alberta health and wellness drug benefit list · please review the alberta health and wellness drug...

Summary of Changes

to the

Alberta Health and Wellness

Drug Benefit List

Effective July 1, 2012

SUMMARY OF CHANGES TO THE ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST

ABC 40211/81160 (R2012/07)

Inquiries should be directed to:

Pharmacy Services

Alberta Blue Cross

10009 108 Street NW

Edmonton AB T5J 3C5

Telephone Number: (780) 498-8370 (Edmonton)

(403) 294-4041 (Calgary)

1-800-361-9632 (Toll Free)

FAX Number: (780) 498-8384

1-877-828-4106 (Toll Free)

109BWebsite: Hhttp://www.health.alberta.ca/services/drug-benefit-list.html

Administered by Alberta Blue Cross

on behalf of Alberta Health and Wellness.

The Drug Benefit List (DBL) is a list of drugs for which

coverage may be provided to program participants. The DBL

is not intended to be, and must not be used as a diagnostic

or prescribing tool. Inclusion of a drug on the DBL does not

mean or imply that the drug is fit or effective for any specific

purpose. Prescribing professionals must always use their

professional judgment and should refer to product

monographs and any applicable practice guidelines when

prescribing drugs. The product monograph contains

information that may be required for the safe and effective

use of the product.

Copies of the Alberta Health and Wellness Drug Benefit List

Publication CD are available from Pharmacy Services,

Alberta Blue Cross at the address shown above.

Binder and contents: $42.00 ($40.00 + $2.00 G.S.T.)

Contents only: $36.75 ($35.00 + $1.75 G.S.T.)

A cheque or money order must accompany the request

for copies.

http://www.health.alberta.ca/services/drug-benefit-list.html


EFFECTIVE JULY 1, 2012

Table of Contents

Restricted Benefits ..................................................................................................................................... 1

Drug Products(s) Added as Restricted Benefit(s) ........................................................................... 1

Multiple Sclerosis (MS) Benefits................................................................................................................. 1

Discontinued Multiple Sclerosis Benefit(s) ...................................................................................... 1

Least Cost Alternative (LCA) Price Change(s) .......................................................................................... 1

Discontinued Listing(s) ............................................................................................................................. 20

Product(s) Removed from the AHWDBL as Price Policy Requirements Not Satisfied ............................ 21

Please review the Alberta Health and Wellness Drug Benefit List in addition to this Summary of Changes


EFFECTIVE JULY 1, 2012 1

Restricted Benefit(s)

Drug Product(s) Added as Restricted Benefit(s)

Trade Name / Strength / Form Generic Description DIN MFR

BLOOD GLUCOSE TEST STRIPS DIABETES SUPPLIES 00000999955 XXX

BLOOD LETTING LANCET DIABETES SUPPLIES 00000999941 XXX

INSULIN PEN NEEDLES DIABETES SUPPLIES 00000999985 XXX

INSULIN SYRINGES DIABETES SUPPLIES 00000999952 XXX

URINE TEST STRIPS DIABETES SUPPLIES 00000999957 XXX

Multiple Sclerosis (MS) Benefit(s)

Discontinued Multiple Sclerosis (MS) Benefit(s)

The following DIN(s) will be honored for claims processing by Alberta Blue Cross until July 31, 2012.


REBIF INIT PACK 8.8 MCG / 0.2 ML /

22 MCG / 0.5 ML INJECTION

SYRINGE

INTERFERON BETA-1A 00002281708 SRO

Least Cost Alternative (LCA) Price Change(s)

The following established IC Grouping(s) are affected and a revised LCA price has been established and will be

applied effective August 1, 2012.

Please review the online Alberta Health and Wellness Drug Benefit List at

http://www.health.alberta.ca/services/drug-benefit-list.html for further information.

Generic Description Strength / Form New LCA Price

ACEBUTOLOL HCL 100 MG TABLET 0.1298



ACYCLOVIR 200 MG TABLET 0.6397



http://www.health.alberta.ca/services/drug-benefit-list.html


2 EFFECTIVE JULY 1, 2012

Least Cost Alternative (LCA) Price Change(s), continued


ALENDRONATE SODIUM 10 MG TABLET 0.6911

ALENDRONATE SODIUM 70 MG TABLET 3.5835

ALFUZOSIN HCL 10 MG SUSTAINED-RELEASE

TABLET

0.4966

AMCINONIDE 0.1 % TOPICAL CREAM 0.2099

AMCINONIDE 0.1 % TOPICAL LOTION 0.3533

AMCINONIDE 0.1 % TOPICAL OINTMENT 0.4199

AMIODARONE HCL 200 MG TABLET 0.7747

AMLODIPINE BESYLATE 2.5 MG TABLET 0.2684

AMLODIPINE BESYLATE 5 MG TABLET 0.5052

AMLODIPINE BESYLATE 10 MG TABLET 0.7499

AMOXICILLIN TRIHYDRATE/

CLAVULANATE POTASSIUM

25 MG ORAL SUSPENSION 0.0517



50 MG ORAL SUSPENSION 0.0869



500 MG TABLET 0.6673



875 MG / 125 MG TABLET 0.8355

ATENOLOL 25 MG TABLET 0.1081


ATENOLOL/ CHLORTHALIDONE 50 MG TABLET 0.3195

ATENOLOL/ CHLORTHALIDONE 100 MG TABLET 0.5236


ATORVASTATIN CALCIUM 10 MG TABLET 0.6558




AZATHIOPRINE 50 MG TABLET 0.3724

AZITHROMYCIN 20 MG SUSPENSION 0.4090

AZITHROMYCIN 40 MG SUSPENSION 0.5796

AZITHROMYCIN 250 MG TABLET 1.8922

AZITHROMYCIN 600 MG TABLET 6.0000

BACLOFEN 10 MG TABLET 0.2517

BACLOFEN 20 MG TABLET 0.4898





BENAZEPRIL HCL 5 MG TABLET 0.5995

BENAZEPRIL HCL 20 MG TABLET 0.8135

BENZYDAMINE HCL 0.15 % ORAL RINSE 0.0290

BETAHISTINE DIHYDROCHLORIDE 16 MG TABLET 0.1770

BETAMETHASONE DIPROPIONATE/

SALICYLIC ACID

0.5 MG TOPICAL LOTION 0.3698

BISOPROLOL FUMARATE 5 MG TABLET 0.1378

BISOPROLOL FUMARATE 10 MG TABLET 0.2284

BRIMONIDINE TARTRATE 0.2 % OPHTHALMIC SOLUTION 1.2418

BROMAZEPAM 3 MG TABLET 0.0575

BROMAZEPAM 6 MG TABLET 0.0841

BUPROPION HCL 100 MG SUSTAINED-RELEASE

TABLET

0.2103

BUPROPION HCL 150 MG SUSTAINED-RELEASE

TABLET

0.3275

BUSPIRONE HCL 10 MG TABLET 0.3723

CANDESARTAN CILEXETIL 8 MG TABLET 0.4455



CAPTOPRIL 12.5 MG TABLET 0.1325

CAPTOPRIL 25 MG TABLET 0.1875



CARBAMAZEPINE 100 MG CHEWABLE TABLET 0.0599

CARBAMAZEPINE 200 MG CHEWABLE TABLET 0.1181

CARBAMAZEPINE 200 MG SUSTAINED-RELEASE

TABLET

0.1467

CARBAMAZEPINE 400 MG SUSTAINED-RELEASE

TABLET

0.2933

CARVEDILOL 3.125 MG TABLET 0.4728



CARVEDILOL 25 MG TABLET 0.4728

CEFAZOLIN SODIUM 500 MG/VIAL INJECTION 2.5000

CEFAZOLIN SODIUM 1 G/VIAL INJECTION 3.7500





CEFAZOLIN SODIUM 10 G/VIAL INJECTION 35.0000

CEFPROZIL 25 MG ORAL SUSPENSION 0.0618

CEFPROZIL 50 MG ORAL SUSPENSION 0.1234

CEFPROZIL 250 MG TABLET 0.6319

CEFPROZIL 500 MG TABLET 1.2389

CEFTRIAXONE SODIUM 2 G/VIAL INJECTION 29.3125

CEFUROXIME AXETIL 250 MG TABLET 0.7237

CEFUROXIME AXETIL 500 MG TABLET 1.4337

CILAZAPRIL 1 MG TABLET 0.2492

CILAZAPRIL 2.5 MG TABLET 0.2755

CILAZAPRIL 5 MG TABLET 0.3201

CILAZAPRIL/

HYDROCHLOROTHIAZIDE

5 MG / 12.5 MG TABLET 0.4170

CIMETIDINE 600 MG TABLET 0.1702

CIMETIDINE 800 MG TABLET 0.2430

CIPROFLOXACIN HCL 0.3 % OPHTHALMIC SOLUTION 0.7639

CIPROFLOXACIN HCL 250 MG TABLET 0.9309



CITALOPRAM HYDROBROMIDE 20 MG TABLET 0.5011

CITALOPRAM HYDROBROMIDE 40 MG TABLET 0.5011

CLARITHROMYCIN 250 MG TABLET 0.5892

CLARITHROMYCIN 500 MG TABLET 1.6293

CLINDAMYCIN HCL 150 MG CAPSULE 0.3541

CLINDAMYCIN HCL 300 MG CAPSULE 0.7082

CLOBAZAM 10 MG TABLET 0.1537

CLOBETASOL 17-PROPIONATE 0.05 % TOPICAL CREAM 0.2470

CLOBETASOL 17-PROPIONATE 0.05 % SCALP LOTION 0.2156

CLOBETASOL 17-PROPIONATE 0.05 % TOPICAL OINTMENT 0.2470

CLOMIPRAMINE HCL 10 MG TABLET 0.1290



CLONAZEPAM 0.5 MG TABLET 0.0746





CLONAZEPAM 1 MG TABLET 0.1487

CLONAZEPAM 2 MG TABLET 0.1286

CLONIDINE HCL 0.025 MG TABLET 0.2584

CLOPIDOGREL BISULFATE 75 MG TABLET 0.9279

CLOXACILLIN SODIUM 25 MG ORAL LIQUID 0.0898

CODEINE PHOSPHATE/

ACETAMINOPHEN/ CAFFEINE

15 MG TABLET 0.0807

CODEINE PHOSPHATE/

ACETAMINOPHEN/ CAFFEINE

30 MG TABLET 0.0798

CODEINE PHOSPHATE/

ACETAMINOPHEN

60 MG TABLET 0.1685

CYANOCOBALAMIN 1000 MCG / ML INJECTION 0.3060

CYCLOBENZAPRINE HCL 10 MG TABLET 0.3727

CYPROTERONE ACETATE 50 MG TABLET 1.4339

DEFEROXAMINE MESYLATE 500 MG / VIAL INJECTION 7.0600

DEFEROXAMINE MESYLATE 2 G / VIAL INJECTION 28.3500

DESMOPRESSIN ACETATE 0.1 MG TABLET 0.4973

DESMOPRESSIN ACETATE 0.2 MG TABLET 0.9945

DESMOPRESSIN ACETATE 10 MCG NASAL METERED

DOSE SPRAY

1.5222

DEXAMETHASONE 0.5 MG TABLET 0.1094

DEXAMETHASONE 4 MG TABLET 0.4263

DEXAMETHASONE SODIUM

PHOSPHATE

4 MG / ML INJECTION 1.6060

DICLOFENAC SODIUM 25 MG ENTERIC-COATED

TABLET

0.1189

DICLOFENAC SODIUM 50 MG ENTERIC-COATED

TABLET

0.3257

DICLOFENAC SODIUM 50 MG RECTAL SUPPOSITORY 0.4891

DICLOFENAC SODIUM 75 MG SUSTAINED-RELEASE

TABLET

0.4491

DICLOFENAC SODIUM 100 MG SUSTAINED-RELEASE

TABLET

0.6402

DICLOFENAC SODIUM 100 MG RECTAL SUPPOSITORY 0.6583





DIFLUNISAL 250 MG TABLET 0.5366

DILTIAZEM HCL 30 MG TABLET 0.1866

DILTIAZEM HCL 60 MG TABLET 0.3273

DILTIAZEM HCL 120 MG CONTROLLED-

DELIVERY CAPSULE

0.5157


DELIVERY CAPSULE

0.6846


DELIVERY CAPSULE

0.9080


DELIVERY CAPSULE

1.1351

DILTIAZEM HCL 120 MG EXTENDED-RELEASE

CAPSULE

0.2987


CAPSULE

0.4045


CAPSULE

0.5365


CAPSULE

0.6607


CAPSULE

0.8089

DIVALPROEX SODIUM (VALPROIC

ACID EQUIV.)

125 MG ENTERIC-COATED

TABLET

0.1011


ACID EQUIV.)


TABLET

0.1817


ACID EQUIV.)


TABLET

0.3637

DOMPERIDONE MALEATE 10 MG TABLET 0.0886

DORZOLAMIDE HCL 2 % OPTHALMIC SOLUTION 1.3505

DORZOLAMIDE HCL/ TIMOLOL

MALEATE

2 % / 0.5 % OPTHALMIC

SOLUTION

2.0459

DOXAZOSIN MESYLATE 1 MG TABLET 0.2176



DOXEPIN HCL 25 MG CAPSULE 0.1576








ENALAPRIL MALEATE 2.5 MG TABLET 0.2731

ENALAPRIL MALEATE 5 MG TABLET 0.3231

ENALAPRIL MALEATE/

HYDROCHLOROTHIAZIDE

5 MG TABLET 0.4927



ENTACAPONE 200 MG TABLET 0.6095

ERYTHROMYCIN 250 MG CAPSULE (ENTERIC-

COATED PELLET)

0.4193

ERYTHROMYCIN 333 MG CAPSULE (ENTERIC-

COATED PELLET)

0.4657

ESTRADIOL-17B 50 MCG / DAY TRANSDERMAL

PATCH

2.1000


PATCH

2.2375


PATCH

2.3375

ETIDRONATE DISODIUM 200 MG TABLET 0.5161

ETIDRONATE DISODIUM/ CALCIUM

CARBONATE


FAMOTIDINE 20 MG TABLET 0.3882

FAMOTIDINE 40 MG TABLET 0.7089

FELODIPINE 5 MG EXTENDED-RELEASE

TABLET

0.4620

FELODIPINE 10 MG EXTENDED-RELEASE

TABLET

0.6733

FENOFIBRATE 100 MG TABLET 0.5407

FENOFIBRATE 160 MG CAPSULE 0.4488

FENOFIBRATE 200 MG CAPSULE 0.6806

FENTANYL 12 MCG / HR TRANSDERMAL

PATCH

2.2300


PATCH

3.7188


PATCH

7.0000






PATCH

9.8438


PATCH

12.2500

FINASTERIDE 5 MG TABLET 0.6714

FLECAINIDE ACETATE 50 MG TABLET 0.4253

FLECAINIDE ACETATE 100 MG TABLET 0.8505

FLUCONAZOLE 50 MG TABLET 1.8241

FLUCONAZOLE 100 MG TABLET 3.2354

FLUOXETINE HCL 10 MG CAPSULE 0.8650

FLUOXETINE HCL 20 MG CAPSULE 0.6920

FLURBIPROFEN 50 MG TABLET 0.2221

FLURBIPROFEN 100 MG TABLET 0.3039

FLUVOXAMINE MALEATE 50 MG TABLET 0.3063

FLUVOXAMINE MALEATE 100 MG TABLET 0.5506

FOSINOPRIL SODIUM 10 MG TABLET 0.3194

FOSINOPRIL SODIUM 20 MG TABLET 0.3841

FUROSEMIDE 20 MG TABLET 0.0373

FUROSEMIDE 40 MG TABLET 0.0558

GABAPENTIN 100 MG CAPSULE 0.1598



GALANTAMINE HYDROBROMIDE 8 MG EXTENDED-RELEASE

CAPSULE

1.8906


CAPSULE

1.8906


CAPSULE

1.8906

GEMFIBROZIL 300 MG CAPSULE 0.1853

GEMFIBROZIL 600 MG TABLET 0.5157

GLICLAZIDE 30 MG SUSTAINED-RELEASE

TABLET

0.1510

GLICLAZIDE 80 MG TABLET 0.1401

GRANISETRON HCL 1 MG TABLET 14.5125





HYDROCHLOROTHIAZIDE/

SPIRONOLACTONE

25 MG TABLET 0.1216


SPIRONOLACTONE

50 MG TABLET 0.2571


AMILORIDE HCL

50 MG TABLET 0.1293

HYDROCORTISONE/ CINCHOCAINE

HCL/ FRAMYCETIN SULFATE/

ESCULIN

5 MG RECTAL OINTMENT 0.4000

HYDROCORTISONE/ CINCHOCAINE

HCL/ FRAMYCETIN SULFATE/

ESCULIN

5 MG RECTAL SUPPOSITORY 0.6000

HYDROCORTISONE ACETATE/ ZINC

SULFATE

0.5 % RECTAL OINTMENT 0.3850

HYDROCORTISONE ACETATE/ ZINC

SULFATE

10 MG RECTAL SUPPOSITORY 0.5833

HYDROCORTISONE SODIUM

SUCCINATE

100 MG / VIAL INJECTION 2.3000


SUCCINATE



SUCCINATE



SUCCINATE

1 G / VIAL INJECTION 9.8900

HYDROMORPHONE HCL 2 MG TABLET 0.1416

HYDROMORPHONE HCL 2 MG / ML INJECTION 0.9450

HYDROMORPHONE HCL 10 MG / ML INJECTION 2.7860

HYDROXYCHLOROQUINE SULFATE 200 MG TABLET 0.2620

IBUPROFEN 400 MG TABLET 0.0474

IBUPROFEN 600 MG TABLET 0.4422

INDAPAMIDE HEMIHYDRATE 1.25 MG TABLET 0.1173

INDAPAMIDE HEMIHYDRATE 2.5 MG TABLET 0.1833

INDOMETHACIN 100 MG RECTAL SUPPOSITORY 0.8910

IPRATROPIUM BROMIDE 125 MCG INHALATION UNIT

DOSE SOLUTION

0.3295

IPRATROPIUM BROMIDE 250 MCG INHALATION

SOLUTION

0.3456





IPRATROPIUM BROMIDE 250 MCG INHALATION UNIT

DOSE SOLUTION

0.6590

IPRATROPIUM BROMIDE/

SALBUTAMOL SULFATE

0.2 MG INHALATION SOLUTION 0.2936

IRBESARTAN 75 MG TABLET 0.4422



IRBESARTAN/

HYDROCHLOROTHIAZIDE


IRBESARTAN/

HYDROCHLOROTHIAZIDE

150 MG / 12.5 MG TABLET 0.4422

IRBESARTAN/

HYDROCHLOROTHIAZIDE

300 MG / 25 MG TABLET 0.4205

ISOSORBIDE-5-MONONITRATE 60 MG EXTENDED-RELEASE

TABLET

0.3523

ISOTRETINOIN 10 MG CAPSULE 0.9313

ISOTRETINOIN 40 MG CAPSULE 1.9003

KETOCONAZOLE 200 MG TABLET 0.9393

KETOROLAC TROMETHAMINE 0.5 % OPHTHALMIC SOLUTION 1.6000

LAMOTRIGINE 25 MG TABLET 0.1438



LANSOPRAZOLE 15 MG DELAYED-RELEASE

CAPSULE

0.7000

LANSOPRAZOLE 30 MG DELAYED-RELEASE

CAPSULE

0.7000

LATANOPROST 0.005 % OPHTHALMIC

SOLUTION

4.1427

LEFLUNOMIDE 10 MG TABLET 4.1027

LEFLUNOMIDE 20 MG TABLET 4.1046

LEVETIRACETAM 500 MG TABLET 0.9750



LEVOBUNOLOL HCL 0.25 % OPHTHALMIC SOLUTION 0.9320

LEVOBUNOLOL HCL 0.5 % OPHTHALMIC SOLUTION 1.2379

LEVODOPA/ CARBIDOPA 100 MG TABLET 0.1877





LEVODOPA/ CARBIDOPA 100 MG TABLET 0.2803

LEVODOPA/ CARBIDOPA 100 MG / 25 MG SUSTAINED-

RELEASE TABLET

0.5510

LEVODOPA/ CARBIDOPA 250 MG / 25 MG TABLET 0.3129

LEVOFLOXACIN 250 MG TABLET 1.8655



LISINOPRIL 5 MG TABLET 0.2094


LISINOPRIL/

HYDROCHLOROTHIAZIDE

10 MG TABLET 0.3256


LISINOPRIL/

HYDROCHLOROTHIAZIDE

20 MG TABLET 0.3913

LISINOPRIL/

HYDROCHLOROTHIAZIDE

20 MG TABLET 0.3506

LISINOPRIL/

HYDROCHLOROTHIAZIDE

20 MG TABLET 0.3913

LITHIUM CARBONATE 150 MG CAPSULE 0.0449

LITHIUM CARBONATE 300 MG CAPSULE 0.0443

LOSARTAN POTASSIUM 25 MG TABLET 0.4407


LOSARTAN POTASSIUM/

HYDROCHLOROTHIAZIDE

50 MG TABLET 0.4407


LOSARTAN POTASSIUM/

HYDROCHLOROTHIAZIDE


LOSARTAN POTASSIUM/

HYDROCHLOROTHIAZIDE


LOVASTATIN 20 MG TABLET 0.7213

LOVASTATIN 40 MG TABLET 1.3176

L-TRYPTOPHAN 500 MG CAPSULE 0.3563

L-TRYPTOPHAN 500 MG TABLET 0.3563

L-TRYPTOPHAN 1 G TABLET 0.7126

MEDROXYPROGESTERONE

ACETATE

2.5 MGTABLET 0.0615





MEDROXYPROGESTERONE

ACETATE

5 MG TABLET 0.1216

MEDROXYPROGESTERONE

ACETATE

10 MG TABLET 0.2468

METFORMIN HCL 500 MG TABLET 0.1022

METFORMIN HCL 850 MG TABLET 0.1331

METHYLPHENIDATE HCL 10 MG TABLET 0.1331

METHYLPHENIDATE HCL 20 MG EXTENDED-RELEASE

TABLET

0.2820

METHYLPHENIDATE HCL 20 MG TABLET 0.2326

METHYLPREDNISOLONE ACETATE 40 MG / ML INJECTION 4.1000

METHYLPREDNISOLONE ACETATE 80 MG / ML INJECTION 8.2000

METHYLPREDNISOLONE ACETATE

(PRESERVED)

40 MG / ML INJECTION 4.1000

METHYLPREDNISOLONE SODIUM

SUCCINATE



SUCCINATE



SUCCINATE



SUCCINATE

1 G / VAIL INJECTION 34.1000

METOPROLOL TARTRATE 50 MG TABLET 0.1047

METOPROLOL TARTRATE 100 MG TABLET 0.2147

METOPROLOL TARTRATE 100 MG SUSTAINED-RELEASE

TABLET

0.1312

METOPROLOL TARTRATE 200 MG SUSTAINED-RELEASE

TABLET

0.2499

METRONIDAZOLE 5 MG/ML INJECTION 0.1869

MINOCYCLINE HCL 50 MG CAPSULE 0.3344

MINOCYCLINE HCL 100 MG CAPSULE 0.6458

MIRTAZAPINE 15 MG TABLET 0.2344

MIRTAZAPINE 30 MG TABLET 0.4546

MOCLOBEMIDE 150 MG TABLET 0.2279

MOCLOBEMIDE 300 MG TABLET 0.4476

MODAFINIL 100 MG TABLET 0.9990





MOMETASONE FUROATE 0.1 % TOPICAL CREAM 0.2379

MOMETASONE FUROATE 0.1 % TOPICAL OINTMENT 0.2253

MONTELUKAST SODIUM 4 MG CHEWABLE TABLET 0.5216

MONTELUKAST SODIUM 4 MG ORAL GRANULE 0.5216

MONTELUKAST SODIUM 5 MG CHEWABLE TABLET 0.5776

MONTELUKAST SODIUM 10 MG TABLET 0.8483

MORPHINE SULFATE 15 MG SUSTAINED-RELEASE

TABLET

0.2559


TABLET

0.3872


TABLET

0.6822


TABLET

1.0400


TABLET

1.9335

NABILONE 0.5 MG CAPSULE 1.1674

NABILONE 1 MG CAPSULE 2.3346

NABUMETONE 500 MG TABLET 0.3625

NAPROXEN 250 MG ENTERIC-COATED

TABLET

0.1570


TABLET

0.2062


TABLET

0.3718

NARATRIPTAN HCL 1 MG TABLET 8.4338

NARATRIPTAN HCL 2.5 MG TABLET 6.1437

NIFEDIPINE 30 MG EXTENDED-RELEASE

TABLET

0.6171

NIFEDIPINE 60 MG EXTENDED-RELEASE

TABLET

0.9374

NITRAZEPAM 5 MG TABLET 0.0500

NITRAZEPAM 10 MG TABLET 0.0748

NIZATIDINE 150 MG CAPSULE 0.3566

NIZATIDINE 300 MG CAPSULE 0.6347

NORFLOXACIN 400 MG TABLET 0.7628





NORTRIPTYLINE HCL 10 MG CAPSULE 0.0893

NORTRIPTYLINE HCL 25 MG CAPSULE 0.1804

OCTREOTIDE ACETATE 50 MCG / ML INJECTION 1.9076

OCTREOTIDE ACETATE 100 MCG / ML INJECTION 3.6007

OCTREOTIDE ACETATE 200 MCG/ML INJECTION 6.9268

OCTREOTIDE ACETATE 500 MCG/ML INJECTION 16.9230

OFLOXACIN 0.3 % OPHTHALMIC SOLUTION 0.9203

OLANZAPINE 2.5 MG TABLET 0.6762

OLANZAPINE 5 MG DISINTEGRATING TABLET 1.3449

OLANZAPINE 5 MG TABLET 1.3524

OLANZAPINE 7.5 MG TABLET 2.0286

OLANZAPINE 10 MG DISINTEGRATING

TABLET

2.6875



OMEPRAZOLE 20 MG CAPSULE / SUSTAINED

RELEASE TABLET

0.7700

ONDANSETRON HCL DIHYDRATE 2 MG / ML INJECTION 3.7143

ONDANSETRON HCL DIHYDRATE 2 MG / ML INJECTION 3.7143

ONDANSETRON HCL DIHYDRATE 4 MG TABLET 5.0410

ONDANSETRON HCL DIHYDRATE 8 MG TABLET 7.6921

ONDANSETRON HCL DIHYDRATE 0.8 MG SOLUTION 1.5710

OXYBUTYNIN CHLORIDE 5 MG TABLET 0.1553

OXYCODONE HCL 5 MG TABLET 0.1287



PAMIDRONATE DISODIUM 60 MG / VIAL INJECTION 176.7000

PANTOPRAZOLE 40 MG ENTERIC-COATED

TABLET

0.7827

PAROXETINE HCL 20 MG TABLET 0.6794

PAROXETINE HCL 30 MG TABLET 0.7218

PENICILLIN V POTASSIUM 60 MG ORAL LIQUID 0.0472

PINDOLOL 5 MG TABLET 0.2147







PIOGLITAZONE HCL 15 MG TABLET 0.8718



PIROXICAM 10 MG CAPSULE 0.3210

PIROXICAM 20 MG CAPSULE 0.5195

PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG TABLET 0.3679

PRAMIPEXOLE DIHYDROCHLORIDE 1 MG TABLET 0.7360

PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG TABLET 0.7360

PRAVASTATIN SODIUM 10 MG TABLET 0.5956



PRAZOSIN HCL 1 MG TABLET 0.1371



PREDNISOLONE SODIUM

PHOSPHATE

1 MG ORAL LIQUID 0.0478

QUETIAPINE FUMARATE 25 MG TABLET 0.1932




QUININE SULFATE 300 MG CAPSULE 0.2888

RABEPRAZOLE SODIUM 10 MG ENTERIC-COATED

TABLET

0.2517

RABEPRAZOLE SODIUM 20 MG ENTERIC-COATED

TABLET

0.5033

RALOXIFENE HCL 60 MG TABLET 0.8457

RAMIPRIL 1.25 MG CAPSULE / TABLET 0.2663

RAMIPRIL 2.5 MG CAPSULE / TABLET 0.3073

RAMIPRIL 5 MG CAPSULE / TABLET 0.3073

RAMIPRIL 10 MG CAPSULE / TABLET 0.3892

RANITIDINE HCL 15 MG ORL SOLUTION 0.0932

REPAGLINIDE 0.5 MG TABLET 0.1094

REPAGLINIDE 1 MG TABLET 0.1138





REPAGLINIDE 2 MG TABLET 0.1182

RISEDRONATE SODIUM 5 MG TABLET 1.3897



RISPERIDONE 0.25 MG TABLET 0.2035

RISPERIDONE 0.5 MG TABLET 0.3409

RISPERIDONE 1 MG TABLET 0.4710


RISPERIDONE 3 MG DISINTEGRATING TABLET 2.1913



RISPERIDONE TARTRATE 1 MG ORL SOLUTION 0.5312

RIVASTIGMINE HYDROGEN

TARTRATE

1.5 MG CAPSULE 0.9805


TARTRATE

3 MG CAPSULE 0.9805


TARTRATE

4.5 MG CAPSULE 0.9805


TARTRATE

6 MG CAPSULE 0.9805

RIZATRIPTAN BENZOATE 5 MG DISINTEGRATING TABLET 5.3270

RIZATRIPTAN BENZOATE 10 MG DISINTEGRATING

TABLET

5.3270

ROPINIROLE HCL 1 MG TABLET 0.4271

ROPINIROLE HCL 0.25 MG TABLET 0.1068



ROSUVASTATIN CALCIUM 5 MG TABLET 0.4854




SALBUTAMOL SULFATE 0.5 MG INHALATION SOLUTION 0.1074

SALBUTAMOL SULFATE 1 MG INHALATION SOLUTION 0.1555

SALBUTAMOL SULFATE 2 MG INHALATION UNIT DOSE

SOLUTION

0.2954





SALBUTAMOL SULFATE 5 MG INHALATION SOLUTION 0.3774

SELEGILINE HCL 5 MG TABLET 0.7906

SERTRALINE HCL 25 MG CAPSULE 0.3169



SIMVASTATIN 5 MG TABLET 0.3704





SOTALOL HCL 80 MG TABLET 0.3708

SOTALOL HCL 160 MG TABLET 0.4058

SPIRONOLACTONE 25 MG TABLET 0.1194

SPIRONOLACTONE 100 MG TABLET 0.2780

SULINDAC 200 MG TABLET 0.3920

SUCRALFATE 1 G TABLET 0.2148

SUMATRIPTAN SUCCINATE 6 MG INJECTION SYRINGE 16.5889

SUMATRIPTAN SUCCINATE 50 MG TABLET 7.1350

SUMATRIPTAN SUCCINATE 100 MG TABLET 7.8600

SYNTHETIC CALCITONIN SALMON

(SALCATONIN)

200 IU NASAL METERED DOSE

SPRAY

1.4000

TAMSULOSIN HCL 0.4 MG EXTENDED-RELEASE

TABLET

0.2100

TAMSULOSIN HCL 0.4 MG SUSTAINED-RELEASE

CAPSULE

0.3415

TELMISARTAN 40 MG TABLET 0.4080

TELMISARTAN 80 MG TABLET 0.4080

TELMISARTAN/

HYDROCHLOROTHIAZIDE

80 MG / 12.5 MGTABLET 0.4080

TELMISARTAN/

HYDROCHLOROTHIAZIDE

80 MG / 25 MGTABLET 0.4080

TEMAZEPAM 15 MG CAPSULE 0.0730

TEMAZEPAM 30 MG CAPSULE 0.0883

TERAZOSIN HCL 1 MG TABLET 0.2563








TERBINAFINE HCL 250 MG TABLET 1.8525

TIAPROFENIC ACID 300 MG TABLET 0.3257

TICLOPIDINE HCL 250 MG TABLET 0.4303

TIMOLOL MALEATE 0.25 % OPHTHALMIC SOLUTION 0.9688

TIMOLOL MALEATE 5 MG TABLET 0.1649



TIZANIDINE HCL 4 MG TABLET 0.3686

TOBRAMYCIN 0.3 % OPHTHALMIC SOLUTION 0.6560

TOPIRAMATE 25 MG TABLET 0.4811



TRAZODONE HCL 50 MG TABLET 0.1384



TRIAMCINOLONE ACETONIDE 10 MG / ML INJECTION 2.4500

TRIAMCINOLONE ACETONIDE 40 MG / ML INJECTION 4.7700

TRIFLURIDINE 1 % OPHTHALMIC SOLUTION 3.0387

TRIMEBUTINE MALEATE 200 MG TABLET 0.5628

VALACYCLOVIR 500 MG TABLET 1.2765

VALPROIC ACID 250 MG CAPSULE 0.1908

VALPROIC ACID 50 MG ORAL SYRUP 0.0398

VALSARTAN 80 MG TABLET 0.4514



VALSARTAN/

HYDROCHLOROTHIAZIDE


VALSARTAN/

HYDROCHLOROTHIAZIDE


VALSARTAN/

HYDROCHLOROTHIAZIDE






VALSARTAN/

HYDROCHLOROTHIAZIDE


VALSARTAN/

HYDROCHLOROTHIAZIDE

80 MG / 12.5 MG TABLET 0.4452

VENLAFAXINE HCL 37.5 MG EXTENDED-RELEASE

CAPSULE

0.3477

VENLAFAXINE HCL 75 MG EXTENDED-RELEASE

CAPSULE

0.6956

VENLAFAXINE HCL 150 MG EXTENDED-RELEASE

CAPSULE

0.7343

VERAPAMIL HCL 120 MG SUSTAINED-RELEASE

TABLET

0.5078


TABLET

0.5315


TABLET

0.7088

WARFARIN SODIUM 1 MG TABLET 0.1147


WARFARIN SODIUM 2.5 MG TABLET 0.0971





ZOLMITRIPTAN 2.5 MG DISPERSIBLE TABLET 5.2110

ZOLMITRIPTAN 2.5 MG TABLET 5.2110



Discontinued Listing(s)

The following DIN(s) will be honored for claims processing by Alberta Blue Cross until July 31, 2012.


5-AMINOSALICYLIC ACID 400 MG

ENTERIC-COATED TABLET

MESALAZINE 00002351463 SNS

APO-BENZYDAMINE 0.15 % ORAL

RINSE

BENZYDAMINE HCL 00002239044 APX

APO-CARBAMAZEPINE 200 MG

TABLET

CARBAMAZEPINE 00000402699 APX

APO-CLONIDINE 0.2 MG TABLET CLONIDINE HCL 00000868957 APX

APO-INDOMETHACIN 25 MG

CAPSULE

INDOMETHACIN 00000611158 APX

APO-INDOMETHACIN 50 MG

CAPSULE

INDOMETHACIN 00000611166 APX

APO-METOCLOP 5 MG TABLET METOCLOPRAMIDE HCL 00000842826 APX

APO-METOCLOP 10 MG TABLET METOCLOPRAMIDE HCL 00000842834 APX

EUGLUCON 5 MG TABLET GLYBURIDE 00000720941 PMS

HEPARIN LOCK FLUSH 10 IU / ML

INJECTION USP

HEPARIN SODIUM 00000725323 HSP

HEPARIN LOCK FLUSH 100 IU / ML

INJECTION USP

HEPARIN SODIUM 00000725315 HSP

MYLAN-TIMOLOL 0.25% OPH

SOLUTION

TIMOLOL MALEATE 00000893773 MYP

PRAMIPEXOLE 1 MG TABLET PRAMIPEXOLE

DIHYDROCHLORIDE

00002367629 SNS

PRAMIPEXOLE 1.5 MG TABLET PRAMIPEXOLE

DIHYDROCHLORIDE

00002367645 SNS

RAN-TAMSULOSIN 0.4 MG

SUSTAINED-RELEASE CAPSULE

TAMSULOSIN HCL 00002294885 RAN

RATIO-CODEINE 5 MG / ML ORAL

SYRUP

CODEINE PHOSPHATE 00000779474 RPH

SOLU-MEDROL ACT-O-VIAL (PRES)

40 MG / VIAL (BASE) INJECTION

METHYLPREDNISOLONE

SODIUM SUCCINATE

00002063719 PFI



METHYLPREDNISOLONE

SODIUM SUCCINATE

00002063727 PFI



METHYLPREDNISOLONE

SODIUM SUCCINATE

00002063700 PFI

TAMSULOSIN 0.4 MG SUSTAINED-

RELEASE CAPSULE

TAMSULOSIN HCL 00002331780 RAN



Product(s) Removed from the AHWDBL as Price Policy

Requirements Not Satisfied

The Alberta government-sponsored drug programs previously covered the following drug product(s). Effective

July 1, 2012, the listed product(s) will no longer be a benefit and will not be considered for coverage by special

authorization. A transition period will be applied and, as of July 31, 2012, claims will no longer pay for these

products.


APO-DORZOLAMIDE 2%

OPHTHALMIC SOLUTION

DORZOLAMIDE HCL 00002296055 APX

APO-LISINOPRIL/ HCTZ 20 MG / 25

MG TABLET

LISINOPRIL/

HYDROCHLOROTHIAZIDE

00002261995 APX

APO-MEDROXY 2.5 MG TABLET MEDROXYPROGESTERONE

ACETATE

00002244726 APX

APO-MEDROXY 5 MG TABLET MEDROXYPROGESTERONE

ACETATE

00002244727 APX

APO-MEDROXY 10 MG TABLET MEDROXYPROGESTERONE

ACETATE

00002277298 APX

APO-METFORMIN 850 MG TABLET METFORMIN HCL 00002229785 APX

APO-METHYLPHENIDATE 20 MG

TABLET

METHYLPHENIDATE HCL 00002249332 APX

AVA-ATENOLOL 25 MG TABLET ATENOLOL 00002360969 AVA

AVA-BISOPROLOL 5 MG TABLET BISOPROLOL FUMARATE 00002363887 AVA

AVA-BUPROPION SR 100 MG

SUSTAINED-RELEASE TABLET

BUPROPION HCL 00002363399 AVA

AVA-HYDROCHLOROTHIAZIDE 25

MG TABLET

HYDROCHLOROTHIAZIDE 00002363968 AVA

AVA-HYDROCHLOROTHIAZIDE 50

MG TABLET

HYDROCHLOROTHIAZIDE 00002363976 AVA

AVA-NORFLOXACIN 400 MG TABLET NORFLOXACIN 00002366304 AVA

CEFAZOLIN 500 MG / VIAL

INJECTION

CEFAZOLIN SODIUM 00002308932 SDZ

CEFAZOLIN 1 G / VIAL INJECTION CEFAZOLIN SODIUM 00002308959 SDZ

CEFAZOLIN 1 G / VIAL INJECTION CEFAZOLIN SODIUM 00002297205 APX

CEFAZOLIN 10 G / VIAL INJECTION CEFAZOLIN SODIUM 00002308967 SDZ

CEFAZOLIN 10 G / VIAL INJECTION CEFAZOLIN SODIUM 00002297213 APX

CO NORFLOXACIN 400 MG TABLET NORFLOXACIN 00002269627 COB

FLAGYL 5 MG / ML INJECTION METRONIDAZOLE 00000870420 BAX

HYDROCHLOROTHIAZIDE 25 MG

TABLET

HYDROCHLOROTHIAZIDE 00002360594 SNS




Requirements Not Satisfied, continued


HYDROCHLOROTHIAZIDE 50 MG

TABLET

HYDROCHLOROTHIAZIDE 00002360608 SNS

JAMP-PIOGLITAZONE 30 MG TABLET PIOGLITAZONE HCL 00002365529 JPC

JAMP-PIOGLITAZONE 45 MG TABLET PIOGLITAZONE HCL 00002365537 JPC

JAMP-TERBINAFINE 250 MG TABLET TERBINAFINE HCL 00002357070 JPC

MYLAN-ALENDRONATE 10 MG

TABLET

ALENDRONATE SODIUM 00002270129 MYP

MYLAN-CLOBETASOL 0.05% SCALP

LOTION

CLOBETASOL 17-PROPIONATE 00002216213 MYP

MYLAN-CLOBETASOL 0.05%

TOPICAL CREAM


MYLAN-CLOBETASOL 0.05%

TOPICAL OINTMENT


MYLAN-TICLOPIDINE 250 MG

TABLET

TICLOPIDINE HCL 00002239744 MYP

NOVO-KETOTIFEN 1 MG TABLET KETOTIFEN FUMARATE 00002230730 TEV

NU-ACEBUTOLOL 100 MG TABLET ACEBUTOLOL HCL 00002165546 NXP



NU-ACYCLOVIR 400 MG TABLET ACYCLOVIR 00002197413 NXP

NU-ACYCLOVIR 800 MG TABLET ACYCLOVIR 00002197421 NXP

NU-AMILZIDE TABLET HYDROCHLOROTHIAZIDE/

AMILORIDE HCL

00000886106 NXP

NU-AMOXI 25 MG / ML ORAL

SUSPENSION

AMOXICILLIN TRIHYDRATE 00000865540 NXP

NU-AMOXI 250 MG CAPSULE AMOXICILLIN TRIHYDRATE 00000865567 NXP

NU-AMOXI 50 MG / ML ORAL

SUSPENSION

AMOXICILLIN TRIHYDRATE 00000865559 NXP

NU-AMOXI 500 MG CAPSULE AMOXICILLIN TRIHYDRATE 00000865575 NXP

NU-BACLO 10 MG TABLET BACLOFEN 00002136090 NXP

NU-BACLO 20 MG TABLET BACLOFEN 00002136104 NXP

NU-BECLOMETHASONE 50 MCG /

DOSE NASAL SPRAY

BECLOMETHASONE

DIPROPIONATE

00002238577 NXP

NU-BUSPIRONE 10MG TABLET BUSPIRONE HCL 00002207672 NXP






NU-CAPTO 100 MG TABLET CAPTOPRIL 00001913859 NXP

NU-CAPTO 12.5 MG TABLET CAPTOPRIL 00001913824 NXP



NU-CARBAMAZEPINE 200 MG

TABLET

CARBAMAZEPINE 00002042568 NXP

NU-CEPHALEX 250 MG TABLET CEPHALEXIN 00000865877 NXP

NU-CEPHALEX 500 MG TABLET CEPHALEXIN 00000865885 NXP

NU-CIMET 300 MG TABLET CIMETIDINE 00000865818 NXP



NU-COTRIMOX TABLET SULFAMETHOXAZOLE/

TRIMETHOPRIM

00000865710 NXP

NU-COTRIMOX-DS 800 MG / 160 MG

TABLET

SULFAMETHOXAZOLE/

TRIMETHOPRIM

00000865729 NXP

NU-CYCLOBENZAPRINE 10 MG

TABLET

CYCLOBENZAPRINE HCL 00002171848 NXP

NU-DICLO 25 MG ENTERIC-COATED

TABLET

DICLOFENAC SODIUM 00000886017 NXP

NU-DILTIAZ 30 MG TABLET DILTIAZEM HCL 00000886068 NXP

NU-DILTIAZ 60 MG TABLET DILTIAZEM HCL 00000886076 NXP

NU-DILTIAZ-CD 120 MG

CONTROLLED-DELIVERY CAPSULE

DILTIAZEM HCL 00002231052 NXP







NU-DIVALPROEX 125 MG ENTERIC-

COATED TABLET

DIVALPROEX SODIUM

(VALPROIC ACID EQUIV.)

00002239517 NXP


COATED TABLET

DIVALPROEX SODIUM


00002239518 NXP


COATED TABLET

DIVALPROEX SODIUM


00002239519 NXP

NU-DOMPERIDONE 10 MG TABLET DOMPERIDONE MALEATE 00002231477 NXP

NU-DOXYCYCLINE 100 MG CAPSULE DOXYCYCLINE HYCLATE 00002044668 NXP

NU-FAMOTIDINE 20 MG TABLET FAMOTIDINE 00002024195 NXP






NU-FAMOTIDINE 40 MG TABLET FAMOTIDINE 00002024209 NXP

NU-FLUOXETINE 10 MG CAPSULE FLUOXETINE HCL 00002192756 NXP

NU-FLUOXETINE 20 MG CAPSULE FLUOXETINE HCL 00002192764 NXP

NU-FLURBIPROFEN 100 MG TABLET FLURBIPROFEN 00002020688 NXP

NU-FLURBIPROFEN 50 MG TABLET FLURBIPROFEN 00002020661 NXP

NU-FLUVOXAMINE 50 MG TABLET FLUVOXAMINE MALEATE 00002231192 NXP

NU-FLUVOXAMINE 100 MG TABLET FLUVOXAMINE MALEATE 00002231193 NXP

NU-GEMFIBROZIL 300 MG CAPSULE GEMFIBROZIL 00002058456 NXP

NU-GEMFIBROZIL 600 MG TABLET GEMFIBROZIL 00002058464 NXP

NU-GLYBURIDE 2.5 MG TABLET GLYBURIDE 00002020734 NXP

NU-GLYBURIDE 5 MG TABLET GLYBURIDE 00002020742 NXP

NU-IBUPROFEN 600 MG TABLET IBUPROFEN 00002020726 NXP

NU-INDAPAMIDE 2.5 MG TABLET INDAPAMIDE HEMIHYDRATE 00002223597 NXP

NU-INDO 25 MG CAPSULE INDOMETHACIN 00000865850 NXP

NU-INDO 50 MG CAPSULE INDOMETHACIN 00000865869 NXP

NU-KETOCON 200 MG TABLET KETOCONAZOLE 00002122197 NXP

NU-KETOROLAC 10 MG TABLET KETOROLAC TROMETHAMINE 00002237910 NXP

NU-LEVOCARB 100 MG / 10 MG

TABLET

LEVODOPA/ CARBIDOPA 00002182831 NXP


TABLET

LEVODOPA/ CARBIDOPA 00002182823 NXP


TABLET

LEVODOPA / CARBIDOPA 00002182858 NXP

NU-METFORMIN 500 MG TABLET METFORMIN HCL 00002162822 NXP

NU-METFORMIN 850 MG TABLET METFORMIN HCL 00002229517 NXP

NU-METOCLOPRAMIDE 5 MG

TABLET

METOCLOPRAMIDE HCL 00002143275 NXP

NU-METOCLOPRAMIDE 10 MG

TABLET

METOCLOPRAMIDE HCL 00002143283 NXP

NU-METOP 50 MG TABLET METOPROLOL TARTRATE 00000865605 NXP

NU-METOP 100 MG TABLET METOPROLOL TARTRATE 00000865613 NXP

NU-MOCLOBEMIDE 100 MG TABLET MOCLOBEMIDE 00002237111 NXP

NU-NAPROX 250 MG TABLET NAPROXEN 00000865648 NXP








NU-NORTRIPTYLINE 10 MG

CAPSULE

NORTRIPTYLINE HCL 00002223139 NXP

NU-NORTRIPTYLINE 25 MG

CAPSULE

NORTRIPTYLINE HCL 00002223147 NXP

NU-OXYBUTYN 5 MG TABLET OXYBUTYNIN CHLORIDE 00002158590 NXP

NU-PEN-VK 300 MG TABLET PRAZOSIN HCL 00000717568 NXP

NU-PINDOL 5 MG TABLET PINDOLOL 00000886149 NXP



NU-PIROX 10 MG CAPSULE PIROXICAM 00000865761 NXP

NU-PIROX 20 MG CAPSULE PIROXICAM 00000865788 NXP

NU-PRAZO 1 MG TABLET PRAZOSIN HCL 00001913794 NXP



NU-RANIT 150 MG TABLET RANITIDINE HCL 00000865737 NXP

NU-RANIT 300 MG TABLET RANITIDINE HCL 00000865745 NXP

NU-SELEGILINE 5 MG TABLET SELEGILINE HCL 00002230717 NXP

NU-SOTALOL 80 MG TABLET SOTALOL HCL 00002200996 NXP

NU-SOTALOL 160 MG TABLET SOTALOL HCL 00002163772 NXP

NU-SUCRALFATE 1 G TABLET SUCRALFATE 00002134829 NXP

NU-SULINDAC 150 MG TABLET SULINDAC 00002042576 NXP

NU-SULINDAC 200 MG TABLET SULINDAC 00002042584 NXP

NU-TERAZOSIN 1 MG TABLET TERAZOSIN HCL 00002233047 NXP




NU-TIAPROFENIC 300 MG TABLET TIAPROFENIC ACID 00002146886 NXP

NU-TICLOPIDINE 250 MG TABLET TICLOPIDINE HCL 00002237560 NXP

NU-TIMOLOL 5 MG TABLET TIMOLOL MALEATE 00002044609 NXP

NU-TIMOLOL 10 MG TABLET TIMOLOL MALEATE 00002044617 NXP

NU-TRAZODONE 50 MG TABLET TRAZODONE HCL 00002165384 NXP

NU-TRAZODONE 100 MG TABLET TRAZODONE HCL 00002165392 NXP






NU-TRAZODONE-D 150 MG TABLET TRAZODONE HCL 00002165406 NXP

NU-TRIAZIDE TABLET HYDROCHLOROTHIAZIDE/

TRIAMTERENE

00000865532 NXP

NU-VALPROIC 250 MG CAPSULE VALPROIC ACID 00002237830 NXP

NU-VERAP 120 MG TABLET VERAPAMIL HCL 00000886041 NXP

NU-VERAP 80 MG TABLET VERAPAMIL HCL 00000886033 NXP

NU-ZOPICLONE 7.5 MG TABLET ZOPICLONE 00002228270 NXP

OCTREOTIDE 100 MCG / ML

INJECTION

OCTREOTIDE ACETATE 00002299437 TEV


INJECTION



INJECTION


ONDANSETRON (PRESERVATIVE

FREE) 2 MG / ML INJECTION

ONDANSETRON HCL

DIHYDRATE

00002265524 TEV

ONDANSETRON (PRESERVED) 2 MG

/ ML INJECTION

ONDANSETRON HCL

DIHYDRATE

00002279436 SDZ

ONDANSETRON (UNPRESERVED) 2

MG / ML INJECTION

ONDANSETRON HCL

DIHYDRATE

00002279428 SDZ

ONDANSETRON (WITH

PRESERVATIVE) 2 MG / ML

INJECTION

ONDANSETRON HCL

DIHYDRATE

00002265532 TEV

PMS-BUPROPION SR 100 MG

SUSTAINED-RELEASE TABLET

BUPROPION HCL 00002325373 PMS

PMS-CITALOPRAM 10 MG TABLET CITALOPRAM HYDROBROMIDE 00002270609 PMS

PMS-CLOBETASOL 0.05% SCALP

LOTION

CLOBETASOL 17-PROPIONATE 00002232195 PMS

PMS-CLOBETASOL 0.05% TOPICAL

CREAM



CREAM



OINTMENT



OINTMENT


RATIO-CLOBETASOL 0.05% SCALP

LOTION

CLOBETASOL 17-PROPIONATE 00001910299 RPH






STERILE CEFAZOLIN SODIUM 500

MG / VIAL (BASE) INJECTION

CEFAZOLIN SODIUM 00002108119 TEV

STERILE CEFAZOLIN SODIUM 1 G /

VIAL (BASE) INJECTION


STERILE CEFAZOLIN SODIUM 10 G /

VIAL (BASE) INJECTION


TEVA-HYDRAZIDE 25 MG TABLET HYDROCHLOROTHIAZIDE 00000021474 TEV

TEVA-HYDRAZIDE 50 MG TABLET HYDROCHLOROTHIAZIDE 00000021482 TEV

TICLOPIDINE 250 MG TABLET TICLOPIDINE HCL 00002343045 SNS

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