2013 Medicare HMO Blue ValueRx/PlusRx Formulary - Blue Cross ...

ULT CFT 0.3 ML 29GX1/2(1/2) .................. 72ULT CFT 0.3 ML 30GX5/16(1/2) .................. 72ULT CFT 0.3 ML 31GX5/16(1/2) .................. 72ULTICARE 30GX0.3 MLSYRINGE. ............. 73ULTICARE 30GX0.5 MLSYRINGE. ............. 73ULTICARE 30GX1 MLSYRINGE. ............. 73ULTICARE 31GX0.3 MLSYRINGE. ............. 73ULTICARE 31GX0.5 MLSYRINGE. ............. 73ULTICARE 31GX1 MLSYRINGE. ............. 73ULTICARE INS 0.5 ML29GX1/2 .............. 73ULTICARE INS SYR 1 ML28GX1/2 .............. 73ULTICARE INS SYR 1 ML29GX1/2 .............. 73ULTICARE INSULIN SYR U1001 ML .................. 73ULTICARE INSUL SYR U1000.3 ML ................ 73ULTICARE INSUL SYR U1000.5 ML ................ 73ULTICARE PEN NEEDLES4MM 32G. ............. 73ULTICARE PEN NEEDLES 6MM 31 G .............. 73ULTICARE PEN NEEDLES6MM 31G. ............. 73ULTICARE PEN NEEDLES 8MM 31 G .............. 73ULTICARE PEN NEEDLES8MM 31G. ............. 73ULTICARE PEN NEEDLES12MM 29G ............ 73ULTICARE SYR 0.3 ML31GX5/16 ............. 73ULTICARE SYR 0.5 ML30GX5/16 ............. 73ULTICARE SYR 0.5 ML31GX5/16 ............. 73ULTICARE SYRIN 0.3 ML29GX1/2 .............. 73ULTICARE SYRIN 0.5 ML28GX1/2 .............. 73ULTICARE THIN 28GLANCETS. ............. 73ULTICARE THIN 30GLANCETS. ............. 73ULTICARE U100 0.3 ML30GX5/16 ............. 73ULTICARE U100 0.5 ML29GX1/2 .............. 73ULTI-LANCE AUTO-ADDEVICE ............... 73ULTILET 28G LANCETS ... 73ULTILET 30G LANCETS ... 73ULTILET ALCOHOL STERLSWAB. ................ 73ULTILET ALCOHOL SWAB 73ULTILET BASIC 30GLANCETS. ............. 73ULTILET CLASSIC 26GLANCETS. ............. 73ULTILET CLASSIC 28GLANCETS. ............. 73ULTILET CLASSIC 30GLANCETS. ............. 73ULTILET INSULIN SYRINGE0.3 ML ................ 73ULTILET INSULIN SYRINGE0.5 ML ................ 73ULTILET INSULIN SYRINGE 1ML. ................... 73ULTILET LANCETS ....... 73ULTILET SAFETY LANCETS 73ultimatecare advantage .... 87ultimatecare one .......... 87ultimatecare one nf ........ 88ultimate ob dha ........... 87ULTRA COMFORT 0.3 ML29GX1/2 .............. 73ULTRA COMFORT 0.3 MLSYRINGE. ............. 73ULTRA COMFORT 0.5 ML28GX1/2 .............. 73ULTRA COMFORT 0.5 ML29GX1/2 .............. 73ULTRA COMFORT 0.5 ML30GX5/16 ............. 73ULTRA COMFORT 0.5 ML31GX5/16 ............. 73ULTRA COMFORT 0.5 MLSYRINGE. ............. 73ULTRA COMFORT 1 ML28GX1/2 .............. 74ULTRA COMFORT 1 ML29GX1/2 .............. 74ULTRA COMFORT 1 ML30GX5/16 ............. 74ULTRA COMFORT 1 ML31GX5/16 ............. 74ULTRA COMFORT 1 MLSYRINGE. ............. 74ULTRA COMFORT 3/10 MLSYR................... 74ULTRACOMFORT 30GX0.5 MLSYR................... 74ULTRACOMFORT 30GX1 MLSYRINGE. ............. 74ULTRACOMFORT 31GX0.5 MLSYR................... 74ULTRACOMFORT 31GX1 MLSYRINGE. ............. 74ULTRACOMFORT INSULINSYR 1 ML. ............. 74ULTRACOMFORT INSUL SYR0.5 ML ................ 74ULTRACOMFORT PENNEEDLES 6MM ........ 74ULTRACOMFORT PENNEEDLES 8MM ........ 74ULTRALANCE 26GLANCETS. ............. 74ULTRALANCE 28GLANCETS. ............. 74ULTRA THIN 28 G LANCET 74ULTRA THIN 28GLANCETS. ............. 74ULTRA THIN 31GLANCETS. ............. 74ULTRA THIN 33GLANCETS. ............. 74ULTRA-THIN II 26GLANCET ............... 74126