chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov chrg# cdsc cdept csrv cupr crev# 3095 med/surg, semi ... - CT.gov
7504236 HUMALOG 75/25 VIAL 636 0 0 4300 7504244 SPORANOX 100MG. CAP 250 0 0 4300 7504251 POVIDONE-IODINE 0 SWAB 250 0 0 4300 7504269 POVIDONE-IODINE 0 SOAP 250 0 0 4300 7504277 POVIDONE-IODINE 0 SOLN 250 0 0 4300 7504285 POTASSIUM IODIDE/IOD SOLN 250 0 0 4300 7504293 IRON DEXTRAN COMPLEX 100MG 2ML VIAL 636 0 0 4300 7504301 IRBESARTAN 150MG. TAB 250 0 0 4300 7504319 IPRATROPIUM HFA AER 250 0 0 4300 7504327 ISOFLURANE LIQUID 250 0 0 4300 7504335 ISONIAZID 100 MG TAB 250 0 0 4300 7504343 ISOSORBIDE DINITRATE TAB 250 0 0 4300 7504350 ISOSORBIDE DINITRATE TAB 250 0 0 4300 7504376 POTASSIUM CHLORIDE 1 TAB SR 250 0 0 4300 7504384 POTASSIUM CHLORIDE 2 TAB SR 250 0 0 4300 7504392 POTASSIUM CHLORIDE 2 250 0 0 4300 7504400 TORADOL 10MG.TAB 250 0 0 4300 7504418 KETOCONAZOLE 200 MG TAB 250 0 0 4300 7504426 KEPPRA 250MG. TAB 250 0 0 4300 7504434 LABETALOL HCL 100 MG TAB 250 0 0 4300 7504442 LABETALOL HCL 5 MG CARPUJECT 250 0 0 4300 7504459 LABETALOL 5MG/ML 20M VIAL 250 0 0 4300 7504467 LANOLIN OINT 250 0 0 4300 7504475 RHO(D) IMMUNE GLOBUL 1500U VIAL 636 0 0 4300 7504491 LEUCOVORIN CALCIUM 5 TAB 250 0 0 4300 7504509 LEVOTHYROXINE SODIUM TAB 250 0 0 4300 7504517 LEVOTHYROXINE SODIUM TAB 250 0 0 4300 7504525 LEVOTHYROXINE SODIUM TAB 250 0 0 4300 7504533 LEVOTHYROXINE SODIUM TAB 250 0 0 4300 7504541 LEVOTHYROXINE SODIUM TAB 250 0 0 4300 7504558 LEVOTHYROXINE SODIUM VIAL 250 0 0 4300 7504566 LIDOCAINE HCL 20 MG SYRINGE 250 0 0 4300 7504574 LIDOCAINE 2% 20ML VIAL 250 0 0 4300 7504582 LIDODERM PATCH 5% PATCH 250 0 0 4300 7504590 LIDOCAINE 1% 50ML VIAL 250 0 0 4300 7504608 LIDOCAINE HCL/EPINEP VIAL 250 0 0 4300 7504616 LIDOCAINE HCL 0 JELLY 637 0 0 4300 7504624 LIDOCAINE HCL 10 MG INJ 250 0 0 4300 7504632 LIDOCAINE HCL/D5W 4 DRIP 250 0 0 4300 7504640 LIDOCAINE HCL 40 MG INJ 250 0 0 4300 7504657 LIDOCAINE HCL/EPINEP VIAL 250 0 0 4300 7504665 LIDOCAINE HCL/EPINEP VIAL 250 0 0 4300 7504673 LIDOCAINE HCL 20 MG VIAL 636 0 0 4300 7504681 LIDOCAINE HCL 5 MG VIAL 250 0 0 4300 7504699 LIDOCAINE HCL 40 MG SOLN 250 0 0 4300 7504707 LINDANE 0 SHAMPOO 250 0 0 4300 7504715 LINDANE 0 LOTION 250 0 0 4300
7504723 LIDOCAINE HCL/D7.5W INJ 250 0 0 4300 7504731 LIOTHYRONINE SODIUM TAB 250 0 0 4300 7504749 PRINIVIL 2.5 MG TAB 250 0 0 4300 7504756 LISINOPRIL 20 MG TAB 250 0 0 4300 7504764 LISINOPRIL 10 MG TAB 250 0 0 4300 7504772 LISINOPRIL 5 MG TAB 250 0 0 4300 7504780 LITHIUM CARBONATE 30 TAB 250 0 0 4300 7504798 LITHIUM CITRATE 8 ME SOLN 250 0 0 4300 7504806 DIPHENOXYLATE HCL/AT TAB 250 0 0 4300 7504814 LINEZOLID 600MG. TAB 250 0 0 4300 7504822 LOPERAMIDE HCL 1 MG LIQUID 250 0 0 4300 7504830 LOPERAMIDE HCL 2 MG CAP 250 0 0 4300 7504848 LORAZEPAM 0.5 MG TAB 250 0 0 4300 7504855 LORAZEPAM 2 MG VIAL 636 0 0 4300 7504863 LORAZEPAM 2 MG TAB 250 0 0 4300 7504871 LORAZEPAM 1 MG TAB 250 0 0 4300 7504889 LOVASTATIN 20 MG TAB 250 0 0 4300 7504897 MAGNESIUM SULFATE 4 VIAL 636 0 0 4300 7504905 MAGNESIUM SULFATE CRYSTAL 250 0 0 4300 7504913 MAGNESIUM CITRATE SOLN 250 0 0 4300 7504921 MAGNESIUM 4GM 100ML INFUS 636 0 0 4300 7504939 MAGNESIUM CHLORIDE 6 SR TAB 250 0 0 4300 7504947 MANNITOL 25% VIAL 636 0 0 4300 7504954 DEXAMETHASONE 0 DROPS 250 0 0 4300 7504962 TRIPLE ANTI OINT U.D OINT 250 0 0 4300 7504970 NEO/POLYMYX B SULF/D DROPS 250 0 0 4300 7504988 NEO/POLYMYX B SULF/D OINT 250 0 0 4300 7504996 HCTZ/TRIAMTERENE 0 TAB 250 0 0 4300 7505001 METHYLDOPA 250 MG TAB 250 0 0 4300 7505019 MECLIZINE HCL 12.5 M TAB 250 0 0 4300 7505027 MECLIZINE HCL 25 MG TAB 250 0 0 4300 7505035 MEGESTROL 10ML U.D. SUSP 250 0 0 4300 7505043 MEGESTROL ACETATE 40 TAB 250 0 0 4300 7505050 MELPHALAN 2 MG TAB 636 0 0 4300 7505068 MEMANTINE 5MG. TAB 250 0 0 4300 7505076 MEPERIDINE HCL 50 MG SYRINGE 636 0 0 4300 7505084 MEPERIDINE HCL 75 MG SYRINGE 636 0 0 4300 7505092 MEPERIDINE HCL 100 M SYRINGE 636 0 0 4300 7505100 MEPERIDINE HCL 25 MG SYRINGE 636 0 0 4300 7505118 MEPIVACAINE HCL 10 M VIAL 636 0 0 4300 7505126 MEPERIDINE HCL 10 MG PCA 636 0 0 4300 7505134 MEPERIDINE HCL 50 MG TAB 250 0 0 4300 7505142 MELOXICAM 7.5MG TAB 250 0 0 4300 7505159 MAALOX 30ML UD SUSP 250 0 0 4300 7505167 MESALAMINE SUPPS 250 0 0 4300 7505209 METHACHOLINE CHLORID VIAL 636 0 0 4300 7505217 METHADONE HCL 5 MG TAB 250 0 0 4300
- Page 81 and 82: 4619177 ALDOLASE 300 0 76.25 4010 4
- Page 83 and 84: 4620241 HEP BE AG 300 0 90.45 4010
- Page 85 and 86: 4621207 FETOMATERNAL HEMORRHAGE SCR
- Page 87 and 88: 4622148 THYROID STIM IMMUNOGLOBULIN
- Page 89 and 90: 4623146 RUBEOLA ANTIBODIES, IGG 300
- Page 91 and 92: 4624086 MUCOR RACEMOSUS, IGE 300 0
- Page 93 and 94: 4800041 SPE COLL TRAVEL/MILE 300 0
- Page 95 and 96: 5600689 MRI KEN HIP W/CONT RT 610 0
- Page 97 and 98: 5800313 MULTIPLE SLEEP LATENCY TEST
- Page 99 and 100: 6103758 BONE DENSITY FX EVAL 320 0
- Page 101 and 102: 6108906 CYSTO SCOUT FILM 320 0 108.
- Page 103 and 104: 6113864 SHLDR-ARTH PRO/INS-RT 761 0
- Page 105 and 106: 6201206 MYO-IMAGING-INFARCT 340 0 9
- Page 107 and 108: 6306005 COLOR FLOW DOPPLER 480 0 25
- Page 109 and 110: 6390132 US-MIDLINE CATHETER 278 0 1
- Page 111 and 112: 6502124 MRI-UP EX NO JT W-LT 610 0
- Page 113 and 114: 6702245 CT UP EXT W/ CON-RT 352 0 1
- Page 115 and 116: 6801187 CHEST INS & EXP LAT 320 0 1
- Page 117 and 118: 6802128 MAMMO DIAG DIGITAL RIGHT 40
- Page 119 and 120: 6901607 FINGER 2 OR MORE RT 320 0 1
- Page 121 and 122: 7000094 MRI-CHEST W/WO CONTR PLF 61
- Page 123 and 124: 7001084 MRI-LOEX NO JT W/WO RT-PLF
- Page 125 and 126: 7500820 ASPIRIN 325 MG TAB 250 0 0
- Page 127 and 128: 7501794 CHOLESTYRAMINE/SUCRO PACKET
- Page 129 and 130: 7502768 DULOXETINE 30MG. CAP EC 250
- Page 131: 7503741 HALOPERIDOL LACTATE VIAL 63
- Page 135 and 136: 7505704 MULTIVITAMINS THERAP 250 0
- Page 137 and 138: 7506645 PHENAZOPYRIDINE HCL TAB 250
- Page 139 and 140: 7507601 SODIUM BICARBONATE SYRINGE
- Page 141 and 142: 7508583 ISOPROPYL ALCOHOL SOLN 250
- Page 143 and 144: 7509532 ISOSORBIDE MONONITRA T SR 2
- Page 145 and 146: 7510506 SUMATRIPTAN SUCCINAT TAB 25
- Page 147 and 148: 7511488 BUPROPION HCL 100 MG TAB 25
- Page 149 and 150: 7512486 LANTUS INSULIN VIAL 636 0 0
- Page 151 and 152: 7513500 POVIDONE-IODINE 10% SOLN 25
- Page 153 and 154: 7514649 PYRAZINAMIDE 500MG TAB 250
- Page 155 and 156: 7515620 BUSPIRONE 2.5 MG TAB 250 0
- Page 157 and 158: 7517618 TETANUS AND DIPTHERIA TOX .
- Page 159 and 160: 7600398 CONTAINER EMPTY 500 270 0 0
- Page 161 and 162: 7690001 RED CAP LUER LOCK MED SUPPL
- Page 163 and 164: 8201709 PROSTETIC TRAIN PER 15 MIN
- Page 165 and 166: 8403214 WHFOWOJT L3808 274 0 509.69
- Page 167 and 168: 8701500 IONTOPHORESIS PER 15 MIN DL
- Page 169 and 170: 9003112 INITIAL PSYCH EVAL MD 900 0
- Page 171 and 172: 9300518 SWALLOW GOAL STATUS 440 0 0
- Page 173 and 174: 9301441 LANG EXPRESS GOAL STATUS 44
- Page 175 and 176: 9302381 MOBILITY GOAL STATUS 420 0
- Page 177 and 178: 9303330 OTHER PT/OT D/C STATUS 420
- Page 179 and 180: 9304296 SUB PT/OT GOAL STATUS 430 0
- Page 181 and 182: 9702796 MIC MEDICAID INTGRTY ALLOWA
7504236 HUMALOG 75/25 VIAL 636 0 0 4300<br />
7504244 SPORANOX 100MG. CAP 250 0 0 4300<br />
7504251 POVIDONE-IODINE 0 SWAB 250 0 0 4300<br />
7504269 POVIDONE-IODINE 0 SOAP 250 0 0 4300<br />
7504277 POVIDONE-IODINE 0 SOLN 250 0 0 4300<br />
7504285 POTASSIUM IODIDE/IOD SOLN 250 0 0 4300<br />
7504293 IRON DEXTRAN COMPLEX 100MG 2ML VIAL 636 0 0 4300<br />
7504301 IRBESARTAN 150MG. TAB 250 0 0 4300<br />
7504319 IPRATROPIUM HFA AER 250 0 0 4300<br />
7504327 ISOFLURANE LIQUID 250 0 0 4300<br />
7504335 ISONIAZID 100 MG TAB 250 0 0 4300<br />
7504343 ISOSORBIDE DINITRATE TAB 250 0 0 4300<br />
7504350 ISOSORBIDE DINITRATE TAB 250 0 0 4300<br />
7504376 POTASSIUM CHLORIDE 1 TAB SR 250 0 0 4300<br />
7504384 POTASSIUM CHLORIDE 2 TAB SR 250 0 0 4300<br />
7504392 POTASSIUM CHLORIDE 2 250 0 0 4300<br />
7504400 TORADOL 10MG.TAB 250 0 0 4300<br />
7504418 KETOCONAZOLE 200 MG TAB 250 0 0 4300<br />
7504426 KEPPRA 250MG. TAB 250 0 0 4300<br />
7504434 LABETALOL HCL 100 MG TAB 250 0 0 4300<br />
7504442 LABETALOL HCL 5 MG CARPUJE<strong>CT</strong> 250 0 0 4300<br />
7504459 LABETALOL 5MG/ML 20M VIAL 250 0 0 4300<br />
7504467 LANOLIN OINT 250 0 0 4300<br />
7504475 RHO(D) IMMUNE GLOBUL 1500U VIAL 636 0 0 4300<br />
7504491 LEUCOVORIN CALCIUM 5 TAB 250 0 0 4300<br />
7504509 LEVOTHYROXINE SODIUM TAB 250 0 0 4300<br />
7504517 LEVOTHYROXINE SODIUM TAB 250 0 0 4300<br />
7504525 LEVOTHYROXINE SODIUM TAB 250 0 0 4300<br />
7504533 LEVOTHYROXINE SODIUM TAB 250 0 0 4300<br />
7504541 LEVOTHYROXINE SODIUM TAB 250 0 0 4300<br />
7504558 LEVOTHYROXINE SODIUM VIAL 250 0 0 4300<br />
7504566 LIDOCAINE HCL 20 MG SYRINGE 250 0 0 4300<br />
7504574 LIDOCAINE 2% 20ML VIAL 250 0 0 4300<br />
7504582 LIDODERM PATCH 5% PATCH 250 0 0 4300<br />
7504590 LIDOCAINE 1% 50ML VIAL 250 0 0 4300<br />
7504608 LIDOCAINE HCL/EPINEP VIAL 250 0 0 4300<br />
7504616 LIDOCAINE HCL 0 JELLY 637 0 0 4300<br />
7504624 LIDOCAINE HCL 10 MG INJ 250 0 0 4300<br />
7504632 LIDOCAINE HCL/D5W 4 DRIP 250 0 0 4300<br />
7504640 LIDOCAINE HCL 40 MG INJ 250 0 0 4300<br />
7504657 LIDOCAINE HCL/EPINEP VIAL 250 0 0 4300<br />
7504665 LIDOCAINE HCL/EPINEP VIAL 250 0 0 4300<br />
7504673 LIDOCAINE HCL 20 MG VIAL 636 0 0 4300<br />
7504681 LIDOCAINE HCL 5 MG VIAL 250 0 0 4300<br />
7504699 LIDOCAINE HCL 40 MG SOLN 250 0 0 4300<br />
7504707 LINDANE 0 SHAMPOO 250 0 0 4300<br />
7504715 LINDANE 0 LOTION 250 0 0 4300
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