Description - DE Medical Assistance Program

S0128 INJ FOLLITROPIN BETA 75 IU 9 $0.00
S0130 INJ C GONADOTROPIN 5000 IU O $0.00
S0132 INJ GANIRELIX ACETAT 250 MCG 9 $0.00
S0133 HISTRELIN IMPLANT O $0.00
S0135 PEGFILGRASTIM INJECTION 6MG O $0.00
S0136 CLOZAPINE, 25 MG 9 $0.00
S0137 DIDANOSINE, 25 MG 9 $0.00
S0138 FINASTERIDE, 5 MG 9 $0.00
S0139 MINOXIDIL, 10 MG 9 $0.00
S0140 SAQUINAVIR, 200 MG 9 $0.00
S0141 ZALCITABINE, 0.375 MG O $0.00
S0142 COLISTIMETHATE INH SOL MG 9 $0.00
S0143 AZTREONAM, INH SOL GRAM O $0.00
S0145 PEG INTERFERON ALFA-2A/180 3 $503.69
S0146 PEG INTERFERON ALFA-2B/10 3 $454.96
S0147 ALGLUCOSIDASE ALFA 20 MG O $0.00
S0155 EPOPROSTENOL DILUTANT 5 $0.00
S0156 EXEMESTANE, 25 MG 5 $0.00
S0157 BECAPLERMIN GEL 1%, 0.5 GM 9 $0.00
S0158 INJECTION LARONIDASE O $0.00
S0159 INJECTION AGALSIDASE O $0.00
S0160 DEXTROAMPHETAMINE 9 $0.00
S0161 CALCITROL 9 $0.00
S0162 INJECTION EFALIZUMAB O $0.00
S0163 INJECTION RISPERIDONELA O $0.00
S0164 INJECTION PANTROPRAZOLE 3 $12.31
S0165 INJECTION ABARELIX O $0.00
S0166 INJ OLANZAPINE 2.5MG 9 $0.00
S0167 INJ APOMORPHINE HCL 1MG O $0.00
S0168 INJ AZACITIDINE 100 MG O $0.00
S0170 ANASTROZOLE 1 MG 9 $0.00
S0171 BUMETANIDE 0.5 MG 5 $0.00
S0172 CHLORAMBUCIL 2 MG 9 $0.00
S0173 DEXAMETHASONE 4 MG O $0.00
S0174 DOLASETRON 50 MG 9 $0.00
S0175 FLUTAMIDE 125 MG 9 $0.00
S0176 HYDROXYUREA 500 MG 9 $0.00
S0177 LEVAMISOLE 50 MG 9 $0.00
S0178 LOMUSTINE 10 MG 9 $0.00
S0179 MEGESTROL 20 MG 9 $0.00
S0180 ETONOGESTREL IMPLANT SYSTEM O $0.00
S0181 ONDANSETRON 4 MG 9 $0.00
S0182 PROCARBAZINE 5 MG 9 $0.00
S0183 PROCHLORPERAZINE 5 MG 9 $0.00
S0187 TAMOXIFEN 10 MG 9 $0.00
S0189 TESTOSTERONE PELLET 75 MG 9 $0.00
S0190 MIFEPRISTONE, ORAL, 200 MG 5 $0.00
S0191 MISOPROSTOL, ORAL, 200 MCG 5 $0.00
S0194 VITAMIN SUPPL 100 CAPS 9 $0.00