Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3307
00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.0507
00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 9.8070
00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G 0.2080
00002166607 5 BENZAGEL 5% TOPICAL LOTION TOP LOT NVC ML 0.1984
00000437999 5% DEXTROSE & 0.45% NACL W 0.15% KCL 20 MEQ INJ INJ DEFAUL BAX ML 0.0030
00000037974 50% DEXTROSE 500 MG/ML INJECTION USP INJ DEFAUL HSP ML 0.5842
00080013172 5-HTP 100 MG CAPSULE ORL CAP VTH CAP 0.2000
00002414570 ABBOTT-CITALOPRAM 10 MG TABLET ORL TAB ABB TAB 0.1432
00002414589 ABBOTT-CITALOPRAM 20 MG TABLET ORL TAB ABB TAB 0.2397
00002414597 ABBOTT-CITALOPRAM 40 MG TABLET ORL TAB ABB TAB 0.2397
00002412942 ABBOTT-CLOPIDOGREL 75 MG TABLET ORL TAB ABB TAB 0.4735
00002414805 ABBOTT-LEVETIRACETAM 250 MG TABLET ORL TAB ABB TAB 0.8000
00002414791 ABBOTT-LEVETIRACETAM 500 MG TABLET ORL TAB ABB TAB 0.9750
00002414783 ABBOTT-LEVETIRACETAM 750 MG TABLET ORL TAB ABB TAB 1.3500
00002414546 ABBOTT-OLANZAPINE ODT 10 MG TABLET ORL DISNTAB ABB TAB 1.2857
00002414538 ABBOTT-OLANZAPINE ODT 5 MG TABLET ORL DISNTAB ABB TAB 0.6434
00002412969 ABBOTT-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.3628
00002412985 ABBOTT-QUETIAPINE 100 MG TABLET ORL TAB ABB TAB 0.3295
00002412993 ABBOTT-QUETIAPINE 200 MG TABLET ORL TAB ABB TAB 0.6617
00002412977 ABBOTT-QUETIAPINE 25 MG TABLET ORL TAB ABB TAB 0.1235
00002413000 ABBOTT-QUETIAPINE 300 MG TABLET ORL TAB ABB TAB 0.9656
00002422638 ABBOTT-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.1204
00002422646 ABBOTT-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT ABB TAB 0.2408
00002414619 ABBOTT-TOPIRAMATE 100 MG TABLET ORL TAB ABB TAB 0.5928
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 1 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002414627 ABBOTT-TOPIRAMATE 200 MG TABLET ORL TAB ABB TAB 0.8853
00002414600 ABBOTT-TOPIRAMATE 25 MG TABLET ORL TAB ABB TAB 0.3128
00002231590 ABELCET 5MG/ML LIPID COMPLEX INJECTION INJ DEFAUL SGM ML 9.4395
00001919385 ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.5417
00001919393 ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.6692
00001919407 ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.7683
00002281066 ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 971.0000
00002245677 ABREVA 10% TOPICAL CREAM TOP CRM GKC G 7.2800
00002364174 ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 11.1930
00002364182 ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 12.6710
00002364190 ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 15.1950
00002364204 ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 17.2650
00002364212 ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 23.0300
00002364220 ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 28.7840
00001922246 AC & C 8 MG TABLET ORL TAB PPH TAB 0.0510
00002401126 ACCEL-ALENDRONATE 10 MG TABLET ORL TAB ACP TAB 0.3989
00002401134 ACCEL-ALENDRONATE 70 MG TABLET ORL TAB ACP TAB 1.9000
00002341107 ACCEL-AMLODIPINE 10 MG TABLET ORL TAB ACP TAB 0.3587
00002341093 ACCEL-AMLODIPINE 5 MG TABLET ORL TAB ACP TAB 0.2417
00002419874 ACCEL-DONEPEZIL 10 MG TABLET ORL TAB ACP TAB 0.8145
00002419866 ACCEL-DONEPEZIL 5 MG TABLET ORL TAB ACP TAB 0.8145
00002400391 ACCEL-FLUOXETINE 10 MG CAPSULE ORL CAP ACP CAP 0.3300
00002400405 ACCEL-FLUOXETINE 20 MG CAPSULE ORL CAP ACP CAP 0.3300
00002400359 ACCEL-QUETIAPINE 100 MG TABLET ORL TAB ACP TAB 0.2100
00002400375 ACCEL-QUETIAPINE 200 MG TABLET ORL TAB ACP TAB 0.4300
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 2 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002400340 ACCEL-QUETIAPINE 25 MG TABLET ORL TAB ACP TAB 0.0800
00002400383 ACCEL-QUETIAPINE 300 MG TABLET ORL TAB ACP TAB 0.6300
00002435349 ACCEL-TOPIRAMATE 100 MG TABLET ORL TAB ACP TAB 0.4400
00002435357 ACCEL-TOPIRAMATE 200 MG TABLET ORL TAB ACP TAB 0.6600
00002435330 ACCEL-TOPIRAMATE 25 MG TABLET ORL TAB ACP TAB 0.2300
00002164396 ACEBUTOLOL-100 100 MG TABLET ORL TAB PDL TAB 0.0787
00002164418 ACEBUTOLOL-200 200 MG TABLET ORL TAB PDL TAB 0.1177
00002164426 ACEBUTOLOL-400 400 MG TABLET ORL TAB PDL TAB 0.2466
00002230435 ACET 160 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.6242
00001999648 ACET CODEINE 30 TABLET ORL TAB PMS TAB 0.1655
00002154234 ACETAMINOPHEN 300MG/15MG CAFFEINE/8MG COD. CAPLET ORL TAB VTH TAB 0.0348
00001977415 ACETAMINOPHEN 325 MG CAPLET ORL TAB TLI TAB 0.0592
00000789801 ACETAMINOPHEN 325 MG TABLET ORL TAB TLI TAB 0.0592
00001938088 ACETAMINOPHEN 325 MG TABLET ORL TAB JPC TAB 0.0120
00000605751 ACETAMINOPHEN 325 MG TABLET ORL TAB VTH TAB 0.0272
00000374148 ACETAMINOPHEN 325 MG TABLET ORL TAB WAM TAB 0.0184
00000789798 ACETAMINOPHEN 500 MG TABLET ORL TAB TLI TAB 0.0243
00001905864 ACETAMINOPHEN 80 MG/ML ORAL DROPS ORL DPS TLI ML 0.1300
00002272482 ACETAMINOPHEN ARTHRITIS PAIN 650 MG EXT.REL TABLET ORL ERT PRI TAB 0.0755
00000706221 ACETAMINOPHEN CAFFEINE & CODEINE 8 MG TABLET ORL TAB WTR TAB 0.0258
00002028174 ACETAMINOPHEN COMPOUND WITH CODEINE CAPLET ORL TAB PPH TAB 0.0398
00001905856 ACETAMINOPHEN COMPRIME A CROQUER 80 MG ORL TAB TLI TAB 0.1000
00002255251 ACETAMINOPHEN EXT STR EASY TO SWALLOW 500 MG TAB ORL TAB PMT TAB 0.0660
00000605778 ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB WTR TAB 0.0306
00002285797 ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB VTH TAB 0.0600
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 3 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002252813 ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB PMT TAB 0.0621
00001904132 ACETAMINOPHEN EXTRA-STRENGTH 500 MG TABLET ORL TAB TAN TAB 0.0179
00001958836 ACETAMINOPHEN ORAL SOLUTION FOR CHILDREN USP ORL SOL TLI ML 0.0296
00002143933 ACETAMINOPHEN WITH CODEINE CAPLET ORL TAB ROG TAB 0.0460
00002025337 ACETAMINOPHEN WITH CODEINE TABLET ORL TAB PMS TAB 0.0398
00002251914 ACETAMINOPHEN, CAFFEINE & 8 MG CODEINE PHOS. TAB ORL TAB PMT TAB 0.0396
00002017431 ACETAMINOPHENE 160 MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB 0.1475
00002022214 ACETAMINOPHENE 325 MG COMPRIME ORL TAB RIV TAB 0.0114
00000382752 ACETAMINOPHENE 325 MG TABLET ORL TAB PDL TAB 0.0114
00002362228 ACETAMINOPHENE 500 MG CAPLET ORL TAB RIV TAB 0.0149
00002022222 ACETAMINOPHENE 500 MG COMPRIME ORL TAB RIV TAB 0.0149
00000386626 ACETAMINOPHENE 500 MG TABLET ORL TAB PDL TAB 0.0149
00002017458 ACETAMINOPHENE 80MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB 0.1000
00000834319 ACETAZONE FORTE C-8 TABLET ORL TAB RPH TAB 0.4495
00000834300 ACETAZONE FORTE TABLET ORL TAB RPH TAB 0.3399
00001999656 ACET-CODEINE 60 MG TABLET ORL TAB PMS TAB 0.2640
00002300435 ACETYLCYSTEINE 20% INHALATION SOLUTION INH SOL ALV ML 1.9500
00000718831 ACETYLSALICYLIC ACID 325 MG TABLET ORL TAB PHH TAB 0.0621
00002426757 ACH-CAPECITABINE 150 MG TABLET ORL TAB AHI TAB 1.4640
00002426765 ACH-CAPECITABINE 500 MG TABLET ORL TAB AHI TAB 4.8800
00002247551 ACID REDUCER 75 MG TABLET ORL TAB PMS TAB 0.1067
00080042609 ACIDOPHILUS PROBIOTIC COMPLETE CAPSULE ORL CAP WNP CAP 0.2892
00080011789 ACIDOPHILUS WITH BIFIDUS CAPSULE ORL CAP WNP CAP 0.1082
00002439247 ACT AMPHETAMINE XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.0758
00002439255 ACT AMPHETAMINE XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.3250
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 4 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002439263 ACT AMPHETAMINE XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.5743
00002439271 ACT AMPHETAMINE XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 2.8235
00002439298 ACT AMPHETAMINE XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 3.0729
00002439239 ACT AMPHETAMINE XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP 1.8266
00002394898 ACT ANASTROZOLE 1 MG TABLET ORL TAB APH TAB 2.5459
00002374765 ACT BETAHISTINE 24 MG TABLET ORL TAB APH TAB 0.4983
00002376520 ACT CANDESARTAN 4 MG TABLET ORL TAB APH TAB 0.3400
00002244816 ACT CLOMIPRAMINE 10 MG TABLET ORL TAB APH TAB 0.1290
00002244817 ACT CLOMIPRAMINE 25 MG TABLET ORL TAB APH TAB 0.1758
00002244818 ACT CLOMIPRAMINE 50 MG TABLET ORL TAB APH TAB 0.3237
00002397145 ACT DICLO-MISO 50 MG/200 MCG ENTERIC-COATED TABLET ORL ECT APH TAB 0.4541
00002397153 ACT DICLO-MISO 75 MG/200 MCG ENTERIC-COATED TABLET ORL ECT APH TAB 0.6179
00002397625 ACT DONEPEZIL ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 3.6176
00002397617 ACT DONEPEZIL ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 3.6176
00002423855 ACT ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APH TAB 1.8690
00002423863 ACT ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC APH TAB 1.8690
00002305682 ACT FAMCICLOVIR 125 MG TABLET ORL TAB APH TAB 2.0240
00002305690 ACT FAMCICLOVIR 250 MG TABLET ORL TAB APH TAB 2.7200
00002305704 ACT FAMCICLOVIR 500 MG TABLET ORL TAB APH TAB 4.2281
00002397285 ACT IMATINIB 100 MG TABLET ORL TAB COB TAB 20.4557
00002397293 ACT IMATINIB 400 MG TABLET ORL TAB COB TAB 81.8228
00002250020 ACT MELOXICAM 15 MG TABLET ORL TAB APH TAB 0.5670
00002250012 ACT MELOXICAM 7.5 MG TABLET ORL TAB APH TAB 0.4914
00002404656 ACT MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL APH ML 3.7567
00002325713 ACT OLANZAPINE 20 MG TABLET ORL TAB APH TAB 10.3093
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 5 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002327589 ACT OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 5.3553
00002327597 ACT OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB 7.5977
00002404095 ACT OLAPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APH ML 10.4520
00002403986 ACT OLOPATADINE 0.1% OPH SOLUTION OPH SOL APH ML 5.2260
00002394189 ACT OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.4390
00002394197 ACT OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.6585
00002394200 ACT OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 1.1413
00002394170 ACT OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 0.3150
00002394219 ACT OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB 2.1080
00002262746 ACT PAROXETINE 10 MG TABLET ORL TAB APH TAB 1.0430
00002297310 ACT PRAMIPEXOLE 0.5 MG TABLET ORL TAB APH TAB 1.3860
00002402955 ACT PREGABALIN 150 MG CAPSULE ORL CAP APH CAP 1.7270
00002402971 ACT PREGABALIN 225 MG CAPSULE ORL CAP APH CAP 1.7270
00002402912 ACT PREGABALIN 25 MG CAPSULE ORL CAP APH CAP 0.6173
00002402998 ACT PREGABALIN 300 MG CAPSULE ORL CAP APH CAP 1.7270
00002402920 ACT PREGABALIN 50 MG CAPSULE ORL CAP APH CAP 0.9683
00002402939 ACT PREGABALIN 75 MG CAPSULE ORL CAP APH CAP 1.2528
00002446820 ACT PROGESTERONE INJECTION 50 MG/ML INJECTION INJ DEFAUL APH ML 5.8610
00002437961 ACT PROPOFOL 10 MG/ML INJECTION INJ DEFAUL APH ML 0.4600
00002372088 ACT SILDENAFIL 100 MG TABLET ORL TAB APH TAB 9.2007
00002372053 ACT SILDENAFIL 25 MG TABLET ORL TAB APH TAB 8.2900
00002372061 ACT SILDENAFIL 50 MG TABLET ORL TAB APH TAB 8.8475
00002257882 ACT SUMATRIPTAN 25 MG TABLET ORL TAB APH TAB 8.9900
00002428644 ACT TADALAFIL 10 MG TABLET ORL TAB APH TAB 11.9255
00002428628 ACT TADALAFIL 2.5 MG TABLET ORL TAB APH TAB 3.6471
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 6 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002428652 ACT TADALAFIL 20 MG TABLET ORL TAB APH TAB 12.3569
00002428636 ACT TADALAFIL 5 MG TABLET ORL TAB APH TAB 3.6471
00002395282 ACT TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APH CAP 113.5966
00002395290 ACT TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APH CAP 159.0358
00002395274 ACT TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APH CAP 22.7194
00002395312 ACT TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APH CAP 283.9834
00002441160 ACT TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APH CAP 6.6300
00002337487 ACT VALSARTAN 40 MG TABLET ORL TAB APH TAB 0.5823
00002454297 ACT-ESCITALOPRAM ODT 10 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB 1.4959
00002454300 ACT-ESCITALOPRAM ODT 20 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB 1.5926
00002238302 ACTIFED 60 MG/2.5 MG TABLET ORL TAB MCL TAB 0.3246
00002428946 ACTIKERALL 0.5 %/10 % TOPICAL SOLUTION TOP SOL CIP ML 1.4620
00002249405 ACTIVELLE 1 MG/0.5 MG TABLET ORL TAB NNA TAB 2.4164
00002309009 ACTIVELLE LD 0.5 MG/0.1 MG TABLET ORL TAB NNA TAB 2.4164
00002316838 ACTONEL 150 MG TABLET ORL TAB ASC TAB 55.8000
00002370417 ACTONEL DR 35 MG DELAYED-RELEASE TABLET ORL DRT ASC TAB 13.3325
00002248722 ACULAR LS 0.4% OPH SOLUTION OPH SOL ALL ML 3.3940
00002286556 ACYCLOVIR 200 MG TABLET ORL TAB SNS TAB 0.6397
00002286564 ACYCLOVIR 400 MG TABLET ORL TAB SNS TAB 1.2700
00002286572 ACYCLOVIR 800 MG TABLET ORL TAB SNS TAB 1.2673
00002236916 ACYCLOVIR SODIUM 25 MG/ML INJECTION INJ DEFAUL HSP ML 4.8620
00002236926 ACYCLOVIR SODIUM 50 MG/ML INJECTION INJ DEFAUL FKC ML 12.5840
00002281074 ACZONE 5% TOPICAL GEL TOP GEL VCL G 1.0590
00002240255 ADACEL INJECTION INJ DEFAUL SFP ML 58.0000
00002352044 ADACEL-POLIO INJECTION INJ DEFAUL SFP ML 79.9000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 7 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002313766 ADALAT XL PLUS 20 MG/81 MG TABLET ORL ERT BAI TAB 0.6555
00002313774 ADALAT XL PLUS 30 MG/81 MG TABLET ORL ERT BAI TAB 0.6170
00002313782 ADALAT XL PLUS 60 MG/81 MG TABLET ORL ERT BAI TAB 0.9373
00000266507 ADASEPT 0.5% TOPICAL LIQUID TOP LIQ ODN ML 0.0314
00002290081 ADASEPT BP5 ACNE GEL 5% TOPICAL GEL TOP GEL ODN ML 0.1790
00002401347 ADCETRIS 50MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL STG VIAL 4840.0000
00002338327 ADCIRCA 20 MG TABLET ORL TB LIL TAB 13.4970
00002248809 ADDERALL XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.4421
00002248810 ADDERALL XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.7353
00002248811 ADDERALL XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.0286
00002248812 ADDERALL XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.3218
00002248813 ADDERALL XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.6152
00002248808 ADDERALL XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.1489
00002412764 ADEMPAS 0.5 MG TABLET ORL TAB BAI TAB 42.7500
00002412772 ADEMPAS 1 MG TABLET ORL TAB BAI TAB 42.7500
00002412799 ADEMPAS 1.5 MG TABLET ORL TAB BAI TAB 42.7500
00002412802 ADEMPAS 2 MG TABLET ORL TAB BAI TAB 42.7500
00002412810 ADEMPAS 2.5 MG TABLET ORL TAB BAI TAB 42.7500
00002071002 ADRIAMYCIN PFS 2 MG/ML INJECTION INJ DEFAUL PFI ML 11.2080
00002296462 ADVAGRAF 0.5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 1.9700
00002296470 ADVAGRAF 1 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 2.5200
00002331667 ADVAGRAF 3 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 7.5600
00002296489 ADVAGRAF 5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 12.6200
00080025646 ADVANCED B COMPLEX ORL CAP AOR CAP 0.2941
00002270447 ADVICOR 1000 MG/20 MG TABLET ORL TAB SUN TAB 1.3900
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 8 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002270439 ADVICOR 500 MG/20 MG TABLET ORL TAB SUN TAB 1.2400
00001933558 ADVIL 200 MG TABLET ORL TAB PDH TAB 0.1870
00002036312 ADVIL COLD AND SINUS CAPLET ORL TAB PDH TAB 0.3750
00002248645 ADVIL COLD AND SINUS PLUS CAPLET ORL TAB PDH TAB 0.4120
00002244577 ADVIL EXTRA STRENGTH 400 MG CAPLET ORL TAB PDH TAB 0.2706
00002248231 ADVIL EXTRA STRENGTH LIQUI-GEL 400 MG CAPSULE ORL CAP PDH CAP 0.3608
00001933531 ADVIL IBUPROFEN 200 MG CAPLET ORL TAB PDH TAB 0.1433
00002246403 ADVIL JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB 0.3070
00002241769 ADVIL LIQUI-GELS 200 MG CAPSULE ORL CAP PDH CAP 0.2469
00002242522 ADVIL PEDIATRIC 40 MG/ML SUSPENSION DROPS ORL DPS PDH ML 0.3160
00002243919 AERIUS 5 MG TABLET ORL TAB SCH TAB 0.9560
00000990109 AEROCHAMBER PLUS FLOW-VU W/ ADULT SMALL MASK DEFAUL ADUDEV TMI DEV 23.5500
00002339528 AFINITOR 10 MG TABLET ORL TAB NOV TAB 193.3027
00002369257 AFINITOR 2.5 MG TABLET ORL TAB NOV TAB 193.3027
00002339501 AFINITOR 5 MG TABLET ORL TAB NOV TAB 193.3027
00002450267 AFINITOR 7.5 MG TABLET ORL TAB NOV TAB 192.1880
00002425645 AFINITOR DISPERZ 2 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 191.3940
00002425653 AFINITOR DISPERZ 3 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 191.3940
00002425661 AFINITOR DISPERZ 5 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 191.3940
00002432692 AG-DONEPEZIL 10 MG TABLET ORL TAB AGP TAB 0.8752
00002432684 AG-DONEPEZIL 5 MG TABLET ORL TAB AGP TAB 0.8752
00002346850 AGRIFLU INJECTION SYRINGE INJ DEFAUL NVD SYR 8.5000
00002428881 AGRIFLU MULTI-DOSE VIAL INJECTION INJ DEFAUL NOV ML 16.2000
00002236859 AGRYLIN 0.5 MG CAPSULE ORL CAP SHB CAP 6.0764
00002410265 AHI-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AHI TAB 0.3646
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 9 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002410273 AHI-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AHI TAB 0.5565
00000001147 ALBALON 0.1% OPH SOLUTION OPH SOL ALL ML 0.5933
00000180408 ALDACTAZIDE-25 TABLET ORL TAB PFI TAB 0.2271
00000594377 ALDACTAZIDE-50 TABLET ORL TAB PFI TAB 0.4814
00000285455 ALDACTONE 100 MG TABLET ORL TAB PFI TAB 0.3526
00000028606 ALDACTONE 25 MG TABLET ORL TAB PFI TAB 0.1496
00002254506 ALDURAZYME 0.58 MG/ML INJECTION INJ DEFAUL GZM ML 209.0000
00002458136 ALECENSARO 150 MG CAPSULE ORL CAP HLR CAP 42.1666
00002381478 ALENDRONATE SODIUM 5 MG TABLET ORL TAB AHI TAB 1.0371
00002301733 ALEVE 220 MG TABLET ORL TAB BAI TAB 0.2240
00002414759 ALFUZOSIN 10 MG PROLONGED-RELEASE TABLET ORL SRT PDL TAB 0.4966
00080014418 ALIGN PROBIOTIC CAPSULE ORL CAP PGI CAP 0.9007
00002253437 ALIMTA 500 MG/VIAL INJECTION INJ DEFAUL LIL VIAL 2750.0000
00000004715 ALKERAN 2 MG TABLET ORL TAB ASN TAB 1.7372
00002231462 ALLEGRA 12 HOUR 60 MG TABLET ORL TAB SAV TAB 0.3792
00002242819 ALLEGRA 24 HOUR 120 MG TABLET ORL TAB SAV TAB 0.8000
00002239853 ALLEGRA-D SUSTAINED-RELEASE TABLET ORL SRT SAV TAB 0.5080
00002146142 ALLER-AIDE 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML 0.0342
00002176483 ALLER-AIDE 25 MG CAPLET ORL TAB ROG TAB 0.2198
00000271411 ALLERDRYL 50 MG CAPSULE ORL CAP VCL CAP 0.1303
00000299987 ALLERGENIC EXTRACT POLLENS 100000 UNIT/ML INJ INJ DEFAUL ALK ML 7.5000
00001949454 ALLERGY 25 MG TABLET ORL TAB TAN TAB 0.0938
00000764647 ALLERGY DROPS 0.012% OPH SOLUTION OPH SOL BSH ML 0.1773
00000833266 ALLERGY ELIXIR 2.5 MG/ML ORAL ELIXIR ORL ELX TAN ML 0.0180
00002141728 ALLERGY FORMULA 25 MG CAPLET ORL TAB PRI TAB 0.1200
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 10 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002240266 ALLERGY RELIEF 10 MG TABLET ORL TAB APX TAB 0.4083
00002375990 ALLERGY REMEDY 10 MG TABLET ORL TAB APX TAB 0.1967
00002230398 ALLERGY TABLETS EXTRA STRENGTH 50 MG TABLET ORL TAB TAN TAB 0.1625
00000804193 ALLERNIX 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML 0.0499
00002097583 ALLERNIX 25 MG CAPLET ORL TAB ROG TAB 0.2413
00002097575 ALLERNIX EXTRA STRENGTH 50 MG CAPLET ORL TAB ROG TAB 0.4400
00002369656 ALLERNIX MULTI SYMPTOM 5 MG TABLET ORL TAB ROG TAB 0.5120
00002364689 ALLER-RELIEF 10 MG TABLET ORL TAB PMS TAB 0.4080
00002240265 ALLER-RELIEF 10 MG TABLET ORL TAB APX TAB 0.4083
00000555681 ALLOPURINOL 100 MG TABLET ORL TAB PDL TAB 0.0780
00002130157 ALLOPURINOL 200 MG TABLET ORL TAB PDL TAB 0.1300
00000555703 ALLOPURINOL 300 MG TABLET ORL TAB PDL TAB 0.2125
00000569801 ALMAGEL 200 ORAL LIQUID ORL LIQ ATL ML 0.0179
00002424029 ALMOTRIPTAN 12.5 MG TABLET ORL TAB PDL TAB 7.0433
00002241407 ALOCRIL 2% OPH SOLUTION OPH SOL ALL ML 6.6200
00000893560 ALOMIDE 0.1% (BASE) OPH SOLUTION OPH SOL ALC ML 1.2110
00002381710 ALOXI 0.05 MG/ML INJECTION INJ DEFAUL EIS ML 18.0000
00002381729 ALOXI 0.5 MG CAPSULE ORL CAP EIS CAP 66.0000
00080005881 ALPHA LIPOIC ACID 100MG CAPSULE ORL CAP WNP CAP 0.1055
00002248151 ALPHAGAN P 0.15% OPHTHALMIC SOLUTION OPH SOL ALL ML 3.6040
00001908189 ALPRAZOLAM-0.25 MG TABLET ORL TAB PDL TAB 0.0609
00001908170 ALPRAZOLAM-0.5 MG TABLET ORL TAB PDL TAB 0.0728
00002248706 ALPRAZOLAM-1 1 MG TABLET ORL TAB PDL TAB 0.3099
00002320924 ALREX 0.2% OPHTHALMIC SUSPENSION OPH SUS BSH ML 5.5620
00000999538 ALSOY INFANT FORMULA ORAL POWDER ORL PWR NHN G 0.0365
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 11 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002281112 ALTACE 15 MG CAPSULE ORL CAP/TAB VCL CAP 1.1920
00002245272 AMARYL 1 MG TABLET ORL TAB SAV TAB 0.9503
00002245273 AMARYL 2 MG TABLET ORL TAB SAV TAB 1.0343
00002245274 AMARYL 4 MG TABLET ORL TAB SAV TAB 1.1070
00002241630 AMBISOME 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 121.0000
00002230575 AMETOP 4% TOPICAL GEL TOP GEL SNE G 2.6511
00000870943 AMI-HYDRO 50 MG/5 MG TABLET ORL TAB PDL TAB 0.0838
00002242971 AMIKACIN SULFATE 250 MG/ML INJECTION INJ DEFAUL SDZ ML 38.5905
00002374684 AMIODARONE SYRINGE 50 MG/ML INJECTION INJ NDL SDZ SYR 66.4500
00000370991 AMITRIPTYLINE 10 MG TABLET ORL TAB PDL TAB 0.0435
00002451786 AMITRIPTYLINE 10 MG TABLET ORL TAB SIV TAB 0.0664
00000371009 AMITRIPTYLINE 25 MG TABLET ORL TAB PDL TAB 0.0829
00002451794 AMITRIPTYLINE 25 MG TABLET ORL TAB SIV TAB 0.1211
00000456349 AMITRIPTYLINE 50 MG TABLET ORL TAB PDL TAB 0.1540
00002451808 AMITRIPTYLINE 50 MG TABLET ORL TAB SIV TAB 0.2347
00002326817 AMLODIPINE 10 MG TABLET ORL TAB PDL TAB 0.3587
00002326795 AMLODIPINE 2.5 MG TABLET ORL TAB PDL TAB 0.1380
00002326809 AMLODIPINE 5 MG TABLET ORL TAB PDL TAB 0.2417
00000638064 AMOSAN 68.6% MOUTHWASH ORL MWH OLB ML 0.3340
00002401576 AMOXICILLIN SUGAR-REDUCED 50 MG/ML ORAL SUSPENSION ORL SUS SIV ML 0.0540
00002326515 AMOXI-CLAV 500 MG/125 MG TABLET ORL TAB PDL TAB 0.6673
00002326523 AMOXI-CLAV 875 MG/125 MG TABLET ORL TAB PDL TAB 1.0008
00002125862 AMPHOJEL 320 MG/5ML ORAL LIQUID ORL LIQ AXC ML 0.0179
00002124971 AMPHOJEL 600 MG TABLET ORL TAB AUP TAB 0.1250
00002227002 AMPICILLIN 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 5.1750
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 12 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002226995 AMPICILLIN 2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 12.7400
00002227029 AMPICILLIN 250 MG/VIAL INJECTION INJ DEFAUL FKC VIAL 2.9470
00002227010 AMPICILLIN 500 MG/VIAL INJECTION INJ DEFAUL FKC VIAL 3.0910
00080006771 A-MULSION ORAL LIQUID ORL LIQ SRL ML 0.4000
00002221861 ANANDRON 50 MG TABLET ORL TAB SAV TAB 2.3428
00002442736 ANASTROZOLE 1 MG TABLET ORL TAB SNS TAB 2.5457
00002245345 ANDROGEL (2.5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G 0.8920
00002245346 ANDROGEL (5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G 0.7887
00002249499 ANDROGEL (75 G/PUMP) 1% TOPICAL GEL TOP GEL BGP G 0.9013
00002268825 ANGELIQ 1 MG/1 MG TABLET ORL TAB BAI TAB 0.7821
00000566756 ANTHRAFORTE 1 1% TOPICAL OINTMENT TOP ONT MPQ G 0.3696
00000566748 ANTHRAFORTE 2 2% TOPICAL OINTMENT TOP ONT MPQ G 0.8066
00002230251 ANTIBIOTIC TOPICAL OINTMENT USP TOP ONT TAR G 0.1500
00002241532 ANTI-NAUSEANT 50 MG TABLET ORL TAB VTH TAB 0.0790
00002222132 ANTIPHLOGISTINE RUB A-535 NO ODOUR 13.3% TOP OINT TOP ONT CHD G 0.0570
00000990104 ANTI-STATIC COMPACT SPACE CHAMBER PLUS MOUTHPIECE DEFAUL DEV MPI DEV 23.5500
00000990107 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ LG MASK DEFAUL ADUDEV MPI DEV 39.8600
00000990106 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ MED MASK DEFAUL PEDDEV MPI DEV 37.6700
00000990105 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ SM MASK DEFAUL INFDEV MPI DEV 37.6700
00001945939 ANUSOL 0.5% RECTAL OINTMENT RT ONT MCL G 0.1530
00001945920 ANUSOL 10 MG RECTAL SUPPOSITORY RT SUP MCL SUP 0.4183
00001945912 ANUSOL PLUS RECTAL OINTMENT RT ONT MCL G 0.1973
00001945904 ANUSOL PLUS RECTAL SUPPOSITORY RT SUP MCL SUP 0.5758
00000621439 ANUZINC 10 MG RECTAL SUPPOSITORY RT SUP SDZ SUP 0.4083
00002248424 ANUZINC PLUS RECTAL OINTMENT RT ONT SDZ G 0.1173
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 13 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080017904 AOR CHROMIUM PICOLINATE 600 MCG CAPSULE ORL CAP AOR CAP 0.1333
00080005832 AOR N.A.C. 500 MG CAPSULE ORL CAP AOR CAP 0.1375
00002396769 APO-ABACAVIR 300 MG TABLET ORL TAB APX TAB 5.9207
00002399539 APO-ABACAVIR-LAMIVUDINE 600 MG/300 MG TABLET ORL TAB APX TAB 20.3573
00002416255 APO-ABACAVIR-LAMIVUDINE-ZIDOVUDINE TABLET ORL TAB APX TAB 15.4613
00002229873 APO-ACETAMINOPHEN 325 MG CAPLET ORL TAB APX TAB 0.0326
00000544981 APO-ACETAMINOPHEN 325 MG TABLET ORL TAB APX TAB 0.0326
00002248727 APO-ALENDRONATE 5 MG TABLET ORL TAB APX TAB 1.0370
00002454467 APO-ALENDRONATE/VITAMIN D3 70 MG/2800 UNIT TABLET ORL TAB APX TAB 3.7300
00002243611 APO-ALPRAZ 1 MG TABLET ORL TAB APX TAB 0.3099
00002243612 APO-ALPRAZ TS 2 MG TABLET ORL TAB APX TAB 0.5508
00002411318 APO-AMLODIPINE-ATORVASTATIN 10 MG/10 MG TABLET ORL TAB APX TAB 0.9194
00002411326 APO-AMLODIPINE-ATORVASTATIN 10 MG/20 MG TABLET ORL TAB APX TAB 1.0234
00002411334 APO-AMLODIPINE-ATORVASTATIN 10 MG/40 MG TABLET ORL TAB APX TAB 1.0624
00002411342 APO-AMLODIPINE-ATORVASTATIN 10 MG/80 MG TABLET ORL TAB APX TAB 1.0624
00002411253 APO-AMLODIPINE-ATORVASTATIN 5 MG/10 MG TABLET ORL TAB APX TAB 0.7551
00002411261 APO-AMLODIPINE-ATORVASTATIN 5 MG/20 MG TABLET ORL TAB APX TAB 0.8591
00002411288 APO-AMLODIPINE-ATORVASTATIN 5 MG/40 MG TABLET ORL TAB APX TAB 0.8981
00002411296 APO-AMLODIPINE-ATORVASTATIN 5 MG/80 MG TABLET ORL TAB APX TAB 0.8981
00002288559 APO-AMOXI CLAV 80 MG/11.4 MG/ML ORAL SUSPENSION ORL SUS APX ML 0.1969
00002374420 APO-ANASTROZOLE 1 MG TABLET ORL TAB APX TAB 2.5460
00000510696 APO-ASEN ECT 325 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.0304
00000472476 APO-ASEN ECT 650 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.2500
00002318024 APO-ATOMOXETINE 10 MG CAPSULE ORL CAP APX CAP 2.3140
00002318083 APO-ATOMOXETINE 100 MG CAPSULE ORL CAP APX CAP 4.3520
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 14 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002318032 APO-ATOMOXETINE 18 MG CAPSULE ORL CAP APX CAP 2.6523
00002318040 APO-ATOMOXETINE 25 MG CAPSULE ORL CAP APX CAP 2.9281
00002318059 APO-ATOMOXETINE 40 MG CAPSULE ORL CAP APX CAP 3.3377
00002318067 APO-ATOMOXETINE 60 MG CAPSULE ORL CAP APX CAP 3.7024
00002318075 APO-ATOMOXETINE 80 MG CAPSULE ORL CAP APX CAP 3.9960
00002296063 APO-BICALUTAMIDE 50 MG TABLET ORL TAB APX TAB 4.0573
00002399210 APO-BOSENTAN 125 MG TABLET ORL TAB APX TAB 22.4625
00002399202 APO-BOSENTAN 62.5 MG TABLET ORL TAB APX TAB 22.4625
00000682047 APO-CAL 250 625 MG TABLET ORL TAB APX TAB 0.0266
00000682039 APO-CAL 500 MG TABLET ORL TAB APX TAB 0.0645
00002365340 APO-CANDESARTAN 4 MG TABLET ORL TAB APX TAB 0.3400
00000893625 APO-CAPTO 100 MG TABLET ORL TAB APX TAB 0.9433
00000893595 APO-CAPTO 12.5 MG TABLET ORL TAB APX TAB 0.2028
00000893609 APO-CAPTO 25 MG TABLET ORL TAB APX TAB 0.2722
00000893617 APO-CAPTO 50 MG TABLET ORL TAB APX TAB 0.5070
00001999559 APO-CAPTO 6.25 MG TABLET ORL TAB APX TAB 0.1237
00002293943 APO-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS APX ML 0.1455
00002231603 APO-CETIRIZINE 10 MG TABLET ORL TAB APX TAB 0.4083
00002453363 APO-CETIRIZINE 20 MG TABLET ORL TAB APX TAB 0.7535
00000399302 APO-CHLORPROPAMIDE 100 MG TABLET ORL TAB APX TAB 0.0803
00000312711 APO-CHLORPROPAMIDE 250 MG TABLET ORL TAB APX TAB 0.1624
00002417316 APO-CICLESONIDE 50 MCG/DOSE METERED DOSE NASAL SP NAS SPM APX DOSE 0.1826
00002298953 APO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL APX G 7.7433
00002452693 APO-CINACALCET 30 MG TABLET ORL TAB APX TAB 10.1946
00002452707 APO-CINACALCET 60 MG TABLET ORL TAB APX TAB 18.5901
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 15 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002452715 APO-CINACALCET 90 MG TABLET ORL TAB APX TAB 27.0515
00002263130 APO-CIPROFLOX 0.3% OPHTHALMIC SOLUTION OPH SOL APX ML 1.7600
00002274744 APO-CLARITHROMYCIN 250 MG TABLET ORL TAB APX TAB 0.4209
00002274752 APO-CLARITHROMYCIN 500 MG TABLET ORL TAB APX TAB 1.6293
00002040786 APO-CLOMIPRAMINE 10 MG TABLET ORL TAB APX TAB 0.1290
00002040778 APO-CLOMIPRAMINE 25 MG TABLET ORL TAB APX TAB 0.1758
00002040751 APO-CLOMIPRAMINE 50 MG TABLET ORL TAB APX TAB 0.3237
00002243433 APO-DICLO RAPIDE 50 MG TABLET ORL TAB APX TAB 0.3937
00002354403 APO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL APX ML 0.5165
00002296055 APO-DORZOLAMIDE 2% OPHTHALMIC SOLUTION OPH SOL APX ML 1.6880
00002386054 APO-ELETRIPTAN 20 MG TABLET ORL TAB APX TAB 10.0850
00002386062 APO-ELETRIPTAN 40 MG TABLET ORL TAB APX TAB 10.0850
00002339099 APO-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APX TAB 1.8690
00002339102 APO-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC APX TAB 1.8690
00002419726 APO-EXEMESTANE 25 MG TABLET ORL TAB APX TAB 3.9008
00002292025 APO-FAMCICLOVIR 125 MG TABLET ORL TAB APX TAB 2.0240
00002292041 APO-FAMCICLOVIR 250 MG TABLET ORL TAB APX TAB 2.7200
00002292068 APO-FAMCICLOVIR 500 MG TABLET ORL TAB APX TAB 4.2280
00000545031 APO-FERROUS GLUCONATE 300 MG TABLET ORL TAB APX TAB 0.0404
00002294745 APO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM APX DOSE 0.1831
00002426471 APO-FROVATRIPTAN 2.5 MG TABLET ORL TAB APX TAB 12.5033
00002293358 APO-GABAPENTIN 600 MG TABLET ORL TAB APX TAB 1.3045
00002293366 APO-GABAPENTIN 800 MG TABLET ORL TAB APX TAB 1.7393
00000885754 APO-GAIN 2% TOPICAL SOLUTION TOP SOL APX ML 0.4956
00002295377 APO-GLIMEPIRIDE 1 MG TABLET ORL TAB APX TAB 0.4900
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 16 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002295385 APO-GLIMEPIRIDE 2 MG TABLET ORL TAB APX TAB 0.4900
00002295393 APO-GLIMEPIRIDE 4 MG TABLET ORL TAB APX TAB 0.4900
00000441643 APO-IBUPROFEN 200 MG TABLET ORL TAB APX TAB 0.0528
00002355337 APO-IMATINIB 100 MG TABLET ORL TAB APX TAB 20.4557
00002355345 APO-IMATINIB 400 MG TABLET ORL TAB APX TAB 81.8228
00002369052 APO-LAMIVUDINE 150 MG TABLET ORL TAB APX TAB 3.6269
00002369060 APO-LAMIVUDINE 300 MG TABLET ORL TAB APX TAB 7.2538
00002375540 APO-LAMIVUDINE-ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB APX TAB 7.8309
00002358514 APO-LETROZOLE 2.5 MG TABLET ORL TAB APX TAB 2.7560
00002243880 APO-LORATADINE 10 MG TABLET ORL TAB APX TAB 0.6267
00002248974 APO-MELOXICAM 15 MG TABLET ORL TAB APX TAB 0.5670
00002248973 APO-MELOXICAM 7.5 MG TABLET ORL TAB APX TAB 0.4914
00002366487 APO-MEMANTINE 10 MG TABLET ORL TAB APX TAB 1.6357
00002273950 APO-METHYLPHENIDATE 5 MG TABLET ORL TAB APX TAB 0.1004
00002452731 APO-METHYLPHENIDATE ER 18 MG EXTENDED REL. TABLET ORL ERT APX TAB 1.4276
00002452758 APO-METHYLPHENIDATE ER 27 MG EXTENDED REL. TABLET ORL ERT APX TAB 1.6475
00002452766 APO-METHYLPHENIDATE ER 36 MG EXTENDED REL. TABLET ORL ERT APX TAB 1.8674
00002330377 APO-METHYLPHENIDATE ER 54 MG EXTENDED REL. TABLET ORL ERT APX TAB 2.3072
00002286610 APO-MIRTAZAPINE 15 MG TABLET ORL TAB APX TAB 0.3750
00002286637 APO-MIRTAZAPINE 45 MG TABLET ORL TAB APX TAB 1.1250
00002406373 APO-MOXIFLOXACIN 0.5 % OPHTHALMIC SOLUTION OPH SOL APX ML 3.7570
00002352559 APO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP APX CAP 1.0310
00002352567 APO-MYCOPHENOLATE 500 MG TABLET ORL TAB APX TAB 2.0620
00002372738 APO-MYCOPHENOLIC ACID 180 MG ENTERIC-COATED TAB ORL ECT APX TAB 1.6980
00002372746 APO-MYCOPHENOLIC ACID 360 MG ENTERIC-COATED TAB ORL ECT APX TAB 3.3960
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 17 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002444275 APO-NALTREXONE 50 MG TABLET ORL TAB APX TAB 7.3025
00002246699 APO-NAPROXEN EC 250 MG ENTERIC-COATED TABLET ORL ECT APX TAB 0.2087
00002365499 APO-NARATRIPTAN 1 MG TABLET ORL TAB APX TAB 8.4338
00002365502 APO-NARATRIPTAN 2.5 MG TABLET ORL TAB APX TAB 6.1437
00002427931 APO-NEVIRAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB 2.0987
00002333015 APO-OLANZAPINE 20 MG TABLET ORL TAB APX TAB 10.3093
00002360632 APO-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB APX TAB 5.3553
00002360640 APO-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB APX TAB 7.5977
00002305054 APO-OLOPATADINE 0.1% OPH SOLUTION OPH SOL APX ML 5.2261
00002402823 APO-OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APX ML 10.4522
00002243661 APO-OXAPROZIN 600 MG TABLET ORL TAB APX TAB 0.6892
00002284294 APO-OXCARBAZEPINE 150 MG TABLET ORL TAB APX TAB 0.6209
00002284308 APO-OXCARBAZEPINE 300 MG TABLET ORL TAB APX TAB 0.9102
00002284316 APO-OXCARBAZEPINE 600 MG TABLET ORL TAB APX TAB 1.8204
00002366754 APO-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.4390
00002394766 APO-OXYCODONE CR 15 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.5300
00002366762 APO-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.6585
00002394774 APO-OXYCODONE CR 30 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.8700
00002306530 APO-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 1.1413
00002366746 APO-OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 0.3150
00002394782 APO-OXYCODONE CR 60 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 1.5750
00002366789 APO-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB 2.1080
00002292912 APO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT APX TAB 1.2750
00002240907 APO-PAROXETINE 10 MG TABLET ORL TAB APX TAB 1.0430
00000755885 APO-PINDOL 10 MG TABLET ORL TAB APX TAB 0.2323
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 18 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000755893 APO-PINDOL 15 MG TABLET ORL TAB APX TAB 0.3370
00000755877 APO-PINDOL 5 MG TABLET ORL TAB APX TAB 0.1361
00002302942 APO-PIOGLITAZONE 15 MG TABLET ORL TAB APX TAB 0.6225
00002302950 APO-PIOGLITAZONE 30 MG TABLET ORL TAB APX TAB 0.8721
00002302977 APO-PIOGLITAZONE 45 MG TABLET ORL TAB APX TAB 1.3113
00000642886 APO-PIROXICAM 10 MG CAPSULE ORL CAP APX CAP 0.4426
00000642894 APO-PIROXICAM 20 MG CAPSULE ORL CAP APX CAP 0.7422
00002292386 APO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB APX TAB 1.3860
00002394278 APO-PREGABALIN 150 MG CAPSULE ORL CAP APX CAP 1.7270
00002394286 APO-PREGABALIN 225 MG CAPSULE ORL CAP APX CAP 1.7270
00002394235 APO-PREGABALIN 25 MG CAPSULE ORL CAP APX CAP 0.6173
00002394294 APO-PREGABALIN 300 MG CAPSULE ORL CAP APX CAP 1.7270
00002394243 APO-PREGABALIN 50 MG CAPSULE ORL CAP APX CAP 0.9683
00002394251 APO-PREGABALIN 75 MG CAPSULE ORL CAP APX CAP 1.2529
00000504335 APO-PROPRANOLOL 120 MG TABLET ORL TAB APX TAB 0.3091
00002325381 APO-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB APX CAP 0.8550
00002404680 APO-RASAGILINE 0.5 MG TABLET ORL TAB APX TAB 6.1285
00002404699 APO-RASAGILINE 1 MG TABLET ORL TAB APX TAB 6.1285
00002377721 APO-RISEDRONATE 150 MG TABLET ORL TAB APX TAB 40.9500
00002280396 APO-RISPERIDONE 1 MG/ML ORAL SOLUTION ORL SOL APX ML 0.7080
00002403366 APO-ROSIGLITAZONE 2 MG TABLET ORL TAB APX TAB 1.1692
00002403374 APO-ROSIGLITAZONE 4 MG TABLET ORL TAB APX TAB 1.8346
00002403382 APO-ROSIGLITAZONE 8 MG TABLET ORL TAB APX TAB 2.6235
00002248203 APO-SILDENAFIL 100 MG TABLET ORL TAB APX TAB 9.2006
00002248201 APO-SILDENAFIL 25 MG TABLET ORL TAB APX TAB 8.2894
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 19 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002248202 APO-SILDENAFIL 50 MG TABLET ORL TAB APX TAB 8.8481
00002418118 APO-SILDENAFIL R 20 MG TABLET ORL TAB APX TAB 7.2940
00002125250 APO-SUCRALFATE 1 G TABLET ORL TAB APX TAB 0.3089
00002422107 APO-TADALAFIL 10 MG TABLET ORL TAB APX TAB 11.9250
00002422085 APO-TADALAFIL 2.5 MG TABLET ORL TAB APX TAB 3.6470
00002422115 APO-TADALAFIL 20 MG TABLET ORL TAB APX TAB 12.3575
00002422093 APO-TADALAFIL 5 MG TABLET ORL TAB APX TAB 3.6470
00002421933 APO-TADALAFIL PAH 20 MG TABLET ORL TB APX TAB 11.4725
00000812404 APO-TAMOX 10 MG TABLET ORL TAB APX TAB 0.1750
00000812390 APO-TAMOX 20 MG TABLET ORL TAB APX TAB 0.3500
00002413094 APO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APX CAP 113.5960
00002413116 APO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APX CAP 159.0360
00002413124 APO-TEMOZOLOMIDE 180 MG CAPSULE ORL CAP APX CAP 253.6726
00002413043 APO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APX CAP 22.7200
00002413132 APO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APX CAP 283.9840
00002413035 APO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APX CAP 5.8500
00000755850 APO-TIMOL 10 MG TABLET ORL TAB APX TAB 0.3239
00000755869 APO-TIMOL 20 MG TABLET ORL TAB APX TAB 0.6304
00000755842 APO-TIMOL 5 MG TABLET ORL TAB APX TAB 0.2077
00002290812 APO-TIMOP GEL 0.5% OPHTHALMIC SOLUTION OPH LAS APX ML 2.7300
00002369680 APO-TOLTERODINE 1 MG TABLET ORL TAB APX TAB 0.8838
00002369699 APO-TOLTERODINE 2 MG TABLET ORL TAB APX TAB 0.8838
00002426153 APO-TRAMADOL 50 MG TABLET ORL TAB APX TAB 0.6386
00002336790 APO-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APX TAB 0.6264
00002415739 APO-TRAVOPROST Z 0.004% OPHTHALMIC SOLUTION OPH SOL APX ML 4.0260
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 20 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002147653 APO-TRAZODONE 150 MG TABLET ORL TAB APX TAB 0.4613
00002437635 APO-TRIAMCINOLONE AQ 55 MCG METERED DOSE SPRAY NAS SPM APX DOSE 0.1700
00002458721 APO-TRYPTOPHAN 750 MG TABLET ORL TAB APX TAB 0.9889
00002371510 APO-VALSARTAN 40 MG TABLET ORL TAB APX TAB 0.5823
00002246894 APO-VERAP SR 180 MG SUSTAINED-RELEASE TABLET ORL SRT APX TAB 0.5204
00001946323 APO-ZIDOVUDINE 100 MG CAPSULE ORL CAP APX CAP 1.3977
00002381575 APO-ZOLMITRIPTAN RAPID 2.5 MG ORALLY DISP. TABLET ORL DISPTAB APX TAB 3.5383
00002434946 APO-ZOLPIDEM ODT 10 MG SUBLINGUAL DISINT TABLET SLG DISNTAB APX TAB 1.1884
00002436159 APO-ZOLPIDEM ODT 5 MG SUBLINGUAL DISINT. TABLET SLG DISNTAB APX TAB 1.1825
00002375885 APPRILON 40 MG MODIFIED RELEASE CAPSULE ORL MRC GAL CAP 2.6357
00000723754 APRESOLINE 20 MG/VIAL INJECTION INJ DEFAUL STM VIAL 11.6500
00002273322 APTIVUS 250 MG CAPSULE ORL CAP BOE CAP 8.2500
00002162075 AQUASOL E 50 UNIT/ML ORAL DROPS ORL DPS NOV ML 0.8488
00002059762 AREDIA 30 MG/VIAL INJECTION INJ DEFAUL NOV ML 16.6930
00002059789 AREDIA 90 MG/VIAL INJECTION INJ DEFAUL NOV ML 50.0790
00002269465 ARICEPT RDT 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB 5.0132
00002269457 ARICEPT RDT 5 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB 5.0132
00002224135 ARIMIDEX 1 MG TABLET ORL TAB AZC TAB 5.2900
00080008677 ARNICA 7% GEL TOP GEL BCI G 0.1314
00080015109 ARNICA GEL-CREAM RUB A535 TOPICAL GEL TOP GEL CHD G 0.0971
00002242705 AROMASIN 25 MG TABLET ORL TAB PFI TAB 5.4763
00002286653 ARTHRITIS PAIN 650 MG EXTENDED RELIEF TABLET ORL ERT VTH TAB 0.0792
00002371146 ARTHRITIS PAIN RELIEF 650 MG EXTENDED-RELEASE TAB ORL ERT VTH TAB 0.0498
00002229632 ARTIFICIAL TEARS EXTRA OPH SOLUTION OPH SOL PMS ML 0.3033
00002229570 ARTIFICIAL TEARS OPH SOLUTION OPH SOL PPH ML 0.2927
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 21 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002381559 ARZERRA 100 MG/5 ML VIAL INJECTION INJ DEFAUL NOV VIAL 336.0000
00002381567 ARZERRA 1000 MG/50 ML VIAL INJECTION INJ DEFAUL NOV VIAL 3360.0000
00000180041 ASA & CODEINE 8 MG TABLET ORL TAB SDR TAB 0.0396
00000530336 ASA 325 MG TABLET ORL TAB VTH TAB 0.0215
00000230324 ASA 325 MG TABLET ORL TAB TEV TAB 0.0621
00000036145 ASA 325 MG TABLET ORL TAB WAM TAB 0.0136
00002372177 ASA 81 MG ENTERIC-COATED TABLET ORL ECT VTH TAB 0.0530
00002433044 ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.0560
00002244993 ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.0361
00002427176 ASA EC 80 MG TABLET ORL TAB SNS TAB 0.0560
00002426811 ASA EC 81 MG ENTERIC-COATED TABLET ORL ECT SNS TAB 0.0530
00002046253 ASADOL 325 MG ENTERIC-COATED TABLET ORL ECT PPH TAB 0.0125
00002009013 ASAPHEN 80 MG TABLET ORL TAB PMS TAB 0.0560
00002243974 ASAPHEN 81 MG CHEWABLE TABLET ORL CTB PMS TAB 0.0749
00002238545 ASAPHEN E.C. 80 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.0560
00002242281 ASAPHEN E.C. 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.0749
00002280167 ASATAB 80 MG CHEWABLE TABLET ORL CTB ODN TAB 0.0580
00002352427 ASATAB EC 325 MG ENTERIC-COATED TABLET ORL ECT ODN TAB 0.0295
00000266086 ASCORBIC ACID 500 MG TABLET ORL TAB PMT TAB 0.0300
00002074710 ASPERCREME CREME RUB 10% TOPICAL CREAM TOP CRM SAH G 0.0581
00002150328 ASPIRIN 325 MG TABLET ORL TAB BAI TAB 0.0958
00002289970 ASPIRIN 81 MG QUICK CHEWS CHEWABLE TABLET ORL CTB BIC TAB 0.1194
00002316897 ASPIRIN STOMACH GUARD EXTRA STRENGTH 500 MG CAPLET ORL TAB BIC TAB 0.0988
00002239090 ATACAND 4 MG TABLET ORL TAB AZC TAB 0.7597
00000013668 ATASOL FORTE 500 MG TABLET ORL TAB CHD TAB 0.0543
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 22 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000293504 ATASOL-15 TABLET ORL TAB CHD TAB 0.0910
00000293512 ATASOL-30 TABLET ORL TAB CHD TAB 0.1338
00000293490 ATASOL-8 TABLET ORL TAB CHD TAB 0.0703
00002326701 ATENOLOL 25 MG TABLET ORL TAB PDL TAB 0.0676
00000828793 ATENOLOL-100 MG TABLET ORL TAB PDL TAB 0.2362
00000828807 ATENOLOL-50 MG TABLET ORL TAB PDL TAB 0.1437
00002396904 ATOMOXETINE 10 MG CAPSULE ORL CAP PDL CAP 1.4040
00002445883 ATOMOXETINE 10 MG CAPSULE ORL CAP SIV CAP 2.3140
00002445905 ATOMOXETINE 18 MG CAPSULE ORL CAP SIV CAP 2.6523
00002396912 ATOMOXETINE 18 MG CAPSULE ORL CAP PDL CAP 1.6093
00002445913 ATOMOXETINE 25 MG CAPSULE ORL CAP SIV CAP 2.9280
00002396920 ATOMOXETINE 25 MG CAPSULE ORL CAP PDL CAP 1.7767
00002445948 ATOMOXETINE 40 MG CAPSULE ORL CAP SIV CAP 3.3373
00002396939 ATOMOXETINE 40 MG CAPSULE ORL CAP PDL CAP 2.0250
00002396947 ATOMOXETINE 60 MG CAPSULE ORL CAP PDL CAP 2.2463
00002445956 ATOMOXETINE 60 MG CAPSULE ORL CAP SIV CAP 3.7023
00002387891 ATORVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.3138
00002346486 ATORVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.3138
00002387905 ATORVASTATIN 20 MG TABLET ORL TAB SIV TAB 0.3923
00002346494 ATORVASTATIN 20 MG TABLET ORL TAB PDL TAB 0.3922
00002387913 ATORVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.4217
00002346508 ATORVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.4216
00002346516 ATORVASTATIN 80 MG TABLET ORL TAB PDL TAB 0.4216
00002387921 ATORVASTATIN 80 MG TABLET ORL TAB SIV TAB 0.4217
00002421429 ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB SNS TAB 4.1308
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 23 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002299925 ATRIANCE 5 MG/ML INJECTION INJ DEFAUL NOV ML 10.1495
00002300699 ATRIPLA TABLET ORL TAB BMG TAB 42.3340
00002094681 ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL ALV ML 2.3000
00002432188 ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL TGT ML 2.3000
00002094703 ATROPINE 0.6 MG/ML INJECTION INJ DEFAUL ALV ML 2.5000
00002432196 ATROPINE 0.6 MG/ML INJECTION BP INJ DEFAUL TGT ML 2.5000
00002148358 ATROPINE SULFATE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.6667
00002163713 ATROVENT 0.06% NASAL SPRAY NAS SPR BOE ML 2.0453
00002332477 AURALGAN OTIC SOLUTION OT SOL PAL ML 0.5236
00002454513 AURO-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB AUR TAB 17.9625
00002449161 AURO-BETAHISTINE 24 MG TABLET ORL TAB AUR TAB 0.4983
00002445808 AURO-CANDESARTAN 16 MG TABLET ORL TAB AUR TAB 0.2850
00002445816 AURO-CANDESARTAN 32 MG TABLET ORL TAB AUR TAB 0.2850
00002445786 AURO-CANDESARTAN 4 MG TABLET ORL TAB AUR TAB 0.1808
00002445794 AURO-CANDESARTAN 8 MG TABLET ORL TAB AUR TAB 0.2850
00002347261 AURO-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS AUR ML 0.0593
00002347245 AURO-CEFPROZIL 250 MG TABLET ORL TAB AUR TAB 0.4332
00002347288 AURO-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS AUR ML 0.1185
00002347253 AURO-CEFPROZIL 500 MG TABLET ORL TAB AUR TAB 0.8494
00002381931 AURO-CIPROFLOXACIN 750 MG TABLET ORL TAB AUR TAB 1.2780
00002418428 AURO-EFAVIRENZ 600 MG TABLET ORL TAB AUR TAB 11.2103
00002428148 AURO-FINASTERIDE 1 MG TABLET ORL TAB AUR TAB 1.1455
00002459965 AURO-FLECAINIDE 100 MG TABLET ORL TAB AUR TAB 0.5558
00002459957 AURO-FLECAINIDE 50 MG TABLET ORL TAB AUR TAB 0.2778
00002385627 AURO-FLUOXETINE 10 MG CAPSULE ORL CAP AUR CAP 0.4595
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 24 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002447878 AURO-IRBESARTAN HCT 150/12.5 MG TABLET ORL TAB AUR TAB 0.3024
00002447886 AURO-IRBESARTAN HCT 300/12.5 MG TABLET ORL TAB AUR TAB 0.3024
00002447894 AURO-IRBESARTAN HCT 300/25 MG TABLET ORL TAB AUR TAB 0.3052
00002414414 AURO-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB AUR TAB 7.8308
00002430592 AURO-LEVOFLOXACIN 250 MG TABLET ORL TAB AUR TAB 1.2038
00002430606 AURO-LEVOFLOXACIN 500 MG TABLET ORL TAB AUR TAB 1.3718
00002430614 AURO-LEVOFLOXACIN 750 MG TABLET ORL TAB AUR TAB 4.8478
00002390892 AURO-MELOXICAM 15 MG TABLET ORL TAB AUR TAB 0.4623
00002390884 AURO-MELOXICAM 7.5 MG TABLET ORL TAB AUR TAB 0.4007
00002411695 AURO-MIRTAZAPINE 15 MG TABLET ORL TAB AUR TAB 0.3750
00002299801 AURO-MIRTAZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.2730
00002299828 AURO-MIRTAZAPINE OD 30 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.5460
00002299836 AURO-MIRTAZAPINE OD 45 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 0.8190
00002430487 AURO-MODAFINIL 100 MG TABLET ORL TAB AUR TAB 0.9293
00002318601 AURO-NEVIRAPINE 200 MG TABLET ORL TAB AUR TAB 2.4690
00002448742 AURO-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 1.9280
00002448750 AURO-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB 7.5977
00002422212 AURO-OMEPRAZOLE 10 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT AUR CAP 0.8166
00002384906 AURO-PIOGLITAZONE 15 MG TABLET ORL TAB AUR TAB 0.5809
00002384914 AURO-PIOGLITAZONE 30 MG TABLET ORL TAB AUR TAB 0.8139
00002384922 AURO-PIOGLITAZONE 45 MG TABLET ORL TAB AUR TAB 1.2237
00002424088 AURO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB AUR TAB 1.3860
00002433907 AURO-PREGABALIN 150 MG CAPSULE ORL CAP AUR CAP 1.7270
00002433869 AURO-PREGABALIN 25 MG CAPSULE ORL CAP AUR CAP 0.6172
00002433877 AURO-PREGABALIN 50 MG CAPSULE ORL CAP AUR CAP 0.9682
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 25 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002433885 AURO-PREGABALIN 75 MG CAPSULE ORL CAP AUR CAP 1.2528
00002405156 AURO-SIMVASTATIN 10 MG TABLET ORL TAB AUR TAB 0.3642
00002405164 AURO-SIMVASTATIN 20 MG TABLET ORL TAB AUR TAB 0.4501
00002405172 AURO-SIMVASTATIN 40 MG TABLET ORL TAB AUR TAB 0.4501
00002405148 AURO-SIMVASTATIN 5 MG TABLET ORL TAB AUR TAB 0.2556
00002405180 AURO-SIMVASTATIN 80 MG TABLET ORL TAB AUR TAB 0.4501
00002435934 AURO-TADALAFIL 10 MG TABLET ORL TAB AUR TAB 11.9250
00002435896 AURO-TADALAFIL 2.5 MG TABLET ORL TAB AUR TAB 3.6470
00002435942 AURO-TADALAFIL 20 MG TABLET ORL TAB AUR TAB 12.3575
00002435926 AURO-TADALAFIL 5 MG TABLET ORL TAB AUR TAB 3.6470
00002439050 AURO-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB AUR TAB 0.6264
00002414201 AURO-VALSARTAN 40 MG TABLET ORL TAB AUR TAB 0.5240
00002298589 AVAMYS 27.5 MCG/DOSE NASAL SPRAY NAS SPM GSK DOSE 0.2157
00002270994 AVASTIN 25 MG/ML INJECTION INJ DEFAUL HLR ML 128.6475
00002370999 AVA-TOPIRAMATE 200 MG TABLET ORL TAB AVA TAB 1.9845
00002237792 AVAXIM 160 U/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR 42.4500
00002243741 AVAXIM-PEDIATRIC 80 UNIT/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR 21.2300
00002317508 AVEENO CREAM TOP CRM JJI G 0.0223
00002241416 AVEENO MOISTURIZING BATH TOP PWR JJI G 0.0461
00002382369 AXIRON 2% TOPICAL SOLUTION TOP SOL LIL ML 1.5259
00002284642 AZILECT 0.5 MG TABLET ORL TAB TMP TAB 7.4793
00002284650 AZILECT 1 MG TABLET ORL TAB TMP TAB 7.4793
00002330911 AZITHROMYCIN 600 MG TABLET ORL TAB SNS TAB 6.0000
00000598577 B COMPLEX 50 TABLET ORL TAB JAM TAB 0.0810
00000598569 B COMPLEX 75 TABLET ORL TAB JAM TAB 0.1616
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 26 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000123803 B COMPLEX PLUS C TABLET ORL TAB JAM TAB 0.0810
00002239693 B COMPLEX VITAMINS WITH VITAMIN C TABLET ORL TAB PMT TAB 0.0663
00080007498 B&C VITAMINS TABLET ORL TAB WBP TAB 0.0631
00080002409 B12 1000 MCG TABLET ORL TAB WNP TAB 0.0850
00002245512 B50 COMPLEX CAPSULE ORL CAP WNP CAP 0.0895
00002241403 B50 COMPLEX WITH LIPOTROPIC FACTORS TABLET ORL TAB PMT TAB 0.0781
00001927906 BACID 1 B CAPSULE ORL CAP ERF CAP 0.6598
00000876488 BACIMYXIN TOPICAL OINTMENT TOP ONT PMS G 0.2433
00000584908 BACITIN 500 UNIT/G TOPICAL OINTMENT TOP ONT PPH G 0.1993
00000030708 BACITRACIN 50,000 U/VIAL INJECTION INJ DEFAUL PFI VIAL 11.9500
00002433532 BACKUP PLAN ONESTEP 1.5 MG TABLET ORL TAB APX TAB 14.8200
00002152584 BACLOFEN 10 MG TABLET ORL TAB PDL TAB 0.1595
00002152592 BACLOFEN 20 MG TABLET ORL TAB PDL TAB 0.3104
00000037818 BACTERIOSTATIC SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL HSP ML 0.2160
00002243425 BALANCED B COMPLEX 100 MG SUSTAINED-RELEASE TABLET ORL SRT PMT TAB 0.0850
00002244010 BALMINIL CODEINE NIGHT TIME + EXPECTORANT ORL SYR ROG ML 0.0295
00000436895 BALMINIL DM 3 MG/ML ORAL SYRUP ORL SYR ROG ML 0.0332
00001908855 BALNETAR 2.5% TOPICAL SOLUTION TOP SOL WSD ML 0.0496
00002060841 BARRIERE 20% TOPICAL CREAM TOP CRM WSP G 0.0660
00002444844 BASAGLAR 100 UNIT/ML INJECTION CARTRIDGE INJ DEFAUL LIL ML 5.2613
00002444852 BASAGLAR 100 UNIT/ML INJECTION KWIKPEN INJ DEFAUL LIL ML 5.2613
00002135620 BASALJEL 500 MG CAPSULE ORL CAP AUP CAP 0.1500
00000658413 BAXEDIN 20% SOLUTION TOP SOL OMG ML 0.0520
00002243966 BAZA CLEANSE & PROTECT 2% TOPICAL LOTION TOP LOT COC ML 0.0485
00000075124 BCG VACCINE (FREEZE-DRIED) 1 MG INJECTION INJ DEFAUL SFP VIAL 193.3000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 27 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000498815 B-COMPLEX 100 SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.2158
00002237567 BEANO 150 UNIT TABLET ORL TAB GSK TAB 0.1800
00080043158 BEDUZIL 1500 1500 MCG TABLET ORL ERT ORI TAB 0.1158
00002019736 BENADRYL 12.5 MG/5 ML ORAL ELIXIR ORL ELX MCL ML 0.0540
00002019701 BENADRYL 2% TOPICAL CREAM TOP CRM MCL G 0.2703
00002017849 BENADRYL 25 MG CAPLET ORL TAB MCL TAB 0.4000
00002019671 BENADRYL 50 MG CAPSULE ORL CAP MCL CAP 0.2514
00002061287 BENADRYL ALLERGY JUNIOR STRENGTH CHEWABLE TABLET ORL CTB MCL TAB 0.4483
00002229367 BENADRYL ALLERGY SINUS HEADACHE CAPLET ORL TAB MCL TAB 0.3175
00002019698 BENADRYL CHILDREN'S 1.25 MG/ML ORAL LIQUID ORL LIQ MCL ML 0.0605
00002239138 BENADRYL EXTRA STRENGTH 50 MG CAPLET ORL TAB MCL TAB 0.4096
00002280876 BENADRYL SPRAY TOP SPR MCL ML 0.0781
00000999476 BENEFIBRE ORAL POWDER ORL PWR NVC G 0.0391
00009991056 BENEPROTEIN ORAL POWDER ORL PWR NHN G 0.0744
00002370050 BENLYSTA 120 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 293.5700
00002370069 BENLYSTA 400 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 978.5600
00002245709 BENYLIN 2 COLD AND FLU WITH CODEINE ORAL SYRUP ORL SYR MCL ML 0.0570
00002003317 BENYLIN COUGH AND CHEST CONGESTION WARMING SYRUP ORL SYR MCL ML 0.0372
00001944738 BENYLIN DM 3 MG/ML ORAL SYRUP ORL SYR MCL ML 0.0502
00002215268 BENYLIN DM FOR CHILDREN 1.5 MG/ML ORAL SYRUP ORL SYR MCL ML 0.0502
00002245383 BENYLIN DM FREEZER POPS 7.5 MG/ PACKET ORAL LIQUID ORL LIQ MCL PCKT 0.5925
00001944746 BENYLIN DM-D FOR CHILDREN ORAL SYRUP ORL SYR MCL ML 0.0502
00001944711 BENYLIN DM-D ORAL SYRUP ORL SYR MCL ML 0.0474
00001944673 BENYLIN DM-D-E ORAL SYRUP ORL SYR MCL ML 0.0502
00001944762 BENYLIN DM-E ORAL SYRUP ORL SYR MCL ML 0.0502
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 28 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002265427 BENYLIN E EXTRA STR W/ MENTHACTIN 40/3MG/ML SYR ORL SYR MCL ML 0.0372
00001912437 BENZAC AC 10% TOPICAL COPOLYMER GEL TOP COPGEL GAL G 0.3333
00001925199 BENZAC W10 10% TOPICAL WASH TOP WAS GAL G 0.3652
00002162121 BENZAGEL 5 5% WASH TOP WAS NVC ML 0.0584
00002225271 BENZAMYCIN TOPICAL GEL TOP GEL VCL G 1.1483
00002336847 BESIVANCE 0.6% OPHTHALMIC SOLUTION OPH SOL BSH ML 2.6780
00000716634 BETADERM 0.1% SCALP LOTION SCP LOT TAR ML 0.0852
00000158348 BETADINE 10% TOPICAL SOLUTION TOP SOL PUR ML 0.0293
00002237835 BETAJECT INJECTION INJ DEFAUL SDZ ML 10.4830
00002449773 BETEFLAM 2.25 MG TOPICAL PATCH TOP PTH CIP PTH 3.1581
00002417030 BEXSERO 0.5 ML INJECTION SYRINGE INJ NDL NOV SYR 102.1100
00002359685 BIACNA 1.2%/0.025% TOPICAL GEL TOP GEL VCL G 1.0582
00002325985 BICALUTAMIDE 50 MG TABLET ORL TAB AHI TAB 4.0572
00002382423 BICALUTAMIDE 50 MG TABLET ORL TAB SIV TAB 4.0573
00002291924 BICILLIN L-A 1,200,000 IU/2 ML INJ SYR INJ NDL PFI SYR 45.3980
00000297763 BICNU 100 MG/VIAL INJECTION INJ DEFAUL BMS VIAL 120.0400
00002230897 BILTRICIDE 600 MG TABLET ORL TAB BAI TAB 6.2900
00080026265 BIO K 20 POTASSIUM 20 MEQ TABLET ORL TAB BMD TAB 0.1995
00002392143 BIO-AMLODIPINE 10 MG TABLET ORL TAB BMD TAB 0.3587
00002392127 BIO-AMLODIPINE 2.5 MG TABLET ORL TAB BMD TAB 0.1380
00002392135 BIO-AMLODIPINE 5 MG TABLET ORL TAB BMD TAB 0.2417
00002392186 BIO-ATENOLOL 100 MG TABLET ORL TAB BMD TAB 0.2362
00002392194 BIO-ATENOLOL 25 MG TABLET ORL TAB BMD TAB 0.0676
00002392178 BIO-ATENOLOL 50 MG TABLET ORL TAB BMD TAB 0.1437
00002448475 BIO-CITALOPRAM 10 MG TABLET ORL TAB BMD TAB 0.1432
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 29 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002448491 BIO-CITALOPRAM 20 MG TABLET ORL TAB BMD TAB 0.2397
00002448513 BIO-CITALOPRAM 40 MG TABLET ORL TAB BMD TAB 0.2397
00000621366 BIODERM TOPICAL OINTMENT TOP ONT ODN G 0.3600
00002425211 BIO-EZETIMIBE 10 MG TABLET ORL TAB BMD TAB 0.4549
00002448424 BIO-FLUOXETINE 10 MG CAPSULE ORL CAP BMD CAP 0.4595
00002247371 BIO-FUROSEMIDE 20 MG TABLET ORL TAB BMD TAB 0.0373
00002247372 BIO-FUROSEMIDE 40 MG TABLET ORL TAB BMD TAB 0.0558
00080012473 BIOGAIA DROPS ORL DPS FEI ML 4.2800
00080062995 BIOGAIA ORAL DROPS ORL SUS FEI ML 4.6800
00002247170 BIO-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PMS TAB 0.0157
00002247171 BIO-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB PMS TAB 0.0217
00002446154 BIO-IRBESARTAN 150 MG TABLET ORL TAB BMD TAB 0.3025
00002446162 BIO-IRBESARTAN 300 MG TABLET ORL TAB BMD TAB 0.3025
00002446146 BIO-IRBESARTAN 75 MG TABLET ORL TAB BMD TAB 0.3025
00080015104 BIO-K EXTRA STRENGTH PROBIOTIC CAPSULE ORL CAP BKP CAP 1.5627
00000989995 BIO-K PLUS RICE PROBIOTIC DRINK ORL LIQ BKP G 0.0536
00080006533 BIOMEDIC MULTIVITAMIN ORL CAP VTH CAP 0.0607
00002216051 BION TEARS OPH SOLUTION OPH SOL ALC ML 0.9604
00080003128 BIONUTRITION FORMULA 3 CAPSULE ORL CAP BNI CAP 1.1666
00002449927 BIO-OMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT BMD TAB 0.4117
00002445867 BIO-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT BMD TAB 0.3628
00002445069 BIO-SERTRALINE 100 MG CAPSULE ORL CAP BMD CAP 0.4200
00002445042 BIO-SERTRALINE 25 MG CAPSULE ORL CAP BMD CAP 0.2004
00002445050 BIO-SERTRALINE 50 MG CAPSULE ORL CAP BMD CAP 0.4000
00080023605 BIOSIL CAPSULE ORL CAP PRN CAP 0.4000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 30 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000999776 BIOTENE ORAL BALANCE GEL ORL GEL GSK G 0.1715
00000999782 BIOTENE ORAL RINSE ORL MWH GSK ML 0.0153
00000999777 BIOTENE SPRAY ORL SPR GSK ML 0.1637
00000437522 BIOTIN 250 MCG TABLET ORL TAB JAM TAB 0.0567
00002326302 BI-PEGLYTE KIT ORL ECT/PWR PPH KIT 19.9900
00002361450 BISACODYL 10 MG RECTAL SUPPOSITORY RT SUP JPC SUP 0.8333
00002273411 BISACODYL-ODAN 5 MGENTERIC-COATED TABLET ORL ECT ODN TAB 0.0550
00002131692 BLEOMYCIN SULFATE 15 UNIT/VIAL INJECTION INJ DEFAUL MNP VIAL 421.3800
00002454130 BLEXTEN 20 MG TABLET ORL TAB TRI TAB 0.7537
00000999809 BLINK CONTACTS LUBRICATING EYE DROP OPH DPS AMO ML 0.3890
00080063321 BLOOD PRESSURE FORMUALTION COMBO 60 MG CAPSULE ORL CAP BLP CAP 0.3365
00080053068 BLOOD PRESSURE FORMULATION COMBO CAPSULE ORL CAP BEL CAP 0.3483
00080038108 BONESURE CAPSULE ORL CAP BPC CAP 0.2994
00002247600 BOOSTRIX INJECTION SYRINGE INJ DEFAUL GSK SYR 28.9300
00002423405 BORTEZOMIB FOR INJECTION 3.5 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 1402.4200
00002253992 BOSTON SIMPLUS MULTI-ACTION SOLUTION DEFAUL SOL BSH ML 0.0951
00002419149 BOSULIF 100 MG TABLET ORL TAB PFI TAB 38.0654
00002419157 BOSULIF 500 MG TABLET ORL TAB PFI TAB 152.2404
00002243721 BOTOX (ONABOTULINUMTOXINA) COSMETIC 100 U/VIAL INJ INJ DEFAUL ALL VIAL 357.0000
00002268140 BRAVELLE 75 UNIT/VIAL POWDER FOR INJECTION INJ DEFAUL FEI VIAL 74.0000
00002455331 BRENZYS 50 MG/ML AUTO INJECTOR SYRINGE INJ NDL SSB SYR 305.0000
00002455323 BRENZYS 50 MG/ML INJECTION SYRINGE INJ NDL SSB SYR 305.0000
00002187086 BREVICON 0.5/35 (21 DAY) TABLET ORL TAB PFI TAB 0.6400
00002187094 BREVICON 0.5/35 (28 DAY) TABLET ORL TB PFI TAB 0.4800
00002189054 BREVICON 1/35 (21 DAY) TABLET ORL TAB PFI TAB 0.6400
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 31 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002189062 BREVICON 1/35 (28 DAY) TABLET ORL TB PFI TAB 0.4800
00002455005 BRILINTA 60 MG TABLET ORL TAB AZC TAB 1.4800
00002301334 BRIMONIDINE P 0.15% OPHTHALMIC SOLUTION OPH SOL AAP ML 1.7330
00002452936 BRIVLERA 10 MG TABLET ORL TAB UCB TAB 4.3200
00002452979 BRIVLERA 100 MG TABLET ORL TAB UCB TAB 4.3200
00002452944 BRIVLERA 25 MG TABLET ORL TAB UCB TAB 4.3200
00002452952 BRIVLERA 50 MG TABLET ORL TAB UCB TAB 4.3200
00002452960 BRIVLERA 75 MG TABLET ORL TAB UCB TAB 4.3200
00002220520 BROMAZEPAM 3 MG TABLET ORL TAB PDL TAB 0.0815
00002220539 BROMAZEPAM 6 MG TABLET ORL TAB PDL TAB 0.1191
00000522791 BRONCHOPHAN FORTE DM ORAL SYRUP ORL SYR ATL ML 0.0279
00000512990 BSS BALANCED SALT OPH SOLUTION OPH SOL ALC ML 0.4387
00000729655 BUCKLEY'S DM ORAL LIQUID ORL LIQ BUA ML 0.0489
00080022907 BUGS BUNNY AND FRIENDS COMPLETE MULTI VIT CHEW TAB ORL CTB BIC TAB 0.0869
00002331616 BUPROPION SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.2667
00000728284 BURINEX 1 MG TABLET ORL TAB LEO TAB 0.7906
00000728276 BURINEX 5 MG TABLET ORL TAB LEO TAB 3.0183
00002223163 BUSPIRONE 10 MG TABLET ORL TAB PDL TAB 0.3517
00002242504 BUTORPHANOL 10 MG/ML NASAL SPRAY NAS SPR AAP ML 22.6120
00002341212 BUTRANS 10 (10 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 23.4000
00002450771 BUTRANS 15 (15 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 32.9600
00002341220 BUTRANS 20 (20 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 42.5300
00002341174 BUTRANS 5 (5 MCG/HR) TRANSDERMAL PATCH TRD PTH PUR PTH 12.7400
00002448610 BYDUREON 2 MG/DOSE INJECTION PEN INJ DEFAUL AZC SYR 48.4675
00002361817 BYETTA 10 MCG/DOSE (2.4 ML) INJECTION SYRINGE INJ NDL AZC SYR 143.6700
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 32 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002361809 BYETTA 5 MCG/DOSE (1.2 ML) INJECTION SYRINGE INJ NDL AZC SYR 143.6700
00002399016 BYSTOLIC 10 MG TABLET ORL TAB FLC TAB 1.2983
00002398990 BYSTOLIC 2.5 MG TABLET ORL TAB FLC TAB 1.2983
00002399024 BYSTOLIC 20 MG TABLET ORL TAB FLC TAB 1.2983
00002399008 BYSTOLIC 5 MG TABLET ORL TAB FLC TAB 1.2983
00002273284 CADUET 10 MG/10 MG TABLET ORL TAB PFI TAB 2.5236
00002273292 CADUET 10 MG/20 MG TABLET ORL TAB PFI TAB 3.1461
00002273306 CADUET 10 MG/40 MG TABLET ORL TAB PFI TAB 3.2960
00002273314 CADUET 10 MG/80 MG TABLET ORL TAB PFI TAB 3.2960
00002273233 CADUET 5 MG/10 MG TABLET ORL TAB PFI TAB 2.3902
00002273241 CADUET 5 MG/20 MG TABLET ORL TAB PFI TAB 2.8187
00002273268 CADUET 5 MG/40 MG TABLET ORL TAB PFI TAB 2.9793
00002273276 CADUET 5 MG/80 MG TABLET ORL TAB PFI TAB 2.9793
00002238389 CAELYX 2 MG/ML PEGYLATED LIPOSOME INJECTION INJ DEFAUL JAI ML 73.4030
00002241460 CAL MAG 2:1 WITH D TABLET ORL TAB WNP TAB 0.0536
00080000159 CALCIA 500 MG/400 IU TABLET ORL TAB MDX TAB 0.1498
00000891738 CALCIJEX 1 MCG/ML INJECTION INJ DEFAUL ABV ML 10.5700
00000730602 CALCIUM & MAGNESIUM WITH VITAMIN D CAPSULE ORL CAP SIS CAP 0.2442
00002240973 CALCIUM (CARBONATE) W/ VITAMIN D 500 MG/125 U TAB ORL TAB WNP TAB 0.0750
00080003658 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.0243
00002240240 CALCIUM 500 MG TABLET ORL TAB PMT TAB 0.0850
00002240977 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.0449
00002230645 CALCIUM 500 MG WITH VITAMIN D TABLET ORL TAB WAM TAB 0.0792
00080000248 CALCIUM 650 MG TABLET ORL TAB JAM TAB 0.0609
00080009369 CALCIUM 650 MG TABLET ORL TAB PMT TAB 0.0342
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 33 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080007105 CALCIUM 650 MG WITH VITAMIN D 400 IU CAPLET ORL TAB JMS TAB 0.0609
00002040875 CALCIUM AND MAGNESIUM CAPLET ORL TAB JAM TAB 0.0345
00002245170 CALCIUM AND MAGNESIUM CITRATE WITH VITAMIN D TAB ORL TAB WNP TAB 0.0467
00080006568 CALCIUM AND MAGNESIUM TABLET ORL TAB GFR TAB 0.1140
00002244861 CALCIUM AND MAGNESIUM WITH VITAMIN D TAB ORL TAB PMT TAB 0.0345
00002240367 CALCIUM AND MAGNESIUM WITH VITAMIN D TABLET ORL TAB WAM TAB 0.0792
00002048965 CALCIUM AND MAGNESIUM WITH ZINC CAPLET ORL TAB JAM TAB 0.0335
00002243418 CALCIUM BONE SOLUTION ORL LIQ ULT ML 0.0343
00000730599 CALCIUM CARBONATE & VITAMIN D3 500 MG/125 U TABLET ORL TAB PMT TAB 0.0345
00000644684 CALCIUM CARBONATE 500 MG (BASE) TABLET ORL TAB WBP TAB 0.0245
00001922238 CALCIUM CARBONATE 500 MG CHEWABLE TABLET ORL CTB WAM TAB 0.0988
00080003855 CALCIUM CITRATE 300 MG TABLET ORL TAB WNP TAB 0.0642
00002243766 CALCIUM CITRATE 300 MG TABLET ORL TAB PMT TAB 0.0791
00002158728 CALCIUM CITRATE 350 MG TABLET ORL TAB SWS TAB 0.0945
00080003662 CALCIUM CITRATE W/ VITAMIN D 300 MG/200 IU TABLET ORL TAB WNP TAB 0.0669
00002243669 CALCIUM CITRATE WITH VITAMIN D TABLET ORL TAB WNP TAB 0.0833
00002237590 CALCIUM CITRATE WITH VITAMIN D TABLET ORL TAB JAM TAB 0.0677
00002141019 CALCIUM GLUCONATE 94 MG/ML INJECTION INJ DEFAUL FKC ML 1.3474
00080025345 CALCIUM MAGNESIUM WITH VITAMIN D ORL TAB WNP TAB 0.0550
00080007103 CALCIUM MAGNESIUM WITH VITAMIN D CAPLET ORL TAB JMS TAB 0.0345
00002040905 CALCIUM MAGNESIUM WITH VITAMIN D TABLET ORL TAB JAM TAB 0.0685
00080007265 CALCIUM SOFT CHEWS WITH VITAMIN D ORL CAP JAM CAP 0.1787
00001906828 CAL-MAG WITH ZINC & VITAMIN D CAPLET ORL TAB SWS TAB 0.0902
00080027151 CALMOSEPTINE OINTMENT TOP ONT CAL G 0.0619
00002198630 CALMYLIN ACE 2 MG/ML SYRUP ORL SYR RPH ML 0.0960
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 34 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000535230 CALMYLIN WITH CODEINE COUGH ORAL LIQUID ORL LIQ RPH ML 0.0515
00002172917 CALMYLIN WITH CODEINE ORAL SYRUP ORL SYR ROG ML 0.0549
00080003751 CALTRATE 600 TABLET ORL TAB PDH TAB 0.1738
00080009423 CALTRATE PLUS CHEWABLES 400 IU ORL TAB PDH TAB 0.2221
00080009761 CALTRATE PLUS TABLET ORL TAB PDH TAB 0.1922
00080023065 CALTRATE SELECT 600 MG/400 IU TABLET ORL TAB PDH TAB 0.2198
00080033741 CALTRATE WITH VITAMIN D 600 MG/800 IU TABLET ORL TAB PDH TAB 0.1738
00002381680 CAMBIA 50 MG ORAL POWDER PACKET ORL PWDPKT TRI PCKT 10.0389
00002293269 CAMPRAL 333 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 0.8000
00002231622 CAMPTOSAR 20 MG/ML INJECTION INJ DEFAUL PFI ML 111.1980
00002377942 CANDESARTAN 16 MG TABLET ORL TAB PDL TAB 0.2850
00002422069 CANDESARTAN 32 MG TABLET ORL TAB PDL TAB 0.2850
00002388693 CANDESARTAN 4 MG TABLET ORL TAB SIV TAB 0.3400
00002388901 CANDESARTAN 4 MG TABLET ORL TAB SNS TAB 0.3400
00002377934 CANDESARTAN 8 MG TABLET ORL TAB PDL TAB 0.2850
00002379260 CANDESARTAN CILEXETIL 4 MG TABLET ORL TAB AHI TAB 0.3400
00002392275 CANDESARTAN-HCTZ 16 MG/12.5 MG TABLET ORL TAB PDL TAB 0.2993
00080038188 CANDIBACTIN BR TABLET ORL TAB MTG TAB 0.3033
00080050373 CANDIBACTIN-AR CAPSULE ORL CAP MTG CAP 0.4550
00002311690 CANESORAL 150 MG CAPSULE ORL CAP BIC CAP 15.4200
00002311739 CANESORAL COMBI-PAK KIT ORL/VAG CAP/CRM BIC KIT 17.6300
00002311720 CANESTEN 1% EXTERNAL CREAM TOP CRM BIC G 13.3100
00002150867 CANESTEN 1% TOPICAL CREAM TOP CRM BAI G 0.3960
00080028872 CANTHACUR 0.7% TOPICAL SOLUTION TOP SOL PMS ML 7.1320
00000589500 CANTHACUR-PS TOPICAL SOLUTION TOP SOL PMS ML 8.9880
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 35 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080023975 CANTHARONE 0.7% TOPICAL SOLUTION TOP SOL DLX ML 6.6600
00000772011 CANTHARONE PLUS TOPICAL SOLUTION TOP SOL DLX ML 7.9933
00002157101 CAPSAICIN 0.025% TOPICAL CREAM TOP CRM VCL G 0.1917
00002157128 CAPSAICIN 0.075% TOPICAL CREAM TOP CRM VCL G 0.2325
00002060043 CARBACHOL 2 MG TABLET ORL TAB BNQ TAB 0.5900
00002413590 CARBAMAZEPINE CR 200 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.0930
00002413604 CARBAMAZEPINE CR 400 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.1859
00002241999 CARBOCAINE 10 MG/ML INJECTION INJ DEFAUL HSP ML 0.6313
00002242001 CARBOCAINE 20 MG/ML INJECTION INJ DEFAUL HSP ML 1.3890
00002245511 CARBOCAL D 400 TABLET ORL TAB SDZ TAB 0.1200
00002011239 CARBOLITH 600 MG CAPSULE ORL CAP VCL CAP 0.1848
00002126680 CARBOPLATIN 10 MG/ML INJECTION INJ DEFAUL HSP ML 21.2240
00001958100 CARDURA-1 1 MG TABLET ORL TAB PFI TAB 0.6659
00001958097 CARDURA-2 2 MG TABLET ORL TAB PFI TAB 0.7989
00001958119 CARDURA-4 4 MG TABLET ORL TAB PFI TAB 1.0388
00002397447 CARIPUL 0.5 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 17.1760
00002397455 CARIPUL 1.5 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 34.4470
00002324520 CARVEDILOL 12.5 MG TABLET ORL TAB PDL TAB 0.6350
00002324539 CARVEDILOL 25 MG TABLET ORL TAB PDL TAB 0.6350
00002324504 CARVEDILOL 3.125 MG TABLET ORL TAB PDL TAB 0.6350
00002324512 CARVEDILOL 6.25 MG TABLET ORL TAB PDL TAB 0.6350
00002184478 CASODEX 50 MG TABLET ORL TAB AZC TAB 7.0500
00000259527 CATAPRES 0.1 MG TABLET ORL TAB BOE TAB 0.1853
00002245859 CATHFLO 1 MG/ML POWDER FOR SOLUTION INJ DEFAUL HLR ML 33.2305
00002215756 CAVERJECT 20 MCG INJECTION INJ DEFAUL PFI VIAL 30.8920
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 36 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000465208 CECLOR 25 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.1183
00000465186 CECLOR 250 MG CAPSULE ORL CAP PPH CAP 1.1092
00000832804 CECLOR 375 MG/5ML ORAL SUSPENSION ORL SUS PHH ML 0.2872
00000465216 CECLOR 50 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.2166
00000465194 CECLOR 500 MG CAPSULE ORL CAP PPH CAP 2.1777
00000360430 CEENU 10 MG CAPSULE ORL CAP BMS CAP 7.5150
00000360414 CEENU 100 MG CAPSULE ORL CAP BMS CAP 21.3850
00000360422 CEENU 40 MG CAPSULE ORL CAP BMS CAP 12.9550
00002237138 CEFAZOLIN 1 G/VIAL USP INJECTION INJ DEFAUL FKC VIAL 6.9000
00002237137 CEFAZOLIN 500 MG/VIAL USP INJECTION INJ DEFAUL FKC VIAL 2.5000
00002437112 CEFAZOLIN FOR INJECTION 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 3.2300
00002437104 CEFAZOLIN FOR INJECTION 500 MG/VIAL INJECTION INJ DEFAUL STM VIAL 2.5000
00002319039 CEFEPIME 2G/VIAL INJECTION INJ DEFAUL APX VIAL 30.1960
00002240773 CEFOXITIN 10 G/VIAL USP INJECTION INJ DEFAUL TEV VIAL 105.9500
00002332027 CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS RAN ML 0.2366
00000886971 CEFTAZIDIME 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 31.9700
00002437848 CEFTAZIDIME 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 22.9270
00000886955 CEFTAZIDIME 2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 60.8100
00002437856 CEFTAZIDIME 2 G/VIAL INJECTION INJ DEFAUL STM VIAL 45.0770
00002439522 CEFTAZIDIME 3 G/VIAL INJECTION INJ DEFAUL STM VIAL 67.5000
00002437864 CEFTAZIDIME 6 G/VIAL INJECTION INJ DEFAUL STM VIAL 135.3000
00000886963 CEFTAZIDIME 6 G/VIAL INJECTION INJ DEFAUL FKC VIAL 190.9900
00002212307 CEFTIN 125 MG/5ML ORAL SUSPENSION ORL SUS GSK ML 0.1750
00002409968 CEFTRIAXONE 100 G/SMARTPAK BULK PACKAGE INJECTION INJ DEFAUL FKC G 21.4200
00002292262 CEFTRIAXONE FOR INJECTION BP 0.25G/VIAL INJECTION INJ DEFAUL SDZ VIAL 7.5250
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 37 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002287668 CEFTRIAXONE SODIUM FOR INJECTION 10 G/VIAL INJ INJ DEFAUL TEV VIAL 214.2000
00002250292 CEFTRIAXONE SODIUM FOR INJECTION BP 1 G/VIAL INJ INJ DEFAUL HSP VIAL 36.3100
00002241639 CEFUROXIME 1.5 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 39.7900
00002422301 CEFUROXIME 1.5 G/VIAL INJECTION USP INJ DEFAUL STM VIAL 39.7900
00002422328 CEFUROXIME 7.5 G/VIAL INJECTION USP INJ DEFAUL STM VIAL 149.2000
00002241640 CEFUROXIME 7.5 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 149.2000
00002422298 CEFUROXIME 750 MG/VIAL INJECTION USP INJ DEFAUL STM VIAL 19.8900
00002241638 CEFUROXIME 750 MG/VIAL INJECTION USP INJ DEFAUL FKC VIAL 19.8900
00002424371 CELECOXIB 100 MG CAPSULE ORL CAP PDL CAP 0.1776
00002424398 CELECOXIB 200 MG CAPSULE ORL CAP PDL CAP 0.3553
00002357844 CELESTODERM-V 0.1% TOPICAL CREAM TOP CRM VCL G 0.0911
00002357852 CELESTODERM-V 0.1% TOPICAL OINTMENT TOP ONT VCL G 0.0911
00002357860 CELESTODERM-V/2 0.05% TOPICAL CREAM TOP CRM VCL G 0.0611
00002357879 CELESTODERM-V/2 0.05% TOPICAL OINTMENT TOP ONT VCL G 0.0611
00002242145 CELLCEPT 200 MG/ ML ORAL SUSPENSION ORL SUS HLR ML 1.8536
00002192748 CELLCEPT 250 MG CAPSULE ORL CAP HLR CAP 2.0806
00002237484 CELLCEPT 500 MG TABLET ORL TAB HLR TAB 4.1612
00002240347 CELLCEPT I.V. 500 MG/VIAL INJECTION POWDER FOR SOL INJ DEFAUL HLR VIAL 32.0000
00000870153 CELLUVISC 1% OPH SOLUTION OPH SOL ALL ML 0.8217
00002299844 CELSENTRI 150 MG TABLET ORL TAB PFI TAB 16.6485
00002299852 CELSENTRI 300 MG TABLET ORL TAB PFI TAB 17.2532
00080013657 CENTRUM ADVANTAGE TABLET ORL TAB PDH TAB 0.1863
00080022930 CENTRUM CARDIO TABLET ORL TAB PDH TAB 0.2226
00080024482 CENTRUM FOR WOMEN ORL TAB PDH TAB 0.1440
00080037227 CENTRUM FORTE TABLET ORL TAB PDH TAB 0.1296
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 38 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080005174 CENTRUM FORTE TABLET ORL TAB PDH TAB 0.1700
00080020794 CENTRUM JUNIOR COMPLETE CHEWABLE TABLET ORL CTB PDH TAB 0.1238
00080043120 CENTRUM MEN 50+ TABLET ORL TAB PDH TAB 0.1440
00080005153 CENTRUM SELECT TABLET ORL TAB WCH TAB 0.1563
00002246362 CENTRUM TABLET ORL TAB PDH TAB 0.0919
00080021452 CENTRUM TABLET ORL TAB PDH TAB 0.0919
00002099365 CEPACOL MINT WITH FLUORIDE MOUTHWASH ORL MWH RBC ML 0.0040
00000828866 CEPHALEXIN 500 MG TABLET ORL TAB PDL TAB 0.4500
00000999039 CERAVE CREAM TOP CRM VCL G 0.0925
00002410923 CERAVE TOPICAL LOTION TOP LOT VCL ML 0.1010
00002230988 CEREBYX 75 MG/ML INJECTION INJ DEFAUL PFI ML 10.1000
00002230694 CEREZYME 200 U/VIAL INJECTION INJ DEFAUL GZM VIAL 1230.0000
00002241751 CEREZYME 400 U/VIAL INJECTION INJ DEFAUL GZM VIAL 2460.0000
00001926683 CERUBIDINE 20 MG/VIAL INJECTION INJ DEFAUL ERF VIAL 93.5000
00000158356 CERUMENEX 10% OTIC DROPS OT DPS PUR ML 0.5740
00000221570 CERUMOL OTIC DROPS OT DPS PAL ML 0.4900
00002342227 CERVARIX 0.5 ML INJECTION INJ DEFAUL GSK ML 190.1400
00002312263 CESAMET 0.25 MG ORAL CAPSULE ORL CAP VCL CAP 1.7384
00002450526 CETIRIZINE 20 MG TABLET ORL TAB PDL TAB 0.7535
00002247766 CETROTIDE 0.25 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 90.0000
00002247767 CETROTIDE 3 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 340.0000
00000496685 CHELATED CHROMIUM 200 MCG TABLET ORL TAB JAM TAB 0.0721
00080009742 CHEWABLE PEPPERMINT VITAMIN D 1000 IU ORL TAB SWS TAB 0.0479
00002248435 CHILDREN'S ADVIL COLD ORAL SUSPENSION ORL SUS PDH ML 0.0590
00002354799 CHILDREN'S EUROPROFEN 20 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.0541
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 39 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002238626 CHILDREN'S MOTRIN 40 MG/ML SUSPENSION DROPS ORL DPS MCL ML 0.2893
00000870455 CHILDRENS TYLENOL COLD DM CHEWABLE TABLET ORL CTB MCL TAB 0.1763
00002039990 CHILDREN'S TYLENOL COLD DM ORAL SUSPENSION ORL SUS MCL ML 0.0549
00002229538 CHILDRENS TYLENOL DECONGESTANT LIQUID ORL LIQ MCL ML 0.0549
00002046040 CHILDREN'S TYLENOL GRAPE 32 MG/ML ORAL SUSPENSION ORL SUS MCL ML 0.0549
00002247621 CHLORAL HYDRATE-ODAN 100 MG/ML ORAL SYRUP ORL SYR ODN ML 0.0433
00000743518 CHLORPROMAZINE HCL 25 MG/ML (BASE) INJECTION INJ DEFAUL SDZ ML 1.8350
00000738972 CHLOR-TRIPOLON 4 MG TABLET ORL TAB BIC TAB 0.2117
00001970399 CHLOR-TRIPOLON N.D. SUSTAINED-RELEASE TABLET ORL TAB SCH TAB 0.4342
00002455609 CHOLESTYRAMINE-ODAN LIGHT 4 G/ORAL POWDER PACKET ORL PWDPKT ODN PCKT 0.9877
00080015373 CHONDROCARE TABLET ORL TAB MTG TAB 0.4500
00002247459 CHORIONIC GONADOTROPIN 10,000 UNIT/VIAL INJECTION INJ DEFAUL FKC VIAL 126.0000
00080005091 CHROMIUM GTF TABLET ORL TAB WNP TAB 0.0412
00002248088 CIALIS 10 MG TABLET ORL TAB LIL TAB 11.9575
00002296888 CIALIS 2.5 MG TABLET ORL TAB LIL TAB 3.6568
00002248089 CIALIS 20 MG TABLET ORL TAB LIL TAB 12.3900
00002296896 CIALIS 5 MG TABLET ORL TAB LIL TAB 3.6568
00002238273 CI-CAL 250 MG TABLET ORL TAB SDZ TAB 0.1368
00002410346 CICLOPIROX 8% TOPICAL SOLUTION TOP SOL STM G 7.7433
00002350963 CILAZAPRIL 1 MG TABLET ORL TAB SNS TAB 0.1557
00002350998 CILAZAPRIL 5 MG TABLET ORL TAB SNS TAB 0.2085
00002200864 CILOXAN 0.3% OPHTHALMIC OINTMENT OPH ONT ALC G 3.2257
00000900005 CINGAL DEFAUL DEV PPH ML 100.0000
00080005972 CINNAMON 500 MG CAPSULE ORL CAP VTH CAP 0.0600
00002456419 CINQAIR 10 MG/ML INJECTION INJ DEFAUL TEV ML 64.0000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 40 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002391449 CIPRALEX MELTZ 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.7600
00002391457 CIPRALEX MELTZ 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.8737
00002251787 CIPRO XL 1000 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.1120
00002247916 CIPRO XL 500 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.1120
00002353334 CIPROFLOXACIN 750 MG TABLET ORL TAB SNS TAB 1.2780
00002304759 CIPROFLOXACIN INTRAVENOUS INFUSION BP 2 MG/ML INJ INJ DEFAUL SDZ ML 0.1540
00002408813 CISATRACURIUM OMEGA MULTIDOSE 2 MG/ML INJECTION INJ DEFAUL OMG ML 1.7850
00002403188 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL TEV ML 6.1524
00002126613 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL MNP ML 6.4600
00002301849 CITALOPRAM 40 MG TABLET ORL TAB MEL TAB 0.2397
00002325047 CITALOPRAM-10 10 MG TABLET ORL TAB PDL TAB 0.1432
00002257513 CITALOPRAM-20 20 MG TABLET ORL TAB PDL TAB 0.2397
00002306247 CITALOPRAM-ODAN 40 MG TABLET ORL TAB ODN TAB 0.2397
00002257521 CITALOPROM-40 40 MG TABLET ORL TAB PDL TAB 0.3329
00000519235 CITANEST PLAIN 4% INJECTION INJ DEFAUL DSC ML 0.8658
00002150220 CITRACAL MG TABLET ORL TAB BAI TAB 0.1535
00002150158 CITRACAL PLUS D CAPLET ORL TAB SFD TAB 0.1548
00000701416 CITRAMINS CAPSULE ORL CAP XXX CAP 0.1856
00080007797 CITRAMINS II CAPSULE ORL CAP XXX CAP 0.1856
00000262609 CITRO MAG 50 MG ORAL LIQUID ORL LIQ ROG ML 0.0146
00002324482 CLARITHROMYCIN 250 MG TABLET ORL TAB PDL TAB 0.4122
00002324490 CLARITHROMYCIN 500 MG TABLET ORL TAB PDL TAB 1.6297
00002442485 CLARITHROMYCIN 500 MG TABLET ORL TAB SIV TAB 1.6292
00002237734 CLARITIN 10 MG RAPID DISSOLVE TONGUE TABLET ORL DISPTAB BIC TAB 0.6700
00000782696 CLARITIN 10 MG TABLET ORL TAB BIC TAB 0.6700
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 41 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00001945157 CLARITIN EXTRA SUSTAINED-RELEASE TABLET ORL SRT BIC TAB 0.6700
00000442968 CLEARASIL BP PLUS 5% TOPICAL LOTION TOP LOT RBC ML 0.1707
00002324989 CLEARLAX ORAL POWDER ORL PWR PRI G 0.0231
00002250616 CLIMARA PRO 4.40 MG/1.39 MG TRANSDERMAL PATCH TRD PTH BAI PTH 7.3650
00002408511 CLINDAMYCIN IV INFUSION 12 MG/ML MINIBAG INJECTION INJ DEFAUL SDZ ML 0.3724
00002408538 CLINDAMYCIN IV INFUSION 18 MG/ML MINIBAG INJECTION INJ DEFAUL SDZ ML 0.5186
00002248525 CLINDAMYCINE-150 150 MG TABLET ORL TAB PDL TAB 0.2217
00002248526 CLINDAMYCINE-300 300 MG CAPSULE ORL CAP PDL CAP 0.4434
00002243659 CLINDA-T 1% (BASE) TOPICAL SOLUTION TOP SOL VCL ML 0.2200
00002243050 CLINDETS PLEDGET 1% TOPICAL PAD TOP PAD GSK PAD 0.6698
00080007070 CLINIDERM GENTLE SPF 45 LOTION TOP LOT SAH ML 0.2415
00002248454 CLOBAZAM-10 10 MG TABLET ORL TAB PDL TAB 0.1097
00002256398 CLOBEX 0.05% TOPICAL LOTION TOP LOT GAL ML 0.8763
00002256371 CLOBEX 0.05% TOPICAL SHAMPOO TOP SHP GAL ML 1.0220
00002299739 CLOBEX 0.05% TOPICAL SPRAY TOP SPR GAL ML 2.0786
00002442027 CLONAZEPAM 0.25 MG TABLET ORL TAB SIV TAB 0.0774
00002442043 CLONAZEPAM 1 MG TABLET ORL TAB SIV TAB 0.1487
00002394820 CLOPIDOGREL 75 MG TABLET ORL TAB PDL TAB 0.6577
00000812382 CLOTRIMADERM 1% TOPICAL CREAM TOP CRM TAR G 0.3065
00002229380 CLOTRIMAZOLE 1% TOPICAL CREAM USP TOP CRM TAR G 0.2100
00002274337 CO BICALUTAMIDE 50 MG TABLET ORL TAB APH TAB 4.0573
00002390183 CO EXEMESTANE 25 MG TABLET ORL TAB APH TAB 3.9008
00002302861 CO PIOGLITAZONE 15 MG TABLET ORL TAB APH TAB 0.6225
00002302888 CO PIOGLITAZONE 30 MG TABLET ORL TAB APH TAB 0.8721
00002302896 CO PIOGLITAZONE 45 MG TABLET ORL TAB APH TAB 1.3113
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 42 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080027715 CO Q 10 120 MG CAPSULE ORL CAP JMS CAP 0.2567
00080006266 CO Q10 100 MG CAPSULE ORL CAP SIS CAP 0.1666
00080007078 CO Q10 LIQUID ORL LIQ INN ML 0.7941
00002244814 CO TEMAZEPAM 15 MG CAPSULE ORL CAP APH CAP 0.0438
00002244815 CO TEMAZEPAM 30 MG CAPSULE ORL CAP APH CAP 0.0526
00002383209 CO TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APH TAB 0.6264
00000068594 COACTIFED ORAL SYRUP ORL SYR GSK ML 0.1643
00000068608 COACTIFED TABLET ORL TAB GSK TAB 1.0012
00002150417 COATED ASPIRIN 325 MG CAPLET ORL ECT BAI TAB 0.0802
00002237726 COATED ASPIRIN DAILY LOW DOSE 81 MG ECT ORL ECT BIC TAB 0.1120
00002150425 COATED ASPIRIN EXTRA STRENGTH 500 MG CAPLET ORL ECT BAI TAB 0.0755
00002243897 COATED DAILY LOW-DOSE ASA 81 MG TABLET ORL ECT PMS TAB 0.0433
00002009757 CODEINE 30 MG TABLET ORL TAB RIV TAB 0.0773
00002163748 CODEINE CONTIN 100 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.6980
00002163780 CODEINE CONTIN 150 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 1.0470
00002163799 CODEINE CONTIN 200 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 1.3960
00002230302 CODEINE CONTIN 50 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.3490
00000050024 CODEINE PHOSPHATE 5 MG/ML ORAL SYRUP ORL SYR ATL ML 0.0578
00002248644 COENZYME Q10 100 MG CAPSULE ORL CAP VTH CAP 0.3266
00002246219 COENZYME Q10 100 MG CAPSULE ORL CAP WNP CAP 0.1403
00080010367 COENZYME Q10 150 MG SOFTGEL ORL CAP WBP CAP 0.3887
00080011974 COENZYME Q10 200 MG SOFTGEL ORL CAP WNP CAP 0.8330
00080006827 COENZYME Q10 30 MG CAPSULE ORL CAP WNP CAP 0.1237
00080006674 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.2473
00002245926 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.2540
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 43 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002231735 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.3000
00080006505 COENZYME Q10 SOFTGEL ORL CAP WNP CAP 0.1390
00000287873 COLCHICINE 0.6 MG TABLET ORL TAB SDZ TAB 0.2565
00000642975 COLESTID ORAL POWDER PACKET ORL PWDPKT PFI PCKT 1.1183
00002132699 COLESTID ORANGE 7.5 G ORAL POWDER PACKET ORL PWDPKT PFI PCKT 1.0997
00000476420 COLY-MYCIN M 150 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 39.5000
00001944363 COMBANTRIN 125 MG TABLET ORL TAB MCL TAB 1.1750
00001944355 COMBANTRIN 50 MG/ML ORAL SUSPENSION ORL SUS MCL ML 0.2789
00002419106 COMBIVENT RESPIMAT 20 MCG/100 MCG INH SOLUTION INH SOL BOE DOSE 0.2392
00002239213 COMBIVIR 150 MG/300 TABLET ORL TAB GSK TAB 11.0848
00002374129 COMPLERA 200 MG/25 MG/300 MG TABLET ORL TAB GIL TAB 41.5741
00002229633 COMPLETE MULTI-ADULT TABLET ORL TAB WAM TAB 0.0607
00000999760 COMPLEX 15 DAILY FACE CREAM TOP CRM MFC ML 0.0632
00002247732 CONCERTA 18 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.2259
00002250241 CONCERTA 27 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.5688
00002247733 CONCERTA 36 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.9118
00002247734 CONCERTA 54 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.5974
00001945149 CONDYLINE 0.5% TOPICAL SOLUTION TOP SOL SAV ML 11.9371
00002417162 CONSTELLA 145 MCG CAPSULE ORL CAP FLC CAP 3.3560
00002417170 CONSTELLA 290 MCG CAPSULE ORL CAP FLC CAP 5.3900
00002425009 CONTINGENCY ONE 1.5 MG TABLET ORL TAB MYP TAB 14.8200
00002456915 COPAXONE 40 MG/ML INJECTION INJ DEFAUL TMP SYR 108.4558
00002224577 COPHYLAC ORAL SOLUTION ORL SOL VCL ML 2.3067
00002176955 COQ10 30 MG CAPSULE ORL CAP JAM CAP 0.2248
00080012965 COQ10 MRB 60 MG SOFTGEL CAPSULE ORL CAP INN CAP 0.7950
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 44 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002036282 CORDARONE 200 MG TABLET ORL TAB PFI TAB 2.0589
00080021088 CORTATE 0.5% TOPICAL CREAM TOP CRM BAI G 0.1333
00002455889 CORTIMENT 9 MG DELAYED AND EXTENDED-RELEASE TABLET ORL DERT FEI TAB 8.2400
00000022381 CORTROSYN 0.25 MG/VIAL INJECTION INJ DEFAUL LYN VIAL 98.7600
00002181215 COTAZYM ECS 4 CAPSULE (ENTERIC-COATED PELLET) ORL CAP/ENCP ORG CAP 0.1795
00002452340 COTELLIC 20 MG TABLET ORL TAB HLR TAB 121.4324
00002099748 COUGH SYRUP WITH CODEINE ORL SYR ROG ML 0.0162
00002240206 COUMADIN 6 MG TABLET ORL TAB BMS TAB 0.5010
00002243063 COVAN ORAL SYRUP ORL SYR PMS ML 0.0573
00002246568 COVERSYL PLUS LD 2 MG/0.625 MG TABLET ORL TAB SEV TAB 0.8477
00080018683 CRANBERRY 500 MG CAPSULE ORL CAP VCL CAP 0.0516
00080027158 CRANBERRY COMPLEX 500 MG CAPSULE ORL CAP JAM CAP 0.1965
00002415194 CREON MINIMICROSPHERES 6 CAPSULE ORL CAP/ENCP BGP CAP 0.1703
00002445158 CREON MINIMICROSPHERES MICRO GRANULES ORL GRNUL BGP G 1.7030
00000299561 CREO-RECTAL ADULT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.7500
00000299596 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.7500
00000299588 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.6020
00002241013 CRINONE 8% VAGINAL GEL VAG GEL SRO G 8.2759
00002277778 CRITIC-AID CLEAR OINTMENT TOP ONT COC G 0.0885
00002229161 CRIXIVAN 200 MG CAPSULE ORL CAP MFC CAP 1.3467
00002229196 CRIXIVAN 400 MG CAPSULE ORL CAP MFC CAP 2.6933
00080049374 CRUCERA-SGS CAPSULE ORL CAP THR CAP 0.7042
00002220644 CYCLOBENZAPRINE 10 MG TABLET ORL TAB PDL TAB 0.3727
00002424584 CYCLOBENZAPRINE 10 MG TABLET ORL TAB SIV TAB 0.3727
00002148331 CYCLOPENTOLATE HCL 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.6667
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 45 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002148382 CYCLOPENTOLATE HCL 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.6667
00002290308 CYESTRA-35 TABLET ORL TAB PMS TAB 1.1114
00002064405 CYKLOKAPRON 500 MG TABLET ORL TAB PFI TAB 1.3276
00002443805 CYRAMZA 10 MG/ ML INJECTION INJ DEFAUL LIL ML 62.6680
00002238526 CYSTADANE 1 G/SCOOP ORAL POWDER ORL PWR ORP G 4.5524
00080038525 CYSTA-Q CAPSULE ORL CAP SLP CAP 0.4900
00002126656 CYTARABINE 100MG/ ML INJECTION INJ DEFAUL MNP ML 12.6700
00000386715 CYTOSAR 100 MG/5 ML INJECTION INJ DEFAUL PFI VIAL 10.7240
00002060604 DALACIN 2% VAGINAL CREAM VAG CRM PAL G 0.8158
00000030570 DALACIN C 150 MG CAPSULE ORL CAP PFI CAP 1.3711
00002182866 DALACIN C 300 MG CAPSULE ORL CAP PFI CAP 2.7419
00000582301 DALACIN T 1% (BASE) TOPICAL SOLUTION TOP SOL PFI ML 0.4837
00000507415 DAN-GARD 2% TOPICAL SHAMPOO TOP SHP VLP ML 0.0400
00001997653 DANTRIUM 100 MG CAPSULE ORL CAP PAR CAP 0.7684
00002455951 DARZALEX 100 MG/5 ML INJECTION INJ DEFAUL JAI ML 119.6040
00002455978 DARZALEX 400 MG/20 ML INJECTION INJ DEFAUL JAI ML 119.6040
00002359456 DAXAS 500 MCG TABLET ORL TAB AZC TAB 2.1357
00002285002 DDAVP MELT 120 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 1.9823
00002285010 DDAVP MELT 240 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 3.5683
00002284995 DDAVP MELT 60 MCG ORALLY DISINTEGRATING TABLET ORL DISNTAB FEI TAB 0.9910
00080001791 DDROPS 1,000 IU/DROP ORAL LIQUID ORL LIQ DDR ML 1.3800
00002389282 DECAPEPTYL 0.1 MG/ML INJECTION SYRINGE INJ DEFAUL FEI SYR 12.8571
00000791172 DECONGEST 0.1 MG NASAL SOLUTION NAS SOL RPH ML 0.1510
00002236796 DEEP PORE ACNE VANISHING TREATMENT 5% LOTION TOP LOT MNT ML 0.1964
00002018403 DELSYM 6 MG/ML CONTROLLED-RELEASE SUSPENSION ORL CRSUS NVC ML 0.0634
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 46 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000030848 DEPO-PROVERA 50 MG/ML INJECTION INJ DEFAUL PFI ML 6.8880
00002247093 DERMAL THERAPY- HEEL CARE CREAM TOP CRM DTR ML 0.0792
00002239903 DERMALAC 12% CREAM TOP CRM TAR G 0.0571
00000873292 DERMA-SMOOTHE/FS 0.01% TOPICAL OIL TOP OIL HDI ML 0.2972
00002230642 DERMATOP 0.1% EMOLLIENT CREAM TOP EMCRM VCL G 1.7930
00002227517 DERMATOP 0.1% TOPICAL OINTMENT TOP ONT VCL G 1.5810
00002238407 DERMAZINC 0.25% TOPICAL SPRAY TOP SPR DPI ML 0.2583
00002300559 DERMOTIC OIL EAR DROPS 0.01% OTIC SOLUTION OT SOL HDI ML 1.7000
00002454416 DESCOVY 200 MG/10 MG TABLET ORL TAB GIL TAB 28.5700
00002454424 DESCOVY 200 MG/25 MG TABLET ORL TAB GIL TAB 28.5700
00002216280 DESIPRAMINE 100 MG TABLET ORL TAB AAP TAB 0.9093
00001942417 DESITIN DIAPER RASH OINTMENT TOP ONT JJI G 0.0588
00002298155 DESLORATADINE ALLERGY CONTROL 5 MG TABLET ORL TAB PMS TAB 0.5193
00002239064 DETROL 1 MG TABLET ORL TAB PFI TAB 1.0217
00002239065 DETROL 2 MG TABLET ORL TAB PFI TAB 1.0217
00000999826 DEX-4 TABLET ALL FLAVOURS ORL TAB AMM TAB 0.1930
00002204274 DEXAMETHASONE OMEGA 10 MG/ML INJECTION INJ DEFAUL OMG ML 1.2830
00002204266 DEXAMETHASONE OMEGA 4 MG/ML INJECTION INJ DEFAUL OMG ML 1.6060
00000489158 DEXASONE 4 MG TABLET ORL TAB VCL TAB 0.8140
00000832030 DEXIDIN 20 MG TOPICAL SOLUTION TOP LIQ ATL ML 0.0390
00000832111 DEXIDIN 4 % TOPICAL LIQUID TOP LIQ ATL ML 0.0265
00002354950 DEXILANT 30 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.2000
00002354969 DEXILANT 60 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.2000
00000833231 DEXTROMETHORPHAN 15 MG/5 ML COUGH SYRUP ORL SYR TAN ML 0.0199
00000060348 DEXTROSE 5% 5 G/100 ML USP INJECTION INJ DEFAUL BAX ML 0.0857
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 47 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002058235 DEY-PAK SODIUM CHLORIDE 0.9% INHALATION SOLUTION INH SOL MYP ML 0.0567
00002237450 D-FORTE 50000 IU CAPSULE ORL CAP SDZ CAP 0.1986
00002398982 DIACOMIT 500 MG ORAL POWDER PACKET ORL PWDPKT BCF PCKT 11.7783
00002245391 DIAMINE TABLET ORL TAB EUP TAB 0.0631
00080028781 DIAMINE TABLET ORL TAB SDZ TAB 0.0631
00002233542 DIANE-35 2 MG/0.035 MG TABLET ORL TAB BHP TAB 1.8062
00002337452 DIAPER RASH 15% TOPICAL CREAM TOP CRM HJS G 0.0093
00002229552 DIARR-EZE 2 MG CAPLET ORL TAB PMS TAB 0.3000
00002248994 DIARRHEA RELIEF 2 MG TABLET ORL TAB PMS TAB 0.1778
00002238162 DIASTAT RECTAL DELIVERY SYS 5 MG/ML RECTAL GEL RT GEL VCL SYS 80.4300
00002065614 DIAZEMULS 5 MG/ML EMULSION INJECTION INJ EML PFI ML 1.1520
00000434388 DIAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.0867
00000313580 DIAZEPAM 5 TABLET ORL TAB PDL TAB 0.0650
00002434571 DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL STM ML 0.6226
00000870978 DICLOFENAC 50 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.2024
00002351684 DICLOFENAC POTASSIUM 50 MG TABLET ORL TAB SNS TAB 0.3937
00002352400 DICLOFENAC SODIUM SR 75 MG TABLET ORL SRT SNS TAB 0.2320
00002224127 DICLOFENAC-SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.4048
00002224119 DICLOFENAC-SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.2320
00002231592 DIFFERIN 0.1% TOPICAL CREAM TOP CRM GAL G 1.9940
00002148749 DIFFERIN 0.1% TOPICAL GEL TOP GEL GAL G 1.9940
00002274000 DIFFERIN XP 0.3% TOPICAL GEL TOP GEL GAL G 2.2287
00002039486 DIFLUNISAL 250 MG TABLET ORL TAB AAP TAB 0.5646
00002039494 DIFLUNISAL 500 MG TABLET ORL TAB AAP TAB 0.7150
00080056878 DIGEST GOLD CAPSULE ORL CAP EMI CAP 0.4291
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 48 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002048264 DIGOXIN 0.25 MG/ML INJECTION INJ DEFAUL SDZ ML 7.6845
00002325306 DILTIAZEM TZ 120 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.2133
00002325314 DILTIAZEM TZ 180 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.2889
00002325322 DILTIAZEM TZ 240 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.3832
00002325330 DILTIAZEM TZ 300 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.4719
00002325349 DILTIAZEM TZ 360 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.5778
00002231472 DILTIAZEM-CD 120 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.4061
00002231474 DILTIAZEM-CD 180 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.5392
00002231475 DILTIAZEM-CD 240 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.7151
00002231057 DILTIAZEM-CD 300 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.7766
00002300648 DIMENHYDRINATE 50 MG/ML INJECTION INJ DEFAUL ALV ML 2.5000
00002244079 DIMETANE EXPECTORANT C ORAL SYRUP ORL SYR PDH ML 0.0919
00002244080 DIMETANE EXPECTORANT DC ORAL SYRUP ORL SYR PDH ML 0.1242
00002243969 DIMETAPP DM COUGH & COLD ORAL LIQUID ORL LIQ PDH ML 0.0513
00002244078 DIMETAPP-C ORAL SYRUP ORL SYR PDH ML 0.1111
00001997750 DIODOQUIN 650 MG TABLET ORL TAB GLE TAB 0.9347
00002027100 DIONEPHRINE 2.5% OPH SOLUTION OPH SOL DIO ML 0.7180
00002270528 DIOVAN 40 MG TABLET ORL TAB NOV TAB 1.2136
00002157624 DIOVOL PLUS AF CHEWABLE TABLET ORL CTB CHD TAB 0.1188
00002157616 DIOVOL PLUS AF-SUSPENSION ORL SUS CHD ML 0.0170
00000116815 DIOVOL PLUS ORAL SUSPENSION ORL SUS CHD ML 0.0170
00000116882 DIOVOL PLUS TABLET ORL TAB CHD TAB 0.1188
00002257548 DIPHENHYDRAMINE HYDROCHLORIDE 25 MG CAPLET ORL TAB JPC TAB 0.1379
00002257556 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG CAPLET ORL TAB JPC TAB 0.1659
00002369567 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG/ML INJECTION INJ DEFAUL FKC ML 4.3900
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 49 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002219336 DIPHENIST 50 MG/ML INJECTION INJ DEFAUL OMG ML 4.1500
00002018950 DIPRIVAN EML IV 10 MG/ML INJECTION INJ DEFAUL AZC ML 0.5400
00000417262 DIPROGEN TOPICAL CREAM TOP CRM SCH G 0.8556
00002243961 DITROPAN XL 10 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.4457
00002243960 DITROPAN XL 5 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.4457
00002240341 DIVALPROEX-125 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.0724
00002240342 DIVALPROEX-250 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.1301
00002240343 DIVALPROEX-500 MG ENTERIC-COATED TABLET ORL TAB PDL TAB 0.2604
00000519251 DIXARIT 0.025 MG TABLET ORL TAB BOE TAB 0.2720
00002228335 DOBUTAMINE HYDROCHLORIDE 12.5 MG/ML INJECTION INJ DEFAUL TEV VIAL 23.2500
00002412225 DOCETAXEL 28 MG/ML (20 MG/0.72 ML) INJECTION INJ DEFAUL TEV ML 317.3194
00002412233 DOCETAXEL 28 MG/ML (80 MG/2.88 ML) INJECTION INJ DEFAUL TEV ML 317.3194
00002246741 DOCUSATE CALCIUM 240 MG CAPSULE ORL CAP ROG CAP 0.1283
00000870218 DOCUSATE SODIUM 10 MG/ML ORAL DROPS ORL DPS ROG ML 0.1996
00002326086 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP PDL CAP 0.0250
00002245946 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP JPC CAP 0.0328
00002246036 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP ROG CAP 0.0405
00000830267 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP TLI CAP 0.0338
00000794406 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP VTH CAP 0.0334
00002246854 DOCUSATE SODIUM 4 MG/ML ORAL SYRUP ORL SYR ROG ML 0.0245
00000614491 DOLORAL 1 MG/ML ORAL SYRUP ORL SYR ATL ML 0.0340
00000614505 DOLORAL 5 MG/ML ORAL SYRUP ORL SYR ATL ML 0.0582
00002246331 DOM-AMIODARONE 200 MG TABLET ORL TAB DPC TAB 0.6177
00002326841 DOM-AMLODIPINE 10 MG TABLET ORL TAB DPC TAB 0.3587
00002326825 DOM-AMLODIPINE 2.5 MG TABLET ORL TAB DPC TAB 0.1380
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 50 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002326833 DOM-AMLODIPINE 5 MG TABLET ORL TAB DPC TAB 0.2417
00002229468 DOM-ATENOLOL 100 MG TABLET ORL TAB DPC TAB 0.2362
00002229467 DOM-ATENOLOL 50 MG TABLET ORL TAB DPC TAB 0.1437
00002399482 DOM-ATORVASTATIN 10 MG TABLET ORL TAB DPC TAB 0.3137
00002399504 DOM-ATORVASTATIN 40 MG TABLET ORL TAB DPC TAB 0.4216
00002278499 DOM-AZITHROMYCIN 250 MG TABLET ORL TAB DPC TAB 1.2317
00002238223 DOM-CARBAMAZEPINE CR 400 MG SUSTAINED-RELEASE TAB ORL SRT DPC TAB 0.2602
00002251280 DOM-CIPROFLOXACIN 500 MG TABLET ORL TAB DPC TAB 0.6979
00002273055 DOM-CITALOPRAM 10 MG TABLET ORL TAB DPC TAB 0.1432
00002248942 DOM-CITALOPRAM 20 MG TABLET ORL TAB DPC TAB 0.2397
00002248943 DOM-CITALOPRAM 40 MG TABLET ORL TAB DPC TAB 0.2397
00002351005 DOM-CLARITHROMYCIN 500 MG TABLET ORL TAB DPC TAB 1.6293
00002247230 DOM-CLOBAZAM 10 MG TABLET ORL TAB DPC TAB 0.1538
00002130998 DOM-CLONAZEPAM 0.5 MG TABLET ORL TAB DPC TAB 0.0554
00002131013 DOM-CLONAZEPAM 2 MG TABLET ORL TAB DPC TAB 0.0954
00002238633 DOM-CYCLOBENZAPRINE 10 MG TABLET ORL TAB DPC TAB 0.3727
00002130092 DOM-DESIPRAMINE 25 MG TABLET ORL TAB DPC TAB 0.2723
00002231662 DOM-DICLOFENAC 25 MG ENTERIC-COATED TABLET ORL ECT DPC TAB 0.1094
00002231664 DOM-DICLOFENAC-SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT DPC TAB 0.2320
00002238315 DOM-DOMPERIDONE 10 MG TABLET ORL TAB DPC TAB 0.0831
00002376709 DOM-FINASTERIDE 5 MG TABLET ORL TAB DPC TAB 0.4633
00002246109 DOM-FLUCONAZOLE 100 MG TABLET ORL TAB DPC TAB 3.2047
00002246108 DOM-FLUCONAZOLE 50 MG TABLET ORL TAB DPC TAB 1.8065
00002177617 DOM-FLUOXETINE 10 MG CAPSULE ORL CAP DPC CAP 0.8650
00002177625 DOM-FLUOXETINE 20 MG CAPSULE ORL CAP DPC CAP 0.6438
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 51 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002241348 DOM-FLUVOXAMINE 100 MG TABLET ORL TAB DPC TAB 0.3783
00002241347 DOM-FLUVOXAMINE 50 MG TABLET ORL TAB DPC TAB 0.2947
00002241608 DOM-GEMFIBROZIL 300 MG CAPSULE ORL CAP DPC CAP 0.1803
00002234514 DOM-GLYBURIDE 5 MG TABLET ORL TAB DPC TAB 0.0683
00002239913 DOM-INDAPAMIDE 1.25 MG TABLET ORL TAB DPC TAB 0.0745
00002239917 DOM-INDAPAMIDE 2.5 MG TABLET ORL TAB DPC TAB 0.1182
00002372193 DOM-IRBESARTAN 150 MG TABLET ORL TAB DPC TAB 0.3025
00002414775 DOM-LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC DPC CAP 0.5000
00002245784 DOM-LORAZEPAM 0.5 MG TABLET ORL TAB DPC TAB 0.0359
00002245785 DOM-LORAZEPAM 1 MG TABLET ORL TAB DPC TAB 0.0447
00002247232 DOM-LOVASTATIN 40 MG TABLET ORL TAB DPC TAB 1.2579
00002231122 DOM-METOPROLOL-L 100 MG TABLET ORL TAB DPC TAB 0.1250
00002231121 DOM-METOPROLOL-L 50 MG TABLET ORL TAB DPC TAB 0.0786
00002376695 DOM-MONTELUKAST FC 10 MG TABLET ORL TAB DPC TAB 0.8195
00002178729 DOM-NORTRIPTYLINE 10 MG CAPSULE ORL CAP DPC CAP 0.0772
00002178737 DOM-NORTRIPTYLINE 25 MG CAPSULE ORL CAP DPC CAP 0.1560
00002125145 DOM-NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION ORL SUS DPC ML 0.0521
00002333430 DOM-OMEPRAZOLE DR 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT DPC TAB 0.4117
00002241285 DOM-OXYBUTYNIN 5 MG TABLET ORL TAB DPC TAB 0.1508
00002310007 DOM-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT DPC TAB 0.3628
00002248447 DOM-PAROXETINE 10 MG TABLET ORL TAB DPC TAB 0.8210
00002248448 DOM-PAROXETINE 20 MG TABLET ORL TAB DPC TAB 0.6320
00002248449 DOM-PAROXETINE 30 MG TABLET ORL TAB DPC TAB 0.6714
00002236857 DOMPERIDONE-10 10 MG TABLET ORL TAB PDL TAB 0.0594
00002238046 DOM-PINDOLOL 10 MG TABLET ORL TAB DPC TAB 0.2323
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 52 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002238047 DOM-PINDOLOL 15 MG TABLET ORL TAB DPC TAB 0.3370
00002231650 DOM-PINDOLOL 5 MG TABLET ORL TAB DPC TAB 0.1361
00002249723 DOM-PRAVASTATIN 10 MG TABLET ORL TAB DPC TAB 0.4050
00002249731 DOM-PRAVASTATIN 20 MG TABLET ORL TAB DPC TAB 0.4778
00002249758 DOM-PRAVASTATIN 40 MG TABLET ORL TAB DPC TAB 0.8057
00002299003 DOM-QUETIAPINE 100 MG TABLET ORL TAB DPC TAB 0.3295
00002299038 DOM-QUETIAPINE 200 MG TABLET ORL TAB DPC TAB 0.6617
00002298996 DOM-QUETIAPINE 25 MG TABLET ORL TAB DPC TAB 0.1235
00002299046 DOM-QUETIAPINE 300 MG TABLET ORL TAB DPC TAB 0.9656
00002320460 DOM-RABEPRAZOLE EC 20 MG ENTERIC-COATED TABLET ORL ECT DPC TAB 0.2408
00002287986 DOM-RAMIPRIL 10 MG CAPSULE ORL CAP/TAB DPC CAP 0.1862
00002287951 DOM-RAMIPRIL 2.5 MG CAPSULE ORL CAP/TAB DPC CAP 0.1470
00002309831 DOM-RISEDRONATE 35 MG TABLET ORL TAB DPC TAB 2.4275
00002396203 DOM-RIZATRIPTAN RDT 10 MG ORALLY DISINT. TABLET ORL DISNTAB DPC TAB 3.7050
00002216949 DOM-SALBUTAMOL 1 MG/ML INHALATION SOLUTION INH SOL DPC ML 0.3618
00002245750 DOM-SERTRALINE 100 MG CAPSULE ORL CAP DPC CAP 0.4200
00002245748 DOM-SERTRALINE 25 MG CAPSULE ORL CAP DPC CAP 0.2004
00002245749 DOM-SERTRALINE 50 MG CAPSULE ORL CAP DPC CAP 0.4000
00002238634 DOM-SOTALOL 80 MG TABLET ORL TAB DPC TAB 0.2966
00002270765 DOM-SUMATRIPTAN 100 MG TABLET ORL TAB DPC TAB 7.8600
00002243749 DOM-TERAZOSIN 10 MG TABLET ORL TAB DPC TAB 0.6183
00002128969 DOM-TRAZODONE 100 MG TABLET ORL TAB DPC TAB 0.0989
00002128950 DOM-TRAZODONE 50 MG TABLET ORL TAB DPC TAB 0.0554
00002414147 DOM-VALSARTAN 80 MG TABLET ORL TAB DPC TAB 0.2957
00002299313 DOM-VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAPSULE ORL ERC DPC CAP 0.3469
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 53 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002299291 DOM-VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAP ORL ERC DPC CAP 0.1643
00002299305 DOM-VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAP ORL ERC DPC CAP 0.3285
00002240321 DOM-VERAPAMIL SR 240 MG SUSTAINED-RELEASE TABLET ORL SRT DPC TAB 0.5075
00002389525 DOM-ZOLMITRIPTAN 2.5 MG TABLET ORL TAB DPC TAB 3.5375
00002246317 DOM-ZOPICLONE 5 MG TABLET ORL TAB DPC TAB 0.1782
00002240823 DOM-ZOPICLONE 7.5 MG TABLET ORL TAB DPC TAB 0.2250
00002416425 DONEPEZIL 10 MG TABLET ORL TAB PDL TAB 1.2340
00002416417 DONEPEZIL 5 MG TABLET ORL TAB PDL TAB 1.2340
00002194341 DOVONEX 50 MCG/ML SCALP SOLUTION SCP SOL LEO ML 0.7777
00002240978 DOXAZOSIN-1 1MG TABLET ORL TAB PDL TAB 0.1416
00002240979 DOXAZOSIN-2 2 MG TABLET ORL TAB PDL TAB 0.1699
00002240980 DOXAZOSIN-4 4 MG TABLET ORL TAB PDL TAB 0.2209
00002375710 DOXORUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 13.0420
00002413973 DOXORUBICIN HYDROCHLORIDE 2MG/ML INJECTION USP INJ DEFAUL MYP ML 11.4000
00000817120 DOXYCIN 100 MG CAPSULE ORL CAP RIV CAP 0.5860
00000860751 DOXYCIN 100 MG TABLET ORL TAB RIV TAB 0.5860
00000887064 DOXYTAB 100 MG TABLET ORL TAB PDL TAB 0.5860
00001974335 DR SCHOLL'S CLEAR AWAY WART REMOVER SYSTEM 40% PTH TOP PTH BAI PTH 0.3356
00001929313 DRISTAN DECONGESTANT NASAL MIST SOLUTION NAS SOL PDH ML 0.3173
00001929372 DRISTAN LONG LASTING 0.05% NASAL MIST SOLUTION NAS SOL PDH ML 0.3173
00001929380 DRISTAN LONG LASTING MENTHOLATED 0.05% NASAL SPRAY NAS SPR PDH ML 0.3173
00000740861 DRIXORAL DESCONGESTANT 0.05% NASAL SOLUTION NAS SOL SCH ML 0.1783
00000298433 DRIXORAL SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.4020
00000342742 DRYSOL 20% TOPICAL SOLUTION TOP SOL SFD ML 0.4203
00000821772 D-TAB 10,000 UNIT TABLET ORL TAB RIV TAB 0.2100
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 54 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002247208 DUKORAL ORAL SUSPENSION ORL SUS AVE DOSE 35.9900
00002452650 DULOXETINE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.4814
00002452669 DULOXETINE 60 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.9769
00002292165 DUODOPA 20 MG/ML / 5MG/ML (100 ML) INTESTINAL GEL INTRA GEL ABV CAS 166.0000
00002239299 DUOFILM 40% TOPICAL PATCH TOP PTH MMH PTH 0.4633
00002125706 DUOLUBE OPH OINTMENT OPH ONT BSH G 1.4771
00000656747 DUONALC E (MILD) 20% TOPICAL SOLUTION TOP SOL VCL ML 0.2196
00000490156 DUONALC E 47.5% TOPICAL SOLUTION TOP SOL VCL ML 0.2196
00002148633 DUOVENT UDV INHALATION SOLUTION INH SOL BOE ML 0.8264
00002275848 DURAGESIC MAT 75 (75 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 43.1400
00002275856 DURAGESIC MAT 100 (100 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 53.7000
00002334186 DURAGESIC MAT 12 (12 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 6.3240
00002275813 DURAGESIC MAT 25 (25 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 16.3000
00002275821 DURAGESIC MAT 50 (50 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 30.6800
00002373017 DURELA 100 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 1.1400
00002373025 DURELA 200 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 2.0800
00002373033 DURELA 300 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 2.8800
00002415534 DUREZOL 0.05% OPHTHALMIC EMULSION OPH EML ALC ML 5.4000
00000999010 DUROLANE DEFAUL DEV QMD ML 143.3300
00002421712 DUTASTERIDE 0.5 MG CAPSULE ORL CAP PDL CAP 0.9624
00001947958 DUVOID 10 MG TABLET ORL TAB PAL TAB 0.3247
00001947931 DUVOID 25 MG TABLET ORL TAB PAL TAB 0.5259
00001947923 DUVOID 50 MG TABLET ORL TAB PAL TAB 0.6927
00002432889 DYMISTA 50 MCG/137 MCG METERED DOSE NASAL SPRAY NAS SPM MDP DOSE 0.7875
00002460203 DYSPORT THERAPEUTIC 300 IU/VIAL INJECTION INJ DEFAUL ISP VIAL 428.4000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 55 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002456117 DYSPORT THERAPEUTIC 500 IU/VIAL INJECTION INJ DEFAUL ISP VIAL 714.0000
00002260638 EBIXA 10 MG TABLET ORL TAB LBC TAB 2.4557
00002381389 EDARBI 40 MG TABLET ORL TAB VCL TAB 1.2100
00002381397 EDARBI 80 MG TABLET ORL TAB VCL TAB 1.2100
00002397749 EDARBYCLOR 40 MG/12.5 MG TABLET ORL TAB VCL TAB 1.2089
00002397765 EDARBYCLOR 40 MG/25 MG TABLET ORL TAB VCL TAB 1.2089
00002397757 EDARBYCLOR 80 MG/12.5 MG TABLET ORL TAB TAK TAB 1.2090
00002370603 EDURANT 25 MG TABLET ORL TAB JAI TAB 15.1370
00080009719 EFAMOL 1000 MG CAPSULE ORL CAP FMD CAP 0.1667
00002349124 EFFIENT 10 MG TABLET ORL TAB LIL TAB 2.7377
00002209764 EGOZINC-HC RECTAL OINTMENT RT ONT PMS G 0.4160
00002210517 EGOZINC-HC RECTAL SUPPOSITORY RT SUP PMS SUP 0.6075
00002438712 EGRIFTA 1 MG/VIAL INJECTION INJ DEFAUL THE VIAL 51.4170
00002425637 ELELYSO 200 UNIT/VIAL INJECTION INJ DEFAUL PFI VIAL 648.3600
00002247238 ELIDEL 1 % TOPICAL CREAM TOP CRM VCL G 2.3223
00002248239 ELIGARD 10.2 MG/SYR INJECTION INJ NDL SAV SYR 310.7200
00002248240 ELIGARD 28.2 MG/SYR INJECTION INJ NDL SAV SYR 891.0000
00002248999 ELIGARD 35.8 MG/SYR INJECTION INJ NDL SAV SYR 1285.2000
00002268892 ELIGARD 58.2 MG/SYR INJECTION INJ NDL SAV SYR 1450.0000
00000627410 ELIXIR DE THEOPHYLLINE ORL ELX ATL ML 0.0052
00002436329 ELLA 30 MG TABLET ORL TAB ASC TAB 25.4300
00002296284 ELOXATIN 5 MG/ML INJECTION INJ DEFAUL SAV ML 51.8160
00002103109 ELTOR-120 120 MG SUSTAINED-RELEASE TABLET ORL SRT SAV TAB 0.2742
00002298805 EMEND 125 MG CAPSULE ORL CAP MFC CAP 32.1250
00002324679 EMEND IV 115 MG/VIAL INJ DEFAUL MFC VIAL 30.1800
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 56 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000886858 EMLA TOPICAL CREAM TOP CRM AZC G 2.0800
00002057794 EMLA TOPICAL PATCH TOP PTH AZC PTH 2.9000
00080008611 EMPOWER 18 PLUS CAPSULE ORL CAP TRU CAP 0.4163
00002334992 ENDOMETRIN 100 MG VAGINAL EFFERVESCENT TABLET VAG EVT FEI TAB 4.0000
00000999558 ENFAMIL A+ 2 ORAL INFANT FORMULA ORL LIQ MJO ML 0.0111
00000999898 ENFAMIL INFANT FORMULA ORAL POWDER ORL PWR MJO G 0.0284
00002296454 ENGERIX-B 10 MCG/0.5 ML SUSPENSION INJ DEFAUL GSK ML 21.5400
00002457393 ENSTILAR 50 MCG/G / 0.5 MG/G TOPICAL FOAM TOP FOA LEO G 1.4853
00000999900 ENSURE ENLIVE ORAL LIQUID ORL LIQ ABN ML 0.0111
00002010526 ENTERIC COATED ASA 325 MG TABLET ORL ECT WTR TAB 0.0280
00000794244 ENTERIC COATED ASA 650 MG TABLET ORL ECT VTH TAB 0.0550
00002246971 ENTEX LA SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.4425
00002446928 ENTRESTO 24.3 MG/25.7 MG TABLET ORL TAB NOV TAB 3.6200
00002446936 ENTRESTO 48.6 MG/51.4 MG TABLET ORL TAB NOV TAB 3.6200
00002446944 ENTRESTO 97.2 MG/102.8 MG TABLET ORL TAB NOV TAB 3.6200
00001905392 ENTROPHEN 10 SUPER EXTRA STRENGTH 650 MG ECCPT ORL ECT PPH TAB 0.0705
00000852015 ENTROPHEN 500 MG ENTERIC-COATED TABLET ORL ECT PPH TAB 0.0686
00002050161 ENTROPHEN REGULAR STRENGTH (CAPLET) 325 MG ECCPT ORL ECT PPH TAB 0.0549
00000010332 ENTROPHEN REGULAR STRENGTH 325 MG ECT ORL ECT PPH TAB 0.0549
00002436841 ENTYVIO 300 MG/VIAL INJECTION INJ DEFAUL TAK VIAL 3290.0000
00000880183 EPI-LYT TOP LOT VCL ML 0.1194
00000721891 EPINEPHRINE 1 MG/ML INJECTION USP INJ NDL HSP SYR 3.9700
00002264927 EPIRUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL HSP ML 13.3196
00000999819 EPSOM SALTS DEFAUL DEFAUL XXX G 0.0035
00002396971 EPURIS 10 MG CAPSULE ORL CAP CIP CAP 1.0887
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 57 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002396998 EPURIS 20 MG CAPSULE ORL CAP CIP CAP 1.4660
00002397005 EPURIS 30 MG CAPSULE ORL CAP CIP CAP 1.8440
00002397013 EPURIS 40 MG CAPSULE ORL CAP CIP CAP 2.2213
00002243801 EQUATE DAILY LOW-DOSE 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.1096
00002271249 ERBITUX 2 MG/ML INJECTION INJ DEFAUL LIL ML 7.2924
00002409267 ERIVEDGE 150 MG CAPSULE ORL CAP HLR CAP 294.2238
00000607142 ERYC 250 MG CAPSULE (ENTERIC-COATED PELLET) ORL CAP/ENCP PFI CAP 0.2811
00002424401 ESCITALOPRAM 10 MG TABLET ORL TAB PDL TAB 1.4680
00002424428 ESCITALOPRAM 20 MG TABLET ORL TAB PDL TAB 1.5630
00002394839 ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT PDL TAB 1.5887
00002442493 ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT SIV TAB 1.8690
00002394847 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC PDL TAB 1.4298
00002442507 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC SIV TAB 1.8690
00002431173 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC SNS TAB 1.8690
00002244990 ESSENTIAL VITAMINS AND MINERALS TABLET ORL TAB WNP TAB 0.0214
00002237515 ESTER C 1000 MG TABLET ORL TAB SIS TAB 0.1598
00002247480 ESTER-C 250 MG CHEWABLE TABLET ORL CTB WNP TAB 0.0799
00080003499 ESTER-C CAPSULE ORL CAP BPC CAP 0.1496
00000727369 ESTRAGYN 1MG/G VAGINAL CREAM VAG CRM SLP G 0.6873
00000247960 ETIBI 100 MG TABLET ORL TAB VCL TAB 0.2092
00000247979 ETIBI 400 MG TABLET ORL TAB VCL TAB 0.6279
00002080036 ETOPOSIDE 20 MG/ML INJECTION INJ DEFAUL TEV ML 15.0000
00000999330 EUFLEXXA DEFAUL DEV FEI ML 56.8333
00080013021 EUPHORBIUM COMPOSITUM SN ORAL DROPS ORL DPS HEE ML 0.7650
00000623377 EURAX 10% TOPICAL CREAM TOP CRM CLC G 0.3584
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 58 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080003010 EURO D 800 IU CAPSULE ORL CAP SDZ CAP 0.0600
00002303825 EURO DOCUSATE C 100 MG CAPSULE ORL CAP SDZ CAP 0.0328
00080011428 EURO K 975 975 MG (25 MEQ) EFFERVESCENT TABLET ORL EVT SDZ TAB 0.5550
00002245668 EURO-CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP ORL SYR SDZ ML 0.0718
00002242651 EURO-D VITAMIN D3 400 IU CAPSULE ORL CAP SDZ CAP 0.0300
00002247385 EURO-DOCUSATE 100 MG CAPSULE ORL CAP SDZ CAP 0.0328
00002246590 EURO-FER 20 MG/ML ORAL SUSPENSION ORL SUS SDZ ML 0.0780
00002237556 EURO-FER 300 MG CAPSULE ORL CAP SDZ CAP 0.1397
00002241802 EURO-FER CF CAPSULE ORL CAP SDZ CAP 0.2330
00002246733 EURO-FERROUS SULFATE 300 MG TABLET ORL TAB SDZ TAB 0.0157
00002412926 EURO-HYDROCORTISONE 1% CREAM TOP CRM SDZ G 0.2000
00002247389 EURO-SENNA 8.6 MG TABLET ORL TAB SDZ TAB 0.0464
00002247390 EURO-SENNA S 8.6 MG/50 MG TABLET ORL TAB SDZ TAB 0.1135
00002264374 EUTHYROX 100 MCG TABLET ORL TAB SRO TAB 0.0306
00002264390 EUTHYROX 112 MCG TABLET ORL TAB SRO TAB 0.0644
00002264404 EUTHYROX 125 MCG TABLET ORL TAB SRO TAB 0.0654
00002264412 EUTHYROX 137 MCG TABLET ORL TAB SRO TAB 0.1148
00002264420 EUTHYROX 150 MCG TABLET ORL TAB SRO TAB 0.0339
00002264439 EUTHYROX 175 MCG TABLET ORL TAB SRO TAB 0.0699
00002264447 EUTHYROX 200 MCG TABLET ORL TAB SRO TAB 0.0359
00002264323 EUTHYROX 25 MCG TABLET ORL TAB SRO TAB 0.0564
00002264455 EUTHYROX 300 MCG TABLET ORL TAB SRO TAB 0.0785
00002264331 EUTHYROX 50 MCG TABLET ORL TAB SRO TAB 0.0249
00002264358 EUTHYROX 75 MCG TABLET ORL TAB SRO TAB 0.0610
00002264366 EUTHYROX 88 MCG TABLET ORL TAB SRO TAB 0.0610
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 59 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080005494 EVENING PRIMROSE OIL SOFTGEL CAPSULE ORL CAP WNP CAP 0.0644
00002248297 EVRA 6 MG/0.6 MG TRANSDERMAL PATCH TRD PTH JAI PTH 5.9533
00002377179 EXACT ANTI-NAUSEANT 50 MG TABLET ORL TAB APX TAB 0.0627
00002243896 EXACT DAILY LOW-DOSE ASA 81 MG ENTERIC-COATED TAB ORL ECT PMS TAB 0.1330
00001990675 EXCEDRIN EXTRA-STRENGTH CAPLET ORL TAB NVC TAB 0.0588
00002302853 EXELON PATCH 10 (9.5 MG/24 H) TRD PTH NOV PTH 4.6747
00002432803 EXELON PATCH 15 (13.3 MG/24 H) TRD PTH NOV PTH 4.5153
00002302845 EXELON PATCH 5 (4.6 MG/24 H) TRD PTH NOV PTH 4.6747
00002226030 EX-LAX CHOCOLATED TABLET ORL TAB NVC TAB 0.2006
00002237524 EX-LAX EXTRA STRENGHT 25 MG TABLET ORL TAB NVC TAB 0.2354
00002184672 EXOREX 1% TOPICAL GEL TOP GEL YNG ML 0.2250
00002184680 EXOREX 2% TOPICAL GEL TOP GEL YNG ML 0.2250
00080030277 EXOS VEGAN VANILLA PROTEIN POWDER ORL PWR THR G 0.0539
00000813095 EXPECTORANT COUGH FORMULA 100 MG/5 ML ORAL SYRUP ORL SYR TAN ML 0.0199
00002315955 EXTRA STRENGTH ALLERGY RELIEF 10 MG TABLET ORL TAB PMS TAB 0.1730
00002242632 EXTRA STRENGTH MOTRIN IB 300 MG TABLET ORL TAB MCL TAB 0.1355
00002244142 EXTRA STRENGTH NIGHTTIME COLD RELIEF TABLET ORL TAB PPH TAB 0.1283
00000889806 EYELUBE .5% OPH DROPS OPH DPS SDZ ML 0.3093
00000874965 EYELUBE 1% OPH DROPS OPH DPS SDZ ML 0.3840
00000707937 EYE-STREAM EYE LIQUID OPH LIQ ALC ML 0.0930
00002415992 EYLEA 2 MG/VIAL INJECTION INJ DEFAUL BAI VIAL 1418.0000
00002422549 EZETIMIBE 10 MG TABLET ORL TAB PDL TAB 0.4612
00002324865 FAMCICLOVIR 125 MG TABLET ORL TAB PDL TAB 0.1394
00002247745 FAMOTIDINE OMEGA-(W PRES,BENZYL ALC) 10 MG/ML INJ INJ DEFAUL OMG ML 1.4000
00002247735 FAMOTIDINE OMEGA-(W/O PRESERVATIVE) 10 MG/ML INJ INJ DEFAUL OMG ML 2.3500
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 60 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002379910 FAMPYRA 10 MG SUSTAINED-RELEASE TABLET ORL SRT BIO TAB 9.4786
00002229110 FAMVIR 125 MG TABLET ORL TAB NOV TAB 3.0170
00002229129 FAMVIR 250 MG TABLET ORL TAB NOV TAB 4.0927
00002177102 FAMVIR 500 MG TABLET ORL TAB NOV TAB 7.2905
00002248624 FASLODEX 250 MG/5 ML INJECTION INJ NDL AZC SYR 582.8950
00002231384 FEMARA 2.5 MG TABLET ORL TAB NOV TAB 6.4113
00002242531 FEMHRT 1/5 TABLET ORL TAB PFI TAB 0.8400
00002240360 FENO-MICRO-200 MG CAPSULE ORL CAP PDL CAP 0.2723
00002395703 FENTANYL 100 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 12.0520
00002395657 FENTANYL 12 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 2.3480
00002395665 FENTANYL 25 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 3.6600
00002395673 FENTANYL 50 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 6.8840
00002395681 FENTANYL 75 MCG/HR TRANSDERMAL PATCH TRD PTH PDL PTH 9.6820
00002384124 FENTANYL CITRATE SDZ 50 MCG/ML INJECTION INJ DEFAUL SDZ ML 2.5988
00002408007 FENTORA 100 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.8968
00002408015 FENTORA 200 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.8968
00002408023 FENTORA 400 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.8968
00002408031 FENTORA 600 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.8968
00002408058 FENTORA 800 MCG EFFERVESCENT TABLET BUC/SLG EVT TMP TAB 10.8968
00002377217 FERAHEME 30 MG/ML INJECTION INJ DEFAUL TAK ML 11.0294
00080033717 FERAMAX 15/1/4 TSP POWDER ORL PWR BIS G 0.2169
00080013210 FERAMAX 150 150 MG CAPSULE ORL CAP BIS CAP 0.4633
00000232599 FERMALAC VAGINAL CAPSULE VAG CAP ROG CAP 1.9310
00002248699 FERODAN 300 MG TABLET ORL TAB ODN TAB 0.0199
00002436523 FERRIPROX 100 MG/ML ORAL SOLUTION ORL SOL APP ML 3.0360
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 61 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002436558 FERRIPROX 1000 MG TABLET ORL TAB APP TAB 30.3642
00002243333 FERRLECIT 12.5 MG/ ML INJECTION INJ DEFAUL SAV ML 5.2720
00002138751 FERROUS FUMARATE 200 MG TABLET ORL TAB VTH TAB 0.0209
00000031089 FERROUS FUMARATE 300 MG TABLET ORL TAB WAM TAB 0.0625
00000031097 FERROUS GLUCONATE 300 MG TABLET ORL TAB JPC TAB 0.0212
00080009681 FERROUS GLUCONATE 300 MG TABLET ORL TAB WAM TAB 0.0625
00002244532 FERROUS GLUCONATE 300 MG TABLET ORL TAB PMT TAB 0.0400
00000041157 FERROUS GLUCONATE 300 MG TABLET ORL TAB ADA TAB 0.0371
00000582727 FERROUS GLUCONATE 324 MG TABLET ORL TAB VTH TAB 0.0231
00002245389 FERROUS GLUCONATE 35 MG TABLET ORL TAB WNP TAB 0.0785
00000782114 FERROUS SULFATE 300 MG TABLET ORL TAB WTR TAB 0.0346
00000346918 FERROUS SULFATE 300 MG TABLET ORL TAB PMT TAB 0.0385
00002441004 FETZIMA 120 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 4.1450
00002440970 FETZIMA 20 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 3.5087
00002440989 FETZIMA 40 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 3.6410
00002440997 FETZIMA 80 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 3.8823
00002460408 FIASP 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 2.9000
00002460416 FIASP 100 UNIT/ML INJECTION CARTRIDGE INJ DEFAUL NNA ML 3.9207
00002460424 FIASP FLEXTOUCH 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 4.0807
00080005803 FIBER PLUS CAPSULE ORL CAP PLT CAP 0.2000
00002207230 FIBRE LAXATIVE 3.4 G/12 G ORAL POWDER ORL PWR PRI G 0.0060
00080009650 FIBRE LAXATIVE SMOOTH TEXTURE ORANGE FLAVOUR ORL PWR ACV G 0.0103
00080009651 FIBRE LAXATIVE UNFLAVOURED ORAL POWDER ORL PWR APH G 0.0109
00002447568 FINASTERIDE 1 MG TABLET ORL TAB SIV TAB 1.1453
00002445085 FINASTERIDE 1 MG TABLET ORL TAB SNS TAB 1.1455
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 62 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002350270 FINASTERIDE 5 MG TABLET ORL TAB PDL TAB 0.4633
00002337037 FIRMAGON 120 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL FEI VIAL 405.5000
00002337029 FIRMAGON 80 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL FEI VIAL 300.0000
00001926853 FLAGYL 500 MG CAPSULE ORL CAP SAV CAP 1.0957
00080000193 FLAX SEED OIL ORL LIQ WNP CAP 0.0410
00002149133 FLAX SEED OIL 500 MG CAPSULE ORL CAP JAM CAP 0.0622
00080000580 FLAXSEED OIL 1000 MG SOFTGEL ORL CAP PMT CAP 0.0937
00080000840 FLAXSEED OIL LIQUID ORL LIQ VML ML 0.0422
00002206218 FLEET PHOSPO-SODA ORAL LIQUID ORL LIQ JJM ML 0.0838
00000999052 FLEXI-T +300 IUD 1 DEFAUL DEFAUL TSN DEV 105.0000
00000999053 FLEXI-T +380 IUD 1 DEFAUL DEFAUL TSN DEV 105.0000
00000999051 FLEXI-T 300 IUD 1 DEFAUL DEFAUL TSN DEV 105.0000
00080021934 FLINTSTONES MULTI VITAMINS COMPLETE CHEWABLE TAB ORL CTB BAI TAB 0.1370
00080022680 FLINTSTONES MULTIPLE VITAMINS COMPLETE CHEW TAB ORL CTB BAI TAB 0.1305
00002230845 FLOLAN 0.5 MG/VIAL INJECTION INJ DEFAUL GLA VIAL 18.6400
00002230848 FLOLAN 1.5 MG/VIAL INJECTION INJ DEFAUL GLA VIAL 37.2700
00002213672 FLONASE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM GSK DOSE 0.2589
00080011335 FLORASMART TABLET ORL TAB RLC TAB 0.5421
00080013321 FLORASTOR 250 MG CAPSULE ORL CAP BCX CAP 1.0150
00002237245 FLOVENT DISKUS 100 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.4053
00002237244 FLOVENT DISKUS 50 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.2522
00002434881 FLUAD PEDIATRIC INJECTION SYRINGE INJ DEFAUL NOV SYR 7.0000
00002261472 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL BAX ML 0.1794
00002248443 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 0.4695
00002388448 FLUCONAZOLE INJECTION SDZ 2 MG/ML INJECTION INJ DEFAUL SDZ ML 0.4695
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 63 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002247749 FLUCONAZOLE OMEGA 2 MG/ML INJECTION INJ DEFAUL OMG ML 0.3660
00002246226 FLUDARA 10 MG TABLET ORL TAB SAV TAB 40.0760
00002249561 FLUMAZENIL 0.1 MG/ML INJECTION INJ DEFAUL SDZ ML 5.0400
00002352621 FLUMIST INFLUENZA VACCINE NASAL SPRAY NAS SPR AZC ML 72.0000
00002426544 FLUMIST QUADRIVALENT NASAL SPRAY NAS SPR AZC ML 90.0000
00001977857 FLUOR A DAY 1.1 MG CHEWABLE TABLET ORL CTB PMS TAB 0.0849
00002090139 FLUOR-A-DAY 0.56 MG CHEWABLE TABLET ORL CTB PMS TAB 0.0849
00000610100 FLUOR-A-DAY 5.56 MG/ML ORAL DROPS ORL DPS PMS ML 0.1760
00002182742 FLUOROURACIL 50 MG/ML INJECTION INJ DEFAUL MNP ML 2.0376
00000012882 FLUOROURACIL 50 MG/ML INJECTION INJ DEFAUL VCL ML 1.6090
00002331721 FLUPENTIXOL DECANOATE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 26.7500
00000578479 FLURAZEPAM 15 MG CAPSULE ORL CAP PDL CAP 0.0675
00000578487 FLURAZEPAM 30 MG CAPSULE ORL CAP PDL CAP 0.0775
00002015986 FLUVIRAL S/F SPLIT-VIRION INFLUENZA VACCINE INJ INJ DEFAUL IAF ML 16.0000
00002420686 FLUVIRAL SUSPENSION FOR INJECTION INJ DEFAUL IAF ML 16.0000
00002236754 FLUVOXAMINE 100 MG TABLET ORL TAB PDL TAB 0.3783
00002236753 FLUVOXAMINE 50 MG TABLET ORL TAB PDL TAB 0.2105
00002420643 FLUZONE QUADRIVALENT 0.5 ML/SYRINGE INJECTION INJ DEFAUL SFP SYR 11.0000
00002432730 FLUZONE QUADRIVALENT 5 ML MULTIDOSE VIAL INJECTION INJ DEFAUL SFP ML 20.0000
00000707511 FML FORTE 0.25% OPH SUSPENSION OPH SUS ALL ML 2.6880
00000247855 FML LIQUIFILM 0.1% OPH SUSPENSION OPH SUS ALL ML 3.2760
00080000549 FOLAPRO 0.8 MG TABLET ORL TAB MTG TAB 0.1916
00000318973 FOLIC ACID 1 MG TABLET ORL TAB JAM TAB 0.0404
00002236747 FOLIC ACID 1 MG TABLET ORL TAB WAM TAB 0.0400
00000647039 FOLIC ACID 1 MG TABLET ORL TAB VTH TAB 0.0079
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 64 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080000273 FOLIC ACID 1 MG TABLET ORL TAB WNP TAB 0.0298
00002048841 FOLIC ACID USP 1 MG TABLET ORL TAB PMT TAB 0.0171
00002435667 FOMEPIZOLE FOR INJECTION 1 G/ML INJ INJ DEFAUL STM ML 820.6233
00002254689 FORTEO 250 MCG/ML INJECTION INJ DEFAUL LIL ML 373.8542
00002241568 FORZA-10 TABLET ORL TAB SDZ TAB 0.1628
00002276429 FOSAVANCE 70 MG/2800 UNIT TABLET ORL TAB MFC TAB 4.8275
00002303000 FOSINOPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.2178
00002303019 FOSINOPRIL-20 20 MG TABLET ORL TAB PDL TAB 0.2619
00002287188 FOSRENOL 1000 MG CHEWABLE TABLET ORL CTB SHB TAB 4.6932
00002287145 FOSRENOL 250 MG CHEWABLE TABLET ORL CTB SHB TAB 1.1761
00002287153 FOSRENOL 500 MG CHEWABLE TABLET ORL CTB SHB TAB 2.3524
00002287161 FOSRENOL 750 MG CHEWABLE TABLET ORL CTB SHB TAB 3.5400
00002377454 FRAGMIN 2,500 IU/ML INJECTION INJ DEFAUL PFI ML 4.0785
00002221799 FRISIUM 10 MG TABLET ORL TAB LUI TAB 0.4393
00002257084 FROVA 2.5 MG TABLET ORL TAB TMP TAB 15.4043
00000989993 FRUCTOSE USP POWDER ORL PWR GNA G 0.0693
00002238578 FUCIDIN H TOPICAL CREAM TOP CRM LEO G 1.3813
00002243862 FUCITHALMIC 1% VISCOUS OPH DROPS (PRESERVED) OPH GEL AMD G 2.5500
00002243861 FUCITHALMIC 1% VISCOUS OPH DROPS (UNPRESERVED) OPH GEL AMD G 4.7790
00002360365 FUROSEMIDE 10MG/ML INJECTION INJ DEFAUL OMG ML 1.0500
00000496723 FUROSEMIDE 20 TABLET ORL TAB PDL TAB 0.0373
00000397792 FUROSEMIDE 40 MG TABLET ORL TAB PDL TAB 0.0558
00000667080 FUROSEMIDE-80 MG TABLET ORL TAB PDL TAB 0.1220
00002247725 FUZEON 108 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 41.2885
00002388200 GABAPENTIN 600 MG TABLET ORL TAB SIV TAB 1.3045
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 65 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002431289 GABAPENTIN 600 MG TABLET ORL TAB SNS TAB 1.3045
00002410990 GABAPENTIN 600 MG TABLET ORL TAB GLM TAB 1.3045
00002392526 GABAPENTIN 600 MG TABLET USP ORL TAB AHI TAB 0.3256
00002431297 GABAPENTIN 800 MG TABLET ORL TAB SNS TAB 1.7393
00002388219 GABAPENTIN 800 MG TABLET ORL TAB SIV TAB 1.7393
00002411008 GABAPENTIN 800 MG TABLET ORL TAB GLM TAB 1.7393
00002392534 GABAPENTIN 800 MG TABLET USP ORL TAB AHI TAB 0.4341
00002416581 GALANTAMINE ER 16 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 1.2467
00002416603 GALANTAMINE ER 24 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 1.2467
00002416573 GALANTAMINE ER 8 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 1.2467
00080031773 GALLEXIER HERBAL BITTERS ORAL SOLUTION ORL SOL FMD ML 0.0868
00002404761 GANCICLOVIR 500 MG/VIAL INJECTION USP INJ DEFAUL FKC VIAL 48.3344
00002283190 GARDASIL 0.5 ML INJECTION INJ DEFAUL MFC ML 287.4600
00002437058 GARDASIL 9 0.5 ML INJECTION INJ DEFAUL MFC ML 315.7800
00000896675 GAS X EXTRA STRENGTH TABLET ORL TAB NVC TAB 0.2456
00002300761 GAS X ULTRA STRENGTH 180 MG CAPSULE ORL CAP NVC CAP 0.2178
00002159791 GAVISCON HEARTBURN RELIEF CHEWABLE TABLET ORL CTB SKB TAB 0.1455
00002231538 GAVISCON HEARTBURN RELIEF EXTRA STRENGTH TABLET ORL TAB SKB TAB 0.2328
00002159775 GAVISCON HEARTBURN RELIEF ORAL LIQUID - FRUIT ORL LIQ SKB ML 0.0214
00002434806 GAZYVA 25 MG/ML INJECTION INJ DEFAUL HLR ML 5429.4400
00002362791 GD-AMLODIPINE/ATORVASTATIN 10 MG/10 MG TABLET ORL TAB GMD TAB 0.9194
00002362805 GD-AMLODIPINE/ATORVASTATIN 10 MG/20 MG TABLET ORL TAB GMD TAB 1.0234
00002362813 GD-AMLODIPINE/ATORVASTATIN 10 MG/40 MG TABLET ORL TAB GMD TAB 1.0624
00002362821 GD-AMLODIPINE/ATORVASTATIN 10 MG/80 MG TABLET ORL TAB GMD TAB 1.0624
00002362759 GD-AMLODIPINE/ATORVASTATIN 5 MG/10 MG TABLET ORL TAB GMD TAB 0.7551
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 66 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002362767 GD-AMLODIPINE/ATORVASTATIN 5 MG/20 MG TABLET ORL TAB GMD TAB 0.8591
00002362775 GD-AMLODIPINE/ATORVASTATIN 5 MG/40 MG TABLET ORL TAB GMD TAB 0.8981
00002362783 GD-AMLODIPINE/ATORVASTATIN 5 MG/80 MG TABLET ORL TAB GMD TAB 0.8981
00002342235 GD-ELETRIPTAN 20 MG TABLET ORL TAB GMD TAB 10.0850
00002342243 GD-ELETRIPTAN 40 MG TABLET ORL TAB GMD TAB 10.0850
00002285843 GD-GABAPENTIN 600 MG TABLET ORL TAB GMD TAB 1.3045
00002285851 GD-GABAPENTIN 800 MG TABLET ORL TAB GMD TAB 1.7393
00002360179 GD-PREGABALIN 150 MG CAPSULE ORL CAP GMD CAP 1.7270
00002360195 GD-PREGABALIN 225 MG CAPSULE ORL CAP GMD CAP 1.7270
00002360136 GD-PREGABALIN 25 MG CAPSULE ORL CAP GMD CAP 0.6173
00002360209 GD-PREGABALIN 300 MG CAPSULE ORL CAP GMD CAP 1.7270
00002360144 GD-PREGABALIN 50 MG CAPSULE ORL CAP GMD CAP 0.9683
00002360152 GD-PREGABALIN 75 MG CAPSULE ORL CAP GMD CAP 1.2528
00002273705 GD-SERTRALINE 100 MG CAPSULE ORL CAP GMD CAP 0.4200
00002273683 GD-SERTRALINE 25 MG CAPSULE ORL CAP GMD CAP 0.2004
00002273691 GD-SERTRALINE 50 MG CAPSULE ORL CAP GMD CAP 0.4008
00002028107 GEL-KAM 0.4% DENTAL GEL DEN GEL COL G 0.0705
00002366150 GELNIQUE 100 MG/G TOPICAL GEL TOP GEL ASC G 1.9760
00001945831 GELUSIL EXTRA STRENGTH CHEWABLE TABLET ORL CTB WLA TAB 0.1484
00001933906 GELUSIL TABLET ORL TAB WSP TAB 0.0598
00002324210 GEMCITABINE 1 G/VIAL INJECTION INJ DEFAUL AHI VIAL 270.0000
00002412292 GEMCITABINE 40 MG/ML INJECTION INJ DEFAUL SDZ ML 10.8120
00002136058 GEMFIBROZIL-600 MG TABLET ORL TAB PDL TAB 0.5157
00002230309 GEMZAR 1 G/VIAL INJECTION INJ DEFAUL LIL VIAL 308.3500
00002230308 GEMZAR 200 MG/VIAL INJECTION INJ DEFAUL LIL VIAL 61.0900
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 67 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080020663 GENESTRA BRAND HMF INTENSIVE PROBIOTIC ORL CAP SRL CAP 1.7166
00080034399 GENESTRA BRANDS DIGEST GLUTEN PLUS CAPSULE ORL CAP SRL CAP 0.3143
00080008885 GENESTRA BRANDS D-MULSION ORL LIQ SRL ML 0.5663
00080012475 GENESTRA BRANDS D-MULSION 400 ORL LIQ SRL ML 0.2367
00002082144 GENTAMICIN (E) 1.2 MG/ML INJECTION INJ DEFAUL BAX ML 0.0794
00002082152 GENTAMICIN (E) 1.6 MG/ML INJECTION INJ DEFAUL BAX ML 0.0890
00002268531 GENTAMICIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 6.0705
00002082136 GENTAMICINE (E) 1 MG/ML INJECTION INJ DEFAUL BAX ML 0.0467
00002231289 GENTEAL 0.3% OPHTHALMIC DROPS OPH DPS ALC ML 0.4327
00002242977 GENTEAL 0.3% OPHTHALMIC GEL OPH GEL ALC ML 0.8110
00080014125 GENTLE IRON CAPSULE ORL CAP VTH CAP 0.0622
00002449498 GENVOYA TABLET ORL TAB GIL TAB 46.3893
00080044443 GI SUSTAIN ORAL POWDER ORL PWR MTG G 0.0676
00002415666 GIOTRIF 20 MG TABLET ORL TAB BOE TAB 73.3000
00002415674 GIOTRIF 30 MG TABLET ORL TAB BOE TAB 73.3000
00002415682 GIOTRIF 40 MG TABLET ORL TAB BOE TAB 73.3000
00080003490 GLA 130 PRIMROSE OIL CAPSULE ORL CAP SRL CAP 0.4438
00002244725 GLEEVEC 100 MG CAPSULE ORL CAP NOV CAP 25.3240
00002253275 GLEEVEC 100 MG TABLET ORL TAB NOV TAB 28.4584
00002253283 GLEEVEC 400 MG TABLET ORL TAB NOV TAB 113.8337
00002248453 GLICLAZIDE-80 MG TABLET ORL TAB PDL TAB 0.0931
00080000015 GLUCOSAMINE SULFATE 500 MG CAPLET ORL TAB JAM TAB 0.0448
00080000082 GLUCOSAMINE SULFATE 500 MG CAPSULE ORL CAP WBP CAP 0.0432
00080000083 GLUCOSAMINE SULFATE 500 MG TABLET ORL TAB WBP TAB 0.0360
00002300451 GLUMETZA 1000 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 1.1944
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 68 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002268493 GLUMETZA 500 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 0.5949
00080009026 GLUTAMINE MAXX ORAL POWDER ORL PWR IHS G 0.0600
00001959352 GLYBURIDE-2.5 MG TABLET ORL TAB PDL TAB 0.0321
00001926039 GLYCERIN RECTAL SUPPOSITORY RT SUP WSP SUP 0.1517
00000873462 GLYCERINE 90% RECTAL SUPPOSITORY USP RT SUP MCO SUP 0.0850
00080006852 GLYCINE ORAL POWDER ORL PWR AOR G 0.0639
00002229516 GLYCON 500 MG TABLET ORL TAB VCL TAB 0.0444
00002239214 GLYCON 850 MG TABLET ORL TAB VCL TAB 0.0610
00002382857 GLYCOPYRROLATE 0.2 MG/ML INJECTION INJ DEFAUL OMG ML 3.9750
00002382849 GLYCOPYRROLATE 0.2 MG/ML MULTIDOSE INJECTION INJ DEFAUL OMG ML 3.1125
00002247884 GLYQUIN XM TOPICAL CREAM TOP CRM VCL G 1.2500
00002459752 GLYXAMBI 10 MG/5 MG TABLET ORL TAB BOE TAB 4.6500
00002459760 GLYXAMBI 25 MG/5 MG TABLET ORL TAB BOE TAB 4.6500
00000652512 GOLYTELY POWDER FOR ORAL LAVAGE SOLUTION ORL PWR BAX G 0.0037
00002248156 GONAL-F 33 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 425.2500
00002248154 GONAL-F 5.5 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 70.8800
00002248157 GONAL-F 77 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 992.2500
00002270404 GONAL-F PEN 300 IU/0.5 ML INJECTION SYRINGE INJ NDL SRO SYR 283.5000
00002270390 GONAL-F PEN 450 IU/0.75 ML INJECTION SYRINGE INJ NDL SRO SYR 425.2500
00002270382 GONAL-F PEN 900 IU/1.5 ML INJECTION SYRINGE INJ NDL SRO SYR 850.5000
00000999546 GOOD START INFANT FORMULA ORL LIQ NHN ML 0.0085
00000999578 GOOD START STAGE 2 INFANT FORMULA ORL PWR NHN G 0.0404
00002232483 GRAMCAL 1000 MG EFFERVESCENT TABLET ORL EVT NVC TAB 0.7295
00080006061 GRAPE SEED CAPLET ORL TAB JAM TAB 0.3122
00002418304 GRASTEK 2800 UNIT SUBLINGUAL TABLET SLG DISNTAB MFC TAB 3.9103
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 69 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002254409 GRAVOL 100 MG LONG ACTING SUSTAINED-RELEASE CAPLET ORL SRT CHD TAB 0.4688
00000511196 GRAVOL 15 MG CHEWABLE TABLET ORL CTB CHD TAB 0.2433
00000230197 GRAVOL 3 MG/ML ORAL LIQUID ORL SYR CHD ML 0.0708
00000013803 GRAVOL 50 MG TABLET ORL TAB CHD TAB 0.2220
00000013609 GRAVOL ADULT 100 MG RECTAL SUPPOSITORY RT SUP CHD SUP 0.5630
00000783595 GRAVOL CHILDREN 25 MG RECTAL SUPPOSITORIES RT SUP CHD SUP 0.4960
00002248180 GRAVOL GINGER LOZENGE ORL LOZ CHD LOZ 0.2275
00000013579 GRAVOL I.M. 50 MG/ML INJECTION INJ DEFAUL CHD ML 1.2080
00002245718 GRAVOL NATURAL SOURCE 500 MG TABLET ORL TAB CHD TAB 0.2275
00002384132 GRAVOL QUICK DISSOLVE CHEWABLE 50 MG TABLET ORL CTB CHD TAB 0.3763
00080014526 GREEN TEA PHYTOSOME COMPLEX CAPSULE ORL CAP JAM CAP 0.2143
00080012417 GREENS+ BONE BUILDER ORAL POWDER ORL PWR GNH G 0.0948
00002384272 GUM PAROEX 0.12% ORAL RINSE ORL MWH SUA ML 0.0153
00000999818 GYNATROF VAGINAL GEL VAG GEL BIK ML 0.8333
00080003089 HAIR & NAILS CAPSULE ORL CAP VTH CAP 0.0933
00002377438 HALAVEN 0.5 MG/ML INJECTION INJ DEFAUL EIS ML 270.0000
00000271691 HALIBUT LIVER OIL SUPER CAPSULE ORL CAP SWS CAP 0.0329
00000202061 HALIBUT LIVER OIL WITH VITAMIN D CAPSULE ORL CAP WAM CAP 0.0268
00002366010 HALOPERIDOL (PRESERVATIVE FREE) 5 MG/ML INJECTION INJ DEFAUL OMG ML 4.9000
00002406411 HALOPERIDOL INJECTION USP 5 MG/ML INJECTION INJ DEFAUL FKC ML 4.6000
00002187078 HAVRIX 1,440 U/ML INJECTION INJ DEFAUL GSK ML 46.4400
00002231056 HAVRIX JUNIOR 720 U/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 23.0000
00080065873 HEMA-FER 12 MG TABLET ORL TAB VAN TAB 0.5357
00002230466 HEMORRHOIDAL RELIEF OINTMENT TOP ONT PRI G 0.2119 LOCFLUS 00000740578 HEPALEAN-LOK 100 IU/ML LOCK FLUSH INJECTION USP INJ H ORG ML 0.3275
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 70 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000579718 HEPARIN LEO 10,000 IU/ML INJECTION INJ DEFAUL LEO ML 1.1000
00002264315 HEPARIN SODIUM 1,000 IU/ML INJECTION USP INJ DEFAUL FKC ML 3.3820
00002303086 HEPARIN SODIUM 1,000 IU/ML INJECTION USP INJ DEFAUL SDZ ML 0.5650
00002382296 HEPARIN SODIUM 1,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 0.5248
00002264307 HEPARIN SODIUM 10,000 IU/ML INJECTION USP INJ DEFAUL FKC ML 6.4912
00002382326 HEPARIN SODIUM 10,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 5.2480
00002382334 HEPARIN SODIUM 5,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 1.2470
00002303094 HEPARIN SODIUM(PRESERVAT FREE)10,000 IU/ML INJ USP INJ DEFAUL SDZ ML 6.0610
00002303108 HEPARIN SODIUM(WITH PRESERVAT)10,000 IU/ML INJ USP INJ DEFAUL SDZ ML 4.2734
00002239194 HEPTOVIR 5 MG/ML ORAL SOLUTION ORL SOL GSK ML 0.2300
00002175622 HERBAL WATER TABLET ORL TAB VCL TAB 0.0621
00002240692 HERCEPTIN 440 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2803.8000
00000575178 HISTANTIL 25 MG TABLET ORL TAB PMS TAB 0.1158
00000575186 HISTANTIL 50 MG TABLET ORL TAB PMS TAB 0.1849
00001948903 HONEY BEE VENOM 1.1 MG INJ DEFAUL ALG VIAL 30.8667
00001948911 HONEY BEE VENOM 120 MCG INJ DEFAUL ALG VIAL 30.8667
00002078759 HUMATIN 250 MG CAPSULE ORL CAP PFI CAP 2.7500
00000745626 HUMATROPE 1 MG/ML INJECTION INJ DEFAUL LIL VIAL 233.3500
00002243079 HUMATROPE 24 MG INJECTION INJ DEFAUL LIL VIAL 1120.0800
00002458357 HUMIRA 40 MG/0.4 ML INJECTION PEN INJ NDL ABV SYR 762.5700
00002458349 HUMIRA 40 MG/0.4 ML INJECTION SYRINGE INJ NDL ABV SYR 762.5700
00002415089 HUMULIN R 100 UNIT/ML INJECTION KWIKPEN INJ DEFAUL LIL ML 2.9307
00000999015 HYALGAN DEFAUL DEV MDX ML 25.0000
00002231116 HYCAMTIN 4 MG / VIAL INJECTION INJ DEFAUL NOV VIAL 653.5700
00001916580 HYCODAN 1 MG/ML ORAL SYRUP ORL SYR BMS ML 0.1328
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 71 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00001916599 HYCODAN 5 MG TABLET ORL TAB BMS TAB 1.1120
00002231476 HYDRASENSE NASAL SOLUTION NAS SOL SCH ML 0.0598
00000465283 HYDREA 500 MG CAPSULE ORL CAP BMS CAP 1.0203
00000341975 HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PDL TAB 0.0157
00002244797 HYDROMORPHONE HP FORTE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 77.7630
00002382636 HYDROMORPHONE HYDROCHLORIDE 10 MG/ML INJ USP HP 10 INJ DEFAUL HSP ML 2.4200
00000564281 HYDROSONE 0.5% CREAM TOP CRM RPH G 0.1267
00002343096 HYDROXYUREA 500 MG CAPSULE ORL CAP SNS CAP 1.0203
00000742813 HYDROXYZINE HCL 50 MG/ML INJECTION USP INJ DEFAUL SDZ ML 10.3070
00000999822 HYLO DROPS OPH SOL CNV ML 3.0000
00000999823 HYLO DUAL OPH SOL CNV ML 3.6690
00000999824 HYLO GEL OPH GEL CNV ML 4.0000
00002229868 HYOSCINE BUTYLBROMIDE 20 MG/ML INJECTION INJ DEFAUL SDZ ML 4.7460
00002230697 HYPERTET S/D 250 IU/SYR INJECTION INJ DEFAUL GRL SYR 78.0000
00002133253 HYPOTEARS 1% OPH SOLUTION OPH SOL ALC ML 0.4147
00002133288 HYPOTEARS 85%/15% EYE OINTMENT OPH ONT ALC G 1.5886
00002275864 HYPURIN NPH INSULIN ISOPHANE PORK 100 UNIT/ML INJ INJ DEFAUL NTI ML 9.9000
00002275872 HYPURIN REGULAR INSULIN PORK 100 UNIT/ML INJ INJ DEFAUL NTI ML 9.9000
00080022866 IBEROGAST ORAL SOLUTION ORL SOL STA ML 0.1951
00002453169 IBRANCE 100 MG CAPSULE ORL CAP PFI CAP 297.6190
00002453177 IBRANCE 125 MG CAPSULE ORL CAP PFI CAP 297.6190
00002453150 IBRANCE 75 MG CAPSULE ORL CAP PFI CAP 297.6190
00002357275 IBUPROFEN 200 MG LIQUID CAPSULE ORL CAP VTH CAP 0.0681
00002257912 IBUPROFEN 200 MG TABLET ORL TAB PMT TAB 0.0498
00002317338 IBUPROFEN 400 MG CAPLET ORL TAB PMT TAB 0.0392
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 72 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000636533 IBUPROFEN 400 MG TABLET ORL TAB PDL TAB 0.0372
00002437333 ICLUSIG 15 MG TABLET ORL TAB ARI TAB 142.8446
00002437341 ICLUSIG 45 MG TABLET ORL TAB ARI TAB 331.6398
00002344939 ILARIS 150 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 16000.0000
00002411393 ILEVRO 0.3% OPHTHALMIC SUSPENSION OPH SUS ALC ML 7.4933
00002434407 IMBRUVICA 140 MG CAPSULE ORL CAP JAI CAP 92.1910
00002358336 IMIPENEM & CILASTATIN 250 MG/250 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 11.7400
00002358344 IMIPENEM & CILASTATIN 500 MG/500 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 21.9400
00002376016 IMODIUM 2 MG CAPSULE ORL CAP MCL CAP 0.9017
00002245185 IMODIUM ADVANCED CAPLET ORL TAB MCL TAB 0.6455
00002237297 IMODIUM ADVANCED CHEWABLE TABLET ORL CTB MCL TAB 0.9280
00002230542 IMODIUM QUICK DISSOLVE 2 MG TABLET ORL TAB MCL TAB 0.8340
00001959042 IMOVAX POLIO INJECTION SYRINGE INJ NDL SFP SYR 44.3200
00001908286 IMOVAX RABIES VACCINE 2.5 UNIT/VIAL INJECTION INJ DEFAUL SFP VIAL 194.3900
00002240713 IMUNOVIR 500 MG TABLET ORL TAB RIP TAB 1.9507
00002244895 IMURAN 50 MG/VIAL INJECTION INJ DEFAUL ASN VIAL 101.3400
00002445824 INDAPAMIDE 1.25 MG TABLET ORL TAB SNS TAB 0.0745
00002445832 INDAPAMIDE 2.5 MG TABLET ORL TAB SNS TAB 0.1182
00002398869 INDAYO 0.15 MG/0.03 MG (91 DAY) TABLET ORL TAB MYP TAB 0.5051
00002042266 INDERAL-LA 120 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 1.1118
00002042274 INDERAL-LA 160 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 1.3148
00002042231 INDERAL-LA 60 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.6403
00002042258 INDERAL-LA 80 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.7222
00000558079 INFANTOL ORAL LIQUID ORL LIQ CHD ML 0.0191
00002046059 INFANTS' TYLENOL 80 MG/ML ORAL SUSPENSION DROPS ORL DPS MCL ML 0.2940
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 73 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002269562 INFLUVAC VACCINE INJECTION SYRINGE INJ DEFAUL ABB SYR 7.4400
00002389630 INLYTA 1 MG TABLET ORL TAB PFI TAB 19.1580
00002389649 INLYTA 5 MG TABLET ORL TAB PFI TAB 95.7900
00080013031 INNO-Q-NOL 100 MG SOFT GEL CAPSULE ORL CAP INN CAP 1.1325
00080026628 INSTAFLEX JOINT SUPPORT CAPSULE ORL CAP DDI CAP 0.3332
00000762040 INSTA-GLUCOSE (1 DOSE PER TUBE) ORAL LIQUID ORL LIQ VCL DOSE 3.8300
00002294990 INSTILLAGEL 2% /0.05% TOPICAL GEL TOP GEL PPH ML 0.9667
00002348756 INTANZA INJECTION SYRINGE INJ DEFAUL SFP SYR 12.0000
00002306778 INTELENCE 100 MG TABLET ORL TAB JAI TAB 6.0178
00002375931 INTELENCE 200 MG TABLET ORL TAB JAI TAB 11.7915
00002238675 INTRON A 10 MIU/ML INJECTION - HUMAN ALBUMIN FREE INJ DEFAUL MFC ML 120.9400
00002223406 INTRON A 10,000,000 UNIT/VIAL INJECTION INJ DEFAUL MFC ML 125.2000
00002238674 INTRON A 6 MIU/ML INJECTION - HUMAN ALBUMIN FREE INJ DEFAUL MFC ML 72.5633
00002240693 INTRON A MULTI-DOSE PEN 15 MIU/ML INJECTION SYR INJ NDL MFC SYR 217.6900
00002240694 INTRON A MULTI-DOSE PEN 25 MIU/ML INJECTION SYR INJ NDL MFC SYR 362.7800
00002240695 INTRON A MULTI-DOSE PEN 50 MIU/ML INJECTION SYR INJ NDL MFC SYR 725.6100
00002409100 INTUNIV XR 1 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.0000
00002409119 INTUNIV XR 2 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.6500
00002409127 INTUNIV XR 3 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 4.3000
00002409135 INTUNIV XR 4 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 4.9500
00002455943 INVEGA TRINZA 175 MG/0.875 ML INJECTION SYRINGE INJ NDL JAI SYR 934.2900
00002455986 INVEGA TRINZA 263 MG/1.315 ML INJECTION SYRINGE INJ NDL JAI SYR 1401.5400
00002455994 INVEGA TRINZA 350 MG/1.75 ML INJECTION SYRINGE INJ NDL JAI SYR 1401.5400
00002456001 INVEGA TRINZA 525 MG/2.625 ML INJECTION SYRINGE INJ NDL JAI SYR 1868.6700
00002216965 INVIRASE 200 MG CAPSULE ORL CAP HLR CAP 1.9021
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 74 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002279320 INVIRASE 500 MG TABLET ORL TAB HLR TAB 4.5176
00002455455 INVOKAMET 150 MG/1000 MG TABLET ORL TAB JAI TAB 1.5338
00002455439 INVOKAMET 150 MG/500 MG TABLET ORL TAB JAI TAB 1.5338
00002455447 INVOKAMET 150 MG/850 MG TABLET ORL TAB JAI TAB 1.5338
00002455420 INVOKAMET 50 MG/1000 MG TABLET ORL TAB JAI TAB 1.5338
00002455404 INVOKAMET 50 MG/500 MG TABLET ORL TAB JAI TAB 1.5338
00002455412 INVOKAMET 50 MG/850 MG TABLET ORL TAB JAI TAB 1.5338
00000888354 IOPIDINE 1% OPH SOLUTION (UNIT DOSE) OPH SOL ALC ML 62.3667
00002246084 IPRAVENT 0.06% NASAL SPRAY NAS SPR AAP ML 1.4900
00002365200 IRBESARTAN 150 MG TABLET ORL TAB PDL TAB 0.3025
00002365219 IRBESARTAN 300 MG TABLET ORL TAB PDL TAB 0.3025
00002365197 IRBESARTAN 75 MG TABLET ORL TAB PDL TAB 0.3025
00002365162 IRBESARTAN-HCTZ 150 MG/12.5 MG TABLET ORL TAB PDL TAB 0.3024
00002365170 IRBESARTAN-HCTZ 300 MG/12.5 MG TABLET ORL TAB PDL TAB 0.3024
00002365189 IRBESARTAN-HCTZ 300 MG/25 MG TABLET ORL TAB PDL TAB 0.3004
00002248676 IRESSA 250 MG TABLET ORL TAB AZC TAB 73.3000
00002392437 ISENTRESS 100 MG CHEWABLE TABLET ORL CTB MFC TAB 3.9838
00002392429 ISENTRESS 25 MG CHEWABLE TABLET ORL CTB MFC TAB 0.9958
00002301881 ISENTRESS 400 MG TABLET ORL TAB MFC TAB 14.0302
00000999562 ISOMIL INFANT FORMULA ORL LIQ ABN ML 0.0318
00000897639 ISOPROTERENOL HYDROCHLORIDE 0.2 MG/ML INJECTION INJ DEFAUL SDZ ML 10.1410
00000000809 ISOPTO TEARS 0.5% OPH DROPS OPH DPS ALC ML 0.5147
00000000817 ISOPTO TEARS 1.0% OPH DROPS OPH DPS ALC ML 0.5147
00000272655 ISOTAMINE 300 MG TABLET ORL TAB VCL TAB 0.0899
00002414295 ISTODAX 10 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 2582.0000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 75 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002333279 IXIARO 6 MCG/0.5ML INJECTION SYRINGE INJ NDL NOV SYR 193.2500
00002452227 JADENU 180 MG TABLET ORL TAB NOV TAB 20.4928
00002452235 JADENU 360 MG TABLET ORL TAB NOV TAB 40.9871
00002452219 JADENU 90 MG TABLET ORL TAB NOV TAB 10.2460
00002434814 JAKAVI 10 MG TABLET ORL TAB NOV TAB 83.8355
00002388014 JAKAVI 15 MG TABLET ORL TAB NOV TAB 83.8355
00002388022 JAKAVI 20 MG TABLET ORL TAB NOV TAB 83.8355
00002388006 JAKAVI 5 MG TABLET ORL TAB NOV TAB 83.8355
00002372010 JALYN 0.5 MG/0.4 MG MODIFIED RELEASE CAPSULE ORL MRC GSK CAP 1.6570
00002246040 JAMP CALCIUM 500 MG TABLET ORL TAB JPC TAB 0.0216
00002417308 JAMP OLANZAPINE FC 20 MG TABLET ORL TAB JPC TAB 10.3093
00002388308 JAMP-ACET-TRAMADOL 37.5 MG/325 MG TABLET ORL TAB JPC TAB 0.6264
00080037789 JAMP-AD 5000 IU/ 400 IU CHEWABLE TABLET ORL CTB JPC TAB 0.1053
00002421593 JAMP-ALLOPURINOL 100 MG TABLET ORL TAB JPC TAB 0.0780
00002421607 JAMP-ALLOPURINOL 200 MG TABLET ORL TAB JPC TAB 0.1300
00002421615 JAMP-ALLOPURINOL 300 MG TABLET ORL TAB JPC TAB 0.2125
00002400154 JAMP-ALPRAZOLAM 2 MG TABLET ORL TAB JPC TAB 0.5508
00002435527 JAMP-AMITRIPTYLINE 10 MG TABLET ORL TAB JPC TAB 0.0435
00002435535 JAMP-AMITRIPTYLINE 25 MG TABLET ORL TAB JPC TAB 0.0829
00002435543 JAMP-AMITRIPTYLINE 50 MG TABLET ORL TAB JPC TAB 0.1540
00002435551 JAMP-AMITRIPTYLINE 75 MG TABLET ORL TAB JPC TAB 0.3634
00002433060 JAMP-AMOXICILLIN 250 MG CAPSULE ORL CAP JPC CAP 0.1750
00002433079 JAMP-AMOXICILLIN 500 MG CAPSULE ORL CAP JPC CAP 0.3417
00002339080 JAMP-ANASTROZOLE 1 MG TABLET ORL TAB JPC TAB 2.5458
00002283905 JAMP-ASA 80 MG TABLET ORL DRT JPC TAB 0.0560
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 76 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002427206 JAMP-ASA 81 MG ENTERIC-COATED TABLET ORL ECT VTH TAB 0.0530
00002357216 JAMP-BICALUTAMIDE 50 MG TABLET ORL TAB JPC TAB 4.0573
00002410893 JAMP-BISACODYL 5 MG SUPPOSITORY RT SUP JPC SUP 0.4367
00002246039 JAMP-BISACODYL 5 MG TABLET ORL TAB JPC TAB 0.0426
00080068124 JAMP-CALCIUM CITRATE (500MG) LIQ D1000 ORAL LIQUID ORL LIQ JPC ML 0.0779
00080028892 JAMP-CALCIUM CITRATE 250 MG + VIT D 1000 IU TABLET ORL TAB JPC TAB 0.1224
00080068122 JAMP-CALCIUM CITRATE LIQ 500 MG ORAL LIQUID ORL LIQ JPC ML 0.0733
00002451778 JAMP-CETIRIZINE 10 MG TABLET ORL TAB JPC TAB 0.4083
00002451751 JAMP-CETIRIZINE 5 MG TABLET ORL TAB JPC TAB 0.3773
00002391619 JAMP-DICYCLOMINE HCL 10 MG TABLET ORL TAB JPC TAB 0.4200
00002366088 JAMP-DICYCLOMINE HCL 20 MG TABLET ORL TAB JPC TAB 0.2207
00002283220 JAMP-DOCUSATE SODIUM 50 MG/ML ORAL SYRUP ORL SYR JPC ML 0.9203
00080036242 JAMP-E 200 IU CHEWABLE TABLET ORL CTB JPC TAB 0.1474
00080024232 JAMP-FER 300 MG CAPSULE ORL CAP JPC CAP 0.1300
00080025200 JAMP-FER FC 100 MG/ 0.5 MG/ 200 MG CAPSULE ORL CAP JPC CAP 0.2281
00080024544 JAMP-FERROUS FUMERATE 300 MG TABLET ORL TAB JPC TAB 0.1172
00080047569 JAMP-FERROUS POLYSACCHARIDE 150 MG CAPSULE ORL CAP JPC CAP 0.3997
00000031100 JAMP-FERROUS SULFATE 300 MG TABLET ORL TAB JPC TAB 0.0165
00080053274 JAMP-FOLIC ACID 1 MG TABLET ORL TAB JPC TAB 0.0152
00002402289 JAMP-GABAPENTIN 600 MG TABLET ORL TAB JPC TAB 1.3045
00002402297 JAMP-GABAPENTIN 800 MG TABLET ORL TAB JPC TAB 1.7393
00080061502 JAMP-HYDROCORTISONE ACETATE 1% UREA 10% LOTION TOP LOT JPC ML 0.1558
00080057189 JAMP-HYDROCORTISONE CREAM 1% TOPICAL CREAM TOP CRM JPC G 0.1251
00002401290 JAMP-IBUPROFEN 400 MG TABLET ORL TAB JPC TAB 0.0372
00080047136 JAMP-IRON POLYPEPTIDE 11 MG TABLET ORL TAB JPC TAB 0.6420
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 77 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080023817 JAMP-K-CITRATE 10 MEQ TABLET ORL SRT JPC TAB 0.1626
00002373009 JAMP-LETROZOLE 2.5 MG TABLET ORL TAB JPC TAB 2.7560
00002386836 JAMP-LIDOCAINE 5% TOPICAL OINTMENT TOP ONT JPC G 0.2800
00080041590 JAMP-MAGNESIUM 100 MG TABLET ORL TAB JPC TAB 0.2632
00080009357 JAMP-MAGNESIUM 100 MG/ML ORAL SOLUTION ORL SOL JPC ML 0.0210
00080043440 JAMP-MAGNESIUM 250 MG TABLET ORL TAB JPC TAB 0.1026
00002419173 JAMP-METHOTREXATE (UNPRESERVED) 25 MG/ML INJECTION INJ DEFAUL JPC ML 5.6250
00002442353 JAMP-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB JPC TAB 0.3865
00002442361 JAMP-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB JPC TAB 0.4280
00002427745 JAMPOCAINE 2% VISCOUS TOPICAL SOLUTION TOP SOL JPC ML 0.0525
00002406640 JAMP-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB JPC TAB 5.3553
00002406659 JAMP-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB JPC TAB 7.5977
00002440717 JAMP-OXCARBAZEPINE 150 MG TABLET ORL TAB JPC TAB 0.6209
00002440725 JAMP-OXCARBAZEPINE 300 MG TABLET ORL TAB JPC TAB 0.9102
00002440733 JAMP-OXCARBAZEPINE 600 MG TABLET ORL TAB JPC TAB 1.8204
00002408414 JAMP-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT JPC TAB 1.2750
00002397307 JAMP-PIOGLITAZONE 15 MG TABLET ORL TAB JPC TAB 0.5809
00002365529 JAMP-PIOGLITAZONE 30 MG TABLET ORL TAB JPC TAB 0.8139
00002365537 JAMP-PIOGLITAZONE 45 MG TABLET ORL TAB JPC TAB 1.2237
00002420430 JAMP-PIP/TAZ 4 G/500 MG/VIAL INJECTION INJ DEFAUL JPC VIAL 12.1100
00002436000 JAMP-PREGABALIN 150 MG CAPSULE ORL CAP JPC CAP 1.7270
00002435977 JAMP-PREGABALIN 25 MG CAPSULE ORL CAP JPC CAP 0.6173
00002436019 JAMP-PREGABALIN 300 MG CAPSULE ORL CAP JPC CAP 1.7270
00002435985 JAMP-PREGABALIN 50 MG CAPSULE ORL CAP JPC CAP 0.9683
00002435993 JAMP-PREGABALIN 75 MG CAPSULE ORL CAP JPC CAP 1.2529
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 78 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002380617 JAMP-PYRANTEL PAMOATE 125 MG TABLET ORL TAB JPC TAB 0.9410
00080040279 JAMP-QUININE 200 MG CAPSULE ORL CAP JPC CAP 0.2390
00080040277 JAMP-QUININE 300 MG CAPSULE ORL CAP JPC CAP 0.3750
00002440334 JAMP-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB JPC CAP 0.8550
00002405687 JAMP-SILDENAFIL 100 MG TABLET ORL TAB JPC TAB 9.2000
00002405660 JAMP-SILDENAFIL 25 MG TABLET ORL TAB JPC TAB 8.2900
00002405679 JAMP-SILDENAFIL 50 MG TABLET ORL TAB JPC TAB 8.8475
00080034416 JAMP-SODIUM PHOSPHATE 0.891 G -2.4 G/5 ML SOLUTION ORL SOL JPC ML 0.0947
00002451840 JAMP-TADALAFIL 10 MG TABLET ORL TAB JPC TAB 11.9250
00002451824 JAMP-TADALAFIL 2.5 MG TABLET ORL TAB JPC TAB 3.6471
00002451859 JAMP-TADALAFIL 20 MG TABLET ORL TAB JPC TAB 12.3575
00002451832 JAMP-TADALAFIL 5 MG TABLET ORL TAB JPC TAB 3.6471
00002447800 JAMP-TIMOLOL 0.5% OPHTHALMIC SOLUTION OPH SOL JPC ML 1.5501
00002435616 JAMP-TOPIRAMATE 100 MG TABLET ORL TAB JPC TAB 0.5928
00002435624 JAMP-TOPIRAMATE 200 MG TABLET ORL TAB JPC TAB 0.8853
00002435608 JAMP-TOPIRAMATE 25 MG TABLET ORL TAB JPC TAB 0.3128
00002420309 JAMP-VANCOMYCIN 1 G/VIAL INJECTION INJ DEFAUL JPC VIAL 58.9900
00002420325 JAMP-VANCOMYCIN 10 G/VIAL INJECTION INJ DEFAUL JPC VIAL 589.9000
00002420317 JAMP-VANCOMYCIN 5 G/VIAL INJECTION INJ DEFAUL JPC VIAL 509.7900
00002420295 JAMP-VANCOMYCIN 500 MG/VIAL INJECTION INJ DEFAUL JPC VIAL 31.0500
00080054130 JAMP-VITAMIN A 10, 000 IU CAPSULE ORL CAP JPC CAP 0.0431
00080028902 JAMP-VITAMIN B12 1000 MCG RAPID DISSOLVE TABLET ORL TAB JPC TAB 0.0884
00002449099 JAMP-VITAMIN D 10,000 UNIT CAPSULE ORL CAP JPC CAP 0.2100
00002379007 JAMP-VITAMIN D 10000 UNIT TABLET ORL TAB JPC TAB 0.2100
00002449110 JAMP-VITAMIN D 50,000 IU CAPSULE ORL CAP JPC CAP 0.9162
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 79 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080054585 JAMP-VITAMIN K + VITAMIN D TABLET ORL TAB JPC TAB 0.0627
00080055096 JAMP-VITAMIN K 100 MCG TABLET ORL TAB JPC TAB 0.0627
00002356805 JAMP-ZOPICLONE 7.5 MG TABLET ORL TAB JPC TAB 0.3125
00002369524 JEVTANA 40 MG/ML INJECTION INJ DEFAUL SAV VIAL 5800.0000
00002437503 JINARC 45 MG/15 MG COMBINATION PACK ORL TAB OTS TAB 45.2057
00002437511 JINARC 60 MG/30 MG COMBINATION PACK ORL TAB OTS TAB 45.2057
00002437538 JINARC 90 MG/30 MG COMBINATION PACK ORL TAB OTS TAB 45.2057
00002413388 JUBLIA 10% TOPICAL SOLUTION TOP SOL VCL ML 11.0850
00002247344 JUNIOR STRENGTH MOTRIN 100 MG CHEWABLE TABLET ORL CTB MCL TAB 0.2250
00002337282 JURNISTA 16 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 5.5843
00002337290 JURNISTA 32 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 11.1677
00002337266 JURNISTA 4 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.3953
00002337274 JURNISTA 8 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.7917
00002420376 JUXTAPID 10 MG CAPSULE ORL CAP AEP CAP 1040.0000
00002420384 JUXTAPID 20 MG CAPSULE ORL CAP AEP CAP 1040.0000
00002420341 JUXTAPID 5 MG CAPSULE ORL CAP AEP CAP 1040.0000
00002412365 KADCYLA 20 MG/ML INJECTION POWDER FOR SOLUTION INJ DEFAUL HLR ML 415.3780
00002312301 KALETRA 100 MG/25 MG TABLET ORL TAB ABV TAB 2.8427
00002285533 KALETRA 200 MG/50 MG TABLET ORL TAB ABV TAB 5.6853
00002243644 KALETRA 80 MG/ML/20MG/ML ORAL SOLUTION ORL SOL ABV ML 2.2746
00002442612 KALYDECO 50 MG GRANULES ORL GRNUL VER PCKT 420.0000
00002442620 KALYDECO 75 MG GRANULES ORL GRNUL VER PCKT 420.0000
00002417235 KAZANO 12.5 MG/1000 MG TABLET ORL TAB TAK TAB 1.1950
00002417219 KAZANO 12.5 MG/500 MG TABLET ORL TAB TAK TAB 1.1950
00002417227 KAZANO 12.5 MG/850 MG TABLET ORL TAB TAK TAB 1.1950
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 80 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080011529 K-CITRA 2 MEQ/ML SOLUTION ORL LIQ SFD ML 0.0349
00002243768 K-CITRA POTASSIUM CITRATE 10 MEQ SRT ORL SRT SFD TAB 0.2699
00000224391 KETALAR 10 MG/ML INJECTION INJ DEFAUL ERF ML 1.6000
00000224405 KETALAR 50 MG/ML INJECTION INJ DEFAUL ERF ML 5.3000
00002246796 KETAMINE 50 MG/ML INJECTION USP INJ DEFAUL SDZ ML 5.1980
00002246795 KETAMINE HYDROCHLORIDE 10 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.6450
00002244947 KETOROLAC TROMETHAMINE 30 MG/ML INJECTION INJ DEFAUL FKC ML 5.1452
00002443376 KETOROLAC TROMETHAMINE 30 MG/ML INJECTION INJ DEFAUL MDA ML 4.4100
00002400871 KETOTIFEN 0.25 MG/ML OPH SOLUTION OPH SOL STM ML 4.2340
00002460548 KEVZARA 200 MG/1.14 ML INJECTION SYRINGE INJ NDL SAV SYR 700.0000
00002441152 KEYTRUDA 50 MG/VIAL INJECTION INJ DEFAUL MFC VIAL 2200.0000
00080020666 KID'S LIQUID VITAMIN D 400 IU ORL LIQ WBP ML 0.1306
00002269341 KIVEXA 600 MG/300 MG TABLET ORL TAB GSK TAB 24.5637
00001928783 KOFFEX SIROP 3 MG/ML ORAL SYRUP ORL SYR ROG ML 0.0190
00080052499 KRILL OIL CAPSULE ORL CAP WNP CAP 0.4383
00080022006 KRILL OIL SOFTGEL CAPSULE ORL CAP WBP CAP 0.2192
00002350580 KUVAN 100 MG TABLET ORL TAB BMI TAB 33.0000
00002459523 KYLEENA 19.5 MG INTRAUTERINE INSERT IU INS BAI SYS 344.6600
00080004073 KYOLIC AGED GARLIC EXTRACT ORAL CAPLET ORL TAB WKG TAB 0.5991
00002451034 KYPROLIS 60 MG/VIAL INJECTION INJ DEFAUL AMG VIAL 1533.3300
00002231689 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL SDZ ML 1.3900
00002387468 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL MYP ML 1.2930
00000210889 LACRI-LUBE OPH OINTMENT OPH ONT ALL G 2.0543
00002250624 LACRISERT 5 MG OPHTHALMIC INSERT OPH INS ATP DEV 3.3380
00080012831 LACTOBACILLUS ACIDOPHILUS & BIFIDUS ORL CAP SWS CAP 0.1123
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 81 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000468401 LAIT DE MAGNESIE ORL SUSP (MILK OF MAGNESIA) ORL SUS ATL ML 0.0068
00002243803 LAMICTAL 2 MG CHEWABLE TABLET ORL CTB GSK TAB 0.1700
00002366282 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.6000
00002385775 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC SIV CAP 0.5000
00000608734 LANSOYL JELLY 78% ORL GEL AUP G 0.0467
00002186926 LANSOYL SUGAR FREE JELLY 78% ORL GEL AUP G 0.0467
00000282081 LANVIS 40 MG TABLET ORL TAB ASN TAB 4.6796
00002375508 LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL RIV ML 3.6320
00002415828 LEFLUNOMIDE 10 MG TABLET ORL TAB PDL TAB 2.6433
00002415836 LEFLUNOMIDE 20 MG TABLET ORL TAB PDL TAB 2.6433
00002450321 LENVIMA (10 MG DAILY DOSE) 10 MG CAPSULE ORL CAP EIS CAP 71.6400
00002450313 LENVIMA (14 MG DAILY DOSE) 10 MG / 4 MG CAPSULE ORL CAP EIS CAP 55.2100
00002450305 LENVIMA (20 MG DAILY DOSE) 10 MG CAPSULE ORL CAP EIS CAP 82.8200
00002450291 LENVIMA (24 MG DAILY DOSE) 10 MG / 4 MG CAPSULE ORL CAP EIS CAP 73.6133
00002061562 LESCOL 20 MG CAPSULE ORL CAP NOV CAP 0.9003
00002061570 LESCOL 40 MG CAPSULE ORL CAP NOV CAP 1.2642
00002348969 LETROZOLE 2.5 MG TABLET ORL TAB APH TAB 2.7560
00002402025 LETROZOLE 2.5 MG TABLET ORL TAB PDL TAB 1.3780
00002338459 LETROZOLE 2.5 MG TABLET ORL TAB AHI TAB 3.0617
00002347997 LETROZOLE 2.5 MG TABLET ORL TAB TEV TAB 2.7560
00002183005 LEUCOVORIN CALCIUM 10 MG/ML INJECTION INJ DEFAUL MNP ML 14.0080
00000004626 LEUKERAN 2 MG TABLET ORL TAB ASN TAB 1.5140
00002236840 LEVAQUIN 25 MG/ML INJECTION INJ DEFAUL JAI ML 2.2895
00002236839 LEVAQUIN 5 MG/ML INJECTION INJ DEFAUL JAI ML 0.4578
00002236842 LEVAQUIN 500 MG TABLET ORL TAB JAI TAB 5.6784
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 82 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002246804 LEVAQUIN 750 MG TABLET ORL TAB JAI TAB 10.0474
00002250470 LEVITRA 10 MG TABLET ORL TAB BAI TAB 12.2325
00002250489 LEVITRA 20 MG TABLET ORL TAB BAI TAB 13.5925
00002250462 LEVITRA 5 MG TABLET ORL TAB BAI TAB 10.9650
00002415879 LEVOFLOXACIN 500 MG TABLET ORL TAB PDL TAB 1.3718
00002245948 LEVOTHYROXINE SODIUM 0.5 MG/VIAL INJECTION INJ DEFAUL FKC VIAL 379.6800
00002243933 LEVULAN KERASTICK 20% TOPICAL SOLUTION TOP SOL DSP ML 166.0000
00000999056 LIBERTE COPPER IUD TT380 STANDARD 10 YEARS DEFAUL DEFAUL MDI DEV 59.0000
00000999054 LIBERTE UT380 COPPER IUD 380MG SHORT DEFAUL DEFAUL MDI DEV 51.0000
00000999055 LIBERTE UT380 COPPER IUD 380MG STANDARD DEFAUL DEFAUL MDI DEV 51.0000
00002422026 LIDOCAINE HCL (WITH PRESERVATIVE) 2% INJECTION INJ DEFAUL TGT ML 0.3500
00002421992 LIDOCAINE HCL 2% INJECTION INJ DEFAUL ALV ML 1.0500
00002296187 LIDOCAINE HCL 2% INJECTION (BLOCK OR INFILTRATION) INJ LIQ ALV ML 1.0500
00000436208 LIDOCAINE HYDROCHLORIDE 2% INJECTION INJ DEFAUL HSP ML 5.8420
00002143879 LIDODAN 2% TOPICAL JELLY TOP JEL ODN ML 0.4067
00002231147 LIDODAN ENDOTRACHEAL 10 MG/DOSE NON-AEROSOL SPRAY TOP SPR ODN DOSE 0.2225
00000874949 LIDOMYXIN OTIC LIQUID OT LIQ SDZ ML 0.5960
00000999897 LIFE BRAND BASE TOPICAL CREAM TOP CRM SDG G 0.0221
00002243101 LIFE BRAND DAILY LOW DOSE ASA 81 MG ECT ORL ECT PMS TAB 0.1597
00080003212 LIFE BRAND ORAL LAXATIVE ORL LIQ HJS ML 0.0920
00000030732 LINCOCIN 300 MG/ML INJECTION INJ DEFAUL PFI ML 3.0190
00002402637 LINEZOLID 2 MG/ML INJECTION INJ DEFAUL TEV ML 0.2958
00002269082 LIPIDIL EZ 145 MG TABLET ORL TAB BGP TAB 1.0977
00002269074 LIPIDIL EZ 48 MG TABLET ORL TAB BGP TAB 0.4287
00002146959 LIPIDIL MICRO 200 MG CAPSULE ORL CAP FAB CAP 1.0890
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 83 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002241601 LIPIDIL SUPRA 100 MG TABLET ORL TAB BGP TAB 1.1130
00000999813 LIPISTART FORMULA ORAL POWDER ORL PWR VTF G 0.0945
00080006893 LIQUID CALCIUM WITH VITAMIN D ORL LIQ WBP ML 0.0168
00080001853 LIQUID GLUCOSAMINE ORL LIQ JAM ML 0.0310
00080001800 LIQUID GLUCOSAMINE/CHONDROITIN & MSM LIQUID ORL LIQ WBP ML 0.0334
00080007222 LIQUID OMEGA-3 PLUS VITAMIN A & D ORL LIQ WNP ML 0.0939
00002266695 LITHMAX 300 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.2545
00002020017 LIVOSTIN 50 MCG PER DOSE NASAL SPRAY NAS SPR JAI ML 2.0653
00080027321 LIVRELIEF EXTRA STRENGTH NERVE PAIN RELIEF TOP CRM DVI G 0.3154
00080022837 LIVRELIEF PAIN RELIEF CREAM TOP CRM DVI G 0.1792
00000074462 LOCACORTEN VIOFORM TOPICAL CREAM TOP CRM PAL G 0.9890
00002417456 LOLO (28 DAY) TABLET ORL TB ASC TAB 0.6214
00000590819 LOPRESOR 1.0 MG/ML INJECTION INJ DEFAUL NOV ML 1.2724
00002221810 LOPROX 1% TOPICAL LOTION TOP LOT VCL ML 0.3072
00002280159 LORATADINE 10 MG TABLET ORL TAB VTH TAB 0.1540
00002244692 LORATADINE 10 MG TABLET ORL TAB VTH TAB 0.4442
00002429810 LORAZEPAM 1 MG TABLET ORL TAB SIV TAB 0.0447
00002429829 LORAZEPAM 2 MG TABLET ORL TAB SIV TAB 0.0699
00002243278 LORAZEPAM 4 MG INJECTION USP INJ DEFAUL SDZ ML 21.2000
00002394383 LOSARTAN 100 MG TABLET ORL TAB PDL TAB 0.2437
00002394367 LOSARTAN 25 MG TABLET ORL TAB PDL TAB 0.2437
00002394375 LOSARTAN 50 MG TABLET ORL TAB PDL TAB 0.2437
00002394405 LOSARTAN-HCTZ 100 MG/12.5 MG TABLET ORL TAB PDL TAB 0.3083
00002394413 LOSARTAN-HCTZ 100 MG/25 MG TABLET ORL TAB PDL TAB 0.3146
00002394391 LOSARTAN-HCTZ 50 MG/12.5 MG TABLET ORL TAB PDL TAB 0.3146
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 84 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002435853 LOTEMAX 0.5% OPHTHALMIC GEL OPH GEL BSH G 4.4000
00002421941 LOTEMAX 0.5% OPHTHALMIC OINTMENT OPH ONT BSH G 6.2857
00002321114 LOTEMAX 0.5% OPHTHALMIC SUSPENSION OPH SUS BSH ML 4.4000
00002169991 LOXAPAC 50 MG/ML INJECTION INJ DEFAUL SDZ ML 19.2730
00002179709 LOZIDE 1.25 MG TABLET ORL TAB SEV TAB 0.2980
00002425629 LUCENTIS 1.65 MG/SYRINGE INJECTION INJ DEFAUL NOV SYR 1575.0000
00000999821 LUGOL 5% IODINE ORAL SOLUTION ORL SOL PCC ML 0.0680
00002239833 LUPRON DEPOT 30 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 1428.0000
00002242934 LUSTRA-AF TOPICAL CREAM TOP CRM MEI G 1.1972
00002046210 LUTREPULSE 0.8 MG/VIAL INJECTION INJ DEFAUL FEI VIAL 115.0000
00002269066 LUVERIS 75 IU/VIAL INJECTION INJ DEFAUL SRO VIAL 26.4900
00002366924 LUXIQ 0.12% TOPICAL FOAM TOP FOA GSK G 0.7531
00002454408 LYNPARZA 50 MG CAPSULE ORL CAP AZC CAP 16.7411
00002268450 LYRICA 150 MG CAPSULE ORL CAP PFI CAP 2.3953
00002268477 LYRICA 225 MG CAPSULE ORL CAP PFI CAP 2.3953
00002268418 LYRICA 25 MG CAPSULE ORL CAP PFI CAP 0.8562
00002268485 LYRICA 300 MG CAPSULE ORL CAP PFI CAP 2.3953
00002268426 LYRICA 50 MG CAPSULE ORL CAP PFI CAP 1.3430
00002268434 LYRICA 75 MG CAPSULE ORL CAP PFI CAP 1.7377
00000463221 LYSODREN 500 MG TABLET ORL TAB BMS TAB 4.7745
00002009765 M.O.S. SULPHATE 10 MG TABLET ORL TAB VCL TAB 0.1751
00002009749 M.O.S. SULPHATE 25 MG TABLET ORL TAB VCL TAB 0.2317
00002009773 M.O.S. SULPHATE 5 MG TABLET ORL TAB VCL TAB 0.1133
00002009706 M.O.S. SULPHATE 50 MG TABLET ORL TAB VCL TAB 0.3553
00000776181 M.O.S.-SR 30 MG SUSTAINED-RELEASE TABLET ORL SRT VCL TAB 0.4670
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 85 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000776203 M.O.S.-SR 60 MG SUSTAINED-RELEASE TABLET ORL SRT VCL TAB 0.8232
00002244690 MAALOX ANTACID WITH ANTI-GAS EXTRA STRENGTH SUSP ORL SUS NVC ML 0.0211
00002244689 MAALOX ANTACID WITH ANTI-GAS ORAL SUSPENSION ORL SUS NVC ML 0.0181
00002238291 MAALOX QUICK DISSOVE EXTRA STR. CHEWABLE TABLET ORL TAB NVC TAB 0.1031
00002267225 MACUGEN 0.3 MG/SYR INJECTION SYRINGE INJ NDL PFI SYR 995.0000
00002068400 MAGNESIUM 100 MG TABLET ORL TAB JAM TAB 0.0697
00080025339 MAGNESIUM 250 MG TABLET ORL TAB WNP TAB 0.0306
00002040921 MAGNESIUM 50 MG TABLET ORL TAB JAM TAB 0.0542
00080005581 MAGNESIUM CITRATE 150 MG CAPSULE ORL CAP WBP CAP 0.0755
00080005079 MAGNESIUM COMPLEX 250 MG CAPLET ORL TAB JAM TAB 0.0892
00080013414 MAGNESIUM EXTRA STRENGTH 500 MG TABLET ORL TAB WNP TAB 0.0755
00000299448 MAGNESIUM OXIDE 420 MG TABLET ORL TAB VCL TAB 0.0328
00080014800 MAGNESIUM PLUS CALCIUM POWDER FOR SUSPENSION ORL PWRSUS NCC G 0.0973
00000392618 MAGNESIUM SULFATE 20% INJECTION INJ DEFAUL SDZ ML 1.1101
00000602264 MAGNESIUM SULFATE 50% INJECTION USP INJ DEFAUL BAX ML 1.4890
00002139499 MAGNESIUM SULFATE 500 MG/ML INJECTION USP INJ DEFAUL FKC ML 0.6444
00000202045 MAGNOLAX ORAL EMULSION ORL EML PPH ML 0.0140
00002264935 MALARONE PEDIATRIC TABLET ORL TAB GSK TAB 1.6250
00002238151 MALARONE TABLET ORL TAB GSK TAB 4.7358
00002243459 MALTLEVOL-12 ORAL LIQUID ORL LIQ CHD ML 0.0206
00000499013 MANDELAMINE 500 MG TABLET ORL TAB ERF TAB 0.4599
00000899356 MANERIX 150 MG TABLET ORL TAB MED TAB 0.6723
00002166747 MANERIX 300 MG TABLET ORL TAB MED TAB 1.3205
00002429861 MAR-AMITRIPTYLINE 10 MG TABLET ORL TAB MAR TAB 0.0664
00002429888 MAR-AMITRIPTYLINE 25 MG TABLET ORL TAB MAR TAB 0.1211
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 86 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002429896 MAR-AMITRIPTYLINE 50 MG TABLET ORL TAB MAR TAB 0.2347
00002429918 MAR-AMITRIPTYLINE 75 MG TABLET ORL TAB MAR TAB 0.3634
00002371707 MAR-AMLODIPINE 2.5 MG TABLET ORL TAB MAR TAB 0.1726
00002379562 MAR-ANASTROZOLE 1 MG TABLET ORL TAB MAR TAB 3.3280
00002454017 MAR-ATORVASTATIN 10 MG TABLET ORL TAB MAR TAB 0.3138
00002454025 MAR-ATORVASTATIN 20 MG TABLET ORL TAB MAR TAB 0.3922
00002454033 MAR-ATORVASTATIN 40 MG TABLET ORL TAB MAR TAB 0.4216
00002454041 MAR-ATORVASTATIN 80 MG TABLET ORL TAB MAR TAB 0.4216
00002305895 MARCAINE 0.25% INJECTION INJ DEFAUL HSP ML 0.7894
00002241918 MARCAINE 2.5 MG/ML INJECTION INJ DEFAUL HSP ML 0.7730
00002241919 MARCAINE 5 MG/ML INJECTION INJ DEFAUL HSP ML 0.9200
00002305909 MARCAINE 5 MG/ML INJECTION INJ DEFAUL HSP ML 0.9368
00002241917 MARCAINE 7.5 MG/ML INJECTION INJ DEFAUL HSP ML 1.9050
00002241915 MARCAINE E 2.5 MG/ML INJECTION INJ DEFAUL HSP ML 0.8015
00002241914 MARCAINE SPINAL 7.5 MG/ML INJECTION INJ DEFAUL HSP ML 12.4250
00002427133 MAR-CETIRIZINE 10 MG TABLET ORL TAB MAR TAB 0.4083
00002427141 MAR-CETIRIZINE 20 MG TABLET ORL TAB MAR TAB 0.7535
00002428792 MAR-FLUCONAZOLE-150 150 MG CAPSULE ORL CAP MAR CAP 3.9400
00002373424 MAR-LETROZOLE 2.5 MG TABLET ORL TAB MAR TAB 3.0617
00002432560 MAR-MODAFINIL 100 MG TABLET ORL TAB MAR TAB 0.9293
00002389118 MAR-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB MAR TAB 6.9623
00002389126 MAR-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB MAR TAB 7.5900
00002411946 MAR-PAROXETINE 10 MG TABLET ORL TAB MAR TAB 1.0430
00002432048 MAR-PRAVASTATIN 10 MG TABLET ORL TAB MAR TAB 0.4050
00002432056 MAR-PRAVASTATIN 20 MG TABLET ORL TAB MAR TAB 0.4777
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 87 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002432064 MAR-PRAVASTATIN 40 MG TABLET ORL TAB MAR TAB 0.5755
00002417561 MAR-PREGABALIN 150 MG CAPSULE ORL CAP MAR CAP 1.8652
00002417529 MAR-PREGABALIN 25 MG CAPSULE ORL CAP MAR CAP 0.6667
00002417537 MAR-PREGABALIN 50 MG CAPSULE ORL CAP MAR CAP 1.0458
00002417545 MAR-PREGABALIN 75 MG CAPSULE ORL CAP MAR CAP 1.3532
00002420503 MAR-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB MAR CAP 0.8550
00002452251 MAR-TADALAFIL 10 MG TABLET ORL TAB MAR TAB 11.9250
00002452286 MAR-TADALAFIL 2.5 MG TABLET ORL TAB MAR TAB 3.6471
00002452243 MAR-TADALAFIL 20 MG TABLET ORL TAB MAR TAB 12.3575
00002452278 MAR-TADALAFIL 5 MG TABLET ORL TAB MAR TAB 3.6471
00002432102 MAR-TOPIRAMATE 100 MG TABLET ORL TAB MAR TAB 0.5928
00002432110 MAR-TOPIRAMATE 200 MG TABLET ORL TAB MAR TAB 0.8853
00002432099 MAR-TOPIRAMATE 25 MG TABLET ORL TAB MAR TAB 0.3128
00002388324 MAR-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MAR TAB 0.6264
00000012750 MATULANE 50 MG CAPSULE ORL CAP SGM CAP 56.7958
00002244533 MAXILENE 4% TOPICAL CREAM TOP CRM RGR G 1.8800
00002245939 MAXILENE 5 % TOPICAL CREAM TOP CRM RGR G 1.7067
00002163632 MAXIPIME 1 G/VIAL INJECTION INJ DEFAUL BMS VIAL 17.7650
00002163640 MAXIPIME 2 G/VIAL INJECTION INJ DEFAUL BMS VIAL 35.5250
00002457733 MDK-NITISINONE 10 MG CAPSULE ORL CAP MEN CAP 104.1667
00002457717 MDK-NITISINONE 2 MG CAPSULE ORL CAP MEN CAP 25.0000
00002457725 MDK-NITISINONE 5 MG CAPSULE ORL CAP MEN CAP 56.6667
00002379104 MED-ANASTROZOLE 1 MG TABLET ORL TAB GMP TAB 3.3280
00002426935 MED-LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL GMP ML 3.6320
00002457814 MED-MOXIFLOXACIN 400 MG TABLET ORL TAB GMP TAB 1.5230
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 88 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002253550 MEDROXY-2.5 2.5 MG TABLET ORL TAB PDL TAB 0.0416
00002253577 MEDROXY-5 5MG TABLET ORL TAB PDL TAB 0.0823
00002244366 MEFLOQUINE 250 MG TABLET ORL TAB AAP TAB 3.6950
00002040891 MEGA-CAL CALCIUM W/ VITAMIN D 650 MG/200 UNIT CPT ORL TAB JAM TAB 0.1028
00002242594 MEGA-VIM CAPLET ORL TAB JAM TAB 0.1893
00002409623 MEKINIST 0.5 MG TABLET ORL TAB NOV TAB 74.6750
00002409658 MEKINIST 2 MG TABLET ORL TAB NOV TAB 298.7000
00080000847 MELATONIN 3 MG SUBLINGUAL TABLET ORL SLT WNP TAB 0.0530
00080015041 MELATONIN 3 MG TABLET ORL TAB JMS TAB 0.0681
00080008343 MELATONIN SUBLINGUAL TABLET ORL SLT WNP TAB 0.0466
00080006449 MELATONIN TIMED RELEASED ORL TAB PLH TAB 0.0556
00002353156 MELOXICAM 15 MG TABLET ORL TAB SNS TAB 0.5670
00002353148 MELOXICAM 7.5 MG TABLET ORL TAB SNS TAB 0.4913
00002446049 MEMANTINE 10 MG TABLET ORL TAB SIV TAB 1.6357
00002443082 MEMANTINE 10 MG TABLET ORL TAB SNS TAB 1.6357
00002279924 MENACTRA A/C/Y/W-135 (0.5ML SINGLE-DOSE) INJECTION INJ DEFAUL SFP ML 220.0000
00002248649 MENINGITEC (10 MCG/15 MCG) 0.5 ML INJECTION INJ DEFAUL NBV ML 130.0400
00002243820 MENJUGATE VACCINE (10 MCG/25 MCG) .5 ML INJECTION INJ DEFAUL NOV VIAL 89.0000
00000588490 MENOMUNE A/C/Y/W-135 (MULTI-DOSE) INJECTION INJ DEFAUL SFP VIAL 157.2900
00001959018 MENOMUNE A/C/Y/W-135 (SINGLE-DOSE) INJECTION INJ DEFAUL SFP VIAL 184.5100
00002283093 MENOPUR 75 IU/VIAL INJECTION INJ DEFAUL FEI VIAL 74.0000
00002347393 MENVEO 0.5 ML INJECTION INJ DEFAUL NOV ML 205.3200
00002415275 MERCAPTOPURINE 50 MG TABLET ORL TAB STM TAB 2.8612
00002378795 MEROPENEM 1G/VIAL INJECTION INJ DEFAUL SDZ VIAL 47.9900
00002378787 MEROPENEM 500 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 23.9950
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 89 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002047667 MERSYNDOL WITH CODEINE TABLET ORL TAB SAV TAB 0.2113
00002320428 M-ESLON IR 10 MG CAPSULE ORL CAP ETP CAP 0.1820
00002320436 M-ESLON IR 20 MG CAPSULE ORL CAP ETP CAP 0.3320
00002320444 M-ESLON IR 30 MG CAPSULE ORL CAP ETP CAP 0.4270
00002320398 M-ESLON IR 5 MG CAPSULE ORL CAP ETP CAP 0.1170
00002244931 MESNA 100 MG/ML INJECTION INJ DEFAUL FKC ML 10.7966
00002241615 METAMUCIL FIBRE APPLE CRISP 3.4 G/2 WAFERS ORL WAF PGI WAF 0.1717
00002241614 METAMUCIL FIBRE CINNAMON SPICE 3.4 G/2 WAFERS ORL WAF PGI WAF 0.2120
00002174812 METAMUCIL FIBRE THERAPY 3.4 G/TSP ORAL POWDER ORL PWR PGI G 0.0246
00002247034 METAMUCIL FIBRE THERAPY CAPSULE ORL CAP PGI CAP 0.1220
00002174782 METAMUCIL FIBRE THERAPY-SMOOTH TEXTURE-ORANGE S.F. ORL PWR PGI G 0.0686
00002174790 METAMUCIL SMOOTH TEXTURE-ORANGE 3 G/TBSP ORAL PWDR ORL PWR PGI G 0.0157
00002174804 METAMUCIL SMOOTH UNFLAVORED SUGAR FREE POWDER ORL PWR PGI G 0.0320
00002242794 METFORMIN 500 MG TABLET ORL TAB MEL TAB 0.0444
00002182971 METHOTREXATE (UNPRESERVED) 25 MG/ML INJECTION INJ DEFAUL MNP ML 7.8755
00002422174 METHOTREXATE 10 MG/0.4ML INJECTION SYRINGE BP INJ NDL PMS SYR 7.0000
00002422182 METHOTREXATE 15 MG/0.6 ML INJECTION SYRINGE BP INJ NDL PMS SYR 8.4000
00002422190 METHOTREXATE 20 MG/0.8 ML INJECTION SYRINGE BP INJ NDL PMS SYR 11.2000
00002417626 METHOTREXATE 25 MG/ML INJECTION (UNPRESERVED) INJ DEFAUL MYP ML 6.2500
00002327236 METHOTREXATE 25 MG/ML INJECTION BP (UNPRESERVED) INJ DEFAUL AHI ML 8.0000
00002422204 METHOTREXATE 25 MG/ML INJECTION SYRINGE BP INJ NDL PMS SYR 14.0000
00002422166 METHOTREXATE 7.5 ML/0.3 ML INJECTION SYRINGE BP INJ NDL PMS SYR 5.6000
00002182947 METHOTREXATE SODIUM (UNPRESERVED) 10 MG/ML INJ INJ DEFAUL MNP ML 9.5050
00002230521 METHOXACET CAPLET ORL TAB RPH TAB 0.1583
00002236872 METHOXACET-C 1/8 CAPLET ORL TAB RPH TAB 0.5828
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 90 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000868868 METHOXISAL CAPLET ORL TAB RPH TAB 0.2772
00001966375 METHOXISAL-C 1/2 TABLET ORL TAB RPH TAB 0.9525
00001966367 METHOXISAL-C 1/4 TABLET ORL TAB RPH TAB 0.8208
00001941895 METHOXISAL-C 1/8 CAPLET ORL TAB RPH TAB 0.5272
00002326248 METHYLPHENIDATE 10 MG TABLET ORL TAB PDL TAB 0.0816
00002326256 METHYLPHENIDATE 20 MG TABLET ORL TAB PDL TAB 0.2326
00002326221 METHYLPHENIDATE 5 MG TABLET ORL TAB PDL TAB 0.1004
00002243563 METOCLOPRAMIDE OMEGA 5MG/ML INJECTION INJ DEFAUL OMG ML 2.9450
00002320037 METOJECT 10 MG/1 ML INJECTION SYRINGE INJ NDL MDX SYR 49.4000
00002320045 METOJECT 15 MG/1.5 ML INJECTION SYRINGE INJ NDL MDX SYR 54.6000
00002304767 METOJECT 20 MG/2 ML INJECTION SYRINGE INJ NDL MDX SYR 59.8000
00002320053 METOJECT 25 MG/2.5 ML INJECTION SYRINGE INJ NDL MDX SYR 65.0000
00002320029 METOJECT 7.5 MG/0.75 ML INJECTION SYRINGE INJ NDL MDX SYR 46.8000
00002454769 METOJECT SUBCUTANEOUS 17.5 MG/0.35 ML INJ SYRINGE INJ NDL MDX SYR 57.2000
00002454866 METOJECT SUBCUTANEOUS 20 MG/0.4 ML INJ SYRINGE INJ NDL MDX SYR 59.8000
00002454777 METOJECT SUBCUTANEOUS 22.5 MG/0.45 ML INJ SYRINGE INJ NDL MDX SYR 62.4000
00002454874 METOJECT SUBCUTANEOUS 25 MG/0.5 ML INJ SYRINGE INJ NDL MDX SYR 65.0000
00002296713 METOPROLOL - 25 25 MG TABLET ORL TAB PDL TAB 0.0643
00002351404 METOPROLOL SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.1871
00002351412 METOPROLOL SR 200 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.3396
00002267853 METOPROLOL TARTRATE 1 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.4162
00000648027 METOPROLOL-100 MG TABLET ORL TAB PDL TAB 0.1250
00000648019 METOPROLOL-50 MG TABLET ORL TAB PDL TAB 0.0786
00002442116 METOPROLOL-L 25 MG TABLET ORL TAB SIV TAB 0.0643
00002092832 METROGEL 0.75% TOPICAL GEL TOP GEL GAL G 1.5697
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 91 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002248206 METROLOTION 0.75% TOPICAL LOTION TOP LOT GAL ML 0.5472
00002248562 METRONIDAZOLE 500 MG CAPSULE ORL CAP AAP CAP 0.7028
00002323273 METVIX 16.8% TOPICAL CREAM TOP CRM GAL G 174.3750
00002085852 MICATIN 2% TOPICAL CREAM TOP CRM WSP G 0.3840
00002171775 MICONAZOLE 3 DAY OVULE TREATMENT VAG OVL VTH OVL 1.6966
00002091143 MICRO PLUS 4 CONCENTRATE INJECTION INJ DEFAUL SDZ ML 2.5276
00002091135 MICRO PLUS 4 REGULAR STRENGTH INJECTION INJ DEFAUL SDZ ML 0.9090
00002063905 MICROLAX MICRO RECTAL ENEMA RT ENM JJM ENM 1.5000
00000787000 MICRO-ZN 5 MG/ML INJECTION INJ DEFAUL SDZ ML 2.4042
00002242904 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL FKC ML 1.3170
00002240285 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.7800
00002423758 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL PFI ML 0.8340
00002382342 MIDAZOLAM 1 MG/ML INJECTION USP INJ DEFAUL HSP ML 0.8250
00002382377 MIDAZOLAM 1 MG/ML INJECTION USP INJ DEFAUL HSP ML 0.5820
00002242905 MIDAZOLAM 5 MG/ML INJECTION INJ DEFAUL FKC ML 4.7150
00002423766 MIDAZOLAM 5 MG/ML INJECTION INJ DEFAUL PFI ML 4.1700
00002382350 MIDAZOLAM 5 MG/ML INJECTION USP INJ DEFAUL HSP ML 2.3000
00002382385 MIDAZOLAM 5 MG/ML INJECTION USP INJ DEFAUL HSP ML 2.5240
00002382873 MIDAZOLAM INJECTION SDZ 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.7800
00002444038 MIFEGYMISO 200 MG/200 MCG TABLET ORL/BUC TAB LNP TAB 60.0000
00002244622 MILRINONE LACTATE 1 MG/ML INJECTION INJ DEFAUL FKC ML 5.9061
00001935348 MINERAL OIL (HEAVY) ORL LIQ RBW ML 0.0092
00000485802 MINERAL OIL 100% ORAL LIQUID ORL LIQ RPH ML 0.0122
00002246500 MINIRIN 0.1 MG TABLET ORL TAB FEI TAB 1.3216
00002042320 MIN-OVRAL (21 DAY) TABLET ORL TAB PFI TAB 0.7933
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 92 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002042339 MIN-OVRAL (28 DAY) TABLET ORL TB PFI TAB 0.5950
00002228319 MINOX 20MG/ML TOPICAL SOLUTION TOP SOL RIV ML 0.4956
00002394863 MINT-ALENDRONATE 10 MG TABLET ORL TAB MPI TAB 0.4986
00002393573 MINT-ANASTROZOLE 1 MG TABLET ORL TAB MPI TAB 1.7821
00002317427 MINT-CIPROFLOXACIN 250 MG TABLET ORL TAB MPI TAB 0.6186
00002317435 MINT-CIPROFLOXACIN 500 MG TABLET ORL TAB MPI TAB 0.6979
00002423294 MINT-GLICLAZIDE MR 60 MG SUSTAINED-RELEASE TABLET ORL SRT MPI TAB 0.1265
00002425947 MINT-HYDROCHLOROTHIAZIDE 12.5 MG TABLET ORL TAB MPI TAB 0.0341
00002426196 MINT-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB MPI TAB 0.0157
00002426218 MINT-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB MPI TAB 0.0217
00002388766 MINT-METFORMIN 500 MG TABLET ORL TAB MPI TAB 0.0444
00002388774 MINT-METFORMIN 850 MG TABLET ORL TAB MPI TAB 0.0610
00002436981 MINT-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB MPI TAB 1.9280
00002437007 MINT-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB MPI TAB 7.5977
00002422727 MINT-OLOPATADINE 0.1% OPHTHALMIC SOLUTION OPH SOL MPI ML 5.2260
00002326477 MINT-PIOGLITAZONE 15 MG TABLET ORL TAB MPI TAB 0.6225
00002326485 MINT-PIOGLITAZONE 30 MG TABLET ORL TAB MPI TAB 0.8721
00002326493 MINT-PIOGLITAZONE 45 MG TABLET ORL TAB MPI TAB 1.3113
00002424207 MINT-PREGABALIN 150 MG CAPSULE ORL CAP MPI CAP 1.7270
00002423804 MINT-PREGABALIN 25 MG CAPSULE ORL CAP MPI CAP 0.6173
00002423812 MINT-PREGABALIN 50 MG CAPSULE ORL CAP MPI CAP 0.9683
00002424185 MINT-PREGABALIN 75 MG CAPSULE ORL CAP MPI CAP 1.2529
00002421348 MINT-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB MPI CAP 0.8551
00002393085 MINT-SILDENAFIL 100 MG TABLET ORL TAB MPI TAB 9.2000
00002393069 MINT-SILDENAFIL 25 MG TABLET ORL TAB MPI TAB 8.2900
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 93 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002393077 MINT-SILDENAFIL 50 MG TABLET ORL TAB MPI TAB 8.8475
00002423308 MINT-TOLTERODINE 1 MG TABLET ORL TAB MPI TAB 0.4910
00002423316 MINT-TOLTERODINE 2 MG TABLET ORL TAB MPI TAB 0.4910
00002389800 MINT-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MPI TAB 0.6264
00002419513 MINT-ZOLMITRIPTAN ODT 2.5 MG ORALLY DISP. TABLET ORL DISPTAB MPI TAB 3.5383
00000042544 MIOSTAT 0.01% OPH SOLUTION OPH SOL ALC ML 13.3822
00002297256 MIRAPEX 0.125 MG TABLET ORL TAB BOE TAB 1.1160
00002241594 MIRAPEX 0.5 MG TABLET ORL TAB BOE TAB 2.2322
00002312786 MIRTAZAPINE-30 30 MG TABLET ORL TAB PDL TAB 0.1950
00002248846 MISOPROSTOL-200 200 MCG TABLET ORL TAB PDL TAB 0.4389
00002230451 MITOMYCIN 20 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 377.2000
00002230450 MITOMYCIN 5 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 94.3000
00001948873 MIXED VESPID VENOM PROTEIN 1.1 MG VIAL INJ INJ DEFAUL ALK ML 71.3833
00001948881 MIXED VESPID VENOM PROTEIN 120 MCG INJ DEFAUL ALG VIAL 71.3833
00080025624 MK 20 A LIBERATION PROLONGEE 20 MEQ TABLET ORL TAB MTR TAB 0.1995
00080035346 MK 8 8 MEQ TABLET ORL TAB MTR TAB 0.2250
00000466085 M-M-R II VIRUS VACCINE LIVE ATTENUATED INJECTION INJ DEFAUL MSD VIAL 30.4980
00002242786 MOBICOX 15 MG TABLET ORL TAB BOE TAB 0.9520
00002242785 MOBICOX 7.5 MG TABLET ORL TAB BOE TAB 0.8251
00002238696 MOI-STIR SPRAY ORAL LIQUID ORL LIQ PMS ML 0.0637
00001909142 MOISTUREL TOPICAL CREAM TOP CRM WSD G 0.0567
00001909169 MOISTUREL TOPICAL LOTION TOP LOT WSD ML 0.0208
00000999058 MONA LISA 10 IUD COPPER STERILE DEFAUL DEFAUL BSN DEV 61.5000
00000999057 MONA LISA 5 IUD COPPER STERILE DEFAUL DEFAUL BSN DEV 48.0000
00002239601 MONISTAT 1 1200 MG VAGINAL OVULE VAG OVL MCL OVL 12.0200
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 94 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002244005 MONISTAT 3 4% VAGINAL CREAM VAG CRM MCL G 0.8013
00002126605 MONISTAT 3 400 MG VAGINAL OVULE VAG OVL MCL OVL 4.0067
00002126249 MONISTAT 3 DUAL-PAK KIT VAG/TOP OVL/CRM MCL KIT 13.7600
00002084309 MONISTAT 7 2% VAGINAL CREAM VAG CRM MCL G 0.3434
00002126257 MONISTAT 7 DUAL-PAK VAGINAL OVULE/TOPICAL CREAM VAG/TOP OVL/CRM MCL KIT 13.7600
00002126567 MONISTAT DERM 2% TOPICAL CREAM TOP CRM MCL G 0.3933
00002239600 MONISTAT-1 COMBINATION PACK VAG OVULE/TOP CREAM VAG/TOP OVL/CRM MCL KIT 13.7600
00000999332 MONOVISC DEFAUL DEV PMS ML 75.0000
00002379856 MONTELUKAST 10 MG TABLET ORL TAB PDL TAB 0.9460
00002379821 MONTELUKAST 4 MG TABLET ORL TAB PDL TAB 0.9460
00002379848 MONTELUKAST 5 MG TABLET ORL TAB PDL TAB 0.9460
00002021056 MORPHINE LP EPIDURAL 0.5 MG/ML INJECTION INJ DEFAUL SDZ ML 3.0115
00001964437 MORPHINE SULFATE 2 MG/ML INJECTION USP INJ DEFAUL SDZ ML 0.2528
00001964429 MORPHINE SULFATE 5 MG/ML INJECTION USP INJ DEFAUL SDZ ML 0.4153
00001980696 MORPHINE SULFATE 1 MG/ML INJECTION USP INJ DEFAUL SDZ ML 0.3726
00002242484 MORPHINE SULFATE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 2.2510
00002382997 MORPHINE SULFATE INJECTION SDZ 10 MG/ML INJ INJ DEFAUL SDZ ML 2.3860
00080028360 MOTION MEDICINE TOPICAL CREAM TOP CRM NDP G 0.1212
00002186934 MOTRIN IB 200 MG TABLET ORL TAB MCL TAB 0.1250
00002442167 MOVANTIK 12.5 MG TABLET ORL TAB AZC TAB 6.0153
00002442175 MOVANTIK 25 MG TABLET ORL TAB AZC TAB 6.0153
00002359499 MOVIPREP POWDER FOR ORAL LAVAGE SOLUTION ORL PWDPKT MFI PCKT 5.8600
00002430037 M-SILDENAFIL 100 MG TABLET ORL TAB MTR TAB 9.2000
00080001844 MSM 1000 MG ORL TAB WNP TAB 0.0654
00002125013 MUCAINE ORAL SUSPENSION ORL SUS AXC ML 0.0243
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 95 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000599875 MUCILLIUM 500 MG/G ORAL POWDER ORL PWR PMS G 0.0175
00002091526 MUCOMYST 20% INHALATION SOLUTION INH SOL WSP ML 0.7200
00002330989 MULTAQ 400 MG TABLET ORL TAB SAV TAB 2.2122
00080050211 MULTI COMPLETE DYE FREE MULTIVITAMINS ORL TAB WNP TAB 0.0556
00000782203 MULTI VITAMIN PLUS IRON TABLET ORL TAB VTH TAB 0.0600
00000782211 MULTI VITAMIN TABLET ORL TAB VTH TAB 0.0270
00000586315 MULTI-1000 INJECTION INJ DEFAUL SDZ ML 1.4140
00002100606 MULTI-12 INJECTION INJ DEFAUL SDZ ML 1.3288
00002244898 MULTIPLE VITAMIN TABLET ORL TAB PMT TAB 0.0700
00000374083 MULTIPLE VITAMIN WITH MINERAL TABLET ORL TAB ADA TAB 0.1100
00002248775 MULTISURE FOR WOMEN ORL CAP WNP CAP 0.0850
00002248778 MULTISURE FOR WOMEN OVER 50 GELATIN CAPSULE ORL CAP WBP CAP 0.0850
00002240942 MULTI-TAR PLUS REGULAR TOPICAL SHAMPOO TOP SHP VCL ML 0.0381
00000233498 MULTIVITAMIN TABLET ORL TAB WAM TAB 0.2226
00080005483 MULTI-VITAMIN TABLET ORL TAB WNP TAB 0.0351
00002242779 MULTIVITAMINS & MULTIMINERALS FORMULA FORTE SR.TAB ORL TAB PMT TAB 0.0800
00002242939 MULTIVITAMINS + MULTIMINERALS 50+ FORMULA TAB. ORL TAB PMT TAB 0.0665
00002242780 MULTIVITAMINS AND MULTIMINERALS FORMULA FORTE TAB ORL TAB PMT TAB 0.0678
00002244864 MULTIVITAMINS FOR ADULTS TABLET ORL TAB PMT TAB 0.0300
00000750816 MURO-128 5% OPH OINTMENT OPH ONT BSH G 2.9486
00000750824 MURO-128 5% OPH SOLUTION OPH SOL BSH ML 0.6880
00002238595 MUSE 1000 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 42.3800
00002238593 MUSE 250 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 42.3800
00002238594 MUSE 500 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 42.3800
00000016063 MUSTARGEN HCL TRITURATION 10 MG/VIAL INJECTION INJ DEFAUL LUI VIAL 7.9500
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 96 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002415380 MYA 28 TABLET ORL TB APX TAB 0.4229
00002311054 MYCAMINE 100 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 196.0000
00002294222 MYCAMINE 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 98.0000
00002457369 MYCOPHENOLATE MOFETIL 250 MG CAPSULE ORL CAP SNS CAP 1.0310
00002457377 MYCOPHENOLATE MOFETIL 500 MG TABLET ORL TAB SNS TAB 2.0620
00002264560 MYFORTIC 180 MG ENTERIC-COATED TABLET ORL ECT NOV TAB 1.9977
00002264579 MYFORTIC 360 MG ENTERIC-COATED TABLET ORL ECT NOV TAB 3.9953
00002450682 MYLAN-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB MYP TAB 20.3573
00002270129 MYLAN-ALENDRONATE 10 MG TABLET ORL TAB MYP TAB 0.5134
00002229813 MYLAN-ALPRAZOLAM 1 MG TABLET ORL TAB MYP TAB 0.3099
00002229814 MYLAN-ALPRAZOLAM 2 MG TABLET ORL TAB MYP TAB 0.5508
00002361418 MYLAN-ANASTROZOLE 1 MG TABLET ORL TAB MYP TAB 2.7497
00002378981 MYLAN-ATOMOXETINE 100 MG CAPSULE ORL CAP MYP CAP 4.3520
00002378930 MYLAN-ATOMOXETINE 18 MG CAPSULE ORL CAP MYP CAP 2.6500
00002378949 MYLAN-ATOMOXETINE 25 MG CAPSULE ORL CAP MYP CAP 2.9281
00002378957 MYLAN-ATOMOXETINE 40 MG CAPSULE ORL CAP MYP CAP 3.3375
00002378965 MYLAN-ATOMOXETINE 60 MG CAPSULE ORL CAP MYP CAP 3.7024
00002378973 MYLAN-ATOMOXETINE 80 MG CAPSULE ORL CAP MYP CAP 3.9960
00002373203 MYLAN-ATORVASTATIN 10 MG TABLET ORL TAB MYP TAB 0.3138
00002373211 MYLAN-ATORVASTATIN 20 MG TABLET ORL TAB MYP TAB 0.3922
00002373238 MYLAN-ATORVASTATIN 40 MG TABLET ORL TAB MYP TAB 0.4216
00002373246 MYLAN-ATORVASTATIN 80 MG TABLET ORL TAB MYP TAB 0.4216
00002402165 MYLAN-ATOVAQUONE/PROGUANIL 250 MG/ 100 MG TABLET ORL TAB MYP TAB 4.1308
00002302403 MYLAN-BICALUTAMIDE 50 MG TABLET ORL TAB MYP TAB 4.0573
00002383500 MYLAN-BOSENTAN 125 MG TABLET ORL TAB MYP TAB 22.4625
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 97 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002383497 MYLAN-BOSENTAN 62.5 MG TABLET ORL TAB MYP TAB 22.4625
00002241003 MYLAN-BUDESONIDE AQ 64 MCG/DOSE MET DOSE NAS SPRAY NAS SPM MYP DOSE 0.0843
00002379120 MYLAN-CANDESARTAN 4 MG TABLET ORL TAB MYP TAB 0.3400
00002163594 MYLAN-CAPTOPRIL 100 MG TABLET ORL TAB MYP TAB 0.5198
00002163551 MYLAN-CAPTOPRIL 12.5 MG TABLET ORL TAB MYP TAB 0.1060
00002163578 MYLAN-CAPTOPRIL 25 MG TABLET ORL TAB MYP TAB 0.1500
00002163586 MYLAN-CAPTOPRIL 50 MG TABLET ORL TAB MYP TAB 0.2795
00002241882 MYLAN-CARBAMAZEPINE CR 200 MG SUSTAIN RELEASE TAB ORL SRT MYP TAB 0.0930
00002227444 MYLAN-CIMETIDINE 300 MG TABLET ORL TAB MYP TAB 0.0860
00002227452 MYLAN-CIMETIDINE 400 MG TABLET ORL TAB MYP TAB 0.1350
00002434539 MYLAN-CINACALCET 30 MG TABLET ORL TAB MYP TAB 10.1947
00002434547 MYLAN-CINACALCET 60 MG TABLET ORL TAB MYP TAB 18.5900
00002434555 MYLAN-CINACALCET 90 MG TABLET ORL TAB MYP TAB 27.0517
00002278669 MYLAN-DOMPERIDONE 10 MG TABLET ORL TAB MYP TAB 0.0594
00002240498 MYLAN-DOXAZOSIN 1 MG TABLET ORL TAB MYP TAB 0.1416
00002240499 MYLAN-DOXAZOSIN 2 MG TABLET ORL TAB MYP TAB 0.1699
00002240500 MYLAN-DOXAZOSIN 4 MG TABLET ORL TAB MYP TAB 0.2209
00002381524 MYLAN-EFAVIRENZ 600 MG TABLET ORL TAB MYP TAB 11.2103
00002383039 MYLAN-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 1.8690
00002383047 MYLAN-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC MYP TAB 1.8690
00002245330 MYLAN-ETIDRONATE 200 MG TABLET ORL TAB MYP TAB 0.3568
00002392631 MYLAN-FINASTERIDE HG 1 MG TABLET ORL TAB MYP TAB 1.1453
00002397471 MYLAN-GABAPENTIN 600 MG TABLET ORL TAB MYP TAB 1.3045
00002397498 MYLAN-GABAPENTIN 800 MG TABLET ORL TAB MYP TAB 1.7393
00000808741 MYLAN-GLYBE 5 MG TABLET ORL TAB MYP TAB 0.0573
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 98 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002242920 MYLAN-HYDROXYUREA 500 MG CAPSULE ORL CAP MYP CAP 1.0203
00002319225 MYLAN-LEFLUNOMIDE 10 MG TABLET ORL TAB MYP TAB 6.0417
00002319233 MYLAN-LEFLUNOMIDE 20 MG TABLET ORL TAB MYP TAB 6.0417
00002297736 MYLAN-LISINOPRIL HCTZ 10 MG/12.5 MG TABLET ORL TAB MYP TAB 0.2083
00002297744 MYLAN-LISINOPRIL HCTZ 20 MG/12.5 MG TABLET ORL TAB MYP TAB 0.2503
00002297752 MYLAN-LISINOPRIL HCTZ 20 MG/25 MG TABLET ORL TAB MYP TAB 0.2503
00002255995 MYLAN-MELOXICAM 15 MG TABLET ORL TAB MYP TAB 0.5670
00002255987 MYLAN-MELOXICAM 7.5 MG TABLET ORL TAB MYP TAB 0.4914
00002430371 MYLAN-MEMANTINE 10 MG TABLET ORL TAB MYP TAB 1.6357
00002371154 MYLAN-MYCOPHENOLATE 250 MG CAPSULE ORL CAP MYP CAP 1.0310
00002370549 MYLAN-MYCOPHENOLATE 500 MG TABLET ORL TAB MYP TAB 2.0620
00002244563 MYLAN-NABUMETONE 500 MG TABLET ORL TAB MYP TAB 0.3625
00002387727 MYLAN-NEVIRAPINE 200 MG TABLET ORL TAB MYP TAB 1.7285
00002382725 MYLAN-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB MYP TAB 4.1240
00002382733 MYLAN-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB MYP TAB 7.5977
00002248012 MYLAN-PAROXETINE 10 MG TABLET ORL TAB MYP TAB 1.0430
00002298279 MYLAN-PIOGLITAZONE 15 MG TABLET ORL TAB MYP TAB 0.5809
00002298287 MYLAN-PIOGLITAZONE 30 MG TABLET ORL TAB MYP TAB 0.8139
00002298295 MYLAN-PIOGLITAZONE 45 MG TABLET ORL TAB MYP TAB 1.2237
00002376350 MYLAN-PRAMIPEXOLE 0.25 MG TABLET ORL TAB MYP TAB 0.2628
00002376369 MYLAN-PRAMIPEXOLE 0.5 MG TABLET ORL TAB MYP TAB 1.0514
00002376377 MYLAN-PRAMIPEXOLE 1 MG TABLET ORL TAB MYP TAB 0.5257
00002376385 MYLAN-PRAMIPEXOLE 1.5 MG TABLET ORL TAB MYP TAB 0.5257
00002245372 MYLAN-PROPAFENONE 150 MG TABLET ORL TAB MYP TAB 0.2965
00002245373 MYLAN-PROPAFENONE 300 MG TABLET ORL TAB MYP TAB 0.5227
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 99 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002397773 MYLAN-RISEDRONATE 150 MG TABLET ORL TAB MYP TAB 40.9500
00002423421 MYLAN-RIVASTIGMINE PATCH 10 (9.5 MG/24 H) TRD PTH MYP PTH 3.9773
00002423413 MYLAN-RIVASTIGMINE PATCH 5 (4.6 MG/24 H) TRD PTH MYP PTH 3.9773
00002229779 MYLAN-SOTALOL 160 MG TABLET ORL TAB MYP TAB 0.1623
00002268906 MYLAN-SUMATRIPTAN 25 MG TABLET ORL TAB MYP TAB 8.9900
00002019795 MYLANTA REGULAR STRENGTH CHEWABLE TABLET ORL CTB WLA TAB 0.1062
00002410656 MYLAN-TADALAFIL 10 MG TABLET ORL TAB MYP TAB 11.9250
00002410621 MYLAN-TADALAFIL 2.5 MG TABLET ORL TAB MYP TAB 3.6471
00002410664 MYLAN-TADALAFIL 20 MG TABLET ORL TAB MYP TAB 12.3569
00002410648 MYLAN-TADALAFIL 5 MG TABLET ORL TAB MYP TAB 3.6471
00002088428 MYLAN-TAMOXIFEN 10 MG TABLET ORL TAB MYP TAB 0.1750
00002396289 MYLAN-TERAZOSIN 1 MG TABLET ORL TAB MYP TAB 0.1835
00002396319 MYLAN-TERAZOSIN 10 MG TABLET ORL TAB MYP TAB 0.4637
00002396297 MYLAN-TERAZOSIN 2 MG TABLET ORL TAB MYP TAB 0.2333
00002396300 MYLAN-TERAZOSIN 5 MG TABLET ORL TAB MYP TAB 0.3168
00002242503 MYLAN-TERBINAFINE 250 MG TABLET ORL TAB MYP TAB 1.8525
00002239744 MYLAN-TICLOPIDINE 250 MG TABLET ORL TAB MYP TAB 0.3139
00002425599 MYLAN-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MYP TAB 0.6264
00002231683 MYLAN-TRAZODONE 50 MG TABLET ORL TAB MYP TAB 0.0554
00002383527 MYLAN-VALSARTAN 40 MG TABLET ORL TAB MYP TAB 0.5239
00002210355 MYLAN-VERAPAMIL SR 180 MG TABLET ORL SRT MYP TAB 0.5204
00002210363 MYLAN-VERAPAMIL SR 240 MG TABLET ORL SRT MYP TAB 0.5075
00002287501 MYLAN-WARFARIN 6 MG TABLET ORL TAB MYP TAB 0.2805
00002287528 MYLAN-WARFARIN 7.5 MG TABLET ORL TAB MYP TAB 0.3014
00002387158 MYLAN-ZOLMITRIPTAN ODT 2.5 MG ORALLY DISP. TABLET ORL DISPTAB MYP TAB 3.5383
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 100 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000004618 MYLERAN 2 MG TABLET ORL TAB ASN TAB 1.6064
00002408694 MYL-PREGABALIN 150 MG CAPSULE ORL CAP MYP CAP 1.7270
00002408651 MYL-PREGABALIN 25 MG CAPSULE ORL CAP MYP CAP 0.6173
00002408708 MYL-PREGABALIN 300 MG CAPSULE ORL CAP MYP CAP 1.7270
00002408678 MYL-PREGABALIN 50 MG CAPSULE ORL CAP MYP CAP 0.9683
00002408686 MYL-PREGABALIN 75 MG CAPSULE ORL CAP MYP CAP 1.2529
00002367378 MYL-RANITIDINE 150 MG TABLET ORL TAB MYP TAB 0.1800
00002367386 MYL-RANITIDINE 300 MG TABLET ORL TAB MYP TAB 0.3600
00002392593 MYL-SILDENAFIL 100 MG TABLET ORL TAB MYP TAB 9.2007
00002392577 MYL-SILDENAFIL 25 MG TABLET ORL TAB MYP TAB 8.2900
00002392585 MYL-SILDENAFIL 50 MG TABLET ORL TAB MYP TAB 8.8475
00001927612 MYOCHRYSINE 25 MG/ML INJECTION INJ DEFAUL AVE ML 15.4700
00002226022 MYOFLEX EXTRA STRENGTH 15% CREAM TOP CRM BIC G 0.0598
00002412683 NAGLAZYME 1 MG/ML INJECTION INJ DEFAUL BMI ML 307.0000
00002382601 NALOXONE HYDROCHLORIDE (PRES. FREE) 0.4 MG/ML INJ INJ DEFAUL SDZ ML 13.7450
00002382482 NALOXONE HYDROCHLORIDE 0.4 MG/ML INJ USP INJ DEFAUL ALV ML 15.0000
00002148706 NALOXONE HYDROCHLORIDE 0.4 MG/ML INJECTION INJ DEFAUL SDZ ML 13.7450
00002148714 NALOXONE HYDROCHLORIDE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 20.1475
00002393034 NALOXONE HYDROCHLORIDE INJECTION 0.4 MG/ML INJ INJ DEFAUL OMG ML 13.7500
00000390283 NAPHCON FORTE 0.1% OPH SOLUTION OPH SOL ALC ML 0.5060
00000481408 NAPHCON-A OPH SOLUTION OPH SOL ALC ML 0.4747
00002242505 NAPRELAN 375 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 0.9604
00002242506 NAPRELAN 500 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 1.5790
00000618721 NAPROXEN 500 MG TABLET ORL TAB PDL TAB 0.2110
00002362430 NAPROXEN 220 MG TABLET ORL TAB PMS TAB 0.0696
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 101 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000590762 NAPROXEN 250 MG TABLET ORL TAB PDL TAB 0.1068
00000655686 NAPROXEN-375 375 MG TABLET ORL TAB PDL TAB 0.1458
00000887056 NAPROXEN-NA 275 MG TABLET ORL TAB PDL TAB 0.3422
00002153386 NAPROXEN-NA DF 550 MG TABLET ORL TAB PDL TAB 0.6667
00002229415 NAROPIN 5 MG/ML INJECTION INJ DEFAUL AZC ML 0.4430
00002213834 NASACORT AQ 55 MCG NASAL METERED DOSE SPRAY NAS SPM SAV DOSE 0.1700
00002192799 NASAL + SINUS DECONGESTANT RELIEF 60 MG TABLET ORL TAB VTH TAB 0.1242
00000788503 NASAL DECONGESTANT SPRAY 0.1% NAS LIQ CNF ML 0.0920
00002417650 NAT-ALPRAZOLAM 1 MG TABLET ORL TAB NTP TAB 0.3099
00002417669 NAT-ALPRAZOLAM 2 MG TABLET ORL TAB NTP TAB 0.5508
00002417855 NAT-ANASTROZOLE 1 MG TABLET ORL TAB NTP TAB 2.5460
00002450550 NATESTO (11 G/PUMP) 4.5% NASAL GEL NAS GEL ACE G 6.1527
00002421585 NAT-LETROZOLE 2.5 MG TABLET ORL TAB NTP TAB 3.1300
00002440229 NAT-LEVETIRACETAM 750 MG TABLET ORL TAB NTP TAB 0.7523
00002457989 NAT-OSELTAMIVIR 75 MG CAPSULE ORL CAP NTP CAP 3.1180
00000024430 NAVANE 2 MG CAPSULE ORL CAP ERF CAP 0.3171
00080029758 NEBUSAL 7% INHALATION SOLUTION MIS DEFAUL STM ML 0.2431
00080027142 NEILMED NASAL SINUS RINSE NAS PWS NPI PCKT 0.2350
00002245057 NEISVAC-C 10 MCG/20 MCG INJECTION SYRINGE INJ NDL PFI SYR 80.1850
00000147680 NEO-BEX (LIDOCAINE HCL) INJECTION VIAL INJ DEFAUL BRO ML 5.5850
00000999808 NEOCATE NUTRA ORAL POWDER ORL PWR NUN G 0.1113
00000874957 NEOSTIGMINE METHYLSULFATE 0.5 MG/ML INJECTION INJ DEFAUL SDZ ML 0.8844
00000885282 NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.9690
00001915436 NEOSTIGMINE METHYLSULFATE 2.5 MG/ML INJECTION INJ DEFAUL SDZ ML 3.4342
00002230593 NEOSTIGMINE OMEGA 0.5 MG/ML INJECTION INJ DEFAUL OMG ML 0.9600
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 102 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002230592 NEOSTIGMINE OMEGA 1 MG/ML INJECTION INJ DEFAUL OMG ML 1.0700
00001958690 NEOSTRATA HQ 2% GEL TOP GEL CDX G 0.7667
00000999459 NEOVISC DEFAUL DEV STL ML 47.7400
00080007796 NERVOHEEL N TABLET ORL TAB HEE TAB 0.2858
00002417197 NESINA 12.5 MG TABLET ORL TAB TAK TAB 2.2000
00002417200 NESINA 25 MG TABLET ORL TAB TAK TAB 2.2000
00002417189 NESINA 6.25 MG TABLET ORL TAB TAK TAB 2.2000
00000999448 NESTLE BREAKFAST ANYTIME ORAL LIQUID ORL LIQ NHN ML 0.0044
00000999799 NESTLE GOOD START 1 GOS OMEGA 3+6 INF FORMULA PWD ORL PWR NHN G 0.0490
00000999801 NESTLE GOOD START 1 GOS OMEGA 3+6 LIQ CONCENTRATE ORL LIQ NHN ML 0.0060
00000999800 NESTLE GOOD START 1 GOS OMEGA 3+6 READY-T-F NURSER ORL LIQ NHN ML 0.0280
00000999802 NESTLE GOOD START 1 INFANT FORMULA POWDER ORL PWR NHN G 0.0290
00000999804 NESTLE GOOD START 1 LIQ CONCENTRATE INFANT FORMULA ORL LIQ NHN ML 0.0050
00000999798 NESTLE GOOD START 1 PROBIOTIC DHA & ARA INFANT PWR ORL PWR NHN G 0.0500
00000999803 NESTLE GOOD START 1 READY-TO-FEED TETRA LIQUID ORL LIQ NHN ML 0.0120
00000999806 NESTLE GOOD START 2 ALSOY OMEGA 3+6 INF FORM PWR ORL PWR NHN G 0.0400
00000999805 NESTLE GOOD START ALSOY OMEGA 3+6 INF FORM POWDER ORL PWR NHN G 0.0400
00002420104 NEUPOGEN 300 MCG/0.5 ML INJECTION SYRINGE INJ NDL AMG SYR 173.1890
00002420112 NEUPOGEN 480 MCG/0.8 ML INJECTION SYRINGE INJ NDL AMG SYR 277.1020
00002403897 NEUPRO 1 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 3.5400
00002403900 NEUPRO 2 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 3.5400
00002403919 NEUPRO 3 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 6.5000
00002403927 NEUPRO 4 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 6.5000
00002403935 NEUPRO 6 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.2700
00002403943 NEUPRO 8 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 7.2700
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 103 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002239717 NEURONTIN 600 MG TABLET ORL TAB PFI TAB 1.9426
00002239718 NEURONTIN 800 MG TABLET ORL TAB PFI TAB 2.5926
00080006269 NEUTROGENA BODY CLEAR BODY WASH PINK GRAPEFRUIT TOP GEL JJI ML 0.0270
00002308983 NEVANAC 0.1% OPHTHALMIC SUSPENSION OPH SUS ALC ML 4.1380
00080039670 NEW NORDIC HAIR VOLUME TABLET ORL TAB NNO TAB 0.9313
00002284227 NEXAVAR 200 MG TABLET ORL TAB BAI TAB 46.0088
00002300524 NEXIUM 10 MG/DOSE DEL REL GRANULES FOR ORAL SUSP ORL DRGRNUL AZC PCKT 2.2000
00002244521 NEXIUM 20 MG DELAYED-RELEASE TABLET ORL DRT AZC TAB 2.2000
00002244522 NEXIUM 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC AZC TAB 2.2000
00000232459 NIACIN 100 MG TABLET ORL TAB ADA TAB 0.0830
00000779806 NIACIN 500 MG SUSTAINED-RELEASE CAPSULE ORL SRC VTH CAP 0.8500
00000309737 NIACIN 500 MG TABLET ORL TAB JAM TAB 0.0567
00002242138 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB QVS TAB 0.1277
00002244702 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB JAM TAB 0.1962
00002262339 NIASPAN 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.2303
00002262347 NIASPAN 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.2837
00002262355 NIASPAN 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.4180
00002309289 NIASPAN FCT 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.3600
00002309254 NIASPAN FCT 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.3600
00002309262 NIASPAN FCT 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.3433
00002247347 NICORETTE MINI LOZENGE 2 MG ORL LOZ MCL LOZ 0.4714
00002247348 NICORETTE MINI LOZENGE 4 MG ORL LOZ MCL LOZ 0.4714
00002065762 NICORETTE PATCH 15MG; NICORETTE COMBOQUIT TOP PTH MCL PTH 3.4771
00080007461 NICOTINE LOZENGES; THRIVE LOZENGES 1 MG ORL LOZ NOV LOZ 0.2542
00080007464 NICOTINE LOZENGES; THRIVE LOZENGES 2 MG ORL LOZ NOV LOZ 0.2889
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 104 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080000117 NICOTINE POLACRILEX; NIC-ASSIST 2 MG GUM ORL GUM PRI PIECE 0.2104
00080000118 NICOTINE POLACRILEX; NIC-ASSIST 4 MG GUM ORL GUM PER PIECE 0.2539
00080000396 NICOTINELL; THRIVE 2 MG ORAL GUM ORL GUM NOV PIECE 0.2542
00080000402 NICOTINELL; THRIVE 4 MG ORAL GUM ORL GUM NVC PIECE 0.2889
00002125226 NIDAGEL 0.75% VAGINAL GEL VAG GEL VCL G 0.3017
00002421631 NIFEDIPINE 30 MG EXTENDED RELEASE TABLET ORL ERT PDL TAB 0.6171
00002421658 NIFEDIPINE 60 MG EXTENDED RELEASE TABLET ORL ERT PDL TAB 0.9374
00002442930 NIFEDIPINE ER 30 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.6171
00002442949 NIFEDIPINE ER 60 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.9374
00002325926 NIMOTOP 30 MG TABLET ORL TAB BAI TAB 10.1885
00002456796 NINLARO 2.3 MG CAPSULE ORL CAP TAK CAP 2964.6500
00002456818 NINLARO 3 MG CAPSULE ORL CAP TAK CAP 2964.6500
00002456826 NINLARO 4 MG CAPSULE ORL CAP TAK CAP 2964.6500
00002182920 NIZORAL 2% TOPICAL SHAMPOO TOP SHP MCL ML 0.1087
00002397927 NOCDURNA 25 MCG SL ORALLY DISINTEGRATING TABLET SLG DISNTAB FEI TAB 1.3200
00002431076 NOCDURNA 50 MCG SL ORALLY DISINTEGRATING TABLET SLG DISNTAB FEI TAB 1.3200
00002048485 NOLVADEX-D 20 MG (BASE) TABLET ORL TAB AZC TAB 0.3867
00080016396 NON-FLUSH/FLUSH FREE NIACIN CAPSULE ORL CAP PLH CAP 0.1560
00080008766 NORDIC NATURALS ARCTIC COD LIVER OIL ORL LIQ NRD ML 0.1105
00080007895 NORDIC NATURALS ARCTIC COD LIVER OIL LIQUID ORL LIQ NRD ML 0.0827
00080002913 NORDIC NATURALS OMEGA-3 LIQUID ORL LIQ NRD ML 0.0827
00002334860 NORDITROPIN NORDIFLEX 10 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 389.4000
00002334879 NORDITROPIN NORDIFLEX 15 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 584.1000
00002334852 NORDITROPIN NORDIFLEX 5 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 194.7000
00002285576 NORLEVO 0.75 MG TABLET ORL TAB BAI TAB 8.6000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 105 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000023760 NORLUTATE 5 MG TABLET ORL TAB PFI TAB 1.5083
00002357593 NORVIR 100 MG FILM-COATED TABLET ORL TAB ABV TAB 1.5037
00002229145 NORVIR 80 MG/ML ORAL SOLUTION ORL SOL ABV ML 1.2316
00002049481 NOVAHISTEX DH ADULT ORAL LIQUID ORL LIQ SAV ML 0.1810
00002049473 NOVAHISTINE DH CHILDREN ORAL LIQUID ORL LIQ SAV ML 0.1490
00000216666 NOVASEN 325 MG ENTERIC-COATED TABLET ORL ECT TEV TAB 0.0304
00000229296 NOVASEN 650 MG ENTERIC COATED TABLET ORL ECT NOP TAB 0.0650
00000907995 NOVASOURCE LIQUID ORL LIQ NHN ML 0.0086
00009854258 NOVASOURCE RENAL LIQUID ORL LIQ NHN ML 0.0086
00002270226 NOVO-BICALUTAMIDE 50 MG TABLET ORL TAB TEV TAB 4.0573
00002266350 NOVO-CILAZAPRIL 1 MG TABLET ORL TAB TEV TAB 0.1557
00002266377 NOVO-CILAZAPRIL 5 MG TABLET ORL TAB TEV TAB 0.2085
00000582417 NOVO-CIMETINE 300 MG TABLET ORL TAB TEV TAB 0.0860
00000603686 NOVO-CIMETINE 600 MG TABLET ORL TAB TEV TAB 0.1720
00002309556 NOVO-CYPROTERONE/ETHINYL ESTRADIOL 2MG/0.035MG TAB ORL TAB TEV TAB 1.1114
00002287730 NOVO-DESMOPRESSIN 0.1 MG TABLET ORL TAB TEV TAB 0.3303
00002287749 NOVO-DESMOPRESSIN 0.2 MG TABLET ORL TAB TEV TAB 0.6607
00000842044 NOVO-DOCUSATE CALCIUM 240 MG CAPSULE ORL CAP TEV CAP 0.0886
00002020084 NOVO-DOCUSATE SODIUM 100 MG CAPSULE ORL CAP TEV CAP 0.0481
00000021458 NOVOFERROGLUC 300 MG TABLET ORL TAB TEV TAB 0.0254
00080000435 NOVO-FERROGLUC 300 MG TABLET ORL TAB XXX TAB 0.0360
00000595829 NOVO-FIBER 469 MG TABLET ORL TAB TEV TAB 0.0979
00080042720 NOVO-FIBRE 469 MG TABLET ORL TAB TEV TAB 0.0979
00000389218 NOVO-GESIC 325 MG TABLET ORL TAB TEV TAB 0.0326
00002273756 NOVO-GLIMEPIRIDE 1 MG TABLET ORL TAB TEV TAB 0.4900
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 106 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002273764 NOVO-GLIMEPIRIDE 2 MG TABLET ORL TAB TEV TAB 0.4900
00002273772 NOVO-GLIMEPIRIDE 4 MG TABLET ORL TAB TEV TAB 0.4900
00002231184 NOVO-INDAPAMIDE 2.5 MG TABLET ORL TAB TEV TAB 0.1183
00002265435 NOVOMIX 30 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 3.6913
00002364883 NOVO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP TEV CAP 1.0310
00002348675 NOVO-MYCOPHENOLATE 500 MG TABLET ORL TAB TEV TAB 2.0620
00002240867 NOVO-NABUMETONE 500 MG TABLET ORL TAB TEV TAB 0.3625
00002240868 NOVO-NABUMETONE 750 MG TABLET ORL TAB TEV TAB 0.9192
00000021288 NOVO-PHENIRAM 4 MG TABLET ORL TAB TEV TAB 0.0655
00000021695 NOVO-PREDNISONE 5 MG TABLET ORL TAB TEV TAB 0.0401
00000232378 NOVO-PREDNISONE 50 MG TABLET ORL TAB TEV TAB 0.1735
00002283891 NOVO-RAMIPRIL 1.25 MG CAPSULE ORL CAP/TAB TEV CAP 0.1274
00002326450 NOVO-SALBUTAMOL HFA 100 MCG/DOSE MDA INH AEM TEV DOSE 0.0325
00002230095 NOVO-TEMAZEPAM 15 MG CAPSULE ORL CAP TEV CAP 0.0438
00002251469 NOVO-ZOPICLONE 7.5 MG TABLET ORL TAB TEV TAB 0.3125
00080041987 NOW GABA 750 MG VEGGIE CAPS CAPSULE ORL CAP NWF CAP 0.2495
00002322854 NPLATE 250 MCG/0.5 ML VIAL INJECTION INJ DEFAUL AMG VIAL 973.5100
00002322862 NPLATE 500 MCG/1 ML VIAL INJECTION INJ DEFAUL AMG VIAL 1947.0400
00001913980 NUBAIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 14.0560
00001913972 NUBAIN 20 MG/ML INJECTION INJ DEFAUL SDZ ML 6.0850
00002449781 NUCALA 100 MG/ML (144 MG/VIAL) RECONSTITUTED INJ INJ DEFAUL GSK VIAL 1938.4600
00002415585 NUCYNTA 100 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.5388
00002415593 NUCYNTA 150 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.0595
00002415607 NUCYNTA 200 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.6698
00002415615 NUCYNTA 250 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.6972
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 107 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002415577 NUCYNTA 50 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.0263
00002360438 NUCYNTA CR 250 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.5895
00002378299 NUCYNTA IR 100 MG TABLET ORL TAB JAI TAB 1.5121
00002378272 NUCYNTA IR 50 MG TABLET ORL TAB JAI TAB 1.0092
00002378280 NUCYNTA IR 75 MG TABLET ORL TAB JAI TAB 1.2604
00000623385 NUPERCAINAL ANESTHETIC 1% RECTAL OINTMENT RT ONT NVC G 0.1407
00000999817 NUTRAMIGEN A+ WITH LGG ORAL POWDER ORL PWR MJO G 0.0624
00002249002 NUTROPIN AQ 5 MG/ML PEN CARTRIDGE INJ CTG HLR ML 197.7350
00002376393 NUTROPIN AQ NUSPIN 10 10 MG/2ML PEN CARTRIDGE INJ CTG HLR ML 197.7350
00002399083 NUTROPIN AQ NUSPIN 20 20 MG/2 ML SOLUTION INJ DEFAUL HLR ML 395.4700
00002399091 NUTROPIN AQ NUSPIN 5 5 MG/2 ML SOLUTION INJ DEFAUL HLR ML 98.8700
00002253186 NUVARING 11.4 MG/2.6 MG SLOW-RELEASE VAGINAL RING VAG SDE MFC RNG 15.5300
00000716901 NYADERM 25,000 U/G VAGINAL CREAM VAG CRM TAR G 0.1250
00000999812 OASIS NUTRISOLUTION ORAL LIQUID ORL LIQ OAS ML 0.0057
00002239742 OBUSFORME EXTRA STRENGTH (W ACETAMINOPHEN) CAPLET ORL TAB WAM TAB 0.3611
00002237577 OBUSFORME METHOCARBAMOL & ACETAMINOPHEN CAPLET ORL TAB WAM TAB 0.3306
00000687766 O-CALCIUM 250 MG AND VITAMIN D TABLET ORL TAB WTR TAB 0.0620
00000622443 O-CALCIUM 500 MG (BASE) TABLET ORL TAB VTH TAB 0.0257
00002413205 OCPHYL 100 MCG/ML INJECTION INJ DEFAUL PPH ML 3.4440
00002413191 OCPHYL 50 MCG/ML INJECTION INJ DEFAUL PPH ML 1.8260
00002024179 OCTOSTIM 15 MCG INJECTION INJ DEFAUL FEI ML 36.2880
00002299445 OCTREOTIDE 200 MCG/ML INJECTION INJ DEFAUL TEV ML 15.5840
00002299453 OCTREOTIDE 500 MCG/ML INJECTION INJ DEFAUL TEV ML 38.0720
00080038562 OCUVITE ADULT 50+ ORL CAP BSH CAP 0.2644
00080053047 ODAN POLYSACCHARIDE IRON COMPLEX 150 150 MG CAP ORL CAP ODN CAP 0.3900
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 108 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000641324 ODAN-ERYTHROMYCIN 5 MG/G OPH OINTMENT OPH ONT ODN G 3.7100
00002459361 ODAN-FLUOXETINE 4 MG/ML ORAL SOLUTION ORL LIQ ODN ML 0.4394
00000358495 ODANS LIQUOR CARBONIS DETERGENS TOP LIQ ODN ML 0.0890
00080046696 ODAN-SODIUM CHLORIDE 5% OPHTHALMIC OINTMENT OPH ONT ODN G 2.5686
00080046737 ODAN-SODIUM CHLORIDE 5% OPHTHALMIC SOLUTION OPH SOL ODN ML 0.5993
00002231529 OFLOXACIN 200 MG TABLET ORL TAB AAP TAB 1.3693
00002231531 OFLOXACIN 300 MG TABLET ORL TAB AAP TAB 1.6089
00002231532 OFLOXACIN 400 MG TABLET ORL TAB AAP TAB 1.6089
00002311992 OLANZAPINE 10 MG TABLET ORL TAB PDL TAB 1.7857
00002312018 OLANZAPINE 15 MG TABLET ORL TAB PDL TAB 2.6775
00002311968 OLANZAPINE 2.5 MG TABLET ORL TAB PDL TAB 0.4493
00002421704 OLANZAPINE 20 MG TABLET ORL TAB PDL TAB 5.9377
00002311976 OLANZAPINE 5 MG TABLET ORL TAB PDL TAB 0.8936
00002311984 OLANZAPINE 7.5 MG TABLET ORL TAB PDL TAB 1.3479
00002416522 OLANZAPINE FOR INJECTION 10MG/VIAL INJ INJ DEFAUL SDZ VIAL 24.0800
00002338653 OLANZAPINE ODT 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 1.7857
00002343681 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SIV TAB 5.3553
00002338661 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 2.6777
00002352990 OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SNS TAB 5.3553
00002425114 OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 5.9377
00002343703 OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB SIV TAB 7.5977
00002338645 OLANZAPINE ODT 5 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PDL TAB 0.8937
00002365677 OLEX 20 MG DELAYED-RELEASE TABLET ORL DRT PPH TAB 0.6636
00002344408 OLUX-E 0.05% TOPICAL FOAM TOP FOA GSK G 1.4449
00002239144 OMBRELLE ECRAN SPF 60 TOPICAL CREAM TOP CRM COS G 0.0991
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 109 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002241277 OMBRELLE EXTREME SPF 30 TOPICAL LOTION TOP LOT COS ML 0.0875
00002303639 OMBRELLE SPF 60 TOPICAL LOTION TOP LOT OMB ML 0.1049
00002239016 OMBRELLE VAPO SPORT SPF 15 TOPICAL LOTION TOP LOT COS ML 0.0868
00080003480 OMEGA 3 CAPSULE ORL CAP PMT CAP 0.0990
00080008273 OMEGA 3 CAPSULE ORL CAP WNP CAP 0.2587
00080044844 OMEGA 3 KRILL OIL 500 MG CAPSULE ORL CAP JMS CAP 0.3078
00080015284 OMEGA 3 LIQUID ORL LIQ WNP ML 0.0261
00080002435 OMEGA 3 PREMIUM FISH OIL 1000 MG CAPSULE ORL CAP WNP CAP 0.0593
00080002596 OMEGA 3 SELECT CAPSULE ORL CAP JAM CAP 0.1131
00080019234 OMEGA 3 TRIPLE STRENGTH 900 MG SOFTGEL ORL CAP WBP CAP 0.2552
00002240743 OMEGA 3-6-9 CAPSULE ORL CAP JAM CAP 0.1647
00080000884 OMEGA 3-6-9 CAPSULE ORL CAP JMS CAP 0.1608
00080003127 OMEGA-3 ELITE SOFTGEL ORL CAP WBP CAP 0.0511
00080003179 OMEGA-3 TABLET ORL TAB JAM TAB 0.1542
00002385384 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT SIV CAP 0.5500
00002339927 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT PDL CAP 0.4117
00002303671 OMNARIS 50 MCG/DOSE METERED DOSE NASAL SPRAY NAS SPM AZC DOSE 0.2184
00002153513 ONCOTICE 800 M UNIT/VIAL FOR BLADDER INSTILLATION BLDIR PWS MFC VIAL 273.1400
00002325160 ONDANSETRON 8 MG TABLET ORL TAB PDL TAB 4.9930
00002271761 ONDANSETRON OMEGA (PRESERVATIVE FREE) 2 MG/ML INJ INJ DEFAUL OMG ML 8.1750
00002271788 ONDANSETRON OMEGA (WITH PRESERVATIVE) 2 MG/ML INJ INJ DEFALT OMG ML 8.1250
00002306212 ONDANSETRON-ODAN 4 MG TABLET ORL TAB ODN TAB 3.3500
00002306220 ONDANSETRON-ODAN 8 MG TABLET ORL TAB ODN TAB 4.9930
00080020211 ONE A DAY FRUITI-SSENTIAL GUMMIES ORL CTB BAI TAB 0.1563
00002248292 ONE A DAY MEN 50 PLUS TABLET ORL TAB BIC TAB 0.1037
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 110 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002248319 ONE A DAY WEIGHTSMART TABLET ORL TAB BAI TAB 0.1213
00002421208 ONRELTEA 0.33 % TOPICAL GEL TOP GEL GAL G 3.5180
00000750794 OPCON-A OPH SOLUTION OPH SOL BSH ML 0.2800
00002446634 OPDIVO (100 MG/10 ML) 10 MG/ML INJECTION INJ DEFAUL BMS ML 195.5560
00002446626 OPDIVO (40 MG/4 ML) 10 MG/ML INJECTION INJ DEFAUL BMS ML 195.5550
00002415690 OPSUMIT 10 MG FILM COATED TABLET ORL TAB ACT TAB 132.0550
00000990059 OPTICHAMBER DEVICE DEFAUL DEV ACM DEV 30.7200
00000990061 OPTICHAMBER LARGE FACE MASK DEVICE DEFAUL ADUDEV ACM DEV 35.3400
00000990062 OPTICHAMBER MEDIUM FACE MASK DEVICE DEFAUL PEDDEV ACM DEV 28.5300
00000990063 OPTICHAMBER SMALL FACE MASK DEVICE DEFAUL INFDEV ACM DEV 29.4300
00000355666 OPTIMINE 1 MG TABLET ORL TAB SCH TAB 0.4216
00002160889 OPTIMYXIN OPHTHALMIC OINTMENT OPH ONT SDZ G 1.4543
00000701785 OPTIMYXIN OTIC OPH DROPS OT/OPH DPS SDZ ML 0.9250
00002371189 OPTION 2 0.75 MG TABLET ORL TAB PRI TAB 7.7950
00080027592 OPUS D-1000 SOFTGEL ORL CAP OPU CAP 0.0700
00002035286 ORABASE PASTE ORL PST CVO G 1.1560
00001985396 ORAJEL MAXIMUM STRENGTH GEL ORL GEL CHD G 0.4063
00002381885 ORALAIR 100 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 1.2600
00002381893 ORALAIR 300 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 3.9000
00002047535 ORFENACE 100 MG TABLET ORL TAB STM TAB 0.4700
00002245641 ORGALUTRAN 250 MCG/ 0.5 ML INJECTION SYRINGE INJ NDL MFC SYR 94.7100
00002451379 ORKAMBI 125 MG/200 MG TABLET ORL TAB VER TAB 170.5357
00002209055 ORO-CLENSE 0.12% ORAL RINSE ORL MWH GER ML 0.0165
00002240336 ORO-MIN REMINERALIZING SOL W FLUORIDE ORAL RINSE ORL RNS XXX ML 0.0225
00080023808 ORTHO BONE CAPSULE ORL CAP AOR CAP 0.1565
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 111 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002042533 ORTHO-CEPT (28 DAY) TABLET ORL TB JAI TAB 0.7850
00000999460 ORTHOVISC DEFAUL DEV PMS ML 50.0000
00000999490 OSTENIL DEFAUL DEV TRB ML 50.2600
00002247548 OSTEOCIT D PLUS TABLET ORL TAB SFD TAB 0.1683
00002301911 OSTO-D2 50000 IU CAPSULE ORL CAP TPI CAP 0.2244
00002434318 OTEZLA 10 MG/20 MG/30 MG TABLET STARTER PACK ORL TAB CLG TAB 19.5715
00002434334 OTEZLA 30 MG TABLET ORL TAB CLG TAB 19.5714
00002238867 OTRIVIN 0.05% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.2340
00000653330 OTRIVIN 0.1% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.2340
00002331403 OTRIVIN MOIST 0.1% NASAL SPRAY NAS SPR NVC ML 0.3075
00000857777 OTRIVIN-SALINE 0.7% NASAL DROPS NAS SOL NVC ML 0.1348
00000810436 OTRIVIN-SALINE 0.7% NASAL SPRAY NAS SPR NVC ML 0.1187
00002262088 OVIDREL 250 MCG INJECTION SYRINGE INJ NDL SRO SYR 72.0000
00002371588 OVIDREL 250 MCG/0.5 ML PEN CARTRIDGE INJECTION INJ DEFAUL SRO ML 72.0000
00000013617 OVOL 40 MG/ML ORAL DROPS ORL DPS CHD ML 0.3393
00002239298 OVOL-180 ULTRA STRENGTH 180 MG CAPSULE ORL CAP CHD CAP 0.1850
00000292990 OVOL-80 80 MG TABLET ORL TAB CHD TAB 0.1300
00002435071 OXALIPLATIN 5 MG/ML INJECTION INJ DEFAUL TEV ML 46.6344
00002436957 OXALIPLATIN INJECTION 5 MG/ML INJECTION INJ DEFAUL SDZ ML 46.6350
00000497754 OXAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.0420
00000497762 OXAZEPAM 15 MG TABLET ORL TAB PDL TAB 0.0660
00000497770 OXAZEPAM 30 MG TABLET ORL TAB PDL TAB 0.0900
00002220636 OXYBUTYNINE-5 5 MG TABLET ORL TAB PDL TAB 0.0986
00002231934 OXY-IR 5 MG TABLET ORL TAB PUR TAB 0.2715
00002139561 OXYTOCIN 10 UNIT/ML INJECTION INJ DEFAUL FKC ML 6.8640
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 112 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002254735 OXYTROL 36 MG TRANSDERMAL PATCH TRD PTH ASC PTH 6.9463
00080001408 OYSTER SHELL CALCIUM 500 MG CAPLET ORL TAB NCI TAB 0.0290
00002248374 OYSTER SHELL CALCIUM WITH VIT D 500 MG TABLET ORL TAB VTH TAB 0.0266
00002363445 OZURDEX 0.7 MG INTRAVITREAL IMPLANT OPH IMP ALL SYS 1371.4400
00002320150 PACLITAXEL 6 MG/ML INJECTION USP INJ DEFAUL SDZ ML 74.8000
00001923420 PALAFER 300 MG CAPSULE ORL CAP GKC CAP 0.2293
00001923455 PALAFER-CF CAPSULE ORL CAP GKC CAP 0.3133
00002246597 PAMIDRONATE DISODIUM 30 MG/10 ML VIAL INJECTION INJ DEFAUL FKC ML 15.7500
00002246598 PAMIDRONATE DISODIUM 60 MG/10 ML INJECTION INJ DEFAUL FKC ML 29.9000
00002246599 PAMIDRONATE DISODIUM 90 MG/10 ML VIAL INJECTION INJ DEFAUL FKC ML 44.8000
00002249677 PAMIDRONATE DISODIUM OMEGA 60 MG/10 ML VIAL INJ INJ DEFAUL OMG ML 17.6700
00002239616 PANTO IV 40 MG/VIAL INJECTION INJ DEFAUL TAK VIAL 13.7000
00002241804 PANTOLOC 20 MG ENTERIC-COATED TABLET ORL ECT TAK TAB 1.8089
00002385740 PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 1.2750
00002309866 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT MEL TAB 0.3628
00002431327 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.3628
00002310201 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT SOR TAB 0.3628
00002318695 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.9785
00002439107 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT DPC TAB 0.3628
00002306727 PANTOPRAZOLE SODIUM FOR INJECTION 40 MG/VIAL INJ INJ DEFAUL SDZ VIAL 10.9600
00002428172 PANTOPRAZOLE-20 20 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 1.2750
00000009881 PAPAVERINE HCL 32.5 MG/ML INJECTION INJ DEFAUL SDZ ML 5.0865
00002282844 PAROXETINE 10 MG TABLET ORL TAB SNS TAB 1.0430
00002388227 PAROXETINE 10 MG TABLET ORL TAB SIV TAB 1.0430
00002248913 PAROXETINE-10 MG TABLET ORL TAB PDL TAB 0.8210
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 113 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002248914 PAROXETINE-20 MG TABLET ORL TAB PDL TAB 0.4513
00002248915 PAROXETINE-30 MG TABLET ORL TAB PDL TAB 0.4796
00002362171 PATADAY 0.2% OPHTHALMIC SOLUTION OPH SOL ALC ML 12.4080
00002233143 PATANOL 0.1% OPH SOLUTION OPH SOL ALC ML 6.2040
00000886327 PATE D'IHLE ZINC OXIDE 25% PASTE TOP PST ATL G 0.0234
00000532576 PATE D'IHLE ZINC OXIDE PASTE TOP PST ROG G 0.0306
00002381737 PAT-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT PAT TAB 0.1204
00002381745 PAT-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT PAT TAB 0.2408
00002027887 PAXIL 10 MG TABLET ORL TAB GSK TAB 1.6920
00002248503 PAXIL CR 12.5 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 1.7830
00002248504 PAXIL CR 25 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 1.9480
00000577790 PDP-ISONIAZID 100 MG TABLET ORL TAB PPH TAB 0.7314
00000577804 PDP-ISONIAZID 300 MG TABLET ORL TAB PPH TAB 0.7533
00000577812 PDP-ISONIAZID 50 MG/5ML ORAL LIQUID ORL LIQ PPH ML 0.2369
00002242863 PEDIAFER 30 MG/ML ORAL SOLUTION USP ORL SYR EUP ML 0.0272
00002232202 PEDIAFER 75 MG/ML ORAL SOLUTION USP ORL SYR SDZ ML 0.1432
00002162431 PEDIAPHARM NAPROXEN 25 MG/ML ORAL SUSPENSION ORL SUS PPI ML 0.0949
00080004595 PEDIAVIT D 400 IU DROPS ORL LIQ SDZ ML 0.1100
00002358034 PEG 3350 ORAL POWDER ORL PWR MES G 0.0668
00002328232 PEGALAX ORAL POWDER ORL PWR MFI G 0.0387
00002254638 PEGETRON 200 MG CAP/120 MCG/0.5 ML CLEARCLICK INJ INJ SYR/CAP MFC KIT 869.2000
00002254581 PEGETRON 200 MG CAP/80 MCG/0.5 ML CLEARLICK INJ INJ SYR/CAP MFC KIT 786.6100
00002250535 PENLAC NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL VCL G 13.5933
00002247265 PENNSAID 1.5% TOPICAL SOLUTION TOP SOL PAL ML 0.9325
00001980602 PENTA-3B PLUS VITAMIN C TABLET ORL TAB SDZ TAB 0.5820
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 114 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00001980599 PENTA-3B TABLET ORL TAB SDZ TAB 0.4780
00002183080 PENTAMIDINE ISETHIONATE 300 MG/VIAL INJECTION BP INJ DEFAUL HSP VIAL 130.9300
00002185938 PEPCID AC 10 MG TABLET ORL TAB MCL TAB 0.3310
00002097079 PEPTO-BISMOL 17.6 MG/ML ORAL LIQUID ORL LIQ PGI ML 0.0223
00002177994 PEPTO-BISMOL CAPLET ORL TAB PGI TAB 0.1521
00002237315 PEPTO-BISMOL CHEWABLES CHEWABLE TABLET ORL CTB PGI TAB 0.1521
00000254916 PERGONAL 75 UNIT/75 UNIT INJECTION INJ DEFAUL SRO VIAL 46.0000
00002240433 PERICHLOR 0.12% ORAL RINSE ORL MWH PMS ML 0.0181
00002237452 PERIDEX 0.12% ORAL RINSE ORL MWH ZIL ML 0.0238
00002207796 PERIOGARD 0.12% ORAL RINSE ORL MWH COL ML 0.0164
00002247104 PERIOSTAT 20 MG CAPSULE ORL CAP PPH CAP 1.2500
00002229501 PERI-WASH II ANTISEPTIC 0.1% CLEANSER TOP WAS COC ML 0.0147
00080017389 PGX 750 DAILY CAPSULE ORL CAP NFN CAP 0.0805
00080001122 PHARMA-CAL 500 MG ORL CAP PPH CAP 0.0216
00080004281 PHARMA-CAL D 500 MG/125 IU TABLET ORL TAB PMS TAB 0.0680
00002371499 PHARMA-D 10,000 UNIT CAPSULE ORL CAP PMS CAP 0.2100
00080001145 PHARMA-D 400 IU GELCAP ORL CAP PPH CAP 0.0300
00002371502 PHARMA-D 50,000 UNIT CAPSULE ORL CAP PMS CAP 0.9500
00080040416 PHARMA-K20 20 MEQ SUSTAINED-RELEASE TABLET ORL TAB/SRT PMS TAB 0.1995
00002247383 PHARMA-LACTULOSE 667 MG/ML SOLUTION ORL SOL PMS ML 0.0145
00080038071 PHARMANAC TM ACETYLCYSTEINE 900 MG TABLET ORL TAB BAP TAB 1.0208
00002436663 PHEBURANE 483 MG/G ORAL GRANULES ORL GRNUL MDK G 9.2690
00002304090 PHENOBARBITAL SODIUM 120 MG/ML INJECTION USP INJ DEFAUL SDZ ML 15.7000
00002304082 PHENOBARBITAL SODIUM 30 MG/ML INJECTION USP INJ DEFAUL SDZ ML 14.0990
00002148455 PHENYLEPHRINE HCL 10% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.0000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 115 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002148447 PHENYLEPHRINE HYDROCHLORIDE OPH SOLUTION (MINIMS) OPH SOL OPT ML 4.0000
00000780626 PHENYTOIN 50 MG/ML INJECTION INJ DEFAUL SDZ ML 6.0785
00002431378 PHENYTOIN SODIUM 50 MG/ML INJECTION USP INJ DEFAUL STM ML 5.2856
00002150638 PHILLIPS MAGNESIA 300 MG CHEWABLE TABLET ORL CTB BAI TAB 0.0487
00002150646 PHILLIPS MILK OF MAGNESIA 80 MG/ML ORAL LIQUID ORL LIQ BAI ML 0.0139
00002243578 PHISODERM FACIAL CLEANSER TOP WAS MNT G 0.0225
00002017733 PHISOHEX 3% TOPICAL CLEANSER TOP CLR SAV ML 0.0714
00002245781 PHL-AMIODARONE 200 MG TABLET ORL TAB PHH TAB 1.2971
00002249359 PHL-CYCLOBENZAPRINE 10 MG TABLET ORL TAB PHH TAB 0.3765
00002248608 PHL-MELOXICAM 15 MG TABLET ORL TAB PHH TAB 0.5670
00002248607 PHL-MELOXICAM 7.5 MG TABLET ORL TAB PHH TAB 0.4914
00002307669 PHL-PIOGLITAZONE 15 MG TABLET ORL TAB PHH TAB 1.5716
00002307677 PHL-PIOGLITAZONE 30 MG TABLET ORL TAB PHH TAB 0.2017
00002307723 PHL-PIOGLITAZONE 45 MG TABLET ORL TAB PHH TAB 3.3105
00002249766 PHL-PRAVASTATIN 10 MG TABLET ORL TAB PHH TAB 0.4050
00002249774 PHL-PRAVASTATIN 20 MG TABLET ORL TAB PHH TAB 0.6689
00002249782 PHL-PRAVASTATIN 40 MG TABLET ORL TAB PHH TAB 0.8057
00002299062 PHL-QUETIAPINE 100 MG TABLET ORL TAB PHH TAB 0.9226
00002299089 PHL-QUETIAPINE 200 MG TABLET ORL TAB PHH TAB 1.8527
00002299054 PHL-QUETIAPINE 25 MG TABLET ORL TAB PHH TAB 0.3458
00002299097 PHL-QUETIAPINE 300 MG TABLET ORL TAB PHH TAB 2.7038
00002236942 PHL-TRAZODONE 100 MG TABLET ORL TAB PHH TAB 0.3956
00002236941 PHL-TRAZODONE 50 MG TABLET ORL TAB PHH TAB 0.2214
00002294052 PHL-ZOPICLONE 5 MG TABLET ORL TAB PHH TAB 0.1782
00002294060 PHL-ZOPICLONE 7.5 MG TABLET ORL TAB PHH TAB 0.2250
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 116 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002230399 PHOSPHATES SOLUTION ORAL LIQUID ORL LIQ PPH ML 0.0856
00002019876 PHOTOFRIN 75MG/ VIAL INJECTION INJ DEFAUL AXC VIAL 19255.1000
00002400987 PICATO 0.015% TOPICAL GEL TOP GEL LEO DOSE 127.6667
00002400995 PICATO 0.05% TOPICAL GEL TOP GEL LEO DOSE 191.5000
00002254794 PICO SALAX ORAL POWDER ORL PWR FEI PCKT 7.7000
00002300583 PICODAN ORL PWDPKT ODN PCKT 3.6000
00002402483 PILOCARPINE HYDROCHLORIDE 5 MG TABLET ORL TAB STM TAB 0.7805
00002148463 PILOCARPINE NITRATE 2% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.6667
00000828424 PINDOLOL-10 MG TABLET ORL TAB PDL TAB 0.2323
00000828416 PINDOLOL-5 MG TABLET ORL TAB PDL TAB 0.1361
00002374013 PIOGLITAZONE HCL 15 MG TABLET ORL TAB SIV TAB 0.9295
00002374021 PIOGLITAZONE HCL 30 MG TABLET ORL TAB SIV TAB 1.3022
00002374048 PIOGLITAZONE HCL 45 MG TABLET ORL TAB SIV TAB 1.9580
00002391600 PIOGLITAZONE HYDROCHLORIDE 15 MG TABLET ORL TAB AHI TAB 0.8718
00002339587 PIOGLITAZONE HYDROCHLORIDE 30 MG TABLET ORL TAB AHI TAB 0.8139
00002339595 PIOGLITAZONE HYDROCHLORIDE 45 MG TABLET ORL TAB AHI TAB 1.2237
00002246640 PIPERACILLIN 2 G/VIAL INJECTION INJ DEFAUL HSP VIAL 9.5000
00002248939 PIPERACILLIN 2 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 15.2800
00002246641 PIPERACILLIN 3 G/VIAL INJECTION INJ DEFAUL HSP VIAL 23.9600
00002248940 PIPERACILLIN 3 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 22.9300
00002246642 PIPERACILLIN 4 G/VIAL INJECTION INJ DEFAUL HSP VIAL 19.0000
00002248941 PIPERACILLIN 4 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 30.5500
00002330547 PIPERACILLIN SOD/TAZOBACTAM SOD 12G/1500 MG VL INJ INJ DEFAUL SDZ VIAL 67.5000
00002439131 PIPERACILLIN SOD/TAZOBACTAM SOD 36G/4500 MG VL INJ INJ DEFAUL STM VIAL 202.5000
00002391511 PIPERACILLIN/TAZOBACTAM 2 G/250 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 9.6120
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 117 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002391538 PIPERACILLIN/TAZOBACTAM 3 G/375 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 9.0800
00002391546 PIPERACILLIN/TAZOBACTAM 4 G/500 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 12.1100
00001926667 PIPORTIL L4 25 MG/ML INJECTION INJ DEFAUL SAV ML 16.4400
00000501190 PLACEBO 100 MG TABLET ORL TAB ODN TAB 0.0750
00002293854 PLAN B 1.5 MG TABLET ORL TAB TEP TAB 17.2000
00002237405 PLANTE GUMMI BEAR MULTIPLE VITAMINS ORAL GUM ORL GUM PLI PIECE 0.1566
00002444399 PLEGRIDY 125 MCG/0.5 ML PS/PEN INJECTION INJ NDL BIO SYR 856.2600
00002444402 PLEGRIDY 63 MCG/94 MCG PS/PEN INJ STARTER PACK INJ NDL BIO SYR 856.2600
00001946897 PMS DEXAMETHASONE 0.5 MG/5 ML ORAL ELIXIR ORL ELX PMS ML 0.4289
00002458381 PMS-ABACAVIR-LAMIVUDINE 600 MG/300 MG TABLET ORL TAB PMS TAB 20.3573
00000792691 PMS-ACETAMINOPHEN 32 MG/ML ORAL SOLUTION ORL SOL PPH ML 0.0260
00002243435 PMS-ADENOSINE 3 MG/ML INJECTION INJ DEFAUL PMS ML 19.5000
00000654523 PMS-AMITRIPTYLINE 10 MG TABLET ORL TAB PMS TAB 0.0664
00000654515 PMS-AMITRIPTYLINE 25 MG TABLET ORL TAB PMS TAB 0.1211
00000654507 PMS-AMITRIPTYLINE 50 MG TABLET ORL TAB PMS TAB 0.2347
00002247304 PMS-AMITRIPTYLINE 50 MG TABLET ORL TAB PMS TAB 0.2346
00002440377 PMS-AMPHETAMINE XR 10 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 2.0758
00002440385 PMS-AMPHETAMINE XR 15 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 2.3250
00002440393 PMS-AMPHETAMINE XR 20 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 2.5743
00002440407 PMS-AMPHETAMINE XR 25 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 2.8235
00002440415 PMS-AMPHETAMINE XR 30 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 3.0729
00002440369 PMS-AMPHETAMINE XR 5 MG EXTENDED-RELEASE CAP ORL ERC PMS CAP 1.8266
00002274949 PMS-ANAGRELIDE 0.5 MG CAPSULE ORL CAP PMS CAP 3.3491
00002320738 PMS-ANASTROZOLE 1 MG TABLET ORL TAB PMS TAB 2.5460
00002284529 PMS-ASA EC 325 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.0309
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 118 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002283700 PMS-ASA EC 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.0538
00002381028 PMS-ATOMOXETINE 10 MG CAPSULE ORL CAP PMS CAP 2.3140
00002381036 PMS-ATOMOXETINE 18 MG CAPSULE ORL CAP PMS CAP 2.6522
00002381044 PMS-ATOMOXETINE 25 MG CAPSULE ORL CAP PMS CAP 2.9281
00002381052 PMS-ATOMOXETINE 40 MG CAPSULE ORL CAP PMS CAP 3.3375
00002381060 PMS-ATOMOXETINE 60 MG CAPSULE ORL CAP PMS CAP 3.7024
00002330237 PMS-BETAHISTINE 24 MG TABLET ORL TAB PMS TAB 0.4983
00002275589 PMS-BICALUTAMIDE 50 MG TABLET ORL TAB PMS TAB 4.0573
00002383020 PMS-BOSENTAN 125 MG TABLET ORL TAB PMS TAB 48.1340
00002383012 PMS-BOSENTAN 62.5 MG TABLET ORL TAB PMS TAB 48.1340
00002325373 PMS-BUPROPION SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PMS TAB 0.1547
00002391171 PMS-CANDESARTAN 4 MG TABLET ORL TAB PMS TAB 0.3400
00002185830 PMS-CEFACLOR 250 MG CAPSULE ORL CAP PMS CAP 0.6430
00002185857 PMS-CEFACLOR 25MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.0762
00002185865 PMS-CEFACLOR 50 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.1395
00002185849 PMS-CEFACLOR 500 MG CAPSULE ORL CAP PMS CAP 1.2625
00002185873 PMS-CEFACLOR 75 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.2010
00002315963 PMS-CETIRIZINE 20 MG TABLET ORL TAB PMS TAB 0.7535
00002413574 PMS-CICLOPIROX NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL PMS G 7.7433
00002416433 PMS-CIPROFLOXACIN XL 500 MG EXTENDED-RELEASE TAB ORL ERT PMS TAB 2.3110
00002232195 PMS-CLOBETASOL 0.05% SCALP LOTION SCP LOT PMS ML 0.2273
00002232191 PMS-CLOBETASOL 0.05% TOPICAL CREAM TOP CRM PMS G 0.3648
00002309548 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.2606
00002232193 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.4068
00000891797 PMS-DIAZEPAM 1 MG/ML ORAL SOLUTION ORL SOL PMS ML 0.1217
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 119 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002247492 PMS-DIAZEPAM 10 MG TABLET ORL TAB PMS TAB 0.0867
00002247490 PMS-DIAZEPAM 2 MG TABLET ORL TAB PMS TAB 0.0508
00002247491 PMS-DIAZEPAM 5 MG TABLET ORL TAB PMS TAB 0.0650
00000721344 PMS-DICITRATE ORAL SOLUTION ORL SOL PMS ML 0.0474
00002356783 PMS-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL PMS ML 0.6227
00002239753 PMS-DICLOFENAC-K 50 MG TABLET ORL TAB PMS TAB 0.3937
00000757683 PMS-DIPHENHYDRAMINE 25 MG CAPSULE ORL CAP PPH CAP 0.0899
00000757691 PMS-DIPHENHYDRAMINE 50 MG CAPSULE ORL CAP PPH CAP 0.1099
00002244527 PMS-DOXAZOSIN 1 MG TABLET ORL TAB PMS TAB 0.1416
00002434342 PMS-ELETRIPTAN 20 MG TABLET ORL TAB PMS TAB 10.0850
00002434350 PMS-ELETRIPTAN 40 MG TABLET ORL TAB PMS TAB 10.0850
00002454386 PMS-ERLOTINIB 100 MG TABLET ORL TAB PMS TAB 47.4667
00002454394 PMS-ERLOTINIB 150 MG TABLET ORL TAB PMS TAB 71.2000
00002379171 PMS-ESOMEPRAZOLE 40 MG DELAYED-RELEASE CAPSULE ORL DRT/DRC PMS CAP 1.8690
00002278081 PMS-FAMCICLOVIR 125 MG TABLET ORL TAB PMS TAB 2.0240
00002278103 PMS-FAMCICLOVIR 250 MG TABLET ORL TAB PMS TAB 2.7200
00002278111 PMS-FAMCICLOVIR 500 MG TABLET ORL TAB PMS TAB 4.2281
00000586323 PMS-FERROUS SULFATE 300 MG TABLET ORL TAB PPH TAB 0.0296
00002222574 PMS-FERROUS SULFATE INFANT DROPS 75 MG/ML ORL DPS PMS ML 0.1900
00002320169 PMS-FINASTERIDE 1 MG TABLET ORL TAB PMS TAB 1.1455
00000726354 PMS-FLUPHENAZINE 5 MG TABLET ORL TAB PMS TAB 0.1720
00002247493 PMS-FUROSEMIDE 20 MG TABLET ORL TAB PMS TAB 0.0373
00002247494 PMS-FUROSEMIDE 40 MG TABLET ORL TAB PMS TAB 0.0746
00002255898 PMS-GABAPENTIN 600 MG TABLET ORL TAB PMS TAB 1.3045
00002255901 PMS-GABAPENTIN 800 MG TABLET ORL TAB PMS TAB 1.7393
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 120 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002247386 PMS-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PMS TAB 0.0474
00002247387 PMS-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB PMS TAB 0.0551
00002324253 PMS-HYDROCODONE 1 MG/ML ORAL SYRUP ORL SYR PMS ML 0.1224
00000836133 PMS-IBUPROFEN 400 MG TABLET ORL TAB PMS TAB 0.1010
00002431114 PMS-IMATINIB 100 MG TABLET ORL TAB PMS TAB 20.4557
00002431122 PMS-IMATINIB 400 MG TABLET ORL TAB PMS TAB 81.8227
00002239619 PMS-INDAPAMIDE 1.25 MG TABLET ORL TAB PMS TAB 0.0745
00002239620 PMS-INDAPAMIDE 2.5 MG TABLET ORL TAB PMS TAB 0.1183
00002288265 PMS-LEFLUNOMIDE 10 MG TABLET ORL TAB PMS TAB 6.0417
00002288273 PMS-LEFLUNOMIDE 20 MG TABLET ORL TAB PMS TAB 6.0417
00002309114 PMS-LETROZOLE 2.5 MG TABLET ORL TAB PMS TAB 2.7560
00002296101 PMS-LEVETIRACETAM 250 MG TABLET ORL TAB PMS TAB 0.4459
00002296128 PMS-LEVETIRACETAM 500 MG TABLET ORL TAB PMS TAB 0.5432
00002296136 PMS-LEVETIRACETAM 750 MG TABLET ORL TAB PMS TAB 1.3500
00000811874 PMS-LIDOCAINE VISCOUS 2% ORAL LIQUID ORL LIQ PMS ML 0.0950
00002074834 PMS-LITHIUM CITRATE 8 MMO/5ML ORAL SYRUP ORL SYR PMS ML 0.0708
00002248268 PMS-MELOXICAM 15 MG TABLET ORL TAB PMS TAB 0.5670
00002248267 PMS-MELOXICAM 7.5 MG TABLET ORL TAB PMS TAB 0.4914
00002321130 PMS-MEMANTINE 10 MG TABLET ORL TAB PMS TAB 1.6357
00002382830 PMS-MEMANTINE 5 MG TABLET ORL TAB PMS TAB 1.6357
00002413728 PMS-METHYLPHENIDATE 18 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.4276
00002413736 PMS-METHYLPHENIDATE 27 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.6475
00002413744 PMS-METHYLPHENIDATE 36 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 1.8674
00002413752 PMS-METHYLPHENIDATE 54 MG EXTENDED RELEASE TABLET ORL ERT PMS TAB 2.3072
00000783137 PMS-METRONIDAZOLE 500 MG CAPSULE ORL CAP PMS CAP 0.7028
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 121 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002432218 PMS-MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL PMS ML 3.7567
00002405776 PMS-NEVIRAPINE 200 MG TABLET ORL TAB PMS TAB 2.4692
00002418630 PMS-NIFEDIPINE ER 30 MG EXTENDED-RELEASE TABLET ORL ERT PMS TAB 0.6171
00002416301 PMS-NIFEDIPINE ER 60 MG EXTENDED-RELEASE TABLET ORL ERT PMS TAB 0.9374
00002367483 PMS-OLANZAPINE 20 MG TABLET ORL TAB PMS TAB 10.3093
00002303213 PMS-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB PMS TAB 5.3553
00002423944 PMS-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB PMS TAB 7.5977
00002309882 PMS-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 0.4390
00002309890 PMS-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 0.6585
00002309904 PMS-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 1.1413
00002309912 PMS-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT PMS TAB 2.1080
00002247750 PMS-PAROXETINE 10 MG TABLET ORL TAB PMS TAB 1.0430
00002303124 PMS-PIOGLITAZONE 15 MG TABLET ORL TAB PMS TAB 0.6225
00002303132 PMS-PIOGLITAZONE 30 MG TABLET ORL TAB PMS TAB 0.8721
00002303140 PMS-PIOGLITAZONE 45 MG TABLET ORL TAB PMS TAB 1.3113
00002240363 PMS-POLYTRIMETHOPRIM OPHTHALMIC SOLUTION OPH SOL PMS ML 2.3880
00002290138 PMS-PRAMIPEXOLE 0.5 MG TABLET ORL TAB PMS TAB 1.3860
00002359634 PMS-PREGABALIN 150 MG CAPSULE ORL CAP PMS CAP 1.7270
00002398079 PMS-PREGABALIN 225 MG CAPSULE ORL CAP PMS CAP 1.7270
00002359596 PMS-PREGABALIN 25 MG CAPSULE ORL CAP PMS CAP 0.6173
00002359642 PMS-PREGABALIN 300 MG CAPSULE ORL CAP PMS CAP 1.7270
00002359618 PMS-PREGABALIN 50 MG CAPSULE ORL CAP PMS CAP 0.9683
00002359626 PMS-PREGABALIN 75 MG CAPSULE ORL CAP PMS CAP 1.2529
00000753661 PMS-PROCHLORPERAZINE 5 MG TABLET ORL TAB PMS TAB 0.1659
00002294559 PMS-PROPAFENONE 150 MG TABLET ORL TAB PMS TAB 0.4275
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 122 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002294575 PMS-PROPAFENONE 300 MG TABLET ORL TAB PMS TAB 0.7537
00002244379 PMS-PROPOFOL 10 MG/ML INJECTION INJ DEFAUL PMS ML 0.4600
00000815993 PMS-PSEUDOEPHEDRINE HCL 6 MG/ML ORAL SYRUP ORL SYR PMS ML 0.0443
00000618810 PMS-PYRAZINAMIDE 500 MG TABLET ORL TAB PMS TAB 1.2408
00002340569 PMS-QUINAPRIL 10 MG TABLET ORL TAB PMS TAB 0.6867
00002340577 PMS-QUINAPRIL 20 MG TABLET ORL TAB PMS TAB 0.6867
00002340585 PMS-QUINAPRIL 40 MG TABLET ORL TAB PMS TAB 0.6867
00002340550 PMS-QUINAPRIL 5 MG TABLET ORL TAB PMS TAB 0.6867
00002343932 PMS-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB PMS CAP 0.8133
00002424177 PMS-RISEDRONATE 150 MG TABLET ORL TAB PMS TAB 40.9500
00002371642 PMS-SILDENAFIL 100 MG TABLET ORL TAB PMS TAB 9.2006
00002371626 PMS-SILDENAFIL 25 MG TABLET ORL TAB PMS TAB 8.2894
00002371634 PMS-SILDENAFIL 50 MG TABLET ORL TAB PMS TAB 8.8481
00002412179 PMS-SILDENAFIL R 20 MG TABLET ORL TAB PMS TAB 7.2940
00002256428 PMS-SUMATRIPTAN 25 MG TABLET ORL TAB PMS TAB 8.9900
00002409437 PMS-TADALAFIL 10 MG TABLET ORL TAB PMS TAB 11.9255
00002409410 PMS-TADALAFIL 2.5 MG TABLET ORL TAB PMS TAB 3.6471
00002409445 PMS-TADALAFIL 20 MG TABLET ORL TAB PMS TAB 12.3569
00002409429 PMS-TADALAFIL 5 MG TABLET ORL TAB PMS TAB 3.6471
00002237460 PMS-TAMOXIFEN 20 MG TABLET ORL TAB PMS TAB 0.3500
00002401665 PMS-TELMISARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PMS TAB 0.2821
00002401673 PMS-TELMISARTAN-HCTZ 80 MG/25 MG TABLET ORL TAB PMS TAB 0.2821
00002083353 PMS-TIMOLOL 0.25% (BASE) OPH SOLUTION OPH SOL PMS ML 0.9680
00002083345 PMS-TIMOLOL 0.5% (BASE) OPH SOLUTION OPH SOL PMS ML 1.5500
00002401657 PMS-TRAMADOL-ACET 37.5 MG/325 MG TABLET ORL TAB PMS TAB 0.6264
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 123 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002312999 PMS-VALSARTAN 40 MG TABLET ORL TAB PMS TAB 0.5240
00002241821 PMS-VANCOMYCIN 1 G/VIAL INJECTION INJ DEFAUL PMS VIAL 58.9900
00002241820 PMS-VANCOMYCIN 500 MG/VIAL INJECTION INJ DEFAUL PMS VIAL 31.0500
00001985604 PMS-YOHIMBINE 6 MG TABLET ORL TAB PMS TAB 0.8245
00002403056 PMS-ZOLEDRONIC ACID 4 MG/5 ML INJECTION INJ DEFAUL PMS ML 38.7860
00002324768 PMS-ZOLMITRIPTAN ODT 2.5 MG ORALLY DISP. TABLET ORL DISPTAB PMS TAB 3.5383
00002436183 PMS-ZOLPIDEM ODT 10 MG SUBLINGUAL DISINT. TABLET SLG DISNTAB PMS TAB 1.1883
00002436175 PMS-ZOLPIDEM ODT 5 MG SUBLINGUAL DISINT. TABLET SLG DISNTAB PMS TAB 1.1827
00002458543 PMS-ZOPICLONE 3.75 MG TABLET ORL TAB PMS TAB 0.2231
00000431648 PNEUMOVAX 23 25 MCG/VIAL INJECTION INJ DEFAUL MSD VIAL 19.2800
00000990067 POCKET CHAMBER DEVICE DEFAUL DEV MMS DEV 15.9900
00000990069 POCKET CHAMBER PEDIATRIC MEDIUM MASK DEVICE DEFAUL PEDDEV MMS DEV 49.9900
00000598208 PODOFILM 250 MG/ML TOPICAL LIQUID TOP LIQ PMS ML 1.6608
00000464988 POLLINEX R INJECTION INJ VIAL/SYR BEE VL/SYR 96.4700
00000999389 POLYCAL ORAL POWDER ORL PWR XXX G 0.0224
00002230844 POLYSPORIN 10,000 U/0.25 MG ANTIBIOTIC TOPICAL CRM TOP CRM JJI G 0.3780
00002237227 POLYSPORIN ANTIBIOTIC TOPICAL OINTMENT TOP ONT JJI G 0.3780
00002239155 POLYSPORIN PLUS PAIN RELIEF EAR DROPS OT SOL JJI ML 0.7600
00002239201 POLYSPORIN PLUS PAIN RELIEF TOPICAL CREAM TOP CRM JJI G 0.4100
00002239157 POLYSPORIN STERILE OPHTHALMIC OINTMENT OPH ONT JJI G 1.6886
00002239156 POLYSPORIN STERILE OTIC OPH DROPS OT/OPH DPS JJI ML 0.7600
00002237226 POLYSPORIN TRIPLE ANTIBIOTIC TOPICAL OINTMENT TOP ONT JJI G 0.4100
00001942921 POLYTOPIC TOPICAL OINTMENT TOP ONT SDZ G 0.3333
00002011956 POLYTRIM OPH SOLUTION OPH SOL ALL ML 3.3560
00002419580 POMALYST 1 MG CAPSULE ORL CAP CLG CAP 500.0000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 124 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002419599 POMALYST 2 MG CAPSULE ORL CAP CLG CAP 500.0000
00002419602 POMALYST 3 MG CAPSULE ORL CAP CLG CAP 500.0000
00002419610 POMALYST 4 MG CAPSULE ORL CAP CLG CAP 500.0000
00002424622 POSANOL 100 MG DELAYED-RELEASE TABLET ORL DRT MFC TAB 47.5173
00002293404 POSANOL 40 MG/ML ORAL SUSPENSION ORL SUS MFC ML 9.5034
00000611271 POTABA 0.5 G CAPSULE ORL CAP GLE CAP 0.3311
00000550175 POTABA 0.5 G TABLET ORL TAB GLE TAB 0.4319
00000316121 POTASSIUM 50 MG TABLET ORL TAB JAM TAB 0.0563
00080028233 POTASSIUM CHLORIDE 20 MEQ TABLET ORL TAB/SRT OPU TAB 0.1995
00080026332 POTASSIUM CITRATE 10 MMOL 10 MEQ TABLET ORL TAB MTR TAB 0.1545
00000804789 POTASSIUM PHOSPHATE 224 MG/ML/ 236 MG/ML INJECTION INJ DEFAUL SDZ ML 1.1869
00002139545 POTASSIUM PHOSPHATES 224 MG/ML/236 MG/ML INJECTION INJ DEFAUL FKC ML 0.6098
00002312433 PRADAXA 75 MG CAPSULE ORL CAP BOE CAP 1.6480
00002453835 PRALUENT 150 MG/ML INJECTION PEN INJ DEFAUL SAV ML 279.3600
00002453819 PRALUENT 75 MG/ML INJECTION PEN INJ DEFAUL SAV ML 279.3600
00002309130 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SIV TAB 1.3860
00002367610 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SNS TAB 1.3860
00000770957 PRAMOX H.C. TOPICAL CREAM TOP CRM DPT G 0.4444
00001954210 PRAMOX H.C. TOPICAL LOTION TOP LOT DPT ML 0.1833
00002243824 PRAVASTATIN-10 10 MG TABLET ORL TAB PDL TAB 0.4050
00002243825 PRAVASTATIN-20 20 MG TABLET ORL TAB PDL TAB 0.4777
00002243826 PRAVASTATIN-40 40 MG TABLET ORL TAB PDL TAB 0.5755
00002148498 PREDNISOLONE SOD PHOS 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.6667
00000156876 PREDNISONE 5 MG TABLET ORL TAB PDL TAB 0.0401
00000607517 PREDNISONE-50 50 MG TABLET ORL TAB PDL TAB 0.1735
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 125 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002403722 PREGABALIN 150 MG CAPSULE ORL CAP SIV CAP 1.7270
00002396521 PREGABALIN 150 MG CAPSULE ORL CAP PDL CAP 1.1698
00002405563 PREGABALIN 150 MG CAPSULE ORL CAP SNS CAP 1.7270
00002403749 PREGABALIN 225 MG CAPSULE ORL CAP SIV CAP 1.1698
00002403692 PREGABALIN 25 MG CAPSULE ORL CAP SIV CAP 0.6173
00002405539 PREGABALIN 25 MG CAPSULE ORL CAP SNS CAP 0.6173
00002396483 PREGABALIN 25 MG CAPSULE ORL CAP PDL CAP 0.4181
00002405598 PREGABALIN 300 MG CAPSULE ORL CAP SNS CAP 1.7270
00002403730 PREGABALIN 300 MG CAPSULE ORL CAP SIV CAP 1.7270
00002396548 PREGABALIN 300 MG CAPSULE ORL CAP PDL CAP 1.1698
00002396505 PREGABALIN 50 MG CAPSULE ORL CAP PDL CAP 0.6558
00002403706 PREGABALIN 50 MG CAPSULE ORL CAP SIV CAP 0.9683
00002405547 PREGABALIN 50 MG CAPSULE ORL CAP SNS CAP 0.9683
00002396513 PREGABALIN 75 MG CAPSULE ORL CAP PDL CAP 0.8486
00002403714 PREGABALIN 75 MG CAPSULE ORL CAP SIV CAP 1.2529
00002405555 PREGABALIN 75 MG CAPSULE ORL CAP SNS CAP 1.2528
00002411768 PREGABALIN-150 150 MG CAPSULE ORL CAP SIV CAP 1.7270
00002411725 PREGABALIN-25 25 MG CAPSULE ORL CAP SIV CAP 0.6173
00002411733 PREGABALIN-50 50 MG CAPSULE ORL CAP SIV CAP 0.9683
00002411741 PREGABALIN-75 75 MG CAPSULE ORL CAP SIV CAP 1.2529
00000999556 PREGESTIMIL A+ INFANT FORMULA ORL PWR MJO G 0.0405
00002182904 PREGNYL 10,000 UNIT INJECTION INJ DEFAUL MFC VIAL 72.0000
00002451581 PREGVIT FOLIC 5 TABLET ORL TAB DUI TAB 0.5312
00002276194 PREGVIT FOLIC 5 TABLET ORL TAB DUI TAB 0.5312
00002246067 PREGVIT TABLET ORL TAB DUI TAB 0.4167
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 126 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002451573 PREGVIT TABLET ORL TAB DUI TAB 0.4167
00002043394 PREMARIN 0.3 MG TABLET ORL TAB PFI TAB 0.3027
00002043408 PREMARIN 0.625 MG TABLET ORL TAB PFI TAB 0.3027
00002043424 PREMARIN 1.25 MG TABLET ORL TAB PFI TAB 0.3027
00002043386 PREMARIN 25 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 44.1500
00002244574 PRENATAL VITAMIN AND MINERAL SUPPLEMENT CAPLET ORL TAB WNP TAB 0.0766
00000886750 PREPARATION H TOPICAL CREAM TOP CRM PDH G 0.2544
00001926217 PREPARATION H TOPICAL OINTMENT TOP ONT PDH G 0.2208
00000999899 PRESIDENT'S CHOICE ORAL LIQUID ORL LIQ PNU ML 0.0071
00000693820 PRESSYN 20 U/ML INJECTION INJ DEFAUL FEI ML 7.9000
00002246133 PRESSYN AR 20U/ML INJECTION INJ DEFAUL FEI ML 10.0000
00002249464 PREVACID FASTAB 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB BGP TAB 2.0000
00002249472 PREVACID FASTAB 30 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB BGP TAB 2.0000
00002210754 PREVIDENT 5000 PLUS DENTAL CREAM DEN CRM COL G 0.2013
00002335204 PREVNAR 13 SUSPENSION 0.5 ML SYRINGE INJECTION INJ NDL PFI SYR 92.4400
00002244081 PREVNAR VACCINE 0.5 ML INJECTION INJ DEFAUL PFI ML 180.1800
00002426501 PREZCOBIX 800 MG/150 MG TABLET ORL TAB JAI TAB 23.8670
00002369753 PREZISTA 150 MG TABLET ORL TAB JAI TAB 3.7860
00002324024 PREZISTA 600 MG TABLET ORL TAB JAI TAB 16.0058
00002338432 PREZISTA 75 MG TABLET ORL TAB JAI TAB 1.8930
00002393050 PREZISTA 800 MG TABLET ORL TAB JAI TAB 21.7160
00080033655 PRIMADOPHILUS OPTIMA MAX BIFIDO 90 BILLION CAPSULE ORL CAP ENT CAP 1.4283
00000839388 PRINIVIL 5 MG TABLET ORL TAB MFC TAB 0.6073
00002239208 PRIORIX VIAL INJECTION INJ DEFAUL GSK VIAL 27.7760
00002321106 PRISTIQ 100 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.7250
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 127 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002321092 PRISTIQ 50 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.7250
00002426366 PRIVA-CELECOXIB 100 MG CAPSULE ORL CAP PMI CAP 0.1730
00002426374 PRIVA-CELECOXIB 200 MG CAPSULE ORL CAP PMI CAP 0.3497
00002445328 PRIVA-DOMPERIDONE 10 MG TABLET ORL TAB PMI TAB 0.0594
00002446677 PRIVA-DONEPEZIL 10 MG TABLET ORL TAB PMI TAB 0.7875
00002446669 PRIVA-DONEPEZIL 5 MG TABLET ORL TAB PMI TAB 0.7875
00002426331 PRIVA-ESCITALOPRAM 10 MG TABLET ORL TAB PMI TAB 1.4680
00002426358 PRIVA-ESCITALOPRAM 20 MG TABLET ORL TAB PMI TAB 1.5630
00002425238 PRIVA-EZETIMIBE 10 MG TABLET ORL TAB PMI TAB 0.4612
00002446502 PRIVA-IRBESARTAN 150 MG TABLET ORL TAB PMI TAB 0.3025
00002446510 PRIVA-IRBESARTAN 300 MG TABLET ORL TAB PMI TAB 0.3025
00002446499 PRIVA-IRBESARTAN 75 MG TABLET ORL TAB PMI TAB 0.3025
00002446715 PRIVA-LOSARTAN 100 MG TABLET ORL TAB PMI TAB 0.2321
00002446693 PRIVA-LOSARTAN 25 MG TABLET ORL TAB PMI TAB 0.2321
00002446707 PRIVA-LOSARTAN 50 MG TABLET ORL TAB PMI TAB 0.2321
00002449919 PRIVA-OMEPRAZOLE 20 MG SUSTAINED-RELEASE TABLET ORL CAP/SRT PMI TAB 0.4117
00002425378 PRIVA-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT PMI TAB 0.3628
00002447096 PRIVA-QUETIAPINE 100 MG TABLET ORL TAB PMI TAB 0.3295
00002447126 PRIVA-QUETIAPINE 200 MG TABLET ORL TAB PMI TAB 0.6617
00002447088 PRIVA-QUETIAPINE 25 MG TABLET ORL TAB PMI TAB 0.1235
00002447134 PRIVA-QUETIAPINE 300 MG TABLET ORL TAB PMI TAB 0.9656
00002448807 PRIVA-SILDENAFIL 100 MG TABLET ORL TAB PMI TAB 9.2000
00002452499 PRIVA-TADALAFIL 10 MG TABLET ORL TAB PMI TAB 11.9250
00002452472 PRIVA-TADALAFIL 2.5 MG TABLET ORL TAB PMI TAB 3.6471
00002452502 PRIVA-TADALAFIL 20 MG TABLET ORL TAB PMI TAB 12.3575
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 128 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002452480 PRIVA-TADALAFIL 5 MG TABLET ORL TAB PMI TAB 3.6471
00002425874 PRIVA-ZOPICLONE 5 MG TABLET ORL TAB PMI TAB 0.1782
00002425882 PRIVA-ZOPICLONE 7.5 MG TABLET ORL TAB PMI TAB 0.2250
00000644315 PRO AMOX-500 MG CAPSULE ORL CAP PDL CAP 0.3417
00002311518 PRO-AAS (CROQUABLE) 80 MG CHEWABLE TABLET ORL CTB PDL TAB 0.0560
00002311496 PRO-AAS EC 80 MG TABLET ORL ECT PDL TAB 0.5600
00002309661 PRO-AMIODARONE-200 200 MG TABLET ORL TAB PDL TAB 0.5147
00000644331 PRO-AMOX 250 MG/5 ML POWDER FOR ORAL SUSPENSION ORL SUS PDL ML 0.0540
00080026419 PROARGI-9 PLUS ORAL POWDER ORL PWR NHP G 0.1252
00002310600 PRO-AZITHROMYCINE 250 MG TABLET ORL TAB PDL TAB 2.4667
00002311038 PRO-BICALUTAMIDE-50 50 MG TABLET ORL TAB PDL TAB 1.6100
00080025685 PROBIOMAX DF CAPSULE ORL CAP XYG CAP 1.3913
00080014464 PROBIOTIC 10 BILLION ORL CAP JAM CAP 0.2398
00002184486 PROCAINAMIDE HYDROCHLORIDE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 3.7242
00080008566 PRO-CAL-D 400 IU ORAL CAPLET ORL DEFAUL PDL TAB 0.1200
00002311062 PRO-CEFADROXIL-500 500 MG CAPSULE ORL CAP PDL CAP 0.8421
00002311453 PRO-CEFUROXIME-500 500 MG TABLET ORL TAB PDL TAB 1.4337
00002232658 PROCET-30 TABLET ORL TAB PDL TAB 0.1300
00002317796 PRO-CIPROFLOXACIN 250 MG TABLET ORL TAB PDL TAB 0.6186
00002317818 PRO-CIPROFLOXACIN 500 MG TABLET ORL TAB PDL TAB 0.6979
00002311593 PRO-CLONAZEPAM 0.5 MG TABLET ORL TAB PDL TAB 0.0554
00002311607 PRO-CLONAZEPAM 1 MG TABLET ORL TAB PDL TAB 0.1487
00002311615 PRO-CLONAZEPAM 2 MG TABLET ORL TAB PDL TAB 0.0954
00002223260 PROCTOSEDYL RECTAL SUPPOSITORY RT SUP AXC SUP 1.2108
00002241799 PROCYTOX 1,000 MG/VIAL INJECTION INJ DEFAUL ASM VIAL 87.5700
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 129 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002241797 PROCYTOX 200 MG/VIAL INJECTION INJ DEFAUL ASM VIAL 51.8700
00002241795 PROCYTOX 25 MG TABLET ORL TAB ASM TAB 0.5002
00002241796 PROCYTOX 50 MG TABLET ORL TAB ASM TAB 0.6690
00002241798 PROCYTOX 500 MG/VIAL INJECTION INJ DEFAUL ASM VIAL 47.1800
00002241800 PROCYTOX INJECTION INJ DEFAUL ASM VIAL 152.3500
00002311267 PRO-DEXAMETHASONE-4 4 MG TABLET ORL TAB PDL TAB 0.3046
00002246645 PRODIEM BULK FIBRE THERAPY 625 MG TABLET ORL TAB NVC TAB 0.1614
00002246576 PRODIEM OVERNIGHT RELIEF THERAPY 15 MG TABLET ORL TAB NVC TAB 0.2030
00002311429 PRO-ENALAPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.3252
00002311402 PRO-ENALAPRIL-2.5 2.5 MG TABLET ORL TAB PDL TAB 0.1863
00002311437 PRO-ENALAPRIL-20 20 MG TABLET ORL TAB PDL TAB 0.3924
00002311410 PRO-ENALAPRIL-5 5 MG TABLET ORL TAB PDL TAB 0.2706
00002310228 PRO-FENO-SUPER-100 100 MG TABLET ORL TAB PDL TAB 0.5406
00002310236 PRO-FENO-SUPER-160 160 MG TABLET ORL CAP/TAB PDL TAB 0.2723
00002247909 PROFERRIN 11 MG TABLET ORL TAB CBI TAB 0.6990
00002310686 PRO-FLUCONAZOLE 100 MG TABLET ORL TAB PDL TAB 2.2890
00002310694 PRO-FLUCONAZOLE 150 MG CAPSULE ORL CAP PDL CAP 3.9400
00002314991 PRO-FLUOXETINE 10 MG CAPSULE ORL CAP PDL CAP 0.4595
00002315009 PRO-FLUOXETINE 20 MG CAPSULE ORL CAP PDL CAP 0.4598
00002310449 PRO-GABAPENTIN 100 MG CAPSULE ORL CAP PDL CAP 0.1040
00002310457 PRO-GABAPENTIN 300 MG CAPSULE ORL CAP PDL CAP 0.2530
00002310465 PRO-GABAPENTIN 400 MG CAPSULE ORL CAP PDL CAP 0.3015
00002310473 PRO-GABAPENTIN 600 MG TABLET ORL TAB PDL TAB 0.9580
00002310481 PRO-GABAPENTIN 800 MG TABLET ORL TAB PDL TAB 1.2773
00000503347 PROGLYCEM 100 MG CAPSULE ORL CAP MFC CAP 1.6802
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 130 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002243144 PROGRAF 0.5 MG CAPSULE ORL CAP ASP CAP 1.9700
00002175991 PROGRAF 1 MG CAPSULE ORL CAP ASP CAP 2.5200
00002175983 PROGRAF 5 MG CAPSULE ORL CAP ASP CAP 12.6200
00080060497 PROGRESSIVE HARMONIZED VEGAN PROTEIN POWDER ORL PWR BPN G 0.0582
00002311011 PRO-HYDROXYQUINE-200 200 MG TABLET ORL TAB PDL TAB 0.2620
00002312530 PRO-INDAPAMIDE 1.25 MG TABLET ORL TAB PDL TAB 0.0745
00002312549 PRO-INDAPAMIDE 2.5 MG TABLET ORL TAB PDL TAB 0.1182
00080053887 PRO-K 20 20 MEQ SUSTAINED-RELEASE TABLET ORL TAB PDL TAB 0.1995
00002204606 PROLASTIN-C 1 G/VIAL INJECTION INJ DEFAUL GRL VIAL 429.0600
00002439123 PROLENSA 0.07% OPHTHALMIC SOLUTION OPH SOL BSH ML 7.6700
00002310988 PRO-LISINOPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.1619
00002310996 PRO-LISINOPRIL-20 20 MG TABLET ORL TAB PDL TAB 0.1945
00002310961 PRO-LISINOPRIL-5 5 MG TABLET ORL TAB PDL TAB 0.1347
00000655643 PRO-LORAZEPAM 0.5 MG TABLET ORL TAB PDL TAB 0.0359
00000655651 PRO-LORAZEPAM 1.0 MG TABLET ORL TAB PDL TAB 0.0447
00000655678 PRO-LORAZEPAM 2 MG TABLET ORL TAB PDL TAB 0.0699
00002314908 PRO-METFORMIN 500 MG TABLET ORL TAB PDL TAB 0.0444
00002314894 PRO-METFORMIN 850 MG TABLET ORL TAB PDL TAB 0.0610
00000567434 PROMETHAZINE HCL 25 MG/ML INJECTION INJ DEFAUL SDZ ML 1.6540
00002310953 PRO-NAPROXEN EC - 500 500 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.2110
00002343053 PROPAFENONE 150 MG TABLET ORL TAB SNS TAB 0.4303
00002343061 PROPAFENONE 300 MG TABLET ORL TAB SNS TAB 0.7537
00002243783 PROPAFENONE-150 150 MG TABLET ORL TAB PDL TAB 0.2965
00002243784 PROPAFENONE-300 300 MG TABLET ORL TAB PDL TAB 0.5227
00002238213 PROPECIA 1 MG TABLET ORL TAB MFC TAB 1.8529
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 131 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002437643 PROPOFOL INJECTION 10 MG/ML INJECTION INJ DEFAUL FKC ML 0.4600
00002317354 PRO-QUETIAPINE 100 MG TABLET ORL TAB PDL TAB 0.3295
00002317362 PRO-QUETIAPINE 200 MG TABLET ORL TAB PDL TAB 0.6617
00002317346 PRO-QUETIAPINE 25 MG TABLET ORL TAB PDL TAB 0.1235
00002317370 PRO-QUETIAPINE 300 MG TABLET ORL TAB PDL TAB 0.9656
00002311224 PRO-QUININE-300 300 MG CAPSULE ORL CAP PDL CAP 0.3750
00002315181 PRO-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.1204
00002315203 PRO-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.2408
00002310023 PRO-RAMIPRIL-1.25 1.25 MG CAPSULE ORL CAP/TAB PDL CAP 0.1274
00002310104 PRO-RAMIPRIL-10 10 MG CAPSULE ORL CAP/TAB PDL CAP 0.1862
00002310066 PRO-RAMIPRIL-2.5 2.5 MG CAPSULE ORL CAP/TAB PDL CAP 0.1470
00002310074 PRO-RAMIPRIL-5 5 MG CAPSULE ORL CAP/TAB PDL CAP 0.1470
00002316536 PRO-SOTALOL 160 MG TABLET ORL TAB PDL TAB 0.1623
00002316528 PRO-SOTALOL 80 MG TABLET ORL TAB PDL TAB 0.2966
00000869945 PROSTIGMIN 15 MG TABLET ORL TAB VCL TAB 0.4756
00002313650 PRO-TOPIRAMATE 25 MG TABLET ORL TAB PDL TAB 0.2702
00000519367 PRO-TRIAZIDE 50/25 MG TABLET ORL TAB PDL TAB 0.0608
00000512524 PROTRIN DF 800 MG/160 MG TABLET ORL TAB PDL TAB 0.1221
00000287709 PROTYLOL 10 MG CAPSULE ORL CAP PDL CAP 0.0609
00000513059 PROTYLOL 20 MG TABLET ORL TAB PDL TAB 0.1690
00000729973 PROVERA 10 MG TABLET ORL TAB PFI TAB 0.8709
00000708917 PROVERA 2.5 MG TABLET ORL TAB PFI TAB 0.2171
00000030937 PROVERA 5 MG TABLET ORL TAB PFI TAB 0.4292
00002324156 PRO-VERAPAMIL SR 120 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.5078
00002324164 PRO-VERAPAMIL SR 180 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.5204
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 132 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002312697 PRO-VERAPAMIL SR 240 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.5075
00002239656 PROVOCHOLINE 100 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 40.0000
00002243834 PROVOCHOLINE 1280 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 487.0000
00002246492 PROVOCHOLINE 160 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 64.0000
00002246493 PROVOCHOLINE 320 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 128.0000
00002313065 PRO-ZOPICLONE 5 MG TABLET ORL TAB PDL TAB 0.1782
00002313073 PRO-ZOPICLONE 7.5 MG TABLET ORL TAB PDL TAB 0.2250
00080002201 PSN 056 CAPSULE ORL CAP PSN CAP 0.0750
00000466409 PULMOPHYLLINE 5.3 MG/ML ORAL ELIXIR ORL ELX RIV ML 0.0086
00002046733 PULMOZYME 1 ML AMPOULE INHALATION SOLUTION INH SOL HLR ML 15.8976
00002242439 PUREGON 100 IU/ML INJECTION INJ DEFAUL MFC ML 97.0000
00002242441 PUREGON 200 IU/ML INJECTION INJ DEFAUL MFC ML 194.0000
00002243948 PUREGON 833 IU/ML INJECTION CARTRIDGE INJ CTG MFC ML 808.3333
00080056141 PUREPALEO PROTEIN ORAL POWDER ORL PWR DFH G 0.0549
00080039387 PURFEM VAGINAL OVULE VAG OVL MFI OVL 2.0690
00002317966 PURG-ODAN ORL POWDER ORL PWDPKT ODN PCKT 6.9000
00000004723 PURINETHOL 50 MG TABLET ORL TAB TEV TAB 2.8610
00080009682 PYCNOGENOL 25 MG ORAL CASPULE ORL CAP NFN CAP 0.5665
00000497517 PYRIDOXINE HCL 100 MG/ML INJECTION INJ DEFAUL HSP ML 1.9500
00002245215 PYRIDOXINE HYDROCHLORIDE 100 MG/ML INJECTION INJ DEFAUL BNQ ML 1.1663
00002339072 Q-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT QDP TAB 0.3628
00080015945 QUEST TABLET ORL TAB PLH TAB 0.3943
00002417790 QUETIAPINE XR 150 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.8753
00002417367 QUETIAPINE XR 150 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.7780
00002417804 QUETIAPINE XR 200 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 1.1882
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 133 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002417375 QUETIAPINE XR 200 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 1.0520
00002417383 QUETIAPINE XR 300 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 1.5440
00002417812 QUETIAPINE XR 300 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 1.7505
00002417391 QUETIAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 2.0960
00002417820 QUETIAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 2.3763
00002417782 QUETIAPINE XR 50 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.4445
00002417359 QUETIAPINE XR 50 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.3950
00002415925 QUINAPRIL 10 MG TABLET ORL TAB PDL TAB 0.5329
00002415933 QUINAPRIL 20 MG TABLET ORL TAB PDL TAB 0.5329
00002415941 QUINAPRIL 40 MG TABLET ORL TAB PDL TAB 0.5329
00002415917 QUINAPRIL 5 MG TABLET ORL TAB PDL TAB 0.5329
00000695440 QUININE-ODAN 200 MG CAPSULE ORL CAP ODN CAP 0.2390
00000695459 QUININE-ODAN 300 MG CAPSULE ORL CAP ODN CAP 0.3750
00000695432 QUININE-ODAN 300 MG TABLET ORL TAB ODN TAB 0.3750
00002442302 QUINSAIR 100 MG/ML INHALATION SOLUTION INH SOL RAP ML 30.0978
00080039114 Q-UROL TABLET ORL TAB SLP TAB 0.7415
00002267667 RABAVERT VACCINE 2.5 UNIT/VIAL INJECTION INJ DEFAUL MFC VIAL 171.8800
00002423723 RAGWITEK 12 UNIT SUBLINGUAL TABLET SLG TAB MFC TAB 3.9103
00002299194 RALIVIA 100 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 1.2546
00002299208 RALIVIA 200 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 2.2888
00002299216 RALIVIA 300 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 3.3491
00002415852 RALOXIFENE 60 MG TABLET ORL TAB PDL TAB 0.4585
00002415895 RAMIPRIL-HCTZ 10 MG/ 12.5 MG TABLET ORL TAB PDL TAB 0.2633
00002415909 RAMIPRIL-HCTZ 10 MG/25 MG TABLET ORL TAB PDL TAB 0.2633
00002415887 RAMIPRIL-HCTZ 5 MG/12.5 MG TABLET ORL TAB PDL TAB 0.2067
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 134 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002384701 RAN-ALENDRONATE 10 MG TABLET ORL TAB RAN TAB 0.4986
00002384698 RAN-ALENDRONATE 5 MG TABLET ORL TAB RAN TAB 1.0370
00002398877 RAN-AMLODIPINE 2.5 MG TABLET ORL TAB RAN TAB 0.1380
00002328690 RAN-ANASTROZOLE 1 MG TABLET ORL TAB RAN TAB 2.5457
00002371324 RAN-BICALUTAMIDE 50 MG TABLET ORL TAB RAN TAB 4.0573
00002380684 RAN-CANDESARTAN 4 MG TABLET ORL TAB RAN TAB 0.3400
00002268043 RAN-CARVEDILOL 12.5 MG TABLET ORL TAB RAN TAB 0.3377
00002268051 RAN-CARVEDILOL 25 MG TABLET ORL TAB RAN TAB 0.3377
00002268027 RAN-CARVEDILOL 3.125 MG TABLET ORL TAB RAN TAB 0.3377
00002268035 RAN-CARVEDILOL 6.25 MG TABLET ORL TAB RAN TAB 0.3377
00002329204 RAN-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS RAN ML 0.1455
00002293579 RAN-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS RAN ML 0.2907
00002361434 RAN-CLARITHROMYCIN 500 MG TABLET ORL TAB RAN TAB 1.6293
00002425017 RAN-CYPROTERONE/ETHINYL ESTRADIOL 2 MG/0.035MG TAB ORL TAB RAN TAB 1.1114
00002423979 RAN-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT RAN TAB 1.8690
00002423987 RAN-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC RAN TAB 1.8690
00002405695 RAN-FLUOXETINE 10 MG CAPSULE ORL CAP RAN CAP 0.4595
00002405709 RAN-FLUOXETINE 20 MG CAPSULE ORL CAP RAN CAP 0.4728
00002351706 RAN-IMIPENEM-CILASTATIN 500 MG/500 MG/VIAL INJ INJ DEFAUL RAN VIAL 21.9400
00002363208 RAN-IRBESARTAN HCTZ 150/12.5 MG TABLET ORL TAB RAN TAB 0.3024
00002363216 RAN-IRBESARTAN HCTZ 300/12.5 MG TABLET ORL TAB RAN TAB 0.3024
00002363224 RAN-IRBESARTAN HCTZ 300/25 MG TABLET ORL TAB RAN TAB 0.3004
00000740748 RANITIDINE 150 MG TABLET ORL TAB PDL TAB 0.1800
00000740756 RANITIDINE 300 MG TABLET ORL TAB PDL TAB 0.3600
00002372282 RAN-LETROZOLE 2.5 MG TABLET ORL TAB RAN TAB 2.7560
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 135 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002404486 RAN-LOSARTAN 100 MG TABLET ORL TAB RAN TAB 0.3025
00002404451 RAN-LOSARTAN 25 MG TABLET ORL TAB RAN TAB 0.3025
00002404478 RAN-LOSARTAN 50 MG TABLET ORL TAB RAN TAB 0.3025
00002421364 RAN-MEMANTINE 10 MG TABLET ORL TAB RAN TAB 1.6357
00002358077 RAN-NABILONE 0.25 MG CAPSULE ORL CAP RAN CAP 1.3962
00002403102 RAN-OLANZAPINE 15 MG TABLET ORL TAB RAN TAB 1.9136
00002403080 RAN-OLANZAPINE 7.5 MG TABLET ORL TAB RAN TAB 0.9568
00002414112 RAN-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB RAN TAB 5.3554
00002414120 RAN-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB RAN TAB 7.5979
00002403617 RAN-OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT RAN CAP 0.4117
00002305038 RAN-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT RAN TAB 1.2750
00002375850 RAN-PIOGLITAZONE 15 MG TABLET ORL TAB RAN TAB 0.5809
00002375869 RAN-PIOGLITAZONE 30 MG TABLET ORL TAB RAN TAB 0.8139
00002375877 RAN-PIOGLITAZONE 45 MG TABLET ORL TAB RAN TAB 1.2237
00002392844 RAN-PREGABALIN 150 MG CAPSULE ORL CAP RAN CAP 1.7270
00002392852 RAN-PREGABALIN 225 MG CAPSULE ORL CAP RAN CAP 1.7270
00002392801 RAN-PREGABALIN 25 MG CAPSULE ORL CAP RAN CAP 0.6173
00002392860 RAN-PREGABALIN 300 MG CAPSULE ORL CAP RAN CAP 1.7270
00002392828 RAN-PREGABALIN 50 MG CAPSULE ORL CAP RAN CAP 0.9683
00002392836 RAN-PREGABALIN 75 MG CAPSULE ORL CAP RAN CAP 1.2528
00002425548 RAN-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB RAN CAP 0.8550
00002452103 RAN-TADALAFIL 10 MG TABLET ORL TAB RAN TAB 11.9255
00002452081 RAN-TADALAFIL 2.5 MG TABLET ORL TAB RAN TAB 3.6471
00002452111 RAN-TADALAFIL 20 MG TABLET ORL TAB RAN TAB 12.3569
00002452073 RAN-TADALAFIL 5 MG TABLET ORL TAB RAN TAB 3.6471
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 136 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002396084 RAN-TOPIRAMATE 100 MG TABLET ORL TAB RAN TAB 0.5928
00002396092 RAN-TOPIRAMATE 200 MG TABLET ORL TAB RAN TAB 0.8853
00002396076 RAN-TOPIRAMATE 25 MG TABLET ORL TAB RAN TAB 0.3128
00002388197 RAN-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB RAN TAB 0.6264
00002363062 RAN-VALSARTAN 40 MG TABLET ORL TAB RAN TAB 0.5239
00002361663 RAPAFLO 4 MG CAPSULE ORL CAP ASC CAP 1.8966
00002361671 RAPAFLO 8 MG CAPSULE ORL CAP ASC CAP 1.8968
00002247111 RAPAMUNE 1 MG TABLET ORL TAB PFI TAB 8.2330
00002243237 RAPAMUNE 1 MG/ML ORAL LIQUID ORL LIQ PFI ML 8.2330
00002302063 RASILEZ 150 MG TABLET ORL TAB NOV TAB 1.2954
00002302071 RASILEZ 300 MG TABLET ORL TAB NOV TAB 1.2954
00002332728 RASILEZ HCT 150 MG/12.5 MG TABLET ORL TAB NOV TAB 1.3007
00002332736 RASILEZ HCT 150 MG/25 MG TABLET ORL TAB NOV TAB 1.3007
00002332744 RASILEZ HCT 300 MG/12.5 MG TABLET ORL TAB NOV TAB 1.3007
00002332752 RASILEZ HCT 300 MG/25 MG TABLET ORL TAB NOV TAB 1.3007
00002244646 RATIO-ACLAVULANATE 125F 25 MG/6.25 MG ORAL SUSP ORL SUS RPH ML 0.0543
00002244647 RATIO-ACLAVULANATE 250F 50 MG/12.5 MG ORAL SUSP ORL SUS RPH ML 0.1830
00002240071 RATIO-AMIODARONE 200 MG TABLET ORL TAB RPH TAB 0.5147
00002259613 RATIO-AMLODIPINE 10 MG TABLET ORL TAB RPH TAB 0.3587
00002259605 RATIO-AMLODIPINE 5 MG TABLET ORL TAB RPH TAB 0.2417
00002275287 RATIO-AZITHROMYCIN 250 MG TABLET ORL TAB RPH TAB 1.2317
00002236507 RATIO-BACLOFEN 10 MG TABLET ORL TAB RPH TAB 0.1595
00000404802 RATIO-BISACODYL 10 MG RECTAL SUPPOSITORY RT SUP RPH SUP 0.7199
00002243026 RATIO-BRIMONIDINE 0.2% OPHTHALMIC SOLUTION OPH SOL RPH ML 1.1560
00002285657 RATIO-BUPROPION SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT RPH TAB 0.1547
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 137 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000550477 RATIO-CALMYDONE ORAL SYRUP ORL SYR RPH ML 0.0596
00002242657 RATIO-CEFUROXIME 500 MG TABLET ORL TAB RPH TAB 1.4337
00002252120 RATIO-CITALOPRAM 40 MG TABLET ORL TAB RPH TAB 0.2397
00002053403 RATIO-COTRIDIN EXPECTORANT ORAL SYRUP ORL SYR RPH ML 0.0610
00002169126 RATIO-COTRIDIN ORAL SYRUP ORL SYR RPH ML 0.0550
00002306905 RATIO-FINASTERIDE 5 MG TABLET ORL TAB RPH TAB 0.4633
00002241371 RATIO-FLUOXETINE HYDROCHLORIDE 10 MG CAPSULE ORL CAP RPH CAP 0.4595
00002241374 RATIO-FLUOXETINE HYDROCHLORIDE 20 MG CAPSULE ORL CAP RPH CAP 0.4598
00002296071 RATIO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM RPH DOSE 0.1831
00002218453 RATIO-FLUVOXAMINE 50 MG TABLET ORL TAB RPH TAB 0.2105
00002260883 RATIO-GABAPENTIN 100 MG CAPSULE ORL CAP RPH CAP 0.0749
00002260905 RATIO-GABAPENTIN 400 MG CAPSULE ORL CAP RPH CAP 0.2171
00002273101 RATIO-GLIMEPIRIDE 1 MG TABLET ORL TAB RPH TAB 0.4900
00002273128 RATIO-GLIMEPIRIDE 2 MG TABLET ORL TAB RPH TAB 0.4900
00002273136 RATIO-GLIMEPIRIDE 4 MG TABLET ORL TAB RPH TAB 0.4900
00001900927 RATIO-GLYBURIDE 2.5 MG TABLET ORL TAB RPH TAB 0.0321
00001900935 RATIO-GLYBURIDE 5 MG TABLET ORL TAB RPH TAB 0.0573
00000607789 RATIO-HEMCORT H.C. RECTAL OINTMENT RT ONT RPH G 0.3853
00000607797 RATIO-HEMCORT H.C. RECTAL SUPPOSITORY RT SUP RPH SUP 0.5833
00001934139 RATIO-INDOMETHACIN 100 MG RECTAL SUPPOSITORY RT SUP RPH SUP 0.8910
00002246963 RATIO-LAMOTRIGINE 150 MG TABLET ORL TAB RPH TAB 0.5505
00000653233 RATIO-LENOLTEC NO.1 TABLET ORL TAB RPH TAB 0.0517
00002031167 RATIO-LEVOBUNOLOL 0.5% OPH SOLUTION OPH SOL RPH ML 1.1520
00002256800 RATIO-LISINOPRIL P 10 MG TABLET ORL TAB RPH TAB 0.1619
00002256819 RATIO-LISINOPRIL P 20 MG TABLET ORL TAB RPH TAB 0.1945
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 138 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002256797 RATIO-LISINOPRIL P 5 MG TABLET ORL TAB RPH TAB 0.1347
00002299887 RATIO-LISINOPRIL Z 10 MG TABLET ORL TAB RPH TAB 0.1619
00002299895 RATIO-LISINOPRIL Z 20 MG TABLET ORL TAB RPH TAB 0.1945
00002299879 RATIO-LISINOPRIL Z 5 MG TABLET ORL TAB RPH TAB 0.1347
00002245822 RATIO-LOVASTATIN 20 MG TABLET ORL TAB RPH TAB 0.4919
00002245823 RATIO-LOVASTATIN 40 MG TABLET ORL TAB RPH TAB 0.8985
00002320908 RATIO-MEMANTINE 10 MG TABLET ORL TAB RPH TAB 1.6357
00002244798 RATIO-METHOTREXATE SODIUM 2.5 MG TABLET ORL TAB RPH TAB 0.6325
00002194163 RATIO-NYSTATIN 100,000 UNIT/G VAGINAL CREAM VAG CRM RPH G 0.3191
00002278529 RATIO-ONDANSETRON 4 MG TABLET ORL TAB RPH TAB 3.3998
00002278537 RATIO-ONDANSETRON 8 MG TABLET ORL TAB RPH TAB 5.1877
00002308681 RATIO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT RPH TAB 1.2750
00002247811 RATIO-PAROXETINE 20 MG TABLET ORL TAB RPH TAB 0.4513
00002301423 RATIO-PIOGLITAZONE 15 MG TABLET ORL TAB RPH TAB 0.5809
00002301431 RATIO-PIOGLITAZONE 30 MG TABLET ORL TAB RPH TAB 0.8139
00002301458 RATIO-PIOGLITAZONE 45 MG TABLET ORL TAB RPH TAB 1.2237
00000828823 RATIO-RANITIDINE 150 MG TABLET ORL TAB RPH TAB 0.1800
00002319861 RATIO-RISEDRONATE 35 MG TABLET ORL TAB RPH TAB 2.4275
00002311291 RATIO-RIVASTIGMINE 3 MG CAPSULE ORL CAP RPH CAP 0.6514
00002311305 RATIO-RIVASTIGMINE 4.5 MG CAPSULE ORL CAP RPH CAP 0.6514
00000860808 RATIO-SALBUTAMOL 5 MG/ML INHALATION SOLUTION INH SOL RPH ML 0.3870
00002239366 RATIO-SALBUTAMOL SULFATE U.D. P.F. 2MG/ML INH SOL INH UDSOL RPH ML 0.2748
00002319500 RATIO-SILDENAFIL R 20 MG TABLET ORL TAB RPH TAB 7.2940
00002218941 RATIO-TERAZOSIN 1 MG TABLET ORL TAB RPH TAB 0.1835
00002218984 RATIO-TERAZOSIN 10 MG TABLET ORL TAB RPH TAB 0.4637
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 139 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002218968 RATIO-TERAZOSIN 2 MG TABLET ORL TAB RPH TAB 0.2333
00002218976 RATIO-TERAZOSIN 5 MG TABLET ORL TAB RPH TAB 0.3168
00000550507 RATIO-TRIACOMB REGULAR TOPICAL CREAM TOP CRM RPH G 0.4027
00002453304 RAVICTI 1.1 G/ML ORAL LIQUID ORL LIQ HZN ML 48.0000
00000989994 RCF SOY FREE FORMULA ORL LIQ ABN ML 0.0211
00002223554 REACTINE 10 MG TABLET ORL TAB MCL TAB 0.7300
00001900978 REACTINE 20 MG TABLET ORL TAB MCL TAB 0.8595
00002223546 REACTINE 5 MG TABLET ORL TAB MCL TAB 0.5067
00002246162 REACTINE ALLERGY & SINUS EXTENDED-RELEASE TABLET ORL ERT MCL TAB 0.7300
00002368064 REACTINE ALLERGY LIQUID GELS 10 MG CAPSULE ORL CAP MCL CAP 0.7296
00002358352 REACTINE FAST MELT 10 MG ODT ORL ODT MCL TAB 0.6492
00002245977 RECOMBIVAX HB (DIALYSIS-PRESER FREE) 40 MCG/ML INJ INJ DEFAUL MFC ML 184.8000
00002243676 RECOMBIVAX HB (PRESERVATIVE FREE) 5MCG/0.5ML INJ INJ DEFAUL MFC ML 22.8000
00000897221 REDOXON (LEMON) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.2640
00000897256 REDOXON (ORANGE) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.2367
00002138670 REFRESH 1.4% OPH SOLUTION OPH SOL ALL ML 0.8533
00002244650 REFRESH LIQUIGEL 1% OPH SOLUTION OPH SOL ALL ML 0.5140
00002399148 REFRESH OPTIVE ADVANCED NAS SOL ALL ML 0.8950
00002435578 REFRESH OPTIVE FUSION OPH SOLUTION OPH SOL ALL ML 0.9500
00002049260 REFRESH PLUS 0.5% OPH SOLUTION OPH SOL ALL ML 0.7592
00002231008 REFRESH TEARS 0.5% OPH SOLUTION OPH SOL ALL ML 0.4167
00002239405 REGRANEX TOPICAL GEL TOP GEL JAI G 35.3333
00002242592 REGULAR VITA-VIM CAPLET ORL TAB JAM TAB 0.1012
00002240863 RELENZA 5 MG/DOSE INHALATION DISK INH DSK GSK DISC 7.4280
00002308215 RELISTOR 20 MG/ML INJECTION INJ DEFAUL SLX ML 63.3333
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 140 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002256290 RELPAX 20 MG TABLET ORL TAB PFI TAB 14.5400
00002256304 RELPAX 40 MG TABLET ORL TAB PFI TAB 14.5400
00002248542 REMERON RD 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.4370
00002248543 REMERON RD 30 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.8737
00002248544 REMERON RD 45 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB MFC TAB 1.3110
00002246552 REMODULIN 1 MG/ML INJECTION INJ DEFAUL NTH ML 45.0000
00002246555 REMODULIN 10 MG/ML INJECTION INJ DEFAUL NTH ML 450.0000
00002246553 REMODULIN 2.5 MG/ML INJECTION INJ DEFAUL NTH ML 112.5000
00002246554 REMODULIN 5 MG/ML INJECTION INJ DEFAUL NTH ML 225.0000
00002244310 RENAGEL 800 MG TABLET ORL TAB SAV TAB 1.6705
00002354586 RENVELA 800 MG TABLET ORL TAB SAV TAB 1.5503
00002216973 REOPRO 2 MG/ML INJECTION INJ DEFAUL JAI ML 124.7680
00002415968 REPAGLINIDE 0.5 MG TABLET ORL TAB PDL TAB 0.0996
00002415976 REPAGLINIDE 1 MG TABLET ORL TAB PDL TAB 0.1036
00002415984 REPAGLINIDE 2 MG TABLET ORL TAB PDL TAB 0.1075
00002446057 REPATHA 140 MG/ML INJECTION SYRINGE/AUTOINJECTOR INJ NDL AMG SYR 279.3600
00002249057 REPLAGAL 1 MG/ML INJECTION INJ DEFAUL PAL ML 657.1429
00002247790 REPRONEX 75 UNIT/VIAL INJECTION INJ DEFAUL FEI VIAL 74.0000
00002377012 RESOTRAN 1 MG FILM-COATED TABLET ORL TAB JAI TAB 2.3000
00002377020 RESOTRAN 2 MG FILM-COATED TABLET ORL TAB JAI TAB 3.5311
00002355655 RESTASIS 0.05% OPH EMULSION OPH EML ALL ML 8.5767
00002318164 RESTORALAX ORAL POWDER ORL PWR SPL G 0.0603
00000443816 RETIN-A 0.025% TOPICAL GEL TOP GEL VCL G 0.4137
00000443794 RETIN-A 0.05% TOPICAL CREAM TOP CRM VCL G 0.4137
00002264633 RETIN-A MICRO 0.04% TOPICAL GEL TOP GEL VCL G 1.1495
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 141 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002243914 RETIN-A MICRO 0.1% GEL TOP GEL VCL G 1.1495
00002306980 RETISERT 0.59 MG INTRAVITREAL IMPLANT OPH IMP BSH SYS 16000.0000
00002008726 RETISOL-A 0.01% TOPICAL CREAM TOP CRM GSK G 0.7353
00002008696 RETISOL-A 0.025% TOPICAL CREAM TOP CRM GSK G 0.7116
00002008718 RETISOL-A 0.05% TOPICAL CREAM TOP CRM GSK G 0.7116
00002008688 RETISOL-A O.1% TOPICAL CREAM TOP CRM GSK G 0.7116
00001902660 RETROVIR 100 MG CAPSULE ORL CAP GSK CAP 1.9785
00001902652 RETROVIR 50 MG/5ML ORAL SYRUP ORL SYR GSK ML 0.1975
00002279401 REVATIO 20 MG TABLET ORL TAB PFI TAB 11.5702
00002445727 REVESTIVE 5 MG/VIAL INJECTION INJ DEFAUL NPS VIAL 904.0000
00002213826 REVIA 50 MG TABLET ORL TAB BAR TAB 7.3028
00002035871 REVITONUS C-1000 ORAL LIQUID ORL LIQ SDZ AMP 0.7875
00002304902 REVLIMID 10 MG CAPSULE ORL CAP CLG CAP 361.0000
00002317699 REVLIMID 15 MG CAPSULE ORL CAP CLG CAP 382.0000
00002459418 REVLIMID 2.5 MG CAPSULE ORL CAP CLG CAP 329.5000
00002440601 REVLIMID 20 MG CAPSULE ORL CAP CLG CAP 403.0000
00002317710 REVLIMID 25 MG CAPSULE ORL CAP CLG CAP 424.0000
00002304899 REVLIMID 5 MG CAPSULE ORL CAP CLG CAP 340.0000
00002361825 REVOLADE 25 MG TABLET ORL TAB NOV TAB 65.0000
00002361833 REVOLADE 50 MG TABLET ORL TAB NOV TAB 130.0000
00002248610 REYATAZ 150 MG CAPSULE ORL CAP BMS CAP 11.2467
00002248611 REYATAZ 200 MG CAPSULE ORL CAP BMS CAP 11.2467
00002294176 REYATAZ 300 MG CAPSULE ORL CAP BMS CAP 22.4933
00002220806 RHINARIS LUBRICATING NASAL GEL NAS GEL PMS G 0.2689
00000732230 RHINARIS NASAL AEROSOL NAS AER PMS DOSE 0.1933
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 142 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080058002 RHINARIS NOZOIL NASAL SPRAY NAS SPR PPH ML 1.7990
00001950541 RHINARIS-CS 2% NASAL SOLUTION NAS SOL PPH ML 0.7677
00002231923 RHINOCORT AQUA 64 MCG/DOSE METERED DOSE NAS. SPRAY NAS SPM AZC DOSE 0.0920
00080026370 RHODIOLA ROSEA CAPSULE ORL CAP AOR CAP 0.2546
00002260107 RHOXAL-ANAGRELIDE 0.5 MG CAPSULE ORL CAP SDZ CAP 3.3491
00002269589 RHOXAL-GLIMEPIRIDE 1 MG TABLET ORL TAB SDZ TAB 0.4900
00002269597 RHOXAL-GLIMEPIRIDE 2 MG TABLET ORL TAB SDZ TAB 0.4900
00002269619 RHOXAL-GLIMEPIRIDE 4 MG TABLET ORL TAB SDZ TAB 0.4900
00002243559 RHOXAL-ORPHENADRINE 100 MG EXTENDED-RELEASE TABLET ORL ERT SDZ TAB 1.0842
00000309702 RIBOFLAVINE 100 MG TABLET ORL TAB JAM TAB 0.0647
00002091887 RIFADIN 150 MG CAPSULE ORL CAP SAV CAP 0.8395
00002092808 RIFADIN 300 MG CAPSULE ORL CAP SAV CAP 1.3211
00002347474 RISEDRONATE 35 MG TABLET ORL TAB PDL TAB 2.4275
00002352141 RISEDRONATE 35 MG TABLET ORL TAB SIV TAB 2.4893
00002298465 RISPERDAL CONSTA 12.5 MG/VIAL INJECTION INJ DEFAUL JAI VIAL 82.0000
00002457350 RITUXAN SC 120 MG/ML INJECTION INJ DEFAUL HLR ML 246.8812
00002247217 RIVA-AMIODARONE 200 MG TABLET ORL TAB RIV TAB 0.5147
00002331500 RIVA-AMLODIPINE 10 MG TABLET ORL TAB RIV TAB 0.3587
00002331489 RIVA-AMLODIPINE 2.5 MG TABLET ORL TAB RIV TAB 0.1380
00002331497 RIVA-AMLODIPINE 5 MG TABLET ORL TAB RIV TAB 0.2417
00002242093 RIVA-ATENOLOL 100 MG TABLET ORL TAB RIV TAB 0.2362
00002242094 RIVA-ATENOLOL 50 MG TABLET ORL TAB RIV TAB 0.1437
00002422751 RIVA-ATORVASTATIN 10 MG TABLET ORL TAB RIV TAB 0.3138
00002422778 RIVA-ATORVASTATIN 20 MG TABLET ORL TAB RIV TAB 0.3922
00002422786 RIVA-ATORVASTATIN 40 MG TABLET ORL TAB RIV TAB 0.4216
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 143 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002422794 RIVA-ATORVASTATIN 80 MG TABLET ORL TAB RIV TAB 0.4216
00002303264 RIVA-CITALOPRAM 20 MG TABLET ORL TAB RIV TAB 0.2397
00002303272 RIVA-CITALOPRAM 40 MG TABLET ORL TAB RIV TAB 0.2397
00002242077 RIVA-CLONAZEPAM 0.5 MG TABLET ORL TAB RIV TAB 0.0554
00002388529 RIVA-CLOPIDOGREL 75 MG TABLET ORL TAB RIV TAB 0.4735
00002242468 RIVACOCET 5 MG/325 MG TABLET ORL TAB RIV TAB 0.1285
00002424436 RIVA-EZETIMIBE 10 MG TABLET ORL TAB RIV TAB 0.4549
00002247306 RIVA-FENOFIBRATE MICRO 200 MG CAPSULE ORL CAP RIV CAP 0.2723
00002251167 RIVA-GABAPENTIN 100 MG CAPSULE ORL CAP RIV CAP 0.1040
00002251175 RIVA-GABAPENTIN 300 MG CAPSULE ORL CAP RIV CAP 0.2530
00002251183 RIVA-GABAPENTIN 400 MG CAPSULE ORL CAP RIV CAP 0.3015
00002239081 RIVA-METFORMIN 500 MG TABLET ORL TAB RIV TAB 0.0586
00002242783 RIVA-METFORMIN 850 MG TABLET ORL TAB RIV TAB 0.0610
00002265265 RIVA-MIRTAZAPINE 30 MG TABLET ORL TAB RIV TAB 0.2338
00002228300 RIVANASE AQ 50 MCG/DOSE METER DOSE NASAL SPRAY NAS SPM RIV DOSE 0.0613
00002337150 RIVA-OLANZAPINE 10 MG TABLET ORL TAB RIV TAB 1.2757
00002337169 RIVA-OLANZAPINE 15 MG TABLET ORL TAB RIV TAB 1.9136
00002337126 RIVA-OLANZAPINE 2.5 MG TABLET ORL TAB RIV TAB 0.3189
00002337134 RIVA-OLANZAPINE 5 MG TABLET ORL TAB RIV TAB 0.6379
00002337142 RIVA-OLANZAPINE 7.5 MG TABLET ORL TAB RIV TAB 0.9568
00002339838 RIVA-OLANZAPINE ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 1.2757
00002339846 RIVA-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 1.9137
00002392399 RIVA-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 2.5447
00002339811 RIVA-OLANZAPINE ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB RIV TAB 0.6380
00002402416 RIVA-OMEPRAZOLE DR 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT RIV TAB 0.4117
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 144 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002316463 RIVA-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.5054
00002330083 RIVA-RABEPRAZOLE EC 10 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.1204
00002330091 RIVA-RABEPRAZOLE EC 20 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.2408
00002380056 RIVA-ROSUVASTATIN 10 MG TABLET ORL TAB RIV TAB 0.2437
00002380064 RIVA-ROSUVASTATIN 20 MG TABLET ORL TAB RIV TAB 0.3046
00002380102 RIVA-ROSUVASTATIN 40 MG TABLET ORL TAB RIV TAB 0.3582
00002380013 RIVA-ROSUVASTATIN 5 MG TABLET ORL TAB RIV TAB 0.2310
00002202352 RIVASA CROQUABLE 80 MG TABLET ORL CTB RIV TAB 0.0560
00001949292 RIVA-SENNA 8.6 MG TABLET ORL TAB RIV TAB 0.0464
00002240112 RIVASOL-HC RECTAL SUPPOSITORY RT SUP RIV SUP 0.5833
00001940112 RIVASONE SCALP 0.1% TOPICAL LOTION TOP LOT RIV ML 0.0853
00002242157 RIVA-SOTALOL 160 MG TABLET ORL TAB RIV TAB 0.1623
00002416999 RIVASTIGMINE 1.5 MG CAPSULE ORL CAP PDL CAP 0.6514
00002417006 RIVASTIGMINE 3 MG CAPSULE ORL CAP PDL CAP 0.6514
00002417014 RIVASTIGMINE 4.5 MG CAPSULE ORL CAP PDL CAP 0.6514
00002417022 RIVASTIGMINE 6 MG CAPSULE ORL CAP PDL CAP 0.6514
00002307790 RIVA-VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAP ORL ERC RIV CAP 0.3469
00002307774 RIVA-VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAP ORL ERC RIV CAP 0.1643
00002307782 RIVA-VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAPSULE ORL ERC RIV CAP 0.3285
00002248082 RIVA-VERAPAMIL SR 240 MG SUSTAINED-RELEASE TABLET ORL SRT RIV TAB 0.5075
00002278030 RIVA-ZOPICLONE 5 MG TABLET ORL TAB RIV TAB 0.1782
00002278049 RIVA-ZOPICLONE 7.5 MG TABLET ORL TAB RIV TAB 0.2250
00002415801 RIZATRIPTAN ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB PDL TAB 3.7050
00002415798 RIZATRIPTAN ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB PDL TAB 3.7050
00002247147 ROBAX PLATINUM TABLET ORL TAB PDH TAB 0.6361
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 145 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002026805 ROBAXACET CAPLET ORL TAB PDH TAB 0.4689
00002231176 ROBAXACET EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.5150
00001934767 ROBAXACET-8 TABLET ORL TAB PDH TAB 0.7081
00001930990 ROBAXIN 500 MG TABLET ORL TAB PDH TAB 0.4826
00001932187 ROBAXIN-750 750 MG TABLET ORL TAB PDH TAB 0.7966
00002230949 ROBAXISAL EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.5150
00001934791 ROBAXISAL-C 1/2 TABLET ORL TAB PDH TAB 1.1788
00001934783 ROBAXISAL-C 1/4 TABLET ORL TAB PDH TAB 0.9867
00001931032 ROBITUSSIN 20 MG ORAL SYRUP ORL SYR PDH ML 0.0508
00002142783 ROBITUSSIN 200 MG/5 ML EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.0508
00001934740 ROBITUSSIN A-C ORAL SYRUP ORL SYR PDH ML 0.1019
00002068419 ROBITUSSIN COUGH AND COLD ORAL SYRUP ORL SYR PDH ML 0.0508
00002142775 ROBITUSSIN DM EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.0508
00001931024 ROBITUSSIN DM ORAL SYRUP ORL SYR PDH ML 0.0508
00002318415 ROCURONIUM BROMIDE 10MG/ML INJECTION INJ DEFAUL SDZ ML 1.0260
00002318121 ROCURONIUM BROMIDE INJECTION 10 MG/ML INJECTION INJ DEFAUL HSP ML 2.7780
00002382415 ROCURONIUM BROMIDE INJECTION 10 MG/ML INJECTION INJ DEFAUL OMG ML 2.4000
00000393444 ROFACT 150 MG CAPSULE ORL CAP VCL CAP 0.6765
00000343617 ROFACT 300 MG CAPSULE ORL CAP VCL CAP 1.0649
00000708925 ROGAINE 20 MG/ML TOPICAL SOLUTION TOP SOL JJI ML 0.6102
00002368684 ROGAINE FOAM 50 MG/G AEROSOL FOAM TOP FOA JJI G 0.4926
00002242979 ROGITINE 10 MG/ML INJECTION INJ DEFAUL PAL ML 46.9960
00002353067 ROPINIROLE 2 MG TABLET ORL TAB SNS TAB 0.3122
00002353075 ROPINIROLE 5 MG TABLET ORL TAB SNS TAB 0.8596
00002440342 ROSIVER 1% TOPICAL CREAM TOP CRM GAL G 2.7498
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 146 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002381184 ROSUVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.3400
00002389045 ROSUVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.3400
00002381192 ROSUVASTATIN 20 MG TABLET ORL TAB PDL TAB 0.3046
00002389053 ROSUVASTATIN 20 MG TABLET ORL TAB SIV TAB 0.3046
00002381206 ROSUVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.3582
00002389061 ROSUVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.3582
00002381176 ROSUVASTATIN 5 MG TABLET ORL TAB PDL TAB 0.3227
00002389037 ROSUVASTATIN 5 MG TABLET ORL TAB SIV TAB 0.3227
00002300591 ROTARIX 1 000 000 CCID50/DOSE (1.5ML) ORAL SUSP ORL SUS GSK DOSE 82.1500
00002284413 ROTATEQ (2 ML/DOSE) ORAL SOLUTION ORL SOL MFC ML 29.0250
00000466425 ROUGIER CALCIUM ORAL LIQUID ORL LIQ ROG ML 0.0210
00002248563 RUB A535 DUAL ACTION TOP CRM CHD G 0.0570
00002222116 RUB A-535 EXTRA STRENGTH TOP CRM CHD G 0.0570
00080015240 RUGBY NICOTINE POLACRILEX; NIC-ASSIST 2 MG GUM ORL GUM APH PIECE 0.1650
00002456478 RUPALL 1 MG/ML ORAL SOLUTION ORL SOL PPI ML 0.1100
00002456451 RUPALL 10 MG TABLET ORL TAB PPI TAB 0.7537
00002453258 S.O.S. NALOXONE HYDROCHLORIDE INJ 0.4 MG/ML INJ INJ DEFAUL SDZ ML 13.7450
00002245735 SAB-SODIUM CHLORIDE 5% OPTHALMIC SOLUTION USP OPH SOL SDZ ML 0.5633
00002064480 SALAZOPYRIN 500 MG TABLET ORL TAB PFI TAB 0.3211
00002064472 SALAZOPYRIN EN-TABS 500 MG ENTERIC-COATED TABLET ORL ECT PFI TAB 0.4928
00000623571 SALIJECT 570 MG/ML INJECTION INJ DEFAUL OMG ML 1.8000
00080024381 SALINEX 9 MG/ML NASAL SPRAY NAS SPR SDZ ML 0.1307
00000779296 SALINEX NASAL LUBRICANT GEL NAS GEL SDZ G 0.1407
00001910701 SALINEX NASAL LUBRICANT SPRAY NAS SPR SDZ ML 0.1697
00080004542 SALMON & FISH OILS 1000 MG SOFTGEL ORL CAP WNP CAP 0.0568
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 147 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080003356 SALMON AND FISH OILS ORAL CAPSULE ORL CAP JAM CAP 0.0923
00002370468 SAMSCA 15 MG TABLET ORL TAB OTS TAB 90.4110
00002370476 SAMSCA 30 MG TABLET ORL TAB OTS TAB 90.4110
00000593257 SANDIMMUNE I.V. 50 MG/ML INJECTION INJ DEFAUL NOV ML 4.6260
00002288079 SANDOZ ALENDRONATE 5 MG TABLET ORL TAB SDZ TAB 1.0370
00002457296 SANDOZ AMPHETAMINE XR 10 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.0758
00002457318 SANDOZ AMPHETAMINE XR 15 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.3250
00002457326 SANDOZ AMPHETAMINE XR 20 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.5743
00002457334 SANDOZ AMPHETAMINE XR 25 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.8235
00002457342 SANDOZ AMPHETAMINE XR 30 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 3.0729
00002457288 SANDOZ AMPHETAMINE XR 5 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 1.8266
00002338467 SANDOZ ANASTROZOLE 1 MG TABLET ORL TAB SDZ TAB 2.5457
00002386410 SANDOZ ATOMOXETINE 10 MG CAPSULE ORL CAP SDZ CAP 2.3140
00002386429 SANDOZ ATOMOXETINE 18 MG CAPSULE ORL CAP SDZ CAP 2.6523
00002386437 SANDOZ ATOMOXETINE 25 MG CAPSULE ORL CAP SDZ CAP 2.9280
00002386445 SANDOZ ATOMOXETINE 40 MG CAPSULE ORL CAP SDZ CAP 3.3373
00002386453 SANDOZ ATOMOXETINE 60 MG CAPSULE ORL CAP SDZ CAP 3.7023
00002386461 SANDOZ ATOMOXETINE 80 MG CAPSULE ORL CAP SDZ CAP 3.9963
00002276089 SANDOZ BICALUTAMIDE 50 MG TABLET ORL TAB SDZ TAB 4.0573
00002386283 SANDOZ BOSENTAN 125 MG TABLET ORL TAB SDZ TAB 48.1340
00002386275 SANDOZ BOSENTAN 62.5 MG TABLET ORL TAB SDZ TAB 48.1340
00002392267 SANDOZ CANDESARTAN 32 MG TABLET ORL TAB SDZ TAB 0.3009
00002326957 SANDOZ CANDESARTAN 4 MG TABLET ORL TAB SDZ TAB 0.3400
00002421917 SANDOZ CAPECITABINE 150 MG TABLET ORL TAB SDZ TAB 1.4640
00002421925 SANDOZ CAPECITABINE 500 MG TABLET ORL TAB SDZ TAB 4.8800
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 148 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002233982 SANDOZ CLONAZEPAM 1 MG TABLET ORL TAB SDZ TAB 0.1487
00002230386 SANDOZ CORTIMYXIN OTIC SOLUTION OT SOL SDZ ML 1.1400
00002400596 SANDOZ DICLOFENAC MISOPROSTOL 50 MG/200 MCG ECT ORL ECT SDZ TAB 0.4541
00002400618 SANDOZ DICLOFENAC MISOPROSTOL 75 MG/200 MCG ECT ORL ECT SDZ TAB 0.6179
00002261774 SANDOZ DICLOFENAC RAPIDE 50 MG TABLET ORL TAB SDZ TAB 0.3937
00002367696 SANDOZ DONEPEZIL ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 3.6177
00002367688 SANDOZ DONEPEZIL ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 3.6177
00002278634 SANDOZ FAMCICLOVIR 125 MG TABLET ORL TAB SDZ TAB 2.0240
00002278642 SANDOZ FAMCICLOVIR 250 MG TABLET ORL TAB SDZ TAB 2.7200
00002278650 SANDOZ FAMCICLOVIR 500 MG TABLET ORL TAB SDZ TAB 4.2281
00002390701 SANDOZ FENOFIBRATE E 145 MG TABLET ORL TAB SDZ TAB 0.9113
00002390698 SANDOZ FENOFIBRATE E 48 MG TABLET ORL TAB SDZ TAB 0.3560
00002327139 SANDOZ FENTANYL PATCH 37 MCG/HR TRANSDERMAL PATCH TRD PTH SDZ PTH 8.5000
00002339471 SANDOZ FINASTERIDE A 1 MG TABLET ORL TAB SDZ TAB 1.1455
00002243487 SANDOZ FLUOXETINE 20 MG CAPSULE ORL CAP SDZ CAP 0.4598
00002400243 SANDOZ FLUVASTATIN 40 MG CAPSULE ORL CAP SDZ CAP 0.3092
00002248009 SANDOZ GLYBURIDE 5 MG TABLET ORL TAB SDZ TAB 0.0573
00002344815 SANDOZ LETROZOLE 2.5 MG TABLET ORL TAB SDZ TAB 2.7560
00002344807 SANDOZ MEMANTINE 10 MG TABLET ORL TAB SDZ TAB 1.6357
00002375532 SANDOZ MEMANTINE FCT 10 MG TABLET ORL TAB SDZ TAB 1.6357
00002237314 SANDOZ MINOCYCLINE 100 MG CAPSULE ORL CAP SDZ CAP 0.5912
00002237313 SANDOZ MINOCYCLINE 50 MG CAPSULE ORL CAP SDZ CAP 0.3064
00002250594 SANDOZ MIRTAZAPINE 15 MG TABLET ORL TAB SDZ TAB 0.3750
00002411520 SANDOZ MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL SDZ ML 3.7567
00002320630 SANDOZ MYCOPHENOLATE MOFETIL 250 MG CAPSULE ORL CAP SDZ CAP 1.0310
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 149 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002313855 SANDOZ MYCOPHENOLATE MOFETIL 500 MG TABLET ORL TAB SDZ TAB 2.0620
00002327791 SANDOZ OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 5.3553
00002327805 SANDOZ OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB SDZ TAB 7.5977
00002358913 SANDOZ OLOPATADINE 0.1% OPH SOLUTION OPH SOL SDZ ML 5.2260
00002420171 SANDOZ OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL SDZ ML 10.4520
00002301075 SANDOZ PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT SDZ TAB 1.2750
00002269422 SANDOZ PAROXETINE 10 MG TABLET ORL TAB SDZ TAB 1.0430
00002431777 SANDOZ PAROXETINE 10 MG TABLET ORL TAB SDZ TAB 1.0430
00002261790 SANDOZ PINDOLOL 10 MG TABLET ORL TAB SDZ TAB 0.2323
00002261804 SANDOZ PINDOLOL 15 MG TABLET ORL TAB SDZ TAB 0.3370
00002297906 SANDOZ PIOGLITAZONE 15 MG TABLET ORL TAB SDZ TAB 0.5809
00002297914 SANDOZ PIOGLITAZONE 30 MG TABLET ORL TAB SDZ TAB 0.8139
00002297922 SANDOZ PIOGLITAZONE 45 MG TABLET ORL TAB SDZ TAB 1.2237
00002239234 SANDOZ POLYTRIMETHOPRIM OPH SOLUTION OPH SOL SDZ ML 2.9040
00002315270 SANDOZ PRAMIPEXOLE 0.5 MG TABLET ORL TAB SDZ TAB 1.3860
00002390841 SANDOZ PREGABALIN 150 MG CAPSULE ORL CAP SDZ CAP 1.7270
00002390817 SANDOZ PREGABALIN 25 MG CAPSULE ORL CAP SDZ CAP 0.6172
00002390868 SANDOZ PREGABALIN 300 MG CAPSULE ORL CAP SDZ CAP 1.7270
00002390825 SANDOZ PREGABALIN 50 MG CAPSULE ORL CAP SDZ CAP 0.9682
00002390833 SANDOZ PREGABALIN 75 MG CAPSULE ORL CAP SDZ CAP 1.2528
00002426307 SANDOZ RIVASTIGMINE PATCH 10 (9.5 MG/24 H) TRD PTH SDZ PTH 3.9773
00002426293 SANDOZ RIVASTIGMINE PATCH 5 (4.6 MG/24 H) TRD PTH SDZ PTH 3.9773
00002154412 SANDOZ SALBUTAMOL 5 MG/ML INHALATION SOLUTION INH SOL SDZ ML 0.3510
00002318822 SANDOZ SILDENAFIL 100 MG TABLET ORL TAB SDZ TAB 9.2006
00002318806 SANDOZ SILDENAFIL 25 MG TABLET ORL TAB SDZ TAB 8.2894
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 150 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002318814 SANDOZ SILDENAFIL 50 MG TABLET ORL TAB SDZ TAB 8.8481
00002247828 SANDOZ SIMVASTATIN 10 MG TABLET ORL TAB SDZ TAB 0.3642
00002247830 SANDOZ SIMVASTATIN 20 MG TABLET ORL TAB SDZ TAB 0.4501
00002247831 SANDOZ SIMVASTATIN 40 MG TABLET ORL TAB SDZ TAB 0.4501
00002247833 SANDOZ SIMVASTATIN 80 MG TABLET ORL TAB SDZ TAB 0.4501
00002257831 SANDOZ SOTALOL 80 MG TABLET ORL TAB SDZ TAB 0.2966
00002416816 SANDOZ TACROLIMUS 0.5 MG CAPSULE ORL CAP SDZ CAP 1.4775
00002416824 SANDOZ TACROLIMUS 1 MG CAPSULE ORL CAP SDZ CAP 1.8900
00002416832 SANDOZ TACROLIMUS 5 MG CAPSULE ORL CAP SDZ CAP 9.4650
00002260069 SANDOZ TOPIRAMATE 100 MG TABLET ORL TAB SDZ TAB 0.6235
00002260050 SANDOZ TOPIRAMATE 25 MG TABLET ORL TAB SDZ TAB 0.3128
00002413817 SANDOZ TRAVOPROST/TIMOLOL PQ 0.004%/0.5% OPH SOL OPH SOL SDZ ML 11.2880
00002356740 SANDOZ VALSARTAN 40 MG TABLET ORL TAB SDZ TAB 0.5240
00002362996 SANDOZ ZOLMITRIPTAN ODT 2.5 MG ORALLY DISP. TABLET ORL DISPTAB SDZ TAB 3.5400
00002266121 SATIVEX BUCCAL SPRAY BUC SPR BHP ML 20.9900
00002437899 SAXENDA 6 MG/ML PEN INJECTION SYRINGE INJ DEFAUL NNA ML 23.6120
00080041540 SCHINOUSSA PROBIOTIC WHEY ISOLATE ORAL POWDER ORL PWR QUA G 0.0357
00001919245 SCHOLL ATHLETE'S FOOT SPRAY 1% TOPICAL POWDER TOP PWR SCH G 0.0594
00002020939 SCLERODEX INJECTION INJ DEFAUL OMG ML 1.7000
00002020793 SCLERODINE 6 INJECTION INJ DEFAUL OMG ML 3.1800
00000541869 SCOPOLAMINE HYDROBROMIDE 0.4 MG/ML INJECTION INJ DEFAUL HSP ML 5.0400
00002242810 SCOPOLAMINE HYDROBROMIDE 0.4 MG/ML INJECTION INJ DEFAUL OMG ML 5.1000
00002242811 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL OMG ML 5.4500
00000541877 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL HSP ML 5.5200
00002296659 SEASONALE (91 DAY) TABLET ORL TAB ASC TAB 0.6426
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 151 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002346176 SEASONIQUE (91 DAY) TABLET ORL TAB ASC TAB 0.6426
00000666106 SEBCUR 4% TOPICAL SHAMPOO TOP SHP DPT ML 0.0575
00000666114 SEBCUR-T TOPICAL SHAMPOO TOP SHP DPT ML 0.0708
00002288389 SEBIVO 600 MG TABLET ORL TAB NOV TAB 18.2975
00000551805 SECARIS NASAL GEL NAS GEL PMS G 0.3240
00001926578 SECTRAL 400 MG (BASE) TABLET ORL TAB SAV TAB 1.0695
00002197502 SELECT 1/35 (21 DAY) TABLET ORL TAB PFI TAB 0.4757
00002199297 SELECT 1/35 (28 DAY) TABLET ORL TB PFI TAB 0.3564
00000633380 SELENIUM 100 MCG TABLET ORL TAB JAM TAB 0.0721
00000554987 SELENIUM 50 MCG TABLET ORL TAB JAM TAB 0.0641
00000243000 SELSUN 2.5% TOPICAL SOLUTION TOP SOL ABB ML 0.0448
00002247134 SENNA LAXATIVE & DOCUSATE SODIUM 8.6MG/50MG TABLET ORL TAB VTH TAB 0.1152
00002237105 SENNA LAXATIVE 8.6 MG TABLET ORL TAB SDR TAB 0.0249
00002257130 SENSIPAR 30 MG TABLET ORL TAB AMG TAB 12.0053
00002257149 SENSIPAR 60 MG TABLET ORL TAB AMG TAB 21.8913
00002257157 SENSIPAR 90 MG TABLET ORL TAB AMG TAB 31.8557
00002357704 SEPTA-AMLODIPINE 2.5 MG TABLET ORL TAB SEP TAB 0.1380
00002368633 SEPTA-ATENOLOL 25 MG TABLET ORL TAB SEP TAB 0.0676
00002247998 SERC 24 MG TABLET ORL TAB BGP TAB 0.7000
00002239046 SEROSTIM 5 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 1633.0000
00002241304 SERTRALINE 100 MG CAPSULE ORL CAP PDL CAP 0.4200
00002241302 SERTRALINE 25 MG CAPSULE ORL CAP PDL CAP 0.2004
00002241303 SERTRALINE 50 MG CAPSULE ORL CAP PDL CAP 0.4000
00002240344 SIALOR 25 MG TABLET ORL TAB PMS TAB 0.9082
00080039305 SIERRASIL JOINT FORMULA 14 CAPSULE ORL CAP SMM CAP 0.2127
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 152 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002413299 SIGNIFOR 0.3 MG/ML INJECTION INJ DEFAUL NOV ML 78.8183
00002413302 SIGNIFOR 0.6 MG /ML INJECTION INJ DEFAUL NOV ML 87.9018
00002413310 SIGNIFOR 0.9 MG /ML INJECTION INJ DEFAUL NOV ML 87.9018
00002437252 SIGNIFOR LAR 20 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4853.5500
00002437260 SIGNIFOR LAR 40 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4853.5500
00002437279 SIGNIFOR LAR 60 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4853.5500
00002424320 SILDENAFIL 100 MG TABLET ORL TAB PDL TAB 9.2000
00002317583 SILDENAFIL 100 MG TABLET ORL TAB PMS TAB 9.2007
00002406160 SILDENAFIL 100 MG TABLET ORL TAB SNS TAB 9.2000
00002317559 SILDENAFIL 25 MG TABLET ORL TAB PMS TAB 8.2900
00002406152 SILDENAFIL 50 MG TABLET ORL TAB SNS TAB 8.8475
00002424312 SILDENAFIL 50 MG TABLET ORL TAB PDL TAB 8.8475
00002317575 SILDENAFIL 50 MG TABLET ORL TAB PMS TAB 8.8480
00002398257 SILENOR 3 MG TABLET ORL TAB PAL TAB 0.6030
00002398265 SILENOR 6 MG TABLET ORL TAB PAL TAB 1.2063
00080012979 SILICA WITH ZINC CAPLET ORL TAB JAM TAB 0.1937
00002338572 SILKIS 3 MCG/G TOPICAL OINTMENT TOP ONT GAL G 1.2500
00000999793 SIMILAC ADVANCE OMEGA 3 & 6 READY-TO-FEED BOTTLE ORL LIQ ABN ML 0.0099
00000999794 SIMILAC ADVANCE OMEGA 3 & 6 READY-TO-FEED CAN ORL LIQ ABN ML 0.0117
00000999454 SIMILAC ADVANCE OMEGA INFANT FORMULA ORL PWR ABN G 0.0117
00000999792 SIMILAC ADVANCE OMEGA-3 & 6 CONCENTRATED LIQUID ORL LIQ ABN ML 0.0104
00000999791 SIMILAC ADVANCE OMEGA-3 & 6 INFANT FORMULA PWR ORL PWR ABN G 0.0415
00000999788 SIMILAC ALIMENTUM OMEGA-3 & 6 INFANT FORMULA PWR ORL PWR ABN G 0.0381
00000999576 SIMILAC GO AND GROW INFANT FORMULA ORL DEFAUL ABN MIS 0.0456
00000999789 SIMILAC ISOMIL OMEGA-3 & 6 INFANT FORMULA POWDER ORL PWR ABN G 0.0306
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 153 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000999790 SIMILAC ISOMIL STEP 2 INFANT FORMULA POWDER ORL PWR ABN G 0.0306
00000999797 SIMILAC PARTIALLY BROKEN DOWN PROTEIN POWDER ORL PWR ABN G 0.0057
00000999796 SIMILAC SENSITIVE INFANT FORMULA CONCENTRATED LIQ ORL LIQ ABN ML 0.0104
00000999795 SIMILAC SENSITIVE INFANT FORMULA POWDER ORL PWR ABN G 0.0375
00002239548 SIMPLY SLEEP 25 MG CAPLET ORL TAB MCL TAB 0.2015
00002413183 SIMPONI 100 MG/1 ML INJECTION AUTO INJECTOR INJ NDL JAI SYR 1516.0000
00002413175 SIMPONI 100 MG/1 ML INJECTION SYRINGE INJ NDL JAI SYR 1516.0000
00002417472 SIMPONI I.V. 50 MG/4.0 ML VIAL INJECTION INJ DEFAUL JAI ML 215.8825
00002247221 SIMVASTATIN-10 MG TABLET ORL TAB PDL TAB 0.3642
00002247222 SIMVASTATIN-20 MG TABLET ORL TAB PDL TAB 0.4501
00002247223 SIMVASTATIN-40 MG TABLET ORL TAB PDL TAB 0.4501
00002247224 SIMVASTATIN-80 80 MG TABLET ORL TAB PDL TAB 0.4501
00001926055 SINUTAB N.D. REGULAR STRENGTH TABLET ORL TAB MCL TAB 0.1808
00001938371 SINUTAB NO DROWSINESS EXTRA STRENGTH TABLET ORL TAB MCL TAB 0.2629
00001926004 SINUTAB REGULAR STRENGTH TABLET ORL TAB MCL TAB 0.1988
00001938363 SINUTAB WITH CODEINE TABLET ORL TAB MCL TAB 0.4063
00001994247 SLEEP AID (REGULAR STRENGTH) 25 MGTABLET ORL TAB TAN TAB 0.0950
00000074225 SLOW K 8 MEQ SUSTAINED-RELEASE TABLET ORL SRT NOV TAB 0.1475
00002245458 SODIUM AUROTHIOMALATE B.P. 50 MG/ML INJECTION INJ DEFAUL SDZ ML 20.0300
00000481912 SODIUM BICARBONATE 325 MG TABLET ORL TAB SLW TAB 0.0304
00080022194 SODIUM BICARBONATE 500 MG TABLET ORL TAB SDZ TAB 0.0754
00000261998 SODIUM BICARBONATE 8.4 % INJECTION INJ DEFAUL HSP ML 0.5842
00002304341 SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL TGT ML 0.1000
00000037842 SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL HSP ML 0.0994
00000060208 SODIUM CHLORIDE 0.9% INJECTION USP INJ DEFAUL BAX ML 0.0202
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 154 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000851388 SODIUM CHLORIDE 0.9% NASAL SPRAY NAS SPR SFY ML 0.0357
00000999807 SODIUM CHLORIDE 1 G CAPSULE ORL CAP GLN CAP 0.1525
00002139510 SODIUM CHLORIDE 234 MG/ML INJECTION INJ DEFAUL FKC ML 0.4213
00000392499 SODIUM CHLORIDE 234 MG/ML INJECTION INJ DEFAUL SDZ ML 4.2790
00000402230 SODIUM CHLORIDE 234 MG/ML INJECTION USP INJ DEFAUL OMG ML 0.3667
00002150204 SODIUM CHLORIDE 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.3350
00000037834 SODIUM CHLORIDE 9 MG/ML IRRIGATION SOLUTION IR SOL HSP ML 0.0280
00000402249 SODIUM CHLORIDE BACTERIOSTATIC 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.1650
00000268313 SODIUM EDECRIN 50 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 503.0400
00000896187 SODIUM PHOSPHATE INJECTION INJ DEFAUL SDZ ML 2.5370
00000028053 SODIUM SULAMYD 10% OPH SOLUTION OPH SOL SDZ ML 0.4933
00002006758 SOFLAX 4 MG/ML ORAL SYRUP ORL SYR PMS ML 0.0232
00002224887 SOFRAMYCIN 0.5% OPH SOLUTION OPH SOL ERF ML 1.3663
00002224879 SOFRAMYCIN 15 MG/50 MCG TOPICAL OINTMENT TOP ONT ERF G 1.0893
00002224860 SOFRAMYCIN NASAL SPRAY NAS SPR ERF ML 3.0000
00001988840 SOFRA-TULLE (10 X 10 CM) TOPICAL GAUZE TOP GAU ERF DRE 1.5500
00001923986 SOLARCAINE FIRST AID LIDOCAINE 0.5% TOPICAL AEROSO TOP AER SCH G 0.0385
00002458152 SOLIFENACIN 10 MG TABLET ORL TAB PDL TAB 0.4223
00002458144 SOLIFENACIN 5 MG TABLET ORL TAB PDL TAB 0.4223
00080002626 SOLUCAL CITRUS ORAL LIQUID ORL DEFAUL JPC ML 0.0457
00080068920 SOLUCAL D+ 1000 CITRUS ORAL LIQUID ORL LIQ JPC ML 0.0471
00080069353 SOLUCAL D+ 1000 GREEN APPLE ORL LIQ JPC ML 0.0471
00080025038 SOLUCAL D+ 1000 RASPBERRY ORAL LIQUID ORL LIQ JPC ML 0.0471
00002230211 SOLU-MEDROL 40 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 5.2672
00000690333 SOLUVER 20% TOPICAL SOLUTION TOP SOL DPT ML 0.7500
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 155 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000837733 SOLUVER PLUS LIQ 27% TOP SOL DPT ML 1.2000
00002272199 SOMAVERT 10 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 118.4000
00002272202 SOMAVERT 15 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 177.4200
00002272210 SOMAVERT 20 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 236.4400
00002448831 SOMAVERT 25 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 295.5500
00002448858 SOMAVERT 30 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 354.6600
00000483818 SOMNOL 30 MG TABLET ORL TAB AXS TAB 0.1145
00002237578 SPASMHALT-8 CAPLET ORL TAB PPH TAB 0.3433
00002237580 SPASMHALT-ASA-8 CAPLET ORL TAB WAM TAB 0.3300
00000999811 SPECIAL ACCESS DRUG - CELONTIN ORL CAP XXX CAP 2.3287
00000999031 SPECIAL ACCESS DRUG - DEFLAZACORT ORL TAB XXX TAB 0.3158
00000999820 SPECIAL ACCESS DRUG - DODECAVIT 0.5 MG/ML INJ INJ DEFAUL XXX ML 34.1775
00000999810 SPECIAL ACCESS DRUG - MVW COMPLETE D1500 SOFTGEL ORL CAP MVW CAP 0.4705
00000999034 SPECIAL ACCESS DRUG - MVW COMPLETE D3000 CHEW TAB ORL CTB MVW TAB 0.5168
00000999033 SPECIAL ACCESS DRUG - MVW COMPLETE D3000 SOFTGEL ORL CAP MVW CAP 0.4705
00000999035 SPECIAL ACCESS DRUG - MVW COMPLETE FORMULATION DRP ORL DPS MVW ML 0.8757
00000999036 SPECIAL ACCESS DRUG - OSPOLOT DEFAUL DEFAUL XXX 0.4221
00000999037 SPECIAL ACCESS DRUG - STEROGYL 15 INJECTION INJ DEFAUL XXX ML 48.3533
00002214415 SPECTRO ECZEMACARE MEDICATED CREAM TOP CRM GKC G 0.4400
00080028131 SPRAY NASAL NAS AER IPC ML 0.0487
00002320193 SPRYCEL 100 MG TABLET ORL TAB BMS TAB 155.6083
00002293129 SPRYCEL 20 MG TABLET ORL TAB BMS TAB 38.6850
00002293137 SPRYCEL 50 MG TABLET ORL TAB BMS TAB 77.8567
00002293145 SPRYCEL 70 MG TABLET ORL TAB BMS TAB 85.8042
00001938991 STANHEXIDINE 2% SOL WITH 4% ISOPROPYL ALCOHOL TOP SOL OMG ML 0.0097
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 156 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00001938983 STANHEXIDINE 4% WITH 4% ISOPROPYL ALCOHOL SOLUTION TOP SOL OMG ML 0.0153
00002245439 STARLIX 120 MG TABLET ORL TAB NOV TAB 0.5582
00002245438 STARLIX 60 MG TABLET ORL TAB NOV TAB 0.5582
00002372436 STAXYN 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB BAI TAB 6.8400
00002459671 STELARA 130MG/26ML (5 MG/ML) VIAL INJECTION INJ DEFAUL JAI VIAL 2079.8400
00002139383 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 95.1660
00002230192 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL HSP VIAL 81.2600
00002139243 STERILE VANCOMYCIN HCL 5 G/VIAL INJECTION INJ DEFAUL FKC VIAL 509.7900
00002139375 STERILE VANCOMYCIN HCL 500 MG/VIAL INJ USP INJ DEFAUL FKC VIAL 47.7040
00002230191 STERILE VANCOMYCIN HCL 500 MG/VIAL INJECTION INJ DEFAUL HSP VIAL 42.7700
00000402257 STERILE WATER FOR INJECTION DEFAUL INJ OMG ML 0.3500
00002142546 STERILE WATER FOR INJECTION DEFAUL INJ HSP ML 0.1910
00000038245 STERILE WATER FOR INJECTION DEFAUL INJ HSP ML 0.0950
00002247228 STIEPROX 1.5 % TOPICAL SHAMPOO TOP SHP GSK ML 0.1347
00001945262 STIEVAMYCIN FORTE TOPICAL GEL TOP GEL GSK G 0.8427
00002015994 STIEVAMYCIN MILD TOPICAL GEL TOP GEL GSK G 0.8427
00001905112 STIEVAMYCIN REGULAR TOPICAL GEL TOP GEL GSK G 0.8427
00002125277 STILAMIN 3 MG/AMPOULE INJECTION INJ DEFAUL SRO VIAL 210.0000
00002403390 STIVARGA 40 MG TABLET ORL TAB BAI TAB 72.6200
00002262800 STRATTERA 10 MG CAPSULE ORL CAP LIL CAP 2.8364
00002279355 STRATTERA 100 MG CAPSULE ORL CAP LIL CAP 5.3529
00002262819 STRATTERA 18 MG CAPSULE ORL CAP LIL CAP 3.1936
00002262827 STRATTERA 25 MG CAPSULE ORL CAP LIL CAP 3.5664
00002262835 STRATTERA 40 MG CAPSULE ORL CAP LIL CAP 4.0939
00002262843 STRATTERA 60 MG CAPSULE ORL CAP LIL CAP 4.4954
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 157 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002279347 STRATTERA 80 MG CAPSULE ORL CAP LIL CAP 4.8771
00002444615 STRENSIQ 18 MG/VIAL INJECTION INJ DEFAUL APG VIAL 1836.0000
00002444623 STRENSIQ 28 MG/VIAL INJECTION INJ DEFAUL APG VIAL 2856.0000
00002444631 STRENSIQ 40 MG/VIAL INJECTION INJ DEFAUL APG VIAL 4080.0000
00002444658 STRENSIQ 80 MG/VIAL INJECTION INJ DEFAUL APG VIAL 8160.0000
00002243660 STREPTOMYCIN 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 89.0000
00000613959 STRESS FORMULA VITAMIN WITH ZINC CAPSULE ORL CAP WAM CAP 0.0617
00002174383 STRESSEASE MULTIVITAMIN AND MINERAL CAPLET ORL TAB JAM TAB 0.1080
00080009625 STRESSTABS FOR WOMEN TABLET ORL TAB PDH TAB 0.1042
00002397137 STRIBILD TABLET ORL TAB GIL TAB 46.3894
00002370433 SUBLINOX 10 MG SUBLINGUAL DISINTEGRATING TABLET SLG DISNTAB MED TAB 1.3670
00002391678 SUBLINOX 5 MG SUBLINGUAL DISINTEGRATING TAB SLG DISNTAB MED TAB 1.3670
00002130939 SUCRALFATE-1 1 G TABLET ORL TAB PDL TAB 0.3089
00002238099 SUDAFED DECONGESTANT 12-HOUR 120 MG CAPLET ORL TAB MCL TAB 0.4850
00002237793 SUDAFED DECONGESTANT EXTRA STRENGTH 60 MG TABLET ORL TAB MCL TAB 0.2908
00002250217 SUDAFED PE DECONGESTANT 10 MG TABLET ORL TAB MCL TAB 0.3000
00002442213 SUFENTANIL CITRATE 50 MCG/ML INJECTION, USP INJ DEFAUL STM ML 13.5500
00002244147 SUFENTANIL CITRATE USP 50 MCG/ML INJECTION INJ DEFAUL SDZ ML 15.5830
00002220407 SULFACET-R TOPICAL LOTION TOP LOT VCL G 1.0300
00000187534 SULFUR TOPICAL SOAP TOP SOP VCL G 0.0733
00002324660 SUMATRIPTAN 100 MG TABLET ORL TAB PDL TAB 7.8600
00002324652 SUMATRIPTAN 50 MG TABLET ORL TAB PDL TAB 7.1350
00000678996 SUPER B COMPLEX CAPSULE ORL CAP SIS CAP 0.2581
00080002944 SUPER CALCIUM 600 MG WITH VITAMIN D 400 IU ORL TAB JAM TAB 0.1251
00080011269 SUPER MULTI IRON FREE TABLET ORL TAB NFN TAB 0.2143
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 158 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080023127 SUPER STRAIN ACIDOPHILUS PROBIOTIC 2 BILLION ORL CAP JAM CAP 0.1258
00002242658 SUPER STRENGTH MOTRIN IB 400 MG TABLET ORL TAB MCL TAB 0.1938
00080017929 SUPER VITA VIM CAPLET ORL TAB JMS TAB 0.1283
00002242595 SUPER VITA-VIM CAPLET ORL TAB JAM TAB 0.1334
00000999816 SUPLASYN DEFAUL DEV MYP ML 37.5000
00099002647 SUPLENA (235 ML) ORAL LIQUID ORL LIQ ABN ML 0.0093
00009853731 SUPLENA ORAL LIQUID ORL LIQ ABN ML 0.0093
00002240749 SUPREFACT DEPOT 9.45 MG IMPLANT INJECTION INJ IMP SAV SYS 1190.3500
00002239888 SUSTIVA 200 MG CAPSULE ORL CAP BMS CAP 5.0708
00002239886 SUSTIVA 50 MG CAPSULE ORL CAP BMS CAP 1.2680
00002246045 SUSTIVA 600 MG TABLET ORL TAB BMS TAB 15.2123
00002280795 SUTENT 12.5 MG CAPSULE ORL CAP PFI CAP 63.7207
00002280809 SUTENT 25 MG CAPSULE ORL CAP PFI CAP 127.4411
00002280817 SUTENT 50 MG CAPSULE ORL CAP PFI CAP 254.8825
00002435128 SYLVANT 100 MG/VIAL INJECTION INJ DEFAUL JAI VIAL 697.7000
00002435136 SYLVANT 400 MG/VIAL INJECTION INJ DEFAUL JAI VIAL 2790.8000
00000253952 SYNACTHEN DEPOT 1 MG/ML INJECTION INJ DEFAUL QST VIAL 680.0000
00002245890 SYNAGIS 100 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 1504.5100
00002245889 SYNAGIS 50 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 752.2600
00002162504 SYNALAR 0.01% TOPICAL SOLUTION TOP SOL VCL ML 0.4128
00002162512 SYNALAR 0.025% TOPICAL OINTMENT TOP ONT VCL G 0.4508
00002456621 SYNJARDY 12.5 MG/1000 MG TABLET ORL TAB BOE TAB 1.3500
00002456605 SYNJARDY 12.5 MG/500 MG TABLET ORL TAB BOE TAB 1.3500
00002456613 SYNJARDY 12.5 MG/850 MG TABLET ORL TAB BOE TAB 1.3500
00002456591 SYNJARDY 5 MG/1000 MG TABLET ORL TAB BOE TAB 1.3500
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 159 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002456575 SYNJARDY 5 MG/500 MG TABLET ORL TAB BOE TAB 1.3500
00002456583 SYNJARDY 5 MG/850 MG TABLET ORL TAB BOE TAB 1.3500
00000990010 SYNVISC DEFAUL DEV GZB ML 67.9100
00000999331 SYNVISC ONE DEFAUL DEV GZB ML 69.0117
00002444062 SYSTANE OPHTHALMIC OINTMENT OPH ONT ALC G 1.5457
00002248967 SYSTANE OPHTHALMIC SOLUTION OPH SOL ALC ML 0.5267
00000999333 SYSTANE ULTRA OPH DPS ALC ML 0.9598
00080032792 SYSTANE VITAMIN- OMEGA 3 CAPSULE ORL CAP ALC CAP 0.2197
00002239122 T.R. SWISS ONE 50 MULTIVITAMIN & MINERAL TABLET ORL TAB SWS TAB 0.2048
00002365871 TACTUPUMP 0.1%/2.5% TOPICAL GEL TOP GEL GAL G 1.4369
00002446235 TACTUPUMP FORTE 0.3%/2.5% TOPICAL GEL TOP GEL GAL G 2.3428
00002455374 TADALAFIL 20 MG TABLET ORL TAB PDL TAB 12.3575
00002455358 TADALAFIL 5 MG TABLET ORL TAB PDL TAB 3.6470
00002409607 TAFINLAR 50 MG CAPSULE ORL CAP NOV CAP 43.4889
00002409615 TAFINLAR 75 MG CAPSULE ORL CAP NOV CAP 65.2333
00002456214 TAGRISSO 40 MG TABLET ORL TAB AZC TAB 294.6764
00002456222 TAGRISSO 80 MG TABLET ORL TAB AZC TAB 294.6764
00002455102 TALTZ 80 MG/ML AUTOINJECTOR INJ NDL LIL SYR 1544.8200
00002455110 TALTZ 80 MG/ML INJECTION SYRINGE INJ NDL LIL SYR 1544.8200
00002304848 TAMIFLU 30 MG CAPSULE ORL CAP HLR CAP 2.0970
00002304856 TAMIFLU 45 MG CAPSULE ORL CAP HLR CAP 3.2270
00002381842 TAMIFLU 6 MG/ML ORAL SUSPENSION ORL SUS HLR ML 0.3226
00002241472 TAMIFLU 75 MG CAPSULE ORL CAP HLR CAP 4.1940
00002413612 TAMSULOSIN CR 0.4 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.1500
00001962353 TANTAPHEN EXTRA STRENGTH 500 MG CAPLET ORL TAB TAN TAB 0.0214
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 160 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002296039 TAPAZOLE 10 MG TABLET ORL TAB PAL TAB 0.5833
00002269015 TARCEVA 100 MG TABLET ORL TAB HLR TAB 55.3837
00002269023 TARCEVA 150 MG TABLET ORL TAB HLR TAB 83.0753
00002269007 TARCEVA 25 MG TABLET ORL TAB HLR TAB 13.3333
00000510335 TARGEL SA TOPICAL LIQUID TOP LIQ ODN G 0.2070
00000344508 TARGEL TOPICAL GEL TOP GEL ODN G 0.1810
00002339609 TARGIN 10 MG/ 5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.0080
00002339617 TARGIN 20 MG/ 10 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.5130
00002339625 TARGIN 40 MG/ 20 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 2.6210
00002387425 TARGIN 5 MG/ 2.5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.7200
00002240946 TARKA 2 MG/ 240 MG TABLET ORL TAB BGP TAB 1.7698
00002238097 TARKA 4 MG/ 240 MG TABLET ORL TAB BGP TAB 1.9640
00002365650 TARO-ANASTROZOLE 1 MG TABLET ORL TAB TAR TAB 1.2730
00002244403 TARO-CARBAMAZEPINE 100 MG CHEWABLE TABLET ORL CTB TAR TAB 0.1188
00002244404 TARO-CARBAMAZEPINE 200 MG CHEWABLE TABLET ORL CTB TAR TAB 0.2354
00002353288 TARO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL TAR G 7.7433
00002266938 TARO-CLINDAMYCIN 1% (BASE) TOPICAL SOLUTION TOP SOL TAR ML 0.2613
00002420988 TARO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL TAR ML 0.6227
00002430940 TARO-EPINEPHRINE 1:1000 AUTO-INJECTOR SYRINGE INJ NDL TAR SYR 67.0700
00002430959 TARO-EPINEPHRINE 1:2000 AUTO-INJECTOR SYRINGE INJ NDL TAR SYR 67.0700
00002264749 TARO-MOMETASONE 0.1% OINTMENT TOP ONT TAR G 0.2720
00001925350 TARO-SONE 0.05% TOPICAL CREAM TOP CRM TAR G 0.2048
00002443511 TARO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP TAR CAP 113.5965
00002443538 TARO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP TAR CAP 159.0360
00002443481 TARO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP TAR CAP 22.7200
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 161 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002443554 TARO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP TAR CAP 283.9840
00002443473 TARO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP TAR CAP 6.6300
00002247651 TARO-TERCONAZOLE 0.4% VAGINAL CREAM VAG CRM TAR G 0.5296
00002450429 TARO-TRAMADOL ER 100 MG EXTENDED-RELEASE TABLET ORL ERT TAR TAB 1.0374
00002450437 TARO-TRAMADOL ER 200 MG EXTENDED-RELEASE TABLET ORL ERT TAR TAB 1.8915
00002450445 TARO-TRAMADOL ER 300 MG EXTENDED-RELEASE TABLET ORL ERT TAR TAB 2.7485
00002368250 TASIGNA 150 MG CAPSULE ORL CAP NOV CAP 28.8593
00002315874 TASIGNA 200 MG CAPSULE ORL CAP NOV CAP 40.5995
00002177099 TAXOTERE 40 MG/ML (20 MG/0.5 ML) INJECTION INJ DEFAUL SAV ML 456.9400
00002177080 TAXOTERE 40 MG/ML (80 MG/2 ML) INJECTION INJ DEFAUL SAV ML 456.9400
00002170817 TAZOCIN 2 G/250 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 11.9220
00002170795 TAZOCIN 3 G/375 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 17.8830
00002170809 TAZOCIN 4 G/500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 23.8450
00002243894 TAZORAC 0.05% TOPICAL CREAM TOP CRM ALL G 1.3600
00002243895 TAZORAC 0.1% TOPICAL CREAM TOP CRM ALL G 1.3600
00000615358 TD POLIO ADSORBED FOR ADULT INJECTION INJ DEFAUL SFP VIAL 60.2240
00001950010 TEARS ENCORE 1.4% OPH SOLUTION OPH SOL AKN ML 0.9710
00002246397 TEARS NATURAL FORTE OPH SOLUTION OPH SOL ALC ML 0.4087
00001943308 TEARS NATURALE FREE OPH SOLUTION OPH SOL ALC ML 0.4944
00000743445 TEARS NATURALE II OPH SOLUTION OPH SOL ALC ML 0.4220
00000390291 TEARS NATURALE OPH DROPS OPH DPS ALC ML 0.4220
00002082519 TEARS NATURALE P.M. OPH OINTMENT OPH ONT ALC G 1.5457
00000579408 TEARS PLUS 1.4% OPH SOLUTION OPH SOL ALL ML 0.4800
00000283991 TEBRAZID 500 MG TABLET ORL TAB VCL TAB 0.4980
00002420201 TECFIDERA 240 MG DELAYED-RELEASE CAPSULE ORL DRC BIO CAP 33.0329
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 162 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002447711 TECHNIVIE TABLET ORL TAB ABV TAB 332.5000
00002395223 TELMISARTAN 40 MG TABLET ORL TAB PDL TAB 0.2824
00002395231 TELMISARTAN 80 MG TABLET ORL TAB PDL TAB 0.2824
00002395525 TELMISARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PDL TAB 0.2824
00002395533 TELMISARTAN-HCTZ 80 MG/25 MG TABLET ORL TAB PDL TAB 0.2824
00002261553 TELZIR 50 MG/ML ORAL SUSPENSION ORL SUS GSK ML 0.5912
00002261545 TELZIR 700 MG TABLET ORL TAB GSK TAB 8.0863
00002241095 TEMODAL 100 MG CAPSULE ORL CAP MFC CAP 153.4045
00002321262 TEMODAL 100 MG/VIAL INJECTION INJ DEFAUL MFC VIAL 411.2600
00002312794 TEMODAL 140 MG CAPSULE ORL CAP MFC CAP 214.7680
00002241094 TEMODAL 20 MG CAPSULE ORL CAP MFC CAP 30.6820
00002241096 TEMODAL 250 MG CAPSULE ORL CAP MFC CAP 383.5000
00002241093 TEMODAL 5 MG CAPSULE ORL CAP MFC CAP 7.6705
00000875988 TEMPRA INFANT 80 MG/ML ORAL DROPS ORL DPS PAL ML 0.2500
00000894710 TERAZOL 3 80 MG VAGINAL OVULE VAG OVL JAI OVL 6.3767
00002130874 TERAZOL 3 DUAL PAK KIT VAG/TOP OVL/CRM JAI KIT 30.4000
00000894729 TERAZOL 7 0.4% VAGINAL CREAM VAG CRM JAI G 0.7060
00002242735 TERBINAFINE-250 MG TABLET ORL TAB PDL TAB 1.8527
00002280248 TESTIM 1% TOPICAL GEL TOP GEL PAL G 0.7493
00000514462 TETANUS & DIPHTHERIA TOXOIDS ADULT INJECTION INJ LIQ CNG ML 43.3800
00002148528 TETRACAINE 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.0000
00002416662 TEVA-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB TEV TAB 20.3573
00002248251 TEVA-ALENDRONATE 5 MG TABLET ORL TAB TEV TAB 1.0370
00002403633 TEVA-ALENDRONATE/CHOLECALCIFEROL 70 MG/2800 U TAB ORL TAB TEV TAB 3.7300
00002326043 TEVA-AMITRIPTYLINE 10 MG TABLET ORL TAB TEV TAB 0.0664
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 163 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002326051 TEVA-AMITRIPTYLINE 25 MG TABLET ORL TAB TEV TAB 0.1211
00002326078 TEVA-AMITRIPTYLINE 50 MG TABLET ORL TAB TEV TAB 0.2347
00002314541 TEVA-ATOMOXETINE 10 MG CAPSULE ORL CAP TEV CAP 2.3140
00002362538 TEVA-ATOMOXETINE 100 MG CAPSULE ORL CAP TEV CAP 4.3520
00002314568 TEVA-ATOMOXETINE 18 MG CAPSULE ORL CAP TEV CAP 2.6523
00002314576 TEVA-ATOMOXETINE 25 MG CAPSULE ORL CAP TEV CAP 2.9280
00002314584 TEVA-ATOMOXETINE 40 MG CAPSULE ORL CAP TEV CAP 3.3377
00002314592 TEVA-ATOMOXETINE 60 MG CAPSULE ORL CAP TEV CAP 3.7023
00002362511 TEVA-ATOMOXETINE 80 MG CAPSULE ORL CAP TEV CAP 3.9960
00002380927 TEVA-ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB TEV TAB 4.1310
00002280205 TEVA-BETAHISTINE 24 MG TABLET ORL TAB TEV TAB 0.4983
00002280183 TEVA-BETAHISTINE 8 MG TABLET ORL TAB TEV TAB 0.2259
00002398419 TEVA-BOSENTAN 125 MG TABLET ORL TAB TEV TAB 48.1340
00002398400 TEVA-BOSENTAN 62.5 MG TABLET ORL TAB TEV TAB 48.1340
00002400022 TEVA-CAPECITABINE 150 MG TABLET ORL TAB TEV TAB 1.4640
00002400030 TEVA-CAPECITABINE 500 MG TABLET ORL TAB TEV TAB 4.8800
00002441624 TEVA-CINACALCET 30 MG TABLET ORL TAB TEV TAB 10.1947
00002441632 TEVA-CINACALCET 60 MG TABLET ORL TAB TEV TAB 18.5900
00002441640 TEVA-CINACALCET 90 MG TABLET ORL TAB TEV TAB 27.0517
00002239355 TEVA-DIFENAC-K 50 MG TABLET ORL TAB TEV TAB 0.3937
00002389762 TEVA-EFAVIRENZ 600 MG TABLET ORL TAB TEV TAB 11.2103
00002382091 TEVA-ELETRIPTAN 20 MG TABLET ORL TAB TEV TAB 10.0850
00002382105 TEVA-ELETRIPTAN 40 MG TABLET ORL TAB TEV TAB 10.0850
00002300680 TEVA-ENALAPRIL 2.5 MG TABLET ORL TAB TEV TAB 0.1863
00002330601 TEVA-ENALAPRIL 40 MG TABLET ORL TAB TEV TAB 1.2560
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 164 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002377705 TEVA-ERLOTINIB 100 MG TABLET ORL TAB TEV TAB 47.4667
00002377713 TEVA-ERLOTINIB 150 MG TABLET ORL TAB TEV TAB 71.2000
00002377691 TEVA-ERLOTINIB 25 MG TABLET ORL TAB TEV TAB 11.8667
00002408473 TEVA-EXEMESTANE 25 MG TABLET ORL TAB TEV TAB 3.9007
00002289083 TEVA-FENOFIBRATE-S 100 MG TABLET ORL TAB TEV TAB 0.5407
00002289091 TEVA-FENOFIBRATE-S 160 MG TABLET ORL CAP/TAB TEV TAB 0.2723
00002415844 TEVA-FROVATRIPTAN 2.5 MG TABLET ORL TAB TEV TAB 12.5029
00002248457 TEVA-GABAPENTIN 600 MG TABLET ORL TAB TEV TAB 1.3045
00002247346 TEVA-GABAPENTIN 800 MG TABLET ORL TAB TEV TAB 1.7393
00002399806 TEVA-IMATINIB 100 MG TABLET ORL TAB TEV TAB 20.4557
00002399814 TEVA-IMATINIB 400 MG TABLET ORL TAB TEV TAB 81.8228
00002316013 TEVA-IRBESARTAN/HCTZ 150/12.5 MG TABLET ORL TAB TEV TAB 0.3024
00002316021 TEVA-IRBESARTAN/HCTZ 300/12.5 MG TABLET ORL TAB TEV TAB 0.3024
00002316048 TEVA-IRBESARTAN/HCTZ 300/25 MG TABLET ORL TAB TEV TAB 0.3004
00002387247 TEVA-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB TEV TAB 7.8309
00002343657 TEVA-LETROZOLE 2.5 MG TABLET ORL TAB TEV TAB 2.7560
00002246542 TEVA-LOVASTATIN 20 MG TABLET ORL TAB TEV TAB 0.4919
00002246543 TEVA-LOVASTATIN 40 MG TABLET ORL TAB TEV TAB 0.8985
00002258323 TEVA-MELOXICAM 15 MG TABLET ORL TAB TEV TAB 0.5670
00002258315 TEVA-MELOXICAM 7.5 MG TABLET ORL TAB TEV TAB 0.4914
00002315068 TEVA-METHYLPHENIDATE ER-C 18 MG EXTEND REL. TABLET ORL ERT TEV TAB 1.4276
00002315076 TEVA-METHYLPHENIDATE ER-C 27 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.6475
00002315084 TEVA-METHYLPHENIDATE ER-C 36 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.8674
00002315092 TEVA-METHYLPHENIDATE ER-C 54 MG EXTEND RELEASE TAB ORL ERT TEV TAB 2.3072
00002261898 TEVA-METOPROL 25 MG TABLET ORL TAB TEV TAB 0.0643
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 165 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002279894 TEVA-MIRTAZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 0.2730
00002279908 TEVA-MIRTAZAPINE OD 30MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 0.5460
00002279916 TEVA-MIRTAZAPINE OD 45MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 0.8190
00002239746 TEVA-MOCLOBEMIDE 100 MG TABLET ORL TAB TEV TAB 0.2520
00002239747 TEVA-MOCLOBEMIDE 150 MG TABLET ORL TAB TEV TAB 0.3120
00002239748 TEVA-MOCLOBEMIDE 300 MG TABLET ORL TAB TEV TAB 0.6126
00002420260 TEVA-MODAFINIL 100 MG TABLET ORL TAB TEV TAB 0.9293
00002392925 TEVA-NABILONE 0.25 MG CAPSULE ORL CAP TEV CAP 1.3962
00002352893 TEVA-NEVIRAPINE 200 MG TABLET ORL TAB TEV TAB 2.4692
00002359707 TEVA-OLANZAPINE 20 MG TABLET ORL TAB TEV TAB 10.3093
00002321378 TEVA-OLANZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 5.3553
00002321386 TEVA-OLANZAPINE OD 20 MG ORALLY DISINT. TABLET ORL DISNTAB TEV TAB 7.5977
00002285479 TEVA-PANTOPRAZOLE 20MG ENTERIC-COATED ORAL TAB ORL ECT TEV TAB 1.2750
00002248556 TEVA-PAROXETINE 10 MG TABLET ORL TAB TEV TAB 1.0430
00000869015 TEVA-PINDOLOL 10 MG TABLET ORL TAB TEV TAB 0.2323
00000869023 TEVA-PINDOLOL 15 MG TABLET ORL TAB TEV TAB 0.3370
00000869007 TEVA-PINDOLOL 5 MG TABLET ORL TAB TEV TAB 0.1361
00002274914 TEVA-PIOGLITAZONE 15 MG TABLET ORL TAB TEV TAB 0.5809
00002274922 TEVA-PIOGLITAZONE 30 MG TABLET ORL TAB TEV TAB 0.8139
00002274930 TEVA-PIOGLITAZONE 45 MG TABLET ORL TAB TEV TAB 1.2237
00002269317 TEVA-PRAMIPEXOLE 0.5 MG TABLET ORL TAB TEV TAB 1.3860
00002361205 TEVA-PREGABALIN 150 MG CAPSULE ORL CAP TEV CAP 1.7270
00002361221 TEVA-PREGABALIN 225 MG CAPSULE ORL CAP TEV CAP 1.7270
00002361159 TEVA-PREGABALIN 25 MG CAPSULE ORL CAP TEV CAP 0.6173
00002361248 TEVA-PREGABALIN 300 MG CAPSULE ORL CAP TEV CAP 1.7270
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 166 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002361175 TEVA-PREGABALIN 50 MG CAPSULE ORL CAP TEV CAP 0.9683
00002361183 TEVA-PREGABALIN 75 MG CAPSULE ORL CAP TEV CAP 1.2529
00002312298 TEVA-RALOXIFENE 60 MG TABLET ORL TAB TEV TAB 0.4583
00002388375 TEVA-RAMIPRIL/HCTZ 10 MG/25 MG TABLET ORL TAB TEV TAB 0.2633
00002388332 TEVA-RAMIPRIL/HCTZ 2.5 MG/12.5 MG TABLET ORL TAB TEV TAB 0.1694
00002388367 TEVA-RAMIPRIL/HCTZ 5 MG/25 MG TABLET ORL TAB TEV TAB 0.2070
00002418436 TEVA-RASAGILINE 0.5 MG TABLET ORL TAB TEV TAB 6.1285
00002418444 TEVA-RASAGILINE 1 MG TABLET ORL TAB TEV TAB 6.1285
00002413809 TEVA-RISEDRONATE 150 MG TABLET ORL TAB TEV TAB 40.9500
00002308754 TEVA-SILDENAFIL 100 MG TABLET ORL TAB TEV TAB 9.2006
00002308738 TEVA-SILDENAFIL 25 MG TABLET ORL TAB TEV TAB 8.2900
00002308746 TEVA-SILDENAFIL 50 MG TABLET ORL TAB TEV TAB 8.8475
00002286815 TEVA-SUMATRIPTAN DF 25 MG TABLET ORL TAB TEV TAB 8.9900
00002440164 TEVA-TADALAFIL 10 MG TABLET ORL TAB TEV TAB 11.9250
00002440148 TEVA-TADALAFIL 2.5 MG TABLET ORL TAB TEV TAB 3.6470
00002440172 TEVA-TADALAFIL 20 MG TABLET ORL TAB TEV TAB 12.3569
00002440156 TEVA-TADALAFIL 5 MG TABLET ORL TAB TEV TAB 3.6470
00000851965 TEVA-TAMOXIFEN 10 MG TABLET ORL TAB TEV TAB 0.1750
00000851973 TEVA-TAMOXIFEN 20 MG TABLET ORL TAB TEV TAB 0.3500
00002230102 TEVA-TEMAZEPAM 30 MG CAPSULE ORL CAP TEV CAP 0.0526
00002230085 TEVA-THEOPHYLLINE SR 100 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.1300
00002230086 TEVA-THEOPHYLLINE SR 200 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.1350
00002230087 TEVA-THEOPHYLLINE SR 300 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.1400
00002236848 TEVA-TICLOPIDINE 250 MG TABLET ORL TAB TEV TAB 0.3139
00002299593 TEVA-TOLTERODINE 1 MG TABLET ORL TAB TEV TAB 0.8838
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 167 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002299607 TEVA-TOLTERODINE 2 MG TABLET ORL TAB TEV TAB 0.8838
00002347180 TEVA-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB TEV TAB 0.6264
00002357542 TEVA-VALACYCLOVIR 1000 MG TABLET (CAPLET) ORL TAB TEV TAB 3.0531
00002356643 TEVA-VALSARTAN 40 MG TABLET ORL TAB TEV TAB 0.5240
00002355205 THALOMID 100 MG CAPSULE ORL CAP CLG CAP 58.9400
00002355221 THALOMID 200 MG CAPSULE ORL CAP CLG CAP 117.8800
00002355191 THALOMID 50 MG CAPSULE ORL CAP CLG CAP 29.4700
00002360101 THEO ER 400 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.3362
00002360128 THEO ER 600 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.4072
00080015438 THERA TEARS NUTRITION CAPSULE ORL CAP AVR CAP 0.1056
00002242082 THERATEARS (PRESERVATIVE-FREE) 0.25% OPH SOLUTION OPH SOL AVR ML 0.6417
00002248854 THERATEARS 0.25% OPH SOLUTION OPH SOL AVR ML 0.4900
00002409356 TIGECYCLINE 50 MG/VIAL INJECTION INJ DEFAUL APX VIAL 71.4225
00001916939 TIMENTIN 3.1G INJECTION INJ DEFAUL GSK VIAL 10.7520
00002242275 TIMOLOL MALEATE-EX 0.25% OPHTHALMIC SOLUTION OPH LAS ALC ML 3.2160
00002242276 TIMOLOL MALEATE-EX 0.5% OPHTHALMIC SOLUTION OPH LAS ALC ML 3.8480
00000576050 TINACTIN 1% TOPICAL AEROSOL TOP AER SCH G 0.0594
00000576034 TINACTIN 1% TOPICAL CREAM TOP CRM SCH G 0.3960
00000576042 TINACTIN 1% TOPICAL POWDER TOP PWR SCH G 0.0668
00002414945 TIVICAY 50 MG TABLET ORL TAB VIV TAB 19.2493
00002259893 TIZANIDINE 4 MG TABLET ORL TAB AAP TAB 0.6884
00002244826 TNKASE 50 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2803.8000
00000533688 TOBRAMYCIN 1.2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 199.0000
00002241209 TOBRAMYCIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 5.1585
00002230640 TOBRAMYCIN 40 MG/ML INJECTION INJ DEFAUL FKC ML 3.5310
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 168 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002337630 TOCTINO 10 MG CAPSULE ORL CAP GST CAP 21.9900
00002337649 TOCTINO 30 MG CAPSULE ORL CAP GST CAP 21.9900
00000312762 TOLBUTAMIDE 500 MG TABLET ORL TAB AAP TAB 0.1111
00002229566 TOMUDEX 2 MG/VIAL INJECTION INJ DEFAUL AZC VIAL 324.6200
00002221926 TOPICORT 0.05% TOPICAL GEL TOP GEL VCL G 0.5122
00002221934 TOPICORT 0.25% TOPICAL OINTMENT TOP ONT VCL G 0.6603
00000749834 TOPIDERM HC 2% TOPICAL CREAM TOP CRM PAL G 0.3317
00002390981 TOPOTECAN 4 MG / VIAL INJECTION INJ DEFAUL SDZ VIAL 567.0000
00002304104 TORISEL 25 MG/ML INJECTION INJ DEFAUL PFI VIAL 1309.6000
00002441829 TOUJEO SOLOSTAR 300 UNIT/ML INJECTION INJ DEFAUL SAV ML 17.6227
00002244982 TRACLEER 125 MG TABLET ORL TAB ACT TAB 64.1786
00002244981 TRACLEER 62.5 MG TABLET ORL TAB ACT TAB 64.1786
00002264846 TRAMACET 37.5 MG/325 MG TABLET ORL TAB JAI TAB 0.8023
00002426803 TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB SNS TAB 0.6264
00002429969 TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB SIV TAB 0.6264
00002417502 TRAMADOL-ACET 37.5 MG/325 MG TABLET ORL TAB PDL TAB 0.6264
00002246365 TRANEXAMIC ACID 100 MG/ML INJECTION INJ DEFAUL SDZ ML 3.8860
00080044392 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 14 MG TRD PTH APH PTH 2.1500
00080044389 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 21 MG TRD PTH APH PTH 2.1500
00080044393 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 7 MG TRD PTH APH PTH 2.2857
00080024336 TRANSDERM-V 1.5 MG TOPICAL PATCH TOP PTH NOV PTH 3.9250
00000605786 TRAVEL AID 50 MG TABLET ORL TAB WTR TAB 0.0488
00002164361 TRAZODONE-100 100 MG TABLET ORL TAB PDL TAB 0.0989
00002164388 TRAZODONE-150 D 150 MG TABLET ORL TAB PDL TAB 0.1453
00002164353 TRAZODONE-50 50 MG TABLET ORL TAB PDL TAB 0.0554
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 169 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002392569 TREANDA 100 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL LUI VIAL 1250.0000
00002392550 TREANDA 25 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL LUI VIAL 312.5000
00002412322 TRELSTAR 22.5 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 1659.9000
00002240000 TRELSTAR 3.75 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 347.3300
00002243856 TRELSTAR LA 11.25 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 1042.0300
00080015032 TRIAMEG H OMEGA 3 500 MG CAPSULE ORL CAP LLN CAP 0.3000
00000896179 TRIAMINIC DM NIGHTIME ORAL SYRUP ORL SYR NVC ML 0.0474
00000789828 TRIATEC-30 TABLET ORL TAB TLI TAB 0.1300
00001977881 TRIATEC-8 FORT TABLET ORL TAB TLI TAB 0.0261
00000852163 TRIATEC-8 TABLET ORL TAB TLI TAB 0.0473
00002296381 TRIDURAL 100 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 1.2205
00002296403 TRIDURAL 200 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 2.2253
00002296411 TRIDURAL 300 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 3.2335
00002248264 TRIFEREXX - 150 150 MG ORAL CAPSULE ORL CAP AXS CAP 0.4283
00002242067 TRILEPTAL 150 MG TABLET ORL TAB NOV TAB 0.8526
00002242068 TRILEPTAL 300 MG TABLET ORL TAB NOV TAB 0.9424
00002244673 TRILEPTAL 60 MG/ML ORAL SUSPENSION ORL SUS NOV ML 0.3409
00002242069 TRILEPTAL 600 MG TABLET ORL TAB NOV TAB 1.8850
00000517895 TRINALIN REPETABS SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.6535
00002432927 TRINTELLIX 10 MG TABLET ORL TAB LBC TAB 2.8621
00002432943 TRINTELLIX 20 MG TABLET ORL TAB LBC TAB 3.1075
00002432919 TRINTELLIX 5 MG TABLET ORL TAB LBC TAB 2.7325
00080002067 TRIPLE STRENGTH ODOURLESS GARLIC SOFTGEL CAPSULE ORL CAP VCL CAP 0.0460
00002407833 TRISENOX 1 MG/ML AMPOULE INJECTION INJ DEFAUL LBC ML 53.0000
00002430932 TRIUMEQ TABLET ORL TAB VIV TAB 43.2020
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 170 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002244757 TRIZIVIR TABLET ORL TAB GSK TAB 18.7613
00000511234 TROMBOJECT 10 MG/ML INJECTION INJ DEFAUL OMG ML 6.4500
00000511226 TROMBOJECT 30 MG/ML INJECTION INJ DEFAUL OMG ML 8.7500
00080015078 TROPHIC KRILL OIL CAPSULE ORL CAP MTA CAP 0.4237
00002148536 TROPICAMIDE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.0000
00080000383 TRUEHOPE EMP CAPSULE ORL CAP TRU CAP 0.2087
00002448599 TRULICITY 0.75 MG/0.5 ML INJECTION PEN INJ DEFAUL LIL ML 97.5300
00002448602 TRULICITY 1.5 MG/0.5 ML INJECTION PEN INJ DEFAUL LIL ML 97.5300
00002274906 TRUVADA 200 MG/300 MG TABLET ORL TAB GIL TAB 27.3870
00000317268 TUBERSOL TUBERCULIN PPD 5 TUB INJECTION INJ DEFAUL AVE ML 177.7100
00001967932 TUMS EXTRA STRENGTH 750 MG CHEWABLE TABLET ORL CTB SKB TAB 0.0442
00001970240 TUMS REGULAR 500 MG CHEWABLE TABLET ORL CTB SKB TAB 0.0311
00002151138 TUMS ULTRA STRENGTH 1G CHEWABLE TABLET ORL CTB SKB TAB 0.0496
00001916971 TUSSIONEX ORAL SUSTAINED-RELEASE SUSPENSION ORL SRSUS SAV ML 0.3406
00001916963 TUSSIONEX TABLET ORL SRT SAV TAB 1.7028
00080019103 TUZEN CAPSULE ORL CAP FEI CAP 0.7600
00002268205 TWINJECT 1:1000 (0.15 MG) INJECTION AUTO INJECTOR INJ NDL PAL SYR 82.4600
00002247310 TWINJECT 1:1000 (0.3 MG) INJECTION AUTO INJECTOR INJ NDL PAL SYR 82.4600
00002230578 TWINRIX INJECTION SYRINGE INJ NDL GSK SYR 48.8800
00002237548 TWINRIX JUNIOR 0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 24.8400
00002285401 TYGACIL 50 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 83.4740
00002326442 TYKERB 250 MG TABLET ORL TAB NOV TAB 23.8994
00002246060 TYLENOL 8 HOUR 650 MG EXTENDED-RELIEF CAPLET ORL ERT MCL TAB 0.1694
00001933728 TYLENOL ALLERGY SINUS EXTRA STRENGTH CAPLET ORL TAB MCL TAB 0.2850
00002238885 TYLENOL ARTHRITIS PAIN 650 MG EXT-RELIEF CAPLET ORL ERT MCL TAB 0.1592
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 171 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000743224 TYLENOL CHILDRENS COLD CHEWABLE TABLET ORL CTB MCL TAB 0.1763
00000890677 TYLENOL COLD DM JUNIOR STRENGTH CHEWABLE TABLET ORL CTB MCL TAB 0.2590
00000743275 TYLENOL COLD EXTRA STRENGTH CAPLET ORL TAB MCL TAB 0.2850
00000743267 TYLENOL COLD EXTRA STRENGTH N.D. CAPLET ORL TAB MCL TAB 0.2850
00002276259 TYLENOL COLD EXTRA STRENGTH NIGHTTIME TABLET ORL TAB MCL TAB 0.3050
00000574007 TYLENOL COLD REGULAR STRENGTH CAPLET ORL TAB MCL TAB 0.2004
00000743283 TYLENOL COLD REGULAR STRENGTH N.D. CAPLET ORL TAB MCL TAB 0.2012
00002290510 TYLENOL EXTRA STR. BACK PAIN 400 MG/500 MG TABLET ORL TAB MCL TAB 0.4894
00000863270 TYLENOL EXTRA-STRENGTH GELCAPS 500 MG CAPSULE ORL CAP MCL CAP 0.1438
00000663980 TYLENOL EXTRA-STRENGTH SINUS MEDICATION CAPLET ORL TAB MCL TAB 0.4783
00002347792 TYLENOL FASTMELTS JUNIOR STRENGTH 160 MG CHEW TAB ORL CTB MCL TAB 0.2745
00002241361 TYLENOL JUNIOR STRENGTH 160 MG SOFT CHEW TABLET ORL CTB MCL TAB 0.2700
00002181061 TYLENOL NO.1 WITH CODEINE TABLET ORL TAB MCL TAB 0.1396
00000559393 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.1442
00000723894 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.1229
00000778400 TYLENOL SINUS CAPLET ORL TAB MCL TAB 0.2004
00002242727 TYPHERIX 25 MCG/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 22.1400
00002130955 TYPHIM VI 50 MCG/ML INJECTION INJ DEFAUL CNG ML 48.5000
00080022377 UDO'S CHOICE SUPER 8 PLUS PROBIOTIC ORL CAP FMD CAP 0.9900
00001966294 ULONE 5 MG ORAL SYRUP ORL SYR MMH ML 0.1406
00080015173 ULTIMATE FLORA CRITICAL CARE 50 BILLION ORL CAP RLC CAP 1.1665
00080040326 ULTIMATE FLORA ULTRA POTENT 100 BILLION CAPSULE ORL CAP RLC CAP 1.2000
00080006259 ULTIMATE OMEGA FACTORS 3-6-9 SOFT GEL CAPSULE ORL CAP NFN CAP 0.2387
00080033880 ULTRA C 1000 TABLET ORL TAB MTG TAB 0.3135
00080032885 ULTRA C TM 500 500 MG TABLET ORL TAB MTG TAB 0.2817
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 172 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080011779 ULTRA FLORA PLUS CAPSULE ORL CAP MTG CAP 0.4116
00080011780 ULTRA FLORA PLUS; ULTRA FLORA BALANCE ORL CAP MTG CAP 0.4167
00002237698 ULTRA STRENGTH PHAZYME 180 MG CAPSULE ORL CAP CBF CAP 0.2221
00080025550 ULTRA-FIBER BALANCED CAPLET ORL TAB AAM TAB 0.0802
00080004965 ULTRA-FIBER SUPPLEMENT CHEWABLE TABLET ORL TAB AAM TAB 0.0917
00002349469 ULTRAM 50 MG TABLET ORL TAB JAI TAB 0.7620
00002324113 ULTRAQUIN 4% HYDROQUINONE CREAM WITH SUNSCREENS TOP CRM SAH G 1.0000
00000626724 ULTRAQUIN 4% TOPICAL GEL TOP GEL SAH G 1.0000
00000632783 ULTRAQUIN PLAIN 4% CREAM TOP CRM SAH G 0.8667
00001962728 ULTRAVATE 0.05% TOPICAL OINTMENT TOP ONT VCL G 0.9256
00001946994 UNISOM-2 NIGHTTIME SLEEP AID TAB 25 MG ORL TAB PDH TAB 0.2040
00002451190 UPTRAVI 1000 MCG TABLET ORL TAB ACT TAB 64.1667
00002451204 UPTRAVI 1200 MCG TABLET ORL TAB ACT TAB 64.1667
00002451212 UPTRAVI 1400 MCG TABLET ORL TAB ACT TAB 64.1667
00002451220 UPTRAVI 1600 MCG TABLET ORL TAB ACT TAB 64.1667
00002451158 UPTRAVI 200 MCG TABLET ORL TAB ACT TAB 64.1667
00002451166 UPTRAVI 400 MCG TABLET ORL TAB ACT TAB 64.1667
00002451174 UPTRAVI 600 MCG TABLET ORL TAB ACT TAB 64.1667
00002451182 UPTRAVI 800 MCG TABLET ORL TAB ACT TAB 64.1667
00001946099 UREMOL 10 10% TOPICAL CREAM TOP CRM GKC G 0.0769
00000398179 UREMOL 20% TOPICAL CREAM TOP CRM GKC G 0.0811
00001946102 UREMOL-10 10% TOPICAL LOTION TOP LOT GKC ML 0.0430
00080005531 URISEC 40 40% TOPICAL CREAM TOP CRM ODN G 1.2500
00002353997 UROCIT-K 10 MEQ EXTENDED-RELEASE TABLET ORL ERT PAL TAB 0.5462
00001914022 UROCIT-K 5 MEQ TABLET ORL SRT SFD TAB 0.3660
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 173 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002241411 UROMITEXAN 100 MG/ML INJECTION INJ DEFAUL AST ML 6.6198
00080030062 UTI CLEANSE TABLET ORL TAB AOR TAB 0.4416
00080046888 UXOR 7.5% GEL TOP GEL JPC G 0.1787
00000990079 VAGINAL PESSARY DEFAUL DEV XXX DEV 141.9500
00000027944 VALISONE 0.1% SCALP LOTION SCP LOT PMS ML 0.0853
00000177016 VALISONE-G TOPICAL CREAM TOP CRM VCL G 1.0427
00000232351 VALISONE-G TOPICAL OINTMENT TOP ONT VCL G 1.0427
00000013285 VALIUM 5 MG TABLET ORL TAB HLR TAB 0.1833
00002367742 VALSARTAN 160 MG TABLET ORL TAB PDL TAB 0.2957
00002367750 VALSARTAN 320 MG TABLET ORL TAB PDL TAB 0.2843
00002366940 VALSARTAN 40 MG TABLET ORL TAB SNS TAB 0.5239
00002384523 VALSARTAN 40 MG TABLET ORL TAB SIV TAB 0.5240
00002367726 VALSARTAN 40 MG TABLET ORL TAB PDL TAB 0.4080
00002367734 VALSARTAN 80 MG TABLET ORL TAB PDL TAB 0.2957
00002384760 VALSARTAN HCT 320 MG/12.5 MG TABLET ORL TAB SIV TAB 0.2910
00002384779 VALSARTAN HCT 320 MG/25 MG TABLET ORL TAB SIV TAB 0.2910
00002367777 VALSARTAN-HCTZ 160 MG/12.5 MG TABLET ORL TAB PDL TAB 0.2957
00002367785 VALSARTAN-HCTZ 160 MG/25 MG TABLET ORL TAB PDL TAB 0.2957
00002367769 VALSARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PDL TAB 0.2957
00002246559 VALTREX 1000 MG CAPLET ORL TAB GSK TAB 6.8867
00002428709 VAN-BICALUTAMIDE 50 MG TABLET ORL TAB VAN TAB 1.6100
00002394634 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJ USP INJ DEFAUL SDZ VIAL 58.9900
00002407922 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJECTION INJ DEFAUL MYP VIAL 58.9900
00002407930 VANCOMYCIN HYDROCHLORIDE 5 G/VIAL INJECTION INJ DEFAUL MYP VIAL 509.7900
00002394626 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 31.0500
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 174 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002407914 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 31.0500
00002432544 VAN-GABAPENTIN 600 MG TABLET ORL TAB VAN TAB 1.3045
00002432552 VAN-GABAPENTIN 800 MG TABLET ORL TAB VAN TAB 1.7393
00002243837 VANIQA 13.9% TOPICAL CREAM TOP CRM ALM G 2.3917
00002433680 VAN-MYCOPHENOLATE 250 MG CAPSULE ORL CAP VAN CAP 0.5155
00002432625 VAN-MYCOPHENOLATE 500 MG TABLET ORL TAB VAN TAB 1.0310
00002438909 VAN-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB VAN CAP 0.8550
00002431866 VAN-SILDENAFIL 100 MG TABLET ORL TAB VAN TAB 9.2006
00002229702 VAQTA 50 U/ML INJECTION INJ DEFAUL MSD ML 45.5400
00002241047 VARILRIX 2000 UNITS/(0.5 ML) VIAL INJECTION INJ DEFAUL GSK VIAL 62.7900
00002246081 VARIVAX III VACCINE 1350 U/VIAL INJECTION INJ DEFAUL MFC VIAL 72.7200
00002139502 VASOPRESSIN 20 UNIT/ML INJECTION INJ DEFAUL FKC ML 19.8300
00002223929 VAXIGRIP INFLUENZA VACCINE INJECTION INJ DEFAUL CNG ML 8.3500
00002308487 VECTIBIX 20 MG/ML (5 ML VIAL) INJECTION INJ DEFAUL AMG ML 128.3640
00002458039 VENCLEXTA 10 MG TABLET ORL TAB ABV TAB 6.7988
00002458063 VENCLEXTA 10 MG/50 MG/100 MG TABLET STARTER PACK ORL TAB ABV TAB 41.9257
00002458055 VENCLEXTA 100 MG TABLET ORL TAB ABV TAB 67.9875
00002458047 VENCLEXTA 50 MG TABLET ORL TAB ABV TAB 33.9938
00002339269 VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.8868
00002339242 VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.4200
00002339250 VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.8399
00002243716 VENOFER 20 MG/ML INJECTION INJ DEFAUL LPI ML 7.5000
00002226286 VENOMIL YELLOW JACKET VENOM PROTEIN 120 MCG INJ INJ DEFAUL BAI VIAL 195.0000
00002243115 VENTOLIN DISKUS 200 MCG/DOSE POWDER FOR INHALATION INH MIP GSK DOSE 0.1928
00000616192 VEPESID 50 MG CAPSULE ORL CAP BMS CAP 39.6050
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 175 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00080033844 VERALAC HYDROSOLUBLE NAIL LACQUER TOP SOL VCL ML 3.7697
00000839299 VERAPAMIL HYDROCHLORIDE 2.5 MG/ML INJECTION INJ DEFAUL HSP ML 19.7250
00002166739 VERAPAMIL HYDROCHLORIDE USP 2.5 MG/ML INJECTION INJ DEFAUL SDZ ML 19.1000
00002348489 VERDESO 0.05% TOPICAL FOAM TOP FOA GSK G 0.2944
00002411849 VEREGEN 10% TOPICAL OINTMENT TOP ONT PAL G 4.0833
00000594601 VERSEL 2.5% TOPICAL LOTION TOP LOT VCL ML 0.0716
00002145839 VESANOID 10 MG CAPSULE ORL CAP CAG CAP 16.3863
00002163691 VEXOL 1% OPH SOLUTION OPH SUS ALC ML 3.5620
00002451557 VIACORAM 14 MG/10 MG TABLET ORL TAB SEV TAB 1.1500
00002451530 VIACORAM 3.5 MG/2.5 MG TABLET ORL TAB SEV TAB 0.9500
00002451549 VIACORAM 7 MG/5 MG TABLET ORL TAB SEV TAB 1.0500
00000717002 VIADERM K.C. TOPICAL CREAM TOP CRM TAR G 0.4233
00000717029 VIADERM K.C. TOPICAL OINTMENT TOP ONT TAR G 0.6233
00002239768 VIAGRA 100 MG TABLET ORL TAB PFI TAB 9.2000
00002239766 VIAGRA 25 MG TABLET ORL TAB PFI TAB 8.2900
00002239767 VIAGRA 50 MG TABLET ORL TAB PFI TAB 8.8475
00002330725 VIBATIV 750 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL PPH VIAL 179.0000
00000024368 VIBRAMYCIN 100 MG CAPSULE ORL CAP PFI CAP 1.7810
00002273330 VICKS CHILDREN'S NYQUIL COLD & COUGH ORAL LIQUID ORL LIQ PGI ML 0.0265
00001938959 VICKS FORMULA 44 ORAL LIQUID ORL LIQ PGI ML 0.0341
00002050684 VICKS NYQUIL ADULT NIGHTTIME COLD MEDICINE ORL LIQ ORL LIQ PGI ML 0.0276
00001935747 VICKS VAPORUB TOPICAL OINTMENT TOP ONT PGI G 0.0704
00002351064 VICTOZA 6 MG/ML PEN INJECTION SYRINGE INJ DEFAUL NNA ML 28.3067
00002370816 VICTRELIS 200 MG CAPSULE ORL CAP MFC CAP 12.5000
00002371456 VICTRELIS TRIPLE 200MG/200MG/100MCG/0.5ML INJ KIT INJ SYR/CAP MFC KIT 2652.5500
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 176 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002371464 VICTRELIS TRIPLE 200MG/200MG/120MCG/0.5MLINJ KIT INJ SYR/CAP MFC KIT 2726.0000
00002371472 VICTRELIS TRIPLE 200MG/200MG/150MCG/0.5ML INJ KIT INJ SYR/CAP MFC KIT 2726.0000
00002371448 VICTRELIS TRIPLE 200MG/200MG/80MCG/0.5ML INJ KIT INJ SYR/CAP MFC KIT 2652.5500
00002336707 VIDAZA 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 628.0000
00002244596 VIDEX EC 125 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 3.9647
00002244597 VIDEX EC 200 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 6.3433
00002244598 VIDEX EC 250 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 7.8577
00002244599 VIDEX EC 400 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL CAP/ENCP BMS CAP 12.7123
00002417685 VIDEXTRA 10,000 UNIT TABLET ORL TAB ORI TAB 0.2100
00002442256 VIDEXTRA 2000 UNIT SOFTGEL CAPSULE ORL CAP ORI CAP 0.0693
00002252260 VIGAMOX 0.5% OPHTHALMIC SOLUTION OPH SOL ALC ML 4.5300
00002427184 VIMIZIM 5MG/5ML (SINGLE-USE) VIAL INJECTION INJ DEFAUL BMI VIAL 1199.0000
00002361701 VIMOVO 375 MG/20 MG TABLET ORL TAB AZC TAB 1.1070
00002361728 VIMOVO 500 MG/20 MG TABLET ORL TAB AZC TAB 1.1030
00002183056 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL MNP ML 18.5630
00002401460 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL TEV ML 17.6790
00002183013 VINCRISTINE SULFATE 1 MG/ML INJECTION INJ DEFAUL HSP ML 63.3650
00002143305 VINCRISTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL TEV ML 31.0000
00000074500 VIOFORM HC TOPICAL CREAM TOP CRM PAL G 0.9377
00002238617 VIRACEPT 250 MG TABLET ORL TAB AGR TAB 1.9690
00002248761 VIRACEPT 625 MG TABLET ORL TAB PFI TAB 4.7106
00002238748 VIRAMUNE 200 MG TABLET ORL TAB BOE TAB 5.0865
00002367289 VIRAMUNE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT BOE TAB 2.5430
00080030855 VISION CARE CAPSULE ORL CAP PLT CAP 0.8991
00000568627 VISKAZIDE 10/25 MG TABLET ORL TAB TRI TAB 1.1007
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 177 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000568635 VISKAZIDE 10/50 MG TABLET ORL TAB TRI TAB 1.1007
00000443174 VISKEN 10 MG TABLET ORL TAB TRI TAB 1.2262
00000417289 VISKEN 15 MG TABLET ORL TAB TRI TAB 1.7788
00000417270 VISKEN 5 MG TABLET ORL TAB TRI TAB 0.7182
00002242367 VISUDYNE 15 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 1703.1000
00080044606 VITALUX ADVANCED CAPLET ORL TAB ALC TAB 0.2083
00080016590 VITALUX CAPLET ORL TAB ALC TAB 0.2353
00080016683 VITALUX PLUS OMEGA 3 CAPSULE ORL CAP ALC CAP 0.2100
00002245911 VITALUX TABLET ORL TAB NOV TAB 0.2398
00002240199 VITALUX TR MULTIVITAMIN/MULTIMINERAL TABLET ORL TAB NCI TAB 0.2398
00080028004 VITALUX-S PLUS OMEGA-3 CAPSULE ORL CAP ALC CAP 0.2100
00080016576 VITALUX-S TABLET ORL TAB ALC TAB 0.2374
00000123137 VITAMIN A & D FORTIFIED CAPSULE ORL CAP JAM CAP 0.0482
00000297720 VITAMIN A 10,000 IU CAPSULE ORL CAP JAM CAP 0.0444
00002245311 VITAMIN A 10,000 IU CAPSULE ORL CAP WNP CAP 0.0260
00080035590 VITAMIN B 100 MG TIME RELEASE TABLET ORL TAB WNP TAB 0.1575
00000487082 VITAMIN B CMPD 100 SUSTAINED-RELEASE TABLET ORL SRT SWS TAB 0.1732
00000407011 VITAMIN B1 100 MG TABLET ORL TAB JAM TAB 0.0567
00002239350 VITAMIN B1 100 MG TABLET ORL TAB PMT TAB 0.0214
00000294853 VITAMIN B1 100 MG TABLET ORL TAB VCL TAB 0.0900
00000816078 VITAMIN B1 100 MG/ML INJECTION USP INJ DEFAUL SDZ ML 2.5370
00080009633 VITAMIN B1 50 MG TABLET ORL TAB JPC TAB 0.0737
00000610267 VITAMIN B1 50 MG TABLET ORL TAB LEA TAB 0.0740
00002247479 VITAMIN B100 COMPLEX TABLET ORL TAB WBP TAB 0.1082
00000331015 VITAMIN B12 100 MCG TABLET ORL TAB JAM TAB 0.0567
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 178 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000450642 VITAMIN B12 100 MCG TABLET ORL TAB VTH TAB 0.0700
00002023598 VITAMIN B12 100 MCG TABLET ORL TAB PMT TAB 0.0568
00002241500 VITAMIN B12 100 MCG/ML INJECTION INJ DEFAUL SDZ ML 2.3240
00080012952 VITAMIN B12 1000 MCG TABLET ORL TAB JAM TAB 0.0893
00080006939 VITAMIN B12 1000 MCG TABLET ORL TAB WNP TAB 0.0974
00002237736 VITAMIN B12 1000 MCG TABLET ORL TAB SWS TAB 0.0420
00080003575 VITAMIN B12 1000 MCG TIME RELEASE TABLET ORL ERT PMT TAB 0.0470
00000502758 VITAMIN B12 250 MCG TABLET ORL TAB SWS TAB 0.1397
00000335940 VITAMIN B12 250 MCG TABLET ORL TAB JAM TAB 0.0647
00000305243 VITAMIN B12 50 MCG TABLET ORL TAB JAM TAB 0.0525
00000689726 VITAMIN B12 500 MCG TABLET ORL TAB SNS TAB 0.0741
00002243767 VITAMIN B12 500 MCG TABLET ORL TAB VTH TAB 0.0465
00000329185 VITAMIN B6 100 MG TABLET ORL TAB JAM TAB 0.0647
00000450677 VITAMIN B6 100 MG TABLET ORL TAB VTH TAB 0.0719
00002239348 VITAMIN B6 100 MG TABLET ORL TAB PMT TAB 0.0228
00000122645 VITAMIN B6 25 MG TABLET ORL TAB JAM TAB 0.0336
00000331031 VITAMIN B6 250 MG TABLET ORL TAB JAM TAB 0.1051
00000305227 VITAMIN B6 50 MG TABLET ORL TAB JAM TAB 0.0485
00000341207 VITAMIN C 1000 MG SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.1087
00000305235 VITAMIN C 1000 MG TABLET ORL TAB JAM TAB 0.0818
00080040321 VITAMIN C 125 MG GUMMY ORL DEFAUL JAM PIECE 0.1250
00001922378 VITAMIN C 500 MG TABLET ORL TAB SWS TAB 0.0479
00000784591 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB VTH TAB 0.0210
00001994336 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB JAM TAB 0.0604
00002243893 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB PMT TAB 0.0333
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 179 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000237116 VITAMIN C 500 MG ORANGE FLAVORED CHEWABLE TABLET ORL CTB TEV TAB 0.0257
00000373699 VITAMIN C 500 MG SUSTAINED-RELEASE CAPSULE ORL SRC JAM CAP 0.0967
00002163268 VITAMIN C 500 MG TABLET ORL TAB JAM TAB 0.0403
00000557838 VITAMIN C 500 MG TABLET ORL TAB WTR TAB 0.0132
00000036188 VITAMIN C 500 MG TABLET ORL TAB WAM TAB 0.0400
00002240883 VITAMIN C 500 MG TABLET ORL TAB WNP TAB 0.0359
00080020803 VITAMIN C 500 MG TIMED RELEASE CAPLET ORL SRT JAM TAB 0.0804
00000463108 VITAMIN C CHEWABLE TABLET ORL TAB GAH TAB 0.0970
00080001870 VITAMIN D 1,000 IU TAB ORL TAB SIS TAB 0.0440
00080017530 VITAMIN D 1000 IU CAPSULE ORL CAP JAM CAP 0.0351
00080008795 VITAMIN D 1000 IU SOFTGEL ORL CAP PRA CAP 0.0608
00080000436 VITAMIN D 1000 IU TABLET ORL TAB JAM TAB 0.0444
00080006264 VITAMIN D 1000 IU TABLET ORL TAB GFR TAB 0.0500
00000323179 VITAMIN D 1000 UNIT TABLET ORL TAB SWS TAB 0.0305
00080002452 VITAMIN D 400 IU TABLET ORL TAB WNP TAB 0.0180
00080009578 VITAMIN D 400 IU TABLET ORL TAB VCL TAB 0.0236
00002242175 VITAMIN D 400 IU TABLET ORL TAB JAM TAB 0.0433
00002240858 VITAMIN D 400 IU TABLET ORL TAB PMT TAB 0.0117
00002240624 VITAMIN D 400 IU TABLET ORL TAB WAM TAB 0.0161
00002229879 VITAMIN D 400 IU TABLET ORL TAB SWS TAB 0.0398
00000765384 VITAMIN D 400 IU TABLET ORL TAB LCO TAB 0.0400
00080018025 VITAMIN D DROPS 400 IU ORL LIQ JAM ML 0.9316
00080015280 VITAMIN D3 1000 IU CAPSULE ORL GEL VTH CAP 0.0415
00080012124 VITAMIN D3 1000 IU ORAL LIQUID ORL LIQ WBP ML 0.1948
00080003663 VITAMIN D3 1000 IU TABLET ORL TAB WNP TAB 0.0327
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 180 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002245842 VITAMIN D3 1000 IU TABLET ORL TAB PMT TAB 0.0178
00080027799 VITAMIN D3 DROPS 1000 IU ORAL LIQUID ORL DPS JMS ML 0.9360
00000480924 VITAMIN E 100 IU NATURAL SOURCE CAPSULE ORL CAP VTH CAP 0.0468
00000122823 VITAMIN E 100 IU OBLONG AMBER CAPSULE ORL CAP JAM CAP 0.0638
00000332348 VITAMIN E 200 IU CAPSULE (NATURAL) ORL CAP LDL CAP 0.0629
00000122831 VITAMIN E 200 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.0821
00002240967 VITAMIN E 400 IU CAPSULE ORL CAP WNP CAP 0.0541
00000782181 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.0816
00000480940 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.0741
00000266108 VITAMIN E 400 IU CAPSULE ORL CAP PMT CAP 0.0542
00000332356 VITAMIN E 400 IU CAPSULE (NATURAL) ORL CAP LDL CAP 0.0539
00000122858 VITAMIN E 400 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.1058
00080013178 VITAMIN E 400 IU SOFTGEL CAPSULE ORL CAP JMS CAP 0.1058
00000330191 VITAMIN E 800 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.2814
00002015293 VITAMIN E NATURAL SOURCE 400 UNIT CAPSULE ORL CAP QVS CAP 0.0592
00000201995 VITAMIN E NF NATURAL SOURCE 400 IU CAPSULE ORL CAP WAM CAP 0.1165
00080030153 VITAMIN K2 100 MCG CAPSULE ORL CAP NFN CAP 0.1248
00000480878 VITAMINE B12 1200 MCG SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.1013
00000816175 VITAMINE C 600 MG CAPSULE ORL CAP SIS CAP 0.2112
00002417995 VITAMINE D 10 000 10000 UNIT TABLET ORL TAB PDL TAB 0.2100
00002248361 VIVAXIM INJECTION INJ DEFAUL SFP SYR 80.7000
00080028217 VIVISCAL MAXIMUM STRENGTH TABLET ORL TAB IRI TAB 0.9998
00000885975 VIVOTIF BERNA 6 B CAPSULE ORL CAP SSV CAP 5.8600
00002307073 VOLIBRIS 10 MG TABLET ORL TAB GSK TAB 122.5200
00002307065 VOLIBRIS 5 MG TABLET ORL TAB GSK TAB 122.5200
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 181 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002290375 VOLTAREN EMULGEL 1.16% TOPICAL GEL TOP GEL NVC G 0.1337
00002393190 VOLTAREN EMULGEL EXTRA STRENGTH 2.32% TOPICAL GEL TOP GEL GKC G 0.1987
00002338580 VOLTAREN EMULGEL JOINT PAIN 1.16% TOPICAL GEL TOP GEL NVC G 0.1157
00000881635 VOLTAREN RAPIDE 50 MG TABLET ORL TAB NOV TAB 0.9332
00002381966 VORICONAZOLE 200 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 130.0800
00002352303 VOTRIENT 200 MG TABLET ORL TAB NOV TAB 34.9949
00002357119 VPRIV 400 UNIT/VIAL INJECTION INJ DEFAUL SHG VIAL 1955.0000
00080037590 VSL #3 ORAL POWDER ORL PWR FEI PCKT 3.1000
00080042116 VSL #3 ORAL POWDER ORL PWDPKT FEI PCKT 3.6557
00002365561 VYLOMA 3.75% TOPICAL CREAM TOP CRM VCL G 38.6667
00002439603 VYVANSE 10 MG CAPSULE ORL CAP SHB CAP 2.2167
00002458071 VYVANSE 70 MG CAPSULE ORL CAP SHB CAP 5.3795
00080006877 WAMPOLE MINERAL CALCIUM ORAL LIQUID ORL LIQ JPC ML 0.0350
00080008041 WAMPOLE MULTIVITAMIN LIQUID ORL LIQ WAM ML 0.0350
00002453703 WAMPOLE-ACETAMINOPHEN/CODEINE/CAFFEINE ORL TAB WAM TAB 0.0504
00002074788 WARTEC 0.5% TOPICAL SOLUTION TOP SOL PAL ML 14.6033
00001948970 WASP VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 41.4833
00001910787 WEBBER OINTMENT VITAMIN E 30 IU/G TOPICAL OINTMENT TOP ONT JLF G 0.1116
00080002343 WELLESSE JOINT MOVEMENT GLUCOSAMINE LIQUID ORL LIQ BOT ML 0.0284
00080024468 WESTCOAST NATURALS CALCIUM MAGNES. PHOS. VIT D LIQ ORL LIQ WES ML 0.0347
00080018599 WESTCOAST NATURALS VITAMIN B12 1000 MCG TABLET ORL TAB WES TAB 0.1277
00001949004 WHITE FACED HORNET VENOM 120 MCG INJ DEFAUL ALG VIAL 35.6833
00002136740 WOBENZYM N TABLET ORL TAB MUC TAB 0.3497
00002424703 WOMEN'S ROGAINE FOAM 5% AEROSOL FOAM TOP FOA JJI G 0.7697
00002384256 XALKORI 200 MG CAPSULE ORL CAP PFI CAP 130.0000
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 182 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002384264 XALKORI 250 MG CAPSULE ORL CAP PFI CAP 130.0000
00000548359 XANAX 0.25 MG TABLET ORL TAB PFI TAB 0.2862
00000548367 XANAX 0.5 MG TABLET ORL TAB PFI TAB 0.3423
00000723770 XANAX 1 MG TABLET ORL TAB PFI TAB 0.6221
00000813958 XANAX TS 2 MG TABLET ORL TAB PFI TAB 1.1056
00002441535 XARELTO 15 MG / 20 MG TABLET STARTER PACK ORL TAB BAI TAB 2.8700
00002238453 XELODA 150 MG TABLET ORL TAB HLR TAB 1.9003
00002238454 XELODA 500 MG TABLET ORL TAB HLR TAB 6.3345
00002240325 XENICAL 120 MG CAPSULE ORL CAP HLR CAP 1.6723
00002404044 XERESE 5%/1% TOPICAL CREAM TOP CRM VCL G 7.1480
00002368153 XGEVA 120 MG/VIAL INJECTION INJ DEFAUL AMG VIAL 575.6100
00002388316 XIAFLEX 0.9 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 1169.7000
00002449943 XIGDUO 5 MG/1000 MG TABLET ORL TAB AZC TAB 1.3100
00002449935 XIGDUO 5 MG/850 MG TABLET ORL TAB AZC TAB 1.3100
00080036707 X-PUR 100% XYLITOL GUM 1.06 G ORAL GUM ORL GUM ORS PIECE 0.1422
00000866598 X-SEB PLUS CONDITIONING TOPICAL SHAMPOO TOP SHP BAK ML 0.0639
00000866601 X-SEB T PLUS CONDITIONING TOPICAL SHAMPOO TOP SHP BAK ML 0.0639
00000509906 X-SEB T TOPICAL SHAMPOO TOP SHP PMS ML 0.0639
00002407329 XTANDI 40 MG CAPSULE ORL CAP ASP CAP 28.3450
00000001791 XYLOCAINE 1% W EPINEPHRINE 1:100,000 INJ INJ DEFAUL AZC ML 0.4010
00002302438 XYLOCAINE 2% INJECTION INJ DEFAUL AZC ML 0.2565
00000385484 XYLOCAINE 2% TOPICAL JELLY URH JEL AZC ML 0.9170
00002373130 XYLOCAINE 2% W EPINEPHRINE 1:200,000 INJECTION ORL DEFAUL AZC ML 0.4010
00000001732 XYLOCAINE HCL 1% LIQUID (BLOCK OR INFILTRATION) INJ LIQ AZC ML 1.0210
00000036641 XYLOCAINE HCL 2% PLAIN LIQ (BLOCK OR INFILTRATION) INJ LIQ AZC ML 1.2230
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 183 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00000001937 XYLOCARD INJ 20 MG/ML INJECTION INJ DEFAUL AZC ML 0.8280
00002268272 XYREM 500 MG/ML ORAL SOLUTION ORL SOL VCL ML 2.6868
00002321157 YAZ 28 TABLET ORL TB BAI TAB 0.5836
00002387433 YAZ PLUS 28 TABLET ORL TB BAI TAB 0.4229
00001948954 YELLOW JACKET VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 35.6833
00001948962 YELLOW JACKET VENOM PROTEIN 120 MCG INJ DEFAUL ALG VIAL 35.6833
00002379384 YERVOY INTRAVENOUS INFUSION 5 MG/ML INJECTION INJ DEFAUL BMS ML 580.0000
00000428833 YF-VAX 109648 U/0.5 ML INJECTION INJ DEFAUL SFP VIAL 137.3100
00000885533 YOHIMBINE-ODAN 2 MG TABLET ORL TAB ODN TAB 0.5260
00001901885 YOHIMBINE-ODAN 5.4 MG TABLET ORL TAB ODN TAB 0.8030
00000600784 ZADITEN 0.2 MG/ML ORAL SYRUP ORL SYR TEV ML 0.4961
00002279223 ZADITOR (PRESERVATIVE FREE) 0.25 MG/ML OPH SOL OPH SOL NOV ML 3.5283
00002242324 ZADITOR 0.25 MG/ML OPH SOLUTION OPH SOL LTH ML 5.2920
00002239170 ZANAFLEX 4 MG TABLET ORL TAB PAL TAB 0.7862
00002230287 ZANTAC 75 MG TABLET ORL TAB GSK TAB 0.4130
00000568392 ZAPEX 10 MG TABLET ORL TAB RIV TAB 0.0420
00000568406 ZAPEX 15 MG TABLET ORL TAB RIV TAB 0.0660
00000568414 ZAPEX 30 MG TABLET ORL TAB RIV TAB 0.0900
00002385058 ZARAH 21 TABLET ORL TAB APH TAB 0.4295
00002385066 ZARAH 28 TABLET ORL TB APH TAB 0.3221
00002250519 ZAVESCA 100 MG CAPSULE ORL CAP ACT CAP 108.5500
00002380242 ZELBORAF 240 MG FILM-COATED TABLET ORL TAB HLR TAB 34.5111
00002108208 ZEMURON 10 MG/ML INJECTION INJ DEFAUL MFC ML 1.2402
00002361752 ZENHALE 100 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.7532
00002361760 ZENHALE 200 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.9128
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 184 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002361744 ZENHALE 50 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.5762
00002216086 ZERIT 15 MG CAPSULE ORL CAP BMS CAP 4.8335
00002216094 ZERIT 20 MG CAPSULE ORL CAP BMS CAP 5.0260
00002216108 ZERIT 30 MG CAPSULE ORL CAP BMS CAP 5.2422
00002216116 ZERIT 40 MG CAPSULE ORL CAP BMS CAP 5.4347
00002240358 ZIAGEN 20 MG/ML ORAL SOLUTION ORL SOL GSK ML 0.4568
00002240357 ZIAGEN 300 MG TABLET ORL TAB GSK TAB 6.9655
00000297666 ZINC 10 MG TABLET ORL TAB JAM TAB 0.0473
00000441589 ZINC 25 MG TABLET ORL TAB JAM TAB 0.0631
00000505463 ZINC 50 MG TABLET ORL TAB JAM TAB 0.0711
00001922351 ZINC 50 MG TABLET ORL TAB SWS TAB 0.0466
00000480886 ZINC 50 MG TIMED RELEASE TABLET ORL TAB JAM TAB 0.0877
00080012983 ZINC COPPER BALANCE 15 MG/2 MG CAPSULE ORL CAP AOR CAP 0.1550
00002244744 ZINC OXIDE 15 % TOPICAL OINTMENT TOP ONT RWP G 0.0270
00002239162 ZINCOFAX 15% TOPICAL OINTMENT TOP ONT PAL G 0.0748
00002239160 ZINCOFAX EXTRA STRENGTH 40% TOPICAL OINTMENT TOP ONT PDH G 0.0595
00002153432 ZINECARD 250 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 137.0600
00002153440 ZINECARD 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 274.1400
00002239952 ZITHROMAX 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 22.1810
00002354802 ZMAX SR 27 MG/ML ORAL SUPENSION ORL SUS PFI ML 0.5322
00002421550 ZOLEDRONIC ACID 4 MG/5 ML INJECTION INJ DEFAUL HSP ML 415.5600
00002413701 ZOLEDRONIC ACID CONCENTRATE 4 MG/5 ML INJECTION INJ DEFAUL OMG ML 38.7856
00002327619 ZOLINZA 100 MG CAPSULE ORL CAP MFC CAP 76.1795
00002379929 ZOLMITRIPTAN 2.5 MG TABLET ORL TAB PDL TAB 3.5375
00002379988 ZOLMITRIPTAN ODT 2.5 MG ORALLY DISPERSIBLE TABLET ORL DISPTAB PDL TAB 3.5375
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 185 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002248992 ZOMIG 2.5 MG NASAL SPRAY NAS SPU AZC DOSE 14.6100
00002375516 ZOSTAVAX II 19,400 UNITS/(0.65 ML) VIAL INJECTION INJ DEFAUL MFC VIAL 176.7700
00000740306 ZOSTRIX 0.025% TOPICAL CREAM TOP CRM GEU G 0.2192
00002004240 ZOSTRIX H.P. 0.075% TOPICAL CREAM TOP CRM GEU G 0.2800
00002039524 ZOVIRAX 5% TOPICAL CREAM TOP CRM VCL G 13.7920
00000569771 ZOVIRAX 5% TOPICAL OINTMENT TOP ONT VCL G 13.7943
00000800686 Z-PLUS TOPICAL SHAMPOO TOP SHP DLX ML 0.0956
00002354772 ZUACTA 0.075% TOPICAL CREAM TOP CRM SAV G 1.8478
00002340445 ZYCLARA 3.75% TOPICAL CREAM TOP CRM VCL G 39.8267
00002438798 ZYDELIG 100 MG TABLET ORL TAB GIL TAB 85.3500
00002438801 ZYDELIG 150 MG TABLET ORL TAB GIL TAB 85.3500
00002436779 ZYKADIA 150 MG CAPSULE ORL CAP NOV CAP 52.0000
00002257270 ZYMAR 0.3% OPHTHALMIC SOLUTION OPH SOL ALL ML 2.7100
00002303817 ZYM-SERTRALINE 100 MG (BASE) CAPSULE ORL CAP ZMC CAP 1.1025
00002303779 ZYM-SERTRALINE 25 MG (BASE) CAPSULE ORL CAP ZMC CAP 0.5040
00002303809 ZYM-SERTRALINE 50 MG (BASE) CAPSULE ORL CAP ZMC CAP 1.0080
00002238851 ZYPREXA 20 MG TABLET ORL TAB LIL TAB 14.3775
00002243088 ZYPREXA ZYDIS 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 10.8932
00002243089 ZYPREXA ZYDIS 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 14.5068
00002371065 ZYTIGA 250 MG TABLET ORL TAB JAI TAB 29.5910
00002457113 ZYTIGA 500 MG TABLET ORL TAB JAI TAB 59.1820
00002360349 ZYTRAM XL 100 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.2240
00002286424 ZYTRAM XL 150 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 1.7980
00002286432 ZYTRAM XL 200 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 2.3610
00002286440 ZYTRAM XL 300 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 3.4160
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 186 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002286459 ZYTRAM XL 400 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 4.4980
00002360322 ZYTRAM XL 75 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.9440
00002243685 ZYVOXAM 2 MG/ML INJECTION INJ DEFAUL PFI ML 0.3574
00002243686 ZYVOXAM 20 MG/ML ORAL SUSPENSION ORL SUS PFI ML 2.6232
00002240357 ZIAGEN 300 MG TABLET ORL TAB GSK TAB 6.9655
00000297666 ZINC 10 MG TABLET ORL TAB JAM TAB 0.0473
00000441589 ZINC 25 MG TABLET ORL TAB JAM TAB 0.0631
00000505463 ZINC 50 MG TABLET ORL TAB JAM TAB 0.0711
00001922351 ZINC 50 MG TABLET ORL TAB SWS TAB 0.0466
00000480886 ZINC 50 MG TIMED RELEASE TABLET ORL TAB JAM TAB 0.0877
00080012983 ZINC COPPER BALANCE 15 MG/2 MG CAPSULE ORL CAP AOR CAP 0.1550
00002244744 ZINC OXIDE 15 % TOPICAL OINTMENT TOP ONT RWP G 0.0270
00002239162 ZINCOFAX 15% TOPICAL OINTMENT TOP ONT PAL G 0.0748
00002239160 ZINCOFAX EXTRA STRENGTH 40% TOPICAL OINTMENT TOP ONT PDH G 0.0595
00002153432 ZINECARD 250 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 137.0600
00002153440 ZINECARD 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 274.1400
00002239952 ZITHROMAX 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 22.1810
00002354802 ZMAX SR 27 MG/ML ORAL SUPENSION ORL SUS PFI ML 0.5322
00000884324 ZOCOR 5 MG TABLET ORL TAB MFC TAB 1.0839
00002421550 ZOLEDRONIC ACID 4 MG/5 ML INJECTION INJ DEFAUL HSP ML 415.5600
00002413701 ZOLEDRONIC ACID CONCENTRATE 4 MG/5 ML INJECTION INJ DEFAUL OMG ML 38.7856
00002327619 ZOLINZA 100 MG CAPSULE ORL CAP MFC CAP 76.1795
00002379929 ZOLMITRIPTAN 2.5 MG TABLET ORL TAB PDL TAB 3.5375
00002379988 ZOLMITRIPTAN ODT 2.5 MG ORALLY DISPERSIBLE TABLET ORL DISPTAB PDL TAB 3.5375
00002248992 ZOMIG 2.5 MG NASAL SPRAY NAS SPU AZC DOSE 14.6100
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 187 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002375516 ZOSTAVAX II 19,400 UNITS/(0.65 ML) VIAL INJECTION INJ DEFAUL MFC VIAL 176.7700
00000740306 ZOSTRIX 0.025% TOPICAL CREAM TOP CRM GEU G 0.2192
00002004240 ZOSTRIX H.P. 0.075% TOPICAL CREAM TOP CRM GEU G 0.2800
00002039524 ZOVIRAX 5% TOPICAL CREAM TOP CRM VCL G 13.7920
00000569771 ZOVIRAX 5% TOPICAL OINTMENT TOP ONT VCL G 13.7943
00000800686 Z-PLUS TOPICAL SHAMPOO TOP SHP DLX ML 0.0956
00002354772 ZUACTA 0.075% TOPICAL CREAM TOP CRM SAV G 1.8478
00002340445 ZYCLARA 3.75% TOPICAL CREAM TOP CRM VCL G 39.8267
00002438798 ZYDELIG 100 MG TABLET ORL TAB GIL TAB 85.3500
00002438801 ZYDELIG 150 MG TABLET ORL TAB GIL TAB 85.3500
00002436779 ZYKADIA 150 MG CAPSULE ORL CAP NOV CAP 67.4666
00002342804 ZYM-AMLODIPINE 10 MG TABLET ORL TAB ZMC TAB 0.3587
00002342790 ZYM-AMLODIPINE 5 MG TABLET ORL TAB ZMC TAB 0.2417
00002257270 ZYMAR 0.3% OPHTHALMIC SOLUTION OPH SOL ALL ML 2.7100
00002303817 ZYM-SERTRALINE 100 MG (BASE) CAPSULE ORL CAP ZMC CAP 1.1025
00002303779 ZYM-SERTRALINE 25 MG (BASE) CAPSULE ORL CAP ZMC CAP 0.5040
00002303809 ZYM-SERTRALINE 50 MG (BASE) CAPSULE ORL CAP ZMC CAP 1.0080
00002238851 ZYPREXA 20 MG TABLET ORL TAB LIL TAB 14.3775
00002243088 ZYPREXA ZYDIS 15 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 10.7111
00002243089 ZYPREXA ZYDIS 20 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB LIL TAB 14.2643
00002371065 ZYTIGA 250 MG TABLET ORL TAB JAI TAB 29.5910
00002457113 ZYTIGA 500 MG TABLET ORL TAB JAI TAB 59.1820
00002360349 ZYTRAM XL 100 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.1660
00002286424 ZYTRAM XL 150 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 1.7130
00002286432 ZYTRAM XL 200 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 2.2490
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 188 of 189 Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2017
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price
00002286440 ZYTRAM XL 300 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 3.2640
00002286459 ZYTRAM XL 400 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 4.2840
00002360322 ZYTRAM XL 75 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.8990
00002243685 ZYVOXAM 2 MG/ML INJECTION INJ DEFAUL PFI ML 0.3515
00002243686 ZYVOXAM 20 MG/ML ORAL SUSPENSION ORL SUS PFI ML 2.5793
This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 189 of 189