Maine State Maximum Allowable Cost List as of 08/14/2017
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- Melina Boone
- 6 years ago
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1 UPD 1ST CHOICE LANCETS SUPER (Lancets***) MISC /17/ /19/ ST CHOICE LANCETS THIN (Lancets***) MISC /17/ /19/ ST CHOICE LANCETS ULTRA (Lancets***) MISC /17/ /19/ ST CHOICE LANCETS ULTRA (Lancets***) MISC /17/ /19/ ST TIER UNILET COMFORTOU (Lancets***) MISC /17/ /19/ ST TIER UNILET COMFORTOU (Lancets***) MISC /17/ /19/ N-1 (Dimethicone Cream 1%) CREA /28/ /19/ N-1 (Dimethicone Cream 1%) CREA /28/ /19/ A & D ZINC OXIDE (Dimethicone-Zinc Oxide-Vitamin A-Vitamin D Cream 1-10%***) A & D ZINC OXIDE (Dimethicone-Zinc Oxide-Vitamin A-Vitamin D Cream 1-10%***) CREA /28/ /19/ CREA /28/ /19/ A + D PERSONAL CARE LOTIO (Emollient - Lotion**) LOTN /13/ /19/ A+D FIRST AID (Skin Protectants Misc - Ointment***) OINT /28/ /19/ A-SOY (Nutritional Supplement Liquid**) LIQD /28/ /19/ Abacavir Sulfate Tab 300 MG (Base Equiv) TABS /10/ /08/2017 Abacavir Sulfate-Lamivudine Tab MG TABS /11/ /08/2017 Abacavir Sulfate-Lamivudine-Zidovudine Tab MG TABS /10/ /08/2017 ABSORBASE (Skin Protectants Misc - Ointment***) OINT /28/ /19/ ABSORBASE (Skin Protectants Misc - Ointment***) OINT /28/ /19/ Acamprosate Calcium Tab Delayed Release 333 MG TBEC /11/ /08/2017 Acarbose Tab 100 MG TABS /22/ /19/2013 Acarbose Tab 25 MG TABS /24/ /10/2015 Acarbose Tab 50 MG TABS /22/ /19/2013 ACCU-CHEK ACTIVE STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK AVIVA (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK AVIVA PLUS (Blood Glucose Monitoring Kit w/ KIT /09/ /11/ ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP /10/ /08/ ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip) STRP /11/ /19/ Page 1 Of 216
2 UPD ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMPACT PLUS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMPACT PLUS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMPACT STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMPACT STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK COMPACT TEST DR (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK FASTCLIX LANCET (Lancets***) MISC /17/ /19/ ACCU-CHEK MULTICLIX LANCE (Lancets***) MISC /17/ /19/ ACCU-CHEK MULTICLIX LANCE (Lancets***) MISC /17/ /19/ ACCU-CHEK NANO SMARTVIEW (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ ACCU-CHEK SAFE-T-PRO LANC (Lancets***) MISC /17/ /19/ ACCU-CHEK SAFE-T-PRO PLUS (Lancets***) MISC /17/ /19/ ACCU-CHEK SMARTVIEW STRIP (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK SMARTVIEW STRIP (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK SMARTVIEW STRIP (Glucose Blood Test Strip) STRP /11/ /19/ ACCU-CHEK SOFT TOUCH LANC (Lancets***) MISC /17/ /19/ ACCU-CHEK SOFTCLIX LANCET (Lancets***) MISC /17/ /19/ ACCU-CHEK SOFTCLIX LANCET (Lancets***) MISC /17/ /19/ ACCU-CHEK SOFTCLIX LANCET (Lancets***) MISC /17/ /19/ ACCU-CHEK SOFTCLIX LANCET (Lancets***) MISC /17/ /19/ ACCU-CHEK VOICEMATE (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ ACCU-CHEK VOICEMATE (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ ACCUTREND GLUCOSE (Glucose Blood Test Strip) STRP /11/ /19/ ACCUTREND GLUCOSE (Glucose Blood Test Strip) STRP /11/ /19/ Acebutolol HCl Cap 200 MG CAPS /22/ /19/2013 Acebutolol HCl Cap 400 MG CAPS /22/ /19/2013 ACERFLEX (Nutritional Supplement Powder**) POWD /05/ /19/ Acetaminophen Cap 500 MG CAPS /22/ /19/2013 Acetaminophen Chew Tab 160 MG CHEW /22/ /19/2013 Acetaminophen Chew Tab 80 MG CHEW /22/ /19/2013 Acetaminophen Elixir 160 MG/5ML ELIX /22/ /19/2013 Acetaminophen Liquid 160 MG/5ML LIQD /22/ /19/2013 Acetaminophen Liquid 167 MG/5ML LIQD /22/ /19/2013 Acetaminophen Soln 100 MG/ML SOLN /22/ /19/2013 Acetaminophen Soln 160 MG/5ML SOLN /22/ /19/2013 Acetaminophen Suppos 120 MG SUPP /22/ /19/2013 Page 2 Of 216
3 UPD Acetaminophen Suppos 650 MG SUPP /22/ /19/2013 Acetaminophen Susp 160 MG/5ML SUSP /22/ /19/2013 Acetaminophen Susp 80 MG/0.8ML SUSP /22/ /19/2013 Acetaminophen Tab 325 MG TABS /22/ /19/2013 Acetaminophen Tab 500 MG TABS /22/ /19/2013 Acetaminophen Tab ER 650 MG TBCR /22/ /19/2013 Acetaminophen w/ Codeine Soln MG/5ML SOLN /22/ /19/2013 Acetaminophen w/ Codeine Tab MG TABS /22/ /19/2013 Acetaminophen w/ Codeine Tab MG TABS /22/ /19/2013 Acetaminophen w/ Codeine Tab MG TABS /13/ /11/2017 Acetaminophen w/ Hydrocodone Cap MG CAPS /22/ /19/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /22/ /19/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /08/ /20/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /22/ /20/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /19/ /05/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /22/ /19/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /22/ /19/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /31/ /09/2013 Acetaminophen w/ Hydrocodone Tab MG TABS /22/ /19/2013 Acetazolamide Cap ER 12HR 500 MG CP /12/ /10/2016 Acetazolamide Tab 125 MG TABS /21/ /02/2014 Acetazolamide Tab 250 MG TABS /14/ /12/2017 Acetic Acid 2% in Aluminum Acetate Otic Soln SOLN /22/ /19/2013 Acetic Acid Irrigation Soln 0.25% SOLN /09/ /06/2013 Acetic Acid Otic Soln 2% SOLN /14/ /12/2017 Acetylcysteine Inhal Soln 10% SOLN /22/ /19/2013 Acetylcysteine Inhal Soln 20% SOLN /22/ /19/2013 ACID BLOCKERS DEPLETION (Nutritional Supplement Therapy Pack**) MISC /20/ /19/ Acitretin Cap 25 MG CAPS /08/ /06/2014 ACTEMRA (Tocilizumab IV Inj 200 MG/10ML) SOLN /01/ /08/2017 ACTEMRA (Tocilizumab IV Inj 400 MG/20ML) SOLN /01/ /08/2017 ACTEMRA (Tocilizumab IV Inj 80 MG/4ML) SOLN /01/ /08/2017 ACTEMRA (Tocilizumab Subcutaneous Soln Prefilled Syringe 162 MG/0.9ML) SOSY /01/ /08/2017 ACTI-LANCE LANCETS 28G (Lancets***) MISC /17/ /19/ ACTI-LANCE LITE SAFETY LA (Lancets***) MISC /17/ /19/ ACTI-LANCE LITE SAFETY LA (Lancets***) MISC /17/ /19/ Page 3 Of 216
4 UPD ACTI-LANCE LITE SAFETY LA (Lancets***) MISC /17/ /19/ ACTI-LANCE LITE SAFETY LA (Lancets***) MISC /17/ /19/ ACTI-LANCE LITE SAFETY LA (Lancets***) MISC /17/ /19/ ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC /17/ /19/ ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC /17/ /19/ ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC /17/ /19/ ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC /17/ /19/ ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC /17/ /19/ ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC /17/ /19/ ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC /17/ /19/ ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC /17/ /19/ ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC /17/ /19/ ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC /17/ /19/ ACTIQ (Fentanyl Citrate Lozenge on a Handle 1600 MCG) LPOP /23/ /19/ ACURA BLOOD GLUCOSE MONIT (Blood Glucose Monitoring Kit w/ ACURA BLOOD GLUCOSE MONIT (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ KIT /01/ /19/ ACURA BLOOD GLUCOSE TEST (Glucose Blood Test Strip) STRP /11/ /19/ ACURA PLUS BLOOD GLUCOSE (Blood Glucose Monitoring Kit w/ ACURA PLUS BLOOD GLUCOSE (Blood Glucose Monitoring Kit w/ ACURA PLUS BLOOD GLUCOSE (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ KIT /01/ /19/ KIT /01/ /19/ Acyclovir Cap 200 MG CAPS /22/ /19/2013 Acyclovir Oint 5% OINT /12/ /09/2015 Acyclovir Susp 200 MG/5ML SUSP /11/ /09/2016 Acyclovir Tab 400 MG TABS /14/ /12/2016 Acyclovir Tab 800 MG TABS /14/ /12/2016 Adapalene Cream 0.1% CREA /12/ /09/2013 Adapalene Gel 0.1% GEL /09/ /07/2015 ADCETRIS (Brentuximab Vedotin For IV Soln 50 MG) SOLR /29/ /08/2017 ADCIRCA (Tadalafil Tab 20 MG (PAH)) TABS /02/ /22/2017 ADEMPAS (Riociguat Tab 0.5 MG) TABS /01/ /11/2017 ADEMPAS (Riociguat Tab 1 MG) TABS /01/ /11/2017 ADEMPAS (Riociguat Tab 1.5 MG) TABS /01/ /11/2017 ADEMPAS (Riociguat Tab 2 MG) TABS /01/ /11/2017 ADEMPAS (Riociguat Tab 2.5 MG) TABS /01/ /11/2017 ADULT GROWTH HORMONE SUPP (Nutritional Supplement Therapy Pack**) MISC /20/ /19/ Page 4 Of 216
5 UPD ADULT ONE DAILY GUMMIES (Multiple Vitamins w/ Minerals Chew Tab**) CHEW /20/ /19/ ADVANCE INTUITION BLOOD G (Blood Glucose Monitoring Kit w/ KIT /23/ /19/ ADVANCE INTUITION TEST ST (Glucose Blood Test Strip) STRP /11/ /19/ ADVANCE MICRO-DRAW TEST S (Glucose Blood Test Strip) STRP /11/ /19/ ADVANCE MICRO-DRAW TEST S (Glucose Blood Test Strip) STRP /11/ /19/ ADVANCED DIABETIC MULTIVI (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ ADVANTAGE INFANT ULA/ (Infant Foods Powder**) POWD /24/ /19/ ADVATE (Antihemophilic Factor rahf-pfm For Inj 1000 Unit) SOLR /08/ /06/2015 ADVATE (Antihemophilic Factor rahf-pfm For Inj 1500 Unit) SOLR /10/ /07/2015 ADVATE (Antihemophilic Factor rahf-pfm For Inj 2000 Unit) SOLR /08/ /06/2015 ADVATE (Antihemophilic Factor rahf-pfm For Inj 250 Unit) SOLR /10/ /07/2014 ADVATE (Antihemophilic Factor rahf-pfm For Inj 3000 Unit) SOLR /08/ /06/2015 ADVATE (Antihemophilic Factor rahf-pfm For Inj 4000 Unit) SOLR /08/ /06/2014 ADVATE (Antihemophilic Factor rahf-pfm For Inj 500 Unit) SOLR /10/ /07/2014 ADVERA (Nutritional Supplement Liquid**) LIQD /28/ /19/ ADVERA (Nutritional Supplement Liquid**) LIQD /28/ /19/ ADVERA (Nutritional Supplement Liquid**) LIQD /28/ /19/ ADVERA (Nutritional Supplement Liquid**) LIQD /28/ /19/ ADVERA (Nutritional Supplement Liquid**) LIQD /28/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ Page 5 Of 216
6 UPD ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVIL (Ibuprofen Tab 200 MG) TABS /20/ /19/ ADVOCATE ARM BLOOD PRESSU (Blood Pressure Monitoring - DEVI /11/ /19/ ADVOCATE BLOOD GLUCOSE MO (Blood Glucose Monitoring Kit w/ ADVOCATE BLOOD GLUCOSE MO (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ KIT /01/ /19/ ADVOCATE LANCETS (Lancets***) MISC /17/ /19/ ADVOCATE LANCETS (Lancets***) MISC /17/ /19/ ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP /11/ /19/ ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP /11/ /19/ ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP /11/ /19/ ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP /11/ /19/ ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP /11/ /19/ ADVOCATE REDI-CODE/TALKIN (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ ADVOCATE SAFETY LANCETS (Lancets***) MISC /17/ /19/ ADVOCATE TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ADYNOVATE (Antihemophilic Factor Recomb Pegylated For Inj 1000 Unit) SOLR /15/ /13/2016 ADYNOVATE (Antihemophilic Factor Recomb Pegylated For Inj 2000 Unit) SOLR /15/ /13/2016 ADYNOVATE (Antihemophilic Factor Recomb Pegylated For Inj 250 Unit) SOLR /15/ /13/2016 ADYNOVATE (Antihemophilic Factor Recomb Pegylated For Inj 500 Unit) SOLR /15/ /13/2016 AF LANCETS SUPER THIN (Lancets***) MISC /17/ /19/ AFINITOR (Everolimus Tab 10 MG) TABS /08/ /12/2017 AFINITOR (Everolimus Tab 5 MG) TABS /08/ /12/2017 AFINITOR (Everolimus Tab 7.5 MG) TABS /08/ /12/2017 AFINITOR DISPERZ (Everolimus Tab for Oral Susp 2 MG) TBSO /08/ /12/2017 AFINITOR DISPERZ (Everolimus Tab for Oral Susp 3 MG) TBSO /08/ /12/2017 AFINITOR DISPERZ (Everolimus Tab for Oral Susp 5 MG) TBSO /08/ /12/2017 AGAMATRIX AMP NO CODE TES (Glucose Blood Test Strip) STRP /11/ /19/ AGAMATRIX JAZZ TEST STRIP (Glucose Blood Test Strip) STRP /11/ /19/ AGAMATRIX JAZZ TEST STRIP (Glucose Blood Test Strip) STRP /11/ /19/ AGAMATRIX JAZZ WIRELESS 2 (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ AGAMATRIX KEYNOTE TEST ST (Glucose Blood Test Strip) STRP /11/ /19/ AGAMATRIX KEYNOTE TEST ST (Glucose Blood Test Strip) STRP /11/ /19/ AGAMATRIX PRESTO (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ Page 6 Of 216
7 UPD AGAMATRIX PRESTO (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ AGAMATRIX PRESTO (Blood Glucose Monitoring Kit w/ KIT /01/ /19/ AGAMATRIX PRESTO TEST STR (Glucose Blood Test Strip) STRP /11/ /19/ AGAMATRIX ULTRA-THIN LANC (Lancets***) MISC /17/ /19/ AKYNZEO (Netupitant-Palonosetron Cap MG) CAPS /10/ /02/2016 Albuterol Sulfate Soln Nebu 0.083% (2.5 MG/3ML) NEBU /22/ /19/2013 Albuterol Sulfate Soln Nebu 0.5% (5 MG/ML) NEBU /14/ /12/2017 Albuterol Sulfate Soln Nebu 0.63 MG/3ML (Base Equiv) NEBU /09/ /07/2017 Albuterol Sulfate Soln Nebu 1.25 MG/3ML (Base Equiv) NEBU /12/ /12/2017 Albuterol Sulfate Syrup 2 MG/5ML SYRP /22/ /19/2013 Albuterol Sulfate Tab 2 MG TABS /17/ /12/2014 Albuterol Sulfate Tab 4 MG TABS /09/ /07/2015 Albuterol Sulfate Tab ER 12HR 4 MG TB /22/ /19/2013 Albuterol Sulfate Tab ER 12HR 8 MG TB /22/ /19/2013 Alclometasone Dipropionate Cream 0.05% CREA /10/ /08/2014 Alclometasone Dipropionate Oint 0.05% OINT /22/ /19/2013 ALDURAZYME (Laronidase Soln For IV Infusion 2.9 MG/5ML (500 Unit/5ML)) SOLN /10/ /02/2016 Alendronate Sodium Tab 10 MG TABS /22/ /19/2013 Alendronate Sodium Tab 35 MG TABS /22/ /19/2013 Alendronate Sodium Tab 40 MG TABS /22/ /19/2013 Alendronate Sodium Tab 5 MG TABS /22/ /19/2013 Alendronate Sodium Tab 70 MG TABS /22/ /19/2013 ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ Page 7 Of 216
8 UPD ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ ALEVE ARTHRITIS (Naproxen Sodium Tab 220 MG) TABS /20/ /19/ Alfuzosin HCl Tab ER 24HR 10 MG TB /17/ /15/2017 ALIMENTUM (Infant Foods Liquid**) LIQD /27/ /19/ ALIMENTUM (Infant Foods Liquid**) LIQD /27/ /19/ ALIMENTUM (Infant Foods Liquid**) LIQD /27/ /19/ ALIMENTUM (Infant Foods Liquid**) LIQD /27/ /19/ ALIMENTUM (Infant Foods Powder**) POWD /24/ /19/ ALITRAQ (Nutritional Supplement Pack**) PACK /15/ /19/ ALITRAQ (Nutritional Supplement Pack**) PACK /15/ /19/ ALIVE MENS ENERGY (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ ALIVE ONCE DAILY WOMENS 5 (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ ALIVE WOMENS 50+ (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ ALIVE WOMENS ENERGY (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ ALKERAN (Melphalan Tab 2 MG) TABS /17/ /09/2016 Allopurinol Tab 100 MG TABS /09/ /07/2017 Allopurinol Tab 300 MG TABS /12/ /10/2016 ALOE AFTERSUN LOTION (Emollient - Lotion**) LOTN /13/ /19/ ALOE VESTA 2-N-1 PROTECTI (Skin Protectants Misc - Ointment***) OINT /28/ /19/ ALOE VESTA PROTECTIVE (Skin Protectants Misc - Ointment***) OINT /28/ /19/ ALOE VESTA PROTECTIVE (Skin Protectants Misc - Ointment***) OINT /28/ /19/ ALOE VESTA PROTECTIVE (Skin Protectants Misc - Ointment***) OINT /28/ /19/ ALOPRIM (Allopurinol Sodium For Inj 500 MG) SOLR /10/ /02/2016 ALOXI (Palonosetron HCl IV Soln 0.25 MG/5ML (Base Equivalent)) SOLN /08/ /12/2016 ALPHANATE/VON WILLEBRAND (Antihemophilic Factor/VWF (Human) For Inj 1000 Unit) ALPHANATE/VON WILLEBRAND (Antihemophilic Factor/VWF (Human) For Inj 1500 Unit) ALPHANATE/VON WILLEBRAND (Antihemophilic Factor/VWF (Human) For Inj 2000 Unit) ALPHANATE/VON WILLEBRAND (Antihemophilic Factor/VWF (Human) For Inj 250 Unit) ALPHANATE/VON WILLEBRAND (Antihemophilic Factor/VWF (Human) For Inj 500 Unit) SOLR /24/ /19/ SOLR /24/ /19/ SOLR /08/ /06/2015 SOLR /24/ /19/ SOLR /24/ /19/ ALPHANINE SD (Coagulation Factor IX For Inj 1000 Unit) SOLR /08/ /06/2015 ALPHANINE SD (Coagulation Factor IX For Inj 1500 Unit) SOLR /08/ /06/2015 Page 8 Of 216
9 UPD ALPHANINE SD (Coagulation Factor IX For Inj 500 Unit) SOLR /24/ /19/ Alprazolam Orally Disintegrating Tab 0.25 MG TBDP /22/ /19/2013 Alprazolam Orally Disintegrating Tab 0.5 MG TBDP /13/ /11/2015 Alprazolam Orally Disintegrating Tab 1 MG TBDP /22/ /19/2013 Alprazolam Orally Disintegrating Tab 2 MG TBDP /22/ /19/2013 Alprazolam Tab 0.25 MG TABS /22/ /19/2013 Alprazolam Tab 0.5 MG TABS /22/ /19/2013 Alprazolam Tab 1 MG TABS /22/ /19/2013 Alprazolam Tab 2 MG TABS /22/ /19/2013 Alprazolam Tab ER 24HR 0.5 MG TB /22/ /19/2013 Alprazolam Tab ER 24HR 1 MG TB /08/ /06/2016 Alprazolam Tab ER 24HR 2 MG TB /09/ /07/2015 Alprazolam Tab ER 24HR 3 MG TB /09/ /07/2015 ALPROLIX (Coagulation Factor IX (Recomb) (rfixfc) For Inj 1000 Unit) SOLR /14/ /12/2014 ALPROLIX (Coagulation Factor IX (Recomb) (rfixfc) For Inj 2000 Unit) SOLR /14/ /12/2014 ALPROLIX (Coagulation Factor IX (Recomb) (rfixfc) For Inj 3000 Unit) SOLR /14/ /12/2014 ALPROLIX (Coagulation Factor IX (Recomb) (rfixfc) For Inj 500 Unit) SOLR /14/ /12/2014 ALSOY SOY ULA (Infant Foods Conc**) CONC /28/ /19/ ALSOY SOY ULA (Infant Foods Conc**) CONC /28/ /19/ ALSOY SOY ULA (Infant Foods Liquid**) LIQD /27/ /19/ ALSOY SOY ULA (Infant Foods Liquid**) LIQD /27/ /19/ ALSOY SOY ULA (Infant Foods Powder**) POWD /24/ /19/ ALSOY SOY ULA (Infant Foods Powder**) POWD /24/ /19/ Alum & Mag Hydroxide-Simethicone Susp MG/5ML LIQD /22/ /19/2013 Alum & Mag Hydroxide-Simethicone Susp MG/5ML SUSP /22/ /19/2013 Alum & Mag Hydroxide-Simethicone Susp MG/5ML LIQD /22/ /19/2013 Alum & Mag Hydroxide-Simethicone Susp MG/5ML SUSP /22/ /19/2013 Aluminum Chloride Soln 20% SOLN /22/ /19/2013 Aluminum Hydroxide Gel Susp 320 MG/5ML SUSP /22/ /19/2013 Amantadine HCl Cap 100 MG CAPS /15/ /10/2017 Amantadine HCl Syrup 50 MG/5ML SYRP /22/ /19/2013 AMBI ESSENTIALS DAILY MOI (Emollient - Lotion**) LOTN /13/ /19/ AMBI EVEN & CLEAR DAILY M (Emollient - Lotion**) LOTN /13/ /19/ AMBI SOFT & EVEN CREAMY O (Emollient - Lotion**) LOTN /13/ /19/ Amcinonide Cream 0.1% CREA /22/ /19/2013 Amiloride & Hydrochlorothiazide Tab 5-50 MG TABS /30/ /05/2013 Page 9 Of 216
10 UPD Amiloride HCl Tab 5 MG TABS /11/ /09/2016 Amino Acids Tab*** TABS /22/ /19/2013 Aminocaproic Acid Inj 250 MG/ML SOLN /22/ /19/2013 Aminocaproic Acid Syrup 25% SYRP /08/ /05/2013 Aminocaproic Acid Tab 500 MG TABS /22/ /19/2013 Amiodarone HCl Tab 100 MG TABS /12/ /10/2016 Amiodarone HCl Tab 200 MG TABS /12/ /10/2016 Amiodarone HCl Tab 400 MG TABS /22/ /19/2013 Amitriptyline HCl Tab 10 MG TABS /21/ /09/2014 Amitriptyline HCl Tab 100 MG TABS /01/ /12/2017 Amitriptyline HCl Tab 150 MG TABS /09/ /07/2017 Amitriptyline HCl Tab 25 MG TABS /08/ /05/2016 Amitriptyline HCl Tab 50 MG TABS /23/ /08/2017 Amitriptyline HCl Tab 75 MG TABS /10/ /08/2017 Amlodipine Besylate Tab 10 MG TABS /22/ /19/2013 Amlodipine Besylate Tab 2.5 MG TABS /22/ /19/2013 Amlodipine Besylate Tab 5 MG TABS /22/ /19/2013 Amlodipine Besylate-Atorvastatin Calcium Tab MG TABS /08/ /05/2016 Amlodipine Besylate-Atorvastatin Calcium Tab MG TABS /14/ /12/2017 Amlodipine Besylate-Atorvastatin Calcium Tab MG TABS /13/ /09/2013 Amlodipine Besylate-Atorvastatin Calcium Tab MG TABS /11/ /09/2015 Amlodipine Besylate-Atorvastatin Calcium Tab MG TABS /11/ /09/2015 Amlodipine Besylate-Atorvastatin Calcium Tab MG TABS /11/ /09/2015 Amlodipine Besylate-Atorvastatin Calcium Tab MG TABS /11/ /09/2015 Amlodipine Besylate-Atorvastatin Calcium Tab 5-10 MG TABS /10/ /08/2017 Amlodipine Besylate-Atorvastatin Calcium Tab 5-20 MG TABS /17/ /15/2017 Amlodipine Besylate-Atorvastatin Calcium Tab 5-40 MG TABS /13/ /09/2013 Amlodipine Besylate-Atorvastatin Calcium Tab 5-80 MG TABS /11/ /09/2015 Amlodipine Besylate-Benazepril HCl Cap MG CAPS /10/ /08/2017 Amlodipine Besylate-Benazepril HCl Cap MG CAPS /10/ /08/2017 Amlodipine Besylate-Benazepril HCl Cap MG CAPS /11/ /09/2013 Amlodipine Besylate-Benazepril HCl Cap 5-10 MG CAPS /08/ /05/2016 Amlodipine Besylate-Benazepril HCl Cap 5-20 MG CAPS /10/ /08/2017 Amlodipine Besylate-Benazepril HCl Cap 5-40 MG CAPS /11/ /09/2013 Amlodipine Besylate-Olmesartan Medoxomil Tab MG TABS /10/ /08/2017 Amlodipine Besylate-Olmesartan Medoxomil Tab MG TABS /10/ /08/2017 Page 10 Of 216
11 UPD Amlodipine Besylate-Olmesartan Medoxomil Tab 5-20 MG TABS /09/ /07/2016 Amlodipine Besylate-Olmesartan Medoxomil Tab 5-40 MG TABS /09/ /07/2016 Amlodipine Besylate-Valsartan Tab MG TABS /10/ /07/2015 Amlodipine Besylate-Valsartan Tab MG TABS /10/ /07/2015 Amlodipine Besylate-Valsartan Tab MG TABS /10/ /08/2017 Amlodipine Besylate-Valsartan Tab MG TABS /10/ /08/2017 Amlodipine-Valsartan-Hydrochlorothiazide Tab MG TABS /13/ /11/2015 Amlodipine-Valsartan-Hydrochlorothiazide Tab MG TABS /13/ /11/2015 Amlodipine-Valsartan-Hydrochlorothiazide Tab MG TABS /13/ /11/2015 Amlodipine-Valsartan-Hydrochlorothiazide Tab MG TABS /13/ /11/2015 Amlodipine-Valsartan-Hydrochlorothiazide Tab MG TABS /13/ /11/2015 Amoxicillin & K Clavulanate Chew Tab MG CHEW /22/ /09/2013 Amoxicillin & K Clavulanate Chew Tab MG CHEW /22/ /19/2013 Amoxicillin & K Clavulanate For Susp MG/5ML SUSR /22/ /19/2013 Amoxicillin & K Clavulanate For Susp MG/5ML SUSR /10/ /08/2017 Amoxicillin & K Clavulanate For Susp MG/5ML SUSR /14/ /12/2017 Amoxicillin & K Clavulanate For Susp MG/5ML SUSR /13/ /11/2017 Amoxicillin & K Clavulanate Tab MG TABS /22/ /19/2013 Amoxicillin & K Clavulanate Tab MG TABS /14/ /12/2017 Amoxicillin & K Clavulanate Tab MG TABS /10/ /08/2017 Amoxicillin & K Clavulanate Tab ER 12HR MG TB /17/ /15/2017 Amoxicillin (Trihydrate) Cap 250 MG CAPS /22/ /19/2013 Amoxicillin (Trihydrate) Cap 500 MG CAPS /22/ /19/2013 Amoxicillin (Trihydrate) Chew Tab 125 MG CHEW /22/ /19/2013 Amoxicillin (Trihydrate) Chew Tab 250 MG CHEW /16/ /10/2016 Amoxicillin (Trihydrate) For Susp 125 MG/5ML SUSR /22/ /19/2013 Amoxicillin (Trihydrate) For Susp 200 MG/5ML SUSR /22/ /19/2013 Amoxicillin (Trihydrate) For Susp 250 MG/5ML SUSR /22/ /19/2013 Amoxicillin (Trihydrate) For Susp 400 MG/5ML SUSR /22/ /19/2013 Amoxicillin (Trihydrate) Tab 500 MG TABS /22/ /19/2013 Amoxicillin (Trihydrate) Tab 875 MG TABS /08/ /05/2016 Amphetamine-Dextroamphetamine Cap ER 24HR 10 MG CP /11/ /08/2017 Amphetamine-Dextroamphetamine Cap ER 24HR 15 MG CP /08/ /06/2016 Amphetamine-Dextroamphetamine Cap ER 24HR 20 MG CP /13/ /11/2017 Amphetamine-Dextroamphetamine Cap ER 24HR 25 MG CP /09/ /07/2017 Amphetamine-Dextroamphetamine Cap ER 24HR 30 MG CP /11/ /08/2017 Page 11 Of 216
12 UPD Amphetamine-Dextroamphetamine Cap ER 24HR 5 MG CP /11/ /09/2015 Amphetamine-Dextroamphetamine Tab 10 MG TABS /09/ /07/2016 Amphetamine-Dextroamphetamine Tab 12.5 MG TABS /09/ /01/2016 Amphetamine-Dextroamphetamine Tab 15 MG TABS /06/ /07/2017 Amphetamine-Dextroamphetamine Tab 20 MG TABS /09/ /07/2017 Amphetamine-Dextroamphetamine Tab 30 MG TABS /13/ /11/2017 Amphetamine-Dextroamphetamine Tab 5 MG TABS /17/ /08/2017 Amphetamine-Dextroamphetamine Tab 7.5 MG TABS /10/ /08/2017 Ampicillin & Sulbactam Sodium For Inj 1.5 (1-0.5) GM SOLR /22/ /19/2013 Ampicillin & Sulbactam Sodium For Inj 15 (10-5) GM SOLR /22/ /19/2013 Ampicillin & Sulbactam Sodium For Inj 3 (2-1) GM SOLR /22/ /19/2013 Ampicillin & Sulbactam Sodium For IV Soln 1.5 (1-0.5) GM SOLR /22/ /19/2013 Ampicillin & Sulbactam Sodium For IV Soln 15 (10-5) GM SOLR /22/ /19/2013 Ampicillin & Sulbactam Sodium For IV Soln 3 (2-1) GM SOLR /22/ /19/2013 Ampicillin Cap 250 MG CAPS /22/ /19/2013 Ampicillin Cap 500 MG CAPS /22/ /19/2013 Ampicillin For Susp 125 MG/5ML SUSR /22/ /19/2013 Ampicillin For Susp 250 MG/5ML SUSR /22/ /19/2013 AMPYRA (Dalfampridine Tab ER 12HR 10 MG) TB /01/ /08/2017 Anagrelide HCl Cap 0.5 MG CAPS /22/ /19/2013 Anagrelide HCl Cap 1 MG CAPS /22/ /19/2013 ANASCORP (Centruroides (Scorpion) Imm F(ab')2 (Equine) For IV Infusion) SOLR /01/ /08/2017 Anastrozole Tab 1 MG TABS /11/ /09/2015 ANTI-SEIZURE DEPLETION (Nutritional Supplement Therapy Pack**) MISC /20/ /19/ ANTI-SEIZURE SUPPORT (Nutritional Supplement Therapy Pack**) MISC /20/ /19/ ANTIOXIDANT FORTE (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ AP-ZEL (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ APATATE FORTE (Multiple Vitamins w/ Minerals Liquid**) LIQD /20/ /19/ AQUA GLYCOLIC HAND & BODY (Emollient - Lotion**) LOTN /13/ /19/ AQUA LACTEN (Emollient - Lotion**) LOTN /13/ /19/ AQUADEKS (Multiple Vitamins w/ Minerals Cap**) CAPS /27/ /19/ AQUADEKS (Multiple Vitamins w/ Minerals Chew Tab**) CHEW /14/ /20/ AQUADERM TREATMENT/MOISTU (Emollient - Lotion**) LOTN /13/ /19/ AQUAMED (Emollient - Lotion**) LOTN /13/ /19/ AQUAPHILIC (Emollient - Ointment**) OINT /13/ /19/ AQUAPHILIC (Emollient - Ointment**) OINT /13/ /19/ Page 12 Of 216
13 UPD AQUAPHOR (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR ADVANCED THERAPY (Emollient - Ointment**) OINT /13/ /19/ AQUAPHOR LIP REPAIR (Skin Protectants Misc - Ointment***) OINT /28/ /19/ ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV Soln 1000 MG) SOLR /06/ /11/ ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV Soln 400 MG) SOLR /06/ /11/ ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV Soln 800 MG) SOLR /06/ /11/ ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Inj 100 MCG/ML) SOLN /17/ /08/2017 ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Inj 150 MCG/0.75ML) SOLN /13/ /27/2015 ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Inj 200 MCG/ML) SOLN /17/ /08/2017 ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Inj 25 MCG/ML) SOLN /17/ /08/2017 ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Inj 300 MCG/ML) SOLN /17/ /08/2017 ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Inj 40 MCG/ML) SOLN /17/ /08/2017 ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Inj 60 MCG/ML) SOLN /17/ /08/2017 ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 100 MCG/0.5ML) ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 150 MCG/0.3ML) ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 200 MCG/0.4ML) ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 25 MCG/0.42ML) ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 300 MCG/0.6ML) ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 40 MCG/0.4ML) ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 500 MCG/ML) ARANESP ALBUMIN FREE (Darbepoetin Alfa Soln Prefilled Syringe 60 MCG/0.3ML) SOSY /17/ /08/2017 SOSY /17/ /08/2017 SOSY /17/ /08/2017 SOSY /17/ /08/2017 SOSY /17/ /08/2017 SOSY /17/ /08/2017 SOSY /17/ /08/2017 SOSY /17/ /08/2017 ARCALYST (Rilonacept For Inj 220 MG) SOLR /10/ /02/2016 ARGINAID EXTRA (Nutritional Supplement Liquid**) LIQD /28/ /19/ ARGINAID EXTRA (Nutritional Supplement Liquid**) LIQD /28/ /19/ Aripiprazole Oral Solution 1 MG/ML SOLN /31/ /12/2017 Aripiprazole Tab 10 MG TABS /09/ /07/2017 Aripiprazole Tab 15 MG TABS /11/ /08/2017 Aripiprazole Tab 2 MG TABS /10/ /08/2017 Page 13 Of 216
14 UPD Aripiprazole Tab 20 MG TABS /10/ /08/2017 Aripiprazole Tab 30 MG TABS /10/ /08/2017 Aripiprazole Tab 5 MG TABS /11/ /08/2017 ARIXTRA (Fondaparinux Sodium Subcutaneous Inj 2.5 MG/0.5ML) SOLN /02/ /12/2014 Armodafinil Tab 150 MG TABS /11/ /08/2017 Armodafinil Tab 200 MG TABS /11/ /08/2017 Armodafinil Tab 250 MG TABS /11/ /08/2017 Armodafinil Tab 50 MG TABS /11/ /08/2017 Artificial Tear Ophth Ointment*** OINT /17/ /15/2017 Artificial Tear Ophth Solution*** SOLN /04/ /05/2016 ARZERRA (Ofatumumab Conc For IV Infusion 100 MG/5ML) CONC /11/ /08/2017 ARZERRA (Ofatumumab Conc For IV Infusion 1000 MG/50ML) CONC /11/ /08/2017 ASCENSIA AUTODISC TEST ST (Glucose Blood Test Disk) DISK /22/ /19/ ASCENSIA AUTODISC TEST ST (Glucose Blood Test Disk) DISK /22/ /19/ ASCENSIA AUTODISC TEST ST (Glucose Blood Test Disk) DISK /22/ /19/ Ascorbic Acid Cap ER 500 MG CPCR /22/ /19/2013 Ascorbic Acid Chew Tab 250 MG CHEW /22/ /19/2013 Ascorbic Acid Chew Tab 500 MG CHEW /22/ /19/2013 Ascorbic Acid Syrup 500 MG/5ML SYRP /22/ /19/2013 Ascorbic Acid Tab 1000 MG TABS /22/ /19/2013 Ascorbic Acid Tab 250 MG TABS /22/ /19/2013 Ascorbic Acid Tab 500 MG TABS /22/ /19/2013 Ascorbic Acid Tab ER 1000 MG TBCR /22/ /19/2013 Ascorbic Acid Tab ER 500 MG TBCR /22/ /19/2013 ASPERCREME/ALOE (Trolamine Salicylate Cream 10%) CREA /28/ /19/ ASPERCREME/ALOE (Trolamine Salicylate Cream 10%) CREA /28/ /19/ ASPERCREME/ALOE (Trolamine Salicylate Cream 10%) CREA /28/ /19/ Aspirin Buffered (Ca Carb-Mg Carb-Mg Ox) Tab 325 MG TABS /22/ /19/2013 Aspirin Chew Tab 81 MG CHEW /22/ /19/2013 Aspirin Tab 325 MG TABS /22/ /19/2013 Aspirin Tab 81 MG TABS /22/ /19/2013 Aspirin Tab Delayed Release 325 MG TBEC /22/ /19/2013 Aspirin Tab Delayed Release 81 MG TBEC /22/ /19/2013 Aspirin-Acetaminophen-Caffeine Tab MG TABS /22/ /19/2013 ASSURE 3 TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE 3 TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ Page 14 Of 216
15 UPD ASSURE 4 TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE 4 TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE HAEMOLANCE PLUS HI (Lancets***) MISC /17/ /19/ ASSURE HAEMOLANCE PLUS LO (Lancets***) MISC /17/ /19/ ASSURE HAEMOLANCE PLUS MI (Lancets***) MISC /17/ /19/ ASSURE HAEMOLANCE PLUS NO (Lancets***) MISC /17/ /19/ ASSURE HAEMOLANCE PLUS PE (Lancets***) MISC /17/ /19/ ASSURE II (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE II CHECK STRIP (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE II TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE LANCE LANCETS (Lancets***) MISC /17/ /19/ ASSURE LANCE LANCETS (Lancets***) MISC /17/ /19/ ASSURE LANCE LANCETS (Lancets***) MISC /17/ /19/ ASSURE LANCE LANCETS (Lancets***) MISC /17/ /19/ ASSURE LANCETS (Lancets***) MISC /17/ /19/ ASSURE PLATINUM TEST STRI (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE PLATINUM TEST STRI (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE PRO TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ ASSURE PRO TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ AT LAST LANCETS (Lancets***) MISC /17/ /19/ AT LAST TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ AT LAST TEST STRIPS (Glucose Blood Test Strip) STRP /11/ /19/ Atenolol & Chlorthalidone Tab MG TABS /19/ /08/2017 Atenolol & Chlorthalidone Tab MG TABS /12/ /09/2015 Atenolol Tab 100 MG TABS /22/ /19/2013 Atenolol Tab 25 MG TABS /22/ /19/2013 Atenolol Tab 50 MG TABS /22/ /19/2013 Atomoxetine HCl Cap 10 MG (Base Equiv) CAPS /14/ /12/2017 Atomoxetine HCl Cap 100 MG (Base Equiv) CAPS /14/ /12/2017 Atomoxetine HCl Cap 18 MG (Base Equiv) CAPS /14/ /12/2017 Atomoxetine HCl Cap 25 MG (Base Equiv) CAPS /14/ /12/2017 Atomoxetine HCl Cap 40 MG (Base Equiv) CAPS /14/ /12/2017 Atomoxetine HCl Cap 60 MG (Base Equiv) CAPS /14/ /12/2017 Atomoxetine HCl Cap 80 MG (Base Equiv) CAPS /14/ /12/2017 Atorvastatin Calcium Tab 10 MG (Base Equivalent) TABS /12/ /10/2016 Atorvastatin Calcium Tab 20 MG (Base Equivalent) TABS /12/ /10/2016 Page 15 Of 216
16 UPD Atorvastatin Calcium Tab 40 MG (Base Equivalent) TABS /12/ /10/2016 Atorvastatin Calcium Tab 80 MG (Base Equivalent) TABS /09/ /07/2017 Atovaquone Susp 750 MG/5ML SUSP /14/ /12/2017 Atovaquone-Proguanil HCl Tab MG TABS /08/ /06/2015 Atropine Sulfate Ophth Oint 1% OINT /22/ /19/2013 Atropine Sulfate Ophth Soln 1% SOLN /12/ /11/ Atropine Sulfate Ophth Soln 1% SOLN /05/ /02/2016 AUBAGIO (Teriflunomide Tab 14 MG) TABS /07/ /09/2016 AUBAGIO (Teriflunomide Tab 7 MG) TABS /07/ /09/2016 AURORA LANCET SUPER THIN (Lancets***) MISC /17/ /19/ AURORA LANCET THIN 23G (Lancets***) MISC /17/ /19/ AVASTIN (Bevacizumab IV Soln 100 MG/4ML (For Infusion)) SOLN /01/ /08/2017 AVASTIN (Bevacizumab IV Soln 400 MG/16ML (For Infusion)) SOLN /01/ /08/2017 AVEENO CONTINUOUS RADIANC (Emollient - Lotion**) LOTN /13/ /19/ AVEENO DAILY FIRMING (Emollient - Lotion**) LOTN /13/ /19/ AVEENO DAILY MOISTURIZING (Dimethicone Lotion 1.3%) LOTN /13/ /19/ AVEENO DAILY MOISTURIZING (Emollient - Lotion**) LOTN /13/ /19/ AVEENO POSITIVELY AGELESS (Emollient - Lotion**) LOTN /13/ /19/ AVEENO POSITIVELY RADIANT (Emollient - Lotion**) LOTN /13/ /19/ AVEENO POSITIVELY SMOOTH (Emollient - Lotion**) LOTN /13/ /19/ AVEENO STRESS RELIEF MOIS (Emollient - Lotion**) LOTN /13/ /19/ AVEENO STRESS RELIEF MOIS (Emollient - Lotion**) LOTN /13/ /19/ AVONEX (Interferon Beta-1a For IM Inj Kit 30MCG (33MCG(6.6 MU)/Vial)) KIT /01/ /08/2017 AVONEX PEN (Interferon Beta-1a IM Auto-Injector Kit 30 MCG/0.5ML) AJKT /01/ /08/2017 Azathioprine Tab 50 MG TABS /17/ /12/2017 Azelastine HCl Nasal Spray 0.1% (137 MCG/SPRAY) SOLN /10/ /08/2017 Azelastine HCl Nasal Spray 0.15% (205.5 MCG/SPRAY) SOLN /14/ /12/2017 Azelastine HCl Ophth Soln 0.05% SOLN /10/ /08/2017 Azithromycin For Susp 100 MG/5ML SUSR /10/ /08/2017 Azithromycin For Susp 200 MG/5ML SUSR /21/ /10/2017 Azithromycin IV For Soln 500 MG SOLR /22/ /19/2013 Azithromycin Tab 250 MG TABS /10/ /08/2017 Azithromycin Tab 500 MG TABS /17/ /08/2017 Azithromycin Tab 600 MG TABS /08/ /05/2016 B-Complex Vitamin Cap** CAPS /22/ /19/2013 B-Complex Vitamin Tab ER** TBCR /22/ /19/2013 Page 16 Of 216
17 UPD B-Complex Vitamin Tab** TABS /22/ /19/2013 B-Complex w/ C & E + Zn Tab*** TABS /22/ /19/2013 B-Complex w/ C & Folic Acid Cap 1 MG*** CAPS /22/ /19/2013 B-Complex w/ C & Folic Acid Tab 0.8 MG*** TABS /22/ /19/2013 B-Complex w/ C & Folic Acid Tab 1 MG*** TABS /22/ /19/2013 B-Complex w/ C & Folic Acid Tab*** TABS /22/ /19/2013 B-Complex w/ C Cap** CAPS /22/ /19/2013 B-Complex w/ C Tab ER** TBCR /22/ /19/2013 B-Complex w/ C Tab** TABS /22/ /19/2013 B-Complex w/ Folic Acid Tab ER** TBCR /22/ /19/2013 B-Complex w/ Folic Acid Tab** TABS /22/ /19/2013 B-Complex w/biotin & Folic Acid Tab ER*** TBCR /22/ /19/2013 B-Complex w/biotin & Folic Acid Tab*** TABS /22/ /19/2013 BABYS ONLY ORGANIC/DAIRY (Infant Foods Powder**) POWD /24/ /19/ BABYS ONLY ORGANIC/DHA & (Infant Foods Powder**) POWD /24/ /19/ BABYS ONLY ORGANIC/LACTOS (Infant Foods Powder**) POWD /24/ /19/ BABYS ONLY ORGANIC/SOY (Infant Foods Powder**) POWD /24/ /19/ BACIGUENT (Bacitracin Oint 500 Unit/GM) OINT /13/ /19/ BACIGUENT (Bacitracin Oint 500 Unit/GM) OINT /13/ /19/ Bacitracin Oint 500 Unit/GM OINT /22/ /19/2013 Bacitracin Zinc Oint 500 Unit/GM OINT /22/ /19/2013 Bacitracin-Polymyxin B Oint*** OINT /22/ /19/2013 Bacitracin-Polymyxin B Ophth Oint OINT /17/ /15/2017 Bacitracin-Polymyxin-Neomycin-HC Ophth Oint 1% OINT /10/ /08/2017 Baclofen Powder POWD /22/ /19/2013 Baclofen Tab 10 MG TABS /13/ /11/2017 Baclofen Tab 20 MG TABS /13/ /11/2017 BACMIN (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ Balsalazide Disodium Cap 750 MG CAPS /14/ /12/2017 BARACLUDE (Entecavir Oral Soln 0.05 MG/ML) SOLN /01/ /08/2017 BARACLUDE (Entecavir Tab 0.5 MG) TABS /01/ /08/2017 BARACLUDE (Entecavir Tab 1 MG) TABS /01/ /08/2017 BASIC AM (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ BASIC PM (Multiple Vitamins w/ Minerals Tab**) TABS /20/ /19/ BAYER BREEZE 2 BLOOD GLUC (Blood Glucose Monitoring Kit w/ KIT /23/ /19/ Page 17 Of 216
Maine State Maximum Allowable Cost List as of 03/13/2015
UPD 1ST CHOICE LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013 1ST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013 1ST CHOICE LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011
Maine State Maximum Allowable Cost List as of 08/08/2014
UPD 1ST CHOICE LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013 1ST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013 1ST CHOICE LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011
ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP /11/ /19/2013 ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip)
1ST CHOICE LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013 1ST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013 1ST CHOICE LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011
ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP /11/ /10/2012 ACCU-CHEK COMFORT CURVE T (Glucose Blood Test Strip)
1ST CHOICE LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 09/15/2011 1ST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011 1ST CHOICE LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011
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Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
Riesbeck's Pharmacy Reward Club Generic Medication List October 2017
Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
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Allergies & Cold and Flu $4, 30-day $10, 90-day Benzonatate 100mg cap 14 42 Loratadine 10mg tab 30 90 Promethazine DM syrup 120ml 360ml Antibiotic Treatments Amoxicillin 125mg/5ml susp (80ml bottle) 1
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New Added Products: Effective 3/1/2017 Drug Reason Tier Restrictions abacavir 600 mg-lamivudine 300 QL ADRENACLICK 0.15 MG/0.15 ML INJECTION,AUTO- INJECTOR ADRENACLICK 0.3 MG/0.3 ML INJECTION, AUTO- INJECTOR
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Allergies & Cold and Flu Benzonatate 100mg 14 42 Ceron DM syrup 120ml 360ml Ceron drops* 30ml 90ml Dec-Chlorphen drops* 30ml 90ml Dec-Chlorphen DM syrup* 118ml 354ml Loratadine 10mg 30 90 Promethazine
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Professionalism & Service with Great Prices
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