Browse by Standard Packs
Standard Packs and Prices for Ready Prepared Pharmaceutical Benefits
| Item code | Drug name Form and Strength |
Pack size | Price | Manufacturer |
|---|---|---|---|---|
| 13801J | BENZATHINE BENZYLPENICILLINbenzathine benzylpenicillin 1.2 million units powder for injection [1 vial] (&) inert substance diluent [5 mL vial], 1 pack | 1 | $50.31 | OJ |
| 3486L | BENZYLPENICILLINbenzylpenicillin 600 mg injection, 1 vial | 1 | $6.86 | CS |
| 3463G | DIPHTHERIA + TETANUS VACCINEdiphtheria 2 units + tetanus 20 units vaccine injection, 5 x 0.5 mL syringes | 5 | $64.24 | CS |
| 3470P | HYDROCORTISONE SODIUM SUCCINATEhydrocortisone (as sodium succinate) 100 mg injection [1 chamber] (&) inert substance diluent [2 mL chamber], 1 dual chamber vial | 1 | $7.21 | PF |
| 13144T | MOLNUPIRAVIRmolnupiravir 200 mg capsule, 40 | 40 | $1091.95 | MK |
| 10786Q | NALOXONEnaloxone hydrochloride 400 microgram/mL injection, 5 x 1 mL ampoules | 5 | $24.42 | JU,PF,XN |
| 13147Y | NIRMATRELVIR (&) RITONAVIRnirmatrelvir 150 mg tablet [4] (&) ritonavir 100 mg tablet [2], 5 x 6 | 1 | $1103.95 | PF |
| 3488N | PROMETHAZINEpromethazine hydrochloride 50 mg/2 mL injection, 5 x 2 mL ampoules | 5 | $13.90 | PF |
