| (3 Packets (aluminum sulfate 1347 MG Powder / calcium acetate 952 MG Powder)) per 16 OZ Topical Solution |
SY |
| (3 Packets (aluminum sulfate 1347 MG Powder / calcium acetate 952 MG Powder)) per 16 OZ Topical Solution |
SY |
| (3 Packets (aluminum sulfate 1347 MG Powder / calcium acetate 952 MG Powder)) per 16 OZ Topical Solution |
SY |
| (3 Packets (aluminum sulfate 1347 MG Powder / calcium acetate 952 MG Powder)) per 16 OZ Topical Solution |
SY |
| (3 Packets (aluminum sulfate 1347 MG Powder / calcium acetate 952 MG Powder)) per 16 OZ Topical Solution |
SY |
| (elagolix 300 MG / estradiol 1 MG / norethindrone 0.5 MG (28) Oral Capsule) / (elagolix 300 MG (28) Oral Capsule) Pack |
SY |
| (Ethinyl Estradiol 0.025 MG / Norethindrone 0.8 MG Chewable Tablet) / 4 (Ferrous fumarate 75 MG Chewable Tablet) 28 Day Pack |
SY |
| (Ethinyl Estradiol 0.025 MG / Norethindrone 0.8 MG Chewable Tablet) / 4 (Ferrous fumarate 75 MG Chewable Tablet) 28 Day Pack |
SY |
| (Ethinyl Estradiol 0.025 MG / Norethindrone 0.8 MG Chewable Tablet) / 4 (Ferrous fumarate 75 MG Chewable Tablet) 28 Day Pack |
SY |
| (Ethinyl Estradiol 0.025 MG / Norethindrone 0.8 MG Chewable Tablet) / 4 (Ferrous fumarate 75 MG Chewable Tablet) 28 Day Pack |
SY |
| { 1 (15 ML) (salicylic acid 2 % Topical Gel [Kleer Plex]) / 1 (30 ML) (salicylic acid 2 % Topical Gel [Kleer Plex]) / 1 (118 ML) (salicylic acid 2 % Medicated Liquid Soap [Kleer Plex]) } Pack [Kleer Plex Acne Care Kit] |
SY |
| {1 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 10 MG Dose Kit] |
BPCK |
| {1 (0.1 ML) (diazepam 100 MG/ML Nasal Spray) } Pack |
GPCK |
| {1 (0.1 ML) (diazepam 50 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 5 MG Dose Kit] |
BPCK |
| {1 (0.1 ML) (diazepam 50 MG/ML Nasal Spray) } Pack |
GPCK |
| {1 (0.1 OZ.) (Benzoyl Peroxide 5 % Topical Gel [Clear Proof Acne Treatment]) / 1 (1 OZ.) (Salicylic Acid 2 % Medicated Liquid Soap [Clear Proof Acne Medication]) / 1 (0.9 FL. OZ.) (Salicylic Acid 2 % Topical Solution [Clear Proof Acne Medication]) } Pack [Clear Proof Acne To-Go System] |
SY |
| {1 (0.32 OZ) (miconazole nitrate 2 % Vaginal Cream [Monistat]) / 3 (miconazole nitrate 200 MG Vaginal Insert [Monistat]) } Pack [Monistat 3 Day Ovule Combination Pack] |
SY |
| {1 (0.32 OZ) (miconazole nitrate 2 % Vaginal Cream [Monistat]) / 3 (miconazole nitrate 200 MG Vaginal Insert [Monistat]) } Pack [Monistat 3 Day Ovule Combination Pack] |
SY |
| {1 (0.32 OZ) (miconazole nitrate 2 % Vaginal Cream [Monistat]) / 3 (miconazole nitrate 200 MG Vaginal Insert [Monistat]) } Pack [Monistat 3 Day Ovule Combination Pack] |
SY |
| {1 (0.32 OZ) (miconazole nitrate 2 % Vaginal Cream [Monistat]) / 3 (miconazole nitrate 200 MG Vaginal Insert [Monistat]) } Pack [Monistat 3 Day Ovule Combination Pack] |
SY |
| {1 (0.32 OZ) (miconazole nitrate 2 % Vaginal Cream [Monistat]) / 3 (miconazole nitrate 200 MG Vaginal Insert [Monistat]) } Pack [Monistat 3 Day Ovule Combination Pack] |
SY |
| {1 (0.4 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]) / 1 (0.8 ML adalimumab 100 MG/ML Prefilled Syringe [Humira]) } Pack [Humira Pediatric Crohn's Disease Starter Package (2 count)] |
BPCK |
| {1 (0.4 ML adalimumab 100 MG/ML Prefilled Syringe) / 1 (0.8 ML adalimumab 100 MG/ML Prefilled Syringe) } Pack |
GPCK |
| {1 (0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe [Yuflyma]) / 1 (0.8 ML adalimumab-aaty 100 MG/ML Prefilled Syringe [Yuflyma]) } Pack [Yuflyma Prefilled Syringe 80 MG/0.8 ML and 40 MG/0.4 ML Starter Package for Pediatric Crohn's Disease] |
BPCK |
| {1 (0.4 ML adalimumab-aaty 100 MG/ML Prefilled Syringe) / 1 (0.8 ML adalimumab-aaty 100 MG/ML Prefilled Syringe) } Pack |
GPCK |
| {1 (0.4 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) / 1 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe [Hyrimoz]) } Pack [Hyrimoz Pediatric Crohn's Starter Kit Patient Weight < 40 KG] |
BPCK |
| {1 (0.4 ML adalimumab-adaz 100 MG/ML Prefilled Syringe) / 1 (0.8 ML adalimumab-adaz 100 MG/ML Prefilled Syringe) } Pack |
GPCK |
| {1 (0.5 ML peginterferon beta-1a 0.126 MG/ML Auto-Injector [Plegridy]) / 1 (0.5 ML peginterferon beta-1a 0.188 MG/ML Auto-Injector [Plegridy]) } Pack [Plegridy Pen Starter Pack] |
BPCK |
| {1 (0.5 ML peginterferon beta-1a 0.126 MG/ML Auto-Injector) / 1 (0.5 ML peginterferon beta-1a 0.188 MG/ML Auto-Injector) } Pack |
GPCK |
| {1 (0.5 ML peginterferon beta-1a 0.126 MG/ML Prefilled Syringe [Plegridy]) / 1 (0.5 ML peginterferon beta-1a 0.188 MG/ML Prefilled Syringe [Plegridy]) } Pack [Plegridy Starter Pack] |
BPCK |