Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
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Next Page | 13 of 15
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 9608Q | PROGESTERONEprogesterone 100 mg pessary, 15 | 15 | $49.80 | ON |
| 9609R | PROGESTERONEprogesterone 200 mg pessary, 15 | 15 | $36.82 | ON |
| 6366C | PROGESTERONEprogesterone 8% vaginal gel, 15 applications | 15 | $97.57 | SG |
| 14720R | PROGESTERONE (&) ESTRADIOLprogesterone 100 mg capsule [30] (&) estradiol 0.06% (750 microgram/actuation) gel [64 actuations], 1 pack | 1 | $47.72 | HB |
| 13927B | PROPANTHELINEpropantheline bromide 15 mg tablet, 100 | 100 | $6.74 | RW |
| 1953T | PROPANTHELINEpropantheline bromide 15 mg tablet, 100 | 100 | $7.97 | RW |
| 13386M | PROPRANOLOLpropranolol hydrochloride 10 mg tablet, 100 | 100 | $5.75 | TX,WG |
| 13386M | PROPRANOLOLpropranolol hydrochloride 10 mg tablet, 100 | 100 | $8.74 | AF |
| 13386M | PROPRANOLOLpropranolol hydrochloride 10 mg tablet, 100 | 100 | $14.23 | IX |
| 13542R | PROPRANOLOLpropranolol hydrochloride 40 mg tablet, 100 | 100 | $6.02 | TX,WG |
| 13542R | PROPRANOLOLpropranolol hydrochloride 40 mg tablet, 100 | 100 | $9.01 | AF |
| 13542R | PROPRANOLOLpropranolol hydrochloride 40 mg tablet, 100 | 100 | $14.50 | IX |
| 15242F | PROPYLENE GLYCOLpropylene glycol 0.6% eye drops, 10 mL | 1 | $5.23 | AQ |
| 13836F | PROPYLTHIOURACILpropylthiouracil 50 mg tablet, 100 | 100 | $16.96 | FF |
| 1955X | PROPYLTHIOURACILpropylthiouracil 50 mg tablet, 100 | 100 | $18.19 | FF |
| 10658Y | PROTEIN FORMULA WITH AMINO ACIDS, CARBOHYDRATES, VITAMINS AND MINERALS WITHOUT PHENYLALANINE, AND SUPPLEMENTED WITH DOCOSAHEXAENOIC ACIDprotein formula with amino acids, carbohydrates, vitamins and minerals without phenylalanine, and supplemented with docosahexaenoic acid oral liquid, 30 x 130 mL pouches | 1 | $346.02 | OH |
| 11401C | PROTEIN FORMULA WITH ARGININE, VITAMIN C, E AND ZINCprotein formula with arginine, vitamin C, E and zinc oral liquid, 24 x 200 mL bottles | 1 | $99.39 | SB |
| 11939J | PROTEIN FORMULA WITH CARBOHYDRATE, FAT, VITAMINS AND MINERALSprotein formula with carbohydrate, fat, vitamins and minerals oral liquid, 12 x 500 mL bottles | 1 | $225.02 | NU |
| 12191P | PROTEIN FORMULA WITH VITAMINS AND MINERALS, AND LOW IN POTASSIUM, PHOSPHORUS, CALCIUM, CHLORIDE AND VITAMIN Aprotein formula with vitamins and minerals, and low in potassium, phosphorus, calcium, chloride and vitamin A oral liquid, 24 x 125 mL bottles | 1 | $165.12 | VF |
| 8259Q | PROTEIN HYDROLYSATE FORMULA WITH MEDIUM CHAIN TRIGLYCERIDESprotein hydrolysate formula with medium chain triglycerides powder for oral liquid, 450 g | 1 | $24.26 | NU |
| 14392L | PYRIDOSTIGMINEpyridostigmine bromide 10 mg tablet, 50 | 50 | $7.68 | IL |
| 2724J | PYRIDOSTIGMINEpyridostigmine bromide 10 mg tablet, 50 | 50 | $8.91 | IL |
| 14462E | PYRIDOSTIGMINEpyridostigmine bromide 180 mg modified release tablet, 50 | 50 | $43.04 | IL |
| 2608G | PYRIDOSTIGMINEpyridostigmine bromide 180 mg modified release tablet, 50 | 50 | $43.47 | IL |
| 14529Q | PYRIDOSTIGMINEpyridostigmine bromide 60 mg tablet, 150 | 150 | $39.74 | IL |
| 14502G | RABEPRAZOLErabeprazole sodium 10 mg enteric tablet, 28 | 28 | $6.04 | AF,RW,SZ,TX,WG |
| 12286P | RABEPRAZOLErabeprazole sodium 20 mg enteric tablet, 30 | 30 | $6.04 | AF,AL,RN,RW,SZ,TX,WG |
| 14396Q | RABEPRAZOLErabeprazole sodium 20 mg enteric tablet, 30 | 30 | $4.81 | AF,AL,RN,RW,SZ,TX,WG |
| 14433P | RABEPRAZOLErabeprazole sodium 20 mg enteric tablet, 30 | 30 | $6.04 | AF,AL,RN,RW,SZ,TX,WG |
| 14463F | RABEPRAZOLErabeprazole sodium 20 mg enteric tablet, 30 | 30 | $6.04 | AF,AL,RN,RW,SZ,TX,WG |
| 13426P | RALOXIFENEraloxifene hydrochloride 60 mg tablet, 28 | 28 | $23.39 | BZ |
| 13426P | RALOXIFENEraloxifene hydrochloride 60 mg tablet, 28 | 28 | $19.30 | GQ,RF,ZS |
| 11248B | RALTEGRAVIRraltegravir 600 mg tablet, 60 | 60 | $437.34 | MK |
| 10286J | RALTEGRAVIRraltegravir 400 mg tablet, 60 | 60 | $437.34 | MK |
| 4610P | RALTITREXEDraltitrexed 2 mg injection, 1 vial | 1 | $0.00 | PF |
| 7256X | RALTITREXEDraltitrexed 2 mg injection, 1 vial | 1 | $0.00 | PF |
| 13430W | RAMIPRILramipril 10 mg capsule, 30 | 30 | $6.22 | AF,RF,SW,SZ,TX,TY,WG |
| 13405M | RAMIPRILramipril 2.5 mg capsule, 30 | 30 | $5.17 | AF,TX |
| 13556L | RAMIPRILramipril 5 mg capsule, 30 | 30 | $5.17 | AF,TX |
| 13582W | RAMIPRILramipril 1.25 mg tablet, 30 | 30 | $5.17 | AL,RF,SW,SZ,WA,WG |
| 13368N | RAMIPRILramipril 10 mg tablet, 30 | 30 | $6.22 | AL,SW,SZ,TX,WG |
| 13466R | RAMIPRILramipril 2.5 mg tablet, 30 | 30 | $5.17 | AL,RF,SW,SZ,TX,WA,WG |
| 13526X | RAMIPRILramipril 5 mg tablet, 30 | 30 | $5.17 | AL,RF,SW,SZ,TX,WA,WG |
| 13431X | RAMIPRILramipril 1.25 mg capsule, 30 | 30 | $5.17 | AF |
| 13534H | RAMIPRIL + FELODIPINEramipril 5 mg + felodipine 5 mg modified release tablet, 30 | 30 | $8.36 | SW |
| 14458Y | RASAGILINErasagiline 1 mg tablet, 30 | 30 | $18.13 | CR,EV,HQ,RW,SZ,WG |
| 14458Y | RASAGILINErasagiline 1 mg tablet, 30 | 30 | $20.13 | TB |
| 14474T | REBOXETINEreboxetine 4 mg tablet, 60 | 60 | $29.17 | PF |
| 6195C | RIFABUTINrifabutin 150 mg capsule, 30 | 30 | $136.72 | PF |
| 9541E | RIFABUTINrifabutin 150 mg capsule, 30 | 30 | $131.46 | PF |
| 12200D | RIFAMPICINrifampicin 150 mg capsule, 10 | 10 | $18.66 | AF |
| 12189M | RIFAMPICINrifampicin 300 mg capsule, 10 | 10 | $8.52 | AF |
| 10298B | RILPIVIRINErilpivirine 25 mg tablet, 30 | 30 | $254.90 | JC |
| 11662T | RILUZOLEriluzole 50 mg/10 mL oral liquid, 300 mL | 1 | $98.50 | JW |
| 14429K | RILUZOLEriluzole 50 mg/10 mL oral liquid, 300 mL | 1 | $98.52 | JW |
| 14393M | RILUZOLEriluzole 50 mg tablet, 56 | 56 | $100.48 | CR,SW,SZ |
| 13631K | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10841.89 | RO |
| 13632L | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10855.22 | RO |
| 13633M | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10841.89 | RO |
| 13639W | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10855.22 | RO |
| 13646F | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10855.22 | RO |
| 13654P | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10841.89 | RO |
| 13656R | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10841.89 | RO |
| 13659X | RISDIPLAMrisdiplam 750 microgram/mL powder for oral liquid, 80 mL | 1 | $10855.22 | RO |
| 13459J | RISEDRONATErisedronate sodium 35 mg tablet, 4 | 4 | $22.88 | SZ,TX,WG |
| 14197F | RISEDRONATErisedronate sodium 35 mg tablet, 4 | 4 | $22.88 | SZ,TX,WG |
| 13364J | RISEDRONATErisedronate sodium 35 mg enteric tablet, 4 | 4 | $22.88 | TT |
| 14198G | RISEDRONATErisedronate sodium 35 mg enteric tablet, 4 | 4 | $22.88 | TT |
| 13360E | RISEDRONATErisedronate sodium 5 mg tablet, 28 | 28 | $26.47 | TT |
| 14209W | RISEDRONATErisedronate sodium 5 mg tablet, 28 | 28 | $26.47 | TT |
| 13488X | RISEDRONATErisedronate sodium 150 mg tablet, 1 | 1 | $24.60 | TT,TX |
| 8780D | RISPERIDONErisperidone 25 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $89.01 | JC |
| 8781E | RISPERIDONErisperidone 37.5 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $115.91 | JC |
| 8782F | RISPERIDONErisperidone 50 mg modified release injection [1 vial] (&) inert substance diluent [2 mL syringe], 1 pack | 1 | $142.53 | JC |
| 10273Q | RITONAVIRritonavir 100 mg tablet, 30 | 30 | $26.90 | VE |
| 13088W | RITUXIMABrituximab 100 mg/10 mL injection, 10 mL vial | 1 | $43.24 | PF |
| 13109Y | RITUXIMABrituximab 100 mg/10 mL injection, 10 mL vial | 1 | $44.97 | PF |
| 13082M | RITUXIMABrituximab 100 mg/10 mL injection, 2 x 10 mL vials | 2 | $86.48 | EW,SZ |
| 13096G | RITUXIMABrituximab 100 mg/10 mL injection, 2 x 10 mL vials | 2 | $89.94 | EW,SZ |
| 13095F | RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial | 1 | $224.83 | EW,PF,SZ |
| 13101M | RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial | 1 | $216.18 | EW,PF,SZ |
| 13090Y | RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial | 1 | $0.00 | EW,PF,SZ |
| 13102N | RITUXIMABrituximab 500 mg/50 mL injection, 50 mL vial | 1 | $0.00 | EW,PF,SZ |
| 14969W | RIVAROXABANrivaroxaban 15 mg capsule, 28 | 28 | $31.48 | NB |
| 14994E | RIVAROXABANrivaroxaban 20 mg capsule, 28 | 28 | $31.12 | NB |
| 13521P | RIVAROXABANrivaroxaban 10 mg tablet, 30 | 30 | $26.95 | AF,AL,CR,DZ,GQ,MQ,RZ,SZ,TB,TX,XT,XW |
| 13462M | RIVAROXABANrivaroxaban 20 mg tablet, 28 | 28 | $23.76 | AF,AL,CR,DZ,GQ,MQ,RZ,SZ,TB,TX,XT,XW |
| 13463N | RIVAROXABANrivaroxaban 15 mg tablet, 28 | 28 | $24.02 | AF,AL,CR,DZ,GQ,MQ,RZ,SZ,TB,TX,XT,XW |
| 13366L | RIVAROXABANrivaroxaban 2.5 mg tablet, 60 | 60 | $24.08 | AF,CR,GQ,TB,TX |
| 10551H | RIZATRIPTANrizatriptan 10 mg orally disintegrating tablet, 2 | 2 | $6.76 | DZ,MQ,RF,TW,WG |
| 9313E | RIZATRIPTANrizatriptan 10 mg wafer, 2 | 2 | $9.16 | AL |
| 9313E | RIZATRIPTANrizatriptan 10 mg wafer, 2 | 2 | $8.56 | AF |
| 13586C | ROSUVASTATINrosuvastatin 10 mg tablet, 30 | 30 | $6.22 | AF,BG,CR,GQ,RA,RW,SZ,TX,TY,WG |
| 13586C | ROSUVASTATINrosuvastatin 10 mg tablet, 30 | 30 | $11.16 | FK |
| 13588E | ROSUVASTATINrosuvastatin 20 mg tablet, 30 | 30 | $6.28 | AF,BG,CR,GQ,RA,RW,SZ,TX,TY,WG |
| 13588E | ROSUVASTATINrosuvastatin 20 mg tablet, 30 | 30 | $11.22 | FK |
| 13589F | ROSUVASTATINrosuvastatin 40 mg tablet, 30 | 30 | $7.90 | AF,BG,CR,GQ,RA,RW,SZ,TX,TY,WG |
| 13589F | ROSUVASTATINrosuvastatin 40 mg tablet, 30 | 30 | $12.84 | FK |
| 13406N | ROSUVASTATINrosuvastatin 5 mg tablet, 30 | 30 | $5.17 | AF,BG,CR,GQ,RA,RW,SZ,TX,TY,WG |
| 13406N | ROSUVASTATINrosuvastatin 5 mg tablet, 30 | 30 | $10.10 | FK |
| 14359R | ROTIGOTINErotigotine 8 mg/24 hours patch, 28 | 28 | $102.61 | UC |
| 14327C | ROTIGOTINErotigotine 2 mg/24 hours patch, 28 | 28 | $60.99 | UC |
| 14326B | ROTIGOTINErotigotine 4 mg/24 hours patch, 28 | 28 | $81.32 | UC |
| 14431M | ROTIGOTINErotigotine 6 mg/24 hours patch, 28 | 28 | $92.28 | UC |
| 12001P | ROXITHROMYCINroxithromycin 150 mg tablet, 10 | 10 | $5.48 | RW,SZ,TY,WG |
| 11993F | ROXITHROMYCINroxithromycin 300 mg tablet, 5 | 5 | $5.48 | RW,SZ,TY,WG |
| 10614P | RUXOLITINIBruxolitinib 5 mg tablet, 56 | 56 | $2333.28 | NV |
| 10616R | RUXOLITINIBruxolitinib 5 mg tablet, 56 | 56 | $2333.28 | NV |
| 12944G | SACITUZUMAB GOVITECANsacituzumab govitecan 180 mg injection, 1 vial | 1 | $0.00 | GI |
| 12945H | SACITUZUMAB GOVITECANsacituzumab govitecan 180 mg injection, 1 vial | 1 | $0.00 | GI |
| 12965J | SACITUZUMAB GOVITECANsacituzumab govitecan 180 mg injection, 1 vial | 1 | $0.00 | GI |
| 12966K | SACITUZUMAB GOVITECANsacituzumab govitecan 180 mg injection, 1 vial | 1 | $0.00 | GI |
| 13445P | SACUBITRIL + VALSARTANsacubitril 97.2 mg + valsartan 102.8 mg tablet, 56 | 56 | $91.10 | CR,FY,GQ,NM,NV,RM,TX |
| 13570F | SACUBITRIL + VALSARTANsacubitril 24.3 mg + valsartan 25.7 mg tablet, 56 | 56 | $91.10 | CR,FY,GQ,NM,NV,RM,TX |
| 13511D | SACUBITRIL + VALSARTANsacubitril 48.6 mg + valsartan 51.4 mg tablet, 56 | 56 | $91.10 | CR,FY,GQ,NM,NV,RM,TX |
| 14391K | SAFINAMIDEsafinamide 50 mg tablet, 30 | 30 | $39.77 | DZ,IX,XT |
| 14528P | SAFINAMIDEsafinamide 100 mg tablet, 30 | 30 | $78.29 | DZ,IX,XT |
| 11130T | SALBUTAMOLsalbutamol 2.5 mg/2.5 mL inhalation solution, 20 x 2.5 mL ampoules | 1 | $6.52 | GK |
| 11095Y | SALBUTAMOLsalbutamol 5 mg/2.5 mL inhalation solution, 20 x 2.5 mL ampoules | 1 | $6.65 | GK |
| 12109H | SALBUTAMOLsalbutamol 100 microgram/actuation inhalation, 200 actuations | 1 | $8.75 | AF |
| 12109H | SALBUTAMOLsalbutamol 100 microgram/actuation inhalation, 200 actuations | 1 | $11.29 | GK |
| 12109H | SALBUTAMOLsalbutamol 100 microgram/actuation inhalation, 200 actuations | 1 | $8.29 | AL |
| 2001H | SALBUTAMOLsalbutamol 5 mg/2.5 mL inhalation solution, 30 x 2.5 mL ampoules | 1 | $7.83 | LR |
| 8354Q | SALBUTAMOLsalbutamol 100 microgram/actuation breath activated inhalation, 200 actuations | 1 | $16.45 | IL |
| 1103C | SALBUTAMOLsalbutamol 2 mg/5 mL oral liquid, 150 mL | 1 | $9.32 | GK |
| 14328D | SALMETEROLsalmeterol 50 microgram/actuation powder for inhalation, 60 actuations | 1 | $19.45 | GK |
| 10086W | SAPROPTERINsapropterin dihydrochloride 100 mg soluble tablet, 30 | 30 | $801.82 | IO |
| 10087X | SAPROPTERINsapropterin dihydrochloride 100 mg soluble tablet, 30 | 30 | $801.82 | IO |
| 11691H | SAPROPTERINsapropterin dihydrochloride 100 mg soluble tablet, 30 | 30 | $801.82 | IO |
| 13895H | SAXAGLIPTINsaxagliptin 2.5 mg tablet, 28 | 28 | $40.95 | AP |
| 13923T | SAXAGLIPTINsaxagliptin 5 mg tablet, 28 | 28 | $40.95 | AP |
| 13876H | SAXAGLIPTIN + METFORMINsaxagliptin 5 mg + metformin hydrochloride 1 g modified release tablet, 28 | 28 | $42.54 | AP |
| 13880M | SAXAGLIPTIN + METFORMINsaxagliptin 2.5 mg + metformin hydrochloride 1 g modified release tablet, 56 | 56 | $43.76 | AP |
| 14030K | SAXAGLIPTIN + METFORMINsaxagliptin 5 mg + metformin hydrochloride 500 mg modified release tablet, 28 | 28 | $41.75 | AP |
| 14955D | SECUKINUMABSecukinumab 300 mg/2 mL injection, 2 mL pen device | 1 | $1289.25 | NV |
| 14957F | SECUKINUMABSecukinumab 300 mg/2 mL injection, 2 mL pen device | 1 | $1289.25 | NV |
| 15004Q | SECUKINUMABSecukinumab 300 mg/2 mL injection, 2 mL pen device | 1 | $1289.25 | NV |
| 15028Y | SECUKINUMABSecukinumab 300 mg/2 mL injection, 2 mL pen device | 1 | $1289.25 | NV |
| 10894J | SECUKINUMABsecukinumab 150 mg/mL injection, 2 x 1 mL pen devices | 2 | $1289.26 | NV |
| 10910F | SECUKINUMABsecukinumab 150 mg/mL injection, 2 x 1 mL pen devices | 2 | $1289.26 | NV |
| 14154Y | SECUKINUMABsecukinumab 150 mg/mL injection, 2 x 1 mL pen devices | 2 | $1289.26 | NV |
| 10890E | SECUKINUMABsecukinumab 150 mg/mL injection, 1 mL pen device | 1 | $661.18 | NV |
| 10900Q | SECUKINUMABsecukinumab 150 mg/mL injection, 1 mL pen device | 1 | $661.18 | NV |
| 12321L | SECUKINUMABsecukinumab 150 mg/mL injection, 1 mL pen device | 1 | $656.18 | NV |
| 14430L | SELEGILINEselegiline hydrochloride 5 mg tablet, 100 | 100 | $42.77 | OX |
| 14703W | SELPERCATINIBselpercatinib 80 mg capsule, 56 | 56 | $4027.03 | LY |
| 15311W | SEMAGLUTIDEsemaglutide 0.68 mg/mL injection, 1 x 3 mL pen device | 1 | $125.77 | NO |
| 15322K | SEMAGLUTIDEsemaglutide 1.34 mg/mL injection, 1 x 3 mL pen device | 1 | $125.77 | NO |
| 14404D | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RW,SZ,TX,WG |
| 14404D | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $11.95 | GO |
| 14506L | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RA,RW,SZ,TX,WG |
| 14506L | SERTRALINEsertraline 100 mg tablet, 30 | 30 | $11.95 | GO |
| 14400X | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RA,RW,SZ,TX,WG |
| 14400X | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $11.95 | GO |
| 14403C | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $5.17 | AF,BG,GQ,RW,SZ,TX,WG |
| 14403C | SERTRALINEsertraline 50 mg tablet, 30 | 30 | $11.95 | GO |
| 11838C | SEVELAMERsevelamer carbonate 800 mg tablet, 180 | 180 | $144.29 | GQ,XT |
| 11855Y | SEVELAMERsevelamer carbonate 800 mg tablet, 180 | 180 | $138.74 | GQ,XT |
| 14027G | SEVELAMERsevelamer carbonate 800 mg tablet, 180 | 180 | $156.58 | GQ,XT |
| 13934J | SEVELAMERsevelamer hydrochloride 800 mg tablet, 180 | 180 | $179.24 | GZ |
| 9546K | SEVELAMERsevelamer hydrochloride 800 mg tablet, 180 | 180 | $158.81 | GZ |
| 9620H | SEVELAMERsevelamer hydrochloride 800 mg tablet, 180 | 180 | $165.16 | GZ |
| 14185N | SILODOSINsilodosin 4 mg capsule, 30 | 30 | $29.25 | YN |
| 14192Y | SILODOSINsilodosin 8 mg capsule, 30 | 30 | $34.00 | YN |
| 12916T | SILTUXIMABsiltuximab 100 mg injection, 1 vial | 1 | $779.28 | RJ |
| 12930M | SILTUXIMABsiltuximab 100 mg injection, 1 vial | 1 | $799.28 | RJ |
| 12922D | SILTUXIMABsiltuximab 400 mg injection, 1 vial | 1 | $3117.10 | RJ |
| 12934R | SILTUXIMABsiltuximab 400 mg injection, 1 vial | 1 | $3137.10 | RJ |
| 13373W | SIMVASTATINsimvastatin 20 mg tablet, 30 | 30 | $5.17 | AF,RW,SZ,TX,WG |
| 13373W | SIMVASTATINsimvastatin 20 mg tablet, 30 | 30 | $14.45 | AL,MQ |
| 13471B | SIMVASTATINsimvastatin 40 mg tablet, 30 | 30 | $5.34 | TX |
| 13471B | SIMVASTATINsimvastatin 40 mg tablet, 30 | 30 | $14.58 | AL |
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