美沙拉嗪等68种西药最高临时零售价格表eluw.docx

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1、附表1：美沙拉嗪嗪等68种西西药最高高临时零零售价格格表金额单位位：元序号省医保编编号药品名称称剂型规格单位最高临时时零售价价备注1764美沙拉嗪嗪缓释颗粒粒剂500mmg*110袋盒70.772532丁咯地尔尔注射剂250mml:00.1gg袋40.223648多索茶碱碱注射剂100mml:00.3gg袋67.554729苦参素片剂0.1gg*122片*2板盒13.445705托烷司琼琼注射剂100mml:55mg瓶146.8630头孢西丁丁注射剂2g支82.557407白消安注射液60mgg*100ml支185008386草分枝杆杆菌F.U.336注射剂1.722ug支55.229582依

2、达拉奉奉注射液30mgg:200ml支147.31044头孢地嗪嗪注射剂1.5gg,溶媒媒结晶瓶136.111258艾司洛尔尔注射剂0.1gg:1mml支95.9912258艾司洛尔尔注射剂0.2gg:2mml支16313685泮托拉唑唑注射剂40mgg盒168685泮托拉唑唑肠溶片40mgg*7片片盒1101410777聚甲酚磺磺醛溶液剂36%,25mml盒96.4410777聚甲酚磺磺醛阴道栓剂剂90mgg*6枚枚盒47.2215841复方利血血平氨苯苯蝶啶片剂20片盒18.7716927羟乙基淀淀粉2000/00.5注射剂500mml*66%,复复合软塑塑袋袋120927羟乙基淀淀粉20

3、00/00.5注射剂500mml*66%,玻玻璃瓶瓶11617895坦洛新缓释片0.2mmg*66片盒49.66序号省医保编编号药品名称称剂型规格单位最高临时时零售价价备注18400小牛脾提提取物注射剂5mg*2mll多肽*3380uug核糖糖支43.6619501西替利嗪嗪分散片10mgg*122片盒25.3320740肝水解肽肽注射剂20mgg:2mml支15.882110722乙酰吉他他霉素颗粒剂1g:110万单单位*114袋盒19.9922(8223)复方依那那普利片剂14片(每片含含马酸依依那普利利10mmg与氢氢噻嗪225mgg)*114片盒5123135伐昔洛韦韦片剂0.3gg*

4、7片片盒103.5135伐昔洛韦韦片剂0.3gg*100片盒145.924495氯雷他定定颗粒剂5mg*6袋盒1825308地塞米松松磷酸钠钠注射剂2mg，冻冻干粉瓶3.3308地塞米松松磷酸钠钠注射剂5mg，冻冻干粉瓶3.526139司他夫定定胶囊20mgg*600粒盒7082725头孢丙稀稀片剂250mmg*66片盒58.5528138去羟肌苷苷分散片100mmg*660片瓶30629972转化糖注射液250mml*果果糖6.25gg与葡萄萄糖6.25gg袋54.9930387胸腺肽肠溶片20mgg*100片盒102.13117替卡西林林克拉维维酸钾注射剂1.6gg瓶41.7717替卡西林

5、林克拉维维酸钾注射剂3.2gg瓶70.9932914低分子量量肝素注射剂0.4mml*442500IuaaXa(预注针针筒)支35917低分子量量肝素注射剂25000AXaaIU*0.55ml支25.33917低分子量量肝素注射剂50000AXaaIU*0.55ml支48.66917低分子量量肝素注射剂41000AXaaIU*0.44ml(预灌针针)支35.66917低分子量量肝素注射剂61500AXaaIU*0.66ml(预灌针针)支43.6633402匹多莫德德片剂0.4gg*6片片盒75402匹多莫德德片剂0.4gg*6片片*5板盒360序号省医保编编号药品名称称剂型规格单位最高临时时零

6、售价价备注34567甘油果糖糖注射液500mml塑瓶122567甘油果糖糖注射液250mml塑瓶64.223529头孢替安安注射剂0.5gg,冻干干粉针瓶7629头孢替安安注射剂1g,冻冻干粉针针瓶129.236384重组人干干扰素aa-2bb泡腾胶囊囊80万IIU*22粒盒49384重组人干干扰素aa-2bb泡腾胶囊囊80万IIU*44粒盒8937768乌司他丁丁注射剂5万IUU,冻干干粉针支95.22768乌司他丁丁注射剂10万IIU,冻冻干粉针针支174.338594利培酮片剂1mg*20片片盒49.9939825厄贝沙坦坦氢氯噻噻嗪片剂75mgg:6.25*10片片*2板盒49.994

7、0589奥氮平片剂10mgg*7片片盒170589奥氮平片剂10mgg*144片盒331.541250罗哌卡因因注射剂10mll*899.4mmg支49.77250罗哌卡因因注射剂10mll*1119.22mg支6242234高乌甲素素注射剂4mg,冻干粉粉针支36.2243705托烷司琼琼注射剂5ml*5mgg支141.844933葡萄糖酸酸亚铁糖浆剂10mll*0.25gg*100支盒13.3345900托特罗定定片剂2mg*14片片盒594611244纳洛酮注射剂1ml*0.44mg支20.4447275复方三维维（III)注射剂复方，冻冻干支4548365阿仑膦酸酸钠片剂10mgg*6

8、片片盒24.9949229曲马多缓释片0.1gg*100片盒44.8850550奥拉西坦坦胶囊剂0.4gg*244粒盒16451195来氟米特特片剂10mgg*166片盒154商品名：爱若华华195来氟米特特片剂20mgg*100片盒166.8商品名：爱若华华序号省医保编编号药品名称称剂型规格单位最高临时时零售价价备注52206氨基葡萄萄糖/吲哚美美辛片剂100mmg*224片盒30.5553502依巴斯汀汀片剂10mgg*100片盒5054270维生素2注射剂1ml*10mmg(440万单单位）支37.1155562扎来普隆隆胶囊剂5mg*14粒粒盒44.99562扎来普隆隆胶囊剂5mg*7

9、粒盒23562扎来普隆隆胶囊剂10mgg*7粒粒盒39.11562扎来普隆隆片剂5mg*7片*2板盒44.99565苯唑西林林注射剂1g,粉粉针支2.25716美洛西林林注射剂3g粉针针支65.5516美洛西林林注射剂2g粉针针支47.5558837川芎嗪注射剂100mmg,冻冻干粉针针支31.33837川芎嗪注射剂50mgg冻干粉粉针支18.445967罗红霉素素胶囊剂75mgg*244粒盒26.3360207酮洛芬肠溶胶囊囊50mgg*122粒盒17.5561卤米松+三氯生生软膏剂5g盒28卤米松+三氯生生软膏剂10g盒456219美洛西林林/舒巴坦坦钠注射剂0.5gg*0.1255g，溶溶媒结晶晶支2663桂哌齐特特注射剂2ml:80mmg支6664西酞普兰兰片剂20mgg*100片盒7865头孢氨苄苄颗粒剂125mmg*110袋盒666罗格列酮酮片剂2mg*14片片盒49.55片剂4mg*7片盒48.55片剂4mg*14片片盒96.5567苯磺酸左左旋氨氯氯地平片剂2.5mmg*114片盒77.77商品名：施慧达达68阿托品眼用凝胶胶剂2.5gg*255mg支25