Drugs: Contract Drugs List Part 1 – Prescription Drugs (S ...
* Restricted to NDC labeler code 00075 (Sanofi-Aventis U.S. LLC) for the 55 mcg/actuation, 16.5 gm nasal spray only and to claims submitted with dates of service from June 1, 1996, through January 31, 2014. TRI. TRIAMTERENE + Capsules 50 mg ea. 100 mg ea. TRIAMTERENE WITH HYDROCHLOROTHIAZIDE + Capsules 37.5 mg/25 mg. ea † 50 mg/25 mg ... ................
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