| 1 |
OTC Vitamin/Supplement Non-Benefit |
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66123264 |
66123264 |
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| 2 |
Needles/Syringes (Insulin Use) (Generic use DIN/PIN - Also works for pen needles) |
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999725 |
999725 |
999725 |
999725 |
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| 3 |
BD Nano Pro Ultrafine Pen Needles |
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97799160 |
97799160 |
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| 4 |
BD Nano Ultrafine Pen Needles |
|
97799527 |
97799527 |
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| 5 |
FreeStyle Libre 2® sensor |
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43120004 |
43120004 |
43120004 |
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| 6 |
FreeStyle Libre 2® reader |
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43120005 |
43120005 |
43120005 |
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| 7 |
FreeStyle Libre 3® Plus sensor |
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43120011 |
43120011 |
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| 8 |
FreeStyle Libre 3® Plus reader |
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43120012 |
43120012 |
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| 9 |
Accu-Chek Guide (Strips) |
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44123064 |
44123064 |
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| 10 |
Bayer Contour Next (Strips) |
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44123051 |
44123051 |
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| 11 |
OneTouch Verio (Strips) |
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44123049 |
44123049 |
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| 12 |
FreeStyle Lite (Strips) |
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44123040 |
44123040 |
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| 13 |
FreeStyle Precision (Strips) |
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44123053 |
44123053 |
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| 13 |
Blood Ketone (Strips) |
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11120002 |
11120002 |
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| 13 |
Ketostix |
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11120003 |
11120003 |
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| 14 |
Lancets |
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11120004 |
11120004 |
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| 14 |
Disulfiram 125 mg Capsule |
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66124089 |
66124089 |
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| 15 |
Disulfiram 250 mg Capsule |
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66124085 |
66124085 |
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| 16 |
Disulfiram 500 mg Capsule |
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66124087 |
66124087 |
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| 17 |
NSAID Topical Compound (non-benefit) (Diclofenac/Voltaren Gels/Creams) |
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66128220 |
66128220 |
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| 18 |
Topical Anti-Fungal Compounded (non-benefit) |
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66124164 |
66124164 |
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| 19 |
Compound Preparations (non-benefit) |
|
66123252 |
66123252 |
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| 20 |
Allergy Serums |
|
999652 |
999652 |
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| 21 |
Magic Mouth Wash |
|
22123334 |
22123334 |
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| 22 |
Shingrix |
02468425 |
02468425 |
02468425 |
02468425 |
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| 23 |
Tetanus, Diphtheria Td ADSORBED (Public) |
02528401 |
66124793 |
66124793 |
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| 24 |
Tetanus and Diphtheria (ADACEL) (Private) |
02240255 |
66124758 |
66124758 |
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| 25 |
Tetanus, diphtheria, acellular pertussis (Boostrix®) (Public) (Grade 9 Students) (Pregnancy 27-32 Weeks ) |
02247600 |
66127901 |
66127901 |
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| 26 |
Human papillomavirus (HPV) (Gardasil® 9) (9 Strains) (Free For 9 to 26 Years) (Free For LGBT Patients) |
02437058 |
66128117 |
66128117 |
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| 27 |
Measles, Mumps, Rubella (MMR) (Priorix™) (Free for Infants at 6 to 11 Months ) (Free for Adult Women) |
02239208 |
66124834 |
66124834 |
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| 28 |
Pneumococcal 20-valent conjugate (Pneumonia ) (Prevnar 20™) |
02527049 |
66128549 |
66128549 |
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