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Quantity Limit Program Target Drugs Dosage/Strength...Paxil (paroxetine)a 30 mg tablet 2 tablets Paxil (paroxetine)a 40 mg tablet 1 tablet Paxil (paroxetine) 10 mg/5 mL suspension
Blue Cross Blue Shield of Massachusetts Formulary: $9 ... · 7/1/2020 · labetalol hcl 100 mg tablet 180 labetalol hcl 200 mg tablet 180 labetalol hcl 300 mg tablet 180 lisinopril
2021 Step Therapy (ST) Criteria...etodolac ER 500 mg tablet,extended release 24 hr • etodolac ER 600 mg tablet,extended release 24 hr • fenoprofen 600 mg tablet • flurbiprofen
4-tier Drug Discount Program - Preferred Prescription Card · 4-tier Drug Discount Program ... IBUPROFEN 800 MG TABLET per 30 NAPROXEN 375 MG TABLET per 60 ETODOLAC 400 MG TABLET
MacGreen Tablet PC MG- 7232W Startup Guide
ANALGESICS - Allegiant Health · 174 N/A Magnesium Oxide Tablet 400 mg 3 yrs 306 N/A Magnesium Oxide Tablet 420 mg 2 yrs 046 Pepto Bismol Bismuth Subsalicylate 262 mg Chewable Tablet
WHO Model List 2002 (Core list) · 2019. 5. 29. · diethylcarbamazine tablet, 50 mg, 100 mg ( dihydrogen citrate) ivermectin scored tablet, 3 mg, 6 mg 6.1.3 Antischistosomals and
2021 Step Therapy Protocols - Imperial Health Plan...• saphris tablet sublingual 10 mg sublingual • saphris tablet sublingual 2.5 mg sublingual • saphris tablet sublingual 5
Summary Product ; EllaOne 30 Mg Tablet
Preferred Drug List February 2020...ibuprofen oral tablet 200 mg Advil OTC ibuprofen oral tablet 400 mg, 600 mg, 800 mg IBU INDOCIN ORAL SUSPENSION 25 MG/5ML INDOCIN RECTAL SUPPOSITORY
Quantity Limit Drug List · fanapt (1 mg tablet, 2 mg tablet, 4 mg tablet) 60 / 30 days fanapt (6 mg tablet, 8 mg tablet, 10 mg tablet, 12 mg tablet) 60 / 30 days fanapt titration
The - worldmedicine.com.tr · 86 cyclosporine 25 mg, 100 mg soft capsule 50 capsules 87 imatinib 100 mg, 400 mg tablet 120 tablets 88 leflunomide 10 mg, 20 mg film coated tablet 30
UPMC Medicare 2016 · 2016-10-31 · 1 ABILIFY Products Affected aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg aripiprazole oral tablet,disintegrating 10 mg, 15
A141 LABETALOL HYDROCHLORIDE 200MG …...A239 RIFAMPICIN & ISONIAZID 300MG|150MG TABLET 560 129,996 52,957 A240 SALBUTAMOL 4MG TABLET 812 9,804 6,522 A241 SELEGILINE 5MG TABLET 1,500
RIFAMPICIN + ISONIAZID + PYRAZINAMIDE + ETHAMBUT ......Rifampicin + Isoniazid + Pyrazinamide + Ethambutol HCl (Quadtab) Tablet is for a 2-month initial phase treatment and should be
Angeliq Tablet 1 mg + 2 mg_Estradiol+
MacGreen Tablet PC MG- 78432C Startup Guide
State of Montana · alendronate sodium FOSAMAX 35 MG TABLET ORAL Generic $0.44857 alendronate sodium FOSAMAX 70 MG TABLET ORAL Generic $0.32525 alfuzosin hcl UROXATRAL 10 MG TABLET,
204441Orig1s000 - Food and Drug Administration...60-mg tablets. The 45-mg tablet is exactly 0.75 times and the 90-mg tablet is exactly 1.5 times the 60-mg tablet. . Dissolution similarity:
ww2.fda.gov.ph · VigRx Plus Tablet 71. Wolf 2000 mg Capsule 72. . Xianggang Tianlong Shengwu 3500 mg Tablet 73 Xianggang Tianlung Shengwu 5000 mg Capsule 74. Xingboshi 5000 mg Capsule
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug ...€¦ · klonopin 0.5 mg tablet . 17470 . klonopin 1 mg tablet . 17471 . klonopin 2 mg tablet . 17472 . librax
2 · nabumetone oral tablet 500 mg, 750 mg 2 naproxen oral suspension 125 mg/5 ml (Naprosyn) 2 naproxen oral tablet 250 mg, 375 mg 1 naproxen oral tablet 500 mg (Naprosyn) 1 naproxen
Drug Target Maximum QuantityCADUET 10 MG-80 MG TABLET 30 tablets per prescription CADUET 2.5 MG-10 MG TABLET 30 tablets per prescription CADUET 2.5 MG-20 MG TABLET 30 tablets per prescription
Stanford Health Care Advantage 2019 Abridged …...clonazepam oral tablet 2 mg (Klonopin) 1 GC; QL (300 per 30 days) clonazepam oral tablet,disintegrating 0.125 mg, 0.25 mg, 0.5 mg,
RITALINE 10 mg, tablet CONCERTA LP 18 mg, 36 mg, 54 mg, tablet · TABLE OF CONTENTS ... depression, tics and Tourette’s syndrome). According to the DSM-IV classification, there
diatime-60-mg-mr-tablet-ca91 kullanma talimati · DiATiME 60 mg MR tablet Ažlzdan alumr. Etkin madde: Her bir MR tablet 60 mg gliklazid içerir. Yarduncl maddeler: Kollidon SR, laktoz
2020 Cigna STAR+PLUS Quantity Limit Criteria · ambien 10 mg tablet tablet 30 30 ambien 5 mg tablet tablet 30 30 ambien cr 12.5 mg tablet tablet, extended release multiphase 30 30
5 mg & 10 mg Tablet Calcium Channel Blocker
Amtrex Enterprises & Company - IndiaMART€¦ · 40 mg Uricostat Tablet 200mg Fungicide Tablet 50 mg Imuran Tablet Tapal Tablet O u r P r o d u c t s. ANTIBIOTICS DRUG Ceftum Tablet
CPL - 18013 · 2018-10-31 · products affected step 2: • trintellix 10 mg tablet • trintellix 20 mg tablet • trintellix 5 mg tablet • viibryd 10 mg (7)-20 mg (23) tablets