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Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits

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Item code Drug name
Form and Strength 		Pack size Price Manufacturer
14554B LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 100 mg + carbidopa 25 mg + entacapone 200 mg tablet, 100 100 $76.08 HX,SZ,TB,TX
8798C LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 100 mg + carbidopa 25 mg + entacapone 200 mg tablet, 100 100 $76.03 HX,SZ,TB,TX
14527N LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 125 mg + carbidopa 31.25 mg + entacapone 200 mg tablet, 100 100 $78.97 HX,SZ,TB,TX
9345W LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 125 mg + carbidopa 31.25 mg + entacapone 200 mg tablet, 100 100 $78.92 HX,SZ,TB,TX
14357P LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 150 mg + carbidopa 37.5 mg + entacapone 200 mg tablet, 100 100 $83.29 SZ,TB
8799D LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 150 mg + carbidopa 37.5 mg + entacapone 200 mg tablet, 100 100 $83.23 HX,SZ,TB,TX
14457X LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 200 mg + carbidopa 50 mg + entacapone 200 mg tablet, 100 100 $89.91 HX,SZ,TB,TX
9292C LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 200 mg + carbidopa 50 mg + entacapone 200 mg tablet, 100 100 $89.86 HX,SZ,TB,TX
14456W LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 50 mg + carbidopa 12.5 mg + entacapone 200 mg tablet, 100 100 $68.88 HX,SZ,TB,TX
8797B LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 50 mg + carbidopa 12.5 mg + entacapone 200 mg tablet, 100 100 $68.83 HX,SZ,TB,TX
14498C LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 75 mg + carbidopa 18.75 mg + entacapone 200 mg tablet, 100 100 $72.04 HX,SZ,TB,TX
9344T LEVODOPA + CARBIDOPA + ENTACAPONElevodopa 75 mg + carbidopa 18.75 mg + entacapone 200 mg tablet, 100 100 $71.99 HX,SZ,TB,TX
13954K LINAGLIPTINlinagliptin 5 mg tablet, 30 30 $43.64 BY
13959Q LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 500 mg tablet, 60 60 $45.66 BY
14065G LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 850 mg tablet, 60 60 $46.49 BY
13879L LINAGLIPTIN + METFORMINlinagliptin 2.5 mg + metformin hydrochloride 1 g tablet, 60 60 $46.97 BY
13966C LIOTHYRONINEliothyronine sodium 20 microgram tablet, 100 100 $46.69 AS
14352J LIQUID PARAFFIN + GLYCEROL + TYLOXAPOL + POLOXAMER-188 + TROMETAMOL HYDROCHLORIDE + TROMETAMOL + CETALKONIUM CHLORIDEliquid paraffin + glycerol + tyloxapol + poloxamer-188 + trometamol hydrochloride + trometamol + cetalkonium chloride eye drops, 10 mL 1 $24.74 CS
13584Y LISINOPRILlisinopril 10 mg tablet, 30 30 $6.16 AL,RW,SZ,TX,WG
13584Y LISINOPRILlisinopril 10 mg tablet, 30 30 $11.00 IX
13402J LISINOPRILlisinopril 20 mg tablet, 30 30 $6.48 AL,RW,SZ,TX,WG
13402J LISINOPRILlisinopril 20 mg tablet, 30 30 $11.31 IX
13583X LISINOPRILlisinopril 5 mg tablet, 30 30 $5.12 AL,RW,SZ,TX,WG
13583X LISINOPRILlisinopril 5 mg tablet, 30 30 $9.94 IX
8290H LITHIUM CARBONATElithium carbonate 450 mg modified release tablet, 100 100 $36.23 AS
10889D LOPERAMIDEloperamide hydrochloride 2 mg capsule, 12 12 $2.45 AS,CR
14341T MACROGOL-3350macrogol-3350 1 g/g powder for oral liquid, 510 g 1 $11.87 KY
14408H MACROGOL-3350 + SODIUM CHLORIDE + BICARBONATE + POTASSIUM CHLORIDEmacrogol-3350 13.125 g + sodium chloride 350.7 mg + sodium bicarbonate 178.5 mg + potassium chloride 46.6 mg powder for oral liquid, 30 sachets 1 $8.67 GX,RF,RW,TX,XT
9327X MEDIUM CHAIN TRIGLYCERIDESmedium chain triglycerides oral liquid, 250 mL bottle 1 $20.24 SB
3128P MEDIUM CHAIN TRIGLYCERIDESmedium chain triglycerides oral oil, 500 mL 1 $52.95 SB
13849X MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 30 30 $15.97 PF
13849X MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 30 30 $9.27 FZ
13928C MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 100 100 $32.00 PF
13928C MEDROXYPROGESTERONEmedroxyprogesterone acetate 10 mg tablet, 100 100 $25.30 FZ
14067J MEDROXYPROGESTERONEmedroxyprogesterone acetate 100 mg tablet, 100 100 $76.47 PF
13881N MEDROXYPROGESTERONEmedroxyprogesterone acetate 200 mg tablet, 60 60 $87.23 PF
13961T MEDROXYPROGESTERONEmedroxyprogesterone acetate 250 mg tablet, 60 60 $89.88 PF
13956M MEDROXYPROGESTERONEmedroxyprogesterone acetate 5 mg tablet, 56 56 $12.46 PF
13956M MEDROXYPROGESTERONEmedroxyprogesterone acetate 5 mg tablet, 56 56 $7.88 FZ
14038W MEDROXYPROGESTERONEmedroxyprogesterone acetate 500 mg tablet, 30 30 $89.88 PF
1598D MERCAPTOPURINEmercaptopurine monohydrate 50 mg tablet, 25 25 $40.14 LM
1598D MERCAPTOPURINEmercaptopurine monohydrate 50 mg tablet, 25 25 $42.00 AS
12463Y MESALAZINEmesalazine 1.6 g enteric tablet, 60 60 $72.51 EU
13395B MESALAZINEmesalazine 1.6 g enteric tablet, 60 60 $72.57 EU
8753Q MESALAZINEmesalazine 1 g/100 mL enema, 7 x 100 mL 1 $51.65 FP
8616L MESALAZINEmesalazine 2 g/60 mL enema, 7 x 60 mL 1 $51.65 FD
13356Y MESALAZINEmesalazine 1.2 g modified release tablet, 120 120 $165.02 RA
8617M MESALAZINEmesalazine 4 g/60 mL enema, 7 x 60 mL 1 $80.83 FD
8768L MESALAZINEmesalazine 1 g/application foam, 14 applications 1 $59.79 FD
13460K MESALAZINEmesalazine 1.5 g modified release granules, 60 sachets 60 $92.51 FD
13355X MESALAZINEmesalazine 1 g modified release granules, 100 sachets 100 $98.08 FP
13398E MESALAZINEmesalazine 1 g modified release granules, 100 sachets 100 $107.09 FD
13456F MESALAZINEmesalazine 4 g modified release granules, 30 sachets 30 $120.80 FP
13361F MESALAZINEmesalazine 500 mg modified release granules, 100 sachets 100 $57.28 FD
8598M MESALAZINEmesalazine 500 mg modified release granules, 100 sachets 100 $57.23 FD
13397D MESALAZINEmesalazine 2 g modified release granules, 60 sachets 60 $120.80 FP
13518L MESALAZINEmesalazine 3 g modified release granules, 30 sachets 30 $92.51 FD
13576M MESALAZINEmesalazine 1 g modified release tablet, 60 60 $64.26 FP
3413P MESALAZINEmesalazine 1 g modified release tablet, 60 60 $64.21 FP
13487W MESALAZINEmesalazine 1.2 g modified release tablet, 60 60 $82.51 NQ,TK
9353G MESALAZINEmesalazine 1.2 g modified release tablet, 60 60 $82.46 NQ,TK
13423L MESALAZINEmesalazine 250 mg enteric tablet, 100 100 $34.04 GO
13422K MESALAZINEmesalazine 800 mg enteric tablet, 90 90 $68.83 EU
11554D MESALAZINEmesalazine 1 g enteric tablet, 60 60 $64.54 FD
13394Y MESALAZINEmesalazine 1 g enteric tablet, 60 60 $64.60 FD
13362G MESALAZINEmesalazine 500 mg enteric tablet, 100 100 $57.28 FD
8731M MESALAZINEmesalazine 500 mg enteric tablet, 100 100 $57.23 FD
13396C MESALAZINEmesalazine 500 mg modified release tablet, 100 100 $57.28 FP
2214M MESALAZINEmesalazine 500 mg modified release tablet, 100 100 $57.23 FP
14056T METFORMINmetformin hydrochloride 1 g tablet, 90 90 $6.70 AF,BG,HQ,MQ,RW,SZ,TY,ZS
14056T METFORMINmetformin hydrochloride 1 g tablet, 90 90 $11.59 AL
13847T METFORMINmetformin hydrochloride 1 g modified release tablet, 60 60 $6.70 AF,CR,MQ,RF,TX,WG
13847T METFORMINmetformin hydrochloride 1 g modified release tablet, 60 60 $12.04 AL
13976N METFORMINmetformin hydrochloride 500 mg tablet, 100 100 $5.63 AF,BG,HQ,RF,SZ,TY,WG,ZS
13976N METFORMINmetformin hydrochloride 500 mg tablet, 100 100 $11.10 AL
13899M METFORMINmetformin hydrochloride 500 mg modified release tablet, 120 120 $6.70 CR,MQ,RW,TX,WG
13899M METFORMINmetformin hydrochloride 500 mg modified release tablet, 120 120 $12.04 AL
13952H METFORMINmetformin hydrochloride 850 mg tablet, 60 60 $5.63 AF,BG,MQ,RF,SZ,TY,WG,ZS
13952H METFORMINmetformin hydrochloride 850 mg tablet, 60 60 $11.10 AL
14005D METHENAMINE HIPPURATEmethenamine hippurate 1 g tablet, 100 100 $20.70 AS,IL
13882P METHOTREXATEmethotrexate 50 mg/2 mL injection, 5 x 2 mL vials 5 $29.82 PF
11275K METHOTREXATEmethotrexate 7.5 mg/0.15 mL injection, 0.15 mL syringe 1 $20.55 LM
14091P METHOTREXATEmethotrexate 7.5 mg/0.15 mL injection, 0.15 mL syringe 1 $20.55 LM
11283W METHOTREXATEmethotrexate 10 mg/0.2 mL injection, 0.2 mL syringe 1 $20.55 LM
14089M METHOTREXATEmethotrexate 10 mg/0.2 mL injection, 0.2 mL syringe 1 $20.55 LM
11268C METHOTREXATEmethotrexate 15 mg/0.3 mL injection, 0.3 mL syringe 1 $20.55 LM
14102F METHOTREXATEmethotrexate 15 mg/0.3 mL injection, 0.3 mL syringe 1 $20.55 LM
11288D METHOTREXATEmethotrexate 20 mg/0.4 mL injection, 0.4 mL syringe 1 $20.55 LM
14097Y METHOTREXATEmethotrexate 20 mg/0.4 mL injection, 0.4 mL syringe 1 $20.55 LM
11295L METHOTREXATEmethotrexate 25 mg/0.5 mL injection, 0.5 mL syringe 1 $20.55 LM
14103G METHOTREXATEmethotrexate 25 mg/0.5 mL injection, 0.5 mL syringe 1 $20.55 LM
10834F METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $9.86 LO
10834F METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $5.92 XT
10836H METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $10.46 LO
10836H METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $6.52 XT
10839L METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $9.86 LO
10839L METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $5.92 AS,XT
10840M METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $10.46 LO
10840M METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $6.52 AS,XT
10843Q METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $9.74 LO
10843Q METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $5.80 AS,XT
10844R METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $10.06 LO
10844R METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $6.12 AS,XT
10845T METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $9.74 LO
10845T METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $5.80 XT
10846W METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $11.66 LO
10846W METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $7.72 XT
10848Y METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $11.66 LO
10848Y METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $7.72 AS,XT
10853F METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $10.06 LO
10853F METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% ointment, 15 g 1 $6.12 XT
10833E METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $9.74 LO
10833E METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $5.80 XT
10835G METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $10.06 LO
10835G METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $6.12 XT
10842P METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $11.66 LO
10842P METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $7.72 XT
10851D METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $9.86 LO
10851D METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $5.92 XT
10855H METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $10.46 LO
10855H METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% cream, 15 g 1 $6.52 XT
10830B METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g 1 $6.93 LO
10838K METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g 1 $7.57 LO
10852E METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g 1 $7.17 LO
10856J METHYLPREDNISOLONEmethylprednisolone aceponate 0.1% lotion, 20 g 1 $8.37 LO
11739W METHYLPREDNISOLONEmethylprednisolone 40 mg injection [1 chamber] (&) inert substance diluent [1 mL chamber], 1 dual chamber vial 1 $6.88 PF
13420H METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 190 mg (controlled release), 30 30 $30.86 AF,AP,CR,RW
13543T METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 47.5 mg (controlled release), 30 30 $20.61 AF,AP,CR,RW
13544W METOPROLOL SUCCINATEMETOPROLOL SUCCINATE Tablet 95 mg (controlled release), 30 30 $25.16 AF,AP,CR,RW
13541Q METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 100 mg, 60 60 $5.37 AF,RW,SZ,TX,VO,WG,ZS
13541Q METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 100 mg, 60 60 $18.52 AP
13598Q METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 50 mg, 100 100 $5.11 AF,RW,SZ,TX,VO,WG,ZS
13598Q METOPROLOL TARTRATEMETOPROLOL TARTRATE Tablet 50 mg, 100 100 $18.26 AP
14366D MIANSERINmianserin hydrochloride 10 mg tablet, 50 50 $10.20 AF
14505K MIANSERINmianserin hydrochloride 20 mg tablet, 50 50 $18.85 AF
14270C MIDAZOLAMmidazolam 10 mg/mL oral liquid, 1 mL syringe 1 $135.37 IX
14299N MIDAZOLAMmidazolam 10 mg/mL oral liquid, 1 mL syringe 1 $135.37 IX
14292F MIDAZOLAMmidazolam 5 mg/0.5 mL oral liquid, 0.5 mL syringe 1 $135.37 IX
14293G MIDAZOLAMmidazolam 5 mg/0.5 mL oral liquid, 0.5 mL syringe 1 $135.37 IX
14238J MIDAZOLAMmidazolam 7.5 mg/0.75 mL oral liquid, 0.75 mL syringe 1 $135.37 IX
14291E MIDAZOLAMmidazolam 7.5 mg/0.75 mL oral liquid, 0.75 mL syringe 1 $135.37 IX
3092R MILK POWDER SYNTHETIC LOW CALCIUMmilk powder synthetic low calcium powder for oral liquid, 400 g 1 $44.49 SB
8630F MILK PROTEIN AND FAT FORMULA WITH VITAMINS AND MINERALS CARBOHYDRATE FREEmilk protein and fat formula with vitamins and minerals carbohydrate free powder for oral liquid, 225 g 1 $37.54 SB
14483G MINOCYCLINEminocycline 50 mg tablet, 60 60 $11.55 AF,AS
14041B MINOXIDILminoxidil 10 mg tablet, 100 100 $33.32 PF
14507M MIRTAZAPINEmirtazapine 15 mg tablet, 30 30 $5.34 AF,BG,RF,SZ,TY,WG
14369G MIRTAZAPINEmirtazapine 15 mg orally disintegrating tablet, 30 30 $6.54 RF
14473R MIRTAZAPINEmirtazapine 30 mg tablet, 30 30 $6.16 AF,BG,RF,SZ,TY,VO,WG
14473R MIRTAZAPINEmirtazapine 30 mg tablet, 30 30 $12.17 AL
14370H MIRTAZAPINEmirtazapine 30 mg orally disintegrating tablet, 30 30 $7.10 RF
14561J MIRTAZAPINEmirtazapine 45 mg tablet, 30 30 $7.51 AF,BG,RF,SZ,TY,VO,WG
14475W MIRTAZAPINEmirtazapine 45 mg orally disintegrating tablet, 30 30 $9.47 RF
14560H MOCLOBEMIDEmoclobemide 150 mg tablet, 60 60 $9.00 AF,SZ,WG,XT
14560H MOCLOBEMIDEmoclobemide 150 mg tablet, 60 60 $11.03 GO
14442D MOCLOBEMIDEmoclobemide 300 mg tablet, 60 60 $13.41 AF,SZ,WG,XT
14442D MOCLOBEMIDEmoclobemide 300 mg tablet, 60 60 $15.44 GO
8816B MODAFINILmodafinil 100 mg tablet, 60 60 $62.66 AF,AL,GQ,RW,SZ,TX,WG
8816B MODAFINILmodafinil 100 mg tablet, 60 60 $68.06 TB
9386B MODIFIED LONG CHAIN AMYLOPECTINmodified long chain amylopectin powder for oral liquid, 30 x 60 g sachets 1 $160.91 VF
10792B MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $7.77 AL
10792B MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $4.24 AF,AS
10809X MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $8.49 AL
10809X MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $4.96 AF,AS
10815F MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $8.09 AL
10815F MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $4.56 AF,AS
10818J MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $7.89 AL
10818J MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $4.36 AF,AS
10827W MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $9.69 AL
10827W MOMETASONEmometasone furoate 0.1% cream, 15 g 1 $6.16 AF,AS
10804P MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $9.72 AL
10804P MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $6.19 AF,EO
10805Q MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $9.96 AL
10805Q MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $6.43 AF,EO
10819K MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $11.16 AL
10819K MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $7.63 AF,EO
10826T MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $10.36 AL
10826T MOMETASONEmometasone furoate 0.1% lotion, 30 mL 1 $6.83 AF,EO
10791Y MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $7.77 AL
10791Y MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $4.24 AF,AS,EO
10793C MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $7.89 AL
10793C MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $4.36 AF,AS,EO
10812C MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $9.69 AL
10812C MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $6.16 AF,AS,EO
10814E MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $8.49 AL
10814E MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $4.96 AF,AS,EO
10828X MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $8.09 AL
10828X MOMETASONEmometasone furoate 0.1% ointment, 15 g 1 $4.56 AF,AS,EO
14553Y MONTELUKASTmontelukast 5 mg chewable tablet, 28 28 $6.70 AF,AL,GX,HQ,RF,SZ,TX,WG
14526M MONTELUKASTmontelukast 4 mg chewable tablet, 28 28 $6.80 AF,AL,GX,HQ,RF,SZ,TX,WG
12009C MORPHINEmorphine sulfate pentahydrate 30 mg tablet, 20 20 $21.16 RW
12067D MORPHINEmorphine sulfate pentahydrate 30 mg tablet, 20 20 $21.16 RW
13750Q MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 100 mL 100 $67.35 LM
13761G MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 100 mL 100 $67.35 LM
13740E MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 300 mL 300 $103.89 LM
13756B MORPHINEmorphine sulfate 10 mg/5 mL oral solution, 300 mL 300 $103.89 LM
13747M MORPHINEmorphine sulfate 2 mg/mL oral solution, 100 mL 100 $48.12 DZ
13753W MORPHINEmorphine sulfate 2 mg/mL oral solution, 100 mL 100 $48.12 DZ
13749P MORPHINEmorphine sulfate 2 mg/mL oral solution, 500 mL 500 $115.24 DZ
13760F MORPHINEmorphine sulfate 2 mg/mL oral solution, 500 mL 500 $115.24 DZ
14077X MORPHINEmorphine hydrochloride trihydrate 10 mg/mL oral liquid, 20 mL 20 $55.24 DZ
14083F MORPHINEmorphine hydrochloride trihydrate 10 mg/mL oral liquid, 20 mL 20 $55.24 DZ
13552G MOXONIDINEmoxonidine 400 microgram tablet, 30 30 $10.13 AL,GO,GQ,RF,SZ,TX,WG
13579Q MOXONIDINEmoxonidine 200 microgram tablet, 30 30 $6.94 AL,GO,GQ,RF,SZ,TX,WG
12931N MYCOBACTERIUM BOVIS BCG DANISH STRAINMycobacterium bovis BCG Danish strain 30 mg injection, 4 vials 1 $479.83 LM
13856G MYCOPHENOLATEmycophenolate 180 mg enteric tablet, 120 120 $96.75 NV,XT
13938N MYCOPHENOLATEmycophenolate 360 mg enteric tablet, 120 120 $193.58 CR,NV,XT
13884R MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 100 $28.74 CR,SZ,TX
14000W MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 50 $28.70 AF,RF,XT
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