Anesthetics Gen Injection
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|
| 00409669501 | AMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00409669502 | AMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00409669511 | AMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00409669512 | AMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143931001 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143931010 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143931101 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143931110 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143950601 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143950610 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143950701 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 00143950710 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 23155016031 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 23155016032 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 23155016041 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 23155016042 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 55150022110 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 55150022220 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 65219044501 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 65219044510 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 65219044512 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 65219044522 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 65219044702 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 65219044720 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 67457090200 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 67457090210 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 67457090300 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 67457090320 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72266014601 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72266014610 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72266014701 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72266014710 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72485050801 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72485050810 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72485050901 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72485050910 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72572016001 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72572016010 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72572016101 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 72572016110 | ETOMIDATE | etomidate | VIAL | 2 mg/mL | Y | ||
| 42023011310 | KETALAR | ketamine HCl | VIAL | 10 mg/mL | Y | ||
| 25021068220 | KETAMINE HCL | ketamine HCl | VIAL | 10 mg/mL | Y | ||
| 55150043801 | KETAMINE HCL | ketamine HCl | VIAL | 10 mg/mL | Y | ||
| 55150043810 | KETAMINE HCL | ketamine HCl | VIAL | 10 mg/mL | Y | ||
| 60793058110 | KETAMINE HCL | ketamine HCl | VIAL | 10 mg/mL | Y | ||
| 65219018401 | KETAMINE HCL | ketamine HCl | VIAL | 10 mg/mL | Y | ||
| 65219018420 | KETAMINE HCL | ketamine HCl | VIAL | 10 mg/mL | Y | ||
| 42023011510 | KETALAR | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 00143950901 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 00143950910 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 00409004005 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 00409004010 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 00409205105 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 00409205115 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 25021068405 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 60793058510 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 65219018601 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 65219018605 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 72572032101 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 72572032110 | KETAMINE HCL | ketamine HCl | VIAL | 100 mg/mL | Y | ||
| 42023011410 | KETALAR | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 00143950801 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 00143950810 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 00409205310 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 00409205320 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 25021068310 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 55150043901 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 55150043910 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 60793058210 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 65219018801 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 65219018810 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 72572032001 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 72572032010 | KETAMINE HCL | ketamine HCl | VIAL | 50 mg/mL | Y | ||
| 42023010501 | BREVITAL SODIUM | methohexital sodium | VIAL | 500 mg | Y | ||
| 23155089331 | METHOHEXITAL SODIUM | methohexital sodium | VIAL | 500 mg | Y | ||
| 00074230760 | MIDAZOLAM HCL | midazolam HCl | SYRINGE | 5 mg/mL | Y | ||
| 00004194701 | VERSED | midazolam HCl | SYRINGE | 5 mg/mL | Y | ||
| 66758001802 | MIDAZOLAM HCL | midazolam HCl | VIAL | 1 mg/mL | Y | ||
| 00409258704 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/10 mL (1 mg/mL) | Y | ||
| 00409258705 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/10 mL (1 mg/mL) | Y | ||
| 00641605601 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/10 mL (1 mg/mL) | Y | ||
| 00641605610 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/10 mL (1 mg/mL) | Y | ||
| 63323041110 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/10 mL (1 mg/mL) | Y | ||
| 63323041113 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/10 mL (1 mg/mL) | Y | ||
| 00641606301 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00641606325 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 63323041202 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 63323041203 | MIDAZOLAM HCL | midazolam HCl | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00641605701 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00641605725 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00641620901 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00641620925 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00641628101 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00641628125 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 23155060031 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 23155060041 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 25021065502 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 63323041112 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 63323041115 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 70860060002 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 70860060041 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 72572043001 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 72572043025 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 72611074101 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 72611074125 | MIDAZOLAM HCL | midazolam HCl | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00641605901 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00641605910 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00641621001 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00641621010 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 63323041118 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 63323041125 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 72572043201 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 72572043210 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00409259603 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00409259605 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00409259613 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00409259615 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00641606001 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00641606010 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00641619001 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00641619010 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00641621101 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00641621110 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 23155060131 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 23155060132 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 23155060141 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 23155060142 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 25021066110 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 47781058922 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 63323041206 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 63323041210 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 63323041213 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 66758001902 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 72611074901 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 72611074910 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL | Y | ||
| 00641606101 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL (1 mL) | Y | ||
| 00641606125 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL (1 mL) | Y | ||
| 63323041218 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL (1 mL) | Y | ||
| 63323041225 | MIDAZOLAM HCL | midazolam HCl | VIAL | 5 mg/mL (1 mL) | Y | ||
| 00143937901 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 00143937910 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 00143938001 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 00143938010 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 25021068882 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 25021068887 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 44567061001 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 44567061010 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 44567061101 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 44567061110 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 65219065002 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 65219065005 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 65219065010 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 65219065050 | MIDAZOLAM HCL-0.9% NACL | midazolam HCl in 0.9 % NaCl/PF | PLAST. BAG | 1 mg/mL | Y | ||
| 00641621901 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00641621910 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00641622001 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00641622010 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 2 mg/2 mL (1 mg/mL) | Y | ||
| 76045000100 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 2 mg/2 mL (1 mg/mL) | Y | ||
| 76045000120 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 2 mg/2 mL (1 mg/mL) | Y | ||
| 76045021100 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 2 mg/2 mL (1 mg/mL) | Y | ||
| 76045021120 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 2 mg/2 mL (1 mg/mL) | Y | ||
| 76045000210 | MIDAZOLAM HCL | midazolam HCl/PF | SYRINGE | 5 mg/mL | Y | ||
| 00409230802 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00409230822 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00409230850 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00409230870 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 10 mg/2 mL (5 mg/mL) | Y | ||
| 00409000101 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00409000125 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00409230516 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00409230517 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 70069081601 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 70069081610 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 2 mg/2 mL (1 mg/mL) | Y | ||
| 00409230504 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00409230505 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00409230550 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00409230555 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 70069081701 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 70069081710 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/5 mL (1 mg/mL) | Y | ||
| 00409230801 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/mL (1 mL) | Y | ||
| 00409230821 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/mL (1 mL) | Y | ||
| 00409230849 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/mL (1 mL) | Y | ||
| 00409230869 | MIDAZOLAM HCL | midazolam HCl/PF | VIAL | 5 mg/mL (1 mL) | Y | ||
| 51754913101 | MIDAZOLAM HCL-0.8% NACL | midazolam in NaCl,iso-osmot/PF | VIAL | 100 mg/100 mL (1 mg/mL) | Y | ||
| 51754913105 | MIDAZOLAM HCL-0.8% NACL | midazolam in NaCl,iso-osmot/PF | VIAL | 100 mg/100 mL (1 mg/mL) | Y | ||
| 00310030020 | DIPRIVAN | propofol | AMPUL | 10 mg/mL | Y | ||
| 63323026901 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026906 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026910 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026916 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026921 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026922 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026923 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026925 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026929 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026930 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026931 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026933 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026935 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026937 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026941 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026943 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026945 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026950 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026957 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026959 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026965 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026967 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026969 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026970 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026975 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026977 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026978 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 63323026994 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 65219080001 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 65219080010 | DIPRIVAN | propofol | VIAL | 10 mg/mL | Y | ||
| 00069020901 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00069020910 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00069023401 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00069023420 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00069024801 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00069024810 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00409469924 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00409469933 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00409469953 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00409469954 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00409601002 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00409601025 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00641619401 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00641619410 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00641619501 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00641619520 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00641619601 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00641619610 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 16714052801 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 16714052810 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 16714052820 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 16714069001 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 16714069010 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 16714097701 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 16714097720 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 23155034531 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 23155034532 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 23155034533 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 23155034541 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 23155034542 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 23155034543 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 23155034544 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 25021060820 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 25021060850 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 25021060851 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 43598026520 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 43598026525 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 43598026558 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 43598054821 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 43598054850 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 43598054910 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 43598054952 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572058301 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572058310 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572058401 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572058420 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572058501 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572058510 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572059001 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572059010 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572060101 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572060120 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572061201 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 72572061210 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 80830118801 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 80830118807 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 80830236401 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 80830236408 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 80830236501 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 80830236507 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 83634060320 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 83634060341 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 83634060342 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 83634060343 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 83634060350 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 83634060351 | PROPOFOL | propofol | VIAL | 10 mg/mL | Y | ||
| 00264485001 | PROPOFOL-LIPURO | propofol in lipid MCT/LCT/PF | VIAL | 1,000 mg/100 mL (10 mg/mL) | Y | ||
| 65219042710 | PROPOVEN (EUA) | propofol in lipid MCT/LCT/PF | VIAL | 2,000 mg/100 mL (20 mg/mL) | Y | ||
| 71390001100 | BYFAVO | remimazolam besylate | VIAL | 20 mg | Y | ||
| 71390001111 | BYFAVO | remimazolam besylate | VIAL | 20 mg | Y |