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|448.17735|06/27/2023|437.42109|06/27/2023|440.33424|06/27/2023|||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|448.17115|06/27/2023|437.41504|06/27/2023|440.32815|06/27/2023|||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|654.60694|10/24/2023|638.89637|10/24/2023|643.15131|10/24/2023|||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|492.71386|06/27/2023|480.88872|06/27/2023|484.09136|06/27/2023|||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|492.4663|06/27/2023|480.6471|06/27/2023|483.84813|06/27/2023|||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|492.15177|06/27/2023|480.34012|06/27/2023|483.53911|06/27/2023|||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|492.1158|06/27/2023|480.30502|06/27/2023|483.50377|06/27/2023|||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|492.22502|06/27/2023|480.41161|06/27/2023|483.61108|06/27/2023|||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|492.52932|05/30/2023|480.70861|05/30/2023|483.91005|05/30/2023|||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|447.9192|06/27/2023|437.16913|06/27/2023|440.08061|06/27/2023|||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|656.65972|10/24/2023|640.89988|10/24/2023|645.16817|10/24/2023|||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|Yes|09/29/2023|
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|Yes|09/29/2023|
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|545.8125|10/24/2023|532.713|10/24/2023|536.26078|10/24/2023|||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|448.07804|06/27/2023|437.32416|06/27/2023|440.23667|06/27/2023|||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|13.6894|10/24/2023|13.36085|10/24/2023|13.44983|10/24/2023|||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|8.07483|04/25/2023|7.88103|04/25/2023|7.93352|04/25/2023|||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|13.71287|07/25/2023|13.38376|07/25/2023|13.47289|07/25/2023|||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|8.95082|10/24/2023|8.736|10/24/2023|8.79418|10/24/2023|||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|Yes|09/29/2023|
olanzapine|No|No|No|No|75%|00002411230|ZYPREXA 2.5 MG TABLET|30|EA|5.7405|10/20/2005||Yes|No||10/20/2005||Yes|No|10/20/2005||Yes|No||||No|No|||Prescription required|Yes|05/10/2022|027|Yes|13.083|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%|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|46|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
lasmiditan succinate|No|No|No|No|75%|00002431208|REYVOW 50 MG TABLET|8|EA|39.8223|11/03/2020||Yes|No||11/03/2020||Yes|No|11/03/2020||Yes|No||||No|No|||Prescription required|Yes|07/30/2020|537|No|88.73747|01/17/2023|86.60777|01/17/2023|87.18456|01/17/2023|||ANTIMIGRAINE AGENTS: OTHER|47|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002441530|ZYPREXA 15 MG TABLET|30|EA|15.30585|10/18/2005||Yes|No||10/18/2005||Yes|No|10/18/2005||Yes|No||||No|No|||Prescription required|Yes|05/10/2022|027|Yes|34.15717|01/17/2023|33.33739|01/17/2023|33.55941|01/17/2023|||ANTIPSYCHOTICS|48|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002442030|ZYPREXA 20 MG TABLET|30|EA|20.4078|10/19/2005||Yes|No||10/19/2005||Yes|No|10/19/2005||Yes|No||||No|No|||Prescription required|Yes|05/10/2022|027|Yes|45.5144|01/17/2023|44.42205|01/17/2023|44.71789|01/17/2023|||ANTIPSYCHOTICS|49|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445385|ZYPREXA ZYDIS 5 MG TABLET|30|EA|7.1939|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/28/2016|027|Yes|16.3954|01/10/2023|16.16118|01/10/2023|15.3916|01/10/2023|||ANTIPSYCHOTICS|50|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445485|ZYPREXA ZYDIS 10 MG TABLET|30|EA|10.6253|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/28/2016|027|Yes|24.2158|01/10/2023|23.86986|01/10/2023|22.7332|01/10/2023|||ANTIPSYCHOTICS|51|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445585|ZYPREXA ZYDIS 15 MG TABLET|30|EA|15.72725|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/28/2016|027|Yes|35.8435|01/10/2023|35.33145|01/10/2023|33.649|01/10/2023|||ANTIPSYCHOTICS|52|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00002445685|ZYPREXA ZYDIS 20 MG TABLET|30|EA|20.8292|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/28/2016|027|Yes|47.4712|01/10/2023|46.79304|01/10/2023|44.5648|01/10/2023|||ANTIPSYCHOTICS|53|||||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|54|||||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|55|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
lasmiditan succinate|No|No|No|No|75%|00002449108|REYVOW 100 MG TABLET|8|EA|39.8223|11/03/2020||Yes|No||11/03/2020||Yes|No|11/03/2020||Yes|No||||No|No|||Prescription required|Yes|07/30/2020|537|No|88.61854|10/24/2023|86.49169|10/24/2023|87.06771|10/24/2023|||ANTIMIGRAINE AGENTS: OTHER|56|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
baricitinib|No|No|No|No|75%|00002473230|OLUMIANT 1 MG TABLET|30|EA|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|57|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|03/31/2022|
abemaciclib|No|No|No|No|75%|00002481554|VERZENIO 100 MG TABLET|14|EA|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|58|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
abemaciclib|No|No|No|No|75%|00002533754|VERZENIO 150 MG TABLET|14|EA|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|
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|60|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
glucagon|No|No|No|No|75%|00002614502|BAQSIMI 3 MG SPRAY|1|EA||02/06/2020||Yes|No||02/06/2020||Yes|No|02/06/2020||Yes|No||||No|No|||Prescription required|No||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%|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|62|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
glucagon|No|No|No|No|75%|00002614527|BAQSIMI 3 MG SPRAY TWO PACK|2|EA|120.744|02/06/2020||Yes|No||02/06/2020||Yes|No|02/06/2020||Yes|No||||No|No|||Prescription required|No||583|No|269.81107|05/23/2023|263.3356|05/23/2023|265.08937|05/23/2023|||GLUCAGON AGENTS|63|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
abemaciclib|No|No|No|No|75%|00002621654|VERZENIO 200 MG TABLET|14|EA|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|64|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|07/30/2021|
pirtobrutinib|No|No|No|No|75%|00002690230|JAYPIRCA 50 MG TABLET|30|EA|100.33333|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription required|No|||No|228.66666|08/02/2023|225.39999|08/02/2023|214.66666|08/02/2023||||65|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
pirtobrutinib|No|No|No|No|75%|00002702660|JAYPIRCA 100 MG TABLET|60|EA|150.5|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription required|No|||No|343|08/02/2023|338.1|08/08/2023|322|08/02/2023||||66|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00002751001|HUMALOG 100 UNIT/ML VIAL|10|ML|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|26.3487|03/28/2023|25.71633|03/28/2023|25.88759|03/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|67|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00002751017|HUMALOG 100 UNIT/ML VIAL|3|ML|11.8121|11/14/2012||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|68|||||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|69|||||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|27.9006|05/23/2023|27.50202|05/23/2023|26.1924|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|70|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002751601|HUMALOG 100 UNIT/ML CARTRIDGE|3|ML||05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription required|No||029|No|||||||32.91933|05/01/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|71|||||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|32.59055|05/23/2023|31.80837|05/23/2023|32.02021|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|72|||||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|73|||||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|74|||||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|75|||||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|76|||||No|Yes|11.23|ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002771201|HUMALOG 200 UNIT/ML KWIKPEN|3|ML|30.4096|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription required|Yes|01/22/2015|029|No|69.3056|05/01/2023|68.31552|05/09/2023|65.0624|05/01/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|77|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|Yes|No|No|No|75%|00002771227|HUMALOG 200 UNIT/ML KWIKPEN|3|ML|30.4096|08/18/2015||Yes|No||08/18/2015||Yes|No|08/18/2015||Yes|No||||No|No|04/08/2020||Prescription required|Yes|09/18/2020|029|No|67.85583|02/28/2023|66.22729|02/28/2023|66.66835|02/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|78|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002771401|HUMALOG JR 100 UNIT/ML KWIKPEN|3|ML||05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription required|No||029|Yes|||||||32.592|05/01/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|79|||||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|80|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00002771501|BASAGLAR 100 UNIT/ML KWIKPEN|3|ML|9.35536|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|029|No|21.32152|04/27/2023|21.01693|04/27/2023|20.01612|04/27/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|81|||||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|82|||||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|83|||||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|84|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002772801|LYUMJEV 100 UNIT/ML VIAL|10|ML|11.8121|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|029|No|26.42469|08/01/2023|25.79049|08/01/2023|25.96225|08/01/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|85|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002773701|INSULIN LISPRO 100 UNIT/ML VL|10|ML|1.075|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|No||029|No|2.39991|10/24/2023|2.34231|10/24/2023|2.35791|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|86|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002775201|INSULIN LISPRO JR 100 UNIT/ML|3|ML||08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|No||029|Yes|||||||10.04667|08/01/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|87|||||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|10.20939|10/24/2023|9.96436|10/24/2023|10.03072|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|88|||||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|01/02/2024|Yes|No||03/01/2002|01/02/2024|Yes|No|03/01/2002|01/02/2024|Yes|No||||No|No|||Prescription required|No||583|No|269.6925|04/25/2023|263.21988|04/25/2023|264.97288|04/25/2023|||GLUCAGON AGENTS|89|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|90|||||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|91|||||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|92|||||No|No||ELI LILLY & CO.|No|||||No|No|Yes|10/23/2018|
insulin lispro-aabc|No|No|No|No|75%|00002820701|LYUMJEV 100 UNIT/ML KWIKPEN|3|ML||06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|029|No|||||||34.606|06/28/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|93|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002820705|LYUMJEV 100 UNIT/ML KWIKPEN|3|ML|15.2048|06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|029|No|33.908|06/28/2023|33.0942|06/28/2023|33.31461|06/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|94|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002821301|HUMALOG TEMPO PEN 100 UNIT/ML|3|ML||04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|029|No|||||||34.6528|04/27/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|95|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002821305|HUMALOG TEMPO PEN 100 UNIT/ML|3|ML|15.2048|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|029|No|33.92045|06/27/2023|33.10635|06/27/2023|33.32684|06/27/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|96|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00002821401|BASAGLAR TEMPO PEN 100 UNIT/ML|3|ML||05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|029|No|||||||20.90137|05/01/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|97|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine,hum.rec.anlog|No|No|No|No|75%|00002821405|BASAGLAR TEMPO PEN 100 UNIT/ML|3|ML|9.35565|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|029|No|20.90137|04/27/2023|20.39973|04/27/2023|20.53559|04/27/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|98|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin regular, human|Yes|No|No|No|75%|00002821501|HUMULIN R 100 UNIT/ML VIAL|10|ML|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|99|||||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|100|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002822201|INSULIN LISPRO 100 UNIT/ML PEN|3|ML||08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|No||029|No|||||||9.974|08/01/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|101|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002822259|INSULIN LISPRO 100 UNIT/ML PEN|3|ML|4.56144|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|No||029|No|10.18584|10/24/2023|9.94137|10/24/2023|10.00758|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|102|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002822801|LYUMJEV 200 UNIT/ML KWIKPEN|3|ML||06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|029|No|||||||69.25667|06/28/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|103|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002822827|LYUMJEV 200 UNIT/ML KWIKPEN|3|ML|30.4096|06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|029|No|67.62667|06/28/2023|66.00362|06/28/2023|66.4432|06/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|104|||||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|10.17785|10/24/2023|9.93358|10/24/2023|9.99973|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|105|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002823501|LYUMJEV TEMPO PEN 100 UNIT/ML|3|ML||06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|029|No|||||||35.36|06/28/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|106|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro-aabc|No|No|No|No|75%|00002823505|LYUMJEV TEMPO PEN 100 UNIT/ML|3|ML|15.2048|06/28/2023||Yes|No||06/28/2023||Yes|No|06/28/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|029|No|34.6528|06/28/2023|34.15776|07/04/2023|32.5312|06/28/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|107|||||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|108|||||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|109|||||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|110|||||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|111|||||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|12/11/2023|Yes|No||10/08/2012|12/11/2023|Yes|No|10/08/2012|12/11/2023|Yes|No||||No|No|07/01/2016|12/11/2023|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|112|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002879701|HUMALOG MIX 75-25 KWIKPEN|3|ML|15.2048|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription required|No||029|No|34.6528|12/19/2017|34.15776|12/19/2017|32.5312|12/19/2017|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|113|||||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|114|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro protamin/lispro|No|No|No|No|75%|00002879801|HUMALOG MIX 50-50 KWIKPEN|3|ML|15.2048|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription required|No||029|No|34.6528|05/01/2023|34.15776|05/09/2023|32.5312|05/01/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|115|||||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|116|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin lispro|No|No|No|No|75%|00002879901|HUMALOG 100 UNIT/ML KWIKPEN|3|ML|15.2048|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Prescription required|No||029|No|34.6528|05/01/2023|34.15776|05/09/2023|32.5312|05/01/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|117|||||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|33.92045|06/27/2023|33.10635|06/27/2023|33.32684|06/27/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|118|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH hum/reg insulin hm|No|No|No|No|75%|00002880301|HUMULIN 70/30 KWIKPEN|3|ML|13.5106|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Over the counter|No||029|No|30.7916|05/01/2023|30.35172|05/01/2023|28.9064|05/01/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|119|||||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|120|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin NPH human isophane|No|No|No|No|75%|00002880501|HUMULIN N 100 UNIT/ML KWIKPEN|3|ML|13.5106|05/01/2023||Yes|No||05/01/2023||Yes|No|05/01/2023||Yes|No||||No|No|||Over the counter|Yes|01/28/2021|029|No|30.7916|05/01/2023|30.35172|05/01/2023|28.9064|05/01/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|121|||||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|122|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin regular, human|No|No|No|No|75%|00002882401|HUMULIN R 500 UNIT/ML KWIKPEN|3|ML||04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription required|No||029|No|||||||92.72833|04/27/2023|HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|123|||||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|91.60672|07/25/2023|89.40815|07/25/2023|90.0036|07/25/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|124|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine-aglr|No|No|No|No|75%|00002898001|REZVOGLAR 100 UNIT/ML KWIKPEN|3|ML||09/11/2023||Yes|No||09/11/2023||Yes|No|09/11/2023||Yes|No||||No|No|||Prescription required|No|||No|||||||6.01|09/11/2023||125|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
insulin glargine-aglr|No|No|No|No|75%|00002898005|REZVOGLAR 100 UNIT/ML KWIKPEN|3|ML|2.63733|09/11/2023||Yes|No||09/11/2023||Yes|No|09/11/2023||Yes|No||||No|No|||Prescription required|No|||No|6.01066|09/11/2023|5.92479|09/11/2023|5.64266|09/11/2023||||126|||||No|No||ELI LILLY & CO.|No|||||No|No|No||
triamcinolone acetonide|No|No|No|No|75%|00003029305|KENALOG-40 40 MG/ML VIAL|1|ML|4.0248|10/18/2006||Yes|No||10/18/2006||Yes|No|10/18/2006||Yes|No||||No|No|||Prescription required|No|||No|9.1728|03/28/2023|9.04176|03/28/2023|8.6112|03/28/2023||||127|||||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|6.95408|10/24/2023|6.85473|10/24/2023|6.52832|10/24/2023||||128|||||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|2.3208|09/26/2023|2.2651|09/26/2023|2.28018|09/26/2023||||129|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052411|SPRYCEL 70 MG TABLET|60|EA|136.89329|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription required|No||173|No|311.98937|07/11/2023|307.53237|07/11/2023|292.88798|07/11/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|130|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052711|SPRYCEL 20 MG TABLET|60|EA|68.44675|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription required|No||173|No|155.99493|07/11/2023|153.76643|07/11/2023|146.44422|07/11/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|131|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003052811|SPRYCEL 50 MG TABLET|60|EA|136.89329|07/18/2006||Yes|No||07/18/2006||Yes|No|07/18/2006||Yes|No||||No|No|||Prescription required|No||173|No|311.98937|07/11/2023|307.53237|07/11/2023|292.88798|07/11/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|132|||||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|133|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|246.72712|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription required|No||173|No|554.98593|07/18/2023|541.66626|07/18/2023|545.27367|07/18/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|134|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003085522|SPRYCEL 80 MG TABLET|30|EA|246.72712|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription required|No||173|No|562.30832|07/11/2023|554.27534|07/11/2023|527.88128|07/11/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|135|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
dasatinib|No|No|No|No|75%|00003085722|SPRYCEL 140 MG TABLET|30|EA|246.72712|08/25/2014||Yes|No||08/25/2014||Yes|No|08/25/2014||Yes|No||||No|No|||Prescription required|No||173|No|562.30832|07/11/2023|554.27534|07/11/2023|527.88128|07/11/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|136|||||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|8.96117|10/24/2023|8.7461|10/24/2023|8.80434|10/24/2023|||ANTICOAGULANTS|137|||||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|8.96117|10/24/2023|8.7461|10/24/2023|8.80434|10/24/2023|||ANTICOAGULANTS|138|||||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|8.96563|10/24/2023|8.75045|10/24/2023|8.80873|10/24/2023|||ANTICOAGULANTS|139|||||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|8.96563|10/24/2023|8.75045|10/24/2023|8.80873|10/24/2023|||ANTICOAGULANTS|140|||||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|8.96563|10/24/2023|8.75045|10/24/2023|8.80873|10/24/2023|||ANTICOAGULANTS|141|||||No|No||BMS PRIMARYCARE|Yes|09/01/2020||||No|No|No||
deucravacitinib|No|No|No|No|75%|00003089511|SOTYKTU 6 MG TABLET|30|EA|88.35611|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|071|Yes|201.36974|08/01/2023|198.49303|08/01/2023|189.04098|08/01/2023|||CYTOKINE AND CAM ANTAGONISTS|142|||||No|No||BMS PRIMARYCARE|No|||||No|No|No||
entecavir|No|No|No|No|75%|00003161112|BARACLUDE 0.5 MG TABLET|30|EA|19.67221|07/12/2005||Yes|No||07/12/2005||Yes|No|07/12/2005||Yes|No||||No|No|||Prescription required|No|||No|44.83434|01/23/2018|44.19385|01/23/2018|42.08938|01/23/2018||||143|||||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||||144|||||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||||145|||||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|146|||||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|147|||||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|148|||||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|149|||||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|150|||||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|151|||||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|152|||||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|153|||||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|8.95402|10/24/2023|8.73912|10/24/2023|8.79732|10/24/2023|||ANTICOAGULANTS|154|||||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|155|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS/H2 PHARMA L|No|||||No|No|No||
hydroxyurea|No|No|No|No|75%|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|156|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|.79363|07/25/2023|.78229|07/25/2023|.74504|07/25/2023|||SICKLE CELL ANEMIA TREATMENTS|157|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|No||136|No|86.63428|01/29/2019|85.39665|01/29/2019|81.33014|01/29/2019|||ANTIVIRALS: GENERAL|158|||||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|159|||||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|2.78481|03/28/2023|2.71797|03/28/2023|2.73607|03/28/2023|||ANTICONVULSANTS|160|||||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|2.45027|03/28/2023|2.39146|03/28/2023|2.40739|03/28/2023|||ANTICONVULSANTS|161|||||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|08/01/2024|Yes|No||06/02/2016|08/01/2024|Yes|No|06/02/2016|08/01/2024|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|162|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||ROCHE LABS.|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00004025901|CELLCEPT 250 MG CAPSULE|100|EA|3.86823|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|163|||||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|164|||||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|165|||||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|166|||||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|8.36153|07/25/2023|8.16085|07/25/2023|8.2152|07/25/2023|||IMMUNOSUPPRESSIVES: ORAL|167|||||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|168|||||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|169|||||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|170|||||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|171|||||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|172|||||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|173|||||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|174|||||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|175|||||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|176|||||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|13.55331|10/24/2023|13.22803|10/24/2023|13.31612|10/24/2023|||SEDATIVE HYPNOTICS|177|||||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||||178|||||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|13.49926|10/24/2023|13.17527|10/24/2023|13.26302|10/24/2023|||SEDATIVE HYPNOTICS|179|||||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|8.75066|10/24/2023|8.54064|10/24/2023|8.59752|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|180|||||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|8.75066|10/24/2023|8.54064|10/24/2023|8.59752|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|181|||||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|8.75066|10/24/2023|8.54064|10/24/2023|8.59752|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|182|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|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|8.74812|10/24/2023|8.53816|10/24/2023|8.59502|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|183|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|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|8.74812|10/24/2023|8.53816|10/24/2023|8.59502|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|184|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|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|8.74812|10/24/2023|8.53816|10/24/2023|8.59502|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|185|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|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|17.50952|10/24/2023|17.08929|10/24/2023|17.2031|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|186|||||No|No||MERCK SHARP & D|No|||||No|No|No||
sitagliptin phos/metformin HCl|No|No|No|No|75%|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|17.50952|10/24/2023|17.08929|10/24/2023|17.2031|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|187|||||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|17.50952|10/24/2023|17.08929|10/24/2023|17.2031|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|188|||||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|17.50179|10/24/2023|17.08174|10/24/2023|17.1955|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|189|||||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|17.50179|10/24/2023|17.08174|10/24/2023|17.1955|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|190|||||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|17.50619|10/24/2023|17.08604|10/24/2023|17.19983|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|191|||||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|17.50619|10/24/2023|17.08604|10/24/2023|17.19983|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|192|||||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|193|||||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|17.49484|10/24/2023|17.07496|10/24/2023|17.18868|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|194|||||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|17.49484|10/24/2023|17.07496|10/24/2023|17.18868|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|195|||||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|17.49484|10/24/2023|17.07496|10/24/2023|17.18868|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|196|||||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|17.49484|10/24/2023|17.07496|10/24/2023|17.18868|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|197|||||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|13.53667|10/24/2023|13.21178|10/24/2023|13.29977|10/24/2023|||SEDATIVE HYPNOTICS|198|||||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|13.4878|10/24/2023|13.16409|10/24/2023|13.25176|10/24/2023|||SEDATIVE HYPNOTICS|199|||||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|200|||||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|201|||||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|202|||||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|203|||||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|8.76396|10/24/2023|8.55362|10/24/2023|8.61059|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|204|||||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|8.76396|10/24/2023|8.55362|10/24/2023|8.61059|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|205|||||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|8.76396|10/24/2023|8.55362|10/24/2023|8.61059|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|206|||||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|8.7532|10/24/2023|8.54312|10/24/2023|8.60001|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|207|||||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|8.7532|10/24/2023|8.54312|10/24/2023|8.60001|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|208|||||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|8.7532|10/24/2023|8.54312|10/24/2023|8.60001|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|209|||||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|210|||||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|211|||||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|4.9588|11/21/2023|4.88796|11/21/2023|4.6552|11/21/2023|||ANGIOTENSIN MODULATORS|212|||||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|213|||||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|214|||||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|215|||||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||||216|||||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||||217|||||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||||218|||||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||||219|||||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|220|||||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||||221|||||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|222|||||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||||223|||||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||||224|||||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|225|||||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|82.69072|07/25/2023|80.70614|07/25/2023|81.24363|07/25/2023|||HIV / AIDS|226|||||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|20.31486|06/27/2023|19.8273|06/27/2023|19.95934|06/27/2023||||227|||||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|20.31486|06/27/2023|19.8273|06/27/2023|19.95934|06/27/2023||||228|||||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|20.31486|06/27/2023|19.8273|06/27/2023|19.95934|06/27/2023||||229|||||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|20.58948|09/26/2023|20.09533|09/26/2023|20.22916|09/26/2023||||230|||||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|20.58948|09/26/2023|20.09533|09/26/2023|20.22916|09/26/2023||||231|||||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|20.58948|09/26/2023|20.09533|09/26/2023|20.22916|09/26/2023||||232|||||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|20.55247|10/24/2023|20.05921|10/24/2023|20.1928|10/24/2023||||233|||||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|20.55247|10/24/2023|20.05921|10/24/2023|20.1928|10/24/2023||||234|||||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|20.55247|10/24/2023|20.05921|10/24/2023|20.1928|10/24/2023||||235|||||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||236|||||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|237|||||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|Yes|10.9337|10/24/2023|10.67129|10/24/2023|10.74236|10/24/2023|||HYPOGLYCEMICS: SGLT2|238|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536306|STEGLATRO 5 MG TABLET|90|EA|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|Yes|10.9337|10/24/2023|10.67129|10/24/2023|10.74236|10/24/2023|||HYPOGLYCEMICS: SGLT2|239|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536403|STEGLATRO 15 MG TABLET|30|EA|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|Yes|10.91632|10/24/2023|10.65432|10/24/2023|10.72528|10/24/2023|||HYPOGLYCEMICS: SGLT2|240|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin pidolate|No|No|No|No|75%|00006536406|STEGLATRO 15 MG TABLET|90|EA|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|Yes|10.91632|10/24/2023|10.65432|10/24/2023|10.72528|10/24/2023|||HYPOGLYCEMICS: SGLT2|241|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536703|STEGLUJAN 5-100 MG TABLET|30|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|111|Yes|17.9634|01/24/2023|17.70678|01/24/2023|16.8636|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|242|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536706|STEGLUJAN 5-100 MG TABLET|90|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|111|Yes|17.9634|01/24/2023|17.70678|01/24/2023|16.8636|01/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|243|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536803|STEGLUJAN 15-100 MG TABLET|30|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|111|Yes|17.66554|07/25/2023|17.24156|07/25/2023|17.35639|07/25/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|244|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/sitagliptin phos|No|No|No|No|75%|00006536806|STEGLUJAN 15-100 MG TABLET|90|EA|7.8819|09/07/2018||Yes|No||09/07/2018||Yes|No|09/07/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|111|Yes|17.66554|07/25/2023|17.24156|07/25/2023|17.35639|07/25/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|245|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006536903|SEGLUROMET 2.5-500 MG TABLET|60|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.5664|01/17/2023|5.48688|01/17/2023|5.2256|01/17/2023|||HYPOGLYCEMICS: SGLT2|246|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006536906|SEGLUROMET 2.5-500 MG TABLET|180|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.5664|01/17/2023|5.48688|01/17/2023|5.2256|01/17/2023|||HYPOGLYCEMICS: SGLT2|247|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537003|SEGLUROMET 7.5-500 MG TABLET|60|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.50987|10/24/2023|5.37763|10/24/2023|5.41344|10/24/2023|||HYPOGLYCEMICS: SGLT2|248|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537006|SEGLUROMET 7.5-500 MG TABLET|180|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.50987|10/24/2023|5.37763|10/24/2023|5.41344|10/24/2023|||HYPOGLYCEMICS: SGLT2|249|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537303|SEGLUROMET 2.5-1,000 MG TABLET|60|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.46971|01/24/2023|5.33843|01/24/2023|5.37399|01/24/2023|||HYPOGLYCEMICS: SGLT2|250|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537306|SEGLUROMET 2.5-1,000 MG TABLET|180|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.46971|01/24/2023|5.33843|01/24/2023|5.37399|01/24/2023|||HYPOGLYCEMICS: SGLT2|251|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537403|SEGLUROMET 7.5-1,000 MG TABLET|60|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.4677|10/24/2023|5.33647|10/24/2023|5.37201|10/24/2023|||HYPOGLYCEMICS: SGLT2|252|||||No|No||MERCK SHARP & D|No|||||No|No|No||
ertugliflozin/metformin|No|No|No|No|75%|00006537406|SEGLUROMET 7.5-1,000 MG TABLET|180|EA|2.4424|07/19/2018||Yes|No||07/19/2018||Yes|No|07/19/2018||Yes|No||||No|No|||Prescription required|Yes|01/31/2019|535|Yes|5.4677|10/24/2023|5.33647|10/24/2023|5.37201|10/24/2023|||HYPOGLYCEMICS: SGLT2|253|||||No|No||MERCK SHARP & D|No|||||No|No|No||
montelukast sodium|No|No|No|No|75%|00006927531|SINGULAIR 5 MG TABLET CHEW|30|EA|3.2723|07/13/2012||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|254|||||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|255|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|2.9455|03/01/2002|07/01/2024|Yes|No||03/01/2002|07/01/2024|Yes|No|03/01/2002|07/01/2024|Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.713|04/04/2023|6.6171|04/04/2023|6.302|04/04/2023|||BETA-BLOCKERS|256|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GSK/WOODWARD PH|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00007414020|COREG 6.25 MG TABLET|100|EA|2.9455|09/28/2007|07/01/2024|Yes|No||09/28/2007|07/01/2024|Yes|No|09/28/2007|07/01/2024|Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.713|04/04/2023|6.6171|04/04/2023|6.302|04/04/2023|||BETA-BLOCKERS|257|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GSK/WOODWARD PH|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00007414120|COREG 12.5 MG TABLET|100|EA|2.9455|09/28/2007|07/01/2024|Yes|No||09/28/2007|07/01/2024|Yes|No|09/28/2007|07/01/2024|Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.713|04/04/2023|6.6171|04/04/2023|6.302|04/04/2023|||BETA-BLOCKERS|258|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||GSK/WOODWARD PH|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00007414220|COREG 25 MG TABLET|100|EA|2.9455|09/28/2007|07/01/2024|Yes|No||09/28/2007|07/01/2024|Yes|No|09/28/2007|07/01/2024|Yes|No||||No|No|||Prescription required|Yes|01/23/2008|070|No|6.713|04/04/2023|6.6171|04/04/2023|6.302|04/04/2023|||BETA-BLOCKERS|259|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|260|||||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|261|||||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|19.05895|10/24/2023|18.60153|10/24/2023|18.72541|10/24/2023|||ANTIDEPRESSANTS: OTHER|262|||||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|19.05895|10/24/2023|18.60153|10/24/2023|18.72541|10/24/2023|||ANTIDEPRESSANTS: OTHER|263|||||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|15.56111|10/24/2023|15.18764|10/24/2023|15.28879|10/24/2023|||ANTIDEPRESSANTS: OTHER|264|||||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|15.56111|10/24/2023|15.18764|10/24/2023|15.28879|10/24/2023|||ANTIDEPRESSANTS: OTHER|265|||||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|266|||||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|267|||||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|268|||||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||||269|||||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|270|||||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|271|||||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|272|||||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|273|||||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|274|||||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|6.11478|10/24/2023|5.96802|10/24/2023|6.00777|10/24/2023||||275|||||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|13.98673|06/27/2023|13.65104|06/27/2023|13.74196|06/27/2023|||ANTIDEPRESSANTS: OTHER|276|||||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|13.97819|03/28/2023|13.64271|03/28/2023|13.73357|03/28/2023|||ANTIDEPRESSANTS: OTHER|277|||||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|13.97819|03/28/2023|13.64271|03/28/2023|13.73357|03/28/2023|||ANTIDEPRESSANTS: OTHER|278|||||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|13.97819|03/28/2023|13.64271|03/28/2023|13.73357|03/28/2023|||ANTIDEPRESSANTS: OTHER|279|||||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|13.92184|03/28/2023|13.58771|03/28/2023|13.6782|03/28/2023|||ANTIDEPRESSANTS: OTHER|280|||||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|13.92184|03/28/2023|13.58771|03/28/2023|13.6782|03/28/2023|||ANTIDEPRESSANTS: OTHER|281|||||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|13.92184|03/28/2023|13.58771|03/28/2023|13.6782|03/28/2023|||ANTIDEPRESSANTS: OTHER|282|||||No|No||WYETH/PFIZER|No|||||No|No|No||
tigecycline|No|No|No|No|75%|00008499020|TYGACIL 50 MG VIAL|1|EA|43|06/20/2017||Yes|No||06/20/2017||Yes|No|06/20/2017||Yes|No||||No|No|||Prescription required|No|||No|98|10/03/2023|96.6|10/03/2023|92|10/03/2023||||283|||||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|8.3549|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|18.5256|07/11/2023|18.08098|07/11/2023|18.2014|07/11/2023||||284|||||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|8.35748|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|19.04728|07/04/2023|18.77517|07/04/2023|17.88112|07/04/2023||||285|||||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|286|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
hydrocortisone sodium succ/PF|No|No|No|No|75%|00009001305|SOLU-CORTEF 250 MG ACT-O-VIAL|1|EA|15.4585|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|35.231|07/04/2023|34.7277|07/04/2023|33.074|07/04/2023||||287|||||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|15.45867|09/13/2011||Yes|No||09/13/2011||Yes|No|09/13/2011||Yes|No||||No|No|||Prescription required|No|||No|35.23139|07/04/2023|34.72808|07/04/2023|33.07436|07/04/2023||||288|||||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|289|||||No|No||PHARMACIA-UPJHN|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|290|||||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|291|||||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|292|||||No|No||PHARMACIA-UPJHN|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|293|||||No|No||PHARMACIA-UPJHN|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||||294|||||No|No||PHARMACIA-UPJHN|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|295|||||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|296|||||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|297|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone|No|No|No|No|75%|00009005604|MEDROL 4 MG DOSEPAK|21|EA|.13084|07/06/2006||Yes|No||07/06/2006||Yes|No|07/06/2006||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|168|Yes|.29819|03/28/2023|.29393|03/28/2023|.27993|03/28/2023|||GLUCOCORTICOIDS: ORAL|298|||||No|No||PHARMACIA-UPJHN|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|299|||||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|300|||||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||||301|||||No|No||PHARMACIA-UPJHN|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|302|||||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|303|||||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|304|||||No|No||PHARMACIA-UPJHN|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|305|||||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|306|||||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|307|||||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|308|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
colestipol HCl|No|No|No|No|75%|00009026001|COLESTID GRANULES PACKET|30|EA|3.04884|03/01/2002|07/10/2024|Yes|No||03/01/2002|07/10/2024|Yes|No|03/01/2002|07/10/2024|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|309|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARMACIA-UPJHN|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|310|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
estradiol cypionate|No|No|No|No|75%|00009027101|DEPO-ESTRADIOL 5 MG/ML VIAL|5|ML|14.5039|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|32.35453|07/11/2023|31.57802|07/11/2023|31.78832|07/11/2023||||311|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009027401|DEPO-MEDROL 100 MG/5 ML VIAL|5|ML|3.05816|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|6.96976|07/05/2022|6.87019|07/05/2022|6.54304|07/05/2022||||312|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009028002|DEPO-MEDROL 200 MG/5 ML VIAL|5|ML|4.23894|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|9.66084|07/05/2022|9.52282|07/05/2022|9.06936|07/05/2022||||313|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009028003|DEPO-MEDROL 400 MG/10 ML VIAL|10|ML|4.24367|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|9.67162|07/05/2022|9.53345|07/05/2022|9.07948|07/05/2022||||314|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009030602|DEPO-MEDROL 400 MG/5 ML VIAL|5|ML|8.48734|11/27/2002||Yes|No||11/27/2002||Yes|No|||No|No||||No|No|||Prescription required|No|||No|19.34324|07/05/2022|19.0669|07/05/2022|18.15896|07/05/2022||||315|||||No|No||PHARMACIA-UPJHN|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|316|||||No|No||PHARMACIA-UPJHN|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||||317|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00009034702|DEPO-TESTOSTERONE 1,000MG/10ML|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|4.91843|04/25/2023|4.80038|04/25/2023|4.83235|04/25/2023||||318|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
glyburide,micronized|No|No|No|No|75%|00009035201|GLYNASE 3 MG PRESTAB|100|EA|1.37256|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|3.12816|01/03/2023|3.08347|01/03/2023|2.93664|01/03/2023||||319|||||No|No||PHARMACIA-UPJHN|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|320|||||No|No||PHARMACIA-UPJHN|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|321|||||No|No||PHARMACIA-UPJHN|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|322|||||No|No||PHARMACIA-UPJHN|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|12.59171|10/24/2023|12.2895|10/24/2023|12.37135|10/24/2023||||323|||||No|No||PHARMACIA-UPJHN|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|6.30964|06/27/2023|6.1582|06/27/2023|6.19922|06/27/2023||||324|||||No|No||PHARMACIA-UPJHN|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|325|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
lincomycin HCl|No|No|No|No|75%|00009055502|LINCOCIN 3,000 MG/10 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|326|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone sod succ|No|No|No|No|75%|00009069801|SOLU-MEDROL 1 GRAM VIAL|1|EA|18.9114|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|43.1004|01/05/2021|42.48468|01/05/2021|40.4616|01/05/2021||||327|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009072809|CLEOCIN PHOS 9 G/60 ML VIAL|60|ML|.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|328|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone sod succ|No|No|No|No|75%|00009075801|SOLU-MEDROL 500 MG VIAL|1|EA|10.4404|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|23.7944|01/05/2021|23.45448|01/05/2021|22.3376|01/05/2021||||329|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin palmitate HCl|No|No|No|No|75%|00009076004|CLEOCIN PEDIATRIC 75 MG/5 ML|100|ML|.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|330|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009077526|CLEOCIN PHOS 600 MG/4 ML VIAL|4|ML|.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|331|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
hydrocortisone sod succinate|No|No|No|No|75%|00009082501|SOLU-CORTEF 100 MG VIAL|1|EA|6.1834|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|13.78425|07/11/2023|13.45342|07/11/2023|13.54302|07/11/2023||||332|||||No|No||PHARMACIA-UPJHN|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|333|||||No|No||PHARMACIA-UPJHN|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|334|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009307301|DEPO-MEDROL 40 MG/ML VIAL|1|ML|4.8848|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|11.1328|07/05/2022|10.97376|07/05/2022|10.4512|07/05/2022||||335|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
methylprednisolone acetate|No|No|No|No|75%|00009307322|DEPO-MEDROL 40 MG/ML VIAL|1|ML|4.8848|10/26/2009||Yes|No||10/26/2009||Yes|No|10/26/2009||Yes|No||||No|No|||Prescription required|No|||No|11.1328|07/05/2022|10.97376|07/05/2022|10.4512|07/05/2022||||336|||||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||||337|||||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|1.91296|03/28/2023|1.88563|03/28/2023|1.79584|03/28/2023|||ACNE AGENTS: TOPICAL|338|||||No|No||PHARMACIA-UPJHN|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|339|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
glyburide,micronized|No|No|No|No|75%|00009344901|GLYNASE 6 MG PRESTAB|100|EA|2.16423|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|4.93243|01/03/2023|4.86197|01/03/2023|4.63045|01/03/2023||||340|||||No|No||PHARMACIA-UPJHN|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|341|||||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|342|||||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|343|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513604|ZYVOX 100 MG/5 ML SUSPENSION|150|ML|1.95478|11/09/2023||Yes|No||11/09/2023||Yes|No|11/09/2023||Yes|No||||No|No|||Prescription required|No||146|No|4.45508|11/09/2023|4.39143|11/09/2023|4.18232|11/09/2023|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|344|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513802|ZYVOX 600 MG TABLET|20|EA|116.53516|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription required|Yes|12/23/2016|146|No|265.59176|01/04/2022|261.79759|01/04/2022|249.33104|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|345|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid|No|No|No|No|75%|00009513803|ZYVOX 600 MG TABLET|30|EA|2.70197|06/01/2016||Yes|No||06/01/2016||Yes|No|06/01/2016||Yes|No||||No|No|||Prescription required|Yes|12/23/2016|146|No|6.15798|01/04/2022|6.07001|01/04/2022|5.78096|01/04/2022|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|346|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
linezolid in dextrose 5%|No|No|No|No|75%|00009514004|ZYVOX 600 MG/300 ML-D5W|300|ML|.0473|06/28/2017||Yes|No||06/28/2017||Yes|No|06/28/2017||Yes|No||||No|No|||Prescription required|Yes|12/23/2016|146|No|.1078|10/03/2023|.10626|10/03/2023|.1012|10/03/2023|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|347|||||No|No||PHARMACIA-UPJHN|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|348|||||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|349|||||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|350|||||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|351|||||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|352|||||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|353|||||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|2.88073|10/24/2023|2.81159|10/24/2023|2.83031|10/24/2023|||SMOKING CESSATION|354|||||No|No||PHARMACIA-UPJHN|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|12.66|10/24/2023|12.35616|10/24/2023|12.43845|10/24/2023|||SMOKING CESSATION|355|||||No|No||PHARMACIA-UPJHN|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||||356|||||No|No||PHARMACIA-UPJHN|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||||357|||||No|No||PHARMACIA-UPJHN|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||||358|||||No|No||PHARMACIA-UPJHN|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||||359|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|06/17/2019|
medroxyprogesterone acetate|Yes|Yes|No|No|75%|00009737611|DEPO-PROVERA 150 MG/ML SYRINGE|1|ML|23.6285|02/25/2013||Yes|No||||No|No|01/01/2013||Yes|No|Refer to program requirements|||No|No|02/25/2013||Prescription required|No|||No|53.851|02/02/2021|53.0817|02/02/2021|50.554|02/02/2021||||360|||||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|361|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00009766701|CLEOCIN 100 MG VAGINAL OVULE|3|EA|26.3375|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||124|No|58.94278|03/28/2023|57.52815|03/28/2023|57.91128|03/28/2023|||ANTIBIOTICS: VAGINAL|362|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
estramustine phosphate sodium|No|No|No|No|75%|00013013202|EMCYT 140 MG CAPSULE|100|EA|7.20585|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||550|No|16.42264|01/04/2022|16.18803|01/04/2022|15.41717|01/04/2022|||ONCOLOGY: ORAL - PROSTATE|363|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00013215036|ESTRING 2 MG VAGINAL RING|1|EA|227.7925|03/01/2002|07/10/2024|Yes|No||03/01/2002|07/10/2024|Yes|No|03/01/2002|07/10/2024|Yes|No||||No|No|||Prescription required|No|||Yes|507.60619|09/26/2023|495.42364|09/26/2023|498.72308|09/26/2023||||364|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARMACIA-UPJHN|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|365|||||No|No||PHARMACIA-UPJHN|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|366|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013264902|GENOTROPIN MINIQUICK 0.2 MG|7|EA|13.05357|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|29.74999|01/04/2022|29.32499|01/04/2022|27.92856|01/04/2022|||GROWTH HORMONE|367|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265002|GENOTROPIN MINIQUICK 0.4 MG|7|EA|26.11082|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|368|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265102|GENOTROPIN MINIQUICK 0.6 MG|7|EA|39.1644|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|89.2584|01/04/2022|87.98328|01/04/2022|83.7936|01/04/2022|||GROWTH HORMONE|369|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265202|GENOTROPIN MINIQUICK 0.8 MG|7|EA|52.21981|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|119.01259|01/04/2022|117.31241|01/04/2022|111.7261|01/04/2022|||GROWTH HORMONE|370|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265302|GENOTROPIN MINIQUICK 1 MG|7|EA|65.27645|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|371|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265402|GENOTROPIN MINIQUICK 1.2 MG|7|EA|78.33125|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|372|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265502|GENOTROPIN MINIQUICK 1.4 MG|7|EA|91.38421|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|208.27099|01/04/2022|205.29569|01/04/2022|195.5197|01/04/2022|||GROWTH HORMONE|373|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265602|GENOTROPIN MINIQUICK 1.6 MG|7|EA|104.43778|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|374|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
somatropin|No|No|No|No|75%|00013265702|GENOTROPIN MINIQUICK 1.8 MG|7|EA|117.49627|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No||014|Yes|267.78219|01/04/2022|263.95673|01/04/2022|251.38736|01/04/2022|||GROWTH HORMONE|375|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|07/30/2021|
somatropin|No|No|No|No|75%|00013265802|GENOTROPIN MINIQUICK 2 MG|7|EA|130.54922|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|376|||||No|No||PHARMACIA-UPJHN|No|||||No|No|Yes|09/30/2022|
rifabutin|No|No|No|No|75%|00013530117|MYCOBUTIN 150 MG CAPSULE|100|EA|11.67264|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|19.06531|01/04/2022|18.79295|01/04/2022|17.89804|01/04/2022||||377|||||No|No||PHARMACIA-UPJHN|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|378|||||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||||379|||||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||||380|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
carboxymethylcellulose sodium|No|No|No|No|75%|00023040350|REFRESH PLUS 0.5% EYE DROPS|50|EA|.11885|09/01/1999||Yes|No||||No|No|09/01/1999||Yes|No||||No|No|||Over the counter|No|||No|.27087|04/04/2023|.267|04/04/2023|.25428|04/04/2023||||381|||||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|382|||||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|91.86568|10/24/2023|89.6609|10/24/2023|90.25803|10/24/2023|||OPHTHALMICS: GLAUCOMA AGENTS|383|||||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|91.81511|10/24/2023|89.61154|10/24/2023|90.20834|10/24/2023|||OPHTHALMICS: GLAUCOMA AGENTS|384|||||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|92.05296|10/24/2023|89.84368|10/24/2023|90.44203|10/24/2023|||OPHTHALMICS: GLAUCOMA AGENTS|385|||||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|386|||||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|2.8192|08/29/2023|2.75153|08/29/2023|2.76986|08/29/2023|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|387|||||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|388|||||No|No||ALLERGAN INC.|No|||||No|Yes|No||
carboxymethylcellulose sodium|No|No|No|No|75%|00023455430|REFRESH CELLUVISC 1% EYE GEL|30|EA|.15766|11/27/2002||Yes|No||||No|No|||No|No||||No|No|||Over the counter|No|||No|.35932|04/04/2023|.35419|04/04/2023|.33732|04/04/2023||||389|||||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|112.39653|08/29/2023|109.69901|08/29/2023|110.42959|08/29/2023|||OPHTHALMICS: ANTI-INFLAMMATORY/IMMUNOMODULATOR|390|||||No|No||ALLERGAN INC.|No|||||No|No|No||
carboxymethyl/gly/poly80/PF|No|No|No|No|75%|00023577330|REFRESH OPTIVE MEGA-3 DROPS|30|EA|.19436|11/08/2017||Yes|No||||No|No|11/08/2017||Yes|No||||No|No|||Over the counter|No|||No|.43158|10/24/2023|.42122|10/24/2023|.42402|10/24/2023||||391|||||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|3.7026|07/25/2023|3.61373|07/25/2023|3.6378|07/25/2023|||ULCERATIVE COLITIS AGENTS|392|||||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|393|||||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|394|||||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||||395|||||No|No||ALLERGAN INC.|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
testosterone|No|No|No|No|90%|00023599002|ANDRODERM 2 MG/24HR PATCH|1|EA|4.4161|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No||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|09/30/2024|Yes|No||02/20/2019|09/30/2024|Yes|No|02/20/2019|09/30/2024|Yes|No||||No|No|||Prescription required|No||084|No|9.82286|11/29/2022|9.58711|11/29/2022|9.65095|11/29/2022|||ANDROGENIC AGENTS|397|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ALLERGAN INC.|No|||||No|No|No||
testosterone|No|No|No|No|90%|00023599204|ANDRODERM 4 MG/24HR PATCH|1|EA|8.8279|02/20/2019||Yes|No||02/20/2019||Yes|No|02/20/2019||Yes|No||||No|No|||Prescription required|No||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|09/30/2024|Yes|No||02/20/2019|09/30/2024|Yes|No|02/20/2019|09/30/2024|Yes|No||||No|No|||Prescription required|No||084|No|19.6219|02/28/2023|19.15097|02/28/2023|19.27851|02/28/2023|||ANDROGENIC AGENTS|399|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|09/30/2023|Yes|No||04/09/2019|09/30/2023|Yes|No|04/09/2019|09/30/2023|Yes|No|Refer to program requirements|||No|No|09/04/2019|09/30/2023|Prescription required|No|||No|5.72658|01/28/2020|5.64477|01/28/2020|5.37597|01/28/2020||||400|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|No||537|Yes|94.40514|10/24/2023|92.13941|10/24/2023|92.75305|10/24/2023|||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|No||537|Yes|94.51007|04/25/2023|92.24182|04/25/2023|92.85614|04/25/2023|||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|No||537|Yes|94.51007|04/25/2023|92.24182|04/25/2023|92.85614|04/25/2023|||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|10.32225|03/28/2023|10.07451|03/28/2023|10.14161|03/28/2023|||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|10.31603|03/28/2023|10.06844|03/28/2023|10.13549|03/28/2023|||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|39.7912|10/24/2023|38.83621|10/24/2023|39.09485|10/24/2023|||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|39.07961|03/28/2023|38.14169|03/28/2023|38.39571|03/28/2023|||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|39.25117|03/28/2023|38.30914|03/28/2023|38.56427|03/28/2023|||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|39.35343|03/28/2023|38.40894|03/28/2023|38.66474|03/28/2023|||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|37.30043|10/24/2023|36.40521|10/24/2023|36.64767|10/24/2023|||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|37.32206|10/24/2023|36.42633|10/24/2023|36.66892|10/24/2023|||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|37.41004|10/24/2023|36.51219|10/24/2023|36.75536|10/24/2023|||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|7.54639|10/24/2023|7.36527|10/24/2023|7.41432|10/24/2023|||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|12.15076|10/24/2023|11.85914|10/24/2023|11.93812|10/24/2023||||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|54.26221|10/24/2023|52.95991|10/24/2023|53.31262|10/24/2023|||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|86.95774|10/24/2023|84.87075|10/24/2023|85.43597|10/24/2023|||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|87.07582|10/24/2023|84.986|10/24/2023|85.55199|10/24/2023|||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|9.39233|03/28/2023|9.16691|03/28/2023|9.22796|03/28/2023|||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|12.098|08/29/2023|11.80764|08/29/2023|11.88628|08/29/2023|||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||PHARMACIA-UPJHN|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||PHARMACIA-UPJHN|No|||||No|No|No||
spironolact/hydrochlorothiazid|No|No|No|No|75%|00025101131|ALDACTAZIDE 25-25 TABLET|100|EA|1.17187|03/01/2002|07/10/2024|Yes|No||03/01/2002|07/10/2024|Yes|No|03/01/2002|07/10/2024|Yes|No||||No|No|||Prescription required|No|||Yes|2.67079|01/04/2022|2.63263|01/04/2022|2.50727|01/04/2022||||458|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARMACIA-UPJHN|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||PHARMACIA-UPJHN|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||PHARMACIA-UPJHN|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||PHARMACIA-UPJHN|No|||||No|No|No||
oxaprozin|No|No|No|No|75%|00025138131|DAYPRO 600 MG CAPLET|100|EA|3.55945|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|03/29/2004|059|Yes|8.11224|01/03/2023|7.99635|01/03/2023|7.61557|01/03/2023|||NSAIDS|462|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
diclofenac sodium/misoprostol|No|No|No|No|75%|00025141160|ARTHROTEC 50 MG-200 MCG TAB|60|EA|3.72515|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||PHARMACIA-UPJHN|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||PHARMACIA-UPJHN|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||PHARMACIA-UPJHN|No|||||No|No|No||
misoprostol|No|No|No|No|75%|00025145160|CYTOTEC 100 MCG TABLET|60|EA|1.71785|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|3.9151|01/03/2023|3.85917|01/03/2023|3.6754|01/03/2023||||466|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
misoprostol|No|No|No|No|75%|00025146131|CYTOTEC 200 MCG TABLET|100|EA|2.50251|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|5.7034|01/03/2023|5.62192|01/03/2023|5.35421|01/03/2023||||467|||||No|No||PHARMACIA-UPJHN|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||PHARMACIA-UPJHN|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|14.95888|10/24/2023|14.59986|10/24/2023|14.69709|10/24/2023|||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|14.95888|10/24/2023|14.59986|10/24/2023|14.69709|10/24/2023|||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|14.95888|10/24/2023|14.59986|10/24/2023|14.69709|10/24/2023|||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|03/08/2024|Yes|No||02/25/2005|03/08/2024|Yes|No|02/25/2005|03/08/2024|Yes|No||||No|No|||Prescription required|No|||No|13.80002|01/10/2023|13.60288|01/10/2023|12.95512|01/10/2023||||478|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||||479|||||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|480|||||No|No||PHARMACIA-UPJHN|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||||481|||||No|No||PHARMACIA-UPJHN|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||||482|||||No|No||PHARMACIA-UPJHN|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||||483|||||No|No||PHARMACIA-UPJHN|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||||484|||||No|No||PHARMACIA-UPJHN|No|||||No|No|No||
verapamil HCl|No|No|No|No|75%|00025292431|CALAN SR 240 MG TABLET|100|EA|4.01675|01/07/2022|01/01/2024|Yes|No||01/07/2022|01/01/2024|Yes|No|01/07/2022|01/01/2024|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|485|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|486|||||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|487|||||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|488|||||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|489|||||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|490|||||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|491|||||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|492|||||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|493|||||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|494|||||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|495|||||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|496|||||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|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%|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|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%|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|499|||||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|1.59369|10/24/2023|1.55544|10/24/2023|1.5658|10/24/2023|||PANCREATIC ENZYMES|500|||||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|1.89175|10/24/2023|1.84634|10/24/2023|1.85864|10/24/2023|||PANCREATIC ENZYMES|501|||||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|1.89175|10/24/2023|1.84634|10/24/2023|1.85864|10/24/2023|||PANCREATIC ENZYMES|502|||||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|3.79791|10/24/2023|3.70676|10/24/2023|3.73144|10/24/2023|||PANCREATIC ENZYMES|503|||||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|3.79791|10/24/2023|3.70676|10/24/2023|3.73144|10/24/2023|||PANCREATIC ENZYMES|504|||||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|7.51949|10/24/2023|7.33902|10/24/2023|7.38789|10/24/2023|||PANCREATIC ENZYMES|505|||||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|7.51949|10/24/2023|7.33902|10/24/2023|7.38789|10/24/2023|||PANCREATIC ENZYMES|506|||||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|11.40453|10/24/2023|11.13082|10/24/2023|11.20495|10/24/2023|||PANCREATIC ENZYMES|507|||||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|11.40453|10/24/2023|11.13082|10/24/2023|11.20495|10/24/2023|||PANCREATIC ENZYMES|508|||||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|8.71602|04/25/2023|8.50683|04/25/2023|8.56348|04/25/2023|||INTRANASAL RHINITIS AGENTS|509|||||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|510|||||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|511|||||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|512|||||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|513|||||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|514|||||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|515|||||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||||516|||||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|16.752|10/24/2023|16.34995|10/24/2023|16.45884|10/24/2023||||517|||||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|26.62387|10/24/2023|25.98489|10/24/2023|26.15795|10/24/2023||||518|||||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|519|||||No|No||MEDA/MYLAN SPEC|No|||||No|No|No||
glimepiride|No|No|No|No|75%|00039022210|AMARYL 2 MG TABLET|100|EA|.92609|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|2.11062|04/25/2017|2.08047|04/25/2017|1.9814|04/25/2017||||520|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|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|3.98085|07/24/2018|3.92398|07/24/2018|3.73713|07/24/2018||||521|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||||522|||||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|13.95753|10/24/2023|13.62254|10/24/2023|13.71327|10/24/2023||||523|||||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|6.4194|10/24/2023|6.26533|10/24/2023|6.30706|10/24/2023||||524|||||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|6.4194|10/24/2023|6.26533|10/24/2023|6.30706|10/24/2023||||525|||||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|6.42504|10/24/2023|6.27083|10/24/2023|6.3126|10/24/2023||||526|||||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|6.42236|10/24/2023|6.26822|10/24/2023|6.30996|10/24/2023||||527|||||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|6.42236|10/24/2023|6.26822|10/24/2023|6.30996|10/24/2023||||528|||||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|6.39543|10/24/2023|6.24193|10/24/2023|6.2835|10/24/2023||||529|||||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|6.41704|10/24/2023|6.26303|10/24/2023|6.30474|10/24/2023||||530|||||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|6.41704|10/24/2023|6.26303|10/24/2023|6.30474|10/24/2023||||531|||||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|8.02907|10/24/2023|7.83637|10/24/2023|7.88856|10/24/2023||||532|||||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|8.04221|10/24/2023|7.84919|10/24/2023|7.90147|10/24/2023||||533|||||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|8.03138|10/24/2023|7.83862|10/24/2023|7.89083|10/24/2023||||534|||||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|8.06341|10/24/2023|7.86988|10/24/2023|7.9223|10/24/2023||||535|||||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||||536|||||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||||537|||||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|538|||||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||||539|||||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||||540|||||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||||541|||||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||||542|||||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||||543|||||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||||544|||||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||||545|||||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|Yes|75.38322|01/10/2023|74.30632|01/10/2023|70.76792|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|546|||||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|Yes|73.98541|01/17/2023|72.20976|01/17/2023|72.69066|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|547|||||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|Yes|73.98541|01/17/2023|72.20976|01/17/2023|72.69066|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|548|||||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|02/15/2024|Yes|No||03/01/2002|02/15/2024|Yes|No|03/01/2002|02/15/2024|Yes|No||03/01/2002|02/15/2024|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|549|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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|550|||||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|551|||||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|552|||||No|No||PFIZER US PHARM|No|||||No|No|No||
voriconazole|No|No|No|No|75%|00049319028|VFEND IV 200 MG VIAL|1|EA|25.929|08/16/2002||Yes|No||08/16/2002||Yes|No|08/16/2002||Yes|No||||No|No|||Prescription required|No|||No|59.094|10/03/2023|58.2498|10/03/2023|55.476|10/03/2023||||553|||||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|554|||||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|555|||||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|07/31/2024|Yes|No||03/01/2002|07/31/2024|Yes|No|03/01/2002|07/31/2024|Yes|No||||No|No|||Prescription required|Yes|07/12/2005|069|No|.47683|01/04/2022|.47002|01/04/2022|.44764|01/04/2022|||ANTIFUNGALS: ORAL|556|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||PFIZER US PHARM|No|||||No|No|No||
fluconazole|No|No|No|No|75%|00049345019|DIFLUCAN 40 MG/ML SUSPENSION|35|ML|.34535|08/22/2009||Yes|No||08/22/2009||Yes|No|08/22/2009||Yes|No||||No|No|||Prescription required|Yes|07/12/2005|069|No|.78707|01/04/2022|.77583|01/04/2022|.73888|01/04/2022|||ANTIFUNGALS: ORAL|557|||||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|09/30/2023|Yes|No||03/01/2002|09/30/2023|Yes|No|03/01/2002|09/30/2023|Yes|No||03/01/2002|09/30/2023|Yes|No|11/01/2012|09/30/2023|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|558|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|559|||||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|560|||||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|561|||||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|562|||||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|563|||||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|564|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
testosterone|No|No|No|No|90%|00051846233|ANDROGEL 1.62% GEL PUMP|75|GM|3.56074|05/23/2011||Yes|No||05/23/2011||Yes|No|05/23/2011||Yes|No||||No|No|||Prescription required|No||084|No|7.93572|02/28/2023|7.74526|02/28/2023|7.79684|02/28/2023|||ANDROGENIC AGENTS|565|||||No|No||ABBVIE US LLC|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00052011030|REMERON 45 MG SOLTAB|30|EA|2.0038|06/22/2006||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|566|||||No|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|567|||||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|568|||||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|.2408|12/02/2004||Yes|No||12/02/2004||Yes|No|12/02/2004||Yes|No||||No|No|||Prescription required|No|||No|.5488|09/05/2023|.54096|09/05/2023|.5152|09/05/2023||||569|||||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|.17006|10/24/2023|.16597|10/24/2023|.16708|10/24/2023||||570|||||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|.17006|10/24/2023|.16597|10/24/2023|.16708|10/24/2023||||571|||||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|.11575|10/24/2023|.11297|10/24/2023|.11372|10/24/2023||||572|||||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|.11575|10/24/2023|.11297|10/24/2023|.11372|10/24/2023||||573|||||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|.19834|10/24/2023|.19357|10/24/2023|.19486|10/24/2023||||574|||||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|.19834|10/24/2023|.19357|10/24/2023|.19486|10/24/2023||||575|||||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|.33366|10/24/2023|.32565|10/24/2023|.32782|10/24/2023||||576|||||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|.33366|10/24/2023|.32565|10/24/2023|.32782|10/24/2023||||577|||||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|.05601|10/24/2023|.05466|10/24/2023|.05502|10/24/2023|||GLUCOCORTICOIDS: ORAL|578|||||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|.08401|10/24/2023|.08199|10/24/2023|.08253|10/24/2023|||GLUCOCORTICOIDS: ORAL|579|||||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|.08401|10/24/2023|.08199|10/24/2023|.08253|10/24/2023|||GLUCOCORTICOIDS: ORAL|580|||||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|.08401|10/24/2023|.08199|10/24/2023|.08253|10/24/2023|||GLUCOCORTICOIDS: ORAL|581|||||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|.26498|10/24/2023|.25862|10/24/2023|.26034|10/24/2023|||GLUCOCORTICOIDS: ORAL|582|||||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|.26498|10/24/2023|.25862|10/24/2023|.26034|10/24/2023|||GLUCOCORTICOIDS: ORAL|583|||||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|.19859|10/24/2023|.19382|10/24/2023|.19511|10/24/2023||||584|||||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|.14668|10/24/2023|.14315|10/24/2023|.14411|10/24/2023||||585|||||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|.14668|10/24/2023|.14315|10/24/2023|.14411|10/24/2023||||586|||||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|.66041|10/24/2023|.64456|10/24/2023|.64885|10/24/2023|||INTRANASAL RHINITIS AGENTS|587|||||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|1.28908|10/24/2023|1.25814|10/24/2023|1.26652|10/24/2023|||INTRANASAL RHINITIS AGENTS|588|||||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|1.8314|10/17/2023|1.78744|10/17/2023|1.79935|10/17/2023||||589|||||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|.19857|10/24/2023|.1938|10/24/2023|.19509|10/24/2023|||ANTIDEPRESSANTS: SSRIs|590|||||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|.26207|10/24/2023|.25578|10/24/2023|.25748|10/24/2023|||ANTIPSYCHOTICS|591|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|.23435|10/24/2023|.22872|10/24/2023|.23024|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|592|||||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|.08045|10/24/2023|.07851|10/24/2023|.07904|10/24/2023||||593|||||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|.08045|10/24/2023|.07851|10/24/2023|.07904|10/24/2023||||594|||||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|.45268|10/24/2023|.44181|10/24/2023|.44475|10/24/2023|||ULCERATIVE COLITIS AGENTS|595|||||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|.88988|10/24/2023|.86852|10/24/2023|.8743|10/24/2023|||ONCOLOGY: ORAL - BREAST|596|||||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|.1434|10/24/2023|.13995|10/24/2023|.14089|10/24/2023|||SEDATIVE HYPNOTICS|597|||||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|.17223|10/24/2023|.16809|10/24/2023|.16921|10/24/2023|||SEDATIVE HYPNOTICS|598|||||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|.21366|10/24/2023|.20853|10/24/2023|.20992|10/24/2023|||PHOSPHATE BINDERS|599|||||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|.21366|10/24/2023|.20853|10/24/2023|.20992|10/24/2023|||PHOSPHATE BINDERS|600|||||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|601|||||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|.17169|10/24/2023|.16756|10/24/2023|.16868|10/24/2023||||602|||||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|.17606|10/24/2023|.17183|10/24/2023|.17297|10/24/2023||||603|||||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|.28543|10/24/2023|.27857|10/24/2023|.28043|10/24/2023||||604|||||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|.17968|10/24/2023|.17536|10/24/2023|.17653|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|605|||||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|.17968|10/24/2023|.17536|10/24/2023|.17653|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|606|||||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|.26815|10/24/2023|.26171|10/24/2023|.26345|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|607|||||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|.26815|10/24/2023|.26171|10/24/2023|.26345|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|608|||||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|.47157|10/24/2023|.46025|10/24/2023|.46331|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|609|||||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|.81201|10/24/2023|.79252|10/24/2023|.79779|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|610|||||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|.63617|10/24/2023|.6209|10/24/2023|.62503|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|611|||||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|.92882|10/24/2023|.90652|10/24/2023|.91256|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|612|||||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|613|||||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|2.82682|06/27/2023|2.75897|06/27/2023|2.77735|06/27/2023|||ANTIDEPRESSANTS: TRICYCLIC|614|||||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|.26765|10/24/2023|.26122|10/24/2023|.26296|10/24/2023|||ANALGESICS: NARCOTICS SHORT|615|||||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|.39899|10/24/2023|.38941|10/24/2023|.392|10/24/2023|||ANALGESICS: NARCOTICS SHORT|616|||||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|.08927|10/24/2023|.088|10/24/2023|.08381|10/24/2023|||ANALGESICS: NARCOTICS SHORT|617|||||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|618|||||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|619|||||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|620|||||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|621|||||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|.60089|09/26/2023|.58646|09/26/2023|.59037|09/26/2023|||ANALGESICS: NARCOTICS SHORT|622|||||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|.60089|09/26/2023|.58646|09/26/2023|.59037|09/26/2023|||ANALGESICS: NARCOTICS SHORT|623|||||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|624|||||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|.17411|10/24/2023|.16993|10/24/2023|.17106|10/24/2023|||ANGIOTENSIN MODULATORS|625|||||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|.17411|10/24/2023|.16993|10/24/2023|.17106|10/24/2023|||ANGIOTENSIN MODULATORS|626|||||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|.22784|10/24/2023|.22237|10/24/2023|.22385|10/24/2023|||ANGIOTENSIN MODULATORS|627|||||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|.22784|10/24/2023|.22237|10/24/2023|.22385|10/24/2023|||ANGIOTENSIN MODULATORS|628|||||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|629|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|.54794|10/24/2023|.53478|10/24/2023|.53835|10/24/2023|||ONCOLOGY: ORAL - BREAST|630|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|11.56432|09/26/2023|11.39911|09/26/2023|10.8563|09/26/2023|||ANTIDEPRESSANTS: TRICYCLIC|631|||||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|632|||||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|633|||||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|634|||||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|Yes|2.09389|10/24/2023|2.04363|10/24/2023|2.05724|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|635|||||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|Yes|1.31202|10/24/2023|1.28053|10/24/2023|1.28905|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|636|||||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|637|||||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|.52007|04/25/2023|.50758|04/25/2023|.51096|04/25/2023|||ANALGESICS: NARCOTICS SHORT|638|||||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|639|||||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|640|||||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|1.1955|10/24/2023|1.1668|10/24/2023|1.17457|10/24/2023|||GLUCOCORTICOIDS: INHALED|641|||||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|1.44836|10/24/2023|1.41359|10/24/2023|1.42301|10/24/2023|||GLUCOCORTICOIDS: INHALED|642|||||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|1.13439|10/24/2023|1.10716|10/24/2023|1.11453|10/24/2023||||643|||||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||||644|||||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|1.75912|10/24/2023|1.7169|10/24/2023|1.72833|10/24/2023||||645|||||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|1.75912|10/24/2023|1.7169|10/24/2023|1.72833|10/24/2023||||646|||||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||||647|||||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|648|||||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|4.071|07/25/2023|3.97329|07/25/2023|3.99975|07/25/2023|||ONCOLOGY: ORAL - BREAST|649|||||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|.23976|09/26/2023|.234|09/26/2023|.23556|09/26/2023|||ANALGESICS: NARCOTICS SHORT|650|||||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|651|||||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|.05995|10/24/2023|.05851|10/24/2023|.0589|10/24/2023|||ANALGESICS: NARCOTICS SHORT|652|||||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|653|||||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|654|||||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||||655|||||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|.51879|10/24/2023|.50633|10/24/2023|.50971|10/24/2023|||ANTIDEPRESSANTS: OTHER|656|||||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|.51879|10/24/2023|.50633|10/24/2023|.50971|10/24/2023|||ANTIDEPRESSANTS: OTHER|657|||||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|.51925|10/24/2023|.50678|10/24/2023|.51016|10/24/2023|||ANTIDEPRESSANTS: OTHER|658|||||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|.51925|10/24/2023|.50678|10/24/2023|.51016|10/24/2023|||ANTIDEPRESSANTS: OTHER|659|||||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|1.05691|10/24/2023|1.03154|10/24/2023|1.03841|10/24/2023|||HIV / AIDS|660|||||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|.53527|10/24/2023|.52242|10/24/2023|.5259|10/24/2023|||ANTIHYPERURICEMICS|661|||||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|.64636|10/24/2023|.63084|10/24/2023|.63504|10/24/2023|||ANTIHYPERURICEMICS|662|||||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|2.11502|10/24/2023|2.06425|10/24/2023|2.078|10/24/2023|||ANTICONVULSANTS|663|||||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|4.30422|10/24/2023|4.20091|10/24/2023|4.22889|10/24/2023|||ANTICONVULSANTS|664|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00054044949|POSACONAZOLE 200 MG/5 ML SUSP|105|ML|5.37651|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|Yes|01/26/2023|069|No|12.25344|08/01/2023|12.0784|08/01/2023|11.50323|08/01/2023|||ANTIFUNGALS: ORAL|665|||||No|No||HIKMA PHARMACEU|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|666|||||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|6.0553|08/29/2023|5.90997|08/29/2023|5.94933|08/29/2023|||IMMUNOSUPPRESSIVES: ORAL|667|||||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|668|||||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|669|||||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|670|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00054048213|EVEROLIMUS 10 MG TABLET|30|EA|96.24288|03/29/2022||Yes|No||03/29/2022||Yes|No|03/29/2022||Yes|No||||No|No|||Prescription required|No||548|No|219.34424|03/29/2022|216.21075|03/29/2022|205.915|03/29/2022|||ONCOLOGY: ORAL - RENAL CELL|671|||||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|672|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
icosapent ethyl|No|No|No|No|75%|00054050823|ICOSAPENT ETHYL 1 GRAM CAPSULE|120|EA|1.08166|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|1.29658|10/24/2023|1.26546|10/24/2023|1.27388|10/24/2023|||LIPOTROPICS: OTHER|673|||||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|.37156|10/24/2023|.36264|10/24/2023|.36505|10/24/2023|||ANALGESICS: NARCOTICS SHORT|674|||||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|.28408|10/24/2023|.27726|10/24/2023|.2791|10/24/2023|||ANALGESICS: NARCOTICS SHORT|675|||||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|.3355|10/24/2023|.32744|10/24/2023|.32962|10/24/2023|||ANALGESICS: NARCOTICS SHORT|676|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
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|.6034|10/24/2023|.58891|10/24/2023|.59284|10/24/2023|||ANTICONVULSANTS|677|||||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||||678|||||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|.49405|10/24/2023|.48219|10/24/2023|.4854|10/24/2023|||ANTIDEPRESSANTS: OTHER|679|||||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|680|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
icosapent ethyl|No|No|No|No|75%|00054062127|ICOSAPENT ETHYL 0.5 GM CAPSULE|240|EA|.64211|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription required|Yes|07/28/2022|055|Yes|1.05992|09/26/2023|1.03448|09/26/2023|1.04137|09/26/2023|||LIPOTROPICS: OTHER|681|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00054062263|DICYCLOMINE 10 MG/5 ML SOLN|473|ML|.10333|09/30/2020||Yes|No||09/30/2020||Yes|No|09/30/2020||Yes|No||||No|No|||Prescription required|No|||No|.20249|10/24/2023|.19763|10/24/2023|.19894|10/24/2023||||682|||||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|14.57463|09/26/2023|14.22483|09/26/2023|14.31957|09/26/2023||||683|||||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|14.57463|09/26/2023|14.22483|09/26/2023|14.31957|09/26/2023||||684|||||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|5.69604|03/28/2023|5.55933|03/28/2023|5.59635|03/28/2023|||ANALGESICS: NARCOTICS SHORT|685|||||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|.18157|10/24/2023|.17721|10/24/2023|.17839|10/24/2023|||ANALGESICS: NARCOTICS LONG|686|||||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|.18157|10/24/2023|.17721|10/24/2023|.17839|10/24/2023|||ANALGESICS: NARCOTICS LONG|687|||||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|.15544|10/24/2023|.1517|10/24/2023|.15271|10/24/2023|||ANALGESICS: NARCOTICS LONG|688|||||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|.15544|10/24/2023|.1517|10/24/2023|.15271|10/24/2023|||ANALGESICS: NARCOTICS LONG|689|||||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||||690|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
albuterol sulfate|No|No|No|No|75%|00054074287|ALBUTEROL HFA 90 MCG INHALER|6.7|GM|2.30916|03/30/2022||Yes|No||03/30/2022||Yes|No|03/30/2022||Yes|No||||No|No|||Prescription required|Yes|05/23/2022|037|Yes|2.91623|10/24/2023|2.84624|10/24/2023|2.86519|10/24/2023|||BRONCHODILATORS: BETA AGONIST|691|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00054074825|DICYCLOMINE 10 MG CAPSULE|100|EA|.08578|09/05/2023||Yes|No||09/05/2023||Yes|No|09/05/2023||Yes|No||||No|No|||Prescription required|No|||No|.11422|10/24/2023|.11147|10/24/2023|.11222|10/24/2023||||692|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00054074831|DICYCLOMINE 10 MG CAPSULE|1000|EA|.07933|09/05/2023||Yes|No||09/05/2023||Yes|No|09/05/2023||Yes|No||||No|No|||Prescription required|No|||No|.11422|10/24/2023|.11147|10/24/2023|.11222|10/24/2023||||693|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
lithium carbonate|No|No|No|No|75%|00054252625|LITHIUM CARBONATE 150 MG CAP|100|EA|.05762|10/18/2006||Yes|No||10/18/2006||Yes|No|10/18/2006||Yes|No||||No|No|||Prescription required|No|||No|.09168|10/24/2023|.08947|10/24/2023|.09007|10/24/2023||||694|||||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|.10027|10/24/2023|.09786|10/24/2023|.09851|10/24/2023||||695|||||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|.10027|10/24/2023|.09786|10/24/2023|.09851|10/24/2023||||696|||||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|.24299|10/24/2023|.23715|10/24/2023|.23873|10/24/2023||||697|||||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|.85371|10/24/2023|.83322|10/24/2023|.83877|10/24/2023|||ANALGESICS: NARCOTICS SHORT|698|||||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|699|||||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|14.29742|10/24/2023|13.95428|10/24/2023|14.04721|10/24/2023|||ANALGESICS: NARCOTICS SHORT|700|||||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|.01793|07/25/2023|.01767|07/25/2023|.01683|07/25/2023||||701|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|4.66767|08/29/2023|4.55564|08/29/2023|4.58598|08/29/2023||||702|||||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|.72387|10/24/2023|.70649|10/24/2023|.7112|10/24/2023|||GLUCOCORTICOIDS: ORAL|703|||||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|.16205|03/28/2023|.15816|03/28/2023|.15921|03/28/2023|||GLUCOCORTICOIDS: ORAL|704|||||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|.02874|10/24/2023|.02805|10/24/2023|.02823|10/24/2023|||GLUCOCORTICOIDS: ORAL|705|||||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|706|||||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|707|||||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||||708|||||No|No||ROXANE/WEST-WAR|No|||||No|No|No||
fluticasone propionate|No|No|No|No|75%|00054327099|FLUTICASONE PROP 50 MCG SPRAY|16|GM|.36657|03/24/2006||Yes|No||03/24/2006||Yes|No|03/24/2006||Yes|No||||No|No|||Prescription required|No||019|No|.32391|10/24/2023|.31613|10/24/2023|.31824|10/24/2023|||INTRANASAL RHINITIS AGENTS|709|||||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|.08953|10/24/2023|.08738|10/24/2023|.08796|10/24/2023||||710|||||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|.08953|10/24/2023|.08738|10/24/2023|.08796|10/24/2023||||711|||||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||||712|||||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|.08694|10/24/2023|.08485|10/24/2023|.08541|10/24/2023||||713|||||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|.48227|10/24/2023|.47069|10/24/2023|.47383|10/24/2023||||714|||||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|.66715|10/24/2023|.65113|10/24/2023|.65547|10/24/2023|||ANXIOLYTICS|715|||||No|No||HIKMA PHARMACEU|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|716|||||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|717|||||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|718|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
methadone HCl|No|No|No|No|90%|00054355663|METHADONE 10 MG/5 ML SOLUTION|500|ML|.04752|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|110|Yes|.1083|06/01/2016|.10676|06/01/2016|.10167|06/01/2016|||ANALGESICS: NARCOTICS LONG|719|||||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|720|||||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|721|||||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|.46408|09/26/2023|.45294|09/26/2023|.45595|09/26/2023|||GLUCOCORTICOIDS: ORAL|722|||||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|.59074|06/27/2023|.57656|06/27/2023|.5804|06/27/2023|||GLUCOCORTICOIDS: ORAL|723|||||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|.08907|10/24/2023|.08693|10/24/2023|.08751|10/24/2023|||BETA-BLOCKERS|724|||||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|725|||||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|.39688|10/24/2023|.38735|10/24/2023|.38993|10/24/2023|||ANTIFUNGALS: ORAL|726|||||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|.39688|10/24/2023|.38735|10/24/2023|.38993|10/24/2023|||ANTIFUNGALS: ORAL|727|||||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|.10556|10/24/2023|.10302|10/24/2023|.10371|10/24/2023|||GLUCOCORTICOIDS: ORAL|728|||||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|.19453|10/24/2023|.18986|10/24/2023|.19112|10/24/2023|||GLUCOCORTICOIDS: ORAL|729|||||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|.23324|10/24/2023|.22764|10/24/2023|.22915|10/24/2023|||GLUCOCORTICOIDS: ORAL|730|||||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|.22827|05/23/2023|.22279|05/23/2023|.22427|05/23/2023|||GLUCOCORTICOIDS: ORAL|731|||||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|.41143|10/24/2023|.40155|10/24/2023|.40422|10/24/2023|||GLUCOCORTICOIDS: ORAL|732|||||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|.34465|10/24/2023|.33637|10/24/2023|.33861|10/24/2023|||GLUCOCORTICOIDS: ORAL|733|||||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|1.1048|10/24/2023|1.07828|10/24/2023|1.08546|10/24/2023|||GLUCOCORTICOIDS: ORAL|734|||||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|.02728|10/24/2023|.02662|10/24/2023|.0268|10/24/2023||||735|||||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|.02728|10/24/2023|.02662|10/24/2023|.0268|10/24/2023||||736|||||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|.03224|10/24/2023|.03146|10/24/2023|.03167|10/24/2023||||737|||||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|.03224|10/24/2023|.03146|10/24/2023|.03167|10/24/2023||||738|||||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|.05282|10/24/2023|.05155|10/24/2023|.05189|10/24/2023||||739|||||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|.05282|10/24/2023|.05155|10/24/2023|.05189|10/24/2023||||740|||||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|.52717|10/24/2023|.51451|10/24/2023|.51794|10/24/2023||||741|||||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|.52717|10/24/2023|.51451|10/24/2023|.51794|10/24/2023||||742|||||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|4.17509|09/26/2023|4.07488|09/26/2023|4.10202|09/26/2023||||743|||||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|4.17509|09/26/2023|4.07488|09/26/2023|4.10202|09/26/2023||||744|||||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||||745|||||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|4.4058|10/24/2023|4.30006|10/24/2023|4.32869|10/24/2023||||746|||||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|.1204|10/24/2023|.11751|10/24/2023|.11829|10/24/2023||||747|||||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|.1204|10/24/2023|.11751|10/24/2023|.11829|10/24/2023||||748|||||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|749|||||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|10/31/2024|Yes|No||07/27/2010|10/31/2024|Yes|No|07/27/2010|10/31/2024|Yes|No||||No|No|||Prescription required|No|||No|.22665|10/24/2023|.22121|10/24/2023|.22268|10/24/2023||||750|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||ROXANE/WEST-WAR|No|||||Yes|No|No||
methotrexate sodium|No|No|No|No|75%|00054455025|METHOTREXATE 2.5 MG TABLET|100|EA|.75933|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.22665|10/24/2023|.22121|10/24/2023|.22268|10/24/2023||||751|||||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|.8586|10/24/2023|.83799|10/24/2023|.84357|10/24/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|752|||||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|.8586|10/24/2023|.83799|10/24/2023|.84357|10/24/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|753|||||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|.04631|10/24/2023|.04519|10/24/2023|.04549|10/24/2023|||GLUCOCORTICOIDS: ORAL|754|||||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|.04631|10/24/2023|.04519|10/24/2023|.04549|10/24/2023|||GLUCOCORTICOIDS: ORAL|755|||||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|.04421|10/24/2023|.04314|10/24/2023|.04343|10/24/2023|||GLUCOCORTICOIDS: ORAL|756|||||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|.04421|10/24/2023|.04314|10/24/2023|.04343|10/24/2023|||GLUCOCORTICOIDS: ORAL|757|||||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|.08002|10/24/2023|.07809|10/24/2023|.07861|10/24/2023|||GLUCOCORTICOIDS: ORAL|758|||||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|.8|08/29/2023|.7808|08/29/2023|.786|08/29/2023|||SEDATIVE HYPNOTICS|759|||||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|.59006|10/24/2023|.57589|10/24/2023|.57973|10/24/2023|||SEDATIVE HYPNOTICS|760|||||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|.59006|10/24/2023|.57589|10/24/2023|.57973|10/24/2023|||SEDATIVE HYPNOTICS|761|||||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|.39688|10/24/2023|.38735|10/24/2023|.38993|10/24/2023|||ANTIFUNGALS: ORAL|762|||||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|.23324|10/24/2023|.22764|10/24/2023|.22915|10/24/2023|||GLUCOCORTICOIDS: ORAL|763|||||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|.34465|10/24/2023|.33637|10/24/2023|.33861|10/24/2023|||GLUCOCORTICOIDS: ORAL|764|||||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|.41143|10/24/2023|.40155|10/24/2023|.40422|10/24/2023|||GLUCOCORTICOIDS: ORAL|765|||||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|.10556|10/24/2023|.10302|10/24/2023|.10371|10/24/2023|||GLUCOCORTICOIDS: ORAL|766|||||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|.19453|10/24/2023|.18986|10/24/2023|.19112|10/24/2023|||GLUCOCORTICOIDS: ORAL|767|||||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|.22827|05/23/2023|.22279|05/23/2023|.22427|05/23/2023|||GLUCOCORTICOIDS: ORAL|768|||||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|1.1048|10/24/2023|1.07828|10/24/2023|1.08546|10/24/2023|||GLUCOCORTICOIDS: ORAL|769|||||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|.02728|10/24/2023|.02662|10/24/2023|.0268|10/24/2023||||770|||||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|.03224|10/24/2023|.03146|10/24/2023|.03167|10/24/2023||||771|||||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|.05282|10/24/2023|.05155|10/24/2023|.05189|10/24/2023||||772|||||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|.52717|10/24/2023|.51451|10/24/2023|.51794|10/24/2023||||773|||||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|.09168|10/24/2023|.08947|10/24/2023|.09007|10/24/2023||||774|||||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|.10027|10/24/2023|.09786|10/24/2023|.09851|10/24/2023||||775|||||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|.1204|10/24/2023|.11751|10/24/2023|.11829|10/24/2023||||776|||||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|.22665|10/24/2023|.22121|10/24/2023|.22268|10/24/2023||||777|||||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|.04631|10/24/2023|.04519|10/24/2023|.04549|10/24/2023|||GLUCOCORTICOIDS: ORAL|778|||||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|.04421|10/24/2023|.04314|10/24/2023|.04343|10/24/2023|||GLUCOCORTICOIDS: ORAL|779|||||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|.08002|10/24/2023|.07809|10/24/2023|.07861|10/24/2023|||GLUCOCORTICOIDS: ORAL|780|||||No|No||WEST-WARD/HIKMA|No|||||Yes|No|No||
sodium oxybate|No|No|No|No|75%|00054962857|SODIUM OXYBATE 0.5 G/ML SOLN|180|ML|13.2225|10/31/2023||Yes|No||10/31/2023||Yes|No|10/31/2023||Yes|No||||No|No|||Prescription required|No|||Yes|30.135|11/07/2023|29.7045|10/31/2023|28.29|10/31/2023||||781|||||No|No||HIKMA PHARMACEU|No|||||No|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|.05601|10/24/2023|.05466|10/24/2023|.05502|10/24/2023|||GLUCOCORTICOIDS: ORAL|782|||||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|.05601|10/24/2023|.05466|10/24/2023|.05502|10/24/2023|||GLUCOCORTICOIDS: ORAL|783|||||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|.04631|10/24/2023|.04519|10/24/2023|.04549|10/24/2023|||GLUCOCORTICOIDS: ORAL|784|||||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|.04631|10/24/2023|.04519|10/24/2023|.04549|10/24/2023|||GLUCOCORTICOIDS: ORAL|785|||||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||786|||||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|09/30/2023|Yes|No||03/01/2002|09/30/2023|Yes|No|03/01/2002|09/30/2023|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|787|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|09/30/2023|Yes|No||03/01/2002|09/30/2023|Yes|No|03/01/2002|09/30/2023|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|788|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||BMS|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|34.46629|10/24/2023|33.63909|10/24/2023|33.86312|10/24/2023|||OPHTHALMICS: GLAUCOMA AGENTS|789|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|790|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 DROP|10|ML|8.4882|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|01/23/2013|002|No|19.3452|01/10/2023|19.06884|01/10/2023|18.1608|01/10/2023|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|791|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||||792|||||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||||793|||||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||||794|||||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||||795|||||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||||796|||||No|No||ALCON LABORATOR|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|32.64576|09/12/2023|32.17939|09/12/2023|30.64704|09/12/2023|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|797|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|2.6746|03/04/2021||Yes|No||||No|No|03/04/2021||Yes|No||||No|No|||Over the counter|No||002|No|6.0956|10/24/2023|6.00852|10/24/2023|5.7224|10/24/2023|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|798|||||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|23.86579|10/24/2023|23.29301|10/24/2023|23.44813|10/24/2023|||OPHTHALMICS: GLAUCOMA AGENTS|799|||||No|No||ALCON LABORATOR|No|||||No|No|No||
olopatadine HCl|No|No|No|No|75%|00065815001|PATADAY ONCE DAILY 0.2% DROPS|2.5|ML|2.5542|03/04/2021||Yes|No||||No|No|03/04/2021||Yes|No||||No|No|||Over the counter|Yes|01/28/2021|002|No|5.8212|10/24/2023|5.73804|10/24/2023|5.4648|10/24/2023|||OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS|800|||||No|No||ALCON LABORATOR|No|||||No|Yes|No||
difluprednate|No|No|No|No|75%|00065924007|DUREZOL 0.05% EYE DROPS|5|ML|18.748|09/26/2013|08/31/2023|Yes|No||09/26/2013|08/31/2023|Yes|No|09/26/2013|08/31/2023|Yes|No||||No|No|||Prescription required|No||013|No|42.728|09/12/2023|42.1176|09/12/2023|40.112|09/12/2023|||OPHTHALMICS: ANTI-INFLAMMATORIES|801|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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||||802|||||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||||803|||||No|No||SANOFI-AV-NOVAP|No|||||No|No|No||
taliglucerase alfa|No|No|No|No|75%|00069010601|ELELYSO 200 UNITS VIAL|1|EA|375.2481|01/08/2013||Yes|No||01/08/2013||Yes|No|01/08/2013||Yes|No||||No|No|||Prescription required|No|||Yes|855.2166|01/03/2023|842.99922|01/03/2023|802.8564|01/03/2023||||804|||||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|69.81265|11/22/2013||Yes|No||11/22/2013||Yes|No|11/22/2013||Yes|No||||No|No|||Prescription required|No||173|No|159.1079|07/04/2023|156.83493|07/04/2023|149.3666|07/04/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|805|||||No|No||PFIZER US PHARM|No|||||No|No|No||
bosutinib|No|No|No|No|75%|00069013601|BOSULIF 500 MG TABLET|30|EA|279.2506|11/12/2012||Yes|No||11/12/2012||Yes|No|11/12/2012||Yes|No||||No|No|||Prescription required|No||173|No|636.4316|07/04/2023|627.33972|07/04/2023|597.4664|07/04/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|806|||||No|No||PFIZER US PHARM|No|||||No|No|No||
axitinib|No|No|No|No|75%|00069014501|INLYTA 1 MG TABLET|180|EA|47.65176|06/15/2012||Yes|No||06/15/2012||Yes|No|06/15/2012||Yes|No||||No|No|||Prescription required|No||548|No|108.60168|07/04/2023|107.05023|07/04/2023|101.9526|07/04/2023|||ONCOLOGY: ORAL - RENAL CELL|807|||||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|142.95528|06/15/2012||Yes|No||06/15/2012||Yes|No|06/15/2012||Yes|No||||No|No|||Prescription required|No||548|No|325.80507|07/04/2023|321.15071|07/04/2023|305.85782|07/04/2023|||ONCOLOGY: ORAL - RENAL CELL|808|||||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|809|||||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|810|||||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|811|||||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|279.2506|08/23/2022||Yes|No||08/23/2022||Yes|No|08/23/2022||Yes|No||||No|No|||Prescription required|No||173|No|636.4316|07/04/2023|627.33972|07/04/2023|597.4664|07/04/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|812|||||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|80.02085|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|068|Yes|182.3731|07/04/2023|179.76777|07/04/2023|171.2074|07/04/2023|||ANTICOAGULANTS|813|||||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|129.82345|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|068|Yes|295.8767|07/04/2023|291.64989|07/04/2023|277.7618|07/04/2023|||ANTICOAGULANTS|814|||||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|815|||||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|129.8385|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|068|Yes|295.911|07/04/2023|291.6837|07/04/2023|277.794|07/04/2023|||ANTICOAGULANTS|816|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069021702|FRAGMIN 10,000 UNIT/ML SYRINGE|1|ML|51.92981|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|068|Yes|118.35166|07/04/2023|116.66092|07/04/2023|111.10564|07/04/2023|||ANTICOAGULANTS|817|||||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|129.8342|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|068|Yes|295.9012|07/04/2023|291.67404|07/04/2023|277.7848|07/04/2023|||ANTICOAGULANTS|818|||||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|129.8256|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|068|Yes|295.8816|07/04/2023|291.65472|07/04/2023|277.7664|07/04/2023|||ANTICOAGULANTS|819|||||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|820|||||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|129.82595|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|068|Yes|295.88241|07/04/2023|291.65552|07/04/2023|277.76716|07/04/2023|||ANTICOAGULANTS|821|||||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|822|||||No|No||PFIZER US PHARM|No|||||No|No|No||
dalteparin sodium,porcine|No|No|No|No|75%|00069023201|FRAGMIN 95,000 UNIT/3.8 ML VL|3.8|ML|117.46355|09/24/2015||Yes|No||09/24/2015||Yes|No|09/24/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|068|Yes|267.70762|07/04/2023|263.88323|07/04/2023|251.31736|07/04/2023|||ANTICOAGULANTS|823|||||No|No||PFIZER US PHARM|No|||||No|No|No||
abrocitinib|No|No|No|No|75%|00069023530|CIBINQO 50 MG TABLET|30|EA|75.99834|03/29/2023||Yes|No||03/29/2023||Yes|No|03/29/2023||Yes|No||||No|No|||Prescription required|Yes|01/26/2023|071|Yes|173.20552|03/29/2023|170.73115|03/29/2023|162.6011|03/29/2023|||CYTOKINE AND CAM ANTAGONISTS|824|||||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|12.03421|03/28/2023|11.74538|03/28/2023|11.82361|03/28/2023|||BLADDER RELAXANT PREPARATIONS|825|||||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|11.95955|03/28/2023|11.67252|03/28/2023|11.75025|03/28/2023|||BLADDER RELAXANT PREPARATIONS|826|||||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|827|||||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|828|||||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|829|||||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|830|||||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|831|||||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|832|||||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|833|||||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|834|||||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|835|||||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|836|||||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|837|||||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|838|||||No|No||PFIZER US PHARM|No|||||No|No|No||
abrocitinib|No|No|No|No|75%|00069033530|CIBINQO 100 MG TABLET|30|EA|75.99834|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|Yes|01/26/2023|071|Yes|173.20552|08/01/2023|170.73115|08/01/2023|162.6011|08/01/2023|||CYTOKINE AND CAM ANTAGONISTS|839|||||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|840|||||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||841|||||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||842|||||No|No||PFIZER US PHARM|No|||||No|No|No||
abrocitinib|No|No|No|No|75%|00069043530|CIBINQO 200 MG TABLET|30|EA|75.99834|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|Yes|01/26/2023|071|Yes|173.20552|08/01/2023|170.73115|08/01/2023|162.6011|08/01/2023|||CYTOKINE AND CAM ANTAGONISTS|843|||||No|No||PFIZER US PHARM|No|||||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|8.21309|03/28/2023|8.09576|03/28/2023|7.71025|03/28/2023|||SMOKING CESSATION|844|||||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|8.67798|03/28/2023|8.55401|03/28/2023|8.14668|03/28/2023|||SMOKING CESSATION|845|||||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|846|||||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|847|||||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|848|||||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|849|||||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|850|||||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|851|||||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|852|||||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|853|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|854|||||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|855|||||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|856|||||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|857|||||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|858|||||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||859|||||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||860|||||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||861|||||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||862|||||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|863|||||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|864|||||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|865|||||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|866|||||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|867|||||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|868|||||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|869|||||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|870|||||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|871|||||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|872|||||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|873|||||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|874|||||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|875|||||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|876|||||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|877|||||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|878|||||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|879|||||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|880|||||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|881|||||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|882|||||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||||883|||||No|No||PFIZER US PHARM|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|08/08/2024|Yes|No||02/01/2005|08/08/2024|Yes|No|02/01/2005|08/08/2024|Yes|No||02/01/2005|08/08/2024|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|884|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|885|||||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|886|||||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|887|||||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|888|||||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|889|||||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|890|||||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|891|||||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|892|||||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|2.11733|03/28/2023|2.08709|03/28/2023|1.9877|03/28/2023|||MACROLIDES/KETOLIDES|893|||||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|894|||||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|895|||||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|09/30/2023|Yes|No||11/17/2005|09/30/2023|Yes|No|11/17/2005|09/30/2023|Yes|No||11/17/2005|09/30/2023|Yes|No|11/01/2012|09/30/2023|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|896|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|897|||||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|898|||||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|899|||||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|900|||||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||||901|||||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|902|||||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|903|||||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|904|||||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||||905|||||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||||906|||||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||||907|||||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|908|||||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|909|||||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||||910|||||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||||911|||||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||||912|||||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||||913|||||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||||914|||||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||||915|||||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|916|||||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|917|||||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||||918|||||No|No||PFIZER US PHARM|No|||||No|No|Yes|03/30/2023|
phenytoin|No|No|No|No|75%|00071000724|DILANTIN 50 MG INFATAB|100|EA|.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|919|||||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|920|||||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|16.88355|10/24/2023|16.47834|10/24/2023|16.58808|10/24/2023|||LIPOTROPICS: STATINS|921|||||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|922|||||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|923|||||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|924|||||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|925|||||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|926|||||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|1.53698|10/24/2023|1.50009|10/24/2023|1.51008|10/24/2023|||ANTICONVULSANTS|927|||||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|1.53698|10/24/2023|1.50009|10/24/2023|1.51008|10/24/2023|||ANTICONVULSANTS|928|||||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|929|||||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||||930|||||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||||931|||||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||||932|||||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||||933|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
methsuximide|No|No|No|No|75%|00071052524|CELONTIN 300 MG CAPSULE|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|934|||||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|935|||||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|936|||||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|937|||||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|938|||||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|939|||||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|940|||||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|941|||||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|942|||||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|943|||||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||09/13/2005||Yes|No|||Prescription required|No||232|No|9.44512|01/10/2023|9.31019|01/10/2023|8.86684|01/10/2023|||NEUROPATHIC PAIN|944|||||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||09/13/2005||Yes|No|||Prescription required|No||232|No|9.2326|01/17/2023|9.01101|01/17/2023|9.07102|01/17/2023|||NEUROPATHIC PAIN|945|||||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||09/13/2005||Yes|No|||Prescription required|No||232|No|9.25441|10/24/2023|9.0323|10/24/2023|9.09245|10/24/2023|||NEUROPATHIC PAIN|946|||||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||05/29/2007||Yes|No|||Prescription required|No||232|No|9.25966|10/24/2023|9.03742|10/24/2023|9.09761|10/24/2023|||NEUROPATHIC PAIN|947|||||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||05/29/2007||Yes|No|||Prescription required|No||232|No|9.2286|10/24/2023|9.00711|10/24/2023|9.06709|10/24/2023|||NEUROPATHIC PAIN|948|||||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||05/29/2007||Yes|No|||Prescription required|No||232|No|9.22228|10/24/2023|9.00094|10/24/2023|9.06089|10/24/2023|||NEUROPATHIC PAIN|949|||||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||06/06/2023||Yes|No|||Prescription required|No||232|No|9.26519|01/17/2023|9.04282|01/17/2023|9.10304|01/17/2023|||NEUROPATHIC PAIN|950|||||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||05/29/2007||Yes|No|||Prescription required|No||232|No|9.25431|01/17/2023|9.0322|01/17/2023|9.09235|01/17/2023|||NEUROPATHIC PAIN|951|||||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||09/14/2018||Yes|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|952|||||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||07/19/2018||Yes|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|953|||||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||07/19/2018||Yes|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|954|||||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||07/19/2018||Yes|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|955|||||No|No||PFIZER/VIATRIS|No|||||No|No|No||
gabapentin|No|No|No|No|75%|00071201247|NEURONTIN 250 MG/5 ML SOLUTION|470|ML|.4479|02/21/2023||Yes|No||02/21/2023||Yes|No|02/21/2023||Yes|No||02/21/2023||Yes|No|||Prescription required|Yes|07/28/2022|232|Yes|1.02079|01/10/2023|1.00621|01/10/2023|.95829|01/10/2023|||NEUROPATHIC PAIN|956|||||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|957|||||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|958|||||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|37.95256|10/24/2023|37.04169|10/24/2023|37.28839|10/24/2023|||UTERINE DISORDER TREATMENTS|959|||||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|18.8742|10/24/2023|18.42121|10/24/2023|18.5439|10/24/2023|||UTERINE DISORDER TREATMENTS|960|||||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|961|||||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|6721.879|06/27/2023|6560.5539|06/27/2023|6604.24611|06/27/2023|||CYTOKINE AND CAM ANTAGONISTS|962|||||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|963|||||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|964|||||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|965|||||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|966|||||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|967|||||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|968|||||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|969|||||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|970|||||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|971|||||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|972|||||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|973|||||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|974|||||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|975|||||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|976|||||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|977|||||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|978|||||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|8.43867|09/28/2020||Yes|No||09/28/2020||Yes|No|09/28/2020||Yes|No||||No|No|||Prescription required|No||577|No|18.71446|06/27/2023|18.26531|06/27/2023|18.38695|06/27/2023|||UTERINE DISORDER TREATMENTS|979|||||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|980|||||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|981|||||No|No||ABBVIE US LLC|No|||||No|No|No||
risankizumab-rzaa|No|No|No|No|75%|00074106501|SKYRIZI 180 MG/1.2 ML ON-BODY|1.2|ML|7071.56858|05/04/2023||Yes|No||05/04/2023||Yes|No|05/04/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|071|Yes|16116.59816|05/04/2023|15886.36104|05/04/2023|15129.86766|05/04/2023|||CYTOKINE AND CAM ANTAGONISTS|982|||||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|Yes|07/27/2023|071|Yes|8058.29907|01/10/2023|7943.18051|01/10/2023|7564.93382|01/10/2023|||CYTOKINE AND CAM ANTAGONISTS|983|||||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|984|||||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|985|||||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||||986|||||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||||987|||||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|988|||||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|989|||||No|No||ABBVIE US LLC|No|||||No|No|No||
ritonavir|No|No|No|No|75%|00074234030|NORVIR 100 MG TABLET|30|EA|5.14339|09/19/2023||Yes|No||09/19/2023||Yes|No|09/19/2023||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|8.40088|09/19/2023|8.28087|09/19/2023|7.88654|09/19/2023|||HIV / AIDS|990|||||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||||991|||||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|992|||||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|993|||||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|152.56411|07/25/2023|148.90257|07/25/2023|149.89423|07/25/2023|||HEPATITIS C AGENTS|994|||||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|995|||||No|No||ABBVIE US LLC|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00074302313|K-TAB ER 20 MEQ TABLET|100|EA|.35634|04/23/2014|02/15/2025|Yes|No||04/23/2014|02/15/2025|Yes|No|04/23/2014|02/15/2025|Yes|No||||No|No|||Prescription required|No|||No|.81212|05/26/2020|.80052|05/26/2020|.7624|05/26/2020||||996|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|997|||||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|998|||||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|999|||||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|1000|||||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|1001|||||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|1002|||||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|1003|||||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|10/26/2023|Yes|No||03/02/2020|10/26/2023|Yes|No|03/02/2020|10/26/2023|Yes|No||||No|No|||Prescription required|No|||No|.82163|03/02/2020|.80989|03/02/2020|.77132|03/02/2020||||1004|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|11/04/2023|Yes|No||03/02/2020|11/04/2023|Yes|No|03/02/2020|11/04/2023|Yes|No||||No|No|||Prescription required|No|||No|.78054|03/02/2020|.76939|03/02/2020|.73275|03/02/2020||||1005|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|05/05/2024|Yes|No||02/24/2010|05/05/2024|Yes|No|02/24/2010|05/05/2024|Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|8.40088|04/25/2023|8.28087|04/25/2023|7.88654|04/25/2023|||HIV / AIDS|1006|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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||||1007|||||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|1008|||||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||||1009|||||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||||1010|||||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||||1011|||||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||||1012|||||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||||1013|||||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|1.43921|10/24/2023|1.40466|10/24/2023|1.41402|10/24/2023||||1014|||||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|1.43921|10/24/2023|1.40466|10/24/2023|1.41402|10/24/2023||||1015|||||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||||1016|||||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|1017|||||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|1018|||||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|1019|||||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|1020|||||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|1021|||||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|1022|||||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|1.44025|10/24/2023|1.40568|10/24/2023|1.41504|10/24/2023||||1023|||||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|1.44025|10/24/2023|1.40568|10/24/2023|1.41504|10/24/2023||||1024|||||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|1.4417|10/24/2023|1.40709|10/24/2023|1.41647|10/24/2023||||1025|||||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|1.4417|10/24/2023|1.40709|10/24/2023|1.41647|10/24/2023||||1026|||||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|1.44184|10/24/2023|1.40723|10/24/2023|1.4166|10/24/2023||||1027|||||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|1.44184|10/24/2023|1.40723|10/24/2023|1.4166|10/24/2023||||1028|||||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|1.70912|10/24/2023|1.6681|10/24/2023|1.67921|10/24/2023|||ANTICONVULSANTS|1029|||||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|1030|||||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|1031|||||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|6.48194|10/24/2023|6.32637|10/24/2023|6.3685|10/24/2023|||ANTICONVULSANTS|1032|||||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|1.44178|10/24/2023|1.40717|10/24/2023|1.41654|10/24/2023||||1033|||||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|1.44178|10/24/2023|1.40717|10/24/2023|1.41654|10/24/2023||||1034|||||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|1.43882|10/24/2023|1.40428|10/24/2023|1.41364|10/24/2023||||1035|||||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|1.43882|10/24/2023|1.40428|10/24/2023|1.41364|10/24/2023||||1036|||||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|1037|||||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|1.44014|10/24/2023|1.40557|10/24/2023|1.41493|10/24/2023||||1038|||||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|1.44014|10/24/2023|1.40557|10/24/2023|1.41493|10/24/2023||||1039|||||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|1.43945|10/24/2023|1.4049|10/24/2023|1.41425|10/24/2023||||1040|||||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|1.43945|10/24/2023|1.4049|10/24/2023|1.41425|10/24/2023||||1041|||||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|1.43613|10/24/2023|1.40166|10/24/2023|1.41099|10/24/2023||||1042|||||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|1.43613|10/24/2023|1.40166|10/24/2023|1.41099|10/24/2023||||1043|||||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|33.2544|10/24/2023|32.45629|10/24/2023|32.67244|10/24/2023|||ANTIMIGRAINE AGENTS: OTHER|1044|||||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|33.204|10/24/2023|32.4071|10/24/2023|32.62293|10/24/2023|||ANTIMIGRAINE AGENTS: OTHER|1045|||||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|33.20288|10/24/2023|32.40601|10/24/2023|32.62182|10/24/2023|||ANTIMIGRAINE AGENTS: OTHER|1046|||||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|1047|||||No|No||ABBVIE US LLC|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00074709806|VUITY 1.25% EYE DROP|5|ML|9.60018|09/19/2023||Yes|No||09/19/2023||Yes|No|09/19/2023||Yes|No||||No|No|||Prescription required|Yes|01/27/2022|088|No|21.87948|09/19/2023|21.56691|09/19/2023|20.53992|09/19/2023|||OPHTHALMICS: GLAUCOMA AGENTS|1048|||||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|1.44239|10/24/2023|1.40777|10/24/2023|1.41714|10/24/2023||||1049|||||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|1.44239|10/24/2023|1.40777|10/24/2023|1.41714|10/24/2023||||1050|||||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||||1051|||||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||||1052|||||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|1053|||||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|1.7901|03/28/2023|1.74713|03/28/2023|1.75877|03/28/2023|||ANTICONVULSANTS|1054|||||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|6.48194|10/24/2023|6.32637|10/24/2023|6.3685|10/24/2023|||ANTICONVULSANTS|1055|||||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|1056|||||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|1057|||||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|02/20/2024|Yes|No||03/01/2002|02/20/2024|Yes|No|03/01/2002|02/20/2024|Yes|No||03/01/2002|02/20/2024|Yes|No|||Prescription required|No|||No|.82163|11/28/2017|.80989|11/28/2017|.77132|11/28/2017||||1058|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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|02/20/2024|Yes|No||03/01/2002|02/20/2024|Yes|No|03/01/2002|02/20/2024|Yes|No||03/01/2002|02/20/2024|Yes|No|||Prescription required|No|||No|.78054|11/28/2017|.76939|11/28/2017|.73275|11/28/2017||||1059|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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||||1060|||||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||||1061|||||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|1.43917|10/24/2023|1.40462|10/24/2023|1.41398|10/24/2023||||1062|||||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|1.43917|10/24/2023|1.40462|10/24/2023|1.41398|10/24/2023||||1063|||||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||||1064|||||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|1065|||||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|1066|||||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|1067|||||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|1068|||||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|1069|||||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|1070|||||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|1071|||||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|1072|||||No|No||SANOFI-AVENTIS|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00078011022|SANDIMMUNE 100 MG/ML SOLN|50|ML|7.0446|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|16.05514|07/11/2023|15.82578|07/11/2023|15.07217|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1073|||||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||||1074|||||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||||1075|||||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||||1076|||||No|No||NOVARTIS|No|||||No|No|No||
cyclosporine|No|No|No|No|75%|00078024015|SANDIMMUNE 25 MG CAPSULE|30|EA|1.81746|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|4.14212|07/11/2023|4.08295|07/11/2023|3.88852|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1077|||||No|No||NOVARTIS|No|||||Yes|No|No||
cyclosporine|No|No|No|No|75%|00078024115|SANDIMMUNE 100 MG CAPSULE|30|EA|7.2541|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|16.5326|07/11/2023|16.29642|07/11/2023|15.5204|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1078|||||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|1079|||||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|1080|||||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|1081|||||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|1082|||||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|1083|||||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|1084|||||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|1085|||||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||||1086|||||No|No||NOVARTIS/SANDOZ|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|17.61604|10/24/2023|17.19325|10/24/2023|17.30775|10/24/2023||||1087|||||No|No||NOVARTIS/SANDOZ|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|1088|||||No|No||NOVARTIS/SANDOZ|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|1.77459|10/24/2023|1.73199|10/24/2023|1.74353|10/24/2023|||ANTICONVULSANTS|1089|||||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|1090|||||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|9.35418|10/24/2023|9.12967|10/24/2023|9.19048|10/24/2023|||ANGIOTENSIN MODULATORS|1091|||||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|1092|||||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|1093|||||No|No||NOVARTIS/SANDOZ|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|1094|||||No|No||NOVARTIS/SANDOZ|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|1095|||||No|No||NOVARTIS/SANDOZ|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|1096|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
amlodipine besylate/benazepril|No|No|No|No|75%|00078037905|LOTREL 10-40 MG CAPSULE|100|EA|6.36804|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|1097|||||No|No||NOVARTIS/SANDOZ|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|1098|||||No|No||NOVARTIS/SANDOZ|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|1099|||||No|No||NOVARTIS/SANDOZ|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|1.33519|10/24/2023|1.30314|10/24/2023|1.31182|10/24/2023|||STIMULANTS AND RELATED AGENTS|1100|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
valsartan/hydrochlorothiazide|No|No|No|No|75%|00078038334|DIOVAN HCT 160-25 MG TABLET|90|EA|5.40768|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|1101|||||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|1102|||||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|1103|||||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|1104|||||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|1105|||||No|No||NOVARTIS/SANDOZ|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|1106|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
everolimus|No|No|No|No|75%|00078041420|ZORTRESS 0.5 MG TABLET|60|EA|8.71194|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|19.85512|07/11/2023|19.57147|07/11/2023|18.6395|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1107|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041461|ZORTRESS 0.5 MG TABLET|1|EA|8.729|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|19.894|07/11/2023|19.6098|07/11/2023|18.676|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1108|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041520|ZORTRESS 0.75 MG TABLET|60|EA|13.06791|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|29.78269|07/11/2023|29.35722|07/11/2023|27.95926|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1109|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041561|ZORTRESS 0.75 MG TABLET|1|EA|13.0806|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|29.8116|07/11/2023|29.38572|07/11/2023|27.9864|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1110|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041720|ZORTRESS 0.25 MG TABLET|60|EA|4.35596|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|9.92755|07/11/2023|9.78573|07/11/2023|9.31974|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1111|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078041761|ZORTRESS 0.25 MG TABLET|1|EA|4.3559|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|9.9274|07/11/2023|9.78558|07/11/2023|9.3196|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1112|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078042220|ZORTRESS 1 MG TABLET|60|EA|17.42395|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|39.71041|07/11/2023|39.14312|07/11/2023|37.27916|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1113|||||No|No||NOVARTIS|No|||||Yes|No|No||
everolimus|No|No|No|No|75%|00078042261|ZORTRESS 1 MG TABLET|1|EA|17.4193|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|39.6998|07/11/2023|39.13266|07/11/2023|37.2692|07/11/2023|||IMMUNOSUPPRESSIVES: ORAL|1114|||||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|1115|||||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|1116|||||No|No||NOVARTIS/SANDOZ|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|13.05908|10/24/2023|12.74566|10/24/2023|12.83054|10/24/2023|||STIMULANTS AND RELATED AGENTS|1117|||||No|No||NOVARTIS/SANDOZ|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|13.19549|10/24/2023|12.87879|10/24/2023|12.96456|10/24/2023|||STIMULANTS AND RELATED AGENTS|1118|||||No|No||NOVARTIS/SANDOZ|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|13.58671|10/24/2023|13.26062|10/24/2023|13.34894|10/24/2023|||STIMULANTS AND RELATED AGENTS|1119|||||No|No||NOVARTIS/SANDOZ|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|13.07031|10/24/2023|12.75662|10/24/2023|12.84157|10/24/2023|||STIMULANTS AND RELATED AGENTS|1120|||||No|No||NOVARTIS/SANDOZ|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|1121|||||No|No||NOVARTIS/SANDOZ|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|.72668|07/25/2023|.70923|07/25/2023|.71396|07/25/2023|||STIMULANTS AND RELATED AGENTS|1122|||||No|No||NOVARTIS/SANDOZ|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|1.04166|10/24/2023|1.01666|10/24/2023|1.02343|10/24/2023|||STIMULANTS AND RELATED AGENTS|1123|||||No|No||NOVARTIS/SANDOZ|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|1.48605|10/24/2023|1.45038|10/24/2023|1.46004|10/24/2023|||STIMULANTS AND RELATED AGENTS|1124|||||No|No||NOVARTIS/SANDOZ|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|1125|||||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|1126|||||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||||1127|||||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||||1128|||||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||||1129|||||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||||1130|||||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|1131|||||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|1132|||||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|1133|||||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|1134|||||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|1135|||||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|1136|||||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|13.56287|10/24/2023|13.23736|10/24/2023|13.32551|10/24/2023|||STIMULANTS AND RELATED AGENTS|1137|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00078050115|EXELON 4.6 MG/24HR PATCH|30|EA|9.83266|09/14/2007||Yes|No||09/14/2007||Yes|No|09/14/2007||Yes|No||||No|No|||Prescription required|No||011|No|22.117|02/28/2023|21.58619|02/28/2023|21.72995|02/28/2023|||ALZHEIMER'S AGENTS|1138|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00078050215|EXELON 9.5 MG/24HR PATCH|30|EA|9.83266|09/14/2007||Yes|No||09/14/2007||Yes|No|09/14/2007||Yes|No||||No|No|||Prescription required|No||011|No|22.06757|03/28/2023|21.53794|03/28/2023|21.68138|03/28/2023|||ALZHEIMER'S AGENTS|1139|||||No|No||NOVARTIS/SANDOZ|No|||||No|No|No||
rivastigmine|No|No|No|No|75%|00078050315|EXELON 13.3 MG/24HR PATCH|30|EA|9.83266|02/07/2013||Yes|No||02/07/2013||Yes|No|02/07/2013||Yes|No||||No|No|||Prescription required|No||011|No|22.40932|05/24/2022|22.08919|05/24/2022|21.03732|05/24/2022|||ALZHEIMER'S AGENTS|1140|||||No|No||NOVARTIS/SANDOZ|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|1141|||||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|2.81772|10/24/2023|2.75009|10/24/2023|2.7684|10/24/2023|||ANTICONVULSANTS|1142|||||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|1.50008|10/24/2023|1.46407|10/24/2023|1.47382|10/24/2023|||ANTICONVULSANTS|1143|||||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|3.00354|10/24/2023|2.93145|10/24/2023|2.95097|10/24/2023|||ANTICONVULSANTS|1144|||||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|6.0472|10/24/2023|5.90206|10/24/2023|5.94137|10/24/2023|||ANTICONVULSANTS|1145|||||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|1146|||||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|1147|||||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|1148|||||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|1149|||||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|1150|||||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|1151|||||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|1152|||||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|1153|||||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|1154|||||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|14.30436|10/24/2023|13.96105|10/24/2023|14.05403|10/24/2023|||STIMULANTS AND RELATED AGENTS|1155|||||No|No||NOVARTIS/SANDOZ|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|1156|||||No|No||NOVARTIS/SANDOZ|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|1157|||||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|1158|||||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|1159|||||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|1160|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063941|COSENTYX SNRDY 300MG DOSE-2PEN|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|1161|||||No|No||NOVARTIS|No|||||No|No|No||
secukinumab|No|No|No|No|75%|00078063968|COSENTYX SENSOREADY 150 MG PEN|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|1162|||||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|1163|||||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|1164|||||No|No||NOVARTIS|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00078064930|GLEEVEC 400 MG TABLET|30|EA|145.08816|03/09/2015||Yes|No||03/09/2015||Yes|No|03/09/2015||Yes|No||||No|No|||Prescription required|No||173|No|330.66604|09/28/2021|325.94224|09/28/2021|310.42118|09/28/2021|||ONCOLOGY: ORAL - HEMATOLOGIC|1165|||||No|No||NOVARTIS|No|||||No|No|No||
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||||1166|||||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||||1167|||||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||||1168|||||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|10.67754|10/24/2023|10.42127|10/24/2023|10.49068|10/24/2023|||ANGIOTENSIN MODULATORS|1169|||||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|10.67754|10/24/2023|10.42127|10/24/2023|10.49068|10/24/2023|||ANGIOTENSIN MODULATORS|1170|||||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|1171|||||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|1172|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|1173|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|1174|||||No|No||NOVARTIS|No|||||No|No|No||
topotecan HCl|No|No|No|No|75%|00078067201|HYCAMTIN 0.25 MG CAPSULE|10|EA|47.49006|08/21/2023||Yes|No||08/21/2023||Yes|No|08/21/2023||Yes|No||||No|No|||Prescription required|No||551|No|108.23316|08/21/2023|106.68697|08/21/2023|101.60664|08/21/2023|||ONCOLOGY: ORAL - LUNG|1175|||||No|No||NOVARTIS/SANDOZ|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|1176|||||No|No||NOVARTIS/SANDOZ|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|1177|||||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|1178|||||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|1179|||||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|1180|||||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|1181|||||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|1182|||||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|1183|||||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|10.67728|10/24/2023|10.42102|10/24/2023|10.49042|10/24/2023|||ANGIOTENSIN MODULATORS|1184|||||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|10.67728|10/24/2023|10.42102|10/24/2023|10.49042|10/24/2023|||ANGIOTENSIN MODULATORS|1185|||||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|1186|||||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|1187|||||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|1188|||||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|1189|||||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|1190|||||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|1191|||||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||||1192|||||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|1193|||||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|1194|||||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||||1195|||||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|34.48643|05/23/2023|33.65875|05/23/2023|33.88291|05/23/2023|||OPHTHALMICS: GLAUCOMA AGENTS|1196|||||No|No||NOVARTIS/SANDOZ|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||||1197|||||No|No||NOVARTIS|No|||||No|No|No||
canakinumab/PF|No|No|No|No|75%|00078073461|ILARIS 150 MG/ML VIAL|1|ML|7660.6736|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|17459.2096|07/11/2023|17209.79232|07/11/2023|16390.2784|07/11/2023|||CYTOKINE AND CAM ANTAGONISTS|1198|||||No|No||NOVARTIS|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|10.67489|10/24/2023|10.41869|10/24/2023|10.48807|10/24/2023|||ANGIOTENSIN MODULATORS|1199|||||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|10.67489|10/24/2023|10.41869|10/24/2023|10.48807|10/24/2023|||ANGIOTENSIN MODULATORS|1200|||||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|31.85482|08/29/2023|31.0903|08/29/2023|31.29736|08/29/2023|||OTIC ANTIBIOTICS|1201|||||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|1202|||||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|1907.9272|02/16/2017||Yes|No||02/16/2017||Yes|No|02/16/2017||Yes|No||||No|No|||Prescription required|No|||No|4348.2992|07/11/2023|4286.18064|07/11/2023|4082.0768|07/11/2023||||1203|||||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|2856.9802|02/16/2017||Yes|No||02/16/2017||Yes|No|02/16/2017||Yes|No||||No|No|||Prescription required|No|||No|6511.2572|07/11/2023|6418.23924|07/11/2023|6112.6088|07/11/2023||||1204|||||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|1205|||||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|1206|||||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|1207|||||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|1208|||||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|72.02429|10/24/2023|70.2957|10/24/2023|70.76386|10/24/2023|||OPHTHALMIC ANTIBIOTIC-STEROID COMBINATIONS|1209|||||No|No||NOVARTIS|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|1210|||||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|10.96169|10/24/2023|10.6986|10/24/2023|10.76986|10/24/2023|||OPHTHALMICS: ANTI-INFLAMMATORY/IMMUNOMODULATOR|1211|||||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|1212|||||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|1213|||||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|1214|||||No|No||NOVARTIS/SANDOZ|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|85.88567|10/24/2023|83.82441|10/24/2023|84.38267|10/24/2023|||OPHTHALMICS: GLAUCOMA AGENTS|1215|||||No|No||NOVARTIS/SANDOZ|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|1216|||||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|1217|||||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|1218|||||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|1219|||||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|1220|||||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|1221|||||No|No||NOVARTIS|No|||||No|No|Yes|03/30/2023|
alpelisib|No|No|No|No|75%|00078102184|VIJOICE 50 MG TABLET|28|EA|499.10714|10/31/2022||Yes|No||10/31/2022||Yes|No|10/31/2022||Yes|No||||No|No|||Prescription required|No|||No|1137.49999|10/11/2022|1121.24999|10/11/2022|1067.85713|10/11/2022||||1222|||||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||||1223|||||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||||1224|||||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|1225|||||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|1226|||||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|1227|||||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|1228|||||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|1229|||||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|1230|||||No|No||NOVARTIS|No|||||No|No|No||
dabrafenib mesylate|No|No|No|No|75%|00078115421|TAFINLAR 10 MG TABLET FOR SUSP|210|EA|7.50098|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription required|No|||No|17.09525|09/12/2023|16.85103|09/12/2023|16.0486|09/12/2023||||1231|||||No|No||NOVARTIS|No|||||No|No|No||
trametinib dimethyl sulfoxide|No|No|No|No|75%|00078116147|MEKINIST 0.05 MG/ML SOLUTION|90|ML|7.40067|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription required|No|||No|16.86666|08/01/2023|16.62571|08/01/2023|15.834|08/01/2023||||1232|||||No|No||NOVARTIS|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00085132801|NOXAFIL 40 MG/ML SUSPENSION|105|ML|5.8953|08/17/2009||Yes|No||08/17/2009||Yes|No|08/17/2009||Yes|No||||No|No|||Prescription required|Yes|07/18/2006|069|No|13.4358|01/28/2020|13.24386|01/28/2020|12.6132|01/28/2020|||ANTIFUNGALS: ORAL|1233|||||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|1234|||||No|No||MERCK SHARP & D|Yes|09/01/2020||||No|No|No||
temozolomide|No|No|No|No|75%|00085142504|TEMODAR 140 MG CAPSULE|14|EA|274.2712|01/25/2013||Yes|No||01/25/2013||Yes|No|01/25/2013||Yes|No||||No|No|||Prescription required|No||239|No|625.0832|01/16/2018|616.15344|01/16/2018|586.8128|01/16/2018|||ONCOLOGY: ORAL - OTHER|1235|||||No|No||MERCK SHARP & D|No|||||Yes|No|No||
posaconazole|No|No|No|No|75%|00085222402|NOXAFIL 300 MG POWDERMIX SUSP|8|EA|88.4037|04/26/2023||Yes|No||04/26/2023||Yes|No|04/26/2023||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|069|No|201.4782|04/26/2023|198.59994|04/26/2023|189.1428|04/26/2023|||ANTIFUNGALS: ORAL|1236|||||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|1237|||||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||||1238|||||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||||1239|||||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|4.41775|10/24/2023|4.31172|10/24/2023|4.34043|10/24/2023||||1240|||||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||||1241|||||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||||1242|||||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|28.02593|10/24/2023|27.3533|10/24/2023|27.53547|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1243|||||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|27.99978|10/24/2023|27.32778|10/24/2023|27.50978|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1244|||||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|1245|||||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|35.078|05/23/2023|34.23612|05/23/2023|34.46413|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1246|||||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|11/30/2023|Yes|No||01/05/2018|11/30/2023|Yes|No|01/05/2018|11/30/2023|Yes|No||01/05/2018|11/30/2023|Yes|No|||Prescription required|No||029|No|28.02593|10/24/2023|27.3533|10/24/2023|27.53547|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1247|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|06/28/2024|Yes|No||01/05/2018|06/28/2024|Yes|No|01/05/2018|06/28/2024|Yes|No||01/05/2018|06/28/2024|Yes|No|||Prescription required|No||029|No|27.99978|10/24/2023|27.32778|10/24/2023|27.50978|10/24/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|1248|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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|.3006|10/24/2023|.29338|10/24/2023|.29533|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1249|||||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|.89314|04/25/2023|.8717|04/25/2023|.87751|04/25/2023|||ANGIOTENSIN MODULATORS|1250|||||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|.27495|10/24/2023|.26835|10/24/2023|.27013|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1251|||||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|.27495|10/24/2023|.26835|10/24/2023|.27013|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1252|||||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|.01726|10/24/2023|.01684|10/24/2023|.01695|10/24/2023|||BETA-BLOCKERS|1253|||||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|.01726|10/24/2023|.01684|10/24/2023|.01695|10/24/2023|||BETA-BLOCKERS|1254|||||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|.02497|10/24/2023|.02437|10/24/2023|.02453|10/24/2023|||ANXIOLYTICS|1255|||||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|.03365|10/24/2023|.03284|10/24/2023|.03306|10/24/2023|||ANXIOLYTICS|1256|||||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|.03046|10/24/2023|.02972|10/24/2023|.02992|10/24/2023|||ANALGESICS: NARCOTICS SHORT|1257|||||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|.03046|10/24/2023|.02972|10/24/2023|.02992|10/24/2023|||ANALGESICS: NARCOTICS SHORT|1258|||||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|.03309|10/24/2023|.03229|10/24/2023|.03251|10/24/2023|||SEDATIVE HYPNOTICS|1259|||||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|.03531|10/24/2023|.03446|10/24/2023|.03469|10/24/2023|||SEDATIVE HYPNOTICS|1260|||||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|.11345|10/24/2023|.11072|10/24/2023|.11146|10/24/2023|||ANTICONVULSANTS|1261|||||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|.11345|10/24/2023|.11072|10/24/2023|.11146|10/24/2023|||ANTICONVULSANTS|1262|||||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|.11345|10/24/2023|.11072|10/24/2023|.11146|10/24/2023|||ANTICONVULSANTS|1263|||||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|.01967|10/24/2023|.01919|10/24/2023|.01932|10/24/2023|||BETA-BLOCKERS|1264|||||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|.01967|10/24/2023|.01919|10/24/2023|.01932|10/24/2023|||BETA-BLOCKERS|1265|||||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|.4538|10/24/2023|.4429|10/24/2023|.44585|10/24/2023|||STEROIDS: TOPICAL HIGH|1266|||||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|.34251|10/24/2023|.33428|10/24/2023|.33651|10/24/2023|||STEROIDS: TOPICAL HIGH|1267|||||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|.34352|10/24/2023|.33527|10/24/2023|.3375|10/24/2023|||STEROIDS: TOPICAL HIGH|1268|||||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|1269|||||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|.98993|10/24/2023|.96617|10/24/2023|.9726|10/24/2023|||STEROIDS: TOPICAL HIGH|1270|||||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|.88407|06/27/2023|.86285|06/27/2023|.86859|06/27/2023|||STEROIDS: TOPICAL HIGH|1271|||||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|.31425|10/24/2023|.3067|10/24/2023|.30875|10/24/2023|||STEROIDS: TOPICAL HIGH|1272|||||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|.42731|10/24/2023|.41705|10/24/2023|.41983|10/24/2023|||STEROIDS: TOPICAL HIGH|1273|||||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|.26637|10/24/2023|.25997|10/24/2023|.2617|10/24/2023|||STEROIDS: TOPICAL HIGH|1274|||||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|.61366|06/27/2023|.59893|06/27/2023|.60292|06/27/2023|||ANTIHISTAMINES: FIRST GENERATION|1275|||||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|.2443|10/24/2023|.23843|10/24/2023|.24002|10/24/2023||||1276|||||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|.2443|10/24/2023|.23843|10/24/2023|.24002|10/24/2023||||1277|||||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|.52799|10/24/2023|.51531|10/24/2023|.51875|10/24/2023|||NSAIDS|1278|||||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|.08433|10/24/2023|.0823|10/24/2023|.08285|10/24/2023|||CALCIUM CHANNEL BLOCKERS|1279|||||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|.08433|10/24/2023|.0823|10/24/2023|.08285|10/24/2023|||CALCIUM CHANNEL BLOCKERS|1280|||||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|.15985|10/24/2023|.15601|10/24/2023|.15705|10/24/2023|||CALCIUM CHANNEL BLOCKERS|1281|||||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|.15985|10/24/2023|.15601|10/24/2023|.15705|10/24/2023|||CALCIUM CHANNEL BLOCKERS|1282|||||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|.21443|10/24/2023|.20928|10/24/2023|.21067|10/24/2023|||CALCIUM CHANNEL BLOCKERS|1283|||||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|.23519|10/24/2023|.22954|10/24/2023|.23107|10/24/2023|||CALCIUM CHANNEL BLOCKERS|1284|||||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|.04564|10/24/2023|.04454|10/24/2023|.04484|10/24/2023|||LIPOTROPICS: STATINS|1285|||||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|.40063|10/24/2023|.39101|10/24/2023|.39361|10/24/2023|||NSAIDS|1286|||||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|.40063|10/24/2023|.39101|10/24/2023|.39361|10/24/2023|||NSAIDS|1287|||||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|.02594|10/24/2023|.02531|10/24/2023|.02548|10/24/2023|||BETA-BLOCKERS|1288|||||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|.02594|10/24/2023|.02531|10/24/2023|.02548|10/24/2023|||BETA-BLOCKERS|1289|||||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|.03851|10/24/2023|.03758|10/24/2023|.03783|10/24/2023|||BETA-BLOCKERS|1290|||||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|.03851|10/24/2023|.03758|10/24/2023|.03783|10/24/2023|||BETA-BLOCKERS|1291|||||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|.16362|10/24/2023|.15969|10/24/2023|.16075|10/24/2023|||NSAIDS|1292|||||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|.23613|10/24/2023|.23046|10/24/2023|.23199|10/24/2023|||NSAIDS|1293|||||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|.23613|10/24/2023|.23046|10/24/2023|.23199|10/24/2023|||NSAIDS|1294|||||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|.06309|10/24/2023|.06157|10/24/2023|.06198|10/24/2023|||LIPOTROPICS: STATINS|1295|||||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|.25583|10/24/2023|.24969|10/24/2023|.25135|10/24/2023|||ANTICONVULSANTS|1296|||||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|.02194|10/24/2023|.02141|10/24/2023|.02155|10/24/2023|||BETA-BLOCKERS|1297|||||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|.02194|10/24/2023|.02141|10/24/2023|.02155|10/24/2023|||BETA-BLOCKERS|1298|||||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|12/31/2023|Yes|No||02/02/2021|12/31/2023|Yes|No|02/02/2021|12/31/2023|Yes|No||09/01/2022|12/31/2023|Yes|No|||Prescription required|Yes|07/28/2022|008|No|.10624|10/24/2023|.10369|10/24/2023|.10438|10/24/2023|||ANTIDEPRESSANTS: SSRIs|1299|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|.07243|10/24/2023|.07069|10/24/2023|.07116|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|1300|||||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|.08841|10/24/2023|.08628|10/24/2023|.08686|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|1301|||||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|.08841|10/24/2023|.08628|10/24/2023|.08686|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|1302|||||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|.11792|10/24/2023|.11508|10/24/2023|.11585|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|1303|||||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|.11792|10/24/2023|.11508|10/24/2023|.11585|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|1304|||||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|.15092|10/24/2023|.14729|10/24/2023|.14827|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|1305|||||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|.15092|10/24/2023|.14729|10/24/2023|.14827|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|1306|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093083201|CLONAZEPAM 0.5 MG TABLET|100|EA|.0129|09/19/2023||Yes|No||09/19/2023||Yes|No|09/19/2023||Yes|No||||No|No|||Prescription required|No||056|Yes|.02623|10/24/2023|.0256|10/24/2023|.02577|10/24/2023|||ANTICONVULSANTS|1307|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093083205|CLONAZEPAM 0.5 MG TABLET|500|EA|.0129|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||06/06/2023||Yes|No|||Prescription required|No||056|Yes|.02623|10/24/2023|.0256|10/24/2023|.02577|10/24/2023|||ANTICONVULSANTS|1308|||||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|.04377|10/24/2023|.04271|10/24/2023|.043|10/24/2023|||LIPOTROPICS: STATINS|1309|||||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|.04377|10/24/2023|.04271|10/24/2023|.043|10/24/2023|||LIPOTROPICS: STATINS|1310|||||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|.05275|10/24/2023|.05148|10/24/2023|.05182|10/24/2023|||LIPOTROPICS: STATINS|1311|||||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|.17317|10/24/2023|.16901|10/24/2023|.17013|10/24/2023|||NSAIDS|1312|||||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|.17317|10/24/2023|.16901|10/24/2023|.17013|10/24/2023|||NSAIDS|1313|||||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|.40895|10/24/2023|.39913|10/24/2023|.40179|10/24/2023|||ANTIFUNGALS: ORAL|1314|||||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|.04764|10/24/2023|.04649|10/24/2023|.0468|10/24/2023|||ANXIOLYTICS|1315|||||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|.04764|10/24/2023|.04649|10/24/2023|.0468|10/24/2023|||ANXIOLYTICS|1316|||||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|.36736|10/24/2023|.35854|10/24/2023|.36093|10/24/2023|||NSAIDS|1317|||||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|.36736|10/24/2023|.35854|10/24/2023|.36093|10/24/2023|||NSAIDS|1318|||||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|3.42727|10/24/2023|3.34501|10/24/2023|3.36729|10/24/2023|||NSAIDS|1319|||||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|3.42727|10/24/2023|3.34501|10/24/2023|3.36729|10/24/2023|||NSAIDS|1320|||||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|.18483|10/24/2023|.18039|10/24/2023|.18159|10/24/2023|||ANTIBIOTICS: TOPICAL|1321|||||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|1322|||||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|1323|||||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|1324|||||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|.09499|10/24/2023|.09271|10/24/2023|.09332|10/24/2023|||BETA-BLOCKERS|1325|||||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|.07836|10/24/2023|.07647|10/24/2023|.07698|10/24/2023|||BETA-BLOCKERS|1326|||||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|.12488|10/24/2023|.12188|10/24/2023|.12269|10/24/2023|||BETA-BLOCKERS|1327|||||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|1328|||||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|.53161|10/24/2023|.51885|10/24/2023|.5223|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1329|||||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|1.0958|10/24/2023|1.0695|10/24/2023|1.07662|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1330|||||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|1331|||||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|2.56691|07/25/2023|2.53024|07/25/2023|2.40975|07/25/2023|||NSAIDS|1332|||||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|1.21645|10/24/2023|1.18725|10/24/2023|1.19516|10/24/2023|||NSAIDS|1333|||||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|.95126|10/24/2023|.92842|10/24/2023|.93461|10/24/2023|||ONCOLOGY: ORAL - PROSTATE|1334|||||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|6.729|10/24/2023|6.5675|10/24/2023|6.61124|10/24/2023||||1335|||||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|6.76167|10/24/2023|6.59938|10/24/2023|6.64334|10/24/2023||||1336|||||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||||1337|||||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|.07171|10/24/2023|.06998|10/24/2023|.07045|10/24/2023|||PENICILLINS|1338|||||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|.07171|10/24/2023|.06998|10/24/2023|.07045|10/24/2023|||PENICILLINS|1339|||||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|.10591|10/24/2023|.10336|10/24/2023|.10405|10/24/2023|||PENICILLINS|1340|||||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|.97871|10/24/2023|.95522|10/24/2023|.96158|10/24/2023|||ANTIBIOTICS: GI|1341|||||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|.08343|10/24/2023|.08142|10/24/2023|.08196|10/24/2023|||ANTICOAGULANTS|1342|||||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|.08343|10/24/2023|.08142|10/24/2023|.08196|10/24/2023|||ANTICOAGULANTS|1343|||||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|.0866|10/24/2023|.08452|10/24/2023|.08508|10/24/2023|||ANTICOAGULANTS|1344|||||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|.0866|10/24/2023|.08452|10/24/2023|.08508|10/24/2023|||ANTICOAGULANTS|1345|||||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|.08682|10/24/2023|.08473|10/24/2023|.0853|10/24/2023|||ANTICOAGULANTS|1346|||||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|.08682|10/24/2023|.08473|10/24/2023|.0853|10/24/2023|||ANTICOAGULANTS|1347|||||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|.10294|10/24/2023|.10046|10/24/2023|.10113|10/24/2023|||ANTICOAGULANTS|1348|||||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|.09067|10/24/2023|.08849|10/24/2023|.08908|10/24/2023|||ANTICOAGULANTS|1349|||||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|.09067|10/24/2023|.08849|10/24/2023|.08908|10/24/2023|||ANTICOAGULANTS|1350|||||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|.10656|10/24/2023|.104|10/24/2023|.10469|10/24/2023|||ANTICOAGULANTS|1351|||||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|.10888|10/24/2023|.10626|10/24/2023|.10697|10/24/2023|||ANTICOAGULANTS|1352|||||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|.09211|10/24/2023|.08989|10/24/2023|.09049|10/24/2023|||ANTICOAGULANTS|1353|||||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|.09211|10/24/2023|.08989|10/24/2023|.09049|10/24/2023|||ANTICOAGULANTS|1354|||||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|.09804|10/24/2023|.09568|10/24/2023|.09632|10/24/2023|||ANTICOAGULANTS|1355|||||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|1356|||||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|1357|||||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|Yes|07/27/2023|021|Yes|138.555|10/24/2023|135.22968|10/24/2023|136.13028|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1358|||||No|No||TEVA USA|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00093201412|SUMATRIPTAN 6 MG/0.5ML AUTOINJ|.5|ML|77.0904|06/14/2017||Yes|No||06/14/2017||Yes|No|06/14/2017||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|021|Yes|63.72273|10/24/2023|62.19338|10/24/2023|62.60758|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1359|||||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|.40201|10/24/2023|.39236|10/24/2023|.39497|10/24/2023|||MACROLIDES/KETOLIDES|1360|||||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|.25715|10/24/2023|.25097|10/24/2023|.25264|10/24/2023|||MACROLIDES/KETOLIDES|1361|||||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|.29382|10/24/2023|.28676|10/24/2023|.28867|10/24/2023|||MACROLIDES/KETOLIDES|1362|||||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|.44717|10/24/2023|.43643|10/24/2023|.43934|10/24/2023|||MACROLIDES/KETOLIDES|1363|||||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|.03234|10/24/2023|.03156|10/24/2023|.03177|10/24/2023|||ANTIPSYCHOTICS|1364|||||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|.12625|10/24/2023|.12322|10/24/2023|.12404|10/24/2023||||1365|||||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|.1297|10/24/2023|.12658|10/24/2023|.12743|10/24/2023||||1366|||||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|.11677|10/24/2023|.11396|10/24/2023|.11472|10/24/2023|||BPH TREATMENTS|1367|||||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|.10556|10/24/2023|.10302|10/24/2023|.10371|10/24/2023|||BPH TREATMENTS|1368|||||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|.06695|10/24/2023|.06534|10/24/2023|.06577|10/24/2023|||BPH TREATMENTS|1369|||||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|.08822|10/24/2023|.0861|10/24/2023|.08667|10/24/2023|||BPH TREATMENTS|1370|||||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|.13423|10/24/2023|.131|10/24/2023|.13188|10/24/2023||||1371|||||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|35.25536|10/24/2023|34.40923|10/24/2023|34.63839|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|1372|||||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|.36571|10/24/2023|.35693|10/24/2023|.35931|10/24/2023||||1373|||||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|.35447|10/24/2023|.34596|10/24/2023|.34826|10/24/2023||||1374|||||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|.53478|10/24/2023|.52194|10/24/2023|.52542|10/24/2023||||1375|||||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|.04904|10/24/2023|.04786|10/24/2023|.04818|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1376|||||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|.04904|10/24/2023|.04786|10/24/2023|.04818|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1377|||||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|.04904|10/24/2023|.04786|10/24/2023|.04818|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1378|||||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|.0445|10/24/2023|.04343|10/24/2023|.04372|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1379|||||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|.0445|10/24/2023|.04343|10/24/2023|.04372|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1380|||||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|.21098|10/24/2023|.20591|10/24/2023|.20728|10/24/2023||||1381|||||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|.21098|10/24/2023|.20591|10/24/2023|.20728|10/24/2023||||1382|||||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|1383|||||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|1.99818|08/29/2023|1.95022|08/29/2023|1.96321|08/29/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1384|||||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|.1279|10/24/2023|.12483|10/24/2023|.12566|10/24/2023|||PENICILLINS|1385|||||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|.17141|10/24/2023|.16729|10/24/2023|.16841|10/24/2023|||PENICILLINS|1386|||||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|1387|||||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|.30384|10/24/2023|.29654|10/24/2023|.29852|10/24/2023|||PENICILLINS|1388|||||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|1389|||||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|2.4115|10/24/2023|2.35362|10/24/2023|2.36929|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1390|||||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|.28556|10/24/2023|.2787|10/24/2023|.28056|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1391|||||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|.33189|10/24/2023|.32392|10/24/2023|.32608|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1392|||||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|.06111|10/24/2023|.05964|10/24/2023|.06004|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1393|||||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|.05966|10/24/2023|.05822|10/24/2023|.05861|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1394|||||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|.17883|10/24/2023|.17453|10/24/2023|.1757|10/24/2023||||1395|||||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|1.13005|08/29/2023|1.10292|08/29/2023|1.11027|08/29/2023||||1396|||||No|No||TEVA USA|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00093300893|LANSOPRAZOLE DR 15 MG ODT|100|EA|5.14052|05/24/2018||Yes|No||05/24/2018||Yes|No|05/24/2018||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|03/22/2018|047|No|2.49616|10/24/2023|2.43625|10/24/2023|2.45247|10/24/2023|||PROTON PUMP INHIBITORS|1397|||||No|No||TEVA USA|No|||||No|No|No||
lansoprazole|No|No|No|No|75%|00093300993|LANSOPRAZOLE DR 30 MG ODT|100|EA|5.14052|05/24/2018||Yes|No||05/24/2018||Yes|No|05/24/2018||Yes|No||09/01/2022||Yes|No|||Prescription required|Yes|03/22/2018|047|No|3.44378|10/24/2023|3.36112|10/24/2023|3.38351|10/24/2023|||PROTON PUMP INHIBITORS|1398|||||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|1.50767|10/24/2023|1.47148|10/24/2023|1.48128|10/24/2023|||ANTIPARKINSON'S AGENTS|1399|||||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|.87979|10/24/2023|.85867|10/24/2023|.86439|10/24/2023|||ANTIPARKINSON'S AGENTS|1400|||||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|.21637|10/24/2023|.21117|10/24/2023|.21258|10/24/2023|||STIMULANTS AND RELATED AGENTS|1401|||||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|.98359|10/24/2023|.95998|10/24/2023|.96637|10/24/2023|||STIMULANTS AND RELATED AGENTS|1402|||||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|.81283|10/24/2023|.79332|10/24/2023|.7986|10/24/2023|||STIMULANTS AND RELATED AGENTS|1403|||||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|.79224|10/24/2023|.77322|10/24/2023|.77837|10/24/2023|||STIMULANTS AND RELATED AGENTS|1404|||||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|1.6251|10/24/2023|1.58609|10/24/2023|1.59666|10/24/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1405|||||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|1.6251|10/24/2023|1.58609|10/24/2023|1.59666|10/24/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1406|||||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|1407|||||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|1408|||||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|.06895|10/24/2023|.06729|10/24/2023|.06774|10/24/2023|||PENICILLINS|1409|||||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|.06895|10/24/2023|.06729|10/24/2023|.06774|10/24/2023|||PENICILLINS|1410|||||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|.10233|10/24/2023|.09987|10/24/2023|.10053|10/24/2023|||PENICILLINS|1411|||||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|.10233|10/24/2023|.09987|10/24/2023|.10053|10/24/2023|||PENICILLINS|1412|||||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|1.03651|10/24/2023|1.01163|10/24/2023|1.01837|10/24/2023||||1413|||||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|1.03651|10/24/2023|1.01163|10/24/2023|1.01837|10/24/2023||||1414|||||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|.54869|07/25/2023|.53552|07/25/2023|.53908|07/25/2023|||PENICILLINS|1415|||||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|1.04777|10/24/2023|1.02262|10/24/2023|1.02943|10/24/2023|||PENICILLINS|1416|||||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||||1417|||||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||||1418|||||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||||1419|||||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|.15506|10/24/2023|.15133|10/24/2023|.15234|10/24/2023||||1420|||||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|.09099|10/24/2023|.0888|10/24/2023|.08939|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1421|||||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|.09099|10/24/2023|.0888|10/24/2023|.08939|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1422|||||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|.14194|10/24/2023|.13853|10/24/2023|.13945|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1423|||||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|.14194|10/24/2023|.13853|10/24/2023|.13945|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1424|||||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|.50459|10/24/2023|.49247|10/24/2023|.49575|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1425|||||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|2.62769|10/24/2023|2.56462|10/24/2023|2.5817|10/24/2023|||BRONCHODILATORS: BETA AGONIST|1426|||||No|No||TEVA USA|No|||||No|No|No||
penciclovir|No|No|No|No|75%|00093318620|PENCICLOVIR 1% CREAM|5|GM|60.33416|06/07/2023||Yes|No||06/07/2023||Yes|No|06/07/2023||Yes|No||||No|No|||Prescription required|Yes|01/27/2022|123|No|107.44033|06/07/2023|104.86176|06/07/2023|105.56012|06/07/2023|||ANTIVIRALS: TOPICAL|1427|||||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|.3059|10/24/2023|.29855|10/24/2023|.30054|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1428|||||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|.3059|10/24/2023|.29855|10/24/2023|.30054|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1429|||||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|.03178|10/24/2023|.03101|10/24/2023|.03122|10/24/2023|||ANTICONVULSANTS|1430|||||No|No||TEVA USA|No|||||No|No|No||
clonazepam|No|No|No|No|75%|00093321205|CLONAZEPAM 1 MG TABLET|500|EA|.01806|09/06/2023||Yes|No||09/06/2023||Yes|No|09/06/2023||Yes|No||09/06/2023||Yes|No|||Prescription required|No||056|Yes|.03178|10/24/2023|.03101|10/24/2023|.03122|10/24/2023|||ANTICONVULSANTS|1431|||||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|.03883|10/24/2023|.03789|10/24/2023|.03815|10/24/2023|||ANTICONVULSANTS|1432|||||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|.03883|10/24/2023|.03789|10/24/2023|.03815|10/24/2023|||ANTICONVULSANTS|1433|||||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|.26576|10/24/2023|.25938|10/24/2023|.2611|10/24/2023|||ANTIFUNGALS: TOPICAL|1434|||||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|.27239|10/24/2023|.26585|10/24/2023|.26762|10/24/2023|||ANTIFUNGALS: TOPICAL|1435|||||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|.2028|10/24/2023|.19793|10/24/2023|.19925|10/24/2023|||ANTIFUNGALS: TOPICAL|1436|||||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|7.27243|10/24/2023|7.09789|10/24/2023|7.14516|10/24/2023||||1437|||||No|No||TEVA USA|No|||||No|No|No||
estradiol|No|No|No|No|75%|00093322397|ESTRADIOL 10 MCG VAGINAL INSRT|18|EA|8.34128|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription required|No|||Yes|7.27243|10/24/2023|7.09789|10/24/2023|7.14516|10/24/2023||||1438|||||No|No||TEVA USA|No|||||No|No|No||
sulfasalazine|No|No|No|No|75%|00093323401|SULFASALAZINE 500 MG TABLET|100|EA|.08019|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription required|No||010|No|.16721|10/24/2023|.16319|10/24/2023|.16428|10/24/2023|||ULCERATIVE COLITIS AGENTS|1439|||||No|No||TEVA USA|No|||||No|No|No||
sulfasalazine|No|No|No|No|75%|00093323405|SULFASALAZINE 500 MG TABLET|500|EA|.08019|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription required|No||010|No|.16721|10/24/2023|.16319|10/24/2023|.16428|10/24/2023|||ULCERATIVE COLITIS AGENTS|1440|||||No|No||TEVA USA|No|||||No|No|No||
sulfasalazine|No|No|No|No|75%|00093323410|SULFASALAZINE 500 MG TABLET|1000|EA|.08019|08/02/2023||Yes|No||08/02/2023||Yes|No|08/02/2023||Yes|No||||No|No|||Prescription required|No||010|No|.16721|10/24/2023|.16319|10/24/2023|.16428|10/24/2023|||ULCERATIVE COLITIS AGENTS|1441|||||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|43.09154|10/24/2023|42.05734|10/24/2023|42.33743|10/24/2023|||ANALGESICS: NARCOTICS LONG|1442|||||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|.20553|10/24/2023|.20059|10/24/2023|.20193|10/24/2023|||BETA-BLOCKERS|1443|||||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|.23736|10/24/2023|.23166|10/24/2023|.2332|10/24/2023|||BETA-BLOCKERS|1444|||||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|.24779|10/24/2023|.24184|10/24/2023|.24345|10/24/2023|||BETA-BLOCKERS|1445|||||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|.15085|10/24/2023|.14722|10/24/2023|.14821|10/24/2023||||1446|||||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|.33405|10/24/2023|.32603|10/24/2023|.3282|10/24/2023|||PAH AGENTS: ORAL AND INHALED|1447|||||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|.02249|10/24/2023|.02195|10/24/2023|.02209|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1448|||||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|.30739|10/24/2023|.30001|10/24/2023|.30201|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1449|||||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|.02251|10/24/2023|.02196|10/24/2023|.02211|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1450|||||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|.02251|10/24/2023|.02196|10/24/2023|.02211|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1451|||||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|.02251|10/24/2023|.02196|10/24/2023|.02211|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1452|||||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|.04018|10/24/2023|.03921|10/24/2023|.03947|10/24/2023|||ANXIOLYTICS|1453|||||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|.04018|10/24/2023|.03921|10/24/2023|.03947|10/24/2023|||ANXIOLYTICS|1454|||||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|.04018|10/24/2023|.03921|10/24/2023|.03947|10/24/2023|||ANXIOLYTICS|1455|||||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|.04298|10/24/2023|.04194|10/24/2023|.04222|10/24/2023|||ANXIOLYTICS|1456|||||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|.04298|10/24/2023|.04194|10/24/2023|.04222|10/24/2023|||ANXIOLYTICS|1457|||||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|.04298|10/24/2023|.04194|10/24/2023|.04222|10/24/2023|||ANXIOLYTICS|1458|||||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|.0753|10/24/2023|.07349|10/24/2023|.07398|10/24/2023|||ANXIOLYTICS|1459|||||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|.0753|10/24/2023|.07349|10/24/2023|.07398|10/24/2023|||ANXIOLYTICS|1460|||||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|.0753|10/24/2023|.07349|10/24/2023|.07398|10/24/2023|||ANXIOLYTICS|1461|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342810|TACROLIMUS 0.03% OINTMENT|100|GM|1.00336|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription required|No||034|Yes|.68214|10/24/2023|.66576|10/24/2023|.6702|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|1462|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342830|TACROLIMUS 0.03% OINTMENT|30|GM|1.00333|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription required|No||034|Yes|1.26748|10/24/2023|1.23706|10/24/2023|1.24529|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|1463|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342892|TACROLIMUS 0.03% OINTMENT|60|GM|1.0034|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription required|No||034|Yes|1.26722|10/24/2023|1.2368|10/24/2023|1.24504|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|1464|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342910|TACROLIMUS 0.1% OINTMENT|100|GM|1.43336|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription required|No||034|Yes|1.35891|10/24/2023|1.32629|10/24/2023|1.33512|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|1465|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342930|TACROLIMUS 0.1% OINTMENT|30|GM|1.43333|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription required|No||034|Yes|1.35716|10/24/2023|1.32458|10/24/2023|1.3334|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|1466|||||No|No||TEVA USA|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00093342992|TACROLIMUS 0.1% OINTMENT|60|GM|1.4334|06/06/2023||Yes|No||06/06/2023||Yes|No|06/06/2023||Yes|No||||No|No|||Prescription required|No||034|Yes|1.21178|10/24/2023|1.18269|10/24/2023|1.19057|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|1467|||||No|No||TEVA USA|No|||||No|No|No||
estradiol|No|No|No|No|75%|00093354143|ESTRADIOL 0.01% CREAM|42.5|GM|1.101|05/21/2018||Yes|No||05/21/2018||Yes|No|05/21/2018||Yes|No||||No|No|||Prescription required|No|||Yes|.54128|10/24/2023|.52828|10/24/2023|.5318|10/24/2023||||1468|||||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|.59633|10/24/2023|.58201|10/24/2023|.58589|10/24/2023|||STIMULANTS AND RELATED AGENTS|1469|||||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|.6786|10/24/2023|.66231|10/24/2023|.66672|10/24/2023|||STIMULANTS AND RELATED AGENTS|1470|||||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|.59776|10/24/2023|.58341|10/24/2023|.58729|10/24/2023|||STIMULANTS AND RELATED AGENTS|1471|||||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|.68847|10/24/2023|.67194|10/24/2023|.67642|10/24/2023|||STIMULANTS AND RELATED AGENTS|1472|||||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|.89273|10/24/2023|.8713|10/24/2023|.8771|10/24/2023|||STIMULANTS AND RELATED AGENTS|1473|||||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|.66564|10/24/2023|.64966|10/24/2023|.65399|10/24/2023|||STIMULANTS AND RELATED AGENTS|1474|||||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|.82451|10/24/2023|.80472|10/24/2023|.81008|10/24/2023|||STIMULANTS AND RELATED AGENTS|1475|||||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|81.975|10/24/2023|80.0076|10/24/2023|80.54043|10/24/2023||||1476|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360782|FLUTICASONE-SALMETEROL 55-14|1|EA|52.7739|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|033|Yes|107.47|10/24/2023|104.89072|10/24/2023|105.58927|10/24/2023|||GLUCOCORTICOIDS: INHALED|1477|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360882|FLUTICASONE-SALMETEROL 113-14|1|EA|52.7739|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|033|Yes|101.8631|10/24/2023|99.41838|10/24/2023|100.08049|10/24/2023|||GLUCOCORTICOIDS: INHALED|1478|||||No|No||TEVA USA|No|||||No|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093360982|FLUTICASONE-SALMETEROL 232-14|1|EA|52.7739|07/06/2018||Yes|No||07/06/2018||Yes|No|07/06/2018||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|033|Yes|102.74344|10/24/2023|100.27759|10/24/2023|100.94542|10/24/2023|||GLUCOCORTICOIDS: INHALED|1479|||||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|21.56657|10/24/2023|21.04897|10/24/2023|21.18915|10/24/2023|||ANTIVIRALS: TOPICAL|1480|||||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|14.57463|09/26/2023|14.22483|09/26/2023|14.31957|09/26/2023||||1481|||||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|14.57463|09/26/2023|14.22483|09/26/2023|14.31957|09/26/2023||||1482|||||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|32.48121|10/24/2023|31.70166|10/24/2023|31.91278|10/24/2023|||ANALGESICS: NARCOTICS LONG|1483|||||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|38.55606|10/24/2023|37.63071|10/24/2023|37.88132|10/24/2023|||ANALGESICS: NARCOTICS LONG|1484|||||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|68.39636|10/24/2023|66.75484|10/24/2023|67.19942|10/24/2023|||ANALGESICS: NARCOTICS LONG|1485|||||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|74.44607|10/24/2023|72.65936|10/24/2023|73.14326|10/24/2023|||ANALGESICS: NARCOTICS LONG|1486|||||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|5.87928|10/24/2023|5.73817|10/24/2023|5.77639|10/24/2023|||NSAIDS|1487|||||No|No||TEVA USA|No|||||No|No|No||
tobramycin|No|No|No|No|75%|00093375028|TOBRAMYCIN 300 MG/4 ML AMPULE|4|ML|10.25937|01/27/2021||Yes|No||01/27/2021||Yes|No|01/27/2021||Yes|No|Submit HHS Form 1143|||No|No|||Prescription required|Yes|07/27/2023|240|Yes|23.38182|01/27/2021|23.0478|01/27/2021|21.95028|01/27/2021|||ANTIBIOTICS: INHALED|1488|||||No|No||TEVA USA|No|||||Yes|No|No||
tobramycin|No|No|No|No|75%|00093375063|TOBRAMYCIN 300 MG/4 ML AMPULE|4|ML|10.25937|01/27/2021||Yes|No||01/27/2021||Yes|No|01/27/2021||Yes|No|Submit HHS Form 1143|||No|No|||Prescription required|Yes|07/27/2023|240|Yes|23.38182|01/27/2021|23.0478|01/27/2021|21.95028|01/27/2021|||ANTIBIOTICS: INHALED|1489|||||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|.25331|10/24/2023|.24723|10/24/2023|.24887|10/24/2023||||1490|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
cefadroxil|No|No|No|No|75%|00093405953|CEFADROXIL 1 GM TABLET|50|EA|2.306|05/21/2007||Yes|No||05/21/2007||Yes|No|05/21/2007||Yes|No||||No|No|||Prescription required|Yes|01/15/2014|046|No|3.56209|09/26/2023|3.47659|09/26/2023|3.49975|09/26/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1491|||||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|5.26572|10/24/2023|5.13934|10/24/2023|5.17356|10/24/2023|||BRONCHODILATORS: BETA AGONIST|1492|||||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|5.92412|10/24/2023|5.78194|10/24/2023|5.82044|10/24/2023|||BRONCHODILATORS: BETA AGONIST|1493|||||No|No||TEVA USA|No|||||Yes|No|No||
prazosin HCl|No|No|No|No|75%|00093406701|PRAZOSIN 1 MG CAPSULE|100|EA|.18481|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.13601|10/24/2023|.13274|10/24/2023|.13362|10/24/2023||||1494|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406710|PRAZOSIN 1 MG CAPSULE|1000|EA|.18482|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.13601|10/24/2023|.13274|10/24/2023|.13362|10/24/2023||||1495|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406801|PRAZOSIN 2 MG CAPSULE|100|EA|.27292|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.19922|10/24/2023|.19443|10/24/2023|.19573|10/24/2023||||1496|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406810|PRAZOSIN 2 MG CAPSULE|1000|EA|.27291|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.19922|10/24/2023|.19443|10/24/2023|.19573|10/24/2023||||1497|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406901|PRAZOSIN 5 MG CAPSULE|100|EA|.45055|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.31409|10/24/2023|.30655|10/24/2023|.30859|10/24/2023||||1498|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406905|PRAZOSIN 5 MG CAPSULE|500|EA|.45053|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.31409|10/24/2023|.30655|10/24/2023|.30859|10/24/2023||||1499|||||No|No||TEVA USA|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00093406952|PRAZOSIN 5 MG CAPSULE|250|EA|.45051|04/10/2007||Yes|No||04/10/2007||Yes|No|04/10/2007||Yes|No||04/10/2007||Yes|No|||Prescription required|No|||No|.31409|10/24/2023|.30655|10/24/2023|.30859|10/24/2023||||1500|||||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|Yes|2.14393|08/01/2023|2.09247|08/01/2023|2.10641|08/01/2023|||ANTIBIOTICS: INHALED|1501|||||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|.0714|09/26/2023|.06968|09/26/2023|.07015|09/26/2023|||PENICILLINS|1502|||||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|.05029|07/25/2023|.04908|07/25/2023|.0494|07/25/2023|||PENICILLINS|1503|||||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|.07823|10/24/2023|.07635|10/24/2023|.07686|10/24/2023|||PENICILLINS|1504|||||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|.05541|09/26/2023|.05408|09/26/2023|.05444|09/26/2023|||PENICILLINS|1505|||||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|.12883|10/24/2023|.12573|10/24/2023|.12657|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1506|||||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|.10897|10/24/2023|.10635|10/24/2023|.10706|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1507|||||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|.17026|10/24/2023|.16617|10/24/2023|.16728|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1508|||||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|.16924|10/24/2023|.16517|10/24/2023|.16627|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1509|||||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|No|||Yes|.33132|06/27/2023|.32336|06/27/2023|.32552|06/27/2023||||1510|||||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|No|||Yes|.37249|10/24/2023|.36355|10/24/2023|.36597|10/24/2023||||1511|||||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|No|||Yes|5.2528|03/29/2022|5.17776|03/29/2022|4.9312|03/29/2022||||1512|||||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|No|||Yes|.39069|10/24/2023|.38131|10/24/2023|.38385|10/24/2023||||1513|||||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|.02725|10/24/2023|.02659|10/24/2023|.02677|10/24/2023|||PENICILLINS|1514|||||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|.02789|10/24/2023|.02722|10/24/2023|.0274|10/24/2023|||PENICILLINS|1515|||||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|.02693|10/24/2023|.02628|10/24/2023|.02645|10/24/2023|||PENICILLINS|1516|||||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|.03506|10/24/2023|.03421|10/24/2023|.03444|10/24/2023|||PENICILLINS|1517|||||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|.0402|08/29/2023|.03923|08/29/2023|.03949|08/29/2023|||PENICILLINS|1518|||||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|.03571|09/26/2023|.03485|09/26/2023|.03508|09/26/2023|||PENICILLINS|1519|||||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|.02951|10/24/2023|.0288|10/24/2023|.02899|10/24/2023|||PENICILLINS|1520|||||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|.04671|10/24/2023|.04558|10/24/2023|.04589|10/24/2023|||PENICILLINS|1521|||||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|.0319|10/24/2023|.03113|10/24/2023|.03134|10/24/2023|||PENICILLINS|1522|||||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|.0764|10/24/2023|.07456|10/24/2023|.07506|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1523|||||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|.05776|10/24/2023|.05637|10/24/2023|.05674|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1524|||||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|.07874|10/24/2023|.07685|10/24/2023|.07736|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1525|||||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|.07406|10/24/2023|.07228|10/24/2023|.07276|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1526|||||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|1.44667|10/24/2023|1.41194|10/24/2023|1.42135|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1527|||||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|1.32227|10/24/2023|1.29053|10/24/2023|1.29913|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1528|||||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|1.55652|10/24/2023|1.51916|10/24/2023|1.52928|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1529|||||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|1.09039|10/24/2023|1.06422|10/24/2023|1.0713|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1530|||||No|No||TEVA USA|No|||||No|No|No||
olmesartan/amlodipin/hcthiazid|No|No|No|No|75%|00093500656|OLMSRTN-AMLDPN-HCTZ 40-5-12.5|30|EA|1.67843|02/17/2017||Yes|No||02/17/2017||Yes|No|02/17/2017||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|017|Yes|1.12065|10/24/2023|1.09375|10/24/2023|1.10103|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|1531|||||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|1532|||||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|3.18759|10/24/2023|3.11108|10/24/2023|3.1318|10/24/2023|||ANTICONVULSANTS|1533|||||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||||1534|||||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||||1535|||||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|2.19763|10/24/2023|2.14488|10/24/2023|2.15917|10/24/2023|||STIMULANTS AND RELATED AGENTS|1536|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093504601|DEXMETHYLPHENIDATE ER 35 MG CP|100|EA|.91452|12/19/2017||Yes|No||12/19/2017||Yes|No|12/19/2017||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|2.95282|08/29/2023|2.88195|08/29/2023|2.90114|08/29/2023|||STIMULANTS AND RELATED AGENTS|1537|||||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|.03066|10/24/2023|.02992|10/24/2023|.03012|10/24/2023|||LIPOTROPICS: STATINS|1538|||||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|.03066|10/24/2023|.02992|10/24/2023|.03012|10/24/2023|||LIPOTROPICS: STATINS|1539|||||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|.08531|10/24/2023|.08326|10/24/2023|.08381|10/24/2023|||LIPOTROPICS: STATINS|1540|||||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|.08531|10/24/2023|.08326|10/24/2023|.08381|10/24/2023|||LIPOTROPICS: STATINS|1541|||||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|.05376|10/24/2023|.05246|10/24/2023|.05281|10/24/2023|||LIPOTROPICS: STATINS|1542|||||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|.05376|10/24/2023|.05246|10/24/2023|.05281|10/24/2023|||LIPOTROPICS: STATINS|1543|||||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|.03755|10/24/2023|.03664|10/24/2023|.03689|10/24/2023|||LIPOTROPICS: STATINS|1544|||||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|.03755|10/24/2023|.03664|10/24/2023|.03689|10/24/2023|||LIPOTROPICS: STATINS|1545|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506001|HYDROXYZINE HCL 10 MG TABLET|100|EA|.0258|10/14/2013||Yes|No||10/14/2013||Yes|No|10/14/2013||Yes|No||10/14/2013||Yes|No|||Prescription required|No||574|Yes|.03387|10/24/2023|.03305|10/24/2023|.03327|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1546|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506005|HYDROXYZINE HCL 10 MG TABLET|500|EA|.0258|05/24/2013||Yes|No||05/24/2013||Yes|No|05/24/2013||Yes|No||05/24/2013||Yes|No|||Prescription required|No||574|Yes|.03387|10/24/2023|.03305|10/24/2023|.03327|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1547|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506101|HYDROXYZINE HCL 25 MG TABLET|100|EA|.03194|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|.0413|10/24/2023|.0403|10/24/2023|.04057|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1548|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506105|HYDROXYZINE HCL 25 MG TABLET|500|EA|.03193|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription required|No||574|Yes|.0413|10/24/2023|.0403|10/24/2023|.04057|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1549|||||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|.0413|10/24/2023|.0403|10/24/2023|.04057|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1550|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506201|HYDROXYZINE HCL 50 MG TABLET|100|EA|.04613|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|.06546|10/24/2023|.06388|10/24/2023|.06431|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1551|||||No|No||TEVA USA|No|||||No|No|No||
hydroxyzine HCl|No|No|No|No|75%|00093506205|HYDROXYZINE HCL 50 MG TABLET|500|EA|.04612|02/28/2013||Yes|No||02/28/2013||Yes|No|02/28/2013||Yes|No||02/28/2013||Yes|No|||Prescription required|No||574|Yes|.06546|10/24/2023|.06388|10/24/2023|.06431|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1552|||||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|.93008|10/24/2023|.90775|10/24/2023|.9138|10/24/2023|||ANGIOTENSIN MODULATORS|1553|||||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|.11771|10/24/2023|.11488|10/24/2023|.11565|10/24/2023|||ANXIOLYTICS|1554|||||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|.11771|10/24/2023|.11488|10/24/2023|.11565|10/24/2023|||ANXIOLYTICS|1555|||||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|1.27514|08/29/2023|1.24453|08/29/2023|1.25282|08/29/2023|||HIV / AIDS|1556|||||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|.42267|10/24/2023|.41252|10/24/2023|.41527|10/24/2023|||ANTIPSYCHOTICS|1557|||||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|.49243|10/24/2023|.48061|10/24/2023|.48381|10/24/2023|||ANTIPSYCHOTICS|1558|||||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|.88254|10/24/2023|.86135|10/24/2023|.86709|10/24/2023|||ANTIPSYCHOTICS|1559|||||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|.89885|10/24/2023|.87727|10/24/2023|.88312|10/24/2023|||ANTIPSYCHOTICS|1560|||||No|No||TEVA USA|No|||||No|No|No||
almotriptan malate|No|No|No|No|75%|00093526018|ALMOTRIPTAN MALATE 6.25 MG TAB|6|EA|14.43366|08/17/2015||Yes|No||08/17/2015||Yes|No|08/17/2015||Yes|No||||No|No|||Prescription required|Yes|07/23/2015|021|Yes|17.11367|01/24/2023|16.70294|01/24/2023|16.81418|01/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1561|||||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|Yes|18.71365|10/24/2023|18.26452|10/24/2023|18.38616|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1562|||||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|1.68024|10/24/2023|1.63991|10/24/2023|1.65083|10/24/2023|||STIMULANTS AND RELATED AGENTS|1563|||||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|2.05167|10/24/2023|2.00242|10/24/2023|2.01576|10/24/2023|||STIMULANTS AND RELATED AGENTS|1564|||||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|1.37438|10/24/2023|1.34139|10/24/2023|1.35032|10/24/2023|||STIMULANTS AND RELATED AGENTS|1565|||||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|1.05335|10/24/2023|1.02806|10/24/2023|1.03491|10/24/2023|||STIMULANTS AND RELATED AGENTS|1566|||||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|1.31731|10/24/2023|1.28569|10/24/2023|1.29425|10/24/2023|||STIMULANTS AND RELATED AGENTS|1567|||||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|1.8255|10/24/2023|1.78168|10/24/2023|1.79355|10/24/2023|||STIMULANTS AND RELATED AGENTS|1568|||||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|.31164|10/24/2023|.30416|10/24/2023|.30618|10/24/2023||||1569|||||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|1.80668|10/24/2023|1.76331|10/24/2023|1.77506|10/24/2023|||STIMULANTS AND RELATED AGENTS|1570|||||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|3.44323|10/24/2023|3.36059|10/24/2023|3.38297|10/24/2023|||STIMULANTS AND RELATED AGENTS|1571|||||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|3.07843|10/24/2023|3.00454|10/24/2023|3.02455|10/24/2023|||STIMULANTS AND RELATED AGENTS|1572|||||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||||1573|||||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|1574|||||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|1575|||||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|1576|||||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|2.34964|08/29/2023|2.31608|08/29/2023|2.20579|08/29/2023|||ANTIPSYCHOTICS|1577|||||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|2.35015|08/29/2023|2.31658|08/29/2023|2.20627|08/29/2023|||ANTIPSYCHOTICS|1578|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541901|CLOZAPINE ODT 100 MG TABLET|100|EA|2.81207|11/14/2017||Yes|No||11/14/2017||Yes|No|11/14/2017||Yes|No||||No|No|||Prescription required|Yes|09/14/2017|027|Yes|4.41636|08/29/2023|4.31036|08/29/2023|4.33907|08/29/2023|||ANTIPSYCHOTICS|1579|||||No|No||TEVA USA|No|||||No|No|No||
clozapine|No|No|No|No|75%|00093541984|CLOZAPINE ODT 100 MG TABLET|48|EA|2.8122|11/14/2017||Yes|No||11/14/2017||Yes|No|11/14/2017||Yes|No||||No|No|||Prescription required|Yes|09/14/2017|027|Yes|4.41636|08/29/2023|4.31036|08/29/2023|4.33907|08/29/2023|||ANTIPSYCHOTICS|1580|||||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|1.72579|10/24/2023|1.68437|10/24/2023|1.69558|10/24/2023||||1581|||||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|.74027|10/24/2023|.7225|10/24/2023|.72731|10/24/2023||||1582|||||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|.74027|10/24/2023|.7225|10/24/2023|.72731|10/24/2023||||1583|||||No|No||TEVA USA|No|||||No|No|No||
olanzapine/fluoxetine HCl|No|No|No|No|75%|00093550356|OLANZAPINE-FLUOXETINE 3-25 MG|30|EA|3.41635|12/06/2013||Yes|No||12/06/2013||Yes|No|12/06/2013||Yes|No||||No|No|||Prescription required|Yes|01/23/2013|027|Yes|3.104|08/29/2023|3.0295|08/29/2023|3.04968|08/29/2023|||ANTIPSYCHOTICS|1584|||||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|1585|||||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|1586|||||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|1587|||||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|17.1121|05/23/2023|16.86764|05/23/2023|16.06442|05/23/2023|||ANTIPSYCHOTICS|1588|||||No|No||TEVA USA|No|||||No|No|No||
sildenafil citrate|No|No|No|No|75%|00093551798|SILDENAFIL 20 MG TABLET|90|EA|.09555|07/18/2013||Yes|No||07/18/2013||Yes|No|07/18/2013||Yes|No|Refer to program requirements|||No|No|||Prescription required|Yes|07/28/2022|171|Yes|.0691|10/24/2023|.06744|10/24/2023|.06789|10/24/2023|||PAH AGENTS: ORAL AND INHALED|1589|||||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|1590|||||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|1591|||||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|1592|||||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|.18673|10/24/2023|.18224|10/24/2023|.18346|10/24/2023|||SEDATIVE HYPNOTICS|1593|||||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|.10777|10/24/2023|.10518|10/24/2023|.10588|10/24/2023|||SEDATIVE HYPNOTICS|1594|||||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|.09837|10/24/2023|.096|10/24/2023|.09664|10/24/2023|||SEDATIVE HYPNOTICS|1595|||||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|1.35438|10/24/2023|1.32187|10/24/2023|1.33067|10/24/2023|||STIMULANTS AND RELATED AGENTS|1596|||||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|1.2797|10/24/2023|1.24898|10/24/2023|1.2573|10/24/2023|||STIMULANTS AND RELATED AGENTS|1597|||||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|.71307|09/26/2023|.69595|09/26/2023|.70059|09/26/2023|||STIMULANTS AND RELATED AGENTS|1598|||||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|1.81754|10/24/2023|1.77391|10/24/2023|1.78573|10/24/2023|||STIMULANTS AND RELATED AGENTS|1599|||||No|No||TEVA USA|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00093555401|DEXMETHYLPHENIDATE ER 30 MG CP|100|EA|.91452|10/01/2014||Yes|No||10/01/2014||Yes|No|10/01/2014||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|2.32773|10/24/2023|2.27186|10/24/2023|2.28699|10/24/2023|||STIMULANTS AND RELATED AGENTS|1600|||||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|1.52976|09/26/2023|1.49304|09/26/2023|1.50298|09/26/2023|||STIMULANTS AND RELATED AGENTS|1601|||||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|3.46443|10/24/2023|3.38128|10/24/2023|3.4038|10/24/2023|||MACROLIDES/KETOLIDES|1602|||||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|3.46443|10/24/2023|3.38128|10/24/2023|3.4038|10/24/2023|||MACROLIDES/KETOLIDES|1603|||||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|8.03328|10/24/2023|7.84048|10/24/2023|7.89269|10/24/2023|||MACROLIDES/KETOLIDES|1604|||||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|8.03328|10/24/2023|7.84048|10/24/2023|7.89269|10/24/2023|||MACROLIDES/KETOLIDES|1605|||||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|02/13/2024|Yes|No||02/22/2016|02/13/2024|Yes|No|02/22/2016|02/13/2024|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|1606|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|02/13/2024|Yes|No||02/22/2016|02/13/2024|Yes|No|02/22/2016|02/13/2024|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|1607|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|02/13/2024|Yes|No||02/22/2016|02/13/2024|Yes|No|02/22/2016|02/13/2024|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|1608|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|02/13/2024|Yes|No||02/22/2016|02/13/2024|Yes|No|02/22/2016|02/13/2024|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|1609|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|2.15695|10/24/2023|2.10518|10/24/2023|2.1192|10/24/2023|||ULCERATIVE COLITIS AGENTS|1610|||||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|4.93165|07/25/2023|4.81329|07/25/2023|4.84534|07/25/2023|||PHOSPHATE BINDERS|1611|||||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|1612|||||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|5.26632|06/27/2023|5.13992|06/27/2023|5.17415|06/27/2023|||PHOSPHATE BINDERS|1613|||||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|1.20716|10/24/2023|1.17818|10/24/2023|1.18603|10/24/2023|||BRONCHODILATORS: BETA AGONIST|1614|||||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|1.17332|10/24/2023|1.14516|10/24/2023|1.15278|10/24/2023|||BRONCHODILATORS: BETA AGONIST|1615|||||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|135.54086|10/24/2023|132.28787|10/24/2023|133.16889|10/24/2023|||EPINEPHRINE: SELF-INJECTED|1616|||||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|138.00875|10/24/2023|134.69654|10/24/2023|135.59359|10/24/2023|||EPINEPHRINE: SELF-INJECTED|1617|||||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||||1618|||||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|.15817|10/24/2023|.15437|10/24/2023|.1554|10/24/2023||||1619|||||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|1.02046|10/24/2023|.99596|10/24/2023|1.0026|10/24/2023|||ACNE AGENTS: TOPICAL|1620|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|.16649|10/24/2023|.16249|10/24/2023|.16357|10/24/2023|||PROTON PUMP INHIBITORS|1621|||||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|.16649|10/24/2023|.16249|10/24/2023|.16357|10/24/2023|||PROTON PUMP INHIBITORS|1622|||||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|.1529|10/24/2023|.14923|10/24/2023|.15022|10/24/2023|||PROTON PUMP INHIBITORS|1623|||||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|.1529|10/24/2023|.14923|10/24/2023|.15022|10/24/2023|||PROTON PUMP INHIBITORS|1624|||||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|1.10635|10/24/2023|1.07979|10/24/2023|1.08698|10/24/2023|||GLUCOCORTICOIDS: INHALED|1625|||||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|1.10635|10/24/2023|1.07979|10/24/2023|1.08698|10/24/2023|||GLUCOCORTICOIDS: INHALED|1626|||||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|.7371|10/24/2023|.7194|10/24/2023|.7242|10/24/2023|||GLUCOCORTICOIDS: INHALED|1627|||||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|.7371|10/24/2023|.7194|10/24/2023|.7242|10/24/2023|||GLUCOCORTICOIDS: INHALED|1628|||||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|3.59538|10/24/2023|3.50909|10/24/2023|3.53246|10/24/2023|||GLUCOCORTICOIDS: INHALED|1629|||||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|1630|||||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|.40529|10/24/2023|.39556|10/24/2023|.39819|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1631|||||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|.40529|10/24/2023|.39556|10/24/2023|.39819|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1632|||||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|.40529|10/24/2023|.39556|10/24/2023|.39819|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1633|||||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|.56231|10/24/2023|.54881|10/24/2023|.55246|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1634|||||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|.56231|10/24/2023|.54881|10/24/2023|.55246|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1635|||||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|.56231|10/24/2023|.54881|10/24/2023|.55246|10/24/2023|||BLADDER RELAXANT PREPARATIONS|1636|||||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|07/28/2024|Yes|No||01/05/2015|07/28/2024|Yes|No|01/05/2015|07/28/2024|Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.08782|10/24/2023|.08571|10/24/2023|.08628|10/24/2023|||NSAIDS|1637|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|.08782|10/24/2023|.08571|10/24/2023|.08628|10/24/2023|||NSAIDS|1638|||||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|07/28/2024|Yes|No||01/05/2015|07/28/2024|Yes|No|01/05/2015|07/28/2024|Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.10988|10/24/2023|.10724|10/24/2023|.10795|10/24/2023|||NSAIDS|1639|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|07/28/2024|Yes|No||01/05/2015|07/28/2024|Yes|No|01/05/2015|07/28/2024|Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.10988|10/24/2023|.10724|10/24/2023|.10795|10/24/2023|||NSAIDS|1640|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|07/28/2024|Yes|No||01/05/2015|07/28/2024|Yes|No|01/05/2015|07/28/2024|Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.47412|10/24/2023|.46274|10/24/2023|.46582|10/24/2023|||NSAIDS|1641|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|.9482|07/25/2023|.92544|07/25/2023|.9316|07/25/2023|||NSAIDS|1642|||||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|1643|||||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|.06988|10/24/2023|.0682|10/24/2023|.06865|10/24/2023|||ANTIDEPRESSANTS: SSRIs|1644|||||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|.06988|10/24/2023|.0682|10/24/2023|.06865|10/24/2023|||ANTIDEPRESSANTS: SSRIs|1645|||||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|.06988|10/24/2023|.0682|10/24/2023|.06865|10/24/2023|||ANTIDEPRESSANTS: SSRIs|1646|||||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|.05865|10/24/2023|.05724|10/24/2023|.05762|10/24/2023|||LIPOTROPICS: STATINS|1647|||||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|.05865|10/24/2023|.05724|10/24/2023|.05762|10/24/2023|||LIPOTROPICS: STATINS|1648|||||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|.08261|10/24/2023|.08062|10/24/2023|.08116|10/24/2023|||LIPOTROPICS: STATINS|1649|||||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|.08261|10/24/2023|.08062|10/24/2023|.08116|10/24/2023|||LIPOTROPICS: STATINS|1650|||||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|03/20/2024|Yes|No||05/12/2009|03/20/2024|Yes|No|05/12/2009|03/20/2024|Yes|No||05/12/2009|03/20/2024|Yes|No|07/01/2016|03/20/2024|Prescription required|No||063|Yes|.16702|10/24/2023|.16301|10/24/2023|.16409|10/24/2023|||LIPOTROPICS: STATINS|1651|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|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|.16702|10/24/2023|.16301|10/24/2023|.16409|10/24/2023|||LIPOTROPICS: STATINS|1652|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|.07523|10/24/2023|.07342|10/24/2023|.07391|10/24/2023|||HYPOGLYCEMICS: TZD|1653|||||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|.07523|10/24/2023|.07342|10/24/2023|.07391|10/24/2023|||HYPOGLYCEMICS: TZD|1654|||||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|.07523|10/24/2023|.07342|10/24/2023|.07391|10/24/2023|||HYPOGLYCEMICS: TZD|1655|||||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|.10586|10/24/2023|.10331|10/24/2023|.104|10/24/2023|||HYPOGLYCEMICS: TZD|1656|||||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|.10586|10/24/2023|.10331|10/24/2023|.104|10/24/2023|||HYPOGLYCEMICS: TZD|1657|||||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|.10586|10/24/2023|.10331|10/24/2023|.104|10/24/2023|||HYPOGLYCEMICS: TZD|1658|||||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|.13503|10/24/2023|.13178|10/24/2023|.13266|10/24/2023|||HYPOGLYCEMICS: TZD|1659|||||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|.13503|10/24/2023|.13178|10/24/2023|.13266|10/24/2023|||HYPOGLYCEMICS: TZD|1660|||||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|.13503|10/24/2023|.13178|10/24/2023|.13266|10/24/2023|||HYPOGLYCEMICS: TZD|1661|||||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|.26158|10/24/2023|.2553|10/24/2023|.257|10/24/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1662|||||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|.26158|10/24/2023|.2553|10/24/2023|.257|10/24/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1663|||||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|.02287|10/24/2023|.02232|10/24/2023|.02246|10/24/2023|||BETA-BLOCKERS|1664|||||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|.02287|10/24/2023|.02232|10/24/2023|.02246|10/24/2023|||BETA-BLOCKERS|1665|||||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|.03132|10/24/2023|.03056|10/24/2023|.03077|10/24/2023|||BETA-BLOCKERS|1666|||||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|.03132|10/24/2023|.03056|10/24/2023|.03077|10/24/2023|||BETA-BLOCKERS|1667|||||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|07/28/2024|Yes|No||01/05/2015|07/28/2024|Yes|No|01/05/2015|07/28/2024|Yes|No||||No|No|||Prescription required|Yes|01/15/2014|059|Yes|.57166|11/21/2023|.56349|11/21/2023|.53666|11/21/2023|||NSAIDS|1668|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|.06356|10/24/2023|.06203|10/24/2023|.06244|10/24/2023|||PLATELET AGGREGATION INHIBITORS|1669|||||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|.06356|10/24/2023|.06203|10/24/2023|.06244|10/24/2023|||PLATELET AGGREGATION INHIBITORS|1670|||||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|.17968|10/24/2023|.17536|10/24/2023|.17653|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|1671|||||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|.17968|10/24/2023|.17536|10/24/2023|.17653|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|1672|||||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|.1977|10/24/2023|.19295|10/24/2023|.19424|10/24/2023|||PROTON PUMP INHIBITORS|1673|||||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|.1104|10/24/2023|.10775|10/24/2023|.10846|10/24/2023|||PROTON PUMP INHIBITORS|1674|||||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|.17006|10/24/2023|.16597|10/24/2023|.16708|10/24/2023||||1675|||||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|.23892|10/24/2023|.23318|10/24/2023|.23473|10/24/2023||||1676|||||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|.07307|10/24/2023|.07131|10/24/2023|.07179|10/24/2023|||BPH TREATMENTS|1677|||||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|.07307|10/24/2023|.07131|10/24/2023|.07179|10/24/2023|||BPH TREATMENTS|1678|||||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|.07307|10/24/2023|.07131|10/24/2023|.07179|10/24/2023|||BPH TREATMENTS|1679|||||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|.0941|10/24/2023|.09184|10/24/2023|.09245|10/24/2023|||ANGIOTENSIN MODULATORS|1680|||||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|.0941|10/24/2023|.09184|10/24/2023|.09245|10/24/2023|||ANGIOTENSIN MODULATORS|1681|||||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|.0941|10/24/2023|.09184|10/24/2023|.09245|10/24/2023|||ANGIOTENSIN MODULATORS|1682|||||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|.12695|10/24/2023|.1239|10/24/2023|.12472|10/24/2023|||ANGIOTENSIN MODULATORS|1683|||||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|.12695|10/24/2023|.1239|10/24/2023|.12472|10/24/2023|||ANGIOTENSIN MODULATORS|1684|||||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|.12695|10/24/2023|.1239|10/24/2023|.12472|10/24/2023|||ANGIOTENSIN MODULATORS|1685|||||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|.12091|10/24/2023|.118|10/24/2023|.11879|10/24/2023|||ANGIOTENSIN MODULATORS|1686|||||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|.12091|10/24/2023|.118|10/24/2023|.11879|10/24/2023|||ANGIOTENSIN MODULATORS|1687|||||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|.12091|10/24/2023|.118|10/24/2023|.11879|10/24/2023|||ANGIOTENSIN MODULATORS|1688|||||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|.09889|10/24/2023|.09651|10/24/2023|.09715|10/24/2023|||ANTIDEPRESSANTS: OTHER|1689|||||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|.09889|10/24/2023|.09651|10/24/2023|.09715|10/24/2023|||ANTIDEPRESSANTS: OTHER|1690|||||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|.10313|10/24/2023|.10065|10/24/2023|.10132|10/24/2023|||ANTIDEPRESSANTS: OTHER|1691|||||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|.10313|10/24/2023|.10065|10/24/2023|.10132|10/24/2023|||ANTIDEPRESSANTS: OTHER|1692|||||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|.14823|10/24/2023|.14467|10/24/2023|.14563|10/24/2023|||ANTIDEPRESSANTS: OTHER|1693|||||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|.14823|10/24/2023|.14467|10/24/2023|.14563|10/24/2023|||ANTIDEPRESSANTS: OTHER|1694|||||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|1.97556|10/24/2023|1.92814|10/24/2023|1.94098|10/24/2023|||FLUOROQUINOLONES: ORAL|1695|||||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|.17518|10/24/2023|.17097|10/24/2023|.17211|10/24/2023|||LIPOTROPICS: OTHER|1696|||||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|.27487|10/24/2023|.26827|10/24/2023|.27005|10/24/2023|||LIPOTROPICS: OTHER|1697|||||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|.27487|10/24/2023|.26827|10/24/2023|.27005|10/24/2023|||LIPOTROPICS: OTHER|1698|||||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|.27993|10/24/2023|.27321|10/24/2023|.27503|10/24/2023|||LIPOTROPICS: OTHER|1699|||||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|.27993|10/24/2023|.27321|10/24/2023|.27503|10/24/2023|||LIPOTROPICS: OTHER|1700|||||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|3.20163|10/24/2023|3.12479|10/24/2023|3.1456|10/24/2023|||LIPOTROPICS: STATINS|1701|||||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|3.20163|10/24/2023|3.12479|10/24/2023|3.1456|10/24/2023|||LIPOTROPICS: STATINS|1702|||||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|2.97205|09/26/2023|2.90072|09/26/2023|2.92003|09/26/2023|||LIPOTROPICS: STATINS|1703|||||No|No||TEVA USA|No|||||No|No|No||
fluvastatin sodium|No|No|No|No|75%|00093744356|FLUVASTATIN SODIUM 40 MG CAP|30|EA|1.71871|07/25/2012||Yes|No||07/25/2012||Yes|No|07/25/2012||Yes|No||07/25/2012||Yes|No|||Prescription required|Yes|07/29/2021|063|Yes|2.97205|09/26/2023|2.90072|09/26/2023|2.92003|09/26/2023|||LIPOTROPICS: STATINS|1704|||||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|3.65941|10/24/2023|3.57158|10/24/2023|3.59537|10/24/2023|||LIPOTROPICS: STATINS|1705|||||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|3.65941|10/24/2023|3.57158|10/24/2023|3.59537|10/24/2023|||LIPOTROPICS: STATINS|1706|||||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|.24808|09/26/2023|.24212|09/26/2023|.24373|09/26/2023|||HYPOGLYCEMICS: METFORMINS|1707|||||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|.29772|10/24/2023|.29057|10/24/2023|.2925|10/24/2023|||HYPOGLYCEMICS: METFORMINS|1708|||||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|.29873|10/24/2023|.29156|10/24/2023|.2935|10/24/2023|||HYPOGLYCEMICS: METFORMINS|1709|||||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|Yes|.48354|10/24/2023|.47193|10/24/2023|.47507|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1710|||||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|Yes|.48354|10/24/2023|.47193|10/24/2023|.47507|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1711|||||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|Yes|.34033|10/24/2023|.33216|10/24/2023|.33437|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1712|||||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|Yes|.34033|10/24/2023|.33216|10/24/2023|.33437|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1713|||||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|1714|||||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|.54794|10/24/2023|.53478|10/24/2023|.53835|10/24/2023|||ONCOLOGY: ORAL - BREAST|1715|||||No|No||TEVA USA|No|||||Yes|No|No||
fluticasone propion/salmeterol|No|No|No|No|75%|00093751631|FLUTICASONE-SALMETEROL 500-50|60|EA|1.0975|10/19/2022||Yes|No||10/19/2022||Yes|No|10/19/2022||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|033|Yes|2.71767|10/24/2023|2.65244|10/24/2023|2.67011|10/24/2023|||GLUCOCORTICOIDS: INHALED|1716|||||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|1.1955|10/24/2023|1.1668|10/24/2023|1.17457|10/24/2023|||GLUCOCORTICOIDS: INHALED|1717|||||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|1.44836|10/24/2023|1.41359|10/24/2023|1.42301|10/24/2023|||GLUCOCORTICOIDS: INHALED|1718|||||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|.15796|10/24/2023|.15416|10/24/2023|.15519|10/24/2023|||ONCOLOGY: ORAL - BREAST|1719|||||No|No||TEVA USA|No|||||No|No|No||
letrozole|No|No|No|No|75%|00093762056|LETROZOLE 2.5 MG TABLET|30|EA|.129|06/16/2011||Yes|No||06/16/2011||Yes|No|06/16/2011||Yes|No||||No|No|||Prescription required|No||502|No|.11509|10/24/2023|.11232|10/24/2023|.11307|10/24/2023|||ONCOLOGY: ORAL - BREAST|1720|||||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|1721|||||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|1.73729|10/24/2023|1.69559|10/24/2023|1.70688|10/24/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|1722|||||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|1723|||||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|1724|||||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|1725|||||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|73.35953|10/24/2023|71.5989|10/24/2023|72.07573|10/24/2023||||1726|||||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|.07596|10/24/2023|.07413|10/24/2023|.07463|10/24/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|1727|||||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|.5516|09/26/2023|.53836|09/26/2023|.54194|09/26/2023|||HIV / AIDS|1728|||||No|No||TEVA USA|No|||||No|No|No||
everolimus|No|No|No|No|75%|00093776624|EVEROLIMUS 2.5 MG TABLET|28|EA|8.03685|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription required|No||548|No|18.31654|10/31/2023|18.05487|10/31/2023|17.19512|10/31/2023|||ONCOLOGY: ORAL - RENAL CELL|1729|||||No|No||TEVA USA|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00093776724|EVEROLIMUS 5 MG TABLET|28|EA|9.53294|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription required|No||548|No|21.72624|10/31/2023|21.41587|10/31/2023|20.39606|10/31/2023|||ONCOLOGY: ORAL - RENAL CELL|1730|||||No|No||TEVA USA|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00093776824|EVEROLIMUS 7.5 MG TABLET|28|EA|10.16903|12/30/2020||Yes|No||12/30/2020||Yes|No|12/30/2020||Yes|No||||No|No|||Prescription required|No||548|No|23.17594|10/31/2023|22.84485|10/31/2023|21.757|10/31/2023|||ONCOLOGY: ORAL - RENAL CELL|1731|||||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|10.9292|10/24/2023|10.66689|10/24/2023|10.73793|10/24/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1732|||||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|10.9292|10/24/2023|10.66689|10/24/2023|10.73793|10/24/2023|||BONE RESORPTION SUPPRESSION AND RELATED AGENTS|1733|||||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|1734|||||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|1735|||||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|1736|||||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|1737|||||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|1738|||||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|1739|||||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||||1740|||||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||||1741|||||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|.13808|10/24/2023|.13476|10/24/2023|.13566|10/24/2023||||1742|||||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|.13808|10/24/2023|.13476|10/24/2023|.13566|10/24/2023||||1743|||||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||||1744|||||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|1745|||||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|.69434|08/29/2023|.67767|08/29/2023|.68218|08/29/2023||||1746|||||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|1747|||||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|3.10241|09/26/2023|3.02795|09/26/2023|3.04811|09/26/2023|||NSAIDS|1748|||||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|.26647|07/25/2023|.26007|07/25/2023|.2618|07/25/2023|||ANTIVIRALS: ORAL|1749|||||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|.39638|10/24/2023|.38686|10/24/2023|.38944|10/24/2023|||ANTIVIRALS: ORAL|1750|||||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|.81684|10/24/2023|.79723|10/24/2023|.80254|10/24/2023|||ANTIVIRALS: ORAL|1751|||||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|.05603|10/24/2023|.05468|10/24/2023|.05504|10/24/2023|||ANTIPSYCHOTICS|1752|||||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|.10685|10/24/2023|.10428|10/24/2023|.10498|10/24/2023|||ANTIPSYCHOTICS|1753|||||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|.14762|10/24/2023|.14407|10/24/2023|.14503|10/24/2023|||ANTIPSYCHOTICS|1754|||||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|.18041|10/24/2023|.17608|10/24/2023|.17725|10/24/2023|||ANTIPSYCHOTICS|1755|||||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|.0412|10/24/2023|.04021|10/24/2023|.04047|10/24/2023|||ANTIPSYCHOTICS|1756|||||No|No||TEVA USA|No|||||No|No|No||
oseltamivir phosphate|No|No|No|No|75%|00093818064|OSELTAMIVIR 6 MG/ML SUSPENSION|60|ML|.301|11/20/2019||Yes|No||11/20/2019||Yes|No|11/20/2019||Yes|No||||No|No|||Prescription required|No||025|No|.25635|10/24/2023|.25019|10/24/2023|.25186|10/24/2023|||ANTIVIRALS: ORAL|1757|||||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|.31315|10/24/2023|.30563|10/24/2023|.30766|10/24/2023||||1758|||||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|1759|||||No|No||TEVA USA|No|||||No|No|No||
norethindrone-e.estradiol-iron|No|Yes|No|No|75%|00093821062|FINZALA 1-0.02(24)-75 CHEW TAB|28|EA|1.64152|06/07/2023||Yes|No||06/07/2023||Yes|No|06/07/2023||Yes|No|Refer to program requirements|||No|No|||Prescription required|No|||No|.131|10/24/2023|.12785|10/24/2023|.1287|10/24/2023||||1760|||||No|No||TEVA USA|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
sunitinib malate|No|No|No|No|75%|00093822428|SUNITINIB MALATE 25 MG CAPSULE|28|EA|150.1646|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||||No|No|||Prescription required|No||548|No|342.2356|11/14/2022|337.34652|11/14/2022|321.2824|11/14/2022|||ONCOLOGY: ORAL - RENAL CELL|1761|||||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|1762|||||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|1763|||||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|.22784|10/24/2023|.22237|10/24/2023|.22385|10/24/2023|||ANGIOTENSIN MODULATORS|1764|||||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|.22784|10/24/2023|.22237|10/24/2023|.22385|10/24/2023|||ANGIOTENSIN MODULATORS|1765|||||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|.17411|10/24/2023|.16993|10/24/2023|.17106|10/24/2023|||ANGIOTENSIN MODULATORS|1766|||||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|.17411|10/24/2023|.16993|10/24/2023|.17106|10/24/2023|||ANGIOTENSIN MODULATORS|1767|||||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|.92843|10/24/2023|.90614|10/24/2023|.91218|10/24/2023||||1768|||||No|No||TEVA USA|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00093831018|ELETRIPTAN HBR 20 MG TABLET|6|EA|7.92848|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|Yes|3.1957|10/24/2023|3.119|10/24/2023|3.13977|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1769|||||No|No||TEVA USA|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00093831118|ELETRIPTAN HBR 40 MG TABLET|6|EA|7.92848|11/28/2017||Yes|No||11/28/2017||Yes|No|11/28/2017||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|Yes|2.39121|10/24/2023|2.33382|10/24/2023|2.34936|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|1770|||||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|.06999|09/26/2023|.06831|09/26/2023|.06876|09/26/2023||||1771|||||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|.08701|10/24/2023|.08492|10/24/2023|.08548|10/24/2023||||1772|||||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|.08701|10/24/2023|.08492|10/24/2023|.08548|10/24/2023||||1773|||||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|.08701|10/24/2023|.08492|10/24/2023|.08548|10/24/2023||||1774|||||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|.05548|10/24/2023|.05414|10/24/2023|.0545|10/24/2023||||1775|||||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|.05548|10/24/2023|.05414|10/24/2023|.0545|10/24/2023||||1776|||||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|.05548|10/24/2023|.05414|10/24/2023|.0545|10/24/2023||||1777|||||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|.05694|10/24/2023|.05557|10/24/2023|.05594|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1778|||||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|.06244|10/24/2023|.06094|10/24/2023|.06134|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1779|||||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|.10807|10/24/2023|.10547|10/24/2023|.10617|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|1780|||||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|.40945|10/24/2023|.39962|10/24/2023|.40228|10/24/2023||||1781|||||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|.45191|10/24/2023|.44106|10/24/2023|.444|10/24/2023||||1782|||||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|1.04208|06/27/2023|1.01707|06/27/2023|1.02384|06/27/2023||||1783|||||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|.44883|10/24/2023|.43805|10/24/2023|.44097|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|1784|||||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|.88354|10/24/2023|.86233|10/24/2023|.86807|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|1785|||||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|1.57689|10/24/2023|1.53904|10/24/2023|1.54929|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|1786|||||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|.05882|10/24/2023|.0574|10/24/2023|.05779|10/24/2023|||ANTIDEPRESSANTS: OTHER|1787|||||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|.07866|10/24/2023|.07677|10/24/2023|.07728|10/24/2023|||ANTIDEPRESSANTS: OTHER|1788|||||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|.09425|10/24/2023|.09198|10/24/2023|.0926|10/24/2023|||ANTIDEPRESSANTS: OTHER|1789|||||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|.07446|10/24/2023|.07267|10/24/2023|.07315|10/24/2023|||ANTIDEPRESSANTS: OTHER|1790|||||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|.11475|10/24/2023|.11199|10/24/2023|.11274|10/24/2023|||ANTIDEPRESSANTS: OTHER|1791|||||No|No||TEVA USA|No|||||No|No|No||
diflunisal|No|No|No|No|75%|00093922201|DIFLUNISAL 500 MG TABLET|100|EA|.71079|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||02/16/2022||Yes|No|||Prescription required|Yes|01/28/2021|059|Yes|1.14717|09/26/2023|1.11963|09/26/2023|1.12709|09/26/2023|||NSAIDS|1792|||||No|No||TEVA USA|No|||||No|No|No||
diflunisal|No|No|No|No|75%|00093922205|DIFLUNISAL 500 MG TABLET|500|EA|.69302|06/07/2023||Yes|No||06/07/2023||Yes|No|06/07/2023||Yes|No||06/07/2023||Yes|No|||Prescription required|Yes|01/27/2022|059|Yes|1.14717|09/26/2023|1.11963|09/26/2023|1.12709|09/26/2023|||NSAIDS|1793|||||No|No||TEVA USA|No|||||No|No|No||
diflunisal|No|No|No|No|75%|00093922206|DIFLUNISAL 500 MG TABLET|60|EA|.71079|02/16/2022||Yes|No||02/16/2022||Yes|No|02/16/2022||Yes|No||02/16/2022||Yes|No|||Prescription required|Yes|01/28/2021|059|Yes|1.14717|09/26/2023|1.11963|09/26/2023|1.12709|09/26/2023|||NSAIDS|1794|||||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|.8895|10/24/2023|.86815|10/24/2023|.87393|10/24/2023|||ULCERATIVE COLITIS AGENTS|1795|||||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|.63478|10/24/2023|.61954|10/24/2023|.62367|10/24/2023|||ANTICONVULSANTS|1796|||||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|.50222|10/24/2023|.49016|10/24/2023|.49343|10/24/2023|||ANTICONVULSANTS|1797|||||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|.52625|10/24/2023|.51362|10/24/2023|.51704|10/24/2023|||ANTICONVULSANTS|1798|||||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|.47612|10/24/2023|.46469|10/24/2023|.46778|10/24/2023|||ANTICONVULSANTS|1799|||||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|1.0094|08/29/2023|.98517|08/29/2023|.99173|08/29/2023|||ANTICONVULSANTS|1800|||||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|.05548|10/24/2023|.05414|10/24/2023|.0545|10/24/2023||||1801|||||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|.05548|10/24/2023|.05414|10/24/2023|.0545|10/24/2023||||1802|||||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|.05548|10/24/2023|.05414|10/24/2023|.0545|10/24/2023||||1803|||||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|.08701|10/24/2023|.08492|10/24/2023|.08548|10/24/2023||||1804|||||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|.08701|10/24/2023|.08492|10/24/2023|.08548|10/24/2023||||1805|||||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|.06999|09/26/2023|.06831|09/26/2023|.06876|09/26/2023||||1806|||||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|.1069|10/24/2023|.10433|10/24/2023|.10502|10/24/2023|||ANTIPARKINSON'S AGENTS|1807|||||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|.1069|10/24/2023|.10433|10/24/2023|.10502|10/24/2023|||ANTIPARKINSON'S AGENTS|1808|||||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|.09412|10/24/2023|.09186|10/24/2023|.09247|10/24/2023|||ANTIPARKINSON'S AGENTS|1809|||||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|.09412|10/24/2023|.09186|10/24/2023|.09247|10/24/2023|||ANTIPARKINSON'S AGENTS|1810|||||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|.09412|10/24/2023|.09186|10/24/2023|.09247|10/24/2023|||ANTIPARKINSON'S AGENTS|1811|||||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||||1812|||||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|.2546|10/24/2023|.24848|10/24/2023|.25014|10/24/2023|||NSAIDS|1813|||||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|.09763|10/24/2023|.09528|10/24/2023|.09592|10/24/2023||||1814|||||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|.03001|10/24/2023|.02928|10/24/2023|.02948|10/24/2023|||NSAIDS|1815|||||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|.02486|10/24/2023|.02426|10/24/2023|.02442|10/24/2023||||1816|||||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|.02059|10/24/2023|.02009|10/24/2023|.02022|10/24/2023||||1817|||||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|1818|||||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|.03501|10/24/2023|.03416|10/24/2023|.03439|10/24/2023|||NSAIDS|1819|||||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|.03501|10/24/2023|.03416|10/24/2023|.03439|10/24/2023|||NSAIDS|1820|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113060490|GS IBUPROFEN 200 MG TABLET|500|EA|.0147|04/22/2009||Yes|No||||No|No|04/22/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.03501|10/24/2023|.03416|10/24/2023|.03439|10/24/2023|||NSAIDS|1821|||||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|.05836|10/24/2023|.05695|10/24/2023|.05733|10/24/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|1822|||||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|.05836|10/24/2023|.05695|10/24/2023|.05733|10/24/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|1823|||||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|.03001|10/24/2023|.02928|10/24/2023|.02948|10/24/2023|||NSAIDS|1824|||||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|.37003|10/24/2023|.36114|10/24/2023|.36355|10/24/2023|||SMOKING CESSATION|1825|||||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|.03001|10/24/2023|.02928|10/24/2023|.02948|10/24/2023|||NSAIDS|1826|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
ibuprofen|No|No|No|No|75%|00113089734|GS CHILD IBUPROFEN 100 MG/5 ML|240|ML|.01201|06/23/2009||Yes|No||||No|No|06/23/2009||Yes|No||||No|No|||Over the counter|No||059|Yes|.02418|10/24/2023|.02359|10/24/2023|.02375|10/24/2023|||NSAIDS|1827|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
omeprazole|No|No|No|No|75%|00113091555|GS OMEPRAZOLE DR 20 MG TABLET|42|EA|.21018|05/18/2009||Yes|No||||No|No|05/18/2009||Yes|No||||No|No|||Over the counter|Yes|07/29/2021|047|No|.4373|10/24/2023|.4268|10/24/2023|.42964|10/24/2023|||PROTON PUMP INHIBITORS|1828|||||No|No||PERRIGO/GOODSEN|No|||||No|Yes|No||
baclofen|No|No|No|No|75%|00115101001|BACLOFEN 10 MG TABLET|100|EA|.02816|09/27/2021|02/29/2024|Yes|No||09/27/2021|02/29/2024|Yes|No|09/27/2021|02/29/2024|Yes|No||||No|No|||Prescription required|No||116|No|.04809|10/24/2023|.04693|10/24/2023|.04724|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1829|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.04809|10/24/2023|.04693|10/24/2023|.04724|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1830|||||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|.15693|10/24/2023|.15316|10/24/2023|.15418|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1831|||||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|10/31/2023|Yes|No||09/27/2021|10/31/2023|Yes|No|09/27/2021|10/31/2023|Yes|No||||No|No|||Prescription required|No||116|No|.09349|11/14/2023|.09215|11/14/2023|.08776|11/14/2023|||SKELETAL MUSCLE RELAXANTS|1832|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.07312|10/24/2023|.07136|10/24/2023|.07184|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1833|||||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|1834|||||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|.7889|06/27/2023|.77763|06/27/2023|.7406|06/27/2023|||PLATELET AGGREGATION INHIBITORS|1835|||||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|1836|||||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|.23905|10/24/2023|.23331|10/24/2023|.23486|10/24/2023|||LIPOTROPICS: OTHER|1837|||||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|2.71505|05/23/2023|2.64988|05/23/2023|2.66753|05/23/2023|||PHOSPHATE BINDERS|1838|||||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|3.54572|07/25/2023|3.46062|07/25/2023|3.48366|07/25/2023|||PHOSPHATE BINDERS|1839|||||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|4.85428|10/24/2023|4.73777|10/24/2023|4.76933|10/24/2023||||1840|||||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||||1841|||||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|1842|||||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|1843|||||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|.35146|10/24/2023|.34302|10/24/2023|.3453|10/24/2023|||ROSACEA AGENTS: TOPICAL|1844|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|.90969|10/24/2023|.88785|10/24/2023|.89377|10/24/2023|||STIMULANTS AND RELATED AGENTS|1845|||||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|.56921|10/24/2023|.55554|10/24/2023|.55924|10/24/2023|||STIMULANTS AND RELATED AGENTS|1846|||||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|.69117|10/24/2023|.67458|10/24/2023|.67907|10/24/2023|||STIMULANTS AND RELATED AGENTS|1847|||||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|.61509|10/24/2023|.60032|10/24/2023|.60432|10/24/2023|||STIMULANTS AND RELATED AGENTS|1848|||||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|.56816|10/24/2023|.55452|10/24/2023|.55821|10/24/2023|||STIMULANTS AND RELATED AGENTS|1849|||||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|.6606|10/24/2023|.64474|10/24/2023|.64903|10/24/2023|||STIMULANTS AND RELATED AGENTS|1850|||||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|5.96824|04/25/2023|5.825|04/25/2023|5.86379|04/25/2023|||LIPOTROPICS: OTHER|1851|||||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|17.41651|06/27/2023|16.99851|06/27/2023|17.11172|06/27/2023|||LIPOTROPICS: OTHER|1852|||||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|.17915|10/24/2023|.17485|10/24/2023|.17601|10/24/2023|||LIPOTROPICS: OTHER|1853|||||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|.3877|10/24/2023|.37839|10/24/2023|.38091|10/24/2023|||LIPOTROPICS: OTHER|1854|||||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|.23451|10/24/2023|.22888|10/24/2023|.2304|10/24/2023||||1855|||||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|.34203|10/24/2023|.33382|10/24/2023|.33604|10/24/2023||||1856|||||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|.05377|10/24/2023|.05247|10/24/2023|.05282|10/24/2023|||BETA-BLOCKERS|1857|||||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|.05377|10/24/2023|.05247|10/24/2023|.05282|10/24/2023|||BETA-BLOCKERS|1858|||||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|.06374|10/24/2023|.06221|10/24/2023|.06262|10/24/2023|||BETA-BLOCKERS|1859|||||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|.06374|10/24/2023|.06221|10/24/2023|.06262|10/24/2023|||BETA-BLOCKERS|1860|||||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|.08826|10/24/2023|.08614|10/24/2023|.08671|10/24/2023|||BETA-BLOCKERS|1861|||||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|.08826|10/24/2023|.08614|10/24/2023|.08671|10/24/2023|||BETA-BLOCKERS|1862|||||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|.19167|10/24/2023|.18706|10/24/2023|.18831|10/24/2023|||BETA-BLOCKERS|1863|||||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|.19167|10/24/2023|.18706|10/24/2023|.18831|10/24/2023|||BETA-BLOCKERS|1864|||||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|04/14/2024|Yes|No||05/29/2018|04/14/2024|Yes|No|05/29/2018|04/14/2024|Yes|No||||No|No|||Prescription required|No||033|Yes|1.10635|10/24/2023|1.07979|10/24/2023|1.08698|10/24/2023|||GLUCOCORTICOIDS: INHALED|1865|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|05/31/2024|Yes|No||05/29/2018|05/31/2024|Yes|No|05/29/2018|05/31/2024|Yes|No||||No|No|||Prescription required|No||033|Yes|.7371|10/24/2023|.7194|10/24/2023|.7242|10/24/2023|||GLUCOCORTICOIDS: INHALED|1866|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|.22114|10/24/2023|.21583|10/24/2023|.21727|10/24/2023|||BETA-BLOCKERS|1867|||||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|117.835|10/24/2023|115.00696|10/24/2023|115.77288|10/24/2023|||EPINEPHRINE: SELF-INJECTED|1868|||||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|115.23667|10/24/2023|112.47098|10/24/2023|113.22002|10/24/2023|||EPINEPHRINE: SELF-INJECTED|1869|||||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|.20654|10/24/2023|.20158|10/24/2023|.20292|10/24/2023|||GLUCOCORTICOIDS: ORAL|1870|||||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|.24072|10/24/2023|.23494|10/24/2023|.2365|10/24/2023|||GLUCOCORTICOIDS: ORAL|1871|||||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|.51067|10/24/2023|.49841|10/24/2023|.50173|10/24/2023|||GLUCOCORTICOIDS: ORAL|1872|||||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|2.19763|10/24/2023|2.14488|10/24/2023|2.15917|10/24/2023|||STIMULANTS AND RELATED AGENTS|1873|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115171001|DEXMETHYLPHENIDATE ER 35 MG CP|100|EA|1.61456|11/15/2017||Yes|No||11/15/2017||Yes|No|11/15/2017||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|2.95282|08/29/2023|2.88195|08/29/2023|2.90114|08/29/2023|||STIMULANTS AND RELATED AGENTS|1874|||||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|1875|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
griseofulvin ultramicrosize|No|No|No|No|75%|00115172501|GRISEOFULVIN ULTRA 250 MG TAB|100|EA|2.19257|11/27/2018||Yes|No||11/27/2018||Yes|No|11/27/2018||Yes|No||||No|No|||Prescription required|Yes|03/09/2018|069|No|3.83146|07/25/2023|3.7395|07/25/2023|3.7644|07/25/2023|||ANTIFUNGALS: ORAL|1876|||||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|1.37438|10/24/2023|1.34139|10/24/2023|1.35032|10/24/2023|||STIMULANTS AND RELATED AGENTS|1877|||||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|1.05335|10/24/2023|1.02806|10/24/2023|1.03491|10/24/2023|||STIMULANTS AND RELATED AGENTS|1878|||||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|1.31731|10/24/2023|1.28569|10/24/2023|1.29425|10/24/2023|||STIMULANTS AND RELATED AGENTS|1879|||||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|1.8255|10/24/2023|1.78168|10/24/2023|1.79355|10/24/2023|||STIMULANTS AND RELATED AGENTS|1880|||||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|1.68024|10/24/2023|1.63991|10/24/2023|1.65083|10/24/2023|||STIMULANTS AND RELATED AGENTS|1881|||||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|2.05167|10/24/2023|2.00242|10/24/2023|2.01576|10/24/2023|||STIMULANTS AND RELATED AGENTS|1882|||||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|5.02063|09/26/2023|4.94891|09/26/2023|4.71325|09/26/2023|||SKELETAL MUSCLE RELAXANTS|1883|||||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|04/11/2024|Yes|No||12/03/2018|04/11/2024|Yes|No|12/03/2018|04/11/2024|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|116|Yes|.46893|10/24/2023|.45767|10/24/2023|.46072|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1884|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|6.729|10/24/2023|6.5675|10/24/2023|6.61124|10/24/2023||||1885|||||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||||1886|||||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|6.76167|10/24/2023|6.59938|10/24/2023|6.64334|10/24/2023||||1887|||||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|.08471|10/24/2023|.08267|10/24/2023|.08322|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1888|||||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|.11071|10/24/2023|.10805|10/24/2023|.10877|10/24/2023|||STIMULANTS AND RELATED AGENTS|1889|||||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|.14999|10/24/2023|.14639|10/24/2023|.14736|10/24/2023|||STIMULANTS AND RELATED AGENTS|1890|||||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|.24688|10/24/2023|.24095|10/24/2023|.24255|10/24/2023|||STIMULANTS AND RELATED AGENTS|1891|||||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|.0674|10/24/2023|.06578|10/24/2023|.06622|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1892|||||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|.0674|10/24/2023|.06578|10/24/2023|.06622|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1893|||||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|.09847|10/24/2023|.0961|10/24/2023|.09674|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1894|||||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|.09847|10/24/2023|.0961|10/24/2023|.09674|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|1895|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
colesevelam HCl|No|No|No|No|75%|00115186418|COLESEVELAM HCL 3.75 G PACKET|30|EA|3.225|09/18/2023||Yes|No||09/18/2023||Yes|No|09/18/2023||Yes|No||||No|No|||Prescription required|Yes|07/28/2022|055|No|3.86325|10/24/2023|3.77053|10/24/2023|3.79564|10/24/2023|||LIPOTROPICS: OTHER|1896|||||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|1897|||||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|1898|||||No|No||AMNEAL PHARMACE|Yes|09/01/2020||||No|No|No||
chloroquine phosphate|No|No|No|No|75%|00115279006|CHLOROQUINE PH 250 MG TABLET|50|EA|1.33196|08/10/2023||Yes|No||08/10/2023||Yes|No|08/10/2023||Yes|No||||No|No|||Prescription required|No|||No|3.03564|11/15/2022|2.99228|11/15/2022|2.84979|11/15/2022||||1899|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
pyridostigmine bromide|No|No|No|No|75%|00115351101|PYRIDOSTIGMINE BR 60 MG TABLET|100|EA|.35088|12/21/2007||Yes|No||12/21/2007||Yes|No|12/21/2007||Yes|No||||No|No|||Prescription required|No|||No|.22442|10/24/2023|.21903|10/24/2023|.22049|10/24/2023||||1900|||||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|.42826|10/24/2023|.41798|10/24/2023|.42076|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1901|||||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|.62393|10/24/2023|.60895|10/24/2023|.61301|10/24/2023|||SKELETAL MUSCLE RELAXANTS|1902|||||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|.94864|07/25/2023|.92587|07/25/2023|.93203|07/25/2023|||SKELETAL MUSCLE RELAXANTS|1903|||||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|.73187|10/24/2023|.7143|10/24/2023|.71906|10/24/2023|||LIPOTROPICS: OTHER|1904|||||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|.09462|10/24/2023|.09234|10/24/2023|.09296|10/24/2023|||LIPOTROPICS: OTHER|1905|||||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|.15036|10/24/2023|.14675|10/24/2023|.14772|10/24/2023|||LIPOTROPICS: OTHER|1906|||||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|.15036|10/24/2023|.14675|10/24/2023|.14772|10/24/2023|||LIPOTROPICS: OTHER|1907|||||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|.18318|10/24/2023|.17878|10/24/2023|.17997|10/24/2023||||1908|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
chloroquine phosphate|No|No|No|No|75%|00115701009|CHLOROQUINE PH 500 MG TABLET|25|EA|3.45582|08/10/2023||Yes|No||08/10/2023||Yes|No|08/10/2023||Yes|No||||No|No|||Prescription required|No|||No|7.87606|11/15/2022|7.76354|11/15/2022|7.39385|11/15/2022||||1909|||||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|.42777|10/24/2023|.4175|10/24/2023|.42028|10/24/2023||||1910|||||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|.42777|10/24/2023|.4175|10/24/2023|.42028|10/24/2023||||1911|||||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||||1912|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115991801|DEXMETHYLPHENIDATE ER 5 MG CAP|100|EA|.96956|08/29/2018||Yes|No||08/29/2018||Yes|No|08/29/2018||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|1.35438|10/24/2023|1.32187|10/24/2023|1.33067|10/24/2023|||STIMULANTS AND RELATED AGENTS|1913|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115991901|DEXMETHYLPHENIDATE ER 10 MG CP|100|EA|1.07706|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|1.2797|10/24/2023|1.24898|10/24/2023|1.2573|10/24/2023|||STIMULANTS AND RELATED AGENTS|1914|||||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|.71307|09/26/2023|.69595|09/26/2023|.70059|09/26/2023|||STIMULANTS AND RELATED AGENTS|1915|||||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|1.81754|10/24/2023|1.77391|10/24/2023|1.78573|10/24/2023|||STIMULANTS AND RELATED AGENTS|1916|||||No|No||AMNEAL PHARMACE|No|||||No|No|No||
dexmethylphenidate HCl|No|No|No|No|75%|00115992201|DEXMETHYLPHENIDATE ER 30 MG CP|100|EA|1.50706|12/03/2018||Yes|No||12/03/2018||Yes|No|12/03/2018||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|2.32773|10/24/2023|2.27186|10/24/2023|2.28699|10/24/2023|||STIMULANTS AND RELATED AGENTS|1917|||||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|No|||Yes|.2976|09/26/2023|.29045|09/26/2023|.29239|09/26/2023||||1918|||||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|No|||Yes|.23939|10/24/2023|.23364|10/24/2023|.2352|10/24/2023||||1919|||||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|No|||Yes|.22341|10/24/2023|.21804|10/24/2023|.2195|10/24/2023||||1920|||||No|No||AMNEAL PHARMACE|Yes|09/01/2020||||Yes|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|.00519|10/24/2023|.00506|10/24/2023|.00509|10/24/2023||||1921|||||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|09/01/2024|Yes|No||03/01/2002|09/01/2024|Yes|No|03/01/2002|09/01/2024|Yes|No||03/01/2002|09/01/2024|Yes|No|||Prescription required|No||109|Yes|.01303|02/28/2023|.01271|02/28/2023|.0128|02/28/2023|||ANALGESICS: NARCOTICS SHORT|1922|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PHARM ASSOC INC|No|||||No|No|No||
acetaminophen with codeine|No|No|No|No|90%|00121050416|ACETAMINOP-CODEINE 120-12 MG/5|473|ML|.00722|03/01/2002|08/01/2024|Yes|No||03/01/2002|08/01/2024|Yes|No|03/01/2002|08/01/2024|Yes|No||03/01/2002|08/01/2024|Yes|No|||Prescription required|No||109|Yes|.01449|08/29/2023|.01414|08/29/2023|.01423|08/29/2023|||ANALGESICS: NARCOTICS SHORT|1923|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||PHARM ASSOC INC|No|||||No|No|No||
metoclopramide HCl|No|No|No|No|75%|00121057616|METOCLOPRAMIDE 5 MG/5 ML SOLN|473|ML|.02681|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No||085|No|.04073|10/24/2023|.03975|10/24/2023|.04001|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1924|||||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|.19106|10/24/2023|.18647|10/24/2023|.18771|10/24/2023|||ANTIPSYCHOTICS|1925|||||No|No||PHARM ASSOC INC|Yes|09/01/2020||||No|No|No||
citric acid/sodium citrate|No|No|No|No|75%|00121059516|SOD CITRATE-CITRIC ACID SOLN|473|ML|.01272|09/07/2015||Yes|No||||No|No|09/07/2015||Yes|No||||No|No|||Over the counter|No|||No|.0224|10/24/2023|.02186|10/24/2023|.022|10/24/2023||||1926|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
amantadine HCl|No|No|No|No|75%|00121064616|AMANTADINE 50 MG/5 ML SOLUTION|473|ML|.02454|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||015|No|.02287|09/26/2023|.02232|09/26/2023|.02246|09/26/2023|||ANTIPARKINSON'S AGENTS|1927|||||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|1928|||||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|1929|||||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|1930|||||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|.06616|10/24/2023|.06457|10/24/2023|.065|10/24/2023|||ANTIPARKINSON'S AGENTS|1931|||||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|.08029|10/24/2023|.07836|10/24/2023|.07888|10/24/2023|||ANTICONVULSANTS|1932|||||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|.03006|10/24/2023|.02933|10/24/2023|.02953|10/24/2023|||ANTICONVULSANTS|1933|||||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|.01704|04/19/2022||Yes|No||04/19/2022||Yes|No|04/19/2022||Yes|No||||No|No|||Prescription required|No||056|No|.03006|10/24/2023|.02933|10/24/2023|.02953|10/24/2023|||ANTICONVULSANTS|1934|||||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|.04768|10/24/2023|.04653|10/24/2023|.04684|10/24/2023||||1935|||||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||||1936|||||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|.34759|05/23/2023|.33924|05/23/2023|.3415|05/23/2023|||ANTIDEPRESSANTS: TRICYCLIC|1937|||||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|04/30/2024|Yes|No||12/28/2006|04/30/2024|Yes|No|12/28/2006|04/30/2024|Yes|No||09/01/2022|04/30/2024|Yes|No|||Prescription required|No||008|No|.27626|10/24/2023|.26962|10/24/2023|.27142|10/24/2023|||ANTIDEPRESSANTS: SSRIs|1938|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|.12612|10/24/2023|.12309|10/24/2023|.12391|10/24/2023|||GLUCOCORTICOIDS: ORAL|1939|||||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|.01421|09/26/2023|.01386|09/26/2023|.01396|09/26/2023||||1940|||||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|.66715|10/24/2023|.65113|10/24/2023|.65547|10/24/2023|||ANXIOLYTICS|1941|||||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|.13287|10/24/2023|.13097|10/24/2023|.12474|10/24/2023|||ANALGESICS: NARCOTICS SHORT|1942|||||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|.06206|09/26/2023|.06057|09/26/2023|.06097|09/26/2023|||ANALGESICS: NARCOTICS SHORT|1943|||||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|1944|||||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|.05036|10/24/2023|.04915|10/24/2023|.04947|10/24/2023|||COUGH AND COLD: NARCOTIC|1945|||||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
codeine phosphate/guaifenesin|No|No|No|No|90%|00121077508|GUAIFEN-CODEINE 100-10 MG/5 ML|237|ML|.02126|11/19/2018|08/01/2024|Yes|No||||No|No|11/19/2018|08/01/2024|Yes|No||||No|No|||Over the counter|No||183|Yes|.04406|02/28/2023|.043|02/28/2023|.04328|02/28/2023|||COUGH AND COLD: NARCOTIC|1946|Discontinued by Manufacturer||Discontinued by Manufacturer||No|No||PHARM ASSOC INC|No|||||No|Yes|No||
codeine phosphate/guaifenesin|No|No|No|No|90%|00121077516|GUAIFEN-CODEINE 100-10 MG/5 ML|473|ML|.01419|11/06/2006||Yes|No||04/15/2011||Yes|No|11/06/2006||Yes|No||||No|No|||Prescription required|No||183|Yes|.03138|10/24/2023|.03062|10/24/2023|.03083|10/24/2023|||COUGH AND COLD: NARCOTIC|1947|||||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|1948|||||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|1949|||||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|.05794|10/24/2023|.05654|10/24/2023|.05692|10/24/2023||||1950|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
nystatin|No|No|No|No|75%|00121086802|NYSTATIN 100,000 UNIT/ML SUSP|60|ML|.09452|02/04/2021||Yes|No||02/04/2021||Yes|No|02/04/2021||Yes|No||||No|No|||Prescription required|No||069|No|.13653|10/24/2023|.13325|10/24/2023|.13414|10/24/2023|||ANTIFUNGALS: ORAL|1951|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
nystatin|No|No|No|No|75%|00121086816|NYSTATIN 100,000 UNIT/ML SUSP|473|ML|.03173|02/04/2021||Yes|No||02/04/2021||Yes|No|02/04/2021||Yes|No||||No|No|||Prescription required|No||069|No|.04781|10/24/2023|.04666|10/24/2023|.04697|10/24/2023|||ANTIFUNGALS: ORAL|1952|||||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|.01271|10/24/2023|.0124|10/24/2023|.01248|10/24/2023||||1953|||||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|.01156|10/24/2023|.01128|10/24/2023|.01135|10/24/2023||||1954|||||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|.00519|10/24/2023|.00506|10/24/2023|.00509|10/24/2023||||1955|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
promethazine HCl|No|No|No|No|75%|00121092716|PROMETHAZINE 6.25 MG/5 ML SOLN|473|ML|.01227|02/13/2023|08/01/2024|Yes|No||02/13/2023|08/01/2024|Yes|No|02/13/2023|08/01/2024|Yes|No||||No|No|||Prescription required|No||085|Yes|.02822|10/24/2023|.02754|10/24/2023|.02772|10/24/2023|||ANTIEMETIC/ANTIVERTIGO AGENTS|1956|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARM ASSOC INC|No|||||No|No|No||
brompheniramine/pseudoephed/DM|No|No|No|No|75%|00121093304|BROMPHEN-PSE-DM 2-30-10 MG/5ML|118|ML|.03625|11/15/2022||Yes|No||11/15/2022||Yes|No|11/15/2022||Yes|No||||No|No|||Prescription required|No||184|Yes|.07451|10/24/2023|.07272|10/24/2023|.0732|10/24/2023|||COUGH AND COLD: NON-NARCOTIC|1957|||||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|.07772|10/24/2023|.07585|10/24/2023|.07635|10/24/2023|||ANTICONVULSANTS|1958|||||No|No||PHARM ASSOC INC|No|||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00121101830|BUPRENORPHINE-NALOX 2-0.5MG TB|30|EA|.39775|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription required|No||145|Yes|.9065|10/02/2023|.89355|10/02/2023|.851|10/02/2023|||OPIATE DEPENDENCE TREATMENTS|1959|||||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|03/15/2024|Yes|No||09/27/2019|03/15/2024|Yes|No|09/27/2019|03/15/2024|Yes|No||||No|No|||Prescription required|No|||No|.05667|10/24/2023|.0553|10/24/2023|.05567|10/24/2023||||1960|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||PHARM ASSOC INC|No|||||No|No|No||
buprenorphine HCl/naloxone HCl|No|No|No|No|90%|00121203630|BUPRENORPHINE-NALOX 8-2 MG TAB|30|EA|.57333|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No||||No|No|||Prescription required|No||145|Yes|1.30666|10/02/2023|1.28799|10/02/2023|1.22666|10/02/2023|||OPIATE DEPENDENCE TREATMENTS|1961|||||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|10.79391|10/24/2023|10.53485|10/24/2023|10.60501|10/24/2023|||ANTICONVULSANTS|1962|||||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|10.79391|10/24/2023|10.53485|10/24/2023|10.60501|10/24/2023|||ANTICONVULSANTS|1963|||||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|16.83524|10/24/2023|16.43119|10/24/2023|16.54062|10/24/2023|||ANTICONVULSANTS|1964|||||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|16.83524|10/24/2023|16.43119|10/24/2023|16.54062|10/24/2023|||ANTICONVULSANTS|1965|||||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|1966|||||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|1967|||||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|1968|||||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|1969|||||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|2.0921|10/24/2023|2.04188|10/24/2023|2.05548|10/24/2023|||ANTICONVULSANTS|1970|||||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||||1971|||||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|.46787|09/26/2023|.45664|09/26/2023|.45968|09/26/2023|||ANGIOTENSIN MODULATORS|1972|||||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|.46787|09/26/2023|.45664|09/26/2023|.45968|09/26/2023|||ANGIOTENSIN MODULATORS|1973|||||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|.28073|10/24/2023|.27399|10/24/2023|.27581|10/24/2023|||ANGIOTENSIN MODULATORS|1974|||||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|.28073|10/24/2023|.27399|10/24/2023|.27581|10/24/2023|||ANGIOTENSIN MODULATORS|1975|||||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|.23262|10/24/2023|.22703|10/24/2023|.22854|10/24/2023|||ANGIOTENSIN MODULATORS|1976|||||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|.23262|10/24/2023|.22703|10/24/2023|.22854|10/24/2023|||ANGIOTENSIN MODULATORS|1977|||||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|.89116|07/25/2023|.86977|07/25/2023|.87556|07/25/2023|||ANGIOTENSIN MODULATORS|1978|||||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|.1404|10/24/2023|.13703|10/24/2023|.13794|10/24/2023||||1979|||||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|.1404|10/24/2023|.13703|10/24/2023|.13794|10/24/2023||||1980|||||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|.19381|10/24/2023|.18915|10/24/2023|.19041|10/24/2023||||1981|||||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|.19381|10/24/2023|.18915|10/24/2023|.19041|10/24/2023||||1982|||||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|.19807|10/24/2023|.19331|10/24/2023|.1946|10/24/2023||||1983|||||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|.19807|10/24/2023|.19331|10/24/2023|.1946|10/24/2023||||1984|||||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||||1985|||||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|.21883|10/24/2023|.21357|10/24/2023|.215|10/24/2023|||ANTICONVULSANTS|1986|||||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|.21883|10/24/2023|.21357|10/24/2023|.215|10/24/2023|||ANTICONVULSANTS|1987|||||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||||1988|||||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|.3322|10/24/2023|.32422|10/24/2023|.32638|10/24/2023|||ANTICONVULSANTS|1989|||||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|.3322|10/24/2023|.32422|10/24/2023|.32638|10/24/2023|||ANTICONVULSANTS|1990|||||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||||1991|||||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|.11074|10/24/2023|.10808|10/24/2023|.1088|10/24/2023|||ANTICONVULSANTS|1992|||||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|.11074|10/24/2023|.10808|10/24/2023|.1088|10/24/2023|||ANTICONVULSANTS|1993|||||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|.14343|10/24/2023|.13998|10/24/2023|.14091|10/24/2023|||ANTICONVULSANTS|1994|||||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|.14343|10/24/2023|.13998|10/24/2023|.14091|10/24/2023|||ANTICONVULSANTS|1995|||||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|.20315|10/24/2023|.19827|10/24/2023|.19959|10/24/2023||||1996|||||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|.30047|10/24/2023|.29325|10/24/2023|.29521|10/24/2023||||1997|||||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|.2559|10/24/2023|.24975|10/24/2023|.25142|10/24/2023||||1998|||||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|.1376|10/24/2023|.13429|10/24/2023|.13519|10/24/2023|||TETRACYCLINES|1999|||||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|.1376|10/24/2023|.13429|10/24/2023|.13519|10/24/2023|||TETRACYCLINES|2000|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301801|COLCHICINE 0.6 MG CAPSULE|100|EA|2.57888|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||05/12/2015||Yes|No|||Prescription required|Yes|01/22/2015|231|No|4.36513|10/24/2023|4.26036|10/24/2023|4.28874|10/24/2023|||ANTIHYPERURICEMICS|2001|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301810|COLCHICINE 0.6 MG CAPSULE|1000|EA|2.57889|05/12/2015||Yes|No||05/12/2015||Yes|No|05/12/2015||Yes|No||05/12/2015||Yes|No|||Prescription required|Yes|01/22/2015|231|No|4.36513|10/24/2023|4.26036|10/24/2023|4.28874|10/24/2023|||ANTIHYPERURICEMICS|2002|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
colchicine|No|No|No|No|75%|00143301830|COLCHICINE 0.6 MG CAPSULE|30|EA|2.57885|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription required|Yes|07/26/2018|231|No|4.36513|10/24/2023|4.26036|10/24/2023|4.28874|10/24/2023|||ANTIHYPERURICEMICS|2003|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143312601|DICYCLOMINE 10 MG CAPSULE|100|EA|.08578|09/09/2016|02/28/2025|Yes|No||09/09/2016|02/28/2025|Yes|No|09/09/2016|02/28/2025|Yes|No||||No|No|||Prescription required|No|||No|.11422|10/24/2023|.11147|10/24/2023|.11222|10/24/2023||||2004|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dicyclomine HCl|No|No|No|No|75%|00143312610|DICYCLOMINE 10 MG CAPSULE|1000|EA|.07933|09/09/2016|01/31/2025|Yes|No||09/09/2016|01/31/2025|Yes|No|09/09/2016|01/31/2025|Yes|No||||No|No|||Prescription required|No|||No|.11422|10/24/2023|.11147|10/24/2023|.11222|10/24/2023||||2005|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
doxycycline hyclate|Yes|No|No|No|75%|00143314250|DOXYCYCLINE HYCLATE 100 MG CAP|50|EA|.516|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|11/01/2012||Prescription required|No||213|No|.12965|10/24/2023|.12653|10/24/2023|.12738|10/24/2023|||TETRACYCLINES|2006|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
gentamicin sulfate|No|No|No|No|75%|00143912825|GENTAMICIN 80 MG/2 ML VIAL|2|ML|.7611|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|No|||No|1.7346|08/01/2023|1.70982|08/01/2023|1.6284|08/01/2023||||2007|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
mitomycin|No|No|No|No|75%|00143913501|MITOMYCIN 20 MG VIAL|1|EA|47.3|10/26/2023||Yes|No||10/26/2023||Yes|No|10/26/2023||Yes|No||||No|No|||Prescription required|No|||No|107.8|10/26/2023|106.26|10/31/2023|101.2|10/26/2023||||2008|||||No|No||WEST-WARD/HI-NO|No|||||No|No|No||
cefazolin sodium|No|No|No|No|75%|00143913925|CEFAZOLIN 2 GM VIAL|1|EA|2.5155|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|No|||No|5.733|08/01/2023|5.6511|08/01/2023|5.382|08/01/2023||||2009|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
amoxicillin/potassium clav|No|No|No|No|75%|00143924920|AMOX-CLAV 875-125 MG TABLET|20|EA|.5074|04/24/2020||Yes|No||04/24/2020||Yes|No|04/24/2020||Yes|No||04/24/2020||Yes|No|||Prescription required|No||046|No|.33189|10/24/2023|.32392|10/24/2023|.32608|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2010|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dihydroergotamine mesylate|No|No|No|No|75%|00143927301|DIHYDROERGOTAMINE 1 MG/ML AMP|1|ML||08/16/2022||Yes|No||08/16/2022||Yes|No|08/16/2022||Yes|No||||No|No|||Prescription required|Yes|12/07/2017|537|Yes|||||||152.49|08/16/2022|ANTIMIGRAINE AGENTS: OTHER|2011|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
dihydroergotamine mesylate|No|No|No|No|75%|00143927310|DIHYDROERGOTAMINE 1 MG/ML AMP|1|ML|64.285|08/16/2022||Yes|No||08/16/2022||Yes|No|08/16/2022||Yes|No||||No|No|||Prescription required|Yes|12/07/2017|537|Yes|146.51|08/16/2022|144.417|08/16/2022|137.54|08/16/2022|||ANTIMIGRAINE AGENTS: OTHER|2012|||||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|.17141|10/24/2023|.16729|10/24/2023|.16841|10/24/2023|||PENICILLINS|2013|||||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|.17141|10/24/2023|.16729|10/24/2023|.16841|10/24/2023|||PENICILLINS|2014|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
estradiol valerate|No|No|No|No|75%|00143928901|ESTRADIOL VALERATE 50 MG/5 ML|5|ML|10.26152|10/26/2023||Yes|No||10/26/2023||Yes|No|10/26/2023||Yes|No||||No|No|||Prescription required|No|||Yes|23.38672|10/26/2023|23.05262|10/26/2023|21.95488|10/26/2023||||2015|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
linezolid in dextrose 5%|No|No|No|No|75%|00143953410|LINEZOLID 600 MG/300 ML-D5W|300|ML|.05016|08/01/2023||Yes|No||08/01/2023||Yes|No|08/01/2023||Yes|No||||No|No|||Prescription required|No||146|No|.11432|08/01/2023|.11269|08/01/2023|.10732|08/01/2023|||LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS|2016|||||No|No||HIKMA PHARMACEU|No|||||No|No|No||
abiraterone acetate|No|No|No|No|75%|00143959721|ABIRATERONE ACETATE 250 MG TAB|120|EA|2.15|03/04/2019||Yes|No||03/04/2019||Yes|No|03/04/2019||Yes|No||||No|No|||Prescription required|No||550|No|.95126|10/24/2023|.92842|10/24/2023|.93461|10/24/2023|||ONCOLOGY: ORAL - PROSTATE|2017|||||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|.9864|03/28/2023|.96272|03/28/2023|.96913|03/28/2023||||2018|||||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||||2019|||||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|3.13467|10/24/2023|3.05943|10/24/2023|3.07981|10/24/2023||||2020|||||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|.93209|10/24/2023|.90971|10/24/2023|.91577|10/24/2023||||2021|||||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||2022|||||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|2.58423|10/24/2023|2.5222|10/24/2023|2.539|10/24/2023||||2023|||||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|13.13104|10/24/2023|12.81589|10/24/2023|12.90124|10/24/2023||||2024|||||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||||2025|||||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||||2026|||||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||||2027|||||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||||2028|||||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||||2029|||||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||||2030|||||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||||2031|||||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||||2032|||||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||||2033|||||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||2034|||||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||2035|||||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||2036|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
progesterone|No|No|No|No|75%|00143972501|PROGESTERONE 500 MG/10 ML VIAL|10|ML|1.46329|10/01/2020||Yes|No||10/01/2020||Yes|No|10/01/2020||Yes|No||||No|No|||Prescription required|No|||No|1.90354|10/24/2023|1.85785|10/24/2023|1.87022|10/24/2023||||2037|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
testosterone cypionate|No|No|No|No|90%|00143972601|TESTOSTERONE CYP 2,000 MG/10ML|10|ML|3.397|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription required|No|||No|4.02857|10/24/2023|3.93188|10/24/2023|3.95807|10/24/2023||||2038|||||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||||2039|||||No|No||WEST-WARD/HIKMA|No|||||No|No|No||
testosterone enanthate|No|No|No|No|90%|00143975001|TESTOSTERON ENAN 1,000 MG/5 ML|5|ML|7.05888|08/11/2022||Yes|No||08/11/2022||Yes|No|08/11/2022||Yes|No||||No|No|||Prescription required|No|||No|13.14015|10/24/2023|12.82478|10/24/2023|12.91019|10/24/2023||||2040|||||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||||2041|||||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|.17209|10/24/2023|.16795|10/24/2023|.16907|10/24/2023|||TETRACYCLINES|2042|||||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|.12965|10/24/2023|.12653|10/24/2023|.12738|10/24/2023|||TETRACYCLINES|2043|||||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|.12965|10/24/2023|.12653|10/24/2023|.12738|10/24/2023|||TETRACYCLINES|2044|||||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|.10591|10/24/2023|.10336|10/24/2023|.10405|10/24/2023|||PENICILLINS|2045|||||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|.10591|10/24/2023|.10336|10/24/2023|.10405|10/24/2023|||PENICILLINS|2046|||||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|.07171|10/24/2023|.06998|10/24/2023|.07045|10/24/2023|||PENICILLINS|2047|||||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|.07171|10/24/2023|.06998|10/24/2023|.07045|10/24/2023|||PENICILLINS|2048|||||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|.06244|10/24/2023|.06094|10/24/2023|.06134|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2049|||||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|.05694|10/24/2023|.05557|10/24/2023|.05594|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2050|||||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|.10807|10/24/2023|.10547|10/24/2023|.10617|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2051|||||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|.03506|10/24/2023|.03421|10/24/2023|.03444|10/24/2023|||PENICILLINS|2052|||||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|.0402|08/29/2023|.03923|08/29/2023|.03949|08/29/2023|||PENICILLINS|2053|||||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|.03571|09/26/2023|.03485|09/26/2023|.03508|09/26/2023|||PENICILLINS|2054|||||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|.02951|10/24/2023|.0288|10/24/2023|.02899|10/24/2023|||PENICILLINS|2055|||||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|.04671|10/24/2023|.04558|10/24/2023|.04589|10/24/2023|||PENICILLINS|2056|||||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|.0319|10/24/2023|.03113|10/24/2023|.03134|10/24/2023|||PENICILLINS|2057|||||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|.01872|10/24/2023|.01827|10/24/2023|.01839|10/24/2023|||PENICILLINS|2058|||||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|.01871|10/24/2023|.01826|10/24/2023|.01838|10/24/2023|||PENICILLINS|2059|||||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|.01896|07/25/2023|.0185|07/25/2023|.01862|07/25/2023|||PENICILLINS|2060|||||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|.02725|10/24/2023|.02659|10/24/2023|.02677|10/24/2023|||PENICILLINS|2061|||||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|.02693|10/24/2023|.02628|10/24/2023|.02645|10/24/2023|||PENICILLINS|2062|||||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|.02789|10/24/2023|.02722|10/24/2023|.0274|10/24/2023|||PENICILLINS|2063|||||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||||2064|||||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||||2065|||||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|.09769|10/24/2023|.09534|10/24/2023|.09598|10/24/2023|||FLUOROQUINOLONES: ORAL|2066|||||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|.15515|10/24/2023|.15142|10/24/2023|.15243|10/24/2023|||FLUOROQUINOLONES: ORAL|2067|||||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|.27555|10/24/2023|.26893|10/24/2023|.27072|10/24/2023|||FLUOROQUINOLONES: ORAL|2068|||||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|.10233|10/24/2023|.09987|10/24/2023|.10053|10/24/2023|||PENICILLINS|2069|||||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||2070|||||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||||2071|||||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||2072|||||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|.06111|10/24/2023|.05964|10/24/2023|.06004|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2073|||||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|.07889|09/26/2023|.07699|09/26/2023|.0775|09/26/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2074|||||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|.05852|05/23/2023|.05711|05/23/2023|.05749|05/23/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2075|||||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|.05966|10/24/2023|.05822|10/24/2023|.05861|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2076|||||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|.08823|10/24/2023|.08611|10/24/2023|.08668|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2077|||||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|.06769|10/24/2023|.06606|10/24/2023|.0665|10/24/2023|||CEPHALOSPORINS AND RELATED ANTIBIOTICS|2078|||||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||2079|||||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|.22335|10/24/2023|.21798|10/24/2023|.21944|10/24/2023|||STEROIDS: TOPICAL HIGH|2080|||||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|.12955|10/24/2023|.12644|10/24/2023|.12728|10/24/2023|||STEROIDS: TOPICAL HIGH|2081|||||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|.05627|10/24/2023|.05491|10/24/2023|.05528|10/24/2023|||STEROIDS: TOPICAL HIGH|2082|||||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|.14654|10/24/2023|.14302|10/24/2023|.14397|10/24/2023|||STEROIDS: TOPICAL HIGH|2083|||||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|.02587|06/27/2023|.02524|06/27/2023|.02541|06/27/2023|||STEROIDS: TOPICAL HIGH|2084|||||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|.05458|10/24/2023|.05327|10/24/2023|.05362|10/24/2023|||STEROIDS: TOPICAL HIGH|2085|||||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|.07143|10/24/2023|.06971|10/24/2023|.07017|10/24/2023|||STEROIDS: TOPICAL HIGH|2086|||||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|.14382|10/24/2023|.14036|10/24/2023|.1413|10/24/2023|||STEROIDS: TOPICAL HIGH|2087|||||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|.03743|10/24/2023|.03653|10/24/2023|.03677|10/24/2023|||STEROIDS: TOPICAL HIGH|2088|||||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|.07019|10/24/2023|.0685|10/24/2023|.06896|10/24/2023|||STEROIDS: TOPICAL HIGH|2089|||||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|.27327|10/24/2023|.26671|10/24/2023|.26848|10/24/2023|||ANTIFUNGALS: TOPICAL|2090|||||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|2091|||||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|.09716|10/24/2023|.09482|10/24/2023|.09545|10/24/2023|||STEROIDS: TOPICAL LOW|2092|||||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|2093|||||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|.14745|10/24/2023|.14391|10/24/2023|.14486|10/24/2023|||STEROIDS: TOPICAL LOW|2094|||||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|.67417|10/24/2023|.65798|10/24/2023|.66237|10/24/2023|||STEROIDS: TOPICAL HIGH|2095|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168003346|BETAMETHASONE VALER 0.1% OINTM|45|GM|.31743|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||120|No|.55225|10/24/2023|.53899|10/24/2023|.54258|10/24/2023|||STEROIDS: TOPICAL HIGH|2096|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone valerate|No|No|No|No|75%|00168004015|BETAMETHASONE VA 0.1% CREAM|15|GM|.64156|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||120|No|.58616|10/24/2023|.57209|10/24/2023|.5759|10/24/2023|||STEROIDS: TOPICAL HIGH|2097|||||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|.4818|10/24/2023|.47023|10/24/2023|.47336|10/24/2023|||STEROIDS: TOPICAL HIGH|2098|||||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|.45186|10/24/2023|.44101|10/24/2023|.44395|10/24/2023|||STEROIDS: TOPICAL HIGH|2099|||||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|.74579|10/24/2023|.72789|10/24/2023|.73273|10/24/2023|||STEROIDS: TOPICAL HIGH|2100|||||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|.54379|10/24/2023|.53073|10/24/2023|.53427|10/24/2023|||STEROIDS: TOPICAL HIGH|2101|||||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|.94978|10/24/2023|.92698|10/24/2023|.93315|10/24/2023|||STEROIDS: TOPICAL HIGH|2102|||||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|.79152|10/24/2023|.77252|10/24/2023|.77766|10/24/2023|||STEROIDS: TOPICAL HIGH|2103|||||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|.35735|10/24/2023|.34877|10/24/2023|.35109|10/24/2023|||STEROIDS: TOPICAL HIGH|2104|||||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|.20948|10/24/2023|.20445|10/24/2023|.20581|10/24/2023|||STEROIDS: TOPICAL MEDIUM|2105|||||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|1.2168|10/24/2023|1.18759|10/24/2023|1.1955|10/24/2023|||STEROIDS: TOPICAL MEDIUM|2106|||||No|No||FOUGERA/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|.40325|09/26/2023|.39357|09/26/2023|.39619|09/26/2023|||STEROIDS: TOPICAL MEDIUM|2107|||||No|No||FOUGERA/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|.11749|10/24/2023|.11467|10/24/2023|.11543|10/24/2023|||STEROIDS: TOPICAL LOW|2108|||||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|.08239|10/24/2023|.08041|10/24/2023|.08094|10/24/2023|||STEROIDS: TOPICAL LOW|2109|||||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|.26576|10/24/2023|.25938|10/24/2023|.2611|10/24/2023|||ANTIFUNGALS: TOPICAL|2110|||||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|.27239|10/24/2023|.26585|10/24/2023|.26762|10/24/2023|||ANTIFUNGALS: TOPICAL|2111|||||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|.2028|10/24/2023|.19793|10/24/2023|.19925|10/24/2023|||ANTIFUNGALS: TOPICAL|2112|||||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|.19602|10/24/2023|.19131|10/24/2023|.19258|10/24/2023|||STEROIDS: TOPICAL HIGH|2113|||||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|2114|||||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|.09598|10/24/2023|.09367|10/24/2023|.0943|10/24/2023|||STEROIDS: TOPICAL LOW|2115|||||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|12/31/2023|Yes|No||01/06/2004|12/31/2023|Yes|No|01/06/2004|12/31/2023|Yes|No||||No|No|||Prescription required|No||121|No|.21144|10/24/2023|.20636|10/24/2023|.20773|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2116|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.19154|10/24/2023|.18694|10/24/2023|.18818|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2117|||||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|.14616|10/24/2023|.14265|10/24/2023|.1436|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2118|||||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|.14691|10/24/2023|.14338|10/24/2023|.14433|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2119|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|.20199|10/24/2023|.19714|10/24/2023|.19845|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2120|||||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|.19156|10/24/2023|.18696|10/24/2023|.1882|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2121|||||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|.13279|10/24/2023|.1296|10/24/2023|.13046|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2122|||||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|.15849|10/24/2023|.15468|10/24/2023|.15571|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2123|||||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|.3111|10/24/2023|.30363|10/24/2023|.30565|10/24/2023|||ACNE AGENTS: TOPICAL|2124|||||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|.21267|10/24/2023|.20756|10/24/2023|.20894|10/24/2023|||ACNE AGENTS: TOPICAL|2125|||||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|.38135|10/24/2023|.37219|10/24/2023|.37467|10/24/2023|||ACNE AGENTS: TOPICAL|2126|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00168020260|CLINDAMYCIN PH 1% GEL|60|GM|1.07041|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|No||104|No|.27588|10/24/2023|.26925|10/24/2023|.27105|10/24/2023|||ACNE AGENTS: TOPICAL|2127|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
clindamycin phosphate|No|No|No|No|75%|00168020360|CLINDAMYCIN PHOSP 1% LOTION|60|ML|.82689|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|Yes|07/26/2018|104|No|.35456|10/24/2023|.34605|10/24/2023|.34835|10/24/2023|||ACNE AGENTS: TOPICAL|2128|||||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|.17229|10/24/2023|.16815|10/24/2023|.16927|10/24/2023||||2129|||||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|.22521|10/24/2023|.2198|10/24/2023|.22126|10/24/2023|||ANTIFUNGALS: TOPICAL|2130|||||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|.14945|10/24/2023|.14586|10/24/2023|.14683|10/24/2023|||ANTIFUNGALS: TOPICAL|2131|||||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|.91367|10/24/2023|.89174|10/24/2023|.89768|10/24/2023|||STEROIDS: TOPICAL LOW|2132|||||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|.53521|10/24/2023|.52236|10/24/2023|.52584|10/24/2023|||STEROIDS: TOPICAL LOW|2133|||||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|.54248|10/24/2023|.52946|10/24/2023|.53298|10/24/2023|||STEROIDS: TOPICAL LOW|2134|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026415|ALCLOMETASONE DIPR 0.05% OINT|15|GM|.47787|04/21/2008|09/30/2024|Yes|No||04/21/2008|09/30/2024|Yes|No|04/21/2008|09/30/2024|Yes|No||||No|No|||Prescription required|Yes|01/25/2012|118|No|.80752|10/24/2023|.78813|10/24/2023|.79338|10/24/2023|||STEROIDS: TOPICAL LOW|2135|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
alclometasone dipropionate|No|No|No|No|75%|00168026445|ALCLOMETASONE DIPR 0.05% OINT|45|GM|.23745|04/21/2008||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|2136|||||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|12/31/2024|Yes|No||04/21/2008|12/31/2024|Yes|No|04/21/2008|12/31/2024|Yes|No||||No|No|||Prescription required|Yes|01/25/2012|118|No|.51401|06/29/2021|.50666|06/29/2021|.48254|06/29/2021|||STEROIDS: TOPICAL LOW|2137|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026515|BETAMETHASONE DP AUG 0.05% CRM|15|GM|.60888|01/04/2008||Yes|No||01/04/2008||Yes|No|01/04/2008||Yes|No||||No|No|||Prescription required|No||120|No|.23252|10/24/2023|.22693|10/24/2023|.22845|10/24/2023|||STEROIDS: TOPICAL HIGH|2138|||||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|.1227|10/24/2023|.11975|10/24/2023|.12055|10/24/2023|||STEROIDS: TOPICAL HIGH|2139|||||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|.67773|08/29/2023|.66146|08/29/2023|.66586|08/29/2023|||STEROIDS: TOPICAL HIGH|2140|||||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|.4006|10/24/2023|.39098|10/24/2023|.39358|10/24/2023|||STEROIDS: TOPICAL HIGH|2141|||||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|.8684|10/24/2023|.84755|10/24/2023|.8532|10/24/2023|||STEROIDS: TOPICAL HIGH|2142|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
betamethasone/propylene glyc|No|No|No|No|75%|00168026850|BETAMETHASONE DP AUG 0.05% OIN|50|GM|.76918|01/06/2004||Yes|No||01/06/2004||Yes|No|01/06/2004||Yes|No||||No|No|||Prescription required|Yes|01/20/2011|120|No|.54259|10/24/2023|.52956|10/24/2023|.53309|10/24/2023|||STEROIDS: TOPICAL HIGH|2143|||||No|No||FOUGERA/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|.23272|10/24/2023|.22713|10/24/2023|.22864|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2144|||||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|1.82261|10/24/2023|1.77886|10/24/2023|1.79071|10/24/2023|||ANTIBIOTICS: VAGINAL|2145|||||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|2146|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|2147|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|2148|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|1.05739|10/24/2023|1.03201|10/24/2023|1.03888|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2149|||||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|.32822|10/24/2023|.32034|10/24/2023|.32247|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2150|||||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|.22243|10/24/2023|.21709|10/24/2023|.21853|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2151|||||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|.93295|10/24/2023|.91055|10/24/2023|.91662|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2152|||||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|1.2924|10/24/2023|1.26138|10/24/2023|1.26978|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2153|||||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|.55267|10/24/2023|.5394|10/24/2023|.54299|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2154|||||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|.53078|10/24/2023|.51804|10/24/2023|.52149|10/24/2023|||ROSACEA AGENTS: TOPICAL|2155|||||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|.4182|10/24/2023|.40816|10/24/2023|.41088|10/24/2023|||STEROIDS: TOPICAL MEDIUM|2156|||||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|.24717|10/24/2023|.24123|10/24/2023|.24284|10/24/2023|||STEROIDS: TOPICAL MEDIUM|2157|||||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|.18019|10/24/2023|.17586|10/24/2023|.17703|10/24/2023|||STEROIDS: TOPICAL MEDIUM|2158|||||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|1.11379|10/24/2023|1.08705|10/24/2023|1.09429|10/24/2023||||2159|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
mupirocin|No|No|No|No|75%|00168035222|MUPIROCIN 2% OINTMENT|22|GM|.63033|02/13/2009|10/31/2023|Yes|No||02/13/2009|10/31/2023|Yes|No|02/13/2009|10/31/2023|Yes|No||||No|No|||Prescription required|No||114|No|1.43658|11/14/2023|1.41605|11/14/2023|1.34862|11/14/2023|||ANTIBIOTICS: TOPICAL|2160|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.45345|10/24/2023|.44256|10/24/2023|.44551|10/24/2023|||STEROIDS: TOPICAL VERY HIGH|2161|||||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|.37739|10/24/2023|.36833|10/24/2023|.37078|10/24/2023||||2162|||||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||||2163|||||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|2164|||||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|2165|||||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|2166|||||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|1.85209|10/24/2023|1.80763|10/24/2023|1.81967|10/24/2023|||ROSACEA AGENTS: TOPICAL|2167|||||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|2168|||||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|2169|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041630|TACROLIMUS 0.1% OINTMENT|30|GM|1.94116|10/07/2016||Yes|No||10/07/2016||Yes|No|10/07/2016||Yes|No||||No|No|||Prescription required|No||034|Yes|1.35716|10/24/2023|1.32458|10/24/2023|1.3334|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2170|||||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|No||034|Yes|1.21178|10/24/2023|1.18269|10/24/2023|1.19057|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2171|||||No|No||FOUGERA/SANDOZ|No|||||No|No|No||
tacrolimus|No|No|No|No|75%|00168041699|TACROLIMUS 0.1% OINTMENT|100|GM|1.94119|02/19/2015||Yes|No||02/19/2015||Yes|No|02/19/2015||Yes|No||||No|No|||Prescription required|No||034|Yes|1.35891|10/24/2023|1.32629|10/24/2023|1.33512|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2172|||||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|No||034|Yes|1.26748|10/24/2023|1.23706|10/24/2023|1.24529|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2173|||||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|No||034|Yes|1.26722|10/24/2023|1.2368|10/24/2023|1.24504|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2174|||||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|No||034|Yes|.68214|10/24/2023|.66576|10/24/2023|.6702|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2175|||||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|3.47813|10/24/2023|3.39465|10/24/2023|3.41726|10/24/2023|||ACNE AGENTS: TOPICAL|2176|||||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|2177|||||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|2178|||||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|2179|||||No|No||NOVO NORDISK|No|||||No|No|No||
somapacitan-beco|No|No|No|No|75%|00169203011|SOGROYA 10 MG/1.5 ML PEN|1.5|ML|755.596|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No|||No|1722.056|09/05/2023|1697.4552|09/05/2023|1616.624|09/05/2023||||2180|||||No|No||NOVO NORDISK|No|||||No|No|No||
somapacitan-beco|No|No|No|No|75%|00169203511|SOGROYA 5 MG/1.5 ML PEN|1.5|ML|377.798|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No|||No|861.028|10/02/2023|848.7276|10/02/2023|808.312|10/02/2023||||2181|||||No|No||NOVO NORDISK|No|||||No|No|No||
somapacitan-beco|No|No|No|No|75%|00169203711|SOGROYA 15 MG/1.5 ML PEN|1.5|ML|1133.394|10/02/2023||Yes|No||10/02/2023||Yes|No|10/02/2023||Yes|No|Submit HHS Form 1312|||No|No|||Prescription required|No|||No|2583.084|10/02/2023|2546.1828|10/02/2023|2424.936|10/02/2023||||2182|||||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|2183|||||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|2184|||||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|2185|||||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|2186|||||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|2187|||||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|2188|||||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|32.32113|08/29/2023|31.54542|08/29/2023|31.75551|08/29/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2189|||||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|79.06613|10/24/2023|77.16854|10/24/2023|77.68247|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2190|||||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|2191|||||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|2192|||||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|2193|||||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|27.76|08/29/2023|27.09376|08/29/2023|27.2742|08/29/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2194|||||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|35.70964|08/29/2023|34.8526|08/29/2023|35.08472|08/29/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2195|||||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|35.1147|06/27/2023|34.61306|06/27/2023|32.96482|06/27/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2196|||||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|2197|||||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|29.0089|05/23/2023|28.31268|05/23/2023|28.50124|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2198|||||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|2199|||||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|35.77529|05/23/2023|34.91668|05/23/2023|35.14922|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2200|||||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|119.64681|06/27/2023|116.77528|06/27/2023|117.55299|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2201|||||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|119.65102|06/27/2023|116.77939|06/27/2023|117.55712|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2202|||||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|300.60684|10/24/2023|293.39227|10/24/2023|295.34622|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2203|||||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|05/14/2024|Yes|No||07/06/2018|05/14/2024|Yes|No|07/06/2018|05/14/2024|Yes|No||07/06/2018|05/14/2024|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|2204|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%|00169418113|OZEMPIC 0.25-0.5 MG/DOSE PEN|3|ML|134.12703|04/13/2023||Yes|No||04/13/2023||Yes|No|04/13/2023||Yes|No||04/13/2023||Yes|No|||Prescription required|No||111|Yes|300.33926|06/27/2023|293.13111|06/27/2023|295.08332|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2205|||||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|30.00704|06/27/2023|29.28687|06/27/2023|29.48191|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2206|||||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|30.02422|06/27/2023|29.30363|06/27/2023|29.49879|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2207|||||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|30.02422|06/27/2023|29.30363|06/27/2023|29.49879|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2208|||||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|30.03302|06/27/2023|29.31222|06/27/2023|29.50744|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2209|||||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|300.58653|06/27/2023|293.37245|06/27/2023|295.32626|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2210|||||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||||2211|||||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||||2212|||||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|35.79382|05/23/2023|34.93476|05/23/2023|35.16742|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2213|||||No|No||NOVO NORDISK|No|||||No|No|No||
insulin detemir|No|No|No|No|75%|00169643210|LEVEMIR FLEXPEN 100 UNIT/ML|3|ML|13.25002|04/04/2023||Yes|No||04/04/2023||Yes|No|04/04/2023||Yes|No||04/04/2023||Yes|No|||Prescription required|No||029|No|29.58848|05/23/2023|28.87835|05/23/2023|29.07068|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2214|||||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|29.58848|05/23/2023|28.87835|05/23/2023|29.07068|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2215|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|2216|||||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|292.622|04/25/2023|285.59907|04/25/2023|287.50111|04/25/2023|||GLUCAGON AGENTS|2217|||||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|2218|||||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|2219|||||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|2220|||||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|2221|||||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|27.79486|05/23/2023|27.12778|05/23/2023|27.30844|05/23/2023|||HYPOGLYCEMICS: INSULIN AND RELATED AGENTS|2222|||||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|2223|||||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|2224|||||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|2225|||||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|2226|||||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|2227|||||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|2228|||||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|2229|||||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|2230|||||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|2231|||||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|2232|||||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|2233|||||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|2234|||||No|No||NOVO NORDISK|No|||||Yes|No|Yes|07/30/2021|
factor IX human rec,pegylated|No|No|No|No|75%|00169790301|REBINYN 3,000 UNIT VIAL|1|EA|3.162|08/21/2023||Yes|No||08/21/2023||Yes|No|08/21/2023||Yes|No||||No|No|||Prescription required|No||105|No|4.557|08/21/2023|4.4919|08/21/2023|4.278|08/21/2023|||HEMOPHILIA TREATMENT|2235|||||No|No||NOVO NORDISK|No|||||Yes|No|No||
factor IX human rec,pegylated|No|No|No|No|75%|00169790501|REBINYN 500 UNIT VIAL|1|EA|3.162|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|2236|||||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|2237|||||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|2238|||||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|2239|||||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|2240|||||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|2241|||||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|.01291|10/24/2023|.0126|10/24/2023|.01268|10/24/2023||||2242|||||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|.01291|10/24/2023|.0126|10/24/2023|.01268|10/24/2023||||2243|||||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|.03426|10/24/2023|.03343|10/24/2023|.03366|10/24/2023||||2244|||||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|.03426|10/24/2023|.03343|10/24/2023|.03366|10/24/2023||||2245|||||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|.04595|10/24/2023|.04484|10/24/2023|.04514|10/24/2023|||ANGIOTENSIN MODULATORS|2246|||||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|.05219|10/24/2023|.05093|10/24/2023|.05127|10/24/2023|||ANGIOTENSIN MODULATORS|2247|||||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|.02264|10/24/2023|.02209|10/24/2023|.02224|10/24/2023|||ANXIOLYTICS|2248|||||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|.02264|10/24/2023|.02209|10/24/2023|.02224|10/24/2023|||ANXIOLYTICS|2249|||||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|.02861|10/24/2023|.02792|10/24/2023|.0281|10/24/2023|||ANXIOLYTICS|2250|||||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|.02861|10/24/2023|.02792|10/24/2023|.0281|10/24/2023|||ANXIOLYTICS|2251|||||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|.02861|10/24/2023|.02792|10/24/2023|.0281|10/24/2023|||ANXIOLYTICS|2252|||||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|.03065|10/24/2023|.02991|10/24/2023|.03011|10/24/2023|||ANXIOLYTICS|2253|||||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|.03065|10/24/2023|.02991|10/24/2023|.03011|10/24/2023|||ANXIOLYTICS|2254|||||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|.03065|10/24/2023|.02991|10/24/2023|.03011|10/24/2023|||ANXIOLYTICS|2255|||||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|.04809|10/24/2023|.04693|10/24/2023|.04724|10/24/2023|||SKELETAL MUSCLE RELAXANTS|2256|||||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|.04809|10/24/2023|.04693|10/24/2023|.04724|10/24/2023|||SKELETAL MUSCLE RELAXANTS|2257|||||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|.07312|10/24/2023|.07136|10/24/2023|.07184|10/24/2023|||SKELETAL MUSCLE RELAXANTS|2258|||||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|.07312|10/24/2023|.07136|10/24/2023|.07184|10/24/2023|||SKELETAL MUSCLE RELAXANTS|2259|||||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||||2260|||||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|.5725|07/25/2023|.55876|07/25/2023|.56248|07/25/2023||||2261|||||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|.0315|10/24/2023|.03074|10/24/2023|.03094|10/24/2023||||2262|||||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|.0315|10/24/2023|.03074|10/24/2023|.03094|10/24/2023||||2263|||||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|.0315|10/24/2023|.03074|10/24/2023|.03094|10/24/2023||||2264|||||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|.05666|10/24/2023|.0553|10/24/2023|.05566|10/24/2023||||2265|||||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|.05666|10/24/2023|.0553|10/24/2023|.05566|10/24/2023||||2266|||||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|2267|||||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|2268|||||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|2269|||||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|No||021|Yes|429.7854|01/17/2023|419.47055|01/17/2023|422.26415|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2270|||||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|No||021|Yes|459.0908|01/10/2023|452.53236|01/10/2023|430.9832|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2271|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
epoprostenol sodium (glycine)|No|No|No|No|75%|00173051700|FLOLAN 0.5 MG VIAL|1|EA|8.0367|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|18.3162|06/01/2016|18.05454|06/01/2016|17.1948|06/01/2016||||2272|||||No|No||GLAXOSMITHKLINE|No|||||Yes|No|Yes|10/23/2018|
epoprostenol sodium (glycine)|No|No|No|No|75%|00173051900|FLOLAN 1.5 MG VIAL|1|EA|19.4102|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|44.2372|06/01/2016|43.60524|06/01/2016|41.5288|06/01/2016||||2273|||||No|No||GLAXOSMITHKLINE|No|||||No|No|Yes|10/23/2018|
salmeterol xinafoate|No|No|No|No|75%|00173052100|SEREVENT DISKUS 50 MCG|60|EA|3.03479|10/10/2003||Yes|No||10/10/2003||Yes|No|10/10/2003||Yes|No||||No|No|||Prescription required|No||037|Yes|6.76115|03/28/2023|6.59888|03/28/2023|6.64282|03/28/2023|||BRONCHODILATORS: BETA AGONIST|2274|||||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|Yes|89.8011|01/17/2023|87.64587|01/17/2023|88.22958|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2275|||||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|Yes|88.6189|01/17/2023|86.49204|01/17/2023|87.06806|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2276|||||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|2277|||||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|2278|||||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||||2279|||||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|2280|||||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|2281|||||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|2282|||||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|No||033|Yes|3.0904|03/28/2023|3.01623|03/28/2023|3.03631|03/28/2023|||GLUCOCORTICOIDS: INHALED|2283|||||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|No||033|Yes|4.35727|03/28/2023|4.25269|03/28/2023|4.28101|03/28/2023|||GLUCOCORTICOIDS: INHALED|2284|||||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|No||033|Yes|3.26675|03/28/2023|3.18834|03/28/2023|3.20958|03/28/2023|||GLUCOCORTICOIDS: INHALED|2285|||||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|2286|||||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|2287|||||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|17.44651|10/24/2023|17.02779|10/24/2023|17.14119|10/24/2023|||ANTICONVULSANTS|2288|||||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|19.15494|10/24/2023|18.69522|10/24/2023|18.81972|10/24/2023|||ANTICONVULSANTS|2289|||||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|20.81765|10/24/2023|20.31802|10/24/2023|20.45334|10/24/2023|||ANTICONVULSANTS|2290|||||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|04/06/2024|Yes|No||03/01/2002|04/06/2024|Yes|No|03/01/2002|04/06/2024|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||||2291|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|04/06/2024|Yes|No||03/01/2002|04/06/2024|Yes|No|03/01/2002|04/06/2024|Yes|No|Refer to program requirements|||No|No|||Prescription required|No|||No|.79674|01/10/2017|.78535|01/10/2017|.74796|01/10/2017||||2292|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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||||2293|||||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||||2294|||||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||||2295|||||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||||2296|||||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|2297|||||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|3.03465|03/28/2023|2.96181|03/28/2023|2.98154|03/28/2023|||BRONCHODILATORS: BETA AGONIST|2298|||||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|2.72281|04/25/2023|2.65746|04/25/2023|2.67516|04/25/2023|||BRONCHODILATORS: BETA AGONIST|2299|||||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|2300|||||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|2301|||||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|2302|||||No|No||GLAXOSMITHKLINE|Yes|09/01/2020||||No|No|No||
dutasteride|No|No|No|No|75%|00173071204|AVODART 0.5 MG SOFTGEL|90|EA|3.9431|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|21.5768|06/20/2023|21.05895|06/20/2023|21.1992|06/20/2023|||BPH TREATMENTS|2303|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|3.9431|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|21.5768|06/20/2023|21.05895|06/20/2023|21.1992|06/20/2023|||BPH TREATMENTS|2304|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|26.08071|06/27/2023|25.45477|06/27/2023|25.62429|06/27/2023|||GLUCOCORTICOIDS: INHALED|2305|||||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|2306|||||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|32.38076|06/27/2023|31.60362|06/27/2023|31.81409|06/27/2023|||GLUCOCORTICOIDS: INHALED|2307|||||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|2308|||||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|42.66155|06/27/2023|41.63767|06/27/2023|41.91497|06/27/2023|||GLUCOCORTICOIDS: INHALED|2309|||||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|2310|||||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|18.48621|03/28/2023|18.04254|03/28/2023|18.1627|03/28/2023|||GLUCOCORTICOIDS: INHALED|2311|||||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|21.86386|03/28/2023|21.33912|03/28/2023|21.48124|03/28/2023|||GLUCOCORTICOIDS: INHALED|2312|||||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|33.92053|03/28/2023|33.10643|03/28/2023|33.32692|03/28/2023|||GLUCOCORTICOIDS: INHALED|2313|||||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|2314|||||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|Yes|33.04995|01/10/2023|32.5778|01/10/2023|31.02648|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2315|||||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|Yes|70.93996|01/17/2023|69.2374|01/17/2023|69.69851|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2316|||||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|Yes|70.73448|01/17/2023|69.03685|01/17/2023|69.49662|01/17/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2317|||||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|No||021|Yes|459.0908|01/10/2023|452.53236|01/10/2023|430.9832|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2318|||||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|No||021|Yes|434.8064|01/10/2023|428.59488|01/10/2023|408.1856|01/10/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|2319|||||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|2320|||||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|2321|||||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|2322|||||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|30.68173|10/24/2023|29.94536|10/24/2023|30.14479|10/24/2023|||ANTICONVULSANTS|2323|||||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|2324|||||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|2325|||||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|2326|||||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|2327|||||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|2328|||||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|2329|||||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|2330|||||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|2331|||||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|2332|||||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|2333|||||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|2334|||||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|2335|||||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|9.70051|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|21.66697|06/20/2023|21.14696|06/20/2023|21.28779|06/20/2023|||BPH TREATMENTS|2336|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|9.70051|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|21.66697|06/20/2023|21.14696|06/20/2023|21.28779|06/20/2023|||BPH TREATMENTS|2337|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|2338|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173085910|BREO ELLIPTA 100-25 MCG INHALR|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|6.31675|10/24/2023|6.16514|10/24/2023|6.2062|10/24/2023|||GLUCOCORTICOIDS: INHALED|2339|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173085914|BREO ELLIPTA 100-25 MCG INHALR|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|2340|||||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|7.36531|10/24/2023|7.18854|10/24/2023|7.23641|10/24/2023|||COPD AGENTS|2341|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
umeclidinium bromide|No|No|No|No|75%|00173087310|INCRUSE ELLIPTA 62.5 MCG INH|30|EA|5.07543|03/18/2015||Yes|No||03/18/2015||Yes|No|03/18/2015||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|098|No|11.3292|06/27/2023|11.05729|06/27/2023|11.13093|06/27/2023|||COPD AGENTS|2342|||||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|6.66163|10/24/2023|6.50175|10/24/2023|6.54505|10/24/2023|||GLUCOCORTICOIDS: INHALED|2343|||||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|8.92248|10/24/2023|8.70834|10/24/2023|8.76633|10/24/2023|||GLUCOCORTICOIDS: INHALED|2344|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
fluticasone/vilanterol|No|No|No|No|75%|00173088210|BREO ELLIPTA 200-25 MCG INHALR|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|6.31469|10/24/2023|6.16313|10/24/2023|6.20418|10/24/2023|||GLUCOCORTICOIDS: INHALED|2345|||||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|10.22268|10/24/2023|9.97733|10/24/2023|10.04378|10/24/2023|||GLUCOCORTICOIDS: INHALED|2346|||||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|10.24814|10/24/2023|10.00218|10/24/2023|10.06879|10/24/2023|||GLUCOCORTICOIDS: INHALED|2347|||||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|6.7215|10/24/2023|6.56018|10/24/2023|6.60387|10/24/2023|||GLUCOCORTICOIDS: INHALED|2348|||||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||||2349|||||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|2350|||||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|2351|||||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|10.22537|10/24/2023|9.97996|10/24/2023|10.04642|10/24/2023|||GLUCOCORTICOIDS: INHALED|2352|||||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|2353|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
niraparib tosylate|No|No|No|No|75%|00173090913|ZEJULA 100 MG TABLET|30|EA|247.8133|08/28/2023||Yes|No||08/28/2023||Yes|No|08/28/2023||Yes|No||||No|No|||Prescription required|No|||No|564.7838|09/05/2023|556.71546|09/05/2023|530.2052|08/28/2023||||2354|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
niraparib tosylate|No|No|No|No|75%|00173091213|ZEJULA 200 MG TABLET|30|EA|247.8133|08/28/2023||Yes|No||08/28/2023||Yes|No|08/28/2023||Yes|No||||No|No|||Prescription required|No|||No|564.7838|09/05/2023|556.71546|09/05/2023|530.2052|08/28/2023||||2355|||||No|No||GLAXOSMITHKLINE|No|||||No|No|No||
niraparib tosylate|No|No|No|No|75%|00173091513|ZEJULA 300 MG TABLET|30|EA|247.8133|08/28/2023||Yes|No||08/28/2023||Yes|No|08/28/2023||Yes|No||||No|No|||Prescription required|No|||No|564.7838|09/05/2023|556.71546|09/05/2023|530.2052|08/28/2023||||2356|||||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|2357|||||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|2358|||||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|2359|||||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|2360|||||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||||2361|||||No|No||MISSION PHARM.|No|||||No|Yes|No||
zinc oxide|No|No|No|No|75%|00178033003|DR. SMITH'S DIAPER 10% OINTMNT|85|GM|.02402|11/02/2010||Yes|No||||No|No|11/02/2010||Yes|No||||No|No|||Over the counter|No|||No|.05476|10/17/2023|.05398|10/17/2023|.0514|10/17/2023||||2362|||||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||||2363|||||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|2364|||||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||||2365|||||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||||2366|||||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||||2367|||||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||||2368|||||No|No||MISSION PHARM.|No|||||No|No|No||
PNV59/iron,carb,fum/FA/dss/dha|No|No|No|No|75%|00178079630|CITRANATAL HARMONY CAPSULE|30|EA|1.73863|05/15/2014||Yes|No||05/15/2014||Yes|No|05/15/2014||Yes|No||||No|No|||Prescription required|Yes|09/07/2023|243|No|3.8871|10/29/2019|3.7938|10/29/2019|3.81907|10/29/2019|||PRENATAL VITAMINS|2369|||||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|2370|||||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|Yes|09/07/2023|243|No|2.00336|10/29/2019|1.95527|10/29/2019|1.9683|10/29/2019|||PRENATAL VITAMINS|2371|||||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|2372|||||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|Yes|09/07/2023|243|No|1.94141|10/29/2019|1.89481|10/29/2019|1.90743|10/29/2019|||PRENATAL VITAMINS|2373|||||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|2374|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MISSION PHARM.|No|||||No|No|No||
mv-min102/iron carb,fum/FA/dha|No|No|No|No|75%|00178089630|CITRANATAL MEDLEY SOFTGEL|30|EA|1.79166|08/01/2023||Yes|No||||No|No|08/01/2023||Yes|No||||No|No|||Over the counter|No|||No|4.08332|08/01/2023|4.02499|08/01/2023|3.83332|08/01/2023||||2375|||||No|No||MISSION PHARM.|No|||||No|Yes|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||||2376|||||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||||2377|||||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||||2378|||||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|.52231|10/24/2023|.50977|10/24/2023|.51316|10/24/2023|||SKELETAL MUSCLE RELAXANTS|2379|||||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|2.51379|09/05/2023|2.47788|09/05/2023|2.35989|09/05/2023|||OPIATE DEPENDENCE TREATMENTS|2380|||||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|.33965|10/24/2023|.33149|10/24/2023|.3337|10/24/2023||||2381|||||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|.52826|10/24/2023|.51558|10/24/2023|.51901|10/24/2023||||2382|||||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|.52826|10/24/2023|.51558|10/24/2023|.51901|10/24/2023||||2383|||||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|.2154|10/24/2023|.21023|10/24/2023|.21163|10/24/2023||||2384|||||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|.2154|10/24/2023|.21023|10/24/2023|.21163|10/24/2023||||2385|||||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|.18579|10/24/2023|.18133|10/24/2023|.18253|10/24/2023||||2386|||||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|.18579|10/24/2023|.18133|10/24/2023|.18253|10/24/2023||||2387|||||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|.35937|10/24/2023|.35074|10/24/2023|.35308|10/24/2023||||2388|||||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|.35937|10/24/2023|.35074|10/24/2023|.35308|10/24/2023||||2389|||||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|.56417|10/24/2023|.55062|10/24/2023|.55429|10/24/2023|||NSAIDS|2390|||||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|.46255|10/24/2023|.45144|10/24/2023|.45445|10/24/2023|||ANGIOTENSIN MODULATORS|2391|||||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|2392|||||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|.40576|10/24/2023|.39602|10/24/2023|.39865|10/24/2023|||ANGIOTENSIN MODULATORS|2393|||||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|.25269|10/24/2023|.24662|10/24/2023|.24826|10/24/2023|||ANGIOTENSIN MODULATORS|2394|||||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|.46893|10/24/2023|.45767|10/24/2023|.46072|10/24/2023|||SKELETAL MUSCLE RELAXANTS|2395|||||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|.0674|10/24/2023|.06578|10/24/2023|.06622|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|2396|||||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|.0674|10/24/2023|.06578|10/24/2023|.06622|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|2397|||||No|No||SANDOZ|No|||||No|No|No||
etodolac|No|No|No|No|75%|00185067501|ETODOLAC 400 MG TABLET|100|EA|.45537|10/07/2016|07/31/2025|Yes|No||10/07/2016|07/31/2025|Yes|No|10/07/2016|07/31/2025|Yes|No||||No|No|||Prescription required|Yes|01/22/2015|059|Yes|.2897|10/24/2023|.28274|10/24/2023|.28463|10/24/2023|||NSAIDS|2398|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||SANDOZ|No|||||No|No|No||
etodolac|No|No|No|No|75%|00185067510|ETODOLAC 400 MG TABLET|1000|EA|.42347|06/09/2016|03/31/2024|Yes|No||06/09/2016|03/31/2024|Yes|No|06/09/2016|03/31/2024|Yes|No||||No|No|||Prescription required|Yes|01/22/2015|059|Yes|.2897|10/24/2023|.28274|10/24/2023|.28463|10/24/2023|||NSAIDS|2399|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||SANDOZ|No|||||No|No|No||
hydroxyzine pamoate|No|No|No|No|75%|00185067601|HYDROXYZINE PAM 50 MG CAP|100|EA|.04506|02/01/2022||Yes|No||02/01/2022||Yes|No|02/01/2022||Yes|No||02/01/2022||Yes|No|||Prescription required|No||574|Yes|.09847|10/24/2023|.0961|10/24/2023|.09674|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|2400|||||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|.09847|10/24/2023|.0961|10/24/2023|.09674|10/24/2023|||ANTIHISTAMINES: FIRST GENERATION|2401|||||No|No||SANDOZ|No|||||No|No|No||
etodolac|No|No|No|No|75%|00185068701|ETODOLAC 500 MG TABLET|100|EA|.48375|07/06/2015|12/31/2023|Yes|No||07/06/2015|12/31/2023|Yes|No|07/06/2015|12/31/2023|Yes|No||||No|No|||Prescription required|Yes|01/22/2015|059|Yes|.35961|10/24/2023|.35097|10/24/2023|.35331|10/24/2023|||NSAIDS|2402|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|.25211|10/24/2023|.24605|10/24/2023|.24769|10/24/2023|||STIMULANTS AND RELATED AGENTS|2403|||||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|.30315|10/24/2023|.29587|10/24/2023|.29784|10/24/2023|||STIMULANTS AND RELATED AGENTS|2404|||||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|.29595|10/24/2023|.28884|10/24/2023|.29077|10/24/2023|||STIMULANTS AND RELATED AGENTS|2405|||||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|.32698|10/24/2023|.31913|10/24/2023|.32125|10/24/2023|||STIMULANTS AND RELATED AGENTS|2406|||||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|.36579|10/24/2023|.35701|10/24/2023|.35938|10/24/2023||||2407|||||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|.62762|10/24/2023|.61255|10/24/2023|.61663|10/24/2023||||2408|||||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|.62762|10/24/2023|.61255|10/24/2023|.61663|10/24/2023||||2409|||||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|.74241|10/24/2023|.72459|10/24/2023|.72941|10/24/2023||||2410|||||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|.74241|10/24/2023|.72459|10/24/2023|.72941|10/24/2023||||2411|||||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|.60602|05/23/2023|.59147|05/23/2023|.59541|05/23/2023||||2412|||||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|36.70663|10/24/2023|35.82567|10/24/2023|36.06426|10/24/2023|||GLUCOCORTICOIDS: INHALED|2413|||||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|32.12677|10/24/2023|31.35572|10/24/2023|31.56455|10/24/2023|||GLUCOCORTICOIDS: INHALED|2414|||||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|6.99996|10/24/2023|6.83196|10/24/2023|6.87746|10/24/2023|||PLATELET AGGREGATION INHIBITORS|2415|||||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|7.00394|10/24/2023|6.83584|10/24/2023|6.88137|10/24/2023|||PLATELET AGGREGATION INHIBITORS|2416|||||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|254.26612|10/24/2023|248.16373|10/24/2023|249.81646|10/24/2023|||GLUCOCORTICOIDS: INHALED|2417|||||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|189.48682|10/24/2023|184.93913|10/24/2023|186.1708|10/24/2023|||GLUCOCORTICOIDS: INHALED|2418|||||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|2419|||||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|5.02608|08/29/2023|4.95428|08/29/2023|4.71836|08/29/2023|||GLUCOCORTICOIDS: INHALED|2420|||||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|2421|||||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|2422|||||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|9.16267|10/24/2023|8.94276|10/24/2023|9.00232|10/24/2023|||PROTON PUMP INHIBITORS|2423|||||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|2424|||||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|9.15169|05/23/2023|8.93204|05/23/2023|8.99153|05/23/2023|||PROTON PUMP INHIBITORS|2425|||||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|9.17924|10/24/2023|8.95893|10/24/2023|9.0186|10/24/2023|||PROTON PUMP INHIBITORS|2426|||||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|2427|||||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|2428|||||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|8.79386|06/27/2023|8.5828|06/27/2023|8.63996|06/27/2023|||PROTON PUMP INHIBITORS|2429|||||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|8.79386|06/27/2023|8.5828|06/27/2023|8.63996|06/27/2023|||PROTON PUMP INHIBITORS|2430|||||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|2431|||||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|2432|||||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|2433|||||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|2434|||||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|2.50443|08/29/2023|2.46866|08/29/2023|2.3511|08/29/2023|||ACNE AGENTS: TOPICAL|2435|||||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|2436|||||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|2437|||||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||||2438|||||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||||2439|||||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|Yes|468.30892|01/26/2021|461.61879|01/26/2021|439.63695|01/26/2021|||ANTIMIGRAINE AGENTS: OTHER|2440|||||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|2441|||||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||||2442|||||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|343.735|05/23/2023|338.8245|05/23/2023|322.69|05/23/2023|||ANTICONVULSANTS|2443|||||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|2444|||||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|57.80023|10/24/2023|56.41302|10/24/2023|56.78872|10/24/2023|||ANTIDEPRESSANTS: OTHER|2445|||||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|57.80023|10/24/2023|56.41302|10/24/2023|56.78872|10/24/2023|||ANTIDEPRESSANTS: OTHER|2446|||||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|76.5212|10/24/2023|74.68469|10/24/2023|75.18207|10/24/2023|||ANTIDEPRESSANTS: OTHER|2447|||||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|2448|||||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|2449|||||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|2450|||||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|2451|||||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|2452|||||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|2453|||||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|2454|||||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|2455|||||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|2456|||||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|2457|||||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|2458|||||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|39.2|09/26/2023|38.64|09/26/2023|36.8|09/26/2023|||ANTIVIRALS: TOPICAL|2459|||||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||||2460|||||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|2461|||||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|2462|||||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||||2463|||||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||||2464|||||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||||2465|||||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||||2466|||||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|1.4381|03/28/2023|1.40358|03/28/2023|1.41293|03/28/2023||||2467|||||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|2468|||||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|2469|||||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|2470|||||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|9.51397|10/24/2023|9.28563|10/24/2023|9.34747|10/24/2023|||IMMUNOMODULATORS: ATOPIC DERMATITIS|2471|||||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|2472|||||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|2473|||||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|2474|||||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|178.67143|10/24/2023|174.38331|10/24/2023|175.54467|10/24/2023|||ANTIFUNGALS: TOPICAL|2475|||||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||||2476|||||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|2477|||||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|77.48533|10/24/2023|75.62568|10/24/2023|76.12933|10/24/2023|||ANTIDEPRESSANTS: OTHER|2478|||||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|176.37947|10/24/2023|172.14636|10/24/2023|173.29282|10/24/2023|||ANTIDEPRESSANTS: OTHER|2479|||||No|No||BAUSCH HEALTH U|No|||||No|No|No||
lamotrigine|No|No|No|No|75%|00228141003|LAMOTRIGINE ER 25 MG TABLET|30|EA|2.08564|06/28/2016||Yes|No||06/28/2016||Yes|No|06/28/2016||Yes|No||||No|No|||Prescription required|No||056|No|.59274|10/24/2023|.57851|10/24/2023|.58236|10/24/2023|||ANTICONVULSANTS|2480|||||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|1.09986|10/24/2023|1.07346|10/24/2023|1.08061|10/24/2023|||ANTICONVULSANTS|2481|||||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|1.2072|10/24/2023|1.17822|10/24/2023|1.18607|10/24/2023|||ANTICONVULSANTS|2482|||||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|.90222|10/24/2023|.88056|10/24/2023|.88643|10/24/2023|||ANTICONVULSANTS|2483|||||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|2.42015|10/24/2023|2.36206|10/24/2023|2.37779|10/24/2023|||ANTICONVULSANTS|2484|||||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|2.66641|10/24/2023|2.60241|10/24/2023|2.61974|10/24/2023|||ANTICONVULSANTS|2485|||||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|.02256|10/24/2023|.02201|10/24/2023|.02216|10/24/2023|||ANXIOLYTICS|2486|||||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|.02256|10/24/2023|.02201|10/24/2023|.02216|10/24/2023|||ANXIOLYTICS|2487|||||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|.02256|10/24/2023|.02201|10/24/2023|.02216|10/24/2023|||ANXIOLYTICS|2488|||||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|.02409|10/24/2023|.02351|10/24/2023|.02366|10/24/2023|||ANXIOLYTICS|2489|||||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|.02409|10/24/2023|.02351|10/24/2023|.02366|10/24/2023|||ANXIOLYTICS|2490|||||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|.02409|10/24/2023|.02351|10/24/2023|.02366|10/24/2023|||ANXIOLYTICS|2491|||||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|.02567|10/24/2023|.02505|10/24/2023|.02522|10/24/2023|||ANXIOLYTICS|2492|||||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|.02567|10/24/2023|.02505|10/24/2023|.02522|10/24/2023|||ANXIOLYTICS|2493|||||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|.02567|10/24/2023|.02505|10/24/2023|.02522|10/24/2023|||ANXIOLYTICS|2494|||||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|.05021|10/24/2023|.049|10/24/2023|.04933|10/24/2023|||ANXIOLYTICS|2495|||||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|.91002|10/24/2023|.88817|10/24/2023|.89409|10/24/2023|||ANXIOLYTICS|2496|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
oxazepam|No|No|No|No|90%|00228206910|OXAZEPAM 15 MG CAPSULE|100|EA|.5212|11/29/2016||Yes|No||11/29/2016||Yes|No|11/29/2016||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|090|Yes|1.1733|10/24/2023|1.14514|10/24/2023|1.15276|10/24/2023|||ANXIOLYTICS|2497|||||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|1.71813|04/25/2023|1.69359|04/25/2023|1.61294|04/25/2023|||ANXIOLYTICS|2498|||||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|.07307|10/24/2023|.07131|10/24/2023|.07179|10/24/2023|||SEDATIVE HYPNOTICS|2499|||||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|.07307|10/24/2023|.07131|10/24/2023|.07179|10/24/2023|||SEDATIVE HYPNOTICS|2500|||||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|.08219|10/24/2023|.08021|10/24/2023|.08075|10/24/2023|||SEDATIVE HYPNOTICS|2501|||||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|.08219|10/24/2023|.08021|10/24/2023|.08075|10/24/2023|||SEDATIVE HYPNOTICS|2502|||||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|.02738|10/24/2023|.02672|10/24/2023|.0269|10/24/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2503|||||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|.02738|10/24/2023|.02672|10/24/2023|.0269|10/24/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2504|||||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|.03672|10/24/2023|.03583|10/24/2023|.03607|10/24/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2505|||||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|.03672|10/24/2023|.03583|10/24/2023|.03607|10/24/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2506|||||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|.04032|10/24/2023|.03935|10/24/2023|.03961|10/24/2023|||ANTIHYPERTENSIVES: SYMPATHOLYTICS|2507|||||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|.38681|10/24/2023|.37752|10/24/2023|.38004|10/24/2023||||2508|||||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|.33045|10/24/2023|.32251|10/24/2023|.32466|10/24/2023|||CALCIUM CHANNEL BLOCKERS|2509|||||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|1.09397|07/25/2023|1.06771|07/25/2023|1.07482|07/25/2023|||CALCIUM CHANNEL BLOCKERS|2510|||||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|.13979|10/24/2023|.13643|10/24/2023|.13734|10/24/2023|||ANTIPARKINSON'S AGENTS|2511|||||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|.13979|10/24/2023|.13643|10/24/2023|.13734|10/24/2023|||ANTIPARKINSON'S AGENTS|2512|||||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|.13979|10/24/2023|.13643|10/24/2023|.13734|10/24/2023|||ANTIPARKINSON'S AGENTS|2513|||||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|.09297|10/24/2023|.09073|10/24/2023|.09134|10/24/2023|||NSAIDS|2514|||||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|.09297|10/24/2023|.09073|10/24/2023|.09134|10/24/2023|||NSAIDS|2515|||||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|.09297|10/24/2023|.09073|10/24/2023|.09134|10/24/2023|||NSAIDS|2516|||||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|.09223|10/24/2023|.09001|10/24/2023|.09061|10/24/2023|||NSAIDS|2517|||||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|.09223|10/24/2023|.09001|10/24/2023|.09061|10/24/2023|||NSAIDS|2518|||||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|.09223|10/24/2023|.09001|10/24/2023|.09061|10/24/2023|||NSAIDS|2519|||||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|.12272|10/24/2023|.11977|10/24/2023|.12057|10/24/2023||||2520|||||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|.12272|10/24/2023|.11977|10/24/2023|.12057|10/24/2023||||2521|||||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|.1209|10/24/2023|.11799|10/24/2023|.11878|10/24/2023||||2522|||||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|.1209|10/24/2023|.11799|10/24/2023|.11878|10/24/2023||||2523|||||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|.17903|10/24/2023|.17473|10/24/2023|.17589|10/24/2023||||2524|||||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|.22653|10/24/2023|.22109|10/24/2023|.22256|10/24/2023||||2525|||||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|.09749|10/24/2023|.09515|10/24/2023|.09578|10/24/2023|||NEUROPATHIC PAIN|2526|||||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|.09749|10/24/2023|.09515|10/24/2023|.09578|10/24/2023|||NEUROPATHIC PAIN|2527|||||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|.12506|10/24/2023|.12205|10/24/2023|.12287|10/24/2023|||NEUROPATHIC PAIN|2528|||||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|.12506|10/24/2023|.12205|10/24/2023|.12287|10/24/2023|||NEUROPATHIC PAIN|2529|||||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|.17971|10/24/2023|.17539|10/24/2023|.17656|10/24/2023|||BETA-BLOCKERS|2530|||||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|.21614|10/24/2023|.21095|10/24/2023|.21235|10/24/2023|||BETA-BLOCKERS|2531|||||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|.19945|10/24/2023|.19466|10/24/2023|.19595|10/24/2023|||BETA-BLOCKERS|2532|||||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|.31092|10/24/2023|.30345|10/24/2023|.30547|10/24/2023|||BETA-BLOCKERS|2533|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00228280111|PILOCARPINE HCL 5 MG TABLET|100|EA|.17552|01/07/2005||Yes|No||01/07/2005||Yes|No|01/07/2005||Yes|No||||No|No|||Prescription required|No|||No|.18318|10/24/2023|.17878|10/24/2023|.17997|10/24/2023||||2534|||||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|.04841|10/24/2023|.04724|10/24/2023|.04756|10/24/2023||||2535|||||No|No||ACTAVIS/TEVA|No|||||No|No|No||
pilocarpine HCl|No|No|No|No|75%|00228283711|PILOCARPINE HCL 7.5 MG TABLET|100|EA|.2798|09/08/2006||Yes|No||09/08/2006||Yes|No|09/08/2006||Yes|No||||No|No|||Prescription required|No|||No|.5868|10/24/2023|.57271|10/24/2023|.57653|10/24/2023||||2536|||||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|5.91736|10/24/2023|5.77534|10/24/2023|5.8138|10/24/2023|||ANTIDEPRESSANTS: SSRIs|2537|||||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|6.21941|10/24/2023|6.07014|10/24/2023|6.11057|10/24/2023|||ANTIDEPRESSANTS: SSRIs|2538|||||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|.22154|10/24/2023|.21622|10/24/2023|.21766|10/24/2023|||STIMULANTS AND RELATED AGENTS|2539|||||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|.21953|10/24/2023|.21426|10/24/2023|.21568|10/24/2023|||STIMULANTS AND RELATED AGENTS|2540|||||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|.20707|10/24/2023|.2021|10/24/2023|.20344|10/24/2023|||STIMULANTS AND RELATED AGENTS|2541|||||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|.22373|10/24/2023|.21836|10/24/2023|.21981|10/24/2023|||STIMULANTS AND RELATED AGENTS|2542|||||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|07/27/2023|232|No|.05114|10/24/2023|.04991|10/24/2023|.05024|10/24/2023|||NEUROPATHIC PAIN|2543|||||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|07/27/2023|232|No|.05725|10/24/2023|.05587|10/24/2023|.05624|10/24/2023|||NEUROPATHIC PAIN|2544|||||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|07/27/2023|232|No|.05405|10/24/2023|.05275|10/24/2023|.0531|10/24/2023|||NEUROPATHIC PAIN|2545|||||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|07/27/2023|232|No|.05835|10/24/2023|.05694|10/24/2023|.05732|10/24/2023|||NEUROPATHIC PAIN|2546|||||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|07/27/2023|232|No|.06703|10/24/2023|.06542|10/24/2023|.06585|10/24/2023|||NEUROPATHIC PAIN|2547|||||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|07/27/2023|232|No|.07266|10/24/2023|.07091|10/24/2023|.07138|10/24/2023|||NEUROPATHIC PAIN|2548|||||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|07/27/2023|232|No|.07836|10/24/2023|.07647|10/24/2023|.07698|10/24/2023|||NEUROPATHIC PAIN|2549|||||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|07/27/2023|232|No|.0906|10/24/2023|.08842|10/24/2023|.08901|10/24/2023|||NEUROPATHIC PAIN|2550|||||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|.0991|10/24/2023|.09672|10/24/2023|.09736|10/24/2023|||NEUROPATHIC PAIN|2551|||||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|.09883|10/24/2023|.09645|10/24/2023|.0971|10/24/2023|||NEUROPATHIC PAIN|2552|||||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|.09883|10/24/2023|.09645|10/24/2023|.0971|10/24/2023|||NEUROPATHIC PAIN|2553|||||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|.11275|10/24/2023|.11004|10/24/2023|.11077|10/24/2023|||NEUROPATHIC PAIN|2554|||||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|.11275|10/24/2023|.11004|10/24/2023|.11077|10/24/2023|||NEUROPATHIC PAIN|2555|||||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|2556|||||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|2557|||||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|.29548|10/24/2023|.28838|10/24/2023|.2903|10/24/2023|||CALCIUM CHANNEL BLOCKERS|2558|||||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|.05642|10/24/2023|.05506|10/24/2023|.05543|10/24/2023|||BPH TREATMENTS|2559|||||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|.05642|10/24/2023|.05506|10/24/2023|.05543|10/24/2023|||BPH TREATMENTS|2560|||||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|.56921|10/24/2023|.55554|10/24/2023|.55924|10/24/2023|||STIMULANTS AND RELATED AGENTS|2561|||||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|.61509|10/24/2023|.60032|10/24/2023|.60432|10/24/2023|||STIMULANTS AND RELATED AGENTS|2562|||||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|.6606|10/24/2023|.64474|10/24/2023|.64903|10/24/2023|||STIMULANTS AND RELATED AGENTS|2563|||||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|.90969|10/24/2023|.88785|10/24/2023|.89377|10/24/2023|||STIMULANTS AND RELATED AGENTS|2564|||||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|.69117|10/24/2023|.67458|10/24/2023|.67907|10/24/2023|||STIMULANTS AND RELATED AGENTS|2565|||||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|.56816|10/24/2023|.55452|10/24/2023|.55821|10/24/2023|||STIMULANTS AND RELATED AGENTS|2566|||||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|.13462|10/24/2023|.13138|10/24/2023|.13226|10/24/2023|||ANXIOLYTICS|2567|||||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|.13879|10/24/2023|.13545|10/24/2023|.13636|10/24/2023|||ANXIOLYTICS|2568|||||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|.24888|10/24/2023|.2429|10/24/2023|.24452|10/24/2023|||ANXIOLYTICS|2569|||||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|.31858|10/24/2023|.31093|10/24/2023|.313|10/24/2023|||ANXIOLYTICS|2570|||||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|2571|||||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|2572|||||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|2573|||||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|2574|||||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|2575|||||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|2576|||||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|.81201|10/24/2023|.79252|10/24/2023|.79779|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|2577|||||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|.63617|10/24/2023|.6209|10/24/2023|.62503|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|2578|||||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|.92882|10/24/2023|.90652|10/24/2023|.91256|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|2579|||||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|2580|||||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|.47157|10/24/2023|.46025|10/24/2023|.46331|10/24/2023|||OPIATE DEPENDENCE TREATMENTS|2581|||||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|4.89614|10/24/2023|4.77863|10/24/2023|4.81045|10/24/2023|||SEDATIVE HYPNOTICS|2582|||||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|5.80929|10/24/2023|5.66986|10/24/2023|5.70762|10/24/2023|||SEDATIVE HYPNOTICS|2583|||||No|No||TEVA USA|No|||||No|No|No||
ropinirole HCl|No|No|No|No|75%|00228364003|ROPINIROLE HCL ER 6 MG TABLET|30|EA|2.77995|07/03/2012||Yes|No||07/03/2012||Yes|No|07/03/2012||Yes|No||||No|No|||Prescription required|Yes|01/25/2012|015|No|.62387|10/24/2023|.60889|10/24/2023|.61295|10/24/2023|||ANTIPARKINSON'S AGENTS|2584|||||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|.55093|10/24/2023|.5377|10/24/2023|.54128|10/24/2023|||ANTIPARKINSON'S AGENTS|2585|||||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|.55093|10/24/2023|.5377|10/24/2023|.54128|10/24/2023|||ANTIPARKINSON'S AGENTS|2586|||||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|.6745|10/24/2023|.65831|10/24/2023|.66269|10/24/2023|||ANTIPARKINSON'S AGENTS|2587|||||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|.6745|10/24/2023|.65831|10/24/2023|.66269|10/24/2023|||ANTIPARKINSON'S AGENTS|2588|||||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|1.41744|10/24/2023|1.38342|10/24/2023|1.39263|10/24/2023|||ANTIPARKINSON'S AGENTS|2589|||||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|1.41744|10/24/2023|1.38342|10/24/2023|1.39263|10/24/2023|||ANTIPARKINSON'S AGENTS|2590|||||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|.81687|03/28/2023|.79726|03/28/2023|.80257|03/28/2023|||ANTIPARKINSON'S AGENTS|2591|||||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|1.05742|09/26/2023|1.04231|09/26/2023|.99268|09/26/2023|||ANXIOLYTICS|2592|||||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|1.1144|08/29/2023|1.08765|08/29/2023|1.09489|08/29/2023|||ANXIOLYTICS|2593|||||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|2594|||||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|2595|||||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|.28345|10/24/2023|.27664|10/24/2023|.27848|10/24/2023|||STIMULANTS AND RELATED AGENTS|2596|||||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|.17152|10/24/2023|.1674|10/24/2023|.16851|10/24/2023|||ANALGESICS: NARCOTICS LONG|2597|||||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|.31085|10/24/2023|.30338|10/24/2023|.30541|10/24/2023|||ANALGESICS: NARCOTICS LONG|2598|||||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|.50058|10/24/2023|.48856|10/24/2023|.49181|10/24/2023|||ANALGESICS: NARCOTICS LONG|2599|||||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|.81959|10/24/2023|.79991|10/24/2023|.80524|10/24/2023|||ANALGESICS: NARCOTICS LONG|2600|||||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|2601|||||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|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription required|No||070|No|.07836|10/24/2023|.07647|10/24/2023|.07698|10/24/2023|||BETA-BLOCKERS|2602|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00245001301|SORINE 120 MG TABLET|100|EA|.91091|01/04/2017|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription required|No||070|No|.09499|10/24/2023|.09271|10/24/2023|.09332|10/24/2023|||BETA-BLOCKERS|2603|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00245001401|SORINE 160 MG TABLET|100|EA|1.13593|01/04/2017|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription required|No||070|No|.12488|10/24/2023|.12188|10/24/2023|.12269|10/24/2023|||BETA-BLOCKERS|2604|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|No|||||No|No|No||
sotalol HCl|No|No|No|No|75%|00245001501|SORINE 240 MG TABLET|100|EA|1.59607|01/04/2017|08/01/2024|Yes|No||01/04/2017|08/01/2024|Yes|No|01/04/2017|08/01/2024|Yes|No||||No|No|||Prescription required|No||070|No|3.63756|01/04/2017|3.58559|01/04/2017|3.41485|01/04/2017|||BETA-BLOCKERS|2605|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||UPSHER-SMITH LA|No|||||No|No|No||
cholestyramine/aspartame|No|No|No|No|75%|00245003623|PREVALITE POWDER|231|GM|.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|.17916|10/24/2023|.17486|10/24/2023|.17602|10/24/2023|||LIPOTROPICS: OTHER|2606|||||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|1.00527|10/24/2023|.98114|10/24/2023|.98767|10/24/2023|||LIPOTROPICS: OTHER|2607|||||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|1.00527|10/24/2023|.98114|10/24/2023|.98767|10/24/2023|||LIPOTROPICS: OTHER|2608|||||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|.2892|10/24/2023|.28225|10/24/2023|.28413|10/24/2023||||2609|||||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|.24565|10/24/2023|.23975|10/24/2023|.24135|10/24/2023||||2610|||||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||||2611|||||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||||2612|||||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||||2613|||||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||||2614|||||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||||2615|||||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||||2616|||||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|.36544|03/28/2023|.36022|03/28/2023|.34306|03/28/2023||||2617|||||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|.26559|03/28/2023|.2618|03/28/2023|.24933|03/28/2023||||2618|||||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|.27112|03/28/2023|.26725|03/28/2023|.25452|03/28/2023||||2619|||||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|.27101|03/28/2023|.26714|03/28/2023|.25442|03/28/2023||||2620|||||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|.11184|10/24/2023|.10915|10/24/2023|.10988|10/24/2023||||2621|||||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|.1612|10/24/2023|.15733|10/24/2023|.15837|10/24/2023||||2622|||||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|.1612|10/24/2023|.15733|10/24/2023|.15837|10/24/2023||||2623|||||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|.28886|10/24/2023|.28192|10/24/2023|.2838|10/24/2023||||2624|||||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|07/14/2024|Yes|No||04/15/2008|07/14/2024|Yes|No|04/15/2008|07/14/2024|Yes|No||||No|No|||Prescription required|No|||No|2.72116|02/19/2019|2.68229|02/19/2019|2.55456|02/19/2019||||2625|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|07/14/2024|Yes|No||04/15/2008|07/14/2024|Yes|No|04/15/2008|07/14/2024|Yes|No||||No|No|||Prescription required|No|||No|9.23111|02/19/2019|9.09923|02/19/2019|8.66594|02/19/2019||||2626|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||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|.674|10/24/2023|.65782|10/24/2023|.6622|10/24/2023||||2627|||||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|.674|10/24/2023|.65782|10/24/2023|.6622|10/24/2023||||2628|||||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|.67696|10/24/2023|.66071|10/24/2023|.66511|10/24/2023|||LIPOTROPICS: OTHER|2629|||||No|No||UPSHER-SMITH LA|No|||||No|No|No||
vigabatrin|No|No|No|No|75%|00245055650|VIGADRONE 500 MG POWDER PACKET|50|EA|42.95975|12/07/2018||Yes|No||12/07/2018||Yes|No|||No|No||||No|No|||Prescription required|No||056|No|97.90827|07/04/2023|96.50958|07/04/2023|91.91388|07/04/2023|||ANTICONVULSANTS|2630|||||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|2631|||||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|19.00926|09/26/2023|18.55303|09/26/2023|18.67659|09/26/2023|||ACNE AGENTS: ORAL|2632|||||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|16.92763|10/24/2023|16.52136|10/24/2023|16.63139|10/24/2023|||ACNE AGENTS: ORAL|2633|||||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|16.72822|10/24/2023|16.32674|10/24/2023|16.43547|10/24/2023|||ACNE AGENTS: ORAL|2634|||||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|Yes|369.1807|11/22/2022|363.90669|11/22/2022|346.5778|11/22/2022|||ANTIMIGRAINE AGENTS: TRIPTANS|2635|||||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|Yes|104.1495|11/22/2022|102.66165|11/22/2022|97.773|11/22/2022|||ANTIMIGRAINE AGENTS: TRIPTANS|2636|||||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|.65092|10/24/2023|.63529|10/24/2023|.63952|10/24/2023|||ANTIBIOTICS: VAGINAL|2637|||||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|3.73875|03/28/2023|3.64902|03/28/2023|3.67332|03/28/2023|||ANDROGENIC AGENTS|2638|||||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|2639|||||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|2640|||||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|2641|||||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|2642|||||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|2643|||||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|2644|||||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|2645|||||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||||2646|||||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||||2647|||||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||||2648|||||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||||2649|||||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||||2650|||||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|.11492|09/26/2023|.11216|09/26/2023|.1129|09/26/2023||||2651|||||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|.11492|09/26/2023|.11216|09/26/2023|.1129|09/26/2023||||2652|||||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|.11492|09/26/2023|.11216|09/26/2023|.1129|09/26/2023||||2653|||||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|.48441|05/23/2023|.47749|05/23/2023|.45475|05/23/2023||||2654|||||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|.46722|05/23/2023|.46055|05/23/2023|.43861|05/23/2023||||2655|||||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|.46726|05/23/2023|.46058|05/23/2023|.43865|05/23/2023||||2656|||||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|.46723|05/23/2023|.46055|05/23/2023|.43862|05/23/2023||||2657|||||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||||2658|||||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||||2659|||||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||||2660|||||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||||2661|||||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||||2662|||||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||||2663|||||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||||2664|||||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|.9|09/26/2023|.8784|09/26/2023|.88425|09/26/2023||||2665|||||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|.9|09/26/2023|.8784|09/26/2023|.88425|09/26/2023||||2666|||||No|No||UPSHER-SMITH LA|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|2667|||||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|.3777|10/24/2023|.36863|10/24/2023|.37109|10/24/2023||||2668|||||No|No||PAR PHARM.|No|||||No|No|No||
posaconazole|No|No|No|No|75%|00254101636|POSACONAZOLE 200 MG/5 ML SUSP|105|ML|4.71624|09/12/2023||Yes|No||09/12/2023||Yes|No|09/12/2023||Yes|No||||No|No|||Prescription required|Yes|07/25/2019|069|No|10.74864|09/12/2023|10.59508|09/12/2023|10.09056|09/12/2023|||ANTIFUNGALS: ORAL|2669|||||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||||2670|||||No|No||PAR PHARM.|No|||||No|No|No||
chlorzoxazone|No|No|No|No|75%|00254200501|CHLORZOXAZONE 750 MG TABLET|100|EA|1.7845|08/03/2023||Yes|No||08/03/2023||Yes|No|08/03/2023||Yes|No||||No|No|||Prescription required|Yes|01/30/2020|116|Yes|4.067|08/03/2023|4.0089|08/03/2023|3.818|08/03/2023|||SKELETAL MUSCLE RELAXANTS|2671|||||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|07/27/2023|231|No|.31236|10/24/2023|.30486|10/24/2023|.30689|10/24/2023|||ANTIHYPERURICEMICS|2672|||||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|07/27/2023|231|No|.31236|10/24/2023|.30486|10/24/2023|.30689|10/24/2023|||ANTIHYPERURICEMICS|2673|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|7.94873|10/24/2023|7.75796|10/24/2023|7.80962|10/24/2023|||ANTIFUNGALS: ORAL|2674|||||No|No||PAR PHARM.|No|||||No|No|No||
chlorzoxazone|No|No|No|No|75%|00254205301|CHLORZOXAZONE 375 MG TABLET|100|EA|1.591|08/03/2023||Yes|No||08/03/2023||Yes|No|08/03/2023||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|116|Yes|3.626|08/03/2023|3.5742|08/03/2023|3.404|08/03/2023|||SKELETAL MUSCLE RELAXANTS|2675|||||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||||2676|||||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||||2677|||||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||||2678|||||No|No||PAR PHARM.|No|||||No|No|Yes|07/30/2021|
lubiprostone|No|No|No|No|75%|00254302802|LUBIPROSTONE 8 MCG CAPSULE|60|EA|.43|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|534|Yes|1.84865|10/24/2023|1.80428|10/24/2023|1.81629|10/24/2023|||GI MOTILITY: CHRONIC|2679|||||No|No||PAR PHARM.|No|||||No|No|No||
lubiprostone|No|No|No|No|75%|00254302902|LUBIPROSTONE 24 MCG CAPSULE|60|EA|.43|10/04/2021||Yes|No||10/04/2021||Yes|No|10/04/2021||Yes|No||||No|No|||Prescription required|Yes|01/28/2021|534|Yes|1.51553|10/24/2023|1.47915|10/24/2023|1.489|10/24/2023|||GI MOTILITY: CHRONIC|2680|||||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|1.01653|05/23/2023|.99213|05/23/2023|.99874|05/23/2023||||2681|||||No|No||MERZ|No|||||No|No|No||
dextrose 5 % in water|No|No|No|No|75%|00264151032|DEXTROSE 5%-WATER IV SOLN|100|ML|.01062|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0242|06/06/2023|.02386|06/06/2023|.02272|06/06/2023||||2682|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264180031|SODIUM CHLORIDE 0.9% SOLUTION|50|ML|.02322|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.05292|06/06/2023|.05216|06/06/2023|.04968|06/06/2023||||2683|||||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|.01169|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.02665|06/06/2023|.02627|06/06/2023|.02502|06/06/2023||||2684|||||No|No||B.BRAUN|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00264210100|STERILE WATER FOR IRRIGATION|1000|ML|.00157|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00359|06/06/2023|.00354|06/06/2023|.00337|06/06/2023||||2685|||||No|No||B.BRAUN|No|||||No|No|No||
water for irrigation,sterile|No|No|No|No|75%|00264210110|STERILE WATER FOR IRRIGATION|500|ML|.00279|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00637|06/06/2023|.00627|06/06/2023|.00598|06/06/2023||||2686|||||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|.00172|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00392|06/06/2023|.00386|06/06/2023|.00368|06/06/2023||||2687|||||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|.00294|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0067|06/06/2023|.0066|06/06/2023|.00629|06/06/2023||||2688|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264220300|LACTATED RINGERS IRRIGATION|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|06/06/2023|.00531|06/06/2023|.00506|06/06/2023||||2689|||||No|No||B.BRAUN|No|||||No|No|No||
physiological irrig soln no.1|No|No|No|No|75%|00264220500|PHYSIOLYTE IRRIGATION SOLN|1000|ML|.0032|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00731|06/06/2023|.0072|06/06/2023|.00686|06/06/2023||||2690|||||No|No||B.BRAUN|No|||||No|No|No||
acetic acid|No|No|No|No|75%|00264230400|ACETIC ACID 0.25% IRRIG SOLN|1000|ML|.00334|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00762|06/06/2023|.00751|06/06/2023|.00715|06/06/2023||||2691|||||No|No||B.BRAUN|No|||||No|No|No||
acetic acid|No|No|No|No|75%|00264230410|ACETIC ACID 0.25% IRRIG SOLN|500|ML|.00595|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01356|06/06/2023|.01336|06/06/2023|.01273|06/06/2023||||2692|||||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|.00172|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00393|06/06/2023|.00388|06/06/2023|.00369|06/06/2023||||2693|||||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|.00319|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00729|06/06/2023|.00718|06/06/2023|.00684|06/06/2023||||2694|||||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|.00586|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01336|06/06/2023|.01317|06/06/2023|.01254|06/06/2023||||2695|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 10 % in water|No|No|No|No|75%|00264752000|DEXTROSE 10%-WATER IV SOLUTION|1000|ML|.00259|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0059|06/06/2023|.00582|06/06/2023|.00554|06/06/2023||||2696|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 10 % in water|No|No|No|No|75%|00264752010|DEXTROSE 10%-WATER IV SOLUTION|500|ML|.0038|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00866|06/06/2023|.00853|06/06/2023|.00813|06/06/2023||||2697|||||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|.00691|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01575|06/06/2023|.01553|06/06/2023|.01479|06/06/2023||||2698|||||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|.00162|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00371|06/06/2023|.00366|06/06/2023|.00348|06/06/2023||||2699|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 % and 0.9 % NaCl|No|No|No|No|75%|00264761010|DEXTROSE 5%-0.9% NACL IV SOLN|500|ML|.00344|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00784|06/06/2023|.00772|06/06/2023|.00736|06/06/2023||||2700|||||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|.00131|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00299|06/06/2023|.00295|06/06/2023|.00281|06/06/2023||||2701|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 %-0.45 % sod chlord|No|No|No|No|75%|00264761210|DEXTROSE 5%-0.45% NACL IV SOLN|500|ML|.00336|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00766|06/06/2023|.00755|06/06/2023|.00719|06/06/2023||||2702|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5 %-0.2 % sod chlorid|No|No|No|No|75%|00264761600|DEXTROSE 5%-0.2% NACL IV SOLN|1000|ML|.00224|03/01/2002||Yes|No||03/01/2002||Yes|No|||No|No||||No|No|||Prescription required|No|||No|.00511|06/06/2023|.00504|06/06/2023|.0048|06/06/2023||||2703|||||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|.00338|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00772|06/06/2023|.00761|06/06/2023|.00724|06/06/2023||||2704|||||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|.00708|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01615|06/06/2023|.01591|06/06/2023|.01516|06/06/2023||||2705|||||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|.00374|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00854|06/06/2023|.00842|06/06/2023|.00802|06/06/2023||||2706|||||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|.00643|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01466|06/06/2023|.01445|06/06/2023|.01376|06/06/2023||||2707|||||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|.00431|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00983|06/06/2023|.00969|06/06/2023|.00923|06/06/2023||||2708|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763400|KCL 10 MEQ/L-D5W-0.45% NACL|1000|ML|.00388|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00885|06/06/2023|.00873|06/06/2023|.00831|06/06/2023||||2709|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763500|KCL 20 MEQ/L-D5W-0.45% NACL|1000|ML|.00194|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00442|06/06/2023|.00436|06/06/2023|.00415|06/06/2023||||2710|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763600|KCL 30 MEQ/L-D5W-0.45% NACL|1000|ML|.00402|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00918|06/06/2023|.00905|06/06/2023|.00862|06/06/2023||||2711|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.45NaCl|No|No|No|No|75%|00264763800|KCL 40 MEQ/L-D5W-0.45% NACL|1000|ML|.00388|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00885|06/06/2023|.00873|06/06/2023|.00831|06/06/2023||||2712|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.2%NaCl|No|No|No|No|75%|00264764500|KCL 20 MEQ/L-D5W-0.2% NACL|1000|ML|.00345|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00786|06/06/2023|.00775|06/06/2023|.00738|06/06/2023||||2713|||||No|No||B.BRAUN|No|||||No|No|No||
potassium chloride/D5-0.9%NaCl|No|No|No|No|75%|00264765200|KCL 20 MEQ/L-D5W-0.9% NACL|1000|ML|.0022|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00501|06/06/2023|.00494|06/06/2023|.00471|06/06/2023||||2714|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775000|LACTATED RINGERS INJECTION|1000|ML|.0013|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00297|06/06/2023|.00293|06/06/2023|.00279|06/06/2023||||2715|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775010|LACTATED RINGERS INJECTION|500|ML|.00317|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00723|06/06/2023|.00712|06/06/2023|.00678|06/06/2023||||2716|||||No|No||B.BRAUN|No|||||No|No|No||
Ringer's solution,lactated|No|No|No|No|75%|00264775020|LACTATED RINGERS INJECTION|250|ML|.00737|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01681|06/06/2023|.01657|06/06/2023|.01578|06/06/2023||||2717|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5%-lactated ringers|No|No|No|No|75%|00264775100|DEXTROSE 5%-LR IV SOLUTION|1000|ML|.00135|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00307|06/06/2023|.00303|06/06/2023|.00288|06/06/2023||||2718|||||No|No||B.BRAUN|No|||||No|No|No||
dextrose 5%-lactated ringers|No|No|No|No|75%|00264775110|DEXTROSE 5%-LR IV SOLUTION|500|ML|.0043|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0098|06/06/2023|.00966|06/06/2023|.0092|06/06/2023||||2719|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264780000|SODIUM CHLORIDE 0.9% SOL-EXCEL|1000|ML|.00117|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00267|06/06/2023|.00263|06/06/2023|.00251|06/06/2023||||2720|||||No|No||B.BRAUN|No|||||No|No|No||
0.9 % sodium chloride|No|No|No|No|75%|00264780009|SODIUM CHLORIDE 0.9% SOLUTION|1000|ML|.00117|04/03/2018||Yes|No||||No|No|04/03/2018||Yes|No||||No|No|||Prescription required|No|||No|.00267|06/06/2023|.00263|06/06/2023|.00251|06/06/2023||||2721|||||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|.0029|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00662|06/06/2023|.00653|06/06/2023|.00621|06/06/2023||||2722|||||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|.00493|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01125|06/06/2023|.01108|06/06/2023|.01056|06/06/2023||||2723|||||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|.00167|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00382|06/06/2023|.00376|06/06/2023|.00358|06/06/2023||||2724|||||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|.00328|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00748|06/06/2023|.00738|06/06/2023|.00702|06/06/2023||||2725|||||No|No||B.BRAUN|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00264785000|STERILE WATER FOR INJECTION|1000|ML|.00185|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00423|06/06/2023|.00417|06/06/2023|.00397|06/06/2023||||2726|||||No|No||B.BRAUN|No|||||No|No|No||
water for injection,sterile|No|No|No|No|75%|00264785020|STERILE WATER FOR INJECTION|250|ML|.00639|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01458|06/06/2023|.01437|06/06/2023|.01368|06/06/2023||||2727|||||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|.01411|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.03216|06/06/2023|.0317|06/06/2023|.03019|06/06/2023||||2728|||||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|.00726|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.01656|06/06/2023|.01632|06/06/2023|.01554|06/06/2023||||2729|||||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|.0132|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.0301|06/06/2023|.02967|06/06/2023|.02826|06/06/2023||||2730|||||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|.00356|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|.00813|06/06/2023|.00801|06/06/2023|.00763|06/06/2023||||2731|||||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||||2732|||||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||||2733|||||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||||2734|||||No|No||SANDOZ|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|2735|||||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|2736|||||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|13.74186|10/24/2023|13.41205|10/24/2023|13.50137|10/24/2023|||COPD AGENTS|2737|||||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|13.74186|10/24/2023|13.41205|10/24/2023|13.50137|10/24/2023|||COPD AGENTS|2738|||||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|2739|||||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|2740|||||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|2741|||||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|2742|||||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|2743|||||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|2744|||||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|2745|||||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|2746|||||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|2747|||||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|2748|||||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|2749|||||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|2750|||||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|2751|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|38.79905|09/22/2021||Yes|No||09/22/2021||Yes|No|09/22/2021||Yes|No||||No|No|||Prescription required|No||239|No|88.42574|10/03/2023|87.16251|10/03/2023|83.01192|10/03/2023|||ONCOLOGY: ORAL - OTHER|2752|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310061060|KOSELUGO 10 MG CAPSULE|60|EA|38.7981|06/12/2020||Yes|No||06/12/2020||Yes|No|06/12/2020||Yes|No||||No|No|||Prescription required|No||239|No|88.42359|10/03/2023|87.1604|10/03/2023|83.0099|10/03/2023|||ONCOLOGY: ORAL - OTHER|2753|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310062528|KOSELUGO 25 MG CAPSULE|28|EA|96.99525|09/22/2021||Yes|No||09/22/2021||Yes|No|09/22/2021||Yes|No||||No|No|||Prescription required|No||239|No|221.05894|10/03/2023|217.90095|10/03/2023|207.52472|10/03/2023|||ONCOLOGY: ORAL - OTHER|2754|||||No|No||ASTRAZENECA/ALE|No|||||No|No|No||
selumetinib/vitamin E TPGS|No|No|No|No|75%|00310062560|KOSELUGO 25 MG CAPSULE|60|EA|96.99531|06/15/2020||Yes|No||06/15/2020||Yes|No|06/15/2020||Yes|No||||No|No|||Prescription required|No||239|No|221.05909|10/03/2023|217.9011|10/03/2023|207.52486|10/03/2023|||ONCOLOGY: ORAL - OTHER|2755|||||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|2756|||||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|2757|||||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|2758|||||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|2759|||||No|No||ASTRAZENECA|No|||||No|No|Yes|07/30/2021|
sodium zirconium cyclosilicate|No|No|No|No|75%|00310110530|LOKELMA 5 GRAM POWDER PACKET|30|EA|11.20049|05/16/2019||Yes|No||05/16/2019||Yes|No|05/16/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.9453|07/11/2023|24.34661|07/11/2023|24.50875|07/11/2023|||POTASSIUM BINDERS|2760|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310110539|LOKELMA 5 GRAM POWDER PACKET|11|EA|11.20032|05/23/2019||Yes|No||05/23/2019||Yes|No|05/23/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.9453|07/11/2023|24.34661|07/11/2023|24.50875|07/11/2023|||POTASSIUM BINDERS|2761|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310111030|LOKELMA 10 GRAM POWDER PACKET|30|EA|11.20049|05/16/2019||Yes|No||05/16/2019||Yes|No|05/16/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.93361|07/11/2023|24.3352|07/11/2023|24.49727|07/11/2023|||POTASSIUM BINDERS|2762|||||No|No||ASTRAZENECA|No|||||No|No|No||
sodium zirconium cyclosilicate|No|No|No|No|75%|00310111039|LOKELMA 10 GRAM POWDER PACKET|11|EA|11.20032|05/23/2019||Yes|No||05/23/2019||Yes|No|05/23/2019||Yes|No||||No|No|||Prescription required|No||578|No|24.93361|07/11/2023|24.3352|07/11/2023|24.49727|07/11/2023|||POTASSIUM BINDERS|2763|||||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|2764|||||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|2765|||||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|2766|||||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||173|No|243.70133|01/10/2023|240.21988|01/10/2023|228.78084|01/10/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|2767|||||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|37.60274|10/24/2023|36.70027|10/24/2023|36.94469|10/24/2023|||COPD AGENTS|2768|||||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|56.13438|10/24/2023|54.78715|10/24/2023|55.15202|10/24/2023|||GLUCOCORTICOIDS: INHALED|2769|||||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|2770|||||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|2771|||||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|2772|||||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|15.51387|10/24/2023|15.14153|10/24/2023|15.24237|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2773|||||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|15.51387|10/24/2023|15.14153|10/24/2023|15.24237|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2774|||||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|7.78654|10/24/2023|7.59966|10/24/2023|7.65027|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2775|||||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|2776|||||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|15.5404|10/24/2023|15.16743|10/24/2023|15.26844|10/24/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2777|||||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|Yes|18.07518|10/24/2023|17.64137|10/24/2023|17.75886|10/24/2023|||HYPOGLYCEMICS: SGLT2|2778|||||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|Yes|18.07567|10/24/2023|17.64185|10/24/2023|17.75934|10/24/2023|||HYPOGLYCEMICS: SGLT2|2779|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310625030|XIGDUO XR 5 MG-500 MG TABLET|30|EA|8.10249|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|Yes|18.04406|10/24/2023|17.611|10/24/2023|17.72828|10/24/2023|||HYPOGLYCEMICS: SGLT2|2780|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310626060|XIGDUO XR 5 MG-1,000 MG TABLET|60|EA|4.05124|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|Yes|9.02331|10/24/2023|8.80675|10/24/2023|8.8654|10/24/2023|||HYPOGLYCEMICS: SGLT2|2781|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310627030|XIGDUO XR 10 MG-500 MG TABLET|30|EA|8.10249|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|Yes|18.11856|10/24/2023|17.68371|10/24/2023|17.80148|10/24/2023|||HYPOGLYCEMICS: SGLT2|2782|||||No|No||ASTRAZENECA|No|||||No|No|No||
dapaglifloz propaned/metformin|No|No|No|No|75%|00310628030|XIGDUO XR 10 MG-1,000 MG TAB|30|EA|8.10249|01/09/2015||Yes|No||01/09/2015||Yes|No|01/09/2015||Yes|No||||No|No|||Prescription required|No||535|Yes|18.08136|10/24/2023|17.6474|10/24/2023|17.76493|10/24/2023|||HYPOGLYCEMICS: SGLT2|2783|||||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|2784|||||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|330.92812|06/27/2023|322.98584|06/27/2023|325.13687|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2785|||||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|227.23279|06/27/2023|221.7792|06/27/2023|223.25621|06/27/2023|||HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS|2786|||||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|2787|||||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|2788|||||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|2789|||||No|No||ASTRAZENECA|No|||||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00310737020|BUDESONIDE-FORMOTEROL 160-4.5|10.2|GM|10.54174|03/06/2020||Yes|No||03/06/2020||Yes|No|03/06/2020||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|033|Yes|22.12607|10/24/2023|21.59504|10/24/2023|21.73886|10/24/2023|||GLUCOCORTICOIDS: INHALED|2790|||||No|No||ASTRAZENECA/PRA|No|||||No|No|No||
budesonide/formoterol fumarate|No|No|No|No|75%|00310737220|BUDESONIDE-FORMOTEROL 80-4.5|10.2|GM|9.22265|03/06/2020||Yes|No||03/06/2020||Yes|No|03/06/2020||Yes|No||||No|No|||Prescription required|Yes|07/27/2023|033|Yes|19.66475|10/24/2023|19.19279|10/24/2023|19.32061|10/24/2023|||GLUCOCORTICOIDS: INHALED|2791|||||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|04/30/2024|Yes|No||10/19/2022|04/30/2024|Yes|No|10/19/2022|04/30/2024|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|2792|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|04/30/2024|Yes|No||10/19/2022|04/30/2024|Yes|No|10/19/2022|04/30/2024|Yes|No||||No|No|||Prescription required|Yes|07/29/2021|063|Yes|8.83201|07/25/2023|8.62004|07/25/2023|8.67744|07/25/2023|||LIPOTROPICS: STATINS|2793|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||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|04/30/2024|Yes|No||07/21/2022|04/30/2024|Yes|No|07/21/2022|04/30/2024|Yes|No||07/21/2022|04/30/2024|Yes|No|||Prescription required|Yes|07/29/2021|063|Yes|8.85751|05/23/2023|8.64492|05/23/2023|8.7025|05/23/2023|||LIPOTROPICS: STATINS|2794|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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|11/30/2023|Yes|No||07/21/2022|11/30/2023|Yes|No|07/21/2022|11/30/2023|Yes|No||07/21/2022|11/30/2023|Yes|No|||Prescription required|Yes|07/29/2021|063|Yes|8.82587|05/23/2023|8.61404|05/23/2023|8.67141|05/23/2023|||LIPOTROPICS: STATINS|2795|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable|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||||2796|||||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||||2797|||||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||||2798|||||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||||2799|||||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||||2800|||||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||||2801|||||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||||2802|||||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||||2803|||||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||||2804|||||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||||2805|||||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||||2806|||||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||||2807|||||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||||2808|||||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||||2809|||||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||||2810|||||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||||2811|||||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||||2812|||||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||||2813|||||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||||2814|||||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||||2815|||||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||||2816|||||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||||2817|||||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||||2818|||||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||||2819|||||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||||2820|||||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||||2821|||||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||||2822|||||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||||2823|||||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||||2824|||||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||||2825|||||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||||2826|||||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||||2827|||||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||||2828|||||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||||2829|||||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||||2830|||||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||||2831|||||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||||2832|||||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||||2833|||||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||||2834|||||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||||2835|||||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||||2836|||||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||||2837|||||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||||2838|||||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||||2839|||||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||||2840|||||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||||2841|||||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||||2842|||||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||||2843|||||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||||2844|||||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||||2845|||||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||||2846|||||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||||2847|||||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||||2848|||||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||||2849|||||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||||2850|||||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||||2851|||||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||||2852|||||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||||2853|||||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|2854|||||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|2855|||||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|2856|||||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|.22665|10/24/2023|.22121|10/24/2023|.22268|10/24/2023||||2857|||||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|.01833|10/24/2023|.01789|10/24/2023|.018|10/24/2023|||BETA-BLOCKERS|2858|||||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|.01833|10/24/2023|.01789|10/24/2023|.018|10/24/2023|||BETA-BLOCKERS|2859|||||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|.15963|10/24/2023|.15579|10/24/2023|.15683|10/24/2023|||BETA-BLOCKERS|2860|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|.02218|10/24/2023|.02164|10/24/2023|.02179|10/24/2023|||BETA-BLOCKERS|2861|||||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|.02218|10/24/2023|.02164|10/24/2023|.02179|10/24/2023|||BETA-BLOCKERS|2862|||||No|No||MYLAN|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378004201|PERPHEN-AMITRIP 4 MG-10 MG TAB|100|EA|.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|2863|||||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|.02852|10/24/2023|.02783|10/24/2023|.02802|10/24/2023|||BETA-BLOCKERS|2864|||||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|.02852|10/24/2023|.02783|10/24/2023|.02802|10/24/2023|||BETA-BLOCKERS|2865|||||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|.52893|10/24/2023|.51623|10/24/2023|.51967|10/24/2023|||BETA-BLOCKERS|2866|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|.34815|10/24/2023|.33979|10/24/2023|.34205|10/24/2023||||2867|||||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|2868|||||No|No||MYLAN|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378007301|PERPHEN-AMITRIP 4 MG-50 MG TAB|100|EA|1.13365|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|2.58367|06/01/2016|2.54676|06/01/2016|2.42548|06/01/2016|||ANTIPSYCHOTICS|2869|||||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|.1069|10/24/2023|.10433|10/24/2023|.10502|10/24/2023|||ANTIPARKINSON'S AGENTS|2870|||||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|.09412|10/24/2023|.09186|10/24/2023|.09247|10/24/2023|||ANTIPARKINSON'S AGENTS|2871|||||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|.15163|10/24/2023|.14799|10/24/2023|.14897|10/24/2023|||ANTIPARKINSON'S AGENTS|2872|||||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|.26055|10/24/2023|.25429|10/24/2023|.25599|10/24/2023|||ANTIPARKINSON'S AGENTS|2873|||||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|.9995|08/29/2023|.97551|08/29/2023|.982|08/29/2023|||BETA-BLOCKERS|2874|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|.04922|10/24/2023|.04803|10/24/2023|.04835|10/24/2023|||ANTIHYPERURICEMICS|2875|||||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|.04922|10/24/2023|.04803|10/24/2023|.04835|10/24/2023|||ANTIHYPERURICEMICS|2876|||||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|.20891|10/24/2023|.20389|10/24/2023|.20525|10/24/2023|||ONCOLOGY: ORAL - BREAST|2877|||||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|.07133|10/24/2023|.06961|10/24/2023|.07008|10/24/2023|||ANTIHYPERURICEMICS|2878|||||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|.07133|10/24/2023|.06961|10/24/2023|.07008|10/24/2023|||ANTIHYPERURICEMICS|2879|||||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|.05377|10/24/2023|.05247|10/24/2023|.05282|10/24/2023|||BETA-BLOCKERS|2880|||||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|.05377|10/24/2023|.05247|10/24/2023|.05282|10/24/2023|||BETA-BLOCKERS|2881|||||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|.06374|10/24/2023|.06221|10/24/2023|.06262|10/24/2023|||BETA-BLOCKERS|2882|||||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|.06374|10/24/2023|.06221|10/24/2023|.06262|10/24/2023|||BETA-BLOCKERS|2883|||||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|.08826|10/24/2023|.08614|10/24/2023|.08671|10/24/2023|||BETA-BLOCKERS|2884|||||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|.08826|10/24/2023|.08614|10/24/2023|.08671|10/24/2023|||BETA-BLOCKERS|2885|||||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|.19167|10/24/2023|.18706|10/24/2023|.18831|10/24/2023|||BETA-BLOCKERS|2886|||||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|.19167|10/24/2023|.18706|10/24/2023|.18831|10/24/2023|||BETA-BLOCKERS|2887|||||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|.22114|10/24/2023|.21583|10/24/2023|.21727|10/24/2023|||BETA-BLOCKERS|2888|||||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|.02728|10/24/2023|.02662|10/24/2023|.0268|10/24/2023||||2889|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|.02728|10/24/2023|.02662|10/24/2023|.0268|10/24/2023||||2890|||||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||||2891|||||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||||2892|||||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|.13059|10/24/2023|.12745|10/24/2023|.1283|10/24/2023||||2893|||||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|.13059|10/24/2023|.12745|10/24/2023|.1283|10/24/2023||||2894|||||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|.2998|10/24/2023|.2926|10/24/2023|.29455|10/24/2023|||ANTIPSYCHOTICS|2895|||||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|.2998|10/24/2023|.2926|10/24/2023|.29455|10/24/2023|||ANTIPSYCHOTICS|2896|||||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|.03224|10/24/2023|.03146|10/24/2023|.03167|10/24/2023||||2897|||||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|.03224|10/24/2023|.03146|10/24/2023|.03167|10/24/2023||||2898|||||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|.02194|10/24/2023|.02141|10/24/2023|.02155|10/24/2023|||BETA-BLOCKERS|2899|||||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|.02194|10/24/2023|.02141|10/24/2023|.02155|10/24/2023|||BETA-BLOCKERS|2900|||||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|2901|||||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|.08635|10/24/2023|.08427|10/24/2023|.08483|10/24/2023||||2902|||||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|.08635|10/24/2023|.08427|10/24/2023|.08483|10/24/2023||||2903|||||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|.02594|10/24/2023|.02531|10/24/2023|.02548|10/24/2023|||BETA-BLOCKERS|2904|||||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|.02594|10/24/2023|.02531|10/24/2023|.02548|10/24/2023|||BETA-BLOCKERS|2905|||||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|.05282|10/24/2023|.05155|10/24/2023|.05189|10/24/2023||||2906|||||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|.10329|10/24/2023|.10081|10/24/2023|.10148|10/24/2023||||2907|||||No|No||MYLAN|No|||||No|No|No||
haloperidol|No|No|No|No|75%|00378025701|HALOPERIDOL 1 MG TABLET|100|EA|.15871|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.26691|10/24/2023|.2605|10/24/2023|.26223|10/24/2023|||ANTIPSYCHOTICS|2908|||||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|.26691|10/24/2023|.2605|10/24/2023|.26223|10/24/2023|||ANTIPSYCHOTICS|2909|||||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|.02264|10/24/2023|.02209|10/24/2023|.02224|10/24/2023|||ANXIOLYTICS|2910|||||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|.02264|10/24/2023|.02209|10/24/2023|.02224|10/24/2023|||ANXIOLYTICS|2911|||||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|.34142|10/24/2023|.33322|10/24/2023|.33544|10/24/2023|||ONCOLOGY: ORAL - BREAST|2912|||||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||||2913|||||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||||2914|||||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|.31315|10/24/2023|.30563|10/24/2023|.30766|10/24/2023||||2915|||||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|.35506|10/24/2023|.34653|10/24/2023|.34884|10/24/2023|||ANTIPSYCHOTICS|2916|||||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|.35506|10/24/2023|.34653|10/24/2023|.34884|10/24/2023|||ANTIPSYCHOTICS|2917|||||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|2918|||||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|.37437|10/24/2023|.36538|10/24/2023|.36781|10/24/2023|||ANTIPSYCHOTICS|2919|||||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|.54316|06/27/2023|.53012|06/27/2023|.53365|06/27/2023|||ANTIPSYCHOTICS|2920|||||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|.02861|10/24/2023|.02792|10/24/2023|.0281|10/24/2023|||ANXIOLYTICS|2921|||||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|.02861|10/24/2023|.02792|10/24/2023|.0281|10/24/2023|||ANXIOLYTICS|2922|||||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|.16208|10/24/2023|.15819|10/24/2023|.15924|10/24/2023|||ANTIPSYCHOTICS|2923|||||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|.16208|10/24/2023|.15819|10/24/2023|.15924|10/24/2023|||ANTIPSYCHOTICS|2924|||||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|.44444|10/24/2023|.43377|10/24/2023|.43666|10/24/2023||||2925|||||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|2926|||||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|.53203|10/24/2023|.51926|10/24/2023|.52271|10/24/2023|||MULTIPLE SCLEROSIS AGENTS|2927|||||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|.61434|10/24/2023|.59959|10/24/2023|.60358|10/24/2023||||2928|||||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|.16124|10/24/2023|.15737|10/24/2023|.15841|10/24/2023||||2929|||||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|.16124|10/24/2023|.15737|10/24/2023|.15841|10/24/2023||||2930|||||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|.16124|10/24/2023|.15737|10/24/2023|.15841|10/24/2023||||2931|||||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|.89682|05/23/2023|.87529|05/23/2023|.88112|05/23/2023|||BETA-BLOCKERS|2932|||||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|1.47838|07/25/2023|1.44289|07/25/2023|1.4525|07/25/2023|||BETA-BLOCKERS|2933|||||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|.19384|10/24/2023|.18918|10/24/2023|.19044|10/24/2023||||2934|||||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|2935|||||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|2936|||||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||||2937|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||||2938|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|.18432|10/24/2023|.17989|10/24/2023|.18109|10/24/2023|||ANTICONVULSANTS|2939|||||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|.18432|10/24/2023|.17989|10/24/2023|.18109|10/24/2023|||ANTICONVULSANTS|2940|||||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|.19016|10/24/2023|.18559|10/24/2023|.18683|10/24/2023|||ANTICONVULSANTS|2941|||||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|.19016|10/24/2023|.18559|10/24/2023|.18683|10/24/2023|||ANTICONVULSANTS|2942|||||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|.03065|10/24/2023|.02991|10/24/2023|.03011|10/24/2023|||ANXIOLYTICS|2943|||||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|.03065|10/24/2023|.02991|10/24/2023|.03011|10/24/2023|||ANXIOLYTICS|2944|||||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|.92843|10/24/2023|.90614|10/24/2023|.91218|10/24/2023||||2945|||||No|No||MYLAN|No|||||No|No|No||
perphenazine/amitriptyline HCl|No|No|No|No|75%|00378057401|PERPHEN-AMITRIP 4 MG-25 MG TAB|100|EA|.68662|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|1.56486|12/26/2017|1.5425|12/26/2017|1.46905|12/26/2017|||ANTIPSYCHOTICS|2946|||||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|2947|||||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|.6293|10/24/2023|.61419|10/24/2023|.61828|10/24/2023|||ANTIPSYCHOTICS|2948|||||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|.81974|10/24/2023|.80006|10/24/2023|.80539|10/24/2023|||ANTIPSYCHOTICS|2949|||||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|2950|||||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|.04631|10/24/2023|.04519|10/24/2023|.04549|10/24/2023|||GLUCOCORTICOIDS: ORAL|2951|||||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|.04631|10/24/2023|.04519|10/24/2023|.04549|10/24/2023|||GLUCOCORTICOIDS: ORAL|2952|||||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|.05601|10/24/2023|.05466|10/24/2023|.05502|10/24/2023|||GLUCOCORTICOIDS: ORAL|2953|||||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|.05601|10/24/2023|.05466|10/24/2023|.05502|10/24/2023|||GLUCOCORTICOIDS: ORAL|2954|||||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|.08401|10/24/2023|.08199|10/24/2023|.08253|10/24/2023|||GLUCOCORTICOIDS: ORAL|2955|||||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|.08401|10/24/2023|.08199|10/24/2023|.08253|10/24/2023|||GLUCOCORTICOIDS: ORAL|2956|||||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|.08401|10/24/2023|.08199|10/24/2023|.08253|10/24/2023|||GLUCOCORTICOIDS: ORAL|2957|||||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|2958|||||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|.03851|10/24/2023|.03758|10/24/2023|.03783|10/24/2023|||BETA-BLOCKERS|2959|||||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|.03851|10/24/2023|.03758|10/24/2023|.03783|10/24/2023|||BETA-BLOCKERS|2960|||||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|.2682|10/24/2023|.26176|10/24/2023|.2635|10/24/2023|||ANTIPSYCHOTICS|2961|||||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|.53992|10/24/2023|.52696|10/24/2023|.53047|10/24/2023|||ANTIPSYCHOTICS|2962|||||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|.53992|10/24/2023|.52696|10/24/2023|.53047|10/24/2023|||ANTIPSYCHOTICS|2963|||||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|7.50716|10/24/2023|7.32698|10/24/2023|7.37578|10/24/2023||||2964|||||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|9.29767|10/24/2023|9.07452|10/24/2023|9.13496|10/24/2023||||2965|||||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|13.05278|10/24/2023|12.73951|10/24/2023|12.82435|10/24/2023||||2966|||||No|No||MYLAN|No|||||No|No|No||
penciclovir|No|No|No|No|75%|00378089655|PENCICLOVIR 1% CREAM|5|GM|60.26708|04/27/2023||Yes|No||04/27/2023||Yes|No|04/27/2023||Yes|No||||No|No|||Prescription required|Yes|01/27/2022|123|No|107.44033|04/27/2023|104.86176|04/27/2023|105.56012|04/27/2023|||ANTIVIRALS: TOPICAL|2967|||||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|2968|||||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|2969|||||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|.51049|10/24/2023|.49823|10/24/2023|.50155|10/24/2023|||ANTIPSYCHOTICS|2970|||||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|1.41373|10/24/2023|1.3798|10/24/2023|1.38898|10/24/2023|||ANTIPSYCHOTICS|2971|||||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|2972|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378104901|DOXEPIN 10 MG CAPSULE|100|EA|.20141|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.10128|10/24/2023|.09884|10/24/2023|.0995|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|2973|||||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|.10128|10/24/2023|.09884|10/24/2023|.0995|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|2974|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107593|TELMISARTAN-AMLODIPINE 40-5 MG|30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription required|Yes|07/17/2014|017|Yes|2.85496|08/29/2023|2.78644|08/29/2023|2.80499|08/29/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|2975|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107693|TELMISARTAN-AMLODIPINE 40-10|30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription required|Yes|07/17/2014|017|Yes|2.32386|05/23/2023|2.26808|05/23/2023|2.28319|05/23/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|2976|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107793|TELMISARTAN-AMLODIPINE 80-5 MG|30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription required|Yes|07/17/2014|017|Yes|2.60744|10/24/2023|2.54486|10/24/2023|2.5618|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|2977|||||No|No||MYLAN|No|||||No|No|No||
telmisartan/amlodipine|No|No|No|No|75%|00378107893|TELMISARTAN-AMLODIPINE 80-10|30|EA|1.78306|05/29/2015||Yes|No||05/29/2015||Yes|No|05/29/2015||Yes|No||05/29/2015||Yes|No|||Prescription required|Yes|07/17/2014|017|Yes|2.49917|08/29/2023|2.43918|08/29/2023|2.45543|08/29/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|2978|||||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|07/27/2023|231|No|.31236|10/24/2023|.30486|10/24/2023|.30689|10/24/2023|||ANTIHYPERURICEMICS|2979|||||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|07/27/2023|231|No|.31236|10/24/2023|.30486|10/24/2023|.30689|10/24/2023|||ANTIHYPERURICEMICS|2980|||||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|.13601|10/24/2023|.13274|10/24/2023|.13362|10/24/2023||||2981|||||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|.13601|10/24/2023|.13274|10/24/2023|.13362|10/24/2023||||2982|||||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|.06223|09/12/2023|.06134|09/12/2023|.05842|09/12/2023||||2983|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|.0588|09/12/2023|.05796|09/12/2023|.0552|09/12/2023||||2984|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|.04908|10/24/2023|.0479|10/24/2023|.04822|10/24/2023||||2985|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|.04908|10/24/2023|.0479|10/24/2023|.04822|10/24/2023||||2986|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|.40417|09/26/2023|.39446|09/26/2023|.39709|09/26/2023|||BETA-BLOCKERS|2987|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|.13979|10/24/2023|.13643|10/24/2023|.13734|10/24/2023|||ANTIPARKINSON'S AGENTS|2988|||||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|.52799|10/24/2023|.51531|10/24/2023|.51875|10/24/2023|||NSAIDS|2989|||||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|.02497|10/24/2023|.02437|10/24/2023|.02453|10/24/2023|||ANXIOLYTICS|2990|||||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|.02497|10/24/2023|.02437|10/24/2023|.02453|10/24/2023|||ANXIOLYTICS|2991|||||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|.12982|10/24/2023|.1267|10/24/2023|.12754|10/24/2023|||ANXIOLYTICS|2992|||||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|.03365|10/24/2023|.03284|10/24/2023|.03306|10/24/2023|||ANXIOLYTICS|2993|||||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|.03365|10/24/2023|.03284|10/24/2023|.03306|10/24/2023|||ANXIOLYTICS|2994|||||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|.04764|10/24/2023|.04649|10/24/2023|.0468|10/24/2023|||ANXIOLYTICS|2995|||||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|.04764|10/24/2023|.04649|10/24/2023|.0468|10/24/2023|||ANXIOLYTICS|2996|||||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|.2611|10/24/2023|.25483|10/24/2023|.25653|10/24/2023|||BETA-BLOCKERS|2997|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|.2611|10/24/2023|.25483|10/24/2023|.25653|10/24/2023|||BETA-BLOCKERS|2998|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|.11771|10/24/2023|.11488|10/24/2023|.11565|10/24/2023|||ANXIOLYTICS|2999|||||No|No||MYLAN|No|||||No|No|No||
sorafenib tosylate|No|No|No|No|75%|00378120178|SORAFENIB 200 MG TABLET|120|EA|43.03583|09/14/2022||Yes|No||09/14/2022||Yes|No|09/14/2022||Yes|No||||No|No|||Prescription required|No||548|No|98.08166|10/17/2023|96.68049|10/17/2023|92.07666|10/17/2023|||ONCOLOGY: ORAL - RENAL CELL|3000|||||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|13.47402|09/12/2023|13.28153|09/12/2023|12.64908|09/12/2023|||ANTIPARKINSON'S AGENTS|3001|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|13.47402|11/14/2023|13.28153|11/14/2023|12.64908|11/14/2023|||ANTIPARKINSON'S AGENTS|3002|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|.14668|10/24/2023|.14315|10/24/2023|.14411|10/24/2023||||3003|||||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|.14668|10/24/2023|.14315|10/24/2023|.14411|10/24/2023||||3004|||||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|.8895|10/24/2023|.86815|10/24/2023|.87393|10/24/2023|||ULCERATIVE COLITIS AGENTS|3005|||||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|Yes|.34033|10/24/2023|.33216|10/24/2023|.33437|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3006|||||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|.19859|10/24/2023|.19382|10/24/2023|.19511|10/24/2023||||3007|||||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|3008|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|1.96417|10/24/2023|1.91702|10/24/2023|1.92979|10/24/2023|||ANTIFUNGALS: ORAL|3009|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|.0691|10/24/2023|.06744|10/24/2023|.06789|10/24/2023|||PAH AGENTS: ORAL AND INHALED|3010|||||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|.50059|10/24/2023|.48857|10/24/2023|.49182|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3011|||||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|.54063|10/24/2023|.52765|10/24/2023|.53116|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3012|||||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|.54099|10/24/2023|.528|10/24/2023|.53152|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3013|||||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|.69981|10/24/2023|.68301|10/24/2023|.68756|10/24/2023|||ANGIOTENSIN MODULATOR COMBINATIONS|3014|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180010|LEVOTHYROXINE 25 MCG TABLET|1000|EA|.14184|12/20/2007||Yes|No||12/20/2007||Yes|No|12/20/2007||Yes|No||||No|No|||Prescription required|No|||No|.05364|10/24/2023|.05235|10/24/2023|.0527|10/24/2023||||3015|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180310|LEVOTHYROXINE 50 MCG TABLET|1000|EA|.16102|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.06006|10/24/2023|.05861|10/24/2023|.059|10/24/2023||||3016|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180377|LEVOTHYROXINE 50 MCG TABLET|90|EA|.161|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.06006|10/24/2023|.05861|10/24/2023|.059|10/24/2023||||3017|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180510|LEVOTHYROXINE 75 MCG TABLET|1000|EA|.17794|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.06241|10/24/2023|.06091|10/24/2023|.06131|10/24/2023||||3018|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180577|LEVOTHYROXINE 75 MCG TABLET|90|EA|.17796|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.06241|10/24/2023|.06091|10/24/2023|.06131|10/24/2023||||3019|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180710|LEVOTHYROXINE 88 MCG TABLET|1000|EA|.18101|10/18/2007||Yes|No||10/18/2007||Yes|No|10/18/2007||Yes|No||||No|No|||Prescription required|No|||No|.07739|10/24/2023|.07553|10/24/2023|.07603|10/24/2023||||3020|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180777|LEVOTHYROXINE 88 MCG TABLET|90|EA|.18097|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.07739|10/24/2023|.07553|10/24/2023|.07603|10/24/2023||||3021|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180910|LEVOTHYROXINE 100 MCG TABLET|1000|EA|.1824|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.07388|10/24/2023|.0721|10/24/2023|.07258|10/24/2023||||3022|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378180977|LEVOTHYROXINE 100 MCG TABLET|90|EA|.18241|06/07/2018||Yes|No||06/07/2018||Yes|No|06/07/2018||Yes|No||||No|No|||Prescription required|No|||No|.07388|10/24/2023|.0721|10/24/2023|.07258|10/24/2023||||3023|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181110|LEVOTHYROXINE 112 MCG TABLET|1000|EA|.21092|01/14/2008||Yes|No||01/14/2008||Yes|No|01/14/2008||Yes|No||||No|No|||Prescription required|No|||No|.07846|10/24/2023|.07657|10/24/2023|.07708|10/24/2023||||3024|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181177|LEVOTHYROXINE 112 MCG TABLET|90|EA|.21093|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.07846|10/24/2023|.07657|10/24/2023|.07708|10/24/2023||||3025|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181310|LEVOTHYROXINE 125 MCG TABLET|1000|EA|.21385|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.08924|10/24/2023|.08709|10/24/2023|.08767|10/24/2023||||3026|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181377|LEVOTHYROXINE 125 MCG TABLET|90|EA|.21385|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription required|No|||No|.08924|10/24/2023|.08709|10/24/2023|.08767|10/24/2023||||3027|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181510|LEVOTHYROXINE 150 MCG TABLET|1000|EA|.22008|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.07754|10/24/2023|.07567|10/24/2023|.07618|10/24/2023||||3028|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181577|LEVOTHYROXINE 150 MCG TABLET|90|EA|.2201|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.07754|10/24/2023|.07567|10/24/2023|.07618|10/24/2023||||3029|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181710|LEVOTHYROXINE 175 MCG TABLET|1000|EA|.26159|08/23/2007||Yes|No||08/23/2007||Yes|No|08/23/2007||Yes|No||||No|No|||Prescription required|No|||No|.10356|10/24/2023|.10107|10/24/2023|.10174|10/24/2023||||3030|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181777|LEVOTHYROXINE 175 MCG TABLET|90|EA|.26162|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription required|No|||No|.10356|10/24/2023|.10107|10/24/2023|.10174|10/24/2023||||3031|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181910|LEVOTHYROXINE 200 MCG TABLET|1000|EA|.26212|07/11/2005||Yes|No||07/11/2005||Yes|No|07/11/2005||Yes|No||||No|No|||Prescription required|No|||No|.11267|10/24/2023|.10996|10/24/2023|.11069|10/24/2023||||3032|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378181977|LEVOTHYROXINE 200 MCG TABLET|90|EA|.2621|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription required|No|||No|.11267|10/24/2023|.10996|10/24/2023|.11069|10/24/2023||||3033|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182177|LEVOTHYROXINE 300 MCG TABLET|90|EA|.33835|09/06/2016||Yes|No||09/06/2016||Yes|No|09/06/2016||Yes|No||||No|No|||Prescription required|No|||No|.14418|10/24/2023|.14071|10/24/2023|.14165|10/24/2023||||3034|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182310|LEVOTHYROXINE 137 MCG TABLET|1000|EA|.21682|02/26/2008||Yes|No||02/26/2008||Yes|No|02/26/2008||Yes|No||||No|No|||Prescription required|No|||No|.08199|10/24/2023|.08002|10/24/2023|.08055|10/24/2023||||3035|||||No|No||MYLAN|No|||||No|No|No||
levothyroxine sodium|No|No|No|No|75%|00378182377|LEVOTHYROXINE 137 MCG TABLET|90|EA|.21681|10/04/2016||Yes|No||10/04/2016||Yes|No|10/04/2016||Yes|No||||No|No|||Prescription required|No|||No|.08199|10/24/2023|.08002|10/24/2023|.08055|10/24/2023||||3036|||||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|.11184|10/24/2023|.10915|10/24/2023|.10988|10/24/2023||||3037|||||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|.1612|10/24/2023|.15733|10/24/2023|.15837|10/24/2023||||3038|||||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|.28886|10/24/2023|.28192|10/24/2023|.2838|10/24/2023||||3039|||||No|No||MYLAN|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00378190577|ROFLUMILAST 500 MCG TABLET|90|EA|1.82286|04/26/2023||Yes|No||04/26/2023||Yes|No|04/26/2023||Yes|No||||No|No|||Prescription required|No||098|No|.43067|10/24/2023|.42033|10/24/2023|.42313|10/24/2023|||COPD AGENTS|3040|||||No|No||MYLAN|No|||||No|No|No||
roflumilast|No|No|No|No|75%|00378190593|ROFLUMILAST 500 MCG TABLET|30|EA|1.82291|04/26/2023||Yes|No||04/26/2023||Yes|No|04/26/2023||Yes|No||||No|No|||Prescription required|No||098|No|.43067|10/24/2023|.42033|10/24/2023|.42313|10/24/2023|||COPD AGENTS|3041|||||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|.5516|09/26/2023|.53836|09/26/2023|.54194|09/26/2023|||HIV / AIDS|3042|||||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||173|No|705.50807|02/16/2023|695.42938|02/16/2023|662.3137|02/16/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3043|||||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||173|No|705.50759|02/16/2023|695.42891|02/16/2023|662.31325|02/16/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3044|||||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||173|No|705.50807|02/16/2023|695.42938|02/16/2023|662.3137|02/16/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3045|||||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||173|No|705.50759|02/16/2023|695.42891|02/16/2023|662.31325|02/16/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3046|||||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||173|No|705.50807|02/15/2023|695.42938|02/15/2023|662.3137|02/15/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3047|||||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||173|No|705.50852|02/16/2023|695.42983|02/16/2023|662.31412|02/16/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3048|||||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||173|No|705.50807|02/15/2023|695.42938|02/15/2023|662.3137|02/15/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3049|||||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||173|No|705.50852|02/16/2023|695.42983|02/16/2023|662.31412|02/16/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3050|||||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|3051|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|.18983|10/24/2023|.18527|10/24/2023|.1865|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|3052|||||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|.20469|09/26/2023|.19977|09/26/2023|.2011|09/26/2023|||IMMUNOSUPPRESSIVES: ORAL|3053|||||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|1.12274|10/24/2023|1.09579|10/24/2023|1.10309|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|3054|||||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|3055|||||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|5.65773|05/23/2023|5.57691|05/23/2023|5.31134|05/23/2023|||CALCIUM CHANNEL BLOCKERS|3056|||||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|3057|||||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|3058|||||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|.2443|10/24/2023|.23843|10/24/2023|.24002|10/24/2023||||3059|||||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|.2443|10/24/2023|.23843|10/24/2023|.24002|10/24/2023||||3060|||||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|.05314|10/24/2023|.05186|10/24/2023|.05221|10/24/2023||||3061|||||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|.05314|10/24/2023|.05186|10/24/2023|.05221|10/24/2023||||3062|||||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|3063|||||No|No||MYLAN|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00378224577|IMATINIB MESYLATE 100 MG TAB|90|EA|1.27566|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription required|No||173|No|.6088|02/28/2023|.59418|02/28/2023|.59814|02/28/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3064|||||No|No||MYLAN|No|||||No|No|No||
imatinib mesylate|No|No|No|No|75%|00378224693|IMATINIB MESYLATE 400 MG TAB|30|EA|5.031|03/19/2018||Yes|No||03/19/2018||Yes|No|03/19/2018||Yes|No||||No|No|||Prescription required|No||173|No|1.73729|10/24/2023|1.69559|10/24/2023|1.70688|10/24/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3065|||||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|.17968|10/24/2023|.17536|10/24/2023|.17653|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|3066|||||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|.17968|10/24/2023|.17536|10/24/2023|.17653|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|3067|||||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|.19922|10/24/2023|.19443|10/24/2023|.19573|10/24/2023||||3068|||||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|.19922|10/24/2023|.19443|10/24/2023|.19573|10/24/2023||||3069|||||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|2.11502|10/24/2023|2.06425|10/24/2023|2.078|10/24/2023|||ANTICONVULSANTS|3070|||||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|4.30422|10/24/2023|4.20091|10/24/2023|4.22889|10/24/2023|||ANTICONVULSANTS|3071|||||No|No||MYLAN|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00378235093|ESOMEPRAZOLE MAG DR 20 MG CAP|30|EA|.36277|09/21/2015||Yes|No||09/21/2015||Yes|No|09/21/2015||Yes|No||09/01/2021||Yes|No|||Prescription required|Yes|07/29/2021|047|No|.16649|10/24/2023|.16249|10/24/2023|.16357|10/24/2023|||PROTON PUMP INHIBITORS|3072|||||No|No||MYLAN|No|||||No|No|No||
esomeprazole magnesium|No|No|No|No|75%|00378235193|ESOMEPRAZOLE MAG DR 40 MG CAP|30|EA|.36277|09/21/2015||Yes|No||09/21/2015||Yes|No|09/21/2015||Yes|No||09/01/2021||Yes|No|||Prescription required|Yes|07/29/2021|047|No|.1529|10/24/2023|.14923|10/24/2023|.15022|10/24/2023|||PROTON PUMP INHIBITORS|3073|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378240101|TRIFLUOPERAZINE 1 MG TABLET|100|EA|.2632|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.59985|06/25/2019|.59128|06/25/2019|.56313|06/25/2019|||ANTIPSYCHOTICS|3074|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378240201|TRIFLUOPERAZINE 2 MG TABLET|100|EA|.38786|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.82658|10/24/2023|.80674|10/24/2023|.81211|10/24/2023|||ANTIPSYCHOTICS|3075|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378240501|TRIFLUOPERAZINE 5 MG TABLET|100|EA|.48852|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|.83548|06/27/2023|.81542|06/27/2023|.82085|06/27/2023|||ANTIPSYCHOTICS|3076|||||No|No||MYLAN|No|||||No|No|No||
trifluoperazine HCl|No|No|No|No|75%|00378241001|TRIFLUOPERAZINE 10 MG TABLET|100|EA|.73637|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||027|Yes|1.67825|08/27/2019|1.65427|08/27/2019|1.5755|08/27/2019|||ANTIPSYCHOTICS|3077|||||No|No||MYLAN|No|||||No|No|No||
capecitabine|No|No|No|No|75%|00378251191|CAPECITABINE 150 MG TABLET|60|EA|1.32583|05/29/2015|08/31/2023|Yes|No||05/29/2015|08/31/2023|Yes|No|05/29/2015|08/31/2023|Yes|No||||No|No|||Prescription required|No||502|No|3.02166|05/21/2019|2.97849|05/21/2019|2.83666|05/21/2019|||ONCOLOGY: ORAL - BREAST|3078|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||Yes|No|No||
phenytoin sodium extended|No|No|No|No|75%|00378267001|PHENYTEK 200 MG CAPSULE|100|EA|.62676|08/24/2009||Yes|No||08/24/2009||Yes|No|08/24/2009||Yes|No||08/24/2009||Yes|No|||Prescription required|No||056|No|1.42844|12/25/2018|1.40804|12/25/2018|1.34099|12/25/2018|||ANTICONVULSANTS|3079|||||No|No||MYLAN|No|||||No|No|No||
telmisartan|Yes|No|No|No|75%|00378292093|TELMISARTAN 20 MG TABLET|30|EA|.46096|10/09/2014||Yes|No||10/09/2014||Yes|No|10/09/2014||Yes|No||10/09/2014||Yes|No|07/01/2016||Prescription required|Yes|07/17/2014|113|Yes|.16401|10/24/2023|.16007|10/24/2023|.16113|10/24/2023|||ANGIOTENSIN MODULATORS|3080|||||No|No||MYLAN|No|||||No|No|No||
meclofenamate sodium|No|No|No|No|75%|00378300001|MECLOFENAMATE 100 MG CAPSULE|100|EA|2.66178|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|Yes|01/23/2013|059|Yes|6.06639|06/01/2016|5.97973|06/01/2016|5.69498|06/01/2016|||NSAIDS|3081|||||No|No||MYLAN|No|||||No|No|No||
candesartan/hydrochlorothiazid|No|No|No|No|75%|00378300177|CANDESARTAN-HCTZ 16-12.5 MG TB|90|EA|1.62372|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||11/04/2013||Yes|No|||Prescription required|Yes|07/29/2021|113|Yes|1.10032|10/24/2023|1.07391|10/24/2023|1.08106|10/24/2023|||ANGIOTENSIN MODULATORS|3082|||||No|No||MYLAN|No|||||No|No|No||
candesartan/hydrochlorothiazid|No|No|No|No|75%|00378300277|CANDESARTAN-HCTZ 32-12.5 MG TB|90|EA|1.65602|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||11/04/2013||Yes|No|||Prescription required|Yes|07/29/2021|113|Yes|1.64057|10/24/2023|1.60119|10/24/2023|1.61186|10/24/2023|||ANGIOTENSIN MODULATORS|3083|||||No|No||MYLAN|No|||||No|No|No||
candesartan/hydrochlorothiazid|No|No|No|No|75%|00378300377|CANDESARTAN-HCTZ 32-25 MG TAB|90|EA|1.79257|11/04/2013||Yes|No||11/04/2013||Yes|No|11/04/2013||Yes|No||11/04/2013||Yes|No|||Prescription required|Yes|07/29/2021|113|Yes|1.34663|10/24/2023|1.31431|10/24/2023|1.32306|10/24/2023|||ANGIOTENSIN MODULATORS|3084|||||No|No||MYLAN|No|||||No|No|No||
thiothixene|No|No|No|No|75%|00378300501|THIOTHIXENE 5 MG CAPSULE|100|EA|.81923|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|1.86709|08/06/2019|1.84042|08/06/2019|1.75278|08/06/2019|||ANTIPSYCHOTICS|3085|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00378302501|CLOMIPRAMINE 25 MG CAPSULE|100|EA|3.86716|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|.46535|10/24/2023|.45418|10/24/2023|.4572|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3086|||||No|No||MYLAN|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00378305001|CLOMIPRAMINE 50 MG CAPSULE|100|EA|3.86716|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|.40521|10/24/2023|.39548|10/24/2023|.39811|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3087|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00378306577|FENOFIBRATE 48 MG TABLET|90|EA|.15331|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription required|No||055|No|.10436|10/24/2023|.10185|10/24/2023|.10253|10/24/2023|||LIPOTROPICS: OTHER|3088|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00378306605|FENOFIBRATE 145 MG TABLET|500|EA|.28007|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription required|No||055|No|.12785|10/24/2023|.12478|10/24/2023|.12561|10/24/2023|||LIPOTROPICS: OTHER|3089|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate nanocrystallized|No|No|No|No|75%|00378306677|FENOFIBRATE 145 MG TABLET|90|EA|.28007|02/09/2014||Yes|No||02/09/2014||Yes|No|02/09/2014||Yes|No||||No|No|||Prescription required|No||055|No|.12785|10/24/2023|.12478|10/24/2023|.12561|10/24/2023|||LIPOTROPICS: OTHER|3090|||||No|No||MYLAN|No|||||No|No|No||
clomipramine HCl|No|No|No|No|75%|00378307501|CLOMIPRAMINE 75 MG CAPSULE|100|EA|3.86716|09/07/2010||Yes|No||09/07/2010||Yes|No|09/07/2010||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|215|No|.64103|10/24/2023|.62564|10/24/2023|.62981|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3091|||||No|No||MYLAN|No|||||No|No|No||
everolimus|No|No|No|No|75%|00378309685|EVEROLIMUS 2.5 MG TABLET|28|EA|24.64606|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription required|No||548|No|56.17009|12/20/2022|55.36766|12/20/2022|52.7311|12/20/2022|||ONCOLOGY: ORAL - RENAL CELL|3092|||||No|No||MYLAN|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00378309785|EVEROLIMUS 5 MG TABLET|28|EA|25.77942|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription required|No||548|No|58.75309|12/20/2022|57.91376|12/20/2022|55.15596|12/20/2022|||ONCOLOGY: ORAL - RENAL CELL|3093|||||No|No||MYLAN|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00378309885|EVEROLIMUS 7.5 MG TABLET|28|EA|25.77942|02/03/2021||Yes|No||02/03/2021||Yes|No|02/03/2021||Yes|No||||No|No|||Prescription required|No||548|No|58.75309|12/20/2022|57.91376|12/20/2022|55.15596|12/20/2022|||ONCOLOGY: ORAL - RENAL CELL|3094|||||No|No||MYLAN|No|||||No|No|Yes|09/30/2022|
everolimus|No|No|No|No|75%|00378309985|EVEROLIMUS 10 MG TABLET|28|EA|25.77942|08/31/2023||Yes|No||08/31/2023||Yes|No|08/31/2023||Yes|No||||No|No|||Prescription required|No||548|No|58.75309|08/31/2023|57.91376|08/31/2023|55.15596|08/31/2023|||ONCOLOGY: ORAL - RENAL CELL|3095|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378312501|DOXEPIN 25 MG CAPSULE|100|EA|.265|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.16017|10/24/2023|.15632|10/24/2023|.15736|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3096|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378312510|DOXEPIN 25 MG CAPSULE|1000|EA|.26509|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.16017|10/24/2023|.15632|10/24/2023|.15736|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3097|||||No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378320501|PRAZOSIN 5 MG CAPSULE|100|EA|.56317|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.31409|10/24/2023|.30655|10/24/2023|.30859|10/24/2023||||3098|||||No|No||MYLAN|No|||||No|No|No||
prazosin HCl|No|No|No|No|75%|00378320525|PRAZOSIN 5 MG CAPSULE|250|EA|.56314|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||03/01/2002||Yes|No|||Prescription required|No|||No|.31409|10/24/2023|.30655|10/24/2023|.30859|10/24/2023||||3099|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322477|CANDESARTAN CILEXETIL 4 MG TAB|90|EA|.54466|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.71847|10/24/2023|.70122|10/24/2023|.70589|10/24/2023|||ANGIOTENSIN MODULATORS|3100|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322493|CANDESARTAN CILEXETIL 4 MG TAB|30|EA|.54466|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.71847|10/24/2023|.70122|10/24/2023|.70589|10/24/2023|||ANGIOTENSIN MODULATORS|3101|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322577|CANDESARTAN CILEXETIL 8 MG TAB|90|EA|.57333|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.65122|10/24/2023|.63559|10/24/2023|.63982|10/24/2023|||ANGIOTENSIN MODULATORS|3102|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378322593|CANDESARTAN CILEXETIL 8 MG TAB|30|EA|.57333|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.65122|10/24/2023|.63559|10/24/2023|.63982|10/24/2023|||ANGIOTENSIN MODULATORS|3103|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323177|CANDESARTAN CILEXETIL 16 MG TB|90|EA|.44433|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.6931|10/24/2023|.67646|10/24/2023|.68097|10/24/2023|||ANGIOTENSIN MODULATORS|3104|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323193|CANDESARTAN CILEXETIL 16 MG TB|30|EA|.44433|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.6931|10/24/2023|.67646|10/24/2023|.68097|10/24/2023|||ANGIOTENSIN MODULATORS|3105|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323277|CANDESARTAN CILEXETIL 32 MG TB|90|EA|.731|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.95837|10/24/2023|.93536|10/24/2023|.94159|10/24/2023|||ANGIOTENSIN MODULATORS|3106|||||No|No||MYLAN|No|||||No|No|No||
candesartan cilexetil|Yes|No|No|No|75%|00378323293|CANDESARTAN CILEXETIL 32 MG TB|30|EA|.731|05/21/2020||Yes|No||05/21/2020||Yes|No|05/21/2020||Yes|No||05/21/2020||Yes|No|06/19/2020||Prescription required|Yes|07/29/2021|113|Yes|.95837|10/24/2023|.93536|10/24/2023|.94159|10/24/2023|||ANGIOTENSIN MODULATORS|3107|||||No|No||MYLAN|No|||||No|No|No||
etoposide|No|No|No|No|75%|00378326694|ETOPOSIDE 50 MG CAPSULE|20|EA|32.39147|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||No|73.82242|06/01/2016|72.76781|06/01/2016|69.30268|06/01/2016||||3108|||||No|No||MYLAN|No|||||Yes|No|No||
norelgestromin/ethin.estradiol|Yes|Yes|No|No|75%|00378334053|XULANE 150-35 MCG/DAY PATCH|3|EA|17.50816|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No|Refer to program requirements|||No|No|09/10/2014||Prescription required|No|||No|37.8982|10/24/2023|36.98864|10/24/2023|37.23498|10/24/2023||||3109|||||No|No||MYLAN|No|||Only covered for non-contraceptive (medical) purposes||No|No|No||
estradiol|No|No|No|No|75%|00378334999|ESTRADIOL 0.025 MG PATCH(1/WK)|4|EA|7.98295|04/11/2005||Yes|No||04/11/2005||Yes|No|04/11/2005||Yes|No||||No|No|||Prescription required|No|||Yes|13.29755|10/24/2023|12.9784|10/24/2023|13.06484|10/24/2023||||3110|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378335099|ESTRADIOL 0.05 MG PATCH (1/WK)|4|EA|7.98295|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|11.95238|10/24/2023|11.66552|10/24/2023|11.74321|10/24/2023||||3111|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378335199|ESTRADIOL 0.075 MG PATCH(1/WK)|4|EA|7.98295|04/11/2005||Yes|No||04/11/2005||Yes|No|04/11/2005||Yes|No||||No|No|||Prescription required|No|||Yes|14.7135|10/24/2023|14.36037|10/24/2023|14.45601|10/24/2023||||3112|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378335299|ESTRADIOL 0.1 MG PATCH (1/WK)|4|EA|7.98295|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No|||Yes|12.17494|10/24/2023|11.88274|10/24/2023|11.96187|10/24/2023||||3113|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378336099|ESTRADIOL 0.0375MG PATCH(1/WK)|4|EA|7.98295|09/28/2006||Yes|No||09/28/2006||Yes|No|09/28/2006||Yes|No||||No|No|||Prescription required|No|||Yes|9.43694|10/24/2023|9.21045|10/24/2023|9.27179|10/24/2023||||3114|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378336199|ESTRADIOL 0.06 MG PATCH (1/WK)|4|EA|7.98295|09/28/2006||Yes|No||09/28/2006||Yes|No|09/28/2006||Yes|No||||No|No|||Prescription required|No|||Yes|11.41136|09/26/2023|11.13748|09/26/2023|11.21166|09/26/2023||||3115|||||No|No||MYLAN|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00378343193|ARMODAFINIL 50 MG TABLET|30|EA|2.49873|06/21/2017||Yes|No||06/21/2017||Yes|No|06/21/2017||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|.21637|10/24/2023|.21117|10/24/2023|.21258|10/24/2023|||STIMULANTS AND RELATED AGENTS|3116|||||No|No||MYLAN|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00378343293|ARMODAFINIL 150 MG TABLET|30|EA|7.52113|06/21/2017||Yes|No||06/21/2017||Yes|No|06/21/2017||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|.98359|10/24/2023|.95998|10/24/2023|.96637|10/24/2023|||STIMULANTS AND RELATED AGENTS|3117|||||No|No||MYLAN|No|||||No|No|No||
armodafinil|No|No|No|No|90%|00378343393|ARMODAFINIL 250 MG TABLET|30|EA|7.52113|06/21/2017||Yes|No||06/21/2017||Yes|No|06/21/2017||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|007|Yes|.79224|10/24/2023|.77322|10/24/2023|.77837|10/24/2023|||STIMULANTS AND RELATED AGENTS|3118|||||No|No||MYLAN|No|||||No|No|No||
azelastine/fluticasone|No|No|No|No|75%|00378345823|AZELASTIN-FLUTIC 137-50MCG SPR|23|GM|3.19396|09/22/2020||Yes|No||09/22/2020||Yes|No|09/22/2020||Yes|No||||No|No|||Prescription required|Yes|04/26/2020|019|No|2.95379|10/24/2023|2.88289|10/24/2023|2.90209|10/24/2023|||INTRANASAL RHINITIS AGENTS|3119|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378351501|MIRTAZAPINE 15 MG TABLET|100|EA|.08681|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription required|No||031|No|.0644|10/24/2023|.06285|10/24/2023|.06327|10/24/2023|||ANTIDEPRESSANTS: OTHER|3120|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378351593|MIRTAZAPINE 15 MG TABLET|30|EA|.12756|07/14/2003||Yes|No||07/14/2003||Yes|No|07/14/2003||Yes|No||||No|No|||Prescription required|No||031|No|.0644|10/24/2023|.06285|10/24/2023|.06327|10/24/2023|||ANTIDEPRESSANTS: OTHER|3121|||||No|No||MYLAN|No|||||No|No|No||
fosamprenavir calcium|No|No|No|No|75%|00378352091|FOSAMPRENAVIR 700 MG TABLET|60|EA|9.99889|02/28/2018||Yes|No||02/28/2018||Yes|No|02/28/2018||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|16.33153|02/28/2018|16.09822|02/28/2018|15.33164|02/28/2018|||HIV / AIDS|3122|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378353001|MIRTAZAPINE 30 MG TABLET|100|EA|.12117|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription required|No||031|No|.08191|10/24/2023|.07994|10/24/2023|.08047|10/24/2023|||ANTIDEPRESSANTS: OTHER|3123|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378353093|MIRTAZAPINE 30 MG TABLET|30|EA|.16125|07/14/2003||Yes|No||07/14/2003||Yes|No|07/14/2003||Yes|No||||No|No|||Prescription required|No||031|No|.08191|10/24/2023|.07994|10/24/2023|.08047|10/24/2023|||ANTIDEPRESSANTS: OTHER|3124|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378354501|MIRTAZAPINE 45 MG TABLET|100|EA|.1532|12/12/2018||Yes|No||12/12/2018||Yes|No|12/12/2018||Yes|No||||No|No|||Prescription required|No||031|No|.11931|10/24/2023|.11644|10/24/2023|.11722|10/24/2023|||ANTIDEPRESSANTS: OTHER|3125|||||No|No||MYLAN|No|||||No|No|No||
mirtazapine|No|No|No|No|75%|00378354593|MIRTAZAPINE 45 MG TABLET|30|EA|.18275|07/14/2003||Yes|No||07/14/2003||Yes|No|07/14/2003||Yes|No||||No|No|||Prescription required|No||031|No|.11931|10/24/2023|.11644|10/24/2023|.11722|10/24/2023|||ANTIDEPRESSANTS: OTHER|3126|||||No|No||MYLAN|No|||||No|No|No||
mercaptopurine|No|No|No|No|75%|00378354725|MERCAPTOPURINE 50 MG TABLET|250|EA|1.22679|07/13/2005||Yes|No||07/13/2005||Yes|No|07/13/2005||Yes|No||||No|No|||Prescription required|No||173|No|.8586|10/24/2023|.83799|10/24/2023|.84357|10/24/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3127|||||No|No||MYLAN|No|||||No|No|No||
mercaptopurine|No|No|No|No|75%|00378354752|MERCAPTOPURINE 50 MG TABLET|25|EA|1.3631|07/13/2005||Yes|No||07/13/2005||Yes|No|07/13/2005||Yes|No||||No|No|||Prescription required|No||173|No|.8586|10/24/2023|.83799|10/24/2023|.84357|10/24/2023|||ONCOLOGY: ORAL - HEMATOLOGIC|3128|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363101|CARVEDILOL 3.125 MG TABLET|100|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.01726|10/24/2023|.01684|10/24/2023|.01695|10/24/2023|||BETA-BLOCKERS|3129|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363105|CARVEDILOL 3.125 MG TABLET|500|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.01726|10/24/2023|.01684|10/24/2023|.01695|10/24/2023|||BETA-BLOCKERS|3130|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363201|CARVEDILOL 6.25 MG TABLET|100|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.01967|10/24/2023|.01919|10/24/2023|.01932|10/24/2023|||BETA-BLOCKERS|3131|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363205|CARVEDILOL 6.25 MG TABLET|500|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.01967|10/24/2023|.01919|10/24/2023|.01932|10/24/2023|||BETA-BLOCKERS|3132|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363301|CARVEDILOL 12.5 MG TABLET|100|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.02287|10/24/2023|.02232|10/24/2023|.02246|10/24/2023|||BETA-BLOCKERS|3133|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363305|CARVEDILOL 12.5 MG TABLET|500|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.02287|10/24/2023|.02232|10/24/2023|.02246|10/24/2023|||BETA-BLOCKERS|3134|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363401|CARVEDILOL 25 MG TABLET|100|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.03132|10/24/2023|.03056|10/24/2023|.03077|10/24/2023|||BETA-BLOCKERS|3135|||||No|No||MYLAN|No|||||No|No|No||
carvedilol|No|No|No|No|75%|00378363405|CARVEDILOL 25 MG TABLET|500|EA|.03414|09/07/2007||Yes|No||09/07/2007||Yes|No|09/07/2007||Yes|No||07/01/2012||Yes|No|||Prescription required|No||070|No|.03132|10/24/2023|.03056|10/24/2023|.03077|10/24/2023|||BETA-BLOCKERS|3136|||||No|No||MYLAN|No|||||No|No|No||
cetirizine HCl|No|No|No|No|75%|00378363501|CETIRIZINE HCL 5 MG TABLET|100|EA|.05719|02/14/2008||Yes|No||||No|No|02/14/2008||Yes|No||||No|No|||Over the counter|No||030|Yes|.05523|10/24/2023|.0539|10/24/2023|.05426|10/24/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|3137|||||No|No||MYLAN|No|||||No|Yes|No||
cetirizine HCl|No|No|No|No|75%|00378363701|CETIRIZINE HCL 10 MG TABLET|100|EA|.05719|02/13/2008||Yes|No||||No|No|02/13/2008||Yes|No||||No|No|||Over the counter|No||030|Yes|.06548|10/24/2023|.0639|10/24/2023|.06433|10/24/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|3138|||||No|No||MYLAN|No|||||No|Yes|No||
cetirizine HCl|No|No|No|No|75%|00378363705|CETIRIZINE HCL 10 MG TABLET|500|EA|.0543|02/13/2008||Yes|No||||No|No|02/13/2008||Yes|No||||No|No|||Over the counter|No||030|Yes|.06548|10/24/2023|.0639|10/24/2023|.06433|10/24/2023|||ANTIHISTAMINES: MINIMALLY SEDATING|3139|||||No|No||MYLAN|No|||||No|Yes|No||
phenytoin sodium extended|No|No|No|No|75%|00378375001|PHENYTEK 300 MG CAPSULE|100|EA|.93916|08/26/2009||Yes|No||08/26/2009||Yes|No|08/26/2009||Yes|No||08/26/2009||Yes|No|||Prescription required|No||056|No|2.14041|12/25/2018|2.10984|12/25/2018|2.00937|12/25/2018|||ANTICONVULSANTS|3140|||||No|No||MYLAN|No|||||No|No|No||
phenytoin sodium extended|No|No|No|No|75%|00378375093|PHENYTEK 300 MG CAPSULE|30|EA|.93912|08/24/2009||Yes|No||08/24/2009||Yes|No|08/24/2009||Yes|No||08/24/2009||Yes|No|||Prescription required|No||056|No|2.14032|12/25/2018|2.10974|12/25/2018|2.00928|12/25/2018|||ANTICONVULSANTS|3141|||||No|No||MYLAN|No|||||No|No|No||
febuxostat|No|No|No|No|75%|00378392593|FEBUXOSTAT 40 MG TABLET|30|EA|1.08804|12/12/2019|09/30/2023|Yes|No||12/12/2019|09/30/2023|Yes|No|12/12/2019|09/30/2023|Yes|No||||No|No|||Prescription required|Yes|07/25/2019|231|No|2.47972|10/10/2023|2.44429|10/10/2023|2.3279|10/10/2023|||ANTIHYPERURICEMICS|3142|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00378395005|ATORVASTATIN 10 MG TABLET|500|EA|.04665|07/05/2017||Yes|No||07/05/2017||Yes|No|07/05/2017||Yes|No||07/05/2017||Yes|No|||Prescription required|No||063|Yes|.03066|10/24/2023|.02992|10/24/2023|.03012|10/24/2023|||LIPOTROPICS: STATINS|3143|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395077|ATORVASTATIN 10 MG TABLET|90|EA|.04667|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription required|No||063|Yes|.03066|10/24/2023|.02992|10/24/2023|.03012|10/24/2023|||LIPOTROPICS: STATINS|3144|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395105|ATORVASTATIN 20 MG TABLET|500|EA|.0664|02/21/2019||Yes|No||02/21/2019||Yes|No|02/21/2019||Yes|No||02/21/2019||Yes|No|07/22/2019||Prescription required|No||063|Yes|.03755|10/24/2023|.03664|10/24/2023|.03689|10/24/2023|||LIPOTROPICS: STATINS|3145|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395177|ATORVASTATIN 20 MG TABLET|90|EA|.0664|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription required|No||063|Yes|.03755|10/24/2023|.03664|10/24/2023|.03689|10/24/2023|||LIPOTROPICS: STATINS|3146|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|No|No|No|No|75%|00378395205|ATORVASTATIN 40 MG TABLET|500|EA|.0664|07/05/2017||Yes|No||07/05/2017||Yes|No|07/05/2017||Yes|No||07/05/2017||Yes|No|||Prescription required|No||063|Yes|.05376|10/24/2023|.05246|10/24/2023|.05281|10/24/2023|||LIPOTROPICS: STATINS|3147|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395277|ATORVASTATIN 40 MG TABLET|90|EA|.0664|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription required|No||063|Yes|.05376|10/24/2023|.05246|10/24/2023|.05281|10/24/2023|||LIPOTROPICS: STATINS|3148|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395305|ATORVASTATIN 80 MG TABLET|500|EA|.0664|02/21/2019||Yes|No||02/21/2019||Yes|No|02/21/2019||Yes|No||02/21/2019||Yes|No|07/22/2019||Prescription required|No||063|Yes|.08531|10/24/2023|.08326|10/24/2023|.08381|10/24/2023|||LIPOTROPICS: STATINS|3149|||||No|No||MYLAN|No|||||No|No|No||
atorvastatin calcium|Yes|No|No|No|75%|00378395377|ATORVASTATIN 80 MG TABLET|90|EA|.0664|04/22/2020||Yes|No||04/22/2020||Yes|No|04/22/2020||Yes|No||04/22/2020||Yes|No|06/19/2020||Prescription required|No||063|Yes|.08531|10/24/2023|.08326|10/24/2023|.08381|10/24/2023|||LIPOTROPICS: STATINS|3150|||||No|No||MYLAN|No|||||No|No|No||
paliperidone|No|No|No|No|75%|00378397893|PALIPERIDONE ER 1.5 MG TABLET|30|EA|10.51335|06/04/2018|04/14/2024|Yes|No||06/04/2018|04/14/2024|Yes|No|06/04/2018|04/14/2024|Yes|No||||No|No|||Prescription required|Yes|01/22/2015|027|Yes|1.85144|10/24/2023|1.807|10/24/2023|1.81903|10/24/2023|||ANTIPSYCHOTICS|3151|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MYLAN/ARCHIS PH|No|||||No|No|No||
paliperidone|No|No|No|No|75%|00378397993|PALIPERIDONE ER 3 MG TABLET|30|EA|10.51335|06/04/2018|04/14/2024|Yes|No||06/04/2018|04/14/2024|Yes|No|06/04/2018|04/14/2024|Yes|No||||No|No|||Prescription required|Yes|01/22/2015|027|Yes|1.78831|10/24/2023|1.74539|10/24/2023|1.75701|10/24/2023|||ANTIPSYCHOTICS|3152|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MYLAN/ARCHIS PH|No|||||No|No|No||
paliperidone|No|No|No|No|75%|00378398093|PALIPERIDONE ER 6 MG TABLET|30|EA|10.51335|06/04/2018|04/14/2024|Yes|No||06/04/2018|04/14/2024|Yes|No|06/04/2018|04/14/2024|Yes|No||||No|No|||Prescription required|Yes|01/22/2015|027|Yes|2.23765|10/24/2023|2.18394|10/24/2023|2.19849|10/24/2023|||ANTIPSYCHOTICS|3153|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MYLAN/ARCHIS PH|No|||||No|No|No||
paliperidone|No|No|No|No|75%|00378398193|PALIPERIDONE ER 9 MG TABLET|30|EA|15.76996|06/04/2018|04/14/2024|Yes|No||06/04/2018|04/14/2024|Yes|No|06/04/2018|04/14/2024|Yes|No||||No|No|||Prescription required|Yes|01/22/2015|027|Yes|2.36138|10/24/2023|2.3047|10/24/2023|2.32005|10/24/2023|||ANTIPSYCHOTICS|3154|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer||No|No||MYLAN/ARCHIS PH|No|||||No|No|No||
nevirapine|No|No|No|No|75%|00378405091|NEVIRAPINE 200 MG TABLET|60|EA|.10219|07/02/2012||Yes|No||07/20/2012||Yes|No|07/02/2012||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|.16692|10/27/2020|.16453|10/27/2020|.1567|10/27/2020|||HIV / AIDS|3155|||||No|No||MYLAN|No|||||No|No|No||
abacavir sulfate|No|No|No|No|75%|00378410591|ABACAVIR 300 MG TABLET|60|EA|4.8213|07/19/2012||Yes|No||07/19/2012||Yes|No|07/19/2012||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|.56793|10/24/2023|.55429|10/24/2023|.55799|10/24/2023|||HIV / AIDS|3156|||||No|No||MYLAN|No|||||No|No|No||
riluzole|No|No|No|No|75%|00378414591|RILUZOLE 50 MG TABLET|60|EA|1.21073|10/09/2014||Yes|No||10/09/2014||Yes|No|10/09/2014||Yes|No||||No|No|||Prescription required|No|||No|.33226|10/24/2023|.32428|10/24/2023|.32644|10/24/2023||||3157|||||No|No||MYLAN|No|||||No|No|No||
atovaquone/proguanil HCl|No|No|No|No|75%|00378416201|ATOVAQUONE-PROGUANIL 250-100|100|EA|2.45972|10/09/2014||Yes|No||10/09/2014||Yes|No|10/09/2014||Yes|No||||No|No|||Prescription required|No|||No|2.16264|10/24/2023|2.11073|10/24/2023|2.12479|10/24/2023||||3158|||||No|No||MYLAN|No|||||No|No|No||
mycophenolate sodium|No|No|No|No|75%|00378420178|MYCOPHENOLIC ACID DR 180 MG TB|120|EA|1.57165|08/05/2014|03/06/2024|Yes|No||08/05/2014|03/06/2024|Yes|No|08/05/2014|03/06/2024|Yes|No||08/05/2014|03/06/2024|Yes|No|||Prescription required|Yes|01/15/2014|229|No|.14868|10/24/2023|.14511|10/24/2023|.14607|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|3159|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||MYLAN/ARCHIS PH|No|||||Yes|No|No||
mycophenolate sodium|No|No|No|No|75%|00378420278|MYCOPHENOLIC ACID DR 360 MG TB|120|EA|3.1433|08/05/2014|03/06/2024|Yes|No||08/05/2014|03/06/2024|Yes|No|08/05/2014|03/06/2024|Yes|No||08/05/2014|03/06/2024|Yes|No|||Prescription required|Yes|01/15/2014|229|No|7.1638|11/21/2023|7.06146|11/21/2023|6.7252|11/21/2023|||IMMUNOSUPPRESSIVES: ORAL|3160|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|Discontinued by Manufacturer|No|No||MYLAN/ARCHIS PH|No|||||Yes|No|No||
doxepin HCl|No|No|No|No|75%|00378425001|DOXEPIN 50 MG CAPSULE|100|EA|.37969|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.22754|10/24/2023|.22207|10/24/2023|.22355|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3161|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378425010|DOXEPIN 50 MG CAPSULE|1000|EA|.37969|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.22754|10/24/2023|.22207|10/24/2023|.22355|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3162|||||No|No||MYLAN|No|||||No|No|No||
ambrisentan|No|No|No|No|75%|00378427093|AMBRISENTAN 5 MG TABLET|30|EA|16.51257|09/11/2019||Yes|No||09/11/2019||Yes|No|09/11/2019||Yes|No|Refer to program requirements|||No|No|||Prescription required|Yes|07/28/2022|171|Yes|37.6333|09/11/2019|37.09568|09/11/2019|35.32922|09/11/2019|||PAH AGENTS: ORAL AND INHALED|3163|||||No|No||MYLAN|No|||||No|No|Yes|07/30/2021|
ambrisentan|No|No|No|No|75%|00378427193|AMBRISENTAN 10 MG TABLET|30|EA|16.51257|09/11/2019||Yes|No||09/11/2019||Yes|No|09/11/2019||Yes|No|Refer to program requirements|||No|No|||Prescription required|Yes|07/28/2022|171|Yes|37.6333|09/11/2019|37.09568|09/11/2019|35.32922|09/11/2019|||PAH AGENTS: ORAL AND INHALED|3164|||||No|No||MYLAN|No|||||No|No|Yes|07/30/2021|
valacyclovir HCl|No|No|No|No|75%|00378427577|VALACYCLOVIR HCL 500 MG TABLET|90|EA|.16721|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|||Prescription required|No||025|No|.28806|10/24/2023|.28114|10/24/2023|.28301|10/24/2023|||ANTIVIRALS: ORAL|3165|||||No|No||MYLAN|No|||||No|No|No||
valacyclovir HCl|No|No|No|No|75%|00378427593|VALACYCLOVIR HCL 500 MG TABLET|30|EA|.172|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|||Prescription required|No||025|No|.28806|10/24/2023|.28114|10/24/2023|.28301|10/24/2023|||ANTIVIRALS: ORAL|3166|||||No|No||MYLAN|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00378427677|VALACYCLOVIR HCL 1 GRAM TABLET|90|EA|.26277|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|11/01/2012||Prescription required|No||025|No|.50396|10/24/2023|.49186|10/24/2023|.49514|10/24/2023|||ANTIVIRALS: ORAL|3167|||||No|No||MYLAN|No|||||No|No|No||
valacyclovir HCl|Yes|No|No|No|75%|00378427693|VALACYCLOVIR HCL 1 GRAM TABLET|30|EA|.27233|06/07/2010||Yes|No||06/07/2010||Yes|No|06/07/2010||Yes|No||07/01/2012||Yes|No|11/01/2012||Prescription required|No||025|No|.50396|10/24/2023|.49186|10/24/2023|.49514|10/24/2023|||ANTIVIRALS: ORAL|3168|||||No|No||MYLAN|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00378428785|ELETRIPTAN HBR 20 MG TABLET|6|EA|5.1385|06/08/2018||Yes|No||06/08/2018||Yes|No|06/08/2018||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|Yes|3.1957|10/24/2023|3.119|10/24/2023|3.13977|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3169|||||No|No||MYLAN|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00378428808|ELETRIPTAN HBR 40 MG TABLET|12|EA|5.1385|06/08/2018||Yes|No||06/08/2018||Yes|No|06/08/2018||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|Yes|2.39121|10/24/2023|2.33382|10/24/2023|2.34936|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3170|||||No|No||MYLAN|No|||||No|No|No||
eletriptan hydrobromide|No|No|No|No|75%|00378428885|ELETRIPTAN HBR 40 MG TABLET|6|EA|5.1385|06/08/2018||Yes|No||06/08/2018||Yes|No|06/08/2018||Yes|No||||No|No|||Prescription required|Yes|07/27/2017|021|Yes|2.39121|10/24/2023|2.33382|10/24/2023|2.34936|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3171|||||No|No||MYLAN|No|||||No|No|No||
naproxen/esomeprazole mag|No|No|No|No|75%|00378438591|NAPROXEN-ESOMEPRAZ DR 375-20MG|60|EA|11.56291|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||11/14/2022||Yes|No|||Prescription required|Yes|01/28/2021|059|Yes|26.35269|11/14/2022|25.97622|11/14/2022|24.73926|11/14/2022|||NSAIDS|3172|||||No|No||MYLAN|No|||||No|No|No||
naproxen/esomeprazole mag|No|No|No|No|75%|00378438691|NAPROXEN-ESOMEPRAZ DR 500-20MG|60|EA|11.56291|11/14/2022||Yes|No||11/14/2022||Yes|No|11/14/2022||Yes|No||11/14/2022||Yes|No|||Prescription required|Yes|01/28/2021|059|Yes|26.35269|11/21/2023|25.97622|11/21/2023|24.73926|11/21/2023|||NSAIDS|3173|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00378439077|FENOFIBRATE 40 MG TABLET|90|EA|3.59412|07/03/2017||Yes|No||07/03/2017||Yes|No|07/03/2017||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|055|No|5.96824|04/25/2023|5.825|04/25/2023|5.86379|04/25/2023|||LIPOTROPICS: OTHER|3174|||||No|No||MYLAN|No|||||No|No|No||
fenofibrate|No|No|No|No|75%|00378439177|FENOFIBRATE 120 MG TABLET|90|EA|10.78243|07/03/2017||Yes|No||07/03/2017||Yes|No|07/03/2017||Yes|No||||No|No|||Prescription required|Yes|07/21/2016|055|No|17.41651|06/27/2023|16.99851|06/27/2023|17.11172|06/27/2023|||LIPOTROPICS: OTHER|3175|||||No|No||MYLAN|No|||||No|No|No||
mycophenolate mofetil|No|No|No|No|75%|00378447201|MYCOPHENOLATE 500 MG TABLET|100|EA|.38983|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|.26815|10/24/2023|.26171|10/24/2023|.26345|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|3176|||||No|No||MYLAN|No|||||Yes|No|No||
mycophenolate mofetil|No|No|No|No|75%|00378447205|MYCOPHENOLATE 500 MG TABLET|500|EA|.38984|08/01/2009||Yes|No||08/01/2009||Yes|No|08/01/2009||Yes|No||08/01/2009||Yes|No|||Prescription required|No||229|No|.26815|10/24/2023|.26171|10/24/2023|.26345|10/24/2023|||IMMUNOSUPPRESSIVES: ORAL|3177|||||No|No||MYLAN|No|||||Yes|No|No||
budesonide|No|No|No|No|75%|00378450093|BUDESONIDE ER 9 MG TABLET|30|EA|22.20262|04/15/2021||Yes|No||04/15/2021||Yes|No|04/15/2021||Yes|No||||No|No|||Prescription required|Yes|01/30/2020|010|No|33.43921|10/24/2023|32.63666|10/24/2023|32.85402|10/24/2023|||ULCERATIVE COLITIS AGENTS|3178|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451493|AMLODIPINE-ATORVAST 5-20 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription required|Yes|07/24/2013|063|Yes|1.9745|06/27/2023|1.92711|06/27/2023|1.93994|06/27/2023|||LIPOTROPICS: STATINS|3179|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451593|AMLODIPINE-ATORVAST 5-40 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription required|Yes|07/17/2014|063|Yes|1.715|09/26/2023|1.67384|09/26/2023|1.68498|09/26/2023|||LIPOTROPICS: STATINS|3180|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451793|AMLODIPINE-ATORVAST 10-10 MG|30|EA|2.35625|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription required|Yes|07/17/2014|063|Yes|1.27567|09/26/2023|1.24505|09/26/2023|1.25334|09/26/2023|||LIPOTROPICS: STATINS|3181|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451893|AMLODIPINE-ATORVAST 10-20 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription required|Yes|07/24/2013|063|Yes|1.505|09/26/2023|1.46888|09/26/2023|1.47866|09/26/2023|||LIPOTROPICS: STATINS|3182|||||No|No||MYLAN|No|||||No|No|No||
amlodipine/atorvastatin|No|No|No|No|75%|00378451993|AMLODIPINE-ATORVAST 10-40 MG|30|EA|3.22371|04/11/2019||Yes|No||04/11/2019||Yes|No|04/11/2019||Yes|No||04/11/2019||Yes|No|||Prescription required|Yes|07/24/2013|063|Yes|1.40887|09/26/2023|1.37505|09/26/2023|1.38421|09/26/2023|||LIPOTROPICS: STATINS|3183|||||No|No||MYLAN|No|||||No|No|No||
fingolimod HCl|No|No|No|No|75%|00378452593|FINGOLIMOD 0.5 MG CAPSULE|30|EA|4.58666|02/21/2023||Yes|No||02/21/2023||Yes|No|02/21/2023||Yes|No||||No|No|||Prescription required|No||043|No|9.74033|09/26/2023|9.50656|09/26/2023|9.56987|09/26/2023|||MULTIPLE SCLEROSIS AGENTS|3184|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456005|POTASSIUM CL ER 8 MEQ TABLET|500|EA|.1845|08/01/2017||Yes|No||08/01/2017||Yes|No|08/01/2017||Yes|No||08/01/2017||Yes|No|||Prescription required|No|||No|.13426|10/24/2023|.13103|10/24/2023|.13191|10/24/2023||||3185|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456077|POTASSIUM CL ER 8 MEQ TABLET|90|EA|.18451|07/25/2017||Yes|No||07/25/2017||Yes|No|07/25/2017||Yes|No||07/25/2017||Yes|No|||Prescription required|No|||No|.13426|10/24/2023|.13103|10/24/2023|.13191|10/24/2023||||3186|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456105|POTASSIUM CL ER 10 MEQ TABLET|500|EA|.19422|10/01/2017||Yes|No||10/01/2017||Yes|No|10/01/2017||Yes|No||10/01/2017||Yes|No|||Prescription required|No|||No|.12918|10/24/2023|.12607|10/24/2023|.12691|10/24/2023||||3187|||||No|No||MYLAN|No|||||No|No|No||
potassium chloride|No|No|No|No|75%|00378456177|POTASSIUM CL ER 10 MEQ TABLET|90|EA|.19421|10/01/2017||Yes|No||10/01/2017||Yes|No|10/01/2017||Yes|No||10/01/2017||Yes|No|||Prescription required|No|||No|.12918|10/24/2023|.12607|10/24/2023|.12691|10/24/2023||||3188|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459510|METOPROLOL SUCC ER 25 MG TAB|1000|EA|.32225|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.07937|10/24/2023|.07746|10/24/2023|.07798|10/24/2023|||BETA-BLOCKERS|3189|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459577|METOPROLOL SUCC ER 25 MG TAB|90|EA|.32225|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.07937|10/24/2023|.07746|10/24/2023|.07798|10/24/2023|||BETA-BLOCKERS|3190|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459610|METOPROLOL SUCC ER 50 MG TAB|1000|EA|.32225|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.07734|10/24/2023|.07548|10/24/2023|.07598|10/24/2023|||BETA-BLOCKERS|3191|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459677|METOPROLOL SUCC ER 50 MG TAB|90|EA|.32225|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.07734|10/24/2023|.07548|10/24/2023|.07598|10/24/2023|||BETA-BLOCKERS|3192|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459710|METOPROLOL SUCC ER 100 MG TAB|1000|EA|.53807|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.13342|10/24/2023|.13021|10/24/2023|.13108|10/24/2023|||BETA-BLOCKERS|3193|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459777|METOPROLOL SUCC ER 100 MG TAB|90|EA|.53807|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.13342|10/24/2023|.13021|10/24/2023|.13108|10/24/2023|||BETA-BLOCKERS|3194|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459805|METOPROLOL SUCC ER 200 MG TAB|500|EA|.85607|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.17498|10/24/2023|.17078|10/24/2023|.17191|10/24/2023|||BETA-BLOCKERS|3195|||||No|No||MYLAN|No|||||No|No|No||
metoprolol succinate|No|No|No|No|75%|00378459877|METOPROLOL SUCC ER 200 MG TAB|90|EA|.85607|07/01/2017||Yes|No||07/01/2017||Yes|No|07/01/2017||Yes|No||07/01/2017||Yes|No|||Prescription required|No||070|No|.17498|10/24/2023|.17078|10/24/2023|.17191|10/24/2023|||BETA-BLOCKERS|3196|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378461926|ESTRADIOL 0.025 MG PATCH(2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription required|No|||Yes|6.48798|10/24/2023|6.33226|10/24/2023|6.37444|10/24/2023||||3197|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462026|ESTRADIOL 0.0375MG PATCH(2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription required|No|||Yes|6.70119|10/24/2023|6.54036|10/24/2023|6.58391|10/24/2023||||3198|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462126|ESTRADIOL 0.05 MG PATCH (2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription required|No|||Yes|6.68694|10/24/2023|6.52645|10/24/2023|6.56991|10/24/2023||||3199|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462226|ESTRADIOL 0.075 MG PATCH(2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription required|No|||Yes|6.70115|10/24/2023|6.54032|10/24/2023|6.58387|10/24/2023||||3200|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378462326|ESTRADIOL 0.1 MG PATCH (2/WK)|8|EA|7.65615|02/25/2019||Yes|No||02/25/2019||Yes|No|02/25/2019||Yes|No||||No|No|||Prescription required|No|||Yes|6.59294|10/24/2023|6.4347|10/24/2023|6.47756|10/24/2023||||3201|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464026|ESTRADIOL 0.1 MG PATCH (2/WK)|8|EA|3.90547|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription required|No|||Yes|6.59294|10/24/2023|6.4347|10/24/2023|6.47756|10/24/2023||||3202|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464126|ESTRADIOL 0.075 MG PATCH(2/WK)|8|EA|3.90386|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription required|No|||Yes|6.70115|10/24/2023|6.54032|10/24/2023|6.58387|10/24/2023||||3203|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464226|ESTRADIOL 0.05 MG PATCH (2/WK)|8|EA|3.89956|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription required|No|||Yes|6.68694|10/24/2023|6.52645|10/24/2023|6.56991|10/24/2023||||3204|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464326|ESTRADIOL 0.0375MG PATCH(2/WK)|8|EA|3.89687|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription required|No|||Yes|6.70119|10/24/2023|6.54036|10/24/2023|6.58391|10/24/2023||||3205|||||No|No||MYLAN|No|||||No|No|No||
estradiol|No|No|No|No|75%|00378464426|ESTRADIOL 0.025 MG PATCH(2/WK)|8|EA|3.89687|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No||||No|No|||Prescription required|No|||Yes|6.48798|10/24/2023|6.33226|10/24/2023|6.37444|10/24/2023||||3206|||||No|No||MYLAN|No|||||No|No|No||
dapsone|No|No|No|No|75%|00378483060|DAPSONE 7.5% GEL PUMP|60|GM|3.09399|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|104|No|2.02263|10/24/2023|1.97408|10/24/2023|1.98723|10/24/2023|||ACNE AGENTS: TOPICAL|3207|||||No|No||MYLAN|No|||||No|No|No||
dapsone|No|No|No|No|75%|00378483090|DAPSONE 7.5% GEL PUMP|90|GM|2.70556|02/15/2023||Yes|No||02/15/2023||Yes|No|02/15/2023||Yes|No||||No|No|||Prescription required|Yes|07/29/2021|104|No|1.64913|10/24/2023|1.60955|10/24/2023|1.62027|10/24/2023|||ACNE AGENTS: TOPICAL|3208|||||No|No||MYLAN|No|||||No|No|No||
nevirapine|No|No|No|No|75%|00378489093|NEVIRAPINE ER 400 MG TABLET|30|EA|4.92|06/26/2015||Yes|No||06/26/2015||Yes|No|06/26/2015||Yes|No|Refer to program requirements|||No|No|||Prescription required|No||237|No|8.036|08/24/2021|7.9212|08/24/2021|7.544|08/24/2021|||HIV / AIDS|3209|||||No|No||MYLAN|No|||||No|No|No||
thiothixene|No|No|No|No|75%|00378501001|THIOTHIXENE 10 MG CAPSULE|100|EA|1.15493|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|2.63218|11/14/2023|2.59457|11/14/2023|2.47102|11/14/2023|||ANTIPSYCHOTICS|3210|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
prasugrel HCl|No|No|No|No|75%|00378518593|PRASUGREL 5 MG TABLET|30|EA|.43|06/05/2018||Yes|No||06/05/2018||Yes|No|06/05/2018||Yes|No||09/01/2022||Yes|No|||Prescription required|No||004|No|.29472|10/24/2023|.28764|10/24/2023|.28956|10/24/2023|||PLATELET AGGREGATION INHIBITORS|3211|||||No|No||MYLAN|No|||||No|No|No||
prasugrel HCl|No|No|No|No|75%|00378518693|PRASUGREL 10 MG TABLET|30|EA|.43|06/05/2018||Yes|No||06/05/2018||Yes|No|06/05/2018||Yes|No||09/01/2022||Yes|No|||Prescription required|No||004|No|.31543|10/24/2023|.30785|10/24/2023|.3099|10/24/2023|||PLATELET AGGREGATION INHIBITORS|3212|||||No|No||MYLAN|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00378527001|ESZOPICLONE 1 MG TABLET|100|EA|.30229|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No||||No|No|||Prescription required|No||054|Yes|.18673|10/24/2023|.18224|10/24/2023|.18346|10/24/2023|||SEDATIVE HYPNOTICS|3213|||||No|No||MYLAN|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00378527101|ESZOPICLONE 2 MG TABLET|100|EA|.30229|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No||||No|No|||Prescription required|No||054|Yes|.10777|10/24/2023|.10518|10/24/2023|.10588|10/24/2023|||SEDATIVE HYPNOTICS|3214|||||No|No||MYLAN|No|||||No|No|No||
eszopiclone|No|No|No|No|90%|00378527201|ESZOPICLONE 3 MG TABLET|100|EA|.30229|09/10/2014||Yes|No||09/10/2014||Yes|No|09/10/2014||Yes|No||||No|No|||Prescription required|No||054|Yes|.09837|10/24/2023|.096|10/24/2023|.09664|10/24/2023|||SEDATIVE HYPNOTICS|3215|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378537501|DOXEPIN 75 MG CAPSULE|100|EA|.58376|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.33687|10/24/2023|.32878|10/24/2023|.33097|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3216|||||No|No||MYLAN|No|||||No|No|No||
doxepin HCl|No|No|No|No|75%|00378537510|DOXEPIN 75 MG CAPSULE|1000|EA|.58376|03/01/2002||Yes|No||03/01/2002||Yes|No|03/01/2002||Yes|No||||No|No|||Prescription required|No||215|No|.33687|10/24/2023|.32878|10/24/2023|.33097|10/24/2023|||ANTIDEPRESSANTS: TRICYCLIC|3217|||||No|No||MYLAN|No|||||No|No|No||
moxifloxacin HCl|No|No|No|No|75%|00378543035|MOXIFLOXACIN 0.5% EYE DROPS|3|ML|4.87333|02/03/2021|10/31/2024|Yes|No||02/03/2021|10/31/2024|Yes|No|02/03/2021|10/31/2024|Yes|No||||No|No|||Prescription required|Yes|01/30/2020|058|No|2.44541|10/24/2023|2.38672|10/24/2023|2.40261|10/24/2023|||OPHTHALMIC ANTIBIOTICS|3218|No Longer Rebatable|No Longer Rebatable|No Longer Rebatable||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551093|OLANZAPINE ODT 5 MG TABLET|30|EA|.36793|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||027|Yes|.42267|10/24/2023|.41252|10/24/2023|.41527|10/24/2023|||ANTIPSYCHOTICS|3219|||||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551193|OLANZAPINE ODT 10 MG TABLET|30|EA|.54051|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||027|Yes|.49243|10/24/2023|.48061|10/24/2023|.48381|10/24/2023|||ANTIPSYCHOTICS|3220|||||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551293|OLANZAPINE ODT 15 MG TABLET|30|EA|.79707|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||027|Yes|.88254|10/24/2023|.86135|10/24/2023|.86709|10/24/2023|||ANTIPSYCHOTICS|3221|||||No|No||MYLAN|No|||||No|No|No||
olanzapine|No|No|No|No|75%|00378551393|OLANZAPINE ODT 20 MG TABLET|30|EA|1.05378|02/17/2015||Yes|No||02/17/2015||Yes|No|02/17/2015||Yes|No||||No|No|||Prescription required|No||027|Yes|.89885|10/24/2023|.87727|10/24/2023|.88312|10/24/2023|||ANTIPSYCHOTICS|3222|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561505|LEVETIRACETAM 500 MG TABLET|500|EA|.20266|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription required|No||056|No|.09479|10/24/2023|.09251|10/24/2023|.09313|10/24/2023|||ANTICONVULSANTS|3223|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561578|LEVETIRACETAM 500 MG TABLET|120|EA|.21334|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription required|No||056|No|.09479|10/24/2023|.09251|10/24/2023|.09313|10/24/2023|||ANTICONVULSANTS|3224|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561705|LEVETIRACETAM 750 MG TABLET|500|EA|.27145|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription required|No||056|No|.14031|10/24/2023|.13694|10/24/2023|.13785|10/24/2023|||ANTICONVULSANTS|3225|||||No|No||MYLAN|No|||||No|No|No||
levetiracetam|No|No|No|No|75%|00378561778|LEVETIRACETAM 750 MG TABLET|120|EA|.28573|02/09/2009||Yes|No||02/09/2009||Yes|No|02/09/2009||Yes|No||09/01/2022||Yes|No|||Prescription required|No||056|No|.14031|10/24/2023|.13694|10/24/2023|.13785|10/24/2023|||ANTICONVULSANTS|3226|||||No|No||MYLAN|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00378563059|SUMATRIPTAN SUCC 25 MG TABLET|9|EA|.44671|09/02/2009||Yes|No||09/02/2009||Yes|No|09/02/2009||Yes|No||||No|No|||Prescription required|No||021|Yes|.36995|10/24/2023|.36107|10/24/2023|.36347|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3227|||||No|No||MYLAN|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00378563159|SUMATRIPTAN SUCC 50 MG TABLET|9|EA|.44671|09/02/2009||Yes|No||09/02/2009||Yes|No|09/02/2009||Yes|No||||No|No|||Prescription required|No||021|Yes|.3944|10/24/2023|.38493|10/24/2023|.38749|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3228|||||No|No||MYLAN|No|||||No|No|No||
sumatriptan succinate|No|No|No|No|75%|00378563259|SUMATRIPTAN SUCC 100 MG TABLET|9|EA|.44671|09/02/2009||Yes|No||09/02/2009||Yes|No|09/02/2009||Yes|No||||No|No|||Prescription required|No||021|Yes|.48942|10/24/2023|.47767|10/24/2023|.48085|10/24/2023|||ANTIMIGRAINE AGENTS: TRIPTANS|3229|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378580793|VALSARTAN 40 MG TABLET|30|EA|.11466|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription required|Yes|07/29/2021|113|Yes|.13234|10/24/2023|.12916|10/24/2023|.13002|10/24/2023|||ANGIOTENSIN MODULATORS|3230|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378581377|VALSARTAN 80 MG TABLET|90|EA|.14333|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription required|Yes|07/29/2021|113|Yes|.14293|10/24/2023|.13949|10/24/2023|.14042|10/24/2023|||ANGIOTENSIN MODULATORS|3231|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378581477|VALSARTAN 160 MG TABLET|90|EA|.1911|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription required|Yes|07/29/2021|113|Yes|.18107|10/24/2023|.17672|10/24/2023|.1779|10/24/2023|||ANGIOTENSIN MODULATORS|3232|||||No|No||MYLAN|No|||||No|No|No||
valsartan|Yes|No|No|No|75%|00378581577|VALSARTAN 320 MG TABLET|90|EA|.23888|03/11/2015||Yes|No||03/11/2015||Yes|No|03/11/2015||Yes|No||03/11/2015||Yes|No|07/01/2016||Prescription required|Yes|07/29/