTS|3065|||||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|2.0883||2.03818||2.0528||||ANTICONVULSANTS|3066|||||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|3067|||||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|18.76788||18.31745||18.44883||||ANTIPSYCHOTICS|3068|||||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|.03016||.02944||.02965||||LIPOTROPICS, STATINS|3069|||||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|.03016||.02944||.02965||||LIPOTROPICS, STATINS|3070|||||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|.03661||.03573||.03599||||LIPOTROPICS, STATINS|3071|||||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|.03661||.03573||.03599||||LIPOTROPICS, STATINS|3072|||||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|.05122||.04999||.05035||||LIPOTROPICS, STATINS|3073|||||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|.05122||.04999||.05035||||LIPOTROPICS, STATINS|3074|||||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|.08427||.08225||.08284||||LIPOTROPICS, STATINS|3075|||||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|.08427||.08225||.08284||||LIPOTROPICS, STATINS|3076|||||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|.11454||.11179||.11259||||HIV / AIDS|3077|||||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|.61037||.59572||.59999||||HIV / AIDS|3078|||||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|.35921||.35059||.3531|||||3079|||||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|2.18411||2.13169||2.14698|||||3080|||||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|.17444||.17025||.17147||||ANTIDEPRESSANTS, TRICYCLIC|3081|||||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|.17444||.17025||.17147||||ANTIDEPRESSANTS, TRICYCLIC|3082|||||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|3083|||||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|3084|||||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|.27153||.26501||.26691||||ANTIVIRALS, ORAL|3085|||||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|.27153||.26501||.26691||||ANTIVIRALS, ORAL|3086|||||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|.49609||.48418||.48766||||ANTIVIRALS, ORAL|3087|||||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|.49609||.48418||.48766||||ANTIVIRALS, ORAL|3088|||||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|2.49633||2.43642||2.45389||||ANTIMIGRAINE AGENTS, TRIPTANS|3089|||||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|2.36558||2.30881||2.32537||||ANTIMIGRAINE AGENTS, TRIPTANS|3090|||||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|2.36558||2.30881||2.32537||||ANTIMIGRAINE AGENTS, TRIPTANS|3091|||||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|5.40163||5.27199||5.3098||||LIPOTROPICS, OTHER|3092|||||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|17.12432||16.71334||16.83321||||LIPOTROPICS, OTHER|3093|||||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|.28413||.27731||.2793||||IMMUNOSUPPRESSIVES, ORAL|3094|||||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|.28413||.27731||.2793||||IMMUNOSUPPRESSIVES, ORAL|3095|||||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|24.847||24.25067||24.4246||||ULCERATIVE COLITIS AGENTS|3096|||||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|.77568||.75706||.76249||||LIPOTROPICS, STATINS|3097|||||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|1.64777||1.60822||1.61976||||LIPOTROPICS, STATINS|3098|||||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|1.09708||1.07075||1.07843||||LIPOTROPICS, STATINS|3099|||||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|1.20105||1.17222||1.18063||||LIPOTROPICS, STATINS|3100|||||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|1.55526||1.51793||1.52882||||LIPOTROPICS, STATINS|3101|||||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|9.75175||9.51771||9.58597||||MULTIPLE SCLEROSIS AGENTS|3102|||||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|.13041||.12728||.12819|||||3103|||||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|.13041||.12728||.12819|||||3104|||||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|.13065||.12751||.12843|||||3105|||||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|.13065||.12751||.12843|||||3106|||||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|.06385||.06232||.06276||||BETA-BLOCKERS|3107|||||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|.06385||.06232||.06276||||BETA-BLOCKERS|3108|||||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|.06663||.06503||.0655||||BETA-BLOCKERS|3109|||||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|.06663||.06503||.0655||||BETA-BLOCKERS|3110|||||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|.10118||.09875||.09946||||BETA-BLOCKERS|3111|||||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|.10118||.09875||.09946||||BETA-BLOCKERS|3112|||||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|.22349||.21813||.21969||||BETA-BLOCKERS|3113|||||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|.22349||.21813||.21969||||BETA-BLOCKERS|3114|||||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|7.2583||7.0841||7.13491|||||3115|||||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|7.91407||7.72413||7.77953|||||3116|||||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|6.5997||6.44131||6.48751|||||3117|||||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|7.39795||7.2204||7.27218|||||3118|||||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|6.919||6.75294||6.80138|||||3119|||||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|6.919||6.75294||6.80138|||||3120|||||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|7.39795||7.2204||7.27218|||||3121|||||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|6.5997||6.44131||6.48751|||||3122|||||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|7.91407||7.72413||7.77953|||||3123|||||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|7.2583||7.0841||7.13491|||||3124|||||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|4.18785||4.08734||4.11666||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3125|||||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|5.11576||4.99298||5.02879||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3126|||||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|5.11576||4.99298||5.02879||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3127|||||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|1.83628||1.79221||1.80506||||ACNE AGENTS, TOPICAL|3128|||||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|1.66799||1.62796||1.63963||||ACNE AGENTS, TOPICAL|3129|||||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|1.4987||1.46273||1.47322||||HIV / AIDS|3130|||||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|2.02987||1.98115||1.99536||||LIPOTROPICS, STATINS|3131|||||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|1.88173||1.83657||1.84974||||LIPOTROPICS, STATINS|3132|||||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|1.99761||1.94967||1.96365||||LIPOTROPICS, STATINS|3133|||||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|.39421||.38475||.38751||||PLATELET AGGREGATION INHIBITORS|3134|||||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|.30675||.29939||.30154||||PLATELET AGGREGATION INHIBITORS|3135|||||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|.15723||.15346||.15456||||SEDATIVE HYPNOTICS|3136|||||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|.11002||.10738||.10815||||SEDATIVE HYPNOTICS|3137|||||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|.11487||.11211||.11292||||SEDATIVE HYPNOTICS|3138|||||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|.28087||.27413||.2761||||ANTIDEPRESSANTS, TRICYCLIC|3139|||||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|.28087||.27413||.2761||||ANTIDEPRESSANTS, TRICYCLIC|3140|||||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|2.61894||2.55609||2.57442||||OPHTHALMIC ANTIBIOTICS|3141|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|.40113||.3915||.39431||||ANTIPSYCHOTICS|3142|||||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|.49112||.47933||.48277||||ANTIPSYCHOTICS|3143|||||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|.71154||.69446||.69944||||ANTIPSYCHOTICS|3144|||||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|.81358||.79405||.79975||||ANTIPSYCHOTICS|3145|||||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|.08403||.08201||.0826||||ANTICONVULSANTS|3146|||||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|.08403||.08201||.0826||||ANTICONVULSANTS|3147|||||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|.12688||.12383||.12472||||ANTICONVULSANTS|3148|||||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|.12688||.12383||.12472||||ANTICONVULSANTS|3149|||||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|.38009||.37097||.37363||||ANTIMIGRAINE AGENTS, TRIPTANS|3150|||||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|.40127||.39164||.39445||||ANTIMIGRAINE AGENTS, TRIPTANS|3151|||||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|.48126||.46971||.47308||||ANTIMIGRAINE AGENTS, TRIPTANS|3152|||||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|.14471||.14124||.14225||||ANGIOTENSIN MODULATORS|3153|||||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|.14686||.14334||.14436||||ANGIOTENSIN MODULATORS|3154|||||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|.18148||.17712||.17839||||ANGIOTENSIN MODULATORS|3155|||||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|.23003||.22451||.22612||||ANGIOTENSIN MODULATORS|3156|||||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|.37918||.37008||.37273||||HYPOGLYCEMICS, METFORMINS|3157|||||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|.16394||.16001||.16115||||HYPOGLYCEMICS, METFORMINS|3158|||||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|2.03755||1.98865||2.00291||||CALCIUM CHANNEL BLOCKERS|3159|||||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|1.89501||1.84953||1.86279||||CALCIUM CHANNEL BLOCKERS|3160|||||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|2.79633||2.72922||2.74879||||CALCIUM CHANNEL BLOCKERS|3161|||||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|.27225||.26572||.26762|||||3162|||||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|.29642||.28931||.29138|||||3163|||||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|.38377||.37456||.37725|||||3164|||||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|.02582||.0252||.02538||||ANTIDEPRESSANTS, SSRIs|3165|||||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|.02582||.0252||.02538||||ANTIDEPRESSANTS, SSRIs|3166|||||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|.03199||.03122||.03145||||ANTIDEPRESSANTS, SSRIs|3167|||||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|.03199||.03122||.03145||||ANTIDEPRESSANTS, SSRIs|3168|||||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|.04627||.04516||.04548||||ANTIDEPRESSANTS, SSRIs|3169|||||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|.04627||.04516||.04548||||ANTIDEPRESSANTS, SSRIs|3170|||||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|1.14912||1.12154||1.12958||||CALCIUM CHANNEL BLOCKERS|3171|||||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|.16485||.16089||.16205||||ANGIOTENSIN MODULATORS|3172|||||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|.18735||.18285||.18417||||ANGIOTENSIN MODULATORS|3173|||||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|.19937||.19459||.19598||||ANGIOTENSIN MODULATORS|3174|||||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|.25113||.2451||.24686||||ANGIOTENSIN MODULATORS|3175|||||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|.26243||.25613||.25797||||ANGIOTENSIN MODULATORS|3176|||||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|.53384||.52103||.52476|||||3177|||||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|1.1624||1.1345||1.14264||||CALCIUM CHANNEL BLOCKERS|3178|||||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|.27432||.26774||.26966||||ANTIDEPRESSANTS, TRICYCLIC|3179|||||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|.27432||.26774||.26966||||ANTIDEPRESSANTS, TRICYCLIC|3180|||||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|1.19345||1.16481||1.17316||||CALCIUM CHANNEL BLOCKERS|3181|||||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|6.60624||6.44769||6.49393||||ANTIEMETIC/ANTIVERTIGO AGENTS|3182|||||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|6.60624||6.44769||6.49393||||ANTIEMETIC/ANTIVERTIGO AGENTS|3183|||||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|6.60624||6.44769||6.49393||||ANTIEMETIC/ANTIVERTIGO AGENTS|3184|||||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|.13918||.13584||.13681|||||3185|||||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|1.72459||1.6832||1.69527||||ACNE AGENTS, ORAL|3186|||||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|2.43247||2.37409||2.39112||||ACNE AGENTS, ORAL|3187|||||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|2.49678||2.43686||2.45433||||ACNE AGENTS, ORAL|3188|||||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|3189|||||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|3190|||||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|3191|||||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|3192|||||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|.04741||.04627||.0466||||PROTON PUMP INHIBITORS|3193|||||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|.05198||.05073||.0511||||PROTON PUMP INHIBITORS|3194|||||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|.05198||.05073||.0511||||PROTON PUMP INHIBITORS|3195|||||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|5.53361||5.4008||5.43954||||STIMULANTS AND RELATED AGENTS|3196|||||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|4.41791||4.31188||4.34281||||STIMULANTS AND RELATED AGENTS|3197|||||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|3.94657||3.85185||3.87948||||STIMULANTS AND RELATED AGENTS|3198|||||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|4.1178||4.01897||4.0478||||STIMULANTS AND RELATED AGENTS|3199|||||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|5.43974||5.30919||5.34726||||STIMULANTS AND RELATED AGENTS|3200|||||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|5.79148||5.65248||5.69302||||STIMULANTS AND RELATED AGENTS|3201|||||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|4.62673||4.51569||4.54808||||STIMULANTS AND RELATED AGENTS|3202|||||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|.85771||.83712||.84313||||ONCOLOGY, ORAL - PROSTATE|3203|||||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|11.25577||10.98563||11.06442||||ONCOLOGY, ORAL - PROSTATE|3204|||||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|||||3205|||||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|46.54105||45.42406||45.74985||||MULTIPLE SCLEROSIS AGENTS|3206|||||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|112.99272||110.28089||111.07184||||MULTIPLE SCLEROSIS AGENTS|3207|||||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|2.92777||2.8575||2.878||||PROTON PUMP INHIBITORS|3208|||||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|2.28058||2.22585||2.24181||||PROTON PUMP INHIBITORS|3209|||||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|3.84996||3.75756||3.78451||||BRONCHODILATORS, BETA AGONIST|3210|||||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|.06795||.06632||.06679||||ANTIDEPRESSANTS, SSRIs|3211|||||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|.06795||.06632||.06679||||ANTIDEPRESSANTS, SSRIs|3212|||||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|.06983||.06815||.06864||||ANTIDEPRESSANTS, SSRIs|3213|||||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|.06983||.06815||.06864||||ANTIDEPRESSANTS, SSRIs|3214|||||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|.09907||.09669||.09739||||ANTIDEPRESSANTS, SSRIs|3215|||||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|.09907||.09669||.09739||||ANTIDEPRESSANTS, SSRIs|3216|||||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|.11753||.11471||.11553||||ANTIDEPRESSANTS, SSRIs|3217|||||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|.11753||.11471||.11553||||ANTIDEPRESSANTS, SSRIs|3218|||||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|3219|||||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|3220|||||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|4.78889||4.67396||4.70748|||||3221|||||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|5.7987||5.65953||5.70012|||||3222|||||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|16.2152||15.82604||15.93954||||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|3223|||||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|17.18094||16.7686||16.88886||||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|3224|||||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|.20671||.20175||.2032||||BRONCHODILATORS, BETA AGONIST|3225|||||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|.20584||.2009||.20234||||BRONCHODILATORS, BETA AGONIST|3226|||||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|3.41974||3.33767||3.3616||||ANTIPARKINSON'S AGENTS|3227|||||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|3.41974||3.33767||3.3616||||ANTIPARKINSON'S AGENTS|3228|||||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|.08093||.07899||.07955||||LIPOTROPICS, OTHER|3229|||||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|.10481||.10229||.10303||||LIPOTROPICS, OTHER|3230|||||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|.0149||.01454||.01465||||HYPOGLYCEMICS, METFORMINS|3231|||||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|.02443||.02384||.02401||||HYPOGLYCEMICS, METFORMINS|3232|||||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|.02514||.02454||.02471||||HYPOGLYCEMICS, METFORMINS|3233|||||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|.10642||.10387||.10461|||||3234|||||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|.50143||.4894||.49291|||||3235|||||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|.23387||.22826||.22989|||||3236|||||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|.22081||.21551||.21706|||||3237|||||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|.14183||.13843||.13942|||||3238|||||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|.24757||.24163||.24336|||||3239|||||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|.18548||.18103||.18233|||||3240|||||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|.19122||.18663||.18797|||||3241|||||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|.16104||.15718||.1583|||||3242|||||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|.35044||.34203||.34448|||||3243|||||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|.10642||.10387||.10461|||||3244|||||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|.66136||.64549||.65012|||||3245|||||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|.75875||.74054||.74585|||||3246|||||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|.19599||.19129||.19266|||||3247|||||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|.37309||.36414||.36675|||||3248|||||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|.209||.20398||.20545|||||3249|||||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|.17726||.17301||.17425|||||3250|||||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|1.06607||1.04048||1.04795|||||3251|||||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|.5828||.56881||.57289|||||3252|||||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|.40161||.39197||.39478|||||3253|||||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|1.68613||1.64566||1.65747|||||3254|||||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|1.67606||1.63583||1.64757|||||3255|||||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|20.43627||19.9458||20.08885||||GLUCOCORTICOIDS, INHALED|3256|||||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|23.36849||22.80765||22.97123||||GLUCOCORTICOIDS, INHALED|3257|||||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|.17662||.17238||.17362||||PROTON PUMP INHIBITORS|3258|||||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|3.27838||3.1997||3.22265||||LIPOTROPICS, STATINS|3259|||||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|3.27838||3.1997||3.22265||||LIPOTROPICS, STATINS|3260|||||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|2.32057||2.26488||2.28112||||LIPOTROPICS, STATINS|3261|||||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|2.32057||2.26488||2.28112||||LIPOTROPICS, STATINS|3262|||||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|.10807||.10548||.10623||||PROTON PUMP INHIBITORS|3263|||||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|.10807||.10548||.10623||||PROTON PUMP INHIBITORS|3264|||||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|.10807||.10548||.10623||||PROTON PUMP INHIBITORS|3265|||||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|3266|||||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|3267|||||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|3268|||||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|3269|||||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|.79859||.77942||.78501||||ACNE AGENTS, TOPICAL|3270|||||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|.84085||.82067||.82656||||ACNE AGENTS, TOPICAL|3271|||||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|1.7424||1.70058||1.71278||||ACNE AGENTS, TOPICAL|3272|||||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|1.52912||1.49242||1.50312||||ACNE AGENTS, TOPICAL|3273|||||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|2.19406||2.1414||2.15676||||ACNE AGENTS, TOPICAL|3274|||||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|1.89377||1.84832||1.86158||||ACNE AGENTS, TOPICAL|3275|||||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|2.94523||2.87454||2.89516||||ACNE AGENTS, TOPICAL|3276|||||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|2.76766||2.70124||2.72061||||ACNE AGENTS, TOPICAL|3277|||||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|3.08651||3.01243||3.03404||||ACNE AGENTS, TOPICAL|3278|||||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|2.38874||2.33141||2.34813||||ACNE AGENTS, TOPICAL|3279|||||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|3.87039||3.7775||3.80459||||ACNE AGENTS, TOPICAL|3280|||||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|8.35586||8.15532||8.21381||||ACNE AGENTS, TOPICAL|3281|||||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|5.69178||5.55518||5.59502||||ACNE AGENTS, TOPICAL|3282|||||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|7.48073||7.30119||7.35356||||ACNE AGENTS, TOPICAL|3283|||||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|7.17219||7.00006||7.05026||||ACNE AGENTS, TOPICAL|3284|||||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|8.3536||8.15311||8.21159|||||3285|||||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|||||3286|||||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|||||3287|||||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|3288|||||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|4.18689||4.0864||4.11571||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3289|||||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|9.35388||9.12939||9.19486||||HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS|3290|||||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|3291|||||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|.68292||.66653||.67131||||ACNE AGENTS, TOPICAL|3292|||||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|.65463||.63892||.6435||||ACNE AGENTS, TOPICAL|3293|||||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|3294|||||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|9.80127||9.56604||9.63465||||STIMULANTS AND RELATED AGENTS|3295|||||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|10.25944||10.01321||10.08503||||STIMULANTS AND RELATED AGENTS|3296|||||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|9.3287||9.10481||9.17011||||STIMULANTS AND RELATED AGENTS|3297|||||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|9.6026||9.37214||9.43936||||STIMULANTS AND RELATED AGENTS|3298|||||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|.06964||.06797||.06846||||BRONCHODILATORS, BETA AGONIST|3299|||||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|.0622||.06071||.06114||||BRONCHODILATORS, BETA AGONIST|3300|||||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|.66965||.65358||.65827||||ACNE AGENTS, TOPICAL|3301|||||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|.77754||.75888||.76432||||ANTIVIRALS, TOPICAL|3302|||||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|2.83941||2.77126||2.79114||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|3303|||||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|2.63709||2.5738||2.59226||||OPHTHALMICS, ANTI-INFLAMMATORY/IMMUNOMODULATOR|3304|||||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|2.04416||1.9951||2.00941||.||OPIATE DEPENDENCE TREATMENTS|3305|||||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|2.04416||1.9951||2.00941||||OPIATE DEPENDENCE TREATMENTS|3306|||||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|3.49069||3.40691||3.43135||.||OPIATE DEPENDENCE TREATMENTS|3307|||||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|3.49069||3.40691||3.43135||||OPIATE DEPENDENCE TREATMENTS|3308|||||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|2.38148||2.32432||2.34099||.||OPIATE DEPENDENCE TREATMENTS|3309|||||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|2.38148||2.32432||2.34099||||OPIATE DEPENDENCE TREATMENTS|3310|||||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|5.46496||5.3338||5.37206||.||OPIATE DEPENDENCE TREATMENTS|3311|||||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|5.46496||5.3338||5.37206||||OPIATE DEPENDENCE TREATMENTS|3312|||||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|.49266||.48084||.48428|||||3313|||||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|||||3314|||||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|||||3315|||||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|1.94175||1.89515||1.90874||||NEUROPATHIC PAIN|3316|||||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|1.93909||1.89255||1.90613||||ALZHEIMER'S AGENTS|3317|||||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|1.88252||1.83734||1.85052||||ALZHEIMER'S AGENTS|3318|||||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|1.93676||1.89028||1.90384||||ALZHEIMER'S AGENTS|3319|||||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|.48847||.47675||.48017|||||3320|||||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|.59071||.57653||.58067|||||3321|||||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|.6892||.67266||.67748|||||3322|||||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|.8398||.81964||.82552|||||3323|||||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|10.15233||9.90867||9.97974||||ANALGESICS, NARCOTICS LONG|3324|||||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|5.50146||5.36942||5.40794||||ANALGESICS, NARCOTICS LONG|3325|||||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|9.8012||9.56597||9.63458||||ANALGESICS, NARCOTICS LONG|3326|||||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|13.08258||12.7686||12.86018||||ANALGESICS, NARCOTICS LONG|3327|||||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|17.6828||17.25841||17.38219||||ANALGESICS, NARCOTICS LONG|3328|||||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|40.5551||39.58178||39.86566||||ANALGESICS, NARCOTICS LONG|3329|||||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|3330|||||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|3331|||||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|.2598||.25356||.25538|||||3332|||||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|1.22747||1.19801||1.2066||||GLUCOCORTICOIDS, INHALED|3333|||||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|1.43829||1.40377||1.41384||||GLUCOCORTICOIDS, INHALED|3334|||||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|2.03023||1.9815||1.99572||||GLUCOCORTICOIDS, INHALED|3335|||||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|15.51146||15.13918||15.24777||||OPHTHALMICS, GLAUCOMA AGENTS|3336|||||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|15.10964||14.74701||14.85278||||OPHTHALMICS, GLAUCOMA AGENTS|3337|||||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|.25154||.2455||.24726||||BRONCHODILATORS, BETA AGONIST|3338|||||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|.3196||.31193||.31417||||BRONCHODILATORS, BETA AGONIST|3339|||||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|.27075||.26425||.26615||||BRONCHODILATORS, BETA AGONIST|3340|||||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|3341|||||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|.13715||.13386||.13482||||ANALGESICS, NARCOTICS SHORT|3342|||||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|.13715||.13386||.13482||||ANALGESICS, NARCOTICS SHORT|3343|||||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|.13715||.13386||.13482||||ANALGESICS, NARCOTICS SHORT|3344|||||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|.13715||.13386||.13482||||ANALGESICS, NARCOTICS SHORT|3345|||||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|.15399||.15029||.15137||||ANALGESICS, NARCOTICS SHORT|3346|||||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|.15399||.15029||.15137||||ANALGESICS, NARCOTICS SHORT|3347|||||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|.15399||.15029||.15137||||ANALGESICS, NARCOTICS SHORT|3348|||||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|.15399||.15029||.15137||||ANALGESICS, NARCOTICS SHORT|3349|||||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|.16495||.16099||.16215||||ANALGESICS, NARCOTICS SHORT|3350|||||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|.16495||.16099||.16215||||ANALGESICS, NARCOTICS SHORT|3351|||||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|.16495||.16099||.16215||||ANALGESICS, NARCOTICS SHORT|3352|||||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|.16495||.16099||.16215||||ANALGESICS, NARCOTICS SHORT|3353|||||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|.77541||.7568||.76223||||STIMULANTS AND RELATED AGENTS|3354|||||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|.80222||.78297||.78858||||STIMULANTS AND RELATED AGENTS|3355|||||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|.94875||.92598||.93262||||STIMULANTS AND RELATED AGENTS|3356|||||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|.18441||.17998||.18128||||ANALGESICS, NARCOTICS SHORT|3357|||||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|.18441||.17998||.18128||||ANALGESICS, NARCOTICS SHORT|3358|||||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|.24084||.23506||.23675||||ANALGESICS, NARCOTICS SHORT|3359|||||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|.24084||.23506||.23675||||ANALGESICS, NARCOTICS SHORT|3360|||||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|.283||.27621||.27819||||ANALGESICS, NARCOTICS SHORT|3361|||||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|.283||.27621||.27819||||ANALGESICS, NARCOTICS SHORT|3362|||||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|.31024||.30279||.30497||||ANALGESICS, NARCOTICS SHORT|3363|||||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|.26684||.26044||.2623||||ANALGESICS, NARCOTICS SHORT|3364|||||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|.26684||.26044||.2623||||ANALGESICS, NARCOTICS SHORT|3365|||||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|.26684||.26044||.2623||||ANALGESICS, NARCOTICS SHORT|3366|||||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|.46179||.45071||.45394||||ANALGESICS, NARCOTICS SHORT|3367|||||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|.46179||.45071||.45394||||ANALGESICS, NARCOTICS SHORT|3368|||||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|.12321||.12025||.12112||||ANALGESICS, NARCOTICS SHORT|3369|||||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|.12321||.12025||.12112||||ANALGESICS, NARCOTICS SHORT|3370|||||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|.1955||.19081||.19218||||ANALGESICS, NARCOTICS SHORT|3371|||||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|.1955||.19081||.19218||||ANALGESICS, NARCOTICS SHORT|3372|||||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|.23279||.2272||.22883||||ANALGESICS, NARCOTICS SHORT|3373|||||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|.23279||.2272||.22883||||ANALGESICS, NARCOTICS SHORT|3374|||||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|3375|||||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|3376|||||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|.10599||.10345||.10419||||ANALGESICS, NARCOTICS SHORT|3377|||||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|7.97251||7.78117||7.83698||||STIMULANTS AND RELATED AGENTS|3378|||||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|7.82792||7.64005||7.69485||||STIMULANTS AND RELATED AGENTS|3379|||||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|8.03327||7.84047||7.8967||||STIMULANTS AND RELATED AGENTS|3380|||||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|.13559||.13234||.13328||||STIMULANTS AND RELATED AGENTS|3381|||||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|.17854||.17426||.1755||||STIMULANTS AND RELATED AGENTS|3382|||||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|.25321||.24713||.24891||||STIMULANTS AND RELATED AGENTS|3383|||||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|1.08122||1.05527||1.06284||||OPIATE DEPENDENCE TREATMENTS|3384|||||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|1.08122||1.05527||1.06284||||OPIATE DEPENDENCE TREATMENTS|3385|||||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|.22069||.21539||.21694|||||3386|||||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|.49438||.48251||.48598||||STIMULANTS AND RELATED AGENTS|3387|||||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|.56023||.54678||.55071||||STIMULANTS AND RELATED AGENTS|3388|||||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|1.37115||1.33824||1.34784||||STIMULANTS AND RELATED AGENTS|3389|||||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|1.59163||1.55343||1.56457||||STIMULANTS AND RELATED AGENTS|3390|||||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|1.28044||1.24971||1.25867||||STIMULANTS AND RELATED AGENTS|3391|||||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|1.7424||1.70058||1.71278||||STIMULANTS AND RELATED AGENTS|3392|||||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|1.5562||1.51885||1.52974||||STIMULANTS AND RELATED AGENTS|3393|||||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|1.68257||1.64219||1.65397||||STIMULANTS AND RELATED AGENTS|3394|||||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|3395|||||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|3396|||||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|.13378||.13057||.13151||||ANALGESICS, NARCOTICS SHORT|3397|||||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|.17641||.17218||.17341||||ANALGESICS, NARCOTICS SHORT|3398|||||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|.4947||.48283||.48629||||ANALGESICS, NARCOTICS SHORT|3399|||||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|5.53361||5.4008||5.43954||||STIMULANTS AND RELATED AGENTS|3400|||||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|4.41791||4.31188||4.34281||||STIMULANTS AND RELATED AGENTS|3401|||||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|3.94657||3.85185||3.87948||||STIMULANTS AND RELATED AGENTS|3402|||||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|4.1178||4.01897||4.0478||||STIMULANTS AND RELATED AGENTS|3403|||||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|5.43974||5.30919||5.34726||||STIMULANTS AND RELATED AGENTS|3404|||||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|5.79148||5.65248||5.69302||||STIMULANTS AND RELATED AGENTS|3405|||||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|4.62673||4.51569||4.54808||||STIMULANTS AND RELATED AGENTS|3406|||||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|.23843||.23271||.23438||||ANALGESICS, NARCOTICS SHORT|3407|||||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|.23843||.23271||.23438||||ANALGESICS, NARCOTICS SHORT|3408|||||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|.39907||.38949||.39229||||ANALGESICS, NARCOTICS SHORT|3409|||||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|.39907||.38949||.39229||||ANALGESICS, NARCOTICS SHORT|3410|||||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|.18703||.18254||.18385||||ANALGESICS, NARCOTICS LONG|3411|||||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|.18152||.17716||.17843||||ANALGESICS, NARCOTICS LONG|3412|||||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|.34922||.34084||.34328||||ANALGESICS, NARCOTICS SHORT|3413|||||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|.465||.45384||.4571||||ANALGESICS, NARCOTICS SHORT|3414|||||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|3415|||||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|.38603||.37677||.37947||||ANALGESICS, NARCOTICS SHORT|3416|||||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|.59147||.57727||.58142||||OPIATE DEPENDENCE TREATMENTS|3417|||||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|.92797||.9057||.91219||||OPIATE DEPENDENCE TREATMENTS|3418|||||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|.23592||.23026||.23191||||ANALGESICS, NARCOTICS LONG|3419|||||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|1.80368||1.76039||1.77302||||ANALGESICS, NARCOTICS LONG|3420|||||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|.37145||.36254||.36514||||ANALGESICS, NARCOTICS LONG|3421|||||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|.58585||.57179||.57589||||ANALGESICS, NARCOTICS LONG|3422|||||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|.94858||.92581||.93245||||ANALGESICS, NARCOTICS LONG|3423|||||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|.19777||.19302||.19441||||ANALGESICS, NARCOTICS SHORT|3424|||||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|.19777||.19302||.19441||||ANALGESICS, NARCOTICS SHORT|3425|||||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|.35127||.34284||.3453||||ANALGESICS, NARCOTICS SHORT|3426|||||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|.35127||.34284||.3453||||ANALGESICS, NARCOTICS SHORT|3427|||||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|.08591||.08385||.08445||||ANALGESICS, NARCOTICS SHORT|3428|||||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|2.19898||2.1462||2.1616||||ANALGESICS, NARCOTICS SHORT|3429|||||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|3430|||||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|.41578||.4058||.40871||||ANTIDEPRESSANTS, TRICYCLIC|3431|||||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|.33121||.32326||.32558||||ANTIDEPRESSANTS, TRICYCLIC|3432|||||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|.43398||.42356||.4266||||ANTIDEPRESSANTS, TRICYCLIC|3433|||||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|.38912||.37978||.3825||||STIMULANTS AND RELATED AGENTS|3434|||||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|.32728||.31943||.32172||||STIMULANTS AND RELATED AGENTS|3435|||||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|.32517||.31737||.31964||||STIMULANTS AND RELATED AGENTS|3436|||||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|.55116||.53793||.54179||||STIMULANTS AND RELATED AGENTS|3437|||||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|.50232||.49026||.49378||||STIMULANTS AND RELATED AGENTS|3438|||||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|.56507||.55151||.55546||||STIMULANTS AND RELATED AGENTS|3439|||||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|.5342||.52138||.52512||||STIMULANTS AND RELATED AGENTS|3440|||||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|.61942||.60455||.60889||||STIMULANTS AND RELATED AGENTS|3441|||||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|.64541||.62992||.63444||||STIMULANTS AND RELATED AGENTS|3442|||||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|.54655||.53343||.53726||||STIMULANTS AND RELATED AGENTS|3443|||||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|.39952||.38993||.39273||||STIMULANTS AND RELATED AGENTS|3444|||||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|1.06456||1.03901||1.04646||||STIMULANTS AND RELATED AGENTS|3445|||||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|.92248||.90034||.9068||||STIMULANTS AND RELATED AGENTS|3446|||||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|1.27289||1.24234||1.25125||||STIMULANTS AND RELATED AGENTS|3447|||||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|3448|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|3449|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|3450|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MALLINCKRODT PH|No|||||No|No|No|| fentanyl citrate|No|No|No|No|90%|00406920830|FENTANYL CITRATE OTFC 800 MCG|30|EA|9.63372|03/26/2010|07/31/2024|Yes|No||03/26/2010|07/31/2024|Yes|No|03/26/2010|07/31/2024|Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|21.95592||21.64226||20.61168||||ANALGESICS, NARCOTICS SHORT|3451|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|3452|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MALLINCKRODT PH|No|||||No|No|No|| fentanyl citrate|No|No|No|No|90%|00406921630|FENTANYL CIT OTFC 1,600 MCG|30|EA|15.44732|03/26/2010|07/31/2024|Yes|No||03/26/2010|07/31/2024|Yes|No|03/26/2010|07/31/2024|Yes|No||||No|No|||Prescription Required|Yes|02/02/2010|109|Yes|35.20552||34.70258||33.05008||||ANALGESICS, NARCOTICS SHORT|3453|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|3454|||||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|3455|||||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|3456|||||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|3457|||||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|3458|||||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|3459|||||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|3460|||||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|3461|||||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|3462|||||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|3463|||||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|3464|||||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|3465|||||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|1.5754||1.53759||1.54862||||SEDATIVE HYPNOTICS|3466|||||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|1.27021||1.23972||1.24862||||SEDATIVE HYPNOTICS|3467|||||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|||||3468|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|||||3469|||||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|||||3470|||||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|1.79342||1.75038||1.76293|||||3471|||||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|7.32311||7.14736||7.19862||||OPIATE DEPENDENCE TREATMENTS|3472|||||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||OPIATE DEPENDENCE TREATMENTS|3473|||||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|3474|||||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|3475|||||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|3476|||||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||OPIATE DEPENDENCE TREATMENTS|3477|||||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|7.32311||7.14736||7.19862||.||OPIATE DEPENDENCE TREATMENTS|3478|||||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|||3479|||||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|||||3480|||||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|||||3481|||||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|||||3482|||||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||OPIATE DEPENDENCE TREATMENTS|3483|||||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|3484|||||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|||||3485|||||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|||||3486|||||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|||||3487|||||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|||||3488|||||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|||||3489|||||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|||||3490|||||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|||||3491|||||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|||||3492|||||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|||||3493|||||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|||3494|||||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|||||3495|||||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|.62804||.61297||.61736|||||3496|||||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|.77429||.75571||.76113|||||3497|||||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|||||3498|||||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|4.56117||4.4517||4.48363|||||3499|||||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|||||3500|||||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|.84433||.82407||.82998|||||3501|||||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|.68239||.66601||.67079|||||3502|||||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|.05643||.05508||.05547|||||3503|||||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|.0726||.07086||.07137|||||3504|||||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|||||3505|||||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|2.15888||2.10707||2.12218|||||3506|||||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|||||3507|||||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|||||3508|||||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|.08214||.08017||.08074|||||3509|||||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|||||3510|||||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|||||3511|||||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|||||3512|||||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|||||3513|||||No|No||HOSPIRA/PFIZER|No|||||No|No|No|| aminophylline|No|No|No|No|75%|00409592201|AMINOP