DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
00865397 | ALPRAZOLAM | APO-ALPRAZ 0.25 MG ORAL TABLET |
0.0609 TAB |
APX | 0.0609 | N/A | YES | REGULAR BENEFIT | |
01913484 | ALPRAZOLAM | TEVA-ALPRAZOL 0.25 MG ORAL TABLET |
0.0609 TAB |
TEV | 0.0609 | N/A | YES | REGULAR BENEFIT | |
00865400 | ALPRAZOLAM | APO-ALPRAZ 0.5 MG ORAL TABLET |
0.0728 TAB |
APX | 0.0728 | N/A | YES | REGULAR BENEFIT | |
01913492 | ALPRAZOLAM | TEVA-ALPRAZOL 0.5 MG ORAL TABLET |
0.0728 TAB |
TEV | 0.0728 | N/A | YES | REGULAR BENEFIT | |
02243611 | ALPRAZOLAM | APO-ALPRAZ 1 MG ORAL TABLET |
N/A TAB |
APX | N/A | N/A | NO | NOT A BENEFIT | |
02243612 | ALPRAZOLAM | APO-ALPRAZ TS 2 MG ORAL TABLET |
N/A TAB |
APX | N/A | N/A | NO | NOT A BENEFIT | |
02177161 | BROMAZEPAM | APO-BROMAZEPAM 3 MG ORAL TABLET |
0.0897 TAB |
APX | 0.0897 | N/A | YES | REGULAR BENEFIT | |
02230584 | BROMAZEPAM | TEVA-BROMAZEPAM 3 MG ORAL TABLET |
0.0897 TAB |
TEV | 0.0897 | N/A | YES | REGULAR BENEFIT | |
02177188 | BROMAZEPAM | APO-BROMAZEPAM 6 MG ORAL TABLET |
0.1310 TAB |
APX | 0.1310 | N/A | YES | REGULAR BENEFIT | |
02230585 | BROMAZEPAM | TEVA-BROMAZEPAM 6 MG ORAL TABLET |
0.1310 TAB |
TEV | 0.1310 | N/A | YES | REGULAR BENEFIT | |
00522988 | CHLORDIAZEPOXIDE HCL | CHLORDIAZEPOXIDE 10 MG ORAL CAPSULE |
0.1298 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00522996 | CHLORDIAZEPOXIDE HCL | CHLORDIAZEPOXIDE 25 MG ORAL CAPSULE |
0.2014 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00522724 | CHLORDIAZEPOXIDE HCL | CHLORDIAZEPOXIDE 5 MG ORAL CAPSULE |
0.0825 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00115630 | CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE | LIBRAX 5 MG * 2.5 MG ORAL CAPSULE |
0.3641 CAP |
VCL | N/A | N/A | NO | REGULAR BENEFIT | |
00860697 | CLORAZEPATE DIPOTASSIUM | CLORAZEPATE 15 MG ORAL CAPSULE |
0.4680 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00860689 | CLORAZEPATE DIPOTASSIUM | CLORAZEPATE 3.75 MG ORAL CAPSULE |
0.1793 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00860700 | CLORAZEPATE DIPOTASSIUM | CLORAZEPATE 7.5 MG ORAL CAPSULE |
0.2337 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00405337 | DIAZEPAM | DIAZEPAM 10 MG ORAL TABLET |
0.1204 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00405329 | DIAZEPAM | DIAZEPAM 2 MG ORAL TABLET |
0.0551 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
02238162 | DIAZEPAM | DIASTAT RECTAL DELIVERY 5 MG RECTAL GEL |
N/A SYS |
VCL | N/A | N/A | NO | NOT A BENEFIT | |
00362158 | DIAZEPAM | DIAZEPAM 5 MG ORAL TABLET |
0.1662 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00399728 | DIAZEPAM | DIAZEPAM 5 MG / ML INJECTION |
1.9384 ML |
SDZ | N/A | N/A | NO | REGULAR BENEFIT | |
00521698 | FLURAZEPAM HCL | FLURAZEPAM 15 MG ORAL CAPSULE |
0.1387 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00521701 | FLURAZEPAM HCL | FLURAZEPAM 30 MG ORAL CAPSULE |
0.1624 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00655740 | LORAZEPAM | APO-LORAZEPAM 0.5 MG ORAL TABLET |
0.0359 TAB |
APX | 0.0359 | N/A | YES | REGULAR BENEFIT | |
02041456 | LORAZEPAM | ATIVAN 0.5 MG ORAL SUBLINGUAL TABLET |
0.1321 TAB |
PFI | 0.0961 | N/A | YES | REGULAR BENEFIT | |
02410745 | LORAZEPAM | LORAZEPAM 0.5 MG ORAL SUBLINGUAL TABLET |
0.0961 TAB |
AAP | 0.0961 | N/A | YES | REGULAR BENEFIT | |
00728187 | LORAZEPAM | PMS-LORAZEPAM 0.5 MG ORAL TABLET |
0.0359 TAB |
PMS | 0.0359 | N/A | YES | REGULAR BENEFIT | |
00711101 | LORAZEPAM | TEVA-LORAZEPAM 0.5 MG ORAL TABLET |
0.0359 TAB |
TEV | 0.0359 | N/A | YES | REGULAR BENEFIT | |
00655759 | LORAZEPAM | APO-LORAZEPAM 1 MG ORAL TABLET |
0.0447 TAB |
APX | 0.0447 | N/A | YES | REGULAR BENEFIT | |
02041464 | LORAZEPAM | ATIVAN 1 MG ORAL SUBLINGUAL TABLET |
0.1661 TAB |
PFI | 0.1210 | N/A | YES | REGULAR BENEFIT | |
02041421 | LORAZEPAM | ATIVAN 1 MG ORAL TABLET |
0.0538 TAB |
PFI | 0.0447 | N/A | YES | REGULAR BENEFIT | |
02410753 | LORAZEPAM | LORAZEPAM 1 MG ORAL SUBLINGUAL TABLET |
0.1210 TAB |
AAP | 0.1210 | N/A | YES | REGULAR BENEFIT | |
00728195 | LORAZEPAM | PMS-LORAZEPAM 1 MG ORAL TABLET |
0.0447 TAB |
PMS | 0.0447 | N/A | YES | REGULAR BENEFIT | |
00637742 | LORAZEPAM | TEVA-LORAZEPAM 1 MG ORAL TABLET |
0.0447 TAB |
TEV | 0.0447 | N/A | YES | REGULAR BENEFIT | |
00655767 | LORAZEPAM | APO-LORAZEPAM 2 MG ORAL TABLET |
0.0699 TAB |
APX | 0.0699 | N/A | YES | REGULAR BENEFIT | |
02041472 | LORAZEPAM | ATIVAN 2 MG ORAL SUBLINGUAL TABLET |
0.2581 TAB |
PFI | 0.1878 | N/A | YES | REGULAR BENEFIT | |
02041448 | LORAZEPAM | ATIVAN 2 MG ORAL TABLET |
0.0843 TAB |
PFI | 0.0699 | N/A | YES | REGULAR BENEFIT | |
02410761 | LORAZEPAM | LORAZEPAM 2 MG ORAL SUBLINGUAL TABLET |
0.1878 TAB |
AAP | 0.1878 | N/A | YES | REGULAR BENEFIT | |
00728209 | LORAZEPAM | PMS-LORAZEPAM 2 MG ORAL TABLET |
0.0699 TAB |
PMS | 0.0699 | N/A | YES | REGULAR BENEFIT | |
00637750 | LORAZEPAM | TEVA-LORAZEPAM 2 MG ORAL TABLET |
0.0699 TAB |
TEV | 0.0699 | N/A | YES | REGULAR BENEFIT | |
02240286 | MIDAZOLAM HCL | MIDAZOLAM 5 MG / ML INJECTION |
4.1000 ML |
SDZ | N/A | N/A | NO | REGULAR BENEFIT | |
00511536 | NITRAZEPAM | MOGADON 10 MG ORAL TABLET |
0.2732 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00511528 | NITRAZEPAM | MOGADON 5 MG ORAL TABLET |
0.1826 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00402680 | OXAZEPAM | APO-OXAZEPAM 10 MG ORAL TABLET |
0.0420 TAB |
APX | N/A | N/A | NO | REGULAR BENEFIT | |
00402745 | OXAZEPAM | APO-OXAZEPAM 15 MG ORAL TABLET |
0.0660 TAB |
APX | N/A | N/A | NO | REGULAR BENEFIT | |
00402737 | OXAZEPAM | APO-OXAZEPAM 30 MG ORAL TABLET |
0.0900 TAB |
APX | N/A | N/A | NO | REGULAR BENEFIT | |
00604453 | TEMAZEPAM | RESTORIL 15 MG ORAL CAPSULE |
0.2461 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00604461 | TEMAZEPAM | RESTORIL 30 MG ORAL CAPSULE |
0.2980 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00808571 | TRIAZOLAM | TRIAZO 0.25 MG ORAL TABLET |
0.4689 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT |
DIN/NPN/ PIN | 00865397 |
Generic Name | ALPRAZOLAM |
Product Name, Strength & Dosage Form | APO-ALPRAZ 0.25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0609 |
Manufacturer | APX |
LCA Price | 0.0609 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 01913484 |
Generic Name | ALPRAZOLAM |
Product Name, Strength & Dosage Form | TEVA-ALPRAZOL 0.25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0609 |
Manufacturer | TEV |
LCA Price | 0.0609 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00865400 |
Generic Name | ALPRAZOLAM |
Product Name, Strength & Dosage Form | APO-ALPRAZ 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0728 |
Manufacturer | APX |
LCA Price | 0.0728 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 01913492 |
Generic Name | ALPRAZOLAM |
Product Name, Strength & Dosage Form | TEVA-ALPRAZOL 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0728 |
Manufacturer | TEV |
LCA Price | 0.0728 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02243611 |
Generic Name | ALPRAZOLAM |
Product Name, Strength & Dosage Form | APO-ALPRAZ 1 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02243612 |
Generic Name | ALPRAZOLAM |
Product Name, Strength & Dosage Form | APO-ALPRAZ TS 2 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02177161 |
Generic Name | BROMAZEPAM |
Product Name, Strength & Dosage Form | APO-BROMAZEPAM 3 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0897 |
Manufacturer | APX |
LCA Price | 0.0897 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02230584 |
Generic Name | BROMAZEPAM |
Product Name, Strength & Dosage Form | TEVA-BROMAZEPAM 3 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0897 |
Manufacturer | TEV |
LCA Price | 0.0897 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02177188 |
Generic Name | BROMAZEPAM |
Product Name, Strength & Dosage Form | APO-BROMAZEPAM 6 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1310 |
Manufacturer | APX |
LCA Price | 0.1310 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02230585 |
Generic Name | BROMAZEPAM |
Product Name, Strength & Dosage Form | TEVA-BROMAZEPAM 6 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1310 |
Manufacturer | TEV |
LCA Price | 0.1310 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00522988 |
Generic Name | CHLORDIAZEPOXIDE HCL |
Product Name, Strength & Dosage Form | CHLORDIAZEPOXIDE 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.1298 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00522996 |
Generic Name | CHLORDIAZEPOXIDE HCL |
Product Name, Strength & Dosage Form | CHLORDIAZEPOXIDE 25 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.2014 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00522724 |
Generic Name | CHLORDIAZEPOXIDE HCL |
Product Name, Strength & Dosage Form | CHLORDIAZEPOXIDE 5 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.0825 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00115630 |
Generic Name | CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE |
Product Name, Strength & Dosage Form | LIBRAX 5 MG * 2.5 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.3641 |
Manufacturer | VCL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00860697 |
Generic Name | CLORAZEPATE DIPOTASSIUM |
Product Name, Strength & Dosage Form | CLORAZEPATE 15 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.4680 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00860689 |
Generic Name | CLORAZEPATE DIPOTASSIUM |
Product Name, Strength & Dosage Form | CLORAZEPATE 3.75 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.1793 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00860700 |
Generic Name | CLORAZEPATE DIPOTASSIUM |
Product Name, Strength & Dosage Form | CLORAZEPATE 7.5 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.2337 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00405337 |
Generic Name | DIAZEPAM |
Product Name, Strength & Dosage Form | DIAZEPAM 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1204 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00405329 |
Generic Name | DIAZEPAM |
Product Name, Strength & Dosage Form | DIAZEPAM 2 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0551 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02238162 |
Generic Name | DIAZEPAM |
Product Name, Strength & Dosage Form | DIASTAT RECTAL DELIVERY 5 MG RECTAL GEL |
Unit Price, Unit of Issue | N/A |
Manufacturer | VCL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00362158 |
Generic Name | DIAZEPAM |
Product Name, Strength & Dosage Form | DIAZEPAM 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1662 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00399728 |
Generic Name | DIAZEPAM |
Product Name, Strength & Dosage Form | DIAZEPAM 5 MG / ML INJECTION |
Unit Price, Unit of Issue | 1.9384 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00521698 |
Generic Name | FLURAZEPAM HCL |
Product Name, Strength & Dosage Form | FLURAZEPAM 15 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.1387 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00521701 |
Generic Name | FLURAZEPAM HCL |
Product Name, Strength & Dosage Form | FLURAZEPAM 30 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.1624 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00655740 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | APO-LORAZEPAM 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0359 |
Manufacturer | APX |
LCA Price | 0.0359 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02041456 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | ATIVAN 0.5 MG ORAL SUBLINGUAL TABLET |
Unit Price, Unit of Issue | 0.1321 |
Manufacturer | PFI |
LCA Price | 0.0961 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02410745 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | LORAZEPAM 0.5 MG ORAL SUBLINGUAL TABLET |
Unit Price, Unit of Issue | 0.0961 |
Manufacturer | AAP |
LCA Price | 0.0961 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00728187 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | PMS-LORAZEPAM 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0359 |
Manufacturer | PMS |
LCA Price | 0.0359 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00711101 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | TEVA-LORAZEPAM 0.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0359 |
Manufacturer | TEV |
LCA Price | 0.0359 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00655759 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | APO-LORAZEPAM 1 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0447 |
Manufacturer | APX |
LCA Price | 0.0447 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02041464 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | ATIVAN 1 MG ORAL SUBLINGUAL TABLET |
Unit Price, Unit of Issue | 0.1661 |
Manufacturer | PFI |
LCA Price | 0.1210 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02041421 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | ATIVAN 1 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0538 |
Manufacturer | PFI |
LCA Price | 0.0447 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02410753 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | LORAZEPAM 1 MG ORAL SUBLINGUAL TABLET |
Unit Price, Unit of Issue | 0.1210 |
Manufacturer | AAP |
LCA Price | 0.1210 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00728195 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | PMS-LORAZEPAM 1 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0447 |
Manufacturer | PMS |
LCA Price | 0.0447 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00637742 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | TEVA-LORAZEPAM 1 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0447 |
Manufacturer | TEV |
LCA Price | 0.0447 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00655767 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | APO-LORAZEPAM 2 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0699 |
Manufacturer | APX |
LCA Price | 0.0699 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02041472 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | ATIVAN 2 MG ORAL SUBLINGUAL TABLET |
Unit Price, Unit of Issue | 0.2581 |
Manufacturer | PFI |
LCA Price | 0.1878 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02041448 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | ATIVAN 2 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0843 |
Manufacturer | PFI |
LCA Price | 0.0699 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02410761 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | LORAZEPAM 2 MG ORAL SUBLINGUAL TABLET |
Unit Price, Unit of Issue | 0.1878 |
Manufacturer | AAP |
LCA Price | 0.1878 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00728209 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | PMS-LORAZEPAM 2 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0699 |
Manufacturer | PMS |
LCA Price | 0.0699 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00637750 |
Generic Name | LORAZEPAM |
Product Name, Strength & Dosage Form | TEVA-LORAZEPAM 2 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0699 |
Manufacturer | TEV |
LCA Price | 0.0699 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02240286 |
Generic Name | MIDAZOLAM HCL |
Product Name, Strength & Dosage Form | MIDAZOLAM 5 MG / ML INJECTION |
Unit Price, Unit of Issue | 4.1000 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00511536 |
Generic Name | NITRAZEPAM |
Product Name, Strength & Dosage Form | MOGADON 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.2732 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00511528 |
Generic Name | NITRAZEPAM |
Product Name, Strength & Dosage Form | MOGADON 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1826 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00402680 |
Generic Name | OXAZEPAM |
Product Name, Strength & Dosage Form | APO-OXAZEPAM 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0420 |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00402745 |
Generic Name | OXAZEPAM |
Product Name, Strength & Dosage Form | APO-OXAZEPAM 15 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0660 |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00402737 |
Generic Name | OXAZEPAM |
Product Name, Strength & Dosage Form | APO-OXAZEPAM 30 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0900 |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00604453 |
Generic Name | TEMAZEPAM |
Product Name, Strength & Dosage Form | RESTORIL 15 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.2461 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00604461 |
Generic Name | TEMAZEPAM |
Product Name, Strength & Dosage Form | RESTORIL 30 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.2980 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00808571 |
Generic Name | TRIAZOLAM |
Product Name, Strength & Dosage Form | TRIAZO 0.25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.4689 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |