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|.5|ML|200.1392|11/03/2014||Yes|No||11/03/2014||Yes|No|11/03/2014||Yes|No||||No|No|||Prescription required|No||111|Yes|446.94514|01/17/2023|436.21845|01/17/2023|439.1236|01/17/2023|||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|.5|ML|200.1392|11/03/2014||Yes|No||11/03/2014||Yes|No|11/03/2014||Yes|No||||No|No|||Prescription required|No||111|Yes|446.91187|01/17/2023|436.18598|01/17/2023|439.09091|01/17/2023|||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|292.056|02/12/2019||Yes|No||02/12/2019||Yes|No|02/12/2019||Yes|No||||No|No|||Prescription required|No||537|Yes|657.52881|01/17/2023|641.74811|01/17/2023|646.02205|01/17/2023|||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|2832.152|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|6454.672|01/10/2023|6362.4624|01/10/2023|6059.488|01/10/2023|||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|2832.152|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|6454.672|01/10/2023|6362.4624|01/10/2023|6059.488|01/10/2023|||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|2832.152|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|6454.672|01/10/2023|6362.4624|01/10/2023|6059.488|01/10/2023|||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|.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|02/09/2023|HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|7|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002145780|MOUNJARO 15 MG/0.5 ML PEN|.5|ML|219.9536|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|02/09/2023|479.21412|02/09/2023|482.40561|02/09/2023|||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|.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|02/09/2023|HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|9|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002146080|MOUNJARO 12.5 MG/0.5 ML PEN|.5|ML|219.9536|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|02/09/2023|479.85504|02/09/2023|483.0508|02/09/2023|||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|.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|02/09/2023|HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|11|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002147180|MOUNJARO 10 MG/0.5 ML PEN|.5|ML|219.9536|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|02/09/2023|478.858|02/09/2023|482.04711|02/09/2023|||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|.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|02/09/2023|HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|13|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002148480|MOUNJARO 7.5 MG/0.5 ML PEN|.5|ML|219.9536|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|02/09/2023|479.3915|02/09/2023|482.58417|02/09/2023|||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|.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|02/09/2023|HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|15|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002149580|MOUNJARO 5 MG/0.5 ML PEN|.5|ML|219.9536|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|490.92721|02/09/2023|479.14495|02/09/2023|482.33598|02/09/2023|||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|.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|02/09/2023|HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|17|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
tirzepatide|No|No|No|No|75%|00002150680|MOUNJARO 2.5 MG/0.5 ML PEN|.5|ML|219.9536|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|02/09/2023|478.95194|02/09/2023|482.14168|02/09/2023|||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|.5|ML|190.6104|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription required|No||111|Yes|||||||||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|.5|ML|200.1392|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription required|No||111|Yes|447.3184|01/17/2023|436.58275|01/17/2023|439.49032|01/17/2023|||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|292.056|08/22/2019||Yes|No||08/22/2019||Yes|No|08/22/2019||Yes|No||||No|No|||Prescription required|No||537|Yes|656.1251|01/17/2023|640.37809|01/17/2023|644.64291|01/17/2023|||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|76.0326|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription required|No||551|No|173.2836|01/10/2023|170.80812|01/10/2023|162.6744|01/10/2023|||ONCOLOGY: ORAL - LUNG|22|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
selpercatinib|No|No|No|No|75%|00002298060|RETEVMO 80 MG CAPSULE|60|EA|76.0326|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription required|No||551|No|173.2836|01/10/2023|170.80812|01/10/2023|162.6744|01/10/2023|||ONCOLOGY: ORAL - LUNG|23|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
galcanezumab-gnlm|No|No|No|No|75%|00002311509|EMGALITY 300 MG (100 MG X3SYR)|1|ML|243.38|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|545.91576|01/17/2023|532.81378|01/17/2023|536.36223|01/17/2023|||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|.5|ML|190.6104|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription required|No||111|Yes|||||||||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|.5|ML|200.1392|06/01/2021||Yes|No||06/01/2021||Yes|No|06/01/2021||Yes|No||||No|No|||Prescription required|No||111|Yes|447.39553|01/17/2023|436.65803|01/17/2023|439.5661|01/17/2023|||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|12.9164|09/25/2018|12.73188|09/25/2018|12.1256|09/25/2018|||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|12.9164|08/23/2022|12.73188|08/23/2022|12.1256|08/23/2022|||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|14.0336|05/24/2022|13.83312|05/24/2022|13.1744|05/24/2022|||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||Yes|No||07/19/2007||Yes|No|07/19/2007||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|027|Yes|9.6138|06/01/2016|9.47646|06/01/2016|9.0252|06/01/2016|||ANTIPSYCHOTICS|30|||||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||Yes|No||01/28/2004||Yes|No|01/28/2004||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|027|Yes|13.1418|06/01/2016|12.95406|06/01/2016|12.3372|06/01/2016|||ANTIPSYCHOTICS|31|||||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|8.1732|01/10/2023|8.05644|01/10/2023|7.6728|01/10/2023|||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|12.9164|09/25/2018|12.73188|09/25/2018|12.1256|09/25/2018|||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|14.0336|08/23/2022|13.83312|08/23/2022|13.1744|08/23/2022|||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|8.98311|01/17/2023|8.76751|01/17/2023|8.8259|01/17/2023|||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|8.98311|01/17/2023|8.76751|01/17/2023|8.8259|01/17/2023|||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|15.141|02/28/2023|14.9247|02/28/2023|14.214|02/28/2023|||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|15.141|09/25/2018|14.9247|09/25/2018|14.214|09/25/2018|||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|8.92162|01/17/2023|8.7075|01/17/2023|8.76549|01/17/2023|||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|50.6884|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription required|No||551|No|115.5224|01/10/2023|113.87208|01/10/2023|108.4496|01/10/2023|||ONCOLOGY: ORAL - LUNG|40|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
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|01/10/2023|12.8961|01/10/2023|12.282|01/10/2023|||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|15.435|01/10/2023|15.2145|01/10/2023|14.49|01/10/2023|||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|18.7768|01/10/2023|18.50856|01/10/2023|17.6272|01/10/2023|||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|22.71374|01/17/2023|22.16861|01/17/2023|22.31624|01/17/2023|||ANTIPSYCHOTICS|44|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
baricitinib|No|No|No|No|75%|00002418230|OLUMIANT 2 MG TABLET|30|EA|37.582|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|85.652|01/10/2023|84.4284|01/10/2023|80.408|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|45|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|03/31/2022|
raloxifene HCl|No|No|No|No|75%|00002418402|EVISTA 60 MG TABLET|100|EA|2.838|11/15/2017|02/21/2023|Yes|No||11/15/2017|02/21/2023|Yes|No|11/15/2017|02/21/2023|Yes|No||||No|No|||Prescription required|No||060|Yes|6.468|04/27/2021|6.3756|04/27/2021|6.072|04/27/2021|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|46|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ELI LILLY & CO.|No|||||No|No|No||
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||060|Yes|6.468|04/27/2021|6.3756|04/27/2021|6.072|04/27/2021|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|47|||||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|88.73747|01/17/2023|86.60777|01/17/2023|87.18456|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|48|||||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|34.15717|01/17/2023|33.33739|01/17/2023|33.55941|01/17/2023|||ANTIPSYCHOTICS|49|||||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|45.5144|01/17/2023|44.42205|01/17/2023|44.71789|01/17/2023|||ANTIPSYCHOTICS|50|||||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|16.3954|01/10/2023|16.16118|01/10/2023|15.3916|01/10/2023|||ANTIPSYCHOTICS|51|||||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|01/10/2023|23.86986|01/10/2023|22.7332|01/10/2023|||ANTIPSYCHOTICS|52|||||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|01/10/2023|35.33145|01/10/2023|33.649|01/10/2023|||ANTIPSYCHOTICS|53|||||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|01/10/2023|46.79304|01/10/2023|44.5648|01/10/2023|||ANTIPSYCHOTICS|54|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
baricitinib|No|No|No|No|75%|00002447930|OLUMIANT 4 MG TABLET|30|EA|75.164|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|171.304|02/16/2023|168.8568|02/16/2023|160.816|02/16/2023|||CYTOKINE AND CAM ANTAGONISTS|55|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
abemaciclib|No|No|No|No|75%|00002448354|VERZENIO 50 MG TABLET|14|EA|111.5979|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription required|No||502|No|254.3394|01/10/2023|250.70598|01/10/2023|238.7676|01/10/2023|||ONCOLOGY: ORAL - BREAST|56|||||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|88.73196|01/17/2023|86.60239|01/17/2023|87.17915|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|57|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
baricitinib|No|No|No|No|75%|00002473230|OLUMIANT 1 MG TABLET|30|EA|37.582|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|85.652|01/10/2023|84.4284|01/10/2023|80.408|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|58|||||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|111.5979|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription required|No||502|No|254.3394|01/10/2023|250.70598|01/10/2023|238.7676|01/10/2023|||ONCOLOGY: ORAL - BREAST|59|||||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|111.5979|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription required|No||502|No|254.3394|01/10/2023|250.70598|01/10/2023|238.7676|01/10/2023|||ONCOLOGY: ORAL - BREAST|60|||||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||583|No|268.86731|02/28/2023|262.41449|02/28/2023|264.16213|02/28/2023|||GLUCAGON AGENTS|61|||||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||583|No|268.86731|02/28/2023|262.41449|02/28/2023|264.16213|02/28/2023|||GLUCAGON AGENTS|62|||||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||583|No|268.86731|02/28/2023|262.41449|02/28/2023|264.16213|02/28/2023|||GLUCAGON AGENTS|63|||||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||583|No|269.516|07/26/2022|263.04761|07/26/2022|264.79947|07/26/2022|||GLUCAGON AGENTS|64|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
abemaciclib|No|No|No|No|75%|00002621654|VERZENIO 200 MG TABLET|14|EA|111.5979|01/31/2018||Yes|No||01/31/2018||Yes|No|01/31/2018||Yes|No||||No|No|||Prescription required|No||502|No|254.3394|01/10/2023|250.70598|01/10/2023|238.7676|01/10/2023|||ONCOLOGY: ORAL - BREAST|65|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
insulin lispro|Yes|No|No|No|75%|00002751001|HUMALOG 100 UNIT/ML VIAL|10|ML|11.8121|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||029|No|26.362|04/26/2022|25.72931|04/26/2022|25.90066|04/26/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|66|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00002751017|HUMALOG 100 UNIT/ML VIAL|3|ML|11.8121|11/14/2012||Yes|No||11/14/2012||Yes|No|11/14/2012||Yes|No||||No|No|07/01/2016||Prescription required|No||029|No|26.9206|09/28/2021|26.53602|09/28/2021|25.2724|09/28/2021|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|67|||||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|12.2421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||029|No|27.35188|02/28/2023|26.69543|02/28/2023|26.87322|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|68|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002751201|HUMALOG MIX 50-50 VIAL|10|ML|12.2421|09/05/2007||Yes|No||09/05/2007||Yes|No|09/05/2007||Yes|No||||No|No|||Prescription required|No||029|No|27.4452|05/24/2022|26.78651|05/24/2022|26.9649|05/24/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|69|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002751659|HUMALOG 100 UNIT/ML CARTRIDGE|3|ML|14.6329|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||029|No|32.56667|07/26/2022|31.78506|07/26/2022|31.99675|07/26/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|70|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002759701|ZYPREXA 10 MG VIAL|1|EA|21.6118|04/27/2004||Yes|No||04/27/2004||Yes|No|04/27/2004||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|027|Yes|49.2548|01/10/2023|48.55116|01/10/2023|46.2392|01/10/2023|||ANTIPSYCHOTICS|71|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine pamoate|No|No|No|No|75%|00002763511|ZYPREXA RELPREVV 210 MG VL KIT|1|EA|253.5624|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|027|Yes|577.8864|06/01/2016|569.63088|06/01/2016|542.5056|06/01/2016|||ANTIPSYCHOTICS|72|||||No|Yes|11.23|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|06/01/2016|813.7584|06/01/2016|775.008|06/01/2016|||ANTIPSYCHOTICS|73|||||No|Yes|11.23|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|06/01/2016|1098.57384|06/01/2016|1046.2608|06/01/2016|||ANTIPSYCHOTICS|74|||||No|Yes|11.23|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|67.85583|02/28/2023|66.22729|02/28/2023|66.66835|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|75|||||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|15.2048|01/05/2018||Yes|No||01/05/2018||Yes|No|01/05/2018||Yes|No||||No|No|||Prescription required|No||029|Yes|33.81272|02/28/2023|33.00121|02/28/2023|33.22099|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|76|||||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|No|20.90137|02/28/2023|20.39973|02/28/2023|20.53559|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|77|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
ixekizumab|No|No|No|No|75%|00002772401|TALTZ 80 MG/ML SYRINGE|1|ML|2832.152|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|6454.672|01/10/2023|6362.4624|01/10/2023|6059.488|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|78|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
ixekizumab|No|No|No|No|75%|00002772411|TALTZ 80 MG/ML SYRINGE|1|ML|2832.152|09/11/2020||Yes|No||09/11/2020||Yes|No|09/11/2020||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|071|Yes|6454.672|01/10/2023|6362.4624|01/10/2023|6059.488|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|79|||||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||029|Yes|10.17494|02/28/2023|9.93074|02/28/2023|9.99687|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|80|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
glucagon|No|No|No|No|75%|00002803101|GLUCAGON 1 MG EMERGENCY KIT|1|EA|120.744|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||583|No|272.93758|06/28/2022|266.38707|06/28/2022|268.16117|06/28/2022|||GLUCAGON AGENTS|81|||||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|Yes|911.988|01/10/2023|898.9596|01/10/2023|856.152|01/10/2023|||GROWTH HORMONE|82|||||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|Yes|1823.976|01/10/2023|1797.9192|01/10/2023|1712.304|01/10/2023|||GROWTH HORMONE|83|||||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|Yes|3647.952|01/10/2023|3595.8384|01/10/2023|3424.608|01/10/2023|||GROWTH HORMONE|84|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|10/23/2018|
insulin regular, human|Yes|No|No|No|75%|00002821501|HUMULIN R 100 UNIT/ML VIAL|10|ML|6.3941|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||029|No|14.27948|02/28/2023|13.93677|02/28/2023|14.02958|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|85|||||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||Yes|No||10/08/2012||Yes|No|10/08/2012||Yes|No||||No|No|07/01/2016||Over the counter|No||029|No|14.18867|11/29/2022|13.84814|11/29/2022|13.94036|11/29/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|86|||||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|10.10474|02/28/2023|9.86222|02/28/2023|9.9279|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|87|||||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|6.3941|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||029|No|14.26509|02/28/2023|13.92272|02/28/2023|14.01545|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|88|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH human isophane|Yes|No|No|No|75%|00002831517|HUMULIN N 100 UNIT/ML VIAL|3|ML|6.3941|10/03/2012|08/17/2023|Yes|No||10/03/2012|08/17/2023|Yes|No|10/03/2012|08/17/2023|Yes|No||||No|No|07/01/2016|08/17/2023|Over the counter|No||029|No|14.5726|01/25/2022|14.36442|01/25/2022|13.6804|01/25/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|89|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|746.21841|10/15/2008||Yes|No||10/15/2008||Yes|No|10/15/2008||Yes|No||||No|No|||Prescription required|No||060|No|1676.53194|01/17/2023|1636.29517|01/17/2023|1647.19263|01/17/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|90|||||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||029|No|71.06383|02/28/2023|69.35829|02/28/2023|69.82021|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|91|||||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|6.3941|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||029|No|14.28236|02/28/2023|13.93958|02/28/2023|14.03241|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|92|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH hum/reg insulin hm|Yes|No|No|No|75%|00002871517|HUMULIN 70-30 VIAL|3|ML|6.3941|10/08/2012||Yes|No||10/08/2012||Yes|No|10/08/2012||Yes|No||||No|No|07/01/2016||Over the counter|No||029|No|14.5726|05/29/2018|14.36442|05/29/2018|13.6804|05/29/2018|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|93|||||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|15.2048|03/04/2009||Yes|No||03/04/2009||Yes|No|03/04/2009||Yes|No||03/04/2009||Yes|No|||Prescription required|No||029|No|33.88926|02/28/2023|33.07591|02/28/2023|33.29619|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|94|||||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|15.2048|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||01/14/2008||Yes|No|||Prescription required|No||029|No|34.0834|02/28/2023|33.26539|02/28/2023|33.48694|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|95|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002879959|HUMALOG 100 UNIT/ML KWIKPEN|3|ML|15.2048|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||01/14/2008||Yes|No|||Prescription required|No||029|No|33.94155|08/23/2022|33.12695|08/23/2022|33.34757|08/23/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|96|||||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|13.5106|04/02/2014||Yes|No||04/02/2014||Yes|No|04/02/2014||Yes|No||||No|No|||Over the counter|No||029|No|30.17609|01/24/2023|29.45186|01/24/2023|29.648|01/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|97|||||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|13.5106|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|30.26216|01/24/2023|29.53586|01/24/2023|29.73257|01/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|98|||||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||029|No|91.8872|09/27/2022|89.6819|09/27/2022|90.27917|09/27/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|99|||||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|8.924|03/29/2022|8.70982|03/29/2022|8.76783|03/29/2022||||100|||||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|6.7958|10/25/2022|6.6327|10/25/2022|6.67687|10/25/2022||||101|||||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|2.36964|04/27/2021|2.33578|04/27/2021|2.22456|04/27/2021||||102|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052411|SPRYCEL 70 MG TABLET|60|EA|133.55441|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription required|No||173|No|304.37982|01/10/2023|300.03154|01/10/2023|285.74432|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|103|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052711|SPRYCEL 20 MG TABLET|60|EA|66.77734|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription required|No||173|No|152.19023|01/10/2023|150.01609|01/10/2023|142.87246|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|104|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052811|SPRYCEL 50 MG TABLET|60|EA|133.55441|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription required|No||173|No|304.37982|01/10/2023|300.03154|01/10/2023|285.74432|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|105|||||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||173|No|1.33779|06/01/2016|1.31868|06/01/2016|1.25589|06/01/2016|||ONCOLOGY: ORAL - HEMATOLOGIC|106|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|240.70941|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription required|No||173|No|541.44969|01/17/2023|528.45489|01/17/2023|531.97432|01/17/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|107|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003085522|SPRYCEL 80 MG TABLET|30|EA|240.70941|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription required|No||173|No|548.59354|01/10/2023|540.75649|01/10/2023|515.00618|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|108|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003085722|SPRYCEL 140 MG TABLET|30|EA|240.70941|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription required|No||173|No|548.59354|01/10/2023|540.75649|01/10/2023|515.00618|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|109|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003089321|ELIQUIS 2.5 MG TABLET|60|EA|4.0187|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription required|No||068|Yes|8.97532|01/17/2023|8.75991|01/17/2023|8.81825|01/17/2023|||ANTICOAGULANTS|110|||||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|4.01908|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription required|No||068|Yes|8.97532|01/17/2023|8.75991|01/17/2023|8.81825|01/17/2023|||ANTICOAGULANTS|111|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003089421|ELIQUIS 5 MG TABLET|60|EA|4.0187|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription required|No||068|Yes|8.97238|01/17/2023|8.75704|01/17/2023|8.81536|01/17/2023|||ANTICOAGULANTS|112|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No||
apixaban|No|No|No|No|75%|00003089431|ELIQUIS 5 MG TABLET|100|EA|4.01908|02/06/2013||Yes|No||02/06/2013||Yes|No|02/06/2013||Yes|No||||No|No|||Prescription required|No||068|Yes|8.97238|01/17/2023|8.75704|01/17/2023|8.81536|01/17/2023|||ANTICOAGULANTS|113|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003089470|ELIQUIS 5 MG TABLET|74|EA|4.01881|07/09/2018||Yes|No||07/09/2018||Yes|No|07/09/2018||Yes|No||||No|No|||Prescription required|No||068|Yes|8.97238|01/17/2023|8.75704|01/17/2023|8.81536|01/17/2023|||ANTICOAGULANTS|114|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||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|44.83434|01/23/2018|44.19385|01/23/2018|42.08938|01/23/2018||||115|||||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|01/23/2018|44.19385|01/23/2018|42.08938|01/23/2018||||116|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
entecavir|No|No|No|No|75%|00003161412|BARACLUDE 0.05 MG/ML SOLUTION|210|ML|1.96718|07/12/2005||Yes|No||07/12/2005||Yes|No|07/12/2005||Yes|No||||No|No|||Prescription required|No|||No|4.48335|01/10/2017|4.4193|01/10/2017|4.20886|01/10/2017||||117|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003218811|ORENCIA 125 MG/ML SYRINGE|1|ML|577.58675|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|1305.16414|01/17/2023|1273.8402|01/17/2023|1282.32376|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|118|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003218851|ORENCIA CLICKJECT 125 MG/ML|1|ML|577.58675|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|1304.32951|01/17/2023|1273.0256|01/17/2023|1281.50374|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|119|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003281411|ORENCIA 50 MG/0.4 ML SYRINGE|.4|ML|1443.96687|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|3290.90125|01/10/2023|3243.88837|01/10/2023|3089.4175|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|120|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
abatacept|No|No|No|No|75%|00003281811|ORENCIA 87.5 MG/0.7 ML SYRINGE|.7|ML|825.12392|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|1880.51499|01/10/2023|1853.65049|01/10/2023|1765.38142|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|121|||||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||237|No|47.34772|04/27/2021|46.67132|04/27/2021|44.44888|04/27/2021|||HIV / AIDS|122|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00003362412|REYATAZ 150 MG CAPSULE|60|EA|14.63259|07/01/2003|12/31/2022|Yes|No||07/01/2003|12/31/2022|Yes|No|07/01/2003|12/31/2022|Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|23.8999|01/23/2018|23.55847|01/23/2018|22.43664|01/23/2018|||HIV / AIDS|123|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS PRIMARYCARE|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00003363112|REYATAZ 200 MG CAPSULE|60|EA|14.63259|07/01/2003||Yes|No||07/01/2003||Yes|No|07/01/2003||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|23.8999|12/25/2018|23.55847|12/25/2018|22.43664|12/25/2018|||HIV / AIDS|124|||||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||237|No|7.38332|01/10/2017|7.27784|01/10/2017|6.93128|01/10/2017|||HIV / AIDS|125|||||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|32.10939|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|No||237|No|52.0974|11/29/2022|50.84706|11/29/2022|51.18569|11/29/2022|||HIV / AIDS|126|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
apixaban|No|No|No|No|75%|00003376474|ELIQUIS DVT-PE TREAT START 5MG|74|EA|4.01881|03/05/2018||Yes|No||03/05/2018||Yes|No|03/05/2018||Yes|No||||No|No|||Prescription required|No||068|Yes|8.97752|01/17/2023|8.76205|01/17/2023|8.82041|01/17/2023|||ANTICOAGULANTS|127|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No||
hydroxyurea|No|No|No|No|75%|00003633517|DROXIA 200 MG CAPSULE|60|EA|.32543|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||580|No|.74169|08/23/2022|.73109|08/23/2022|.69628|08/23/2022|||SICKLE CELL ANEMIA TREATMENTS|128|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|.32543|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||580|No|.74169|03/01/2022|.73109|03/01/2022|.69628|03/01/2022|||SICKLE CELL ANEMIA TREATMENTS|129|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|.34822|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||580|No|.77413|07/26/2022|.75555|07/26/2022|.76058|07/26/2022|||SICKLE CELL ANEMIA TREATMENTS|130|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|07/28/2022|136|No|86.63428|01/29/2019|85.39665|01/29/2019|81.33014|01/29/2019|||ANTIVIRALS: GENERAL|131|||||No|No||GENENTECH, INC.|No|||||No|No|No||
valganciclovir HCl|No|No|No|No|75%|00004003909|VALCYTE 50 MG/ML SOLUTION|88|ML|5.22923|03/31/2010||Yes|No||03/31/2010||Yes|No|03/31/2010||Yes|No||||No|No|||Prescription required|No||136|No|11.91779|02/26/2019|11.74754|02/26/2019|11.18813|02/26/2019|||ANTIVIRALS: GENERAL|132|||||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||056|Yes|2.8057|04/26/2022|2.73836|04/26/2022|2.7566|04/26/2022|||ANTICONVULSANTS|133|||||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||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|Yes|2.43328|06/28/2022|2.37488|06/28/2022|2.39069|06/28/2022|||ANTICONVULSANTS|134|||||No|No||ROCHE LABS.|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00004009801|KLONOPIN 2 MG TABLET|100|EA|1.73449|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|Yes|3.95302|07/11/2017|3.89655|07/11/2017|3.711|07/11/2017|||ANTICONVULSANTS|135|||||No|No||ROCHE LABS.|No|||||No|No|No||
ibandronate sodium|No|No|No|No|75%|00004018683|BONIVA 150 MG TABLET|3|EA|82.10706|06/02/2016||Yes|No||06/02/2016||Yes|No|06/02/2016||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|060|No|187.12772|01/23/2018|184.45447|01/23/2018|175.67092|01/23/2018|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|136|||||No|No||ROCHE LABS.|No|||||No|No|No||
saquinavir mesylate|No|No|No|No|75%|00004024451|INVIRASE 500 MG TABLET|120|EA|6.0087|02/23/2005||Yes|No||02/23/2005||Yes|No|02/23/2005||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|9.81421|01/23/2018|9.674|01/23/2018|9.21334|01/23/2018|||HIV / AIDS|137|||||No|No||GENENTECH, INC.|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004025901|CELLCEPT 250 MG CAPSULE|100|EA|3.86823|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|8.81598|01/29/2019|8.69003|01/29/2019|8.27622|01/29/2019|||IMMUNOSUPPRESSIVES: ORAL|138|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004025943|CELLCEPT 250 MG CAPSULE|500|EA|3.86823|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|8.81598|01/29/2019|8.69003|01/29/2019|8.27622|01/29/2019|||IMMUNOSUPPRESSIVES: ORAL|139|||||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|17.63196|01/29/2019|17.38007|01/29/2019|16.55245|01/29/2019|||IMMUNOSUPPRESSIVES: ORAL|140|||||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|17.63196|01/29/2019|17.38007|01/29/2019|16.55245|01/29/2019|||IMMUNOSUPPRESSIVES: ORAL|141|||||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|8.45782|02/26/2019|8.33699|02/26/2019|7.93999|02/26/2019|||IMMUNOSUPPRESSIVES: ORAL|142|||||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|01/09/2018|986.75934|01/09/2018|939.7708|01/09/2018|||HEPATITIS C AGENTS|143|||||No|No||GENENTECH, INC.|No|||||No|No|No||
peginterferon alfa-2a|No|No|No|No|75%|00004035730|PEGASYS 180 MCG/0.5 ML SYRINGE|.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|01/09/2018|1973.51868|01/09/2018|1879.5416|01/09/2018|||HEPATITIS C AGENTS|144|||||No|No||GENENTECH, INC.|No|||||No|No|No||
enfuvirtide|No|No|No|No|75%|00004038140|FUZEON 90 MG VIAL|60|EA|35.85559|06/20/2012||Yes|No||06/20/2012||Yes|No|06/20/2012||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|58.56414|01/23/2018|57.72751|01/23/2018|54.97858|01/23/2018|||HIV / AIDS|145|||||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|14.63482|02/28/2023|14.28358|02/28/2023|14.37871|02/28/2023|||ANTIVIRALS: ORAL|146|||||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|01/26/2021|13.46024|01/26/2021|12.81928|01/26/2021|||ANTIVIRALS: ORAL|147|||||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|01/26/2021|13.46024|01/26/2021|12.81928|01/26/2021|||ANTIVIRALS: ORAL|148|||||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|2.43944|01/24/2023|2.38089|01/24/2023|2.39674|01/24/2023|||ANTIVIRALS: ORAL|149|||||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||502|No|13.2865|01/10/2017|13.09669|01/10/2017|12.47304|01/10/2017|||ONCOLOGY: ORAL - BREAST|150|||||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||502|No|44.28219|06/26/2018|43.64958|06/26/2018|41.57103|06/26/2018|||ONCOLOGY: ORAL - BREAST|151|||||No|No||GENENTECH, INC.|No|||||Yes|No|No||
suvorexant|No|No|No|No|75%|00006000530|BELSOMRA 5 MG TABLET|30|EA|6.0673|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|054|Yes|13.43137|01/24/2023|13.10901|01/24/2023|13.19632|01/24/2023|||SEDATIVE HYPNOTICS|152|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ivermectin|No|No|No|No|75%|00006003220|STROMECTOL 3 MG TABLET|20|EA|2.00057|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.55945|11/29/2022|4.49431|11/29/2022|4.2803|11/29/2022||||153|||||No|No||MERCK SHARP & D|No|||||No|No|No||
suvorexant|No|No|No|No|75%|00006003330|BELSOMRA 10 MG TABLET|30|EA|6.0673|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|054|Yes|13.52474|01/24/2023|13.20014|01/24/2023|13.28805|01/24/2023|||SEDATIVE HYPNOTICS|154|||||No|No||MERCK SHARP & D|No|||||No|No|No||
finasteride|No|No|No|No|75%|00006007231|PROSCAR 5 MG TABLET|30|EA|2.0253|10/06/2006||Yes|No||10/06/2006||Yes|No|10/06/2006||Yes|No||||No|No|||Prescription required|Yes|07/18/2006|003|No|4.6158|10/09/2018|4.54986|10/09/2018|4.3332|10/09/2018|||BPH TREATMENTS|155|||||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|3.9216|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|8.73805|01/24/2023|8.52833|01/24/2023|8.58513|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|156|||||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|3.9216|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|8.73805|01/24/2023|8.52833|01/24/2023|8.58513|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|157|||||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|3.9216|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|8.73805|01/24/2023|8.52833|01/24/2023|8.58513|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|158|||||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|3.9216|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|8.74681|01/24/2023|8.53688|01/24/2023|8.59374|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|159|||||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|3.9216|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|8.74681|01/24/2023|8.53688|01/24/2023|8.59374|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|160|||||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|3.9216|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|8.74681|01/24/2023|8.53688|01/24/2023|8.59374|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|161|||||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|7.8432|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|17.4924|01/24/2023|17.07258|01/24/2023|17.18628|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|162|||||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|7.8432|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|17.4924|01/24/2023|17.07258|01/24/2023|17.18628|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|163|||||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|7.8432|02/14/2012||Yes|No||02/14/2012||Yes|No|02/14/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|111|Yes|17.4924|01/24/2023|17.07258|01/24/2023|17.18628|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|164|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006011231|JANUVIA 50 MG TABLET|30|EA|7.8432|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription required|No||111|Yes|17.51856|01/24/2023|17.09811|01/24/2023|17.21198|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|165|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006011254|JANUVIA 50 MG TABLET|90|EA|7.8432|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription required|No||111|Yes|17.51856|01/24/2023|17.09811|01/24/2023|17.21198|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|166|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006022131|JANUVIA 25 MG TABLET|30|EA|7.8432|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription required|No||111|Yes|17.48804|01/24/2023|17.06832|01/24/2023|17.18199|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|167|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006022154|JANUVIA 25 MG TABLET|90|EA|7.8432|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription required|No||111|Yes|17.48804|01/24/2023|17.06832|01/24/2023|17.18199|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|168|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006022761|ISENTRESS 400 MG TABLET|60|EA|19.104|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|30.94017|01/24/2023|30.1976|01/24/2023|30.39871|01/24/2023|||HIV / AIDS|169|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027728|JANUVIA 100 MG TABLET|100|EA|7.8432|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription required|No||111|Yes|17.50707|01/24/2023|17.0869|01/24/2023|17.20069|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|170|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027731|JANUVIA 100 MG TABLET|30|EA|7.8432|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription required|No||111|Yes|17.50707|01/24/2023|17.0869|01/24/2023|17.20069|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|171|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027754|JANUVIA 100 MG TABLET|90|EA|7.8432|11/02/2006||Yes|No||11/02/2006||Yes|No|11/02/2006||Yes|No||||No|No|||Prescription required|No||111|Yes|17.50707|01/24/2023|17.0869|01/24/2023|17.20069|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|172|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phosphate|No|No|No|No|75%|00006027782|JANUVIA 100 MG TABLET|1000|EA|7.8432|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No||111|Yes|17.50707|01/24/2023|17.0869|01/24/2023|17.20069|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|173|||||No|No||MERCK SHARP & D|No|||||No|No|No||
suvorexant|No|No|No|No|75%|00006032530|BELSOMRA 15 MG TABLET|30|EA|6.0673|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|054|Yes|13.5008|01/24/2023|13.17678|01/24/2023|13.26453|01/24/2023|||SEDATIVE HYPNOTICS|174|||||No|No||MERCK SHARP & D|No|||||No|No|No||
suvorexant|No|No|No|No|75%|00006033530|BELSOMRA 20 MG TABLET|30|EA|6.0673|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|054|Yes|13.51357|01/24/2023|13.18924|01/24/2023|13.27708|01/24/2023|||SEDATIVE HYPNOTICS|175|||||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|01/29/2019|211.33182|01/29/2019|201.2684|01/29/2019|||ANTIEMETIC/ANTIVERTIGO AGENTS|176|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
raltegravir potassium|No|No|No|No|75%|00006047361|ISENTRESS 25 MG TABLET CHEW|60|EA|1.194|01/07/2015||Yes|No||01/07/2015||Yes|No|01/07/2015||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|1.9502|01/17/2023|1.92234|01/17/2023|1.8308|01/17/2023|||HIV / AIDS|177|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006047761|ISENTRESS 100 MG TABLET CHEW|60|EA|4.776|01/07/2015||Yes|No||01/07/2015||Yes|No|01/07/2015||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|7.8008|01/17/2023|7.68936|01/17/2023|7.3232|01/17/2023|||HIV / AIDS|178|||||No|No||MERCK SHARP & D|No|||||No|No|No||
simvastatin|No|No|No|No|75%|00006054331|ZOCOR 80 MG TABLET|30|EA|3.4658|07/11/2006|02/21/2023|Yes|No||07/11/2006|02/21/2023|Yes|No|07/11/2006|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|01/23/2007|063|Yes|7.8988|06/13/2017|7.78596|06/13/2017|7.4152|06/13/2017|||LIPOTROPICS: STATINS|179|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MERCK SHARP & D|No|||||No|No|No||
simvastatin|No|No|No|No|75%|00006054354|ZOCOR 80 MG TABLET|90|EA|3.4658|01/30/2007|02/21/2023|Yes|No||01/30/2007|02/21/2023|Yes|No|01/30/2007|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|01/23/2007|063|Yes|7.8988|06/13/2017|7.78596|06/13/2017|7.4152|06/13/2017|||LIPOTROPICS: STATINS|180|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||173|No|122.5784|01/16/2018|120.82728|01/16/2018|115.0736|01/16/2018|||ONCOLOGY: ORAL - HEMATOLOGIC|181|||||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|3.9216|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription required|No||111|Yes|8.7583|01/24/2023|8.5481|01/24/2023|8.60502|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|182|||||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|3.9216|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription required|No||111|Yes|8.7583|01/24/2023|8.5481|01/24/2023|8.60502|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|183|||||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|3.9216|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No||111|Yes|8.7583|01/24/2023|8.5481|01/24/2023|8.60502|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|184|||||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|3.9216|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription required|No||111|Yes|8.74043|01/24/2023|8.53065|01/24/2023|8.58747|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|185|||||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|3.9216|05/01/2007||Yes|No||05/01/2007||Yes|No|05/01/2007||Yes|No||||No|No|||Prescription required|No||111|Yes|8.74043|01/24/2023|8.53065|01/24/2023|8.58747|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|186|||||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|3.9216|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No||111|Yes|8.74043|01/24/2023|8.53065|01/24/2023|8.58747|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|187|||||No|No||MERCK SHARP & D|No|||||No|No|No||
losartan/hydrochlorothiazide|No|No|No|No|75%|00006074731|HYZAAR 100-25 TABLET|30|EA|2.408|09/16/2010||Yes|No||09/16/2010||Yes|No|09/16/2010||Yes|No||||No|No|||Prescription required|Yes|01/20/2011|113|Yes|5.92795|01/24/2023|5.78567|01/24/2023|5.82421|01/24/2023|||ANGIOTENSIN MODULATORS|188|||||No|No||MERCK SHARP & D|No|||||No|No|No||
losartan/hydrochlorothiazide|No|No|No|No|75%|00006074754|HYZAAR 100-25 TABLET|90|EA|2.408|09/16/2010||Yes|No||09/16/2010||Yes|No|09/16/2010||Yes|No||||No|No|||Prescription required|Yes|01/20/2011|113|Yes|5.92795|01/24/2023|5.78567|01/24/2023|5.82421|01/24/2023|||ANGIOTENSIN MODULATORS|189|||||No|No||MERCK SHARP & D|No|||||No|No|No||
simvastatin|No|No|No|No|75%|00006074931|ZOCOR 40 MG TABLET|30|EA|3.4658|07/07/2006|01/19/2024|Yes|No||07/07/2006|01/19/2024|Yes|No|07/07/2006|01/19/2024|Yes|No||||No|No|||Prescription required|Yes|01/23/2007|063|Yes|7.8988|06/26/2018|7.78596|06/26/2018|7.4152|06/26/2018|||LIPOTROPICS: STATINS|190|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MERCK SHARP & D|No|||||No|No|No||
losartan potassium|No|No|No|No|75%|00006095154|COZAAR 25 MG TABLET|90|EA|1.1911|09/11/2010||Yes|No||09/11/2010||Yes|No|09/11/2010||Yes|No||||No|No|||Prescription required|Yes|01/20/2011|113|Yes|2.7146|06/13/2017|2.67582|06/13/2017|2.5484|06/13/2017|||ANGIOTENSIN MODULATORS|191|||||No|No||MERCK SHARP & D|No|||||No|No|No||
losartan potassium|No|No|No|No|75%|00006095231|COZAAR 50 MG TABLET|30|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|Yes|3.94385|01/24/2023|3.84919|01/24/2023|3.87483|01/24/2023|||ANGIOTENSIN MODULATORS|192|||||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|Yes|3.6358|08/30/2022|3.58386|08/30/2022|3.4132|08/30/2022|||ANGIOTENSIN MODULATORS|193|||||No|No||MERCK SHARP & D|No|||||No|No|No||
losartan potassium|No|No|No|No|75%|00006096031|COZAAR 100 MG TABLET|30|EA|2.1758|09/04/2010|01/14/2024|Yes|No||09/04/2010|01/14/2024|Yes|No|09/04/2010|01/14/2024|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|113|Yes|5.40561|01/24/2023|5.27587|01/24/2023|5.31101|01/24/2023|||ANGIOTENSIN MODULATORS|194|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MERCK SHARP & D|No|||||No|No|No||
losartan potassium|No|No|No|No|75%|00006096054|COZAAR 100 MG TABLET|90|EA|2.1758|09/04/2010||Yes|No||09/04/2010||Yes|No|09/04/2010||Yes|No||||No|No|||Prescription required|Yes|01/20/2011|113|Yes|5.40561|01/24/2023|5.27587|01/24/2023|5.31101|01/24/2023|||ANGIOTENSIN MODULATORS|195|||||No|No||MERCK SHARP & D|No|||||No|No|No||
montelukast sodium|No|No|No|No|75%|00006171131|SINGULAIR 4 MG TABLET CHEW|30|EA|3.2723|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|042|Yes|7.4578|06/26/2018|7.35126|06/26/2018|7.0012|06/26/2018|||LEUKOTRIENE MODIFIERS|196|||||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|No|334.9934|01/16/2018|330.20778|01/16/2018|314.4836|01/16/2018|||ANTIEMETIC/ANTIVERTIGO AGENTS|197|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
doravirine|No|No|No|No|75%|00006306901|PIFELTRO 100 MG TABLET|30|EA|33.54|12/10/2018||Yes|No||12/10/2018||Yes|No|12/10/2018||Yes|No||||No|No|||Prescription required|No||237|No|54.33468|01/24/2023|53.03064|01/24/2023|53.38382|01/24/2023|||HIV / AIDS|198|||||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|01/26/2017|064|No|254.8|12/10/2019|251.16|12/10/2019|239.2|12/10/2019|||HEPATITIS C AGENTS|199|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307502|PREVYMIS 240 MG TABLET|28|EA|107.0141|12/11/2019||Yes|No||12/11/2019||Yes|No|12/11/2019||Yes|No||||No|No|||Prescription required|No|||No|243.8926|01/17/2023|240.40842|01/17/2023|228.9604|01/17/2023||||200|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307504|PREVYMIS 240 MG TABLET|14|EA|107.0141|05/23/2018||Yes|No||05/23/2018||Yes|No|05/23/2018||Yes|No||||No|No|||Prescription required|No|||No|243.8926|01/17/2023|240.40842|01/17/2023|228.9604|01/17/2023||||201|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307602|PREVYMIS 480 MG TABLET|28|EA|107.0141|01/02/2020||Yes|No||01/02/2020||Yes|No|01/02/2020||Yes|No||||No|No|||Prescription required|No|||No|243.8926|01/17/2023|240.40842|01/17/2023|228.9604|01/17/2023||||202|||||No|No||MERCK SHARP & D|No|||||No|No|No||
letermovir|No|No|No|No|75%|00006307604|PREVYMIS 480 MG TABLET|14|EA|107.0141|08/08/2018||Yes|No||08/08/2018||Yes|No|08/08/2018||Yes|No||||No|No|||Prescription required|No|||No|243.8926|01/17/2023|240.40842|01/17/2023|228.9604|01/17/2023||||203|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006308001|ISENTRESS HD 600 MG TABLET|60|EA|19.104|07/17/2017||Yes|No||07/17/2017||Yes|No|07/17/2017||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|31.01531|01/24/2023|30.27094|01/24/2023|30.47254|01/24/2023|||HIV / AIDS|204|||||No|No||MERCK SHARP & D|No|||||No|No|No||
imipenem/cilastatin sodium|No|No|No|No|75%|00006351659|PRIMAXIN 500 MG VIAL|1|EA|14.04001|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|31.99817|06/01/2016|31.54105|06/01/2016|30.0391|06/01/2016||||205|||||No|No||MERCK SHARP & D|No|||||No|No|No||
dorzolamide HCl|No|No|No|No|75%|00006351936|TRUSOPT 2% EYE DROPS|10|ML|3.2594|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|07/27/2011|088|No|7.4284|10/29/2019|7.32228|10/29/2019|6.9736|10/29/2019|||OPHTHALMICS: GLAUCOMA AGENTS|206|||||No|No||MERCK SHARP & D|No|||||No|No|No||
raltegravir potassium|No|No|No|No|75%|00006360361|ISENTRESS 100 MG POWDER PACKET|60|EA|4.776|07/22/2019||Yes|No||07/22/2019||Yes|No|07/22/2019||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|7.8008|01/17/2023|7.68936|01/17/2023|7.3232|01/17/2023|||HIV / AIDS|207|||||No|No||MERCK SHARP & D|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00006380118|MAXALT MLT 10 MG TABLET|3|EA|15.7251|05/25/2011||Yes|No||05/25/2011||Yes|No|05/25/2011||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|No|35.8386|06/29/2021|35.32662|06/29/2021|33.6444|06/29/2021|||ANTIMIGRAINE AGENTS: TRIPTANS|208|||||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|06/01/2016|326.22786|06/01/2016|310.6932|06/01/2016||||209|||||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|06/01/2016|338.95008|06/01/2016|322.8096|06/01/2016||||210|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertapenem sodium|No|No|No|No|75%|00006384371|INVANZ 1 GM VIAL|1|EA|55.3238|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||||No|No|||Prescription required|No|||No|126.0868|01/29/2019|124.28556|01/29/2019|118.3672|01/29/2019||||211|||||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|01/29/2019|249.34392|01/29/2019|237.4704|01/29/2019|||ANTIEMETIC/ANTIVERTIGO AGENTS|212|||||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|51.048|12/10/2018||Yes|No||12/10/2018||Yes|No|12/10/2018||Yes|No||||No|No|||Prescription required|No||237|No|83.3784|01/17/2023|82.18728|01/17/2023|78.2736|01/17/2023|||HIV / AIDS|213|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502801|VERQUVO 2.5 MG TABLET|14|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.83251|01/24/2023|20.33252|01/24/2023|20.46794|01/24/2023||||214|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502802|VERQUVO 2.5 MG TABLET|30|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.83251|01/24/2023|20.33252|01/24/2023|20.46794|01/24/2023||||215|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502804|VERQUVO 2.5 MG TABLET|100|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.83251|01/24/2023|20.33252|01/24/2023|20.46794|01/24/2023||||216|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502901|VERQUVO 5 MG TABLET|14|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.63997|01/24/2023|20.14461|01/24/2023|20.27877|01/24/2023||||217|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502902|VERQUVO 5 MG TABLET|30|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.63997|01/24/2023|20.14461|01/24/2023|20.27877|01/24/2023||||218|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006502904|VERQUVO 5 MG TABLET|100|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.63997|01/24/2023|20.14461|01/24/2023|20.27877|01/24/2023||||219|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006503001|VERQUVO 10 MG TABLET|30|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.65742|01/24/2023|20.16164|01/24/2023|20.29591|01/24/2023||||220|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006503002|VERQUVO 10 MG TABLET|90|EA|9.2106|06/07/2021||Yes|No||06/07/2021||Yes|No|06/07/2021||Yes|No||||No|No|||Prescription required|No|||No|20.65742|01/24/2023|20.16164|01/24/2023|20.29591|01/24/2023||||221|||||No|No||MERCK SHARP & D|No|||||No|No|No||
vericiguat|No|No|No|No|75%|00006503004|VERQUVO 10 MG TABLET|100|EA|9.2106|08/25/2021||Yes|No||08/25/2021||Yes|No|08/25/2021||Yes|No||||No|No|||Prescription required|No|||No|20.65742|01/24/2023|20.16164|01/24/2023|20.29591|01/24/2023||||222|||||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||Yes|No||12/27/2021||Yes|No|12/27/2021||Yes|No||||No|No|||Prescription required|No|||No|.0098|01/03/2022|.00966|01/03/2022|.0092|01/03/2022|.0001|12/27/2021||223|||||No|No||MERCK SHARP & D|No|||||No|No|No||
belzutifan|No|No|No|No|75%|00006533101|WELIREG 40 MG TABLET|90|EA|134.9641|02/22/2022||Yes|No||02/22/2022||Yes|No|02/22/2022||Yes|No||||No|No|||Prescription required|No||548|No|307.5926|01/17/2023|303.19842|01/17/2023|288.7604|01/17/2023|||ONCOLOGY: ORAL - RENAL CELL|224|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536303|STEGLATRO 5 MG TABLET|30|EA|4.8848|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|535|No|10.90019|01/24/2023|10.63858|01/24/2023|10.70943|01/24/2023|||HYPOGLYCEMICS: SGLT2|225|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536306|STEGLATRO 5 MG TABLET|90|EA|4.8848|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|535|No|10.90019|01/24/2023|10.63858|01/24/2023|10.70943|01/24/2023|||HYPOGLYCEMICS: SGLT2|226|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536307|STEGLATRO 5 MG TABLET|500|EA|4.8848|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|535|No|10.90019|01/24/2023|10.63858|01/24/2023|10.70943|01/24/2023|||HYPOGLYCEMICS: SGLT2|227|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536403|STEGLATRO 15 MG TABLET|30|EA|4.8848|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|535|No|10.9171|01/24/2023|10.65508|01/24/2023|10.72605|01/24/2023|||HYPOGLYCEMICS: SGLT2|228|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536406|STEGLATRO 15 MG TABLET|90|EA|4.8848|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|535|No|10.9171|01/24/2023|10.65508|01/24/2023|10.72605|01/24/2023|||HYPOGLYCEMICS: SGLT2|229|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536407|STEGLATRO 15 MG TABLET|500|EA|4.8848|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|535|No|10.9171|01/24/2023|10.65508|01/24/2023|10.72605|01/24/2023|||HYPOGLYCEMICS: SGLT2|230|||||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|17.9634|01/24/2023|17.70678|01/24/2023|16.8636|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|231|||||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|17.9634|01/24/2023|17.70678|01/24/2023|16.8636|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|232|||||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|17.62557|07/26/2022|17.20255|07/26/2022|17.31712|07/26/2022|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|233|||||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|17.62557|07/26/2022|17.20255|07/26/2022|17.31712|07/26/2022|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|234|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.5664|01/17/2023|5.48688|01/17/2023|5.2256|01/17/2023|||HYPOGLYCEMICS: SGLT2|235|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.5664|01/17/2023|5.48688|01/17/2023|5.2256|01/17/2023|||HYPOGLYCEMICS: SGLT2|236|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006536907|SEGLUROMET 2.5-500 MG TABLET|500|EA|2.4424|09/30/2019||Yes|No||09/30/2019||Yes|No|09/30/2019||Yes|No||||No|No|||Prescription required|Yes|01/25/2018|535|No|5.5664|01/17/2023|5.48688|01/17/2023|5.2256|01/17/2023|||HYPOGLYCEMICS: SGLT2|237|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.4582|01/24/2023|5.3272|01/24/2023|5.36268|01/24/2023|||HYPOGLYCEMICS: SGLT2|238|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.4582|01/24/2023|5.3272|01/24/2023|5.36268|01/24/2023|||HYPOGLYCEMICS: SGLT2|239|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537007|SEGLUROMET 7.5-500 MG TABLET|500|EA|2.4424|09/30/2019||Yes|No||09/30/2019||Yes|No|09/30/2019||Yes|No||||No|No|||Prescription required|Yes|01/25/2018|535|No|5.4582|01/24/2023|5.3272|01/24/2023|5.36268|01/24/2023|||HYPOGLYCEMICS: SGLT2|240|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.46971|01/24/2023|5.33843|01/24/2023|5.37399|01/24/2023|||HYPOGLYCEMICS: SGLT2|241|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.46971|01/24/2023|5.33843|01/24/2023|5.37399|01/24/2023|||HYPOGLYCEMICS: SGLT2|242|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537307|SEGLUROMET 2.5-1,000 MG TABLET|500|EA|2.4424|09/30/2019||Yes|No||09/30/2019||Yes|No|09/30/2019||Yes|No||||No|No|||Prescription required|Yes|01/25/2018|535|No|5.46971|01/24/2023|5.33843|01/24/2023|5.37399|01/24/2023|||HYPOGLYCEMICS: SGLT2|243|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.4547|01/24/2023|5.32378|01/24/2023|5.35924|01/24/2023|||HYPOGLYCEMICS: SGLT2|244|||||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|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|No|5.4547|01/24/2023|5.32378|01/24/2023|5.35924|01/24/2023|||HYPOGLYCEMICS: SGLT2|245|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537407|SEGLUROMET 7.5-1,000 MG TABLET|500|EA|2.4424|09/30/2019||Yes|No||09/30/2019||Yes|No|09/30/2019||Yes|No||||No|No|||Prescription required|Yes|01/25/2018|535|No|5.4547|01/24/2023|5.32378|01/24/2023|5.35924|01/24/2023|||HYPOGLYCEMICS: SGLT2|246|||||No|No||MERCK SHARP & D|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00006672268|SINEMET 10-100 MG TABLET|100|EA|.4472|07/30/2021|02/21/2023|Yes|No||07/30/2021|02/21/2023|Yes|No|07/30/2021|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/30/2020|015|No|1.0192|07/30/2021|1.00464|07/30/2021|.9568|07/30/2021|||ANTIPARKINSON'S AGENTS|247|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MERCK SHARP & D|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00006672468|SINEMET 25-100 MG TABLET|100|EA|.5031|07/30/2021|02/21/2023|Yes|No||07/30/2021|02/21/2023|Yes|No|07/30/2021|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/30/2020|015|No|1.1466|08/03/2021|1.13022|07/30/2021|1.0764|07/30/2021|||ANTIPARKINSON'S AGENTS|248|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MERCK SHARP & D|No|||||No|No|No||
montelukast sodium|No|No|No|No|75%|00006911731|SINGULAIR 10 MG TABLET|30|EA|3.2723|07/13/2012|02/21/2023|Yes|No||07/13/2012|02/21/2023|Yes|No|07/13/2012|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|042|Yes|7.4578|03/07/2023|7.35126|03/07/2023|7.0012|03/07/2023|||LEUKOTRIENE MODIFIERS|249|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|042|Yes|7.4578|06/26/2018|7.35126|06/26/2018|7.0012|06/26/2018|||LEUKOTRIENE MODIFIERS|250|||||No|No||MERCK SHARP & D|No|||||No|No|No||
carvedilol phosphate|No|No|No|No|75%|00007337313|COREG CR 80 MG CAPSULE|30|EA|4.53736|02/01/2007|11/07/2023|Yes|No||02/01/2007|11/07/2023|Yes|No|02/01/2007|11/07/2023|Yes|No||||No|No|||Prescription required|No||070|No|10.34096|10/05/2021|10.19323|10/12/2021|9.70784|10/05/2021|||BETA-BLOCKERS|251|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GSK/WOODWARD PH|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00007413920|COREG 3.125 MG TABLET|100|EA|2.6832|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.1152|11/08/2022|6.02784|11/08/2022|5.7408|11/08/2022|||BETA-BLOCKERS|252|||||No|No||GSK/WOODWARD PH|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00007414020|COREG 6.25 MG TABLET|100|EA|2.6832|09/28/2007||Yes|No||09/28/2007||Yes|No|09/28/2007||Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.1152|11/08/2022|6.02784|11/08/2022|5.7408|11/08/2022|||BETA-BLOCKERS|253|||||No|No||GSK/WOODWARD PH|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00007414120|COREG 12.5 MG TABLET|100|EA|2.6832|09/28/2007||Yes|No||09/28/2007||Yes|No|09/28/2007||Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.1152|11/08/2022|6.02784|11/08/2022|5.7408|11/08/2022|||BETA-BLOCKERS|254|||||No|No||GSK/WOODWARD PH|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00007414220|COREG 25 MG TABLET|100|EA|2.6832|09/28/2007||Yes|No||09/28/2007||Yes|No|09/28/2007||Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.1152|11/08/2022|6.02784|11/08/2022|5.7408|11/08/2022|||BETA-BLOCKERS|255|||||No|No||GSK/WOODWARD PH|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083321|EFFEXOR XR 75 MG CAPSULE|30|EA|7.84807|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|17.44097|01/17/2023|17.02238|01/17/2023|17.13575|01/17/2023|||ANTIDEPRESSANTS: OTHER|256|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083322|EFFEXOR XR 75 MG CAPSULE|90|EA|7.84879|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|17.44097|01/17/2023|17.02238|01/17/2023|17.13575|01/17/2023|||ANTIDEPRESSANTS: OTHER|257|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083621|EFFEXOR XR 150 MG CAPSULE|30|EA|8.54868|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|19.06968|01/17/2023|18.612|01/17/2023|18.73596|01/17/2023|||ANTIDEPRESSANTS: OTHER|258|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083622|EFFEXOR XR 150 MG CAPSULE|90|EA|8.54834|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|19.06968|01/17/2023|18.612|01/17/2023|18.73596|01/17/2023|||ANTIDEPRESSANTS: OTHER|259|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083721|EFFEXOR XR 37.5 MG CAPSULE|30|EA|7.00441|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|15.96354|01/10/2023|15.73549|01/10/2023|14.98618|01/10/2023|||ANTIDEPRESSANTS: OTHER|260|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00008083722|EFFEXOR XR 37.5 MG CAPSULE|90|EA|7.00421|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|15.9631|01/10/2023|15.73505|01/10/2023|14.98576|01/10/2023|||ANTIDEPRESSANTS: OTHER|261|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00008084181|PROTONIX DR 40 MG TABLET|90|EA|7.4992|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|16.75119|01/10/2023|16.34916|01/10/2023|16.45804|01/10/2023|||PROTON PUMP INHIBITORS|262|||||No|No||WYETH/PFIZER|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00008084381|PROTONIX DR 20 MG TABLET|90|EA|7.4992|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|17.0912|01/03/2023|16.84704|01/03/2023|16.0448|01/03/2023|||PROTON PUMP INHIBITORS|263|||||No|No||WYETH/PFIZER|No|||||No|No|No||
pantoprazole sodium|No|No|No|No|75%|00008084402|PROTONIX 40 MG SUSPENSION|30|EA|7.46465|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription required|No||047|No|16.69628|01/10/2023|16.29556|01/10/2023|16.40409|01/10/2023|||PROTON PUMP INHIBITORS|264|||||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|01/04/2022|4.90245|01/04/2022|4.669|01/04/2022||||265|||||No|No||WYETH/PFIZER|No|||||No|No|No||
sirolimus|No|No|No|No|75%|00008103006|RAPAMUNE 1 MG/ML ORAL SOLN|60|ML|14.07697|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||229|No|32.08241|01/03/2023|31.62409|01/03/2023|30.11818|01/03/2023|||IMMUNOSUPPRESSIVES: ORAL|266|||||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||229|No|16.93456|01/10/2023|16.52813|01/10/2023|16.6382|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|267|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
sirolimus|No|No|No|No|75%|00008104105|RAPAMUNE 1 MG TABLET|100|EA|14.7806|03/24/2008||Yes|No||03/24/2008||Yes|No|03/24/2008||Yes|No||03/24/2008||Yes|No|||Prescription required|No||229|No|33.45321|01/10/2023|32.65033|01/10/2023|32.86777|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|268|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
sirolimus|No|No|No|No|75%|00008104110|RAPAMUNE 1 MG TABLET|100|EA|14.7806|06/09/2006||Yes|No||06/09/2006||Yes|No|06/09/2006||Yes|No||06/09/2006||Yes|No|||Prescription required|No||229|No|33.45321|01/10/2023|32.65033|01/10/2023|32.86777|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|269|||||No|No||WYETH/PFIZER|No|||||Yes|No|No||
sirolimus|No|No|No|No|75%|00008104205|RAPAMUNE 2 MG TABLET|100|EA|29.56103|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||03/08/2006||Yes|No|||Prescription required|No||229|No|66.7287|01/10/2023|65.12721|01/10/2023|65.56094|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|270|||||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|2.74053|03/17/2014||Yes|No||03/17/2014||Yes|No|03/17/2014||Yes|No||||No|No|||Prescription required|No|||Yes|6.24586|01/25/2022|6.15663|01/25/2022|5.86346|01/25/2022||||271|||||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||031|No|14.04555|01/11/2022|13.70845|01/11/2022|13.79975|01/11/2022|||ANTIDEPRESSANTS: OTHER|272|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008121101|PRISTIQ ER 50 MG TABLET|90|EA|6.27732|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription required|No||031|No|13.99675|01/11/2022|13.66082|01/11/2022|13.7518|01/11/2022|||ANTIDEPRESSANTS: OTHER|273|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008121114|PRISTIQ ER 50 MG TABLET|14|EA|6.27707|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription required|No||031|No|13.99675|01/11/2022|13.66082|01/11/2022|13.7518|01/11/2022|||ANTIDEPRESSANTS: OTHER|274|||||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||031|No|13.99675|01/11/2022|13.66082|01/11/2022|13.7518|01/11/2022|||ANTIDEPRESSANTS: OTHER|275|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008122201|PRISTIQ ER 100 MG TABLET|90|EA|6.27732|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription required|No||031|No|13.97675|01/11/2022|13.6413|01/11/2022|13.73215|01/11/2022|||ANTIDEPRESSANTS: OTHER|276|||||No|No||WYETH/PFIZER|No|||||No|No|No||
desvenlafaxine succinate|No|No|No|No|75%|00008122214|PRISTIQ ER 100 MG TABLET|14|EA|6.27707|06/02/2008||Yes|No||06/02/2008||Yes|No|06/02/2008||Yes|No||||No|No|||Prescription required|No||031|No|13.97675|01/11/2022|13.6413|01/11/2022|13.73215|01/11/2022|||ANTIDEPRESSANTS: OTHER|277|||||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||031|No|13.97675|01/11/2022|13.6413|01/11/2022|13.73215|01/11/2022|||ANTIDEPRESSANTS: OTHER|278|||||No|No||WYETH/PFIZER|No|||||No|No|No||
tigecycline|No|No|No|No|75%|00008499020|TYGACIL 50 MG VIAL|1|EA|68.30894|06/20/2017||Yes|No||06/20/2017||Yes|No|06/20/2017||Yes|No||||No|No|||Prescription required|No|||No|155.68084|01/04/2022|153.45682|01/04/2022|146.14936|01/04/2022||||279|||||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|7.955|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|17.70216|01/11/2022|17.2773|01/11/2022|17.39237|01/11/2022||||280|||||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|7.95947|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|18.14019|01/04/2022|17.88104|01/04/2022|17.02956|01/04/2022||||281|||||No|No||PFIZER US PHARM|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00009001201|CORTEF 5 MG TABLET|50|EA|.43223|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|.98509|01/04/2022|.97102|01/04/2022|.92478|01/04/2022|||GLUCOCORTICOIDS: ORAL|282|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
hydrocortisone sodium succ/PF|No|No|No|No|75%|00009001305|SOLU-CORTEF 250 MG ACT-O-VIAL|1|EA|14.7232|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|33.5552|01/04/2022|33.07584|01/04/2022|31.5008|01/04/2022||||283|||||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|14.72251|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|33.55363|01/04/2022|33.07429|01/04/2022|31.49932|01/04/2022||||284|||||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|01/04/2022|1.72566|01/04/2022|1.64348|01/04/2022|||GLUCOCORTICOIDS: ORAL|285|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009002901|XANAX 0.25 MG TABLET|100|EA|2.23101|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|4.99743|01/17/2023|4.87749|01/17/2023|4.90997|01/17/2023|||ANXIOLYTICS|286|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009002902|XANAX 0.25 MG TABLET|500|EA|2.23101|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|4.99743|01/17/2023|4.87749|01/17/2023|4.90997|01/17/2023|||ANXIOLYTICS|287|||||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|1.66374|01/04/2022|1.63997|01/04/2022|1.56188|01/04/2022|||GLUCOCORTICOIDS: ORAL|288|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00009004401|CORTEF 20 MG TABLET|100|EA|1.38382|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|3.15383|01/04/2022|3.10878|01/04/2022|2.96074|01/04/2022|||GLUCOCORTICOIDS: ORAL|289|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
medroxyprogesterone acetate|No|No|No|No|75%|00009005101|PROVERA 10 MG TABLET|100|EA|2.20783|03/22/2023||Yes|No||03/22/2023||Yes|No|03/22/2023||Yes|No||||No|No|||Prescription required|No|||No|5.03181|03/22/2023|4.95992|03/22/2023|4.72374|03/22/2023||||290|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005501|XANAX 0.5 MG TABLET|100|EA|2.77947|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|6.23974|01/17/2023|6.08998|01/17/2023|6.13054|01/17/2023|||ANXIOLYTICS|291|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005503|XANAX 0.5 MG TABLET|500|EA|2.7795|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|6.23974|01/17/2023|6.08998|01/17/2023|6.13054|01/17/2023|||ANXIOLYTICS|292|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
methylprednisolone|No|No|No|No|75%|00009005602|MEDROL 4 MG TABLET|100|EA|.13097|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|.2985|01/04/2022|.29424|01/04/2022|.28023|01/04/2022|||GLUCOCORTICOIDS: ORAL|293|||||No|No||PHARMACI/PFIZER|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|.29237|01/11/2022|.28535|01/11/2022|.28725|01/11/2022|||GLUCOCORTICOIDS: ORAL|294|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005707|XANAX XR 0.5 MG TABLET|60|EA|4.29957|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|9.79902|01/10/2023|9.65903|01/10/2023|9.19908|01/10/2023|||ANXIOLYTICS|295|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009005907|XANAX XR 1 MG TABLET|60|EA|5.35006|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|12.19316|01/10/2023|12.01897|01/10/2023|11.44664|01/10/2023|||ANXIOLYTICS|296|||||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|03/21/2023|2.52879|03/21/2023|2.40837|03/21/2023||||297|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009006607|XANAX XR 2 MG TABLET|60|EA|7.10087|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|16.18338|01/10/2023|15.95219|01/10/2023|15.19256|01/10/2023|||ANXIOLYTICS|298|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009006807|XANAX XR 3 MG TABLET|60|EA|10.65038|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|24.27296|01/10/2023|23.9262|01/10/2023|22.78686|01/10/2023|||ANXIOLYTICS|299|||||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|01/04/2022|2.77725|01/04/2022|2.645|01/04/2022|||GLUCOCORTICOIDS: ORAL|300|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009009001|XANAX 1 MG TABLET|100|EA|3.70879|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|8.23306|01/17/2023|8.03546|01/17/2023|8.08898|01/17/2023|||ANXIOLYTICS|301|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009009004|XANAX 1 MG TABLET|500|EA|3.70876|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|8.23306|01/17/2023|8.03546|01/17/2023|8.08898|01/17/2023|||ANXIOLYTICS|302|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00009009401|XANAX 2 MG TABLET|100|EA|6.3059|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|14.0343|01/17/2023|13.69747|01/17/2023|13.78869|01/17/2023|||ANXIOLYTICS|303|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
clindamycin HCl|No|No|No|No|75%|00009022502|CLEOCIN HCL 150 MG CAPSULE|100|EA|.0626|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|.14268|01/04/2022|.14064|01/04/2022|.13395|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|304|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009026001|COLESTID GRANULES PACKET|30|EA|3.04884|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|6.94852|01/03/2023|6.84925|01/03/2023|6.5231|01/03/2023|||LIPOTROPICS: OTHER|305|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009026002|COLESTID GRANULES|500|GM|.36302|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|.82735|01/03/2023|.81553|01/03/2023|.7767|01/03/2023|||LIPOTROPICS: OTHER|306|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
estradiol cypionate|No|No|No|No|75%|00009027101|DEPO-ESTRADIOL 5 MG/ML VIAL|5|ML|13.2526|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|29.56318|01/10/2023|28.85366|01/10/2023|29.04582|01/10/2023||||307|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009027401|DEPO-MEDROL 20 MG/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|07/05/2022|6.87019|07/05/2022|6.54304|07/05/2022||||308|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009028002|DEPO-MEDROL 40 MG/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|07/05/2022|9.52282|07/05/2022|9.06936|07/05/2022||||309|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009028003|DEPO-MEDROL 40 MG/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|9.67162|07/05/2022|9.53345|07/05/2022|9.07948|07/05/2022||||310|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009030602|DEPO-MEDROL 80 MG/ML VIAL|5|ML|8.48734|11/27/2002||Yes|No||11/27/2002||Yes|No|||No|No||||No|No|||Prescription required|No|||No|19.34324|07/05/2022|19.0669|07/05/2022|18.15896|07/05/2022||||311|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin HCl|No|No|No|No|75%|00009033102|CLEOCIN HCL 75 MG CAPSULE|100|EA|.09601|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|01/04/2022|.2157|01/04/2022|.20543|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|312|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
glyburide,micronized|No|No|No|No|75%|00009034101|GLYNASE 1.5 MG PRESTAB|100|EA|.81166|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|1.84984|01/03/2023|1.82342|01/03/2023|1.73659|01/03/2023||||313|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00009034702|DEPO-TESTOSTERONE 100 MG/ML VL|10|ML|3.31788|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|7.56168|01/25/2022|7.45365|01/25/2022|7.09872|01/25/2022||||314|||||No|No||PHARMACI/PFIZER|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|01/03/2023|3.08347|01/03/2023|2.93664|01/03/2023||||315|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009037003|COLESTID FLAVORED GRANULES|60|EA|3.34439|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|7.6221|01/03/2023|7.51321|01/03/2023|7.15544|01/03/2023|||LIPOTROPICS: OTHER|316|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009037005|COLESTID FLAVORED GRANULES|450|GM|.31206|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|.71121|01/03/2023|.70105|01/03/2023|.66767|01/03/2023|||LIPOTROPICS: OTHER|317|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin HCl|No|No|No|No|75%|00009039514|CLEOCIN HCL 300 MG CAPSULE|100|EA|.1222|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|.27851|01/04/2022|.27453|01/04/2022|.26146|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|318|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00009041701|DEPO-TESTOSTERONE 200 MG/ML|1|ML|9.03|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription required|No|||No|14.68591|02/28/2023|14.33344|02/28/2023|14.4289|02/28/2023||||319|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00009041702|DEPO-TESTOSTERONE 200 MG/ML|10|ML|5.24385|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|5.34767|02/28/2023|5.21932|02/28/2023|5.25408|02/28/2023||||320|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009045003|COLESTID 1 GM TABLET|120|EA|.95664|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||055|No|2.12511|01/10/2023|2.0741|01/10/2023|2.08792|01/10/2023|||LIPOTROPICS: OTHER|321|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
lincomycin HCl|No|No|No|No|75%|00009055502|LINCOCIN 300 MG/ML VIAL|10|ML|7.23518|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|16.48948|01/04/2022|16.25391|01/04/2022|15.47992|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|322|||||No|No||PHARMACI/PFIZER|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|01/05/2021|42.48468|01/05/2021|40.4616|01/05/2021||||323|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009072809|CLEOCIN PHOS 9 G/60 ML VIAL|60|ML|.16723|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|01/04/2022|.3757|01/04/2022|.35781|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|324|||||No|No||PHARMACI/PFIZER|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|01/05/2021|23.45448|01/05/2021|22.3376|01/05/2021||||325|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin palmitate HCl|No|No|No|No|75%|00009076004|CLEOCIN PEDIATRIC 75 MG/5 ML|100|ML|.13312|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|.3034|01/04/2022|.29907|01/04/2022|.28483|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|326|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009077526|CLEOCIN PHOS 600 MG/4 ML VIAL|4|ML|.31643|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|01/04/2022|.71087|01/04/2022|.67702|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|327|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
hydrocortisone sod succinate|No|No|No|No|75%|00009082501|SOLU-CORTEF 100 MG VIAL|1|EA|5.8867|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|13.12286|11/29/2022|12.80791|11/29/2022|12.8932|11/29/2022||||328|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009087026|CLEOCIN PHOS 150 MG/ML VIAL|2|ML|.53474|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|1.21872|01/04/2022|1.20131|01/04/2022|1.14411|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|329|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009090218|CLEOCIN PHOS 150 MG/ML VIAL|6|ML|.30555|11/27/2002||Yes|No||11/27/2002||Yes|No|||No|No||||No|No|||Prescription required|Yes|07/17/2014|146|No|.69638|01/04/2022|.68643|01/04/2022|.65375|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|330|||||No|No||PHARMACI/PFIZER|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|11.1328|07/05/2022|10.97376|07/05/2022|10.4512|07/05/2022||||331|||||No|No||PHARMACI/PFIZER|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|11.1328|07/05/2022|10.97376|07/05/2022|10.4512|07/05/2022||||332|||||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|07/05/2022|10.98187|07/05/2022|10.45892|07/05/2022||||333|||||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|.46517|03/29/2022|.454|03/29/2022|.45702|03/29/2022|||ACNE AGENTS: TOPICAL|334|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
clindamycin phosphate|Yes|No|No|No|75%|00009344801|CLEOCIN 2% VAGINAL CREAM|40|GM|2.16171|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|4.9267|01/04/2022|4.85632|01/04/2022|4.62507|01/04/2022|||ANTIBIOTICS: VAGINAL|335|||||No|No||PHARMACI/PFIZER|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|4.93243|01/03/2023|4.86197|01/03/2023|4.63045|01/03/2023||||336|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009347522|DEPO-MEDROL 80 MG/ML VIAL|1|ML|8.4796|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription required|No|||No|18.31645|07/12/2022|17.87685|07/12/2022|17.99591|07/12/2022||||337|||||No|No||PFIZER/NOVAPLUS|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009347523|DEPO-MEDROL 80 MG/ML VIAL|1|ML|8.48132|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription required|No|||No|19.32952|07/05/2022|19.05338|07/05/2022|18.14608|07/05/2022||||338|||||No|No||PFIZER/NOVAPLUS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009454102|DETROL 1 MG TABLET|60|EA|3.4549|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|7.87396|01/10/2023|7.76148|01/10/2023|7.39188|01/10/2023|||BLADDER RELAXANT PREPARATIONS|339|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009454402|DETROL 2 MG TABLET|60|EA|3.54621|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|8.08206|01/10/2023|7.9666|01/10/2023|7.58724|01/10/2023|||BLADDER RELAXANT PREPARATIONS|340|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513601|ZYVOX 100 MG/5 ML SUSPENSION|150|ML|1.95478|06/02/2009||Yes|No||06/02/2009||Yes|No|06/02/2009||Yes|No||||No|No|||Prescription required|No||146|No|4.45508|01/04/2022|4.39143|01/04/2022|4.18232|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|341|||||No|No||PHARMACI/PFIZER|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|12/23/2016|146|No|265.59176|01/04/2022|261.79759|01/04/2022|249.33104|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|342|||||No|No||PHARMACI/PFIZER|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|12/23/2016|146|No|6.15798|01/04/2022|6.07001|01/04/2022|5.78096|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|343|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
linezolid in dextrose 5%|No|No|No|No|75%|00009514004|ZYVOX 600 MG/300 ML-D5W|300|ML|.06891|06/28/2017||Yes|No||06/28/2017||Yes|No|06/28/2017||Yes|No||||No|No|||Prescription required|Yes|12/23/2016|146|No|.15706|01/04/2022|.15482|01/04/2022|.14744|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|344|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519001|DETROL LA 2 MG CAPSULE|30|EA|5.62597|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|12.82198|01/10/2023|12.63881|01/10/2023|12.03696|01/10/2023|||BLADDER RELAXANT PREPARATIONS|345|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519002|DETROL LA 2 MG CAPSULE|90|EA|5.62573|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|12.82144|01/10/2023|12.63828|01/10/2023|12.03646|01/10/2023|||BLADDER RELAXANT PREPARATIONS|346|||||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||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|006|No|12.82132|01/10/2023|12.63815|01/10/2023|12.03634|01/10/2023|||BLADDER RELAXANT PREPARATIONS|347|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519101|DETROL LA 4 MG CAPSULE|30|EA|5.62597|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|12.82198|01/10/2023|12.63881|01/10/2023|12.03696|01/10/2023|||BLADDER RELAXANT PREPARATIONS|348|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00009519102|DETROL LA 4 MG CAPSULE|90|EA|5.62573|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|12.82144|01/10/2023|12.63828|01/10/2023|12.03646|01/10/2023|||BLADDER RELAXANT PREPARATIONS|349|||||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||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|006|No|12.82132|01/10/2023|12.63815|01/10/2023|12.03634|01/10/2023|||BLADDER RELAXANT PREPARATIONS|350|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nicotine|No|No|No|No|75%|00009540001|NICOTROL CARTRIDGE INHALER|168|EA|1.29595|07/07/2016||Yes|No||||No|No|07/07/2016||Yes|No||||No|No|||Prescription required|Yes|07/17/2014|040|No|2.90624|01/10/2023|2.83649|01/10/2023|2.85538|01/10/2023|||SMOKING CESSATION|351|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
nicotine|No|No|No|No|75%|00009540101|NICOTROL NS 10 MG/ML SPRAY|10|ML|5.71523|07/07/2016||Yes|No||||No|No|07/07/2016||Yes|No||||No|No|||Prescription required|Yes|07/17/2014|040|No|12.78016|01/10/2023|12.47343|01/10/2023|12.5565|01/10/2023|||SMOKING CESSATION|352|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
pegvisomant|No|No|No|No|75%|00009716801|SOMAVERT 15 MG VIAL|1|EA|166.1262|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription required|No|||No|378.6132|01/03/2023|373.20444|01/03/2023|355.4328|01/03/2023||||353|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|03/31/2022|
pegvisomant|No|No|No|No|75%|00009718801|SOMAVERT 20 MG VIAL|1|EA|221.4844|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription required|No|||No|504.7784|01/03/2023|497.56728|01/03/2023|473.8736|01/03/2023||||354|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|03/22/2019|
pegvisomant|No|No|No|No|75%|00009719901|SOMAVERT 25 MG VIAL|1|EA|276.8555|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription required|No|||No|630.973|01/03/2023|621.9591|01/03/2023|592.342|01/03/2023||||355|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|03/22/2019|
pegvisomant|No|No|No|No|75%|00009720001|SOMAVERT 30 MG VIAL|1|EA|332.2266|02/22/2017||Yes|No||02/22/2017||Yes|No|02/22/2017||Yes|No||||No|No|||Prescription required|No|||No|757.1676|01/03/2023|746.35092|01/03/2023|710.8104|01/03/2023||||356|||||No|No||PHARMACI/PFIZER|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|53.851|02/02/2021|53.0817|02/02/2021|50.554|02/02/2021||||357|||||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||502|No|37.6052|01/04/2022|37.06798|01/04/2022|35.30284|01/04/2022|||ONCOLOGY: ORAL - BREAST|358|||||No|No||PHARMACI/PFIZER|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||124|No|58.57162|01/11/2022|57.1659|01/11/2022|57.54661|01/11/2022|||ANTIBIOTICS: VAGINAL|359|||||No|No||PHARMACI/PFIZER|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||550|No|16.42264|01/04/2022|16.18803|01/04/2022|15.41717|01/04/2022|||ONCOLOGY: ORAL - PROSTATE|360|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
estradiol|No|No|No|No|75%|00013215036|ESTRING 2 MG VAGINAL RING|1|EA|227.7925|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|507.71926|01/10/2023|495.53399|01/10/2023|498.83417|01/10/2023||||361|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
somatropin|No|No|No|No|75%|00013262681|GENOTROPIN 5 MG CARTRIDGE|1|EA|308.4175|12/21/2009||Yes|No||12/21/2009||Yes|No|12/21/2009||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|698.88281|01/10/2023|682.10962|01/10/2023|686.65236|01/10/2023|||GROWTH HORMONE|362|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013264681|GENOTROPIN 12 MG CARTRIDGE|1|EA|740.2149|12/21/2009||Yes|No||12/21/2009||Yes|No|12/21/2009||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|1687.0014|01/03/2023|1662.90138|01/03/2023|1583.7156|01/03/2023|||GROWTH HORMONE|363|||||No|No||PHARMACI/PFIZER|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||014|Yes|29.74999|01/04/2022|29.32499|01/04/2022|27.92856|01/04/2022|||GROWTH HORMONE|364|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265002|GENOTROPIN MINIQUICK 0.4 MG|7|EA|26.11082|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|59.50839|01/04/2022|58.65827|01/04/2022|55.86502|01/04/2022|||GROWTH HORMONE|365|||||No|No||PHARMACI/PFIZER|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||014|Yes|89.2584|01/04/2022|87.98328|01/04/2022|83.7936|01/04/2022|||GROWTH HORMONE|366|||||No|No||PHARMACI/PFIZER|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||014|Yes|119.01259|01/04/2022|117.31241|01/04/2022|111.7261|01/04/2022|||GROWTH HORMONE|367|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265302|GENOTROPIN MINIQUICK 1 MG|7|EA|65.27645|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|148.76959|01/04/2022|146.64431|01/04/2022|139.66125|01/04/2022|||GROWTH HORMONE|368|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265402|GENOTROPIN MINIQUICK 1.2 MG|7|EA|78.33125|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|178.52239|01/04/2022|175.97207|01/04/2022|167.59245|01/04/2022|||GROWTH HORMONE|369|||||No|No||PHARMACI/PFIZER|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||014|Yes|208.27099|01/04/2022|205.29569|01/04/2022|195.5197|01/04/2022|||GROWTH HORMONE|370|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265602|GENOTROPIN MINIQUICK 1.6 MG|7|EA|104.43778|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|238.02099|01/04/2022|234.62069|01/04/2022|223.44828|01/04/2022|||GROWTH HORMONE|371|||||No|No||PHARMACI/PFIZER|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||014|Yes|267.78219|01/04/2022|263.95673|01/04/2022|251.38736|01/04/2022|||GROWTH HORMONE|372|||||No|No||PHARMACI/PFIZER|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265802|GENOTROPIN MINIQUICK 2 MG|7|EA|130.54922|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|297.53079|01/04/2022|293.28035|01/04/2022|279.31462|01/04/2022|||GROWTH HORMONE|373|||||No|No||PHARMACI/PFIZER|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|01/04/2022|18.79295|01/04/2022|17.89804|01/04/2022||||374|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
latanoprost|No|No|No|No|75%|00013830304|XALATAN 0.005% EYE DROPS|2.5|ML|43.2924|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|96.75463|01/17/2023|94.43251|01/17/2023|95.06142|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|375|||||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|2.73559|12/04/2018|2.69651|12/04/2018|2.5681|12/04/2018||||376|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
mineral oil/petrolatum,white|No|No|No|No|75%|00023031207|REFRESH LACRI-LUBE OINTMENT|7|GM|1.03875|11/27/2002||Yes|No||||No|No|||No|No||||No|No|||Over the counter|No|||No|2.36739|12/25/2018|2.33357|12/25/2018|2.22245|12/25/2018||||377|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
sulfacetamide/prednisolone|No|No|No|No|75%|00023031304|BLEPHAMIDE EYE OINTMENT|3.5|GM|18.76765|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/28/2016|036|No|42.77279|01/12/2021|42.16175|01/12/2021|40.15405|01/12/2021|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|378|||||No|No||ALLERGAN INC.|No|||||No|No|No||
fluorometholone|No|No|No|No|75%|00023031604|FML S.O.P. 0.1% OINTMENT|3.5|GM|19.70628|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/23/2013|013|No|44.91199|01/12/2021|44.27039|01/12/2021|42.16228|01/12/2021|||OPHTHALMICS: ANTI-INFLAMMATORIES|379|||||No|No||ALLERGAN INC.|No|||||No|No|No||
carboxymethylcellulose sodium|No|No|No|No|75%|00023040350|REFRESH PLUS 0.5% EYE DROPS|50|EA|.11008|09/01/1999||Yes|No||||No|No|09/01/1999||Yes|No||||No|No|||Over the counter|No|||No|.25088|06/29/2021|.24729|06/29/2021|.23552|06/29/2021||||380|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
ketorolac tromethamine|No|No|No|No|75%|00023218105|ACULAR 0.5% EYE DROPS|5|ML|23.68698|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|10/23/2010|013|No|53.98428|01/12/2021|53.21307|01/12/2021|50.67912|01/12/2021|||OPHTHALMICS: ANTI-INFLAMMATORIES|381|||||No|No||ALLERGAN INC.|No|||||No|No|No||
bimatoprost|No|No|No|No|75%|00023320503|LUMIGAN 0.01% EYE DROPS|2.5|ML|41.18024|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|91.904|01/17/2023|89.6983|01/17/2023|90.29568|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|382|||||No|No||ALLERGAN INC.|No|||||No|No|No||
bimatoprost|No|No|No|No|75%|00023320505|LUMIGAN 0.01% EYE DROPS|5|ML|41.16304|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|91.87389|01/17/2023|89.66891|01/17/2023|90.26609|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|383|||||No|No||ALLERGAN INC.|No|||||No|No|No||
bimatoprost|No|No|No|No|75%|00023320508|LUMIGAN 0.01% EYE DROPS|7.5|ML|41.16132|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|91.75935|01/17/2023|89.55712|01/17/2023|90.15356|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|384|||||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|10.91818|12/21/2021|10.7622|12/21/2021|10.24972|12/21/2021|||OPHTHALMICS: ANTI-INFLAMMATORIES|385|||||No|No||ALLERGAN INC.|No|||||No|No|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|2.78712|08/01/2022|2.7473|08/01/2022|2.61648|08/01/2022|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|386|||||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|08/09/2022|2.10008|08/01/2022|2.00008|08/01/2022|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|387|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
carboxymethylcellulose sodium|No|No|No|No|75%|00023455430|REFRESH CELLUVISC 1% EYE GEL|30|EA|.13874|11/27/2002||Yes|No||||No|No|||No|No||||No|No|||Over the counter|No|||No|.3162|06/29/2021|.31168|06/29/2021|.29684|06/29/2021||||388|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
cyclosporine|No|No|No|No|75%|00023530105|RESTASIS MULTIDOSE 0.05% EYE|5.5|ML|50.47652|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|112.4689|10/25/2022|109.76964|10/25/2022|110.50069|10/25/2022|||OPHTHALMICS: ANTI-INFLAMMATORY/IMMUNOMODULATOR|389|||||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|.18332|11/08/2017||Yes|No||||No|No|11/08/2017||Yes|No||||No|No|||Over the counter|No|||No|.41974|12/27/2022|.40966|12/27/2022|.41239|12/27/2022||||390|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
mesalamine|No|No|No|No|75%|00023585318|DELZICOL DR 400 MG CAPSULE|180|EA|1.66818|11/09/2016||Yes|No||11/09/2016||Yes|No|11/09/2016||Yes|No||||No|No|||Prescription required|No||010|No|3.80191|04/26/2022|3.74759|04/26/2022|3.56914|04/26/2022|||ULCERATIVE COLITIS AGENTS|391|||||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|02/20/2019|12.73188|02/26/2019|12.1256|02/20/2019|||BLADDER RELAXANT PREPARATIONS|392|||||No|No||ALLERGAN INC.|No|||||No|No|No||
oxybutynin chloride|No|No|No|No|75%|00023586111|GELNIQUE 10% GEL SACHET|1|GM|5.66926|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|006|No|12.92064|02/20/2019|12.73606|02/20/2019|12.12958|02/20/2019|||BLADDER RELAXANT PREPARATIONS|393|||||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|3.48969|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|7.8187|01/17/2023|7.63105|01/17/2023|7.68187|01/17/2023||||394|||||No|No||ALLERGAN INC.|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
mesalamine|No|No|No|No|75%|00023590118|ASACOL HD DR 800 MG TABLET|180|EA|4.04319|08/25/2017||Yes|No||08/25/2017||Yes|No|08/25/2017||Yes|No||||No|No|||Prescription required|Yes|01/26/2017|010|No|9.21471|10/26/2021|9.08307|10/26/2021|8.65054|10/26/2021|||ULCERATIVE COLITIS AGENTS|395|||||No|No||ALLERGAN INC.|No|||||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||084|No|9.82286|11/29/2022|9.58711|11/29/2022|9.65095|11/29/2022|||ANDROGENIC AGENTS|396|||||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||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No||084|No|9.82286|11/29/2022|9.58711|11/29/2022|9.65095|11/29/2022|||ANDROGENIC AGENTS|397|||||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||084|No|19.6219|02/28/2023|19.15097|02/28/2023|19.27851|02/28/2023|||ANDROGENIC AGENTS|398|||||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||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No||084|No|19.6219|02/28/2023|19.15097|02/28/2023|19.27851|02/28/2023|||ANDROGENIC AGENTS|399|||||No|No||ALLERGAN INC.|No|||||No|No|No||
noreth-ethinyl estradiol/iron|Yes|Yes|No|No|75%|00023603003|GENERESS FE CHEWABLE TABLET|28|EA|2.51268|04/09/2019||Yes|No||04/09/2019||Yes|No|04/09/2019||Yes|No|Refer to program requirements|||No|No|09/04/2019||Prescription required|No|||No|5.72658|01/28/2020|5.64477|01/28/2020|5.37597|01/28/2020||||400|||||No|No||ALLERGAN INC.|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
iron dextran complex|No|No|No|No|75%|00023608210|INFED 100 MG/2 ML VIAL|2|ML|7.27065|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No|||No|16.57033|01/10/2023|16.33361|01/10/2023|15.55582|01/10/2023||||401|||||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|01/24/2023|174.80183|01/24/2023|166.47793|01/24/2023||||402|||||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|01/28/2020|8.41965|01/28/2020|8.01872|01/28/2020|||BPH TREATMENTS|403|||||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|26.0288|01/28/2020|25.65696|01/28/2020|24.4352|01/28/2020||||404|||||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|02/26/2019|25.65696|02/26/2019|24.4352|02/20/2019||||405|||||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|83.2804|08/25/2020|82.09068|08/25/2020|78.1816|08/25/2020|||BLADDER RELAXANT PREPARATIONS|406|||||No|No||ALLERGAN INC.|No|||||No|No|No||
oxybutynin|No|No|No|No|75%|00023615308|OXYTROL 3.9 MG/24HR PATCH|8|EA|36.54193|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|83.28162|08/25/2020|82.09188|08/25/2020|78.18275|08/25/2020|||BLADDER RELAXANT PREPARATIONS|407|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ubrogepant|No|No|No|No|75%|00023649810|UBRELVY 50 MG TABLET|10|EA|42.31157|05/19/2020||Yes|No||05/19/2020||Yes|No|05/19/2020||Yes|No||||No|No|||Prescription required|Yes|07/28/2022|537|No|94.26771|01/17/2023|92.00528|01/17/2023|92.61802|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|408|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ubrogepant|No|No|No|No|75%|00023650110|UBRELVY 100 MG TABLET|10|EA|42.31157|05/19/2020||Yes|No||05/19/2020||Yes|No|05/19/2020||Yes|No||||No|No|||Prescription required|Yes|07/28/2022|537|No|94.57869|01/17/2023|92.3088|01/17/2023|92.92356|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|409|||||No|No||ALLERGAN INC.|No|||||No|No|No||
ubrogepant|No|No|No|No|75%|00023650116|UBRELVY 100 MG TABLET|16|EA|42.31119|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||||No|No|||Prescription required|Yes|07/28/2022|537|No|94.57869|01/17/2023|92.3088|01/17/2023|92.92356|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|410|||||No|No||ALLERGAN INC.|No|||||No|No|No||
polymyxin B sulf/trimethoprim|No|No|No|No|75%|00023782410|POLYTRIM EYE DROPS|10|ML|3.43441|03/01/2002|09/30/2023|Yes|No||03/01/2002|09/30/2023|Yes|No|03/01/2002|09/30/2023|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|058|No|7.82726|01/12/2021|7.71544|01/12/2021|7.34804|01/12/2021|||OPHTHALMIC ANTIBIOTICS|411|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALLERGAN INC.|No|||||No|No|No||
nedocromil sodium|No|No|No|No|75%|00023884205|ALOCRIL 2% EYE DROPS|5|ML|19.30786|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|07/22/2009|002|No|44.00396|01/12/2021|43.37533|01/12/2021|41.30984|01/12/2021|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|412|||||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||086|No|10.31325|02/08/2022|10.06573|02/08/2022|10.13276|02/08/2022|||OPHTHALMICS: ANTI-INFLAMMATORY/IMMUNOMODULATOR|413|||||No|No||ALLERGAN INC.|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00023916360|RESTASIS 0.05% EYE EMULSION|60|EA|4.62701|11/19/2012||Yes|No||11/19/2012||Yes|No|11/19/2012||Yes|No||||No|No|||Prescription required|No||086|No|10.33963|02/08/2022|10.09147|02/08/2022|10.15868|02/08/2022|||OPHTHALMICS: ANTI-INFLAMMATORY/IMMUNOMODULATOR|414|||||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|39.52419|01/17/2023|38.5756|01/17/2023|38.83251|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|415|||||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|39.64871|01/17/2023|38.69714|01/17/2023|38.95485|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|416|||||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|39.82295|01/17/2023|38.86719|01/17/2023|39.12604|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|417|||||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||088|No|39.18914|02/08/2022|38.2486|02/08/2022|38.50333|02/08/2022|||OPHTHALMICS: GLAUCOMA AGENTS|418|||||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||088|No|39.10077|02/08/2022|38.16235|02/08/2022|38.4165|02/08/2022|||OPHTHALMICS: GLAUCOMA AGENTS|419|||||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||088|No|39.21785|02/08/2022|38.27662|02/08/2022|38.53153|02/08/2022|||OPHTHALMICS: GLAUCOMA AGENTS|420|||||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|01/12/2021|54.70458|01/12/2021|52.0996|01/12/2021|||OPHTHALMICS: ANTI-INFLAMMATORIES|421|||||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|37.32115|01/17/2023|36.42544|01/17/2023|36.66802|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|422|||||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|37.20658|01/17/2023|36.31362|01/17/2023|36.55546|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|423|||||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|37.34485|01/17/2023|36.44857|01/17/2023|36.69131|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|424|||||No|No||ALLERGAN INC.|No|||||No|No|No||
clopidogrel bisulfate|No|No|No|No|75%|00024117190|PLAVIX 75 MG TABLET|90|EA|3.37516|12/29/2020||Yes|No||12/29/2020||Yes|No|12/29/2020||Yes|No||||No|No|||Prescription required|Yes|12/01/2021|004|No|7.55514|01/17/2023|7.37381|01/17/2023|7.42292|01/17/2023|||PLATELET AGGREGATION INHIBITORS|425|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dronedarone HCl|No|No|No|No|75%|00024414260|MULTAQ 400 MG TABLET|60|EA|5.44673|07/22/2009||Yes|No||07/22/2009||Yes|No|07/22/2009||Yes|No||||No|No|||Prescription required|No|||No|12.13431|01/17/2023|11.84308|01/17/2023|11.92195|01/17/2023||||426|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024540131|AMBIEN 5 MG TABLET|100|EA|9.23906|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|20.60487|01/17/2023|20.11035|01/17/2023|20.24428|01/17/2023|||SEDATIVE HYPNOTICS|427|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024542131|AMBIEN 10 MG TABLET|100|EA|9.23906|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|20.62979|01/17/2023|20.13467|01/17/2023|20.26876|01/17/2023|||SEDATIVE HYPNOTICS|428|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024550131|AMBIEN CR 6.25 MG TABLET|100|EA|9.23906|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|21.05647|01/10/2023|20.75566|01/10/2023|19.7673|01/10/2023|||SEDATIVE HYPNOTICS|429|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00024552131|AMBIEN CR 12.5 MG TABLET|100|EA|9.23906|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|20.50311|01/17/2023|20.01103|01/17/2023|20.1443|01/17/2023|||SEDATIVE HYPNOTICS|430|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
lixisenatide|No|No|No|No|75%|00024574502|ADLYXIN 10-20 MCG STARTER PACK|3|ML|48.62798|01/15/2018|09/30/2023|Yes|No||01/15/2018|09/30/2023|Yes|No|01/15/2018|09/30/2023|Yes|No||||No|No|||Prescription required|Yes|07/27/2017|111|Yes|110.82656|01/12/2021|109.24332|01/12/2021|104.04126|01/12/2021|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|431|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||SANOFI-AVENTIS|No|||||No|No|No||
lixisenatide|No|No|No|No|75%|00024574702|ADLYXIN 20 MCG MAINTENANCE PK|3|ML|48.62798|01/15/2018|09/30/2023|Yes|No||01/15/2018|09/30/2023|Yes|No|01/15/2018|09/30/2023|Yes|No||||No|No|||Prescription required|Yes|07/27/2017|111|Yes|110.82656|01/12/2021|109.24332|01/12/2021|104.04126|01/12/2021|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|432|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|24.32223|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|54.27102|01/17/2023|52.96851|01/17/2023|53.32127|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|433|||||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|9.53187|01/10/2023|9.3957|01/10/2023|8.94828|01/10/2023|||BPH TREATMENTS|434|||||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|7.12818|01/10/2023|7.02635|01/10/2023|6.69176|01/10/2023|||ANGIOTENSIN MODULATORS|435|||||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|7.35966|01/17/2023|7.18302|01/17/2023|7.23086|01/17/2023|||ANGIOTENSIN MODULATORS|436|||||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|8.81685|01/17/2023|8.60524|01/17/2023|8.66255|01/17/2023|||ANGIOTENSIN MODULATORS|437|||||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|01/10/2023|8.94612|01/10/2023|8.52012|01/10/2023|||ANGIOTENSIN MODULATORS|438|||||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|9.88558|01/10/2023|9.74436|01/10/2023|9.28034|01/10/2023|||ANGIOTENSIN MODULATORS|439|||||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|39.00195|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|87.07746|01/17/2023|84.9876|01/17/2023|85.5536|01/17/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|440|||||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|39.00243|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|87.10855|01/17/2023|85.01794|01/17/2023|85.58415|01/17/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|441|||||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|772.73263|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|1761.11157|01/10/2023|1735.95284|01/10/2023|1653.28841|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|442|||||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|772.73263|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|1761.11157|01/10/2023|1735.95284|01/10/2023|1653.28841|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|443|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591102|DUPIXENT 100 MG/0.67 ML SYRING|.67|ML|1151.34745|04/20/2022||Yes|No||04/20/2022||Yes|No|04/20/2022||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|034|Yes|2624.00118|01/10/2023|2586.51545|01/10/2023|2463.34805|01/10/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|444|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591401|DUPIXENT 300 MG/2 ML SYRINGE|2|ML|385.7014|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|867.39309|01/17/2023|846.57565|01/17/2023|852.21371|01/17/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|445|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
dupilumab|No|No|No|No|75%|00024591502|DUPIXENT 300 MG/2 ML PEN|2|ML|385.7014|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|867.73855|01/17/2023|846.91282|01/17/2023|852.55312|01/17/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|446|||||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|676.66912|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|1530.50223|01/17/2023|1493.77017|01/17/2023|1503.71844|01/17/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|447|||||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|11/03/2022|IMMUNOMODULATORS: ATOPIC DERMATITIS|448|||||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|676.66912|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|1542.17613|01/10/2023|1520.14504|01/10/2023|1447.75719|01/10/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|449|||||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|772.73263|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|1761.11157|01/10/2023|1735.95284|01/10/2023|1653.28841|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|450|||||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|772.73263|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|1761.11157|01/10/2023|1735.95284|01/10/2023|1653.28841|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|451|||||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|9.42775|01/18/2022|9.20148|01/18/2022|9.26276|01/18/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|452|||||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|12.13349|10/25/2022|11.84228|10/25/2022|11.92115|10/25/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|453|||||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|12.81512|07/09/2019|12.63205|07/09/2019|12.03052|07/09/2019|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|454|||||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|1.28324|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|2.92461|01/03/2023|2.88283|01/03/2023|2.74555|01/03/2023||||455|||||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|160.94846|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|366.81277|01/03/2023|361.57259|01/03/2023|344.35485|01/03/2023||||456|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00025100131|ALDACTONE 25 MG TABLET|100|EA|1.15321|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|2.62826|01/03/2023|2.59071|01/03/2023|2.46734|01/03/2023||||457|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
spironolact/hydrochlorothiazid|No|No|No|No|75%|00025101131|ALDACTAZIDE 25-25 TABLET|100|EA|1.17187|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|2.67079|01/04/2022|2.63263|01/04/2022|2.50727|01/04/2022||||458|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
spironolact/hydrochlorothiazid|No|No|No|No|75%|00025102131|ALDACTAZIDE 50-50 TABLET|100|EA|2.1613|03/01/2002|10/17/2023|Yes|No||03/01/2002|10/17/2023|Yes|No|03/01/2002|10/17/2023|Yes|No||||No|No|||Prescription required|No|||Yes|4.92577|01/04/2022|4.8554|01/04/2022|4.62419|01/04/2022||||459|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARMACI/PFIZER|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00025103131|ALDACTONE 100 MG TABLET|100|EA|3.39506|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|7.73759|01/03/2023|7.62705|01/03/2023|7.26386|01/03/2023||||460|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00025104131|ALDACTONE 50 MG TABLET|100|EA|2.02512|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.6154|01/03/2023|4.54947|01/03/2023|4.33283|01/03/2023||||461|||||No|No||PHARMACI/PFIZER|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|01/03/2023|7.99635|01/03/2023|7.61557|01/03/2023|||NSAIDS|462|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
diclofenac sodium/misoprostol|No|No|No|No|75%|00025141160|ARTHROTEC 50 MG-200 MCG TAB|60|EA|3.72515|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|8.48989|01/03/2023|8.36861|01/03/2023|7.9701|01/03/2023|||NSAIDS|463|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
diclofenac sodium/misoprostol|No|No|No|No|75%|00025141190|ARTHROTEC 50 MG-200 MCG TAB|90|EA|3.72494|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|8.4894|01/03/2023|8.36812|01/03/2023|7.96964|01/03/2023|||NSAIDS|464|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
diclofenac sodium/misoprostol|No|No|No|No|75%|00025142160|ARTHROTEC 75 MG-200 MCG TAB|60|EA|3.72515|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|8.48989|01/03/2023|8.36861|01/03/2023|7.9701|01/03/2023|||NSAIDS|465|||||No|No||PHARMACI/PFIZER|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|01/03/2023|3.85917|01/03/2023|3.6754|01/03/2023||||466|||||No|No||PHARMACI/PFIZER|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|01/03/2023|5.62192|01/03/2023|5.35421|01/03/2023||||467|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
misoprostol|No|No|No|No|75%|00025146160|CYTOTEC 200 MCG TABLET|60|EA|2.50266|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|5.70375|01/03/2023|5.62227|01/03/2023|5.35454|01/03/2023||||468|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025151501|CELEBREX 50 MG CAPSULE|60|EA|1.91557|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|4.36573|01/10/2023|4.30336|01/10/2023|4.09844|01/10/2023|||NSAIDS|469|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152031|CELEBREX 100 MG CAPSULE|100|EA|4.09897|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|9.34185|01/10/2023|9.20839|01/10/2023|8.7699|01/10/2023|||NSAIDS|470|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152034|CELEBREX 100 MG CAPSULE|100|EA|4.09897|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|9.34185|01/10/2023|9.20839|01/10/2023|8.7699|01/10/2023|||NSAIDS|471|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152051|CELEBREX 100 MG CAPSULE|500|EA|4.09906|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|9.34206|01/10/2023|9.2086|01/10/2023|8.7701|01/10/2023|||NSAIDS|472|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152531|CELEBREX 200 MG CAPSULE|100|EA|6.72343|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|15.02481|01/17/2023|14.66421|01/17/2023|14.76187|01/17/2023|||NSAIDS|473|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152534|CELEBREX 200 MG CAPSULE|100|EA|6.72343|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|15.02481|01/17/2023|14.66421|01/17/2023|14.76187|01/17/2023|||NSAIDS|474|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025152551|CELEBREX 200 MG CAPSULE|500|EA|6.7234|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|15.02481|01/17/2023|14.66421|01/17/2023|14.76187|01/17/2023|||NSAIDS|475|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00025153002|CELEBREX 400 MG CAPSULE|60|EA|10.08557|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|22.98573|01/10/2023|22.65736|01/10/2023|21.57844|01/10/2023|||NSAIDS|476|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00025171001|INSPRA 25 MG TABLET|30|EA|6.05511|02/25/2005||Yes|No||02/25/2005||Yes|No|02/25/2005||Yes|No||||No|No|||Prescription required|No|||No|13.80002|01/10/2023|13.60288|01/10/2023|12.95512|01/10/2023||||477|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00025171002|INSPRA 25 MG TABLET|90|EA|6.05511|02/25/2005||Yes|No||02/25/2005||Yes|No|02/25/2005||Yes|No||||No|No|||Prescription required|No|||No|13.80002|01/10/2023|13.60288|01/10/2023|12.95512|01/10/2023||||478|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00025172001|INSPRA 50 MG TABLET|90|EA|6.05511|02/25/2005|12/27/2023|Yes|No||02/25/2005|12/27/2023|Yes|No|02/25/2005|12/27/2023|Yes|No||||No|No|||Prescription required|No|||No|13.80002|01/10/2023|13.60288|01/10/2023|12.95512|01/10/2023||||479|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00025172003|INSPRA 50 MG TABLET|30|EA|6.05511|02/25/2005||Yes|No||02/25/2005||Yes|No|02/25/2005||Yes|No||||No|No|||Prescription required|No|||No|13.80002|01/10/2023|13.60288|01/10/2023|12.95512|01/10/2023||||480|||||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|01/04/2022|5.94263|01/04/2022|5.65965|01/04/2022|||ANTIBIOTICS: GI|481|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025273231|NORPACE CR 100 MG CAPSULE|100|EA|1.82031|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.14863|01/03/2023|4.08936|01/03/2023|3.89463|01/03/2023||||482|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025274231|NORPACE CR 150 MG CAPSULE|100|EA|2.15129|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.90294|01/03/2023|4.83289|01/03/2023|4.60276|01/03/2023||||483|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025275231|NORPACE 100 MG CAPSULE|100|EA|2.00969|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.58022|01/03/2023|4.51479|01/03/2023|4.2998|01/03/2023||||484|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00025276231|NORPACE 150 MG CAPSULE|100|EA|2.37458|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|5.41185|01/03/2023|5.33454|01/03/2023|5.08051|01/03/2023||||485|||||No|No||PHARMACI/PFIZER|No|||||No|No|No||
verapamil HCl|No|No|No|No|75%|00025292431|CALAN SR 240 MG TABLET|100|EA|4.01675|01/07/2022||Yes|No||01/07/2022||Yes|No|01/07/2022||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|045|No|9.15447|01/03/2023|9.02369|01/03/2023|8.59399|01/03/2023|||CALCIUM CHANNEL BLOCKERS|486|||||No|No||PFIZER US PHARM|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||105|No|1.9796|01/10/2023|1.95132|01/10/2023|1.8584|01/10/2023|||HEMOPHILIA TREATMENT|487|||||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||105|No|1.9796|01/10/2023|1.95132|01/10/2023|1.8584|01/10/2023|||HEMOPHILIA TREATMENT|488|||||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||105|No|1.9796|01/10/2023|1.95132|01/10/2023|1.8584|01/10/2023|||HEMOPHILIA TREATMENT|489|||||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||105|No|1.9796|01/10/2023|1.95132|01/10/2023|1.8584|01/10/2023|||HEMOPHILIA TREATMENT|490|||||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||105|No|1.9796|01/10/2023|1.95132|01/10/2023|1.8584|01/10/2023|||HEMOPHILIA TREATMENT|491|||||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|1.428|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.058|01/10/2023|2.0286|01/10/2023|1.932|01/10/2023|||HEMOPHILIA TREATMENT|492|||||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|1.428|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.058|01/10/2023|2.0286|01/10/2023|1.932|01/10/2023|||HEMOPHILIA TREATMENT|493|||||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|1.428|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.058|01/10/2023|2.0286|01/10/2023|1.932|01/10/2023|||HEMOPHILIA TREATMENT|494|||||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|1.428|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.058|01/10/2023|2.0286|01/10/2023|1.932|01/10/2023|||HEMOPHILIA TREATMENT|495|||||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|1.428|10/07/2016||Yes|No||10/07/2016||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.058|01/10/2023|2.0286|01/10/2023|1.932|01/10/2023|||HEMOPHILIA TREATMENT|496|||||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|1.7884|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5774|01/10/2023|2.54058|01/10/2023|2.4196|01/10/2023|||HEMOPHILIA TREATMENT|497|||||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|1.7884|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5774|01/10/2023|2.54058|01/10/2023|2.4196|01/10/2023|||HEMOPHILIA TREATMENT|498|||||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|1.7884|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5774|01/10/2023|2.54058|01/10/2023|2.4196|01/10/2023|||HEMOPHILIA TREATMENT|499|||||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|1.7884|12/07/2018||Yes|No||12/07/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5774|01/10/2023|2.54058|01/10/2023|2.4196|01/10/2023|||HEMOPHILIA TREATMENT|500|||||No|No||BAYER,PHARM DIV|No|||||Yes|No|Yes|07/30/2021|
lipase/protease/amylase|No|No|No|No|75%|00032120370|CREON DR 3,000 UNIT CAPSULE|70|EA|.71871|08/16/2011||Yes|No||08/16/2011||Yes|No|08/16/2011||Yes|No||||No|No|||Prescription required|No||108|No|1.60401|01/17/2023|1.56551|01/17/2023|1.57593|01/17/2023|||PANCREATIC ENZYMES|501|||||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|.85092|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription required|No||108|No|1.90378|01/17/2023|1.85808|01/17/2023|1.87046|01/17/2023|||PANCREATIC ENZYMES|502|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032120607|CREON DR 6,000 UNIT CAPSULE|250|EA|.85102|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription required|No||108|No|1.90378|01/17/2023|1.85808|01/17/2023|1.87046|01/17/2023|||PANCREATIC ENZYMES|503|||||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|1.7009|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription required|No||108|No|3.7942|01/17/2023|3.70313|01/17/2023|3.7278|01/17/2023|||PANCREATIC ENZYMES|504|||||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|1.70087|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription required|No||108|No|3.7942|01/17/2023|3.70313|01/17/2023|3.7278|01/17/2023|||PANCREATIC ENZYMES|505|||||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|3.3715|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription required|No||108|No|7.51834|01/17/2023|7.33789|01/17/2023|7.38676|01/17/2023|||PANCREATIC ENZYMES|506|||||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|3.31717|08/12/2009||Yes|No||08/12/2009||Yes|No|08/12/2009||Yes|No||08/12/2009||Yes|No|||Prescription required|No||108|No|7.51834|01/17/2023|7.33789|01/17/2023|7.38676|01/17/2023|||PANCREATIC ENZYMES|507|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lipase/protease/amylase|No|No|No|No|75%|00032301613|CREON DR 36,000 UNIT CAPSULE|100|EA|5.11919|07/30/2013||Yes|No||07/30/2013||Yes|No|07/30/2013||Yes|No||07/30/2013||Yes|No|||Prescription required|No||108|No|11.41726|01/17/2023|11.14324|01/17/2023|11.21745|01/17/2023|||PANCREATIC ENZYMES|508|||||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|5.11856|07/30/2013||Yes|No||07/30/2013||Yes|No|07/30/2013||Yes|No||07/30/2013||Yes|No|||Prescription required|No||108|No|11.41726|01/17/2023|11.14324|01/17/2023|11.21745|01/17/2023|||PANCREATIC ENZYMES|509|||||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|8.73946|03/29/2022|8.52971|03/29/2022|8.58651|03/29/2022|||INTRANASAL RHINITIS AGENTS|510|||||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||056|No|14.40541|01/10/2023|14.19962|01/10/2023|13.52344|01/10/2023|||ANTICONVULSANTS|511|||||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||056|No|16.15333|01/17/2023|15.76565|01/17/2023|15.87064|01/17/2023|||ANTICONVULSANTS|512|||||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||Yes|No||04/18/2008||Yes|No|04/18/2008||Yes|No||||No|No|||Prescription required|No||056|No|7.21635|01/10/2023|7.11326|01/10/2023|6.77453|01/10/2023|||ANTICONVULSANTS|513|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
felbamate|No|No|No|No|75%|00037044267|FELBATOL 600 MG/5 ML SUSP|237|ML|3.27777|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|7.47028|01/10/2023|7.36356|01/10/2023|7.01292|01/10/2023|||ANTICONVULSANTS|514|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
carisoprodol|No|No|No|No|90%|00037200101|SOMA 350 MG TABLET|100|EA|4.3863|09/24/2009||Yes|No||09/24/2009||Yes|No|09/24/2009||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|116|Yes|9.99668|01/10/2023|9.85387|01/10/2023|9.38464|01/10/2023|||SKELETAL MUSCLE RELAXANTS|515|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
carisoprodol|No|No|No|No|90%|00037225010|SOMA 250 MG TABLET|100|EA|3.00746|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|6.85421|01/10/2023|6.7563|01/10/2023|6.43457|01/10/2023|||SKELETAL MUSCLE RELAXANTS|516|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
penicillamine|No|No|No|No|75%|00037440101|DEPEN 250 MG TITRATAB|100|EA|30.97186|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|70.58704|01/10/2023|69.57866|01/10/2023|66.26539|01/10/2023||||517|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00037601030|EDLUAR 10 MG SL TABLET|30|EA|6.01785|07/13/2009|05/31/2023|Yes|No||07/13/2009|05/31/2023|Yes|No|07/13/2009|05/31/2023|Yes|No||||No|No|||Prescription required|Yes|02/02/2010|054|Yes|13.2871|01/17/2023|12.9682|01/17/2023|13.05457|01/17/2023|||SEDATIVE HYPNOTICS|518|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
zolpidem tartrate|No|No|No|No|90%|00037605030|EDLUAR 5 MG SL TABLET|30|EA|6.03318|07/13/2009|01/31/2023|Yes|No||07/13/2009|01/31/2023|Yes|No|07/13/2009|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|02/02/2010|054|Yes|13.7151|02/07/2023|13.51917|02/07/2023|12.8754|02/07/2023|||SEDATIVE HYPNOTICS|519|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
hydrocortisone/pramoxine|No|No|No|No|75%|00037682210|PROCTOFOAM-HC 1%-1% FOAM|10|GM|7.5809|04/08/2015||Yes|No||04/08/2015||Yes|No|04/08/2015||Yes|No||||No|No|||Prescription required|No|||No|16.88023|01/17/2023|16.4751|01/17/2023|16.58482|01/17/2023||||520|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
hydrocortisone acetate|No|No|No|No|75%|00037683015|CORTIFOAM 10% AEROSOL|15|GM|11.97435|02/18/2016||Yes|No||02/18/2016||Yes|No|02/18/2016||Yes|No||||No|No|||Prescription required|No|||No|26.45131|03/29/2022|25.81647|03/29/2022|25.98841|03/29/2022||||521|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
olsalazine sodium|No|No|No|No|75%|00037686010|DIPENTUM 250 MG CAPSULE|100|EA|6.11395|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|13.93413|03/22/2022|13.73507|03/22/2022|13.08102|03/22/2022|||ULCERATIVE COLITIS AGENTS|522|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
glimepiride|No|No|No|No|75%|00039022110|AMARYL 1 MG TABLET|100|EA|.57142|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|1.30232|06/01/2016|1.28371|06/01/2016|1.22258|06/01/2016||||523|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
glimepiride|No|No|No|No|75%|00039022210|AMARYL 2 MG TABLET|100|EA|.92609|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|2.11062|04/25/2017|2.08047|04/25/2017|1.9814|04/25/2017||||524|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
glimepiride|No|No|No|No|75%|00039022310|AMARYL 4 MG TABLET|100|EA|1.7467|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|3.98085|07/24/2018|3.92398|07/24/2018|3.73713|07/24/2018||||525|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046074905|PREMARIN 25 MG VIAL|1|EA|153.6519|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|350.1834|01/03/2023|345.18078|01/03/2023|328.7436|01/03/2023||||526|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046087221|PREMARIN VAGINAL CREAM-APPL|30|GM|6.2628|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription required|No|||Yes|13.95431|01/10/2023|13.6194|01/10/2023|13.7101|01/10/2023||||527|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110081|PREMARIN 0.3 MG TABLET|100|EA|2.88293|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription required|No|||Yes|6.41437|01/10/2023|6.26042|01/10/2023|6.30211|01/10/2023||||528|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110091|PREMARIN 0.3 MG TABLET|1000|EA|2.88283|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription required|No|||Yes|6.41437|01/10/2023|6.26042|01/10/2023|6.30211|01/10/2023||||529|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110181|PREMARIN 0.45 MG TABLET|100|EA|2.88293|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription required|No|||Yes|6.42126|01/10/2023|6.26714|01/10/2023|6.30888|01/10/2023||||530|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110281|PREMARIN 0.625 MG TABLET|100|EA|2.88293|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription required|No|||Yes|6.43491|01/10/2023|6.28047|01/10/2023|6.32229|01/10/2023||||531|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110291|PREMARIN 0.625 MG TABLET|1000|EA|2.88283|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription required|No|||Yes|6.43491|01/10/2023|6.28047|01/10/2023|6.32229|01/10/2023||||532|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110381|PREMARIN 0.9 MG TABLET|100|EA|2.88293|03/08/2006||Yes|No||03/08/2006||Yes|No|03/08/2006||Yes|No||||No|No|||Prescription required|No|||Yes|6.41922|01/10/2023|6.26515|01/10/2023|6.30688|01/10/2023||||533|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110481|PREMARIN 1.25 MG TABLET|100|EA|2.88293|05/31/2005||Yes|No||05/31/2005||Yes|No|05/31/2005||Yes|No||||No|No|||Prescription required|No|||Yes|6.46402|01/10/2023|6.30888|01/10/2023|6.35089|01/10/2023||||534|||||No|No||WYETH/PFIZER|No|||||No|No|No||
estrogens, conjugated|No|No|No|No|75%|00046110491|PREMARIN 1.25 MG TABLET|1000|EA|2.88283|09/16/2004||Yes|No||09/16/2004||Yes|No|||No|No||||No|No|||Prescription required|No|||Yes|6.46402|01/10/2023|6.30888|01/10/2023|6.35089|01/10/2023||||535|||||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|3.60539|11/13/2009||Yes|No||11/13/2009||Yes|No|11/13/2009||Yes|No||||No|No|||Prescription required|No|||Yes|8.051|01/10/2023|7.85777|01/10/2023|7.9101|01/10/2023||||536|||||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|3.60539|03/18/2010||Yes|No||03/18/2010||Yes|No|03/18/2010||Yes|No||||No|No|||Prescription required|No|||Yes|8.01799|01/10/2023|7.82555|01/10/2023|7.87767|01/10/2023||||537|||||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|3.60539|08/29/2011||Yes|No||08/29/2011||Yes|No|08/29/2011||Yes|No||||No|No|||Prescription required|No|||Yes|8.05245|01/10/2023|7.85919|01/10/2023|7.91153|01/10/2023||||538|||||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|3.60539|01/27/2014||Yes|No||01/27/2014||Yes|No|01/27/2014||Yes|No||||No|No|||Prescription required|No|||Yes|8.09078|01/10/2023|7.8966|01/10/2023|7.94919|01/10/2023||||539|||||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|01/04/2022|7.44979|01/04/2022|7.09504|01/04/2022||||540|||||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|01/04/2022|14.06689|01/04/2022|13.39704|01/04/2022||||541|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ziprasidone HCl|No|No|No|No|75%|00049005460|GEODON 40 MG CAPSULE|60|EA|10.21543|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|23.28169|01/10/2023|22.94909|01/10/2023|21.85628|01/10/2023|||ANTIPSYCHOTICS|542|||||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|02/08/2022|.37674|02/08/2022|.3588|02/08/2022||||543|||||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|.6958|02/08/2022|.68586|02/08/2022|.6532|02/08/2022||||544|||||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|.6958|02/08/2022|.68586|02/08/2022|.6532|02/08/2022||||545|||||No|No||PFIZER US PHARM|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|01/05/2021|12.28848|01/05/2021|11.70332|01/05/2021||||546|||||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|01/05/2021|12.28848|01/05/2021|11.70332|01/05/2021||||547|||||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|01/05/2021|49.15008|01/05/2021|46.8096|01/05/2021||||548|||||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|01/05/2021|49.15008|01/05/2021|46.8096|01/05/2021||||549|||||No|No||PFIZER US PHARM|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00049233045|RELPAX 20 MG TABLET|6|EA|33.07631|02/08/2010||Yes|No||02/08/2010||Yes|No|02/08/2010||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|021|No|75.38322|01/10/2023|74.30632|01/10/2023|70.76792|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|550|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00049234005|RELPAX 40 MG TABLET|12|EA|33.07631|07/15/2007||Yes|No||07/15/2007||Yes|No|07/15/2007||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|021|No|73.98541|01/17/2023|72.20976|01/17/2023|72.69066|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|551|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00049234045|RELPAX 40 MG TABLET|6|EA|33.07631|02/08/2010||Yes|No||02/08/2010||Yes|No|02/08/2010||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|021|No|73.98541|01/17/2023|72.20976|01/17/2023|72.69066|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|552|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00049278066|CARDURA 8 MG TABLET|100|EA|2.72577|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|Yes|04/28/2004|003|No|6.21222|01/10/2023|6.12347|01/10/2023|5.83188|01/10/2023|||BPH TREATMENTS|553|||||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||069|No|6.6981|01/04/2022|6.60241|01/04/2022|6.28801|01/04/2022|||ANTIFUNGALS: ORAL|554|||||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|1.45888|01/04/2022|1.43804|01/04/2022|1.36956|01/04/2022|||ANTIFUNGALS: ORAL|555|||||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|3.64918|01/04/2022|3.59705|01/04/2022|3.42576|01/04/2022|||ANTIFUNGALS: ORAL|556|||||No|No||PFIZER US PHARM|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00049319028|VFEND IV 200 MG VIAL|1|EA|64.4742|08/16/2002||Yes|No||08/16/2002||Yes|No|08/16/2002||Yes|No||||No|No|||Prescription required|No|||No|146.9412|01/05/2021|144.84204|01/05/2021|137.9448|01/05/2021||||557|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fluconazole|No|No|No|No|75%|00049341030|DIFLUCAN 50 MG TABLET|30|EA|.48905|03/01/2002|06/30/2023|Yes|No||03/01/2002|06/30/2023|Yes|No|03/01/2002|06/30/2023|Yes|No||03/01/2002|06/30/2023|Yes|No|||Prescription required|Yes|07/12/2005|069|No|1.11458|01/04/2022|1.09866|01/04/2022|1.04634|01/04/2022|||ANTIFUNGALS: ORAL|558|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|1.11196|01/04/2022|1.09608|01/04/2022|1.04388|01/04/2022|||ANTIFUNGALS: ORAL|559|||||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|01/04/2022|60.46419|01/04/2022|57.58494|01/04/2022|||ANTIFUNGALS: ORAL|560|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fluconazole|No|No|No|No|75%|00049344019|DIFLUCAN 10 MG/ML SUSPENSION|35|ML|.20922|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|07/12/2005|069|No|.47683|01/04/2022|.47002|01/04/2022|.44764|01/04/2022|||ANTIFUNGALS: ORAL|561|||||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|.78707|01/04/2022|.77583|01/04/2022|.73888|01/04/2022|||ANTIFUNGALS: ORAL|562|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fluconazole|Yes|No|No|No|75%|00049350079|DIFLUCAN 150 MG TABLET|1|EA|26.17732|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|07/12/2005|069|No|59.65995|01/04/2022|58.80766|01/04/2022|56.0073|01/04/2022|||ANTIFUNGALS: ORAL|563|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ziprasidone mesylate|No|No|No|No|75%|00049392083|GEODON 20 MG/ML VIAL|1|EA|26.38523|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|60.13378|01/10/2023|59.27472|01/10/2023|56.45212|01/10/2023|||ANTIPSYCHOTICS|564|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049490030|ZOLOFT 50 MG TABLET|30|EA|5.92267|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|13.24412|01/17/2023|12.92626|01/17/2023|13.01234|01/17/2023|||ANTIDEPRESSANTS: SSRIs|565|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049490041|ZOLOFT 50 MG TABLET|100|EA|5.92299|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|13.24412|01/17/2023|12.92626|01/17/2023|13.01234|01/17/2023|||ANTIDEPRESSANTS: SSRIs|566|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049491030|ZOLOFT 100 MG TABLET|30|EA|5.92267|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|13.2411|01/17/2023|12.92331|01/17/2023|13.00938|01/17/2023|||ANTIDEPRESSANTS: SSRIs|567|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049491041|ZOLOFT 100 MG TABLET|100|EA|5.92299|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|13.2411|01/17/2023|12.92331|01/17/2023|13.00938|01/17/2023|||ANTIDEPRESSANTS: SSRIs|568|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
sertraline HCl|No|No|No|No|75%|00049496030|ZOLOFT 25 MG TABLET|30|EA|5.92267|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|13.49818|01/10/2023|13.30535|01/10/2023|12.67176|01/10/2023|||ANTIDEPRESSANTS: SSRIs|569|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
testosterone|No|No|No|No|90%|00051842530|ANDROGEL 1% (25 MG/2.5 G) PKT|2.5|GM|3.57226|03/01/2002|03/01/2023|Yes|No||03/01/2002|03/01/2023|Yes|No|03/01/2002|03/01/2023|Yes|No||||No|No|||Prescription required|Yes|03/09/2018|084|No|8.14144|01/29/2019|8.02514|01/29/2019|7.64299|01/29/2019|||ANDROGENIC AGENTS|570|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ABBVIE US LLC|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||084|No|7.93572|02/28/2023|7.74526|02/28/2023|7.79684|02/28/2023|||ANDROGENIC AGENTS|571|||||No|No||ABBVIE US LLC|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00052010630|REMERON 15 MG SOLTAB|30|EA|1.8275|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/10/2005|031|No|4.165|10/09/2018|4.1055|10/09/2018|3.91|10/09/2018|||ANTIDEPRESSANTS: OTHER|572|||||No|No||MERCK SHARP & D|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00052010830|REMERON 30 MG SOLTAB|30|EA|1.8834|06/22/2006||Yes|No||06/22/2006||Yes|No|06/22/2006||Yes|No||||No|No|||Prescription required|Yes|01/10/2005|031|No|4.2924|10/09/2018|4.23108|10/09/2018|4.0296|10/09/2018|||ANTIDEPRESSANTS: OTHER|573|||||No|No||MERCK SHARP & D|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00052011030|REMERON 45 MG SOLTAB|30|EA|2.0038|06/22/2006||Yes|No||06/22/2006||Yes|No|06/22/2006||Yes|No||||No|No|||Prescription required|Yes|01/10/2005|031|No|4.5668|10/09/2018|4.50156|10/09/2018|4.2872|10/09/2018|||ANTIDEPRESSANTS: OTHER|574|||||No|No||MERCK SHARP & D|No|||||No|No|No||
etonogestrel/ethinyl estradiol|Yes|Yes|No|No|75%|00052027301|NUVARING VAGINAL RING|1|EA|69.9309|01/23/2007||Yes|No||01/23/2007||Yes|No|||No|No||||No|No|11/01/2012||Prescription required|No|||No|155.65974|09/27/2022|151.9239|09/27/2022|152.93569|09/27/2022||||575|||||No|No||MERCK SHARP & D|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
etonogestrel/ethinyl estradiol|Yes|Yes|No|No|75%|00052027303|NUVARING VAGINAL RING|1|EA|69.9309|01/23/2007||Yes|No||01/23/2007||Yes|No|||No|No||||No|No|11/01/2012||Prescription required|No|||No|155.65974|09/27/2022|151.9239|09/27/2022|152.93569|09/27/2022||||576|||||No|No||MERCK SHARP & D|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
etonogestrel|Yes|Yes|No|No|75%|00052433001|NEXPLANON 68 MG IMPLANT|1|EA|443.1752|01/07/2016|05/31/2023|Yes|No||||No|No|||No|No||||No|No|01/07/2016|05/31/2023|Prescription required|No|||No|1010.0272|08/24/2021|995.59824|08/24/2021|948.1888|08/24/2021||||577|Discontinued by Manufacturer||||Yes|No||MERCK SHARP & D|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00052436401|REMERON 15 MG TABLET|30|EA|2.2962|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|5.2332|06/09/2020|5.15844|06/09/2020|4.9128|06/09/2020|||ANTIDEPRESSANTS: OTHER|578|||||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|06/09/2020|5.313|06/09/2020|5.06|06/09/2020|||ANTIDEPRESSANTS: OTHER|579|||||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|.2322|12/02/2004||Yes|No||12/02/2004||Yes|No|12/02/2004||Yes|No||||No|No|||Prescription required|No|||No|.5292|08/02/2022|.52164|08/02/2022|.4968|08/02/2022||||580|||||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|.19851|02/28/2023|.19374|02/28/2023|.19503|02/28/2023||||581|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
calcitriol|No|No|No|No|75%|00054000725|CALCITRIOL 0.25 MCG CAPSULE|100|EA|.40673|10/23/2007||Yes|No||10/23/2007||Yes|No|10/23/2007||Yes|No||10/23/2007||Yes|No|||Prescription required|No|||No|.19851|02/28/2023|.19374|02/28/2023|.19503|02/28/2023||||582|||||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|.13094|02/28/2023|.12779|02/28/2023|.12864|02/28/2023||||583|||||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|.13094|02/28/2023|.12779|02/28/2023|.12864|02/28/2023||||584|||||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|.21663|02/28/2023|.21143|02/28/2023|.21283|02/28/2023||||585|||||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|.21663|02/28/2023|.21143|02/28/2023|.21283|02/28/2023||||586|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001221|FLECAINIDE ACETATE 150 MG TAB|60|EA|.55405|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription required|No|||No|.31796|02/28/2023|.31032|02/28/2023|.31239|02/28/2023||||587|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
flecainide acetate|No|No|No|No|75%|00054001225|FLECAINIDE ACETATE 150 MG TAB|100|EA|.55405|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription required|No|||No|.31796|02/28/2023|.31032|02/28/2023|.31239|02/28/2023||||588|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
prednisone|No|No|No|No|75%|00054001720|PREDNISONE 10 MG TABLET|100|EA|.09184|12/30/2010||Yes|No||12/30/2010||Yes|No|12/30/2010||Yes|No||12/30/2010||Yes|No|||Prescription required|No||168|Yes|.06687|02/28/2023|.06526|02/28/2023|.06569|02/28/2023|||GLUCOCORTICOIDS: ORAL|589|||||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|.09799|12/30/2010||Yes|No||12/30/2010||Yes|No|12/30/2010||Yes|No||12/30/2010||Yes|No|||Prescription required|No||168|Yes|.1007|02/28/2023|.09828|02/28/2023|.09893|02/28/2023|||GLUCOCORTICOIDS: ORAL|590|||||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|.08909|01/26/2005||Yes|No||01/26/2005||Yes|No|01/26/2005||Yes|No||01/26/2005||Yes|No|||Prescription required|No||168|Yes|.1007|02/28/2023|.09828|02/28/2023|.09893|02/28/2023|||GLUCOCORTICOIDS: ORAL|591|||||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||168|Yes|.1007|02/28/2023|.09828|02/28/2023|.09893|02/28/2023|||GLUCOCORTICOIDS: ORAL|592|||||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||168|Yes|.27581|02/28/2023|.26919|02/28/2023|.27098|02/28/2023|||GLUCOCORTICOIDS: ORAL|593|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054001925|PREDNISONE 50 MG TABLET|100|EA|.14|01/26/2005||Yes|No||01/26/2005||Yes|No|01/26/2005||Yes|No||01/26/2005||Yes|No|||Prescription required|No||168|Yes|.27581|02/28/2023|.26919|02/28/2023|.27098|02/28/2023|||GLUCOCORTICOIDS: ORAL|594|||||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|.18472|03/01/2004||Yes|No||03/01/2004||Yes|No|03/01/2004||Yes|No||||No|No|||Prescription required|No|||No|.18322|02/28/2023|.17882|02/28/2023|.18001|02/28/2023||||595|||||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|.13958|02/28/2023|.13623|02/28/2023|.13713|02/28/2023||||596|||||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|.16002|01/12/2005||Yes|No||01/12/2005||Yes|No|01/12/2005||Yes|No||||No|No|||Prescription required|No|||No|.13958|02/28/2023|.13623|02/28/2023|.13713|02/28/2023||||597|||||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|Yes|07/12/2005|019|No|.7906|02/28/2023|.77162|02/28/2023|.77676|02/28/2023|||INTRANASAL RHINITIS AGENTS|598|||||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|Yes|07/12/2005|019|No|1.44494|02/28/2023|1.41026|02/28/2023|1.41965|02/28/2023|||INTRANASAL RHINITIS AGENTS|599|||||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|1.9807|03/29/2022|1.93316|03/29/2022|1.94603|03/29/2022||||600|||||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||008|No|.23083|01/24/2023|.22529|01/24/2023|.22679|01/24/2023|||ANTIDEPRESSANTS: SSRIs|601|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
risperidone|No|No|No|No|75%|00054006344|RISPERIDONE 1 MG/ML SOLUTION|30|ML|.43|07/30/2009|05/31/2024|Yes|No||07/30/2009|05/31/2024|Yes|No|07/30/2009|05/31/2024|Yes|No||||No|No|||Prescription required|No||027|Yes|.31764|02/28/2023|.31001|02/28/2023|.31208|02/28/2023|||ANTIPSYCHOTICS|602|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||085|No|.2526|02/28/2023|.24653|02/28/2023|.24817|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|603|||||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|.07838|02/28/2023|.07649|02/28/2023|.077|02/28/2023||||604|||||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|.07838|02/28/2023|.07649|02/28/2023|.077|02/28/2023||||605|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
balsalazide disodium|No|No|No|No|75%|00054007928|BALSALAZIDE DISODIUM 750 MG CP|280|EA|.32403|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|.42202|02/28/2023|.41189|02/28/2023|.41463|02/28/2023|||ULCERATIVE COLITIS AGENTS|606|||||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||502|No|1.03284|02/28/2023|1.00805|02/28/2023|1.01476|02/28/2023|||ONCOLOGY: ORAL - BREAST|607|||||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||054|Yes|.192|02/28/2023|.18739|02/28/2023|.18864|02/28/2023|||SEDATIVE HYPNOTICS|608|||||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||054|Yes|.19748|02/28/2023|.19274|02/28/2023|.19402|02/28/2023|||SEDATIVE HYPNOTICS|609|||||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||052|Yes|.23239|02/28/2023|.22681|02/28/2023|.22832|02/28/2023|||PHOSPHATE BINDERS|610|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
calcium acetate|No|No|No|No|75%|00054008826|CALCIUM ACETATE 667 MG CAPSULE|200|EA|.24447|12/09/2008||Yes|No||12/09/2008||Yes|No|12/09/2008||Yes|No||12/09/2008||Yes|No|||Prescription required|No||052|Yes|.23239|02/28/2023|.22681|02/28/2023|.22832|02/28/2023|||PHOSPHATE BINDERS|611|||||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|06/01/2016|2.89452|06/01/2016|2.75668|06/01/2016|||ALZHEIMER'S AGENTS|612|||||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|.18554|02/28/2023|.18108|02/28/2023|.18229|02/28/2023||||613|||||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|.16987|02/28/2023|.16579|02/28/2023|.16689|02/28/2023||||614|||||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|.31309|02/28/2023|.30557|02/28/2023|.30761|02/28/2023||||615|||||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||229|No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|616|||||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||229|No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|617|||||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||229|No|.31019|02/28/2023|.30274|02/28/2023|.30476|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|618|||||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||229|No|.31019|02/28/2023|.30274|02/28/2023|.30476|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|619|||||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||145|Yes|.37763|02/28/2023|.36856|02/28/2023|.37102|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|620|||||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||145|Yes|.73811|02/28/2023|.72039|02/28/2023|.72519|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|621|||||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||145|Yes|.64329|02/28/2023|.62785|02/28/2023|.63203|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|622|||||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||145|Yes|1.0599|02/28/2023|1.03446|02/28/2023|1.04135|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|623|||||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|2.05432|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|4.68195|03/01/2022|4.61506|03/01/2022|4.3953|03/01/2022|||ANTIDEPRESSANTS: TRICYCLIC|624|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
protriptyline HCl|No|No|No|No|75%|00054021125|PROTRIPTYLINE HCL 10 MG TABLET|100|EA|2.05432|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|3.08567|02/28/2023|3.01161|02/28/2023|3.03167|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|625|||||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||109|Yes|.22871|02/28/2023|.22322|02/28/2023|.2247|02/28/2023|||ANALGESICS: NARCOTICS SHORT|626|||||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|.31617|08/04/2008||Yes|No||08/04/2008||Yes|No|08/04/2008||Yes|No||||No|No|||Prescription required|No||109|Yes|.37054|02/28/2023|.36164|02/28/2023|.36405|02/28/2023|||ANALGESICS: NARCOTICS SHORT|627|||||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||109|Yes|.09012|10/25/2022|.08795|10/25/2022|.08854|10/25/2022|||ANALGESICS: NARCOTICS SHORT|628|||||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|.0198|08/04/2008||Yes|No||08/04/2008||Yes|No|08/04/2008||Yes|No||||No|No|||Prescription required|No||109|Yes|.04513|11/23/2021|.04449|11/23/2021|.04237|11/23/2021|||ANALGESICS: NARCOTICS SHORT|629|||||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||109|Yes|.1271|06/26/2020|.12529|06/26/2020|.11932|06/26/2020|||ANALGESICS: NARCOTICS SHORT|630|||||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||109|Yes|.06928|11/28/2017|.06829|11/28/2017|.06504|11/28/2017|||ANALGESICS: NARCOTICS SHORT|631|||||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|.70462|02/28/2023|.69455|02/28/2023|.66148|02/28/2023|||ANALGESICS: NARCOTICS SHORT|632|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
codeine sulfate|No|No|No|No|90%|00054024424|CODEINE SULFATE 30 MG TABLET|100|EA|.36945|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|.55136|02/28/2023|.53812|02/28/2023|.54171|02/28/2023|||ANALGESICS: NARCOTICS SHORT|633|||||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|.55136|02/28/2023|.53812|02/28/2023|.54171|02/28/2023|||ANALGESICS: NARCOTICS SHORT|634|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
codeine sulfate|No|No|No|No|90%|00054024525|CODEINE SULFATE 60 MG TABLET|100|EA|.61085|11/12/2009||Yes|No||11/12/2009||Yes|No|11/12/2009||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|109|Yes|1.39218|03/29/2022|1.37229|03/29/2022|1.30695|03/29/2022|||ANALGESICS: NARCOTICS SHORT|635|||||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||113|Yes|.19871|02/28/2023|.19394|02/28/2023|.19523|02/28/2023|||ANGIOTENSIN MODULATORS|636|||||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||113|Yes|.19871|02/28/2023|.19394|02/28/2023|.19523|02/28/2023|||ANGIOTENSIN MODULATORS|637|||||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||113|Yes|.23159|02/28/2023|.22603|02/28/2023|.22753|02/28/2023|||ANGIOTENSIN MODULATORS|638|||||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||113|Yes|.23159|02/28/2023|.22603|02/28/2023|.22753|02/28/2023|||ANGIOTENSIN MODULATORS|639|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
capecitabine|No|No|No|No|75%|00054027121|CAPECITABINE 150 MG TABLET|60|EA|1.1825|03/29/2017|11/30/2023|Yes|No||03/29/2017|11/30/2023|Yes|No|03/29/2017|11/30/2023|Yes|No||||No|No|||Prescription required|No||502|No|2.695|08/22/2017|2.6565|08/22/2017|2.53|08/22/2017|||ONCOLOGY: ORAL - BREAST|640|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
capecitabine|No|No|No|No|75%|00054027223|CAPECITABINE 500 MG TABLET|120|EA|2.32916|03/29/2017|11/30/2023|Yes|No||03/29/2017|11/30/2023|Yes|No|03/29/2017|11/30/2023|Yes|No||||No|No|||Prescription required|No||502|No|.5561|02/28/2023|.54275|02/28/2023|.54636|02/28/2023|||ONCOLOGY: ORAL - BREAST|641|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||Yes|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|4.999|09/27/2022|4.87902|09/27/2022|4.91151|09/27/2022|||ANTIDEPRESSANTS: TRICYCLIC|642|||||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|11.56432|04/26/2022|11.39911|04/26/2022|10.8563|04/26/2022|||ANTIDEPRESSANTS: TRICYCLIC|643|||||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|12/06/2016|11.39911|12/06/2016|10.8563|12/06/2016|||ANTIDEPRESSANTS: TRICYCLIC|644|||||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|11.56432|02/27/2018|11.39911|02/27/2018|10.8563|02/27/2018|||ANTIDEPRESSANTS: TRICYCLIC|645|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
naratriptan HCl|No|No|No|No|75%|00054027803|NARATRIPTAN HCL 1 MG TABLET|9|EA|4.70897|08/02/2010||Yes|No||08/02/2010||Yes|No|08/02/2010||Yes|No||||No|No|||Prescription required|Yes|02/02/2010|021|No|1.31417|11/29/2022|1.28262|11/29/2022|1.29117|11/29/2022|||ANTIMIGRAINE AGENTS: TRIPTANS|646|||||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|4.70897|08/02/2010||Yes|No||08/02/2010||Yes|No|08/02/2010||Yes|No||||No|No|||Prescription required|Yes|02/02/2010|021|No|1.39787|02/28/2023|1.36432|02/28/2023|1.3734|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|647|||||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|.39556|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|.90153|04/01/2021|.88865|04/01/2021|.84633|04/01/2021|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|648|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
oxymorphone HCl|No|No|No|No|90%|00054028325|OXYMORPHONE HCL 5 MG TABLET|100|EA|1.11477|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|.52773|02/28/2023|.51506|02/28/2023|.51849|02/28/2023|||ANALGESICS: NARCOTICS SHORT|649|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
oxymorphone HCl|No|No|No|No|90%|00054028425|OXYMORPHONE HCL 10 MG TABLET|100|EA|2.02422|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|.53663|11/29/2022|.52375|11/29/2022|.52723|11/29/2022|||ANALGESICS: NARCOTICS SHORT|650|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
azelastine HCl|No|No|No|No|75%|00054029399|AZELASTINE 0.1% (137 MCG) SPRY|30|ML|.258|04/07/2021|12/31/2022|Yes|No||04/07/2021|12/31/2022|Yes|No|04/07/2021|12/31/2022|Yes|No||||No|No|||Prescription required|No||019|Yes|.588|01/10/2023|.5796|01/10/2023|.552|01/10/2023|||INTRANASAL RHINITIS AGENTS|651|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
linezolid|No|No|No|No|75%|00054031950|LINEZOLID 100 MG/5 ML SUSP|150|ML|1.92579|12/17/2019||Yes|No||12/17/2019||Yes|No|12/17/2019||Yes|No||||No|No|||Prescription required|Yes|07/28/2022|146|No|4.38902|12/17/2019|4.32632|12/17/2019|4.12031|12/17/2019|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|652|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00054032656|FLUTICASONE-SALMETEROL 100-50|60|EA|.67158|08/23/2021||Yes|No||08/23/2021||Yes|No|08/23/2021||Yes|No||||No|No|||Prescription required|Yes|12/01/2021|033|Yes|1.31548|02/28/2023|1.2839|02/28/2023|1.29245|02/28/2023|||GLUCOCORTICOIDS: INHALED|653|||||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|Yes|1.63392|02/28/2023|1.5947|02/28/2023|1.60532|02/28/2023|||GLUCOCORTICOIDS: INHALED|654|||||No|No||WEST-WARD/HIKMA|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|.90768|02/28/2023|.88589|02/28/2023|.89179|02/28/2023||||655|||||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|06/30/2017|104.3193|06/30/2017|99.35172|06/30/2017||||656|||||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|1.83986|02/28/2023|1.7957|02/28/2023|1.80766|02/28/2023||||657|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||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|1.83986|02/28/2023|1.7957|02/28/2023|1.80766|02/28/2023||||658|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||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|08/29/2017|4.49479|08/29/2017|4.28076|08/29/2017||||659|||||No|No||WEST-WARD/HIKMA|Yes|09/01/2020||||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||502|No|7.33961|06/01/2016|7.23476|06/01/2016|6.89024|06/01/2016|||ONCOLOGY: ORAL - BREAST|660|||||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||502|No|13.4701|05/25/2021|13.27767|05/25/2021|12.6454|05/25/2021|||ONCOLOGY: ORAL - BREAST|661|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
hydromorphone HCl|No|No|No|No|90%|00054038663|HYDROMORPHONE 1 MG/ML SOLUTION|473|ML|.2063|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|.246|02/28/2023|.24009|02/28/2023|.24169|02/28/2023|||ANALGESICS: NARCOTICS SHORT|662|||||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||109|Yes|.70232|06/01/2016|.69229|06/01/2016|.65932|06/01/2016|||ANALGESICS: NARCOTICS SHORT|663|||||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||109|Yes|.09868|02/28/2023|.09631|02/28/2023|.09695|02/28/2023|||ANALGESICS: NARCOTICS SHORT|664|||||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|.02193|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|.04999|06/01/2016|.04928|06/01/2016|.04693|06/01/2016|||ANALGESICS: NARCOTICS LONG|665|||||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|.02193|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|.04999|06/01/2016|.04928|06/01/2016|.04693|06/01/2016|||ANALGESICS: NARCOTICS LONG|666|||||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|04/14/2021|56.8491|04/14/2021|54.142|04/14/2021||||667|||||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|.49968|02/28/2023|.48768|02/28/2023|.49093|02/28/2023|||ANTIDEPRESSANTS: OTHER|668|||||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|No|.49968|02/28/2023|.48768|02/28/2023|.49093|02/28/2023|||ANTIDEPRESSANTS: OTHER|669|||||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|.53426|02/28/2023|.52143|02/28/2023|.52491|02/28/2023|||ANTIDEPRESSANTS: OTHER|670|||||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|No|.53426|02/28/2023|.52143|02/28/2023|.52491|02/28/2023|||ANTIDEPRESSANTS: OTHER|671|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00054040713|RITONAVIR 100 MG TABLET|30|EA|3.19999|06/04/2018||Yes|No||06/04/2018||Yes|No|06/04/2018||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|.89567|02/28/2023|.87417|02/28/2023|.87999|02/28/2023|||HIV / AIDS|672|||||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|.6582|02/28/2023|.6424|02/28/2023|.64668|02/28/2023|||ANTIHYPERURICEMICS|673|||||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|.74979|02/28/2023|.73179|02/28/2023|.73666|02/28/2023|||ANTIHYPERURICEMICS|674|||||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||056|No|2.39707|09/27/2022|2.33954|09/27/2022|2.35512|09/27/2022|||ANTICONVULSANTS|675|||||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||056|No|4.63707|02/28/2023|4.52578|02/28/2023|4.55592|02/28/2023|||ANTICONVULSANTS|676|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flucytosine|No|No|No|No|75%|00054042725|FLUCYTOSINE 250 MG CAPSULE|100|EA|28.23173|05/08/2020|05/31/2023|Yes|No||05/08/2020|05/31/2023|Yes|No|05/08/2020|05/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|069|No|64.34209|05/08/2020|63.42292|05/08/2020|60.40278|05/08/2020|||ANTIFUNGALS: ORAL|677|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
flucytosine|No|No|No|No|75%|00054042825|FLUCYTOSINE 500 MG CAPSULE|100|EA|54.62892|05/08/2020|05/31/2023|Yes|No||05/08/2020|05/31/2023|Yes|No|05/08/2020|05/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|069|No|124.50312|05/08/2020|122.7245|05/08/2020|116.88048|05/08/2020|||ANTIFUNGALS: ORAL|678|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054047021|EVEROLIMUS 0.25 MG TABLET|60|EA|3.40925|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|7.76993|06/12/2020|7.65893|06/12/2020|7.29422|06/12/2020|||IMMUNOSUPPRESSIVES: ORAL|679|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00054047121|EVEROLIMUS 0.5 MG TABLET|60|EA|6.81857|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|12.55297|12/27/2022|12.25169|12/27/2022|12.33329|12/27/2022|||IMMUNOSUPPRESSIVES: ORAL|680|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00054047221|EVEROLIMUS 0.75 MG TABLET|60|EA|10.22776|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|23.30979|06/12/2020|22.97679|06/12/2020|21.88266|06/12/2020|||IMMUNOSUPPRESSIVES: ORAL|681|||||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||548|No|209.70138|11/23/2021|206.70564|11/23/2021|196.86252|11/23/2021|||ONCOLOGY: ORAL - RENAL CELL|682|||||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||548|No|219.34424|02/02/2022|216.21075|02/02/2022|205.915|02/02/2022|||ONCOLOGY: ORAL - RENAL CELL|683|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054048114|EVEROLIMUS 5 MG TABLET|28|EA|103.11737|10/02/2020|01/31/2023|Yes|No||10/02/2020|01/31/2023|Yes|No|10/02/2020|01/31/2023|Yes|No||||No|No|||Prescription required|No||548|No|235.01169|11/23/2021|231.65438|11/23/2021|220.62322|11/23/2021|||ONCOLOGY: ORAL - RENAL CELL|684|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|Yes|09/30/2022|
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||548|No|219.34424|03/29/2022|216.21075|03/29/2022|205.915|03/29/2022|||ONCOLOGY: ORAL - RENAL CELL|685|||||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||548|No|219.34424|02/02/2022|216.21075|02/02/2022|205.915|02/02/2022|||ONCOLOGY: ORAL - RENAL CELL|686|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054049714|EVEROLIMUS 7.5 MG TABLET|28|EA|103.11737|10/02/2020|12/31/2022|Yes|No||10/02/2020|12/31/2022|Yes|No|10/02/2020|12/31/2022|Yes|No||||No|No|||Prescription required|No||548|No|235.01169|11/23/2021|231.65438|11/23/2021|220.62322|11/23/2021|||ONCOLOGY: ORAL - RENAL CELL|687|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|Yes|09/30/2022|
icosapent ethyl|No|No|No|No|75%|00054050823|ICOSAPENT ETHYL 1 GRAM CAPSULE|120|EA|1.08166|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|1.58818|02/28/2023|1.55006|02/28/2023|1.56038|02/28/2023|||LIPOTROPICS: OTHER|688|||||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|.436|02/28/2023|.42553|02/28/2023|.42837|02/28/2023|||ANALGESICS: NARCOTICS SHORT|689|||||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|.28524|02/28/2023|.27839|02/28/2023|.28024|02/28/2023|||ANALGESICS: NARCOTICS SHORT|690|||||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|.33348|02/28/2023|.32547|02/28/2023|.32764|02/28/2023|||ANALGESICS: NARCOTICS SHORT|691|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
bosentan|No|No|No|No|75%|00054052021|BOSENTAN 62.5 MG TABLET|60|EA|8.33598|01/03/2020|02/28/2023|Yes|No||01/03/2020|02/28/2023|Yes|No|01/03/2020|02/28/2023|Yes|No|Refer to program requirements|||No|No|||Prescription required|Yes|07/26/2018|171|No|18.99828|01/07/2020|18.72687|01/03/2020|17.83512|01/03/2020|||PAH AGENTS: ORAL AND INHALED|692|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|Yes|07/30/2021|
rufinamide|No|No|No|No|75%|00054052863|RUFINAMIDE 40 MG/ML SUSPENSION|460|ML|1.12395|04/14/2021||Yes|No||04/14/2021||Yes|No|04/14/2021||Yes|No||||No|No|||Prescription required|No||056|No|1.15832|01/24/2023|1.13052|01/24/2023|1.13804|01/24/2023|||ANTICONVULSANTS|693|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
droxidopa|No|No|No|No|75%|00054053222|DROXIDOPA 100 MG CAPSULE|90|EA|.59621|06/03/2021|01/31/2023|Yes|No||06/03/2021|01/31/2023|Yes|No|06/03/2021|01/31/2023|Yes|No||||No|No|||Prescription required|No|||No|1.35881|06/03/2021|1.3394|06/03/2021|1.27562|06/03/2021||||694|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
droxidopa|No|No|No|No|75%|00054053322|DROXIDOPA 200 MG CAPSULE|90|EA|1.19248|06/03/2021|01/31/2023|Yes|No||06/03/2021|01/31/2023|Yes|No|06/03/2021|01/31/2023|Yes|No||||No|No|||Prescription required|No|||No|2.71775|06/03/2021|2.67893|06/03/2021|2.55136|06/03/2021||||695|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
droxidopa|No|No|No|No|75%|00054053422|DROXIDOPA 300 MG CAPSULE|90|EA|1.7887|06/03/2021|01/31/2023|Yes|No||06/03/2021|01/31/2023|Yes|No|06/03/2021|01/31/2023|Yes|No||||No|No|||Prescription required|No|||No|4.07657|06/03/2021|4.01833|06/03/2021|3.82698|06/03/2021||||696|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|08/26/2021|59.39045|08/26/2021|56.56233|08/26/2021||||697|||||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|No|.54504|02/28/2023|.53195|02/28/2023|.5355|02/28/2023|||ANTIDEPRESSANTS: OTHER|698|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054060421|EVEROLIMUS 1 MG TABLET|60|EA|13.63708|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|31.07987|04/05/2022|30.63587|04/05/2022|29.17702|04/05/2022|||IMMUNOSUPPRESSIVES: ORAL|699|||||No|No||WEST-WARD/HIKMA|No|||||Yes|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|.18126|02/28/2023|.1769|02/28/2023|.17808|02/28/2023||||700|||||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|9.17155|12/27/2022|8.95143|12/27/2022|9.01104|12/27/2022||||701|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methylergonovine maleate|No|No|No|No|75%|00054063913|METHYLERGONOVINE 0.2 MG TABLET|28|EA|23.11357|04/24/2020||Yes|No||04/24/2020||Yes|No|04/24/2020||Yes|No||||No|No|||Prescription required|No|||No|9.17155|12/27/2022|8.95143|12/27/2022|9.01104|12/27/2022||||702|||||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|2.61336|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|5.95604|09/15/2022|5.87096|09/15/2022|5.59139|09/15/2022|||ANALGESICS: NARCOTICS SHORT|703|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054070920|METHADONE HCL 5 MG TABLET|100|EA|.13222|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|.11986|02/28/2023|.11698|02/28/2023|.11776|02/28/2023|||ANALGESICS: NARCOTICS LONG|704|||||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|.11986|02/28/2023|.11698|02/28/2023|.11776|02/28/2023|||ANALGESICS: NARCOTICS LONG|705|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054071020|METHADONE HCL 10 MG TABLET|100|EA|.15045|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|.10098|02/28/2023|.09855|02/28/2023|.09921|02/28/2023|||ANALGESICS: NARCOTICS LONG|706|||||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|.10098|02/28/2023|.09855|02/28/2023|.09921|02/28/2023|||ANALGESICS: NARCOTICS LONG|707|||||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|59.98998|06/28/2022||Yes|No||06/28/2022||Yes|No|06/28/2022||Yes|No||||No|No|||Prescription required|No|||No|136.72136|06/28/2022|134.7682|06/28/2022|128.35067|06/28/2022||||708|||||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|3.31187|02/28/2023|3.23238|02/28/2023|3.25391|02/28/2023|||BRONCHODILATORS: BETA AGONIST|709|||||No|No||WEST-WARD/HIKMA|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|.08335|02/28/2023|.08134|02/28/2023|.08189|02/28/2023||||710|||||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|.05646|02/28/2023|.0551|02/28/2023|.05547|02/28/2023||||711|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054252731|LITHIUM CARBONATE 300 MG CAP|1000|EA|.09193|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.05646|02/28/2023|.0551|02/28/2023|.05547|02/28/2023||||712|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054253125|LITHIUM CARBONATE 600 MG CAP|100|EA|.16146|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.17821|02/28/2023|.17393|02/28/2023|.17509|02/28/2023||||713|||||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|.46762|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|.93293|02/28/2023|.91053|02/28/2023|.9166|02/28/2023|||ANALGESICS: NARCOTICS SHORT|714|||||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|06/01/2016|2.95016|06/01/2016|2.80968|06/01/2016|||ANXIOLYTICS|715|||||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|13.88543|02/28/2023|13.55217|02/28/2023|13.64243|02/28/2023|||ANALGESICS: NARCOTICS SHORT|716|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
calcium carbonate|No|No|No|No|75%|00054311763|CALCIUM CARB 1,250 MG/5 ML SUS|500|ML|.00786|09/01/1999|01/31/2024|Yes|No||||No|No|09/01/1999|01/31/2024|Yes|No||09/01/1999|01/31/2024|Yes|No|||Over the counter|No|||No|.01768|07/26/2022|.01725|07/26/2022|.01737|07/26/2022||||717|No Longer Rebatable||No Longer Rebatable|No Longer Rebatable|No|No||ROXANE/WEST-WAR|No|||||No|Yes|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|5.83347|02/28/2023|5.69346|02/28/2023|5.73138|02/28/2023||||718|||||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|.76633|02/28/2023|.74793|02/28/2023|.75291|02/28/2023|||GLUCOCORTICOIDS: ORAL|719|||||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||168|Yes|.20804|09/28/2021|.20507|09/28/2021|.1953|09/28/2021|||GLUCOCORTICOIDS: ORAL|720|||||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|.0139|12/30/2008||Yes|No||12/30/2008||Yes|No|12/30/2008||Yes|No||||No|No|||Prescription required|No||168|Yes|.03169|06/26/2018|.03124|06/26/2018|.02975|06/26/2018|||GLUCOCORTICOIDS: ORAL|721|||||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|1.03944|10/25/2022|1.02459|10/25/2022|.9758|10/25/2022|||ANXIOLYTICS|722|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
diazepam|No|No|No|No|75%|00054318863|DIAZEPAM 5 MG/5 ML SOLUTION|500|ML|.04966|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.11319|09/06/2022|.11157|09/06/2022|.10626|09/06/2022|||ANXIOLYTICS|723|||||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|1.14332|01/29/2019|1.12699|01/29/2019|1.07332|01/29/2019||||724|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00054327099|FLUTICASONE PROP 50 MCG SPRAY|16|GM|.29562|03/24/2006||Yes|No||03/24/2006||Yes|No|03/24/2006||Yes|No||||No|No|||Prescription required|No||019|No|.28327|02/28/2023|.27647|02/28/2023|.27831|02/28/2023|||INTRANASAL RHINITIS AGENTS|725|||||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|.08872|02/28/2023|.08659|02/28/2023|.08716|02/28/2023||||726|||||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|.08872|02/28/2023|.08659|02/28/2023|.08716|02/28/2023||||727|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054329863|FUROSEMIDE 40 MG/5 ML SOLN|500|ML|.03331|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|06/01/2016|.07484|06/01/2016|.07128|06/01/2016||||728|||||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|.0714|02/28/2023|.06968|02/28/2023|.07015|02/28/2023||||729|||||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|.45677|02/28/2023|.4458|02/28/2023|.44877|02/28/2023||||730|||||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||090|Yes|.62037|02/28/2023|.60548|02/28/2023|.60951|02/28/2023|||ANXIOLYTICS|731|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
meperidine HCl|No|No|No|No|90%|00054354563|MEPERIDINE 50 MG/5 ML SOLUTION|500|ML|.07257|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|.1654|11/28/2017|.16304|11/28/2017|.15527|11/28/2017|||ANALGESICS: NARCOTICS SHORT|732|||||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|.66248|08/29/2017|.65301|08/29/2017|.62192|08/29/2017|||ANALGESICS: NARCOTICS LONG|733|||||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|.06252|12/26/2017|.06163|12/26/2017|.05869|12/26/2017|||ANALGESICS: NARCOTICS LONG|734|||||No|No||ROXANE/WEST-WAR|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|.1083|06/01/2016|.10676|06/01/2016|.10167|06/01/2016|||ANALGESICS: NARCOTICS LONG|735|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00054363063|NAPROXEN 125 MG/5 ML SUSPEN|500|ML|.77093|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|1.75702|03/02/2021|1.73192|03/02/2021|1.64944|03/02/2021|||NSAIDS|736|||||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|08/29/2017|4.18599|08/29/2017|3.98666|08/29/2017|||GLUCOCORTICOIDS: ORAL|737|||||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||168|Yes|.50616|02/28/2023|.49401|02/28/2023|.4973|02/28/2023|||GLUCOCORTICOIDS: ORAL|738|||||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||168|Yes|.6076|08/08/2017|.59892|08/08/2017|.5704|08/08/2017|||GLUCOCORTICOIDS: ORAL|739|||||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||070|No|.0905|10/25/2022|.08832|10/25/2022|.08891|10/25/2022|||BETA-BLOCKERS|740|||||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|.05924|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.13502|06/28/2016|.13309|06/28/2016|.12675|06/28/2016|||BETA-BLOCKERS|741|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
clotrimazole|No|No|No|No|75%|00054414622|CLOTRIMAZOLE 10 MG TROCHE|70|EA|.8509|10/03/2006||Yes|No||10/03/2006||Yes|No|10/03/2006||Yes|No||10/03/2006||Yes|No|||Prescription required|No||069|No|.40083|02/28/2023|.39121|02/28/2023|.39381|02/28/2023|||ANTIFUNGALS: ORAL|742|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
clotrimazole|No|No|No|No|75%|00054414623|CLOTRIMAZOLE 10 MG TROCHE|140|EA|.74721|10/03/2006||Yes|No||10/03/2006||Yes|No|10/03/2006||Yes|No||10/03/2006||Yes|No|||Prescription required|No||069|No|.40083|02/28/2023|.39121|02/28/2023|.39381|02/28/2023|||ANTIFUNGALS: ORAL|743|||||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||168|Yes|.10655|02/28/2023|.10399|02/28/2023|.10468|02/28/2023|||GLUCOCORTICOIDS: ORAL|744|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418025|DEXAMETHASONE 0.75 MG TABLET|100|EA|.0887|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||168|Yes|.18672|01/24/2023|.18223|01/24/2023|.18345|01/24/2023|||GLUCOCORTICOIDS: ORAL|745|||||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||168|Yes|.23661|02/28/2023|.23093|02/28/2023|.23246|02/28/2023|||GLUCOCORTICOIDS: ORAL|746|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418225|DEXAMETHASONE 1.5 MG TABLET|100|EA|.17092|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||168|Yes|.29827|01/24/2023|.29111|01/24/2023|.29305|01/24/2023|||GLUCOCORTICOIDS: ORAL|747|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418325|DEXAMETHASONE 2 MG TABLET|100|EA|.2131|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||168|Yes|.40367|02/28/2023|.39398|02/28/2023|.3966|02/28/2023|||GLUCOCORTICOIDS: ORAL|748|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054418425|DEXAMETHASONE 4 MG TABLET|100|EA|.42621|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||168|Yes|.3601|02/28/2023|.35145|02/28/2023|.35379|02/28/2023|||GLUCOCORTICOIDS: ORAL|749|||||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||168|Yes|.89393|02/28/2023|.87247|02/28/2023|.87828|02/28/2023|||GLUCOCORTICOIDS: ORAL|750|||||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|.03079|02/28/2023|.03005|02/28/2023|.03025|02/28/2023||||751|||||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|.03079|02/28/2023|.03005|02/28/2023|.03025|02/28/2023||||752|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054429925|FUROSEMIDE 40 MG TABLET|100|EA|.0494|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.0315|02/28/2023|.03074|02/28/2023|.03094|02/28/2023||||753|||||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|.0315|02/28/2023|.03074|02/28/2023|.03094|02/28/2023||||754|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054430125|FUROSEMIDE 80 MG TABLET|100|EA|.05512|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.05549|02/28/2023|.05415|02/28/2023|.05451|02/28/2023||||755|||||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|.05549|02/28/2023|.05415|02/28/2023|.05451|02/28/2023||||756|||||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|.76509|02/28/2023|.74672|02/28/2023|.7517|02/28/2023||||757|||||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|.76509|02/28/2023|.74672|02/28/2023|.7517|02/28/2023||||758|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449705|LEUCOVORIN CALCIUM 10 MG TAB|12|EA|2.67925|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.36174|02/28/2023|4.25705|02/28/2023|4.2854|02/28/2023||||759|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
leucovorin calcium|No|No|No|No|75%|00054449710|LEUCOVORIN CALCIUM 10 MG TAB|24|EA|2.38183|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.36174|02/28/2023|4.25705|02/28/2023|4.2854|02/28/2023||||760|||||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|5.1891|06/01/2016|5.11497|06/01/2016|4.8714|06/01/2016||||761|||||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|5.62456|02/28/2023|5.48957|02/28/2023|5.52613|02/28/2023||||762|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054452725|LITHIUM CARBONATE 300 MG TAB|100|EA|.09141|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.13408|02/28/2023|.13086|02/28/2023|.13173|02/28/2023||||763|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054452731|LITHIUM CARBONATE 300 MG TAB|1000|EA|.08876|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.13408|02/28/2023|.13086|02/28/2023|.13173|02/28/2023||||764|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054453825|DISKETS 40 MG TABLET DISPR|100|EA|.1099|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|.25048|06/01/2016|.2469|06/01/2016|.23515|06/01/2016|||ANALGESICS: NARCOTICS LONG|765|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
methotrexate sodium|No|No|No|No|75%|00054455015|METHOTREXATE 2.5 MG TABLET|36|EA|.77638|07/27/2010||Yes|No||07/27/2010||Yes|No|07/27/2010||Yes|No||||No|No|||Prescription required|No|||No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023||||766|||||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
methotrexate sodium|No|No|No|No|75%|00054455025|METHOTREXATE 2.5 MG TABLET|100|EA|.75933|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023||||767|||||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||173|No|.90201|02/28/2023|.88036|02/28/2023|.88622|02/28/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|768|||||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||173|No|.90201|02/28/2023|.88036|02/28/2023|.88622|02/28/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|769|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
prednisone|No|No|No|No|75%|00054472825|PREDNISONE 5 MG TABLET|100|EA|.07778|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||168|Yes|.055|02/28/2023|.05368|02/28/2023|.05403|02/28/2023|||GLUCOCORTICOIDS: ORAL|770|||||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|.077|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||168|Yes|.055|02/28/2023|.05368|02/28/2023|.05403|02/28/2023|||GLUCOCORTICOIDS: ORAL|771|||||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|.08698|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||168|Yes|.06592|02/28/2023|.06433|02/28/2023|.06476|02/28/2023|||GLUCOCORTICOIDS: ORAL|772|||||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||168|Yes|.06592|02/28/2023|.06433|02/28/2023|.06476|02/28/2023|||GLUCOCORTICOIDS: ORAL|773|||||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||168|Yes|.08917|02/28/2023|.08702|02/28/2023|.0876|02/28/2023|||GLUCOCORTICOIDS: ORAL|774|||||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|1.2614|03/07/2019||Yes|No||03/07/2019||Yes|No|03/07/2019||Yes|No||||No|No|||Prescription required|No||054|Yes|1.08886|02/28/2023|1.06272|02/28/2023|1.0698|02/28/2023|||SEDATIVE HYPNOTICS|775|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
triazolam|No|No|No|No|90%|00054485925|TRIAZOLAM 0.25 MG TABLET|100|EA|1.2614|03/07/2019||Yes|No||03/07/2019||Yes|No|03/07/2019||Yes|No||||No|No|||Prescription required|No||054|Yes|.88571|02/28/2023|.86445|02/28/2023|.87021|02/28/2023|||SEDATIVE HYPNOTICS|776|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
triazolam|No|No|No|No|90%|00054485929|TRIAZOLAM 0.25 MG TABLET|500|EA|.63071|07/01/2016||Yes|No||07/01/2016||Yes|No|07/01/2016||Yes|No||||No|No|||Prescription required|No||054|Yes|.88571|02/28/2023|.86445|02/28/2023|.87021|02/28/2023|||SEDATIVE HYPNOTICS|777|||||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||069|No|.40083|02/28/2023|.39121|02/28/2023|.39381|02/28/2023|||ANTIFUNGALS: ORAL|778|||||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||168|Yes|.23661|02/28/2023|.23093|02/28/2023|.23246|02/28/2023|||GLUCOCORTICOIDS: ORAL|779|||||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||168|Yes|.3601|02/28/2023|.35145|02/28/2023|.35379|02/28/2023|||GLUCOCORTICOIDS: ORAL|780|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054817625|DEXAMETHASONE 2 MG TABLET|100|EA|.26582|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription required|No||168|Yes|.40367|02/28/2023|.39398|02/28/2023|.3966|02/28/2023|||GLUCOCORTICOIDS: ORAL|781|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054817925|DEXAMETHASONE 0.5 MG TABLET|100|EA|.07408|01/20/2011||Yes|No||01/20/2011||Yes|No|01/20/2011||Yes|No||01/20/2011||Yes|No|||Prescription required|No||168|Yes|.10655|02/28/2023|.10399|02/28/2023|.10468|02/28/2023|||GLUCOCORTICOIDS: ORAL|782|||||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||168|Yes|.18672|01/24/2023|.18223|01/24/2023|.18345|01/24/2023|||GLUCOCORTICOIDS: ORAL|783|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
dexamethasone|No|No|No|No|75%|00054818125|DEXAMETHASONE 1.5 MG TABLET|100|EA|.19633|01/20/2011||Yes|No||01/20/2011||Yes|No|02/16/2001||Yes|No||01/20/2011||Yes|No|||Prescription required|No||168|Yes|.29827|01/24/2023|.29111|01/24/2023|.29305|01/24/2023|||GLUCOCORTICOIDS: ORAL|784|||||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||168|Yes|.89393|02/28/2023|.87247|02/28/2023|.87828|02/28/2023|||GLUCOCORTICOIDS: ORAL|785|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
furosemide|No|No|No|No|75%|00054829725|FUROSEMIDE 20 MG TABLET|100|EA|.07236|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription required|No|||No|.03079|02/28/2023|.03005|02/28/2023|.03025|02/28/2023||||786|||||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|.0315|02/28/2023|.03074|02/28/2023|.03094|02/28/2023||||787|||||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|.05549|02/28/2023|.05415|02/28/2023|.05451|02/28/2023||||788|||||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|.76509|02/28/2023|.74672|02/28/2023|.7517|02/28/2023||||789|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054852625|LITHIUM CARBONATE 150 MG CAP|100|EA|.06458|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription required|No|||No|.08335|02/28/2023|.08134|02/28/2023|.08189|02/28/2023||||790|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054852725|LITHIUM CARBONATE 300 MG CAP|100|EA|.12611|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription required|No|||No|.05646|02/28/2023|.0551|02/28/2023|.05547|02/28/2023||||791|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054852825|LITHIUM CARBONATE 300 MG TAB|100|EA|.11545|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||||No|No|||Prescription required|No|||No|.13408|02/28/2023|.13086|02/28/2023|.13173|02/28/2023||||792|||||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|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023||||793|||||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||168|Yes|.055|02/28/2023|.05368|02/28/2023|.05403|02/28/2023|||GLUCOCORTICOIDS: ORAL|794|||||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|.09567|01/21/2011||Yes|No||01/21/2011||Yes|No|01/21/2011||Yes|No||01/21/2011||Yes|No|||Prescription required|No||168|Yes|.06592|02/28/2023|.06433|02/28/2023|.06476|02/28/2023|||GLUCOCORTICOIDS: ORAL|795|||||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||168|Yes|.08917|02/28/2023|.08702|02/28/2023|.0876|02/28/2023|||GLUCOCORTICOIDS: ORAL|796|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054981725|PREDNISONE 10 MG TABLET|100|EA|.0835|04/01/2021||Yes|No||04/01/2021||Yes|No|04/01/2021||Yes|No||04/01/2021||Yes|No|||Prescription required|No||168|Yes|.06687|02/28/2023|.06526|02/28/2023|.06569|02/28/2023|||GLUCOCORTICOIDS: ORAL|797|||||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||168|Yes|.06687|02/28/2023|.06526|02/28/2023|.06569|02/28/2023|||GLUCOCORTICOIDS: ORAL|798|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054982825|PREDNISONE 5 MG TABLET|100|EA|.07778|04/30/2021||Yes|No||04/30/2021||Yes|No|04/30/2021||Yes|No||04/30/2021||Yes|No|||Prescription required|No||168|Yes|.055|02/28/2023|.05368|02/28/2023|.05403|02/28/2023|||GLUCOCORTICOIDS: ORAL|799|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00054982831|PREDNISONE 5 MG TABLET|1000|EA|.077|04/30/2021||Yes|No||04/30/2021||Yes|No|04/30/2021||Yes|No||04/30/2021||Yes|No|||Prescription required|No||168|Yes|.055|02/28/2023|.05368|02/28/2023|.05403|02/28/2023|||GLUCOCORTICOIDS: ORAL|800|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
NALTREXONE HCL|No|No|No|No|75%|00056001176|NALTREXONE HCL|100|EA|1.10299|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription required|No|||No|||||||.7816|10/01/2020||801|||||No|No||DU PONT PHARMA|Yes|09/01/2020||||No|No|No||
efavirenz|No|No|No|No|75%|00056047030|SUSTIVA 50 MG CAPSULE|30|EA|1.63539|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|2.67114|01/10/2017|2.63298|01/10/2017|2.5076|01/10/2017|||HIV / AIDS|802|||||No|No||BMS|No|||||No|No|No||
efavirenz|No|No|No|No|75%|00056047492|SUSTIVA 200 MG CAPSULE|90|EA|6.53746|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|10.67785|01/23/2018|10.52531|01/23/2018|10.0241|01/23/2018|||HIV / AIDS|803|||||No|No||BMS|No|||||No|No|No||
efavirenz|No|No|No|No|75%|00056051030|SUSTIVA 600 MG TABLET|30|EA|19.61239|03/21/2002|03/31/2023|Yes|No||03/21/2002|03/31/2023|Yes|No|03/21/2002|03/31/2023|Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|32.03358|03/24/2020|31.57596|03/24/2020|30.07234|03/24/2020|||HIV / AIDS|804|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS|No|||||No|No|No||
nepafenac|No|No|No|No|75%|00065000203|NEVANAC 0.1% DROPTAINER|3|ML|44.92783|08/30/2005|04/30/2023|Yes|No||08/30/2005|04/30/2023|Yes|No|08/30/2005|04/30/2023|Yes|No||||No|No|||Prescription required|Yes|01/28/2021|013|No|102.39366|01/10/2023|100.93089|01/10/2023|96.12466|01/10/2023|||OPHTHALMICS: ANTI-INFLAMMATORIES|805|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALCON/NOVARTIS|No|||||No|No|No||
betaxolol HCl|No|No|No|No|75%|00065024610|BETOPTIC S 0.25% EYE DROPS|10|ML|14.02058|03/01/2002|12/29/2023|Yes|No||03/01/2002|12/29/2023|Yes|No|03/01/2002|12/29/2023|Yes|No||||No|No|||Prescription required|Yes|01/25/2012|088|No|34.45151|02/07/2023|33.62467|02/07/2023|33.8486|02/07/2023|||OPHTHALMICS: GLAUCOMA AGENTS|806|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
betaxolol HCl|No|No|No|No|75%|00065024615|BETOPTIC S 0.25% EYE DROPS|15|ML|14.01943|03/01/2002|12/29/2023|Yes|No||03/01/2002|12/29/2023|Yes|No|03/01/2002|12/29/2023|Yes|No||||No|No|||Prescription required|Yes|01/25/2012|088|No|31.95126|08/02/2022|31.49481|08/02/2022|29.99506|08/02/2022|||OPHTHALMICS: GLAUCOMA AGENTS|807|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
brinzolamide|No|No|No|No|75%|00065027510|AZOPT 1% EYE DROPS|10|ML|14.75889|03/01/2002|03/11/2023|Yes|No||03/01/2002|03/11/2023|Yes|No|03/01/2002|03/11/2023|Yes|No||||No|No|||Prescription required|No||088|No|34.63005|08/09/2022|33.79892|08/09/2022|34.02402|08/09/2022|||OPHTHALMICS: GLAUCOMA AGENTS|808|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
brinzolamide|No|No|No|No|75%|00065027515|AZOPT 1% EYE DROPS|15|ML|15.49548|03/01/2002|07/28/2023|Yes|No||03/01/2002|07/28/2023|Yes|No|03/01/2002|07/28/2023|Yes|No||||No|No|||Prescription required|No||088|No|34.69367|02/28/2023|33.86102|02/28/2023|34.08653|02/28/2023|||OPHTHALMICS: GLAUCOMA AGENTS|809|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
lodoxamide tromethamine|No|No|No|No|75%|00065034510|ALOMIDE 0.1% EYE DROPS|10|ML|8.4882|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/23/2013|002|No|19.3452|01/10/2023|19.06884|01/10/2023|18.1608|01/10/2023|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|810|||||No|No||ALCON/NOVARTIS|No|||||No|No|No||
cyclopentolate/phenylephrine|No|No|No|No|75%|00065035905|CYCLOMYDRIL EYE DROPS|5|ML|5.02498|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|11.45228|03/07/2023|11.28867|03/07/2023|10.75112|03/07/2023||||811|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039515|CYCLOGYL 0.5% EYE DROPS|15|ML|2.60752|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|5.94272|03/07/2023|5.85782|03/07/2023|5.57888|03/07/2023||||812|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039605|CYCLOGYL 1% EYE DROPS|5|ML|4.92264|01/02/2008||Yes|No||01/02/2008||Yes|No|01/02/2008||Yes|No||||No|No|||Prescription required|No|||No|11.21904|03/07/2023|11.05876|03/07/2023|10.53216|03/07/2023||||813|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039705|CYCLOGYL 2% EYE DROPS|5|ML|5.92282|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|13.49852|03/07/2023|13.30568|03/07/2023|12.67208|03/07/2023||||814|||||No|No||ALCON LABORATOR|No|||||No|No|No||
cyclopentolate HCl|No|No|No|No|75%|00065039715|CYCLOGYL 2% EYE DROPS|15|ML|3.27918|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|7.47348|03/07/2023|7.36671|03/07/2023|7.01592|03/07/2023||||815|||||No|No||ALCON LABORATOR|No|||||No|No|No||
tobramycin|No|No|No|No|75%|00065064305|TOBREX 0.3% EYE DROP|5|ML|8.77802|03/01/2002|01/20/2023|Yes|No||03/01/2002|01/20/2023|Yes|No|03/01/2002|01/20/2023|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|058|No|20.00572|01/09/2018|19.71992|01/09/2018|18.78088|01/09/2018|||OPHTHALMIC ANTIBIOTICS|816|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
tobramycin|No|No|No|No|75%|00065064435|TOBREX 0.3% EYE OINTMENT|3.5|GM|26.33565|03/01/2002|07/14/2023|Yes|No||03/01/2002|07/14/2023|Yes|No|03/01/2002|07/14/2023|Yes|No||||No|No|||Prescription required|No||058|No|67.983|01/17/2023|66.3514|01/17/2023|66.79329|01/17/2023|||OPHTHALMIC ANTIBIOTICS|817|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
tobramycin/dexamethasone|No|No|No|No|75%|00065064705|TOBRADEX EYE DROPS|5|ML|14.32416|01/02/2008|08/31/2023|Yes|No||01/02/2008|08/31/2023|Yes|No|01/02/2008|08/31/2023|Yes|No||||No|No|||Prescription required|No||036|No|35.24573|01/17/2023|34.39983|01/17/2023|34.62892|01/17/2023|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|818|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALCON/NOVARTIS|No|||||No|No|No||
tobramycin/dexamethasone|No|No|No|No|75%|00065064710|TOBRADEX EYE DROPS|10|ML|14.32201|03/01/2002|12/29/2023|Yes|No||03/01/2002|12/29/2023|Yes|No|03/01/2002|12/29/2023|Yes|No||||No|No|||Prescription required|No||036|No|32.64086|08/02/2022|32.17456|08/02/2022|30.64244|08/02/2022|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|819|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
tobramycin/dexamethasone|No|No|No|No|75%|00065064725|TOBRADEX EYE DROPS|2.5|ML|14.30008|01/02/2008|05/31/2023|Yes|No||01/02/2008|05/31/2023|Yes|No|01/02/2008|05/31/2023|Yes|No||||No|No|||Prescription required|No||036|No|32.59088|08/02/2022|32.12529|08/02/2022|30.59552|08/02/2022|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|820|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALCON/NOVARTIS|No|||||No|No|No||
tobramycin/dexamethasone|No|No|No|No|75%|00065065205|TOBRADEX ST 0.3-0.05% EYE DROP|5|ML|19.48502|07/18/2011||Yes|No||07/18/2011||Yes|No|07/18/2011||Yes|No||||No|No|||Prescription required|Yes|01/20/2011|036|No|45.84025|07/26/2022|44.74008|07/26/2022|45.03804|07/26/2022|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|821|||||No|No||ALCON/EYEVANCE|No|||||No|No|No||
ciprofloxacin HCl|No|No|No|No|75%|00065065605|CILOXAN 0.3% EYE DROPS|5|ML|10.39912|03/01/2002|04/30/2023|Yes|No||03/01/2002|04/30/2023|Yes|No|03/01/2002|04/30/2023|Yes|No||||No|No|||Prescription required|Yes|07/12/2005|058|No|23.70032|01/09/2018|23.36174|01/09/2018|22.24928|01/09/2018|||OPHTHALMIC ANTIBIOTICS|822|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALCON/NOVARTIS|No|||||No|No|No||
olopatadine HCl|No|No|No|No|75%|00065081604|PATADAY ONCE DAILY 0.7% DROPS|2.5|ML||03/04/2021||Yes|No||||No|No|03/04/2021||Yes|No||||No|No|||Over the counter|No||002|No|6.48233|01/24/2023|6.32675|01/24/2023|6.36888|01/24/2023|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|823|||||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|10.70216|08/17/2022||Yes|No||08/17/2022||Yes|No|08/17/2022||Yes|No||||No|No|||Prescription required|No||088|No|23.83508|01/03/2023|23.26303|01/03/2023|23.41796|01/03/2023|||OPHTHALMICS: GLAUCOMA AGENTS|824|||||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||03/04/2021||Yes|No||||No|No|03/04/2021||Yes|No||||No|No|||Over the counter|Yes|01/28/2021|002|No|6.12255|01/24/2023|5.9756|01/24/2023|6.0154|01/24/2023|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|825|||||No|No||ALCON LABORATOR|No|||||No|Yes|No||
ciprofloxacin/hydrocortisone|No|No|No|No|75%|00065853110|CIPRO HC OTIC SUSPENSION|10|ML|13.58241|03/01/2002|05/10/2023|Yes|No||03/01/2002|05/10/2023|Yes|No|03/01/2002|05/10/2023|Yes|No||||No|No|||Prescription required|Yes|01/23/2013|051|No|34.91797|01/17/2023|34.07993|01/17/2023|34.3069|01/17/2023|||OTIC ANTIBIOTICS|826|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ALCON/NOVARTIS|No|||||No|No|No||
difluprednate|No|No|No|No|75%|00065924007|DUREZOL 0.05% EYE DROPS|5|ML|18.748|09/26/2013||Yes|No||09/26/2013||Yes|No|09/26/2013||Yes|No||||No|No|||Prescription required|No||013|No|41.83483|08/09/2022|40.83079|08/09/2022|41.10272|08/09/2022|||OPHTHALMICS: ANTI-INFLAMMATORIES|827|||||No|No||ALCON/NOVARTIS|No|||||No|No|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|06/01/2016|172.48896|06/01/2016|164.2752|06/01/2016||||828|||||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|01/05/2018|172.48896|01/05/2018|164.2752|01/05/2018||||829|||||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|||No|855.2166|01/03/2023|842.99922|01/03/2023|802.8564|01/03/2023||||830|||||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|67.12754|11/22/2013||Yes|No||11/22/2013||Yes|No|11/22/2013||Yes|No||||No|No|||Prescription required|No||173|No|152.98836|01/03/2023|150.80282|01/03/2023|143.62173|01/03/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|831|||||No|No||PFIZER US PHARM|No|||||No|No|No||
bosutinib|No|No|No|No|75%|00069013601|BOSULIF 500 MG TABLET|30|EA|268.5102|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription required|No||173|No|611.95348|01/03/2023|603.21129|01/03/2023|574.48694|01/03/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|832|||||No|No||PFIZER US PHARM|No|||||No|No|No||
axitinib|No|No|No|No|75%|00069014501|INLYTA 1 MG TABLET|180|EA|45.819|06/15/2012||Yes|No||06/15/2012||Yes|No|06/15/2012||Yes|No||||No|No|||Prescription required|No||548|No|104.42471|01/03/2023|102.93293|01/03/2023|98.03136|01/03/2023|||ONCOLOGY: ORAL - RENAL CELL|833|||||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|137.45702|06/15/2012||Yes|No||06/15/2012||Yes|No|06/15/2012||Yes|No||||No|No|||Prescription required|No||548|No|313.27415|01/03/2023|308.7988|01/03/2023|294.0941|01/03/2023|||ONCOLOGY: ORAL - RENAL CELL|834|||||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|308.73447|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|No||502|No|703.62739|01/03/2023|693.57557|01/03/2023|660.54816|01/03/2023|||ONCOLOGY: ORAL - BREAST|835|||||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|308.73447|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|No||502|No|703.62739|01/03/2023|693.57557|01/03/2023|660.54816|01/03/2023|||ONCOLOGY: ORAL - BREAST|836|||||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|308.73447|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||||No|No|||Prescription required|No||502|No|703.62739|01/03/2023|693.57557|01/03/2023|660.54816|01/03/2023|||ONCOLOGY: ORAL - BREAST|837|||||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|268.5102|08/23/2022||Yes|No||08/23/2022||Yes|No|08/23/2022||Yes|No||||No|No|||Prescription required|No||173|No|611.95348|01/03/2023|603.21129|01/03/2023|574.48694|01/03/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|838|||||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|.2|ML|72.74525|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|165.7915|01/03/2023|163.42305|01/03/2023|155.641|01/03/2023|||ANTICOAGULANTS|839|||||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|.2|ML|118.0221|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|268.9806|01/03/2023|265.13802|01/03/2023|252.5124|01/03/2023|||ANTICOAGULANTS|840|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dacomitinib|No|No|No|No|75%|00069019730|VIZIMPRO 15 MG TABLET|30|EA|223.05992|03/18/2019||Yes|No||03/18/2019||Yes|No|03/18/2019||Yes|No||||No|No|||Prescription required|No||551|No|508.36912|01/03/2023|501.1067|01/03/2023|477.24448|01/03/2023|||ONCOLOGY: ORAL - LUNG|841|||||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|.3|ML|118.035|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|269.01|01/03/2023|265.167|01/03/2023|252.54|01/03/2023|||ANTICOAGULANTS|842|||||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|47.20884|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|107.59224|01/03/2023|106.0552|01/03/2023|101.00496|01/03/2023|||ANTICOAGULANTS|843|||||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|.5|ML|118.0307|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|269.0002|01/03/2023|265.15734|01/03/2023|252.5308|01/03/2023|||ANTICOAGULANTS|844|||||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|.6|ML|118.02353|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|268.98386|01/03/2023|265.14123|01/03/2023|252.51546|01/03/2023|||ANTICOAGULANTS|845|||||No|No||PFIZER US PHARM|No|||||No|No|No||
lorlatinib|No|No|No|No|75%|00069022701|LORBRENA 25 MG TABLET|30|EA|96.27456|11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription required|No||551|No|219.41644|01/03/2023|216.28192|01/03/2023|205.98278|01/03/2023|||ONCOLOGY: ORAL - LUNG|846|||||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|.72|ML|118.02365|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|268.98413|01/03/2023|265.1415|01/03/2023|252.51572|01/03/2023|||ANTICOAGULANTS|847|||||No|No||PFIZER US PHARM|No|||||No|No|No||
lorlatinib|No|No|No|No|75%|00069023101|LORBRENA 100 MG TABLET|30|EA|288.82297|11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription required|No||551|No|658.2477|01/03/2023|648.84416|01/03/2023|617.94682|01/03/2023|||ONCOLOGY: ORAL - LUNG|848|||||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|106.78484|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|243.3701|01/03/2023|239.89338|01/03/2023|228.46989|01/03/2023|||ANTICOAGULANTS|849|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fesoterodine fumarate|No|No|No|No|75%|00069024230|TOVIAZ ER 4 MG TABLET|30|EA|5.39721|02/24/2009||Yes|No||02/24/2009||Yes|No|02/24/2009||Yes|No||||No|No|||Prescription required|No||006|No|12.0064|01/11/2022|11.71824|01/11/2022|11.79628|01/11/2022|||BLADDER RELAXANT PREPARATIONS|850|||||No|No||PFIZER US PHARM|No|||||No|No|No||
fesoterodine fumarate|No|No|No|No|75%|00069024430|TOVIAZ ER 8 MG TABLET|30|EA|5.39721|02/24/2009||Yes|No||02/24/2009||Yes|No|02/24/2009||Yes|No||||No|No|||Prescription required|No||006|No|12.05064|01/11/2022|11.76142|01/11/2022|11.83975|01/11/2022|||BLADDER RELAXANT PREPARATIONS|851|||||No|No||PFIZER US PHARM|No|||||No|No|No||
palbociclib|No|No|No|No|75%|00069028403|IBRANCE 75 MG TABLET|21|EA|308.73447|04/30/2020||Yes|No||04/30/2020||Yes|No|04/30/2020||Yes|No||||No|No|||Prescription required|No||502|No|703.62739|01/03/2023|693.57557|01/03/2023|660.54816|01/03/2023|||ONCOLOGY: ORAL - BREAST|852|||||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|.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|02/16/2023|423.108|02/16/2023|402.96|02/16/2023|||COLONY STIMULATING FACTORS|853|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029110|NIVESTYM 300 MCG/0.5 ML SYRING|.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|02/16/2023|423.108|02/16/2023|402.96|02/16/2023|||COLONY STIMULATING FACTORS|854|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029201|NIVESTYM 480 MCG/0.8 ML SYRING|.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|02/16/2023|423.108|02/16/2023|402.96|02/16/2023|||COLONY STIMULATING FACTORS|855|||||No|No||PFIZER US PHARM|No|||||No|No|No||
filgrastim-aafi|No|No|No|No|75%|00069029210|NIVESTYM 480 MCG/0.8 ML SYRING|.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|02/16/2023|423.108|02/16/2023|402.96|02/16/2023|||COLONY STIMULATING FACTORS|856|||||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|02/06/2023|COLONY STIMULATING FACTORS|857|||||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|02/15/2023|211.554|02/15/2023|201.48|02/15/2023|||COLONY STIMULATING FACTORS|858|||||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|02/16/2023|COLONY STIMULATING FACTORS|859|||||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|02/16/2023|211.554|02/16/2023|201.48|02/16/2023|||COLONY STIMULATING FACTORS|860|||||No|No||PFIZER US PHARM|No|||||No|No|No||
talazoparib tosylate|No|No|No|No|75%|00069029630|TALZENNA 0.25 MG CAPSULE|30|EA|83.67843|02/27/2019||Yes|No||02/27/2019||Yes|No|02/27/2019||Yes|No||||No|No|||Prescription required|No||502|No|190.70898|01/03/2023|187.98456|01/03/2023|179.03292|01/03/2023|||ONCOLOGY: ORAL - BREAST|861|||||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|149.54876|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription required|No||173|No|340.83207|01/03/2023|335.96304|01/03/2023|319.9648|01/03/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|862|||||No|No||PFIZER US PHARM|No|||||No|No|No||
pegfilgrastim-apgf|No|No|No|No|75%|00069032401|NYVEPRIA 6 MG/0.6 ML SYRINGE|.6|ML|2812.91666|02/09/2023||Yes|No||02/09/2023||Yes|No|02/09/2023||Yes|No||||No|No|||Prescription required|No||148|No|6410.83332|02/09/2023|6319.24999|02/09/2023|6018.33332|02/09/2023|||COLONY STIMULATING FACTORS|863|||||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|30.95951|01/16/2015||Yes|No||01/16/2015||Yes|No|01/16/2015||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||171|Yes|89.01427|01/10/2023|87.74263|01/10/2023|83.56441|01/10/2023|||PAH AGENTS: ORAL AND INHALED|864|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069034506|PAXLOVID 300-100 MG PACK (EUA)|6|EA|.0043|04/30/2022||Yes|No||04/30/2022||Yes|No|04/30/2022||Yes|No||||No|No|||Prescription required|No|||No|.0098|05/24/2022|.00966|05/24/2022|.0092|05/24/2022|.0001|04/30/2022||865|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069034530|PAXLOVID 300-100 MG PACK (EUA)|30|EA|.0043|04/30/2022||Yes|No||04/30/2022||Yes|No|04/30/2022||Yes|No||||No|No|||Prescription required|No|||No|.0098|05/24/2022|.00966|05/24/2022|.0092|05/24/2022|.0001|04/30/2022||866|||||No|No||PFIZER US PHARM|No|||||No|No|No||
varenicline tartrate|No|No|No|No|75%|00069046856|CHANTIX 0.5 MG TABLET|56|EA|3.6037|09/17/2022||Yes|No||09/17/2022||Yes|No|09/17/2022||Yes|No||||No|No|||Prescription required|No||040|No|8.21309|01/03/2023|8.09576|01/03/2023|7.71025|01/03/2023|||SMOKING CESSATION|867|||||No|No||PFIZER US PHARM|Yes|09/01/2020||||No|No|No||
varenicline tartrate|No|No|No|No|75%|00069046956|CHANTIX 1 MG TABLET|56|EA|3.6037|09/17/2022||Yes|No||09/17/2022||Yes|No|09/17/2022||Yes|No||||No|No|||Prescription required|No||040|No|8.01002|03/15/2022|7.81777|03/15/2022|7.86984|03/15/2022|||SMOKING CESSATION|868|||||No|No||PFIZER US PHARM|Yes|09/01/2020||||No|No|No||
varenicline tartrate|No|No|No|No|75%|00069047103|CHANTIX STARTING MONTH BOX|53|EA|3.80768|09/17/2022||Yes|No||09/17/2022||Yes|No|09/17/2022||Yes|No||||No|No|||Prescription required|No||040|No|8.45696|01/11/2022|8.25399|01/11/2022|8.30896|01/11/2022|||SMOKING CESSATION|869|||||No|No||PFIZER US PHARM|Yes|09/01/2020||||No|No|No||
palbociclib|No|No|No|No|75%|00069048603|IBRANCE 100 MG TABLET|21|EA|308.73447|04/30/2020||Yes|No||04/30/2020||Yes|No|04/30/2020||Yes|No||||No|No|||Prescription required|No||502|No|703.62739|01/03/2023|693.57557|01/03/2023|660.54816|01/03/2023|||ONCOLOGY: ORAL - BREAST|870|||||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|79.0307|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|178.54813|01/10/2023|174.26297|01/10/2023|175.42353|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|871|||||No|No||PFIZER US PHARM|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00069055038|SUTENT 12.5 MG CAPSULE|28|EA|96.26425|08/10/2006||Yes|No||08/10/2006||Yes|No|08/10/2006||Yes|No||||No|No|||Prescription required|No||548|No|215.92842|01/10/2023|210.74613|01/10/2023|212.14967|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|872|||||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|308.73447|04/30/2020||Yes|No||04/30/2020||Yes|No|04/30/2020||Yes|No||||No|No|||Prescription required|No||502|No|703.62739|01/03/2023|693.57557|01/03/2023|660.54816|01/03/2023|||ONCOLOGY: ORAL - BREAST|873|||||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|192.52881|08/10/2006||Yes|No||08/10/2006||Yes|No|08/10/2006||Yes|No||||No|No|||Prescription required|No||548|No|435.98434|01/10/2023|425.52071|01/10/2023|428.35461|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|874|||||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|288.79322|03/05/2015||Yes|No||03/05/2015||Yes|No|03/05/2015||Yes|No||||No|No|||Prescription required|No||548|No|658.17989|01/03/2023|648.77732|01/03/2023|617.88316|01/03/2023|||ONCOLOGY: ORAL - RENAL CELL|875|||||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|01/04/2022|.87886|01/04/2022|.83701|01/04/2022|||TETRACYCLINES|876|||||No|No||PFIZER US PHARM|No|||||No|No|No||
doxycycline calcium|No|No|No|No|75%|00069097195|VIBRAMYCIN 50 MG/5 ML SYRUP|473|ML|.46354|02/09/2021|08/31/2023|Yes|No||02/09/2021|08/31/2023|Yes|No|02/09/2021|08/31/2023|Yes|No||02/09/2021|08/31/2023|Yes|No|||Prescription required|Yes|01/30/2020|213|No|1.05644|07/05/2022|1.04135|07/05/2022|.99176|07/05/2022|||TETRACYCLINES|877|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||PFIZER US PHARM|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00069098038|SUTENT 50 MG CAPSULE|28|EA|335.16534|08/09/2006||Yes|No||08/09/2006||Yes|No|08/09/2006||Yes|No||||No|No|||Prescription required|No||548|No|763.86519|01/03/2023|752.95283|01/03/2023|717.09793|01/03/2023|||ONCOLOGY: ORAL - RENAL CELL|878|||||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|39.51534|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|89.28476|01/10/2023|87.14192|01/10/2023|87.72227|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|879|||||No|No||PFIZER US PHARM|No|||||No|No|No||
tofacitinib citrate|No|No|No|No|75%|00069100201|XELJANZ 10 MG TABLET|60|EA|39.51534|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|90.05823|01/03/2023|88.77169|01/03/2023|84.54446|01/03/2023|||CYTOKINE AND CAM ANTAGONISTS|880|||||No|No||PFIZER US PHARM|No|||||No|No|No||
tofacitinib citrate|No|No|No|No|75%|00069102902|XELJANZ 1 MG/ML SOLUTION|240|ML|7.90305|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|18.01161|01/03/2023|17.7543|01/03/2023|16.90886|01/03/2023|||CYTOKINE AND CAM ANTAGONISTS|881|||||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|14.1384|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|32.2224|02/27/2023|31.76208|02/27/2023|30.2496|02/27/2023|||IMMUNE GLOBULINS|882|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069108506|PAXLOVID 300-100 MG PACK (EUA)|6|EA|.0043|12/27/2021||Yes|No||12/27/2021||Yes|No|12/27/2021||Yes|No||||No|No|||Prescription required|No|||No|.0098|12/27/2021|.00966|12/27/2021|.0092|12/27/2021|.0001|12/27/2021||883|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069108530|PAXLOVID 300-100 MG PACK (EUA)|30|EA|.0043|12/27/2021||Yes|No||12/27/2021||Yes|No|12/27/2021||Yes|No||||No|No|||Prescription required|No|||No|.0098|12/27/2021|.00966|12/27/2021|.0092|12/27/2021|.0001|12/27/2021||884|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069110104|PAXLOVID 150-100 MG PACK (EUA)|4|EA|.0043|04/30/2022||Yes|No||04/30/2022||Yes|No|04/30/2022||Yes|No||||No|No|||Prescription required|No|||No|.0098|05/24/2022|.00966|05/24/2022|.0092|05/24/2022|.0001|04/30/2022||885|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nirmatrelvir/ritonavir|No|No|No|No|75%|00069110120|PAXLOVID 150-100 MG PACK (EUA)|20|EA|.0043|04/30/2022||Yes|No||04/30/2022||Yes|No|04/30/2022||Yes|No||||No|No|||Prescription required|No|||No|.0098|05/24/2022|.00966|05/24/2022|.0092|05/24/2022|.0001|04/30/2022||886|||||No|No||PFIZER US PHARM|No|||||No|No|No||
talazoparib tosylate|No|No|No|No|75%|00069119530|TALZENNA 1 MG CAPSULE|30|EA|251.035|02/27/2019||Yes|No||02/27/2019||Yes|No|02/27/2019||Yes|No||||No|No|||Prescription required|No||502|No|572.12628|01/03/2023|563.95305|01/03/2023|537.09814|01/03/2023|||ONCOLOGY: ORAL - BREAST|887|||||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|223.05992|03/18/2019||Yes|No||03/18/2019||Yes|No|03/18/2019||Yes|No||||No|No|||Prescription required|No||551|No|508.36912|01/03/2023|501.1067|01/03/2023|477.24448|01/03/2023|||ONCOLOGY: ORAL - LUNG|888|||||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||038|Yes|||||||21.61|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|889|||||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||038|Yes|21.6188|10/13/2020|21.30996|10/13/2020|20.2952|10/07/2020|||ERYTHROPOIESIS STIMULATING PROTEINS|890|||||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||038|Yes|||||||32.42|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|891|||||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||038|Yes|32.4282|10/07/2020|31.96494|10/07/2020|30.4428|10/07/2020|||ERYTHROPOIESIS STIMULATING PROTEINS|892|||||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||038|Yes|||||||43.23|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|893|||||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||038|Yes|43.2376|10/13/2020|42.61992|10/13/2020|40.5904|10/07/2020|||ERYTHROPOIESIS STIMULATING PROTEINS|894|||||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||038|Yes|||||||108.09|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|895|||||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||038|Yes|108.094|10/07/2020|106.5498|10/13/2020|101.476|10/07/2020|||ERYTHROPOIESIS STIMULATING PROTEINS|896|||||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||038|Yes|||||||432.37|10/07/2020|ERYTHROPOIESIS STIMULATING PROTEINS|897|||||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||038|Yes|432.376|10/07/2020|426.1992|10/13/2020|405.904|10/07/2020|||ERYTHROPOIESIS STIMULATING PROTEINS|898|||||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|14.13875|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|32.22321|02/27/2023|31.76288|02/27/2023|30.25036|02/27/2023|||IMMUNE GLOBULINS|899|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
immun glob G(IgG)-hipp/maltose|No|No|No|No|75%|00069150902|CUTAQUIG 16.5% (4 G/24 ML) VL|24|ML|14.13875|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|32.22321|02/27/2023|31.76288|02/27/2023|30.25036|02/27/2023|||IMMUNE GLOBULINS|900|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
amlodipine besylate|No|No|No|No|75%|00069152068|NORVASC 2.5 MG TABLET|90|EA|3.46928|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|7.90674|01/10/2023|7.79379|01/10/2023|7.42266|01/10/2023|||CALCIUM CHANNEL BLOCKERS|901|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine besylate|No|No|No|No|75%|00069153068|NORVASC 5 MG TABLET|90|EA|3.46928|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|7.75092|01/17/2023|7.56489|01/17/2023|7.61527|01/17/2023|||CALCIUM CHANNEL BLOCKERS|902|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine besylate|No|No|No|No|75%|00069153072|NORVASC 5 MG TABLET|300|EA|3.4693|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|7.75092|01/17/2023|7.56489|01/17/2023|7.61527|01/17/2023|||CALCIUM CHANNEL BLOCKERS|903|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
glasdegib maleate|No|No|No|No|75%|00069153130|DAURISMO 100 MG TABLET|30|EA|299.09753|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription required|No||173|No|681.66414|01/03/2023|671.92608|01/03/2023|639.9296|01/03/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|904|||||No|No||PFIZER US PHARM|No|||||No|No|No||
amlodipine besylate|No|No|No|No|75%|00069154068|NORVASC 10 MG TABLET|90|EA|4.75637|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|10.65718|01/17/2023|10.4014|01/17/2023|10.47067|01/17/2023|||CALCIUM CHANNEL BLOCKERS|905|||||No|No||PFIZER/VIATRIS|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|14.13875|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|32.22321|02/27/2023|31.76288|02/27/2023|30.25036|02/27/2023|||IMMUNE GLOBULINS|906|||||No|No||PFIZER US PHARM|No|||||Yes|No|No||
tafamidis meglumine|No|No|No|No|75%|00069197540|VYNDAQEL 20 MG CAPSULE|120|EA|74.78882|02/03/2020||Yes|No||02/03/2020||Yes|No|02/03/2020||Yes|No||||No|No|||Prescription required|No|||No|170.44895|01/03/2023|168.01396|01/03/2023|160.0133|01/03/2023||||907|||||No|No||PFIZER US PHARM|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069215030|CADUET 5 MG-10 MG TABLET|30|EA|7.5035|02/01/2005|02/03/2024|Yes|No||02/01/2005|02/03/2024|Yes|No|02/01/2005|02/03/2024|Yes|No||02/01/2005|02/03/2024|Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|17.101|01/10/2023|16.8567|01/10/2023|16.054|01/10/2023|||LIPOTROPICS: STATINS|908|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069216030|CADUET 10 MG-10 MG TABLET|30|EA|7.5035|02/01/2005|02/21/2023|Yes|No||02/01/2005|02/21/2023|Yes|No|02/01/2005|02/21/2023|Yes|No||02/01/2005|02/21/2023|Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|17.101|01/10/2023|16.8567|01/10/2023|16.054|01/10/2023|||LIPOTROPICS: STATINS|909|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069217030|CADUET 5 MG-20 MG TABLET|30|EA|10.26467|02/01/2005|02/03/2024|Yes|No||02/01/2005|02/03/2024|Yes|No|02/01/2005|02/03/2024|Yes|No||02/01/2005|02/03/2024|Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|23.3939|01/10/2023|23.0597|01/10/2023|21.96162|01/10/2023|||LIPOTROPICS: STATINS|910|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069218030|CADUET 10 MG-20 MG TABLET|30|EA|10.26467|02/01/2005|01/27/2024|Yes|No||02/01/2005|01/27/2024|Yes|No|02/01/2005|01/27/2024|Yes|No||02/01/2005|01/27/2024|Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|23.3939|01/10/2023|23.0597|01/10/2023|21.96162|01/10/2023|||LIPOTROPICS: STATINS|911|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069219030|CADUET 5 MG-40 MG TABLET|30|EA|10.26467|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|23.3939|01/10/2023|23.0597|01/10/2023|21.96162|01/10/2023|||LIPOTROPICS: STATINS|912|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069225030|CADUET 10 MG-40 MG TABLET|30|EA|10.26467|02/01/2005|01/18/2024|Yes|No||02/01/2005|01/18/2024|Yes|No|02/01/2005|01/18/2024|Yes|No||02/01/2005|01/18/2024|Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|23.3939|01/10/2023|23.0597|01/10/2023|21.96162|01/10/2023|||LIPOTROPICS: STATINS|913|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069226030|CADUET 5 MG-80 MG TABLET|30|EA|10.26467|02/01/2005|01/27/2024|Yes|No||02/01/2005|01/27/2024|Yes|No|02/01/2005|01/27/2024|Yes|No||02/01/2005|01/27/2024|Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|23.3939|01/10/2023|23.0597|01/10/2023|21.96162|01/10/2023|||LIPOTROPICS: STATINS|914|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PFIZER/VIATRIS|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00069227030|CADUET 10 MG-80 MG TABLET|30|EA|10.26467|02/01/2005|01/18/2024|Yes|No||02/01/2005|01/18/2024|Yes|No|02/01/2005|01/18/2024|Yes|No||02/01/2005|01/18/2024|Yes|No|||Prescription required|Yes|07/22/2009|063|Yes|23.3939|01/10/2023|23.0597|01/10/2023|21.96162|01/10/2023|||LIPOTROPICS: STATINS|915|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PFIZER/VIATRIS|No|||||No|No|No||
dacomitinib|No|No|No|No|75%|00069229930|VIZIMPRO 45 MG TABLET|30|EA|223.05992|03/18/2019||Yes|No||03/18/2019||Yes|No|03/18/2019||Yes|No||||No|No|||Prescription required|No||551|No|508.36912|01/03/2023|501.1067|01/03/2023|477.24448|01/03/2023|||ONCOLOGY: ORAL - LUNG|916|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069265066|PROCARDIA XL 30 MG TABLET|100|EA|2.81297|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|6.41096|01/03/2023|6.31937|01/03/2023|6.01845|01/03/2023|||CALCIUM CHANNEL BLOCKERS|917|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069265072|PROCARDIA XL 30 MG TABLET|300|EA|2.81299|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|6.41102|01/03/2023|6.31943|01/03/2023|6.01851|01/03/2023|||CALCIUM CHANNEL BLOCKERS|918|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069266066|PROCARDIA XL 60 MG TABLET|100|EA|4.86781|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|11.09409|01/03/2023|10.9356|01/03/2023|10.41486|01/03/2023|||CALCIUM CHANNEL BLOCKERS|919|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069266072|PROCARDIA XL 60 MG TABLET|300|EA|4.86784|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|11.09414|01/03/2023|10.93566|01/03/2023|10.41491|01/03/2023|||CALCIUM CHANNEL BLOCKERS|920|||||No|No||PFIZER US PHARM|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00069267066|PROCARDIA XL 90 MG TABLET|100|EA|5.61635|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|12.80007|01/03/2023|12.61721|01/03/2023|12.01639|01/03/2023|||CALCIUM CHANNEL BLOCKERS|921|||||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|01/04/2022|120.43025|01/04/2022|114.69548|01/04/2022|||MACROLIDES/KETOLIDES|922|||||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|01/04/2022|23.8602|01/04/2022|22.724|01/04/2022|||MACROLIDES/KETOLIDES|923|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|Yes|No|No|No|75%|00069306075|ZITHROMAX 250 MG Z-PAK TABLET|6|EA|.92903|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|2.08064|03/01/2022|2.0307|03/01/2022|2.04422|03/01/2022|||MACROLIDES/KETOLIDES|924|||||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|01/04/2022|2.8761|01/04/2022|2.73914|01/04/2022|||MACROLIDES/KETOLIDES|925|||||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|68.29292|01/04/2022|67.31731|01/04/2022|64.11172|01/04/2022|||MACROLIDES/KETOLIDES|926|||||No|No||PFIZER US PHARM|No|||||No|No|No||
azithromycin|Yes|No|No|No|75%|00069307086|ZITHROMAX 500 MG TABLET|50|EA|29.96403|11/17/2005||Yes|No||11/17/2005||Yes|No|11/17/2005||Yes|No||11/17/2005||Yes|No|11/01/2012||Prescription required|Yes|07/18/2006|018|No|68.29012|01/04/2022|67.31455|01/04/2022|64.10909|01/04/2022|||MACROLIDES/KETOLIDES|927|||||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|01/04/2022|1.70982|01/04/2022|1.6284|01/04/2022|||MACROLIDES/KETOLIDES|928|||||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|01/04/2022|3.26829|01/04/2022|3.11266|01/04/2022|||MACROLIDES/KETOLIDES|929|||||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|.96988|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|2.21043|01/04/2022|2.17886|01/04/2022|2.0751|01/04/2022|||MACROLIDES/KETOLIDES|930|||||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|01/04/2022|.85491|01/04/2022|.8142|01/04/2022|||MACROLIDES/KETOLIDES|931|||||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|01/04/2022|5.88294|01/04/2022|5.6028|01/04/2022||||932|||||No|No||PFIZER US PHARM|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00069322066|FELDENE 10 MG CAPSULE|100|EA|3.50604|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|7.99052|01/03/2023|7.87637|01/03/2023|7.50131|01/03/2023|||NSAIDS|933|||||No|No||PFIZER US PHARM|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00069323066|FELDENE 20 MG CAPSULE|100|EA|6.00004|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|13.67452|01/03/2023|13.47917|01/03/2023|12.83731|01/03/2023|||NSAIDS|934|||||No|No||PFIZER US PHARM|No|||||No|No|No||
sildenafil citrate|No|No|No|No|75%|00069419068|REVATIO 20 MG TABLET|90|EA|25.33105|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||171|Yes|57.73125|01/10/2023|56.90651|01/10/2023|54.19668|01/10/2023|||PAH AGENTS: ORAL AND INHALED|935|||||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|2.26881|01/03/2023|2.2364|01/03/2023|2.12991|01/03/2023||||936|||||No|No||PFIZER US PHARM|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00069437071|MINIPRESS 2 MG CAPSULE|250|EA|1.38566|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|01/03/2023|3.11291|01/03/2023|2.96468|01/03/2023||||937|||||No|No||PFIZER US PHARM|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00069438071|MINIPRESS 5 MG CAPSULE|250|EA|2.36231|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|01/03/2023|5.30697|01/03/2023|5.05425|01/03/2023||||938|||||No|No||PFIZER US PHARM|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|Yes|.17904|01/04/2022|.17648|01/04/2022|.16808|01/04/2022|||ANTIHISTAMINES: FIRST GENERATION|939|||||No|No||PFIZER US PHARM|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00069542066|VISTARIL 50 MG CAPSULE|100|EA|1.30801|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|Yes|2.98106|01/04/2022|2.93847|01/04/2022|2.79854|01/04/2022|||ANTIHISTAMINES: FIRST GENERATION|940|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069580043|TIKOSYN 125 MCG CAPSULE|40|EA|4.71774|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|10.75207|01/03/2023|10.59846|01/03/2023|10.09378|01/03/2023||||941|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069580060|TIKOSYN 125 MCG CAPSULE|60|EA|4.71774|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|10.75207|01/03/2023|10.59846|01/03/2023|10.09378|01/03/2023||||942|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069581043|TIKOSYN 250 MCG CAPSULE|40|EA|4.71774|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|10.75207|01/03/2023|10.59846|01/03/2023|10.09378|01/03/2023||||943|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069581060|TIKOSYN 250 MCG CAPSULE|60|EA|4.71774|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|10.75207|01/03/2023|10.59846|01/03/2023|10.09378|01/03/2023||||944|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069582043|TIKOSYN 500 MCG CAPSULE|40|EA|4.71774|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|10.55892|01/10/2023|10.3055|01/10/2023|10.37413|01/10/2023||||945|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dofetilide|No|No|No|No|75%|00069582060|TIKOSYN 500 MCG CAPSULE|60|EA|4.71774|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|10.55892|01/10/2023|10.3055|01/10/2023|10.37413|01/10/2023||||946|||||No|No||PFIZER US PHARM|No|||||No|No|No||
crizotinib|No|No|No|No|75%|00069814020|XALKORI 250 MG CAPSULE|60|EA|151.63211|12/06/2011||Yes|No||12/06/2011||Yes|No|12/06/2011||Yes|No||||No|No|||Prescription required|No||551|No|345.58017|01/03/2023|340.64331|01/03/2023|324.4222|01/03/2023|||ONCOLOGY: ORAL - LUNG|947|||||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|151.63211|12/06/2011||Yes|No||12/06/2011||Yes|No|12/06/2011||Yes|No||||No|No|||Prescription required|No||551|No|345.58017|01/03/2023|340.64331|01/03/2023|324.4222|01/03/2023|||ONCOLOGY: ORAL - LUNG|948|||||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|299.1553|02/03/2020||Yes|No||02/03/2020||Yes|No|02/03/2020||Yes|No||||No|No|||Prescription required|No|||No|681.7958|01/03/2023|672.05586|01/03/2023|640.0532|01/03/2023||||949|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/31/2022|
phenytoin|No|No|No|No|75%|00071000724|DILANTIN 50 MG INFATAB|100|EA|.6456|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||056|No|1.43728|01/17/2023|1.40278|01/17/2023|1.41212|01/17/2023|||ANTICONVULSANTS|950|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015523|LIPITOR 10 MG TABLET|90|EA|5.30586|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||063|Yes|11.88268|01/17/2023|11.59749|01/17/2023|11.67473|01/17/2023|||LIPOTROPICS: STATINS|951|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015623|LIPITOR 20 MG TABLET|90|EA|7.56871|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||063|Yes|16.91892|01/17/2023|16.51286|01/17/2023|16.62283|01/17/2023|||LIPOTROPICS: STATINS|952|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015723|LIPITOR 40 MG TABLET|90|EA|7.56871|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||063|Yes|16.90811|01/17/2023|16.50231|01/17/2023|16.61221|01/17/2023|||LIPOTROPICS: STATINS|953|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00071015823|LIPITOR 80 MG TABLET|90|EA|7.56871|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||063|Yes|17.24962|01/10/2023|17.0032|01/10/2023|16.19352|01/10/2023|||LIPOTROPICS: STATINS|954|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
quinapril/hydrochlorothiazide|No|No|No|No|75%|00071022323|ACCURETIC 20-25 MG TABLET|90|EA|2.13695|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|4.87026|01/03/2023|4.80069|01/03/2023|4.57208|01/03/2023|||ANGIOTENSIN MODULATORS|955|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ethosuximide|No|No|No|No|75%|00071023724|ZARONTIN 250 MG CAPSULE|100|EA|1.6791|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|3.8268|01/03/2023|3.77213|01/03/2023|3.5925|01/03/2023|||ANTICONVULSANTS|956|||||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|2.50062|01/03/2023|2.4649|01/03/2023|2.34752|01/03/2023|||ANTIDEPRESSANTS: OTHER|957|||||No|No||PFIZER US PHARM|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00071036924|DILANTIN 100 MG CAPSULE|100|EA|.68903|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||02/08/2008||Yes|No|||Prescription required|No||056|No|1.5366|01/17/2023|1.49972|01/17/2023|1.5097|01/17/2023|||ANTICONVULSANTS|958|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00071036932|DILANTIN 100 MG CAPSULE|1000|EA|.68899|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||02/08/2008||Yes|No|||Prescription required|No||056|No|1.5366|01/17/2023|1.49972|01/17/2023|1.5097|01/17/2023|||ANTICONVULSANTS|959|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071040124|NEURONTIN 800 MG TABLET|100|EA|6.75474|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|15.39452|01/10/2023|15.1746|01/10/2023|14.452|01/10/2023|||NEUROPATHIC PAIN|960|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041724|NITROSTAT 0.3 MG TABLET SL|100|EA|.3034|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.69148|01/10/2023|.6816|01/10/2023|.64915|01/10/2023||||961|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041813|NITROSTAT 0.4 MG TABLET SL|25|EA|.66198|10/01/2021||Yes|No||10/01/2021||Yes|No|10/01/2021||Yes|No||10/01/2021||Yes|No|||Prescription required|No|||No|1.50871|01/10/2023|1.48715|01/10/2023|1.41634|01/10/2023||||962|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041824|NITROSTAT 0.4 MG TABLET SL|100|EA|.3034|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.69148|01/10/2023|.6816|01/10/2023|.64915|01/10/2023||||963|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00071041924|NITROSTAT 0.6 MG TABLET SL|100|EA|.3034|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.69148|01/10/2023|.6816|01/10/2023|.64915|01/10/2023||||964|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
methsuximide|No|No|No|No|75%|00071052524|CELONTIN 300 MG KAPSEAL|100|EA|1.93508|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|4.41019|01/03/2023|4.34719|01/03/2023|4.14018|01/03/2023|||ANTICONVULSANTS|965|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071052723|ACCUPRIL 5 MG TABLET|90|EA|2.19844|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|5.0104|01/03/2023|4.93882|01/03/2023|4.70364|01/03/2023|||ANGIOTENSIN MODULATORS|966|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071053023|ACCUPRIL 10 MG TABLET|90|EA|2.19844|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|5.0104|01/03/2023|4.93882|01/03/2023|4.70364|01/03/2023|||ANGIOTENSIN MODULATORS|967|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071053223|ACCUPRIL 20 MG TABLET|90|EA|2.19844|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|5.0104|01/03/2023|4.93882|01/03/2023|4.70364|01/03/2023|||ANGIOTENSIN MODULATORS|968|||||No|No||PFIZER US PHARM|No|||||No|No|No||
quinapril HCl|No|No|No|No|75%|00071053523|ACCUPRIL 40 MG TABLET|90|EA|2.19844|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|5.0104|01/03/2023|4.93882|01/03/2023|4.70364|01/03/2023|||ANGIOTENSIN MODULATORS|969|||||No|No||PFIZER US PHARM|No|||||No|No|No||
gemfibrozil|No|No|No|No|75%|00071073720|LOPID 600 MG TABLET|60|EA|.56021|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|1.27677|01/03/2023|1.25853|01/03/2023|1.1986|01/03/2023|||LIPOTROPICS: OTHER|970|||||No|No||PFIZER US PHARM|No|||||No|No|No||
gemfibrozil|No|No|No|No|75%|00071073730|LOPID 600 MG TABLET|500|EA|.56024|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|1.27684|01/03/2023|1.2586|01/03/2023|1.19866|01/03/2023|||LIPOTROPICS: OTHER|971|||||No|No||PFIZER US PHARM|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071080324|NEURONTIN 100 MG CAPSULE|100|EA|1.18525|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|2.70127|01/10/2023|2.66268|01/10/2023|2.53588|01/10/2023|||NEUROPATHIC PAIN|972|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071080524|NEURONTIN 300 MG CAPSULE|100|EA|2.9636|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|6.57791|01/17/2023|6.42004|01/17/2023|6.46279|01/17/2023|||NEUROPATHIC PAIN|973|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071080624|NEURONTIN 400 MG CAPSULE|100|EA|3.55528|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|8.10273|01/10/2023|7.98698|01/10/2023|7.60665|01/10/2023|||NEUROPATHIC PAIN|974|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101268|LYRICA 25 MG CAPSULE|90|EA|4.14428|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No||||No|No|||Prescription required|No||232|No|9.44512|01/10/2023|9.31019|01/10/2023|8.86684|01/10/2023|||NEUROPATHIC PAIN|975|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101368|LYRICA 50 MG CAPSULE|90|EA|4.14428|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No||||No|No|||Prescription required|No||232|No|9.2326|01/17/2023|9.01101|01/17/2023|9.07102|01/17/2023|||NEUROPATHIC PAIN|976|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101468|LYRICA 75 MG CAPSULE|90|EA|4.14428|09/13/2005||Yes|No||09/13/2005||Yes|No|09/13/2005||Yes|No||||No|No|||Prescription required|No||232|No|9.2324|01/17/2023|9.01082|01/17/2023|9.07083|01/17/2023|||NEUROPATHIC PAIN|977|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101568|LYRICA 100 MG CAPSULE|90|EA|4.14428|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||||No|No|||Prescription required|No||232|No|9.24024|01/17/2023|9.01847|01/17/2023|9.07853|01/17/2023|||NEUROPATHIC PAIN|978|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101668|LYRICA 150 MG CAPSULE|90|EA|4.14428|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||||No|No|||Prescription required|No||232|No|9.28086|01/17/2023|9.05811|01/17/2023|9.11844|01/17/2023|||NEUROPATHIC PAIN|979|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101768|LYRICA 200 MG CAPSULE|90|EA|4.14428|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||||No|No|||Prescription required|No||232|No|9.21665|01/17/2023|8.99545|01/17/2023|9.05535|01/17/2023|||NEUROPATHIC PAIN|980|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101868|LYRICA 300 MG CAPSULE|90|EA|4.14428|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||||No|No|||Prescription required|No||232|No|9.26519|01/17/2023|9.04282|01/17/2023|9.10304|01/17/2023|||NEUROPATHIC PAIN|981|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071101968|LYRICA 225 MG CAPSULE|90|EA|4.14428|05/29/2007||Yes|No||05/29/2007||Yes|No|05/29/2007||Yes|No||||No|No|||Prescription required|No||232|No|9.25431|01/17/2023|9.0322|01/17/2023|9.09235|01/17/2023|||NEUROPATHIC PAIN|982|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102001|LYRICA 20 MG/ML ORAL SOLUTION|473|ML|1.10397|09/14/2018||Yes|No||09/14/2018||Yes|No|09/14/2018||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|232|No|2.51604|01/10/2023|2.48009|01/10/2023|2.36199|01/10/2023|||NEUROPATHIC PAIN|983|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102601|LYRICA CR 82.5 MG TABLET|30|EA|7.12137|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|232|No|16.2301|01/10/2023|15.99824|01/10/2023|15.23642|01/10/2023|||NEUROPATHIC PAIN|984|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102701|LYRICA CR 165 MG TABLET|30|EA|7.12137|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|232|No|16.2301|01/10/2023|15.99824|01/10/2023|15.23642|01/10/2023|||NEUROPATHIC PAIN|985|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00071102901|LYRICA CR 330 MG TABLET|30|EA|7.12137|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|232|No|16.2301|01/10/2023|15.99824|01/10/2023|15.23642|01/10/2023|||NEUROPATHIC PAIN|986|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071201244|NEURONTIN 250 MG/5 ML SOLUTION|470|ML|.4479|07/20/2020|07/12/2023|Yes|No||07/20/2020|07/12/2023|Yes|No|07/20/2020|07/12/2023|Yes|No||07/20/2020|07/12/2023|Yes|No|||Prescription required|Yes|07/29/2021|232|Yes|1.02079|01/10/2023|1.00621|01/10/2023|.95829|01/10/2023|||NEUROPATHIC PAIN|987|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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||||No|No|||Prescription required|Yes|07/28/2022|232|Yes|1.02079|01/10/2023|1.00621|01/10/2023|.95829|01/10/2023|||NEUROPATHIC PAIN|988|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
ethosuximide|No|No|No|No|75%|00071241819|ZARONTIN 250 MG/5 ML SOLUTION|474|ML|.37268|10/17/2022||Yes|No||10/17/2022||Yes|No|10/17/2022||Yes|No||||No|No|||Prescription required|No||056|No|.84938|01/03/2023|.83725|01/03/2023|.79738|01/03/2023|||ANTICONVULSANTS|989|||||No|No||PFIZER US PHARM|No|||||No|No|No||
ethosuximide|No|No|No|No|75%|00071241835|ZARONTIN 250 MG/5 ML SOLUTION|474|ML|.369|03/16/2021|06/03/2023|Yes|No||03/16/2021|06/03/2023|Yes|No|03/16/2021|06/03/2023|Yes|No||||No|No|||Prescription required|No||056|No|.84097|01/04/2022|.82896|01/04/2022|.78948|01/04/2022|||ANTICONVULSANTS|990|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PFIZER US PHARM|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00071374066|DILANTIN 30 MG CAPSULE|100|EA|.59408|10/14/2009||Yes|No||10/14/2009||Yes|No|10/14/2009||Yes|No||10/14/2009||Yes|No|||Prescription required|No||056|No|1.32097|01/17/2023|1.28926|01/17/2023|1.29785|01/17/2023|||ANTICONVULSANTS|991|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
elagolix sodium|No|No|No|No|75%|00074003828|ORILISSA 150 MG TABLET|28|EA|16.87734|11/09/2018||Yes|No||11/09/2018||Yes|No|11/09/2018||Yes|No||||No|No|||Prescription required|No||577|No|37.96014|01/17/2023|37.04909|01/17/2023|37.29583|01/17/2023||||992|||||No|No||ABBVIE US LLC|No|||||No|No|No||
elagolix sodium|No|No|No|No|75%|00074003956|ORILISSA 200 MG TABLET|56|EA|8.43867|11/09/2018||Yes|No||11/09/2018||Yes|No|11/09/2018||Yes|No||||No|No|||Prescription required|No||577|No|19.0204|01/17/2023|18.56391|01/17/2023|18.68754|01/17/2023||||993|||||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||071|Yes|5088.1404|01/10/2023|5015.45268|01/10/2023|4776.6216|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|994|||||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||071|Yes|6784.1823|01/10/2023|6687.26541|01/10/2023|6368.8242|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|995|||||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||071|Yes|6784.19372|01/10/2023|6687.27667|01/10/2023|6368.83492|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|996|||||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||071|Yes|6784.1823|01/10/2023|6687.26541|01/10/2023|6368.8242|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|997|||||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||071|Yes|3373.39012|01/17/2023|3292.42875|01/17/2023|3314.35579|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|998|||||No|No||ABBVIE US LLC|No|||||No|No|No||
lopinavir/ritonavir|No|No|No|No|75%|00074052260|KALETRA 100-25 MG TABLET|60|EA|2.56029|01/03/2008||Yes|No||01/03/2008||Yes|No|01/03/2008||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|4.18181|01/09/2018|4.12207|01/09/2018|3.92578|01/09/2018|||HIV / AIDS|999|||||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||071|Yes|3371.49113|01/17/2023|3290.57534|01/17/2023|3312.49003|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1000|||||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|5.29975|09/19/2016||Yes|No||09/19/2016||Yes|No|09/19/2016||Yes|No||||No|No|||Prescription required|No||173|No|12.0785|01/10/2023|11.90595|01/10/2023|11.339|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1001|||||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|5.30097|09/19/2016||Yes|No||09/19/2016||Yes|No|09/19/2016||Yes|No||||No|No|||Prescription required|No||173|No|12.08129|01/10/2023|11.9087|01/10/2023|11.34162|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1002|||||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|26.50642|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription required|No||173|No|60.40999|01/10/2023|59.54699|01/10/2023|56.71142|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1003|||||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|26.5052|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription required|No||173|No|60.4072|01/10/2023|59.54424|01/10/2023|56.7088|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1004|||||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|53.0061|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription required|No||173|No|120.8046|01/10/2023|119.07882|01/10/2023|113.4084|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1005|||||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|53.01212|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription required|No||173|No|120.81832|01/10/2023|119.09234|01/10/2023|113.42128|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1006|||||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|53.00809|12/19/2022||Yes|No||12/19/2022||Yes|No|12/19/2022||Yes|No||||No|No|||Prescription required|No||173|No|120.80914|01/10/2023|119.0833|01/10/2023|113.41266|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1007|||||No|No||ABBVIE US LLC|No|||||No|No|No||
venetoclax|No|No|No|No|75%|00074057634|VENCLEXTA 100 MG TABLET|180|EA|53.01212|02/28/2019||Yes|No||02/28/2019||Yes|No|02/28/2019||Yes|No||||No|No|||Prescription required|No||173|No|120.81832|01/10/2023|119.09234|01/10/2023|113.42128|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1008|||||No|No||ABBVIE US LLC|No|||||No|No|Yes|07/30/2021|
venetoclax|No|No|No|No|75%|00074057928|VENCLEXTA STARTING PACK|42|EA|32.69075|09/20/2016||Yes|No||09/20/2016||Yes|No|09/20/2016||Yes|No||||No|No|||Prescription required|No||173|No|74.5045|01/10/2023|73.44015|01/10/2023|69.943|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1009|||||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||071|Yes|3392.0838|01/10/2023|3343.62546|01/10/2023|3184.4052|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1010|||||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||071|Yes|3392.0838|01/10/2023|3343.62546|01/10/2023|3184.4052|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1011|||||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|8.03685|09/28/2020||Yes|No||09/28/2020||Yes|No|09/28/2020||Yes|No||||No|No|||Prescription required|No||577|No|18.0829|02/01/2022|17.64891|02/01/2022|17.76644|02/01/2022||||1012|||||No|No||ABBVIE US LLC|No|||||No|No|No||
upadacitinib|No|No|No|No|75%|00074104328|RINVOQ ER 45 MG TABLET|28|EA|175.58036|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|400.15989|01/10/2023|394.44332|01/10/2023|375.6603|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1013|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074105001|SKYRIZI 150 MG/ML SYRINGE|1|ML|8485.8823|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|19262.39616|01/17/2023|18800.09865|01/17/2023|18925.30422|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1014|||||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|3535.78428|12/15/2022||Yes|No||12/15/2022||Yes|No|12/15/2022||Yes|No||||No|No|||Prescription required|No|||Yes|8058.29907|01/10/2023|7943.18051|01/10/2023|7564.93382|01/10/2023||||1015|||||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||071|Yes|4522.7882|01/10/2023|4458.17694|01/10/2023|4245.8828|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1016|||||No|No||ABBVIE US LLC|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00074194063|NORVIR 80 MG/ML SOLUTION|240|ML|3.60049|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|5.88081|06/01/2016|5.7968|06/01/2016|5.52076|06/01/2016|||HIV / AIDS|1017|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074204202|SKYRIZI 150 MG DOSE KIT-2 SYRN|1|EA|8485.8823|09/10/2019||Yes|No||09/10/2019||Yes|No|09/10/2019||Yes|No||||No|No|||Prescription required|Yes|01/30/2020|071|Yes|19339.9178|01/10/2023|19063.63326|01/10/2023|18155.8412|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1018|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074210001|SKYRIZI 150 MG/ML PEN|1|ML|8485.8823|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|19053.77256|01/17/2023|18596.48201|01/17/2023|18720.33154|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1019|||||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|845.079|08/25/2009||Yes|No||08/25/2009||Yes|No|08/25/2009||Yes|No||||No|No|||Prescription required|No|||No|1925.994|01/10/2023|1898.4798|01/10/2023|1808.076|01/10/2023||||1020|||||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|1534.2228|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription required|No|||No|3496.6008|01/10/2023|3446.64936|01/10/2023|3282.5232|01/10/2023||||1021|||||No|No||ABBVIE US LLC|No|||||No|No|No||
upadacitinib|No|No|No|No|75%|00074230630|RINVOQ ER 15 MG TABLET|30|EA|87.79109|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|198.28168|01/17/2023|193.52291|01/17/2023|194.81175|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1022|||||No|No||ABBVIE US LLC|No|||||No|No|No||
upadacitinib|No|No|No|No|75%|00074231030|RINVOQ ER 30 MG TABLET|30|EA|87.79109|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|200.08202|01/10/2023|197.2237|01/10/2023|187.8321|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1023|||||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|1689.7925|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription required|No|||No|3851.155|01/10/2023|3796.1385|01/10/2023|3615.37|01/10/2023||||1024|||||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||071|Yes|6784.19372|01/10/2023|6687.27667|01/10/2023|6368.83492|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1025|||||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||064|No|92.4042|12/07/2021|91.08414|12/07/2021|86.7468|12/07/2021|||HEPATITIS C AGENTS|1026|||||No|No||ABBVIE US LLC|No|||||No|No|No||
glecaprevir/pibrentasvir|No|No|No|No|75%|00074262528|MAVYRET 100-40 MG TABLET|84|EA|67.57142|02/01/2018||Yes|No||01/25/2023||Yes|No|09/01/2021||Yes|No||||No|No|||Prescription required|No||064|No|152.79|08/23/2022|149.12304|08/23/2022|150.11617|08/23/2022|||HEPATITIS C AGENTS|1027|||||No|No||ABBVIE US LLC|No|||||No|No|No||
glecaprevir/pibrentasvir|No|No|No|No|75%|00074262584|MAVYRET 100-40 MG TABLET|84|EA|67.57142|12/20/2021|02/10/2023|Yes|No||01/25/2023|02/10/2023|Yes|No|12/20/2021|02/10/2023|Yes|No||||No|No|||Prescription required|No||064|No|152.79|08/23/2022|149.12304|08/23/2022|150.11617|08/23/2022|||HEPATITIS C AGENTS|1028|No Longer Covered|No Longer Covered|No Longer Covered||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|.93871|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|2.13938|01/10/2023|2.10882|01/10/2023|2.0084|01/10/2023|||ANTIPARKINSON'S AGENTS|1029|||||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||Yes|No||04/23/2014||Yes|No|04/23/2014||Yes|No||||No|No|||Prescription required|No|||No|.81212|05/26/2020|.80052|05/26/2020|.7624|05/26/2020||||1030|||||No|No||ABBVIE US LLC|No|||||No|No|No||
ombita/paritap/riton/dasabuvir|No|No|No|No|75%|00074309328|VIEKIRA PAK|112|EA|106.62848|04/06/2015||Yes|No||01/25/2023||Yes|No|09/01/2021||Yes|No||||No|No|||Prescription required|Yes|03/09/2018|064|No|243.01374|12/10/2019|239.54212|12/10/2019|228.13535|12/10/2019|||HEPATITIS C AGENTS|1031|||||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||229|No|1.7163|11/28/2017|1.69178|11/28/2017|1.61122|11/28/2017|||IMMUNOSUPPRESSIVES: ORAL|1032|||||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||229|No|6.8564|06/01/2016|6.75845|06/01/2016|6.43662|06/01/2016|||IMMUNOSUPPRESSIVES: ORAL|1033|||||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|1.29319|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|12/25/2018|2.90518|12/25/2018|2.76684|12/25/2018|||LIPOTROPICS: OTHER|1034|||||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|8.84231|09/24/2019|8.71599|09/24/2019|8.30094|09/24/2019|||LIPOTROPICS: OTHER|1035|||||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|.55489|03/27/2018|.54696|03/27/2018|.52092|03/27/2018|||LIPOTROPICS: OTHER|1036|||||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|1.01332|12/04/2018|.99884|12/04/2018|.95128|12/04/2018|||LIPOTROPICS: OTHER|1037|||||No|No||ABBVIE US LLC|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00074327813|K-TAB ER 10 MEQ TABLET|100|EA|.36051|03/02/2020||Yes|No||03/02/2020||Yes|No|03/02/2020||Yes|No||||No|No|||Prescription required|No|||No|.82163|03/02/2020|.80989|03/02/2020|.77132|03/02/2020||||1038|||||No|No||ABBVIE US LLC|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00074327819|K-TAB ER 10 MEQ TABLET|1000|EA|.34248|03/02/2020||Yes|No||03/02/2020||Yes|No|03/02/2020||Yes|No||||No|No|||Prescription required|No|||No|.78054|03/02/2020|.76939|03/02/2020|.73275|03/02/2020||||1039|||||No|No||ABBVIE US LLC|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00074333330|NORVIR 100 MG TABLET|30|EA|5.14339|02/24/2010||Yes|No||02/24/2010||Yes|No|02/24/2010||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|8.3238|04/26/2022|8.12402|04/26/2022|8.17813|04/26/2022|||HIV / AIDS|1040|||||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|2511.3118|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription required|No|||No|5669.91506|01/17/2023|5533.83709|01/17/2023|5570.69154|01/17/2023||||1041|||||No|No||ABBVIE US LLC|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00074339930|NORVIR 100 MG POWDER PACKET|30|EA|5.14339|10/16/2018||Yes|No||10/16/2018||Yes|No|10/16/2018||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|8.40088|10/16/2018|8.28087|10/16/2018|7.88654|10/16/2018|||HIV / AIDS|1042|||||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|5022.7053|07/08/2011||Yes|No||07/08/2011||Yes|No|07/08/2011||Yes|No||||No|No|||Prescription required|No|||No|11447.0958|01/10/2023|11283.56586|01/10/2023|10746.2532|01/10/2023||||1043|||||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|702.4738|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription required|No|||No|1580.75251|01/17/2023|1542.81444|01/17/2023|1553.08934|01/17/2023||||1044|||||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|837.1068|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription required|No|||No|1884.18777|01/17/2023|1838.96726|01/17/2023|1851.21448|01/17/2023||||1045|||||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|2107.4386|06/05/2009||Yes|No||06/05/2009||Yes|No|06/05/2009||Yes|No||||No|No|||Prescription required|No|||No|4774.08963|01/17/2023|4659.51147|01/17/2023|4690.54306|01/17/2023||||1046|||||No|No||ABBVIE US LLC|No|||||No|No|No||
leuprolide acetate|No|No|No|No|75%|00074368303|LUPRON DEPOT-4 MONTH KIT|1|EA|3348.4229|05/15/2009||Yes|No||05/15/2009||Yes|No|05/15/2009||Yes|No||||No|No|||Prescription required|No|||No|7631.2894|01/10/2023|7522.27098|01/10/2023|7164.0676|01/10/2023||||1047|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074372719|SYNTHROID 137 MCG TABLET|1000|EA|.64599|07/15/2015||Yes|No||07/15/2015||Yes|No|07/15/2015||Yes|No||||No|No|||Prescription required|No|||No|1.44139|01/17/2023|1.40679|01/17/2023|1.41616|01/17/2023||||1048|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074372790|SYNTHROID 137 MCG TABLET|90|EA|.64604|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44139|01/17/2023|1.40679|01/17/2023|1.41616|01/17/2023||||1049|||||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|4602.6856|09/01/2011||Yes|No||09/01/2011||Yes|No|09/01/2011||Yes|No||||No|No|||Prescription required|No|||No|10489.8416|01/10/2023|10339.98672|01/10/2023|9847.6064|01/10/2023||||1050|||||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||071|Yes|3370.96704|01/17/2023|3290.06383|01/17/2023|3311.97511|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1051|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074382611|DEPAKOTE ER 250 MG TABLET|100|EA|1.5145|10/16/2007||Yes|No||10/16/2007||Yes|No|10/16/2007||Yes|No||||No|No|||Prescription required|No||056|No|3.1961|01/24/2023|3.11939|01/24/2023|3.14016|01/24/2023|||ANTICONVULSANTS|1052|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074382613|DEPAKOTE ER 250 MG TABLET|100|EA|1.43233|05/12/2004|06/01/2023|Yes|No||05/12/2004|06/01/2023|Yes|No|05/12/2004|06/01/2023|Yes|No||||No|No|||Prescription required|No||056|No|3.1961|01/24/2023|3.11939|01/24/2023|3.14016|01/24/2023|||ANTICONVULSANTS|1053|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|1.92025|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|3.13642|12/25/2018|3.09161|12/25/2018|2.94439|12/25/2018|||HIV / AIDS|1054|||||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||071|Yes|3369.03246|01/17/2023|3288.17568|01/17/2023|3310.07439|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1055|||||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||071|Yes|3364.46888|01/17/2023|3283.72162|01/17/2023|3305.59067|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1056|||||No|No||ABBVIE US LLC|No|||||No|No|No||
adalimumab|No|No|No|No|75%|00074433907|HUMIRA PEN PS-UV-ADOL HS 40 MG|4|EA|1488.36652|04/10/2009||Yes|No||04/10/2009||Yes|No|04/10/2009||Yes|No||||No|No|||Prescription required|No||071|Yes|3364.52774|01/17/2023|3283.77907|01/17/2023|3305.6485|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1057|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074434119|SYNTHROID 25 MCG TABLET|1000|EA|.64601|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44511|01/17/2023|1.41042|01/17/2023|1.41982|01/17/2023||||1058|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074434190|SYNTHROID 25 MCG TABLET|90|EA|.64604|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44511|01/17/2023|1.41042|01/17/2023|1.41982|01/17/2023||||1059|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074455219|SYNTHROID 50 MCG TABLET|1000|EA|.64575|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44127|01/17/2023|1.40667|01/17/2023|1.41604|01/17/2023||||1060|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074455290|SYNTHROID 50 MCG TABLET|90|EA|.64576|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44127|01/17/2023|1.40667|01/17/2023|1.41604|01/17/2023||||1061|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074518219|SYNTHROID 75 MCG TABLET|1000|EA|.64602|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44338|01/17/2023|1.40873|01/17/2023|1.41812|01/17/2023||||1062|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074518290|SYNTHROID 75 MCG TABLET|90|EA|.64595|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44338|01/17/2023|1.40873|01/17/2023|1.41812|01/17/2023||||1063|||||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|.76449|08/11/2009||Yes|No||08/11/2009||Yes|No|08/11/2009||Yes|No||08/11/2009||Yes|No|||Prescription required|No||056|No|1.7082|01/17/2023|1.6672|01/17/2023|1.6783|01/17/2023|||ANTICONVULSANTS|1064|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074621413|DEPAKOTE DR 250 MG TABLET|100|EA|1.57509|09/11/2008||Yes|No||09/11/2008||Yes|No|09/11/2008||Yes|No||09/11/2008||Yes|No|||Prescription required|No||056|No|3.51356|01/17/2023|3.42923|01/17/2023|3.45207|01/17/2023|||ANTICONVULSANTS|1065|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074621453|DEPAKOTE DR 250 MG TABLET|500|EA|1.5751|09/11/2008||Yes|No||09/11/2008||Yes|No|09/11/2008||Yes|No||09/11/2008||Yes|No|||Prescription required|No||056|No|3.51356|01/17/2023|3.42923|01/17/2023|3.45207|01/17/2023|||ANTICONVULSANTS|1066|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074621513|DEPAKOTE DR 500 MG TABLET|100|EA|2.90456|09/11/2008|04/06/2023|Yes|No||09/11/2008|04/06/2023|Yes|No|09/11/2008|04/06/2023|Yes|No||09/11/2008|04/06/2023|Yes|No|||Prescription required|No||056|No|6.45559|01/17/2023|6.30065|01/17/2023|6.34261|01/17/2023|||ANTICONVULSANTS|1067|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074621553|DEPAKOTE DR 500 MG TABLET|500|EA|2.90454|09/11/2008||Yes|No||09/11/2008||Yes|No|09/11/2008||Yes|No||09/11/2008||Yes|No|||Prescription required|No||056|No|6.45559|01/17/2023|6.30065|01/17/2023|6.34261|01/17/2023|||ANTICONVULSANTS|1068|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074659419|SYNTHROID 88 MCG TABLET|1000|EA|.64592|01/16/2003||Yes|No||01/16/2003||Yes|No|01/16/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44157|01/17/2023|1.40697|01/17/2023|1.41634|01/17/2023||||1069|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074659490|SYNTHROID 88 MCG TABLET|90|EA|.64595|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44157|01/17/2023|1.40697|01/17/2023|1.41634|01/17/2023||||1070|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074662419|SYNTHROID 100 MCG TABLET|1000|EA|.64576|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription required|No|||No|1.4411|01/17/2023|1.40651|01/17/2023|1.41588|01/17/2023||||1071|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074662490|SYNTHROID 100 MCG TABLET|90|EA|.64576|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.4411|01/17/2023|1.40651|01/17/2023|1.41588|01/17/2023||||1072|||||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||237|No|8.36381|03/29/2022|8.24432|03/29/2022|7.85174|03/29/2022|||HIV / AIDS|1073|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706819|SYNTHROID 125 MCG TABLET|1000|EA|.64601|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44011|01/17/2023|1.40554|01/17/2023|1.4149|01/17/2023||||1074|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706890|SYNTHROID 125 MCG TABLET|90|EA|.64614|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44011|01/17/2023|1.40554|01/17/2023|1.4149|01/17/2023||||1075|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706919|SYNTHROID 150 MCG TABLET|1000|EA|.64605|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44081|01/17/2023|1.40623|01/17/2023|1.41559|01/17/2023||||1076|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074706990|SYNTHROID 150 MCG TABLET|90|EA|.64614|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44081|01/17/2023|1.40623|01/17/2023|1.41559|01/17/2023||||1077|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074707019|SYNTHROID 175 MCG TABLET|1000|EA|.64517|01/22/2003||Yes|No||01/22/2003||Yes|No|01/22/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44144|01/17/2023|1.40684|01/17/2023|1.41621|01/17/2023||||1078|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074707090|SYNTHROID 175 MCG TABLET|90|EA|.64518|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44144|01/17/2023|1.40684|01/17/2023|1.41621|01/17/2023||||1079|||||No|No||ABBVIE US LLC|No|||||No|No|No||
atogepant|No|No|No|No|75%|00074709430|QULIPTA 60 MG TABLET|30|EA|14.91455|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|33.4259|01/17/2023|32.62367|01/17/2023|32.84094|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|1080|||||No|No||ABBVIE US LLC|No|||||No|No|No||
atogepant|No|No|No|No|75%|00074709530|QULIPTA 10 MG TABLET|30|EA|14.91455|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|33.41212|01/17/2023|32.61022|01/17/2023|32.8274|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|1081|||||No|No||ABBVIE US LLC|No|||||No|No|No||
atogepant|No|No|No|No|75%|00074709630|QULIPTA 30 MG TABLET|30|EA|14.91455|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|33.09299|01/17/2023|32.29875|01/17/2023|32.51386|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|1082|||||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|12.64028|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|28.18912|02/28/2023|27.51258|02/28/2023|27.69581|02/28/2023|||OPHTHALMICS: GLAUCOMA AGENTS|1083|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074712613|DEPAKOTE ER 500 MG TABLET|100|EA|2.51949|03/01/2002|04/11/2023|Yes|No||03/01/2002|04/11/2023|Yes|No|03/01/2002|04/11/2023|Yes|No||03/01/2002|04/11/2023|Yes|No|||Prescription required|No||056|No|5.62288|01/17/2023|5.48793|01/17/2023|5.52447|01/17/2023|||ANTICONVULSANTS|1084|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074712653|DEPAKOTE ER 500 MG TABLET|500|EA|2.51952|10/30/2003|03/30/2023|Yes|No||10/30/2003|03/30/2023|Yes|No|10/30/2003|03/30/2023|Yes|No||||No|No|||Prescription required|No||056|No|5.62288|01/17/2023|5.48793|01/17/2023|5.52447|01/17/2023|||ANTICONVULSANTS|1085|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714819|SYNTHROID 200 MCG TABLET|1000|EA|.64594|01/22/2003||Yes|No||01/22/2003||Yes|No|01/22/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44123|01/17/2023|1.40664|01/17/2023|1.416|01/17/2023||||1086|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714890|SYNTHROID 200 MCG TABLET|90|EA|.64604|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44123|01/17/2023|1.40664|01/17/2023|1.416|01/17/2023||||1087|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714919|SYNTHROID 300 MCG TABLET|1000|EA|.64558|01/22/2003||Yes|No||01/22/2003||Yes|No|01/22/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44384|01/17/2023|1.40918|01/17/2023|1.41857|01/17/2023||||1088|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074714990|SYNTHROID 300 MCG TABLET|90|EA|.64557|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44384|01/17/2023|1.40918|01/17/2023|1.41857|01/17/2023||||1089|||||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||229|No|7.74827|06/01/2016|7.63758|06/01/2016|7.27388|06/01/2016|||IMMUNOSUPPRESSIVES: ORAL|1090|||||No|No||ABBVIE US LLC|No|||||Yes|No|No||
divalproex sodium|No|No|No|No|75%|00074732513|DEPAKOTE DR 125 MG TABLET|100|EA|.80186|08/18/2022||Yes|No||08/18/2022||Yes|No|08/18/2022||Yes|No||08/18/2022||Yes|No|||Prescription required|No||056|No|1.8275|01/10/2023|1.80139|01/10/2023|1.71561|01/10/2023|||ANTICONVULSANTS|1091|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074732713|DEPAKOTE DR 500 MG TABLET|100|EA|2.90456|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||06/20/2022||Yes|No|||Prescription required|No||056|No|6.45559|01/17/2023|6.30065|01/17/2023|6.34261|01/17/2023|||ANTICONVULSANTS|1092|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074740113|DEPAKOTE ER 250 MG TABLET|100|EA|1.43233|10/05/2022||Yes|No||10/05/2022||Yes|No|10/05/2022||Yes|No||||No|No|||Prescription required|No||056|No|3.1961|01/24/2023|3.11939|01/24/2023|3.14016|01/24/2023|||ANTICONVULSANTS|1093|||||No|No||ABBVIE US LLC|No|||||No|No|No||
divalproex sodium|No|No|No|No|75%|00074740213|DEPAKOTE ER 500 MG TABLET|100|EA|2.51949|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||06/20/2022||Yes|No|||Prescription required|No||056|No|5.62288|01/17/2023|5.48793|01/17/2023|5.52447|01/17/2023|||ANTICONVULSANTS|1094|||||No|No||ABBVIE US LLC|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00074780413|K-TAB ER 10 MEQ TABLET|100|EA|.36051|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.82163|11/28/2017|.80989|11/28/2017|.77132|11/28/2017||||1095|||||No|No||ABBVIE US LLC|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00074780419|K-TAB ER 10 MEQ TABLET|1000|EA|.34248|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.78054|11/28/2017|.76939|11/28/2017|.73275|11/28/2017||||1096|||||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|12.75044|09/12/2019|12.56829|09/12/2019|11.9698|09/12/2019||||1097|||||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|25.50024|09/12/2019|25.13595|09/12/2019|23.939|09/12/2019||||1098|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074929619|SYNTHROID 112 MCG TABLET|1000|EA|.64565|01/21/2003||Yes|No||01/21/2003||Yes|No|01/21/2003||Yes|No||||No|No|||Prescription required|No|||No|1.44012|01/17/2023|1.40555|01/17/2023|1.41491|01/17/2023||||1099|||||No|No||ABBVIE US LLC|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00074929690|SYNTHROID 112 MCG TABLET|90|EA|.64576|04/25/2011||Yes|No||04/25/2011||Yes|No|04/25/2011||Yes|No||||No|No|||Prescription required|No|||No|1.44012|01/17/2023|1.40555|01/17/2023|1.41491|01/17/2023||||1100|||||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|5069.399|09/01/2011||Yes|No||09/01/2011||Yes|No|09/01/2011||Yes|No||||No|No|||Prescription required|No|||No|11553.514|01/10/2023|11388.4638|01/10/2023|10846.156|01/10/2023||||1101|||||No|No||ABBVIE US LLC|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062040|LOVENOX 40 MG/0.4 ML SYRINGE|.4|ML|10.66722|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|24.31135|07/19/2022|23.96404|07/19/2022|22.8229|07/19/2022|||ANTICOAGULANTS|1102|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062160|LOVENOX 60 MG/0.6 ML SYRINGE|.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|24.33992|07/19/2022|23.99221|07/19/2022|22.84972|07/19/2022|||ANTICOAGULANTS|1103|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062280|LOVENOX 80 MG/0.8 ML SYRINGE|.8|ML|10.67958|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|24.33952|07/19/2022|23.99181|07/19/2022|22.84935|07/19/2022|||ANTICOAGULANTS|1104|||||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|07/19/2022|23.99157|07/19/2022|22.84912|07/19/2022|||ANTICOAGULANTS|1105|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075062430|LOVENOX 30 MG/0.3 ML SYRINGE|.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|24.31052|07/19/2022|23.96323|07/19/2022|22.82212|07/19/2022|||ANTICOAGULANTS|1106|||||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|24.31052|07/19/2022|23.96323|07/19/2022|22.82212|07/19/2022|||ANTICOAGULANTS|1107|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
enoxaparin sodium|No|No|No|No|75%|00075291201|LOVENOX 120 MG/0.8 ML SYRINGE|.8|ML|16.02448|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|36.52092|07/19/2022|35.99919|07/19/2022|34.28495|07/19/2022|||ANTICOAGULANTS|1108|||||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|07/19/2022|35.99992|07/19/2022|34.28564|07/19/2022|||ANTICOAGULANTS|1109|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00078011022|SANDIMMUNE 100 MG/ML SOLN|50|ML|6.90648|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|15.74036|01/10/2023|15.5155|01/10/2023|14.77667|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1110|||||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|01/10/2023|13.63605|01/10/2023|12.98672|01/10/2023||||1111|||||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|01/10/2023|26.45101|01/10/2023|25.19144|01/10/2023||||1112|||||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|01/10/2023|127.57768|01/10/2023|121.50256|01/10/2023||||1113|||||No|No||NOVARTIS|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00078024015|SANDIMMUNE 25 MG CAPSULE|30|EA|1.78192|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|4.06112|01/10/2023|4.0031|01/10/2023|3.81248|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1114|||||No|No||NOVARTIS|No|||||Yes|No|No||
cyclosporine|No|No|No|No|75%|00078024115|SANDIMMUNE 100 MG CAPSULE|30|EA|7.11191|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|16.20854|01/10/2023|15.97699|01/10/2023|15.21618|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1115|||||No|No||NOVARTIS|No|||||Yes|No|No||
cyclosporine, modified|No|No|No|No|75%|00078024615|NEORAL 25 MG GELATIN CAPSULE|30|EA|1.11785|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||229|No|2.50904|01/17/2023|2.44882|01/17/2023|2.46513|01/17/2023|||IMMUNOSUPPRESSIVES: ORAL|1116|||||No|No||NOVARTIS|No|||||Yes|No|No||
cyclosporine, modified|No|No|No|No|75%|00078024815|NEORAL 100 MG GELATIN CAPSULE|30|EA|4.46698|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||229|No|10.18056|01/10/2023|10.03512|01/10/2023|9.55726|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1117|||||No|No||NOVARTIS|No|||||Yes|No|No||
letrozole|No|No|No|No|75%|00078024915|FEMARA 2.5 MG TABLET|30|EA|11.05945|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||502|No|25.20526|01/10/2023|24.84519|01/10/2023|23.66208|01/10/2023|||ONCOLOGY: ORAL - BREAST|1118|||||No|No||NOVARTIS|No|||||No|No|No||
cyclosporine, modified|No|No|No|No|75%|00078027422|NEORAL 100 MG/ML SOLUTION|50|ML|4.86932|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|11.09752|01/10/2023|10.93898|01/10/2023|10.41808|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1119|||||No|No||NOVARTIS|No|||||Yes|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078031434|DIOVAN HCT 80-12.5 MG TABLET|90|EA|4.38265|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|9.98837|01/10/2023|9.84568|01/10/2023|9.37684|01/10/2023|||ANGIOTENSIN MODULATORS|1120|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078031534|DIOVAN HCT 160-12.5 MG TAB|90|EA|4.76836|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|10.86743|01/10/2023|10.71218|01/10/2023|10.20208|01/10/2023|||ANGIOTENSIN MODULATORS|1121|||||No|No||NOVARTIS|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078033705|TRILEPTAL 300 MG TABLET|100|EA|4.3304|04/16/2004||Yes|No||04/16/2004||Yes|No|04/16/2004||Yes|No||||No|No|||Prescription required|No||056|No|9.66789|01/17/2023|9.43586|01/17/2023|9.4987|01/17/2023|||ANTICONVULSANTS|1122|||||No|No||NOVARTIS|No|||||No|No|No||
estradiol|No|No|No|No|75%|00078034542|VIVELLE-DOT 0.075 MG PATCH|8|EA|7.8862|05/13/2016||Yes|No||05/13/2016||Yes|No|05/13/2016||Yes|No||||No|No|||Prescription required|No|||Yes|17.50755|01/17/2023|17.08736|01/17/2023|17.20116|01/17/2023||||1123|||||No|No||NOVARTIS|No|||||No|No|No||
estradiol|No|No|No|No|75%|00078034642|VIVELLE-DOT 0.1 MG PATCH|8|EA|7.88835|05/13/2016||Yes|No||05/13/2016||Yes|No|05/13/2016||Yes|No||||No|No|||Prescription required|No|||Yes|17.60502|01/17/2023|17.18249|01/17/2023|17.29693|01/17/2023||||1124|||||No|No||NOVARTIS|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00078035415|LESCOL XL 80 MG TABLET|30|EA|5.34189|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|12.17454|01/10/2023|12.00061|01/10/2023|11.42916|01/10/2023|||LIPOTROPICS: STATINS|1125|||||No|No||NOVARTIS|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078035752|TRILEPTAL 300 MG/5 ML SUSP|250|ML|.79787|05/12/2004||Yes|No||05/12/2004||Yes|No|05/12/2004||Yes|No||||No|No|||Prescription required|No||056|No|1.78066|01/17/2023|1.73792|01/17/2023|1.74949|01/17/2023|||ANTICONVULSANTS|1126|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan|No|No|No|No|75%|00078035834|DIOVAN 80 MG TABLET|90|EA|3.89713|04/09/2004||Yes|No||04/09/2004||Yes|No|04/09/2004||Yes|No||04/09/2004||Yes|No|||Prescription required|No||113|Yes|8.70887|01/17/2023|8.49985|01/17/2023|8.55646|01/17/2023|||ANGIOTENSIN MODULATORS|1127|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan|No|No|No|No|75%|00078035934|DIOVAN 160 MG TABLET|90|EA|4.19068|02/01/2004||Yes|No||02/01/2004||Yes|No|02/01/2004||Yes|No||02/01/2004||Yes|No|||Prescription required|No||113|Yes|9.35606|01/17/2023|9.13151|01/17/2023|9.19232|01/17/2023|||ANGIOTENSIN MODULATORS|1128|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan|No|No|No|No|75%|00078036034|DIOVAN 320 MG TABLET|90|EA|5.30156|04/12/2004||Yes|No||04/12/2004||Yes|No|04/12/2004||Yes|No||04/12/2004||Yes|No|||Prescription required|No||113|Yes|11.81263|01/17/2023|11.52912|01/17/2023|11.6059|01/17/2023|||ANGIOTENSIN MODULATORS|1129|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078036405|LOTREL 10-20 MG CAPSULE|100|EA|5.77937|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|13.17159|01/10/2023|12.98342|01/10/2023|12.36516|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1130|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078037005|RITALIN LA 20 MG CAPSULE|100|EA|4.93803|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|11.25412|01/10/2023|11.09335|01/10/2023|10.56509|01/10/2023|||STIMULANTS AND RELATED AGENTS|1131|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078037105|RITALIN LA 30 MG CAPSULE|100|EA|5.05043|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|11.51029|01/10/2023|11.34586|01/10/2023|10.80558|01/10/2023|||STIMULANTS AND RELATED AGENTS|1132|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078037205|RITALIN LA 40 MG CAPSULE|100|EA|5.19074|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|11.83007|01/10/2023|11.66106|01/10/2023|11.10578|01/10/2023|||STIMULANTS AND RELATED AGENTS|1133|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078037905|LOTREL 10-40 MG CAPSULE|100|EA|6.36804|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|14.51321|01/10/2023|14.30588|01/10/2023|13.62464|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1134|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078038005|FOCALIN 2.5 MG TABLET|100|EA|.29136|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|.65183|01/17/2023|.63618|01/17/2023|.64042|01/17/2023|||STIMULANTS AND RELATED AGENTS|1135|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078038105|FOCALIN 5 MG TABLET|100|EA|.41533|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|.92497|01/17/2023|.90277|01/17/2023|.90878|01/17/2023|||STIMULANTS AND RELATED AGENTS|1136|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078038205|FOCALIN 10 MG TABLET|100|EA|.59735|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|1.32922|01/17/2023|1.29731|01/17/2023|1.30595|01/17/2023|||STIMULANTS AND RELATED AGENTS|1137|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078038334|DIOVAN HCT 160-25 MG TABLET|90|EA|5.40768|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|12.32448|01/10/2023|12.14841|01/10/2023|11.56992|01/10/2023|||ANGIOTENSIN MODULATORS|1138|||||No|No||NOVARTIS|No|||||No|No|No||
mycophenolate sodium|No|No|No|No|75%|00078038566|MYFORTIC 180 MG TABLET|120|EA|2.83298|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|6.45656|01/10/2023|6.36432|01/10/2023|6.06126|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1139|||||No|No||NOVARTIS|No|||||Yes|No|No||
mycophenolate sodium|No|No|No|No|75%|00078038666|MYFORTIC 360 MG TABLET|120|EA|5.66589|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|12.91297|01/10/2023|12.72849|01/10/2023|12.12238|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1140|||||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||173|No|91.76545|05/29/2018|90.45452|05/29/2018|86.14716|05/29/2018|||ONCOLOGY: ORAL - HEMATOLOGIC|1141|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078040505|LOTREL 5-10 MG CAPSULE|100|EA|4.71056|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|10.7357|01/10/2023|10.58233|01/10/2023|10.07841|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1142|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078040605|LOTREL 5-20 MG CAPSULE|100|EA|4.97445|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|11.33713|01/10/2023|11.17517|01/10/2023|10.64302|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1143|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078041420|ZORTRESS 0.5 MG TABLET|60|EA|8.54115|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|19.46589|01/10/2023|19.18781|01/10/2023|18.2741|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1144|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041461|ZORTRESS 0.5 MG TABLET|1|EA|8.557|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|19.502|01/10/2023|19.2234|01/10/2023|18.308|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1145|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041520|ZORTRESS 0.75 MG TABLET|60|EA|12.81163|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|29.19861|01/10/2023|28.78148|01/10/2023|27.41094|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1146|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041561|ZORTRESS 0.75 MG TABLET|1|EA|12.8226|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|29.2236|01/10/2023|28.80612|01/10/2023|27.4344|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1147|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041720|ZORTRESS 0.25 MG TABLET|60|EA|4.27054|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|9.73287|01/10/2023|9.59382|01/10/2023|9.13698|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1148|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041761|ZORTRESS 0.25 MG TABLET|1|EA|4.2699|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|9.7314|01/10/2023|9.59238|01/10/2023|9.1356|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1149|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078042220|ZORTRESS 1 MG TABLET|60|EA|17.08232|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|38.9318|01/10/2023|38.37563|01/10/2023|36.54822|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1150|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078042261|ZORTRESS 1 MG TABLET|1|EA|17.0796|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|38.9256|01/10/2023|38.36952|01/10/2023|36.5424|01/10/2023|||IMMUNOSUPPRESSIVES: ORAL|1151|||||No|No||NOVARTIS|No|||||Yes|No|No||
valsartan|No|No|No|No|75%|00078042315|DIOVAN 40 MG TABLET|30|EA|3.26026|09/08/2005||Yes|No||09/08/2005||Yes|No|09/08/2005||Yes|No||09/08/2005||Yes|No|||Prescription required|No||113|Yes|7.43036|01/10/2023|7.32421|01/10/2023|6.97544|01/10/2023|||ANGIOTENSIN MODULATORS|1152|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078042405|RITALIN LA 10 MG CAPSULE|100|EA|4.93803|04/21/2004||Yes|No||04/21/2004||Yes|No|04/21/2004||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|11.25412|01/10/2023|11.09335|01/10/2023|10.56509|01/10/2023|||STIMULANTS AND RELATED AGENTS|1153|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043005|FOCALIN XR 5 MG CAPSULE|100|EA|5.84146|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription required|No||007|Yes|13.00519|01/17/2023|12.69306|01/17/2023|12.77759|01/17/2023|||STIMULANTS AND RELATED AGENTS|1154|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043105|FOCALIN XR 10 MG CAPSULE|100|EA|5.92793|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription required|No||007|Yes|13.18233|01/17/2023|12.86595|01/17/2023|12.95163|01/17/2023|||STIMULANTS AND RELATED AGENTS|1155|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043205|FOCALIN XR 20 MG CAPSULE|100|EA|6.09619|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription required|No||007|Yes|13.64699|01/17/2023|13.31946|01/17/2023|13.40816|01/17/2023|||STIMULANTS AND RELATED AGENTS|1156|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043305|FOCALIN XR 30 MG CAPSULE|100|EA|5.87255|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription required|No||007|Yes|13.07293|01/17/2023|12.75917|01/17/2023|12.84415|01/17/2023|||STIMULANTS AND RELATED AGENTS|1157|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078043405|FOCALIN XR 40 MG CAPSULE|100|EA|6.72145|09/30/2010||Yes|No||09/30/2010||Yes|No|09/30/2010||Yes|No||||No|No|||Prescription required|No||007|Yes|14.95534|01/17/2023|14.59641|01/17/2023|14.69362|01/17/2023|||STIMULANTS AND RELATED AGENTS|1158|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078043905|RITALIN 5 MG TABLET|100|EA|.32594|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|.74284|01/10/2023|.73222|01/10/2023|.69736|01/10/2023|||STIMULANTS AND RELATED AGENTS|1159|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078044005|RITALIN 10 MG TABLET|100|EA|.46465|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|1.03495|01/17/2023|1.01011|01/17/2023|1.01683|01/17/2023|||STIMULANTS AND RELATED AGENTS|1160|||||No|No||NOVARTIS|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00078044105|RITALIN 20 MG TABLET|100|EA|.66817|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|1.49232|01/17/2023|1.4565|01/17/2023|1.4662|01/17/2023|||STIMULANTS AND RELATED AGENTS|1161|||||No|No||NOVARTIS|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078045605|TRILEPTAL 150 MG TABLET|100|EA|2.37102|02/28/2006||Yes|No||02/28/2006||Yes|No|02/28/2006||Yes|No||||No|No|||Prescription required|No||056|No|5.40372|01/10/2023|5.32652|01/10/2023|5.07288|01/10/2023|||ANTICONVULSANTS|1162|||||No|No||NOVARTIS|No|||||No|No|No||
oxcarbazepine|No|No|No|No|75%|00078045705|TRILEPTAL 600 MG TABLET|100|EA|7.95887|02/28/2006||Yes|No||02/28/2006||Yes|No|02/28/2006||Yes|No||||No|No|||Prescription required|No||056|No|17.77868|01/17/2023|17.35199|01/17/2023|17.46755|01/17/2023|||ANTICONVULSANTS|1163|||||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|01/10/2023|33.53952|01/10/2023|31.9424|01/10/2023||||1164|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078046815|EXJADE 125 MG TABLET|30|EA|20.95361|07/20/2006||Yes|No||07/20/2006||Yes|No|07/20/2006||Yes|No||||No|No|||Prescription required|No|||No|47.75474|01/10/2023|47.07253|01/10/2023|44.83098|01/10/2023||||1165|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078046915|EXJADE 250 MG TABLET|30|EA|41.90636|07/20/2006||Yes|No||07/20/2006||Yes|No|07/20/2006||Yes|No||||No|No|||Prescription required|No|||No|95.50752|01/10/2023|94.14313|01/10/2023|89.66012|01/10/2023||||1166|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078047015|EXJADE 500 MG TABLET|30|EA|83.8113|07/11/2006||Yes|No||07/11/2006||Yes|No|07/11/2006||Yes|No||||No|No|||Prescription required|No|||No|191.0118|01/10/2023|188.28306|01/10/2023|179.3172|01/10/2023||||1167|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078047134|DIOVAN HCT 320-12.5 MG TAB|90|EA|6.04144|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|13.76888|01/10/2023|13.57218|01/10/2023|12.92588|01/10/2023|||ANGIOTENSIN MODULATORS|1168|||||No|No||NOVARTIS|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078047234|DIOVAN HCT 320-25 MG TABLET|90|EA|6.854|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|15.62075|01/10/2023|15.3976|01/10/2023|14.66438|01/10/2023|||ANGIOTENSIN MODULATORS|1169|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078048815|EXFORGE 5-160 MG TABLET|30|EA|4.39818|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|10.02376|01/10/2023|9.88056|01/10/2023|9.41006|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1170|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078048915|EXFORGE 10-160 MG TABLET|30|EA|4.98914|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|11.3706|01/10/2023|11.20816|01/10/2023|10.67444|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1171|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078049015|EXFORGE 5-320 MG TABLET|30|EA|5.57853|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|12.71386|01/10/2023|12.53223|01/10/2023|11.93546|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1172|||||No|No||NOVARTIS|No|||||No|No|No||
amlodipine besylate/valsartan|No|No|No|No|75%|00078049115|EXFORGE 10-320 MG TABLET|30|EA|6.33375|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|14.43506|01/10/2023|14.22885|01/10/2023|13.55128|01/10/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1173|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078049305|FOCALIN XR 15 MG CAPSULE|100|EA|6.09619|04/20/2009||Yes|No||04/20/2009||Yes|No|04/20/2009||Yes|No||||No|No|||Prescription required|No||007|Yes|13.58201|01/17/2023|13.25604|01/17/2023|13.34432|01/17/2023|||STIMULANTS AND RELATED AGENTS|1174|||||No|No||NOVARTIS|No|||||No|No|No||
tobramycin in 0.225% sod chlor|No|No|No|No|75%|00078049471|TOBI 300 MG/5 ML SOLUTION|5|ML|11.82094|03/06/2008|12/31/2022|Yes|No||03/06/2008|12/31/2022|Yes|No|03/06/2008|12/31/2022|Yes|No|Submit HHS Form 1143|||No|No|||Prescription required|Yes|07/23/2015|240|No|28.82662|01/10/2023|28.41481|01/10/2023|27.06172|01/10/2023|||ANTIBIOTICS: INHALED|1175|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/MYLAN|No|||||Yes|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||011|No|22.117|02/28/2023|21.58619|02/28/2023|21.72995|02/28/2023|||ALZHEIMER'S AGENTS|1176|||||No|No||NOVARTIS|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||011|No|21.96922|04/26/2022|21.44195|04/26/2022|21.58475|04/26/2022|||ALZHEIMER'S AGENTS|1177|||||No|No||NOVARTIS|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||011|No|22.40932|05/24/2022|22.08919|05/24/2022|21.03732|05/24/2022|||ALZHEIMER'S AGENTS|1178|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078050883|TEGRETOL 100 MG/5 ML SUSP|450|ML|.17994|10/02/2008||Yes|No||10/02/2008||Yes|No|10/02/2008||Yes|No||10/02/2008||Yes|No|||Prescription required|No||056|No|.39874|01/17/2023|.38917|01/17/2023|.39176|01/17/2023|||ANTICONVULSANTS|1179|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078050905|TEGRETOL 200 MG TABLET|100|EA|1.25727|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription required|No||056|No|2.81052|01/17/2023|2.74306|01/17/2023|2.76133|01/17/2023|||ANTICONVULSANTS|1180|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078051005|TEGRETOL XR 100 MG TABLET|100|EA|.67299|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription required|No||056|No|1.49407|01/17/2023|1.45821|01/17/2023|1.46792|01/17/2023|||ANTICONVULSANTS|1181|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078051105|TEGRETOL XR 200 MG TABLET|100|EA|1.34323|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription required|No||056|No|2.98306|01/17/2023|2.91146|01/17/2023|2.93085|01/17/2023|||ANTICONVULSANTS|1182|||||No|No||NOVARTIS|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00078051205|TEGRETOL XR 400 MG TABLET|100|EA|2.68431|07/08/2008||Yes|No||07/08/2008||Yes|No|07/08/2008||Yes|No||07/08/2008||Yes|No|||Prescription required|No||056|No|5.996|01/17/2023|5.85209|01/17/2023|5.89107|01/17/2023|||ANTICONVULSANTS|1183|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078052651|TASIGNA 200 MG CAPSULE|28|EA|71.24501|12/15/2015||Yes|No||12/15/2015||Yes|No|12/15/2015||Yes|No||||No|No|||Prescription required|No||173|No|162.37234|01/10/2023|160.05274|01/10/2023|152.43118|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1184|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078052687|TASIGNA 200 MG CAPSULE|28|EA|71.24547|08/19/2008||Yes|No||08/19/2008||Yes|No|08/19/2008||Yes|No||||No|No|||Prescription required|No||173|No|162.37339|01/10/2023|160.05377|01/10/2023|152.43216|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1185|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078056651|AFINITOR 5 MG TABLET|28|EA|278.34452|04/06/2009||Yes|No||04/06/2009||Yes|No|04/06/2009||Yes|No||||No|No|||Prescription required|No||548|No|634.36659|01/10/2023|625.30421|01/10/2023|595.52782|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1186|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078056751|AFINITOR 10 MG TABLET|28|EA|278.34452|04/06/2009||Yes|No||04/06/2009||Yes|No|04/06/2009||Yes|No||||No|No|||Prescription required|No||548|No|634.36659|01/10/2023|625.30421|01/10/2023|595.52782|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1187|||||No|No||NOVARTIS|No|||||No|No|No||
interferon beta-1b|No|No|No|No|75%|00078056912|EXTAVIA 0.3 MG KIT|15|EA|221.0521|01/11/2010||Yes|No||01/11/2010||Yes|No|01/11/2010||Yes|No||||No|No|||Prescription required|No||043|No|503.79316|01/10/2023|496.59612|01/10/2023|472.94868|01/10/2023|||MULTIPLE SCLEROSIS AGENTS|1188|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078059251|TASIGNA 150 MG CAPSULE|28|EA|71.24501|12/15/2015||Yes|No||12/15/2015||Yes|No|12/15/2015||Yes|No||||No|No|||Prescription required|No||173|No|162.37234|01/10/2023|160.05274|01/10/2023|152.43118|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1189|||||No|No||NOVARTIS|No|||||No|No|No||
nilotinib HCl|No|No|No|No|75%|00078059287|TASIGNA 150 MG CAPSULE|28|EA|71.24547|09/30/2010||Yes|No||09/30/2010||Yes|No|09/30/2010||Yes|No||||No|No|||Prescription required|No||173|No|162.37339|01/10/2023|160.05377|01/10/2023|152.43216|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1190|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078059451|AFINITOR 2.5 MG TABLET|28|EA|266.10811|01/03/2011||Yes|No||01/03/2011||Yes|No|01/03/2011||Yes|No||||No|No|||Prescription required|No||548|No|606.47894|01/10/2023|597.81496|01/10/2023|569.34758|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1191|||||No|No||NOVARTIS|No|||||No|No|No||
fingolimod HCl|No|No|No|No|75%|00078060715|GILENYA 0.5 MG CAPSULE|30|EA|149.39619|06/17/2015||Yes|No||06/17/2015||Yes|No|06/17/2015||Yes|No||||No|No|||Prescription required|No||043|No|337.91715|01/17/2023|329.80713|01/17/2023|332.00359|01/17/2023|||MULTIPLE SCLEROSIS AGENTS|1192|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078060805|FOCALIN XR 25 MG CAPSULE|100|EA|6.40115|10/03/2011||Yes|No||10/13/2011||Yes|No|10/03/2011||Yes|No||||No|No|||Prescription required|No||007|Yes|14.20644|01/17/2023|13.86548|01/17/2023|13.95782|01/17/2023|||STIMULANTS AND RELATED AGENTS|1193|||||No|No||NOVARTIS|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00078060905|FOCALIN XR 35 MG CAPSULE|100|EA|6.72145|10/03/2011||Yes|No||10/03/2011||Yes|No|10/03/2011||Yes|No||||No|No|||Prescription required|No||007|Yes|15.05421|01/17/2023|14.6929|01/17/2023|14.79076|01/17/2023|||STIMULANTS AND RELATED AGENTS|1194|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062051|AFINITOR 7.5 MG TABLET|28|EA|278.34452|10/08/2014||Yes|No||10/08/2014||Yes|No|10/08/2014||Yes|No||||No|No|||Prescription required|No||548|No|634.36659|01/10/2023|625.30421|01/10/2023|595.52782|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1195|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062651|AFINITOR DISPERZ 2 MG TABLET|28|EA|264.7811|08/05/2013||Yes|No||08/05/2013||Yes|No|08/05/2013||Yes|No||||No|No|||Prescription required|No||548|No|603.4546|01/10/2023|594.83382|01/10/2023|566.5084|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1196|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062751|AFINITOR DISPERZ 3 MG TABLET|28|EA|267.43343|08/05/2013||Yes|No||08/05/2013||Yes|No|08/05/2013||Yes|No||||No|No|||Prescription required|No||548|No|609.49944|01/10/2023|600.79231|01/10/2023|572.18315|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1197|||||No|No||NOVARTIS|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078062851|AFINITOR DISPERZ 5 MG TABLET|28|EA|278.34452|08/05/2013||Yes|No||08/05/2013||Yes|No|08/05/2013||Yes|No||||No|No|||Prescription required|No||548|No|634.36659|01/10/2023|625.30421|01/10/2023|595.52782|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1198|||||No|No||NOVARTIS|No|||||No|No|No||
pasireotide diaspartate|No|No|No|No|75%|00078063420|SIGNIFOR 0.6 MG/ML AMPULE|1|ML|120.3871|02/09/2022|04/30/2023|Yes|No||02/09/2022|04/30/2023|Yes|No|02/09/2022|04/30/2023|Yes|No||||No|No|||Prescription required|No|||No|274.3706|01/10/2023|270.45102|01/10/2023|257.5724|01/10/2023||||1199|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/RECORD|No|||||No|No|No||
pasireotide diaspartate|No|No|No|No|75%|00078063520|SIGNIFOR 0.9 MG/ML AMPULE|1|ML|120.3871|09/14/2021|03/31/2023|Yes|No||09/14/2021|03/31/2023|Yes|No|09/14/2021|03/31/2023|Yes|No||||No|No|||Prescription required|No|||No|274.3706|01/10/2023|270.45102|01/10/2023|257.5724|01/10/2023||||1200|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/RECORD|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063941|COSENTYX 300 MG DOSE-2 PENS|1|ML|1488.7159|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|3353.07093|01/17/2023|3272.59722|01/17/2023|3294.39218|01/17/2023|||CYTOKINE AND CAM ANTAGONISTS|1201|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063968|COSENTYX 150 MG/ML PEN INJECT|1|ML|2977.4318|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|6785.7748|01/10/2023|6688.83516|01/10/2023|6370.3192|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1202|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063997|COSENTYX 150 MG/ML SYRINGE|1|ML|2977.4318|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|6785.7748|01/10/2023|6688.83516|01/10/2023|6370.3192|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1203|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063998|COSENTYX 300 MG DOSE-2 SYRINGE|1|ML|1488.7159|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|3392.8874|01/10/2023|3344.41758|01/10/2023|3185.1596|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1204|||||No|No||NOVARTIS|No|||||No|No|No||
pasireotide pamoate|No|No|No|No|75%|00078064381|SIGNIFOR LAR 60 MG KIT|1|EA|6856.7757|09/14/2021|07/31/2023|Yes|No||09/14/2021|07/31/2023|Yes|No|09/14/2021|07/31/2023|Yes|No||||No|No|||Prescription required|No|||No|15627.0702|01/10/2023|15403.82634|01/10/2023|14670.3108|01/10/2023||||1205|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/RECORD|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||173|No|330.66604|09/28/2021|325.94224|09/28/2021|310.42118|09/28/2021|||ONCOLOGY: ORAL - HEMATOLOGIC|1206|||||No|No||NOVARTIS|No|||||No|No|No||
panobinostat lactate|No|No|No|No|75%|00078065006|FARYDAK 10 MG CAPSULE|6|EA|1009.24655|05/18/2015|12/31/2022|Yes|No||05/18/2015|12/31/2022|Yes|No|05/18/2015|12/31/2022|Yes|No||||No|No|||Prescription required|No||173|No|2300.1433|04/27/2021|2267.28411|04/27/2021|2159.3182|04/27/2021|||ONCOLOGY: ORAL - HEMATOLOGIC|1207|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/SECURA|No|||||No|No|Yes|07/30/2021|
panobinostat lactate|No|No|No|No|75%|00078065106|FARYDAK 15 MG CAPSULE|6|EA|1009.24655|05/18/2015|12/31/2022|Yes|No||05/18/2015|12/31/2022|Yes|No|05/18/2015|12/31/2022|Yes|No||||No|No|||Prescription required|No||173|No|2300.1433|04/27/2021|2267.28411|04/27/2021|2159.3182|04/27/2021|||ONCOLOGY: ORAL - HEMATOLOGIC|1208|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/SECURA|No|||||No|No|Yes|07/30/2021|
panobinostat lactate|No|No|No|No|75%|00078065206|FARYDAK 20 MG CAPSULE|6|EA|1009.24655|05/12/2015|12/31/2022|Yes|No||05/12/2015|12/31/2022|Yes|No|05/12/2015|12/31/2022|Yes|No||||No|No|||Prescription required|No||173|No|2300.1433|04/27/2021|2267.28411|04/27/2021|2159.3182|04/27/2021|||ONCOLOGY: ORAL - HEMATOLOGIC|1209|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/SECURA|No|||||No|No|Yes|07/30/2021|
deferasirox|No|No|No|No|75%|00078065415|JADENU 90 MG TABLET|30|EA|20.79066|06/02/2015||Yes|No||06/02/2015||Yes|No|06/02/2015||Yes|No||||No|No|||Prescription required|No|||No|47.75474|01/10/2023|47.07253|01/10/2023|44.83098|01/10/2023||||1210|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078065515|JADENU 180 MG TABLET|30|EA|41.64023|06/02/2015||Yes|No||06/02/2015||Yes|No|06/02/2015||Yes|No||||No|No|||Prescription required|No|||No|95.50752|01/10/2023|94.14313|01/10/2023|89.66012|01/10/2023||||1211|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078065615|JADENU 360 MG TABLET|30|EA|85.7169|06/02/2015||Yes|No||06/02/2015||Yes|No|06/02/2015||Yes|No||||No|No|||Prescription required|No|||No|191.0118|01/10/2023|188.28306|01/10/2023|179.3172|01/10/2023||||1212|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078065920|ENTRESTO 24 MG-26 MG TABLET|60|EA|4.78711|08/13/2015||Yes|No||08/13/2015||Yes|No|08/13/2015||Yes|No||||No|No|||Prescription required|No||113|Yes|10.68737|01/17/2023|10.43087|01/17/2023|10.50034|01/17/2023|||ANGIOTENSIN MODULATORS|1213|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078065967|ENTRESTO 24 MG-26 MG TABLET|180|EA|4.78719|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription required|No||113|Yes|10.68737|01/17/2023|10.43087|01/17/2023|10.50034|01/17/2023|||ANGIOTENSIN MODULATORS|1214|||||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|09/10/2019|5.91192|09/10/2019|5.6304|09/10/2019|||COPD AGENTS|1215|||||No|No||NOVARTIS/SUNOVI|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078066615|MEKINIST 0.5 MG TABLET|30|EA|57.10457|08/12/2016|09/22/2023|Yes|No||08/12/2016|09/22/2023|Yes|No|08/12/2016|09/22/2023|Yes|No||||No|No|||Prescription required|No||563|No|130.1453|08/02/2022|128.28608|08/02/2022|122.17722|08/02/2022|||ONCOLOGY: ORAL - SKIN|1216|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||NOVARTIS|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078066815|MEKINIST 2 MG TABLET|30|EA|194.35584|08/12/2016|12/22/2023|Yes|No||08/12/2016|12/22/2023|Yes|No|08/12/2016|12/22/2023|Yes|No||||No|No|||Prescription required|No||563|No|442.95052|08/02/2022|436.62265|08/02/2022|415.8311|08/02/2022|||ONCOLOGY: ORAL - SKIN|1217|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||NOVARTIS|No|||||No|No|No||
pazopanib HCl|No|No|No|No|75%|00078067066|VOTRIENT 200 MG TABLET|120|EA|55.03046|09/23/2016|06/14/2023|Yes|No||09/23/2016|06/14/2023|Yes|No|09/23/2016|06/14/2023|Yes|No||||No|No|||Prescription required|No||548|No|125.41827|01/11/2022|123.62658|01/11/2022|117.7396|01/11/2022|||ONCOLOGY: ORAL - RENAL CELL|1218|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||NOVARTIS|No|||||No|No|No||
lapatinib ditosylate|No|No|No|No|75%|00078067119|TYKERB 250 MG TABLET|150|EA|27.63268|09/19/2016||Yes|No||09/19/2016||Yes|No|09/19/2016||Yes|No||||No|No|||Prescription required|No||502|No|62.97681|01/10/2023|62.07714|01/10/2023|59.12109|01/10/2023|||ONCOLOGY: ORAL - BREAST|1219|||||No|No||NOVARTIS|No|||||No|No|No||
topotecan HCl|No|No|No|No|75%|00078067301|HYCAMTIN 1 MG CAPSULE|10|EA|189.9568|05/16/2017||Yes|No||05/16/2017||Yes|No|05/16/2017||Yes|No||||No|No|||Prescription required|No||551|No|432.9248|01/10/2023|426.74016|01/10/2023|406.4192|01/10/2023|||ONCOLOGY: ORAL - LUNG|1220|||||No|No||NOVARTIS|No|||||No|No|No||
dabrafenib mesylate|No|No|No|No|75%|00078068166|TAFINLAR 75 MG CAPSULE|120|EA|48.33275|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription required|No||563|No|110.15371|01/10/2023|108.58009|01/10/2023|103.40961|01/10/2023|||ONCOLOGY: ORAL - SKIN|1221|||||No|No||NOVARTIS|No|||||No|No|No||
dabrafenib mesylate|No|No|No|No|75%|00078068266|TAFINLAR 50 MG CAPSULE|120|EA|37.50359|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription required|No||563|No|85.4733|01/10/2023|84.25225|01/10/2023|80.24024|01/10/2023|||ONCOLOGY: ORAL - SKIN|1222|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068415|PROMACTA 12.5 MG TABLET|30|EA|96.17451|11/21/2016||Yes|No||11/21/2016||Yes|No|11/21/2016||Yes|No||||No|No|||Prescription required|No||235|No|219.18842|01/10/2023|216.05716|01/10/2023|205.76872|01/10/2023|||THROMBOPOIESIS STIMULATING PROTEINS|1223|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068515|PROMACTA 25 MG TABLET|30|EA|96.17451|07/27/2016||Yes|No||07/27/2016||Yes|No|07/27/2016||Yes|No||||No|No|||Prescription required|No||235|No|219.18842|01/10/2023|216.05716|01/10/2023|205.76872|01/10/2023|||THROMBOPOIESIS STIMULATING PROTEINS|1224|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068615|PROMACTA 50 MG TABLET|30|EA|174.04551|07/27/2016||Yes|No||07/27/2016||Yes|No|07/27/2016||Yes|No||||No|No|||Prescription required|No||235|No|396.66186|01/10/2023|390.99526|01/10/2023|372.37644|01/10/2023|||THROMBOPOIESIS STIMULATING PROTEINS|1225|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078068715|PROMACTA 75 MG TABLET|30|EA|261.06833|05/20/2016||Yes|No||05/20/2016||Yes|No|05/20/2016||Yes|No||||No|No|||Prescription required|No||235|No|594.99294|01/10/2023|586.49304|01/10/2023|558.5648|01/10/2023|||THROMBOPOIESIS STIMULATING PROTEINS|1226|||||No|No||NOVARTIS|No|||||No|No|No||
ceritinib|No|No|No|No|75%|00078069484|ZYKADIA 150 MG TABLET|84|EA|62.33356|11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription required|No||551|No|142.06254|01/10/2023|140.03307|01/10/2023|133.36483|01/10/2023|||ONCOLOGY: ORAL - LUNG|1227|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078069620|ENTRESTO 97 MG-103 MG TABLET|60|EA|4.78711|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Prescription required|No||113|Yes|10.69382|01/17/2023|10.43716|01/17/2023|10.50667|01/17/2023|||ANGIOTENSIN MODULATORS|1228|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078069667|ENTRESTO 97 MG-103 MG TABLET|180|EA|4.78719|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription required|No||113|Yes|10.69382|01/17/2023|10.43716|01/17/2023|10.50667|01/17/2023|||ANGIOTENSIN MODULATORS|1229|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078069761|PROMACTA 25 MG SUSPENSION PCKT|30|EA|96.17967|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|219.20018|01/10/2023|216.06875|01/10/2023|205.77976|01/10/2023|||THROMBOPOIESIS STIMULATING PROTEINS|1230|||||No|No||NOVARTIS|No|||||No|No|No||
midostaurin|No|No|No|No|75%|00078069802|RYDAPT 25 MG CAPSULE|2|EA|82.78145|07/17/2017||Yes|No||07/17/2017||Yes|No|07/17/2017||Yes|No||||No|No|||Prescription required|No||173|No|188.6647|01/10/2023|185.96949|01/10/2023|177.1138|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1231|||||No|No||NOVARTIS|No|||||No|No|No||
midostaurin|No|No|No|No|75%|00078069899|RYDAPT 25 MG CAPSULE|56|EA|82.77952|07/17/2017||Yes|No||07/17/2017||Yes|No|07/17/2017||Yes|No||||No|No|||Prescription required|No||173|No|188.66031|01/10/2023|185.96517|01/10/2023|177.10968|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1232|||||No|No||NOVARTIS|No|||||No|No|No||
alpelisib|No|No|No|No|75%|00078070184|PIQRAY 200 MG DAILY DOSE PACK|28|EA|313.3926|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription required|No||502|No|714.2436|01/10/2023|704.04012|01/10/2023|670.5144|01/10/2023|||ONCOLOGY: ORAL - BREAST|1233|||||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|156.6963|04/13/2020||Yes|No||04/13/2020||Yes|No|04/13/2020||Yes|No||||No|No|||Prescription required|No||502|No|357.1218|01/10/2023|352.02006|01/10/2023|335.2572|01/10/2023|||ONCOLOGY: ORAL - BREAST|1234|||||No|No||NOVARTIS|No|||||No|No|Yes|03/31/2022|
capmatinib hydrochloride|No|No|No|No|75%|00078070956|TABRECTA 150 MG TABLET|56|EA|82.84064|11/10/2020||Yes|No||11/10/2020||Yes|No|11/10/2020||Yes|No||||No|No|||Prescription required|No||551|No|188.79961|01/10/2023|186.10247|01/10/2023|177.24045|01/10/2023|||ONCOLOGY: ORAL - LUNG|1235|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078071315|JADENU SPRINKLE 180 MG GRANULE|30|EA|41.90636|01/30/2018||Yes|No||01/30/2018||Yes|No|01/30/2018||Yes|No||||No|No|||Prescription required|No|||No|95.50752|01/10/2023|94.14313|01/10/2023|89.66012|01/10/2023||||1236|||||No|No||NOVARTIS|No|||||No|No|No||
alpelisib|No|No|No|No|75%|00078071502|PIQRAY 250 MG DAILY DOSE PACK|56|EA|156.6963|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription required|No||502|No|357.1218|01/10/2023|352.02006|01/10/2023|335.2572|01/10/2023|||ONCOLOGY: ORAL - BREAST|1237|||||No|No||NOVARTIS|No|||||No|No|Yes|03/31/2022|
capmatinib hydrochloride|No|No|No|No|75%|00078071656|TABRECTA 200 MG TABLET|56|EA|82.84064|11/10/2020||Yes|No||11/10/2020||Yes|No|11/10/2020||Yes|No||||No|No|||Prescription required|No||551|No|188.79961|01/10/2023|186.10247|01/10/2023|177.24045|01/10/2023|||ONCOLOGY: ORAL - LUNG|1238|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078072015|JADENU SPRINKLE 360 MG GRANULE|30|EA|83.8113|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription required|No|||No|191.0118|01/10/2023|188.28306|01/10/2023|179.3172|01/10/2023||||1239|||||No|No||NOVARTIS|No|||||No|No|No||
brinzolamide|No|No|No|No|75%|00078072210|AZOPT 1% EYE DROPS|10|ML|15.49677|08/16/2022||Yes|No||08/16/2022||Yes|No|08/16/2022||Yes|No||||No|No|||Prescription required|No||088|No|34.63005|08/16/2022|33.79892|08/16/2022|34.02402|08/16/2022|||OPHTHALMICS: GLAUCOMA AGENTS|1240|||||No|No||NOVARTIS|No|||||No|No|No||
deferasirox|No|No|No|No|75%|00078072715|JADENU SPRINKLE 90 MG GRANULE|30|EA|20.95361|10/09/2017||Yes|No||10/09/2017||Yes|No|10/09/2017||Yes|No||||No|No|||Prescription required|No|||No|47.75474|01/10/2023|47.07253|01/10/2023|44.83098|01/10/2023||||1241|||||No|No||NOVARTIS|No|||||No|No|No||
canakinumab/PF|No|No|No|No|75%|00078073461|ILARIS 150 MG/ML VIAL|1|ML|7510.4617|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|17116.8662|01/10/2023|16872.33954|01/10/2023|16068.8948|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1242|||||No|No||NOVARTIS|No|||||No|No|No||
pasireotide pamoate|No|No|No|No|75%|00078074181|SIGNIFOR LAR 30 MG KIT|1|EA|6856.7757|09/14/2021|06/30/2023|Yes|No||09/14/2021|06/30/2023|Yes|No|09/14/2021|06/30/2023|Yes|No||||No|No|||Prescription required|No|||No|15627.0702|01/10/2023|15403.82634|01/10/2023|14670.3108|01/10/2023||||1243|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||NOVARTIS/RECORD|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078077720|ENTRESTO 49 MG-51 MG TABLET|60|EA|4.78711|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Prescription required|No||113|Yes|10.68483|01/17/2023|10.42839|01/17/2023|10.49784|01/17/2023|||ANGIOTENSIN MODULATORS|1244|||||No|No||NOVARTIS|No|||||No|No|No||
sacubitril/valsartan|No|No|No|No|75%|00078077767|ENTRESTO 49 MG-51 MG TABLET|180|EA|4.78719|02/26/2019||Yes|No||02/26/2019||Yes|No|02/26/2019||Yes|No||||No|No|||Prescription required|No||113|Yes|10.68483|01/17/2023|10.42839|01/17/2023|10.49784|01/17/2023|||ANGIOTENSIN MODULATORS|1245|||||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||Yes|No||01/05/2021||Yes|No|01/05/2021||Yes|No||||No|No|||Prescription required|No||051|No|31.79831|10/25/2022|31.03515|10/25/2022|31.24183|10/25/2022|||OTIC ANTIBIOTICS|1246|||||No|No||NOVARTIS|No|||||No|No|No||
tobramycin|No|No|No|No|75%|00078081301|TOBREX 0.3% EYE OINTMENT|3.5|GM|30.38994|12/07/2022||Yes|No||12/07/2022||Yes|No|12/07/2022||Yes|No||||No|No|||Prescription required|No||058|No|67.983|01/17/2023|66.3514|01/17/2023|66.79329|01/17/2023|||OPHTHALMIC ANTIBIOTICS|1247|||||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|1870.5129|02/16/2017||Yes|No||02/16/2017||Yes|No|02/16/2017||Yes|No||||No|No|||Prescription required|No|||No|4263.0294|01/10/2023|4202.12898|01/10/2023|4002.0276|01/10/2023||||1248|||||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|2800.9598|02/16/2017||Yes|No||02/16/2017||Yes|No|02/16/2017||Yes|No||||No|No|||Prescription required|No|||No|6383.5828|01/10/2023|6292.38876|01/10/2023|5992.7512|01/10/2023||||1249|||||No|No||NOVARTIS|No|||||No|No|No||
olopatadine HCl|No|No|No|No|75%|00078083430|PATANASE 665 MCG NASAL SPRAY|30.5|GM|4.71012|11/03/2022||Yes|No||11/03/2022||Yes|No|11/03/2022||Yes|No||||No|No|||Prescription required|Yes|07/28/2022|019|No|10.73469|01/10/2023|10.58134|01/10/2023|10.07746|01/10/2023|||INTRANASAL RHINITIS AGENTS|1250|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate|No|No|No|No|75%|00078086001|KISQALI 200 MG DAILY DOSE|21|EA|134.1213|05/15/2017||Yes|No||05/15/2017||Yes|No|05/15/2017||Yes|No||||No|No|||Prescription required|No||502|No|305.6718|01/10/2023|301.30506|01/10/2023|286.9572|01/10/2023|||ONCOLOGY: ORAL - BREAST|1251|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate|No|No|No|No|75%|00078086742|KISQALI 400 MG DAILY DOSE|42|EA|134.12181|05/15/2017||Yes|No||05/15/2017||Yes|No|05/15/2017||Yes|No||||No|No|||Prescription required|No||502|No|305.67296|01/10/2023|301.3062|01/10/2023|286.95829|01/10/2023|||ONCOLOGY: ORAL - BREAST|1252|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate|No|No|No|No|75%|00078087463|KISQALI 600 MG DAILY DOSE|63|EA|111.76819|05/15/2017||Yes|No||05/15/2017||Yes|No|05/15/2017||Yes|No||||No|No|||Prescription required|No||502|No|254.7275|01/10/2023|251.08854|01/10/2023|239.13194|01/10/2023|||ONCOLOGY: ORAL - BREAST|1253|||||No|No||NOVARTIS|No|||||No|No|No||
tobramycin/dexamethasone|No|No|No|No|75%|00078087601|TOBRADEX EYE OINTMENT|3.5|GM|32.3532|06/20/2022||Yes|No||06/20/2022||Yes|No|06/20/2022||Yes|No||||No|No|||Prescription required|No||036|No|72.00386|01/17/2023|70.27576|01/17/2023|70.74379|01/17/2023|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|1254|||||No|No||NOVARTIS|No|||||No|No|No||
brinzolamide/brimonidine tart|No|No|No|No|75%|00078090438|SIMBRINZA 1%-0.2% EYE DROPS|8|ML|10.2512|02/08/2021|02/28/2023|Yes|No||02/08/2021|02/28/2023|Yes|No|02/08/2021|02/28/2023|Yes|No||||No|No|||Prescription required|No||088|No|23.3632|03/14/2023|23.02944|03/14/2023|21.9328|03/14/2023|||OPHTHALMICS: GLAUCOMA AGENTS|1255|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALCON LABORATOR|No|||||No|No|No||
ribociclib succinate/letrozole|No|No|No|No|75%|00078090961|KISQALI FEMARA 200 MG CO-PACK|49|EA|57.48055|07/10/2017||Yes|No||07/10/2017||Yes|No|07/10/2017||Yes|No||||No|No|||Prescription required|No||502|No|131.00219|01/10/2023|129.13073|01/10/2023|122.98165|01/10/2023|||ONCOLOGY: ORAL - BREAST|1256|||||No|No||NOVARTIS|No|||||No|No|No||
lifitegrast|No|No|No|No|75%|00078091112|XIIDRA 5% EYE DROPS|60|EA|4.90522|12/09/2020||Yes|No||12/09/2020||Yes|No|12/09/2020||Yes|No||||No|No|||Prescription required|No||086|No|10.94713|01/17/2023|10.68439|01/17/2023|10.75555|01/17/2023|||OPHTHALMICS: ANTI-INFLAMMATORY/IMMUNOMODULATOR|1257|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate/letrozole|No|No|No|No|75%|00078091661|KISQALI FEMARA 400 MG CO-PACK|70|EA|80.47308|07/10/2017||Yes|No||07/10/2017||Yes|No|07/10/2017||Yes|No||||No|No|||Prescription required|No||502|No|183.40377|01/10/2023|180.78372|01/10/2023|172.17497|01/10/2023|||ONCOLOGY: ORAL - BREAST|1258|||||No|No||NOVARTIS|No|||||No|No|No||
ribociclib succinate/letrozole|No|No|No|No|75%|00078092361|KISQALI FEMARA 600 MG CO-PACK|91|EA|77.37797|07/10/2017||Yes|No||07/10/2017||Yes|No|07/10/2017||Yes|No||||No|No|||Prescription required|No||502|No|176.34981|01/10/2023|173.83053|01/10/2023|165.55288|01/10/2023|||ONCOLOGY: ORAL - BREAST|1259|||||No|No||NOVARTIS|No|||||No|No|No||
travoprost|No|No|No|No|75%|00078094625|TRAVATAN Z 0.004% EYE DROP|5|ML|38.49962|10/13/2022||Yes|No||10/13/2022||Yes|No|10/13/2022||Yes|No||||No|No|||Prescription required|No||088|No|86.45851|01/17/2023|84.3835|01/17/2023|84.94548|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|1260|||||No|No||NOVARTIS|No|||||No|No|No||
travoprost|No|No|No|No|75%|00078094640|TRAVATAN Z 0.004% EYE DROP|2.5|ML|38.50048|10/13/2022||Yes|No||10/13/2022||Yes|No|10/13/2022||Yes|No||||No|No|||Prescription required|No||088|No|86.08633|01/17/2023|84.02025|01/17/2023|84.57981|01/17/2023|||OPHTHALMICS: GLAUCOMA AGENTS|1261|||||No|No||NOVARTIS|No|||||No|No|No||
eltrombopag olamine|No|No|No|No|75%|00078097261|PROMACTA 12.5 MG SUSPEN PACKET|30|EA|96.17451|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|219.18842|01/10/2023|216.05716|01/10/2023|205.76872|01/10/2023|||THROMBOPOIESIS STIMULATING PROTEINS|1262|||||No|No||NOVARTIS|No|||||No|No|No||
siponimod|No|No|No|No|75%|00078097912|MAYZENT 0.25MG START-2MG MAINT|12|EA|33.08813|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription required|No||043|No|75.41017|01/10/2023|74.33288|01/10/2023|70.79322|01/10/2023|||MULTIPLE SCLEROSIS AGENTS|1263|||||No|No||NOVARTIS|No|||||No|No|Yes|07/30/2021|
siponimod|No|No|No|No|75%|00078097950|MAYZENT 0.25 MG TABLET|28|EA|33.08819|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription required|No||043|No|75.41029|01/10/2023|74.333|01/10/2023|70.79333|01/10/2023|||MULTIPLE SCLEROSIS AGENTS|1264|||||No|No||NOVARTIS|No|||||No|No|Yes|07/30/2021|
siponimod|No|No|No|No|75%|00078098615|MAYZENT 2 MG TABLET|30|EA|132.35299|04/10/2020||Yes|No||04/10/2020||Yes|No|04/10/2020||Yes|No||||No|No|||Prescription required|No||043|No|301.6417|01/10/2023|297.33253|01/10/2023|283.17384|01/10/2023|||MULTIPLE SCLEROSIS AGENTS|1265|||||No|No||NOVARTIS|No|||||No|No|Yes|07/30/2021|
ofatumumab|No|No|No|No|75%|00078100768|KESIMPTA 20 MG/0.4 ML PEN|.4|ML|8776.39675|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||||No|No|||Prescription required|No||043|No|20002.0205|01/10/2023|19716.27735|01/10/2023|18777.407|01/10/2023|||MULTIPLE SCLEROSIS AGENTS|1266|||||No|No||NOVARTIS|No|||||No|No|No||
siponimod|No|No|No|No|75%|00078101415|MAYZENT 1 MG TABLET|30|EA|132.35299|11/01/2022||Yes|No||11/01/2022||Yes|No|11/01/2022||Yes|No||||No|No|||Prescription required|No||043|No|301.6417|01/10/2023|297.33253|01/10/2023|283.17384|01/10/2023|||MULTIPLE SCLEROSIS AGENTS|1267|||||No|No||NOVARTIS|No|||||No|No|No||
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|10/11/2022|1121.24999|10/11/2022|1067.85713|10/11/2022||||1268|||||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|10/31/2022|1121.24999|10/31/2022|1067.85713|10/31/2022||||1269|||||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|568.74999|10/31/2022|560.62499|10/31/2022|533.92856|10/31/2022||||1270|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078105697|COSENTYX 75 MG/0.5 ML SYRINGE|.5|ML|2977.4318|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|6785.7748|01/10/2023|6688.83516|01/10/2023|6370.3192|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|1271|||||No|No||NOVARTIS|No|||||No|No|No||
pazopanib HCl|No|No|No|No|75%|00078107766|VOTRIENT 200 MG TABLET|120|EA|60.47849|07/20/2022||Yes|No||07/20/2022||Yes|No|07/20/2022||Yes|No||||No|No|||Prescription required|No||548|No|137.8347|01/10/2023|135.86563|01/10/2023|129.39584|01/10/2023|||ONCOLOGY: ORAL - RENAL CELL|1272|||||No|No||NOVARTIS|No|||||No|No|No||
asciminib hydrochloride|No|No|No|No|75%|00078109120|SCEMBLIX 20 MG TABLET|60|EA|144.08784|09/27/2022||Yes|No||09/27/2022||Yes|No|09/27/2022||Yes|No||||No|No|||Prescription required|No||173|No|328.38624|01/10/2023|323.695|01/10/2023|308.28096|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1273|||||No|No||NOVARTIS|No|||||No|No|No||
asciminib hydrochloride|No|No|No|No|75%|00078109820|SCEMBLIX 40 MG TABLET|60|EA|144.08784|09/27/2022||Yes|No||09/27/2022||Yes|No|09/27/2022||Yes|No||||No|No|||Prescription required|No||173|No|328.38624|01/10/2023|323.695|01/10/2023|308.28096|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1274|||||No|No||NOVARTIS|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078110515|MEKINIST 0.5 MG TABLET|30|EA|61.67289|11/15/2022||Yes|No||11/15/2022||Yes|No|11/15/2022||Yes|No||||No|No|||Prescription required|No||563|No|140.55682|01/10/2023|138.54886|01/10/2023|131.9513|01/10/2023|||ONCOLOGY: ORAL - SKIN|1275|||||No|No||NOVARTIS|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078111215|MEKINIST 2 MG TABLET|30|EA|209.90435|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription required|No||563|No|478.38666|02/16/2023|471.55257|02/16/2023|449.09768|02/16/2023|||ONCOLOGY: ORAL - SKIN|1276|||||No|No||NOVARTIS|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00085057502|DIPROLENE 0.05% OINTMENT|15|GM|2.5929|04/28/2006||Yes|No||04/28/2006||Yes|No|04/28/2006||Yes|No||||No|No|||Prescription required|Yes|02/10/2009|120|No|5.9094|06/13/2017|5.82498|06/13/2017|5.5476|06/13/2017|||STEROIDS: TOPICAL HIGH|1277|||||No|No||MERCK SHARP & D|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00085057505|DIPROLENE 0.05% OINTMENT|50|GM|1.7415|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|02/10/2009|120|No|3.969|06/13/2017|3.9123|06/13/2017|3.726|06/13/2017|||STEROIDS: TOPICAL HIGH|1278|||||No|No||MERCK SHARP & D|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|01/28/2020|13.24386|01/28/2020|12.6132|01/28/2020|||ANTIFUNGALS: ORAL|1279|||||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||033|Yes|220.2844|08/30/2022|217.13748|08/30/2022|206.7976|08/30/2022|||GLUCOCORTICOIDS: INHALED|1280|||||No|No||MERCK SHARP & D|Yes|09/01/2020||||No|No|No||
temozolomide|No|No|No|No|75%|00085141702|TEMODAR 250 MG CAPSULE|5|EA|489.77|01/25/2013|02/21/2023|Yes|No||01/25/2013|02/21/2023|Yes|No|01/25/2013|02/21/2023|Yes|No||||No|No|||Prescription required|No||239|No|1116.22|01/29/2019|1100.274|01/29/2019|1047.88|01/29/2019|||ONCOLOGY: ORAL - OTHER|1281|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MERCK SHARP & D|No|||||Yes|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||239|No|625.0832|01/16/2018|616.15344|01/16/2018|586.8128|01/16/2018|||ONCOLOGY: ORAL - OTHER|1282|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
mometasone furoate|No|No|No|No|75%|00085222201|ASMANEX HFA 50 MCG INHALER|13|GM|5.86751|07/01/2020|02/21/2023|Yes|No||07/01/2020|02/21/2023|Yes|No|07/01/2020|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/25/2019|033|No|13.37247|03/07/2023|13.18143|03/07/2023|12.55374|03/07/2023|||GLUCOCORTICOIDS: INHALED|1283|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MERCK SHARP & D|No|||||No|No|No||
mometasone/formoterol|No|No|No|No|75%|00085222301|DULERA 50 MCG-5 MCG INHALER|13|GM|10.2985|06/30/2020|02/21/2023|Yes|No||06/30/2020|02/21/2023|Yes|No|06/30/2020|02/21/2023|Yes|No||||No|No|||Prescription required|No||033|Yes|23.471|03/07/2023|23.1357|03/07/2023|22.034|03/07/2023|||GLUCOCORTICOIDS: INHALED|1284|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|No||069|No|67.1594|07/28/2020|66.19998|07/28/2020|63.0476|07/28/2020|||ANTIFUNGALS: ORAL|1285|||||No|No||MERCK SHARP & D|No|||||No|No|No||
mometasone furoate|No|No|No|No|75%|00085433301|ASMANEX HFA 100 MCG INHALER|13|GM|6.3296|07/17/2019|01/31/2024|Yes|No||07/17/2019|01/31/2024|Yes|No|07/17/2019|01/31/2024|Yes|No||07/17/2019|01/31/2024|Yes|No|||Prescription required|Yes|07/23/2015|033|Yes|14.81399|10/25/2022|14.45845|10/25/2022|14.55474|10/25/2022|||GLUCOCORTICOIDS: INHALED|1286|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||MERCK SHARP & D|No|||||No|No|No||
mometasone furoate|No|No|No|No|75%|00085433401|ASMANEX HFA 200 MCG INHALER|13|GM|7.439|07/19/2019|02/21/2023|Yes|No||07/19/2019|02/21/2023|Yes|No|07/19/2019|02/21/2023|Yes|No||07/19/2019|02/21/2023|Yes|No|||Prescription required|Yes|07/23/2015|033|Yes|16.954|03/07/2023|16.7118|03/07/2023|15.916|03/07/2023|||GLUCOCORTICOIDS: INHALED|1287|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MERCK SHARP & D|No|||||No|No|No||
mometasone/formoterol|No|No|No|No|75%|00085720601|DULERA 100 MCG-5 MCG INHALER|13|GM|10.2985|08/17/2010|02/21/2023|Yes|No||08/17/2010|02/21/2023|Yes|No|08/17/2010|02/21/2023|Yes|No||||No|No|||Prescription required|No||033|Yes|23.471|03/07/2023|23.1357|03/07/2023|22.034|03/07/2023|||GLUCOCORTICOIDS: INHALED|1288|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|07/12/2022|.15842|07/12/2022|.15088|07/12/2022||||1289|||||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|07/12/2022|.15842|07/12/2022|.15088|07/12/2022||||1290|||||No|No||MJ NUTRITIONAL|No|||||No|Yes|No||
rifapentine|No|No|No|No|75%|00088210224|PRIFTIN 150 MG TABLET|24|EA|1.98373|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription required|No|||No|4.43217|01/17/2023|4.32579|01/17/2023|4.3546|01/17/2023||||1291|||||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|01/10/2023|48.12225|01/10/2023|45.83072|01/10/2023||||1292|||||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|01/10/2023|48.12225|01/10/2023|45.83072|01/10/2023||||1293|||||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|12.558|09/30/2010||Yes|No||09/30/2010||Yes|No|09/30/2010||Yes|No||07/01/2013||Yes|No|||Prescription required|No||029|No|28.0503|01/17/2023|27.37709|01/17/2023|27.55941|01/17/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1294|||||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|12.55901|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||029|No|28.04751|01/17/2023|27.37436|01/17/2023|27.55667|01/17/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1295|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glulisine|Yes|No|No|No|75%|00088250033|APIDRA 100 UNIT/ML VIAL|10|ML|12.20985|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|27.269|02/28/2023|26.61454|02/28/2023|26.79179|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1296|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glulisine|Yes|No|No|No|75%|00088250205|APIDRA SOLOSTAR 100 UNIT/ML|3|ML|15.72424|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|35.13267|07/26/2022|34.28948|07/26/2022|34.51784|07/26/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1297|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00088502005|LANTUS SOLOSTAR 100 UNIT/ML|3|ML|12.19222|01/05/2018||Yes|No||01/05/2018||Yes|No|01/05/2018||Yes|No||01/05/2018||Yes|No|||Prescription required|No||029|No|28.0503|01/17/2023|27.37709|01/17/2023|27.55941|01/17/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1298|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00088502101|LANTUS 100 UNIT/ML VIAL|10|ML|12.19308|01/05/2018||Yes|No||01/05/2018||Yes|No|01/05/2018||Yes|No||01/05/2018||Yes|No|||Prescription required|No||029|No|28.04751|01/17/2023|27.37436|01/17/2023|27.55667|01/17/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1299|||||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|.52473|02/28/2023|.51213|02/28/2023|.51554|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1300|||||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|.965|12/27/2022|.94184|12/27/2022|.94811|12/27/2022|||ANGIOTENSIN MODULATORS|1301|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093001805|TOLTERODINE TARTRATE 2 MG TAB|500|EA|1.16838|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|.38911|02/28/2023|.37977|02/28/2023|.3823|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1302|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093001806|TOLTERODINE TARTRATE 2 MG TAB|60|EA|1.16837|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|.38911|02/28/2023|.37977|02/28/2023|.3823|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1303|||||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||070|No|.01822|02/28/2023|.01778|02/28/2023|.0179|02/28/2023|||BETA-BLOCKERS|1304|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093005105|CARVEDILOL 3.125 MG TABLET|500|EA|.02515|11/15/2011||Yes|No||11/15/2011||Yes|No|11/15/2011||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.01822|02/28/2023|.01778|02/28/2023|.0179|02/28/2023|||BETA-BLOCKERS|1305|||||No|No||TEVA USA|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00093005301|BUSPIRONE HCL 5 MG TABLET|100|EA|.02214|01/28/2011||Yes|No||01/28/2011||Yes|No|01/28/2011||Yes|No||||No|No|||Prescription required|No||090|No|.02848|02/28/2023|.02779|02/28/2023|.02798|02/28/2023|||ANXIOLYTICS|1306|||||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||090|No|.03849|02/28/2023|.03756|02/28/2023|.03781|02/28/2023|||ANXIOLYTICS|1307|||||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||109|Yes|.02853|02/28/2023|.02784|02/28/2023|.02803|02/28/2023|||ANALGESICS: NARCOTICS SHORT|1308|||||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||109|Yes|.02853|02/28/2023|.02784|02/28/2023|.02803|02/28/2023|||ANALGESICS: NARCOTICS SHORT|1309|||||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||054|Yes|.03283|02/28/2023|.03204|02/28/2023|.03225|02/28/2023|||SEDATIVE HYPNOTICS|1310|||||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||054|Yes|.0351|02/28/2023|.03425|02/28/2023|.03448|02/28/2023|||SEDATIVE HYPNOTICS|1311|||||No|No||TEVA USA|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00093009001|EPITOL 200 MG TABLET|100|EA|.55009|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||056|No|.17553|02/28/2023|.17131|02/28/2023|.17245|02/28/2023|||ANTICONVULSANTS|1312|||||No|No||TEVA USA|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00093010901|CARBAMAZEPINE 200 MG TABLET|100|EA|.55009|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||056|No|.17553|02/28/2023|.17131|02/28/2023|.17245|02/28/2023|||ANTICONVULSANTS|1313|||||No|No||TEVA USA|No|||||No|No|No||
carbamazepine|No|No|No|No|75%|00093010910|CARBAMAZEPINE 200 MG TABLET|1000|EA|.5336|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||056|No|.17553|02/28/2023|.17131|02/28/2023|.17245|02/28/2023|||ANTICONVULSANTS|1314|||||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||070|No|.02026|02/28/2023|.01977|02/28/2023|.0199|02/28/2023|||BETA-BLOCKERS|1315|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093013505|CARVEDILOL 6.25 MG TABLET|500|EA|.02515|11/15/2011||Yes|No||11/15/2011||Yes|No|11/15/2011||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.02026|02/28/2023|.01977|02/28/2023|.0199|02/28/2023|||BETA-BLOCKERS|1316|||||No|No||TEVA USA|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00093015001|ACETAMINOPHEN-COD #3 TABLET|100|EA|.0774|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|||Prescription required|No||109|Yes|.1764|03/14/2023|.17388|03/14/2023|.1656|03/14/2023|||ANALGESICS: NARCOTICS SHORT|1317|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|.6581|02/28/2023|.6423|02/28/2023|.64658|02/28/2023|||STEROIDS: TOPICAL HIGH|1318|||||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|.49584|02/28/2023|.48393|02/28/2023|.48716|02/28/2023|||STEROIDS: TOPICAL HIGH|1319|||||No|No||TEVA USA|No|||||No|No|No||
fluocinonide|No|No|No|No|75%|00093026292|FLUOCINONIDE 0.05% CREAM|60|GM|1.04453|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|.53542|02/28/2023|.52256|02/28/2023|.52605|02/28/2023|||STEROIDS: TOPICAL HIGH|1320|||||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|2.51728|08/23/2022|2.48132|08/23/2022|2.36316|08/23/2022|||STEROIDS: TOPICAL HIGH|1321|||||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|2.51728|03/01/2022|2.48132|03/01/2022|2.36316|03/01/2022|||STEROIDS: TOPICAL HIGH|1322|||||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|.85683|10/25/2022|.83626|10/25/2022|.84183|10/25/2022|||STEROIDS: TOPICAL HIGH|1323|||||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|.26919|02/28/2023|.26272|02/28/2023|.26447|02/28/2023|||STEROIDS: TOPICAL HIGH|1324|||||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|.4153|02/28/2023|.40533|02/28/2023|.40803|02/28/2023|||STEROIDS: TOPICAL HIGH|1325|||||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|.33836|02/28/2023|.33023|02/28/2023|.33243|02/28/2023|||STEROIDS: TOPICAL HIGH|1326|||||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|.66218|10/25/2022|.65272|10/25/2022|.62164|10/25/2022|||ANTIHISTAMINES: FIRST GENERATION|1327|||||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|.26754|02/28/2023|.26111|02/28/2023|.26285|02/28/2023||||1328|||||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|.26754|02/28/2023|.26111|02/28/2023|.26285|02/28/2023||||1329|||||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||059|Yes|.65658|02/28/2023|.64082|02/28/2023|.64508|02/28/2023|||NSAIDS|1330|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093031801|DILTIAZEM 30 MG TABLET|100|EA|.06445|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||045|No|.09197|02/28/2023|.08976|02/28/2023|.09036|02/28/2023|||CALCIUM CHANNEL BLOCKERS|1331|||||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||045|No|.09197|02/28/2023|.08976|02/28/2023|.09036|02/28/2023|||CALCIUM CHANNEL BLOCKERS|1332|||||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||045|No|.16527|02/28/2023|.1613|02/28/2023|.16237|02/28/2023|||CALCIUM CHANNEL BLOCKERS|1333|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093031905|DILTIAZEM 60 MG TABLET|500|EA|.09927|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||045|No|.16527|02/28/2023|.1613|02/28/2023|.16237|02/28/2023|||CALCIUM CHANNEL BLOCKERS|1334|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093032001|DILTIAZEM 90 MG TABLET|100|EA|.13815|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||045|No|.20647|02/28/2023|.20151|02/28/2023|.20285|02/28/2023|||CALCIUM CHANNEL BLOCKERS|1335|||||No|No||TEVA USA|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00093032101|DILTIAZEM 120 MG TABLET|100|EA|.18601|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||045|No|.30072|02/28/2023|.2935|02/28/2023|.29545|02/28/2023|||CALCIUM CHANNEL BLOCKERS|1336|||||No|No||TEVA USA|No|||||No|No|No||
lovastatin|Yes|No|No|No|75%|00093057610|LOVASTATIN 20 MG TABLET|1000|EA|.08797|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|07/01/2016||Prescription required|No||063|Yes|.04708|02/28/2023|.04595|02/28/2023|.04625|02/28/2023|||LIPOTROPICS: STATINS|1337|||||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|.40071|01/24/2023|.39109|01/24/2023|.39369|01/24/2023|||NSAIDS|1338|||||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|.40071|01/24/2023|.39109|01/24/2023|.39369|01/24/2023|||NSAIDS|1339|||||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||070|No|.02774|02/28/2023|.02707|02/28/2023|.02725|02/28/2023|||BETA-BLOCKERS|1340|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093075210|ATENOLOL 50 MG TABLET|1000|EA|.01417|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.02774|02/28/2023|.02707|02/28/2023|.02725|02/28/2023|||BETA-BLOCKERS|1341|||||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||070|No|.04487|02/28/2023|.04379|02/28/2023|.04408|02/28/2023|||BETA-BLOCKERS|1342|||||No|No||TEVA USA|No|||||No|No|No||
atenolol|No|No|No|No|75%|00093075305|ATENOLOL 100 MG TABLET|500|EA|.02557|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||02/08/2008||Yes|No|||Prescription required|No||070|No|.04487|02/28/2023|.04379|02/28/2023|.04408|02/28/2023|||BETA-BLOCKERS|1343|||||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|.13542|02/28/2023|.13216|02/28/2023|.13305|02/28/2023|||NSAIDS|1344|||||No|No||TEVA USA|No|||||No|No|No||
piroxicam|No|No|No|No|75%|00093075701|PIROXICAM 20 MG CAPSULE|100|EA|.90781|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|.50693|02/28/2023|.49476|02/28/2023|.49805|02/28/2023|||NSAIDS|1345|||||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|.50693|02/28/2023|.49476|02/28/2023|.49805|02/28/2023|||NSAIDS|1346|||||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||063|Yes|.06655|02/28/2023|.06495|02/28/2023|.06538|02/28/2023|||LIPOTROPICS: STATINS|1347|||||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||056|No|.26252|02/28/2023|.25621|02/28/2023|.25792|02/28/2023|||ANTICONVULSANTS|1348|||||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||070|No|.02447|02/28/2023|.02388|02/28/2023|.02404|02/28/2023|||BETA-BLOCKERS|1349|||||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||070|No|.02447|02/28/2023|.02388|02/28/2023|.02404|02/28/2023|||BETA-BLOCKERS|1350|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|No|No|No|No|75%|00093080701|FLUOXETINE HCL 20 MG TABLET|100|EA|.17341|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|008|No|.13538|02/28/2023|.13213|02/28/2023|.13301|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1351|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|No|No|No|No|75%|00093080756|FLUOXETINE HCL 20 MG TABLET|30|EA|.17343|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|008|No|.13538|02/28/2023|.13213|02/28/2023|.13301|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1352|||||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||215|No|.06919|02/28/2023|.06752|02/28/2023|.06797|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|1353|||||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||215|No|.09171|02/28/2023|.0895|02/28/2023|.0901|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|1354|||||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||215|No|.09171|02/28/2023|.0895|02/28/2023|.0901|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|1355|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081201|NORTRIPTYLINE HCL 50 MG CAP|100|EA|.14013|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.11353|02/28/2023|.1108|02/28/2023|.11154|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|1356|||||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||215|No|.11353|02/28/2023|.1108|02/28/2023|.11154|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|1357|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081301|NORTRIPTYLINE HCL 75 MG CAP|100|EA|.19405|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.15855|02/28/2023|.15474|02/28/2023|.15577|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|1358|||||No|No||TEVA USA|No|||||No|No|No||
nortriptyline HCl|No|No|No|No|75%|00093081305|NORTRIPTYLINE HCL 75 MG CAP|500|EA|.18921|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.15855|02/28/2023|.15474|02/28/2023|.15577|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|1359|||||No|No||TEVA USA|No|||||No|No|No||
oxaprozin|No|No|No|No|75%|00093092401|OXAPROZIN 600 MG TABLET|100|EA|1.26041|05/15/2003||Yes|No||05/15/2003||Yes|No|05/15/2003||Yes|No||||No|No|||Prescription required|Yes|01/23/2013|059|Yes|.61142|02/28/2023|.59674|02/28/2023|.60072|02/28/2023|||NSAIDS|1360|||||No|No||TEVA USA|No|||||No|No|No||
oxaprozin|No|No|No|No|75%|00093092405|OXAPROZIN 600 MG TABLET|500|EA|1.2289|05/15/2003||Yes|No||05/15/2003||Yes|No|05/15/2003||Yes|No||||No|No|||Prescription required|Yes|01/23/2013|059|Yes|.61142|02/28/2023|.59674|02/28/2023|.60072|02/28/2023|||NSAIDS|1361|||||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||063|Yes|.04861|02/28/2023|.04744|02/28/2023|.04775|02/28/2023|||LIPOTROPICS: STATINS|1362|||||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||063|Yes|.04861|02/28/2023|.04744|02/28/2023|.04775|02/28/2023|||LIPOTROPICS: STATINS|1363|||||No|No||TEVA USA|No|||||No|No|No||
lovastatin|Yes|No|No|No|75%|00093092810|LOVASTATIN 40 MG TABLET|1000|EA|.14143|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|07/01/2016||Prescription required|No||063|Yes|.0591|02/28/2023|.05768|02/28/2023|.05806|02/28/2023|||LIPOTROPICS: STATINS|1364|||||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||059|Yes|.2023|02/28/2023|.19744|02/28/2023|.19875|02/28/2023|||NSAIDS|1365|||||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||059|Yes|.2023|02/28/2023|.19744|02/28/2023|.19875|02/28/2023|||NSAIDS|1366|||||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||069|No|.37654|02/28/2023|.3675|02/28/2023|.36995|02/28/2023|||ANTIFUNGALS: ORAL|1367|||||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||090|No|.04869|02/28/2023|.04752|02/28/2023|.04783|02/28/2023|||ANXIOLYTICS|1368|||||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||090|No|.04869|02/28/2023|.04752|02/28/2023|.04783|02/28/2023|||ANXIOLYTICS|1369|||||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||059|Yes|.2337|12/27/2022|.22809|12/27/2022|.22961|12/27/2022|||NSAIDS|1370|||||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||059|Yes|.2337|12/27/2022|.22809|12/27/2022|.22961|12/27/2022|||NSAIDS|1371|||||No|No||TEVA USA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00093100601|NAPROXEN DR 500 MG TABLET|100|EA|.37895|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||07/01/2012||Yes|No|||Prescription required|No||059|Yes|3.5368|02/28/2023|3.45191|02/28/2023|3.4749|02/28/2023|||NSAIDS|1372|||||No|No||TEVA USA|No|||||No|No|No||
naproxen|No|No|No|No|75%|00093100605|NAPROXEN DR 500 MG TABLET|500|EA|.35998|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||07/01/2012||Yes|No|||Prescription required|No||059|Yes|3.5368|02/28/2023|3.45191|02/28/2023|3.4749|02/28/2023|||NSAIDS|1373|||||No|No||TEVA USA|No|||||No|No|No||
mupirocin|No|No|No|No|75%|00093101042|MUPIROCIN 2% OINTMENT|22|GM|.62662|11/14/2003||Yes|No||11/14/2003||Yes|No|11/14/2003||Yes|No||||No|No|||Prescription required|No||114|No|.1662|02/28/2023|.16221|02/28/2023|.16329|02/28/2023|||ANTIBIOTICS: TOPICAL|1374|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093102406|NEFAZODONE HCL 100 MG TABLET|60|EA|.58945|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|1.34341|01/11/2022|1.32422|01/11/2022|1.26116|01/11/2022|||ANTIDEPRESSANTS: OTHER|1375|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093102506|NEFAZODONE HCL 200 MG TABLET|60|EA|.6485|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|1.47799|01/11/2022|1.45688|01/11/2022|1.3875|01/11/2022|||ANTIDEPRESSANTS: OTHER|1376|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093102606|NEFAZODONE HCL 250 MG TABLET|60|EA|.67774|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|1.54463|01/11/2022|1.52257|01/11/2022|1.45006|01/11/2022|||ANTIDEPRESSANTS: OTHER|1377|||||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||070|No|.10033|02/28/2023|.09792|02/28/2023|.09857|02/28/2023|||BETA-BLOCKERS|1378|||||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||070|No|.0756|02/28/2023|.07378|02/28/2023|.07427|02/28/2023|||BETA-BLOCKERS|1379|||||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||070|No|.12647|02/28/2023|.12343|02/28/2023|.12425|02/28/2023|||BETA-BLOCKERS|1380|||||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||070|No|.64484|06/28/2016|.63562|06/28/2016|.60536|06/28/2016|||BETA-BLOCKERS|1381|||||No|No||TEVA USA|No|||||No|No|No||
cefprozil|No|No|No|No|75%|00093107701|CEFPROZIL 250 MG TABLET|100|EA|.58329|05/17/2006||Yes|No||05/17/2006||Yes|No|05/17/2006||Yes|No||||No|No|||Prescription required|No||046|No|.60448|02/28/2023|.58997|02/28/2023|.5939|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1382|||||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||046|No|1.12059|02/28/2023|1.09369|02/28/2023|1.10097|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1383|||||No|No||TEVA USA|No|||||No|No|No||
cefaclor|No|No|No|No|75%|00093108701|CEFACLOR ER 500 MG TABLET|100|EA|6.01767|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|13.7147|10/25/2022|13.51878|10/25/2022|12.87503|10/25/2022|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1384|||||No|No||TEVA USA|No|||||No|No|No||
etodolac|No|No|No|No|75%|00093111801|ETODOLAC ER 600 MG TABLET|100|EA|1.12629|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|2.05024|07/26/2022|2.00103|07/26/2022|2.01436|07/26/2022|||NSAIDS|1385|||||No|No||TEVA USA|No|||||No|No|No||
etodolac|No|No|No|No|75%|00093112201|ETODOLAC ER 400 MG TABLET|100|EA|.99803|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/23/2013|059|Yes|1.31723|02/28/2023|1.28561|02/28/2023|1.29417|02/28/2023|||NSAIDS|1386|||||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||550|No|1.70447|02/28/2023|1.66356|02/28/2023|1.67464|02/28/2023|||ONCOLOGY: ORAL - PROSTATE|1387|||||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|7.67481|02/28/2023|7.49061|02/28/2023|7.5405|02/28/2023||||1388|||||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|6.90579|02/28/2023|6.74005|02/28/2023|6.78493|02/28/2023||||1389|||||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|18.84506|03/29/2022|18.57585|03/29/2022|17.69128|03/29/2022||||1390|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093117201|PENICILLIN VK 250 MG TABLET|100|EA|.08264|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription required|No||209|No|.07227|02/28/2023|.07053|02/28/2023|.071|02/28/2023|||PENICILLINS|1391|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093117210|PENICILLIN VK 250 MG TABLET|1000|EA|.0785|12/08/2006||Yes|No||12/08/2006||Yes|No|12/08/2006||Yes|No||12/08/2006||Yes|No|||Prescription required|No||209|No|.07227|02/28/2023|.07053|02/28/2023|.071|02/28/2023|||PENICILLINS|1392|||||No|No||TEVA USA|No|||||No|No|No||
penicillin V potassium|No|No|No|No|75%|00093117410|PENICILLIN VK 500 MG TABLET|1000|EA|.13342|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription required|No||209|No|.09313|02/28/2023|.09089|02/28/2023|.0915|02/28/2023|||PENICILLINS|1393|||||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||115|No|.81303|04/26/2022|.79351|04/26/2022|.7988|04/26/2022|||ANTIBIOTICS: GI|1394|||||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||068|Yes|.08615|02/28/2023|.08408|02/28/2023|.08464|02/28/2023|||ANTICOAGULANTS|1395|||||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|.09093|02/18/2016||Yes|No||02/18/2016||Yes|No|02/18/2016||Yes|No||02/18/2016||Yes|No|||Prescription required|No||068|Yes|.08615|02/28/2023|.08408|02/28/2023|.08464|02/28/2023|||ANTICOAGULANTS|1396|||||No|No||TEVA USA|No|||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171301|WARFARIN SODIUM 2 MG TABLET|100|EA|.09786|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription required|No||068|Yes|.09715|02/28/2023|.09481|02/28/2023|.09544|02/28/2023|||ANTICOAGULANTS|1397|||||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|.09493|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription required|No||068|Yes|.09715|02/28/2023|.09481|02/28/2023|.09544|02/28/2023|||ANTICOAGULANTS|1398|||||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||068|Yes|.10292|02/28/2023|.10044|02/28/2023|.10111|02/28/2023|||ANTICOAGULANTS|1399|||||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||068|Yes|.10292|02/28/2023|.10044|02/28/2023|.10111|02/28/2023|||ANTICOAGULANTS|1400|||||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||068|Yes|.11495|02/28/2023|.11219|02/28/2023|.11293|02/28/2023|||ANTICOAGULANTS|1401|||||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|.10169|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription required|No||068|Yes|.0915|02/28/2023|.0893|02/28/2023|.08989|02/28/2023|||ANTICOAGULANTS|1402|||||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||068|Yes|.0915|02/28/2023|.0893|02/28/2023|.08989|02/28/2023|||ANTICOAGULANTS|1403|||||No|No||TEVA USA|No|||||No|No|No||
warfarin sodium|No|No|No|No|75%|00093171801|WARFARIN SODIUM 6 MG TABLET|100|EA|.14512|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription required|No||068|Yes|.10992|02/28/2023|.10728|02/28/2023|.10799|02/28/2023|||ANTICOAGULANTS|1404|||||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||068|Yes|.11834|02/28/2023|.11549|02/28/2023|.11626|02/28/2023|||ANTICOAGULANTS|1405|||||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|.10229|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription required|No||068|Yes|.09665|02/28/2023|.09433|02/28/2023|.09495|02/28/2023|||ANTICOAGULANTS|1406|||||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|.09923|09/17/2015||Yes|No||09/17/2015||Yes|No|09/17/2015||Yes|No||09/17/2015||Yes|No|||Prescription required|No||068|Yes|.09665|02/28/2023|.09433|02/28/2023|.09495|02/28/2023|||ANTICOAGULANTS|1407|||||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||068|Yes|.1029|02/28/2023|.10043|02/28/2023|.10109|02/28/2023|||ANTICOAGULANTS|1408|||||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|2.92034|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|6.65567|06/29/2021|6.56058|06/29/2021|6.24818|06/29/2021|||SKELETAL MUSCLE RELAXANTS|1409|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093192106|CYCLOBENZAPRINE ER 30 MG CAP|60|EA|2.92034|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|6.65567|06/29/2021|6.56058|06/29/2021|6.24818|06/29/2021|||SKELETAL MUSCLE RELAXANTS|1410|||||No|No||TEVA USA|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00093201312|SUMATRIPTAN 4 MG/0.5 ML INJECT|.5|ML|77.0904|06/14/2017||Yes|No||06/14/2017||Yes|No|06/14/2017||Yes|No||||No|No|||Prescription required|No||021|No|132.245|10/25/2022|129.07112|10/25/2022|129.93071|10/25/2022|||ANTIMIGRAINE AGENTS: TRIPTANS|1411|||||No|No||TEVA USA|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00093201412|SUMATRIPTAN 6 MG/0.5 ML INJECT|.5|ML|77.0904|06/14/2017||Yes|No||06/14/2017||Yes|No|06/14/2017||Yes|No||||No|No|||Prescription required|No||021|No|68.89298|02/28/2023|67.23954|02/28/2023|67.68735|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1412|||||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||018|No|.46318|02/28/2023|.45206|02/28/2023|.45507|02/28/2023|||MACROLIDES/KETOLIDES|1413|||||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||018|No|.30277|02/28/2023|.2955|02/28/2023|.29747|02/28/2023|||MACROLIDES/KETOLIDES|1414|||||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||018|No|.35544|02/28/2023|.3469|02/28/2023|.34921|02/28/2023|||MACROLIDES/KETOLIDES|1415|||||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||018|No|.57257|02/28/2023|.55882|02/28/2023|.56255|02/28/2023|||MACROLIDES/KETOLIDES|1416|||||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||027|Yes|.03381|02/28/2023|.03299|02/28/2023|.03321|02/28/2023|||ANTIPSYCHOTICS|1417|||||No|No||TEVA USA|No|||||No|No|No||
cilostazol|No|No|No|No|75%|00093206406|CILOSTAZOL 100 MG TABLET|60|EA|.15687|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||||No|No|||Prescription required|No|||No|.1309|02/28/2023|.12775|02/28/2023|.1286|02/28/2023||||1418|||||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|.11348|02/28/2023|.11075|02/28/2023|.11149|02/28/2023||||1419|||||No|No||TEVA USA|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00093206701|DOXAZOSIN MESYLATE 8 MG TAB|100|EA|.31957|02/18/2015||Yes|No||02/18/2015||Yes|No|02/18/2015||Yes|No||02/18/2015||Yes|No|||Prescription required|No||003|No|.11517|02/28/2023|.1124|02/28/2023|.11315|02/28/2023|||BPH TREATMENTS|1420|||||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||003|No|.1031|02/28/2023|.10062|02/28/2023|.10129|02/28/2023|||BPH TREATMENTS|1421|||||No|No||TEVA USA|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00093206901|DOXAZOSIN MESYLATE 2 MG TAB|100|EA|.28994|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||10/28/2014||Yes|No|||Prescription required|No||003|No|.08637|02/28/2023|.08429|02/28/2023|.08485|02/28/2023|||BPH TREATMENTS|1422|||||No|No||TEVA USA|No|||||No|No|No||
doxazosin mesylate|No|No|No|No|75%|00093207001|DOXAZOSIN MESYLATE 1 MG TAB|100|EA|.28994|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||10/28/2014||Yes|No|||Prescription required|No||003|No|.0986|02/28/2023|.09623|02/28/2023|.09687|02/28/2023|||BPH TREATMENTS|1423|||||No|No||TEVA USA|No|||||No|No|No||
norgestimate-ethinyl estradiol|Yes|Yes|No|No|75%|00093214062|TRI-LO-SPRINTEC TABLET|28|EA|.18018|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|.16266|02/28/2023|.15875|02/28/2023|.15981|02/28/2023||||1424|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||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||145|No|40.5358|02/28/2023|39.56294|02/28/2023|39.82642|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|1425|||||No|Yes|11.23|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|.4352|02/28/2023|.42475|02/28/2023|.42758|02/28/2023||||1426|||||No|No||TEVA USA|No|||||No|No|No||
liothyronine sodium|No|No|No|No|75%|00093217901|LIOTHYRONINE SOD 5 MCG TAB|100|EA|.23615|07/09/2021||Yes|No||07/09/2021||Yes|No|07/09/2021||Yes|No||||No|No|||Prescription required|No|||No|.31032|02/28/2023|.30287|02/28/2023|.30488|02/28/2023||||1427|||||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|.67129|01/24/2023|.65517|01/24/2023|.65954|01/24/2023||||1428|||||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||085|No|.0483|02/28/2023|.04714|02/28/2023|.04745|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1429|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220305|METOCLOPRAMIDE 10 MG TABLET|500|EA|.02999|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||085|No|.0483|02/28/2023|.04714|02/28/2023|.04745|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1430|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220310|METOCLOPRAMIDE 10 MG TABLET|1000|EA|.02863|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||085|No|.0483|02/28/2023|.04714|02/28/2023|.04745|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1431|||||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||085|No|.04315|02/28/2023|.04211|02/28/2023|.04239|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1432|||||No|No||TEVA USA|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00093220405|METOCLOPRAMIDE 5 MG TABLET|500|EA|.02717|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||085|No|.04315|02/28/2023|.04211|02/28/2023|.04239|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1433|||||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|.19322|02/28/2023|.18858|02/28/2023|.18983|02/28/2023||||1434|||||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|.19322|02/28/2023|.18858|02/28/2023|.18983|02/28/2023||||1435|||||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|1.32701|10/25/2022|1.30806|10/25/2022|1.24577|10/25/2022|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1436|||||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|1.63614|11/29/2022|1.59687|11/29/2022|1.6075|11/29/2022|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1437|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093226301|AMOXICILLIN 500 MG TABLET|100|EA|.16064|04/19/2006||Yes|No||04/19/2006||Yes|No|04/19/2006||Yes|No||04/19/2006||Yes|No|||Prescription required|No||209|No|.12365|02/28/2023|.12068|02/28/2023|.12148|02/28/2023|||PENICILLINS|1438|||||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||209|No|.14359|02/28/2023|.14014|02/28/2023|.14107|02/28/2023|||PENICILLINS|1439|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093226701|AMOXICILLIN 125 MG TAB CHEW|100|EA|.09369|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription required|No||209|No|.21354|10/25/2022|.21049|10/25/2022|.20046|10/25/2022|||PENICILLINS|1440|||||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||209|No|.26547|12/27/2022|.25909|12/27/2022|.26082|12/27/2022|||PENICILLINS|1441|||||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|.99437|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|10/25/2022|2.23387|10/25/2022|2.1275|10/25/2022|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1442|||||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|2.60554|02/28/2023|2.543|02/28/2023|2.55994|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1443|||||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|.60651|11/07/2002||Yes|No||11/07/2002||Yes|No|11/07/2002||Yes|No||11/07/2002||Yes|No|||Prescription required|No||046|No|.30111|02/28/2023|.29388|02/28/2023|.29584|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1444|||||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||046|No|.33644|02/28/2023|.32836|02/28/2023|.33055|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1445|||||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|.05955|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription required|No||046|No|.06091|02/28/2023|.05944|02/28/2023|.05984|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1446|||||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|.22252|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription required|No||046|No|.0727|02/28/2023|.07095|02/28/2023|.07142|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1447|||||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|.20722|02/28/2023|.20224|02/28/2023|.20359|02/28/2023||||1448|||||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|1.5405|02/28/2023|1.50352|02/28/2023|1.51354|02/28/2023||||1449|||||No|No||TEVA USA|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00093300893|LANSOPRAZOLE ODT 15 MG TABLET|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|4.56678|02/14/2023|4.45717|02/14/2023|4.48686|02/14/2023|||PROTON PUMP INHIBITORS|1450|||||No|No||TEVA USA|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00093300993|LANSOPRAZOLE ODT 30 MG TABLET|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|3.96501|02/28/2023|3.86984|02/28/2023|3.89562|02/28/2023|||PROTON PUMP INHIBITORS|1451|||||No|No||TEVA USA|No|||||No|No|No||
rasagiline mesylate|No|No|No|No|75%|00093306056|RASAGILINE MESYLATE 0.5 MG TAB|30|EA|2.9561|05/16/2017||Yes|No||05/16/2017||Yes|No|05/16/2017||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|015|No|1.69157|01/24/2023|1.65097|01/24/2023|1.66196|01/24/2023|||ANTIPARKINSON'S AGENTS|1452|||||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|1.55085|02/28/2023|1.51362|02/28/2023|1.52371|02/28/2023|||ANTIPARKINSON'S AGENTS|1453|||||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|Yes|.36308|02/28/2023|.35436|02/28/2023|.35672|02/28/2023|||STIMULANTS AND RELATED AGENTS|1454|||||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|Yes|.85628|02/28/2023|.83572|02/28/2023|.84129|02/28/2023|||STIMULANTS AND RELATED AGENTS|1455|||||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|.87385|02/28/2023|.85287|02/28/2023|.85855|02/28/2023|||STIMULANTS AND RELATED AGENTS|1456|||||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|.93755|02/28/2023|.91504|02/28/2023|.92114|02/28/2023|||STIMULANTS AND RELATED AGENTS|1457|||||No|No||TEVA USA|No|||||No|No|No||
risedronate sodium|No|No|No|No|75%|00093309829|RISEDRONATE SODIUM 35 MG TAB|12|EA|21.31115|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|2.01648|02/28/2023|1.96808|02/28/2023|1.98119|02/28/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1458|||||No|No||TEVA USA|No|||||No|No|No||
risedronate sodium|No|No|No|No|75%|00093309844|RISEDRONATE SODIUM 35 MG TAB|4|EA|21.31187|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|2.01648|02/28/2023|1.96808|02/28/2023|1.98119|02/28/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1459|||||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|6.94296|06/01/2016|6.84378|06/01/2016|6.51788|06/01/2016|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1460|||||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|48.56944|06/01/2016|47.87559|06/01/2016|45.5958|06/01/2016|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1461|||||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||209|No|.05384|02/28/2023|.05254|02/28/2023|.05289|02/28/2023|||PENICILLINS|1462|||||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||209|No|.05384|02/28/2023|.05254|02/28/2023|.05289|02/28/2023|||PENICILLINS|1463|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093310905|AMOXICILLIN 500 MG CAPSULE|500|EA|.07159|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||209|No|.07074|02/28/2023|.06904|02/28/2023|.0695|02/28/2023|||PENICILLINS|1464|||||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||209|No|.07074|02/28/2023|.06904|02/28/2023|.0695|02/28/2023|||PENICILLINS|1465|||||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|1.29265|02/28/2023|1.26162|02/28/2023|1.27002|02/28/2023||||1466|||||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|1.29265|02/28/2023|1.26162|02/28/2023|1.27002|02/28/2023||||1467|||||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||209|No|.42822|11/29/2022|.41794|11/29/2022|.42072|11/29/2022|||PENICILLINS|1468|||||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||209|No|1.01482|08/23/2022|.99046|08/23/2022|.99706|08/23/2022|||PENICILLINS|1469|||||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|1.95314|10/25/2022|1.92523|10/25/2022|1.83356|10/25/2022||||1470|||||No|No||TEVA USA|No|||||No|No|No||
disopyramide phosphate|No|No|No|No|75%|00093312901|DISOPYRAMIDE 150 MG CAPSULE|100|EA|.96616|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|1.56288|11/29/2022|1.52537|11/29/2022|1.53552|11/29/2022||||1471|||||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|12/30/2020|137.1179|12/30/2020|130.58848|12/30/2020||||1472|||||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|.31515|02/14/2023|.30758|02/14/2023|.30963|02/14/2023||||1473|||||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||046|No|.09011|02/28/2023|.08794|02/28/2023|.08853|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1474|||||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||046|No|.09011|02/28/2023|.08794|02/28/2023|.08853|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1475|||||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||046|No|.11182|02/28/2023|.10913|02/28/2023|.10986|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1476|||||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||046|No|.11182|02/28/2023|.10913|02/28/2023|.10986|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1477|||||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||046|No|.4752|02/28/2023|.46379|02/28/2023|.46688|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1478|||||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|2.91019|02/28/2023|2.84034|02/28/2023|2.85926|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1479|||||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||046|No|.28217|02/28/2023|.27539|02/28/2023|.27723|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1480|||||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||046|No|.28217|02/28/2023|.27539|02/28/2023|.27723|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1481|||||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||056|Yes|.02842|02/28/2023|.02773|02/28/2023|.02792|02/28/2023|||ANTICONVULSANTS|1482|||||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||056|Yes|.03354|02/28/2023|.03273|02/28/2023|.03295|02/28/2023|||ANTICONVULSANTS|1483|||||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||056|Yes|.03354|02/28/2023|.03273|02/28/2023|.03295|02/28/2023|||ANTICONVULSANTS|1484|||||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|.29027|02/28/2023|.2833|02/28/2023|.28519|02/28/2023|||ANTIFUNGALS: TOPICAL|1485|||||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|.27632|02/28/2023|.26968|02/28/2023|.27148|02/28/2023|||ANTIFUNGALS: TOPICAL|1486|||||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|.22254|02/28/2023|.21719|02/28/2023|.21864|02/28/2023|||ANTIFUNGALS: TOPICAL|1487|||||No|No||TEVA USA|No|||||No|No|No||
estradiol|No|No|No|No|75%|00093322308|ESTRADIOL 10 MCG VAGINAL INSRT|8|EA|8.34092|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription required|No|||Yes|8.1542|02/28/2023|7.95849|02/28/2023|8.0115|02/28/2023||||1488|||||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|8.1542|02/28/2023|7.95849|02/28/2023|8.0115|02/28/2023||||1489|||||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|42.29984|02/28/2023|41.28464|02/28/2023|41.55959|02/28/2023|||ANALGESICS: NARCOTICS LONG|1490|||||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|.28964|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||02/03/2021||Yes|No|||Prescription required|No||070|Yes|.27226|02/28/2023|.26572|02/28/2023|.26749|02/28/2023|||BETA-BLOCKERS|1491|||||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|.28964|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||02/03/2021||Yes|No|||Prescription required|No||070|Yes|.25235|02/28/2023|.24629|02/28/2023|.24793|02/28/2023|||BETA-BLOCKERS|1492|||||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||070|Yes|.31847|02/28/2023|.31082|02/28/2023|.31289|02/28/2023|||BETA-BLOCKERS|1493|||||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|.14935|02/28/2023|.14576|02/28/2023|.14673|02/28/2023||||1494|||||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|.40527|08/07/2020||Yes|No||08/07/2020||Yes|No|08/07/2020||Yes|No|Refer to program requirements|||No|No|||Prescription required|Yes|07/26/2018|171|Yes|.37135|02/28/2023|.36243|02/28/2023|.36485|02/28/2023|||PAH AGENTS: ORAL AND INHALED|1495|||||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||116|Yes|.02429|02/28/2023|.0237|02/28/2023|.02386|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1496|||||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||116|Yes|.41571|02/28/2023|.40573|02/28/2023|.40843|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1497|||||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||116|Yes|.02033|02/28/2023|.01984|02/28/2023|.01997|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1498|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093342205|CYCLOBENZAPRINE 10 MG TABLET|500|EA|.029|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||||No|No|||Prescription required|No||116|Yes|.02033|02/28/2023|.01984|02/28/2023|.01997|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1499|||||No|No||TEVA USA|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00093342210|CYCLOBENZAPRINE 10 MG TABLET|1000|EA|.029|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||||No|No|||Prescription required|No||116|Yes|.02033|02/28/2023|.01984|02/28/2023|.01997|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1500|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342501|LORAZEPAM 0.5 MG TABLET|100|EA|.01874|06/13/2022||Yes|No||06/13/2022||Yes|No|06/13/2022||Yes|No||||No|No|||Prescription required|No||090|Yes|.03671|02/28/2023|.03582|02/28/2023|.03606|02/28/2023|||ANXIOLYTICS|1501|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342505|LORAZEPAM 0.5 MG TABLET|500|EA|.01876|03/28/2022||Yes|No||03/28/2022||Yes|No|03/28/2022||Yes|No||||No|No|||Prescription required|No||090|Yes|.03671|02/28/2023|.03582|02/28/2023|.03606|02/28/2023|||ANXIOLYTICS|1502|||||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||090|Yes|.03671|02/28/2023|.03582|02/28/2023|.03606|02/28/2023|||ANXIOLYTICS|1503|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342601|LORAZEPAM 1 MG TABLET|100|EA|.02128|03/28/2022||Yes|No||03/28/2022||Yes|No|03/28/2022||Yes|No||||No|No|||Prescription required|No||090|Yes|.0401|02/28/2023|.03913|02/28/2023|.03939|02/28/2023|||ANXIOLYTICS|1504|||||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||090|Yes|.0401|02/28/2023|.03913|02/28/2023|.03939|02/28/2023|||ANXIOLYTICS|1505|||||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||090|Yes|.0401|02/28/2023|.03913|02/28/2023|.03939|02/28/2023|||ANXIOLYTICS|1506|||||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||090|Yes|.07102|02/28/2023|.06931|02/28/2023|.06977|02/28/2023|||ANXIOLYTICS|1507|||||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||090|Yes|.07102|02/28/2023|.06931|02/28/2023|.06977|02/28/2023|||ANXIOLYTICS|1508|||||No|No||TEVA USA|No|||||No|No|No||
lorazepam|No|No|No|No|90%|00093342710|LORAZEPAM 2 MG TABLET|1000|EA|.03209|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||||No|No|||Prescription required|No||090|Yes|.07102|02/28/2023|.06931|02/28/2023|.06977|02/28/2023|||ANXIOLYTICS|1509|||||No|No||TEVA USA|No|||||No|No|No||
estradiol|No|No|No|No|75%|00093354143|ESTRADIOL 0.01% CREAM|42.5|GM|2.7525|05/21/2018||Yes|No||05/21/2018||Yes|No|05/21/2018||Yes|No||||No|No|||Prescription required|No|||Yes|.67599|02/28/2023|.65976|02/28/2023|.66416|02/28/2023||||1510|||||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||007|Yes|.82407|02/28/2023|.80429|02/28/2023|.80964|02/28/2023|||STIMULANTS AND RELATED AGENTS|1511|||||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||007|Yes|.98176|02/28/2023|.95819|02/28/2023|.96457|02/28/2023|||STIMULANTS AND RELATED AGENTS|1512|||||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||007|Yes|.92544|02/28/2023|.90322|02/28/2023|.90924|02/28/2023|||STIMULANTS AND RELATED AGENTS|1513|||||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||007|Yes|.93831|02/28/2023|.91579|02/28/2023|.92188|02/28/2023|||STIMULANTS AND RELATED AGENTS|1514|||||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||007|Yes|.90753|02/28/2023|.88574|02/28/2023|.89164|02/28/2023|||STIMULANTS AND RELATED AGENTS|1515|||||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||007|Yes|1.03213|02/14/2023|1.00735|02/14/2023|1.01406|02/14/2023|||STIMULANTS AND RELATED AGENTS|1516|||||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||007|Yes|1.28073|02/28/2023|1.24999|02/28/2023|1.25831|02/28/2023|||STIMULANTS AND RELATED AGENTS|1517|||||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|86.51222|02/28/2023|84.43592|02/28/2023|84.99825|02/28/2023||||1518|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360782|FLUTICASONE-SALMETEROL 55-14|1|EA|50.31|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|105.69111|02/28/2023|103.15452|02/28/2023|103.84151|02/28/2023|||GLUCOCORTICOIDS: INHALED|1519|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360882|FLUTICASONE-SALMETEROL 113-14|1|EA|50.31|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|033|Yes|103.59962|02/28/2023|101.11322|02/28/2023|101.78662|02/28/2023|||GLUCOCORTICOIDS: INHALED|1520|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360982|FLUTICASONE-SALMETEROL 232-14|1|EA|50.31|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|033|Yes|103.65513|02/28/2023|101.1674|02/28/2023|101.84116|02/28/2023|||GLUCOCORTICOIDS: INHALED|1521|||||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|37.42235|02/28/2023|36.52421|02/28/2023|36.76745|02/28/2023|||ANTIVIRALS: TOPICAL|1522|||||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|9.17155|12/27/2022|8.95143|12/27/2022|9.01104|12/27/2022||||1523|||||No|No||TEVA USA|No|||||No|No|No||
methylergonovine maleate|No|No|No|No|75%|00093365528|METHYLERGONOVINE 0.2 MG TABLET|28|EA|8.53933|06/06/2019||Yes|No||06/06/2019||Yes|No|06/06/2019||Yes|No||||No|No|||Prescription required|No|||No|9.17155|12/27/2022|8.95143|12/27/2022|9.01104|12/27/2022||||1524|||||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|27.1556|02/28/2023|26.50386|02/28/2023|26.68037|02/28/2023|||ANALGESICS: NARCOTICS LONG|1525|||||No|No||TEVA USA|No|||||No|No|No||
buprenorphine|No|No|No|No|90%|00093365740|BUPRENORPHINE 10 MCG/HR PATCH|4|EA|34.15597|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|41.24133|02/28/2023|40.25153|02/28/2023|40.5196|02/28/2023|||ANALGESICS: NARCOTICS LONG|1526|||||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|71.4109|02/28/2023|69.69703|02/28/2023|70.1612|02/28/2023|||ANALGESICS: NARCOTICS LONG|1527|||||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|87.05663|02/28/2023|84.96727|02/28/2023|85.53313|02/28/2023|||ANALGESICS: NARCOTICS LONG|1528|||||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|5.34806|02/28/2023|5.2197|02/28/2023|5.25446|02/28/2023|||NSAIDS|1529|||||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|07/25/2019|240|No|23.38182|01/27/2021|23.0478|01/27/2021|21.95028|01/27/2021|||ANTIBIOTICS: INHALED|1530|||||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|07/25/2019|240|No|23.38182|01/27/2021|23.0478|01/27/2021|21.95028|01/27/2021|||ANTIBIOTICS: INHALED|1531|||||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|.33632|02/28/2023|.32824|02/28/2023|.33043|02/28/2023||||1532|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
cefadroxil|No|No|No|No|75%|00093405953|CEFADROXIL 1 GM TABLET|50|EA|2.306|05/21/2007||Yes|No||05/21/2007||Yes|No|05/21/2007||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|046|No|2.73124|02/28/2023|2.66569|02/28/2023|2.68344|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1533|||||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|3.45357|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|5.50318|02/28/2023|5.3711|02/28/2023|5.40687|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1534|||||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|5.26964|02/28/2023|5.14316|02/28/2023|5.17742|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1535|||||No|No||TEVA USA|No|||||Yes|No|No||
prazosin HCl|No|No|No|No|75%|00093406701|PRAZOSIN 1 MG CAPSULE|100|EA|.23103|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.1923|02/28/2023|.18768|02/28/2023|.18893|02/28/2023||||1536|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406710|PRAZOSIN 1 MG CAPSULE|1000|EA|.23103|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.1923|02/28/2023|.18768|02/28/2023|.18893|02/28/2023||||1537|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406801|PRAZOSIN 2 MG CAPSULE|100|EA|.34116|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.27102|02/28/2023|.26451|02/28/2023|.26627|02/28/2023||||1538|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406810|PRAZOSIN 2 MG CAPSULE|1000|EA|.34114|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.27102|02/28/2023|.26451|02/28/2023|.26627|02/28/2023||||1539|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406901|PRAZOSIN 5 MG CAPSULE|100|EA|.56317|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.50775|02/28/2023|.49556|02/28/2023|.49886|02/28/2023||||1540|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406905|PRAZOSIN 5 MG CAPSULE|500|EA|.56317|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.50775|02/28/2023|.49556|02/28/2023|.49886|02/28/2023||||1541|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406952|PRAZOSIN 5 MG CAPSULE|250|EA|.56314|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.50775|02/28/2023|.49556|02/28/2023|.49886|02/28/2023||||1542|||||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|1.59471|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|2.02461|01/24/2023|1.97601|01/24/2023|1.98917|01/24/2023|||ANTIBIOTICS: INHALED|1543|||||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|.03418|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription required|No||209|No|.07791|10/25/2022|.07679|10/25/2022|.07314|10/25/2022|||PENICILLINS|1544|||||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|.02504|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription required|No||209|No|.05708|10/25/2022|.05626|10/25/2022|.05359|10/25/2022|||PENICILLINS|1545|||||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|.03835|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription required|No||209|No|.06863|01/24/2023|.06698|01/24/2023|.06742|01/24/2023|||PENICILLINS|1546|||||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|.02777|12/07/2006||Yes|No||12/07/2006||Yes|No|12/07/2006||Yes|No||12/07/2006||Yes|No|||Prescription required|No||209|No|.04525|01/24/2023|.04416|01/24/2023|.04445|01/24/2023|||PENICILLINS|1547|||||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||046|No|.17672|02/28/2023|.17247|02/28/2023|.17362|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1548|||||No|No||TEVA USA|No|||||No|No|No||
cefdinir|No|No|No|No|75%|00093413673|CEFDINIR 125 MG/5 ML SUSP|100|ML|.26053|05/12/2008||Yes|No||05/12/2008||Yes|No|05/12/2008||Yes|No||||No|No|||Prescription required|No||046|No|.1392|02/28/2023|.13585|02/28/2023|.13676|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1549|||||No|No||TEVA USA|No|||||No|No|No||
cefdinir|No|No|No|No|75%|00093413764|CEFDINIR 250 MG/5 ML SUSP|60|ML|.5347|05/12/2008||Yes|No||05/12/2008||Yes|No|05/12/2008||Yes|No||||No|No|||Prescription required|No||046|No|.1987|02/07/2023|.19393|02/07/2023|.19522|02/07/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1550|||||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||046|No|.14885|02/28/2023|.14527|02/28/2023|.14624|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1551|||||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|08/28/2020|037|Yes|.52266|02/28/2023|.51519|02/28/2023|.49066|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1552|||||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|08/28/2020|037|Yes|.3155|02/28/2023|.30792|02/28/2023|.30997|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1553|||||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|08/28/2020|037|Yes|5.2528|03/29/2022|5.17776|03/29/2022|4.9312|03/29/2022|||BRONCHODILATORS: BETA AGONIST|1554|||||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|08/28/2020|037|Yes|.37352|02/28/2023|.36455|02/28/2023|.36698|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1555|||||No|No||TEVA USA|No|||||Yes|No|No||
amoxicillin|No|No|No|No|75%|00093415573|AMOXICILLIN 250 MG/5 ML SUSP|100|ML|.01599|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||209|No|.02151|02/28/2023|.02099|02/28/2023|.02113|02/28/2023|||PENICILLINS|1556|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093415579|AMOXICILLIN 250 MG/5 ML SUSP|80|ML|.01741|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||209|No|.02855|02/28/2023|.02786|02/28/2023|.02805|02/28/2023|||PENICILLINS|1557|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093415580|AMOXICILLIN 250 MG/5 ML SUSP|150|ML|.01498|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||209|No|.02175|02/28/2023|.02122|02/28/2023|.02136|02/28/2023|||PENICILLINS|1558|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416073|AMOXICILLIN 200 MG/5 ML SUSP|100|ML|.03134|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription required|No||209|No|.04266|02/28/2023|.04163|02/28/2023|.04191|02/28/2023|||PENICILLINS|1559|||||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||209|No|.04745|02/28/2023|.04631|02/28/2023|.04661|02/28/2023|||PENICILLINS|1560|||||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||209|No|.04179|02/28/2023|.04078|02/28/2023|.04105|02/28/2023|||PENICILLINS|1561|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416173|AMOXICILLIN 400 MG/5 ML SUSP|100|ML|.03375|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription required|No||209|No|.02875|03/14/2023|.02806|03/14/2023|.02824|03/14/2023|||PENICILLINS|1562|||||No|No||TEVA USA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00093416176|AMOXICILLIN 400 MG/5 ML SUSP|50|ML|.03379|04/18/2006||Yes|No||04/18/2006||Yes|No|04/18/2006||Yes|No||04/18/2006||Yes|No|||Prescription required|No||209|No|.04151|02/28/2023|.04051|02/28/2023|.04078|02/28/2023|||PENICILLINS|1563|||||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||209|No|.02692|02/28/2023|.02627|02/28/2023|.02644|02/28/2023|||PENICILLINS|1564|||||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||046|No|.08928|02/28/2023|.08713|02/28/2023|.08771|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1565|||||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||046|No|.08333|02/28/2023|.08133|02/28/2023|.08187|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1566|||||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||046|No|.08536|02/28/2023|.08331|02/28/2023|.08386|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1567|||||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||046|No|.08244|02/28/2023|.08046|02/28/2023|.08099|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1568|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093440401|CLOZAPINE 50 MG TABLET|100|EA|.5676|04/10/2007|02/28/2023|Yes|No||04/10/2007|02/28/2023|Yes|No|04/10/2007|02/28/2023|Yes|No||||No|No|||Prescription required|No||027|Yes|1.2936|03/14/2023|1.27512|03/14/2023|1.2144|03/14/2023|||ANTIPSYCHOTICS|1569|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|1.8178|02/28/2023|1.77417|02/28/2023|1.78598|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1570|||||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|1.5438|02/28/2023|1.50674|02/28/2023|1.51678|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1571|||||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|1.77874|02/28/2023|1.73605|02/28/2023|1.74761|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1572|||||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|1.09613|02/28/2023|1.06982|02/28/2023|1.07694|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1573|||||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|.89387|01/24/2023|.87241|01/24/2023|.87822|01/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1574|||||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||056|No|6.2207|06/29/2021|6.13183|06/29/2021|5.83984|06/29/2021|||ANTICONVULSANTS|1575|||||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||056|No|2.27589|01/24/2023|2.22126|01/24/2023|2.23606|01/24/2023|||ANTICONVULSANTS|1576|||||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|12/14/2021|3.15283|12/14/2021|3.00269|12/14/2021||||1577|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
disulfiram|No|No|No|No|75%|00093503601|DISULFIRAM 500 MG TABLET|100|EA|2.24541|08/02/2011||Yes|No||08/02/2011||Yes|No|08/02/2011||Yes|No||||No|No|||Prescription required|No|||No|5.11746|08/29/2017|5.04435|08/29/2017|4.80414|08/29/2017||||1578|||||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|2.44245|02/28/2023|2.38383|02/28/2023|2.3997|02/28/2023|||STIMULANTS AND RELATED AGENTS|1579|||||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|1.2143|02/28/2023|1.18515|02/28/2023|1.19304|02/28/2023|||STIMULANTS AND RELATED AGENTS|1580|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505610|ATORVASTATIN 10 MG TABLET|1000|EA|.05479|10/25/2022||Yes|No||10/25/2022||Yes|No|10/25/2022||Yes|No||10/25/2022||Yes|No|||Prescription required|No||063|Yes|.03146|02/28/2023|.0307|02/28/2023|.0309|02/28/2023|||LIPOTROPICS: STATINS|1581|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505698|ATORVASTATIN 10 MG TABLET|90|EA|.05479|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription required|No||063|Yes|.03146|02/28/2023|.0307|02/28/2023|.0309|02/28/2023|||LIPOTROPICS: STATINS|1582|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505705|ATORVASTATIN 80 MG TABLET|500|EA|.0782|10/25/2022||Yes|No||10/25/2022||Yes|No|10/25/2022||Yes|No||10/25/2022||Yes|No|||Prescription required|No||063|Yes|.09031|02/28/2023|.08814|02/28/2023|.08872|02/28/2023|||LIPOTROPICS: STATINS|1583|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505798|ATORVASTATIN 80 MG TABLET|90|EA|.0782|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription required|No||063|Yes|.09031|02/28/2023|.08814|02/28/2023|.08872|02/28/2023|||LIPOTROPICS: STATINS|1584|||||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||063|Yes|.05817|02/28/2023|.05677|02/28/2023|.05715|02/28/2023|||LIPOTROPICS: STATINS|1585|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505898|ATORVASTATIN 40 MG TABLET|90|EA|.0782|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription required|No||063|Yes|.05817|02/28/2023|.05677|02/28/2023|.05715|02/28/2023|||LIPOTROPICS: STATINS|1586|||||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||063|Yes|.04|02/28/2023|.03904|02/28/2023|.0393|02/28/2023|||LIPOTROPICS: STATINS|1587|||||No|No||TEVA USA|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00093505998|ATORVASTATIN 20 MG TABLET|90|EA|.0782|09/07/2017||Yes|No||09/07/2017||Yes|No|09/07/2017||Yes|No||09/07/2017||Yes|No|||Prescription required|No||063|Yes|.04|02/28/2023|.03904|02/28/2023|.0393|02/28/2023|||LIPOTROPICS: STATINS|1588|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506001|HYDROXYZINE HCL 10 MG TABLET|100|EA|.0731|10/14/2013||Yes|No||10/14/2013||Yes|No|10/14/2013||Yes|No||10/14/2013||Yes|No|||Prescription required|No||574|Yes|.03473|02/28/2023|.03389|02/28/2023|.03412|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1589|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506005|HYDROXYZINE HCL 10 MG TABLET|500|EA|.06708|05/24/2013||Yes|No||05/24/2013||Yes|No|05/24/2013||Yes|No||05/24/2013||Yes|No|||Prescription required|No||574|Yes|.03473|02/28/2023|.03389|02/28/2023|.03412|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1590|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506101|HYDROXYZINE HCL 25 MG TABLET|100|EA|.17393|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription required|No||574|Yes|.05099|02/28/2023|.04976|02/28/2023|.05009|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1591|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506105|HYDROXYZINE HCL 25 MG TABLET|500|EA|.16967|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription required|No||574|Yes|.05099|02/28/2023|.04976|02/28/2023|.05009|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1592|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506110|HYDROXYZINE HCL 25 MG TABLET|1000|EA|.16544|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription required|No||574|Yes|.05099|02/28/2023|.04976|02/28/2023|.05009|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1593|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506201|HYDROXYZINE HCL 50 MG TABLET|100|EA|.1333|05/24/2013||Yes|No||05/24/2013||Yes|No|05/24/2013||Yes|No||05/24/2013||Yes|No|||Prescription required|No||574|Yes|.09207|02/28/2023|.08986|02/28/2023|.09045|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1594|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506205|HYDROXYZINE HCL 50 MG TABLET|500|EA|.20695|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription required|No||574|Yes|.09207|02/28/2023|.08986|02/28/2023|.09045|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1595|||||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|.91013|01/24/2023|.88828|01/24/2023|.8942|01/24/2023|||ANGIOTENSIN MODULATORS|1596|||||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||090|No|.18446|02/28/2023|.18003|02/28/2023|.18123|02/28/2023|||ANXIOLYTICS|1597|||||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||090|No|.18446|02/28/2023|.18003|02/28/2023|.18123|02/28/2023|||ANXIOLYTICS|1598|||||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||237|No|5.0466|02/28/2023|4.92548|02/28/2023|4.95828|02/28/2023|||HIV / AIDS|1599|||||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||027|Yes|.39013|02/28/2023|.38076|02/28/2023|.3833|02/28/2023|||ANTIPSYCHOTICS|1600|||||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||027|Yes|.55418|02/28/2023|.54087|02/28/2023|.54448|02/28/2023|||ANTIPSYCHOTICS|1601|||||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||027|Yes|.86372|02/28/2023|.84299|02/28/2023|.8486|02/28/2023|||ANTIPSYCHOTICS|1602|||||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||027|Yes|1.03311|02/28/2023|1.00831|02/28/2023|1.01503|02/28/2023|||ANTIPSYCHOTICS|1603|||||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|No|17.11367|01/24/2023|16.70294|01/24/2023|16.81418|01/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1604|||||No|No||TEVA USA|No|||||No|No|No||
almotriptan malate|No|No|No|No|75%|00093526129|ALMOTRIPTAN MALATE 12.5 MG TAB|12|EA|14.43617|08/17/2015||Yes|No||08/17/2015||Yes|No|08/17/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|021|No|17.56898|02/28/2023|17.14732|02/28/2023|17.26152|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1605|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|No|No|No|No|75%|00093526256|FLUOXETINE HCL 60 MG TABLET|30|EA|.64041|02/02/2021||Yes|No||02/02/2021||Yes|No|02/02/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/30/2020|008|No|.65776|02/28/2023|.64197|02/28/2023|.64624|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1606|||||No|No||TEVA USA|No|||||No|No|No||
solifenacin succinate|No|No|No|No|75%|00093526356|SOLIFENACIN 5 MG TABLET|30|EA|.23506|02/02/2021|01/23/2024|Yes|No||02/02/2021|01/23/2024|Yes|No|02/02/2021|01/23/2024|Yes|No||||No|No|||Prescription required|Yes|07/26/2018|006|No|.22471|02/28/2023|.21931|02/28/2023|.22077|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1607|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||TEVA USA|No|||||No|No|No||
solifenacin succinate|No|No|No|No|75%|00093526456|SOLIFENACIN 10 MG TABLET|30|EA|.23506|02/02/2021|01/23/2024|Yes|No||02/02/2021|01/23/2024|Yes|No|02/02/2021|01/23/2024|Yes|No||||No|No|||Prescription required|Yes|07/26/2018|006|No|.21471|02/28/2023|.20955|02/28/2023|.21095|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1608|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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||Yes|No||01/31/2017||Yes|No|01/31/2017||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|007|Yes|1.67725|01/24/2023|1.63699|01/24/2023|1.64789|01/24/2023|||STIMULANTS AND RELATED AGENTS|1609|||||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||Yes|No||01/31/2017||Yes|No|01/31/2017||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|007|Yes|1.83355|02/14/2023|1.78954|02/14/2023|1.80146|02/14/2023|||STIMULANTS AND RELATED AGENTS|1610|||||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|1.59664|02/28/2023|1.55832|02/28/2023|1.56869|02/28/2023|||STIMULANTS AND RELATED AGENTS|1611|||||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|1.53028|02/28/2023|1.49355|02/28/2023|1.5035|02/28/2023|||STIMULANTS AND RELATED AGENTS|1612|||||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|1.30973|02/28/2023|1.27829|02/28/2023|1.2868|02/28/2023|||STIMULANTS AND RELATED AGENTS|1613|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093529801|METHYLPHENIDATE CD 40 MG CAP|100|EA|1.61589|01/31/2017||Yes|No||01/31/2017||Yes|No|01/31/2017||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|007|Yes|1.62774|02/28/2023|1.58867|02/28/2023|1.59925|02/28/2023|||STIMULANTS AND RELATED AGENTS|1614|||||No|No||TEVA USA|No|||||No|No|No||
norethindrone-e.estradiol-iron|Yes|Yes|No|No|75%|00093532862|JUNEL FE 24 TABLET|28|EA|.82503|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|.41439|02/28/2023|.40444|02/28/2023|.40713|02/28/2023||||1615|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093534601|METHYLPHENIDATE LA 20 MG CAP|100|EA|1.6988|07/27/2012||Yes|No||07/27/2012||Yes|No|07/27/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|1.1283|02/28/2023|1.10122|02/28/2023|1.10855|02/28/2023|||STIMULANTS AND RELATED AGENTS|1616|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093534701|METHYLPHENIDATE LA 30 MG CAP|100|EA|1.73745|07/27/2012||Yes|No||07/27/2012||Yes|No|07/27/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|1.24472|02/28/2023|1.21484|02/28/2023|1.22293|02/28/2023|||STIMULANTS AND RELATED AGENTS|1617|||||No|No||TEVA USA|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00093534801|METHYLPHENIDATE LA 40 MG CAP|100|EA|1.78574|07/27/2012||Yes|No||07/27/2012||Yes|No|07/27/2012||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|1.52718|02/14/2023|1.49052|02/14/2023|1.50045|02/14/2023|||STIMULANTS AND RELATED AGENTS|1618|||||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|1.37749|03/07/2023|1.35781|03/07/2023|1.29316|03/07/2023||||1619|||||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|7.42317|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|16.91793|02/09/2021|16.67625|02/09/2021|15.88214|02/09/2021|||ANTIPSYCHOTICS|1620|||||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|22.55734|02/09/2021|22.23509|02/09/2021|21.17628|02/09/2021|||ANTIPSYCHOTICS|1621|||||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|11/09/2018|1.72141|11/09/2018|1.63944|11/09/2018|||ANTIPSYCHOTICS|1622|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541701|CLOZAPINE ODT 25 MG TABLET|100|EA|1.03096|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|2.1217|08/23/2022|2.07077|08/23/2022|2.08457|08/23/2022|||ANTIPSYCHOTICS|1623|||||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|2.1217|08/23/2022|2.07077|08/23/2022|2.08457|08/23/2022|||ANTIPSYCHOTICS|1624|||||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|6.4089|03/29/2022|6.31735|03/29/2022|6.01652|03/29/2022|||ANTIPSYCHOTICS|1625|||||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|6.4092|03/29/2022|6.31764|03/29/2022|6.0168|03/29/2022|||ANTIPSYCHOTICS|1626|||||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|1.90155|02/28/2023|1.85591|02/28/2023|1.86827|02/28/2023||||1627|||||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|1.75117|06/18/2010||Yes|No||06/18/2010||Yes|No|06/18/2010||Yes|No||||No|No|||Prescription required|No|||Yes|1.0536|02/28/2023|1.02831|02/28/2023|1.03516|02/28/2023||||1628|||||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|1.75117|06/18/2010||Yes|No||06/18/2010||Yes|No|06/18/2010||Yes|No||||No|No|||Prescription required|No|||Yes|1.0536|02/28/2023|1.02831|02/28/2023|1.03516|02/28/2023||||1629|||||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|4.79456|10/25/2022|4.67949|10/25/2022|4.71065|10/25/2022|||ANTIPSYCHOTICS|1630|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550456|OLANZAPINE-FLUOXETINE 6-25 MG|30|EA|4.98198|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription required|Yes|01/25/2012|027|Yes|4.20453|11/29/2022|4.10362|11/29/2022|4.13095|11/29/2022|||ANTIPSYCHOTICS|1631|||||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|11.35428|01/24/2023|11.19207|01/24/2023|10.65912|01/24/2023|||ANTIPSYCHOTICS|1632|||||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|12/24/2019|16.86764|12/24/2019|16.06442|12/24/2019|||ANTIPSYCHOTICS|1633|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550756|OLANZAPINE-FLUOXETINE 12-50 MG|30|EA|7.50837|07/13/2012||Yes|No||07/13/2012||Yes|No|07/13/2012||Yes|No||||No|No|||Prescription required|Yes|01/25/2012|027|Yes|8.48618|05/17/2022|8.28251|05/17/2022|8.33767|05/17/2022|||ANTIPSYCHOTICS|1634|||||No|No||TEVA USA|No|||||No|No|No||
sildenafil citrate|No|No|No|No|75%|00093551798|SILDENAFIL 20 MG TABLET|90|EA|.3792|07/18/2013||Yes|No||07/18/2013||Yes|No|07/18/2013||Yes|No|Refer to program requirements|||No|No|||Prescription required|Yes|07/28/2022|171|Yes|.06803|02/28/2023|.06639|02/28/2023|.06683|02/28/2023|||PAH AGENTS: ORAL AND INHALED|1635|||||No|No||TEVA USA|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00093552606|ATAZANAVIR SULFATE 150 MG CAP|60|EA|3.16059|03/22/2018||Yes|No||03/22/2018||Yes|No|03/22/2018||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|5.1623|03/02/2021|5.08855|03/02/2021|4.84624|03/02/2021|||HIV / AIDS|1636|||||No|No||TEVA USA|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00093552706|ATAZANAVIR SULFATE 200 MG CAP|60|EA|3.16059|03/22/2018||Yes|No||03/22/2018||Yes|No|03/22/2018||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|5.1623|03/02/2021|5.08855|03/02/2021|4.84624|03/02/2021|||HIV / AIDS|1637|||||No|No||TEVA USA|No|||||No|No|No||
atazanavir sulfate|No|No|No|No|75%|00093552856|ATAZANAVIR SULFATE 300 MG CAP|30|EA|6.32119|03/22/2018||Yes|No||03/22/2018||Yes|No|03/22/2018||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|3.48342|02/28/2023|3.39981|02/28/2023|3.42246|02/28/2023|||HIV / AIDS|1638|||||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||054|Yes|.18332|02/28/2023|.17892|02/28/2023|.18011|02/28/2023|||SEDATIVE HYPNOTICS|1639|||||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||054|Yes|.09844|02/28/2023|.09607|02/28/2023|.09671|02/28/2023|||SEDATIVE HYPNOTICS|1640|||||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||054|Yes|.10033|02/28/2023|.09792|02/28/2023|.09857|02/28/2023|||SEDATIVE HYPNOTICS|1641|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555001|DEXMETHYLPHENIDATE ER 5 MG CAP|100|EA|.55147|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|.78225|02/28/2023|.76347|02/28/2023|.76856|02/28/2023|||STIMULANTS AND RELATED AGENTS|1642|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555101|DEXMETHYLPHENIDATE ER 10 MG CP|100|EA|.55147|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|.89512|02/28/2023|.87363|02/28/2023|.87945|02/28/2023|||STIMULANTS AND RELATED AGENTS|1643|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555201|DEXMETHYLPHENIDATE ER 15 MG CP|100|EA|.55147|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|.66887|02/28/2023|.65281|02/28/2023|.65716|02/28/2023|||STIMULANTS AND RELATED AGENTS|1644|||||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|1.61551|02/28/2023|1.57673|02/28/2023|1.58723|02/28/2023|||STIMULANTS AND RELATED AGENTS|1645|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555401|DEXMETHYLPHENIDATE ER 30 MG CP|100|EA|.91452|10/01/2014||Yes|No||10/01/2014||Yes|No|10/01/2014||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|1.72022|02/28/2023|1.67893|02/28/2023|1.69011|02/28/2023|||STIMULANTS AND RELATED AGENTS|1646|||||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|1.28044|02/28/2023|1.2497|02/28/2023|1.25803|02/28/2023|||STIMULANTS AND RELATED AGENTS|1647|||||No|No||TEVA USA|No|||||No|No|No||
erythromycin base|No|No|No|No|75%|00093557101|ERYTHROMYCIN 250 MG TABLET|100|EA|2.84423|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|5.24957|02/28/2023|5.12358|02/28/2023|5.1577|02/28/2023|||MACROLIDES/KETOLIDES|1648|||||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|5.24957|02/28/2023|5.12358|02/28/2023|5.1577|02/28/2023|||MACROLIDES/KETOLIDES|1649|||||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|7.49483|01/24/2023|7.31495|01/24/2023|7.36367|01/24/2023|||MACROLIDES/KETOLIDES|1650|||||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|7.49483|01/24/2023|7.31495|01/24/2023|7.36367|01/24/2023|||MACROLIDES/KETOLIDES|1651|||||No|No||TEVA USA|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00093573101|OXYCODONE HCL ER 10 MG TABLET|100|EA|1.04004|02/22/2016||Yes|No||02/22/2016||Yes|No|02/22/2016||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|2.37032|09/27/2022|2.33646|09/27/2022|2.2252|09/27/2022|||ANALGESICS: NARCOTICS LONG|1652|||||No|No||TEVA USA|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00093573201|OXYCODONE HCL ER 20 MG TABLET|100|EA|1.93955|02/22/2016||Yes|No||02/22/2016||Yes|No|02/22/2016||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|4.42038|08/23/2022|4.35723|08/23/2022|4.14975|08/23/2022|||ANALGESICS: NARCOTICS LONG|1653|||||No|No||TEVA USA|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00093573301|OXYCODONE HCL ER 40 MG TABLET|100|EA|3.32179|02/22/2016||Yes|No||02/22/2016||Yes|No|02/22/2016||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|7.57059|11/29/2022|7.46244|11/29/2022|7.10709|11/29/2022|||ANALGESICS: NARCOTICS LONG|1654|||||No|No||TEVA USA|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00093573401|OXYCODONE HCL ER 80 MG TABLET|100|EA|5.79644|02/22/2016||Yes|No||02/22/2016||Yes|No|02/22/2016||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|13.21049|12/27/2022|13.02177|12/27/2022|12.40169|12/27/2022|||ANALGESICS: NARCOTICS LONG|1655|||||No|No||TEVA USA|No|||||No|No|No||
mesalamine|No|No|No|No|75%|00093590786|MESALAMINE DR 400 MG CAPSULE|180|EA|1.4413|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|2.31542|02/28/2023|2.25984|02/28/2023|2.2749|02/28/2023|||ULCERATIVE COLITIS AGENTS|1656|||||No|No||TEVA USA|No|||||No|No|No||
lanthanum carbonate|No|No|No|No|75%|00093593898|LANTHANUM CARB 500 MG TAB CHEW|90|EA|2.94286|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|6.83905|11/09/2022|6.67491|11/09/2022|6.71936|11/09/2022|||PHOSPHATE BINDERS|1657|||||No|No||TEVA USA|No|||||No|No|No||
lanthanum carbonate|No|No|No|No|75%|00093593998|LANTHANUM CARB 750 MG TAB CHEW|90|EA|2.94286|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|6.707|11/09/2022|6.61118|11/09/2022|6.29636|11/09/2022|||PHOSPHATE BINDERS|1658|||||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|2.94286|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|7.19815|11/29/2022|7.02539|11/29/2022|7.07218|11/29/2022|||PHOSPHATE BINDERS|1659|||||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|1.87112|02/28/2023|1.82621|02/28/2023|1.83837|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1660|||||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|1.17919|02/28/2023|1.15088|02/28/2023|1.15855|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1661|||||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|129.31304|02/28/2023|126.20952|02/28/2023|127.05006|02/28/2023|||EPINEPHRINE: SELF-INJECTED|1662|||||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|130.29297|02/28/2023|127.16593|02/28/2023|128.01284|02/28/2023|||EPINEPHRINE: SELF-INJECTED|1663|||||No|No||TEVA USA|No|||||No|No|No||
L-norgest/e.estradiol-e.estrad|Yes|Yes|No|No|75%|00093603182|RIVELSA TABLET|91|EA|1.57079|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|3.57995|06/05/2018|3.52881|06/05/2018|3.36077|06/05/2018||||1664|||||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|.39418|02/28/2023|.38471|02/28/2023|.38728|02/28/2023||||1665|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
adapalene/benzoyl peroxide|No|No|No|No|75%|00093630345|ADAPALENE-BNZYL PEROX 0.3-2.5%|45|GM|5.03281|03/29/2022|11/28/2023|Yes|No||03/29/2022|11/28/2023|Yes|No|03/29/2022|11/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|104|No|1.09849|02/28/2023|1.07212|02/28/2023|1.07926|02/28/2023|||ACNE AGENTS: TOPICAL|1666|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||TEVA USA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00093645056|ESOMEPRAZOLE MAG DR 20 MG CAP|30|EA|4.76926|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|No|.16996|02/28/2023|.16588|02/28/2023|.16698|02/28/2023|||PROTON PUMP INHIBITORS|1667|||||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|No|.16996|02/28/2023|.16588|02/28/2023|.16698|02/28/2023|||PROTON PUMP INHIBITORS|1668|||||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|No|.17419|02/28/2023|.17|02/28/2023|.17114|02/28/2023|||PROTON PUMP INHIBITORS|1669|||||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|No|.17419|02/28/2023|.17|02/28/2023|.17114|02/28/2023|||PROTON PUMP INHIBITORS|1670|||||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||033|Yes|.88573|02/28/2023|.86447|02/28/2023|.87022|02/28/2023|||GLUCOCORTICOIDS: INHALED|1671|||||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||033|Yes|.88573|02/28/2023|.86447|02/28/2023|.87022|02/28/2023|||GLUCOCORTICOIDS: INHALED|1672|||||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||033|Yes|.55052|02/28/2023|.5373|02/28/2023|.54088|02/28/2023|||GLUCOCORTICOIDS: INHALED|1673|||||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||033|Yes|.55052|02/28/2023|.5373|02/28/2023|.54088|02/28/2023|||GLUCOCORTICOIDS: INHALED|1674|||||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||033|Yes|3.24897|02/28/2023|3.17099|02/28/2023|3.19211|02/28/2023|||GLUCOCORTICOIDS: INHALED|1675|||||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|1.41022|01/11/2022|1.39007|01/11/2022|1.32388|01/11/2022|||ANTIDEPRESSANTS: OTHER|1676|||||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|.55606|02/28/2023|.54271|02/28/2023|.54632|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1677|||||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|.55606|02/28/2023|.54271|02/28/2023|.54632|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1678|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716398|TOLTERODINE TART ER 2 MG CAP|90|EA|2.76422|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|.55606|02/28/2023|.54271|02/28/2023|.54632|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1679|||||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|.60826|02/28/2023|.59366|02/28/2023|.59761|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1680|||||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|.60826|02/28/2023|.59366|02/28/2023|.59761|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1681|||||No|No||TEVA USA|No|||||No|No|No||
tolterodine tartrate|No|No|No|No|75%|00093716498|TOLTERODINE TART ER 4 MG CAP|90|EA|2.76422|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|.60826|02/28/2023|.59366|02/28/2023|.59761|02/28/2023|||BLADDER RELAXANT PREPARATIONS|1682|||||No|No||TEVA USA|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00093716501|CELECOXIB 100 MG CAPSULE|100|EA|.51737|01/05/2015||Yes|No||01/05/2015||Yes|No|01/05/2015||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.1012|02/28/2023|.09877|02/28/2023|.09942|02/28/2023|||NSAIDS|1683|||||No|No||TEVA USA|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00093716505|CELECOXIB 100 MG CAPSULE|500|EA|.51737|01/05/2015||Yes|No||01/05/2015||Yes|No|01/05/2015||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.1012|02/28/2023|.09877|02/28/2023|.09942|02/28/2023|||NSAIDS|1684|||||No|No||TEVA USA|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00093716601|CELECOXIB 200 MG CAPSULE|100|EA|.85686|01/05/2015||Yes|No||01/05/2015||Yes|No|01/05/2015||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.11482|02/28/2023|.11206|02/28/2023|.11281|02/28/2023|||NSAIDS|1685|||||No|No||TEVA USA|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00093716605|CELECOXIB 200 MG CAPSULE|500|EA|.85686|01/05/2015||Yes|No||01/05/2015||Yes|No|01/05/2015||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.11482|02/28/2023|.11206|02/28/2023|.11281|02/28/2023|||NSAIDS|1686|||||No|No||TEVA USA|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00093717006|CELECOXIB 400 MG CAPSULE|60|EA|1.32031|01/05/2015||Yes|No||01/05/2015||Yes|No|01/05/2015||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.36283|02/28/2023|.35412|02/28/2023|.35648|02/28/2023|||NSAIDS|1687|||||No|No||TEVA USA|No|||||No|No|No||
etodolac|No|No|No|No|75%|00093717201|ETODOLAC ER 500 MG TABLET|100|EA|1.0602|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|1.36854|02/28/2023|1.33569|02/28/2023|1.34459|02/28/2023|||NSAIDS|1688|||||No|No||TEVA USA|No|||||No|No|No||
nefazodone HCl|No|No|No|No|75%|00093717801|NEFAZODONE HCL 50 MG TABLET|100|EA|.55994|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|1.27615|01/11/2022|1.25792|01/11/2022|1.19802|01/11/2022|||ANTIDEPRESSANTS: OTHER|1689|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|Yes|No|No|No|75%|00093718801|FLUOXETINE HCL 10 MG TABLET|100|EA|.14804|01/02/2020||Yes|No||01/02/2020||Yes|No|01/02/2020||Yes|No||09/01/2022||Yes|No|03/20/2020||Prescription required|Yes|07/28/2022|008|No|.21234|02/28/2023|.20724|02/28/2023|.20862|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1690|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|No|No|No|No|75%|00093718810|FLUOXETINE HCL 10 MG TABLET|1000|EA|.14804|07/10/2014||Yes|No||07/10/2014||Yes|No|07/10/2014||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|008|No|.21234|02/28/2023|.20724|02/28/2023|.20862|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1691|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|No|No|No|No|75%|00093718856|FLUOXETINE HCL 10 MG TABLET|30|EA|.14806|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|008|No|.21234|02/28/2023|.20724|02/28/2023|.20862|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1692|||||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||008|No|.07657|02/28/2023|.07473|02/28/2023|.07523|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1693|||||No|No||TEVA USA|No|||||No|No|No||
fluoxetine HCl|Yes|No|No|No|75%|00093719805|FLUOXETINE HCL 40 MG CAPSULE|500|EA|.63317|10/02/2008||Yes|No||10/02/2008||Yes|No|10/02/2008||Yes|No||||No|No|07/01/2016||Prescription required|No||008|No|.07657|02/28/2023|.07473|02/28/2023|.07523|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1694|||||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||008|No|.07657|02/28/2023|.07473|02/28/2023|.07523|02/28/2023|||ANTIDEPRESSANTS: SSRIs|1695|||||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||063|Yes|.06409|02/28/2023|.06255|02/28/2023|.06296|02/28/2023|||LIPOTROPICS: STATINS|1696|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093720198|PRAVASTATIN SODIUM 20 MG TAB|90|EA|.1159|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||063|Yes|.06409|02/28/2023|.06255|02/28/2023|.06296|02/28/2023|||LIPOTROPICS: STATINS|1697|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093720210|PRAVASTATIN SODIUM 40 MG TAB|1000|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||063|Yes|.09097|02/28/2023|.08878|02/28/2023|.08937|02/28/2023|||LIPOTROPICS: STATINS|1698|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093720298|PRAVASTATIN SODIUM 40 MG TAB|90|EA|.17008|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||063|Yes|.09097|02/28/2023|.08878|02/28/2023|.08937|02/28/2023|||LIPOTROPICS: STATINS|1699|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093727010|PRAVASTATIN SODIUM 80 MG TAB|1000|EA|.17009|05/12/2009||Yes|No||05/12/2009||Yes|No|05/12/2009||Yes|No||05/12/2009||Yes|No|07/01/2016||Prescription required|No||063|Yes|.17596|02/28/2023|.17173|02/28/2023|.17288|02/28/2023|||LIPOTROPICS: STATINS|1700|||||No|No||TEVA USA|No|||||No|No|No||
pravastatin sodium|Yes|No|No|No|75%|00093727098|PRAVASTATIN SODIUM 80 MG TAB|90|EA|.17008|05/12/2009|02/09/2024|Yes|No||05/12/2009|02/09/2024|Yes|No|05/12/2009|02/09/2024|Yes|No||05/12/2009|02/09/2024|Yes|No|07/01/2016|02/09/2024|Prescription required|No||063|Yes|.17596|02/28/2023|.17173|02/28/2023|.17288|02/28/2023|||LIPOTROPICS: STATINS|1701|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727105|PIOGLITAZONE HCL 15 MG TABLET|500|EA|.12089|05/22/2015||Yes|No||05/22/2015||Yes|No|05/22/2015||Yes|No||05/22/2015||Yes|No|||Prescription required|No||009|Yes|.08525|02/28/2023|.0832|02/28/2023|.08375|02/28/2023|||HYPOGLYCEMICS: TZD|1702|||||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||009|Yes|.08525|02/28/2023|.0832|02/28/2023|.08375|02/28/2023|||HYPOGLYCEMICS: TZD|1703|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727198|PIOGLITAZONE HCL 15 MG TABLET|90|EA|.12087|09/18/2015||Yes|No||09/18/2015||Yes|No|09/18/2015||Yes|No||09/18/2015||Yes|No|||Prescription required|No||009|Yes|.08525|02/28/2023|.0832|02/28/2023|.08375|02/28/2023|||HYPOGLYCEMICS: TZD|1704|||||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||009|Yes|.11933|02/28/2023|.11646|02/28/2023|.11724|02/28/2023|||HYPOGLYCEMICS: TZD|1705|||||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||009|Yes|.11933|02/28/2023|.11646|02/28/2023|.11724|02/28/2023|||HYPOGLYCEMICS: TZD|1706|||||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||009|Yes|.11933|02/28/2023|.11646|02/28/2023|.11724|02/28/2023|||HYPOGLYCEMICS: TZD|1707|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727305|PIOGLITAZONE HCL 45 MG TABLET|500|EA|.2004|02/02/2018||Yes|No||02/02/2018||Yes|No|02/02/2018||Yes|No||02/02/2018||Yes|No|||Prescription required|No||009|Yes|.1444|02/28/2023|.14093|02/28/2023|.14187|02/28/2023|||HYPOGLYCEMICS: TZD|1708|||||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||009|Yes|.1444|02/28/2023|.14093|02/28/2023|.14187|02/28/2023|||HYPOGLYCEMICS: TZD|1709|||||No|No||TEVA USA|No|||||No|No|No||
pioglitazone HCl|No|No|No|No|75%|00093727398|PIOGLITAZONE HCL 45 MG TABLET|90|EA|.20042|09/18/2015||Yes|No||09/18/2015||Yes|No|09/18/2015||Yes|No||09/18/2015||Yes|No|||Prescription required|No||009|Yes|.1444|02/28/2023|.14093|02/28/2023|.14187|02/28/2023|||HYPOGLYCEMICS: TZD|1710|||||No|No||TEVA USA|No|||||No|No|No||
raloxifene HCl|No|No|No|No|75%|00093729001|RALOXIFENE HCL 60 MG TABLET|100|EA|1.66732|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|.27218|02/28/2023|.26564|02/28/2023|.26741|02/28/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1711|||||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|.27218|02/28/2023|.26564|02/28/2023|.26741|02/28/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1712|||||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||070|No|.02309|02/28/2023|.02253|02/28/2023|.02268|02/28/2023|||BETA-BLOCKERS|1713|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093729505|CARVEDILOL 12.5 MG TABLET|500|EA|.02515|11/15/2011||Yes|No||11/15/2011||Yes|No|11/15/2011||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.02309|02/28/2023|.02253|02/28/2023|.02268|02/28/2023|||BETA-BLOCKERS|1714|||||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||070|No|.0321|02/28/2023|.03132|02/28/2023|.03153|02/28/2023|||BETA-BLOCKERS|1715|||||No|No||TEVA USA|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00093729605|CARVEDILOL 25 MG TABLET|500|EA|.02515|09/15/2010||Yes|No||09/15/2010||Yes|No|09/15/2010||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.0321|02/28/2023|.03132|02/28/2023|.03153|02/28/2023|||BETA-BLOCKERS|1716|||||No|No||TEVA USA|No|||||No|No|No||
celecoxib|No|No|No|No|75%|00093730606|CELECOXIB 50 MG CAPSULE|60|EA|.25083|01/05/2015||Yes|No||01/05/2015||Yes|No|01/05/2015||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.14562|02/28/2023|.14212|02/28/2023|.14307|02/28/2023|||NSAIDS|1717|||||No|No||TEVA USA|No|||||No|No|No||
clopidogrel bisulfate|No|No|No|No|75%|00093731405|CLOPIDOGREL 75 MG TABLET|500|EA|.07163|06/05/2012||Yes|No||06/05/2012||Yes|No|06/05/2012||Yes|No||06/05/2012||Yes|No|||Prescription required|No||004|No|.05987|02/28/2023|.05843|02/28/2023|.05882|02/28/2023|||PLATELET AGGREGATION INHIBITORS|1718|||||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||004|No|.05987|02/28/2023|.05843|02/28/2023|.05882|02/28/2023|||PLATELET AGGREGATION INHIBITORS|1719|||||No|No||TEVA USA|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00093733401|MYCOPHENOLATE 250 MG CAPSULE|100|EA|.27627|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription required|No||229|No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|1720|||||No|No||TEVA USA|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00093733405|MYCOPHENOLATE 250 MG CAPSULE|500|EA|.27627|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||09/23/2009||Yes|No|||Prescription required|No||229|No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|1721|||||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|No|.24651|02/28/2023|.24059|02/28/2023|.24219|02/28/2023|||PROTON PUMP INHIBITORS|1722|||||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|.12612|02/28/2023|.12309|02/28/2023|.12391|02/28/2023|||PROTON PUMP INHIBITORS|1723|||||No|No||TEVA USA|No|||||No|No|No||
calcitriol|No|No|No|No|75%|00093735201|CALCITRIOL 0.25 MCG CAPSULE|100|EA|.41086|08/14/2018||Yes|No||08/14/2018||Yes|No|08/14/2018||Yes|No||08/14/2018||Yes|No|||Prescription required|No|||No|.19851|02/28/2023|.19374|02/28/2023|.19503|02/28/2023||||1724|||||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|.28885|02/28/2023|.28191|02/28/2023|.28379|02/28/2023||||1725|||||No|No||TEVA USA|No|||||No|No|No||
finasteride|No|No|No|No|75%|00093735505|FINASTERIDE 5 MG TABLET|500|EA|.23056|04/01/2008||Yes|No||04/01/2008||Yes|No|04/01/2008||Yes|No||||No|No|||Prescription required|No||003|No|.06326|02/28/2023|.06174|02/28/2023|.06215|02/28/2023|||BPH TREATMENTS|1726|||||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||003|No|.06326|02/28/2023|.06174|02/28/2023|.06215|02/28/2023|||BPH TREATMENTS|1727|||||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||003|No|.06326|02/28/2023|.06174|02/28/2023|.06215|02/28/2023|||BPH TREATMENTS|1728|||||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|.05917|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||113|Yes|.11222|02/28/2023|.10952|02/28/2023|.11025|02/28/2023|||ANGIOTENSIN MODULATORS|1729|||||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||113|Yes|.11222|02/28/2023|.10952|02/28/2023|.11025|02/28/2023|||ANGIOTENSIN MODULATORS|1730|||||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|.05928|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||113|Yes|.11222|02/28/2023|.10952|02/28/2023|.11025|02/28/2023|||ANGIOTENSIN MODULATORS|1731|||||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||113|Yes|.13477|02/28/2023|.13153|02/28/2023|.13241|02/28/2023|||ANGIOTENSIN MODULATORS|1732|||||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||113|Yes|.13477|02/28/2023|.13153|02/28/2023|.13241|02/28/2023|||ANGIOTENSIN MODULATORS|1733|||||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||113|Yes|.13477|02/28/2023|.13153|02/28/2023|.13241|02/28/2023|||ANGIOTENSIN MODULATORS|1734|||||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||113|Yes|.13644|02/28/2023|.13316|02/28/2023|.13405|02/28/2023|||ANGIOTENSIN MODULATORS|1735|||||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||113|Yes|.13644|02/28/2023|.13316|02/28/2023|.13405|02/28/2023|||ANGIOTENSIN MODULATORS|1736|||||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||113|Yes|.13644|02/28/2023|.13316|02/28/2023|.13405|02/28/2023|||ANGIOTENSIN MODULATORS|1737|||||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||031|No|.1017|02/28/2023|.09925|02/28/2023|.09992|02/28/2023|||ANTIDEPRESSANTS: OTHER|1738|||||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||031|No|.1017|02/28/2023|.09925|02/28/2023|.09992|02/28/2023|||ANTIDEPRESSANTS: OTHER|1739|||||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||031|No|.11294|02/28/2023|.11022|02/28/2023|.11096|02/28/2023|||ANTIDEPRESSANTS: OTHER|1740|||||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||031|No|.11294|02/28/2023|.11022|02/28/2023|.11096|02/28/2023|||ANTIDEPRESSANTS: OTHER|1741|||||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||031|No|.1476|02/28/2023|.14405|02/28/2023|.14501|02/28/2023|||ANTIDEPRESSANTS: OTHER|1742|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093738698|VENLAFAXINE HCL ER 150 MG CAP|90|EA|.15842|07/09/2010||Yes|No||07/09/2010||Yes|No|07/09/2010||Yes|No||09/01/2022||Yes|No|||Prescription required|No||031|No|.1476|02/28/2023|.14405|02/28/2023|.14501|02/28/2023|||ANTIDEPRESSANTS: OTHER|1743|||||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|1.35429|02/28/2023|1.32178|02/28/2023|1.33058|02/28/2023|||FLUOROQUINOLONES: ORAL|1744|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739286|NIACIN ER 500 MG TABLET|180|EA|1.45745|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|.19387|02/28/2023|.18921|02/28/2023|.19047|02/28/2023|||LIPOTROPICS: OTHER|1745|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739386|NIACIN ER 750 MG TABLET|180|EA|2.07885|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|.41228|02/28/2023|.40238|02/28/2023|.40506|02/28/2023|||LIPOTROPICS: OTHER|1746|||||No|No||TEVA USA|No|||||No|No|No||
niacin|No|No|No|No|75%|00093739398|NIACIN ER 750 MG TABLET|90|EA|2.07885|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|.41228|02/28/2023|.40238|02/28/2023|.40506|02/28/2023|||LIPOTROPICS: OTHER|1747|||||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|.4762|02/28/2023|.46477|02/28/2023|.46786|02/28/2023|||LIPOTROPICS: OTHER|1748|||||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|.4762|02/28/2023|.46477|02/28/2023|.46786|02/28/2023|||LIPOTROPICS: OTHER|1749|||||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|Yes|3.06679|12/27/2022|2.99318|12/27/2022|3.01312|12/27/2022|||LIPOTROPICS: STATINS|1750|||||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|Yes|3.06679|12/27/2022|2.99318|12/27/2022|3.01312|12/27/2022|||LIPOTROPICS: STATINS|1751|||||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|Yes|3.61264|02/28/2023|3.52593|02/28/2023|3.54941|02/28/2023|||LIPOTROPICS: STATINS|1752|||||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|3.61264|02/28/2023|3.52593|02/28/2023|3.54941|02/28/2023|||LIPOTROPICS: STATINS|1753|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744601|FLUVASTATIN ER 80 MG TABLET|100|EA|2.78265|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|3.503|02/28/2023|3.41892|02/28/2023|3.44169|02/28/2023|||LIPOTROPICS: STATINS|1754|||||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|3.503|02/28/2023|3.41892|02/28/2023|3.44169|02/28/2023|||LIPOTROPICS: STATINS|1755|||||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|.2882|10/25/2022|.28128|10/25/2022|.28315|10/25/2022|||HYPOGLYCEMICS: METFORMINS|1756|||||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|.28929|02/28/2023|.28234|02/28/2023|.28422|02/28/2023|||HYPOGLYCEMICS: METFORMINS|1757|||||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|.28905|02/28/2023|.28211|02/28/2023|.28399|02/28/2023|||HYPOGLYCEMICS: METFORMINS|1758|||||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||021|No|.61058|02/28/2023|.59592|02/28/2023|.59989|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1759|||||No|No||TEVA USA|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00093747143|RIZATRIPTAN 5 MG TABLET|18|EA|.64332|04/15/2014||Yes|No||04/15/2014||Yes|No|04/15/2014||Yes|No||||No|No|||Prescription required|No||021|No|.61058|02/28/2023|.59592|02/28/2023|.59989|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1760|||||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||021|No|.44968|02/28/2023|.43888|02/28/2023|.44181|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1761|||||No|No||TEVA USA|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00093747243|RIZATRIPTAN 10 MG TABLET|18|EA|.64332|04/15/2014||Yes|No||04/15/2014||Yes|No|04/15/2014||Yes|No||||No|No|||Prescription required|No||021|No|.44968|02/28/2023|.43888|02/28/2023|.44181|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1762|||||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||502|No|1.1956|03/02/2021|1.17852|03/02/2021|1.1224|03/02/2021|||ONCOLOGY: ORAL - BREAST|1763|||||No|No||TEVA USA|No|||||Yes|No|No||
capecitabine|No|No|No|No|75%|00093747489|CAPECITABINE 500 MG TABLET|120|EA|.73995|09/12/2014||Yes|No||09/12/2014||Yes|No|09/12/2014||Yes|No||||No|No|||Prescription required|No||502|No|.5561|02/28/2023|.54275|02/28/2023|.54636|02/28/2023|||ONCOLOGY: ORAL - BREAST|1764|||||No|No||TEVA USA|No|||||Yes|No|No||
montelukast sodium|No|No|No|No|75%|00093748756|MONTELUKAST SOD 4 MG GRANULES|30|EA|1.30533|03/22/2018||Yes|No||03/22/2018||Yes|No|03/22/2018||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|042|Yes|1.20604|02/28/2023|1.17709|02/28/2023|1.18493|02/28/2023|||LEUKOTRIENE MODIFIERS|1765|||||No|No||TEVA USA|No|||||No|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|Yes|2.97192|02/28/2023|2.90059|02/28/2023|2.91991|02/28/2023|||GLUCOCORTICOIDS: INHALED|1766|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093751731|FLUTICASONE-SALMETEROL 100-50|60|EA|.67158|10/19/2022||Yes|No||10/19/2022||Yes|No|10/19/2022||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|033|Yes|1.31548|02/28/2023|1.2839|02/28/2023|1.29245|02/28/2023|||GLUCOCORTICOIDS: INHALED|1767|||||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|Yes|1.63392|02/28/2023|1.5947|02/28/2023|1.60532|02/28/2023|||GLUCOCORTICOIDS: INHALED|1768|||||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||502|No|.11003|02/28/2023|.10738|02/28/2023|.1081|02/28/2023|||ONCOLOGY: ORAL - BREAST|1769|||||No|No||TEVA USA|No|||||No|No|No||
letrozole|No|No|No|No|75%|00093762056|LETROZOLE 2.5 MG TABLET|30|EA|.15766|06/16/2011||Yes|No||06/16/2011||Yes|No|06/16/2011||Yes|No||||No|No|||Prescription required|No||502|No|.1023|02/28/2023|.09984|02/28/2023|.1005|02/28/2023|||ONCOLOGY: ORAL - BREAST|1770|||||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||173|No|.6088|02/28/2023|.59418|02/28/2023|.59814|02/28/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1771|||||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||173|No|1.96323|02/28/2023|1.91611|02/28/2023|1.92887|02/28/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1772|||||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||551|No|54.67354|11/09/2022|53.89249|11/09/2022|51.32618|11/09/2022|||ONCOLOGY: ORAL - LUNG|1773|||||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||551|No|210.89012|03/19/2021|207.8774|03/19/2021|197.97848|03/19/2021|||ONCOLOGY: ORAL - LUNG|1774|||||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||551|No|238.53232|03/19/2021|235.12471|03/19/2021|223.9283|03/19/2021|||ONCOLOGY: ORAL - LUNG|1775|||||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|78.54282|02/28/2023|76.65779|02/28/2023|77.16832|02/28/2023||||1776|||||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|Yes|.06531|02/28/2023|.06374|02/28/2023|.06416|02/28/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|1777|||||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||237|No|.58212|02/28/2023|.56814|02/28/2023|.57193|02/28/2023|||HIV / AIDS|1778|||||No|No||TEVA USA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00093776624|EVEROLIMUS 2.5 MG TABLET|28|EA|98.5841|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription required|No||548|No|224.68004|12/30/2020|221.47032|12/30/2020|210.92412|12/30/2020|||ONCOLOGY: ORAL - RENAL CELL|1779|||||No|No||TEVA USA|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00093776724|EVEROLIMUS 5 MG TABLET|28|EA|103.11737|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription required|No||548|No|235.01169|12/30/2020|231.65438|12/30/2020|220.62322|12/30/2020|||ONCOLOGY: ORAL - RENAL CELL|1780|||||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|103.11737|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription required|No||548|No|235.01169|12/30/2020|231.65438|12/30/2020|220.62322|12/30/2020|||ONCOLOGY: ORAL - RENAL CELL|1781|||||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|13.91811|02/28/2023|13.58407|02/28/2023|13.67454|02/28/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1782|||||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|13.91811|02/28/2023|13.58407|02/28/2023|13.67454|02/28/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1783|||||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|09/14/2016|11.77071|09/14/2016|11.2102|09/14/2016|||ANALGESICS: NARCOTICS SHORT|1784|||||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|15.1289|05/23/2017|14.91277|05/23/2017|14.20264|05/23/2017|||ANALGESICS: NARCOTICS SHORT|1785|||||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|18.53048|09/20/2016|18.26576|09/20/2016|17.39596|09/20/2016|||ANALGESICS: NARCOTICS SHORT|1786|||||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|11/28/2017|21.64226|11/28/2017|20.61168|11/28/2017|||ANALGESICS: NARCOTICS SHORT|1787|||||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|28.5451|01/24/2017|28.13731|01/24/2017|26.79744|01/24/2017|||ANALGESICS: NARCOTICS SHORT|1788|||||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|09/14/2016|34.70258|09/14/2016|33.05008|09/14/2016|||ANALGESICS: NARCOTICS SHORT|1789|||||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|23.88524|08/30/2021|23.54402|08/30/2021|22.42288|08/30/2021||||1790|||||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|.16238|10/25/2022|.16006|10/25/2022|.15244|10/25/2022||||1791|||||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|.20776|10/25/2022|.20479|10/25/2022|.19504|10/25/2022||||1792|||||No|No||TEVA USA|No|||||No|No|No||
glyburide,micronized|Yes|No|No|No|75%|00093803505|GLYBURIDE MICRO 3 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|.19729|10/25/2022|.19447|10/25/2022|.18521|10/25/2022||||1793|||||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|.20272|11/29/2022|.19785|11/29/2022|.19917|11/29/2022||||1794|||||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||056|No|8.5518|06/25/2018|8.42963|06/25/2018|8.02822|06/25/2018|||ANTICONVULSANTS|1795|||||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|.76113|02/28/2023|.74286|02/28/2023|.74781|02/28/2023||||1796|||||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||056|No|11.19944|06/25/2018|11.03944|06/25/2018|10.51376|06/25/2018|||ANTICONVULSANTS|1797|||||No|No||TEVA USA|No|||||No|No|No||
ibuprofen/famotidine|No|No|No|No|75%|00093810798|IBUPROFEN-FAMOTIDIN 800-26.6MG|90|EA|1.93021|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|2.67028|02/28/2023|2.60619|02/28/2023|2.62355|02/28/2023|||NSAIDS|1798|||||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||025|No|.26593|01/24/2023|.25954|01/24/2023|.26127|01/24/2023|||ANTIVIRALS: ORAL|1799|||||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||025|No|.47519|02/28/2023|.46378|02/28/2023|.46687|02/28/2023|||ANTIVIRALS: ORAL|1800|||||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||025|No|.8516|02/28/2023|.83116|02/28/2023|.83669|02/28/2023|||ANTIVIRALS: ORAL|1801|||||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||027|Yes|.05541|02/28/2023|.05408|02/28/2023|.05444|02/28/2023|||ANTIPSYCHOTICS|1802|||||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||027|Yes|.11307|01/24/2023|.11035|01/24/2023|.11109|01/24/2023|||ANTIPSYCHOTICS|1803|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093816401|QUETIAPINE FUMARATE 300 MG TAB|100|EA|.72936|04/17/2012||Yes|No||04/17/2012||Yes|No|04/17/2012||Yes|No||||No|No|||Prescription required|No||027|Yes|.14889|02/28/2023|.14531|02/28/2023|.14628|02/28/2023|||ANTIPSYCHOTICS|1804|||||No|No||TEVA USA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00093816501|QUETIAPINE FUMARATE 400 MG TAB|100|EA|.8572|04/17/2012||Yes|No||04/17/2012||Yes|No|04/17/2012||Yes|No||||No|No|||Prescription required|No||027|Yes|.17588|02/28/2023|.17165|02/28/2023|.1728|02/28/2023|||ANTIPSYCHOTICS|1805|||||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||027|Yes|.04901|02/28/2023|.04783|02/28/2023|.04815|02/28/2023|||ANTIPSYCHOTICS|1806|||||No|No||TEVA USA|No|||||No|No|No||
oseltamivir phosphate|No|No|No|No|75%|00093818064|OSELTAMIVIR 6 MG/ML SUSPENSION|60|ML|.49636|11/20/2019||Yes|No||11/20/2019||Yes|No|11/20/2019||Yes|No||||No|No|||Prescription required|No||025|No|.37544|01/03/2023|.36642|01/03/2023|.36886|01/03/2023|||ANTIVIRALS: ORAL|1807|||||No|No||TEVA USA|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00093819201|CIMETIDINE 300 MG TABLET|100|EA|.15888|02/02/2018||Yes|No||02/02/2018||Yes|No|02/02/2018||Yes|No||||No|No|||Prescription required|No|||No|.31192|02/28/2023|.30443|02/28/2023|.30646|02/28/2023||||1808|||||No|No||TEVA USA|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00093819928|SUNITINIB MALATE 12.5 MG CAP|28|EA|75.08214|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription required|No||548|No|171.11744|11/14/2022|168.67291|11/14/2022|160.64086|11/14/2022|||ONCOLOGY: ORAL - RENAL CELL|1809|||||No|No||TEVA USA|No|||||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||548|No|342.2356|11/14/2022|337.34652|11/14/2022|321.2824|11/14/2022|||ONCOLOGY: ORAL - RENAL CELL|1810|||||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||548|No|513.35374|11/14/2022|506.02011|11/14/2022|481.92392|11/14/2022|||ONCOLOGY: ORAL - RENAL CELL|1811|||||No|No||TEVA USA|No|||||No|No|No||
sunitinib malate|No|No|No|No|75%|00093823128|SUNITINIB MALATE 50 MG CAPSULE|28|EA|261.41542|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||||No|No|||Prescription required|No||548|No|595.78399|11/09/2022|587.27279|11/09/2022|559.30742|11/09/2022|||ONCOLOGY: ORAL - RENAL CELL|1812|||||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||113|Yes|.23159|02/28/2023|.22603|02/28/2023|.22753|02/28/2023|||ANGIOTENSIN MODULATORS|1813|||||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||113|Yes|.23159|02/28/2023|.22603|02/28/2023|.22753|02/28/2023|||ANGIOTENSIN MODULATORS|1814|||||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||113|Yes|.19871|02/28/2023|.19394|02/28/2023|.19523|02/28/2023|||ANGIOTENSIN MODULATORS|1815|||||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||113|Yes|.19871|02/28/2023|.19394|02/28/2023|.19523|02/28/2023|||ANGIOTENSIN MODULATORS|1816|||||No|No||TEVA USA|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00093830501|CIMETIDINE 800 MG TABLET|100|EA|.49617|03/08/2011||Yes|No||03/08/2011||Yes|No|03/08/2011||Yes|No||03/08/2011||Yes|No|||Prescription required|No|||No|.95036|02/28/2023|.92755|02/28/2023|.93372|02/28/2023||||1817|||||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|No|3.13924|02/28/2023|3.06389|02/28/2023|3.0843|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1818|||||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|No|3.57095|02/28/2023|3.48524|02/28/2023|3.50845|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1819|||||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|.07676|01/24/2023|.07491|01/24/2023|.07541|01/24/2023||||1820|||||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|.07885|02/28/2023|.07695|02/28/2023|.07747|02/28/2023||||1821|||||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|.07885|02/28/2023|.07695|02/28/2023|.07747|02/28/2023||||1822|||||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|.07885|02/28/2023|.07695|02/28/2023|.07747|02/28/2023||||1823|||||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|.10111|02/28/2023|.09868|02/28/2023|.09934|02/28/2023||||1824|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834405|GLYBURIDE 5 MG TABLET|500|EA|.11667|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|.10111|02/28/2023|.09868|02/28/2023|.09934|02/28/2023||||1825|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093834410|GLYBURIDE 5 MG TABLET|1000|EA|.10374|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|.10111|02/28/2023|.09868|02/28/2023|.09934|02/28/2023||||1826|||||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|.15563|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription required|No||046|No|.05521|02/28/2023|.05388|02/28/2023|.05424|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1827|||||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||046|No|.06067|02/28/2023|.05921|02/28/2023|.0596|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1828|||||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|.16505|02/01/2005||Yes|No||02/01/2005||Yes|No|02/01/2005||Yes|No||02/01/2005||Yes|No|||Prescription required|No||046|No|.07825|02/28/2023|.07637|02/28/2023|.07688|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1829|||||No|No||TEVA USA|No|||||No|No|No||
mexiletine HCl|No|No|No|No|75%|00093873901|MEXILETINE 150 MG CAPSULE|100|EA|.55611|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.44058|02/28/2023|.43|02/28/2023|.43286|02/28/2023||||1830|||||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|.58053|02/28/2023|.56659|02/28/2023|.57037|02/28/2023||||1831|||||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|1.10618|02/28/2023|1.07963|02/28/2023|1.08682|02/28/2023||||1832|||||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||229|No|.40012|02/28/2023|.39051|02/28/2023|.39311|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|1833|||||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|1.00886|02/28/2023|.98464|02/28/2023|.9912|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|1834|||||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||229|No|1.44559|02/28/2023|1.41089|02/28/2023|1.42029|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|1835|||||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||031|No|.06155|02/28/2023|.06007|02/28/2023|.06047|02/28/2023|||ANTIDEPRESSANTS: OTHER|1836|||||No|No||TEVA USA|No|||||No|No|No||
venlafaxine HCl|No|No|No|No|75%|00093914801|VENLAFAXINE HCL 37.5 MG TABLET|100|EA|.13781|06/24/2020||Yes|No||06/24/2020||Yes|No|06/24/2020||Yes|No||09/01/2022||Yes|No|||Prescription required|No||031|No|.09209|02/28/2023|.08987|02/28/2023|.09047|02/28/2023|||ANTIDEPRESSANTS: OTHER|1837|||||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||031|No|.06992|02/28/2023|.06824|02/28/2023|.06869|02/28/2023|||ANTIDEPRESSANTS: OTHER|1838|||||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||031|No|.07732|02/28/2023|.07546|02/28/2023|.07596|02/28/2023|||ANTIDEPRESSANTS: OTHER|1839|||||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||031|No|.10489|02/28/2023|.10237|02/28/2023|.10305|02/28/2023|||ANTIDEPRESSANTS: OTHER|1840|||||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|.958|01/24/2023|.935|01/24/2023|.94123|01/24/2023|||NSAIDS|1841|||||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|.958|01/24/2023|.935|01/24/2023|.94123|01/24/2023|||NSAIDS|1842|||||No|No||TEVA USA|No|||||No|No|No||
mesalamine|No|No|No|No|75%|00093922489|MESALAMINE ER 0.375 GRAM CAP|120|EA|1.35499|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|.89135|02/28/2023|.86995|02/28/2023|.87575|02/28/2023|||ULCERATIVE COLITIS AGENTS|1843|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093929067|CLONAZEPAM 0.125 MG ODT|60|EA|.40211|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription required|No||056|Yes|.57811|02/28/2023|.56423|02/28/2023|.56799|02/28/2023|||ANTICONVULSANTS|1844|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093929167|CLONAZEPAM 0.25 MG ODT|60|EA|.40211|11/09/2022||Yes|No||11/09/2022||Yes|No|11/09/2022||Yes|No||11/09/2022||Yes|No|||Prescription required|No||056|Yes|.52018|02/28/2023|.50769|02/28/2023|.51107|02/28/2023|||ANTICONVULSANTS|1845|||||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||056|Yes|.707|02/28/2023|.69003|02/28/2023|.69462|02/28/2023|||ANTICONVULSANTS|1846|||||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||056|Yes|.60515|02/28/2023|.59062|02/28/2023|.59455|02/28/2023|||ANTICONVULSANTS|1847|||||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||056|Yes|1.2534|02/28/2023|1.22331|02/28/2023|1.23146|02/28/2023|||ANTICONVULSANTS|1848|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093936401|GLYBURIDE 5 MG TABLET|100|EA|.13738|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|.10111|02/28/2023|.09868|02/28/2023|.09934|02/28/2023||||1849|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093936405|GLYBURIDE 5 MG TABLET|500|EA|.13394|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|.10111|02/28/2023|.09868|02/28/2023|.09934|02/28/2023||||1850|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093936410|GLYBURIDE 5 MG TABLET|1000|EA|.1305|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|.10111|02/28/2023|.09868|02/28/2023|.09934|02/28/2023||||1851|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093943301|GLYBURIDE 2.5 MG TABLET|100|EA|.08879|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|.07885|02/28/2023|.07695|02/28/2023|.07747|02/28/2023||||1852|||||No|No||TEVA USA|No|||||No|No|No||
glyburide|Yes|No|No|No|75%|00093943305|GLYBURIDE 2.5 MG TABLET|500|EA|.08655|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|.07885|02/28/2023|.07695|02/28/2023|.07747|02/28/2023||||1853|||||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|.07676|01/24/2023|.07491|01/24/2023|.07541|01/24/2023||||1854|||||No|No||TEVA USA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00093970101|CARBIDOPA-LEVODOPA 10-100 TAB|100|EA|.09558|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription required|No||015|No|.13478|02/28/2023|.13154|02/28/2023|.13242|02/28/2023|||ANTIPARKINSON'S AGENTS|1855|||||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||015|No|.13478|02/28/2023|.13154|02/28/2023|.13242|02/28/2023|||ANTIPARKINSON'S AGENTS|1856|||||No|No||TEVA USA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00093970201|CARBIDOPA-LEVODOPA 25-100 TAB|100|EA|.10857|11/07/2022||Yes|No||11/07/2022||Yes|No|11/07/2022||Yes|No||||No|No|||Prescription required|No||015|No|.11453|02/28/2023|.11178|02/28/2023|.11252|02/28/2023|||ANTIPARKINSON'S AGENTS|1857|||||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||015|No|.11453|02/28/2023|.11178|02/28/2023|.11252|02/28/2023|||ANTIPARKINSON'S AGENTS|1858|||||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||015|No|.11453|02/28/2023|.11178|02/28/2023|.11252|02/28/2023|||ANTIPARKINSON'S AGENTS|1859|||||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|12/04/2018|13.02844|12/04/2018|12.40804|12/04/2018||||1860|||||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|.12613|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.34403|02/28/2023|.33577|02/28/2023|.338|02/28/2023|||NSAIDS|1861|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
famotidine|No|No|No|No|75%|00113014165|GS ACID REDUCER 10 MG TABLET|30|EA|.11696|05/06/2020||Yes|No||||No|No|05/06/2020||Yes|No||||No|No|||Over the counter|No|||No|.09617|02/28/2023|.09386|02/28/2023|.09448|02/28/2023||||1862|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113016626|GS CHILD IBUPROFEN 100 MG/5 ML|120|ML|.01849|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.0296|02/28/2023|.02888|02/28/2023|.02908|02/28/2023|||NSAIDS|1863|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
polyethylene glycol 3350|No|No|No|No|75%|00113030602|GS CLEARLAX POWDER|238|GM|.01871|03/29/2019||Yes|No||||No|No|03/29/2019||Yes|No||||No|No|||Over the counter|No|||No|.02497|02/28/2023|.02437|02/28/2023|.02453|02/28/2023||||1864|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
polyethylene glycol 3350|No|No|No|No|75%|00113030603|GS CLEARLAX POWDER|510|GM|.01563|03/29/2019||Yes|No||||No|No|03/29/2019||Yes|No||||No|No|||Over the counter|No|||No|.02068|02/28/2023|.02018|02/28/2023|.02031|02/28/2023||||1865|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
guaifenesin/dextromethorphan|No|No|No|No|75%|00113057826|GS TUSSIN DM LIQUID|118|ML|.01989|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||184|Yes|.01405|12/27/2022|.01371|12/27/2022|.0138|12/27/2022|||COUGH AND COLD: NON-NARCOTIC|1866|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113060471|GS IBUPROFEN 200 MG TABLET|50|EA|.04325|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.03354|02/28/2023|.03273|02/28/2023|.03295|02/28/2023|||NSAIDS|1867|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113060478|GS IBUPROFEN 200 MG TABLET|100|EA|.03409|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.03354|02/28/2023|.03273|02/28/2023|.03295|02/28/2023|||NSAIDS|1868|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113060490|GS IBUPROFEN 200 MG TABLET|500|EA|.0043|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.03354|02/28/2023|.03273|02/28/2023|.03295|02/28/2023|||NSAIDS|1869|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
loratadine|No|No|No|No|75%|00113061239|GS ALLERGY RELIEF 10 MG TABLET|30|EA|.24037|06/20/2007||Yes|No||||No|No|06/20/2007||Yes|No||||No|No|||Over the counter|No||030|Yes|.0579|02/28/2023|.05651|02/28/2023|.05688|02/28/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|1870|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
loratadine|No|No|No|No|75%|00113061265|GS ALLERGY RELIEF 10 MG TABLET|30|EA|.24037|01/31/2005||Yes|No||||No|No|01/31/2005||Yes|No||||No|No|||Over the counter|No||030|Yes|.0579|02/28/2023|.05651|02/28/2023|.05688|02/28/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|1871|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113066026|GS CHILD IBUPROFEN 100 MG/5 ML|120|ML|.01849|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.0296|02/28/2023|.02888|02/28/2023|.02908|02/28/2023|||NSAIDS|1872|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
nicotine polacrilex|No|No|No|No|75%|00113073402|GS NICOTINE 2 MG MINI LOZENGE|81|EA|.16063|01/05/2021||Yes|No||||No|No|01/05/2021||Yes|No||||No|No|||Over the counter|No||040|No|.36861|01/24/2023|.35976|01/24/2023|.36215|01/24/2023|||SMOKING CESSATION|1873|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113089726|GS CHILD IBUPROFEN 100 MG/5 ML|120|ML|.01849|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.0296|02/28/2023|.02888|02/28/2023|.02908|02/28/2023|||NSAIDS|1874|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113089734|GS CHILD IBUPROFEN 100 MG/5 ML|240|ML|.01368|06/23/2009||Yes|No||||No|No|06/23/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.02412|02/28/2023|.02354|02/28/2023|.02369|02/28/2023|||NSAIDS|1875|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
omeprazole|No|No|No|No|75%|00113091555|GS OMEPRAZOLE DR 20 MG TABLET|42|EA|.20783|05/18/2009||Yes|No||||No|No|05/18/2009||Yes|No||||No|No|||Over the counter|Yes|07/29/2021|047|No|.43236|02/28/2023|.42198|02/28/2023|.42479|02/28/2023|||PROTON PUMP INHIBITORS|1876|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
fenofibrate,micronized|No|No|No|No|75%|00115052201|FENOFIBRATE 134 MG CAPSULE|100|EA|.09137|05/22/2009|02/03/2023|Yes|No||05/22/2009|02/03/2023|Yes|No|05/22/2009|02/03/2023|Yes|No||||No|No|||Prescription required|No||055|No|.13821|02/28/2023|.13489|02/28/2023|.13579|02/28/2023|||LIPOTROPICS: OTHER|1877|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate,micronized|No|No|No|No|75%|00115052202|FENOFIBRATE 134 MG CAPSULE|500|EA|.09137|10/14/2013|02/03/2023|Yes|No||10/14/2013|02/03/2023|Yes|No|10/14/2013|02/03/2023|Yes|No||||No|No|||Prescription required|No||055|No|.20825|03/07/2023|.20527|03/07/2023|.1955|03/07/2023|||LIPOTROPICS: OTHER|1878|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
baclofen|No|No|No|No|75%|00115101001|BACLOFEN 10 MG TABLET|100|EA|.02816|09/27/2021||Yes|No||09/27/2021||Yes|No|09/27/2021||Yes|No||||No|No|||Prescription required|No||116|No|.05688|02/28/2023|.05551|02/28/2023|.05588|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1879|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
baclofen|No|No|No|No|75%|00115101003|BACLOFEN 10 MG TABLET|1000|EA|.02817|12/15/2021||Yes|No||12/15/2021||Yes|No|12/15/2021||Yes|No||||No|No|||Prescription required|No||116|No|.05688|02/28/2023|.05551|02/28/2023|.05588|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1880|||||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||Yes|No||12/20/2021||Yes|No|12/20/2021||Yes|No||||No|No|||Prescription required|No||116|No|.22513|02/28/2023|.21972|02/28/2023|.22119|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1881|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
baclofen|No|No|No|No|75%|00115101201|BACLOFEN 20 MG TABLET|100|EA|.04102|09/27/2021||Yes|No||09/27/2021||Yes|No|09/27/2021||Yes|No||||No|No|||Prescription required|No||116|No|.09546|02/28/2023|.09316|02/28/2023|.09378|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1882|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
baclofen|No|No|No|No|75%|00115101203|BACLOFEN 20 MG TABLET|1000|EA|.04099|09/22/2021||Yes|No||09/22/2021||Yes|No|09/22/2021||Yes|No||||No|No|||Prescription required|No||116|No|.09546|02/28/2023|.09316|02/28/2023|.09378|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1883|||||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|.49|10/25/2022|.483|10/25/2022|.46|10/25/2022|||PLATELET AGGREGATION INHIBITORS|1884|||||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|1.33732|06/28/2022|1.30522|06/28/2022|1.31391|06/28/2022|||PLATELET AGGREGATION INHIBITORS|1885|||||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|1.05546|08/23/2022|1.04038|08/23/2022|.99084|08/23/2022|||PLATELET AGGREGATION INHIBITORS|1886|||||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|.41077|02/28/2023|.40091|02/28/2023|.40358|02/28/2023|||LIPOTROPICS: OTHER|1887|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
doxycycline monohydrate|No|No|No|No|75%|00115132713|DOXYCYCLINE MONO 150 MG CAP|60|EA|7.82055|06/01/2011|02/21/2023|Yes|No||06/01/2011|02/21/2023|Yes|No|06/01/2011|02/21/2023|Yes|No||06/01/2011|02/21/2023|Yes|No|||Prescription required|Yes|01/20/2011|213|No|17.82358|06/01/2016|17.56896|06/01/2016|16.73234|06/01/2016|||TETRACYCLINES|1888|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||AMNEAL PHARMACE|No|||||No|No|No||
sevelamer carbonate|No|No|No|No|75%|00115136529|SEVELAMER 0.8 GM POWDER PACKET|90|EA|.8361|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|3.10067|09/27/2022|3.02625|09/27/2022|3.0464|09/27/2022|||PHOSPHATE BINDERS|1889|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
sevelamer carbonate|No|No|No|No|75%|00115136629|SEVELAMER 2.4 GM POWDER PACKET|90|EA|.8361|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|1.90555|08/23/2022|1.87832|08/23/2022|1.78888|08/23/2022|||PHOSPHATE BINDERS|1890|||||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|6.49463|02/28/2023|6.33875|02/28/2023|6.38097|02/28/2023||||1891|||||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|||No|60.89602|05/18/2021|60.02608|05/18/2021|57.16769|05/18/2021||||1892|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00115143613|CYCLOBENZAPRINE ER 15 MG CAP|60|EA|2.92034|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|6.65567|12/29/2020|6.56058|12/29/2020|6.24818|12/29/2020|||SKELETAL MUSCLE RELAXANTS|1893|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
cyclobenzaprine HCl|No|No|No|No|75%|00115143713|CYCLOBENZAPRINE ER 30 MG CAP|60|EA|2.92034|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|6.65567|12/29/2020|6.56058|12/29/2020|6.24818|12/29/2020|||SKELETAL MUSCLE RELAXANTS|1894|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00115147446|METRONIDAZOLE TOPICAL 0.75% GL|45|GM|.93644|11/01/2012|09/30/2023|Yes|No||11/01/2012|09/30/2023|Yes|No|11/01/2012|09/30/2023|Yes|No||||No|No|||Prescription required|No||221|No|.46806|02/28/2023|.45682|02/28/2023|.45986|02/28/2023|||ROSACEA AGENTS: TOPICAL|1895|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00115148361|DICLOFENAC SODIUM 3% GEL|100|GM|.39977|01/21/2014|04/22/2023|Yes|No||01/21/2014|04/22/2023|Yes|No|01/21/2014|04/22/2023|Yes|No||||No|No|||Prescription required|No|||Yes|.45818|02/28/2023|.44718|02/28/2023|.45016|02/28/2023||||1896|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148601|DEXTROAMP-AMPHET ER 5 MG CAP|100|EA|.50142|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|.69643|01/31/2023|.67971|01/31/2023|.68424|01/31/2023|||STIMULANTS AND RELATED AGENTS|1897|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148701|DEXTROAMP-AMPHET ER 10 MG CAP|100|EA|.50142|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|.62245|02/28/2023|.60751|02/28/2023|.61155|02/28/2023|||STIMULANTS AND RELATED AGENTS|1898|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148801|DEXTROAMP-AMPHET ER 15 MG CAP|100|EA|.50142|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|.63242|02/28/2023|.61724|02/28/2023|.62135|02/28/2023|||STIMULANTS AND RELATED AGENTS|1899|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115148901|DEXTROAMP-AMPHET ER 20 MG CAP|100|EA|.50142|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|.67751|02/28/2023|.66124|02/28/2023|.66565|02/28/2023|||STIMULANTS AND RELATED AGENTS|1900|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115149001|DEXTROAMP-AMPHET ER 25 MG CAP|100|EA|.50142|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|.69556|02/28/2023|.67886|02/28/2023|.68338|02/28/2023|||STIMULANTS AND RELATED AGENTS|1901|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dextroamphetamine/amphetamine|No|No|No|No|75%|00115149101|DEXTROAMP-AMPHET ER 30 MG CAP|100|EA|.50142|07/07/2016||Yes|No||07/07/2016||Yes|No|07/07/2016||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|.70831|02/28/2023|.69131|02/28/2023|.69591|02/28/2023|||STIMULANTS AND RELATED AGENTS|1902|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
naftifine HCl|No|No|No|No|75%|00115151048|NAFTIFINE HCL 1% GEL|90|GM|1.80652|03/03/2020|02/22/2023|Yes|No||03/03/2020|02/22/2023|Yes|No|03/03/2020|02/22/2023|Yes|No||||No|No|||Prescription required|Yes|03/09/2018|061|No|4.11719|03/03/2020|4.05837|03/03/2020|3.86512|03/03/2020|||ANTIFUNGALS: TOPICAL|1903|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
naftifine HCl|No|No|No|No|75%|00115151058|NAFTIFINE HCL 1% GEL|60|GM|2.70978|03/03/2020|02/21/2023|Yes|No||03/03/2020|02/21/2023|Yes|No|03/03/2020|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|03/09/2018|061|No|6.17579|03/03/2020|6.08756|03/03/2020|5.79768|03/03/2020|||ANTIFUNGALS: TOPICAL|1904|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
naftifine HCl|No|No|No|No|75%|00115151063|NAFTIFINE HCL 1% GEL|40|GM|4.06468|03/03/2020|02/22/2023|Yes|No||03/03/2020|02/22/2023|Yes|No|03/03/2020|02/22/2023|Yes|No||||No|No|||Prescription required|Yes|03/09/2018|061|No|9.26369|03/03/2020|9.13135|03/03/2020|8.69653|03/03/2020|||ANTIFUNGALS: TOPICAL|1905|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
naftifine HCl|No|No|No|No|75%|00115151246|NAFTIFINE HCL 2% CREAM|45|GM|3.0549|09/07/2017|02/22/2023|Yes|No||09/07/2017|02/22/2023|Yes|No|09/07/2017|02/22/2023|Yes|No||||No|No|||Prescription required|Yes|01/26/2017|061|No|6.96235|09/27/2022|6.86288|09/27/2022|6.53608|09/27/2022|||ANTIFUNGALS: TOPICAL|1906|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
naftifine HCl|No|No|No|No|75%|00115151258|NAFTIFINE HCL 2% CREAM|60|GM|3.0616|09/07/2017|02/22/2023|Yes|No||09/07/2017|02/22/2023|Yes|No|09/07/2017|02/22/2023|Yes|No||||No|No|||Prescription required|Yes|01/26/2017|061|No|2.87072|12/27/2022|2.80182|12/27/2022|2.82048|12/27/2022|||ANTIFUNGALS: TOPICAL|1907|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115152210|FENOFIBRATE 40 MG TABLET|90|EA|3.59412|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|6.57837|06/28/2022|6.42048|06/28/2022|6.46324|06/28/2022|||LIPOTROPICS: OTHER|1908|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115152310|FENOFIBRATE 120 MG TABLET|90|EA|10.78243|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|12.34038|09/27/2022|12.04421|09/27/2022|12.12442|09/27/2022|||LIPOTROPICS: OTHER|1909|||||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|03/09/2018|055|No|.15739|01/24/2023|.15361|01/24/2023|.15463|01/24/2023|||LIPOTROPICS: OTHER|1910|||||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|.46328|02/28/2023|.45216|02/28/2023|.45517|02/28/2023|||LIPOTROPICS: OTHER|1911|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00115155601|OXYCODONE HCL ER 10 MG TABLET|100|EA|1.04004|12/06/2016|01/31/2023|Yes|No||12/06/2016|01/31/2023|Yes|No|12/06/2016|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|2.37032|09/27/2022|2.33646|09/27/2022|2.2252|09/27/2022|||ANALGESICS: NARCOTICS LONG|1912|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00115155701|OXYCODONE HCL ER 15 MG TABLET|100|EA|1.66358|07/07/2016|12/31/2022|Yes|No||07/07/2016|12/31/2022|Yes|No|07/07/2016|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|3.79142|08/27/2019|3.73726|08/27/2019|3.55929|08/27/2019|||ANALGESICS: NARCOTICS LONG|1913|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00115155801|OXYCODONE HCL ER 20 MG TABLET|100|EA|1.93955|07/07/2016|01/31/2023|Yes|No||07/07/2016|01/31/2023|Yes|No|07/07/2016|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|4.42038|08/23/2022|4.35723|08/23/2022|4.14975|08/23/2022|||ANALGESICS: NARCOTICS LONG|1914|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00115155901|OXYCODONE HCL ER 30 MG TABLET|100|EA|2.93083|07/07/2016|01/31/2023|Yes|No||07/07/2016|01/31/2023|Yes|No|07/07/2016|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|6.67958|09/24/2019|6.58415|09/24/2019|6.27062|09/24/2019|||ANALGESICS: NARCOTICS LONG|1915|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00115156001|OXYCODONE HCL ER 40 MG TABLET|100|EA|3.32179|07/07/2016|01/31/2023|Yes|No||07/07/2016|01/31/2023|Yes|No|07/07/2016|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|7.57059|11/29/2022|7.46244|11/29/2022|7.10709|11/29/2022|||ANALGESICS: NARCOTICS LONG|1916|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00115156101|OXYCODONE HCL ER 60 MG TABLET|100|EA|5.10981|07/18/2016|12/31/2022|Yes|No||07/18/2016|12/31/2022|Yes|No|07/18/2016|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|11.64563|08/27/2019|11.47926|08/27/2019|10.93263|08/27/2019|||ANALGESICS: NARCOTICS LONG|1917|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
oxycodone HCl|No|No|No|No|90%|00115156201|OXYCODONE HCL ER 80 MG TABLET|100|EA|5.79644|07/18/2016|01/31/2023|Yes|No||07/18/2016|01/31/2023|Yes|No|07/18/2016|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/23/2015|110|Yes|13.21049|12/27/2022|13.02177|12/27/2022|12.40169|12/27/2022|||ANALGESICS: NARCOTICS LONG|1918|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
azelaic acid|No|No|No|No|75%|00115162456|AZELAIC ACID 15% GEL|50|GM|1.29|02/26/2019|01/25/2023|Yes|No||02/26/2019|01/25/2023|Yes|No|02/26/2019|01/25/2023|Yes|No||||No|No|||Prescription required|Yes|01/28/2021|221|No|.83022|02/28/2023|.81029|02/28/2023|.81569|02/28/2023|||ROSACEA AGENTS: TOPICAL|1919|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|.36538|02/28/2023|.35661|02/28/2023|.35898|02/28/2023||||1920|||||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|.4916|02/28/2023|.4798|02/28/2023|.48299|02/28/2023||||1921|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115165901|PROPRANOLOL 10 MG TABLET|100|EA|.06888|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription required|No||070|No|.08198|02/28/2023|.08001|02/28/2023|.08054|02/28/2023|||BETA-BLOCKERS|1922|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00115165903|PROPRANOLOL 10 MG TABLET|1000|EA|.06888|02/23/2017||Yes|No||02/23/2017||Yes|No|02/23/2017||Yes|No||02/23/2017||Yes|No|||Prescription required|No||070|No|.08198|02/28/2023|.08001|02/28/2023|.08054|02/28/2023|||BETA-BLOCKERS|1923|||||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||070|No|.07628|02/28/2023|.07444|02/28/2023|.07494|02/28/2023|||BETA-BLOCKERS|1924|||||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||070|No|.07628|02/28/2023|.07444|02/28/2023|.07494|02/28/2023|||BETA-BLOCKERS|1925|||||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||070|No|.10682|02/28/2023|.10425|02/28/2023|.10495|02/28/2023|||BETA-BLOCKERS|1926|||||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||070|No|.10682|02/28/2023|.10425|02/28/2023|.10495|02/28/2023|||BETA-BLOCKERS|1927|||||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||070|No|.1993|02/28/2023|.19451|02/28/2023|.19581|02/28/2023|||BETA-BLOCKERS|1928|||||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||070|No|.1993|02/28/2023|.19451|02/28/2023|.19581|02/28/2023|||BETA-BLOCKERS|1929|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
budesonide|No|No|No|No|75%|00115168774|BUDESONIDE 0.25 MG/2 ML SUSP|2|ML|.35833|05/29/2018||Yes|No||05/29/2018||Yes|No|05/29/2018||Yes|No||||No|No|||Prescription required|No||033|Yes|.88573|02/28/2023|.86447|02/28/2023|.87022|02/28/2023|||GLUCOCORTICOIDS: INHALED|1930|||||No|No||AMNEAL PHARMACE|No|||||Yes|No|No||
budesonide|No|No|No|No|75%|00115168974|BUDESONIDE 0.5 MG/2 ML SUSP|2|ML|.17916|05/29/2018||Yes|No||05/29/2018||Yes|No|05/29/2018||Yes|No||||No|No|||Prescription required|No||033|Yes|.55052|02/28/2023|.5373|02/28/2023|.54088|02/28/2023|||GLUCOCORTICOIDS: INHALED|1931|||||No|No||AMNEAL PHARMACE|Yes|09/01/2020||||Yes|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||070|No|.3228|02/28/2023|.31505|02/28/2023|.31715|02/28/2023|||BETA-BLOCKERS|1932|||||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|111.2889|02/28/2023|108.61796|02/28/2023|109.34134|02/28/2023|||EPINEPHRINE: SELF-INJECTED|1933|||||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|119.54625|02/28/2023|116.67714|02/28/2023|117.45419|02/28/2023|||EPINEPHRINE: SELF-INJECTED|1934|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00115169606|HYDROCORTISONE 5 MG TABLET|50|EA|.12151|03/29/2021||Yes|No||03/29/2021||Yes|No|03/29/2021||Yes|No||||No|No|||Prescription required|No||168|Yes|.17227|02/28/2023|.16813|02/28/2023|.16925|02/28/2023|||GLUCOCORTICOIDS: ORAL|1935|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00115169701|HYDROCORTISONE 10 MG TABLET|100|EA|.20532|04/08/2021||Yes|No||04/08/2021||Yes|No|03/29/2021||Yes|No||||No|No|||Prescription required|No||168|Yes|.31871|02/28/2023|.31106|02/28/2023|.31313|02/28/2023|||GLUCOCORTICOIDS: ORAL|1936|||||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||168|Yes|.48617|02/28/2023|.4745|02/28/2023|.47766|02/28/2023|||GLUCOCORTICOIDS: ORAL|1937|||||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|2.44245|02/28/2023|2.38383|02/28/2023|2.3997|02/28/2023|||STIMULANTS AND RELATED AGENTS|1938|||||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|1.2143|02/28/2023|1.18515|02/28/2023|1.19304|02/28/2023|||STIMULANTS AND RELATED AGENTS|1939|||||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|3.90922|07/23/2019|3.85337|07/23/2019|3.66988|07/23/2019|||ANTIFUNGALS: ORAL|1940|||||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|4.4467|11/29/2022|4.33997|11/29/2022|4.36888|11/29/2022|||ANTIFUNGALS: ORAL|1941|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115173601|METHYLPHENIDATE ER(CD) 10MG CP|100|EA|.73327|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|1.59664|02/28/2023|1.55832|02/28/2023|1.56869|02/28/2023|||STIMULANTS AND RELATED AGENTS|1942|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115173701|METHYLPHENIDATE ER(CD) 20MG CP|100|EA|.73327|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|1.53028|02/28/2023|1.49355|02/28/2023|1.5035|02/28/2023|||STIMULANTS AND RELATED AGENTS|1943|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115173801|METHYLPHENIDATE ER(CD) 30MG CP|100|EA|.73327|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|1.30973|02/28/2023|1.27829|02/28/2023|1.2868|02/28/2023|||STIMULANTS AND RELATED AGENTS|1944|||||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|1.62774|02/28/2023|1.58867|02/28/2023|1.59925|02/28/2023|||STIMULANTS AND RELATED AGENTS|1945|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115174001|METHYLPHENIDATE ER(CD) 50MG CP|100|EA|.99123|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|1.67725|01/24/2023|1.63699|01/24/2023|1.64789|01/24/2023|||STIMULANTS AND RELATED AGENTS|1946|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115174101|METHYLPHENIDATE ER(CD) 60MG CP|100|EA|.99123|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|1.83355|02/14/2023|1.78954|02/14/2023|1.80146|02/14/2023|||STIMULANTS AND RELATED AGENTS|1947|||||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|Yes|3.84983|09/27/2022|3.75743|09/27/2022|3.78245|09/27/2022|||SKELETAL MUSCLE RELAXANTS|1948|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
metaxalone|No|No|No|No|75%|00115174801|METAXALONE 800 MG TABLET|100|EA|.645|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|116|Yes|.60997|02/28/2023|.59533|02/28/2023|.59929|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1949|||||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|7.67481|02/28/2023|7.49061|02/28/2023|7.5405|02/28/2023||||1950|||||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|18.84506|04/07/2020|18.57585|04/07/2020|17.69128|04/07/2020||||1951|||||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|6.90579|02/28/2023|6.74005|02/28/2023|6.78493|02/28/2023||||1952|||||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||574|Yes|.0915|02/28/2023|.0893|02/28/2023|.08989|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1953|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
methylphenidate HCl|No|No|No|No|75%|00115180001|METHYLPHENIDATE 5 MG TABLET|100|EA|.04321|12/06/2018||Yes|No||12/06/2018||Yes|No|12/06/2018||Yes|No||||No|No|||Prescription required|No||007|Yes|.08931|02/28/2023|.08716|02/28/2023|.08774|02/28/2023|||STIMULANTS AND RELATED AGENTS|1954|||||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||007|Yes|.12267|02/28/2023|.11972|02/28/2023|.12052|02/28/2023|||STIMULANTS AND RELATED AGENTS|1955|||||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||007|Yes|.17778|02/28/2023|.17351|02/28/2023|.17466|02/28/2023|||STIMULANTS AND RELATED AGENTS|1956|||||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||574|Yes|.07039|02/28/2023|.0687|02/28/2023|.06915|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1957|||||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||574|Yes|.07039|02/28/2023|.0687|02/28/2023|.06915|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1958|||||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||574|Yes|.09935|02/28/2023|.09696|02/28/2023|.09761|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1959|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00115180402|HYDROXYZINE PAM 50 MG CAP|500|EA|.06658|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription required|No||574|Yes|.09935|02/28/2023|.09696|02/28/2023|.09761|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|1960|||||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|2.22861|06/01/2016|2.19678|06/01/2016|2.09217|06/01/2016|||ANTIVIRALS: ORAL|1961|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
orphenadrine citrate|No|No|No|No|75%|00115201101|ORPHENADRINE ER 100 MG TABLET|100|EA|.42355|03/29/2005|02/21/2023|Yes|No||03/29/2005|02/21/2023|Yes|No|||No|No||||No|No|||Prescription required|Yes|01/25/2012|116|Yes|.9653|03/07/2023|.95151|03/07/2023|.9062|03/07/2023|||SKELETAL MUSCLE RELAXANTS|1962|No Longer Rebatable|No Longer Rebatable|||No|No||AMNEAL PHARMACE|No|||||No|No|No||
orphenadrine citrate|No|No|No|No|75%|00115201102|ORPHENADRINE ER 100 MG TABLET|500|EA|.42355|03/29/2005|02/21/2023|Yes|No||03/29/2005|02/21/2023|Yes|No|||No|No||||No|No|||Prescription required|Yes|01/25/2012|116|Yes|.9653|03/07/2023|.95151|03/07/2023|.9062|03/07/2023|||SKELETAL MUSCLE RELAXANTS|1963|No Longer Rebatable|No Longer Rebatable|||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00115214216|COLESTIPOL HCL 1 GM TABLET|120|EA|.44354|12/20/2021|03/18/2023|Yes|No||12/20/2021|03/18/2023|Yes|No|12/20/2021|03/18/2023|Yes|No||||No|No|||Prescription required|Yes|07/28/2022|055|No|.80938|02/28/2023|.78995|02/28/2023|.79521|02/28/2023|||LIPOTROPICS: OTHER|1964|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|3.332|10/06/2020|3.2844|10/06/2020|3.128|10/06/2020|||BRONCHODILATORS: BETA AGONIST|1965|||||No|No||AMNEAL PHARMACE|Yes|09/01/2020||||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|.22995|02/28/2023|.22443|02/28/2023|.22592|02/28/2023||||1966|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00115423301|MIDODRINE HCL 10 MG TABLET|100|EA|1.60673|09/11/2009|02/21/2023|Yes|No||09/11/2009|02/21/2023|Yes|No|09/11/2009|02/21/2023|Yes|No||09/11/2009|02/21/2023|Yes|No|||Prescription required|No|||No|3.66186|03/07/2023|3.60955|03/07/2023|3.43767|03/07/2023||||1967|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|.54468|02/28/2023|.5316|02/28/2023|.53514|02/28/2023|||SKELETAL MUSCLE RELAXANTS|1968|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dantrolene sodium|No|No|No|No|75%|00115442201|DANTROLENE SODIUM 50 MG CAP|100|EA|.56269|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|.72886|01/24/2023|.71136|01/24/2023|.7161|01/24/2023|||SKELETAL MUSCLE RELAXANTS|1969|||||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|1.24108|12/27/2022|1.21129|12/27/2022|1.21936|12/27/2022|||SKELETAL MUSCLE RELAXANTS|1970|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00115521116|COLESTIPOL HCL 1 GM TABLET|120|EA|.44354|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|.80938|02/28/2023|.78995|02/28/2023|.79521|02/28/2023|||LIPOTROPICS: OTHER|1971|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00115521218|COLESTIPOL HCL GRANULES PACKET|30|EA|1.35206|05/22/2009|02/21/2023|Yes|No||05/22/2009|02/21/2023|Yes|No|05/22/2009|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|055|No|3.08144|03/07/2023|3.03742|03/07/2023|2.89278|03/07/2023|||LIPOTROPICS: OTHER|1972|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00115521229|COLESTIPOL HCL GRANULES PACKET|90|EA|1.35177|05/22/2009|02/21/2023|Yes|No||05/22/2009|02/21/2023|Yes|No|05/22/2009|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|055|No|3.08078|03/07/2023|3.03677|03/07/2023|2.89216|03/07/2023|||LIPOTROPICS: OTHER|1973|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00115521302|COLESTIPOL HCL GRANULES|500|GM|.16099|05/22/2009|02/21/2023|Yes|No||05/22/2009|02/21/2023|Yes|No|05/22/2009|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|055|No|.36691|06/01/2016|.36167|06/01/2016|.34444|06/01/2016|||LIPOTROPICS: OTHER|1974|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||AMNEAL PHARMACE|No|||||No|No|No||
nadolol/bendroflumethiazide|No|No|No|No|75%|00115532201|NADOLOL-BENDROFLU 80-5 MG TAB|100|EA|2.11396|08/23/2007|02/21/2023|Yes|No||08/23/2007|02/21/2023|Yes|No|08/23/2007|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|070|Yes|4.81787|06/01/2016|4.74904|06/01/2016|4.5229|06/01/2016|||BETA-BLOCKERS|1975|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||055|No|.1062|02/28/2023|.10365|02/28/2023|.10434|02/28/2023|||LIPOTROPICS: OTHER|1976|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115552202|FENOFIBRATE 160 MG TABLET|500|EA|.16722|05/19/2011||Yes|No||05/19/2011||Yes|No|05/19/2011||Yes|No||||No|No|||Prescription required|No||055|No|.17359|02/28/2023|.16942|02/28/2023|.17055|02/28/2023|||LIPOTROPICS: OTHER|1977|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00115552210|FENOFIBRATE 160 MG TABLET|90|EA|.16721|09/03/2008||Yes|No||09/03/2008||Yes|No|09/03/2008||Yes|No||||No|No|||Prescription required|No||055|No|.17359|02/28/2023|.16942|02/28/2023|.17055|02/28/2023|||LIPOTROPICS: OTHER|1978|||||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|.23169|02/28/2023|.22612|02/28/2023|.22763|02/28/2023||||1979|||||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|.42789|02/28/2023|.41762|02/28/2023|.4204|02/28/2023||||1980|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
fludrocortisone acetate|No|No|No|No|75%|00115703302|FLUDROCORTISONE 0.1 MG TABLET|500|EA|.25341|05/22/2009||Yes|No||05/22/2009||Yes|No|05/22/2009||Yes|No||||No|No|||Prescription required|No|||No|.42789|02/28/2023|.41762|02/28/2023|.4204|02/28/2023||||1981|||||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|05/18/2021|60.02608|05/18/2021|57.16769|05/18/2021||||1982|||||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|.78225|02/28/2023|.76347|02/28/2023|.76856|02/28/2023|||STIMULANTS AND RELATED AGENTS|1983|||||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|.89512|02/28/2023|.87363|02/28/2023|.87945|02/28/2023|||STIMULANTS AND RELATED AGENTS|1984|||||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|.66887|02/28/2023|.65281|02/28/2023|.65716|02/28/2023|||STIMULANTS AND RELATED AGENTS|1985|||||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|1.61551|02/28/2023|1.57673|02/28/2023|1.58723|02/28/2023|||STIMULANTS AND RELATED AGENTS|1986|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115992201|DEXMETHYLPHENIDATE ER 30 MG CP|100|EA|1.50706|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|1.72022|02/28/2023|1.67893|02/28/2023|1.69011|02/28/2023|||STIMULANTS AND RELATED AGENTS|1987|||||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|08/28/2020|037|Yes|.30351|02/28/2023|.29622|02/28/2023|.29819|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1988|||||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|08/28/2020|037|Yes|.27303|02/28/2023|.26647|02/28/2023|.26825|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1989|||||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|08/28/2020|037|Yes|.25555|02/28/2023|.24941|02/28/2023|.25107|02/28/2023|||BRONCHODILATORS: BETA AGONIST|1990|||||No|No||AMNEAL PHARMACE|Yes|09/01/2020||||Yes|No|No||
minocycline HCl|No|No|No|No|75%|00115993508|MINOCYCLINE ER 65 MG TABLET|30|EA|3.225|05/23/2018|02/08/2023|Yes|No||05/23/2018|02/08/2023|Yes|No|05/23/2018|02/08/2023|Yes|No||||No|No|||Prescription required|Yes|03/09/2018|213|No|7.35|08/25/2020|7.245|08/25/2020|6.9|08/25/2020|||TETRACYCLINES|1991|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
minocycline HCl|No|No|No|No|75%|00115993608|MINOCYCLINE ER 115 MG TABLET|30|EA|3.225|05/23/2018|02/08/2023|Yes|No||05/23/2018|02/08/2023|Yes|No|05/23/2018|02/08/2023|Yes|No||||No|No|||Prescription required|Yes|03/09/2018|213|No|7.35|08/25/2020|7.245|08/25/2020|6.9|08/25/2020|||TETRACYCLINES|1992|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||AMNEAL PHARMACE|No|||||No|No|No||
chlorhexidine gluconate|No|No|No|No|75%|00116200116|CHLORHEXIDINE 0.12% RINSE|473|ML|.00249|09/27/2007||Yes|No||09/27/2007||Yes|No|09/27/2007||Yes|No||||No|No|||Prescription required|No|||No|.00574|02/28/2023|.0056|02/28/2023|.00563|02/28/2023||||1993|||||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|.01019|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||109|Yes|.01303|02/28/2023|.01271|02/28/2023|.0128|02/28/2023|||ANALGESICS: NARCOTICS SHORT|1994|||||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||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||109|Yes|.01369|02/28/2023|.01336|02/28/2023|.01345|02/28/2023|||ANALGESICS: NARCOTICS SHORT|1995|||||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||085|No|.03731|02/28/2023|.03641|02/28/2023|.03665|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1996|||||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||027|Yes|.17081|02/28/2023|.16671|02/28/2023|.16782|02/28/2023|||ANTIPSYCHOTICS|1997|||||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||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Over the counter|No|||No|.02744|02/28/2023|.02678|02/28/2023|.02695|02/28/2023||||1998|||||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|.01636|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.01964|02/28/2023|.01916|02/28/2023|.01929|02/28/2023|||ANTIPARKINSON'S AGENTS|1999|||||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||027|Yes|2.56236|02/08/2022|2.52576|02/08/2022|2.40548|02/08/2022|||ANTIPSYCHOTICS|2000|||||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|.22925|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.52249|02/08/2022|.51503|02/08/2022|.4905|02/08/2022|||ANTIPSYCHOTICS|2001|||||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||027|Yes|.53031|03/15/2022|.52274|03/15/2022|.49784|03/15/2022|||ANTIPSYCHOTICS|2002|||||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|.03876|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.06333|01/24/2023|.06181|01/24/2023|.06222|01/24/2023|||ANTIPARKINSON'S AGENTS|2003|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
ethosuximide|No|No|No|No|75%|00121067016|ETHOSUXIMIDE 250 MG/5 ML SOLN|473|ML|.0512|12/11/2020||Yes|No||12/11/2020||Yes|No|12/11/2020||Yes|No||||No|No|||Prescription required|No||056|No|.08185|02/28/2023|.07988|02/28/2023|.08041|02/28/2023|||ANTICONVULSANTS|2004|||||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||056|No|.01923|02/28/2023|.01876|02/28/2023|.01889|02/28/2023|||ANTICONVULSANTS|2005|||||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|.01136|04/19/2022||Yes|No||04/19/2022||Yes|No|04/19/2022||Yes|No||||No|No|||Prescription required|No||056|No|.01923|02/28/2023|.01876|02/28/2023|.01889|02/28/2023|||ANTICONVULSANTS|2006|||||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|.0496|02/28/2023|.0484|02/28/2023|.04873|02/28/2023||||2007|||||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|.04114|03/01/2022|.04055|03/01/2022|.03862|03/01/2022||||2008|||||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|.17259|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|.39336|02/08/2022|.38774|02/08/2022|.36927|02/08/2022|||ANTIDEPRESSANTS: TRICYCLIC|2009|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
fluoxetine HCl|No|No|No|No|75%|00121072104|FLUOXETINE 20 MG/5 ML SOLUTION|120|ML|.17966|12/28/2006||Yes|No||12/28/2006||Yes|No|12/28/2006||Yes|No||09/01/2022||Yes|No|||Prescription required|No||008|No|.27086|02/28/2023|.26435|02/28/2023|.26611|02/28/2023|||ANTIDEPRESSANTS: SSRIs|2010|||||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||168|Yes|.13013|02/28/2023|.127|02/28/2023|.12785|02/28/2023|||GLUCOCORTICOIDS: ORAL|2011|||||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|.01805|01/24/2023|.01761|01/24/2023|.01773|01/24/2023||||2012|||||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||090|Yes|.62037|02/28/2023|.60548|02/28/2023|.60951|02/28/2023|||ANXIOLYTICS|2013|||||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||Yes|No||09/02/2014||Yes|No|09/02/2014||Yes|No||||No|No|||Prescription required|No||109|Yes|.1985|10/25/2022|.19373|10/25/2022|.19502|10/25/2022|||ANALGESICS: NARCOTICS SHORT|2014|||||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|.02749|09/02/2014||Yes|No||09/02/2014||Yes|No|09/02/2014||Yes|No||||No|No|||Prescription required|No||109|Yes|.05774|02/28/2023|.05635|02/28/2023|.05672|02/28/2023|||ANALGESICS: NARCOTICS SHORT|2015|||||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|1.07018|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|2.43903|10/03/2017|2.40419|10/03/2017|2.2897|10/03/2017|||GLUCOCORTICOIDS: ORAL|2016|||||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|||Prescription required|No||183|Yes|.05595|02/28/2023|.0546|02/28/2023|.05497|02/28/2023|||COUGH AND COLD: NARCOTIC|2017|||||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|.0195|11/19/2018||Yes|No||||No|No|11/19/2018||Yes|No||||No|No|||Over the counter|No||183|Yes|.04406|02/28/2023|.043|02/28/2023|.04328|02/28/2023|||COUGH AND COLD: NARCOTIC|2018|||||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|.01135|11/06/2006||Yes|No||04/15/2011||Yes|No|11/06/2006||Yes|No||||No|No|||Prescription required|No||183|Yes|.03073|02/28/2023|.02999|02/28/2023|.03019|02/28/2023|||COUGH AND COLD: NARCOTIC|2019|||||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|3.46592|10/03/2017|3.41641|10/03/2017|3.25372|10/03/2017|||GLUCOCORTICOIDS: ORAL|2020|||||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|.17584|09/14/2022||Yes|No||09/14/2022||Yes|No|09/14/2022||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|109|Yes|.40077|09/14/2022|.39504|09/14/2022|.37623|09/14/2022|||ANALGESICS: NARCOTICS SHORT|2021|||||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|.06784|02/28/2023|.06621|02/28/2023|.06665|02/28/2023||||2022|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
nystatin|No|No|No|No|75%|00121086802|NYSTATIN 100,000 UNIT/ML SUSP|60|ML|.086|02/04/2021||Yes|No||02/04/2021||Yes|No|02/04/2021||Yes|No||||No|No|||Prescription required|No||069|No|.09778|02/28/2023|.09543|02/28/2023|.09606|02/28/2023|||ANTIFUNGALS: ORAL|2023|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
nystatin|No|No|No|No|75%|00121086816|NYSTATIN 100,000 UNIT/ML SUSP|473|ML|.02885|02/04/2021||Yes|No||02/04/2021||Yes|No|02/04/2021||Yes|No||||No|No|||Prescription required|No||069|No|.05373|02/28/2023|.05244|02/28/2023|.05278|02/28/2023|||ANTIFUNGALS: ORAL|2024|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
lactulose|No|No|No|No|75%|00121087316|LACTULOSE 10 GM/15 ML SOLUTION|473|ML|.00704|06/01/2020||Yes|No||06/01/2020||Yes|No|06/01/2020||Yes|No||||No|No|||Prescription required|No|||No|.01509|02/28/2023|.01472|02/28/2023|.01482|02/28/2023||||2025|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
lactulose|No|No|No|No|75%|00121087332|LACTULOSE 10 GM/15 ML SOLUTION|946|ML|.00635|06/01/2020||Yes|No||06/01/2020||Yes|No|06/01/2020||Yes|No||||No|No|||Prescription required|No|||No|.01318|02/28/2023|.01286|02/28/2023|.01294|02/28/2023||||2026|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
chlorhexidine gluconate|No|No|No|No|75%|00121089316|CHLORHEXIDINE 0.12% RINSE|473|ML|.00463|04/15/2021||Yes|No||04/15/2021||Yes|No|04/15/2021||Yes|No||||No|No|||Prescription required|No|||No|.00574|02/28/2023|.0056|02/28/2023|.00563|02/28/2023||||2027|||||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||Yes|No||02/13/2023||Yes|No|02/13/2023||Yes|No||||No|No|||Prescription required|No||085|Yes|.02957|02/28/2023|.02886|02/28/2023|.02905|02/28/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|2028|||||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|.03625|11/15/2022||Yes|No||11/15/2022||Yes|No|11/15/2022||Yes|No||||No|No|||Prescription required|No||184|Yes|.08326|02/28/2023|.08126|02/28/2023|.0818|02/28/2023|||COUGH AND COLD: NON-NARCOTIC|2029|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
phenobarbital|No|No|No|No|75%|00121094216|PHENOBARBITAL 20 MG/5 ML SOLN|473|ML|.0325|04/19/2022||Yes|No||04/19/2022||Yes|No|04/19/2022||Yes|No||||No|No|||Prescription required|No||056|No|.07498|02/28/2023|.07318|02/28/2023|.07366|02/28/2023|||ANTICONVULSANTS|2030|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00121168016|POTASSIUM CL 10% (20 MEQ/15ML)|473|ML|.02681|09/27/2019||Yes|No||09/27/2019||Yes|No|09/27/2019||Yes|No||||No|No|||Prescription required|No|||No|.09093|02/28/2023|.08874|02/28/2023|.08933|02/28/2023||||2031|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247735|VIMPAT 50 MG TABLET|60|EA|4.84624|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription required|No||056|No|10.79518|01/17/2023|10.53609|01/17/2023|10.60626|01/17/2023|||ANTICONVULSANTS|2032|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247760|VIMPAT 50 MG TABLET|60|EA|5.33142|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription required|No||056|No|10.79518|01/17/2023|10.53609|01/17/2023|10.60626|01/17/2023|||ANTICONVULSANTS|2033|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247835|VIMPAT 100 MG TABLET|60|EA|7.57666|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription required|No||056|No|16.89334|01/17/2023|16.48789|01/17/2023|16.5977|01/17/2023|||ANTICONVULSANTS|2034|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247860|VIMPAT 100 MG TABLET|60|EA|8.33497|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription required|No||056|No|16.89334|01/17/2023|16.48789|01/17/2023|16.5977|01/17/2023|||ANTICONVULSANTS|2035|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247935|VIMPAT 150 MG TABLET|60|EA|8.02429|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription required|No||056|No|17.89038|01/17/2023|17.46101|01/17/2023|17.57729|01/17/2023|||ANTICONVULSANTS|2036|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131247960|VIMPAT 150 MG TABLET|60|EA|8.82718|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription required|No||056|No|17.89038|01/17/2023|17.46101|01/17/2023|17.57729|01/17/2023|||ANTICONVULSANTS|2037|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131248035|VIMPAT 200 MG TABLET|60|EA|8.02652|06/01/2009||Yes|No||06/01/2009||Yes|No|06/01/2009||Yes|No||||No|No|||Prescription required|No||056|No|17.91949|01/17/2023|17.48942|01/17/2023|17.60589|01/17/2023|||ANTICONVULSANTS|2038|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131248060|VIMPAT 200 MG TABLET|60|EA|8.83005|12/04/2012||Yes|No||12/04/2012||Yes|No|12/04/2012||Yes|No||||No|No|||Prescription required|No||056|No|17.91949|01/17/2023|17.48942|01/17/2023|17.60589|01/17/2023|||ANTICONVULSANTS|2039|||||No|No||UCB PHARMA|No|||||No|No|No||
lacosamide|No|No|No|No|75%|00131541072|VIMPAT 10 MG/ML SOLUTION|200|ML|.94036|09/16/2020||Yes|No||09/16/2020||Yes|No|09/16/2020||Yes|No||||No|No|||Prescription required|No||056|No|2.10029|01/17/2023|2.04988|01/17/2023|2.06353|01/17/2023|||ANTICONVULSANTS|2040|||||No|No||UCB PHARMA|No|||||No|No|No||
sodium phosphate,mono-dibasic|No|No|No|No|75%|00132020220|FLEET PEDIA-LAX ENEMA|66|ML|.00813|09/07/2015||Yes|No||||No|No|09/07/2015||Yes|No||||No|No|||Over the counter|No|||No|.01855|11/24/2020|.01828|11/24/2020|.01741|11/24/2020||||2041|||||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|.44674|11/29/2022|.43601|11/29/2022|.43892|11/29/2022|||ANGIOTENSIN MODULATORS|2042|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117110|CAPTOPRIL 12.5 MG TABLET|1000|EA|.43553|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|.44674|11/29/2022|.43601|11/29/2022|.43892|11/29/2022|||ANGIOTENSIN MODULATORS|2043|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117201|CAPTOPRIL 25 MG TABLET|100|EA|.46663|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|.37084|02/28/2023|.36193|02/28/2023|.36435|02/28/2023|||ANGIOTENSIN MODULATORS|2044|||||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|.37084|02/28/2023|.36193|02/28/2023|.36435|02/28/2023|||ANGIOTENSIN MODULATORS|2045|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117301|CAPTOPRIL 50 MG TABLET|100|EA|.8102|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|.59211|02/28/2023|.57789|02/28/2023|.58174|02/28/2023|||ANGIOTENSIN MODULATORS|2046|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
captopril|Yes|No|No|No|75%|00143117310|CAPTOPRIL 50 MG TABLET|1000|EA|.81018|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|.59211|02/28/2023|.57789|02/28/2023|.58174|02/28/2023|||ANGIOTENSIN MODULATORS|2047|||||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|1.37792|03/29/2022|1.34484|03/29/2022|1.3538|03/29/2022|||ANGIOTENSIN MODULATORS|2048|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143122701|DICYCLOMINE 20 MG TABLET|100|EA|.11932|11/28/2015||Yes|No||11/28/2015||Yes|No|11/28/2015||Yes|No||||No|No|||Prescription required|No|||No|.15009|02/28/2023|.14648|02/28/2023|.14746|02/28/2023||||2049|||||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|.15009|02/28/2023|.14648|02/28/2023|.14746|02/28/2023||||2050|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
digoxin|No|No|No|No|75%|00143124001|DIGOXIN 125 MCG TABLET|100|EA|.50955|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription required|No|||No|.20824|02/28/2023|.20324|02/28/2023|.20459|02/28/2023||||2051|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
digoxin|No|No|No|No|75%|00143124010|DIGOXIN 125 MCG TABLET|1000|EA|.42548|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription required|No|||No|.20824|02/28/2023|.20324|02/28/2023|.20459|02/28/2023||||2052|||||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|.50955|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription required|No|||No|.22486|02/28/2023|.21946|02/28/2023|.22092|02/28/2023||||2053|||||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|.42548|05/01/2008||Yes|No||05/01/2008||Yes|No|05/01/2008||Yes|No||05/01/2008||Yes|No|||Prescription required|No|||No|.22486|02/28/2023|.21946|02/28/2023|.22092|02/28/2023||||2054|||||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||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|06/01/2016|.04629|06/01/2016|.04408|06/01/2016||||2055|||||No|No||WEST-WARD,INC.|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||056|No|.26513|02/28/2023|.25876|02/28/2023|.26049|02/28/2023|||ANTICONVULSANTS|2056|||||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||056|No|.26513|02/28/2023|.25876|02/28/2023|.26049|02/28/2023|||ANTICONVULSANTS|2057|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
PHENOBARBITAL|No|No|No|No|75%|00143145510|PHENOBARBITAL 60 MG TABLET|1000|EA||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|06/01/2016|.07232|06/01/2016|.06888|06/01/2016||||2058|||||No|No||WEST-WARD,INC.|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||056|No|.33412|02/28/2023|.3261|02/28/2023|.32827|02/28/2023|||ANTICONVULSANTS|2059|||||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||056|No|.33412|02/28/2023|.3261|02/28/2023|.32827|02/28/2023|||ANTICONVULSANTS|2060|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
PHENOBARBITAL|No|No|No|No|75%|00143145810|PHENOBARBITAL 100 MG TABLET|1000|EA||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|06/01/2016|.10125|06/01/2016|.09643|06/01/2016||||2061|||||No|No||WEST-WARD,INC.|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||056|No|.12528|02/28/2023|.12227|02/28/2023|.12308|02/28/2023|||ANTICONVULSANTS|2062|||||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||056|No|.12528|02/28/2023|.12227|02/28/2023|.12308|02/28/2023|||ANTICONVULSANTS|2063|||||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||056|No|.19502|02/28/2023|.19033|02/28/2023|.1916|02/28/2023|||ANTICONVULSANTS|2064|||||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||056|No|.19502|02/28/2023|.19033|02/28/2023|.1916|02/28/2023|||ANTICONVULSANTS|2065|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
isosorbide dinitrate|No|No|No|No|75%|00143176901|ISOSORBIDE DINITRATE 5 MG TAB|100|EA|.22587|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.29394|02/28/2023|.28688|02/28/2023|.28879|02/28/2023||||2066|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
isosorbide dinitrate|No|No|No|No|75%|00143177101|ISOSORBIDE DINITRATE 10 MG TAB|100|EA|.24849|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.35552|02/28/2023|.34698|02/28/2023|.34929|02/28/2023||||2067|||||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|.32066|02/28/2023|.31296|02/28/2023|.31504|02/28/2023||||2068|||||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|.131|02/28/2023|.12785|02/28/2023|.1287|02/28/2023|||TETRACYCLINES|2069|||||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|.131|02/28/2023|.12785|02/28/2023|.1287|02/28/2023|||TETRACYCLINES|2070|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301801|COLCHICINE 0.6 MG CAPSULE|100|EA|2.24541|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|4.15372|02/28/2023|4.05403|02/28/2023|4.08102|02/28/2023|||ANTIHYPERURICEMICS|2071|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301810|COLCHICINE 0.6 MG CAPSULE|1000|EA|2.24547|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|4.15372|02/28/2023|4.05403|02/28/2023|4.08102|02/28/2023|||ANTIHYPERURICEMICS|2072|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301830|COLCHICINE 0.6 MG CAPSULE|30|EA|2.24546|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|4.15372|02/28/2023|4.05403|02/28/2023|4.08102|02/28/2023|||ANTIHYPERURICEMICS|2073|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143312601|DICYCLOMINE 10 MG CAPSULE|100|EA|.08578|09/09/2016||Yes|No||09/09/2016||Yes|No|09/09/2016||Yes|No||||No|No|||Prescription required|No|||No|.12073|02/28/2023|.11783|02/28/2023|.11861|02/28/2023||||2074|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143312610|DICYCLOMINE 10 MG CAPSULE|1000|EA|.07933|09/09/2016||Yes|No||09/09/2016||Yes|No|09/09/2016||Yes|No||||No|No|||Prescription required|No|||No|.12073|02/28/2023|.11783|02/28/2023|.11861|02/28/2023||||2075|||||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||213|No|.13732|02/28/2023|.13402|02/28/2023|.13491|02/28/2023|||TETRACYCLINES|2076|||||No|No||WEST-WARD/HIKMA|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||046|No|.33644|02/28/2023|.32836|02/28/2023|.33055|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2077|||||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|No|||||||152.49|08/16/2022|ANTIMIGRAINE AGENTS: OTHER|2078|||||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|No|146.51|08/16/2022|144.417|08/16/2022|137.54|08/16/2022|||ANTIMIGRAINE AGENTS: OTHER|2079|||||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||209|No|.14359|02/28/2023|.14014|02/28/2023|.14107|02/28/2023|||PENICILLINS|2080|||||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||209|No|.14359|02/28/2023|.14014|02/28/2023|.14107|02/28/2023|||PENICILLINS|2081|||||No|No||WEST-WARD/HIKMA|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||550|No|1.70447|02/28/2023|1.66356|02/28/2023|1.67464|02/28/2023|||ONCOLOGY: ORAL - PROSTATE|2082|||||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||08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription required|No|||No|.9696|12/27/2022|.94632|12/27/2022|.95263|12/27/2022||||2083|||||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|08/11/2022|3.41094|08/11/2022|3.24852|08/11/2022||||2084|||||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|3.68427|11/29/2022|3.59584|11/29/2022|3.61979|11/29/2022||||2085|||||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|1.85179|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription required|No|||No|.98399|02/28/2023|.96037|02/28/2023|.96677|02/28/2023||||2086|||||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|08/11/2022||2087|||||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|2.47918|02/28/2023|2.41967|02/28/2023|2.43579|02/28/2023||||2088|||||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|||No|13.27937|02/28/2023|12.96066|02/28/2023|13.04698|02/28/2023||||2089|||||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|06/07/2022|1.932|06/07/2022|1.84|06/07/2022||||2090|||||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|06/07/2022|1.932|06/07/2022|1.84|06/07/2022||||2091|||||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|06/07/2022|2.5116|06/07/2022|2.392|06/07/2022||||2092|||||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|06/07/2022|2.5116|06/07/2022|2.392|06/07/2022||||2093|||||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|06/01/2016|.7728|06/01/2016|.736|06/01/2016||||2094|||||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|06/01/2016|.44339|06/01/2016|.42228|06/01/2016||||2095|||||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|06/01/2016|.60375|06/01/2016|.575|06/01/2016||||2096|||||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|.06858|08/06/2012||Yes|No||08/06/2012||Yes|No|08/06/2012||Yes|No||||No|No|||Prescription required|No|||No|.15631|06/01/2016|.15407|06/01/2016|.14674|06/01/2016||||2097|||||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|06/01/2016|.14683|06/01/2016|.13984|06/01/2016||||2098|||||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||03/14/2012||Yes|No||03/14/2012||Yes|No|03/14/2012||Yes|No||||No|No|||Prescription required|No|||No|||||||.04244|06/01/2016||2099|||||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||03/14/2012||Yes|No||03/14/2012||Yes|No|03/14/2012||Yes|No||||No|No|||Prescription required|No|||No|||||||.06239|06/01/2016||2100|||||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||03/14/2012||Yes|No||03/14/2012||Yes|No|03/14/2012||Yes|No||||No|No|||Prescription required|No|||No|||||||.1224|06/01/2016||2101|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
progesterone|No|No|No|No|75%|00143972501|PROGESTERONE 500 MG/10 ML VIAL|10|ML|1.46329|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription required|No|||No|2.0385|02/28/2023|1.98957|02/28/2023|2.00282|02/28/2023||||2102|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00143972601|TESTOSTERON CYP 2,000 MG/10 ML|10|ML|3.397|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription required|No|||No|3.8058|02/28/2023|3.71446|02/28/2023|3.73919|02/28/2023||||2103|||||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|06/01/2016|28.98|06/01/2016|27.6|06/01/2016||||2104|||||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|6.42334|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription required|No|||No|12.38867|02/28/2023|12.09134|02/28/2023|12.17186|02/28/2023||||2105|||||No|No||WEST-WARD/HIKMA|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|09/18/2020|3.33984|09/18/2020|3.1808|09/18/2020||||2106|||||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||213|No|.2179|02/28/2023|.21267|02/28/2023|.21408|02/28/2023|||TETRACYCLINES|2107|||||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||213|No|.13732|02/28/2023|.13402|02/28/2023|.13491|02/28/2023|||TETRACYCLINES|2108|||||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||213|No|.13732|02/28/2023|.13402|02/28/2023|.13491|02/28/2023|||TETRACYCLINES|2109|||||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||209|No|.09313|02/28/2023|.09089|02/28/2023|.0915|02/28/2023|||PENICILLINS|2110|||||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|.04761|04/20/2020||Yes|No||04/20/2020||Yes|No|04/20/2020||Yes|No||04/20/2020||Yes|No|||Prescription required|No||209|No|.09313|02/28/2023|.09089|02/28/2023|.0915|02/28/2023|||PENICILLINS|2111|||||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||209|No|.07227|02/28/2023|.07053|02/28/2023|.071|02/28/2023|||PENICILLINS|2112|||||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||209|No|.07227|02/28/2023|.07053|02/28/2023|.071|02/28/2023|||PENICILLINS|2113|||||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||046|No|.06067|02/28/2023|.05921|02/28/2023|.0596|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2114|||||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||046|No|.05521|02/28/2023|.05388|02/28/2023|.05424|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2115|||||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||046|No|.07825|02/28/2023|.07637|02/28/2023|.07688|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2116|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988601|AMOXICILLIN 200 MG/5 ML SUSP|100|ML|.02618|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription required|No||209|No|.04266|02/28/2023|.04163|02/28/2023|.04191|02/28/2023|||PENICILLINS|2117|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988650|AMOXICILLIN 200 MG/5 ML SUSP|50|ML|.02631|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription required|No||209|No|.04745|02/28/2023|.04631|02/28/2023|.04661|02/28/2023|||PENICILLINS|2118|||||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||209|No|.04179|02/28/2023|.04078|02/28/2023|.04105|02/28/2023|||PENICILLINS|2119|||||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||209|No|.02875|03/14/2023|.02806|03/14/2023|.02824|03/14/2023|||PENICILLINS|2120|||||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||209|No|.04151|02/28/2023|.04051|02/28/2023|.04078|02/28/2023|||PENICILLINS|2121|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988775|AMOXICILLIN 400 MG/5 ML SUSP|75|ML|.02803|10/27/2009||Yes|No||10/27/2009||Yes|No|10/27/2009||Yes|No||10/27/2009||Yes|No|||Prescription required|No||209|No|.02692|02/28/2023|.02627|02/28/2023|.02644|02/28/2023|||PENICILLINS|2122|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988801|AMOXICILLIN 125 MG/5 ML SUSP|100|ML|.0101|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription required|No||209|No|.01831|02/28/2023|.01787|02/28/2023|.01798|02/28/2023|||PENICILLINS|2123|||||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||209|No|.01746|02/28/2023|.01704|02/28/2023|.01715|02/28/2023|||PENICILLINS|2124|||||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||209|No|.02|02/28/2023|.01952|02/28/2023|.01965|02/28/2023|||PENICILLINS|2125|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988901|AMOXICILLIN 250 MG/5 ML SUSP|100|ML|.01268|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription required|No||209|No|.02151|02/28/2023|.02099|02/28/2023|.02113|02/28/2023|||PENICILLINS|2126|||||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||209|No|.02175|02/28/2023|.02122|02/28/2023|.02136|02/28/2023|||PENICILLINS|2127|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143988980|AMOXICILLIN 250 MG/5 ML SUSP|80|ML|.01397|09/05/2006||Yes|No||09/05/2006||Yes|No|09/05/2006||Yes|No||09/05/2006||Yes|No|||Prescription required|No||209|No|.02855|02/28/2023|.02786|02/28/2023|.02805|02/28/2023|||PENICILLINS|2128|||||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|11/06/2018|1.93393|11/06/2018|1.84184|11/06/2018||||2129|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefazolin sodium|No|No|No|No|75%|00143992490|CEFAZOLIN 1 GM VIAL|1|EA|.58806|08/20/2007||Yes|No||08/20/2007||Yes|No|08/20/2007||Yes|No||||No|No|||Prescription required|No|||No|1.34024|11/06/2018|1.3211|11/06/2018|1.25819|11/06/2018||||2130|||||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||028|No|.09116|02/28/2023|.08897|02/28/2023|.08956|02/28/2023|||FLUOROQUINOLONES: ORAL|2131|||||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||028|No|.15146|02/28/2023|.14782|02/28/2023|.1488|02/28/2023|||FLUOROQUINOLONES: ORAL|2132|||||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||028|No|.23365|02/28/2023|.22804|02/28/2023|.22956|02/28/2023|||FLUOROQUINOLONES: ORAL|2133|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
amoxicillin|No|No|No|No|75%|00143993905|AMOXICILLIN 500 MG CAPSULE|500|EA|.06475|02/08/2008||Yes|No||02/08/2008||Yes|No|02/08/2008||Yes|No||05/21/2007||Yes|No|||Prescription required|No||209|No|.07074|02/28/2023|.06904|02/28/2023|.0695|02/28/2023|||PENICILLINS|2134|||||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||04/18/2005||Yes|No||04/18/2005||Yes|No|04/18/2005||Yes|No||||No|No|||Prescription required|No|||No|||||||4.41|06/01/2016||2135|||||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|04/23/2019|2.82342|04/23/2019|2.68897|04/23/2019||||2136|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefuroxime sodium|No|No|No|No|75%|00143997990|CEFUROXIME SOD 750 MG VIAL|1|EA||04/18/2005||Yes|No||04/18/2005||Yes|No|04/18/2005||Yes|No||||No|No|||Prescription required|No|||No|||||||2.205|06/01/2016||2137|||||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||046|No|.06091|02/28/2023|.05944|02/28/2023|.05984|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2138|||||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||046|No|.08273|02/28/2023|.08074|02/28/2023|.08128|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2139|||||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||046|No|.0649|02/28/2023|.06334|02/28/2023|.06376|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2140|||||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||046|No|.0727|02/28/2023|.07095|02/28/2023|.07142|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2141|||||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||046|No|.08303|02/28/2023|.08103|02/28/2023|.08157|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2142|||||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||046|No|.08181|02/28/2023|.07984|02/28/2023|.08037|02/28/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2143|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
cefazolin sodium|No|No|No|No|75%|00143998391|CEFAZOLIN 10 GM VIAL|1|EA||01/26/2005||Yes|No||01/26/2005||Yes|No|01/26/2005||Yes|No||||No|No|||Prescription required|No|||No|||||||16.8|06/01/2016||2144|||||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||120|No|.24853|02/28/2023|.24256|02/28/2023|.24418|02/28/2023|||STEROIDS: TOPICAL HIGH|2145|||||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||120|No|.15477|02/28/2023|.15105|02/28/2023|.15206|02/28/2023|||STEROIDS: TOPICAL HIGH|2146|||||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||120|No|.06877|02/28/2023|.06711|02/28/2023|.06756|02/28/2023|||STEROIDS: TOPICAL HIGH|2147|||||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||120|No|.1701|02/28/2023|.16601|02/28/2023|.16712|02/28/2023|||STEROIDS: TOPICAL HIGH|2148|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000416|TRIAMCINOLONE 0.1% CREAM|453.6|GM|.01895|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||120|No|.02502|01/24/2023|.02441|01/24/2023|.02458|01/24/2023|||STEROIDS: TOPICAL HIGH|2149|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000480|TRIAMCINOLONE 0.1% CREAM|80|GM|.03762|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||120|No|.0551|02/28/2023|.05377|02/28/2023|.05413|02/28/2023|||STEROIDS: TOPICAL HIGH|2150|||||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||120|No|.07222|02/28/2023|.07048|02/28/2023|.07095|02/28/2023|||STEROIDS: TOPICAL HIGH|2151|||||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||120|No|.11813|02/28/2023|.11529|02/28/2023|.11606|02/28/2023|||STEROIDS: TOPICAL HIGH|2152|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000616|TRIAMCINOLONE 0.1% OINTMENT|453.6|GM|.02369|04/24/2009||Yes|No||04/24/2009||Yes|No|04/24/2009||Yes|No||||No|No|||Prescription required|No||120|No|.04158|01/24/2023|.04058|01/24/2023|.04085|01/24/2023|||STEROIDS: TOPICAL HIGH|2153|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00168000680|TRIAMCINOLONE 0.1% OINTMENT|80|GM|.06245|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||120|No|.0724|02/28/2023|.07066|02/28/2023|.07113|02/28/2023|||STEROIDS: TOPICAL HIGH|2154|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
nystatin|No|No|No|No|75%|00168000715|NYSTATIN 100,000 UNIT/GM OINT|15|GM|.40133|03/16/2013||Yes|No||03/16/2013||Yes|No|03/16/2013||Yes|No||||No|No|||Prescription required|No||061|No|.28035|02/28/2023|.27362|02/28/2023|.27544|02/28/2023|||ANTIFUNGALS: TOPICAL|2155|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
nystatin|No|No|No|No|75%|00168000730|NYSTATIN 100,000 UNIT/GM OINT|30|GM|.301|03/16/2013|03/31/2024|Yes|No||03/16/2013|03/31/2024|Yes|No|03/16/2013|03/31/2024|Yes|No||||No|No|||Prescription required|No||061|No|.28689|02/28/2023|.28|02/28/2023|.28186|02/28/2023|||ANTIFUNGALS: TOPICAL|2156|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168001516|HYDROCORTISONE 1% CREAM|453.6|GM|.05687|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription required|No||118|No|.12962|06/01/2016|.12777|06/01/2016|.12168|06/01/2016|||STEROIDS: TOPICAL LOW|2157|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168001531|HYDROCORTISONE 1% CREAM|28.35|GM|.091|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription required|No||118|No|.08135|02/28/2023|.07939|02/28/2023|.07992|02/28/2023|||STEROIDS: TOPICAL LOW|2158|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168002016|HYDROCORTISONE 1% OINTMENT|453.6|GM|.05687|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||118|No|.12962|06/01/2016|.12777|06/01/2016|.12168|06/01/2016|||STEROIDS: TOPICAL LOW|2159|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168002031|HYDROCORTISONE 1% OINTMENT|28.35|GM|.091|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription required|No||118|No|.16528|01/24/2023|.16131|01/24/2023|.16238|01/24/2023|||STEROIDS: TOPICAL LOW|2160|||||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||120|No|.70802|02/28/2023|.69102|02/28/2023|.69562|02/28/2023|||STEROIDS: TOPICAL HIGH|2161|||||No|No||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||120|No|.49897|02/28/2023|.48699|02/28/2023|.49023|02/28/2023|||STEROIDS: TOPICAL HIGH|2162|||||No|No||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||120|No|.70105|02/28/2023|.68422|02/28/2023|.68878|02/28/2023|||STEROIDS: TOPICAL HIGH|2163|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168004046|BETAMETHASONE VA 0.1% CREAM|45|GM|.43649|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||120|No|.48|02/28/2023|.46848|02/28/2023|.4716|02/28/2023|||STEROIDS: TOPICAL HIGH|2164|||||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|.5829|02/28/2023|.56891|02/28/2023|.57269|02/28/2023|||STEROIDS: TOPICAL HIGH|2165|||||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|.74784|02/28/2023|.72989|02/28/2023|.73475|02/28/2023|||STEROIDS: TOPICAL HIGH|2166|||||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|.5782|02/28/2023|.56432|02/28/2023|.56808|02/28/2023|||STEROIDS: TOPICAL HIGH|2167|||||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|.67961|02/28/2023|.66329|02/28/2023|.66771|02/28/2023|||STEROIDS: TOPICAL HIGH|2168|||||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|.98066|02/28/2023|.95712|02/28/2023|.96349|02/28/2023|||STEROIDS: TOPICAL HIGH|2169|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone dipropionate|No|No|No|No|75%|00168005760|BETAMETHASONE DP 0.05% LOT|60|ML|.28659|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||120|No|.35031|02/28/2023|.3419|02/28/2023|.34417|02/28/2023|||STEROIDS: TOPICAL HIGH|2170|||||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|.27562|02/28/2023|.269|02/28/2023|.27079|02/28/2023|||STEROIDS: TOPICAL MEDIUM|2171|||||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|1.28711|01/24/2023|1.25621|01/24/2023|1.26458|01/24/2023|||STEROIDS: TOPICAL MEDIUM|2172|||||No|No||SANDOZ|No|||||No|No|No||
fluocinolone acetonide|No|No|No|No|75%|00168006460|FLUOCINOLONE 0.025% OINTMENT|60|GM|.60479|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|1.00033|02/28/2023|.97632|02/28/2023|.98282|02/28/2023|||STEROIDS: TOPICAL MEDIUM|2173|||||No|No||SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168008016|HYDROCORTISONE 2.5% CREAM|453.6|GM|.05687|03/19/2008||Yes|No||03/19/2008||Yes|No|03/19/2008||Yes|No||||No|No|||Prescription required|No||118|No|.11452|02/28/2023|.11177|02/28/2023|.11251|02/28/2023|||STEROIDS: TOPICAL LOW|2174|||||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||118|No|.08145|02/28/2023|.07949|02/28/2023|.08002|02/28/2023|||STEROIDS: TOPICAL LOW|2175|||||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|.29027|02/28/2023|.2833|02/28/2023|.28519|02/28/2023|||ANTIFUNGALS: TOPICAL|2176|||||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|.27632|02/28/2023|.26968|02/28/2023|.27148|02/28/2023|||ANTIFUNGALS: TOPICAL|2177|||||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|.22254|02/28/2023|.21719|02/28/2023|.21864|02/28/2023|||ANTIFUNGALS: TOPICAL|2178|||||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|.2828|02/28/2023|.27601|02/28/2023|.27785|02/28/2023|||STEROIDS: TOPICAL HIGH|2179|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
hydrocortisone|No|No|No|No|75%|00168014616|HYDROCORTISONE 2.5% OINTMENT|453.6|GM|.05687|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||118|No|.12962|06/01/2016|.12777|06/01/2016|.12168|06/01/2016|||STEROIDS: TOPICAL LOW|2180|||||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||118|No|.10084|02/28/2023|.09841|02/28/2023|.09907|02/28/2023|||STEROIDS: TOPICAL LOW|2181|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016215|CLOBETASOL 0.05% OINTMENT|15|GM|1.10854|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||121|No|.31207|02/28/2023|.30458|02/28/2023|.3066|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2182|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016230|CLOBETASOL 0.05% OINTMENT|30|GM|.9417|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||121|No|.2455|02/28/2023|.2396|02/28/2023|.2412|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2183|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016246|CLOBETASOL 0.05% OINTMENT|45|GM|.99148|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||121|No|.20267|02/28/2023|.1978|02/28/2023|.19912|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2184|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016260|CLOBETASOL 0.05% OINTMENT|60|GM|.93374|01/06/2004|11/30/2023|Yes|No||01/06/2004|11/30/2023|Yes|No|01/06/2004|11/30/2023|Yes|No||||No|No|||Prescription required|No||121|No|.18531|02/28/2023|.18086|02/28/2023|.18206|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2185|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||121|No|.24711|02/28/2023|.24117|02/28/2023|.24278|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2186|||||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||121|No|.22451|02/28/2023|.21912|02/28/2023|.22058|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2187|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016346|CLOBETASOL 0.05% CREAM|45|GM|.46315|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||||No|No|||Prescription required|No||121|No|.21953|02/28/2023|.21426|02/28/2023|.21568|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2188|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168016360|CLOBETASOL 0.05% CREAM|60|GM|.41444|09/23/2009||Yes|No||09/23/2009||Yes|No|09/23/2009||Yes|No||||No|No|||Prescription required|No||121|No|.21313|02/28/2023|.20801|02/28/2023|.2094|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2189|||||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||104|No|.27741|02/28/2023|.27075|02/28/2023|.27255|02/28/2023|||ACNE AGENTS: TOPICAL|2190|||||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||104|No|.1962|02/28/2023|.19149|02/28/2023|.19276|02/28/2023|||ACNE AGENTS: TOPICAL|2191|||||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||104|No|.49684|02/28/2023|.48491|02/28/2023|.48814|02/28/2023|||ACNE AGENTS: TOPICAL|2192|||||No|No||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||104|No|.38346|02/28/2023|.37425|02/28/2023|.37674|02/28/2023|||ACNE AGENTS: TOPICAL|2193|||||No|No||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|.44422|02/28/2023|.43355|02/28/2023|.43644|02/28/2023|||ACNE AGENTS: TOPICAL|2194|||||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||||No|No|||Prescription required|No|||No|.16398|02/28/2023|.16004|02/28/2023|.16111|02/28/2023||||2195|||||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||061|No|.19905|02/28/2023|.19427|02/28/2023|.19556|02/28/2023|||ANTIFUNGALS: TOPICAL|2196|||||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||061|No|.16003|02/28/2023|.15618|02/28/2023|.15722|02/28/2023|||ANTIFUNGALS: TOPICAL|2197|||||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|.97651|02/28/2023|.95307|02/28/2023|.95942|02/28/2023|||STEROIDS: TOPICAL LOW|2198|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026345|ALCLOMETASONE DIPRO 0.05% CRM|45|GM|.74542|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|.75527|02/28/2023|.73714|02/28/2023|.74205|02/28/2023|||STEROIDS: TOPICAL LOW|2199|||||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|.78791|02/28/2023|.769|02/28/2023|.77412|02/28/2023|||STEROIDS: TOPICAL LOW|2200|||||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||Yes|No||04/21/2008||Yes|No|04/21/2008||Yes|No||||No|No|||Prescription required|Yes|01/25/2012|118|No|.79358|02/28/2023|.77453|02/28/2023|.77969|02/28/2023|||STEROIDS: TOPICAL LOW|2201|||||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||Yes|No||04/21/2008||Yes|No|04/21/2008||Yes|No||||No|No|||Prescription required|Yes|01/25/2012|118|No|.54117|03/29/2022|.53344|03/29/2022|.50804|03/29/2022|||STEROIDS: TOPICAL LOW|2202|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026460|ALCLOMETASONE DIPR 0.05% OINT|60|GM|.22553|04/21/2008||Yes|No||04/21/2008||Yes|No|04/21/2008||Yes|No||||No|No|||Prescription required|Yes|01/25/2012|118|No|.51401|06/29/2021|.50666|06/29/2021|.48254|06/29/2021|||STEROIDS: TOPICAL LOW|2203|||||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||120|No|.20444|02/28/2023|.19953|02/28/2023|.20086|02/28/2023|||STEROIDS: TOPICAL HIGH|2204|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026550|BETAMETHASONE DP AUG 0.05% CRM|50|GM|.4085|01/26/2004||Yes|No||01/26/2004||Yes|No|01/26/2004||Yes|No||||No|No|||Prescription required|No||120|No|.1367|02/28/2023|.13341|02/28/2023|.1343|02/28/2023|||STEROIDS: TOPICAL HIGH|2205|||||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|.65713|02/28/2023|.64135|02/28/2023|.64563|02/28/2023|||STEROIDS: TOPICAL HIGH|2206|||||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|.64721|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|.66928|02/28/2023|.65321|02/28/2023|.65756|02/28/2023|||STEROIDS: TOPICAL HIGH|2207|||||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|.96783|02/28/2023|.9446|02/28/2023|.95089|02/28/2023|||STEROIDS: TOPICAL HIGH|2208|||||No|No||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|.78191|02/28/2023|.76314|02/28/2023|.76822|02/28/2023|||STEROIDS: TOPICAL HIGH|2209|||||No|No||SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168026950|CLOBETASOL 0.05% SOLUTION|50|ML|.86|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||121|No|.28617|02/28/2023|.2793|02/28/2023|.28116|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2210|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|Yes|No|No|No|75%|00168027740|CLINDAMYCIN 2% VAGINAL CREAM|40|GM|1.12079|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|1.62114|02/28/2023|1.58223|02/28/2023|1.59277|02/28/2023|||ANTIBIOTICS: VAGINAL|2211|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
amcinonide|No|No|No|No|75%|00168027815|AMCINONIDE 0.1% CREAM|15|GM|3.612|01/26/2004|10/25/2023|Yes|No||01/26/2004|10/25/2023|Yes|No|01/26/2004|10/25/2023|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|120|No|8.232|06/01/2016|8.1144|06/01/2016|7.728|06/01/2016|||STEROIDS: TOPICAL HIGH|2212|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
amcinonide|No|No|No|No|75%|00168027830|AMCINONIDE 0.1% CREAM|30|GM|2.709|01/26/2004|10/25/2023|Yes|No||01/26/2004|10/25/2023|Yes|No|01/26/2004|10/25/2023|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|120|No|6.174|08/23/2016|6.0858|08/23/2016|5.796|08/23/2016|||STEROIDS: TOPICAL HIGH|2213|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
amcinonide|No|No|No|No|75%|00168027860|AMCINONIDE 0.1% CREAM|60|GM|2.322|01/26/2004|10/25/2023|Yes|No||01/26/2004|10/25/2023|Yes|No|01/26/2004|10/25/2023|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|120|No|5.292|06/01/2016|5.2164|06/01/2016|4.968|06/01/2016|||STEROIDS: TOPICAL HIGH|2214|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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||121|No|1.33973|02/28/2023|1.30757|02/28/2023|1.31628|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2215|||||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||121|No|.4574|01/24/2023|.44642|01/24/2023|.44939|01/24/2023|||STEROIDS: TOPICAL VERY HIGH|2216|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00168029360|CLOBETASOL 0.05% GEL|60|GM|.89074|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||121|No|.84283|01/24/2023|.8226|01/24/2023|.82808|01/24/2023|||STEROIDS: TOPICAL VERY HIGH|2217|||||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||121|No|.62105|02/28/2023|.60614|02/28/2023|.61018|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2218|||||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||121|No|.74992|02/28/2023|.73192|02/28/2023|.73679|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2219|||||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||121|No|.99134|02/28/2023|.96754|02/28/2023|.97399|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2220|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00168032346|METRONIDAZOLE 0.75% CREAM|45|GM|.68178|12/02/2005||Yes|No||12/02/2005||Yes|No|12/02/2005||Yes|No||||No|No|||Prescription required|No||221|No|.52525|02/28/2023|.51264|02/28/2023|.51605|02/28/2023|||ROSACEA AGENTS: TOPICAL|2221|||||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||119|No|.30928|02/28/2023|.30185|02/28/2023|.30386|02/28/2023|||STEROIDS: TOPICAL MEDIUM|2222|||||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||119|No|.2183|02/28/2023|.21306|02/28/2023|.21447|02/28/2023|||STEROIDS: TOPICAL MEDIUM|2223|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00168033260|FLUTICASONE PROP 0.05% CREAM|60|GM|.27612|06/18/2004||Yes|No||06/18/2004||Yes|No|06/18/2004||Yes|No||||No|No|||Prescription required|No||119|No|.19928|02/28/2023|.19449|02/28/2023|.19579|02/28/2023|||STEROIDS: TOPICAL MEDIUM|2224|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
terconazole|No|No|No|No|75%|00168034720|TERCONAZOLE 0.8% CREAM|20|GM|.84344|04/21/2021||Yes|No||04/21/2021||Yes|No|04/21/2021||Yes|No||||No|No|||Prescription required|No|||No|1.15204|02/28/2023|1.12439|02/28/2023|1.13187|02/28/2023||||2225|||||No|No||FOUGERA|No|||||No|No|No||
mupirocin|No|No|No|No|75%|00168035222|MUPIROCIN 2% OINTMENT|22|GM|.63033|02/13/2009||Yes|No||02/13/2009||Yes|No|02/13/2009||Yes|No||||No|No|||Prescription required|No||114|No|.1662|02/28/2023|.16221|02/28/2023|.16329|02/28/2023|||ANTIBIOTICS: TOPICAL|2226|||||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||121|No|.51315|02/28/2023|.50083|02/28/2023|.50416|02/28/2023|||STEROIDS: TOPICAL VERY HIGH|2227|||||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||||No|No|||Prescription required|No|||No|.4481|02/28/2023|.43734|02/28/2023|.44025|02/28/2023||||2228|||||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||||No|No|||Prescription required|No|||No|1.61974|02/28/2023|1.5966|02/28/2023|1.52057|02/28/2023||||2229|||||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|16.06514|05/25/2021|15.83563|05/25/2021|15.08156|05/25/2021|||ANTIFUNGALS: TOPICAL|2230|||||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|8.15032|09/28/2021|8.03389|09/28/2021|7.65132|09/28/2021|||ANTIFUNGALS: TOPICAL|2231|||||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|8.14651|10/29/2019|8.03013|10/29/2019|7.64774|10/29/2019|||ANTIFUNGALS: TOPICAL|2232|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clotrimazole/betamethasone dip|No|No|No|No|75%|00168037030|CLOTRIMAZOLE-BETAMETHASONE LOT|30|ML|1.77446|03/19/2009||Yes|No||03/19/2009||Yes|No|03/19/2009||Yes|No||||No|No|||Prescription required|Yes|01/20/2011|061|No|3.02778|02/28/2023|2.95511|02/28/2023|2.97479|02/28/2023|||ANTIFUNGALS: TOPICAL|2233|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00168038360|METRONIDAZOLE 0.75% LOTION|59|ML|.52474|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|1.86851|02/28/2023|1.82366|02/28/2023|1.83581|02/28/2023|||ROSACEA AGENTS: TOPICAL|2234|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
prednicarbate|No|No|No|No|75%|00168041015|PREDNICARBATE 0.1% OINTMENT|15|GM|.71666|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|1.63332|06/01/2016|1.60999|06/01/2016|1.53332|06/01/2016|||STEROIDS: TOPICAL MEDIUM|2235|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
prednicarbate|No|No|No|No|75%|00168041060|PREDNICARBATE 0.1% OINTMENT|60|GM|.44067|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|06/01/2016|.98998|06/01/2016|.94284|06/01/2016|||STEROIDS: TOPICAL MEDIUM|2236|||||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|Yes|07/17/2014|034|Yes|1.94104|02/28/2023|1.89445|02/28/2023|1.90707|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2237|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041660|TACROLIMUS 0.1% OINTMENT|60|GM|1.94123|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||||No|No|||Prescription required|Yes|07/17/2014|034|Yes|1.75702|02/28/2023|1.71485|02/28/2023|1.72627|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2238|||||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|Yes|07/17/2014|034|Yes|1.96583|02/28/2023|1.91865|02/28/2023|1.93142|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2239|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041730|TACROLIMUS 0.03% OINTMENT|30|GM|1.94116|05/21/2015||Yes|No||05/21/2015||Yes|No|05/21/2015||Yes|No||||No|No|||Prescription required|Yes|07/17/2014|034|Yes|1.71918|02/28/2023|1.67791|02/28/2023|1.68909|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2240|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041760|TACROLIMUS 0.03% OINTMENT|60|GM|1.94123|02/19/2015||Yes|No||02/19/2015||Yes|No|02/19/2015||Yes|No||||No|No|||Prescription required|Yes|07/17/2014|034|Yes|.67428|02/28/2023|.65809|02/28/2023|.66248|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2241|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041799|TACROLIMUS 0.03% OINTMENT|100|GM|1.94119|02/19/2015||Yes|No||02/19/2015||Yes|No|02/19/2015||Yes|No||||No|No|||Prescription required|Yes|07/17/2014|034|Yes|1.28984|01/24/2023|1.25888|01/24/2023|1.26726|01/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2242|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
adapalene|No|No|No|No|75%|00168042446|ADAPALENE 0.1% CREAM|45|GM|2.25386|08/02/2010||Yes|No||08/02/2010||Yes|No|08/02/2010||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|104|No|2.93871|02/28/2023|2.86818|02/28/2023|2.88728|02/28/2023|||ACNE AGENTS: TOPICAL|2243|||||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|5.9211|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||029|No|13.22505|02/28/2023|12.90764|02/28/2023|12.99361|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2244|||||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|5.9211|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||029|No|13.21613|02/28/2023|12.89894|02/28/2023|12.98484|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2245|||||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|5.9211|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|13.22868|02/28/2023|12.91119|02/28/2023|12.99717|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2246|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169210011|RELION NOVOLOG 100 UNIT/ML VL|10|ML|12.44248|09/30/2021||Yes|No||09/30/2021||Yes|No|09/30/2021||Yes|No||09/30/2021||Yes|No|||Prescription required|No||029|No|28.35728|09/30/2021|27.95217|09/30/2021|26.62112|09/30/2021|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2247|||||No|No||NOVO NORDISK-WA|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169210125|RELION NOVOLOG U-100 FLEXPEN|3|ML|16.01979|09/30/2021||Yes|No||09/30/2021||Yes|No|09/30/2021||Yes|No||09/30/2021||Yes|No|||Prescription required|No||029|No|36.51022|09/30/2021|35.98864|09/30/2021|34.2749|09/30/2021|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2248|||||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|12.90516|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||02/02/2022||Yes|No|||Prescription required|No||029|No|29.41176|02/02/2022|28.99159|02/02/2022|27.61104|02/02/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2249|||||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|16.01979|02/02/2022||Yes|No||02/02/2022||Yes|No|02/02/2022||Yes|No||02/02/2022||Yes|No|||Prescription required|No||029|No|36.51022|02/02/2022|35.98864|02/02/2022|34.2749|02/02/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2250|||||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|64.9782|02/28/2023|63.41872|02/28/2023|63.84108|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2251|||||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|32.53266|02/28/2023|31.75187|02/28/2023|31.96333|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2252|||||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|32.65306|10/25/2022|31.86938|10/25/2022|32.08163|10/25/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2253|||||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|35.50997|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|79.47468|01/17/2023|77.56728|01/17/2023|78.08387|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2254|||||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|7.4605|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|16.64317|02/28/2023|16.24373|02/28/2023|16.35191|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2255|||||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|7.4605|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|16.62854|02/28/2023|16.22945|02/28/2023|16.33754|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2256|||||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|7.4605|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|16.60133|02/28/2023|16.20289|02/28/2023|16.3108|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2257|||||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|27.71316|10/25/2022|27.04804|10/25/2022|27.22817|10/25/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2258|||||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|35.72844|10/25/2022|34.87095|10/25/2022|35.10319|10/25/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2259|||||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|34.36226|06/28/2022|33.53756|06/28/2022|33.76092|06/28/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2260|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169330312|NOVOLOG PENFILL 100 UNIT/ML|3|ML|15.40747|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||029|No|34.36045|02/28/2023|33.53579|02/28/2023|33.75914|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2261|||||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|12.90516|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||029|No|28.9335|07/26/2022|28.23909|07/26/2022|28.42716|07/26/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2262|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin detemir|No|No|No|No|75%|00169368712|LEVEMIR 100 UNIT/ML VIAL|10|ML|13.25002|03/15/2007||Yes|No||03/15/2007||Yes|No|03/15/2007||Yes|No||03/15/2007||Yes|No|||Prescription required|No||029|No|29.51015|02/28/2023|28.8019|02/28/2023|28.99372|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2263|||||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|16.01979|09/02/2004||Yes|No||09/02/2004||Yes|No|09/02/2004||Yes|No||09/02/2004||Yes|No|||Prescription required|No||029|No|35.73216|07/26/2022|34.87458|07/26/2022|35.10684|07/26/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2264|||||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|53.3587|02/23/2010||Yes|No||02/23/2010||Yes|No|02/23/2010||Yes|No||11/01/2016||Yes|No|||Prescription required|No||111|Yes|119.15598|01/17/2023|116.29623|01/17/2023|117.07075|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2265|||||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|53.3587|02/23/2010||Yes|No||02/23/2010||Yes|No|02/23/2010||Yes|No||11/01/2016||Yes|No|||Prescription required|No||111|Yes|119.0821|01/17/2023|116.22412|01/17/2023|116.99816|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2266|||||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|134.12703|05/11/2021||Yes|No||05/11/2021||Yes|No|05/11/2021||Yes|No||05/11/2021||Yes|No|||Prescription required|No||111|Yes|301.07319|01/17/2023|293.84743|01/17/2023|295.8044|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2267|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169413212|OZEMPIC 0.25-0.5 MG/DOSE PEN|1.5|ML|268.25406|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||07/06/2018||Yes|No|||Prescription required|No||111|Yes|599.53845|01/17/2023|585.14952|01/17/2023|589.04652|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2268|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169413602|OZEMPIC 1 MG/DOSE (2 MG/1.5ML)|1.5|ML|127.86193|07/06/2018|01/01/2023|Yes|No||07/06/2018|01/01/2023|Yes|No|07/06/2018|01/01/2023|Yes|No||07/06/2018|01/01/2023|Yes|No|||Prescription required|No||111|Yes|285.23404|01/18/2022|278.38842|01/18/2022|280.24244|01/18/2022|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2269|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169430313|RYBELSUS 3 MG TABLET|30|EA|12.78619|03/30/2020|02/09/2023|Yes|No||03/30/2020|02/09/2023|Yes|No|03/30/2020|02/09/2023|Yes|No||03/30/2020|02/09/2023|Yes|No|||Prescription required|Yes|07/30/2020|111|Yes|29.9802|01/17/2023|29.26067|01/17/2023|29.45554|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2270|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169430330|RYBELSUS 3 MG TABLET|30|EA|13.4127|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|29.9802|01/17/2023|29.26067|01/17/2023|29.45554|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2271|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169430713|RYBELSUS 7 MG TABLET|30|EA|12.78619|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|29.97012|01/17/2023|29.25083|01/17/2023|29.44564|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2272|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169430730|RYBELSUS 7 MG TABLET|30|EA|13.4127|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|29.97012|01/17/2023|29.25083|01/17/2023|29.44564|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2273|||||No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169431413|RYBELSUS 14 MG TABLET|30|EA|12.78619|03/30/2020|02/09/2023|Yes|No||03/30/2020|02/09/2023|Yes|No|03/30/2020|02/09/2023|Yes|No||03/30/2020|02/09/2023|Yes|No|||Prescription required|Yes|07/30/2020|111|Yes|29.98013|01/17/2023|29.2606|01/17/2023|29.45547|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2274|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||NOVO NORDISK|No|||||No|No|No||
semaglutide|No|No|No|No|75%|00169431430|RYBELSUS 14 MG TABLET|30|EA|13.4127|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|29.98013|01/17/2023|29.2606|01/17/2023|29.45547|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2275|||||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|134.12703|11/15/2022||Yes|No||11/15/2022||Yes|No|11/15/2022||Yes|No||11/15/2022||Yes|No|||Prescription required|No||111|Yes|299.85322|01/17/2023|292.65674|01/17/2023|294.60578|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2276|||||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|20.37967|02/28/2023|19.89055|02/28/2023|20.02302|02/28/2023||||2277|||||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|20.37967|02/28/2023|19.89055|02/28/2023|20.02302|02/28/2023||||2278|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin aspart|No|No|No|No|75%|00169633910|NOVOLOG 100 UNIT/ML FLEXPEN|3|ML|16.01979|05/05/2004||Yes|No||05/05/2004||Yes|No|05/05/2004||Yes|No||05/05/2004||Yes|No|||Prescription required|No||029|No|35.80362|07/26/2022|34.94433|07/26/2022|35.17705|07/26/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2279|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin detemir|No|No|No|No|75%|00169643810|LEVEMIR FLEXTOUCH 100 UNIT/ML|3|ML|13.25002|06/19/2014|02/01/2024|Yes|No||06/19/2014|02/01/2024|Yes|No|06/19/2014|02/01/2024|Yes|No||06/19/2014|02/01/2024|Yes|No|||Prescription required|No||029|No|29.55595|02/28/2023|28.8466|02/28/2023|29.03872|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2280|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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|11.8048|03/25/2014||Yes|No||03/25/2014||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|17.0128|01/10/2023|16.76976|01/10/2023|15.9712|01/10/2023|||HEMOPHILIA TREATMENT|2281|||||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||583|No|286.58446|01/17/2023|279.70643|01/17/2023|281.56923|01/17/2023|||GLUCAGON AGENTS|2282|||||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|1.7476|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5186|01/10/2023|2.48262|01/10/2023|2.3644|01/10/2023|||HEMOPHILIA TREATMENT|2283|||||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|1.7476|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5186|01/10/2023|2.48262|01/10/2023|2.3644|01/10/2023|||HEMOPHILIA TREATMENT|2284|||||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|1.7476|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5186|01/10/2023|2.48262|01/10/2023|2.3644|01/10/2023|||HEMOPHILIA TREATMENT|2285|||||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|1.7476|05/22/2013||Yes|No||05/22/2013||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.5186|01/10/2023|2.48262|01/10/2023|2.3644|01/10/2023|||HEMOPHILIA TREATMENT|2286|||||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|12.44248|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||029|No|27.80117|07/26/2022|27.13394|07/26/2022|27.31464|07/26/2022|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2287|||||No|No||NOVO NORDISK|No|||||No|No|No||
somatropin|No|No|No|No|75%|00169770321|NORDITROPIN FLEXPRO 30 MG/3 ML|3|ML|660.351|05/20/2015||Yes|No||05/20/2015||Yes|No|05/20/2015||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|1504.986|01/10/2023|1483.4862|01/10/2023|1412.844|01/10/2023|||GROWTH HORMONE|2288|||||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|220.117|04/15/2010||Yes|No||04/15/2010||Yes|No|04/15/2010||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|487.62044|01/17/2023|475.91754|01/17/2023|479.08708|01/17/2023|||GROWTH HORMONE|2289|||||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|440.234|04/15/2010||Yes|No||04/15/2010||Yes|No|04/15/2010||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|990.93332|01/17/2023|967.15092|01/17/2023|973.59198|01/17/2023|||GROWTH HORMONE|2290|||||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|660.351|04/15/2010||Yes|No||04/15/2010||Yes|No|04/15/2010||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|1504.986|01/10/2023|1483.4862|01/10/2023|1412.844|01/10/2023|||GROWTH HORMONE|2291|||||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|1.4076|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.0286|01/10/2023|1.99962|01/10/2023|1.9044|01/10/2023|||HEMOPHILIA TREATMENT|2292|||||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|1.4076|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.0286|01/10/2023|1.99962|01/10/2023|1.9044|01/10/2023|||HEMOPHILIA TREATMENT|2293|||||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|1.4076|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.0286|01/10/2023|1.99962|01/10/2023|1.9044|01/10/2023|||HEMOPHILIA TREATMENT|2294|||||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|1.4076|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.0286|01/10/2023|1.99962|01/10/2023|1.9044|01/10/2023|||HEMOPHILIA TREATMENT|2295|||||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|1.4076|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.0286|01/10/2023|1.99962|01/10/2023|1.9044|01/10/2023|||HEMOPHILIA TREATMENT|2296|||||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|1.4076|05/20/2015||Yes|No||05/20/2015||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.0286|01/10/2023|1.99962|01/10/2023|1.9044|01/10/2023|||HEMOPHILIA TREATMENT|2297|||||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|3.162|06/22/2018||Yes|No||06/22/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|4.557|01/10/2023|4.4919|01/10/2023|4.278|01/10/2023|||HEMOPHILIA TREATMENT|2298|||||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|3.162|06/22/2018||Yes|No||06/22/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|4.557|01/10/2023|4.4919|01/10/2023|4.278|01/10/2023|||HEMOPHILIA TREATMENT|2299|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
factor IX human rec,pegylated|No|No|No|No|75%|00169790501|REBINYN 500 UNIT VIAL|1|EA|3.162|06/22/2018||Yes|No||06/22/2018||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|4.557|01/10/2023|4.4919|01/10/2023|4.278|01/10/2023|||HEMOPHILIA TREATMENT|2300|||||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|1.666|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.401|01/10/2023|2.3667|01/10/2023|2.254|01/10/2023|||HEMOPHILIA TREATMENT|2301|||||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|1.666|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.401|01/10/2023|2.3667|01/10/2023|2.254|01/10/2023|||HEMOPHILIA TREATMENT|2302|||||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|1.666|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.401|01/10/2023|2.3667|01/10/2023|2.254|01/10/2023|||HEMOPHILIA TREATMENT|2303|||||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|1.666|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.401|01/10/2023|2.3667|01/10/2023|2.254|01/10/2023|||HEMOPHILIA TREATMENT|2304|||||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|1.666|03/09/2020||Yes|No||03/09/2020||Yes|No|04/01/2021||Yes|No||||No|No|||Prescription required|No||105|No|2.401|01/10/2023|2.3667|01/10/2023|2.254|01/10/2023|||HEMOPHILIA TREATMENT|2305|||||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|.01258|02/28/2023|.01227|02/28/2023|.01235|02/28/2023||||2306|||||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|.01258|02/28/2023|.01227|02/28/2023|.01235|02/28/2023||||2307|||||No|No||TEVA USA|No|||||No|No|No||
hydrochlorothiazide|Yes|No|No|No|75%|00172208960|HYDROCHLOROTHIAZIDE 50 MG TAB|100|EA|.03504|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|.02614|02/28/2023|.02551|02/28/2023|.02568|02/28/2023||||2308|||||No|No||TEVA USA|No|||||No|No|No||
hydrochlorothiazide|Yes|No|No|No|75%|00172208980|HYDROCHLOROTHIAZIDE 50 MG TAB|1000|EA|.03373|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|.02614|02/28/2023|.02551|02/28/2023|.02568|02/28/2023||||2309|||||No|No||TEVA USA|No|||||No|No|No||
lisinopril|Yes|No|No|No|75%|00172376170|LISINOPRIL 40 MG TABLET|500|EA|.0524|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||113|No|.05226|02/28/2023|.051|02/28/2023|.05134|02/28/2023|||ANGIOTENSIN MODULATORS|2310|||||No|No||TEVA USA|No|||||No|No|No||
lisinopril|Yes|No|No|No|75%|00172376260|LISINOPRIL 30 MG TABLET|100|EA|.05009|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||113|No|.0575|02/28/2023|.05612|02/28/2023|.05649|02/28/2023|||ANGIOTENSIN MODULATORS|2311|||||No|No||TEVA USA|No|||||No|No|No||
diazepam|No|No|No|No|75%|00172392560|DIAZEPAM 2 MG TABLET|100|EA|.01285|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.02231|02/28/2023|.02177|02/28/2023|.02191|02/28/2023|||ANXIOLYTICS|2312|||||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||090|Yes|.02231|02/28/2023|.02177|02/28/2023|.02191|02/28/2023|||ANXIOLYTICS|2313|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392660|DIAZEPAM 5 MG TABLET|100|EA|.02059|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.03067|02/28/2023|.02993|02/28/2023|.03013|02/28/2023|||ANXIOLYTICS|2314|||||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||090|Yes|.03067|02/28/2023|.02993|02/28/2023|.03013|02/28/2023|||ANXIOLYTICS|2315|||||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||090|Yes|.03067|02/28/2023|.02993|02/28/2023|.03013|02/28/2023|||ANXIOLYTICS|2316|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392760|DIAZEPAM 10 MG TABLET|100|EA|.03977|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.03088|02/28/2023|.03013|02/28/2023|.03033|02/28/2023|||ANXIOLYTICS|2317|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392770|DIAZEPAM 10 MG TABLET|500|EA|.03877|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.03088|02/28/2023|.03013|02/28/2023|.03033|02/28/2023|||ANXIOLYTICS|2318|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
diazepam|No|No|No|No|75%|00172392780|DIAZEPAM 10 MG TABLET|1000|EA|.01561|04/01/2011||Yes|No||04/01/2011||Yes|No|04/01/2011||Yes|No||||No|No|||Prescription required|No||090|Yes|.03088|02/28/2023|.03013|02/28/2023|.03033|02/28/2023|||ANXIOLYTICS|2319|||||No|No||TEVA USA|Yes|09/01/2020||||No|No|No||
baclofen|No|No|No|No|75%|00172409660|BACLOFEN 10 MG TABLET|100|EA|.09395|07/13/2010||Yes|No||07/13/2010||Yes|No|07/13/2010||Yes|No||||No|No|||Prescription required|No||116|No|.05688|02/28/2023|.05551|02/28/2023|.05588|02/28/2023|||SKELETAL MUSCLE RELAXANTS|2320|||||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||116|No|.05688|02/28/2023|.05551|02/28/2023|.05588|02/28/2023|||SKELETAL MUSCLE RELAXANTS|2321|||||No|No||TEVA USA|No|||||No|No|No||
baclofen|No|No|No|No|75%|00172409760|BACLOFEN 20 MG TABLET|100|EA|.15505|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||116|No|.09546|02/28/2023|.09316|02/28/2023|.09378|02/28/2023|||SKELETAL MUSCLE RELAXANTS|2322|||||No|No||TEVA USA|No|||||No|No|No||
baclofen|No|No|No|No|75%|00172409780|BACLOFEN 20 MG TABLET|1000|EA|.15506|05/09/2012||Yes|No||09/01/2020||Yes|No|09/01/2020||Yes|No||||No|No|||Prescription required|No||116|No|.09546|02/28/2023|.09316|02/28/2023|.09378|02/28/2023|||SKELETAL MUSCLE RELAXANTS|2323|||||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||Yes|No||06/28/2010||Yes|No|06/28/2010||Yes|No||||No|No|||Prescription required|No|||No|1.75518|10/27/2020|1.7301|10/27/2020|1.64772|10/27/2020||||2324|||||No|No||TEVA USA|No|||||No|No|No||
anagrelide HCl|No|No|No|No|75%|00172524160|ANAGRELIDE HCL 0.5 MG CAPSULE|100|EA|.35814|06/28/2010||Yes|No||06/28/2010||Yes|No|06/28/2010||Yes|No||||No|No|||Prescription required|No|||No|.71538|06/28/2022|.69821|06/28/2022|.70286|06/28/2022||||2325|||||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|.03084|02/28/2023|.03009|02/28/2023|.0303|02/28/2023||||2326|||||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|.03084|02/28/2023|.03009|02/28/2023|.0303|02/28/2023||||2327|||||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|.03084|02/28/2023|.03009|02/28/2023|.0303|02/28/2023||||2328|||||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|.06264|02/28/2023|.06113|02/28/2023|.06154|02/28/2023||||2329|||||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|.06264|02/28/2023|.06113|02/28/2023|.06154|02/28/2023||||2330|||||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||229|No|4.62148|07/28/2020|4.55546|07/28/2020|4.33853|07/28/2020|||IMMUNOSUPPRESSIVES: ORAL|2331|||||No|No||TEVA USA|No|||||Yes|No|No||
bupropion HCl|No|No|No|No|75%|00173013555|WELLBUTRIN SR 150 MG TABLET|60|EA|3.38545|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|7.71569|01/10/2023|7.60547|01/10/2023|7.2433|01/10/2023|||ANTIDEPRESSANTS: OTHER|2332|||||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||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|07/26/2012|019|No|11.49971|11/29/2022|11.33543|11/29/2022|10.79564|11/29/2022|||INTRANASAL RHINITIS AGENTS|2333|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173047800|IMITREX 6 MG/0.5 ML CARTRIDGES|1|ML|190.7824|06/22/2009||Yes|No||06/22/2009||Yes|No|06/22/2009||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|No|429.7854|01/17/2023|419.47055|01/17/2023|422.26415|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2334|||||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|201.4378|06/26/2009||Yes|No||06/26/2009||Yes|No|06/26/2009||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|No|459.0908|01/10/2023|452.53236|01/10/2023|430.9832|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2335|||||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|||No|18.3162|06/01/2016|18.05454|06/01/2016|17.1948|06/01/2016||||2336|||||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|||No|44.2372|06/01/2016|43.60524|06/01/2016|41.5288|06/01/2016||||2337|||||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|Yes|07/17/2007|037|Yes|6.78572|02/08/2022|6.62286|02/08/2022|6.66696|02/08/2022|||BRONCHODILATORS: BETA AGONIST|2338|||||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||Yes|No||03/25/2009||Yes|No|03/25/2009||Yes|No||||No|No|||Prescription required|No||021|No|89.8011|01/17/2023|87.64587|01/17/2023|88.22958|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2339|||||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||Yes|No||08/13/2007||Yes|No|08/13/2007||Yes|No||||No|No|||Prescription required|No||021|No|88.6189|01/17/2023|86.49204|01/17/2023|87.06806|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2340|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173052600|LAMICTAL 5 MG DISPER TABLET|100|EA|6.6229|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|15.09405|01/10/2023|14.87842|01/10/2023|14.16993|01/10/2023|||ANTICONVULSANTS|2341|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173052700|LAMICTAL 25 MG DISPER TABLET|100|EA|7.10983|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|15.79026|01/17/2023|15.41129|01/17/2023|15.51393|01/17/2023|||ANTICONVULSANTS|2342|||||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|6.49846|01/28/2020|6.40563|01/28/2020|6.1006|01/28/2020||||2343|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
naratriptan HCl|No|No|No|No|75%|00173056100|AMERGE 1 MG TABLET|9|EA|24.32844|09/26/2006|02/28/2023|Yes|No||09/26/2006|02/28/2023|Yes|No|09/26/2006|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|01/23/2008|021|No|55.44621|01/10/2017|54.65412|01/10/2017|52.05154|01/10/2017|||ANTIMIGRAINE AGENTS: TRIPTANS|2344|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
naratriptan HCl|No|No|No|No|75%|00173056200|AMERGE 2.5 MG TABLET|9|EA|24.32844|07/06/2009|02/28/2023|Yes|No||07/06/2009|02/28/2023|Yes|No|07/06/2009|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|01/23/2008|021|No|55.44621|01/23/2018|54.65412|01/23/2018|52.05154|01/23/2018|||ANTIMIGRAINE AGENTS: TRIPTANS|2345|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00173056504|VALTREX 1 GM CAPLET|30|EA|10.10371|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|22.47728|01/17/2023|21.93782|01/17/2023|22.08392|01/17/2023|||ANTIVIRALS: ORAL|2346|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00173056510|VALTREX 1 GM CAPLET|90|EA|10.10389|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|22.47728|01/17/2023|21.93782|01/17/2023|22.08392|01/17/2023|||ANTIVIRALS: ORAL|2347|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173059402|LAMICTAL TB START KIT (ORANGE)|49|EA|6.98381|01/11/2005||Yes|No||01/11/2005||Yes|No|01/11/2005||Yes|No||||No|No|||Prescription required|No||056|No|15.91659|01/10/2023|15.68921|01/10/2023|14.9421|01/10/2023|||ANTICONVULSANTS|2348|||||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||Yes|No||07/02/2007||Yes|No|07/02/2007||Yes|No||||No|No|||Prescription required|Yes|09/18/2020|033|Yes|3.10634|02/08/2022|3.03178|02/08/2022|3.05197|02/08/2022|||GLUCOCORTICOIDS: INHALED|2349|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173060102|FLOVENT 250 MCG DISKUS|60|EA|1.96244|07/29/2009||Yes|No||07/29/2009||Yes|No|07/29/2009||Yes|No||||No|No|||Prescription required|Yes|09/18/2020|033|Yes|4.37945|02/08/2022|4.27434|02/08/2022|4.3028|02/08/2022|||GLUCOCORTICOIDS: INHALED|2350|||||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||Yes|No||07/29/2009||Yes|No|07/29/2009||Yes|No||||No|No|||Prescription required|Yes|09/18/2020|033|Yes|3.27324|02/08/2022|3.19468|02/08/2022|3.21595|02/08/2022|||GLUCOCORTICOIDS: INHALED|2351|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
lamotrigine|No|No|No|No|75%|00173063302|LAMICTAL 25 MG TABLET|100|EA|6.84465|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|15.2417|01/17/2023|14.87589|01/17/2023|14.97497|01/17/2023|||ANTICONVULSANTS|2352|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173063310|LAMICTAL TAB START KIT (BLUE)|35|EA|6.84486|06/14/2009||Yes|No||06/14/2009||Yes|No|06/14/2009||Yes|No||||No|No|||Prescription required|No||056|No|15.59991|01/10/2023|15.37705|01/10/2023|14.64481|01/10/2023|||ANTICONVULSANTS|2353|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173064255|LAMICTAL 100 MG TABLET|100|EA|7.8183|05/12/2004||Yes|No||05/12/2004||Yes|No|05/12/2004||Yes|No||||No|No|||Prescription required|No||056|No|17.45287|01/17/2023|17.034|01/17/2023|17.14744|01/17/2023|||ANTICONVULSANTS|2354|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173064360|LAMICTAL 150 MG TABLET|60|EA|8.5691|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|19.19079|01/17/2023|18.73021|01/17/2023|18.85495|01/17/2023|||ANTICONVULSANTS|2355|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173064460|LAMICTAL 200 MG TABLET|60|EA|9.32834|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||056|No|20.85373|01/17/2023|20.35324|01/17/2023|20.48878|01/17/2023|||ANTICONVULSANTS|2356|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamivudine|No|No|No|No|75%|00173066200|EPIVIR HBV 100 MG TABLET|60|EA|9.7563|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|15.93529|01/10/2017|15.70764|01/10/2017|14.95966|01/10/2017||||2357|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamivudine|No|No|No|No|75%|00173066300|EPIVIR HBV 25 MG/5 ML SOLN|240|ML|.4878|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|.79674|01/10/2017|.78535|01/10/2017|.74796|01/10/2017||||2358|||||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|01/28/2020|6.92759|01/28/2020|6.5977|01/28/2020||||2359|||||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|6.5952|06/01/2016|6.50098|06/01/2016|6.19141|06/01/2016||||2360|||||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|6.72932|06/01/2016|6.63319|06/01/2016|6.31732|06/01/2016||||2361|||||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|1.07035|04/29/2009||Yes|No||04/29/2009||Yes|No|04/29/2009||Yes|No||||No|No|||Prescription required|No|||No|2.43941|06/01/2016|2.40456|06/01/2016|2.29006|06/01/2016||||2362|||||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|2.891|03/26/2019|2.8497|03/26/2019|2.714|03/26/2019|||ANTIVIRALS: ORAL|2363|||||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||037|Yes|3.04135|02/08/2022|2.96835|02/08/2022|2.98812|02/08/2022|||BRONCHODILATORS: BETA AGONIST|2364|||||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||037|Yes|2.7141|02/08/2022|2.64896|02/08/2022|2.6666|02/08/2022|||BRONCHODILATORS: BETA AGONIST|2365|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173069500|ADVAIR 100-50 DISKUS|60|EA|2.27218|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||033|Yes|5.06351|02/28/2023|4.94198|02/28/2023|4.97489|02/28/2023|||GLUCOCORTICOIDS: INHALED|2366|||||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|2.82316|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||033|Yes|6.29355|02/28/2023|6.1425|02/28/2023|6.18341|02/28/2023|||GLUCOCORTICOIDS: INHALED|2367|||||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|3.71305|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||033|Yes|8.27236|02/28/2023|8.07382|02/28/2023|8.12759|02/28/2023|||GLUCOCORTICOIDS: INHALED|2368|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
dutasteride|No|No|No|No|75%|00173071204|AVODART 0.5 MG SOFTGEL|90|EA|3.5862|08/16/2005|12/21/2023|Yes|No||08/16/2005|12/21/2023|Yes|No|08/16/2005|12/21/2023|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|003|No|7.97685|11/15/2022|7.7854|11/15/2022|7.83725|11/15/2022|||BPH TREATMENTS|2369|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GSK/WOODWARD PH|No|||||No|No|No||
dutasteride|No|No|No|No|75%|00173071215|AVODART 0.5 MG SOFTGEL|30|EA|3.5862|09/09/2003|12/21/2023|Yes|No||09/09/2003|12/21/2023|Yes|No|09/09/2003|12/21/2023|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|003|No|7.97685|11/15/2022|7.7854|11/15/2022|7.83725|11/15/2022|||BPH TREATMENTS|2370|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GSK/WOODWARD PH|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00173071520|ADVAIR HFA 45-21 MCG INHALER|12|GM|11.70173|12/18/2008||Yes|No||12/18/2008||Yes|No|12/18/2008||Yes|No||||No|No|||Prescription required|No||033|Yes|26.17902|08/23/2022|25.55072|08/23/2022|25.72088|08/23/2022|||GLUCOCORTICOIDS: INHALED|2371|||||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|11.76265|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription required|No||033|Yes|26.8079|01/12/2021|26.42493|01/12/2021|25.1666|01/12/2021|||GLUCOCORTICOIDS: INHALED|2372|||||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|14.53937|12/18/2008||Yes|No||12/18/2008||Yes|No|12/18/2008||Yes|No||||No|No|||Prescription required|No||033|Yes|32.46319|08/23/2022|31.68407|08/23/2022|31.89508|08/23/2022|||GLUCOCORTICOIDS: INHALED|2373|||||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|11.76265|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription required|No||033|Yes|26.8079|06/28/2022|26.42493|06/28/2022|25.1666|06/28/2022|||GLUCOCORTICOIDS: INHALED|2374|||||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|19.1221|08/27/2010||Yes|No||08/27/2010||Yes|No|08/27/2010||Yes|No||||No|No|||Prescription required|No||033|Yes|42.68837|08/23/2022|41.66384|08/23/2022|41.94132|08/23/2022|||GLUCOCORTICOIDS: INHALED|2375|||||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|17.4451|01/14/2010||Yes|No||01/14/2010||Yes|No|01/14/2010||Yes|No||||No|No|||Prescription required|No||033|Yes|39.7586|01/12/2021|39.19062|01/12/2021|37.3244|01/12/2021|||GLUCOCORTICOIDS: INHALED|2376|||||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||Yes|No||05/04/2007||Yes|No|05/04/2007||Yes|No||||No|No|||Prescription required|No||033|Yes|18.53668|02/08/2022|18.09179|02/08/2022|18.21228|02/08/2022|||GLUCOCORTICOIDS: INHALED|2377|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173071920|FLOVENT HFA 110 MCG INHALER|12|GM|9.81223|03/13/2007||Yes|No||03/13/2007||Yes|No|03/13/2007||Yes|No||||No|No|||Prescription required|No||033|Yes|21.88307|02/08/2022|21.35787|02/08/2022|21.50011|02/08/2022|||GLUCOCORTICOIDS: INHALED|2378|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00173072020|FLOVENT HFA 220 MCG INHALER|12|GM|15.24098|05/16/2007||Yes|No||05/16/2007||Yes|No|05/16/2007||Yes|No||||No|No|||Prescription required|No||033|Yes|34.00346|02/08/2022|33.18737|02/08/2022|33.40839|02/08/2022|||GLUCOCORTICOIDS: INHALED|2379|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
bupropion HCl|No|No|No|No|75%|00173072200|WELLBUTRIN SR 200 MG TABLET|60|EA|6.28666|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|14.32775|01/10/2023|14.12307|01/10/2023|13.45054|01/10/2023|||ANTIDEPRESSANTS: OTHER|2380|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073500|IMITREX 25 MG TABLET|9|EA|14.5015|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|33.04995|01/10/2023|32.5778|01/10/2023|31.02648|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2381|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073601|IMITREX 50 MG TABLET|9|EA|31.61073|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|70.93996|01/17/2023|69.2374|01/17/2023|69.69851|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2382|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073701|IMITREX 100 MG TABLET|9|EA|31.61073|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|70.73448|01/17/2023|69.03685|01/17/2023|69.49662|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2383|||||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|201.4378|06/22/2010||Yes|No||06/22/2010||Yes|No|06/22/2010||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|No|459.0908|01/10/2023|452.53236|01/10/2023|430.9832|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2384|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00173073902|IMITREX 4 MG/0.5 ML CARTRIDGES|1|ML|190.7824|09/28/2010||Yes|No||09/28/2010||Yes|No|09/28/2010||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|No|434.8064|01/10/2023|428.59488|01/10/2023|408.1856|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2385|||||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||056|No|13.72032|01/10/2023|13.52431|01/10/2023|12.8803|01/10/2023|||ANTICONVULSANTS|2386|||||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||056|No|26.81853|01/17/2023|26.17488|01/17/2023|26.3492|01/17/2023|||ANTICONVULSANTS|2387|||||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||056|No|28.74263|01/17/2023|28.0528|01/17/2023|28.23963|01/17/2023|||ANTICONVULSANTS|2388|||||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||056|No|30.76117|01/17/2023|30.0229|01/17/2023|30.22284|01/17/2023|||ANTICONVULSANTS|2389|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173075800|LAMICTAL XR START KIT (BLUE)|28|EA|7.52484|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription required|No||056|No|17.14964|01/10/2023|16.90465|01/10/2023|16.09966|01/10/2023|||ANTICONVULSANTS|2390|||||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||056|No|39.19355|01/10/2023|38.63364|01/10/2023|36.79394|01/10/2023|||ANTICONVULSANTS|2391|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173076000|LAMICTAL XR START KIT (ORANGE)|35|EA|8.59901|06/28/2009||Yes|No||06/28/2009||Yes|No|06/28/2009||Yes|No||||No|No|||Prescription required|No||056|No|19.59775|01/10/2023|19.31778|01/10/2023|18.39789|01/10/2023|||ANTICONVULSANTS|2392|||||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||056|No|46.21084|01/17/2023|45.10177|01/17/2023|45.40215|01/17/2023|||ANTICONVULSANTS|2393|||||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||056|No|13.12318|01/10/2023|12.9357|01/10/2023|12.31972|01/10/2023|||ANTICONVULSANTS|2394|||||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||056|No|13.83777|01/31/2023|13.50566|01/31/2023|13.5956|01/31/2023|||ANTICONVULSANTS|2395|||||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||056|No|14.72325|01/31/2023|14.36989|01/31/2023|14.46559|01/31/2023|||ANTICONVULSANTS|2396|||||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||056|No|17.50799|01/17/2023|17.08779|01/17/2023|17.2016|01/17/2023|||ANTICONVULSANTS|2397|||||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||056|No|18.74487|01/10/2023|18.47708|01/10/2023|17.59722|01/10/2023|||ANTICONVULSANTS|2398|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173077900|LAMICTAL ODT START KIT (BLUE)|28|EA|7.19727|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription required|No||056|No|16.40309|01/10/2023|16.16876|01/10/2023|15.39882|01/10/2023|||ANTICONVULSANTS|2399|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173078000|LAMICTAL ODT START KIT (GREEN)|56|EA|10.28068|06/17/2009||Yes|No||06/17/2009||Yes|No|06/17/2009||Yes|No||||No|No|||Prescription required|No||056|No|23.43039|01/10/2023|23.09567|01/10/2023|21.99588|01/10/2023|||ANTICONVULSANTS|2400|||||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||056|No|42.73844|01/10/2023|42.12789|01/10/2023|40.1218|01/10/2023|||ANTICONVULSANTS|2401|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
dutasteride/tamsulosin HCl|No|No|No|No|75%|00173080913|JALYN 0.5-0.4 MG CAPSULE|30|EA|3.5862|07/16/2010|03/31/2024|Yes|No||07/16/2010|03/31/2024|Yes|No|07/16/2010|03/31/2024|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|003|No|8.01011|11/15/2022|7.81786|11/15/2022|7.86993|11/15/2022|||BPH TREATMENTS|2402|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GSK/WOODWARD PH|No|||||No|No|No||
dutasteride/tamsulosin HCl|No|No|No|No|75%|00173080959|JALYN 0.5-0.4 MG CAPSULE|90|EA|3.5862|07/16/2010|03/31/2024|Yes|No||07/16/2010|03/31/2024|Yes|No|07/16/2010|03/31/2024|Yes|No||||No|No|||Prescription required|Yes|01/20/2011|003|No|8.01011|11/15/2022|7.81786|11/15/2022|7.86993|11/15/2022|||BPH TREATMENTS|2403|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GSK/WOODWARD PH|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00173081728|LAMICTAL TAB START KIT (GREEN)|98|EA|6.98363|05/05/2011||Yes|No||05/05/2011||Yes|No|05/05/2011||Yes|No||||No|No|||Prescription required|No||056|No|15.91619|01/10/2023|15.68882|01/10/2023|14.94173|01/10/2023|||ANTICONVULSANTS|2404|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173085910|BREO ELLIPTA 100-25 MCG INH|60|EA|2.83341|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|6.32549|01/17/2023|6.17367|01/17/2023|6.21479|01/17/2023|||GLUCOCORTICOIDS: INHALED|2405|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173085914|BREO ELLIPTA 100-25 MCG INH|28|EA|2.33904|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|5.24146|01/17/2023|5.11566|01/17/2023|5.14973|01/17/2023|||GLUCOCORTICOIDS: INHALED|2406|||||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|3.3039|06/30/2014||Yes|No||06/30/2014||Yes|No|06/30/2014||Yes|No||||No|No|||Prescription required|No||098|Yes|7.37471|01/17/2023|7.19771|01/17/2023|7.24565|01/17/2023|||COPD AGENTS|2407|||||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|07/23/2015|098|No|11.32019|08/23/2022|11.0485|08/23/2022|11.12208|08/23/2022|||COPD AGENTS|2408|||||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|6.67706|01/17/2023|6.51681|01/17/2023|6.56021|01/17/2023|||GLUCOCORTICOIDS: INHALED|2409|||||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|8.92153|01/17/2023|8.70741|01/17/2023|8.7654|01/17/2023|||GLUCOCORTICOIDS: INHALED|2410|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173088210|BREO ELLIPTA 200-25 MCG INH|60|EA|2.83341|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|6.32218|01/17/2023|6.17044|01/17/2023|6.21154|01/17/2023|||GLUCOCORTICOIDS: INHALED|2411|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/umeclidin/vilanter|No|No|No|No|75%|00173088710|TRELEGY ELLIPTA 100-62.5-25|60|EA|4.57606|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|10.22938|01/17/2023|9.98387|01/17/2023|10.05036|01/17/2023|||GLUCOCORTICOIDS: INHALED|2412|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/umeclidin/vilanter|No|No|No|No|75%|00173088714|TRELEGY ELLIPTA 100-62.5-25|28|EA|4.56982|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|10.25413|01/17/2023|10.00803|01/17/2023|10.07468|01/17/2023|||GLUCOCORTICOIDS: INHALED|2413|||||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|6.68109|01/17/2023|6.52074|01/17/2023|6.56417|01/17/2023|||GLUCOCORTICOIDS: INHALED|2414|||||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|06/03/2019|15.456|06/03/2019|14.72|06/03/2019||||2415|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
mepolizumab|No|No|No|No|75%|00173089201|NUCALA 100 MG/ML AUTO-INJECTOR|1|ML|1539.9977|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|3509.7622|01/10/2023|3459.62274|01/10/2023|3294.8788|01/10/2023|||IMMUNOMODULATORS: ASTHMA|2416|||||No|No||GLAXOSMITHKLINE|No|||||No|No|Yes|09/30/2022|
mepolizumab|No|No|No|No|75%|00173089242|NUCALA 100 MG/ML SYRINGE|1|ML|1539.9977|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|3509.7622|01/10/2023|3459.62274|01/10/2023|3294.8788|01/10/2023|||IMMUNOMODULATORS: ASTHMA|2417|||||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|4.57606|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|10.24482|01/17/2023|9.99894|01/17/2023|10.06553|01/17/2023|||GLUCOCORTICOIDS: INHALED|2418|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/umeclidin/vilanter|No|No|No|No|75%|00173089314|TRELEGY ELLIPTA 200-62.5-25|28|EA|4.56982|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|10.1465|01/17/2023|9.90298|01/17/2023|9.96893|01/17/2023|||GLUCOCORTICOIDS: INHALED|2419|||||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|12.91987|01/17/2023|12.60979|01/17/2023|12.69377|01/17/2023|||ANTIVIRALS: ORAL|2420|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
valacyclovir HCl|No|No|No|No|75%|00173093310|VALTREX 500 MG CAPLET|90|EA|5.77298|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|12.91987|01/17/2023|12.60979|01/17/2023|12.69377|01/17/2023|||ANTIVIRALS: ORAL|2421|||||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|7.03414|02/28/2023|6.86532|02/28/2023|6.91104|02/28/2023|||ANTIDEPRESSANTS: OTHER|2422|||||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|.97504|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Over the counter|No||506|No|2.16864|06/23/2020|2.11659|06/23/2020|2.13068|06/23/2020|||IRON: ORAL|2423|||||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|.02168|03/24/2010||Yes|No||||No|No|03/24/2010||Yes|No||||No|No|||Over the counter|No|||No|.04943|01/26/2021|.04872|01/26/2021|.0464|01/26/2021||||2424|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
zinc oxide|No|No|No|No|75%|00178033003|DR. SMITH'S DIAPER 10% OINTMNT|85|GM|.02114|11/02/2010||Yes|No||||No|No|11/02/2010||Yes|No||||No|No|||Over the counter|No|||No|.04818|08/29/2017|.04749|08/29/2017|.04523|08/29/2017||||2425|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
zinc oxide|No|No|No|No|75%|00178034003|DR. SMITH'S DIAPER RASH SPRAY|100|GM|.02829|11/05/2014||Yes|No||||No|No|11/05/2014||Yes|No||||No|No|||Over the counter|No|||No|.06448|01/28/2020|.06356|01/28/2020|.06053|01/28/2020||||2426|||||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|6.6715|10/06/2020|6.57619|10/06/2020|6.26304|10/06/2020|||STEROIDS: TOPICAL LOW|2427|||||No|No||MISSION PHARM.|No|||||No|No|No||
acetohydroxamic acid|No|No|No|No|75%|00178050001|LITHOSTAT 250 MG TABLET|100|EA|2.795|01/04/2005||Yes|No||01/04/2005||Yes|No|01/04/2005||Yes|No||||No|No|||Prescription required|No|||No|6.37|08/02/2022|6.279|08/02/2022|5.98|08/02/2022||||2428|||||No|No||MISSION PHARM.|No|||||No|No|No||
potassium citrate|No|No|No|No|75%|00178060001|UROCIT-K SR 5 MEQ TABLET|100|EA|.65626|01/04/2005||Yes|No||01/04/2005||Yes|No|01/04/2005||Yes|No||||No|No|||Prescription required|No|||No|1.49567|06/01/2016|1.4743|06/01/2016|1.4041|06/01/2016||||2429|||||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|2.09631|06/01/2016|2.06637|06/01/2016|1.96797|06/01/2016||||2430|||||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|3.56918|06/01/2016|3.5182|06/01/2016|3.35066|06/01/2016||||2431|||||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|No||243|No|3.8871|10/29/2019|3.7938|10/29/2019|3.81907|10/29/2019|||PRENATAL VITAMINS|2432|||||No|No||MISSION PHARM.|No|||||No|No|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|10/29/2019|3.87266|10/29/2019|3.89845|10/29/2019|||IRON: ORAL|2433|||||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|.89762|05/15/2014||Yes|No||05/15/2014||Yes|No|05/15/2014||Yes|No||||No|No|||Prescription required|No||243|No|2.00336|10/29/2019|1.95527|10/29/2019|1.9683|10/29/2019|||PRENATAL VITAMINS|2434|||||No|No||MISSION PHARM.|No|||||No|No|No||
prenatal 48/iron/folic acid/B6|No|No|No|No|75%|00178083230|CITRANATAL B-CALM COMBO PACK|90|EA|.52335|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|No|1.19276|01/05/2021|1.17572|01/05/2021|1.11974|01/05/2021|||PRENATAL VITAMINS|2435|||||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|.86651|05/29/2014||Yes|No||05/29/2014||Yes|No|05/29/2014||Yes|No||||No|No|||Prescription required|No||243|No|1.94141|10/29/2019|1.89481|10/29/2019|1.90743|10/29/2019|||PRENATAL VITAMINS|2436|||||No|No||MISSION PHARM.|No|||||No|No|No||
PNV 76/iron,gluc/folic/dss/dha|No|No|No|No|75%|00178089430|CITRANATAL DHA PACK|60|EA|.82674|02/27/2018|10/31/2023|Yes|No||02/27/2018|10/31/2023|Yes|No|02/27/2018|10/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/30/2020|243|No|1.846|06/23/2020|1.80169|06/23/2020|1.81369|06/23/2020|||PRENATAL VITAMINS|2437|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MISSION PHARM.|No|||||No|No|No||
tiopronin|No|No|No|No|75%|00178090001|THIOLA 100 MG TABLET|100|EA|12.12995|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|27.64501|06/01/2016|27.25008|06/01/2016|25.95246|06/01/2016||||2438|||||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|36.38984|11/20/2019||Yes|No||11/20/2019||Yes|No|11/20/2019||Yes|No||||No|No|||Prescription required|No|||No|82.93499|11/20/2019|81.75021|11/20/2019|77.85734|11/20/2019||||2439|||||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|12.12995|11/20/2019||Yes|No||11/20/2019||Yes|No|11/20/2019||Yes|No||||No|No|||Prescription required|No|||No|27.64501|11/20/2019|27.25008|11/20/2019|25.95246|11/20/2019||||2440|||||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|.40226|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|.48901|02/28/2023|.47727|02/28/2023|.48045|02/28/2023|||SKELETAL MUSCLE RELAXANTS|2441|||||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||145|No|.63092|02/28/2023|.61577|02/28/2023|.61987|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|2442|||||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|.47444|02/28/2023|.46305|02/28/2023|.46613|02/28/2023||||2443|||||No|No||SANDOZ|No|||||No|No|No||
nitrofurantoin monohyd/m-cryst|No|No|No|No|75%|00185012201|NITROFURANTOIN MONO-MCR 100 MG|100|EA|.67269|06/02/2005||Yes|No||06/02/2005||Yes|No|06/02/2005||Yes|No||06/02/2005||Yes|No|||Prescription required|No|||No|.41999|02/28/2023|.40991|02/28/2023|.41264|02/28/2023||||2444|||||No|No||SANDOZ|No|||||No|No|No||
nitrofurantoin monohyd/m-cryst|No|No|No|No|75%|00185012210|NITROFURANTOIN MONO-MCR 100 MG|1000|EA|.67269|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||10/07/2016||Yes|No|||Prescription required|No|||No|.41999|02/28/2023|.40991|02/28/2023|.41264|02/28/2023||||2445|||||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|.2441|02/28/2023|.23824|02/28/2023|.23982|02/28/2023||||2446|||||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|.2441|02/28/2023|.23824|02/28/2023|.23982|02/28/2023||||2447|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185012901|BUMETANIDE 1 MG TABLET|100|EA|.19504|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.21132|02/28/2023|.20624|02/28/2023|.20762|02/28/2023||||2448|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185012905|BUMETANIDE 1 MG TABLET|500|EA|.19504|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.21132|02/28/2023|.20624|02/28/2023|.20762|02/28/2023||||2449|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185013001|BUMETANIDE 2 MG TABLET|100|EA|.36184|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.44347|02/28/2023|.43282|02/28/2023|.4357|02/28/2023||||2450|||||No|No||SANDOZ|No|||||No|No|No||
bumetanide|No|No|No|No|75%|00185013005|BUMETANIDE 2 MG TABLET|500|EA|.36184|05/11/2003||Yes|No||05/11/2003||Yes|No|05/11/2003||Yes|No||05/11/2003||Yes|No|||Prescription required|No|||No|.44347|02/28/2023|.43282|02/28/2023|.4357|02/28/2023||||2451|||||No|No||SANDOZ|No|||||No|No|No||
oxaprozin|No|No|No|No|75%|00185014101|OXAPROZIN 600 MG TABLET|100|EA|.6302|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|.61142|02/28/2023|.59674|02/28/2023|.60072|02/28/2023|||NSAIDS|2452|||||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|.57792|02/28/2023|.56404|02/28/2023|.5678|02/28/2023|||ANGIOTENSIN MODULATORS|2453|||||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|.8768|06/08/2021|.86428|06/08/2021|.82312|06/08/2021|||ANGIOTENSIN MODULATORS|2454|||||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|.49339|02/28/2023|.48154|02/28/2023|.48475|02/28/2023|||ANGIOTENSIN MODULATORS|2455|||||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|.38441|02/28/2023|.37518|02/28/2023|.37768|02/28/2023|||ANGIOTENSIN MODULATORS|2456|||||No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|Yes|No|No|No|75%|00185041001|BUPROPION HCL SR 100 MG TABLET|100|EA|.19315|06/17/2010|02/28/2023|Yes|No||06/17/2010|02/28/2023|Yes|No|06/17/2010|02/28/2023|Yes|No||09/01/2022||Yes|No|07/01/2016|02/28/2023|Prescription required|No||031|No|.10923|02/28/2023|.1066|02/28/2023|.10731|02/28/2023|||ANTIDEPRESSANTS: OTHER|2457|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|Yes|No|No|No|75%|00185041005|BUPROPION HCL SR 100 MG TABLET|500|EA|.19313|02/24/2004|02/28/2023|Yes|No||02/24/2004|02/28/2023|Yes|No|02/24/2004|02/28/2023|Yes|No||09/01/2022||Yes|No|07/01/2016|02/28/2023|Prescription required|No||031|No|.10923|02/28/2023|.1066|02/28/2023|.10731|02/28/2023|||ANTIDEPRESSANTS: OTHER|2458|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|Yes|No|No|No|75%|00185041060|BUPROPION HCL SR 100 MG TABLET|60|EA|.29053|02/24/2004|02/28/2023|Yes|No||02/24/2004|02/28/2023|Yes|No|02/24/2004|02/28/2023|Yes|No||09/01/2022||Yes|No|07/01/2016|02/28/2023|Prescription required|No||031|No|.10923|02/28/2023|.1066|02/28/2023|.10731|02/28/2023|||ANTIDEPRESSANTS: OTHER|2459|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|Yes|No|No|No|75%|00185041501|BUPROPION HCL SR 150 MG TABLET|100|EA|.1935|08/23/2011|02/28/2023|Yes|No||08/23/2011|02/28/2023|Yes|No|08/23/2011|02/28/2023|Yes|No||09/01/2022||Yes|No|07/01/2016|02/28/2023|Prescription required|No||031|No|.08671|02/28/2023|.08462|02/28/2023|.08519|02/28/2023|||ANTIDEPRESSANTS: OTHER|2460|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|Yes|No|No|No|75%|00185041505|BUPROPION HCL SR 150 MG TABLET|500|EA|.1935|03/30/2004|02/28/2023|Yes|No||03/30/2004|02/28/2023|Yes|No|03/30/2004|02/28/2023|Yes|No||09/01/2022||Yes|No|07/01/2016|02/28/2023|Prescription required|No||031|No|.08671|02/28/2023|.08462|02/28/2023|.08519|02/28/2023|||ANTIDEPRESSANTS: OTHER|2461|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00185041552|BUPROPION HCL SR 150 MG TABLET|250|EA|.1935|10/11/2016|02/28/2023|Yes|No||10/11/2016|02/28/2023|Yes|No|10/11/2016|02/28/2023|Yes|No||09/01/2022||Yes|No|||Prescription required|No||031|No|.08671|02/28/2023|.08462|02/28/2023|.08519|02/28/2023|||ANTIDEPRESSANTS: OTHER|2462|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|Yes|No|No|No|75%|00185041560|BUPROPION HCL SR 150 MG TABLET|60|EA|.1935|03/30/2004|02/28/2023|Yes|No||03/30/2004|02/28/2023|Yes|No|03/30/2004|02/28/2023|Yes|No||09/01/2022||Yes|No|07/01/2016|02/28/2023|Prescription required|No||031|No|.08671|02/28/2023|.08462|02/28/2023|.08519|02/28/2023|||ANTIDEPRESSANTS: OTHER|2463|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|Yes|.60997|02/28/2023|.59533|02/28/2023|.59929|02/28/2023|||SKELETAL MUSCLE RELAXANTS|2464|||||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||574|Yes|.07039|02/28/2023|.0687|02/28/2023|.06915|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|2465|||||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||574|Yes|.07039|02/28/2023|.0687|02/28/2023|.06915|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|2466|||||No|No||SANDOZ|No|||||No|No|No||
etodolac|No|No|No|No|75%|00185067501|ETODOLAC 400 MG TABLET|100|EA|.45537|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|059|Yes|.30474|02/28/2023|.29742|02/28/2023|.2994|02/28/2023|||NSAIDS|2467|||||No|No||SANDOZ|No|||||No|No|No||
etodolac|No|No|No|No|75%|00185067510|ETODOLAC 400 MG TABLET|1000|EA|.42347|06/09/2016||Yes|No||06/09/2016||Yes|No|06/09/2016||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|059|Yes|.30474|02/28/2023|.29742|02/28/2023|.2994|02/28/2023|||NSAIDS|2468|||||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||574|Yes|.09935|02/28/2023|.09696|02/28/2023|.09761|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|2469|||||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||574|Yes|.09935|02/28/2023|.09696|02/28/2023|.09761|02/28/2023|||ANTIHISTAMINES: FIRST GENERATION|2470|||||No|No||SANDOZ|No|||||No|No|No||
etodolac|No|No|No|No|75%|00185068701|ETODOLAC 500 MG TABLET|100|EA|.48375|07/06/2015||Yes|No||07/06/2015||Yes|No|07/06/2015||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|059|Yes|.38595|02/28/2023|.37668|02/28/2023|.37919|02/28/2023|||NSAIDS|2471|||||No|No||SANDOZ|No|||||No|No|No||
sulfadiazine|No|No|No|No|75%|00185075701|SULFADIAZINE 500 MG TABLET|100|EA|1.73629|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||No|3.95714|09/18/2018|3.90061|09/18/2018|3.71486|09/18/2018||||2472|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
rifampin|No|No|No|No|75%|00185079901|RIFAMPIN 300 MG CAPSULE|100|EA|1.57956|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||No|.69118|02/28/2023|.67459|02/28/2023|.67908|02/28/2023||||2473|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
rifampin|No|No|No|No|75%|00185079905|RIFAMPIN 300 MG CAPSULE|500|EA|1.57954|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||No|.69118|02/28/2023|.67459|02/28/2023|.67908|02/28/2023||||2474|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
rifampin|No|No|No|No|75%|00185079930|RIFAMPIN 300 MG CAPSULE|30|EA|1.57953|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||No|.69118|02/28/2023|.67459|02/28/2023|.67908|02/28/2023||||2475|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
rifampin|No|No|No|No|75%|00185079960|RIFAMPIN 300 MG CAPSULE|60|EA|1.57953|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||No|.69118|02/28/2023|.67459|02/28/2023|.67908|02/28/2023||||2476|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
rifampin|No|No|No|No|75%|00185080101|RIFAMPIN 150 MG CAPSULE|100|EA|1.1152|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||No|.78445|02/28/2023|.76562|02/28/2023|.77072|02/28/2023||||2477|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||SANDOZ|No|||||No|No|No||
rifampin|No|No|No|No|75%|00185080130|RIFAMPIN 150 MG CAPSULE|30|EA|1.11527|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||No|.78445|02/28/2023|.76562|02/28/2023|.77072|02/28/2023||||2478|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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||007|Yes|.26392|02/28/2023|.25758|02/28/2023|.2593|02/28/2023|||STIMULANTS AND RELATED AGENTS|2479|||||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||007|Yes|.30312|02/28/2023|.29584|02/28/2023|.29781|02/28/2023|||STIMULANTS AND RELATED AGENTS|2480|||||No|No||SANDOZ|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00185093997|CHOLESTYRAMINE LIGHT POWDER|239.4|GM|.1145|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|||Prescription required|No||055|No|.24207|02/28/2023|.23626|02/28/2023|.23783|02/28/2023|||LIPOTROPICS: OTHER|2481|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||SANDOZ|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00185093998|CHOLESTYRAMINE LIGHT PACKET|60|EA|.88171|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|||Prescription required|No||055|No|1.1332|02/28/2023|1.106|02/28/2023|1.11336|02/28/2023|||LIPOTROPICS: OTHER|2482|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||SANDOZ|No|||||No|No|No||
cholestyramine (with sugar)|No|No|No|No|75%|00185094097|CHOLESTYRAMINE POWDER|378|GM|.11932|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|||Prescription required|No||055|No|.13368|02/28/2023|.13047|02/28/2023|.13134|02/28/2023|||LIPOTROPICS: OTHER|2483|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||SANDOZ|No|||||No|No|No||
cholestyramine (with sugar)|No|No|No|No|75%|00185094098|CHOLESTYRAMINE PACKET|60|EA|.88171|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|||Prescription required|No||055|No|1.06283|02/28/2023|1.03732|02/28/2023|1.04423|02/28/2023|||LIPOTROPICS: OTHER|2484|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||SANDOZ|No|||||No|No|No||
quinidine sulfate|No|No|No|No|75%|00185104701|QUINIDINE SULFATE 300 MG TAB|100|EA|.19633|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|||Prescription required|No|||No|.44746|06/27/2017|.44107|06/27/2017|.42007|06/27/2017||||2485|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||SANDOZ|No|||||No|No|No||
bupropion HCl|Yes|No|No|No|75%|00185111160|BUPROPION HCL SR 200 MG TABLET|60|EA|.58716|07/07/2005|02/28/2023|Yes|No||07/07/2005|02/28/2023|Yes|No|07/07/2005|02/28/2023|Yes|No||09/01/2022||Yes|No|07/01/2016|02/28/2023|Prescription required|No||031|No|.17498|02/28/2023|.17078|02/28/2023|.17191|02/28/2023|||ANTIDEPRESSANTS: OTHER|2486|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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||007|Yes|.2574|02/28/2023|.25122|02/28/2023|.25289|02/28/2023|||STIMULANTS AND RELATED AGENTS|2487|||||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||007|Yes|.33756|02/28/2023|.32945|02/28/2023|.33165|02/28/2023|||STIMULANTS AND RELATED AGENTS|2488|||||No|No||SANDOZ|No|||||No|No|No||
quinidine sulfate|No|No|No|No|75%|00185434601|QUINIDINE SULFATE 200 MG TAB|100|EA|.10599|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|||Prescription required|No|||No|.24157|12/27/2022|.23811|12/27/2022|.22678|12/27/2022||||2489|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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|.52107|02/28/2023|.50856|02/28/2023|.51195|02/28/2023||||2490|||||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||Yes|No||04/06/2010||Yes|No|04/06/2010||Yes|No||||No|No|||Prescription required|No|||No|.64428|02/28/2023|.62881|02/28/2023|.633|02/28/2023||||2491|||||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|.64428|02/28/2023|.62881|02/28/2023|.633|02/28/2023||||2492|||||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||Yes|No||04/06/2010||Yes|No|04/06/2010||Yes|No||||No|No|||Prescription required|No|||No|.89175|02/28/2023|.87034|02/28/2023|.87614|02/28/2023||||2493|||||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|.89175|02/28/2023|.87034|02/28/2023|.87614|02/28/2023||||2494|||||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|.81032|09/27/2022|.79087|09/27/2022|.79613|09/27/2022||||2495|||||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|16.46098|06/25/2007||Yes|No||06/25/2007||Yes|No|06/25/2007||Yes|No||||No|No|||Prescription required|No||033|Yes|36.76148|01/17/2023|35.8792|01/17/2023|36.11815|01/17/2023|||GLUCOCORTICOIDS: INHALED|2496|||||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|14.4012|06/25/2007||Yes|No||06/25/2007||Yes|No|06/25/2007||Yes|No||||No|No|||Prescription required|No||033|Yes|32.11152|01/17/2023|31.34084|01/17/2023|31.54956|01/17/2023|||GLUCOCORTICOIDS: INHALED|2497|||||No|No||ASTRAZENECA|No|||||No|No|No||
ticagrelor|No|No|No|No|75%|00186077660|BRILINTA 60 MG TABLET|60|EA|3.13949|07/13/2016||Yes|No||07/13/2016||Yes|No|07/13/2016||Yes|No||||No|No|||Prescription required|No||004|No|7.01036|01/17/2023|6.84211|01/17/2023|6.88767|01/17/2023|||PLATELET AGGREGATION INHIBITORS|2498|||||No|No||ASTRAZENECA|No|||||No|No|No||
ticagrelor|No|No|No|No|75%|00186077760|BRILINTA 90 MG TABLET|60|EA|3.13949|09/05/2011||Yes|No||09/05/2011||Yes|No|09/05/2011||Yes|No||||No|No|||Prescription required|No||004|No|6.99868|01/17/2023|6.83071|01/17/2023|6.8762|01/17/2023|||PLATELET AGGREGATION INHIBITORS|2499|||||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||033|Yes|253.93644|01/17/2023|247.84196|01/17/2023|249.49255|01/17/2023|||GLUCOCORTICOIDS: INHALED|2500|||||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||033|Yes|189.96009|01/17/2023|185.40104|01/17/2023|186.63578|01/17/2023|||GLUCOCORTICOIDS: INHALED|2501|||||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|4.2705|03/01/2022|4.20949|03/01/2022|4.00904|03/01/2022|||GLUCOCORTICOIDS: INHALED|2502|||||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|4.90979|08/23/2022|4.79195|08/23/2022|4.82386|08/23/2022|||GLUCOCORTICOIDS: INHALED|2503|||||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|10.05284|07/28/2020|9.90922|07/28/2020|9.43736|07/28/2020|||GLUCOCORTICOIDS: INHALED|2504|||||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||047|No|9.16592|02/28/2023|8.94593|02/28/2023|9.00551|02/28/2023|||PROTON PUMP INHIBITORS|2505|||||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||047|No|9.22633|12/27/2022|9.00489|12/27/2022|9.06486|12/27/2022|||PROTON PUMP INHIBITORS|2506|||||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||047|No|9.20447|11/29/2022|8.98356|11/29/2022|9.04339|11/29/2022|||PROTON PUMP INHIBITORS|2507|||||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||047|No|9.21048|07/26/2022|8.98942|07/26/2022|9.04929|07/26/2022|||PROTON PUMP INHIBITORS|2508|||||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||047|No|9.18878|12/27/2022|8.96824|12/27/2022|9.02797|12/27/2022|||PROTON PUMP INHIBITORS|2509|||||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|No|8.99346|12/27/2022|8.86498|12/27/2022|8.44284|12/27/2022|||PROTON PUMP INHIBITORS|2510|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186502054|NEXIUM DR 20 MG CAPSULE|90|EA|3.94591|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|8.99301|12/27/2022|8.86454|12/27/2022|8.44242|12/27/2022|||PROTON PUMP INHIBITORS|2511|||||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|No|8.81494|08/23/2022|8.60338|08/23/2022|8.66067|08/23/2022|||PROTON PUMP INHIBITORS|2512|||||No|No||ASTRAZENECA|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00186504054|NEXIUM DR 40 MG CAPSULE|90|EA|3.94591|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|8.81494|08/23/2022|8.60338|08/23/2022|8.66067|08/23/2022|||PROTON PUMP INHIBITORS|2513|||||No|No||ASTRAZENECA|No|||||No|No|No||
halobetasol propionate|No|No|No|No|75%|00187000201|BRYHALI 0.01% LOTION|100|GM|2.2329|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|4.96087|01/17/2023|4.8418|01/17/2023|4.87405|01/17/2023|||STEROIDS: TOPICAL VERY HIGH|2514|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
halobetasol propionate|No|No|No|No|75%|00187000260|BRYHALI 0.01% LOTION|60|GM|2.23291|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|4.984|01/17/2023|4.86438|01/17/2023|4.89678|01/17/2023|||STEROIDS: TOPICAL VERY HIGH|2515|||||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|680.80466|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|1551.60132|01/10/2023|1529.43559|01/10/2023|1456.60532|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|2516|||||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|2.45|03/03/2020|2.415|03/03/2020|2.3|03/03/2020|||ACNE AGENTS: TOPICAL|2517|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
tretinoin|No|No|No|No|75%|00187000545|ALTRENO 0.05% LOTION|45|GM|1.09888|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|2.44511|08/23/2022|2.38642|08/23/2022|2.40232|08/23/2022|||ACNE AGENTS: TOPICAL|2518|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
enalapril maleate|No|No|No|No|75%|00187014090|VASOTEC 2.5 MG TABLET|90|EA|7.36604|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|16.78772|01/10/2023|16.54789|01/10/2023|15.7599|01/10/2023|||ANGIOTENSIN MODULATORS|2519|||||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|06/01/2016|12.59181|06/01/2016|11.9922|06/01/2016|||ANGIOTENSIN MODULATORS|2520|||||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|12/19/2022|8.85802|12/19/2022|8.43621|12/19/2022||||2521|||||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|19.78237|12/19/2022|19.49977|12/19/2022|18.57121|12/19/2022||||2522|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
dihydroergotamine mesylate|No|No|No|No|75%|00187024503|MIGRANAL NASAL SPRAY|1|ML|205.48248|03/30/2009||Yes|No||03/30/2009||Yes|No|03/30/2009||Yes|No||||No|No|||Prescription required|Yes|07/17/2014|537|No|468.30892|01/26/2021|461.61879|01/26/2021|439.63695|01/26/2021|||ANTIMIGRAINE AGENTS: OTHER|2523|||||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|39.35732|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|89.69808|01/10/2023|88.41668|01/10/2023|84.20636|01/10/2023|||ANTIPARKINSON'S AGENTS|2524|||||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|4.33672|09/06/2019||Yes|No||09/06/2019||Yes|No|09/06/2019||Yes|No||||No|No|||Prescription required|No|||No|9.70727|01/17/2023|9.47429|01/17/2023|9.53739|01/17/2023||||2525|||||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||Yes|No||10/17/2005||Yes|No|10/17/2005||Yes|No||||No|No|||Prescription required|No||056|Yes|335.59429|05/24/2022|327.54002|05/24/2022|329.72138|05/24/2022|||ANTICONVULSANTS|2526|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diazepam|No|No|No|No|75%|00187065920|DIASTAT ACUDIAL 12.5-15-20 MG|1|EA|150.8225|10/17/2005||Yes|No||10/17/2005||Yes|No|10/17/2005||Yes|No||||No|No|||Prescription required|No||056|Yes|343.735|01/26/2021|338.8245|01/26/2021|322.69|01/26/2021|||ANTICONVULSANTS|2527|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00187073030|WELLBUTRIN XL 150 MG TABLET|30|EA|26.04739|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|58.23467|01/17/2023|56.83703|01/17/2023|57.21556|01/17/2023|||ANTIDEPRESSANTS: OTHER|2528|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00187073090|WELLBUTRIN XL 150 MG TABLET|90|EA|26.04897|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|58.23467|01/17/2023|56.83703|01/17/2023|57.21556|01/17/2023|||ANTIDEPRESSANTS: OTHER|2529|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HCl|No|No|No|No|75%|00187073130|WELLBUTRIN XL 300 MG TABLET|30|EA|34.38366|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|76.4151|01/17/2023|74.58113|01/17/2023|75.07783|01/17/2023|||ANTIDEPRESSANTS: OTHER|2530|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187077247|CARDIZEM 60 MG TABLET|100|EA|4.31702|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|9.8388|06/01/2016|9.69825|06/01/2016|9.23643|06/01/2016|||CALCIUM CHANNEL BLOCKERS|2531|||||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|18.11108|06/01/2016|17.85235|06/01/2016|17.00224|06/01/2016|||CALCIUM CHANNEL BLOCKERS|2532|||||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|01/11/2022|27.48591|01/11/2022|26.17706|01/11/2022|||CALCIUM CHANNEL BLOCKERS|2533|||||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|01/11/2022|34.67102|01/11/2022|33.02002|01/11/2022|||CALCIUM CHANNEL BLOCKERS|2534|||||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|01/11/2022|33.09451|01/11/2022|31.51858|01/11/2022|||CALCIUM CHANNEL BLOCKERS|2535|||||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|47.68484|01/11/2022|47.00362|01/11/2022|44.76536|01/11/2022|||CALCIUM CHANNEL BLOCKERS|2536|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
diltiazem HCl|No|No|No|No|75%|00187079742|CARDIZEM CD 240 MG CAPSULE|90|EA|20.89823|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|47.62853|01/11/2022|46.94813|01/11/2022|44.7125|01/11/2022|||CALCIUM CHANNEL BLOCKERS|2537|||||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|62.46094|01/11/2022|61.56864|01/11/2022|58.6368|01/11/2022|||CALCIUM CHANNEL BLOCKERS|2538|||||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|01/11/2022|89.8293|01/11/2022|85.55172|01/11/2022|||CALCIUM CHANNEL BLOCKERS|2539|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
tolcapone|No|No|No|No|75%|00187093801|TASMAR 100 MG TABLET|90|EA|50.97157|03/01/2005||Yes|No||03/01/2005||Yes|No|||No|No||||No|No|||Prescription required|Yes|06/09/2004|015|No|116.16777|01/17/2017|114.50823|01/17/2017|109.05546|01/17/2017|||ANTIPARKINSON'S AGENTS|2540|||||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||123|No|4.9|12/22/2020|4.83|12/22/2020|4.6|12/22/2020|||ANTIVIRALS: TOPICAL|2541|||||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||123|No|38.24667|09/27/2022|37.32874|09/27/2022|37.57735|09/27/2022|||ANTIVIRALS: TOPICAL|2542|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
phytonadione (vit K1)|No|No|No|No|75%|00187170405|MEPHYTON 5 MG TABLET|100|EA|25.26684|09/05/2013||Yes|No||09/05/2013||Yes|No|09/05/2013||Yes|No||||No|No|||Prescription required|No|||No|57.58489|05/28/2019|56.76225|05/28/2019|54.05929|05/28/2019||||2543|||||No|No||BAUSCH HEALTH U|No|||||No|Yes|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|3.93862|06/01/2016|3.88235|06/01/2016|3.69748|06/01/2016|||CALCIUM CHANNEL BLOCKERS|2544|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
tazarotene|No|No|No|No|75%|00187209845|ARAZLO 0.045% LOTION|45|GM|4.96363|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|10.98546|01/17/2023|10.7218|01/17/2023|10.79321|01/17/2023|||ACNE AGENTS: TOPICAL|2545|||||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|06/01/2016|205.43728|06/01/2016|195.65456|06/01/2016||||2546|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00187301030|MESTINON 60 MG TABLET|100|EA|8.47736|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|19.3205|01/10/2023|19.04449|01/10/2023|18.13761|01/10/2023||||2547|||||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|1.45575|07/10/2002||Yes|No||07/10/2002||Yes|No|07/10/2002||Yes|No||||No|No|||Prescription required|No|||No|3.31776|01/10/2023|3.27036|01/10/2023|3.11463|01/10/2023||||2548|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00187301330|MESTINON 180 MG TIMESPAN|30|EA|16.07899|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|36.64514|01/10/2023|36.12163|01/10/2023|34.40156|01/10/2023||||2549|||||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|1.47|03/23/2021|1.449|03/23/2021|1.38|03/23/2021||||2550|||||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|75.30682|06/01/2016|74.23101|06/01/2016|70.6962|06/01/2016|||ANTIFUNGALS: ORAL|2551|||||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|06/01/2016|143.63821|06/01/2016|136.79829|06/01/2016|||ANTIFUNGALS: ORAL|2552|||||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||034|Yes|9.52474|02/28/2023|9.29614|02/28/2023|9.35805|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2553|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pimecrolimus|No|No|No|No|75%|00187510102|ELIDEL 1% CREAM|60|GM|4.28645|01/12/2012||Yes|No||01/12/2012||Yes|No|01/12/2012||Yes|No||||No|No|||Prescription required|No||034|Yes|9.62875|02/28/2023|9.39766|02/28/2023|9.46024|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2554|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
pimecrolimus|No|No|No|No|75%|00187510203|ELIDEL 1% CREAM|100|GM|4.28636|01/12/2012||Yes|No||01/12/2012||Yes|No|01/12/2012||Yes|No||||No|No|||Prescription required|No||034|Yes|9.58634|02/28/2023|9.35626|02/28/2023|9.41857|02/28/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2555|||||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|No|240.84284|01/16/2018|237.40222|01/16/2018|226.09736|01/16/2018|||ANTIVIRALS: TOPICAL|2556|||||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|7.83743|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|17.86206|11/29/2022|17.60689|11/29/2022|16.76847|11/29/2022|||ACNE AGENTS: TOPICAL|2557|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
efinaconazole|No|No|No|No|75%|00187540004|JUBLIA 10% TOPICAL SOLUTION|4|ML|80.16167|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|179.07746|01/17/2023|174.7796|01/17/2023|175.9436|01/17/2023|||ANTIFUNGALS: TOPICAL|2558|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bexarotene|No|No|No|No|75%|00187552675|TARGRETIN 75 MG CAPSULE|100|EA|106.96073|04/25/2014||Yes|No||04/25/2014||Yes|No|04/25/2014||Yes|No||||No|No|||Prescription required|No|||No|243.77098|06/01/2016|240.28853|06/01/2016|228.84622|06/01/2016||||2559|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HBr|No|No|No|No|75%|00187581030|APLENZIN ER 174 MG TABLET|30|EA|26.38222|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|58.91816|01/17/2023|57.50412|01/17/2023|57.88709|01/17/2023|||ANTIDEPRESSANTS: OTHER|2560|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HBr|No|No|No|No|75%|00187581130|APLENZIN ER 348 MG TABLET|30|EA|34.7784|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|77.67303|01/17/2023|75.80887|01/17/2023|76.31375|01/17/2023|||ANTIDEPRESSANTS: OTHER|2561|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
bupropion HBr|No|No|No|No|75%|00187581230|APLENZIN ER 522 MG TABLET|30|EA|79.14508|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|176.84489|01/17/2023|172.60061|01/17/2023|173.7501|01/17/2023|||ANTIDEPRESSANTS: OTHER|2562|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
hyoscyamine sulfate|No|No|No|No|75%|00225029515|ANASPAZ 0.125 MG TABLET ODT|100|EA|.1075|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Prescription required|No|||No|.245|01/10/2023|.2415|01/10/2023|.23|01/10/2023||||2563|||||No|No||B.F ASCHER & CO|No|||||No|No|No||
hyoscyamine sulfate|No|No|No|No|75%|00225029520|ANASPAZ 0.125 MG TABLET ODT|500|EA|.10535|09/07/2015||Yes|No||09/07/2015||Yes|No|09/07/2015||Yes|No||||No|No|||Prescription required|No|||No|.2401|01/10/2023|.23667|01/10/2023|.2254|01/10/2023||||2564|||||No|No||B.F ASCHER & CO|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||056|No|.87588|02/28/2023|.85485|02/28/2023|.86055|02/28/2023|||ANTICONVULSANTS|2565|||||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||056|No|1.11112|02/28/2023|1.08445|02/28/2023|1.09167|02/28/2023|||ANTICONVULSANTS|2566|||||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||056|No|1.20441|02/28/2023|1.1755|02/28/2023|1.18333|02/28/2023|||ANTICONVULSANTS|2567|||||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||056|No|1.13515|02/28/2023|1.1079|02/28/2023|1.11528|02/28/2023|||ANTICONVULSANTS|2568|||||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||056|No|3.32539|02/28/2023|3.24558|02/28/2023|3.26719|02/28/2023|||ANTICONVULSANTS|2569|||||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||056|No|3.65097|02/28/2023|3.56334|02/28/2023|3.58707|02/28/2023|||ANTICONVULSANTS|2570|||||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||090|Yes|.02043|02/28/2023|.01993|02/28/2023|.02007|02/28/2023|||ANXIOLYTICS|2571|||||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||090|Yes|.02043|02/28/2023|.01993|02/28/2023|.02007|02/28/2023|||ANXIOLYTICS|2572|||||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||090|Yes|.02043|02/28/2023|.01993|02/28/2023|.02007|02/28/2023|||ANXIOLYTICS|2573|||||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||090|Yes|.02229|02/28/2023|.02175|02/28/2023|.02189|02/28/2023|||ANXIOLYTICS|2574|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202950|ALPRAZOLAM 0.5 MG TABLET|500|EA|.02119|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.02229|02/28/2023|.02175|02/28/2023|.02189|02/28/2023|||ANXIOLYTICS|2575|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228202996|ALPRAZOLAM 0.5 MG TABLET|1000|EA|.02119|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.02229|02/28/2023|.02175|02/28/2023|.02189|02/28/2023|||ANXIOLYTICS|2576|||||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||090|Yes|.02445|02/28/2023|.02386|02/28/2023|.02402|02/28/2023|||ANXIOLYTICS|2577|||||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||090|Yes|.02445|02/28/2023|.02386|02/28/2023|.02402|02/28/2023|||ANXIOLYTICS|2578|||||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||090|Yes|.02445|02/28/2023|.02386|02/28/2023|.02402|02/28/2023|||ANXIOLYTICS|2579|||||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||090|Yes|.04831|02/28/2023|.04715|02/28/2023|.04746|02/28/2023|||ANXIOLYTICS|2580|||||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|.72149|02/28/2023|.70417|02/28/2023|.70886|02/28/2023|||ANXIOLYTICS|2581|||||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|.96585|02/28/2023|.94266|02/28/2023|.94894|02/28/2023|||ANXIOLYTICS|2582|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
oxazepam|No|No|No|No|90%|00228207310|OXAZEPAM 30 MG CAPSULE|100|EA|.75387|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|1.23564|04/26/2022|1.20598|04/26/2022|1.21401|04/26/2022|||ANXIOLYTICS|2583|||||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||054|Yes|.07048|02/28/2023|.06878|02/28/2023|.06924|02/28/2023|||SEDATIVE HYPNOTICS|2584|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
temazepam|No|No|No|No|90%|00228207650|TEMAZEPAM 15 MG CAPSULE|500|EA|.03753|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||054|Yes|.07048|02/28/2023|.06878|02/28/2023|.06924|02/28/2023|||SEDATIVE HYPNOTICS|2585|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
temazepam|No|No|No|No|90%|00228207710|TEMAZEPAM 30 MG CAPSULE|100|EA|.05009|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||054|Yes|.09417|02/28/2023|.0919|02/28/2023|.09252|02/28/2023|||SEDATIVE HYPNOTICS|2586|||||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||054|Yes|.09417|02/28/2023|.0919|02/28/2023|.09252|02/28/2023|||SEDATIVE HYPNOTICS|2587|||||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||166|No|.02747|02/28/2023|.02681|02/28/2023|.02698|02/28/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2588|||||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||166|No|.02747|02/28/2023|.02681|02/28/2023|.02698|02/28/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2589|||||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||166|No|.03685|02/28/2023|.03596|02/28/2023|.0362|02/28/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2590|||||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||166|No|.03685|02/28/2023|.03596|02/28/2023|.0362|02/28/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2591|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
clonidine HCl|No|No|No|No|75%|00228212910|CLONIDINE HCL 0.3 MG TABLET|100|EA|.02777|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||166|No|.03696|02/28/2023|.03607|02/28/2023|.03631|02/28/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2592|||||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|.43111|02/28/2023|.42076|02/28/2023|.42356|02/28/2023||||2593|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00228249710|NIFEDIPINE 10 MG CAPSULE|100|EA|.36747|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|.33202|02/28/2023|.32405|02/28/2023|.3262|02/28/2023|||CALCIUM CHANNEL BLOCKERS|2594|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
nifedipine|No|No|No|No|75%|00228253010|NIFEDIPINE 20 MG CAPSULE|100|EA|.79214|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|.97066|08/23/2022|.94736|08/23/2022|.95367|08/23/2022|||CALCIUM CHANNEL BLOCKERS|2595|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228253810|CARBIDOPA-LEVODOPA 10-100 TAB|100|EA|.09558|03/01/2002|01/18/2023|Yes|No||03/01/2002|01/18/2023|Yes|No|03/01/2002|01/18/2023|Yes|No||||No|No|||Prescription required|No||015|No|.21785|03/14/2023|.21474|03/14/2023|.20451|03/14/2023|||ANTIPARKINSON'S AGENTS|2596|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228253850|CARBIDOPA-LEVODOPA 10-100 TAB|500|EA|.09367|03/01/2002|06/14/2023|Yes|No||03/01/2002|06/14/2023|Yes|No|03/01/2002|06/14/2023|Yes|No||||No|No|||Prescription required|No||015|No|.13478|02/28/2023|.13154|02/28/2023|.13242|02/28/2023|||ANTIPARKINSON'S AGENTS|2597|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228253910|CARBIDOPA-LEVODOPA 25-100 TAB|100|EA|.10857|03/01/2002|02/25/2023|Yes|No||03/01/2002|02/25/2023|Yes|No|03/01/2002|02/25/2023|Yes|No||||No|No|||Prescription required|No||015|No|.11453|02/28/2023|.11178|02/28/2023|.11252|02/28/2023|||ANTIPARKINSON'S AGENTS|2598|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228253950|CARBIDOPA-LEVODOPA 25-100 TAB|500|EA|.10638|03/01/2002|03/24/2023|Yes|No||03/01/2002|03/24/2023|Yes|No|03/01/2002|03/24/2023|Yes|No||||No|No|||Prescription required|No||015|No|.11453|02/28/2023|.11178|02/28/2023|.11252|02/28/2023|||ANTIPARKINSON'S AGENTS|2599|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228253996|CARBIDOPA-LEVODOPA 25-100 TAB|1000|EA|.10638|03/01/2002|01/18/2023|Yes|No||03/01/2002|01/18/2023|Yes|No|03/01/2002|01/18/2023|Yes|No||||No|No|||Prescription required|No||015|No|.11453|02/28/2023|.11178|02/28/2023|.11252|02/28/2023|||ANTIPARKINSON'S AGENTS|2600|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00228254010|CARBIDOPA-LEVODOPA 25-250 TAB|100|EA|.12538|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.15092|02/28/2023|.14729|02/28/2023|.14827|02/28/2023|||ANTIPARKINSON'S AGENTS|2601|||||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||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.15092|02/28/2023|.14729|02/28/2023|.14827|02/28/2023|||ANTIPARKINSON'S AGENTS|2602|||||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||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.15092|02/28/2023|.14729|02/28/2023|.14827|02/28/2023|||ANTIPARKINSON'S AGENTS|2603|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255006|DICLOFENAC SOD EC 50 MG TAB|60|EA|.13609|04/17/2007||Yes|No||04/17/2007||Yes|No|04/17/2007||Yes|No||||No|No|||Prescription required|No||059|Yes|.10362|02/28/2023|.10113|02/28/2023|.1018|02/28/2023|||NSAIDS|2604|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255011|DICLOFENAC SOD EC 50 MG TAB|100|EA|.13609|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||059|Yes|.10362|02/28/2023|.10113|02/28/2023|.1018|02/28/2023|||NSAIDS|2605|||||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||059|Yes|.10362|02/28/2023|.10113|02/28/2023|.1018|02/28/2023|||NSAIDS|2606|||||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||059|Yes|.08967|02/28/2023|.08751|02/28/2023|.0881|02/28/2023|||NSAIDS|2607|||||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||059|Yes|.08967|02/28/2023|.08751|02/28/2023|.0881|02/28/2023|||NSAIDS|2608|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
diclofenac sodium|No|No|No|No|75%|00228255196|DICLOFENAC SOD EC 75 MG TAB|1000|EA|.16266|07/01/2009||Yes|No||07/01/2009||Yes|No|07/01/2009||Yes|No||||No|No|||Prescription required|No||059|Yes|.08967|02/28/2023|.08751|02/28/2023|.0881|02/28/2023|||NSAIDS|2609|||||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|.13366|02/28/2023|.13045|02/28/2023|.13132|02/28/2023||||2610|||||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|.13366|02/28/2023|.13045|02/28/2023|.13132|02/28/2023||||2611|||||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|.13085|02/28/2023|.1277|02/28/2023|.12856|02/28/2023||||2612|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
indapamide|No|No|No|No|75%|00228259796|INDAPAMIDE 1.25 MG TABLET|1000|EA|.13417|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.13085|02/28/2023|.1277|02/28/2023|.12856|02/28/2023||||2613|||||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|.13134|02/28/2023|.12818|02/28/2023|.12904|02/28/2023||||2614|||||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|.21294|02/28/2023|.20782|02/28/2023|.20921|02/28/2023||||2615|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00228263611|GABAPENTIN 600 MG TABLET|100|EA|.27915|12/15/2004||Yes|No||12/15/2004||Yes|No|12/15/2004||Yes|No||07/01/2012||Yes|No|||Prescription required|No||232|Yes|.10388|02/28/2023|.10138|02/28/2023|.10206|02/28/2023|||NEUROPATHIC PAIN|2616|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00228263650|GABAPENTIN 600 MG TABLET|500|EA|.27915|12/15/2004||Yes|No||12/15/2004||Yes|No|12/15/2004||Yes|No||07/01/2012||Yes|No|||Prescription required|No||232|Yes|.10388|02/28/2023|.10138|02/28/2023|.10206|02/28/2023|||NEUROPATHIC PAIN|2617|||||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||232|Yes|.13081|02/28/2023|.12767|02/28/2023|.12852|02/28/2023|||NEUROPATHIC PAIN|2618|||||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||232|Yes|.13081|02/28/2023|.12767|02/28/2023|.12852|02/28/2023|||NEUROPATHIC PAIN|2619|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
glyburide/metformin HCl|Yes|No|No|No|75%|00228275211|GLYBURIDE-METFORMIN 2.5-500 MG|100|EA|.04321|07/06/2005|12/31/2022|Yes|No||07/06/2005|12/31/2022|Yes|No|07/06/2005|12/31/2022|Yes|No||||No|No|07/01/2016|12/31/2022|Prescription required|No||012|No|.09849|01/10/2023|.09708|01/10/2023|.09246|01/10/2023|||HYPOGLYCEMICS: METFORMINS|2620|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ACTAVIS/TEVA|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00228277811|PROPRANOLOL ER 60 MG CAPSULE|100|EA|.72321|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|.19815|02/28/2023|.19339|02/28/2023|.19468|02/28/2023|||BETA-BLOCKERS|2621|||||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|.21898|02/28/2023|.21372|02/28/2023|.21514|02/28/2023|||BETA-BLOCKERS|2622|||||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|.26722|02/28/2023|.2608|02/28/2023|.26254|02/28/2023|||BETA-BLOCKERS|2623|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00228278111|PROPRANOLOL ER 160 MG CAPSULE|100|EA|1.37182|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|.35091|02/28/2023|.34248|02/28/2023|.34476|02/28/2023|||BETA-BLOCKERS|2624|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00228280111|PILOCARPINE HCL 5 MG TABLET|100|EA|.51535|01/07/2005||Yes|No||01/07/2005||Yes|No|01/07/2005||Yes|No||||No|No|||Prescription required|No|||No|.23169|02/28/2023|.22612|02/28/2023|.22763|02/28/2023||||2625|||||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|.0474|02/28/2023|.04626|02/28/2023|.04657|02/28/2023||||2626|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00228283711|PILOCARPINE HCL 7.5 MG TABLET|100|EA|.55685|09/08/2006||Yes|No||09/08/2006||Yes|No|09/08/2006||Yes|No||||No|No|||Prescription required|No|||No|.97012|02/28/2023|.94683|02/28/2023|.95314|02/28/2023||||2627|||||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|No|5.3536|02/28/2023|5.22511|02/28/2023|5.25991|02/28/2023|||ANTIDEPRESSANTS: SSRIs|2628|||||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|5.82337|02/28/2023|5.6836|02/28/2023|5.72146|02/28/2023|||ANTIDEPRESSANTS: SSRIs|2629|||||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||007|Yes|.22198|02/28/2023|.21665|02/28/2023|.21809|02/28/2023|||STIMULANTS AND RELATED AGENTS|2630|||||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||007|Yes|.23936|02/28/2023|.23361|02/28/2023|.23517|02/28/2023|||STIMULANTS AND RELATED AGENTS|2631|||||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||007|Yes|.25544|02/28/2023|.2493|02/28/2023|.25096|02/28/2023|||STIMULANTS AND RELATED AGENTS|2632|||||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||007|Yes|.269|02/28/2023|.26254|02/28/2023|.26429|02/28/2023|||STIMULANTS AND RELATED AGENTS|2633|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228285609|PREGABALIN 25 MG CAPSULE|90|EA|.05971|04/20/2021||Yes|No||04/20/2021||Yes|No|04/20/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.07085|02/28/2023|.06914|02/28/2023|.06961|02/28/2023|||NEUROPATHIC PAIN|2634|||||No|No||TEVA USA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228285709|PREGABALIN 50 MG CAPSULE|90|EA|.05971|04/20/2021||Yes|No||04/20/2021||Yes|No|04/20/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.06889|02/28/2023|.06723|02/28/2023|.06768|02/28/2023|||NEUROPATHIC PAIN|2635|||||No|No||TEVA USA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228285809|PREGABALIN 75 MG CAPSULE|90|EA|.05971|04/20/2021||Yes|No||04/20/2021||Yes|No|04/20/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.07134|02/28/2023|.06962|02/28/2023|.07009|02/28/2023|||NEUROPATHIC PAIN|2636|||||No|No||TEVA USA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228285909|PREGABALIN 100 MG CAPSULE|90|EA|.05971|04/20/2021||Yes|No||04/20/2021||Yes|No|04/20/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.06221|02/28/2023|.06071|02/28/2023|.06112|02/28/2023|||NEUROPATHIC PAIN|2637|||||No|No||TEVA USA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228286009|PREGABALIN 150 MG CAPSULE|90|EA|.06688|04/20/2021||Yes|No||04/20/2021||Yes|No|04/20/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.07021|02/28/2023|.06852|02/28/2023|.06898|02/28/2023|||NEUROPATHIC PAIN|2638|||||No|No||TEVA USA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228286109|PREGABALIN 200 MG CAPSULE|90|EA|.07166|04/20/2021||Yes|No||04/20/2021||Yes|No|04/20/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.08722|02/28/2023|.08512|02/28/2023|.08569|02/28/2023|||NEUROPATHIC PAIN|2639|||||No|No||TEVA USA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228286209|PREGABALIN 225 MG CAPSULE|90|EA|.07644|05/26/2021||Yes|No||05/26/2021||Yes|No|05/26/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.09002|02/28/2023|.08785|02/28/2023|.08844|02/28/2023|||NEUROPATHIC PAIN|2640|||||No|No||TEVA USA|No|||||No|No|No||
pregabalin|No|No|No|No|90%|00228286309|PREGABALIN 300 MG CAPSULE|90|EA|.08121|05/25/2021||Yes|No||05/25/2021||Yes|No|05/25/2021||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|07/28/2022|232|No|.0973|02/28/2023|.09496|02/28/2023|.09559|02/28/2023|||NEUROPATHIC PAIN|2641|||||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||232|No|.1129|02/28/2023|.11019|02/28/2023|.11092|02/28/2023|||NEUROPATHIC PAIN|2642|||||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||232|No|.10597|02/28/2023|.10342|02/28/2023|.10411|02/28/2023|||NEUROPATHIC PAIN|2643|||||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||232|No|.10597|02/28/2023|.10342|02/28/2023|.10411|02/28/2023|||NEUROPATHIC PAIN|2644|||||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||232|No|.11183|02/28/2023|.10914|02/28/2023|.10987|02/28/2023|||NEUROPATHIC PAIN|2645|||||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||232|No|.11183|02/28/2023|.10914|02/28/2023|.10987|02/28/2023|||NEUROPATHIC PAIN|2646|||||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|06/01/2016|7.90123|06/01/2016|7.52498|06/01/2016|||TETRACYCLINES|2647|||||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|10.30832|09/24/2019|10.16106|09/24/2019|9.6772|09/24/2019|||TETRACYCLINES|2648|||||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|2.11239|02/18/2014||Yes|No||02/18/2014||Yes|No|02/18/2014||Yes|No||02/18/2014||Yes|No|||Prescription required|No||045|No|.59378|02/28/2023|.57952|02/28/2023|.58338|02/28/2023|||CALCIUM CHANNEL BLOCKERS|2649|||||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||003|No|.05737|02/28/2023|.05599|02/28/2023|.05636|02/28/2023|||BPH TREATMENTS|2650|||||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||003|No|.05737|02/28/2023|.05599|02/28/2023|.05636|02/28/2023|||BPH TREATMENTS|2651|||||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|.62245|02/28/2023|.60751|02/28/2023|.61155|02/28/2023|||STIMULANTS AND RELATED AGENTS|2652|||||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|.67751|02/28/2023|.66124|02/28/2023|.66565|02/28/2023|||STIMULANTS AND RELATED AGENTS|2653|||||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|Yes|.70831|02/28/2023|.69131|02/28/2023|.69591|02/28/2023|||STIMULANTS AND RELATED AGENTS|2654|||||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|Yes|.69643|01/31/2023|.67971|01/31/2023|.68424|01/31/2023|||STIMULANTS AND RELATED AGENTS|2655|||||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|Yes|.63242|02/28/2023|.61724|02/28/2023|.62135|02/28/2023|||STIMULANTS AND RELATED AGENTS|2656|||||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|Yes|.69556|02/28/2023|.67886|02/28/2023|.68338|02/28/2023|||STIMULANTS AND RELATED AGENTS|2657|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228308306|ALPRAZOLAM ER 0.5 MG TABLET|60|EA|.30938|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|.15327|02/28/2023|.14959|02/28/2023|.15058|02/28/2023|||ANXIOLYTICS|2658|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228308406|ALPRAZOLAM ER 1 MG TABLET|60|EA|.41344|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|.17898|02/28/2023|.17468|02/28/2023|.17584|02/28/2023|||ANXIOLYTICS|2659|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228308606|ALPRAZOLAM ER 3 MG TABLET|60|EA|.79657|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|.19675|02/28/2023|.19202|02/28/2023|.1933|02/28/2023|||ANXIOLYTICS|2660|||||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|.21949|02/28/2023|.21422|02/28/2023|.21564|02/28/2023|||ANXIOLYTICS|2661|||||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|4.49202|11/28/2017|4.42785|11/28/2017|4.217|11/28/2017|||ANALGESICS: NARCOTICS LONG|2662|||||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|07/25/2017|8.59836|07/25/2017|8.18892|07/25/2017|||ANALGESICS: NARCOTICS LONG|2663|||||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|08/29/2017|12.92836|08/29/2017|12.31272|08/29/2017|||ANALGESICS: NARCOTICS LONG|2664|||||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|01/23/2018|15.2541|01/23/2018|14.52772|01/23/2018|||ANALGESICS: NARCOTICS LONG|2665|||||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|06/01/2016|6.56532|06/01/2016|6.25268|06/01/2016|||ANALGESICS: NARCOTICS LONG|2666|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228311711|MORPHINE SULFATE ER 75 MG CAP|100|EA|4.87069|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|11.10065|06/01/2016|10.94207|06/01/2016|10.42102|06/01/2016|||ANALGESICS: NARCOTICS LONG|2667|||||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||145|Yes|.73811|02/28/2023|.72039|02/28/2023|.72519|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|2668|||||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|2.00251|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription required|No||145|Yes|.64329|02/28/2023|.62785|02/28/2023|.63203|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|2669|||||No|No||ACTAVIS/TEVA|Yes|09/01/2020||||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||145|Yes|1.0599|02/28/2023|1.03446|02/28/2023|1.04135|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|2670|||||No|No||ACTAVIS/TEVA|Yes|09/01/2020||||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||145|Yes|.97128|01/24/2023|.94796|01/24/2023|.95428|01/24/2023|||OPIATE DEPENDENCE TREATMENTS|2671|||||No|No||ACTAVIS/TEVA|Yes|09/01/2020||||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||145|Yes|.37763|02/28/2023|.36856|02/28/2023|.37102|02/28/2023|||OPIATE DEPENDENCE TREATMENTS|2672|||||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|7.50484|02/28/2023|7.32472|02/28/2023|7.3735|02/28/2023|||SEDATIVE HYPNOTICS|2673|||||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|7.49495|02/28/2023|7.31507|02/28/2023|7.36378|02/28/2023|||SEDATIVE HYPNOTICS|2674|||||No|No||TEVA USA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228350106|MORPHINE SULFATE ER 10 MG CAP|60|EA|1.62783|02/10/2015|03/21/2023|Yes|No||02/10/2015|03/21/2023|Yes|No|02/10/2015|03/21/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|110|Yes|2.51132|02/28/2023|2.45104|02/28/2023|2.46737|02/28/2023|||ANALGESICS: NARCOTICS LONG|2675|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228350206|MORPHINE SULFATE ER 20 MG CAP|60|EA|1.79869|02/10/2015|02/28/2023|Yes|No||02/10/2015|02/28/2023|Yes|No|02/10/2015|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|110|Yes|4.09934|03/14/2023|4.04077|03/14/2023|3.84836|03/14/2023|||ANALGESICS: NARCOTICS LONG|2676|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228350306|MORPHINE SULFATE ER 30 MG CAP|60|EA|1.95635|02/10/2015|02/28/2023|Yes|No||02/10/2015|02/28/2023|Yes|No|02/10/2015|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|110|Yes|4.45866|03/14/2023|4.39497|03/14/2023|4.18568|03/14/2023|||ANALGESICS: NARCOTICS LONG|2677|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228350406|MORPHINE SULFATE ER 50 MG CAP|60|EA|3.26921|02/10/2015|02/28/2023|Yes|No||02/10/2015|02/28/2023|Yes|No|02/10/2015|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|110|Yes|7.45077|09/27/2022|7.34433|09/27/2022|6.9946|09/27/2022|||ANALGESICS: NARCOTICS LONG|2678|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228350506|MORPHINE SULFATE ER 60 MG CAP|60|EA|3.91263|02/10/2015|02/28/2023|Yes|No||02/10/2015|02/28/2023|Yes|No|02/10/2015|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|110|Yes|8.91717|10/26/2021|8.78978|10/26/2021|8.37122|10/26/2021|||ANALGESICS: NARCOTICS LONG|2679|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228350606|MORPHINE SULFATE ER 80 MG CAP|60|EA|5.21252|02/10/2015|02/28/2023|Yes|No||02/10/2015|02/28/2023|Yes|No|02/10/2015|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|110|Yes|11.87971|10/23/2018|11.71|10/23/2018|11.15238|10/23/2018|||ANALGESICS: NARCOTICS LONG|2680|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228350706|MORPHINE SULFATE ER 100 MG CAP|60|EA|6.53858|02/10/2015|02/28/2023|Yes|No||02/10/2015|02/28/2023|Yes|No|02/10/2015|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/24/2013|110|Yes|14.90188|09/24/2019|14.68899|09/24/2019|13.98952|09/24/2019|||ANALGESICS: NARCOTICS LONG|2681|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ACTAVIS/TEVA|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|1.08898|02/28/2023|1.06284|02/28/2023|1.06992|02/28/2023|||ANTIPARKINSON'S AGENTS|2682|||||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|.63615|02/28/2023|.62088|02/28/2023|.62501|02/28/2023|||ANTIPARKINSON'S AGENTS|2683|||||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|.63615|02/28/2023|.62088|02/28/2023|.62501|02/28/2023|||ANTIPARKINSON'S AGENTS|2684|||||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|.75491|02/28/2023|.73679|02/28/2023|.74169|02/28/2023|||ANTIPARKINSON'S AGENTS|2685|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228365909|ROPINIROLE HCL ER 4 MG TABLET|90|EA|1.85334|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|.75491|02/28/2023|.73679|02/28/2023|.74169|02/28/2023|||ANTIPARKINSON'S AGENTS|2686|||||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|1.33348|02/28/2023|1.30147|02/28/2023|1.31014|02/28/2023|||ANTIPARKINSON'S AGENTS|2687|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228366009|ROPINIROLE HCL ER 8 MG TABLET|90|EA|2.77999|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|1.33348|02/28/2023|1.30147|02/28/2023|1.31014|02/28/2023|||ANTIPARKINSON'S AGENTS|2688|||||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|1.46627|12/27/2022|1.43107|12/27/2022|1.44061|12/27/2022|||ANTIPARKINSON'S AGENTS|2689|||||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|.87264|09/27/2022|.85169|09/27/2022|.85736|09/27/2022|||ANXIOLYTICS|2690|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
alprazolam|No|No|No|No|90%|00228402211|ALPRAZOLAM ODT 0.5 MG TAB|100|EA|.57809|06/14/2016||Yes|No||06/14/2016||Yes|No|06/14/2016||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|090|Yes|1.31751|05/25/2021|1.29869|05/25/2021|1.23684|05/25/2021|||ANXIOLYTICS|2691|||||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|1.75782|11/28/2017|1.73271|11/28/2017|1.6502|11/28/2017|||ANXIOLYTICS|2692|||||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|06/14/2016|2.9461|06/14/2016|2.80581|06/14/2016|||ANXIOLYTICS|2693|||||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|Yes|.42109|02/28/2023|.41098|02/28/2023|.41372|02/28/2023|||STIMULANTS AND RELATED AGENTS|2694|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
morphine sulfate|No|No|No|No|90%|00228427011|MORPHINE SULF ER 15 MG TABLET|100|EA|.28822|11/12/2015||Yes|No||11/12/2015||Yes|No|11/12/2015||Yes|No||||No|No|||Prescription required|No||110|Yes|.1953|02/28/2023|.19061|02/28/2023|.19188|02/28/2023|||ANALGESICS: NARCOTICS LONG|2695|||||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||110|Yes|.36562|02/28/2023|.35684|02/28/2023|.35922|02/28/2023|||ANALGESICS: NARCOTICS LONG|2696|||||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||110|Yes|.58492|02/28/2023|.57088|02/28/2023|.57468|02/28/2023|||ANALGESICS: NARCOTICS LONG|2697|||||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||110|Yes|1.09538|02/28/2023|1.06909|02/28/2023|1.07621|02/28/2023|||ANALGESICS: NARCOTICS LONG|2698|||||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||110|Yes|6.60422|07/26/2022|6.50987|07/26/2022|6.19988|07/26/2022|||ANALGESICS: NARCOTICS LONG|2699|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00245001201|SORINE 80 MG TABLET|100|EA|.68606|01/04/2017||Yes|No||01/04/2017||Yes|No|01/04/2017||Yes|No||||No|No|||Prescription required|No||070|No|.0756|02/28/2023|.07378|02/28/2023|.07427|02/28/2023|||BETA-BLOCKERS|2700|||||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||Yes|No||01/04/2017||Yes|No|01/04/2017||Yes|No||||No|No|||Prescription required|No||070|No|.10033|02/28/2023|.09792|02/28/2023|.09857|02/28/2023|||BETA-BLOCKERS|2701|||||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||Yes|No||01/04/2017||Yes|No|01/04/2017||Yes|No||||No|No|||Prescription required|No||070|No|.12647|02/28/2023|.12343|02/28/2023|.12425|02/28/2023|||BETA-BLOCKERS|2702|||||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||Yes|No||01/04/2017||Yes|No|01/04/2017||Yes|No||||No|No|||Prescription required|No||070|No|3.63756|01/04/2017|3.58559|01/04/2017|3.41485|01/04/2017|||BETA-BLOCKERS|2703|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00245003623|PREVALITE POWDER|231|GM|.11866|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||055|No|.18577|02/28/2023|.18131|02/28/2023|.18251|02/28/2023|||LIPOTROPICS: OTHER|2704|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00245003642|PREVALITE PACKET|42|EA|.88354|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||055|No|1.1332|02/28/2023|1.106|02/28/2023|1.11336|02/28/2023|||LIPOTROPICS: OTHER|2705|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00245003660|PREVALITE PACKET|60|EA|.88171|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||055|No|1.1332|02/28/2023|1.106|02/28/2023|1.11336|02/28/2023|||LIPOTROPICS: OTHER|2706|||||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|.43395|07/11/2008||Yes|No||07/11/2008||Yes|No|07/11/2008||Yes|No||07/11/2008||Yes|No|||Prescription required|No|||No|.36862|02/28/2023|.35977|02/28/2023|.36216|02/28/2023||||2707|||||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|.60823|07/11/2008||Yes|No||07/11/2008||Yes|No|07/11/2008||Yes|No||07/11/2008||Yes|No|||Prescription required|No|||No|.30379|02/28/2023|.29649|02/28/2023|.29847|02/28/2023||||2708|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
ferrous sulfate|No|No|No|No|75%|00245010801|FERROUS SULF EC 325 MG TABLET|100|EA|.25877|||No|No||||No|No|||No|No||08/19/2013||Yes|No|||Over the counter|No|||No|.58976|07/07/2020|.58133|07/07/2020|.55365|07/07/2020||||2709|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
ferrous sulfate|No|No|No|No|75%|00245010810|FERROUS SULF EC 325 MG TABLET|1000|EA|.12381|||No|No||||No|No|||No|No||08/19/2013||Yes|No|||Over the counter|No|||No|.28219|07/07/2020|.27815|07/07/2020|.26491|07/07/2020||||2710|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
ferrous sulfate|No|No|No|No|75%|00245010811|FERROUS SULF EC 325 MG TABLET|100|EA|.13738|||No|No||||No|No|||No|No||08/19/2013||Yes|No|||Over the counter|No|||No|.31311|07/07/2020|.30863|07/07/2020|.29394|07/07/2020||||2711|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
ferrous sulfate|No|No|No|No|75%|00245010889|FERROUS SULF EC 325 MG TABLET|1|EA|.258|||No|No||||No|No|||No|No||08/19/2013||Yes|No|||Over the counter|No|||No|.588|07/07/2020|.5796|07/07/2020|.552|07/07/2020||||2712|||||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|2.73126|11/29/2022|2.69224|11/29/2022|2.56404|11/29/2022||||2713|||||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|2.73126|11/29/2022|2.69224|11/29/2022|2.56404|11/29/2022||||2714|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014701|PACERONE 200 MG TABLET|100|EA|.16034|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.11264|03/29/2022|.10993|03/29/2022|.11066|03/29/2022||||2715|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014715|PACERONE 200 MG TABLET|500|EA|.11653|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.11264|03/29/2022|.10993|03/29/2022|.11066|03/29/2022||||2716|||||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|.11264|03/29/2022|.10993|03/29/2022|.11066|03/29/2022||||2717|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
amiodarone HCl|No|No|No|No|75%|00245014790|PACERONE 200 MG TABLET|90|EA|.11891|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription required|No|||No|.11264|03/29/2022|.10993|03/29/2022|.11066|03/29/2022||||2718|||||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|.22415|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||05/21/2008||Yes|No|||Prescription required|No|||No|.17979|02/28/2023|.17547|02/28/2023|.17664|02/28/2023||||2719|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00245021201|MIDODRINE HCL 5 MG TABLET|100|EA|1.29602|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||09/06/2016||Yes|No|||Prescription required|No|||No|.25736|02/28/2023|.25118|02/28/2023|.25285|02/28/2023||||2720|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00245021211|MIDODRINE HCL 5 MG TABLET|100|EA|.3154|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||05/21/2008||Yes|No|||Prescription required|No|||No|.25736|02/28/2023|.25118|02/28/2023|.25285|02/28/2023||||2721|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00245021311|MIDODRINE HCL 10 MG TABLET|100|EA|.53904|05/21/2008||Yes|No||05/21/2008||Yes|No|05/21/2008||Yes|No||05/21/2008||Yes|No|||Prescription required|No|||No|.42755|02/28/2023|.41728|02/28/2023|.42006|02/28/2023||||2722|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
oxandrolone|No|No|No|No|90%|00245027111|OXANDROLONE 2.5 MG TABLET|100|EA|1.19398|04/15/2008||Yes|No||04/15/2008||Yes|No|04/15/2008||Yes|No||||No|No|||Prescription required|No|||No|2.72116|02/19/2019|2.68229|02/19/2019|2.55456|02/19/2019||||2723|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
oxandrolone|No|No|No|No|90%|00245027206|OXANDROLONE 10 MG TABLET|60|EA|4.05038|04/15/2008||Yes|No||04/15/2008||Yes|No|04/15/2008||Yes|No||||No|No|||Prescription required|No|||No|9.23111|02/19/2019|9.09923|02/19/2019|8.66594|02/19/2019||||2724|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245036001|KLOR-CON 20 MEQ PACKET|100|EA|1.2255|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||07/19/2018||Yes|No|||Prescription required|No|||No|.78932|02/28/2023|.77037|02/28/2023|.7755|02/28/2023||||2725|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245036030|KLOR-CON 20 MEQ PACKET|30|EA|1.21833|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||07/19/2018||Yes|No|||Prescription required|No|||No|.78932|02/28/2023|.77037|02/28/2023|.7755|02/28/2023||||2726|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine (with sugar)|No|No|No|No|75%|00245053637|CHOLESTYRAMINE POWDER|378|GM|.11932|03/08/2012|07/01/2023|Yes|No||03/08/2012|07/01/2023|Yes|No|03/08/2012|07/01/2023|Yes|No||03/08/2012|07/01/2023|Yes|No|||Prescription required|No||055|No|.13368|02/28/2023|.13047|02/28/2023|.13134|02/28/2023|||LIPOTROPICS: OTHER|2727|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine (with sugar)|No|No|No|No|75%|00245053660|CHOLESTYRAMINE PACKET|60|EA|.88171|04/04/2014||Yes|No||04/04/2014||Yes|No|04/04/2014||Yes|No||04/04/2014||Yes|No|||Prescription required|No||055|No|1.06283|02/28/2023|1.03732|02/28/2023|1.04423|02/28/2023|||LIPOTROPICS: OTHER|2728|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
vigabatrin|No|No|No|No|75%|00245055650|VIGADRONE 500 MG POWDER PACKET|50|EA|40.33778|12/07/2018||Yes|No||12/07/2018||Yes|No|12/07/2018||Yes|No||||No|No|||Prescription required|No||056|No|91.93262|12/07/2018|90.6193|12/07/2018|86.30409|12/07/2018|||ANTICONVULSANTS|2729|||||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||144|No|24.94328|08/04/2022|24.58695|08/04/2022|23.41614|08/04/2022|||ACNE AGENTS: ORAL|2730|||||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||144|No|24.94328|08/04/2022|24.58695|08/04/2022|23.41614|08/04/2022|||ACNE AGENTS: ORAL|2731|||||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||144|No|16.71573|02/28/2023|16.31455|02/28/2023|16.4232|02/28/2023|||ACNE AGENTS: ORAL|2732|||||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||144|No|15.187|08/04/2022|14.82251|08/04/2022|14.92122|08/04/2022|||ACNE AGENTS: ORAL|2733|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00245080938|ZEMBRACE SYMTOUCH 3 MG/0.5 ML|.5|ML|161.98745|04/12/2022||Yes|No||04/12/2022||Yes|No|04/12/2022||Yes|No||||No|No|||Prescription required|Yes|07/30/2020|021|No|369.1807|11/22/2022|363.90669|11/22/2022|346.5778|11/22/2022|||ANTIMIGRAINE AGENTS: TRIPTANS|2734|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
sumatriptan|No|No|No|No|75%|00245081261|TOSYMRA 10 MG NASAL SPRAY|6|EA|45.69825|02/23/2022||Yes|No||02/23/2022||Yes|No|02/23/2022||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|021|No|104.1495|11/22/2022|102.66165|11/22/2022|97.773|11/22/2022|||ANTIMIGRAINE AGENTS: TRIPTANS|2735|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
metronidazole|Yes|No|No|No|75%|00245086070|VANDAZOLE VAGINAL 0.75% GEL|70|GM|.75108|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|.64955|02/28/2023|.63396|02/28/2023|.63818|02/28/2023|||ANTIBIOTICS: VAGINAL|2736|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
testosterone|No|No|No|No|90%|00245087105|VOGELXO 50 MG/5 GRAM GEL|5|GM|1.27749|06/18/2015||Yes|No||06/18/2015||Yes|No|06/18/2015||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|084|No|3.81256|09/27/2022|3.72105|09/27/2022|3.74584|09/27/2022|||ANDROGENIC AGENTS|2737|||||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|1.27577|06/18/2015||Yes|No||06/18/2015||Yes|No|06/18/2015||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|084|No|2.90759|06/01/2016|2.86605|06/01/2016|2.72957|06/01/2016|||ANDROGENIC AGENTS|2738|||||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|1.27577|06/18/2015||Yes|No||06/18/2015||Yes|No|06/18/2015||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|084|No|2.90759|06/01/2016|2.86605|06/01/2016|2.72957|06/01/2016|||ANDROGENIC AGENTS|2739|||||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||056|No|9.57524|02/21/2023|9.43845|02/21/2023|8.989|02/21/2023|||ANTICONVULSANTS|2740|||||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||056|No|12.4731|02/21/2023|12.29491|02/21/2023|11.70944|02/21/2023|||ANTICONVULSANTS|2741|||||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||056|No|33.80542|02/21/2023|33.32248|02/21/2023|31.7357|02/21/2023|||ANTICONVULSANTS|2742|||||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||056|No|24.71232|02/21/2023|24.35929|02/21/2023|23.19932|02/21/2023|||ANTICONVULSANTS|2743|||||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||056|No|30.3973|02/21/2023|29.96305|02/21/2023|28.53624|02/21/2023|||ANTICONVULSANTS|2744|||||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|3.92|09/30/2021|3.864|09/30/2021|3.68|09/30/2021||||2745|||||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|3.26666|09/30/2021|3.21999|09/30/2021|3.06666|09/30/2021||||2746|||||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|.47598|12/09/2019|.46918|12/09/2019|.44684|12/09/2019||||2747|||||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|.42051|12/09/2019|.41451|12/09/2019|.39477|12/09/2019||||2748|||||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|.42051|12/09/2019|.41451|12/09/2019|.39477|12/09/2019||||2749|||||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|.10098|12/27/2022|.09855|12/27/2022|.09921|12/27/2022||||2750|||||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|.10098|12/27/2022|.09855|12/27/2022|.09921|12/27/2022||||2751|||||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|.10098|12/27/2022|.09855|12/27/2022|.09921|12/27/2022||||2752|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531701|KLOR-CON M10 TABLET|100|EA|.21254|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription required|No|||No|.20109|05/24/2022|.19626|05/24/2022|.19757|05/24/2022||||2753|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531710|KLOR-CON M10 TABLET|1000|EA|.205|12/09/2019||Yes|No||12/09/2019||Yes|No|12/09/2019||Yes|No||12/09/2019||Yes|No|||Prescription required|No|||No|.20109|05/24/2022|.19626|05/24/2022|.19757|05/24/2022||||2754|||||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|.20109|05/24/2022|.19626|05/24/2022|.19757|05/24/2022||||2755|||||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|.20109|05/24/2022|.19626|05/24/2022|.19757|05/24/2022||||2756|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531801|KLOR-CON M15 TABLET|100|EA|.36532|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription required|No|||No|.8326|12/24/2019|.82071|12/24/2019|.78163|12/24/2019||||2757|||||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|.77812|12/24/2019|.767|12/24/2019|.73048|12/24/2019||||2758|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531901|KLOR-CON M20 TABLET|100|EA|.23387|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription required|No|||No|.13181|01/24/2023|.12864|01/24/2023|.1295|01/24/2023||||2759|||||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|.13181|01/24/2023|.12864|01/24/2023|.1295|01/24/2023||||2760|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531911|KLOR-CON M20 TABLET|100|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|.13181|01/24/2023|.12864|01/24/2023|.1295|01/24/2023||||2761|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531915|KLOR-CON M20 TABLET|500|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|.13181|01/24/2023|.12864|01/24/2023|.1295|01/24/2023||||2762|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00245531990|KLOR-CON M20 TABLET|90|EA|.2158|12/06/2019||Yes|No||12/06/2019||Yes|No|12/06/2019||Yes|No||12/06/2019||Yes|No|||Prescription required|No|||No|.13181|01/24/2023|.12864|01/24/2023|.1295|01/24/2023||||2763|||||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|.75472|02/28/2023|.7366|02/28/2023|.74151|02/28/2023||||2764|||||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|.75472|02/28/2023|.7366|02/28/2023|.74151|02/28/2023||||2765|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00254100752|ALBUTEROL HFA 90 MCG INHALER|6.7|GM|2.30916|09/09/2019|02/21/2023|Yes|No||09/09/2019|02/21/2023|Yes|No|09/09/2019|02/21/2023|Yes|No||||No|No|||Prescription required|Yes|05/23/2022|037|Yes|5.26273|03/07/2023|5.18755|03/07/2023|4.94052|03/07/2023|||BRONCHODILATORS: BETA AGONIST|2766|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|7.1864|11/29/2022|7.01392|11/29/2022|7.06063|11/29/2022|||GLUCAGON AGENTS|2767|||||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|.34504|02/28/2023|.33675|02/28/2023|.339|02/28/2023||||2768|||||No|No||PAR PHARM.|No|||||No|No|No||
penicillamine|No|No|No|No|75%|00254200001|PENICILLAMINE 250 MG TABLET|100|EA|20.00755|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||||No|No|||Prescription required|No|||No|45.59861|05/21/2020|44.9472|05/21/2020|42.80686|05/21/2020||||2769|||||No|No||PAR PHARM.|No|||||No|No|No||
colchicine|No|No|No|No|75%|00254200801|COLCHICINE 0.6 MG TABLET|100|EA|2.41384|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|231|No|.42779|02/28/2023|.41752|02/28/2023|.4203|02/28/2023|||ANTIHYPERURICEMICS|2770|||||No|No||PAR PHARM.|No|||||No|No|No||
colchicine|No|No|No|No|75%|00254200811|COLCHICINE 0.6 MG TABLET|30|EA|2.41387|12/03/2018|12/06/2023|Yes|No||12/03/2018|12/06/2023|Yes|No|12/03/2018|12/06/2023|Yes|No||||No|No|||Prescription required|Yes|07/26/2018|231|No|.42779|02/28/2023|.41752|02/28/2023|.4203|02/28/2023|||ANTIHYPERURICEMICS|2771|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|Yes|07/25/2019|069|No|9.60487|10/25/2022|9.37435|10/25/2022|9.43678|10/25/2022|||ANTIFUNGALS: ORAL|2772|||||No|No||PAR PHARM.|No|||||No|No|No||
nitisinone|No|No|No|No|75%|00254302002|NITISINONE 2 MG CAPSULE|60|EA|31.24315|05/11/2020||Yes|No||05/11/2020||Yes|No|05/11/2020||Yes|No||||No|No|||Prescription required|No|||Yes|71.20533|05/11/2020|70.18811|05/11/2020|66.84582|05/11/2020||||2773|||||No|No||PAR PHARM.|No|||||No|No|Yes|07/30/2021|
nitisinone|No|No|No|No|75%|00254302102|NITISINONE 5 MG CAPSULE|60|EA|78.10741|05/11/2020||Yes|No||05/11/2020||Yes|No|05/11/2020||Yes|No||||No|No|||Prescription required|No|||Yes|178.01225|05/11/2020|175.46922|05/11/2020|167.11354|05/11/2020||||2774|||||No|No||PAR PHARM.|No|||||No|No|Yes|07/30/2021|
nitisinone|No|No|No|No|75%|00254302202|NITISINONE 10 MG CAPSULE|60|EA|156.21505|05/11/2020||Yes|No||05/11/2020||Yes|No|05/11/2020||Yes|No||||No|No|||Prescription required|No|||Yes|356.02501|05/11/2020|350.93894|05/11/2020|334.22756|05/11/2020||||2775|||||No|No||PAR PHARM.|No|||||No|No|Yes|07/30/2021|
lubiprostone|No|No|No|No|75%|00254302802|LUBIPROSTONE 8 MCG CAPSULE|60|EA|2.12764|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|534|Yes|4.34262|02/28/2023|4.23839|02/28/2023|4.26662|02/28/2023|||GI MOTILITY: CHRONIC|2776|||||No|No||PAR PHARM.|No|||||No|No|No||
lubiprostone|No|No|No|No|75%|00254302902|LUBIPROSTONE 24 MCG CAPSULE|60|EA|2.12764|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|534|Yes|4.44432|02/28/2023|4.33765|02/28/2023|4.36654|02/28/2023|||GI MOTILITY: CHRONIC|2777|||||No|No||PAR PHARM.|No|||||No|No|No||
glycopyrrolate|No|No|No|No|75%|00259050116|CUVPOSA 1 MG/5 ML SOLUTION|473|ML|.63783|04/16/2013||Yes|No||04/16/2013||Yes|No|04/16/2013||Yes|No||||No|No|||Prescription required|No|||No|1.0138|05/24/2022|.98946|05/24/2022|.99605|05/24/2022||||2778|||||No|No||MERZ|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00264151032|DEXTROSE 5%-WATER IV SOLN|100|ML|.00976|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.02224|06/30/2020|.02192|06/30/2020|.02088|06/30/2020||||2779|||||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|.02132|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0486|02/07/2023|.04791|02/07/2023|.04563|02/07/2023||||2780|||||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|.01066|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0243|02/07/2023|.02395|02/07/2023|.02281|02/07/2023||||2781|||||No|No||B.BRAUN|No|||||No|No|No||
sodium/pot/mag/calc/chlor/acet|No|No|No|No|75%|00264194320|HYPERLYTE CR VIAL|250|ML|.03279|09/07/2015|01/31/2023|Yes|No||09/07/2015|01/31/2023|Yes|No|09/07/2015|01/31/2023|Yes|No||||No|No|||Prescription required|No|||No|.07473|06/30/2020|.07366|06/30/2020|.07015|06/30/2020||||2782|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||B.BRAUN|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00264210100|STERILE WATER FOR IRRIGATION|1000|ML|.00134|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00305|06/30/2020|.00301|06/30/2020|.00287|06/30/2020||||2783|||||No|No||B.BRAUN|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00264210110|STERILE WATER FOR IRRIGATION|500|ML|.00255|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00582|02/14/2023|.00573|02/14/2023|.00546|02/14/2023||||2784|||||No|No||B.BRAUN|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00264210150|STERILE WATER FOR IRRIGATION|2000|ML|.00078|03/01/2002|08/31/2023|Yes|No||03/01/2002|08/31/2023|Yes|No|03/01/2002|08/31/2023|Yes|No||||No|No|||Prescription required|No|||No|.00179|07/02/2019|.00176|07/02/2019|.00168|07/02/2019||||2785|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|.00146|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00333|06/30/2020|.00328|06/30/2020|.00312|06/30/2020||||2786|||||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|.00268|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00611|02/07/2023|.00602|02/07/2023|.00574|02/07/2023||||2787|||||No|No||B.BRAUN|No|||||No|No|No||
sodium chloride irrig solution|No|No|No|No|75%|00264220150|SODIUM CHLORIDE 0.9% IRRIG.|2000|ML|.00091|03/01/2002|06/30/2023|Yes|No||03/01/2002|06/30/2023|Yes|No|03/01/2002|06/30/2023|Yes|No||||No|No|||Prescription required|No|||No|.00207|06/30/2020|.00204|06/30/2020|.00195|06/30/2020||||2788|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264220300|LACTATED RINGERS IRRIGATION|1000|ML|.00215|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00491|02/07/2023|.00484|02/07/2023|.00461|02/07/2023||||2789|||||No|No||B.BRAUN|No|||||No|No|No||
physiological irrig soln no.1|No|No|No|No|75%|00264220500|PHYSIOLYTE IRRIGATION SOLN|1000|ML|.00294|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00671|02/07/2023|.00661|02/07/2023|.0063|02/07/2023||||2790|||||No|No||B.BRAUN|No|||||No|No|No||
acetic acid|No|No|No|No|75%|00264230400|ACETIC ACID 0.25% IRRIG SOLN|1000|ML|.00309|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00704|02/07/2023|.00694|02/07/2023|.00661|02/07/2023||||2791|||||No|No||B.BRAUN|No|||||No|No|No||
acetic acid|No|No|No|No|75%|00264230410|ACETIC ACID 0.25% IRRIG SOLN|500|ML|.00549|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01252|02/07/2023|.01234|02/07/2023|.01175|02/07/2023||||2792|||||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|.00158|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00361|06/30/2020|.00356|06/30/2020|.00339|06/30/2020||||2793|||||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|.00291|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00664|02/07/2023|.00654|02/07/2023|.00623|02/07/2023||||2794|||||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|.00536|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01223|02/07/2023|.01205|02/07/2023|.01148|02/07/2023||||2795|||||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|.00236|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00539|02/07/2023|.00531|02/07/2023|.00506|02/07/2023||||2796|||||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|.00346|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00789|02/07/2023|.00778|02/07/2023|.00741|02/07/2023||||2797|||||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|.00631|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01438|02/07/2023|.01418|02/07/2023|.0135|02/07/2023||||2798|||||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|.00149|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00341|02/07/2023|.00336|02/07/2023|.0032|02/07/2023||||2799|||||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|.00315|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00719|02/07/2023|.00709|02/07/2023|.00675|02/07/2023||||2800|||||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|.0012|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00275|02/07/2023|.00271|02/07/2023|.00258|02/07/2023||||2801|||||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|.00308|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00703|02/07/2023|.00693|02/07/2023|.0066|02/07/2023||||2802|||||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|.00205|03/01/2002||Yes|No||03/01/2002||Yes|No|||No|No||||No|No|||Prescription required|No|||No|.00467|02/07/2023|.0046|02/07/2023|.00438|02/07/2023||||2803|||||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|.00308|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00703|02/07/2023|.00693|02/07/2023|.0066|02/07/2023||||2804|||||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|.00646|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01473|02/07/2023|.01452|02/07/2023|.01383|02/07/2023||||2805|||||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|.00342|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0078|02/07/2023|.00768|02/07/2023|.00732|02/07/2023||||2806|||||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|.00586|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01336|02/07/2023|.01317|02/07/2023|.01254|02/07/2023||||2807|||||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|.00394|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00898|02/07/2023|.00885|02/07/2023|.00843|02/07/2023||||2808|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763400|D5%-1/2NS-KCL 10 MEQ/L IV SOL|1000|ML|.00354|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00808|02/07/2023|.00796|02/07/2023|.00759|02/07/2023||||2809|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763500|KCL 20 MEQ IN D5W-0.45% NACL|1000|ML|.00177|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00404|02/07/2023|.00398|02/07/2023|.00379|02/07/2023||||2810|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763600|D5%-1/2NS-KCL 30 MEQ/L IV SOL|1000|ML|.00354|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00808|02/07/2023|.00796|02/07/2023|.00759|02/07/2023||||2811|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763800|D5%-1/2NS-KCL 40 MEQ/L IV SOL|1000|ML|.00358|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00817|02/07/2023|.00805|02/07/2023|.00767|02/07/2023||||2812|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.2%NaCl|No|No|No|No|75%|00264764500|KCL 20 MEQ IN D5W-0.2% NACL|1000|ML|.00331|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00755|02/07/2023|.00744|02/07/2023|.00709|02/07/2023||||2813|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.9%NaCl|No|No|No|No|75%|00264765200|KCL 20 MEQ IN D5W-NS|1000|ML|.00202|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00462|02/07/2023|.00455|02/07/2023|.00434|02/07/2023||||2814|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775000|LACTATED RINGERS INJECTION|1000|ML|.00109|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00248|02/07/2023|.00245|02/07/2023|.00233|02/07/2023||||2815|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775010|LACTATED RINGERS INJECTION|500|ML|.00291|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00664|02/07/2023|.00654|02/07/2023|.00623|02/07/2023||||2816|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775020|LACTATED RINGERS INJECTION|250|ML|.00677|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01544|02/07/2023|.01522|02/07/2023|.01449|02/07/2023||||2817|||||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|.00123|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00282|02/07/2023|.00278|02/07/2023|.00264|02/07/2023||||2818|||||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|.00394|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00899|02/07/2023|.00886|02/07/2023|.00844|02/07/2023||||2819|||||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|.00101|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00232|02/07/2023|.00228|02/07/2023|.00218|02/07/2023||||2820|||||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|.00101|04/03/2018||Yes|No||||No|No|04/03/2018||Yes|No||||No|No|||Prescription required|No|||No|.00232|02/07/2023|.00228|02/07/2023|.00218|02/07/2023||||2821|||||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|.00264|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00603|02/07/2023|.00595|02/07/2023|.00566|02/07/2023||||2822|||||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|.0045|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01027|02/07/2023|.01012|02/07/2023|.00964|02/07/2023||||2823|||||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|.00153|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0035|02/07/2023|.00345|02/07/2023|.00329|02/07/2023||||2824|||||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|.00299|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00682|02/07/2023|.00672|02/07/2023|.0064|02/07/2023||||2825|||||No|No||B.BRAUN|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00264785000|STERILE WATER FOR INJECTION|1000|ML|.00171|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00391|02/07/2023|.00385|02/07/2023|.00367|02/07/2023||||2826|||||No|No||B.BRAUN|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00264785020|STERILE WATER FOR INJECTION|250|ML|.00612|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01395|02/07/2023|.01375|02/07/2023|.0131|02/07/2023||||2827|||||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|.0136|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.031|02/07/2023|.03056|02/07/2023|.0291|02/07/2023||||2828|||||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|.00719|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0164|02/07/2023|.01617|02/07/2023|.0154|02/07/2023||||2829|||||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|.01308|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.02983|02/07/2023|.0294|02/07/2023|.028|02/07/2023||||2830|||||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|.00353|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00805|02/07/2023|.00794|02/07/2023|.00756|02/07/2023||||2831|||||No|No||B.BRAUN|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00281032608|NITRO-BID 2% OINTMENT|1|GM|.94769|12/11/2015||Yes|No||12/11/2015||Yes|No|12/11/2015||Yes|No||||No|No|||Prescription required|No|||No|2.15987|06/19/2018|2.12901|06/19/2018|2.02763|06/19/2018||||2832|||||No|No||SANDOZ|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00281032630|NITRO-BID 2% OINTMENT|30|GM|.48833|10/12/2016||Yes|No||10/12/2016||Yes|No|10/12/2016||Yes|No||||No|No|||Prescription required|No|||No|1.1136|02/28/2023|1.08687|02/28/2023|1.09411|02/28/2023||||2833|||||No|No||SANDOZ|No|||||No|No|No||
nitroglycerin|No|No|No|No|75%|00281032660|NITRO-BID 2% OINTMENT|60|GM|.48833|10/12/2016||Yes|No||10/12/2016||Yes|No|10/12/2016||Yes|No||||No|No|||Prescription required|No|||No|1.11294|08/23/2022|1.09704|08/23/2022|1.0448|08/23/2022||||2834|||||No|No||SANDOZ|No|||||No|No|No||
calcitriol|No|No|No|No|75%|00299201210|VECTICAL 3 MCG/G OINTMENT|100|GM|3.90676|04/22/2009|12/31/2022|Yes|No||04/22/2009|12/31/2022|Yes|No|04/22/2009|12/31/2022|Yes|No||||No|No|||Prescription required|No|||No|9.3489|02/07/2023|9.21535|02/07/2023|8.77652|02/07/2023||||2835|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00299382060|METROGEL TOPICAL 1% GEL|60|GM|2.69788|05/02/2006|12/31/2022|Yes|No||05/02/2006|12/31/2022|Yes|No|05/02/2006|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|01/28/2021|221|No|6.14867|05/24/2022|6.06083|05/24/2022|5.77222|05/24/2022|||ROSACEA AGENTS: TOPICAL|2836|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
doxycycline monohydrate|No|No|No|No|75%|00299382230|ORACEA 40 MG CAPSULE|30|EA|11.88376|10/21/2008|12/31/2022|Yes|No||10/21/2008|12/31/2022|Yes|No|10/21/2008|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|02/02/2010|213|No|28.43796|02/07/2023|28.0317|02/07/2023|26.69686|02/07/2023|||TETRACYCLINES|2837|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
metronidazole|No|No|No|No|75%|00299383645|METROCREAM 0.75% CREAM|45|GM|5.97604|03/01/2002|12/31/2022|Yes|No||03/01/2002|12/31/2022|Yes|No|03/01/2002|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|01/28/2021|221|No|13.61981|06/01/2016|13.42524|06/01/2016|12.78594|06/01/2016|||ROSACEA AGENTS: TOPICAL|2838|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00299384902|CLOBEX 0.05% SPRAY|59|ML|3.22463|04/26/2007|12/31/2022|Yes|No||04/26/2007|12/31/2022|Yes|No|04/26/2007|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|02/10/2009|121|No|7.71657|02/07/2023|7.60634|02/07/2023|7.24413|02/07/2023|||STEROIDS: TOPICAL VERY HIGH|2839|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
clobetasol propionate|No|No|No|No|75%|00299384904|CLOBEX 0.05% SPRAY|125|ML|3.00948|04/04/2007|12/31/2022|Yes|No||04/04/2007|12/31/2022|Yes|No|04/04/2007|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|02/10/2009|121|No|7.20174|02/07/2023|7.09886|02/07/2023|6.76082|02/07/2023|||STEROIDS: TOPICAL VERY HIGH|2840|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
adapalene/benzoyl peroxide|No|No|No|No|75%|00299590645|EPIDUO FORTE 0.3-2.5% GEL PUMP|45|GM|6.10695|06/01/2016|12/31/2022|Yes|No||06/01/2016|12/31/2022|Yes|No|06/01/2016|12/31/2022|Yes|No||||No|No|||Prescription required|No||104|No|13.91817|01/10/2023|13.71934|01/10/2023|13.06604|01/10/2023|||ACNE AGENTS: TOPICAL|2841|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
adapalene|No|No|No|No|75%|00299591202|DIFFERIN 0.1% LOTION|59|ML|3.53438|05/03/2010|12/31/2022|Yes|No||05/03/2010|12/31/2022|Yes|No|05/03/2010|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|04/01/2012|104|No|8.45772|02/07/2023|8.33689|02/07/2023|7.9399|02/07/2023|||ACNE AGENTS: TOPICAL|2842|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
adapalene|No|No|No|No|75%|00299591545|DIFFERIN 0.1% CREAM|45|GM|5.05584|04/29/2002|12/31/2022|Yes|No||04/29/2002|12/31/2022|Yes|No|04/29/2002|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|04/01/2012|104|No|11.52261|01/10/2023|11.358|01/10/2023|10.81714|01/10/2023|||ACNE AGENTS: TOPICAL|2843|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
adapalene|No|No|No|No|75%|00299591825|DIFFERIN 0.3% GEL PUMP|45|GM|5.24647|06/13/2012|12/31/2022|Yes|No||06/13/2012|12/31/2022|Yes|No|06/13/2012|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|04/01/2012|104|No|11.95708|01/10/2023|11.78627|01/10/2023|11.22502|01/10/2023|||ACNE AGENTS: TOPICAL|2844|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
fluocinolone/tretinoin/h-quin|No|No|No|No|75%|00299595030|TRI-LUMA CREAM|30|GM|3.18916|02/03/2004|12/31/2022|Yes|No||02/03/2004|12/31/2022|Yes|No|02/03/2004|12/31/2022|Yes|No||||No|No|||Prescription required|No|||No|7.26832|01/10/2023|7.16449|01/10/2023|6.82332|01/10/2023||||2845|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
brimonidine tartrate|No|No|No|No|75%|00299598035|MIRVASO 0.33% GEL PUMP|30|GM|8.28825|12/21/2016|12/31/2022|Yes|No||12/21/2016|12/31/2022|Yes|No|12/21/2016|12/31/2022|Yes|No||||No|No|||Prescription required|Yes|01/28/2021|221|No|19.83388|02/07/2023|19.55054|02/07/2023|18.61956|02/07/2023|||ROSACEA AGENTS: TOPICAL|2846|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||GALDERMA LABORA|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310008828|DALIRESP 250 MCG TABLET|28|EA|6.17602|09/24/2018||Yes|No||09/24/2018||Yes|No|09/24/2018||Yes|No||||No|No|||Prescription required|Yes|03/22/2018|098|No|13.75234|01/17/2023|13.42228|01/17/2023|13.51167|01/17/2023|||COPD AGENTS|2847|||||No|No||ASTRAZENECA|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310008839|DALIRESP 250 MCG TABLET|20|EA|6.17458|09/24/2018||Yes|No||09/24/2018||Yes|No|09/24/2018||Yes|No||||No|No|||Prescription required|Yes|03/22/2018|098|No|13.75234|01/17/2023|13.42228|01/17/2023|13.51167|01/17/2023|||COPD AGENTS|2848|||||No|No||ASTRAZENECA|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310009530|DALIRESP 500 MCG TABLET|30|EA|6.17609|09/03/2015||Yes|No||09/03/2015||Yes|No|09/03/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|098|No|13.77072|01/17/2023|13.44022|01/17/2023|13.52973|01/17/2023|||COPD AGENTS|2849|||||No|No||ASTRAZENECA|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00310009590|DALIRESP 500 MCG TABLET|90|EA|6.17618|09/03/2015||Yes|No||09/03/2015||Yes|No|09/03/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|098|No|13.77072|01/17/2023|13.44022|01/17/2023|13.52973|01/17/2023|||COPD AGENTS|2850|||||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|6.53366|07/25/2017|6.44032|07/25/2017|6.13364|07/25/2017|||ANTIPSYCHOTICS|2851|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027210|SEROQUEL 200 MG TABLET|100|EA|5.40832|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|12.32595|01/29/2019|12.14986|01/29/2019|11.5713|01/29/2019|||ANTIPSYCHOTICS|2852|||||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|16.1615|02/28/2017|15.93062|02/28/2017|15.17202|02/28/2017|||ANTIPSYCHOTICS|2853|||||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|3.80739|02/28/2017|3.753|02/28/2017|3.57429|02/28/2017|||ANTIPSYCHOTICS|2854|||||No|No||ASTRAZENECA|No|||||No|No|No||
quetiapine fumarate|No|No|No|No|75%|00310027810|SEROQUEL 50 MG TABLET|100|EA|2.7452|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|6.25651|06/01/2016|6.16713|06/01/2016|5.87346|06/01/2016|||ANTIPSYCHOTICS|2855|||||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|18.99338|05/23/2017|18.72204|05/23/2017|17.83052|05/23/2017|||ANTIPSYCHOTICS|2856|||||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|8.04776|05/28/2019|7.93279|05/28/2019|7.55504|05/28/2019|||ANTIPSYCHOTICS|2857|||||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|14.45108|08/24/2021|14.24463|08/24/2021|13.56632|08/24/2021|||ANTIPSYCHOTICS|2858|||||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|15.9054|12/24/2019|15.67818|12/24/2019|14.9316|12/24/2019|||ANTIPSYCHOTICS|2859|||||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|20.85406|09/29/2020|20.55615|09/29/2020|19.57728|09/29/2020|||ANTIPSYCHOTICS|2860|||||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|24.50882|11/23/2021|24.15869|11/23/2021|23.00828|11/23/2021|||ANTIPSYCHOTICS|2861|||||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||551|No|254.43674|04/09/2019|250.80193|04/09/2019|238.85898|04/09/2019|||ONCOLOGY: ORAL - LUNG|2862|||||No|No||ASTRAZENECA|No|||||No|No|No||
acalabrutinib|No|No|No|No|75%|00310051260|CALQUENCE 100 MG CAPSULE|60|EA|106.93017|07/06/2018|01/26/2024|Yes|No||07/06/2018|01/26/2024|Yes|No|07/06/2018|01/26/2024|Yes|No||||No|No|||Prescription required|No||173|No|243.70133|01/10/2023|240.21988|01/10/2023|228.78084|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|2863|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310061028|KOSELUGO 10 MG CAPSULE|28|EA|36.22012|09/22/2021||Yes|No||09/22/2021||Yes|No|09/22/2021||Yes|No||||No|No|||Prescription required|No||239|No|82.54819|10/11/2022|81.36893|10/11/2022|77.49422|10/11/2022|||ONCOLOGY: ORAL - OTHER|2864|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310061060|KOSELUGO 10 MG CAPSULE|60|EA|36.21933|06/12/2020||Yes|No||06/12/2020||Yes|No|06/12/2020||Yes|No||||No|No|||Prescription required|No||239|No|82.54638|10/11/2022|81.36714|10/11/2022|77.49252|10/11/2022|||ONCOLOGY: ORAL - OTHER|2865|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310062528|KOSELUGO 25 MG CAPSULE|28|EA|90.54817|09/22/2021||Yes|No||09/22/2021||Yes|No|09/22/2021||Yes|No||||No|No|||Prescription required|No||239|No|206.36559|10/11/2022|203.41751|10/11/2022|193.73096|10/11/2022|||ONCOLOGY: ORAL - OTHER|2866|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310062560|KOSELUGO 25 MG CAPSULE|60|EA|90.54825|06/15/2020||Yes|No||06/15/2020||Yes|No|06/15/2020||Yes|No||||No|No|||Prescription required|No||239|No|206.36578|10/11/2022|203.4177|10/11/2022|193.73114|10/11/2022|||ONCOLOGY: ORAL - OTHER|2867|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
olaparib|No|No|No|No|75%|00310066812|LYNPARZA 100 MG TABLET|120|EA|56.92813|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription required|No||239|No|129.74318|01/10/2023|127.8897|01/10/2023|121.79972|01/10/2023|||ONCOLOGY: ORAL - OTHER|2868|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
olaparib|No|No|No|No|75%|00310066860|LYNPARZA 100 MG TABLET|60|EA|56.92813|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription required|No||239|No|129.74318|01/10/2023|127.8897|01/10/2023|121.79972|01/10/2023|||ONCOLOGY: ORAL - OTHER|2869|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
olaparib|No|No|No|No|75%|00310067912|LYNPARZA 150 MG TABLET|120|EA|56.92813|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription required|No||239|No|129.74318|01/10/2023|127.8897|01/10/2023|121.79972|01/10/2023|||ONCOLOGY: ORAL - OTHER|2870|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
olaparib|No|No|No|No|75%|00310067960|LYNPARZA 150 MG TABLET|60|EA|56.92813|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription required|No||239|No|129.74318|01/10/2023|127.8897|01/10/2023|121.79972|01/10/2023|||ONCOLOGY: ORAL - OTHER|2871|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
rosuvastatin calcium|No|No|No|No|75%|00310075190|CRESTOR 10 MG TABLET|90|EA|3.96383|05/01/2008|05/09/2023|Yes|No||05/01/2008|05/09/2023|Yes|No|05/01/2008|05/09/2023|Yes|No||05/01/2008|05/09/2023|Yes|No|||Prescription required|Yes|07/26/2012|063|Yes|8.86076|09/27/2022|8.6481|09/27/2022|8.70569|09/27/2022|||LIPOTROPICS: STATINS|2872|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||ASTRAZENECA|No|||||No|No|No||
rosuvastatin calcium|No|No|No|No|75%|00310075290|CRESTOR 20 MG TABLET|90|EA|3.96383|05/01/2008|01/24/2023|Yes|No||05/01/2008|01/24/2023|Yes|No|05/01/2008|01/24/2023|Yes|No||05/01/2008|01/24/2023|Yes|No|||Prescription required|Yes|07/26/2012|063|Yes|8.81017|06/28/2022|8.59872|06/28/2022|8.65599|06/28/2022|||LIPOTROPICS: STATINS|2873|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||ASTRAZENECA|No|||||No|No|No||
rosuvastatin calcium|No|No|No|No|75%|00310075430|CRESTOR 40 MG TABLET|30|EA|3.96402|05/01/2008|01/24/2023|Yes|No||05/01/2008|01/24/2023|Yes|No|05/01/2008|01/24/2023|Yes|No||05/01/2008|01/24/2023|Yes|No|||Prescription required|Yes|07/26/2012|063|Yes|8.81058|06/28/2022|8.59912|06/28/2022|8.65639|06/28/2022|||LIPOTROPICS: STATINS|2874|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||ASTRAZENECA|No|||||No|No|No||
rosuvastatin calcium|No|No|No|No|75%|00310075590|CRESTOR 5 MG TABLET|90|EA|3.96383|05/01/2008|05/09/2023|Yes|No||05/01/2008|05/09/2023|Yes|No|05/01/2008|05/09/2023|Yes|No||05/01/2008|05/09/2023|Yes|No|||Prescription required|Yes|07/26/2012|063|Yes|8.84105|02/28/2023|8.62886|02/28/2023|8.68633|02/28/2023|||LIPOTROPICS: STATINS|2875|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310110530|LOKELMA 5 GRAM POWDER PACKET|30|EA|10.98091|05/16/2019||Yes|No||05/16/2019||Yes|No|05/16/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.45613|01/17/2023|23.86918|01/17/2023|24.02814|01/17/2023|||POTASSIUM BINDERS|2876|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310110539|LOKELMA 5 GRAM POWDER PACKET|11|EA|10.98063|05/23/2019||Yes|No||05/23/2019||Yes|No|05/23/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.45613|01/17/2023|23.86918|01/17/2023|24.02814|01/17/2023|||POTASSIUM BINDERS|2877|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310111030|LOKELMA 10 GRAM POWDER PACKET|30|EA|10.98091|05/16/2019||Yes|No||05/16/2019||Yes|No|05/16/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.44469|01/17/2023|23.85801|01/17/2023|24.0169|01/17/2023|||POTASSIUM BINDERS|2878|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310111039|LOKELMA 10 GRAM POWDER PACKET|11|EA|10.98063|05/23/2019||Yes|No||05/23/2019||Yes|No|05/23/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.44469|01/17/2023|23.85801|01/17/2023|24.0169|01/17/2023|||POTASSIUM BINDERS|2879|||||No|No||ASTRAZENECA|No|||||No|No|No||
osimertinib mesylate|No|No|No|No|75%|00310134930|TAGRISSO 40 MG TABLET|30|EA|231.26346|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription required|No||551|No|527.06556|01/10/2023|519.53605|01/10/2023|494.79624|01/10/2023|||ONCOLOGY: ORAL - LUNG|2880|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
osimertinib mesylate|No|No|No|No|75%|00310135030|TAGRISSO 80 MG TABLET|30|EA|231.26346|12/27/2016||Yes|No||12/27/2016||Yes|No|12/27/2016||Yes|No||||No|No|||Prescription required|No||551|No|527.06556|01/10/2023|519.53605|01/10/2023|494.79624|01/10/2023|||ONCOLOGY: ORAL - LUNG|2881|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
benralizumab|No|No|No|No|75%|00310183030|FASENRA PEN 30 MG/ML|1|ML|2369.9063|02/27/2020||Yes|No||02/27/2020||Yes|No|02/27/2020||Yes|No||||No|No|||Prescription required|No||206|Yes|5401.1818|01/10/2023|5324.02206|01/10/2023|5070.4972|01/10/2023|||IMMUNOMODULATORS: ASTHMA|2882|||||No|No||ASTRAZENECA|No|||||No|No|No||
acalabrutinib maleate|No|No|No|No|75%|00310351260|CALQUENCE 100 MG TABLET|60|EA|106.93017|11/21/2022||Yes|No||11/21/2022||Yes|No|11/21/2022||Yes|No||||No|No|||Prescription required|No|||No|243.70133|01/10/2023|240.21988|01/10/2023|228.78084|01/10/2023||||2883|||||No|No||ASTRAZENECA|No|||||No|No|No||
glycopyrrolate/formoterol fum|No|No|No|No|75%|00310460012|BEVESPI AEROSPHERE INHALER|10.7|GM|16.84555|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|37.61192|01/17/2023|36.70923|01/17/2023|36.95371|01/17/2023|||COPD AGENTS|2884|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide/glycopyr/formoterol|No|No|No|No|75%|00310461612|BREZTRI AEROSPHERE INHALER|10.7|GM|25.17107|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|56.29164|01/17/2023|54.94064|01/17/2023|55.30653|01/17/2023|||GLUCOCORTICOIDS: INHALED|2885|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide/glycopyr/formoterol|No|No|No|No|75%|00310461639|BREZTRI AEROSPHERE INHALER|5.9|GM|25.17248|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|56.43359|01/17/2023|55.07918|01/17/2023|55.446|01/17/2023|||GLUCOCORTICOIDS: INHALED|2886|||||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||111|Yes|15.52082|01/17/2023|15.14832|01/17/2023|15.2492|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2887|||||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||111|Yes|15.52082|01/17/2023|15.14832|01/17/2023|15.2492|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2888|||||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||111|Yes|15.51727|01/17/2023|15.14485|01/17/2023|15.24571|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2889|||||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||111|Yes|15.51727|01/17/2023|15.14485|01/17/2023|15.24571|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2890|||||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||111|Yes|7.73617|01/17/2023|7.5505|01/17/2023|7.60078|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2891|||||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||111|Yes|15.48001|01/17/2023|15.10848|01/17/2023|15.2091|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2892|||||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||111|Yes|15.51041|01/17/2023|15.13816|01/17/2023|15.23897|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2893|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin propanediol|No|No|No|No|75%|00310620530|FARXIGA 5 MG TABLET|30|EA|8.10249|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||535|No|18.08704|01/17/2023|17.65295|01/17/2023|17.77051|01/17/2023|||HYPOGLYCEMICS: SGLT2|2894|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin propanediol|No|No|No|No|75%|00310621030|FARXIGA 10 MG TABLET|30|EA|8.10249|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||535|No|18.08793|01/17/2023|17.65381|01/17/2023|17.77139|01/17/2023|||HYPOGLYCEMICS: SGLT2|2895|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin/metformin HCl|No|No|No|No|75%|00310625030|XIGDUO XR 5 MG-500 MG TABLET|30|EA|8.10249|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|No|18.13981|01/17/2023|17.70445|01/17/2023|17.82236|01/17/2023|||HYPOGLYCEMICS: SGLT2|2896|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin/metformin HCl|No|No|No|No|75%|00310626060|XIGDUO XR 5 MG-1,000 MG TABLET|60|EA|4.05124|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|No|9.06279|01/17/2023|8.84528|01/17/2023|8.90419|01/17/2023|||HYPOGLYCEMICS: SGLT2|2897|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin/metformin HCl|No|No|No|No|75%|00310627030|XIGDUO XR 10 MG-500 MG TABLET|30|EA|8.10249|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|No|18.1387|01/17/2023|17.70337|01/17/2023|17.82127|01/17/2023|||HYPOGLYCEMICS: SGLT2|2898|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapagliflozin/metformin HCl|No|No|No|No|75%|00310628030|XIGDUO XR 10 MG-1,000 MG TAB|30|EA|8.10249|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|No|18.09474|01/17/2023|17.66046|01/17/2023|17.77808|01/17/2023|||HYPOGLYCEMICS: SGLT2|2899|||||No|No||ASTRAZENECA|No|||||No|No|No||
exenatide|No|No|No|No|75%|00310651201|BYETTA 5 MCG DOSE PEN INJ|1.2|ML|295.69308|02/10/2015||Yes|No||02/10/2015||Yes|No|02/10/2015||Yes|No||||No|No|||Prescription required|No||111|Yes|660.49689|01/17/2023|644.64496|01/17/2023|648.93819|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2900|||||No|No||ASTRAZENECA|No|||||No|No|No||
exenatide|No|No|No|No|75%|00310652401|BYETTA 10 MCG DOSE PEN INJ|2.4|ML|147.84653|02/10/2015||Yes|No||02/10/2015||Yes|No|02/10/2015||Yes|No||||No|No|||Prescription required|No||111|Yes|330.54241|01/17/2023|322.60939|01/17/2023|324.75791|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2901|||||No|No||ASTRAZENECA|No|||||No|No|No||
exenatide microspheres|No|No|No|No|75%|00310654004|BYDUREON BCISE 2 MG AUTOINJECT|.85|ML|101.60014|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|226.85848|01/17/2023|221.41387|01/17/2023|222.88845|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2902|||||No|No||ASTRAZENECA|No|||||No|No|No||
pramlintide acetate|No|No|No|No|75%|00310661502|SYMLINPEN 60 PEN INJECTOR|1.5|ML|144.15606|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||111|Yes|328.54172|01/10/2023|323.84827|01/10/2023|308.42692|01/10/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2903|||||No|No||ASTRAZENECA|No|||||No|No|No||
pramlintide acetate|No|No|No|No|75%|00310662702|SYMLINPEN 120 PEN INJECTOR|2.7|ML|95.10405|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||111|Yes|216.74877|01/10/2023|213.65236|01/10/2023|203.47844|01/10/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2904|||||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|17.98716|01/17/2023|17.55546|01/17/2023|17.67238|01/17/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2905|||||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|07/25/2019|033|Yes|22.74332|02/28/2023|22.19748|02/28/2023|22.34531|02/28/2023|||GLUCOCORTICOIDS: INHALED|2906|||||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|07/25/2019|033|Yes|19.35431|02/28/2023|18.8898|02/28/2023|19.0156|02/28/2023|||GLUCOCORTICOIDS: INHALED|2907|||||No|No||ASTRAZENECA/PRA|No|||||No|No|No||
rosuvastatin calcium|No|No|No|No|75%|00310756090|CRESTOR 5 MG TABLET|90|EA|3.96383|10/19/2022||Yes|No||10/19/2022||Yes|No|10/19/2022||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|063|Yes|8.84105|02/28/2023|8.62886|02/28/2023|8.68633|02/28/2023|||LIPOTROPICS: STATINS|2908|||||No|No||ASTRAZENECA|No|||||No|No|No||
rosuvastatin calcium|No|No|No|No|75%|00310757090|CRESTOR 10 MG TABLET|90|EA|3.96383|10/19/2022||Yes|No||10/19/2022||Yes|No|10/19/2022||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|063|Yes|8.86076|10/19/2022|8.6481|10/19/2022|8.70569|10/19/2022|||LIPOTROPICS: STATINS|2909|||||No|No||ASTRAZENECA|No|||||No|No|No||
rosuvastatin calcium|No|No|No|No|75%|00310758090|CRESTOR 20 MG TABLET|90|EA|3.96383|07/21/2022||Yes|No||07/21/2022||Yes|No|07/21/2022||Yes|No||07/21/2022||Yes|No|||Prescription required|Yes|07/29/2021|063|Yes|8.81017|07/21/2022|8.59872|07/21/2022|8.65599|07/21/2022|||LIPOTROPICS: STATINS|2910|||||No|No||ASTRAZENECA|No|||||No|No|No||
rosuvastatin calcium|No|No|No|No|75%|00310759030|CRESTOR 40 MG TABLET|30|EA|3.96402|07/21/2022||Yes|No||07/21/2022||Yes|No|07/21/2022||Yes|No||07/21/2022||Yes|No|||Prescription required|Yes|07/29/2021|063|Yes|8.81058|07/21/2022|8.59912|07/21/2022|8.65639|07/21/2022|||LIPOTROPICS: STATINS|2911|||||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|.00759|05/10/2022|.00748|05/10/2022|.00713|05/10/2022||||2912|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00338000346|STERILE WATER FOR IRRIGATION|2000|ML|.00238|03/11/2004||Yes|No||03/11/2004||Yes|No|03/11/2004||Yes|No||||No|No|||Prescription required|No|||No|.00543|05/10/2022|.00536|05/10/2022|.0051|05/10/2022||||2913|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00338000347|STERILE WATER FOR IRRIGATION|3000|ML|.0023|03/07/2005||Yes|No||03/07/2005||Yes|No|03/07/2005||Yes|No||||No|No|||Prescription required|No|||No|.00526|05/10/2022|.00518|05/10/2022|.00494|05/10/2022||||2914|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00338000404|STERILE WATER FOR IRRIGATION|1000|ML|.00152|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00346|05/10/2022|.00341|05/10/2022|.00325|05/10/2022||||2915|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00338001304|STERILE WATER FOR INJECTION|1000|ML|.0038|03/07/2005||Yes|No||03/07/2005||Yes|No|03/07/2005||Yes|No||||No|No|||Prescription required|No|||No|.00867|05/10/2022|.00854|05/10/2022|.00814|05/10/2022||||2916|||||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|.00396|05/10/2022|.00391|05/10/2022|.00372|05/10/2022||||2917|||||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|.00218|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00496|05/10/2022|.00489|05/10/2022|.00466|05/10/2022||||2918|||||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|05/10/2022|.04909|05/10/2022|.04675|05/10/2022||||2919|||||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|05/10/2022|.02444|05/10/2022|.02328|05/10/2022||||2920|||||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|.02024|08/24/2006||Yes|No||08/24/2006||Yes|No|08/24/2006||Yes|No||||No|No|||Prescription required|No|||No|.04614|05/10/2022|.04548|05/10/2022|.04332|05/10/2022||||2921|||||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|.02306|05/10/2022|.02273|05/10/2022|.02165|05/10/2022||||2922|||||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|.05344|05/10/2022|.05268|05/10/2022|.05017|05/10/2022||||2923|||||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|.02646|05/10/2022|.02609|05/10/2022|.02484|05/10/2022||||2924|||||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|05/10/2022|.00909|05/10/2022|.00866|05/10/2022||||2925|||||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|.00246|10/28/2014||Yes|No||10/28/2014||Yes|No|10/28/2014||Yes|No||||No|No|||Prescription required|No|||No|.00562|05/10/2022|.00554|05/10/2022|.00528|05/10/2022||||2926|||||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|.00172|12/05/2005||Yes|No||12/05/2005||Yes|No|12/05/2005||Yes|No||||No|No|||Prescription required|No|||No|.00392|05/10/2022|.00387|05/10/2022|.00368|05/10/2022||||2927|||||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|.00675|02/29/2008||Yes|No||02/29/2008||Yes|No|02/29/2008||Yes|No||||No|No|||Prescription required|No|||No|.0154|05/10/2022|.01518|05/10/2022|.01446|05/10/2022||||2928|||||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|05/10/2022|.00814|05/10/2022|.00775|05/10/2022||||2929|||||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|.00211|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00482|05/10/2022|.00475|05/10/2022|.00452|05/10/2022||||2930|||||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|.0208|02/29/2008||Yes|No||02/29/2008||Yes|No|02/29/2008||Yes|No||||No|No|||Prescription required|No|||No|.04742|05/10/2022|.04674|05/10/2022|.04451|05/10/2022||||2931|||||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|.01012|02/29/2008||Yes|No||02/29/2008||Yes|No|02/29/2008||Yes|No||||No|No|||Prescription required|No|||No|.02306|05/10/2022|.02273|05/10/2022|.02165|05/10/2022||||2932|||||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|.00232|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00529|05/10/2022|.00521|05/10/2022|.00496|05/10/2022||||2933|||||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|.0022|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00502|05/10/2022|.00495|05/10/2022|.00471|05/10/2022||||2934|||||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|.00504|05/10/2022|.00497|05/10/2022|.00473|05/10/2022||||2935|||||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|.01331|05/10/2022|.01312|05/10/2022|.0125|05/10/2022||||2936|||||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|05/10/2022|.03853|05/10/2022|.03669|05/10/2022||||2937|||||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|.04187|05/10/2022|.04127|05/10/2022|.03931|05/10/2022||||2938|||||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|.0329|12/10/2003||Yes|No||12/10/2003||Yes|No|12/10/2003||Yes|No||||No|No|||Prescription required|No|||No|.07499|05/10/2022|.07392|05/10/2022|.0704|05/10/2022||||2939|||||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|.04079|05/10/2022|.04021|05/10/2022|.03829|05/10/2022||||2940|||||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|05/10/2022|.07861|05/10/2022|.07486|05/10/2022||||2941|||||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|05/10/2022|.08017|05/10/2022|.07636|05/10/2022||||2942|||||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|.04984|08/24/2006||Yes|No||08/24/2006||Yes|No|||No|No||||No|No|||Prescription required|No|||No|.11361|05/10/2022|.11198|05/10/2022|.10665|05/10/2022||||2943|||||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|.02492|09/15/2010||Yes|No||09/15/2010||Yes|No|||No|No||||No|No|||Prescription required|No|||No|.0568|05/10/2022|.05598|05/10/2022|.05332|05/10/2022||||2944|||||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|.00707|05/10/2022|.00697|05/10/2022|.00664|05/10/2022||||2945|||||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|.00421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00961|05/10/2022|.00947|05/10/2022|.00902|05/10/2022||||2946|||||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|.21009|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription required|No|||No|.47882|02/05/2019|.47198|02/05/2019|.44951|02/05/2019||||2947|||||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|.33272|02/05/2019|.32797|02/05/2019|.31235|02/05/2019||||2948|||||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|.10504|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription required|No|||No|.23941|02/05/2019|.23599|02/05/2019|.22475|02/05/2019||||2949|||||No|No||BAXTER HEALTHCA|No|||||No|No|No||
pen G pot/dextrose-water|No|No|No|No|75%|00338102141|PEN G K 1 MILLION UNIT/50 ML|50|ML|.08536|03/31/2005||Yes|No||03/31/2005||Yes|No|03/31/2005||Yes|No||||No|No|||Prescription required|No|||No|.19454|02/05/2019|.19177|02/05/2019|.18263|02/05/2019||||2950|||||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|.08883|03/31/2005||Yes|No||03/31/2005||Yes|No|03/31/2005||Yes|No||||No|No|||Prescription required|No|||No|.20246|02/05/2019|.19957|02/05/2019|.19007|02/05/2019||||2951|||||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|.09223|03/31/2005||Yes|No||03/31/2005||Yes|No|03/31/2005||Yes|No||||No|No|||Prescription required|No|||No|.21021|02/05/2019|.2072|02/05/2019|.19734|02/05/2019||||2952|||||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|01/02/2018|.02213|01/02/2018|.02107|01/02/2018||||2953|||||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|.0386|08/09/2013||Yes|No||08/09/2013||Yes|No|08/09/2013||Yes|No||||No|No|||Prescription required|No|||No|.08799|05/10/2022|.08673|05/10/2022|.0826|05/10/2022||||2954|||||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|.0687|08/09/2013||Yes|No||08/09/2013||Yes|No|08/09/2013||Yes|No||||No|No|||Prescription required|No|||No|.15658|05/10/2022|.15434|05/10/2022|.14699|05/10/2022||||2955|||||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|.05026|08/09/2013||Yes|No||08/09/2013||Yes|No|08/09/2013||Yes|No||||No|No|||Prescription required|No|||No|.11456|05/10/2022|.11292|05/10/2022|.10754|05/10/2022||||2956|||||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|.23199|10/15/2008||Yes|No||10/15/2008||Yes|No|10/15/2008||Yes|No||||No|No|||Prescription required|No|||No|.52873|03/01/2022|.52118|03/01/2022|.49636|03/01/2022||||2957|||||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|06/01/2016|.41132|06/01/2016|.39173|06/01/2016||||2958|||||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|02/05/2019|.1017|02/05/2019|.09685|02/05/2019||||2959|||||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|.03334|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription required|No|||No|.07599|02/05/2019|.07491|02/05/2019|.07134|02/05/2019||||2960|||||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|02/05/2019|.13074|02/05/2019|.12452|02/05/2019||||2961|||||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|.03462|05/15/2011||Yes|No||05/15/2011||Yes|No|05/15/2011||Yes|No||||No|No|||Prescription required|No|||No|.07891|06/01/2016|.07779|06/01/2016|.07408|06/01/2016||||2962|||||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|02/05/2019|.27415|02/05/2019|.26109|02/05/2019||||2963|||||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|.28904|06/19/2008||Yes|No||06/19/2008||Yes|No|06/19/2008||Yes|No||||No|No|||Prescription required|No|||No|.65875|06/01/2016|.64934|06/01/2016|.61842|06/01/2016||||2964|||||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|.04812|11/18/2003||Yes|No||11/18/2003||Yes|No|11/18/2003||Yes|No||||No|No|||Prescription required|No|||No|.10968|05/10/2022|.10811|05/10/2022|.10296|05/10/2022||||2965|||||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|05/10/2022|.32543|05/10/2022|.30993|05/10/2022||||2966|||||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|.33537|05/10/2022|.33058|05/10/2022|.31484|05/10/2022||||2967|||||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|.04474|03/04/2005||Yes|No||03/04/2005||Yes|No|03/04/2005||Yes|No||||No|No|||Prescription required|No|||No|.10197|01/02/2018|.10052|01/02/2018|.09573|01/02/2018||||2968|||||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|.18287|12/13/2016|.18026|12/13/2016|.17168|12/13/2016||||2969|||||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||548|No|451.3243|05/17/2022|444.87681|05/17/2022|423.6922|05/17/2022|||ONCOLOGY: ORAL - RENAL CELL|2970|||||No|No||MYLAN|No|||||No|No|No||
everolimus|No|No|No|No|75%|00378000685|EVEROLIMUS 3 MG TAB FOR SUSP|28|EA|200.01357|05/17/2022||Yes|No||05/17/2022||Yes|No|05/17/2022||Yes|No||||No|No|||Prescription required|No||548|No|455.84489|05/17/2022|449.33282|05/17/2022|427.93602|05/17/2022|||ONCOLOGY: ORAL - RENAL CELL|2971|||||No|No||MYLAN|No|||||No|No|No||
everolimus|No|No|No|No|75%|00378000785|EVEROLIMUS 5 MG TAB FOR SUSP|28|EA|208.17405|05/17/2022||Yes|No||05/17/2022||Yes|No|05/17/2022||Yes|No||||No|No|||Prescription required|No||548|No|474.44319|05/17/2022|467.66543|05/17/2022|445.39565|05/17/2022|||ONCOLOGY: ORAL - RENAL CELL|2972|||||No|No||MYLAN|No|||||No|No|No||
methotrexate sodium|No|No|No|No|75%|00378001401|METHOTREXATE 2.5 MG TABLET|100|EA|1.01243|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023||||2973|||||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||070|No|.01684|02/28/2023|.01643|02/28/2023|.01654|02/28/2023|||BETA-BLOCKERS|2974|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378001805|METOPROLOL TARTRATE 25 MG TAB|500|EA|.0196|06/25/2008||Yes|No||06/25/2008||Yes|No|06/25/2008||Yes|No||06/25/2008||Yes|No|||Prescription required|No||070|No|.01684|02/28/2023|.01643|02/28/2023|.01654|02/28/2023|||BETA-BLOCKERS|2975|||||No|No||MYLAN|No|||||No|No|No||
nadolol|No|No|No|No|75%|00378002801|NADOLOL 20 MG TABLET|100|EA|.66349|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|||Prescription required|Yes|07/17/2014|070|No|.17921|02/28/2023|.1749|02/28/2023|.17607|02/28/2023|||BETA-BLOCKERS|2976|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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||070|No|.02248|02/28/2023|.02194|02/28/2023|.02208|02/28/2023|||BETA-BLOCKERS|2977|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378003210|METOPROLOL TARTRATE 50 MG TAB|1000|EA|.01827|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.02248|02/28/2023|.02194|02/28/2023|.02208|02/28/2023|||BETA-BLOCKERS|2978|||||No|No||MYLAN|No|||||No|No|No||
clorazepate dipotassium|No|No|No|No|90%|00378004001|CLORAZEPATE 7.5 MG TABLET|100|EA|.5992|03/01/2002|01/01/2023|Yes|No||03/01/2002|01/01/2023|Yes|No|03/01/2002|01/01/2023|Yes|No||||No|No|||Prescription required|No||090|Yes|1.51607|02/28/2023|1.47968|02/28/2023|1.48953|02/28/2023|||ANXIOLYTICS|2979|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MYLAN/AUROBINDO|Yes|09/01/2020||||No|No|No||
clorazepate dipotassium|No|No|No|No|90%|00378004005|CLORAZEPATE 7.5 MG TABLET|500|EA|.5992|03/01/2002|01/01/2023|Yes|No||03/01/2002|01/01/2023|Yes|No|03/01/2002|01/01/2023|Yes|No||||No|No|||Prescription required|No||090|Yes|1.51607|02/28/2023|1.47968|02/28/2023|1.48953|02/28/2023|||ANXIOLYTICS|2980|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MYLAN/AUROBINDO|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378004201|PERPHEN-AMITRIP 4 MG-10 MG TAB|100|EA|.55405|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|1.26273|06/01/2016|1.24469|06/01/2016|1.18542|06/01/2016|||ANTIPSYCHOTICS|2981|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378004701|METOPROLOL TARTRATE 100 MG TAB|100|EA|.03117|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.0328|02/28/2023|.03201|02/28/2023|.03222|02/28/2023|||BETA-BLOCKERS|2982|||||No|No||MYLAN|No|||||No|No|No||
metoprolol tartrate|No|No|No|No|75%|00378004710|METOPROLOL TARTRATE 100 MG TAB|1000|EA|.02687|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.0328|02/28/2023|.03201|02/28/2023|.03222|02/28/2023|||BETA-BLOCKERS|2983|||||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|.76091|02/28/2023|.74264|02/28/2023|.74759|02/28/2023|||BETA-BLOCKERS|2984|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|.15286|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.3415|01/24/2023|.3333|01/24/2023|.33552|01/24/2023||||2985|||||No|No||MYLAN|No|||||No|No|No||
timolol maleate|No|No|No|No|75%|00378005501|TIMOLOL MALEATE 5 MG TABLET|100|EA|.47355|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|10/24/2017|1.06385|10/24/2017|1.01319|10/24/2017|||BETA-BLOCKERS|2986|||||No|No||MYLAN|No|||||No|No|No||
clorazepate dipotassium|No|No|No|No|90%|00378007001|CLORAZEPATE 15 MG TABLET|100|EA|.98491|03/01/2002|01/01/2023|Yes|No||03/01/2002|01/01/2023|Yes|No|03/01/2002|01/01/2023|Yes|No||||No|No|||Prescription required|No||090|Yes|2.45328|02/28/2023|2.3944|02/28/2023|2.41034|02/28/2023|||ANXIOLYTICS|2987|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MYLAN/AUROBINDO|Yes|09/01/2020||||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||027|Yes|2.58367|06/01/2016|2.54676|06/01/2016|2.42548|06/01/2016|||ANTIPSYCHOTICS|2988|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378007801|CARBIDOPA-LEVODOPA 10-100 TAB|100|EA|.11244|06/25/2020||Yes|No||06/25/2020||Yes|No|06/25/2020||Yes|No||||No|No|||Prescription required|No||015|No|.13478|02/28/2023|.13154|02/28/2023|.13242|02/28/2023|||ANTIPARKINSON'S AGENTS|2989|||||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||015|No|.11453|02/28/2023|.11178|02/28/2023|.11252|02/28/2023|||ANTIPARKINSON'S AGENTS|2990|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378008801|CARBIDOPA-LEVO ER 25-100 TAB|100|EA|.29708|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.18292|02/28/2023|.17852|02/28/2023|.17971|02/28/2023|||ANTIPARKINSON'S AGENTS|2991|||||No|No||MYLAN|No|||||No|No|No||
carbidopa/levodopa|No|No|No|No|75%|00378009401|CARBIDOPA-LEVO ER 50-200 TAB|100|EA|.60423|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.24333|02/28/2023|.23749|02/28/2023|.23907|02/28/2023|||ANTIPARKINSON'S AGENTS|2992|||||No|No||MYLAN|No|||||No|No|No||
pindolol|No|No|No|No|75%|00378012701|PINDOLOL 10 MG TABLET|100|EA|.61859|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|.80549|01/24/2023|.78615|01/24/2023|.79139|01/24/2023|||BETA-BLOCKERS|2993|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||231|No|.04829|02/28/2023|.04713|02/28/2023|.04744|02/28/2023|||ANTIHYPERURICEMICS|2994|||||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||231|No|.04829|02/28/2023|.04713|02/28/2023|.04744|02/28/2023|||ANTIHYPERURICEMICS|2995|||||No|No||MYLAN|No|||||No|No|No||
tamoxifen citrate|No|No|No|No|75%|00378014491|TAMOXIFEN 10 MG TABLET|60|EA|.16375|03/04/2003||Yes|No||03/04/2003||Yes|No|03/04/2003||Yes|No||||No|No|||Prescription required|No||502|No|.21796|02/28/2023|.21272|02/28/2023|.21414|02/28/2023|||ONCOLOGY: ORAL - BREAST|2996|||||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||231|No|.0826|02/28/2023|.08061|02/28/2023|.08115|02/28/2023|||ANTIHYPERURICEMICS|2997|||||No|No||MYLAN|No|||||No|No|No||
allopurinol|No|No|No|No|75%|00378018105|ALLOPURINOL 300 MG TABLET|500|EA|.24512|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||231|No|.0826|02/28/2023|.08061|02/28/2023|.08115|02/28/2023|||ANTIHYPERURICEMICS|2998|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018201|PROPRANOLOL 10 MG TABLET|100|EA|.12267|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.08198|02/28/2023|.08001|02/28/2023|.08054|02/28/2023|||BETA-BLOCKERS|2999|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018210|PROPRANOLOL 10 MG TABLET|1000|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||070|No|.08198|02/28/2023|.08001|02/28/2023|.08054|02/28/2023|||BETA-BLOCKERS|3000|||||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||070|No|.07628|02/28/2023|.07444|02/28/2023|.07494|02/28/2023|||BETA-BLOCKERS|3001|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018310|PROPRANOLOL 20 MG TABLET|1000|EA|.15335|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.07628|02/28/2023|.07444|02/28/2023|.07494|02/28/2023|||BETA-BLOCKERS|3002|||||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||070|No|.10682|02/28/2023|.10425|02/28/2023|.10495|02/28/2023|||BETA-BLOCKERS|3003|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018410|PROPRANOLOL 40 MG TABLET|1000|EA|.21548|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.10682|02/28/2023|.10425|02/28/2023|.10495|02/28/2023|||BETA-BLOCKERS|3004|||||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||070|No|.1993|02/28/2023|.19451|02/28/2023|.19581|02/28/2023|||BETA-BLOCKERS|3005|||||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||070|No|.1993|02/28/2023|.19451|02/28/2023|.19581|02/28/2023|||BETA-BLOCKERS|3006|||||No|No||MYLAN|No|||||No|No|No||
propranolol HCl|No|No|No|No|75%|00378018701|PROPRANOLOL 60 MG TABLET|100|EA|.38295|05/17/2011||Yes|No||05/17/2011||Yes|No|05/17/2011||Yes|No||||No|No|||Prescription required|No||070|No|.3228|02/28/2023|.31505|02/28/2023|.31715|02/28/2023|||BETA-BLOCKERS|3007|||||No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378020801|FUROSEMIDE 20 MG TABLET|100|EA|.0215|03/01/2002|02/29/2024|Yes|No||03/01/2002|02/29/2024|Yes|No|03/01/2002|02/29/2024|Yes|No||03/01/2002|02/29/2024|Yes|No|||Prescription required|No|||No|.03079|02/28/2023|.03005|02/28/2023|.03025|02/28/2023||||3008|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378020810|FUROSEMIDE 20 MG TABLET|1000|EA|.01936|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.03079|02/28/2023|.03005|02/28/2023|.03025|02/28/2023||||3009|||||No|No||MYLAN|No|||||No|No|No||
amitriptyline/chlordiazepoxide|No|No|No|No|75%|00378021101|CHLORDIAZEPO-AMITRIPTYL 5-12.5|100|EA|.5273|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|1.20177|04/28/2020|1.1846|04/28/2020|1.12819|04/28/2020||||3010|||||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|1.20173|04/28/2020|1.18456|04/28/2020|1.12815|04/28/2020||||3011|||||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|.19682|02/28/2023|.19209|02/28/2023|.19337|02/28/2023||||3012|||||No|No||MYLAN|No|||||No|No|No||
chlorthalidone|No|No|No|No|75%|00378021310|CHLORTHALIDONE 50 MG TABLET|1000|EA|.51192|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.19682|02/28/2023|.19209|02/28/2023|.19337|02/28/2023||||3013|||||No|No||MYLAN|No|||||No|No|No||
haloperidol|No|No|No|No|75%|00378021401|HALOPERIDOL 2 MG TABLET|100|EA|.2174|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.36421|02/28/2023|.35546|02/28/2023|.35783|02/28/2023|||ANTIPSYCHOTICS|3014|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378021410|HALOPERIDOL 2 MG TABLET|1000|EA|.21739|08/23/2009||Yes|No||08/23/2009||Yes|No|08/23/2009||Yes|No||||No|No|||Prescription required|No||027|Yes|.36421|02/28/2023|.35546|02/28/2023|.35783|02/28/2023|||ANTIPSYCHOTICS|3015|||||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|.0315|02/28/2023|.03074|02/28/2023|.03094|02/28/2023||||3016|||||No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378021610|FUROSEMIDE 40 MG TABLET|1000|EA|.01999|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.0315|02/28/2023|.03074|02/28/2023|.03094|02/28/2023||||3017|||||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||070|No|.02447|02/28/2023|.02388|02/28/2023|.02404|02/28/2023|||BETA-BLOCKERS|3018|||||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||070|No|.02447|02/28/2023|.02388|02/28/2023|.02404|02/28/2023|||BETA-BLOCKERS|3019|||||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|12/26/2017|1.31607|12/26/2017|1.2534|12/26/2017|||BETA-BLOCKERS|3020|||||No|No||MYLAN|No|||||No|No|No||
chlorthalidone|No|No|No|No|75%|00378022201|CHLORTHALIDONE 25 MG TABLET|100|EA|.41516|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.11175|02/28/2023|.10906|02/28/2023|.10979|02/28/2023||||3021|||||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|.11175|02/28/2023|.10906|02/28/2023|.10979|02/28/2023||||3022|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378023101|ATENOLOL 50 MG TABLET|100|EA|.03031|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.02774|02/28/2023|.02707|02/28/2023|.02725|02/28/2023|||BETA-BLOCKERS|3023|||||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||070|No|.02774|02/28/2023|.02707|02/28/2023|.02725|02/28/2023|||BETA-BLOCKERS|3024|||||No|No||MYLAN|No|||||No|No|No||
furosemide|No|No|No|No|75%|00378023201|FUROSEMIDE 80 MG TABLET|100|EA|.0325|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.05549|02/28/2023|.05415|02/28/2023|.05451|02/28/2023||||3025|||||No|No||MYLAN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00378024301|SPIRONOLACTONE 50 MG TABLET|100|EA|.1833|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.10543|02/28/2023|.10289|02/28/2023|.10358|02/28/2023||||3026|||||No|No||MYLAN|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00378025501|ALBUTEROL SULFATE 2 MG TAB|100|EA|2.02104|03/01/2002|01/31/2023|Yes|No||03/01/2002|01/31/2023|Yes|No|03/01/2002|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/17/2014|037|No|4.60609|02/14/2023|4.54029|02/14/2023|4.32409|02/14/2023|||BRONCHODILATORS: BETA AGONIST|3027|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|Yes|09/01/2020||||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||027|Yes|.26578|02/28/2023|.2594|02/28/2023|.26112|02/28/2023|||ANTIPSYCHOTICS|3028|||||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||027|Yes|.26578|02/28/2023|.2594|02/28/2023|.26112|02/28/2023|||ANTIPSYCHOTICS|3029|||||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||090|Yes|.02231|02/28/2023|.02177|02/28/2023|.02191|02/28/2023|||ANXIOLYTICS|3030|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378027105|DIAZEPAM 2 MG TABLET|500|EA|.01225|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.02231|02/28/2023|.02177|02/28/2023|.02191|02/28/2023|||ANXIOLYTICS|3031|||||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||502|No|.30066|02/28/2023|.29344|02/28/2023|.29539|02/28/2023|||ONCOLOGY: ORAL - BREAST|3032|||||No|No||MYLAN|No|||||No|No|No||
amitriptyline/chlordiazepoxide|No|No|No|No|75%|00378027701|CHLORDIAZEPOX-AMITRIPTYL 10-25|100|EA|.74398|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|1.69559|05/26/2020|1.67137|05/26/2020|1.59178|05/26/2020||||3033|||||No|No||MYLAN|No|||||No|No|No||
amitriptyline/chlordiazepoxide|No|No|No|No|75%|00378027705|CHLORDIAZEPOX-AMITRIPTYL 10-25|500|EA|.74398|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|1.69559|05/26/2020|1.67137|05/26/2020|1.59178|05/26/2020||||3034|||||No|No||MYLAN|No|||||No|No|No||
cimetidine|No|No|No|No|75%|00378031701|CIMETIDINE 300 MG TABLET|100|EA|.15888|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.31192|02/28/2023|.30443|02/28/2023|.30646|02/28/2023||||3035|||||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||027|Yes|.37792|02/28/2023|.36884|02/28/2023|.3713|02/28/2023|||ANTIPSYCHOTICS|3036|||||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||027|Yes|.37792|02/28/2023|.36884|02/28/2023|.3713|02/28/2023|||ANTIPSYCHOTICS|3037|||||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||027|Yes|1.12837|11/28/2017|1.11225|11/28/2017|1.05928|11/28/2017|||ANTIPSYCHOTICS|3038|||||No|No||MYLAN|No|||||No|No|No||
haloperidol|No|No|No|No|75%|00378033401|HALOPERIDOL 10 MG TABLET|100|EA|.64766|03/26/2010||Yes|No||03/26/2010||Yes|No|03/26/2010||Yes|No||||No|No|||Prescription required|No||027|Yes|.35031|02/28/2023|.3419|02/28/2023|.34417|02/28/2023|||ANTIPSYCHOTICS|3039|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
haloperidol|No|No|No|No|75%|00378033501|HALOPERIDOL 20 MG TABLET|100|EA|1.2448|03/26/2010||Yes|No||03/26/2010||Yes|No|03/26/2010||Yes|No||||No|No|||Prescription required|No||027|Yes|.94441|02/28/2023|.92174|02/28/2023|.92788|02/28/2023|||ANTIPSYCHOTICS|3040|||||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||090|Yes|.03067|02/28/2023|.02993|02/28/2023|.03013|02/28/2023|||ANXIOLYTICS|3041|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378034505|DIAZEPAM 5 MG TABLET|500|EA|.0193|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.03067|02/28/2023|.02993|02/28/2023|.03013|02/28/2023|||ANXIOLYTICS|3042|||||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||027|Yes|.21095|02/28/2023|.20588|02/28/2023|.20725|02/28/2023|||ANTIPSYCHOTICS|3043|||||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||027|Yes|.21095|02/28/2023|.20588|02/28/2023|.20725|02/28/2023|||ANTIPSYCHOTICS|3044|||||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|.40906|02/28/2023|.39924|02/28/2023|.4019|02/28/2023||||3045|||||No|No||MYLAN|No|||||No|No|No||
hydroxychloroquine sulfate|No|No|No|No|75%|00378037301|HYDROXYCHLOROQUINE 200 MG TAB|100|EA|1.79648|03/01/2002|04/30/2023|Yes|No||03/01/2002|04/30/2023|Yes|No|03/01/2002|04/30/2023|Yes|No||||No|No|||Prescription required|No|||No|.20722|02/28/2023|.20224|02/28/2023|.20359|02/28/2023||||3046|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||043|No|5.45999|10/25/2022|5.38199|10/25/2022|5.1257|10/25/2022|||MULTIPLE SCLEROSIS AGENTS|3047|||||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||043|No|.4654|02/28/2023|.45423|02/28/2023|.45725|02/28/2023|||MULTIPLE SCLEROSIS AGENTS|3048|||||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|.63974|02/28/2023|.62438|02/28/2023|.62854|02/28/2023||||3049|||||No|No||MYLAN|No|||||No|No|No||
diphenoxylate HCl/atropine|No|No|No|No|75%|00378041501|DIPHENOXYLATE-ATROP 2.5-0.025|100|EA|.301|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.17133|02/28/2023|.16721|02/28/2023|.16833|02/28/2023||||3050|||||No|No||MYLAN|No|||||No|No|No||
diphenoxylate HCl/atropine|No|No|No|No|75%|00378041510|DIPHENOXYLATE-ATROP 2.5-0.025|1000|EA|.301|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.17133|02/28/2023|.16721|02/28/2023|.16833|02/28/2023||||3051|||||No|No||MYLAN|No|||||No|No|No||
diphenoxylate HCl/atropine|No|No|No|No|75%|00378041577|DIPHENOXYLATE-ATROP 2.5-0.025|90|EA|.301|02/03/2010||Yes|No||02/03/2010||Yes|No|02/03/2010||Yes|No||02/03/2010||Yes|No|||Prescription required|No|||No|.17133|02/28/2023|.16721|02/28/2023|.16833|02/28/2023||||3052|||||No|No||MYLAN|No|||||No|No|No||
metoprolol/hydrochlorothiazide|No|No|No|No|75%|00378042401|METOPROLOL-HCTZ 50-25 MG TAB|100|EA|.48215|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|1.10957|11/29/2022|1.08294|11/29/2022|1.09015|11/29/2022|||BETA-BLOCKERS|3053|||||No|No||MYLAN|No|||||No|No|No||
metoprolol/hydrochlorothiazide|No|No|No|No|75%|00378043401|METOPROLOL-HCTZ 100-25 MG TAB|100|EA|.75361|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|1.2366|02/28/2023|1.20692|02/28/2023|1.21495|02/28/2023|||BETA-BLOCKERS|3054|||||No|No||MYLAN|No|||||No|No|No||
spironolactone|No|No|No|No|75%|00378043701|SPIRONOLACTONE 100 MG TABLET|100|EA|.33002|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.18397|02/28/2023|.17955|02/28/2023|.18075|02/28/2023||||3055|||||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||027|Yes|1.43677|01/23/2018|1.41625|01/23/2018|1.34881|01/23/2018|||ANTIPSYCHOTICS|3056|||||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|06/01/2016|1.79521|06/01/2016|1.70972|06/01/2016|||BETA-BLOCKERS|3057|||||No|No||MYLAN|No|||||No|No|No||
triamterene/hydrochlorothiazid|No|No|No|No|75%|00378046001|MAXZIDE 75 MG-50 MG TABLET|100|EA|1.46165|12/30/2009|04/30/2024|Yes|No||12/30/2009|04/30/2024|Yes|No|12/30/2009|04/30/2024|Yes|No||||No|No|||Prescription required|No|||Yes|3.33121|06/01/2016|3.28362|06/01/2016|3.12726|06/01/2016||||3058|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
triamterene/hydrochlorothiazid|No|No|No|No|75%|00378046401|MAXZIDE 37.5 MG-25 MG TABLET|100|EA|.65175|02/03/2010|03/31/2024|Yes|No||02/03/2010|03/31/2024|Yes|No|02/03/2010|03/31/2024|Yes|No||||No|No|||Prescription required|No|||Yes|1.48538|05/23/2017|1.46416|05/23/2017|1.39444|05/23/2017||||3059|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||056|No|.171|02/28/2023|.16689|02/28/2023|.168|02/28/2023|||ANTICONVULSANTS|3060|||||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||056|No|.171|02/28/2023|.16689|02/28/2023|.168|02/28/2023|||ANTICONVULSANTS|3061|||||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||056|No|.19633|02/28/2023|.19161|02/28/2023|.19289|02/28/2023|||ANTICONVULSANTS|3062|||||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||056|No|.19633|02/28/2023|.19161|02/28/2023|.19289|02/28/2023|||ANTICONVULSANTS|3063|||||No|No||MYLAN|No|||||No|No|No||
diazepam|No|No|No|No|75%|00378047701|DIAZEPAM 10 MG TABLET|100|EA|.04106|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|Yes|.03088|02/28/2023|.03013|02/28/2023|.03033|02/28/2023|||ANXIOLYTICS|3064|||||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||090|Yes|.03088|02/28/2023|.03013|02/28/2023|.03033|02/28/2023|||ANXIOLYTICS|3065|||||No|No||MYLAN|Yes|09/01/2020||||No|No|No||
cimetidine|No|No|No|No|75%|00378054101|CIMETIDINE 800 MG TABLET|100|EA|.49617|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.95036|02/28/2023|.92755|02/28/2023|.93372|02/28/2023||||3066|||||No|No||MYLAN|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00378057201|ALBUTEROL SULFATE 4 MG TAB|100|EA|2.02104|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|Yes|07/17/2014|037|No|4.60609|03/14/2023|4.54029|03/14/2023|4.32409|03/14/2023|||BRONCHODILATORS: BETA AGONIST|3067|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|Yes|09/01/2020||||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||027|Yes|1.56486|12/26/2017|1.5425|12/26/2017|1.46905|12/26/2017|||ANTIPSYCHOTICS|3068|||||No|No||MYLAN|No|||||No|No|No||
amiloride/hydrochlorothiazide|No|No|No|No|75%|00378057701|AMILORIDE HCL-HCTZ 5-50 MG TAB|100|EA|.1744|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||Yes|.39748|03/14/2023|.3918|03/14/2023|.37315|03/14/2023||||3069|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
amiloride/hydrochlorothiazide|No|No|No|No|75%|00378057705|AMILORIDE HCL-HCTZ 5-50 MG TAB|500|EA|.1744|03/01/2002|02/28/2023|Yes|No||03/01/2002|02/28/2023|Yes|No|03/01/2002|02/28/2023|Yes|No||||No|No|||Prescription required|No|||Yes|.39748|03/14/2023|.3918|03/14/2023|.37315|03/14/2023||||3070|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||027|Yes|.46687|08/27/2019|.4602|08/27/2019|.43828|08/27/2019|||ANTIPSYCHOTICS|3071|||||No|No||MYLAN|No|||||No|No|No||
thioridazine HCl|No|No|No|No|75%|00378061401|THIORIDAZINE 25 MG TABLET|100|EA|.28818|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.65679|11/23/2021|.64741|11/23/2021|.61658|11/23/2021|||ANTIPSYCHOTICS|3072|||||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||027|Yes|.82133|10/27/2020|.8096|10/27/2020|.77105|10/27/2020|||ANTIPSYCHOTICS|3073|||||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||027|Yes|.93531|01/29/2019|.92195|01/29/2019|.87804|01/29/2019|||ANTIPSYCHOTICS|3074|||||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||168|Yes|.055|02/28/2023|.05368|02/28/2023|.05403|02/28/2023|||GLUCOCORTICOIDS: ORAL|3075|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064010|PREDNISONE 5 MG TABLET|1000|EA|.0693|06/04/2019||Yes|No||06/04/2019||Yes|No|06/04/2019||Yes|No||06/04/2019||Yes|No|||Prescription required|No||168|Yes|.055|02/28/2023|.05368|02/28/2023|.05403|02/28/2023|||GLUCOCORTICOIDS: ORAL|3076|||||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||168|Yes|.06687|02/28/2023|.06526|02/28/2023|.06569|02/28/2023|||GLUCOCORTICOIDS: ORAL|3077|||||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||168|Yes|.06687|02/28/2023|.06526|02/28/2023|.06569|02/28/2023|||GLUCOCORTICOIDS: ORAL|3078|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064201|PREDNISONE 20 MG TABLET|100|EA|.08019|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||12/30/2020||Yes|No|||Prescription required|No||168|Yes|.1007|02/28/2023|.09828|02/28/2023|.09893|02/28/2023|||GLUCOCORTICOIDS: ORAL|3079|||||No|No||MYLAN|No|||||Yes|No|No||
prednisone|No|No|No|No|75%|00378064205|PREDNISONE 20 MG TABLET|500|EA|.07937|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||12/30/2020||Yes|No|||Prescription required|No||168|Yes|.1007|02/28/2023|.09828|02/28/2023|.09893|02/28/2023|||GLUCOCORTICOIDS: ORAL|3080|||||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||168|Yes|.1007|02/28/2023|.09828|02/28/2023|.09893|02/28/2023|||GLUCOCORTICOIDS: ORAL|3081|||||No|No||MYLAN|No|||||Yes|No|No||
timolol maleate|No|No|No|No|75%|00378071501|TIMOLOL MALEATE 20 MG TABLET|100|EA|1.08084|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|2.46332|06/01/2016|2.42813|06/01/2016|2.31251|06/01/2016|||BETA-BLOCKERS|3082|||||No|No||MYLAN|No|||||No|No|No||
atenolol|No|No|No|No|75%|00378075701|ATENOLOL 100 MG TABLET|100|EA|.05568|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||070|No|.04487|02/28/2023|.04379|02/28/2023|.04408|02/28/2023|||BETA-BLOCKERS|3083|||||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||070|No|.04487|02/28/2023|.04379|02/28/2023|.04408|02/28/2023|||BETA-BLOCKERS|3084|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378082501|CLOZAPINE 25 MG TABLET|100|EA|.36175|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.25802|02/28/2023|.25182|02/28/2023|.2535|02/28/2023|||ANTIPSYCHOTICS|3085|||||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||027|Yes|.64171|02/28/2023|.6263|02/28/2023|.63048|02/28/2023|||ANTIPSYCHOTICS|3086|||||No|No||MYLAN|No|||||No|No|No||
clozapine|No|No|No|No|75%|00378086005|CLOZAPINE 100 MG TABLET|500|EA|.89442|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.64171|02/28/2023|.6263|02/28/2023|.63048|02/28/2023|||ANTIPSYCHOTICS|3087|||||No|No||MYLAN|No|||||No|No|No||
clonidine|No|No|No|No|75%|00378087199|CLONIDINE 0.1 MG/DAY PATCH|4|EA|11.39392|07/20/2010||Yes|No||07/20/2010||Yes|No|07/20/2010||Yes|No||01/01/2012||Yes|No|||Prescription required|No|||No|7.37136|02/28/2023|7.19444|02/28/2023|7.24236|02/28/2023||||3088|||||No|No||MYLAN|No|||||No|No|No||
clonidine|No|No|No|No|75%|00378087299|CLONIDINE 0.2 MG/DAY PATCH|4|EA|19.18337|07/20/2010||Yes|No||07/20/2010||Yes|No|07/20/2010||Yes|No||01/01/2012||Yes|No|||Prescription required|No|||No|11.07938|02/28/2023|10.81347|02/28/2023|10.88549|02/28/2023||||3089|||||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|||No|15.05004|02/28/2023|14.68883|02/28/2023|14.78666|02/28/2023||||3090|||||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||145|Yes|.52266|11/12/2019|.51519|11/12/2019|.49066|11/12/2019|||OPIATE DEPENDENCE TREATMENTS|3091|||||No|No||MYLAN|Yes|09/01/2020||||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||145|Yes|1.63332|11/12/2019|1.60999|11/12/2019|1.53332|11/12/2019|||OPIATE DEPENDENCE TREATMENTS|3092|||||No|No||MYLAN|Yes|09/01/2020||||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||027|Yes|.44991|02/28/2023|.43911|02/28/2023|.44203|02/28/2023|||ANTIPSYCHOTICS|3093|||||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||027|Yes|1.4657|02/28/2023|1.43052|02/28/2023|1.44005|02/28/2023|||ANTIPSYCHOTICS|3094|||||No|No||MYLAN|No|||||No|No|No||
thiothixene|No|No|No|No|75%|00378100101|THIOTHIXENE 1 MG CAPSULE|100|EA|.40867|03/01/2002|09/30/2023|Yes|No||03/01/2002|09/30/2023|Yes|No|03/01/2002|09/30/2023|Yes|No||||No|No|||Prescription required|No||027|Yes|.93139|06/25/2019|.91808|06/25/2019|.87436|06/25/2019|||ANTIPSYCHOTICS|3095|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
azathioprine|No|No|No|No|75%|00378100501|AZATHIOPRINE 50 MG TABLET|100|EA|.20059|01/25/2010|04/30/2023|Yes|No||01/25/2010|04/30/2023|Yes|No|01/25/2010|04/30/2023|Yes|No||02/28/2011|04/30/2023|Yes|No|||Prescription required|No||229|No|.18554|02/28/2023|.18108|02/28/2023|.18229|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|3096|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||MYLAN|No|||||Yes|No|No||
eplerenone|No|No|No|No|75%|00378103077|EPLERENONE 25 MG TABLET|90|EA|.60175|06/06/2018|02/21/2023|Yes|No||06/06/2018|02/21/2023|Yes|No|06/06/2018|02/21/2023|Yes|No||||No|No|||Prescription required|No|||No|1.37145|03/07/2023|1.35185|03/07/2023|1.28748|03/07/2023||||3097|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN/PRASCO LA|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00378103093|EPLERENONE 25 MG TABLET|30|EA|.60171|06/06/2018|02/21/2023|Yes|No||06/06/2018|02/21/2023|Yes|No|06/06/2018|02/21/2023|Yes|No||||No|No|||Prescription required|No|||No|1.37134|03/07/2023|1.35175|03/07/2023|1.28738|03/07/2023||||3098|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN/PRASCO LA|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00378103177|EPLERENONE 50 MG TABLET|90|EA|.60175|06/06/2018|02/21/2023|Yes|No||06/06/2018|02/21/2023|Yes|No|06/06/2018|02/21/2023|Yes|No||||No|No|||Prescription required|No|||No|1.37145|03/07/2023|1.35185|03/07/2023|1.28748|03/07/2023||||3099|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN/PRASCO LA|No|||||No|No|No||
eplerenone|No|No|No|No|75%|00378103193|EPLERENONE 50 MG TABLET|30|EA|.60185|06/06/2018|02/21/2023|Yes|No||06/06/2018|02/21/2023|Yes|No|06/06/2018|02/21/2023|Yes|No||||No|No|||Prescription required|No|||No|1.37166|03/07/2023|1.35207|03/07/2023|1.28768|03/07/2023||||3100|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN/PRASCO LA|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||215|No|.1364|02/28/2023|.13312|02/28/2023|.13401|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|3101|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378104910|DOXEPIN 10 MG CAPSULE|1000|EA|.20139|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.1364|02/28/2023|.13312|02/28/2023|.13401|02/28/2023|||ANTIDEPRESSANTS: TRICYCLIC|3102|||||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|4.06372|06/01/2016|4.00567|06/01/2016|3.81492|06/01/2016|||ANGIOTENSIN MODULATOR COMBINATIONS|3103|||||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|4.06372|06/01/2016|4.00567|06/01/2016|3.81492|06/01/2016|||ANGIOTENSIN MODULATOR COMBINATIONS|3104|||||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|3.04656|01/24/2023|2.97344|01/24/2023|2.99324|01/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3105|||||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|4.06372|06/01/2016|4.00567|06/01/2016|3.81492|06/01/2016|||ANGIOTENSIN MODULATOR COMBINATIONS|3106|||||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||Yes|No||07/21/2020||Yes|No|07/21/2020||Yes|No||07/21/2020||Yes|No|||Prescription required|Yes|07/25/2019|231|No|.42779|02/28/2023|.41752|02/28/2023|.4203|02/28/2023|||ANTIHYPERURICEMICS|3107|||||No|No||MYLAN|No|||||No|No|No||
colchicine|No|No|No|No|75%|00378108693|COLCHICINE 0.6 MG TABLET|30|EA|.86917|07/21/2020||Yes|No||07/21/2020||Yes|No|07/21/2020||Yes|No||07/21/2020||Yes|No|||Prescription required|Yes|07/25/2019|231|No|.42779|02/28/2023|.41752|02/28/2023|.4203|02/28/2023|||ANTIHYPERURICEMICS|3108|||||No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378110101|PRAZOSIN 1 MG CAPSULE|100|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|.1923|02/28/2023|.18768|02/28/2023|.18893|02/28/2023||||3109|||||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|.1923|02/28/2023|.18768|02/28/2023|.18893|02/28/2023||||3110|||||No|No||MYLAN|No|||||No|No|No||
glipizide|Yes|No|No|No|75%|00378110501|GLIPIZIDE 5 MG TABLET|100|EA|.0273|03/01/2002|08/31/2023|Yes|No||03/01/2002|08/31/2023|Yes|No|03/01/2002|08/31/2023|Yes|No||03/01/2002|08/31/2023|Yes|No|07/01/2016|08/31/2023|Prescription required|No|||No|.0352|02/28/2023|.03435|02/28/2023|.03458|02/28/2023||||3111|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%|00378110505|GLIPIZIDE 5 MG TABLET|500|EA|.0258|03/01/2002|08/31/2023|Yes|No||03/01/2002|08/31/2023|Yes|No|03/01/2002|08/31/2023|Yes|No||03/01/2002|08/31/2023|Yes|No|07/01/2016|08/31/2023|Prescription required|No|||No|.0352|02/28/2023|.03435|02/28/2023|.03458|02/28/2023||||3112|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%|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|.04839|02/28/2023|.04722|02/28/2023|.04754|02/28/2023||||3113|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|.04839|02/28/2023|.04722|02/28/2023|.04754|02/28/2023||||3114|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
nadolol|No|No|No|No|75%|00378113201|NADOLOL 80 MG TABLET|100|EA|1.06648|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|||Prescription required|Yes|07/17/2014|070|No|.5339|02/28/2023|.52108|02/28/2023|.52455|02/28/2023|||BETA-BLOCKERS|3115|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||015|No|.15092|02/28/2023|.14729|02/28/2023|.14827|02/28/2023|||ANTIPARKINSON'S AGENTS|3116|||||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||059|Yes|.65658|02/28/2023|.64082|02/28/2023|.64508|02/28/2023|||NSAIDS|3117|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378114001|BUSPIRONE HCL 5 MG TABLET|100|EA|.03418|03/26/2002||Yes|No||03/26/2002||Yes|No|03/26/2002||Yes|No||||No|No|||Prescription required|No||090|No|.02848|02/28/2023|.02779|02/28/2023|.02798|02/28/2023|||ANXIOLYTICS|3118|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378114005|BUSPIRONE HCL 5 MG TABLET|500|EA|.03418|03/26/2002||Yes|No||03/26/2002||Yes|No|03/26/2002||Yes|No||||No|No|||Prescription required|No||090|No|.02848|02/28/2023|.02779|02/28/2023|.02798|02/28/2023|||ANXIOLYTICS|3119|||||No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378114501|BUSPIRONE HCL 7.5 MG TABLET|100|EA|.19543|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||||No|No|||Prescription required|No||090|No|.16854|02/28/2023|.16449|02/28/2023|.16559|02/28/2023|||ANXIOLYTICS|3120|||||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||090|No|.03849|02/28/2023|.03756|02/28/2023|.03781|02/28/2023|||ANXIOLYTICS|3121|||||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||090|No|.03849|02/28/2023|.03756|02/28/2023|.03781|02/28/2023|||ANXIOLYTICS|3122|||||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||090|No|.04869|02/28/2023|.04752|02/28/2023|.04783|02/28/2023|||ANXIOLYTICS|3123|||||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||090|No|.04869|02/28/2023|.04752|02/28/2023|.04783|02/28/2023|||ANXIOLYTICS|3124|||||No|No||MYLAN|No|||||No|No|No||
nadolol|No|No|No|No|75%|00378117101|NADOLOL 40 MG TABLET|100|EA|.77627|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|||Prescription required|Yes|07/17/2014|070|No|.4013|02/28/2023|.39166|02/28/2023|.39427|02/28/2023|||BETA-BLOCKERS|3125|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
nadolol|No|No|No|No|75%|00378117110|NADOLOL 40 MG TABLET|1000|EA|.77627|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|03/01/2002|11/30/2023|Yes|No||03/01/2002|11/30/2023|Yes|No|||Prescription required|Yes|07/17/2014|070|No|.4013|02/28/2023|.39166|02/28/2023|.39427|02/28/2023|||BETA-BLOCKERS|3126|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
buspirone HCl|No|No|No|No|75%|00378117591|BUSPIRONE HCL 30 MG TABLET|60|EA|.62514|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||090|No|.18446|02/28/2023|.18003|02/28/2023|.18123|02/28/2023|||ANXIOLYTICS|3127|||||No|No||MYLAN|No|||||No|No|No||
sorafenib tosylate|No|No|No|No|75%|00378120178|SORAFENIB 200 MG TABLET|120|EA|72.52605|09/14/2022||Yes|No||09/14/2022||Yes|No|09/14/2022||Yes|No||||No|No|||Prescription required|No||548|No|165.29194|09/14/2022|162.93063|09/14/2022|155.17203|09/14/2022|||ONCOLOGY: ORAL - RENAL CELL|3128|||||No|No||MYLAN|No|||||No|No|No||
rasagiline mesylate|No|No|No|No|75%|00378127093|RASAGILINE MESYLATE 0.5 MG TAB|30|EA|5.91207|02/28/2018|08/31/2023|Yes|No||02/28/2018|08/31/2023|Yes|No|02/28/2018|08/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/21/2016|015|No|1.69157|01/24/2023|1.65097|01/24/2023|1.66196|01/24/2023|||ANTIPARKINSON'S AGENTS|3129|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
rasagiline mesylate|No|No|No|No|75%|00378127193|RASAGILINE MESYLATE 1 MG TAB|30|EA|5.91207|02/28/2018|10/31/2023|Yes|No||02/28/2018|10/31/2023|Yes|No|02/28/2018|10/31/2023|Yes|No||||No|No|||Prescription required|Yes|07/21/2016|015|No|1.55085|02/28/2023|1.51362|02/28/2023|1.52371|02/28/2023|||ANTIPARKINSON'S AGENTS|3130|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.13958|02/28/2023|.13623|02/28/2023|.13713|02/28/2023||||3131|||||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|.13958|02/28/2023|.13623|02/28/2023|.13713|02/28/2023||||3132|||||No|No||MYLAN|No|||||No|No|No||
mesalamine|No|No|No|No|75%|00378137578|MESALAMINE ER 0.375 GRAM CAP|120|EA|1.57816|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|.89135|02/28/2023|.86995|02/28/2023|.87575|02/28/2023|||ULCERATIVE COLITIS AGENTS|3133|||||No|No||MYLAN|No|||||No|No|No||
rizatriptan benzoate|No|No|No|No|75%|00378140496|RIZATRIPTAN 10 MG TABLET|12|EA|1.3484|06/29/2018||Yes|No||06/29/2018||Yes|No|06/29/2018||Yes|No||||No|No|||Prescription required|No||021|No|.44968|02/28/2023|.43888|02/28/2023|.44181|02/28/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3134|||||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|.18322|02/28/2023|.17882|02/28/2023|.18001|02/28/2023||||3135|||||No|No||MYLAN|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00378156001|PHENYTOIN SOD EXT 100 MG CAP|100|EA|.22024|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||056|No|.15127|02/28/2023|.14763|02/28/2023|.14862|02/28/2023|||ANTICONVULSANTS|3136|||||No|No||MYLAN|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00378156010|PHENYTOIN SOD EXT 100 MG CAP|1000|EA|.22027|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||056|No|.15127|02/28/2023|.14763|02/28/2023|.14862|02/28/2023|||ANTICONVULSANTS|3137|||||No|No||MYLAN|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00378161001|DICYCLOMINE 10 MG CAPSULE|100|EA|.03504|03/01/2002|06/30/2023|Yes|No||03/01/2002|06/30/2023|Yes|No|03/01/2002|06/30/2023|Yes|No||||No|No|||Prescription required|No|||No|.12073|02/28/2023|.11783|02/28/2023|.11861|02/28/2023||||3138|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00378161005|DICYCLOMINE 10 MG CAPSULE|500|EA|.03397|03/01/2002|06/30/2023|Yes|No||03/01/2002|06/30/2023|Yes|No|03/01/2002|06/30/2023|Yes|No||||No|No|||Prescription required|No|||No|.12073|02/28/2023|.11783|02/28/2023|.11861|02/28/2023||||3139|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|9.19338|01/24/2017|9.06204|01/24/2017|8.63052|01/24/2017|||ANTIFUNGALS: ORAL|3140|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|1.88728|02/28/2023|1.84198|02/28/2023|1.85425|02/28/2023|||ANTIFUNGALS: ORAL|3141|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No|No||MYLAN|No|||||No|No|No||
sildenafil citrate|No|No|No|No|75%|00378165777|SILDENAFIL 20 MG TABLET|90|EA|.043|01/25/2013||Yes|No||01/25/2013||Yes|No|01/25/2013||Yes|No|Refer to program requirements|||No|No|||Prescription required|Yes|07/28/2022|171|Yes|.06803|02/28/2023|.06639|02/28/2023|.06683|02/28/2023|||PAH AGENTS: ORAL AND INHALED|3142|||||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||017|Yes|.5071|02/28/2023|.49492|02/28/2023|.49822|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3143|||||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||017|Yes|.55185|02/28/2023|.5386|02/28/2023|.54219|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3144|||||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||017|Yes|.53578|02/28/2023|.52292|02/28/2023|.5264|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3145|||||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||017|Yes|.70019|02/28/2023|.68338|02/28/2023|.68793|02/28/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3146|||||No|No||MYLAN|No|||||No|No|No||
ursodiol|No|No|No|No|75%|00378173001|URSODIOL 300 MG CAPSULE|100|EA|1.0965|02/16/2014|01/31/2023|Yes|No||02/16/2014|01/31/2023|Yes|No|02/16/2014|01/31/2023|Yes|No||||No|No|||Prescription required|Yes|03/09/2018|198|No|2.499|02/14/2023|2.4633|02/14/2023|2.346|02/14/2023|||BILE SALTS|3147|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180010|LEVOTHYROXINE 25 MCG TABLET|1000|EA|.15656|12/20/2007||Yes|No||12/20/2007||Yes|No|12/20/2007||Yes|No||||No|No|||Prescription required|No|||No|.09955|02/28/2023|.09716|02/28/2023|.0978|02/28/2023||||3148|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180310|LEVOTHYROXINE 50 MCG TABLET|1000|EA|.17773|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.11072|02/28/2023|.10806|02/28/2023|.10878|02/28/2023||||3149|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180377|LEVOTHYROXINE 50 MCG TABLET|90|EA|.17773|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.11072|02/28/2023|.10806|02/28/2023|.10878|02/28/2023||||3150|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180510|LEVOTHYROXINE 75 MCG TABLET|1000|EA|.1964|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.11773|02/28/2023|.1149|02/28/2023|.11566|02/28/2023||||3151|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180577|LEVOTHYROXINE 75 MCG TABLET|90|EA|.19641|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.11773|02/28/2023|.1149|02/28/2023|.11566|02/28/2023||||3152|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180710|LEVOTHYROXINE 88 MCG TABLET|1000|EA|.19979|10/18/2007||Yes|No||10/18/2007||Yes|No|10/18/2007||Yes|No||||No|No|||Prescription required|No|||No|.12436|02/28/2023|.12137|02/28/2023|.12218|02/28/2023||||3153|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180777|LEVOTHYROXINE 88 MCG TABLET|90|EA|.19975|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.12436|02/28/2023|.12137|02/28/2023|.12218|02/28/2023||||3154|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180910|LEVOTHYROXINE 100 MCG TABLET|1000|EA|.20133|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.12387|02/28/2023|.12089|02/28/2023|.1217|02/28/2023||||3155|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180977|LEVOTHYROXINE 100 MCG TABLET|90|EA|.20133|06/07/2018||Yes|No||06/07/2018||Yes|No|06/07/2018||Yes|No||||No|No|||Prescription required|No|||No|.12387|02/28/2023|.12089|02/28/2023|.1217|02/28/2023||||3156|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181110|LEVOTHYROXINE 112 MCG TABLET|1000|EA|.23281|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||||No|No|||Prescription required|No|||No|.11655|02/28/2023|.11375|02/28/2023|.11451|02/28/2023||||3157|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181177|LEVOTHYROXINE 112 MCG TABLET|90|EA|.23281|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.11655|02/28/2023|.11375|02/28/2023|.11451|02/28/2023||||3158|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181310|LEVOTHYROXINE 125 MCG TABLET|1000|EA|.23603|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.14317|02/28/2023|.13973|02/28/2023|.14066|02/28/2023||||3159|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181377|LEVOTHYROXINE 125 MCG TABLET|90|EA|.23601|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription required|No|||No|.14317|02/28/2023|.13973|02/28/2023|.14066|02/28/2023||||3160|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181510|LEVOTHYROXINE 150 MCG TABLET|1000|EA|.24291|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.14373|02/28/2023|.14028|02/28/2023|.14121|02/28/2023||||3161|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181577|LEVOTHYROXINE 150 MCG TABLET|90|EA|.24295|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.14373|02/28/2023|.14028|02/28/2023|.14121|02/28/2023||||3162|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181710|LEVOTHYROXINE 175 MCG TABLET|1000|EA|.28874|08/23/2007||Yes|No||08/23/2007||Yes|No|08/23/2007||Yes|No||||No|No|||Prescription required|No|||No|.19274|02/28/2023|.18811|02/28/2023|.18936|02/28/2023||||3163|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181777|LEVOTHYROXINE 175 MCG TABLET|90|EA|.28876|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription required|No|||No|.19274|02/28/2023|.18811|02/28/2023|.18936|02/28/2023||||3164|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181910|LEVOTHYROXINE 200 MCG TABLET|1000|EA|.28932|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.20015|02/28/2023|.19534|02/28/2023|.19664|02/28/2023||||3165|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181977|LEVOTHYROXINE 200 MCG TABLET|90|EA|.28929|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription required|No|||No|.20015|02/28/2023|.19534|02/28/2023|.19664|02/28/2023||||3166|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182177|LEVOTHYROXINE 300 MCG TABLET|90|EA|.37347|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription required|No|||No|.15486|02/28/2023|.15114|02/28/2023|.15214|02/28/2023||||3167|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182310|LEVOTHYROXINE 137 MCG TABLET|1000|EA|.23932|02/26/2008||Yes|No||02/26/2008||Yes|No|02/26/2008||Yes|No||||No|No|||Prescription required|No|||No|.1595|02/28/2023|.15567|02/28/2023|.1567|02/28/2023||||3168|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182377|LEVOTHYROXINE 137 MCG TABLET|90|EA|.23931|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.1595|02/28/2023|.15567|02/28/2023|.1567|02/28/2023||||3169|||||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|.17979|02/28/2023|.17547|02/28/2023|.17664|02/28/2023||||3170|||||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|.25736|02/28/2023|.25118|02/28/2023|.25285|02/28/2023||||3171|||||No|No||MYLAN|No|||||No|No|No||
midodrine HCl|No|No|No|No|75%|00378190301|MIDODRINE HCL 10 MG TABLET|100|EA|1.40373|03/09/2004||Yes|No||03/09/2004||Yes|No|03/09/2004||Yes|No||03/09/2004||Yes|No|||Prescription required|No|||No|.42755|02/28/2023|.41728|02/28/2023|.42006|02/28/2023||||3172|||||No|No||MYLAN|No|||||No|No|No||
emtricitabine/tenofovir (TDF)|No|No|No|No|75%|00378193093|EMTRICITABINE-TENOFV 200-300MG|30|EA|1.45539|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|.58212|02/28/2023|.56814|02/28/2023|.57193|02/28/2023|||HIV / AIDS|3173|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193601|LENALIDOMIDE 5 MG CAPSULE|100|EA|309.55966|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription required|No|||No|705.50807|02/16/2023|695.42938|02/16/2023|662.3137|02/16/2023||||3174|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193628|LENALIDOMIDE 5 MG CAPSULE|28|EA|309.55945|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription required|No|||No|705.50759|02/16/2023|695.42891|02/16/2023|662.31325|02/16/2023||||3175|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193701|LENALIDOMIDE 10 MG CAPSULE|100|EA|309.55966|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription required|No|||No|705.50807|02/16/2023|695.42938|02/16/2023|662.3137|02/16/2023||||3176|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378193728|LENALIDOMIDE 10 MG CAPSULE|28|EA|309.55945|02/16/2023||Yes|No||02/16/2023||Yes|No|02/16/2023||Yes|No||||No|No|||Prescription required|No|||No|705.50759|02/16/2023|695.42891|02/16/2023|662.31325|02/16/2023||||3177|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378194001|LENALIDOMIDE 25 MG CAPSULE|100|EA|309.55966|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription required|No|||No|705.50807|02/15/2023|695.42938|02/15/2023|662.3137|02/15/2023||||3178|||||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|||No|705.50852|02/16/2023|695.42983|02/16/2023|662.31412|02/16/2023||||3179|||||No|No||MYLAN|No|||||No|No|No||
lenalidomide|No|No|No|No|75%|00378194101|LENALIDOMIDE 15 MG CAPSULE|100|EA|309.55966|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription required|No|||No|705.50807|02/15/2023|695.42938|02/15/2023|662.3137|02/15/2023||||3180|||||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|||No|705.50852|02/16/2023|695.42983|02/16/2023|662.31412|02/16/2023||||3181|||||No|No||MYLAN|No|||||No|No|No||
thiothixene|No|No|No|No|75%|00378200201|THIOTHIXENE 2 MG CAPSULE|100|EA|.5402|03/01/2002|10/31/2023|Yes|No||03/01/2002|10/31/2023|Yes|No|03/01/2002|10/31/2023|Yes|No||||No|No|||Prescription required|No||027|Yes|1.23117|08/06/2019|1.21358|08/06/2019|1.15579|08/06/2019|||ANTIPSYCHOTICS|3182|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||229|No|.19225|02/28/2023|.18763|02/28/2023|.18888|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|3183|||||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||229|No|.2543|02/28/2023|.24819|02/28/2023|.24984|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|3184|||||No|No||MYLAN|No|||||Yes|No|No||
tacrolimus|No|No|No|No|75%|00378204701|TACROLIMUS 5 MG CAPSULE (IR)|100|EA|2.0142|04/04/2011||Yes|No||04/04/2011||Yes|No|04/04/2011||Yes|No||01/01/2011||Yes|No|||Prescription required|No||229|No|1.30708|02/28/2023|1.27571|02/28/2023|1.2842|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|3185|||||No|No||MYLAN|No|||||Yes|No|No||
nisoldipine|No|No|No|No|75%|00378209601|NISOLDIPINE ER 8.5 MG TABLET|100|EA|1.9807|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|4.51417|04/26/2022|4.44968|04/26/2022|4.23779|04/26/2022|||CALCIUM CHANNEL BLOCKERS|3186|||||No|No||MYLAN|No|||||No|No|No||
nisoldipine|No|No|No|No|75%|00378209701|NISOLDIPINE ER 17 MG TABLET|100|EA|2.48247|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|5.08612|05/24/2022|4.96405|05/24/2022|4.99711|05/24/2022|||CALCIUM CHANNEL BLOCKERS|3187|||||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|No|6.17017|06/01/2016|6.08203|06/01/2016|5.79241|06/01/2016|||CALCIUM CHANNEL BLOCKERS|3188|||||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|No|6.17017|08/23/2022|6.08203|08/23/2022|5.79241|08/23/2022|||CALCIUM CHANNEL BLOCKERS|3189|||||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|.26754|02/28/2023|.26111|02/28/2023|.26285|02/28/2023||||3190|||||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|.26754|02/28/2023|.26111|02/28/2023|.26285|02/28/2023||||3191|||||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|.04899|02/28/2023|.04781|02/28/2023|.04813|02/28/2023||||3192|||||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|.04899|02/28/2023|.04781|02/28/2023|.04813|02/28/2023||||3193|||||No|No||MYLAN|No|||||No|No|No||
meclofenamate sodium|No|No|No|No|75%|00378215001|MECLOFENAMATE 50 MG CAPSULE|100|EA|1.43387|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|3.2679|06/01/2016|3.22122|06/01/2016|3.06783|06/01/2016|||NSAIDS|3194|||||No|No||MYLAN|No|||||No|No|No||
efavirenz|No|No|No|No|75%|00378223393|EFAVIRENZ 600 MG TABLET|30|EA|17.88639|03/23/2018|01/31/2023|Yes|No||03/23/2018|01/31/2023|Yes|No|03/23/2018|01/31/2023|Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|29.21444|08/23/2022|28.79709|08/23/2022|27.4258|08/23/2022|||HIV / AIDS|3195|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00378224577|IMATINIB MESYLATE 100 MG TAB|90|EA|1.46601|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription required|No||173|No|.6088|02/28/2023|.59418|02/28/2023|.59814|02/28/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3196|||||No|No||MYLAN|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00378224693|IMATINIB MESYLATE 400 MG TAB|30|EA|5.28255|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription required|No||173|No|1.96323|02/28/2023|1.91611|02/28/2023|1.92887|02/28/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3197|||||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||229|No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|3198|||||No|No||MYLAN|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00378225005|MYCOPHENOLATE 250 MG CAPSULE|500|EA|.18922|08/01/2009||Yes|No||08/01/2009||Yes|No|08/01/2009||Yes|No||08/01/2009||Yes|No|||Prescription required|No||229|No|.19362|02/28/2023|.18897|02/28/2023|.19023|02/28/2023|||IMMUNOSUPPRESSIVES: ORAL|3199|||||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|.27102|02/28/2023|.26451|02/28/2023|.26627|02/28/2023||||3200|||||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|.27102|02/28/2023|.26451|02/28/2023|.26627|02/28/2023||||3201|||||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||056|No|2.39707|11/14/2022|2.33954|11/14/2022|2.35512|11/14/2022|||ANTICONVULSANTS|3202|||||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||056|No|4.63707|02/28/2023|4.52578|02/28/2023|4.55592|02/28/2023|||ANTI