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Contract Number
Active Ingredient
Therapeutic Code
Therapeutic Description
41
POLYETHYLENE GLYCOL 400|PROPYLENE GLYCOL
5292
EENT DRUGS MISCELLANEOPUS
42
POLYETHYLENE GLYCOL|PROPYLENE GLYCOL
5292
EENT DRUGS MISCELLANEOPUS
42
LOPERAMIDE
5608
ANTIDIARRHEA AGENTS
41
LOPERAMIDE
5608
ANTIDIARRHEA AGENTS
40
LOPERAMIDE
5608
ANTIDIARRHEA AGENTS
41
SIMETHICONE
5610
ANTIFLATULENTS
40
SIMETHICONE
5610
ANTIFLATULENTS
42
SIMETHICONE
5610
ANTIFLATULENTS
40
PSYLLIUM FIBER PWDR
5612
CATHARTICS AND LAXATIVES
40
PSYLLIUM
5612
CATHARTICS AND LAXATIVES
42
GLYCERINE
5612
CATHARTICS AND LAXATIVES
40
GLYCERINE
5612
CATHARTICS AND LAXATIVES
42
SODIUM BIPHOSPHATE|SODIUM PHOSPHATE
5612
CATHARTICS AND LAXATIVES
40
SODIUM BIPHOSPHATE|SODIUM PHOSPHATE
5612
CATHARTICS AND LAXATIVES
41
SODIUM BIPHOSPHATE|SODIUM PHOSPHATE
5612
CATHARTICS AND LAXATIVES
41
PSYLLIUM
5612
CATHARTICS AND LAXATIVES
40
DIMENHYDRINATE
5622
ANTIEMETICS
42
DIMENHYDRINATE
5622
ANTIEMETICS
42
GRANISETRON
5622
ANTIEMETICS
41
GRANISETRON
5622
ANTIEMETICS