facility | tax_id | update_date | version | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| allegiance-behavioral-health-center-of-plainview | 201871394 | 4/1/2023 | 1.0.0 | |||||||||||||||
| SERVICE DESCRIPTION | CDM CODE | BILLING CODE | ITEM/SERVICE DESCRIPTION | BILLING REVENUE CODE | GROSS CHARGE | BCBS of Texas (Commercial) | Beacon Health Options | Cigna Behavioral Health (Commercial) | Medicare (Traditional) | Optum (United Healthcare/United Behavioral Health) | TriWest (VCP) | Vantage Health Plan | Wellcare (Harmony Health Plan) | Zellis PPO | De-Identified Minimum Negotiated Rate | De-Identified Maximum Negotiated Rate | DISCOUNTED CASH PRICE | |
| Inpatient Psychiatric Services | 110002 | Private Room | 114 | 1208 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 110001 | Semi-Private Room | 124 | 1050 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 23926026 | Wound Care | 239 | 568 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000007 | A/B Otic Drops | 250 | 67 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000018 | Abilify 10mg | 250 | 60 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000019 | Abilify 15 Mg | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000020 | Abilify 2 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000022 | Abilify 20mg Tablet | 250 | 83 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000023 | Abilify 30 Mg | 250 | 88 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000024 | Abilify 5 Mg | 250 | 78 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000031 | Acarbose 50 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000032 | Accolate 20 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000033 | Accu Check Cmfrt Curv 100 | 250 | 136 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000034 | Accupril 20mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000041 | Acebutolol 400 Mg | 250 | 72 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000042 | Acetaminophen | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000044 | Acetaminophen 325mg | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000046 | Acetaminophen 500 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000054 | Acetazolamide 250 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000061 | Acidophillus | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000062 | Aciphex 20 Mg | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000063 | Acto Plus 15/850mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000065 | Actonel 35 Mg | 250 | 143 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000066 | Actos 15 Mg | 250 | 32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000067 | Actos 30 Mg | 250 | 48 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000068 | Actos 45mg | 250 | 182 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000069 | Acular Opth Sol'n 5m | 250 | 120 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000073 | Acyclovir 400 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000079 | Add Fee-Ivp-B | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000084 | Advair | 250 | 408 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000085 | Advair Discus 250/50 | 250 | 294 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000088 | Advair Diskus Inh | 250 | 819 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000090 | 80053 | Advanced Eye Relief | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000091 | Advil 200mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000094 | Aerobid | 250 | 651 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000095 | Aerochamber | 250 | 225 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000097 | 80156 | Aggremox Cap | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000099 | Aggrenox ER Caps | 250 | 43 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000100 | 86762 | Akwa Tears | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000106 | Albuterol .83mg/ML 75 | 250 | 151 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000111 | 89300 | Albuterol 200 Metered 17 Gm | 250 | 62 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000115 | 82003 | Albuterol 90mcg Inh 17gm | 250 | 51 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000124 | Aldactone 25mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000128 | 83874 | Alendronate 35mg | 250 | 88 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000129 | 82480 | Alendronate 70 Mg | 250 | 143 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000132 | Aleve | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000136 | 86710 | Align | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000139 | Allegra 180 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000141 | Allegra 600 Mg | 250 | 113 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000143 | Allegra-D | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000144 | Allopurin0l 100 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000145 | Allopurinal 300mg/Shein | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000150 | Alocromil 2% 5ml Eye | 250 | 453 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000154 | Alphagan P O. 15% 5 ML | 250 | 358 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000159 | Alprazolam 0.25mg/Purepac | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000160 | Alprazolam 0.5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000165 | Altace 2.5 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000166 | Altace 5 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000170 | 83020 | Amantadine 100 Mg Tab | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000174 | Amaryl 2 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000175 | Amaryl 4 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000176 | Ambien 10mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000178 | Ambien 5mg | 250 | 53 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000179 | Ambien Cr 12.5 Mg | 250 | 48 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000181 | Ambilify 10 Mg | 250 | 40 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000182 | Amblify 15 Mg | 250 | 80 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000200 | Amiodarone HCL 200 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000201 | Amitiza 24 Mcg | 250 | 40 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000207 | Amitriptyline 25 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000210 | 80076 | Amitriptyline HCL 10x21 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000214 | Amlodipine (Norvasc) 5mg Tab | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000216 | Amlodipine Besylate 10 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000218 | Amlodipine Besylate 5mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000226 | Amlopidine-Benaz | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000230 | 84402 | Ammonium Lactate 2% 400gm | 250 | 128 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000240 | Amoxicillin 500mg | 250 | 12.45 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000244 | Amoxicillin/Clav K. 875/125 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000264 | Anafranil 25 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000265 | 82435 | Analgestic Creme Rub | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000266 | Anaspaz Tab | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000268 | 86870 | Anastrozole 1 Mg | 250 | 50 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000271 | Antacid Susp Plus | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000274 | Antioxidant Vitamins | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000278 | Anusol Hc Supp | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000279 | 84132 | Apap 500 Mg X-Str Ca | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000284 | Aplrazolam 0.5 Mg/Greenstone | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000289 | Aquaphor 3.5mg Oint | 250 | 213 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000296 | Aricept 10 Mg Tablet | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000298 | Aricept 5 Mg Tablet | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000299 | Arimidex 1 Mg | 250 | 49 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000307 | 82382 | Arthrotec 75 Tablet | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000312 | Asacol 400 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000313 | Ascensia Elite #50 | 250 | 218 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000316 | Ascorbic Acid 500 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000317 | 87207 | Asmanex Twisthaler | 250 | 168 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000320 | Aspercreme 10% | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000322 | Aspirin 325mg Tab | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000323 | Aspirin 81mg Chewable Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000325 | Aspirin Ec (Ecotrin) 325mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000327 | 80198 | Asprin 81mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000330 | Atacand 16 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000331 | 86756 | Atacand 32 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000333 | Atarex 25mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000335 | Atenolol (Tenormin) 25mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000336 | Atenolol (Tenormin) 50mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000337 | Atenolol 100mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000339 | Atenolol 25mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000340 | Atenolol 50 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000342 | Ativan 0.25 Mg Tab | 250 | 4.5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000344 | Ativan 0.5 Mg | 250 | 9 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000346 | Ativan 1mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000347 | Ativan 2 Mg Injectable | 250 | 233 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000348 | Ativan 2mg/ML | 250 | 115 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000363 | Atrovent Inhalation | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000364 | Atrovent Inhaler | 250 | 380 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000371 | Augmentin 875 Mg Tab | 250 | 41 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000373 | Avalide 150/12.5 Mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000374 | Avandia 2mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000375 | Avandia 4mg | 250 | 78 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000377 | Avapro 150mg | 250 | 39 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000381 | Avelox 400mg | 250 | 118 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000382 | Avodart 0.5 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000383 | Awka Tears 1.4%-15ml | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000395 | 86157 | Azithromycin 250 Mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000397 | Azma Cprt Inhaler | 250 | 434 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000400 | Azo Tabs | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000405 | B-1 | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000409 | Bacitracin 15 Gm | 250 | 68 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000415 | Baclofen 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000421 | Bactrim Ds | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000423 | Bactroban Oint. 2% 22 Gm | 250 | 401 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000429 | Beconase Aq Nasal Spray | 250 | 458 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000434 | Benadryl 25 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000436 | Benadryl 50 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000443 | 82040 | Benazepril Hctz 20/1 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000445 | Benefiber Sugar Feee | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000447 | Benicar 20mg Tab | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000448 | Benicar 40 Mg | 250 | 51 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000450 | 82164 | Benicar 5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000457 | Benztrop 1 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000458 | J0515 | Benztropine (Cogentin) 1mg Tab | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000461 | Benztropine 0.5 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000462 | Benztropine 1 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000474 | Betapace 80 Mg | 250 | 71 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000476 | Bethameth Driprop .5 | 250 | 499 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000482 | 84165 | Bethanechol 50mg | 250 | 95 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000485 | Biaxin 500 Mg | 250 | 113 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000498 | Bisacodyl (Dulcolax) 5mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000500 | Bisacodyl 5mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000501 | 85044 | Biscolax | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000502 | Bismo 20 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000504 | 80194 | Bisoprolol | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000508 | 84432 | Black Cohosh | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000510 | Blistex Lip Medex | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000511 | 85046 | Boniva Tab 150 | 250 | 145 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000512 | Boost | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000515 | Brimonidine 0.2% | 250 | 98 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000516 | 86707 | Brimonidine 0.2% Eye | 250 | 213 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000517 | 86706 | Brimonidine Tartrate 5 ML | 250 | 262 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000526 | 86777 | Budesonide 0.5 Mg | 250 | 192 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000532 | 83002 | Bumetanide 1 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000533 | 85032 | Bumetanide 2 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000535 | Bumex 1mg | 250 | 89 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000545 | 80190 | Bupropion HCL Xl 300 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000547 | Bupropion Sr N200 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000548 | Buspar 15 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000549 | Buspar 5mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000552 | Buspirone 10 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000553 | Buspirone 15 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000555 | Buspirone 30 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000556 | Buspirone 5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000562 | 83825 | Butalbital/Apap/Caff | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000568 | 86320 | Bystolic 5 Mg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000570 | 82565 | Caduet 5 Mg/42mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000573 | Calan 120 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000575 | Calan Sr 180mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000580 | Calcitrate 600 + D | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000583 | Calcitriol 0.25 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000588 | Calcium 500mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000590 | Calcium 600+d | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000593 | 82465 | Calcium Antacid 150 Tab | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000599 | 82340 | Calcium Carbonate 60 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000612 | Caltrate 600 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000615 | Caltrol 0.25 Mg | 250 | 39 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000616 | Campral 333 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000619 | Capoten 25mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000622 | Captopril 50mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000625 | Captoril 25 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000626 | Carafate 1 Gm Tab | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000637 | Carbamazepine 100mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000638 | Carbamazepine 200mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000654 | Carbidopal/Levodopa 25/250mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000657 | Cardina 2 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000660 | Cardizem CD 120 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000661 | Cardizem CD 180mg | 250 | 46 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000662 | Cardizem CD 240 Mg | 250 | 150 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000664 | Cardura 2 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000669 | Carisoprodol 350mg Tab | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000677 | 82952 | Carvedilol 12.5 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000678 | Carvedilol 25mg | 250 | 9 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000679 | Carvedilol 3.125 Mg | 250 | 4.5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000680 | 86038 | Carvedilol 3.25 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000682 | 93225 | Carvedilol 6.25mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000688 | Catapress Tts 0.3 Patch | 250 | 536 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000689 | Cecon Bottle | 250 | 513 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000697 | 86880 | Cefdinar 300 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000709 | Ceftin 250mg | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000714 | 87075 | Ceftriaxone 1 Gm | 250 | 62 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000715 | 82693 | Ceftriaxone 1 Gm Vial | 250 | 101 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000724 | Celebrex 100 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000725 | Celebrex 200 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000733 | Celexa 20 Mg | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000735 | Cellcept 250mg | 250 | 88 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000737 | Centrum Silver Tab | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000738 | Century 50 Plus | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000739 | Century Senior Tabs | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000742 | Cepacol Lozenges | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000746 | Cephalexin 500 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000756 | 82247 | Cetirizine 10 Mg | 250 | 32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000761 | Chantix .5 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000762 | Chantix 1 Mg | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000765 | 85018 | Chlestyramine Packet | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000767 | Chloraseptic Spray | 250 | 62 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000772 | 82977 | Chlordiazepoxide 25mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000775 | Chlorex-A Tablets | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000778 | 84481 | Chlorhexidine 0.12% 473 ML | 250 | 64 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000780 | 83018 | Chlorophyll 3mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000785 | Chlorpromazine HCL | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000790 | Chlorthalidone 25 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000794 | Cholestyramine Packs | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000803 | Cilostazol 50 Mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000806 | Ciloxan Opth Drops | 250 | 318 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000807 | 86703 | Cimetidine 800 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000810 | Cipro 500mg Tablet | 250 | 80 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000814 | Ciprofloxacin (Cipro) 0.3% Oph | 250 | 131 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000819 | Ciprofloxacin 250 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000820 | Ciprofloxacin 500 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000821 | 81050 | Ciprofloxacin HCL | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000822 | 82668 | Ciprofloxacin Opht S 5 ML | 250 | 89 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000827 | 82671 | Citalopram 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000828 | Citalopram 20mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000829 | 82677 | Citalopram 40 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000831 | Citracal Plus W/ Mag | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000834 | Cl0nidine 0.1 Mg | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000835 | Clarinex 5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000839 | Claritin | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000842 | Cleocin 150 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000843 | Climara 0.1 Mg Patch | 250 | 50 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000860 | Clobenzaprine HCL | 250 | 46 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000867 | Clonazepam 1 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000875 | Clonidine .2 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000876 | Clonidine 0.1 | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000878 | Clonidine 0.3mg Tablet | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000880 | Clonidine Tts Patch 0.1 Mg | 250 | 447 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000881 | Clonidine Tts Patch 0.2mg | 250 | 349 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000882 | Clonidine Tts Patch 0.3 Mg | 250 | 185 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000883 | Clonozapam 0.5 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000887 | 80185 | Clorazepate 7.5mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000891 | Clotrim Antifungal | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000903 | Clozaril 25 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000911 | Coenzyme Q10 50 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000916 | Cogentin 2 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000918 | 87270 | Cogentin1 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000919 | Colace 100mg | 250 | 6.81 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000921 | Colace Liquid 10 Cc | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000923 | Col-Benemid | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000924 | Colcace Liquid 5ml | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000925 | Colchicine 0.6mg Tab | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000931 | 87491 | Colestipol HCL 1gm | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000936 | Combigan Eye Drops | 250 | 233 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000938 | Combivent Inhaler 14.7gm | 250 | 430 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000941 | Compazine 10 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000945 | 84450 | Compound Rx 30gm | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000946 | Comtan 200 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000949 | Copaxone 20mg | 250 | 390 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000952 | Cordarone 200mg | 250 | 126 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000959 | Corgard 40mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000960 | Corge 12.5 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000961 | Corona Ointment | 250 | 67 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000962 | 84460 | Correc Cr 40mg | 250 | 84 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000967 | Cosopt Eye Drops | 250 | 312 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000972 | Coumadin 2.5 Mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000973 | Coumadin 3.5 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000974 | Coumadin 5 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000976 | Coumadin 7.5mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000978 | Cozaar 100 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000979 | 86304 | Cozaar 25 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25000980 | Cozaar 50 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000984 | Crestor 10 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000991 | Cyanocobalamin (Vit B12) 1000m | 250 | 32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25000997 | Cyclobenzarine HCL | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001006 | Cyclosporine Opth 0.4% | 250 | 99 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001007 | Cymbalta 20mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001008 | Cymbalta 30mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001009 | Cymbalta 60 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001014 | Cytotec 100 Mcg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001016 | Cytra K 5ml | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001047 | Darvocet N 100mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001049 | Darvon 65mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001059 | Demadex Non-Frm 20mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001062 | Depakene 250 Mg/5ml | 250 | 120 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001079 | Depakote 1000 Mg | 250 | 42 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001081 | Depakote 125 Mg Sprinkles | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001083 | Depakote 250 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001084 | 84153 | Depakote 250mg/5ml S 140ml | 250 | 240 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001085 | Depakote 500mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001086 | Depakote 750 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001089 | 83615 | Deplin 7.5 Mg Tab | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001090 | Depo Provera | 250 | 729 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001091 | Depomedrol 80 Mg | 250 | 157 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001093 | 84134 | Desipramine 25 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001107 | Desyrel 100mg | 250 | 92 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001108 | 86063 | Detrol La 2 Mg Tab | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001109 | Detrol La 4 Mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001117 | Dexamrth 1mg/ML | 250 | 123 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001136 | Diabeta 5 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001145 | Diazepam 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001152 | 85008 | Diclofenac Sod | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001158 | Dicyclomine 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001159 | Dicyclomine HCL 20 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001163 | Diflucan 150 Mg | 250 | 45 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001171 | Digoxin 0.125mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001173 | Digoxin 0.25mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001174 | 82950 | Digoxin 250mcg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001177 | Dilacor XR 180mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001178 | Dilantin 100mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001184 | Dilantin 50mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001204 | Diltiazem CD 180mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001205 | Diltiazem CD 30 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001207 | Diltiazem ER 120 | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001210 | Diltiazem HCL CD (Cardizem) Ca | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001216 | Diovan 160 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001221 | Diovan 80 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001222 | Diovan Hct 80/12.5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001223 | Diovan Hctz 160/12.5 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001226 | 85025 | Diphedryl Sod | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001227 | 84234 | Diphenhist 25 Mg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001228 | Diphenhist Elixer Rugby | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001232 | Diphenhydramine 25 (Rug) | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001233 | Diphenhydramine 50(Rug) | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001235 | 85014 | Diphenoxyl/Atropine | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001239 | Dipyridamole 25 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001247 | Ditropan Xl 5mg | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001255 | 86618 | Divalproex Sod 500 M | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001256 | 86609 | Divalproex Sod Dr 25 | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001257 | 83970 | Divalproex Sod ER 50 | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001261 | Divan 40mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001271 | Docusate Calcium | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001274 | Docusate Sodium 100mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001277 | Donepezil HCL 10 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001280 | Donnatel/Maalox | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001288 | 83519 | Dorzolamide-Timolol | 250 | 386 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001294 | 82533 | Doxazosin Mesylate | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001298 | 82951 | Doxepin 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001299 | Doxepin 100 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001300 | Doxepin 25mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001303 | Doxepin HCL 25mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001309 | Doxycycline 100mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001315 | Q0167 | Dronabinol (Marinol) 2.5mg Cap | 250 | 16.28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001316 | 87802 | Dronedarone 400 Mg | 250 | 92 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001317 | 85730 | Droperidol 2.5 Mg/ML 20 | 250 | 48 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001320 | Dss 100mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001321 | Dss W/Casan | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001322 | Dulcolax | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001332 | Duoneb 2.5 | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001336 | Duragesic 50 Mcg/Hr 5's | 250 | 152 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001339 | Dyazide | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001343 | Dynacirc Cr 5mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001344 | Dynapen 250mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001346 | Dytan 25 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001352 | Ees Filmtb 400 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001356 | Effexor 37.5 Mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001358 | Effexor XR 150mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001359 | Effexor XR 75 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001360 | 89051 | Effient 10 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001362 | Elavil 50mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001367 | Elidel 1% 60 Gr Cream | 250 | 235 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001368 | Elidel 1% Cream 30 Gram | 250 | 443 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001371 | Eliquis 5 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001373 | Elnorm 6mg | 250 | 73 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001378 | Enablex 7.5 Mg | 250 | 40 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001382 | Enalapril 10mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001384 | Enalapril 20 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001385 | 83718 | Enalapril Maleate | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001408 | Enteric Coated Aspirin | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001429 | Epogen 20,000 Units | 250 | 1408 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001437 | 87045 | Ergocalciferol 50,000 | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001440 | Eryped 200mg/5ml | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001444 | Erythromycin 500 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001453 | Esidrix 25 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001454 | Eskalith Cr | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001457 | Estazolam 1 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001465 | Estradiol 2mg Tablet | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001476 | 86316 | Estropipate 0.625 | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001477 | Estropipate 0.75mg Tab | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001488 | Etodolac 600 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001495 | E-Vista 60 Mg | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001496 | 86787 | Evoxac 30 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001497 | Exelon 1.5 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001498 | Exelon 3mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001499 | Exelon 4.5 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001500 | 84479 | Exelon 4.6 /24hr P 30 | 250 | 264 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001501 | Exelon 6 Mg | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001504 | 86317 | Exelon Patch 9.5 Mg | 250 | 37 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001509 | 85048 | Exforge 5 320mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001512 | Eye Stream 30ml | 250 | 150 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001517 | Famotidine 20 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001528 | 84439 | Felodipine ER 5mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001531 | Femera 25mg | 250 | 122 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001535 | 82085 | Fenofibrate 200 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001545 | Fentanyl 75mcg/Hr Pathc | 250 | 279 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001554 | 84703 | Feosol | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001555 | 87070 | Fergon | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001558 | Ferrex 150mg Cap | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001559 | Ferro Sulf 325mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001578 | 83498 | Fexofenadine HCL | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001579 | 87102 | Fiber Laxative 625 | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001580 | Fiber Powder | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001581 | Fibercon 500mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001582 | 80178 | Fibercon 625 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001586 | 82374 | Finasteride 5mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001588 | Fioricet 1 Tab | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001590 | Fiorinal/Cod #3 | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001596 | Flagyl 500 Mg | 250 | 45 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001600 | Flax Seed Oil 1000 Mg Softgel | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001605 | Fleets Phospho-Soda 3oz. | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001606 | Flexeril 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001609 | Flomax 0.4 Mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001610 | Flonase Nasal Spray | 250 | 140 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001613 | Floranex Tab | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001616 | Florinef 0.1 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001622 | Flovent 44 Mcg Inhaler | 250 | 515 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001624 | 82010 | Flovent Hfa 100 Mcg | 250 | 230 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001625 | Flu Vaccine | 250 | 83 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001626 | Flu Vaccube .05 ML | 250 | 62 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001638 | 86593 | Fludrocortisone Ace | 250 | 45 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001642 | Fluocinolone .01% 60 | 250 | 263 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001647 | Fluoprazine 2mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001652 | Fluoxetine | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001656 | 84295 | Fluoxetine 20 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001668 | 82270 | Fluphenazine Dec 25m | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001670 | Flurazepam | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001684 | 84080 | Fluticasone 50mcg | 250 | 90 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001685 | Fluticasone Nasal Spray | 250 | 70 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001686 | Fluticasone P Cr 15 | 250 | 90 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001691 | 83090 | Fluvoxamine Laleate | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001693 | 83036 | Fluzone | 250 | 237 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001695 | 82365 | Folamin Tablet | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001699 | Folic Acid 1mg Tab | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001707 | Foltx Tabs | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001709 | Foradil 12ud Inhaler | 250 | 399 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001710 | 86664 | Foradil Aerolizer 12mcg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001714 | 86235 | Fortical Nasal Spray | 250 | 120 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001716 | Fosamax 70 Mg | 250 | 221 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001721 | Fosinopril/Hctz | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001733 | Furosemide 20mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001734 | Furosemide 40 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001737 | Furosemide 80mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001744 | Gabapentin 100 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001747 | Gabapentin 300 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001749 | Gabapentin 600 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001752 | 84484 | Gabitril 12mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001757 | 85362 | Galantamine Hb 212 M | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001767 | Gaviscon 20-80 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001770 | Gemfibrozil 600 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001772 | Genasyme 80mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001773 | 81003 | Genebs 500mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001774 | Generlac Soln 10g/15ml | 250 | 219 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001775 | Gentacidin 3mg/ML | 250 | 326 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001783 | Gentamicin Opth Sol 5ml | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001785 | 86677 | Genteal Drops | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001790 | Geodon 20 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001791 | Geodon 20 Mg/Inj | 250 | 654 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001793 | Geodon 40 Mg | 250 | 37 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001796 | Geodon 60 Mg Tab | 250 | 61 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001797 | Geodon 80 Mg | 250 | 44 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001798 | 83605 | Geritol Complete | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001799 | 86334 | Ginko Biloba 60 Mg | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001802 | 84244 | Glimepiride 2 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001804 | 82310 | Glimepiride 40 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001806 | Glipizide 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001810 | Glipizide E-R 5mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001814 | 82595 | Glucagon 1 Mg Emer Kit | 250 | 183 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001818 | Glucophage 500 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001820 | Glucophage XR 500mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001823 | Glucosamine Complex 500 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001824 | Glucosamine/Chondroiton | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001829 | Glucotrol 5mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001831 | Glucovance 2.5/500 | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001833 | Glucovance 5/500 Tab | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001840 | Glyburide 2.5 Mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001843 | 80299 | Glyburide 5mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001850 | Glycolax 255 Gram | 250 | 135 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001855 | Glynase 3mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001879 | Gualfensin Dm 10cc | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001883 | Guanfucine 2mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001886 | Gwatuss 100mg/5ml | 250 | 51 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001889 | Haldol 1 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001890 | Haldol 10 Mg Tab | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001894 | Haldol 5 Mg | 250 | 42 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001896 | Haldol 5mg/ML | 250 | 113 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001901 | Haldol Liq 2/1 5ml | 250 | 52 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001902 | 80074 | Halls Mentolyptus (60) | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001906 | Haloperidol 0.5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001908 | Haloperidol 1 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001911 | Haloperidol 2 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001914 | Haloperidol 5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001918 | Haloperidol ML 120 | 250 | 68 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001919 | Haloperidol Oral Sol 60 ML | 250 | 68 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001921 | Hcts 1% 30gm | 250 | 135 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001922 | 82438 | Hctz 12.5 Capsule | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001925 | Hemmorrhoidal Cr | 250 | 42 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001927 | 86160 | Hemocyte Plus Cap | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001928 | Hemorrhoidal Hc Supp | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001930 | Hep Lock 100u/ML 30 ML | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001943 | Humalog Ins Inj | 250 | 78 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001944 | Humalog Insulin U-100 1oml | 250 | 135 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001946 | 85660 | Humira 40 Mg/0.8 ML | 250 | 1016 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001947 | Humulin 70/30 | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001950 | Humulin R Insulin U 100 | 250 | 140 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001951 | Hyazzr 50-12.5 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001956 | Hydralazine 10 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001959 | 86803 | Hydralazine 25mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25001960 | Hydralazine 50 Mg | 250 | 4.5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001961 | Hydralazine 75 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001962 | Hydrea 500 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001963 | Hydro Valerate 0.2% | 250 | 251 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001969 | Hydrocholorothiazide 25mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001973 | Hydrocodone Apap 7.5/500 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001978 | Hydrocodone/Apap 10/325 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001984 | Hydrocodone/Apap 5/500 Wt | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25001990 | 87177 | Hydrocodone-Apap 5/3 | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002001 | 86645 | Hydrocortisone 5 Mg Tab | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002010 | Hydrocotisone 1% Cr 1oz | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002016 | 84403 | Hydroxychloroquine 2 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002028 | Hydroxyzine HCL 25mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002030 | Hydroxyzine Pam 25mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002031 | Hydroxyzome 50 Mg | 250 | 135 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002035 | Hyoscyamine S/L.125 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002038 | Hypotears Eye Drops | 250 | 73 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002039 | Hytrin | 250 | 224 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002042 | 86318 | I Caps Plus | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002047 | 84436 | Ibuprofen 100 Mg/5 ML | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002048 | 81001 | Ibuprofen 200mg Tab | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002050 | Ibuprofen 400mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002052 | Ibuprofen 800 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002058 | Imdur 30 Mg | 250 | 43 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002062 | 80150 | Imipramine HCL 50mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002063 | Immitrex 50 Mg | 250 | 226 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002064 | Immodium 2mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002070 | Inderal 10mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002072 | Inderal 40 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002073 | Inderal La 120 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002084 | Indomothacin 25 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002087 | Innopran Xl 120 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002088 | Inspra 25 Mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002100 | Insulin Humulin R | 250 | 126 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002106 | 87899 | Invega 3 Mg | 250 | 43 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002110 | 81015 | Ipratr-Albuterol 0.5 90 | 250 | 116 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002117 | Ipratropoim 0.02% 05mg/2.5ml | 250 | 239 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002127 | Ismo 20 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002133 | Isopto Tears | 250 | 175 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002134 | Isordil 10mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002136 | 83898 | Isosorbide 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002137 | Isosorbide 20mg Oral Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002144 | Isosorbide Mon 30mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002153 | IV Nacl | 250 | 204 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002158 | 84585 | Janumet 50-1,000 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002159 | Januvia 100 Mg | 250 | 60 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002160 | Januvia 25 Mg | 250 | 50 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002161 | 84066 | Januvia 50 Mg | 250 | 45 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002162 | Jevity 1.5 | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002164 | 89060 | Juven | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002169 | K Dur 20 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002177 | Kaolin Pectin 30 ML | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002190 | Kcl Sol'n 10% 20meq/15ml | 250 | 94 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002191 | 87536 | Keflex 250 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002192 | Keflex 500mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002193 | 87190 | Kenalog | 250 | 71 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002194 | Kenalog Cm 80gm Tube | 250 | 431 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002195 | Kenalog Lotion 1% | 250 | 461 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002196 | Keppra 1000 Mg Tab | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002199 | Keppra 500 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002204 | 85300 | Ketocanazole Cr 2% | 250 | 53 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002211 | Ketorolac (Toradol) 10mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002217 | Klonopin 0.5 Mg | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002218 | Klonopin 1 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002224 | 86663 | Konsyl Powder | 250 | 81 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002225 | Kristalose 10mng Pckt | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002226 | Kwell Lotion 60ml | 250 | 304 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002235 | Labetalol HCL | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002237 | Labetalol HCL 200 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002238 | Lacri-Lube 7gm | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002241 | 82945 | Lactaid Fast Act | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002250 | Lactulose 30 ML Voc | 250 | 146 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002251 | 84550 | Lactulose Sol 473ml | 250 | 72 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002252 | Lamictal 100mg | 250 | 88 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002253 | Lamictal 150mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002256 | Lamictal 25mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002257 | Lamictal Tablets 100 Mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002265 | 86900 | Lamotrigine 100 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002272 | Lanoxin .125 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002280 | Lantus Insulin 100 | 250 | 147 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002281 | Lantus Insulin Inj | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002284 | Latanoprost Drp 0.005% | 250 | 209 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002287 | 87186 | Latuda 40 Mg | 250 | 78 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002288 | Latuda 80 Mg | 250 | 150 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002289 | Laxative Suppository | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002290 | Lecithin 120 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002293 | Lescol 20 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002294 | Lescol Xl 80mg | 250 | 56 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002300 | 87621 | Levaquin 250 Mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002301 | Levaquin 500mg | 250 | 62 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002303 | Levbid ER 0.375mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002307 | 86709 | Levemir Vl | 250 | 519 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002316 | 85049 | Levetiracetam 500 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002329 | Levothroid .05 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002331 | Levothroid 0.1 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002332 | Levothroid 0.125 | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002333 | Levothroid 100 Mcg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002335 | Levothroid 75mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002337 | Levothyroid 25mcg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002340 | Levothyroxine (Synthroid) 112m | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002346 | 83880 | Levothyroxine 100 Mcg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002347 | 80164 | Levothyroxine 125mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002348 | 87081 | Levothyroxine 150 Mcg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002349 | 84154 | Levothyroxine 175mcg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002351 | 80168 | Levothyroxine 25mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002352 | 80170 | Levothyroxine 50 Mcg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002353 | 83655 | Levothyroxine 75mcg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002354 | 87535 | Levothyroxine 88 Mcg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002357 | Levothyroxine Sod 150 Mcg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002365 | Levoxyl 75 Mcg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002366 | 80061 | Levthyroxine | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002367 | Lexapro 10 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002369 | Lexapro 20mg Tablet | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002372 | Lexapro 5mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002379 | Lidex .05% 15 Gu | 250 | 269 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002384 | Lidocaine 1% 20 ML | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002402 | Lidoderm 5% Patch | 250 | 263 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002404 | Limbrel 500 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002408 | J2020 | Linezolid (Zyvox) 600mg Tab | 250 | 453 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002409 | Lioresal 10mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002418 | Lipitor 10 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002419 | Lipitor 20 Mg | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002420 | Lipitor 40mg | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002421 | Lipitor 80 Mg | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002424 | 80162 | Lisinopril 10mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002425 | 82948 | Lisinopril 2.5 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002426 | Lisinopril 20 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002429 | Lisinopril 40 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002430 | Lisinopril 5mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002431 | Lisinopril/Hctz 12.5 | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002440 | Lithium 300 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002443 | Lithium Carbonate 150 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002446 | Lithium Carbonate ER 450 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002449 | Lodine 500 Mg | 250 | 51 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002450 | Lodosyn 25 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002452 | 83550 | Lofibra | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002453 | Lomotil 2.5 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002454 | 83525 | Lomox Tablet | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002455 | Loniten 2.5mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002459 | 82785 | Loperamide Hci Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002460 | Lopid 600 Mg | 250 | 45 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002462 | Lopressor 25mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002466 | Loratadine 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002472 | Lorazepam 0.5 Mg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002476 | Lorazepam 2mg/ML Inj 1ml | 250 | 38 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002478 | 84146 | Lorazepam Intensol 2 (30ml) | 250 | 279 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002479 | Lorazepam Tab : 1mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002483 | Lortab 10/500 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002493 | Lortab 7.5 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002498 | Lortab-5 | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002506 | 86403 | Lotemax 0.55 Eye | 250 | 83 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002508 | Lotensin 10mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002514 | Lotrel 10/20 Mg Capsule | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002516 | Lotrel 5/10 Cap | 250 | 51 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002518 | Lotrimin 1% Cr. 30 Gm | 250 | 189 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002520 | Lotycin Oint 1gm | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002521 | Lovastatin 10 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002522 | 80051 | Lovastatin 20mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002527 | 84443 | Lovaza 1 Gm | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002531 | Lovenox 40mg | 250 | 210 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002540 | Loxitane 25mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002543 | Lozol Tab 2.5mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002545 | 87522 | Lubricant Eye Ointment | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002546 | Lumigan Eye Drops | 250 | 425 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002549 | Lunesta 1 Mg | 250 | 100 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002550 | Lunesta 2 Mg | 250 | 40 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002551 | Lunesta 3 Mg | 250 | 40 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002552 | 82575 | Lyrica 100 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002555 | Lyrica 25 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002556 | 84681 | Lyrica 300 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002560 | Maalox 0 | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002561 | Maalox 30 Cc | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002562 | Macrobid 100mg | 250 | 48 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002564 | Macrodantin 50 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002568 | Mag Ox 400 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002576 | Magnesium Citrate | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002581 | 86225 | Magnesium Oxide 241 | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002588 | Mandelamne 1 Gm | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002595 | Mavik 1 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002600 | Maxzide 75/50 | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002602 | Meclizine 12.5 Mg | 250 | 4.14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002603 | Meclizine 25 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002606 | Medrol Dose Pak | 250 | 132 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002608 | 84133 | Medroxyprogesterone 7 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002636 | Megace Susp. 5ml | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002639 | Megestrol Acetate 40 Mg | 250 | 129 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002644 | Melatonin 1 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002646 | Melatonin 3mg Tab | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002650 | 82550 | Meloxicam 7.5 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002660 | Mephyton 5 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002674 | Metaformin 500mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002678 | Metamucil Pkt | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002685 | Metformin 1000 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002687 | Metformin 500 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002690 | 87210 | Metformin 850 Mg | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002691 | 80201 | Metformin HCL 500mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002699 | 86694 | Methadone 5 Mg Tab | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002700 | 86689 | Methadone HCL 10mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002703 | Methenamine Mandelate 1 Gm | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002707 | Methocarbamol (Robaxin) 500mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002709 | 85613 | Methocarbamol 750 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002713 | 86778 | Methotrexate 2.5mg Tab | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002714 | Methotrexate 25mg | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002739 | Metoclopramide 10mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002740 | Metoclopramide 5mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002744 | Metolazone 2.5 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002745 | 84702 | Metolazone 5 Mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002749 | Metoprolol 12.5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002750 | Metoprolol 25mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002753 | 85610 | Metoprolol Succ | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002754 | Metoprolol Succ ER 25 Mg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002755 | Metoprolol Succ ER 50 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002762 | Metoprolol Tartrate Tab : 25mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002764 | Metoprolol Xl 50mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002767 | 82232 | Metronidazole 500mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002770 | Mevacor 20 Mg | 250 | 78 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002774 | Miacalcin 200 U Dose | 250 | 226 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002775 | Miacalcin Nasal Spray 3.7 | 250 | 458 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002776 | Miacalin 200u Dose | 250 | 226 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002777 | 86765 | Mi-Acid Gas | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002779 | Micardis 40 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002788 | 84155 | Micro-K 8 Meq Extenca | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002797 | 87205 | Midorine HCL 5 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002799 | Migrazone Capsules | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002803 | Milk of Magnesia 30 Cc | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002806 | Mineral Oil 30 Cc | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002811 | Minocin 100mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002815 | 84999 | Minoxidil 10 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002820 | Miralax Packet | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002821 | Miralex 255 Gm | 250 | 154 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002825 | Mirapex 0.5 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002829 | Mirtazapine 15 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002830 | Mirtazapine 30 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002832 | Mirtazapine 7.5 Mg | 250 | 9 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002837 | 83661 | Moban 25 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002838 | Moban 50 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002840 | Mobic 7.5 Mg | 250 | 60 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002845 | 86000 | Moexpril HCL 15mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002849 | Mometasone 0.1% Cream 15 Gr | 250 | 226 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002850 | Monistat 7 Vag Supp | 250 | 100 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002852 | Monopril 20mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002868 | 82106 | Morphine Sulf ER 30 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002871 | Motrin 120ml | 250 | 53 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002872 | Motrin 600mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002873 | Motrin Susp 5ml | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002877 | Ms Contin 30 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002881 | Mucinex 600 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002888 | 85379 | Multigen Plus Caplet | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002894 | Multivitamin With Mineral | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002898 | Murine Tears Plus | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002909 | Mylicon 80 | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002912 | 84233 | Mysoline 50mg Tab | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002914 | Nabumetone 500mg Tab | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002915 | Nabumetone 750 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002920 | Nacl 4 Meq/ML 250 ML | 250 | 266 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002922 | 86301 | Nadolol 20 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002931 | Namenda 10mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002932 | Namenda 5 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002940 | Naphcon-A 5ml | 250 | 136 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002946 | Naproxen 250 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002948 | Naproxen 500 Mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002952 | 78267 | Naproxen Sod | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002957 | Nasacort Aq | 250 | 424 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002960 | Nasal Solutions | 250 | 62 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002961 | 83010 | Nasalcrom 4% Spray | 250 | 107 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002962 | Nasonex Nasal Spray | 250 | 557 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002965 | 86336 | Nature Tear Drops | 250 | 46 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002967 | Navane 5 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002968 | 85651 | Nb Valerian Root | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002978 | 82044 | Neo/Polymyxin/Hc Ear 10ml | 250 | 64 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25002989 | Neosporin Ung Pk | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002993 | Nep-Synephrine 1% | 250 | 113 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25002998 | Neurontin 100mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003000 | Neurontin 300 Mg | 250 | 38 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003007 | Nexium 20 Mg | 250 | 41 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003008 | Nexium 40 Mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003009 | 84478 | Niacin 250 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003013 | 85007 | Niaspin 1,000 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003016 | Nicoderm Patch 21mg | 250 | 150 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003023 | Nicotine Patch 14mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003024 | Nicotine Patch 21 Mg | 250 | 18.75 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003025 | Nicotine Patch 7 Mg | 250 | 12.63 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003027 | Nifediac Cc 60 Mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003029 | Nifedipine 15 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003030 | 83721 | Nifedipine 60mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003032 | Nifedipine ER 30 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003034 | Nifedipine ER 90 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003035 | Niferex 150mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003036 | Nilandon 150 Mg | 250 | 143 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003039 | Nirovam 0.25 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003044 | Nitro Dur 0.4mg | 250 | 98 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003046 | Nitro Tab 0.4 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003047 | 86022 | Nitro Transderm 0.2 M | 250 | 194 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003055 | Nitrofurantoin Mono. 100mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003058 | 82150 | Nitrofurantoin-Macro 7 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003065 | Nitroglycerin Patch T 0.2 | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003068 | Nitroglycerin ST 6.5 | 250 | 62 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003079 | Nitroquick | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003080 | Nitrostat 0.4mg/25 | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003081 | 82627 | Nizatidine 150 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003082 | Nolvadex 10 Mg | 250 | 52 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003084 | Norco 10/325 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003086 | Norco 5/325 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003092 | Norpramin 25mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003094 | Nortriptyline 50 Mg | 250 | 4.32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003097 | Norvasac 5mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003098 | Norvasc 10mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003099 | Norvasc 2.5 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003102 | Novolin 70/30 | 250 | 75 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003105 | 85220 | Novolin N 100/U/ML | 250 | 123 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003107 | 83935 | Novolin R 100 Units | 250 | 271 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003114 | Novolog Mix 70/30 | 250 | 368 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003129 | Nuedexta 10/5 Mg | 250 | 46 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003130 | Nuedexta 20/10 | 250 | 56 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003141 | Nystatin Cream 15gm | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003144 | 86903 | Nystatin Oral Susp 75ml | 250 | 89 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003146 | Nystatin Powder 30 Gms | 250 | 155 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003159 | Occuvite | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003168 | Ogen 1.25 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003170 | Olanzapine (Zyprexa) 10mg Inj | 250 | 142 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003171 | Olanzapine (Zyprexa) 5mg Tab | 250 | 48 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003188 | Omacor 1 Gm | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003189 | Omega 3fa 1000mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003190 | 80152 | Omega-3 Fish Oil | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003192 | Omeprazole 20mg Caps | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003194 | Omnicef 300mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003200 | 87425 | Ondansetron HCL 4 Mg | 250 | 86 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003202 | 80202 | One A Day | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003204 | 84520 | One-A-Day Mens | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003207 | 89320 | Opana ER 10 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003212 | Orabase-B 20% Paste | 250 | 57 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003213 | Orajel | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003214 | Orap 2 Mg | 250 | 32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003217 | 86781 | Orphenadrine ER 100 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003221 | Os Cal 500d | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003226 | 82436 | Osteo Bi Flex | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003229 | Oxandrin 2 Mg | 250 | 56 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003232 | Oxazepam Cap : 10mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003233 | 82105 | Oxazepam Cap : 15mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003235 | 80101 | Oxcarbazepine 150mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003238 | Oxybutynin (Ditropan Xl) 5mg T | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003240 | Oxybutynin 10 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003243 | Oxybutynin Choloride 5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003253 | 85240 | Oxycodone HCL 40 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003263 | Oxytrol Patch | 250 | 75 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003265 | Oyster Shell Calcium | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003269 | Pain Reliever Tab 325mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003273 | Pancrease Ec Caps | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003284 | Pantroprazol 40 Mg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003285 | 80188 | Paoxetine HCL 40mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003290 | Parcopa 25/100 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003295 | Parlodel 2.5 Mg | 250 | 46 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003300 | Paroxetine HCL 10mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003301 | Paroxetine HCL 20 Mg | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003302 | Paroxetine HCL 30 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003309 | Patanol Opth Soln 0.1% 5ml | 250 | 113 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003310 | Paxil 10 Mg | 250 | 14.37 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003311 | Paxil 20 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003313 | Paxil 40 Mg | 250 | 7.5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003316 | Paxil Cr 12.5 | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003317 | Paxil Cr 25 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003318 | Paxil Mcr 37.5 | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003319 | Pc Tar 6 Oz. Shampoo | 250 | 221 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003324 | Pehnytoin Na Extended 100 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003331 | Penicillin Vk 250mg Tab | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003339 | Pentoxifyllin 400mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003340 | Pepcid Complete | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003354 | Periactin 4 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003355 | Peridex 473ml Sol | 250 | 179 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003358 | Perparation-H Ointment | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003360 | Perphenazine | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003364 | Perphenazine 4 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003372 | Phenazopyridine 200 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003373 | Phenazopyridine HCL 100mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003374 | Phenazopyrodome 100m | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003375 | Phenergan 25mg/1cc | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003382 | Phenergan Supp | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003384 | Phenobarb 30 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003385 | Phenobarbital 15mg Pd | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003403 | Phenytek 300mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003408 | Phenytoin 125mg/5 M237 | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003413 | Phoslo 667mg Gelcap | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003419 | 87206 | Pindolol 10 Mg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003420 | Pindolol Tab : 5mg | 250 | 4.16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003431 | Plaquenil 200mg | 250 | 44 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003434 | Plavix 75mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003437 | Pletac 50mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003438 | Pletal 100mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003442 | Pneumovac 23 Vaccine | 250 | 224 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003446 | 80158 | Polyethylene Glycol 255 | 250 | 48 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003449 | Potass Cl Meq | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003451 | Potassium 20mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003456 | Potassium Ch 10meq | 250 | 9 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003479 | Potassium Cl 10% Liq 105 ML | 250 | 32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003488 | 87220 | Pradaxa 150 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003501 | Pravachol 10mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003502 | Pravachol 20 Mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003503 | Pravachol 40 Mg | 250 | 41 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003511 | Prazosin 1 Mg | 250 | 12.81 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003515 | Precose 50mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003518 | 83930 | Prednisolone Acetate | 250 | 122 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003520 | Prednisolone Opth 1% 5ml | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003523 | Prednisone 10 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003527 | Prednisone 20mg Tab | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003537 | Prelone 5mg/ML | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003540 | Premarin 0.45 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003541 | Premarin 0.625 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003542 | Premarin 1.25 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003544 | Premarin Vag Cream | 250 | 167 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003546 | Prenatal Vitamin | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003550 | 83001 | Preservision Softgel | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003551 | Prevacid 15mg | 250 | 49 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003552 | Prevacid 30mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003554 | 82330 | Prevastatin Sod | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003559 | Primidone 250 Mg Tablet | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003561 | Prinivil 2.5 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003562 | Prisolec Otc | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003564 | 80048 | Pristiq 50 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003566 | 82784 | Proair Hfa 90mcg Inh 8.50 Gm | 250 | 200 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003574 | Procardia Xl 30 Mg 1 Tab | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003575 | 80196 | Procardia Xl 60 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003578 | Q0164 | Prochlorperazine (Compazine) 5 | 250 | 2.2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003579 | Prochlorperazine Supp 25mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003580 | Procrit 10,000 Units | 250 | 1002 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003581 | Procrit 20,000 U/ML | 250 | 1815 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003582 | Procrit 2000 U/ML 6-1ml | 250 | 90 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003583 | Procrit 3,000 Unites/ML | 250 | 278 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003585 | Procrit Epoetin Alfa 4000 | 250 | 278 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003588 | 86901 | Proctozone-Hc 2.5 Cream | 250 | 137 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003593 | Promethazine 25mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003598 | Promethazine Supp | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003600 | Promethegan 25 Mg Supp. | 250 | 44 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003607 | Propoxyphene N Apap 100/650 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003610 | Propranolol 10 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003611 | Propranolol 40 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003622 | Proscar 5 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003625 | 86920 | Prostate Formula | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003628 | Protocream Hc 30gm | 250 | 440 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003629 | Protonix 20 Mg | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003631 | Protonix 40mg Tab | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003633 | Provera 5 Mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003635 | Provigil 200 Mg | 250 | 53 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003636 | 82491 | Proxy-N/Apap 100 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003637 | Prozac 10 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003638 | Prozac 20 Mg | 250 | 78 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003642 | Prozac Weekly 90 Mg | 250 | 345 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003650 | Pulmicort 0.5 Mg | 250 | 126 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003660 | Pyridoxine 100mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003662 | Qualfenesin Dm 10cc | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003666 | Questran Pckt 9g | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003678 | Quinapril 10mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003679 | Quinapril 20mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003680 | 83520 | Quinapril 40 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003684 | Quinidine 200mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003693 | Quintine Sulfate 260m | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003695 | 82746 | Qvar 80 Mcg Inhaler | 250 | 516 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003705 | 82941 | Ramipril 2.5 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003706 | 82507 | Ramipril 5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003707 | 87116 | Rampipril 10 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003709 | Ranexa 500 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003715 | Ranitidine Tab : 150mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003718 | Rapamune 1 Mg | 250 | 167 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003720 | Razadyne 12 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003723 | Razadyne 8 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003724 | Recaltrol 0.25 Mcg | 250 | 39 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003725 | Refresh Eye Drops | 250 | 57 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003729 | Relafen 500 Mg | 250 | 45 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003730 | 82103 | Reliable Gentle Laxative | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003731 | Remeron 15 Mg | 250 | 73 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003732 | Remeron 30 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003734 | Remeron 7.5 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003735 | Remifemin Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003736 | Reminyl 12mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003744 | Requip .25 Mg | 250 | 100 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003747 | Requip 1mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003755 | 87340 | Restasis 0.05% Eye Emulsion | 250 | 179 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003757 | Restoril 15mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003759 | Restoril 7.5 Mg | 250 | 14.37 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003761 | Rezadyne 4mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003762 | Rhinocort Agua | 250 | 378 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003774 | Risperdal Lig 30 ML | 250 | 932 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003775 | Risperdal 0.25 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003776 | Risperdal 0.5mg Tab | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003778 | Risperdal 1mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003780 | Risperdal 2 Mg | 250 | 42 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003781 | Risperdal 3 Mg | 250 | 54 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003782 | Risperdal 4 Mg | 250 | 71 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003785 | Risperdal Consta 25mg | 250 | 946 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003789 | 85060 | Risperdone 1mg/ML | 250 | 136 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003790 | 82747 | Risperidone .25 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003791 | 81099 | Risperidone .5 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003792 | Risperidone 1 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003796 | 87086 | Risperidone 4 Mg | 250 | 44 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003798 | Ritalan 5 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003813 | Robitussin 5ml | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003814 | Robitussin Dm | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003817 | Rocaltrol 0.25mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003820 | Rocephin 500mg Vial | 250 | 152 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003822 | 36415 | Ropinirol 0.5 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003825 | Ropinirole .25mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003827 | Ropinirole HCL | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003834 | Rozerem 8mg | 250 | 75 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003835 | Rythmol 150 Mg Tab | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003837 | Saline Nasal Spray 1.5 Oz | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003846 | 84588 | Sanctura XR 60mg | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003848 | 86886 | Saphris 10 Mg | 250 | 52 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003849 | 86850 | Saphris 5 Mg | 250 | 49 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003851 | 83625 | Sb 12hr Nasal 0.5% | 250 | 162 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003860 | Senna 8.6mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003861 | Senna Gen Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003862 | Senna Plus | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003867 | Sennalax-S Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003868 | Senokot 187mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003871 | Septra Ds | 250 | 43 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003873 | Serevent Disl Inh | 250 | 548 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003874 | 82088 | Seroguel 400 Mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003875 | Seroquel 100 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003878 | Seroquel 200mg Tablet | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003879 | Seroquel 25 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003880 | Seroquel 300 Mg | 250 | 56 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003882 | 80069 | Seroquel 50mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003893 | 82553 | Sertraline HCL 100 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003894 | 82552 | Sertraline HCL 25 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003895 | 80102 | Sertraline Hyc 50 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003896 | Serzone 100mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003898 | Sherrous Sulfate Ltq | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003899 | Shopax 100 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003914 | Simvastatin 20 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003915 | 80055 | Simvastatin 40 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003918 | Sinemet 10/100 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003920 | Sinemet 25/100 | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003921 | Sinemet 25/250 | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003923 | Sinemet Cr 50/200 | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003925 | Singulair 10 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003928 | Skelaxin 800mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003929 | Slo-Niacin 250mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003930 | Slow Fe 160mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003932 | Slow K-8 Meq | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003933 | 86738 | Slow Mag 64 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003934 | 85384 | Smz/Tmp Ds 800/160 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003945 | Sodium Bicarnonate 10gr | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003947 | Sodium Chloride | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003974 | Solu Medrol 125 Mg Vial | 250 | 53 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003978 | Sonata 10mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003979 | Sonata 5mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003988 | 80182 | Spiriva 18mcg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25003990 | Spiriva Handihaler | 250 | 429 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003992 | Spiriva Refill | 250 | 35 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003993 | Spirono/Hctz 2/25 | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003997 | Spironolactone 25 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25003998 | Spironolactone 50 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004000 | Sporanox 25mg Inj | 250 | 660 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004005 | Ssystane Eye Drops | 250 | 104 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004006 | 84466 | ST John's Wart | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004012 | Starlix 120mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004014 | Starttera 40 Mg | 250 | 135 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004020 | 82670 | Stomahesive Paste 60gm | 250 | 129 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004021 | Stool Softner | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004022 | Strattera 25 Mg | 250 | 120 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004024 | Stress W/Zinc | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004029 | Sucralfate 1 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004042 | 82055 | Sulfamethoxazole/Tmp | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004047 | 86860 | Sulindac Tab : 150mg | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004052 | 84144 | Sumatriptan Succ | 250 | 101 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004056 | 84120 | Super Thera Vite Mt | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004059 | Sustane Lubricant Eye Drops | 250 | 100 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004061 | 86922 | Symbicort 80 4.5 | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004063 | 82390 | Symbyax 6/25mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004064 | Symmetrel 100mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004066 | Symmetrel 50 Mg/5ml | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004068 | Synthroid .05 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004069 | Synthroid .2 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004071 | Synthroid 0.075 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004072 | Synthroid 0.125mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004075 | Synthroid 0.1mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004090 | Tamoxifen 10mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004097 | Tapazole 5mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004098 | Tarka 2/240 | 250 | 50 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004102 | 84300 | Tbc Spray 113.40 ML | 250 | 64 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004103 | Tears Pure | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004106 | Tegretol 200mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004112 | Tekurna 150 Mg | 250 | 40 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004117 | Temazepam 15 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004118 | Temazepam 30 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004123 | Tenex 1 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004125 | Tenormin 25mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004126 | Tenormin 50mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004127 | Terazosin | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004131 | Terazosin 5mg | 250 | 20 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004137 | 80100 | Terbinafine HCL 250 | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004143 | Tessalon Perls 100 Mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004149 | 80200 | Tetanus Toxoid Adsor 5ml | 250 | 418 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004156 | Theo-24 200 Mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004157 | Theo-Dur 300mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004160 | 82570 | Theophylline 300mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004163 | Thera Tears Nutrition Tabs | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004164 | Theragran M | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004165 | Therapeutic M | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004167 | Theravite Liquid 4oz | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004168 | Thermotab | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004170 | 84100 | Thiamin 100 Mg/ML V 2 | 250 | 81 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004171 | 84081 | Thiamin 100 Mg/ML V8 | 250 | 113 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004172 | Thiamin 50 Mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004174 | Thiamine (Vit B1) 100mg Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004175 | Thiamine 100 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004176 | Thiamine 100 Mg/ML Inj | 250 | 64 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004183 | Thiothixene Cap : 5mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004188 | Thyroid 2 Gr | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004189 | Thyroid 30 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004190 | Thyroid 60 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004191 | Thyroid Tab : 1grain | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004199 | 86430 | Tikosyn 250 Mcg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004203 | 86325 | Timolol 0.5% Eye Drops | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004209 | Timoptic .5% 5ml | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004213 | Tizanidine 2 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004229 | Tofranil 25mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004230 | Tofranil 50mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004236 | Topamax 100 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004244 | 85002 | Topiramate 100 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004247 | Toprol Xl | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004253 | Torsemide 10 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004254 | Torsemide 20 Mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004264 | Tramadol 50mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004265 | 80184 | Tramadol HCL /Acet | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004267 | Tramadol HCL Tab 50 Mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004269 | Tramadol/Apap 37.5/325 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004275 | Tranxene 3.75 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004277 | Traqzadone HCL | 250 | 49 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004279 | Travatan 0.004% Eye Drops | 250 | 323 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004282 | Trazadone 150 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004283 | Trazadone HCL | 250 | 49 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004285 | Trazodone 100 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004287 | Trazodone 20 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004289 | Trazodone 25 Mg | 250 | 12.96 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004290 | Trazodone 50 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004292 | 86308 | Trental 400mg | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004297 | Triamcinolone Cr .1 80gm | 250 | 118 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004300 | 85097 | Triamter/Hctz 37.5 | 250 | 5 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004301 | Triamterene Hctz 37.5/25 | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004302 | Triamterene Hctz 75/50 | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004305 | Tricor 145mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004309 | Trifluoperazine 2mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004313 | Trihexyphenidyl 5 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004319 | Trileptal 300 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004324 | 86704 | Trilipix 45 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004327 | Trimethobenzamide 200mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004331 | Trimethsulfa 160/800 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004332 | Trimpex 100 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004335 | Triple Antibiiotic Oint 15 Gr | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004349 | Tums 750 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004353 | Tussin Cough 8oz | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004354 | Tussin Dm 8 Oz | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004358 | Tylenol | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004361 | Tylenol 325 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004363 | Tylenol 650 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004364 | 82140 | Tylenol Ex Str 500 Mg (84 Tabs | 250 | 37 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004367 | Tylenol W/Codine #3 | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004370 | 87040 | Uloric 40 Mg | 250 | 32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004372 | Ultracet 37.5/325 | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004373 | Ultram 50mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004374 | Uniphyl 400mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004375 | Uniretic 15 Mg/25 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004376 | Univasc 15mg | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004378 | Urecholine 25mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004386 | Uroxatral 10mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004389 | 82728 | Ursodiol 300 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004413 | Valprotic Acid 250 Mg | 250 | 129 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004421 | 87324 | Valturna 300-320 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004422 | Vanamide Cream 8.5 Gm | 250 | 299 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004433 | Vantin 200 Mg | 250 | 54 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004437 | Vasotec 10mg | 250 | 38 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004438 | Vasotec 5mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004443 | Venlafaxine (Effexor) 75mg Cap | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004444 | 85302 | Venlafaxine HCL 37.5 Mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004445 | 82947 | Venlafaxine HCL 75mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004447 | Ventol Ud 0.083% | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004448 | Ventolin 0.5 ML | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004449 | Ventolin 17mg Inh | 250 | 252 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004452 | Ventonlin 1gm Inhaler | 250 | 504 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004455 | 82248 | Verapamil 180 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004467 | Vesicare 5mg | 250 | 96 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004469 | Viactiv Chew Tab | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004473 | Vicon C | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004478 | 86684 | Vigamox Drops | 250 | 192 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004486 | Visken 5mg | 250 | 12 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004488 | Vistaril 25mg | 250 | 71 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004492 | Vitamin A | 250 | 16 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004499 | Vitamin B-1 | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004502 | Vitamin B-12 1000 Mc | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004503 | Vitamin B12 1000 Mcg Tablet | 250 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004504 | Vitamin B12 1000 Mcg/ML | 250 | 56 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004511 | 82607 | Vitamin B6 100 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004515 | Vitamin C 500 Mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004516 | Vitamin D 1000 Units-Tablet | 250 | 3 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004517 | Vitamin D 400 U | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004525 | Vitamin E 400 Unit Cap | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004536 | 86665 | Volaren 1% Gel | 250 | 222 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004538 | Voltaren 75mg | 250 | 43 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004541 | Vytorin 10/10 Mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004542 | Vytorin 10/20 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004554 | 85013 | Warfarin 6 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004555 | Warfarin Sod 1mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004556 | Warfarin Sod 2.5 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004557 | Warfarin Sod 3 Mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004558 | Warfarin Sod 4mg | 250 | 13 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004559 | Warfarin Sod 5 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004561 | 85540 | Warfarin Sodium 7.5mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004562 | Water 45 M | 250 | 43 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004563 | Welchol 625 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004564 | Wellbutrin 300 Mg | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004567 | Wellbutrin Xl 150mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004570 | Women's One A Day | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004571 | Xalatan Ophth Solution | 250 | 368 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004573 | Xanax 0.25 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004574 | Xanax 0.5 Mg | 250 | 7 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004575 | 87800 | Xarelto 10 Mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004581 | Xifaxan 550 Mg | 250 | 141 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004583 | Xopenex 1.25 Mg/10.5 ML | 250 | 67 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004586 | Xopenex Inh Sol'n 0.63 Mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004588 | Xylocaine 1% 20ml | 250 | 67 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004591 | Z0cor 20mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004595 | 84560 | Zaleplon 10 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004596 | Zanaflex 4mg | 250 | 31 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004597 | Zantac 150 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004598 | Zaroxalyn 5mg | 250 | 21 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004599 | 87590 | Zaroxolyn 2.5 Mg | 250 | 8 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004600 | Zegerid 40mg Osus Pw | 250 | 34 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004601 | Zelform 6 Mg | 250 | 37 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004602 | Zelnorm 2 Mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004605 | Zestril 10 Mg | 250 | 27 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004606 | Zestril 20mg | 250 | 32 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004607 | Zestril 5mg | 250 | 30 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004608 | Zetia 10 Mg | 250 | 64 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004610 | Ziac 5 Mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004614 | Zinc 50mg | 250 | 15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004616 | 83497 | Zinc Gluconate | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004620 | 86140 | Zinc Sulfate 220 Mg | 250 | 4 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004629 | Zithromax 250 Mg | 250 | 36 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004631 | Zocor 10 Mg | 250 | 26 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004633 | Zocor 40mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004634 | Zocor 80 Mg | 250 | 41 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004636 | Zofran 4mg Tab | 250 | 158 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004641 | Zoloft 100 Mg | 250 | 28 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004644 | Zoloft 25 Mg | 250 | 23 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004645 | Zoloft 50mg | 250 | 17 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004649 | Zolpidem 10 Mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004653 | 84075 | Zolpidem Tartrate | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004654 | Zonegran 100 Mg | 250 | 14 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004657 | Zonisamide 100mg | 250 | 6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004660 | Zovirax | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004664 | 83540 | Zylet 5ml Opth Sol | 250 | 264 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Inpatient Psychiatric Services | 25004665 | Zyloprim 100mg | 250 | 18 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004666 | Zyloprim 300mg | 250 | 10 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004669 | Zyprexa 10mg | 250 | 38 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004670 | Zyprexa 10mg/ML (Injec) | 250 | 163 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004671 | Zyprexa 15mg | 250 | 84 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004672 | Zyprexa 2.5 Mg | 250 | 48 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004674 | Zyprexa 5 Mg | 250 | 19 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004676 | Zyprexa 7.5 Mg | 250 | 61 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004677 | Zyprexa Zydis 10 Mg | 250 | 80 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004678 | Zyprexa Zydis 15mg | 250 | 135 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004681 | Zyprexa Zydis 5mg | 250 | 56 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004682 | Zyprexia 10mg | 250 | 60 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004683 | Zyrtec 10mg | 250 | 22 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004684 | Zyrtec 5mg | 250 | 11 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004711 | Norvasc 5 Mg | 250 | 24 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004714 | Aripiprazole 2 Mg | 250 | 89 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004715 | Nbl Balance B 100 Tab | 250 | 2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004739 | Simbrinza Eye Drops | 250 | 631 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004742 | Breo Ellipta Inh 100/25 | 250 | 406.15 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004751 | Kaopectate 30 Cc | 250 | 3.6 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004752 | Tolterodine Tart ER 4 Mg | 250 | 25 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004753 | Durezol Opth Emulsn 0.05% | 250 | 728 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004754 | Toujeo Insulin 1 Unit | 250 | 1.2 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004766 | Rivastigmine 4.6 Patch | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004767 | Rivastigmine 9.5 Patch | 250 | 33 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004768 | Vraylar 3 Mg | 250 | 167 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |
| Inpatient Psychiatric Services | 25004802 | Janumet 50/500 Mg | 250 | 25.71 | N/A | N/A | N/A | N/A | N/A |