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
7511983 FLUVASTATIN SODIUM 2 CAP 250 0 0 4300 7512007 CASTOR OIL 250 0 0 4300 7512015 ALPROSTADIL 500 MCG INJ 250 0 0 4300 7512023 DILTIAZEM HCL 300 MG C SR 24 250 0 0 4300 7512031 SCOPOLAMINE HYDROBRO VIAL 250 0 0 4300 7512049 TRAZODONE HCL 100 MG TAB 250 0 0 4300 7512056 RAMIPRIL 5 MG CAP 250 0 0 4300 7512064 BISOPROLOL FUMARATE TAB 250 0 0 4300 7512072 PIOGLITAZONE HCL 15 TAB 250 0 0 4300 7512080 DISULFIRAM 250 MG TAB 250 0 0 4300 7512098 METOPROLOL TARTRATE TAB 250 0 0 4300 7512106 QUETIAPINE FUMARATE TAB 250 0 0 4300 7512114 RISPERIDONE 0.5 MG TAB 250 0 0 4300 7512122 NALTREXONE HCL 50 MG TAB 250 0 0 4300 7512130 ZIPRASIDONE HCL 20 M CAP 250 0 0 4300 7512148 ZIPRASIDONE HCL 40 M CAP 250 0 0 4300 7512155 GLIPIZIDE 2.5 MG TAB 250 0 0 4300 7512163 ISOSORBIDE MONONITRA T SR 24 250 0 0 4300 7512171 AMILORIDE HCL 5 MG TAB 250 0 0 4300 7512189 FLECAINIDE ACETATE 5 TAB 250 0 0 4300 7512197 DIVALPROEX SODIUM 50 TAB 250 0 0 4300 7512205 PIOGLITAZONE HCL 45 TAB 250 0 0 4300 7512213 QUETIAPINE 200 MG TAB 250 0 0 4300 7512221 METOPROLOL XL 50MG TAB 250 0 0 4300 7512239 LEVOTHYROXINE SODIUM TAB 250 0 0 4300 7512247 SERTRALINE HCL 100 M TAB 250 0 0 4300 7512254 ACARBOSE 25 MG TAB 250 0 0 4300 7512262 DILTIAZEM HCL 5 MG VIAL 250 0 0 4300 7512270 CARBOPROST TROMETHAM 250 MCG INJ 250 0 0 4300 7512288 NAPH MB-DB/K PH MBDB PACKET 250 0 0 4300 7512296 GABAPENTIN 400 MG CAP 250 0 0 4300 7512304 LANSOPRAZOLE 15 MG CAP 250 0 0 4300 7512312 VALPROIC ACID 5ML UD CUP 250 0 0 4300 7512320 PAPAIN/UREA 0.83 MMU OINT 250 0 0 4300 7512338 AMIKACIN 250MG 2ML VIAL 636 0 0 4300 7512346 CALCITONIN SALMON SPRAY 250 0 0 4300 7512353 IRON POLYSACCHARIDES CAP 250 0 0 4300 7512387 INFLIXIMAB 100 MG VIAL 636 0 0 4300 7512395 HYALURONATE SODIUM 1 SYRINGE 250 0 0 4300 7512403 ANTIVENIN CROTALIDA VIAL 250 0 0 4300 7512411 CLOTRIMAZOLE CREAM 250 0 0 4300 7512429 RISPERIDONE 1 MG TAB 250 0 0 4300 7512437 CIPROFLOXACIN LACTAT 400 MG PB 636 0 0 4300 7512445 ACTIGALL 300 MG CAP 250 0 0 4300 7512452 CHLORASEPTIC SPRAY SOLN 250 0 0 4300 7512460 HYOSCYAMINE 0.375 MG TAB 250 0 0 4300 7512478 ADVIL 200 MG TAB 250 0 0 4300
7512486 LANTUS INSULIN VIAL 636 0 0 4300 7512494 LORAZEPAM 2 MG PO CONC 250 0 0 4300 7512502 ACTIVASE 100MG VIAL 636 0 0 4300 7512510 ACETAMINOPHEN 5ML UD SOLN 250 0 0 4300 7512528 DIPHENHYDRAMINE 10UD ELIXIR 636 0 0 4300 7512536 PHENYTOIN 100MG IV VIAL 636 0 0 4300 7512544 ENECTEPLASE 50MG. KIT 636 0 0 4300 7512551 METOPROLOL SUCCINATE T SR 24 250 0 0 4300 7512569 DILTIAZEM 5ML VIAL 250 0 0 4300 7512577 PHOSLO TAB 250 0 0 4300 7512585 HYDROXYZINE 50MG/IML VIAL 636 0 0 4300 7512593 AMMONIUM LACTATE LOTION 250 0 0 4300 7512601 CYANOCOBOLAMIN 500MG TAB 250 0 0 4300 7512619 TRILEPTAL 300MG TAB 250 0 0 4300 7512627 LACTULOSE 30ML UD SOLN 250 0 0 4300 7512643 LITHOBID 300 MG SR TAB 250 0 0 4300 7512650 MAGNESIUM SULF 50% 1 GM VIAL 636 0 0 4300 7512668 MIDAZOLAM 100MG/100ML KIT 636 0 0 4300 7512676 BSS EYE SOL 500 ML SOLN 250 0 0 4300 7512684 CATHFLOALTE PLASE 2MG VIAL 250 0 0 4300 7512692 ACET/COD 12.5ML ELIXIR 250 0 0 4300 7512700 FAMOTIDINE 10 MG VIAL 250 0 0 4300 7512718 MIRAPEX 0.125 MG TAB 250 0 0 4300 7512726 MAG OXIDE 400 MG TAB 250 0 0 4300 7512734 LOVENOX 60MG SYRINGE 636 0 0 4300 7512742 ETHANOLAMINE OLEATE 100 MG 2ML INJ 636 0 0 4300 7512759 ROPINIROLE .25MG 250 0 0 4300 7512767 MELOXICAM 7.5MG 250 0 0 4300 7512775 EPLERENONE 25MG 250 0 0 4300 7512783 ALBUTEROL HFA 250 0 0 4300 7512791 DICLOXACILLIN TO GO 250 MG CAP 250 0 0 4300 7512809 EDROPHONIUM 10 MG/ML VIAL 150 MG 250 0 0 4300 7512817 FLUORESCEIN OPTH STRIP 250 0 0 4300 7512825 GLUCAGON 1 MG VIAL 636 0 0 4300 7512833 GLYCERIN LIQUID 250 0 0 4300 7512841 ISOSORBIDE DIN 40MG SR TAB 250 0 0 4300 7512858 MORPHINE 60 MG SR TAB 250 0 0 4300 7512866 NAPROXEN TO GO 375 PACK TAB 250 0 0 4300 7512874 PREGABALIN 25 MG CAP 250 0 0 4300 7512882 PROPOFOL 1% 100ML BOTTLE 250 0 0 4300 7512890 LEVOFLOXACIN 250 MG TAB 250 0 0 4300 7512908 OLANZAPINE 2.5 MG TAB 250 0 0 4300 7512916 HEPATITIS B IMM GLOB 5ML VIAL 636 0 0 4300 7512924 CYCLOBENZAPRINE 10 RX TO GO TAB 250 0 0 4300 7512932 OXYCODONE/APAP RX TO GO ED TAB 250 0 0 4300 7512940 IBUPROFEN RX TO GO 600MG TAB 250 0 0 4300 7512957 SULFAMETHOX/TMP DS RX TO GO TAB 250 0 0 4300
- 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 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: 7511488 BUPROPION HCL 100 MG TAB 25
- 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
- Page 187 and 188: 9805813 H/L SAGA B/D I/P ALLOWANCE
- Page 189 and 190: 9822297 STATE INCOME TAXES WITHHELD
- Page 191 and 192: 9826116 RENTAL INCOME LLC - VAN LEA
- Page 193 and 194: 9827627 HC HOSPICE MED SUPLS MED/SU
- Page 195 and 196: 9829565 MATERIAL MGMT-NON-MED SUP S
- Page 197 and 198: 9915646 SUPP TRICARE PAYMENT 0 0 10
7511983 FLUVASTATIN SODIUM 2 CAP 250 0 0 4300<br />
7512007 CASTOR OIL 250 0 0 4300<br />
7512015 ALPROSTADIL 500 MCG INJ 250 0 0 4300<br />
7512023 DILTIAZEM HCL 300 MG C SR 24 250 0 0 4300<br />
7512031 SCOPOLAMINE HYDROBRO VIAL 250 0 0 4300<br />
7512049 TRAZODONE HCL 100 MG TAB 250 0 0 4300<br />
7512056 RAMIPRIL 5 MG CAP 250 0 0 4300<br />
7512064 BISOPROLOL FUMARATE TAB 250 0 0 4300<br />
7512072 PIOGLITAZONE HCL 15 TAB 250 0 0 4300<br />
7512080 DISULFIRAM 250 MG TAB 250 0 0 4300<br />
7512098 METOPROLOL TARTRATE TAB 250 0 0 4300<br />
7512106 QUETIAPINE FUMARATE TAB 250 0 0 4300<br />
7512114 RISPERIDONE 0.5 MG TAB 250 0 0 4300<br />
7512122 NALTREXONE HCL 50 MG TAB 250 0 0 4300<br />
7512130 ZIPRASIDONE HCL 20 M CAP 250 0 0 4300<br />
7512148 ZIPRASIDONE HCL 40 M CAP 250 0 0 4300<br />
7512155 GLIPIZIDE 2.5 MG TAB 250 0 0 4300<br />
7512163 ISOSORBIDE MONONITRA T SR 24 250 0 0 4300<br />
7512171 AMILORIDE HCL 5 MG TAB 250 0 0 4300<br />
7512189 FLECAINIDE ACETATE 5 TAB 250 0 0 4300<br />
7512197 DIVALPROEX SODIUM 50 TAB 250 0 0 4300<br />
7512205 PIOGLITAZONE HCL 45 TAB 250 0 0 4300<br />
7512213 QUETIAPINE 200 MG TAB 250 0 0 4300<br />
7512221 METOPROLOL XL 50MG TAB 250 0 0 4300<br />
7512239 LEVOTHYROXINE SODIUM TAB 250 0 0 4300<br />
7512247 SERTRALINE HCL 100 M TAB 250 0 0 4300<br />
7512254 ACARBOSE 25 MG TAB 250 0 0 4300<br />
7512262 DILTIAZEM HCL 5 MG VIAL 250 0 0 4300<br />
7512270 CARBOPROST TROMETHAM 250 MCG INJ 250 0 0 4300<br />
7512288 NAPH MB-DB/K PH MBDB PACKET 250 0 0 4300<br />
7512296 GABAPENTIN 400 MG CAP 250 0 0 4300<br />
7512304 LANSOPRAZOLE 15 MG CAP 250 0 0 4300<br />
7512312 VALPROIC ACID 5ML UD CUP 250 0 0 4300<br />
7512320 PAPAIN/UREA 0.83 MMU OINT 250 0 0 4300<br />
7512338 AMIKACIN 250MG 2ML VIAL 636 0 0 4300<br />
7512346 CALCITONIN SALMON SPRAY 250 0 0 4300<br />
7512353 IRON POLYSACCHARIDES CAP 250 0 0 4300<br />
7512387 INFLIXIMAB 100 MG VIAL 636 0 0 4300<br />
7512395 HYALURONATE SODIUM 1 SYRINGE 250 0 0 4300<br />
7512403 ANTIVENIN CROTALIDA VIAL 250 0 0 4300<br />
7512411 CLOTRIMAZOLE CREAM 250 0 0 4300<br />
7512429 RISPERIDONE 1 MG TAB 250 0 0 4300<br />
7512437 CIPROFLOXACIN LA<strong>CT</strong>AT 400 MG PB 636 0 0 4300<br />
7512445 A<strong>CT</strong>IGALL 300 MG CAP 250 0 0 4300<br />
7512452 CHLORASEPTIC SPRAY SOLN 250 0 0 4300<br />
7512460 HYOSCYAMINE 0.375 MG TAB 250 0 0 4300<br />
7512478 ADVIL 200 MG TAB 250 0 0 4300
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