Home Health iDBL
Interactive Drug Benefit List
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 Details
01913484 ALPRAZOLAM TEVA-ALPRAZOL 0.25 MG ORAL TABLET 0.0609
TAB 		TEV 0.0609 N/A YES REGULAR BENEFIT Details
00865400 ALPRAZOLAM APO-ALPRAZ 0.5 MG ORAL TABLET 0.0728
TAB 		APX 0.0728 N/A YES REGULAR BENEFIT Details
01913492 ALPRAZOLAM TEVA-ALPRAZOL 0.5 MG ORAL TABLET 0.0728
TAB 		TEV 0.0728 N/A YES REGULAR BENEFIT Details
02243611 ALPRAZOLAM APO-ALPRAZ 1 MG ORAL TABLET N/A
TAB 		APX N/A N/A NO NOT A BENEFIT Details
02243612 ALPRAZOLAM APO-ALPRAZ TS 2 MG ORAL TABLET N/A
TAB 		APX N/A N/A NO NOT A BENEFIT Details
02177161 BROMAZEPAM APO-BROMAZEPAM 3 MG ORAL TABLET 0.0897
TAB 		APX 0.0897 N/A YES REGULAR BENEFIT Details
02230584 BROMAZEPAM TEVA-BROMAZEPAM 3 MG ORAL TABLET 0.0897
TAB 		TEV 0.0897 N/A YES REGULAR BENEFIT Details
02177188 BROMAZEPAM APO-BROMAZEPAM 6 MG ORAL TABLET 0.1310
TAB 		APX 0.1310 N/A YES REGULAR BENEFIT Details
02230585 BROMAZEPAM TEVA-BROMAZEPAM 6 MG ORAL TABLET 0.1310
TAB 		TEV 0.1310 N/A YES REGULAR BENEFIT Details
00522988 CHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE 10 MG ORAL CAPSULE 0.1364
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00522996 CHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE 25 MG ORAL CAPSULE 0.2117
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00522724 CHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE 5 MG ORAL CAPSULE 0.0867
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00115630 CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE LIBRAX 5 MG * 2.5 MG ORAL CAPSULE 0.3783
CAP 		VCL N/A N/A NO REGULAR BENEFIT Details
00860697 CLORAZEPATE DIPOTASSIUM CLORAZEPATE 15 MG ORAL CAPSULE 0.4919
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00860689 CLORAZEPATE DIPOTASSIUM CLORAZEPATE 3.75 MG ORAL CAPSULE 0.1884
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00860700 CLORAZEPATE DIPOTASSIUM CLORAZEPATE 7.5 MG ORAL CAPSULE 0.2456
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00405337 DIAZEPAM DIAZEPAM 10 MG ORAL TABLET 0.1204
TAB 		AAP N/A N/A NO REGULAR BENEFIT Details
00405329 DIAZEPAM DIAZEPAM 2 MG ORAL TABLET 0.0551
TAB 		AAP N/A N/A NO REGULAR BENEFIT Details
02238162 DIAZEPAM DIASTAT RECTAL DELIVERY 5 MG RECTAL GEL N/A
SYS 		VCL N/A N/A NO NOT A BENEFIT Details
00362158 DIAZEPAM DIAZEPAM 5 MG ORAL TABLET 0.1662
TAB 		AAP N/A N/A NO REGULAR BENEFIT Details
00399728 DIAZEPAM DIAZEPAM 5 MG / ML INJECTION 2.0340
ML 		SDZ N/A N/A NO REGULAR BENEFIT Details
00521698 FLURAZEPAM HCL FLURAZEPAM 15 MG ORAL CAPSULE 0.1458
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00521701 FLURAZEPAM HCL FLURAZEPAM 30 MG ORAL CAPSULE 0.1707
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00655740 LORAZEPAM APO-LORAZEPAM 0.5 MG ORAL TABLET 0.0359
TAB 		APX 0.0359 N/A YES REGULAR BENEFIT Details
02041456 LORAZEPAM ATIVAN 0.5 MG ORAL SUBLINGUAL TABLET 0.1373
TAB 		PFI 0.1010 N/A YES REGULAR BENEFIT Details
02410745 LORAZEPAM LORAZEPAM 0.5 MG ORAL SUBLINGUAL TABLET 0.1010
TAB 		AAP 0.1010 N/A YES REGULAR BENEFIT Details
00728187 LORAZEPAM PMS-LORAZEPAM 0.5 MG ORAL TABLET 0.0359
TAB 		PMS 0.0359 N/A YES REGULAR BENEFIT Details
00711101 LORAZEPAM TEVA-LORAZEPAM 0.5 MG ORAL TABLET 0.0359
TAB 		TEV 0.0359 N/A YES REGULAR BENEFIT Details
00655759 LORAZEPAM APO-LORAZEPAM 1 MG ORAL TABLET 0.0447
TAB 		APX 0.0447 N/A YES REGULAR BENEFIT Details
02041464 LORAZEPAM ATIVAN 1 MG ORAL SUBLINGUAL TABLET 0.1726
TAB 		PFI 0.1272 N/A YES REGULAR BENEFIT Details
02041421 LORAZEPAM ATIVAN 1 MG ORAL TABLET 0.0565
TAB 		PFI 0.0447 N/A YES REGULAR BENEFIT Details
02410753 LORAZEPAM LORAZEPAM 1 MG ORAL SUBLINGUAL TABLET 0.1272
TAB 		AAP 0.1272 N/A YES REGULAR BENEFIT Details
00728195 LORAZEPAM PMS-LORAZEPAM 1 MG ORAL TABLET 0.0447
TAB 		PMS 0.0447 N/A YES REGULAR BENEFIT Details
00637742 LORAZEPAM TEVA-LORAZEPAM 1 MG ORAL TABLET 0.0447
TAB 		TEV 0.0447 N/A YES REGULAR BENEFIT Details
00655767 LORAZEPAM APO-LORAZEPAM 2 MG ORAL TABLET 0.0699
TAB 		APX 0.0699 N/A YES REGULAR BENEFIT Details
02041472 LORAZEPAM ATIVAN 2 MG ORAL SUBLINGUAL TABLET 0.2710
TAB 		PFI 0.1974 N/A YES REGULAR BENEFIT Details
02041448 LORAZEPAM ATIVAN 2 MG ORAL TABLET 0.0885
TAB 		PFI 0.0699 N/A YES REGULAR BENEFIT Details
02410761 LORAZEPAM LORAZEPAM 2 MG ORAL SUBLINGUAL TABLET 0.1974
TAB 		AAP 0.1974 N/A YES REGULAR BENEFIT Details
00728209 LORAZEPAM PMS-LORAZEPAM 2 MG ORAL TABLET 0.0699
TAB 		PMS 0.0699 N/A YES REGULAR BENEFIT Details
00637750 LORAZEPAM TEVA-LORAZEPAM 2 MG ORAL TABLET 0.0699
TAB 		TEV 0.0699 N/A YES REGULAR BENEFIT Details
02240286 MIDAZOLAM HCL MIDAZOLAM 5 MG / ML INJECTION 4.1000
ML 		SDZ N/A N/A NO REGULAR BENEFIT Details
00511536 NITRAZEPAM MOGADON 10 MG ORAL TABLET 0.2871
TAB 		AAP N/A N/A NO REGULAR BENEFIT Details
00511528 NITRAZEPAM MOGADON 5 MG ORAL TABLET 0.1919
TAB 		AAP N/A N/A NO REGULAR BENEFIT Details
00402680 OXAZEPAM APO-OXAZEPAM 10 MG ORAL TABLET 0.0420
TAB 		APX N/A N/A NO REGULAR BENEFIT Details
00402745 OXAZEPAM APO-OXAZEPAM 15 MG ORAL TABLET 0.0660
TAB 		APX N/A N/A NO REGULAR BENEFIT Details
00402737 OXAZEPAM APO-OXAZEPAM 30 MG ORAL TABLET 0.0900
TAB 		APX N/A N/A NO REGULAR BENEFIT Details
00604453 TEMAZEPAM RESTORIL 15 MG ORAL CAPSULE 0.2587
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00604461 TEMAZEPAM RESTORIL 30 MG ORAL CAPSULE 0.3132
CAP 		AAP N/A N/A NO REGULAR BENEFIT Details
00808571 TRIAZOLAM TRIAZO 0.25 MG ORAL TABLET 0.4928
TAB 		AAP N/A N/A NO REGULAR BENEFIT Details
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 0.1364
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 0.2117
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 0.0867
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 0.3783
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 0.4919
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 0.1884
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 0.2456
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 2.0340
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 0.1458
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 0.1707
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 0.1373
Manufacturer PFI
LCA Price 0.1010
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 0.1010
Manufacturer AAP
LCA Price 0.1010
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 0.1726
Manufacturer PFI
LCA Price 0.1272
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 0.0565
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 0.1272
Manufacturer AAP
LCA Price 0.1272
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 0.2710
Manufacturer PFI
LCA Price 0.1974
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 0.0885
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 0.1974
Manufacturer AAP
LCA Price 0.1974
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 0.2871
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 0.1919
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 0.2587
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 0.3132
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 0.4928
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
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NOTICE:
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.