NEW YORK STATE DEPARTMENT OF HEALTH 08/06 ... - eMedNY
NEW YORK STATE DEPARTMENT OF HEALTH 08/06 ... - eMedNY
NEW YORK STATE DEPARTMENT OF HEALTH 08/06 ... - eMedNY
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<strong>NEW</strong> <strong>YORK</strong> <strong>STATE</strong> <strong>DEPARTMENT</strong> <strong>OF</strong> <strong>HEALTH</strong> 02/28/2014 PAGE: 419LIST <strong>OF</strong> MEDICAID REIMBURSABLE DRUGSRX TYPE: 01 PRICING ERRORS ARE NOT REIMBURSABLE PRICES EFFECTIVE 02/28/2014LTM BASISIND NDC CODE MRA COST COST ALTERNATE FORMULARY DESCRIPTION PA CD LABELER <strong>OF</strong> MRA--- ------------- ------------ -------------- -------------------------------------------------- ----- ------------------ ----------GEN 31722-0327-01 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 CAMBER PHARMACE EAGEN 31722-0327-10 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 CAMBER PHARMACE EAGEN 51672-4027-01 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 TARO PHARM USA EAGEN 51672-4027-03 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 TARO PHARM USA EAGEN 51672-4027-07 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 TARO PHARM USA EAGEN 65162-0761-10 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 AMNEAL PHARMACE EAGEN 65162-0761-11 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 AMNEAL PHARMACE EAGEN 68382-0052-01 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 ZYDUS PHARMACEU EAGEN 68382-0052-10 0.<strong>06</strong>520 WARFARIN SODIUM 1 MG TABLET 0 ZYDUS PHARMACEU EAGEN 00555-<strong>08</strong>35-02 0.07180 WARFARIN SODIUM 10 MG TABLET 0 BARR EA--- ------------- ------------ -------------- -------------------------------------------------- ----- ------------------ ----------GEN 31722-0335-01 0.07180 WARFARIN SODIUM 10 MG TABLET 0 CAMBER PHARMACE EAGEN 51672-4035-01 0.07180 WARFARIN SODIUM 10 MG TABLET 0 TARO PHARM USA EAGEN 51672-4035-03 0.07180 WARFARIN SODIUM 10 MG TABLET 0 TARO PHARM USA EAGEN 65162-0769-10 0.07180 WARFARIN SODIUM 10 MG TABLET 0 AMNEAL PHARMACE EAGEN 65162-0769-11 0.07180 WARFARIN SODIUM 10 MG TABLET 0 AMNEAL PHARMACE EAGEN 68382-0059-01 0.07180 WARFARIN SODIUM 10 MG TABLET 0 ZYDUS PHARMACEU EAGEN 00555-<strong>08</strong>69-02 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 BARR EAGEN 00555-<strong>08</strong>69-05 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 BARR EAGEN 31722-0328-01 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 CAMBER PHARMACE EAGEN 31722-0328-10 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 CAMBER PHARMACE EA--- ------------- ------------ -------------- -------------------------------------------------- ----- ------------------ ----------GEN 51672-4028-01 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 TARO PHARM USA EAGEN 51672-4028-03 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 TARO PHARM USA EAGEN 51672-4028-07 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 TARO PHARM USA EAGEN 62584-0984-01 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 AHP EAGEN 62584-0984-11 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 AHP EAGEN 65162-0762-10 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 AMNEAL PHARMACE EAGEN 65162-0762-11 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 AMNEAL PHARMACE EAGEN 68382-0053-01 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 ZYDUS PHARMACEU EAGEN 68382-0053-10 0.<strong>06</strong>520 WARFARIN SODIUM 2 MG TABLET 0 ZYDUS PHARMACEU EAGEN 00555-<strong>08</strong>32-02 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 BARR EA--- ------------- ------------ -------------- -------------------------------------------------- ----- ------------------ ----------GEN 00555-<strong>08</strong>32-05 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 BARR EAGEN 31722-0329-01 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 CAMBER PHARMACE EAGEN 31722-0329-10 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 CAMBER PHARMACE EAGEN 51672-4029-01 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 TARO PHARM USA EAGEN 51672-4029-03 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 TARO PHARM USA EAGEN 51672-4029-07 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 TARO PHARM USA EAGEN 65162-0763-10 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 AMNEAL PHARMACE EAGEN 65162-0763-11 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 AMNEAL PHARMACE EAGEN 68<strong>08</strong>4-0027-01 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 AHP EAGEN 68<strong>08</strong>4-0027-11 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 AHP EA--- ------------- ------------ -------------- -------------------------------------------------- ----- ------------------ ----------GEN 68382-0<strong>06</strong>4-01 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 ZYDUS PHARMACEU EAGEN 68382-0<strong>06</strong>4-10 0.<strong>06</strong>520 WARFARIN SODIUM 2.5 MG TABLET 0 ZYDUS PHARMACEU EAGEN 00555-0925-02 0.<strong>06</strong>520 WARFARIN SODIUM 3 MG TABLET 0 BARR EAGEN 31722-0330-01 0.<strong>06</strong>520 WARFARIN SODIUM 3 MG TABLET 0 CAMBER PHARMACE EAGEN 31722-0330-10 0.<strong>06</strong>520 WARFARIN SODIUM 3 MG TABLET 0 CAMBER PHARMACE EA** PRIOR APPROVAL CODES:PA code "0" = PA not required; PA code "N" = PA requiredPA code "G" = PA required for Non Preferred drugs OR drugs not meeting clinical criteria (FQD, STEP) OR drugs inClinical Drug Review Program, the Brand Less than Generic Program or the Mandatory Generic Program*** OTC, SUPPLY AND COMPOUND PRODUCTS LISTING AT BACK <strong>OF</strong> REPORT
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