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
7506173 NITROGLYCERIN SPRAY 250 0 0 4300 7506181 NITROGLYCERIN 0.4 MG PAT 24 HR 250 0 0 4300 7506199 NITROGLYCERIN 0.1 MG PATCH 250 0 0 4300 7506207 NITROGLYCERIN 0.2 MG PATCH 250 0 0 4300 7506215 NITROGLYCERIN 0.6 MG PATCH 250 0 0 4300 7506223 NITROGLYCERIN 0INT 250 0 0 4300 7506231 NITRO OINT UD 250 0 0 4300 7506249 NYSTATIN/TRIAMCIN CREAM 250 0 0 4300 7506256 NYSTATIN 100 MU CREAM 250 0 0 4300 7506264 NYSTATIN 100 MU POWDER 250 0 0 4300 7506272 NYSTATIN 100 MU OINT 250 0 0 4300 7506280 NYSTATIN 100 MU TAB 250 0 0 4300 7506298 SOD CHLORIDE/NAHCO3/ SOLN 250 0 0 4300 7506306 OLANZAPINE 20MG. ZYD TAB LN 250 0 0 4300 7506314 BENICAR 20MG. TAB 250 0 0 4300 7506322 OPIUM/BELLADONNA ALK SUPP 250 0 0 4300 7506330 OLANZAPINE 10MG IM VIAL 250 0 0 4300 7506348 OXACILLIN SODIUM 1 G ADDV 636 0 0 4300 7506355 OXACILLIN SODIUM 2 G ADDV 636 0 0 4300 7506363 OXACILLIN SODIUM 2 G VIAL 636 0 0 4300 7506371 OXAZEPAM 15 MG CAP 250 0 0 4300 7506389 DITROPAN XL 5MG TAB XL 250 0 0 4300 7506397 OXYBUTYNIN CHLORIDE TAB 250 0 0 4300 7506405 OXYMETAZOLINE HCL 0 SPRAY 250 0 0 4300 7506413 OXYTOCIN 10 U VIAL 636 0 0 4300 7506421 AMYLASE/LIPASE/PROTE TAB 250 0 0 4300 7506439 PALONOSETRON HCL INJ .25 MG VIAL 636 0 0 4300 7506447 FLOXIN OTIC 5ML DROPS 250 0 0 4300 7506454 PAXIL CR 12.5MG. TAB 250 0 0 4300 7506462 PEN G 2 M.U. FZ PIGG 636 0 0 4300 7506470 PEN G 3 M.U. FZ PIGG 636 0 0 4300 7506488 PENICILLIN G POTASSI 5 MILLION VIAL 636 0 0 4300 7506496 PENICILLIN V POTASSI SUS REC 250 0 0 4300 7506504 PENICILLIN G BENZATH 2,400,00 UN 636 0 0 4300 7506512 PENICILLIN G POTASSI VIAL 636 0 0 4300 7506520 PENIC G BENZ 1.2MU SYRINGE 636 0 0 4300 7506538 ACTICIN 5% CR/60GM CREAM 250 0 0 4300 7506546 PERMETHRIN 1% 2OZ LIQUID 250 0 0 4300 7506553 PHENOBARB 5ML ELIXIR 250 0 0 4300 7506561 PANTOPRAZOLE 40MG. EC TAB 250 0 0 4300 7506579 PENTOXIFYLLINE 400 M SR TAB 250 0 0 4300 7506587 OXYCODONE HCL/ACETAM TAB 250 0 0 4300 7506595 PERPHENAZINE 2 MG TAB 250 0 0 4300 7506603 PERPHENAZINE 4 MG TAB 636 0 0 4300 7506611 PERPHENAZINE 8 MG TAB 250 0 0 4300 7506629 PETROLATUM WHITE JELLY 250 0 0 4300 7506637 LANOLIN/MIN OIL/PETR OINT 250 0 0 4300
7506645 PHENAZOPYRIDINE HCL TAB 250 0 0 4300 7506652 PHENELZINE SULFATE 1 TAB 250 0 0 4300 7506660 PHENOBARB 65MG. 1ML VIAL 636 0 0 4300 7506678 PHENOBARB 130MG 1ML VIAL 636 0 0 4300 7506686 PHENOBARB TAB 16.2MG TAB 250 0 0 4300 7506694 PHENTOLAMINE MESYLAT VIAL 636 0 0 4300 7506702 PHENYLEPHRINE HCL 10 MG 1 ML INJ 636 0 0 4300 7506710 CEPASTAT LOZENGES 250 0 0 4300 7506728 PHENYLEPHRINE HCL 0 SPRAY 250 0 0 4300 7506736 PHENYLEPHRINE HCL DROPS 250 0 0 4300 7506744 PHENYLEPHRINE HCL SPRAY 250 0 0 4300 7506751 PHENYTOIN 50 MG CHEW TAB 250 0 0 4300 7506769 PHENYTOIN SODIUM EXT CAP 250 0 0 4300 7506777 PHENYTOIN SODIUM 50 VIAL 636 0 0 4300 7506785 NA PHOS M-B/NA PHOS SOLN 250 0 0 4300 7506793 PHYSOSTIGMINE SALICY TAB 250 0 0 4300 7506801 PHYTONADIONE 5 MG 250 0 0 4300 7506819 PHYTONADIONE 2 MG INJ 636 0 0 4300 7506827 PHYTONADIONE 10 MG INJ 636 0 0 4300 7506835 PILOCARPINE HCL 0 DROPS 250 0 0 4300 7506843 PILOCARPINE HCL DROPS 250 0 0 4300 7506850 PIPERACILLIN 3GM VIAL 250 0 0 4300 7506868 PIPERACILLIN 4GM VIAL 250 0 0 4300 7506876 POLY VITAMIN DROPS 250 0 0 4300 7506884 PNEUMOCOCCAL 23-VAL VIAL 636 0 0 4300 7506892 SODIUM POLYSTYRENE SUSP 250 0 0 4300 7506900 TUBERCULIN PURIF.PRO VIAL 250 0 0 4300 7506918 MIRALAX POWDER PACKET 250 0 0 4300 7506926 PRAMIPEXOLE 0.25MG TAB 250 0 0 4300 7506934 PRAZOSIN 1MG. CAP 250 0 0 4300 7506942 PRAZOSIN 5MG CAP 250 0 0 4300 7506959 PRALIDOXIME CHLORIDE 1 GM VIAL 636 0 0 4300 7506967 PREDNISONE 1 MG TAB 636 0 0 4300 7506975 ORAPRED U.D. SOLN 250 0 0 4300 7506983 PREDNISONE 50 MG TAB 636 0 0 4300 7506991 PREDNISOLONE ACETATE DROPS 250 0 0 4300 7507007 PREDNISONE 20 MG TAB 636 0 0 4300 7507015 PREDNISONE 10 MG TAB 636 0 0 4300 7507023 PREDNISONE 5MG TABS 636 0 0 4300 7507031 PREDNISOLONE 5ML 15 MG SYRUP 636 0 0 4300 7507049 PRIMIDONE 250 MG TAB 250 0 0 4300 7507056 PRIMIDONE 50 MG TAB 250 0 0 4300 7507064 PROBENECID 500 MG TAB 250 0 0 4300 7507072 PROCAINE 10% 2ML 200 MG INJ 250 0 0 4300 7507098 PROCHLORPERAZINE MAL SUPP 250 0 0 4300 7507106 PROCHLORPERAZINE MAL 10 MG TAB 636 0 0 4300 7507114 PROCHLORPERAZINE MAL 5 MG TAB 636 0 0 4300
- 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 and 132: 7503741 HALOPERIDOL LACTATE VIAL 63
- Page 133 and 134: 7504723 LIDOCAINE HCL/D7.5W INJ 250
- Page 135: 7505704 MULTIVITAMINS THERAP 250 0
- 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
- Page 183 and 184: 9704602 UNITED HLTHCR/UNITED HLTHCR
- Page 185 and 186: 9707886 TR PAUL ALLOWANCE 0 0 5210
7506645 PHENAZOPYRIDINE HCL TAB 250 0 0 4300<br />
7506652 PHENELZINE SULFATE 1 TAB 250 0 0 4300<br />
7506660 PHENOBARB 65MG. 1ML VIAL 636 0 0 4300<br />
7506678 PHENOBARB 130MG 1ML VIAL 636 0 0 4300<br />
7506686 PHENOBARB TAB 16.2MG TAB 250 0 0 4300<br />
7506694 PHENTOLAMINE MESYLAT VIAL 636 0 0 4300<br />
7506702 PHENYLEPHRINE HCL 10 MG 1 ML INJ 636 0 0 4300<br />
7506710 CEPASTAT LOZENGES 250 0 0 4300<br />
7506728 PHENYLEPHRINE HCL 0 SPRAY 250 0 0 4300<br />
7506736 PHENYLEPHRINE HCL DROPS 250 0 0 4300<br />
7506744 PHENYLEPHRINE HCL SPRAY 250 0 0 4300<br />
7506751 PHENYTOIN 50 MG CHEW TAB 250 0 0 4300<br />
7506769 PHENYTOIN SODIUM EXT CAP 250 0 0 4300<br />
7506777 PHENYTOIN SODIUM 50 VIAL 636 0 0 4300<br />
7506785 NA PHOS M-B/NA PHOS SOLN 250 0 0 4300<br />
7506793 PHYSOSTIGMINE SALICY TAB 250 0 0 4300<br />
7506801 PHYTONADIONE 5 MG 250 0 0 4300<br />
7506819 PHYTONADIONE 2 MG INJ 636 0 0 4300<br />
7506827 PHYTONADIONE 10 MG INJ 636 0 0 4300<br />
7506835 PILOCARPINE HCL 0 DROPS 250 0 0 4300<br />
7506843 PILOCARPINE HCL DROPS 250 0 0 4300<br />
7506850 PIPERACILLIN 3GM VIAL 250 0 0 4300<br />
7506868 PIPERACILLIN 4GM VIAL 250 0 0 4300<br />
7506876 POLY VITAMIN DROPS 250 0 0 4300<br />
7506884 PNEUMOCOCCAL 23-VAL VIAL 636 0 0 4300<br />
7506892 SODIUM POLYSTYRENE SUSP 250 0 0 4300<br />
7506900 TUBERCULIN PURIF.PRO VIAL 250 0 0 4300<br />
7506918 MIRALAX POWDER PACKET 250 0 0 4300<br />
7506926 PRAMIPEXOLE 0.25MG TAB 250 0 0 4300<br />
7506934 PRAZOSIN 1MG. CAP 250 0 0 4300<br />
7506942 PRAZOSIN 5MG CAP 250 0 0 4300<br />
7506959 PRALIDOXIME CHLORIDE 1 GM VIAL 636 0 0 4300<br />
7506967 PREDNISONE 1 MG TAB 636 0 0 4300<br />
7506975 ORAPRED U.D. SOLN 250 0 0 4300<br />
7506983 PREDNISONE 50 MG TAB 636 0 0 4300<br />
7506991 PREDNISOLONE ACETATE DROPS 250 0 0 4300<br />
7507007 PREDNISONE 20 MG TAB 636 0 0 4300<br />
7507015 PREDNISONE 10 MG TAB 636 0 0 4300<br />
7507023 PREDNISONE 5MG TABS 636 0 0 4300<br />
7507031 PREDNISOLONE 5ML 15 MG SYRUP 636 0 0 4300<br />
7507049 PRIMIDONE 250 MG TAB 250 0 0 4300<br />
7507056 PRIMIDONE 50 MG TAB 250 0 0 4300<br />
7507064 PROBENECID 500 MG TAB 250 0 0 4300<br />
7507072 PROCAINE 10% 2ML 200 MG INJ 250 0 0 4300<br />
7507098 PROCHLORPERAZINE MAL SUPP 250 0 0 4300<br />
7507106 PROCHLORPERAZINE MAL 10 MG TAB 636 0 0 4300<br />
7507114 PROCHLORPERAZINE MAL 5 MG TAB 636 0 0 4300
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