Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
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| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 10827W | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $9.75 | AL |
| 10827W | MOMETASONEmometasone furoate 0.1% cream, 15 g | 1 | $6.22 | AF,JM |
| 10819K | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $7.69 | EO |
| 10826T | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $12.37 | AL |
| 10826T | MOMETASONEmometasone furoate 0.1% lotion, 30 mL | 1 | $6.87 | AF,EO |
| 10828X | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $8.11 | AL |
| 10828X | MOMETASONEmometasone furoate 0.1% ointment, 15 g | 1 | $4.58 | AF,EO,JM |
| 14526M | MONTELUKASTmontelukast 4 mg chewable tablet, 28 | 28 | $6.86 | AL,HQ,RF,SZ,TX,WG |
| 14553Y | MONTELUKASTmontelukast 5 mg chewable tablet, 28 | 28 | $6.76 | AL,HQ,RF,SZ,TX,WG |
| 12009C | MORPHINEmorphine sulfate pentahydrate 30 mg tablet, 20 | 20 | $21.40 | RW |
| 12067D | MORPHINEmorphine sulfate pentahydrate 30 mg tablet, 20 | 20 | $21.40 | RW |
| 13552G | MOXONIDINEmoxonidine 400 microgram tablet, 30 | 30 | $8.93 | AL,GO,GQ,RF,SZ,TX,TY,WG |
| 13579Q | MOXONIDINEmoxonidine 200 microgram tablet, 30 | 30 | $6.76 | AL,GO,GQ,RF,SZ,TX,TY,WG |
| 12931N | MYCOBACTERIUM BOVIS BCG DANISH STRAINMycobacterium bovis BCG Danish strain 30 mg injection, 4 vials | 1 | $596.42 | LM |
| 13856G | MYCOPHENOLATEmycophenolate 180 mg enteric tablet, 120 | 120 | $96.81 | NV,XT |
| 13938N | MYCOPHENOLATEmycophenolate 360 mg enteric tablet, 120 | 120 | $147.36 | CR,NV,XT |
| 13884R | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $21.66 | CR,SZ,TX |
| 8649F | MYCOPHENOLATEmycophenolate mofetil 250 mg capsule, 100 | 100 | $22.28 | CR,SZ,TX |
| 14071N | MYCOPHENOLATEmycophenolate mofetil 1 g/5 mL powder for oral liquid, 165 mL | 1 | $210.05 | CR,RO |
| 14000W | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $21.64 | AF,CR,GQ,SZ,XT |
| 8650G | MYCOPHENOLATEmycophenolate mofetil 500 mg tablet, 50 | 50 | $22.26 | AF,CR,GQ,SZ,XT |
| 1674D | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $7.18 | IX |
| 5176K | NAPROXENnaproxen 250 mg tablet, 50 | 50 | $7.18 | IX |
| 8298R | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.58 | AS |
| 9734H | NARATRIPTANnaratriptan 2.5 mg tablet, 2 | 2 | $8.58 | AS |
| 13568D | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $10.47 | AF,AL,FK,GQ,SZ,TX,WG |
| 9316H | NEBIVOLOLnebivolol 1.25 mg tablet, 28 | 28 | $11.70 | AF,AL,FK,GQ,SZ,TX,WG |
| 13441K | NEBIVOLOLnebivolol 10 mg tablet, 28 | 28 | $28.52 | AF,CR,FK,GQ,SZ,TX,WG |
| 13510C | NEBIVOLOLnebivolol 5 mg tablet, 28 | 28 | $25.51 | AF,CR,FK,GQ,SZ,TX,WG |
| 13550E | NICORANDILnicorandil 10 mg tablet, 60 | 1 | $11.14 | AF,TX |
| 13551F | NICORANDILnicorandil 20 mg tablet, 60 | 1 | $14.55 | AF,TX |
| 13502P | NIFEDIPINEnifedipine 30 mg modified release tablet, 30 | 30 | $9.35 | TX |
| 13376B | NIFEDIPINEnifedipine 60 mg modified release tablet, 30 | 30 | $11.12 | TX |
| 2732T | NITRAZEPAMnitrazepam 5 mg tablet, 25 | 25 | $5.17 | AF,IL |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $12.90 | AF,RF |
| 14306Y | NIZATIDINEnizatidine 150 mg capsule, 60 | 60 | $20.49 | RW |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $12.90 | AF,RF |
| 14372K | NIZATIDINEnizatidine 300 mg capsule, 30 | 30 | $20.49 | RW |
| 13873E | NORETHISTERONEnorethisterone 5 mg tablet, 30 | 30 | $24.67 | BN |
| 15134M | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15150J | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15163C | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15165E | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15182C | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15196T | ODEVIXIBATOdevixibat 1.2 mg capsule, 30 | 30 | $33505.67 | IS |
| 15135N | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15136P | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15157R | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15185F | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15192N | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15195R | ODEVIXIBATOdevixibat 200 microgram capsule, 30 | 30 | $5592.84 | IS |
| 15151K | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15167G | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15174P | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15183D | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15184E | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15186G | ODEVIXIBATOdevixibat 400 microgram capsule, 30 | 30 | $11185.67 | IS |
| 15158T | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15164D | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15166F | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15181B | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15193P | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 15194Q | ODEVIXIBATOdevixibat 600 microgram capsule, 30 | 30 | $16752.84 | IS |
| 12642J | OFATUMUMABofatumumab 20 mg/0.4 mL injection, 0.4 mL pen device | 1 | $2109.64 | NV |
| 5567B | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.39 | VE |
| 8383F | OFLOXACINofloxacin 0.3% eye drops, 5 mL | 1 | $10.39 | VE |
| 9294E | OLANZAPINEolanzapine 210 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $157.31 | PB |
| 9295F | OLANZAPINEolanzapine 300 mg modified release injection [1 vial] (&) inert substance diluent [3 mL vial], 1 pack | 1 | $256.01 | PB |
| 11503K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 11522K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12169L | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12170M | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12921C | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 12932P | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 13782J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 13783K | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14181J | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14216F | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 14689D | OLAPARIBolaparib 100 mg tablet, 56 | 56 | $3311.78 | AP |
| 11528R | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 11539H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12157W | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12161C | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12913P | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 12929L | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13800H | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13807Q | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14208T | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14215E | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 14687B | OLAPARIBolaparib 150 mg tablet, 56 | 56 | $3311.78 | AP |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $6.58 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13505T | OLMESARTANolmesartan medoxomil 20 mg tablet, 30 | 30 | $10.58 | AL |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $8.56 | AF,BG,CR,MQ,RW,SZ,TX,TY,WG |
| 13533G | OLMESARTANolmesartan medoxomil 40 mg tablet, 30 | 30 | $13.06 | AL |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $8.03 | AF,CR,RW,SZ,TY,WG |
| 13964Y | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 5 mg tablet, 30 | 30 | $12.03 | AL |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $6.35 | AF,CR,RW,SZ,TY,WG |
| 13449W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 20 mg + amlodipine 5 mg tablet, 30 | 30 | $10.35 | AL |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $8.44 | AF,CR,RW,SZ,TY,WG |
| 13943W | OLMESARTAN + AMLODIPINEolmesartan medoxomil 40 mg + amlodipine 10 mg tablet, 30 | 30 | $12.44 | AL |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.70 | AL,TX |
| 13482N | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.96 | AF |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $12.85 | AL,TX |
| 13512E | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $16.85 | AF |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $13.23 | AL,TX |
| 14002Y | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 10 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $17.23 | AF |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $8.45 | AL,TX |
| 13481M | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $12.45 | AF |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.29 | AL,TX |
| 13513F | OLMESARTAN + AMLODIPINE + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + amlodipine 5 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $15.29 | AF |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $8.19 | AF,CR,RW,SZ,TX,TY,WG |
| 13602X | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 25 mg tablet, 30 | 30 | $12.06 | AL |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $6.76 | AF,CR,RW,SZ,TX,TY,WG |
| 13447R | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 20 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $9.76 | AL |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $7.53 | AF,CR,RW,SZ,TX,TY,WG |
| 13601W | OLMESARTAN + HYDROCHLOROTHIAZIDEolmesartan medoxomil 40 mg + hydrochlorothiazide 12.5 mg tablet, 30 | 30 | $11.39 | AL |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 12270T | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 12272X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.53 | FJ,FQ,SZ |
| 14363Y | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $12.68 | PB |
| 14364B | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 14397R | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 14533X | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | AF,RW,TX,WG |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $6.76 | FJ,FQ,SZ |
| 14557E | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $13.91 | PB |
| 14558F | OMEPRAZOLEomeprazole 20 mg enteric tablet, 30 | 30 | $5.53 | AF,RW,TX,WG |
| 14432N | OMEPRAZOLEomeprazole 10 mg enteric tablet, 30 | 30 | $6.22 | PB |
| 12281J | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 14464G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 14465H | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $5.53 | AF,CR,HX,SZ,TX,WG |
| 14559G | OMEPRAZOLEomeprazole 20 mg enteric capsule, 30 | 30 | $6.76 | AF,CR,HX,SZ,TX,WG |
| 15268N | OPICAPONEopicapone 50 mg capsule, 30 | 30 | $143.19 | XY |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $5.17 | AF,TX,WG |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $6.01 | RW |
| 3135B | OXAZEPAMoxazepam 30 mg tablet, 25 | 25 | $9.09 | AS |
| 3134Y | OXAZEPAMoxazepam 15 mg tablet, 25 | 25 | $5.17 | AF,AS |
| 13936L | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.36 | NV |
| 8588B | OXCARBAZEPINEoxcarbazepine 60 mg/mL oral liquid, 250 mL | 1 | $45.68 | NV |
| 14562K | OXCARBAZEPINEoxcarbazepine 150 mg tablet, 100 | 100 | $45.68 | NV |
| 14033N | OXCARBAZEPINEoxcarbazepine 300 mg tablet, 100 | 100 | $74.85 | NV |
| 13935K | OXCARBAZEPINEoxcarbazepine 600 mg tablet, 100 | 100 | $125.09 | NV |
| 13984B | OXYBUTYNINoxybutynin 3.9 mg/24 hours patch, 8 | 1 | $28.79 | TT |
| 13957N | OXYBUTYNINoxybutynin hydrochloride 5 mg tablet, 100 | 100 | $11.30 | SW |
| 12031F | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $16.27 | BZ,MF |
| 12074L | OXYCODONEoxycodone hydrochloride 10 mg capsule, 20 | 20 | $16.27 | BZ,MF |
| 15087C | PALOVAROTENEpalovarotene 10 mg capsule, 28 | 28 | $99981.03 | IS |
| 12595X | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.65 | GO |
| 13407P | PANCREATIC EXTRACTpancreatic extract 35 000 units modified release capsule, 100 | 100 | $76.67 | GO |
| 13560Q | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.48 | GO |
| 8020D | PANCREATIC EXTRACTpancreatic extract 10 000 units modified release capsule, 100 | 100 | $27.47 | GO |
| 13470Y | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.77 | GO |
| 8021E | PANCREATIC EXTRACTpancreatic extract 25 000 units modified release capsule, 100 | 100 | $54.74 | GO |
| 13375Y | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.97 | GO |
| 5453B | PANCREATIC EXTRACTpancreatic extract 5000 units/100 mg enteric coated granules, 20 g | 1 | $34.96 | GO |
| 12282K | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.58 | NQ |
| 14395P | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $22.35 | NQ |
| 14466J | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.58 | NQ |
| 14500E | PANTOPRAZOLEpantoprazole 40 mg enteric coated granules, 30 sachets | 30 | $23.58 | NQ |
| 14501F | PANTOPRAZOLEpantoprazole 20 mg enteric tablet, 30 | 30 | $5.17 | AF,BG,HQ,RA,RW,SZ,TW,TX,WG,ZS |
| 14501F | PANTOPRAZOLEpantoprazole 20 mg enteric tablet, 30 | 30 | $10.12 | NQ |
| 12277E | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,WG,ZS |
| 12277E | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $10.50 | NQ |
| 14330F | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,WG,ZS |
| 14330F | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $10.50 | NQ |
| 14362X | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $5.55 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,WG,ZS |
| 14362X | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $10.50 | NQ |
| 14394N | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $4.32 | AF,BG,CR,HQ,RA,RW,SZ,TW,TX,WG,ZS |
| 14394N | PANTOPRAZOLEpantoprazole 40 mg enteric tablet, 30 | 30 | $9.27 | NQ |
| 5224Y | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.31 | BG,OW,QS,SI,SW,SZ,TX,XT |
| 8784H | PARACETAMOLparacetamol 500 mg tablet, 100 | 100 | $3.31 | TX |
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