Attachment B - List of Exclusions~1.xlsx
XLSX spreadsheet 4 MB Posted
- Attached to
- Pharmacy Benefit Manager
- Solicitation number
- S000000161
- Issued by
- Pulaski County, Arkansas
About this file
This document appears to be an Attachment B - List of Exclusions related to a Pharmacy Benefit Manager contract opportunity for the state of Arkansas. The contract opportunity requests pharmacy benefit management services, and includes details on the covered drugs, drug status, package sizes, and other product information. The contract term and any renewal options are not provided.
The pricing terms, set asides, incumbents, funding requirements, and other salient commercial details are also not included in the provided document. The document focuses solely on the list of excluded drugs and does not contain information about the overall procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment D - Formulary Disruption Reporting~1.xlsx | XLSX spreadsheet | |
| S000000161 Q and A.pdf | ||
| Attachment C - Retail Network Disruption Report~1.xlsx | XLSX spreadsheet | |
| Attachment G Arkansas Independents Network.xlsx | XLSX spreadsheet | |
| Contract and Grant Disclosure~17.pdf | ||
| Attachment A - Non-Disclosure Agreement~1.docx | DOCX document | |
| Attachment E - Financial and Formulary Scoring Examples~1.xlsx | XLSX spreadsheet | |
| Attachment F - Specialty Pharmacy Listing- Revised.xlsx | XLSX spreadsheet | |
| S000000161 - Drug Pricing Product Exclusions.xlsx | XLSX spreadsheet | |
| S000000161 Bidders Conference PPT.pdf | ||
| S000000161 Cost Workbook.xlsx | XLSX spreadsheet | |
| S000000161 Pharmacy Benefits Manager.pdf | ||
| S000000161 Technical Proposal Packet.docx | DOCX document |
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Sheet1
| S000000161 Attachment B- List of Exclusions | |||||||||||||
| NDC CODE | BRAND NAME | GENERIC NAME | AHFS 6 DESCRIPTION | OTC/RX | STRENGTH DESCRIPTION | ROUTE | DOSAGE | PACKAGE SIZE | BRAND/GENERIC INDICATOR | REPACKAGED | INSTITUTIONAL | FORMULARY STATUS | FORMULARY STATUS REASON |
| 2120001 | AMYVID | FLORBETAPIR F-18 | RADIOACTIVE AGENTS | F | 10 MCI | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2120030 | AMYVID | FLORBETAPIR F-18 | RADIOACTIVE AGENTS | F | 10 MCI | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2120050 | AMYVID | FLORBETAPIR F-18 | RADIOACTIVE AGENTS | F | 10 MCI | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2140701 | QUINIDINE GLUCONATE | QUINIDINE GLUCONATE | ANTIARRHYTHMIC AGENTS | F | 80 MG/ML | INJECTION | VIAL | 10 | GENERIC | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2197561 | AXIRON | TESTOSTERONE | ANDROGENS | F | 30MG/1.5ML | TRANSDERM. | SOL MD PMP | 90 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2197590 | AXIRON | TESTOSTERONE | ANDROGENS | F | 30MG/1.5ML | TRANSDERM. | SOL MD PMP | 90 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2298026 | RETEVMO | SELPERCATINIB | ANTINEOPLASTIC AGENTS | F | 80 MG | ORAL | CAPSULE | 120 | SSB | 0 | 0 | NC | |
| 2298060 | RETEVMO | SELPERCATINIB | ANTINEOPLASTIC AGENTS | F | 80 MG | ORAL | CAPSULE | 60 | SSB | 0 | 0 | NC | |
| 2300475 | PROZAC WEEKLY | FLUOXETINE HCL | ANTIDEPRESSANTS | F | 90 MG | ORAL | CAPSULE DR | 4 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2311501 | EMGALITY SYRINGE | GALCANEZUMAB-GNLM | CALCITONIN GENE-RELATED PEPTIDE ANTAG. | F | 300MG/3ML | SUBCUTANE. | SYRINGE | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2311509 | EMGALITY SYRINGE | GALCANEZUMAB-GNLM | CALCITONIN GENE-RELATED PEPTIDE ANTAG. | F | 300MG/3ML | SUBCUTANE. | SYRINGE | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2397760 | RETEVMO | SELPERCATINIB | ANTINEOPLASTIC AGENTS | F | 40 MG | ORAL | CAPSULE | 60 | SSB | 0 | 0 | NC | |
| 2431208 | REYVOW | LASMIDITAN SUCCINATE | SELECTIVE SEROTONIN AGONISTS | F | 50 MG | ORAL | TABLET | 8 | SSB | 0 | 0 | NC | |
| 2449108 | REYVOW | LASMIDITAN SUCCINATE | SELECTIVE SEROTONIN AGONISTS | F | 100 MG | ORAL | TABLET | 8 | SSB | 0 | 0 | NC | |
| 2473230 | OLUMIANT | BARICITINIB | DISEASE-MODIFYING ANTIRHEUMATIC AGENTS | F | 1 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | |
| 2719001 | LARTRUVO | OLARATUMAB | ANTINEOPLASTIC AGENTS | F | 190MG/19ML | INTRAVEN. | VIAL | 19 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2733511 | HUMATROPE | SOMATROPIN | PITUITARY | F | 5 MG | INJECTION | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2734901 | HUMATROPE | SOMATROPIN | PITUITARY | F | 5 MG | INJECTION | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2750101 | GEMZAR | GEMCITABINE HCL | ANTINEOPLASTIC AGENTS | F | 200 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2750201 | GEMZAR | GEMCITABINE HCL | ANTINEOPLASTIC AGENTS | F | 1 G | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2758901 | BEBTELOVIMAB (EUA) | BEBTELOVIMAB | MONOCLONAL ANTIBODIES | F | 175MG/2 ML | INTRAVEN. | VIAL | 2 | GENERIC | 0 | 0 | NC | |
| 2762301 | ALIMTA | PEMETREXED DISODIUM | ANTINEOPLASTIC AGENTS | F | 500 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2763511 | ZYPREXA RELPREVV | OLANZAPINE PAMOATE | ANTIPSYCHOTIC AGENTS | F | 210 MG | INTRAMUSC. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2763611 | ZYPREXA RELPREVV | OLANZAPINE PAMOATE | ANTIPSYCHOTIC AGENTS | F | 300 MG | INTRAMUSC. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2763711 | ZYPREXA RELPREVV | OLANZAPINE PAMOATE | ANTIPSYCHOTIC AGENTS | F | 405 MG | INTRAMUSC. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2764001 | ALIMTA | PEMETREXED DISODIUM | ANTINEOPLASTIC AGENTS | F | 100 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2765801 | ZYPREXA RELPREVV | OLANZAPINE PAMOATE | ANTIPSYCHOTIC AGENTS | F | 210 MG | INTRAMUSC. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2765901 | ZYPREXA RELPREVV | OLANZAPINE PAMOATE | ANTIPSYCHOTIC AGENTS | F | 300 MG | INTRAMUSC. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2766001 | ZYPREXA RELPREVV | OLANZAPINE PAMOATE | ANTIPSYCHOTIC AGENTS | F | 405 MG | INTRAMUSC. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2766901 | CYRAMZA | RAMUCIRUMAB | ANTINEOPLASTIC AGENTS | F | 100MG/10ML | INTRAVEN. | VIAL | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2767801 | CYRAMZA | RAMUCIRUMAB | ANTINEOPLASTIC AGENTS | F | 500MG/50ML | INTRAVEN. | VIAL | 50 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2771501 | BASAGLAR KWIKPEN U-100 | INSULIN GLARGINE,HUM.REC.ANLOG | INSULINS | F | 100/ML (3) | SUBCUTANE. | INSULN PEN | 3 | SSB | 0 | 0 | NC | |
| 2771559 | BASAGLAR KWIKPEN U-100 | INSULIN GLARGINE,HUM.REC.ANLOG | INSULINS | F | 100/ML (3) | SUBCUTANE. | INSULN PEN | 3 | SSB | 0 | 0 | NC | |
| 2771601 | PORTRAZZA | NECITUMUMAB | ANTINEOPLASTIC AGENTS | F | 800MG/50ML | INTRAVEN. | VIAL | 50 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2791001 | BAMLANIVIMAB (EUA) | BAMLANIVIMAB | MONOCLONAL ANTIBODIES | F | 700MG/20ML | INTRAVEN. | VIAL | 20 | GENERIC | 0 | 0 | NC | |
| 2795001 | ETESEVIMAB (EUA) | ETESEVIMAB | MONOCLONAL ANTIBODIES | F | 700MG/20ML | INTRAVEN. | VIAL | 20 | GENERIC | 0 | 0 | NC | |
| 2814701 | HUMATROPE | SOMATROPIN | PITUITARY | F | 6 MG | INJECTION | CARTRIDGE | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2814801 | HUMATROPE | SOMATROPIN | PITUITARY | F | 12 MG | INJECTION | CARTRIDGE | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2814901 | HUMATROPE | SOMATROPIN | PITUITARY | F | 24 MG | INJECTION | CARTRIDGE | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2840001 | FORTEO | TERIPARATIDE | PARATHYROID AGENTS | F | 20MCG/DOSE | SUBCUTANE. | PEN INJCTR | 2.4000000954 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2850101 | HUMULIN R U-500 | INSULIN REGULAR, HUMAN | INSULINS | F | 500/ML | SUBCUTANE. | VIAL | 20 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2892601 | LARTRUVO | OLARATUMAB | ANTINEOPLASTIC AGENTS | F | 500MG/50ML | INTRAVEN. | VIAL | 50 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2956001 | HUMATROPEN | PEN INJECTOR DEVICE | DEVICES | O | 6 | SUBCUTANE. | PEN INJCTR | 1 | NON DRUG | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2956101 | HUMATROPEN | PEN INJECTOR DEVICE | DEVICES | O | 12 | SUBCUTANE. | PEN INJCTR | 1 | NON DRUG | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2956201 | HUMATROPEN | PEN INJECTOR DEVICE | DEVICES | O | 24 | SUBCUTANE. | PEN INJCTR | 1 | NON DRUG | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 2967301 | HUMAPEN LUXURA HD | INSULIN ADMIN. SUPPLIES | DEVICES | F | SUBCUTANE. | INSULN PEN | 1 | NON DRUG | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] | |
| 3001101 | DAKLINZA | DACLATASVIR DIHYDROCHLORIDE | HCV ANTIVIRALS | F | 90 MG | ORAL | TABLET | 28 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3021301 | DAKLINZA | DACLATASVIR DIHYDROCHLORIDE | HCV ANTIVIRALS | F | 30 MG | ORAL | TABLET | 28 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3021501 | DAKLINZA | DACLATASVIR DIHYDROCHLORIDE | HCV ANTIVIRALS | F | 60 MG | ORAL | TABLET | 28 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3031505 | KENALOG-80 | TRIAMCINOLONE ACETONIDE | ADRENALS | F | 80 MG/ML | INJECTION | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3031520 | KENALOG-80 | TRIAMCINOLONE ACETONIDE | ADRENALS | F | 80 MG/ML | INJECTION | VIAL | 5 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3049420 | KENALOG-10 | TRIAMCINOLONE ACETONIDE | ADRENALS | F | 10 MG/ML | INJECTION | VIAL | 5 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3052620 | NITRATEST PAPER | URINE PHENAPHTHAZINE-PH TEST | PH | O | 15 FEET | MISCELL. | EACH | 1 | NON DRUG | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3223011 | AZACTAM-ISO-OSMOTIC DEXTROSE | AZTREONAM/DEXTROSE-WATER | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 1 G/50 ML | INTRAVEN. | FROZ.PIGGY | 50 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3224011 | AZACTAM-ISO-OSMOTIC DEXTROSE | AZTREONAM/DEXTROSE-WATER | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 2 G/50 ML | INTRAVEN. | FROZ.PIGGY | 50 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3232711 | YERVOY | IPILIMUMAB | ANTINEOPLASTIC AGENTS | F | 50 MG/10ML | INTRAVEN. | VIAL | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3232822 | YERVOY | IPILIMUMAB | ANTINEOPLASTIC AGENTS | F | 200MG/40ML | INTRAVEN. | VIAL | 40 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3256016 | AZACTAM | AZTREONAM | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 1 G | INJECTION | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3257016 | AZACTAM | AZTREONAM | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 2 G | INJECTION | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3373413 | OPDIVO | NIVOLUMAB | ANTINEOPLASTIC AGENTS | F | 240MG/24ML | INTRAVEN. | VIAL | 24 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3375614 | OPDIVO | NIVOLUMAB | ANTINEOPLASTIC AGENTS | F | 120MG/12ML | INTRAVEN. | VIAL | 12 | SSB | 0 | 0 | NC | |
| 3376474 | ELIQUIS | APIXABAN | ANTICOAGULANTS | F | 5 MG (74) | ORAL | TAB DS PK | 74 | SSB | 0 | 0 | NC | |
| 3377211 | OPDIVO | NIVOLUMAB | ANTINEOPLASTIC AGENTS | F | 40 MG/4 ML | INTRAVEN. | VIAL | 4 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 3377412 | OPDIVO | NIVOLUMAB | ANTINEOPLASTIC AGENTS | F | 100MG/10ML | INTRAVEN. | VIAL | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4018682 | BONIVA | IBANDRONATE SODIUM | BONE RESORPTION INHIBITORS | F | 150 MG | ORAL | TABLET | 3 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4018683 | BONIVA | IBANDRONATE SODIUM | BONE RESORPTION INHIBITORS | F | 150 MG | ORAL | TABLET | 3 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4019109 | BONIVA | IBANDRONATE SODIUM | BONE RESORPTION INHIBITORS | F | 3 MG/3 ML | INTRAVEN. | SYRINGE | 3 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4025752 | XENICAL | ORLISTAT | GI DRUGS, MISCELLANEOUS | F | 120 MG | ORAL | CAPSULE | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4029809 | CELLCEPT | MYCOPHENOLATE MOFETIL HCL | IMMUNOSUPPRESSIVE AGENTS | F | 500 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4029830 | CELLCEPT | MYCOPHENOLATE MOFETIL HCL | IMMUNOSUPPRESSIVE AGENTS | F | 500 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4694003 | CYTOVENE | GANCICLOVIR SODIUM | NUCLEOSIDES AND NUCLEOTIDES | F | 500 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 4694004 | CYTOVENE | GANCICLOVIR SODIUM | NUCLEOSIDES AND NUCLEOTIDES | F | 500 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5250002 | FIBERCON | CALCIUM POLYCARBOPHIL | CATHARTICS AND LAXATIVES | O | 625 MG | ORAL | TABLET | 36 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5250023 | FIBERCON | CALCIUM POLYCARBOPHIL | CATHARTICS AND LAXATIVES | O | 625 MG | ORAL | TABLET | 140 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5250033 | FIBERCON | CALCIUM POLYCARBOPHIL | CATHARTICS AND LAXATIVES | O | 625 MG | ORAL | TABLET | 90 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5423720 | CENTRUM KIDS | PEDI MV180/IRON,CARBONYL/VIT K | MULTIVITAMIN PREPARATIONS | Q | 8 MG-10MCG | ORAL | TAB CHEW | 80 | SSB | 0 | 0 | NC | |
| 5434462 | CENTRUM | MULTIVIT-MIN/FERROUS GLUCONATE | MULTIVITAMIN PREPARATIONS | Q | 9 MG/15 ML | ORAL | LIQUID | 236 | GENERIC | 0 | 0 | NC | |
| 5436556 | CENTRUM SPECIALIST PRENATAL | PRENATAL VIT101/IRON/FOLIC/DHA | MULTIVITAMIN PREPARATIONS | Q | 27-800-200 | ORAL | COMBO. PKG | 56 | SSB | 0 | 0 | NC | |
| 5445174 | CENTRUM COMPLETE | MULTIVITAMIN/IRON/FOLIC ACID | MULTIVITAMIN PREPARATIONS | Q | 18MG-0.4MG | ORAL | TABLET | 200 | GENERIC | 0 | 0 | NC | |
| 5446119 | CENTRUM SILVER | FOLIC ACID/MULTIVIT-MIN/LUTEIN | MULTIVITAMIN PREPARATIONS | Q | 400-250MCG | ORAL | TAB CHEW | 60 | MSB | 0 | 0 | NC | |
| 5447060 | CENTRUM SPECIALIST ENERGY | MV-MN/IRON/FA/VIT K/K.GINSENG | MULTIVITAMIN PREPARATIONS | Q | 18-400-25 | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | |
| 5449860 | CENTRUM SPECIALIST HEART | MULTIVIT,IRON,MINS/FOLIC ACID | MULTIVITAMIN PREPARATIONS | Q | 3-200-400 | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | |
| 5452835 | CENTRUM CHEWABLES | MULTIVIT-MIN/IRON/FOLIC/VIT K1 | MULTIVITAMIN PREPARATIONS | Q | 8MG-400-10 | ORAL | TAB CHEW | 100 | SSB | 0 | 0 | NC | |
| 5452890 | CENTRUM CHEWABLES | MULTIVIT-MIN/IRON/FOLIC/VIT K1 | MULTIVITAMIN PREPARATIONS | Q | 8MG-400-80 | ORAL | TAB CHEW | 90 | SSB | 0 | 0 | NC | |
| 5475557 | CENTRUM WOMEN | MULTIVITAMIN/IRON/FOLIC ACID | MULTIVITAMIN PREPARATIONS | Q | 18MG-0.4MG | ORAL | TABLET | 120 | GENERIC | 0 | 0 | NC | |
| 5475592 | CENTRUM WOMEN | MULTIVITAMIN/IRON/FOLIC ACID | MULTIVITAMIN PREPARATIONS | Q | 18MG-0.4MG | ORAL | TABLET | 120 | GENERIC | 0 | 0 | NC | |
| 5475652 | CENTRUM SILVER WOMEN | MULTIVIT-MIN/IRON/FOLIC/LUTEIN | MULTIVITAMIN PREPARATIONS | Q | 8-400-300 | ORAL | TABLET | 100 | MSB | 0 | 0 | NC | |
| 5475671 | CENTRUM SILVER WOMEN | MULTIVIT-MIN/IRON/FOLIC/LUTEIN | MULTIVITAMIN PREPARATIONS | Q | 8-400-300 | ORAL | TABLET | 200 | MSB | 0 | 0 | NC | |
| 5475756 | CENTRUM MEN | MULTIVIT-MINS/IRON/FOLIC/LYCOP | MULTIVITAMIN PREPARATIONS | Q | 8-200-600 | ORAL | TABLET | 120 | MSB | 0 | 0 | NC | |
| 5475770 | CENTRUM ULTRA MEN'S | MULTIVIT-MINS/IRON/FOLIC/LYCOP | MULTIVITAMIN PREPARATIONS | Q | 8-200-600 | ORAL | TABLET | 200 | MSB | 0 | 0 | NC | |
| 5475850 | CENTRUM SILVER ULTRA MEN'S | MULTIVIT-MIN/FA/LYCOPEN/LUTEIN | MULTIVITAMIN PREPARATIONS | Q | 300-600MCG | ORAL | TABLET | 100 | MSB | 0 | 0 | NC | |
| 5475865 | CENTRUM SILVER MEN | MULTIVIT-MIN/FA/LYCOPEN/LUTEIN | MULTIVITAMIN PREPARATIONS | Q | 300-600MCG | ORAL | TABLET | 65 | MSB | 0 | 0 | NC | |
| 5475870 | CENTRUM SILVER ULTRA MEN'S | MULTIVIT-MIN/FA/LYCOPEN/LUTEIN | MULTIVITAMIN PREPARATIONS | Q | 300-600MCG | ORAL | TABLET | 200 | MSB | 0 | 0 | NC | |
| 5486090 | CENTRUM MULTIGUMMIES | MULTIVIT-MINERALS/FOLIC ACID | MULTIVITAMIN PREPARATIONS | Q | 80 MCG | ORAL | TAB CHEW | 150 | SSB | 0 | 0 | NC | |
| 5487460 | CENTRUM ADULT 50 FRESH-FRUITY | MULTIVIT-MINERALS/FOLIC ACID | MULTIVITAMIN PREPARATIONS | Q | 120 MCG | ORAL | TAB CHEW | 60 | SSB | 0 | 0 | NC | |
| 5490592 | CENTRUM FLAVOR BURST ADULT | MULTIVIT WITH MINERALS NO.55 | MULTIVITAMIN PREPARATIONS | Q | ORAL | TAB CHEW | 120 | SSB | 0 | 0 | NC | ||
| 5490692 | CENTRUM FLAVOR BURST KIDS | MULTIVIT WITH MINERALS NO.55 | MULTIVITAMIN PREPARATIONS | Q | ORAL | TAB CHEW | 120 | SSB | 0 | 0 | NC | ||
| 5550919 | CALTRATE 600 PLUS D3 | CALCIUM CARBONATE/VITAMIN D3 | REPLACEMENT PREPARATIONS | Q | 600 MG-20 | ORAL | TABLET | 60 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5550924 | CALTRATE 600 PLUS D3 | CALCIUM CARBONATE/VITAMIN D3 | REPLACEMENT PREPARATIONS | Q | 600 MG-20 | ORAL | TABLET | 120 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5550925 | CALTRATE 600 PLUS D3 | CALCIUM CARBONATE/VITAMIN D3 | REPLACEMENT PREPARATIONS | Q | 600 MG-20 | ORAL | TABLET | 200 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5551210 | CALTRATE + D3 PLUS MINERALS | CALCIUM/D3/MAG OX/COP/MANG/ZN | REPLACEMENT PREPARATIONS | Q | 300 MG-800 | ORAL | TABLET | 150 | SSB | 0 | 0 | NC | |
| 5551795 | CALTRATE GUMMY BITES | CALCIUM PHOSPHATE TRIB/VIT D3 | REPLACEMENT PREPARATIONS | Q | 250-0.01MG | ORAL | TAB CHEW | 100 | SSB | 0 | 0 | NC | |
| 5555619 | CALTRATE 600+D PLUS | CAL/D3/MAG11/ZINC/COP/MANG/BOR | REPLACEMENT PREPARATIONS | Q | 600 MG-800 | ORAL | TABLET | 60 | MSB | 0 | 0 | NC | |
| 5555623 | CALTRATE 600+D PLUS | CAL/D3/MAG11/ZINC/COP/MANG/BOR | REPLACEMENT PREPARATIONS | Q | 600 MG-800 | ORAL | TABLET | 120 | MSB | 0 | 0 | NC | |
| 5556711 | CALTRATE 600-D3 PLUS MINERALS | CA/D3/MAG/ZINC/COPP/MANG/MGBOR | REPLACEMENT PREPARATIONS | Q | 600 MG-800 | ORAL | TAB CHEW | 90 | SSB | 0 | 0 | NC | |
| 5556720 | CALTRATE 600-D3 PLUS MINERALS | CA/D3/MAG/ZINC/COPP/MANG/MGBOR | REPLACEMENT PREPARATIONS | Q | 600 MG-800 | ORAL | TAB CHEW | 60 | SSB | 0 | 0 | NC | |
| 5556819 | CALTRATE 600 + D | CALCIUM CARBONATE/VITAMIN D3 | REPLACEMENT PREPARATIONS | Q | 600 MG-20 | ORAL | TAB CHEW | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5556919 | CALTRATE 600 + D | CALCIUM CARBONATE/VITAMIN D3 | REPLACEMENT PREPARATIONS | Q | 600 MG-20 | ORAL | TAB CHEW | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 5760450 | CENTRUM PRONUTRIENTS OMEGA-3 | OMEGA-3S/DHA/EPA/FISH OIL | ANTILIPEMIC AGENTS, MISCELLANEOUS | Q | 332.5 MG | ORAL | CAPSULE | 50 | SSB | 0 | 0 | NC | |
| 6000510 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 5 MG | ORAL | TABLET | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6000513 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 5 MG | ORAL | TABLET | 3 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6000530 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 5 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6003310 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 10 MG | ORAL | TABLET | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6003313 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 10 MG | ORAL | TABLET | 3 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6003330 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 10 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6007131 | PROPECIA | FINASTERIDE | SKIN AND MUCOUS MEMBRANE AGENTS, MISC. | F | 1 MG | ORAL | TABLET | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6007154 | PROPECIA | FINASTERIDE | SKIN AND MUCOUS MEMBRANE AGENTS, MISC. | F | 1 MG | ORAL | TABLET | 90 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6007861 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50MG-500MG | ORAL | TBMP 24HR | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6007862 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50MG-500MG | ORAL | TBMP 24HR | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6007882 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50MG-500MG | ORAL | TBMP 24HR | 1000 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6008061 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50-1000 MG | ORAL | TBMP 24HR | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6008062 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50-1000 MG | ORAL | TBMP 24HR | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6008082 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50-1000 MG | ORAL | TBMP 24HR | 1000 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6008131 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100-1000MG | ORAL | TBMP 24HR | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6008154 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100-1000MG | ORAL | TBMP 24HR | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6008182 | JANUMET XR | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100-1000MG | ORAL | TBMP 24HR | 1000 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6011201 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50 MG | ORAL | TABLET | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6011228 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50 MG | ORAL | TABLET | 100 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6011231 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6011254 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50 MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6022101 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 25 MG | ORAL | TABLET | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6022128 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 25 MG | ORAL | TABLET | 100 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6022131 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 25 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6022154 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 25 MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027044 | FOSAMAX PLUS D | ALENDRONATE SODIUM/VITAMIN D3 | BONE RESORPTION INHIBITORS | F | 70 MG-5600 | ORAL | TABLET | 4 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027701 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100 MG | ORAL | TABLET | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027702 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027728 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100 MG | ORAL | TABLET | 100 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027731 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027733 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027754 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100 MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6027782 | JANUVIA | SITAGLIPTIN PHOSPHATE | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 100 MG | ORAL | TABLET | 1000 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6032510 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 15 MG | ORAL | TABLET | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6032513 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 15 MG | ORAL | TABLET | 3 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6032530 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 15 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6033510 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 20 MG | ORAL | TABLET | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6033513 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 20 MG | ORAL | TABLET | 3 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6033530 | BELSOMRA | SUVOREXANT | UNKNOWN | F | 20 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6035101 | ZONTIVITY | VORAPAXAR SULFATE | PLATELET-AGGREGATION INHIBITORS | F | 2.08 MG | ORAL | TABLET | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6035131 | ZONTIVITY | VORAPAXAR SULFATE | PLATELET-AGGREGATION INHIBITORS | F | 2.08 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6035148 | ZONTIVITY | VORAPAXAR SULFATE | PLATELET-AGGREGATION INHIBITORS | F | 2.08 MG | ORAL | TABLET | 100 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6035154 | ZONTIVITY | VORAPAXAR SULFATE | PLATELET-AGGREGATION INHIBITORS | F | 2.08 MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6057561 | JANUMET | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50MG-500MG | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6057562 | JANUMET | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50MG-500MG | ORAL | TABLET | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6057582 | JANUMET | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50MG-500MG | ORAL | TABLET | 1000 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6057761 | JANUMET | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50-1000 MG | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6057762 | JANUMET | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50-1000 MG | ORAL | TABLET | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6057782 | JANUMET | SITAGLIPTIN PHOS/METFORMIN HCL | DIPEPTIDYL PEPTIDASE-4(DPP-4) INHIBITORS | F | 50-1000 MG | ORAL | TABLET | 1000 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6071044 | FOSAMAX PLUS D | ALENDRONATE SODIUM/VITAMIN D3 | BONE RESORPTION INHIBITORS | F | 70 MG-2800 | ORAL | TABLET | 4 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6171131 | SINGULAIR | MONTELUKAST SODIUM | LEUKOTRIENE MODIFIERS | F | 4 MG | ORAL | TAB CHEW | 30 | MSB | 0 | 0 | NC | |
| 6302500 | ZINPLAVA | BEZLOTOXUMAB | SERUMS | F | 1000 MG/40 | INTRAVEN. | VIAL | 40 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6302501 | ZINPLAVA | BEZLOTOXUMAB | SERUMS | F | 1000 MG/40 | INTRAVEN. | VIAL | 40 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6302601 | KEYTRUDA | PEMBROLIZUMAB | ANTINEOPLASTIC AGENTS | F | 100 MG/4ML | INTRAVEN. | VIAL | 4 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6302602 | KEYTRUDA | PEMBROLIZUMAB | ANTINEOPLASTIC AGENTS | F | 100 MG/4ML | INTRAVEN. | VIAL | 4 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6302604 | KEYTRUDA | PEMBROLIZUMAB | ANTINEOPLASTIC AGENTS | F | 100 MG/4ML | INTRAVEN. | VIAL | 4 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6306100 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6306101 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6306102 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6306103 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6306104 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6306105 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307501 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 240 MG | ORAL | TABLET | 7 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307502 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 240 MG | ORAL | TABLET | 28 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307503 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 240 MG | ORAL | TABLET | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307504 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 240 MG | ORAL | TABLET | 14 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307601 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 480 MG | ORAL | TABLET | 7 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307602 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 480 MG | ORAL | TABLET | 28 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307603 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 480 MG | ORAL | TABLET | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6307604 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 480 MG | ORAL | TABLET | 14 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6351458 | PRIMAXIN | IMIPENEM/CILASTATIN SODIUM | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 250 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6351659 | PRIMAXIN | IMIPENEM/CILASTATIN SODIUM | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 500 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6382210 | CANCIDAS | CASPOFUNGIN ACETATE | ECHINOCANDINS | F | 50 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6382310 | CANCIDAS | CASPOFUNGIN ACETATE | ECHINOCANDINS | F | 70 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6384130 | SINGULAIR | MONTELUKAST SODIUM | LEUKOTRIENE MODIFIERS | F | 4 MG | ORAL | GRAN PACK | 30 | MSB | 0 | 0 | NC | |
| 6385601 | RECARBRIO | IMIPENEM/CILASTATIN/RELEBACTAM | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 1.25 G | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | |
| 6385602 | RECARBRIO | IMIPENEM/CILASTATIN/RELEBACTAM | MISCELLANEOUS B-LACTAM ANTIBIOTICS | F | 1.25 G | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | |
| 6391568 | SINEMET 10-100 | CARBIDOPA/LEVODOPA | DOPAMINE PRECURSORS | F | 10MG-100MG | ORAL | TABLET | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6391668 | SINEMET 25-100 | CARBIDOPA/LEVODOPA | DOPAMINE PRECURSORS | F | 25MG-100MG | ORAL | TABLET | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6391768 | SINEMET 25-250 | CARBIDOPA/LEVODOPA | DOPAMINE PRECURSORS | F | 25MG-250MG | ORAL | TABLET | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6391868 | SINEMET CR | CARBIDOPA/LEVODOPA | DOPAMINE PRECURSORS | F | 25MG-100MG | ORAL | TABLET ER | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6391968 | SINEMET CR | CARBIDOPA/LEVODOPA | DOPAMINE PRECURSORS | F | 50MG-200MG | ORAL | TABLET ER | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6394101 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6394132 | EMEND | FOSAPREPITANT DIMEGLUMINE | NEUROKININ-1 RECEPTOR ANTAGONISTS | F | 150 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6404701 | ROTATEQ | ROTAVIRUS VACCINE,LIVE ORAL PV | VACCINES | F | 2 ML | ORAL | SOLUTION | 2 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6404702 | ROTATEQ | ROTAVIRUS VACCINE,LIVE ORAL PV | VACCINES | F | 2 ML | ORAL | SOLUTION | 2 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6404720 | ROTATEQ | ROTAVIRUS VACCINE,LIVE ORAL PV | VACCINES | F | 2 ML | ORAL | SOLUTION | 2 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6404741 | ROTATEQ | ROTAVIRUS VACCINE,LIVE ORAL PV | VACCINES | F | 2 ML | ORAL | SOLUTION | 2 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6422901 | GRASTEK | GRASS POLLEN-TIMOTHY, STANDARD | ALLERGENIC EXTRACTS | F | 2800 UNIT | SUBLINGUAL | TAB SUBL | 10 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6422930 | GRASTEK | GRASS POLLEN-TIMOTHY, STANDARD | ALLERGENIC EXTRACTS | F | 2800 UNIT | SUBLINGUAL | TAB SUBL | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6430900 | DILUENT-MERCK LIVE VIRUS VACC | DILUENT 1,LIVE VIRUS VAC(SWFI) | PHARMACEUTICAL AIDS | F | SUBCUTANE. | VIAL | 0.6999999881 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] | |
| 6430901 | DILUENT-MERCK LIVE VIRUS VACC | DILUENT 1,LIVE VIRUS VAC(SWFI) | PHARMACEUTICAL AIDS | F | SUBCUTANE. | VIAL | 0.6999999881 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] | |
| 6432901 | VAXNEUVANCE | PNEUMOC 15-VAL CONJ-DIP CRM/PF | VACCINES | F | 0.5 ML | INTRAMUSC. | SYRINGE | 0.5 | SSB | 0 | 0 | NC | |
| 6432902 | VAXNEUVANCE | PNEUMOC 15-VAL CONJ-DIP CRM/PF | VACCINES | F | 0.5 ML | INTRAMUSC. | SYRINGE | 0.5 | SSB | 0 | 0 | NC | |
| 6432903 | VAXNEUVANCE | PNEUMOC 15-VAL CONJ-DIP CRM/PF | VACCINES | F | 0.5 ML | INTRAMUSC. | SYRINGE | 0.5 | SSB | 0 | 0 | NC | |
| 6496300 | ZOSTAVAX | ZOSTER VACCINE LIVE/PF | VACCINES | F | 19400 UNIT | SUBCUTANE. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6496301 | ZOSTAVAX | ZOSTER VACCINE LIVE/PF | VACCINES | F | 19400 UNIT | SUBCUTANE. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6496341 | ZOSTAVAX | ZOSTER VACCINE LIVE/PF | VACCINES | F | 19400 UNIT | SUBCUTANE. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6500301 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 240MG/12ML | INTRAVEN. | VIAL | 12 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6500302 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 240MG/12ML | INTRAVEN. | VIAL | 12 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6500401 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 480MG/24ML | INTRAVEN. | VIAL | 24 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6500402 | PREVYMIS | LETERMOVIR | ANTIVIRALS, MISCELLANEOUS | F | 480MG/24ML | INTRAVEN. | VIAL | 24 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6502801 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 2.5 MG | ORAL | TABLET | 14 | SSB | 0 | 0 | NC | |
| 6502802 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 2.5 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | |
| 6502804 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 2.5 MG | ORAL | TABLET | 100 | SSB | 0 | 0 | NC | |
| 6502901 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 5 MG | ORAL | TABLET | 14 | SSB | 0 | 0 | NC | |
| 6502902 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 5 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | |
| 6502904 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 5 MG | ORAL | TABLET | 100 | SSB | 0 | 0 | NC | |
| 6503001 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 10 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | |
| 6503002 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 10 MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | |
| 6503004 | VERQUVO | VERICIGUAT | VASODILATING AGENTS, MISCELLANEOUS | F | 10 MG | ORAL | TABLET | 100 | SSB | 0 | 0 | NC | |
| 6503301 | ONTRUZANT | TRASTUZUMAB-DTTB | ANTINEOPLASTIC AGENTS | F | 150 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | |
| 6503302 | ONTRUZANT | TRASTUZUMAB-DTTB | ANTINEOPLASTIC AGENTS | F | 150 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | |
| 6503401 | ONTRUZANT | TRASTUZUMAB-DTTB | ANTINEOPLASTIC AGENTS | F | 420 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | |
| 6503402 | ONTRUZANT | TRASTUZUMAB-DTTB | ANTINEOPLASTIC AGENTS | F | 420 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | |
| 6536303 | STEGLATRO | ERTUGLIFLOZIN PIDOLATE | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 5 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536306 | STEGLATRO | ERTUGLIFLOZIN PIDOLATE | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 5 MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536307 | STEGLATRO | ERTUGLIFLOZIN PIDOLATE | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 5 MG | ORAL | TABLET | 500 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536403 | STEGLATRO | ERTUGLIFLOZIN PIDOLATE | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 15 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536406 | STEGLATRO | ERTUGLIFLOZIN PIDOLATE | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 15 MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536407 | STEGLATRO | ERTUGLIFLOZIN PIDOLATE | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 15 MG | ORAL | TABLET | 500 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536703 | STEGLUJAN | ERTUGLIFLOZIN/SITAGLIPTIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 5 MG-100MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536706 | STEGLUJAN | ERTUGLIFLOZIN/SITAGLIPTIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 5 MG-100MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536803 | STEGLUJAN | ERTUGLIFLOZIN/SITAGLIPTIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 15MG-100MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536806 | STEGLUJAN | ERTUGLIFLOZIN/SITAGLIPTIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 15MG-100MG | ORAL | TABLET | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536903 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 2.5-500 MG | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536906 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 2.5-500 MG | ORAL | TABLET | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6536907 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 2.5-500 MG | ORAL | TABLET | 500 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537003 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 7.5-500 MG | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537006 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 7.5-500 MG | ORAL | TABLET | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537007 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 7.5-500 MG | ORAL | TABLET | 500 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537303 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 2.5-1000MG | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537306 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 2.5-1000MG | ORAL | TABLET | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537307 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 2.5-1000MG | ORAL | TABLET | 500 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537403 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 7.5-1000MG | ORAL | TABLET | 60 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537406 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 7.5-1000MG | ORAL | TABLET | 180 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6537407 | SEGLUROMET | ERTUGLIFLOZIN/METFORMIN | SODIUM-GLUC COTRANSPORT 2 (SGLT2) INHIB | F | 7.5-1000MG | ORAL | TABLET | 500 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542030 | RAGWITEK | WEED POLLEN-SHORT RAGWEED | ALLERGENIC EXTRACTS | F | 12 UNIT | SUBLINGUAL | TAB SUBL | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542054 | RAGWITEK | WEED POLLEN-SHORT RAGWEED | ALLERGENIC EXTRACTS | F | 12 UNIT | SUBLINGUAL | TAB SUBL | 90 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542302 | BRIDION | SUGAMMADEX SODIUM | ANTIDOTES | F | 200 MG/2ML | INTRAVEN. | VIAL | 2 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542305 | BRIDION | SUGAMMADEX SODIUM | ANTIDOTES | F | 500 MG/5ML | INTRAVEN. | VIAL | 5 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542312 | BRIDION | SUGAMMADEX SODIUM | ANTIDOTES | F | 200 MG/2ML | INTRAVEN. | VIAL | 2 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542315 | BRIDION | SUGAMMADEX SODIUM | ANTIDOTES | F | 500 MG/5ML | INTRAVEN. | VIAL | 5 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542402 | ANTIVENIN LATRODECTUS MACTANS | ANTIVENIN,LATRODECTUS MACTANS | SERUMS | F | 6000 UNIT | INJECTION | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542505 | BRIDION | SUGAMMADEX SODIUM | ANTIDOTES | F | 500 MG/5ML | INTRAVEN. | VIAL | 5 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6542515 | BRIDION | SUGAMMADEX SODIUM | ANTIDOTES | F | 500 MG/5ML | INTRAVEN. | VIAL | 5 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6672268 | SINEMET 10-100 | CARBIDOPA/LEVODOPA | DOPAMINE PRECURSORS | F | 10MG-100MG | ORAL | TABLET | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6672468 | SINEMET 25-100 | CARBIDOPA/LEVODOPA | DOPAMINE PRECURSORS | F | 25MG-100MG | ORAL | TABLET | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 6911754 | SINGULAIR | MONTELUKAST SODIUM | LEUKOTRIENE MODIFIERS | F | 10 MG | ORAL | TABLET | 90 | MSB | 0 | 0 | NC | |
| 6927531 | SINGULAIR | MONTELUKAST SODIUM | LEUKOTRIENE MODIFIERS | F | 5 MG | ORAL | TAB CHEW | 30 | MSB | 0 | 0 | NC | |
| 7337013 | COREG CR | CARVEDILOL PHOSPHATE | BETA-ADRENERGIC BLOCKING AGENTS | F | 10 MG | ORAL | CPMP 24HR | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 7337113 | COREG CR | CARVEDILOL PHOSPHATE | BETA-ADRENERGIC BLOCKING AGENTS | F | 20 MG | ORAL | CPMP 24HR | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 7337213 | COREG CR | CARVEDILOL PHOSPHATE | BETA-ADRENERGIC BLOCKING AGENTS | F | 40 MG | ORAL | CPMP 24HR | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 7337313 | COREG CR | CARVEDILOL PHOSPHATE | BETA-ADRENERGIC BLOCKING AGENTS | F | 80 MG | ORAL | CPMP 24HR | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 7338313 | COREG CR | CARVEDILOL PHOSPHATE | BETA-ADRENERGIC BLOCKING AGENTS | F | 10 MG | ORAL | CPMP 24HR | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 7338513 | COREG CR | CARVEDILOL PHOSPHATE | BETA-ADRENERGIC BLOCKING AGENTS | F | 20 MG | ORAL | CPMP 24HR | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 7338713 | COREG CR | CARVEDILOL PHOSPHATE | BETA-ADRENERGIC BLOCKING AGENTS | F | 40 MG | ORAL | CPMP 24HR | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 7440701 | ARGATROBAN | ARGATROBAN | ANTICOAGULANTS | F | 100 MG/ML | INTRAVEN. | VIAL | 2.5 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8010001 | BESPONSA | INOTUZUMAB OZOGAMICIN | ANTINEOPLASTIC AGENTS | F | 0.9 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8042301 | ANTIVENIN MICRURUS FULVIUS | ANTIVENIN,MICRURUS FULVIUS | SERUMS | F | INJECTION | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] | |
| 8042303 | ANTIVENIN MICRURUS FULVIUS | ANTIVENIN,MICRURUS FULVIUS | SERUMS | F | INJECTION | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] | |
| 8092351 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8092355 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8092360 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8094101 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8094102 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8094103 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8112312 | DUAVEE | ESTROGENS,CONJ/BAZEDOXIFENE | ESTROGENS | F | 0.45-20 MG | ORAL | TABLET | 30 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8117901 | TORISEL | TEMSIROLIMUS | ANTINEOPLASTIC AGENTS | F | FDN 30MG/3 | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8117905 | TORISEL | TEMSIROLIMUS | ANTINEOPLASTIC AGENTS | F | FDN 30MG/3 | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8121030 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 25 MG | ORAL | TAB ER 24H | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8121101 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 50 MG | ORAL | TAB ER 24H | 90 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8121114 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 50 MG | ORAL | TAB ER 24H | 14 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8121130 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 50 MG | ORAL | TAB ER 24H | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8121150 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 50 MG | ORAL | TAB ER 24H | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8122201 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 100 MG | ORAL | TAB ER 24H | 90 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8122214 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 100 MG | ORAL | TAB ER 24H | 14 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8122230 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 100 MG | ORAL | TAB ER 24H | 30 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8122250 | PRISTIQ | DESVENLAFAXINE SUCCINATE | ANTIDEPRESSANTS | F | 100 MG | ORAL | TAB ER 24H | 100 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8200101 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8200110 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8200125 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8400101 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8400110 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8400125 | PROTONIX IV | PANTOPRAZOLE SODIUM | PROTON-PUMP INHIBITORS | F | 40 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8451001 | MYLOTARG | GEMTUZUMAB OZOGAMICIN | ANTINEOPLASTIC AGENTS | F | 4.5 MG | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8499001 | TYGACIL | TIGECYCLINE | TETRACYCLINES | F | 50 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8499002 | TYGACIL | TIGECYCLINE | TETRACYCLINES | F | 50 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8499019 | TYGACIL | TIGECYCLINE | TETRACYCLINES | F | 50 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8499020 | TYGACIL | TIGECYCLINE | TETRACYCLINES | F | 50 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8499419 | TYGACIL | TIGECYCLINE | TETRACYCLINES | F | 50 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 8499420 | TYGACIL | TIGECYCLINE | TETRACYCLINES | F | 50 MG | INTRAVEN. | VIAL | 1 | MSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 9000302 | SOLU-MEDROL | METHYLPREDNISOLONE SOD SUCC/PF | ADRENALS | F | 500 MG/4ML | INTRAVEN. | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
| 9000501 | SOLU-CORTEF | HYDROCORTISONE SODIUM SUCC/PF | ADRENALS | F | 1000MG/8ML | INJECTION | VIAL | 1 | SSB | 0 | 0 | NC | HARD_MSG: [DRUG NOT COVERED] [INTERNAL_REJECT_CODE=284 NCPDP_REJECT_CODE=70] |
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