ࡱ> 130 bjbj 8 $ $ ggggg{{{8 {###^!*g#####ggH#,gg#`<{O0!O!&!gt##############!#########$ -: Generic Upper Limits changing effective June 1, 2014 Amoxicillin; Clavulanate 500 mg; 125 mg, Tablet, Oral 0.94016 Amoxicillin; Clavulanate 875 mg; 125 mg, Tablet, Oral 0.96960 Azelastine 137 mcg, Nasal Spray 1.47100 Chlorpromazine 10 mg, Tablet, Oral 0.76320 Chlorpromazine 25 mg, Tablet, Oral 1.06640 Chlorpromazine 50 mg, Tablet, Oral 1.50030 Chlorpromazine 100 mg, Tablet, Oral 2.20310 Chlorpromazine 200 mg, Tablet, Oral 3.11440 Clindamycin 75 mg/5 ml, Pediatric Granules, Solution, Oral 0.44530 Cyclosporine Modified 25 mg, Capsule, Oral 0.72360 Cyclosporine Modified 100 mg, Capsule, Oral 2.58740 Escitalopram Oxalate 5 mg/5 ml, Solution, Oral 0.51310 Fentanyl Transdermal Patches 25 mcg/hr Transdermal Patch 3.41794 Fentanyl Transdermal Patches 50 mcg/hr Transdermal Patch 6.22897 Fentanyl Transdermal Patches 75 mcg/hr Transdermal Patch 9.62367 Fentanyl Transdermal Patches 100 mcg/hr Transdermal Patch 12.22295 Finasteride 5 mg, Tablet, Oral 0.26201 Fluticasone Propionate 50 mcg, Nasal Spray 0.65292 Irbesartan 75 mg, Tablet, Oral 0.23470 Irbesartan 150 mg, Tablet, Oral 0.28860 Irbesartan 300 mg, Tablet, Oral 0.39090 Irbesartan; Hydrochlorothiazide 150 mg; 12.5 mg, Tablet, Oral 0.28330 Irbesartan; Hydrochlorothiazide 300 mg; 12.5 mg, Tablet, Oral 0.54860 Levalbuterol 0.31 mg/3 ml, Inhalation Solution 1.10250 Levalbuterol 0.63 mg/3 ml, Inhalation Solution 1.10250 Levalbuterol 1.25 mg/3 ml, Inhalation Solution 1.10250 Methotrexate 2.5 mg, Tablet, Oral 2.22620 Montelukast Sodium 4 mg, Tablet, Chewable, Oral 0.41410 Montelukast Sodium 5 mg, Tablet, Chewable, Oral 0.39490 Montelukast Sodium 10 mg, Tablet, Oral 0.28880 Olanzapine 2.5 mg, Tablet, Oral 0.35071 Olanzapine 5 mg, Tablet, Oral 0.39172 Olanzapine 7.5 mg, Tablet, Oral 0.45404 Olanzapine 10 mg, Tablet, Oral 0.54064 Olanzapine 15 mg, Tablet, Oral 0.76846 Olanzapine 20 mg, Tablet, Oral 0.98344 Oxcarbazepine 150 mg, Tablet, Oral 0.24623 Oxcarbazepine 300 mg, Tablet, Oral 0.34597 Oxcarbazepine 600 mg, Tablet, Oral 0.60808 Quetiapine Fumarate 25 mg, Tablet, Oral 0.21718 Quetiapine Fumarate 50 mg, Tablet, Oral 0.28932 Quetiapine Fumarate 100 mg, Tablet, Oral 0.30789 Quetiapine Fumarate 200 mg, Tablet, Oral 0.53194 Quetiapine Fumurate 300 mg, Tablet, Oral 0.61671 Quetiapine Fumurate 400 mg, Tablet, Oral 0.63864 Repaglinide 0.5 mg, Tablet, Oral 0.67190 Repaglinide 1 mg, Tablet, Oral 0.67190 Repaglinide 2 mg, Tablet, Oral 0.67190 Tacrolimus 0.5 mg, Capsule, Oral 0.95330 Tacrolimus 1 mg, Capsule, Oral 1.63281 Tacrolimus 5 mg, Capsule, Oral 11.51006 Venlafaxine Hydrochloride 37.5 mg, Extended Release, Capsule, Oral 0.22730 Venlafaxine Hydrochloride 75 mg, Extended Release, Capsule, Oral 0.18110 Venlafaxine Hydrochloride 150 mg, Extended Release, Capsule, Oral 0.25040     (456hejheUh\3 hbhvjX h}\hvjX h\3h\3h?LhvjX56t 0 [ ) ]  W  C k . e gd\3gdbgdvjX 6e)P{1bEm0ygd\3gd\3gd;] 6&P1:ppEI/ =!"#$% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 bNormal_HmH sH tH VV  Heading 1$@&^`05;OJQJDA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List 8O8 Style21$ CJOJQJ@+@  Endnote Text CJOJQJPCP Body Text Indent ^`0 5OJQJ6U !6  Hyperlink >*B*phP 2P X$0 Balloon TextCJOJQJaJmHsHtHN/AN X$0Balloon Text CharCJOJQJ^JaJ^/R^ vjX RAHeading PP'5;B*OJQJ_HmH phsH tH N/bN vjXRAText!B*OJQJ_HmH phsH tH P/qP vjX RAText Char!B*OJQJ_HmH phsH tH \o\ vjXGULEffectiveDate5CJOJQJ_HmH sH tH POP pEI Drug Namesxx$ 1$ CJOJQJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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